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Different intraoperative decisions for undiagnosed paraganglioma:Two case reports

World Journal of Clinical Cases 2022年第30期10卷 11059-11065页

作者： dongho kang Bo-eun Kim Minjae Hong Joungmin Kim Seongtae Jeong Seongheon Lee Department of Anesthesiology and Pain Medicine Chonnam National University Medical SchoolChonnam National University HospitalGwangju 61469South Korea

BACKGROUND Paragangliomas may be preoperatively misdiagnosed as non-functioning retroperitoneal tumors and are sometimes suspected only at the time of intraoperative *** preoperative alpha blockade preparation,a hypertensive crisis during tumor manipulation and hypotension after tumor removal may result in critical ***,primary consideration should be given to the continuation or discontinuation of surgery on the basis of the possibility of gentle surgical manipulation and hemodynamic *** report two cases of paragangliomas detected *** SUMMARY A 65-year-woman underwent laparoscopic small-bowel wedge resection.A hypertensive crisis occurred during manipulation of the mass,and an unrecognized catecholamine-producing paraganglioma was *** surgeon and anesthesiologists believed that tumor excision could be performed with minimal manipulation of the tumor because the tumor was in a favorable *** hemodynamic instability did not occur with aggressive use of vasoactive drugs.A week later,a 54-year-man underwent open resection of a 3-cm-sized retroperitoneal mass and showed the same findings during mass *** this patient,continuous manipulation of the mass seemed inevitable due to adhesion between the right adrenal gland and the mass in a narrow surgical *** surgeon and anesthesiologists decided to cancel the surgical procedure and planned to perform a reoperation after alpha blockade *** weeks later,the tumor was uneventfully removed with small doses of vasoactive *** When an undiagnosed paraganglioma is suspected intraoperatively,reoperation after adequate preparation should be considered as an option to avoid fatal outcomes.

关键词： Paraganglioma Undiagnosed diseases Hypertensive crisis Preoperative alpha blockade Surgery cancellation Neuroendocrine tumors Case report

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New-onset diabetes after adult liver transplantation in the Korean Organ Transplantation Registry (KOTRY) study

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Hepatobiliary Surgery and Nutrition 2020年第4期9卷 425-439页

作者： Jong Man Kim Shin Hwang Kwang-Woong Lee Jae-Geun Lee Je Ho Ryu Bong-Wan Kim Dong Lak Choi Young Kyoung You Dong-Sik Kim Yang Won Nah Koo Jeong kang Jai Young Cho Geun Hong In Seok Choi Hee Chul Yu dongho Choi Myoung Soo Kim 无 Department of Surgery Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea Department of Surgery Asan Medical CenterCollege of Medicine University of UlsanSouth Korea Department of Surgery Seoul National University College of MedicineSeoulSouth Korea Department of Surgery Yonsei University College of MedicineSeoulSouth Korea Department of Surgery Pusan National University College of MedicineBusanSouth Korea Department of Liver Transplantation and Hepatobiliary Surgery Ajou University School of MedicineSuwonSouth Korea Department of Surgery Catholic University of Daegu College of MedicineDaeguSouth Korea Department of Surgery College of MedicineCatholic University of KoreaSeoulSouth Korea Division of HBP Surgery and Liver Transplantation Department of SurgeryKorea University College of MedicineSeoulSouth Korea Department of Surgery Ulsan University HospitalUniversity of Ulsan College of MedicineUlsanSouth Korea Department of Surgery Keimyung University School of MedicineDaeguSouth Korea Department of Surgery Seoul National University Bundang HospitalSeoul National University College of MedicineSungnamSouth Korea Department of Surgery Ewha Woman’s University School of MedicineSeoulSouth Korea Department of Surgery Konyang University HospitalDaejonSouth Korea Department of Surgery Chonbuk National University School of MedicineJeonjuSouth Korea Department of Surgery Hanyang University College of MedicineSeoulSouth Korea The Korean Organ Transplantation Registry Study Group

Background:New-onset diabetes after transplantation(NODAT)is a serious complication following liver transplantation(LT).The present study aimed to investigate the incidence of and risk factors for NODAT using the Korean Organ Transplantation Registry(KOTRY)***:Patients with history of pediatric transplantation(age≤18 years),re-transplantation,multi-organ transplantation,or pre-existing diabetes mellitus were excluded.A total of 1,919 non-diabetic adult patients who underwent a primary LT between May 2014 and December 2017 were *** factors were identified using Cox regression ***:NODAT occurred in 19.7%(n=377)of adult liver transplant *** analysis showed steroid use,increased age,and high body mass index(BMI)in recipients,and implantation of a left-side liver graft was closely associated with NODAT in adult *** living donor liver transplant(LDLT)patients(n=1,473),open donor hepatectomy in the living donors,steroid use,small for size liver graft(graft to recipient weight ratio≤0.8),increased age,and high BMI in the recipient were predictive factors for *** use of antimetabolite and basiliximab induction reduced the incidence of NODAT in adult LT and in adult ***:Basiliximab induction,early steroid withdrawal,and antimetabolite therapy may prevent NODAT after adult *** BMI or advanced age in liver recipients,open donor hepatectomy in living donors,and small size liver graft can predict the occurrence of NODAT after adult LT or LDLT.

关键词： Diabetes living donors immunosuppression Asia

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