Restoration of glycemic control in patients with type 2 diabetes mellitus after bariatric surgery is associated with reduction in microparticles.

Background: Microparticles bud from cellular elements during inflammation and are associated with the vascular dysfunction related to type 2 diabetes mellitus. Although weight loss is known to reduce inflammation, the metabolic effects of bariatric surgery on microparticle concentration and composition are not known. Our objectives were to determine the effect of bariatric surgery on the microparticle concentration and to correlate these changes with clinical parameters in a multispecialty group practice.

Retroperitoneal masses mimicking adrenal tumors.

Objective: To report 10 cases of neoplasms that were initially thought to be primarily adrenal-derived masses but were later confirmed as tumors of a different origin.

Methods: Between 2000 and 2011, a total of 229 patients underwent adrenalectomy at our institution. Of this overall group, 10 patients had retroperitoneal pathologic conditions mimicking adrenal tumors.

Resection and radiofrequency ablation in the treatment of hepatocellular carcinoma: a single-center experience.

Background: We have been utilizing both resection and laparoscopic radiofrequency ablation (RFA) to treat hepatocellular carcinoma (HCC). The aim of this study is to describe patient characteristics and outcome for each treatment modality from a single institution.

Methods: Medical records of HCC patients who underwent resection (n = 92) or laparoscopic (RFA) (n = 92) between 1997 and 2010 were reviewed.

The utility of PET/CT in the management of patients with colorectal liver metastases undergoing laparascopic radiofrequency thermal ablation.

Background: There are scant data in the literature about the use of PET in the management of patients undergoing RFA of colorectal liver metastases (CLM). The aim of this study is to look at the use of PET versus contrast-enhanced CT (ce CT) scans on the initial assessment and follow-up of patients with CLM undergoing laparoscopic RFA.

Methods: The patients who had PET scans pre-RFA and post-RFA were identified from a prospective IRB-approved database within a 14-year period.

Percutaneous and video-assisted ablation of endocrine tumors: liver, adrenal, and thyroid.

Radiofrequency ablation (RFA) relies on cell destruction using heat, which is generated by the vibration of electrons as a result of high-frequency electrical energy. RFA was initially employed for the treatment of arrhythmogenic cardiac lesions. It has since been used to treat solid tumors of various organs, both primary and metastatic.

Weight Loss as a Cure for Type 2 Diabetes? Fact or Fantasy.

Although individuals with obesity and type 2 diabetes are insulin resistant, pancreatic beta cell failure is the core defect that distinguishes individuals who eventually develop diabetes. This process is known to occur well before the onset of hyperglycemia. Although clinical trial data support the effectiveness of intensive lifestyle modification in delaying the onset of diabetes in obese subjects, less is known about the effects of and mechanisms underlying bariatric surgery, particularly gastric bypass surgery, on diabetes.

Multimodality treatment of neuroendocrine liver metastases.

Background: Neuroendocrine liver metastases have a distinct tumor biology and symptomatology that render their management challenging. This difficulty is reflected in the literature, which lacks consensus on a treatment algorithm. The aim of this study is to propose a treatment algorithm based on patient morbidity and the efficacy of different treatment options.

Pregnancy and acromegaly: a review.

To review the literature regarding the diagnosis and management of acromegaly during pregnancy. A systematic literature search was performed using MEDLINE including hand-searching reference lists from original articles. The diagnosis of acromegaly during pregnancy is made difficult due to the physiologic changes in pituitary GH secretion and IGF-1 production resulting from placental GH secretion and the inability of commercial assays to discriminate between pituitary and placental GH.

Robotic transaxillary total thyroidectomy using a unilateral approach.

There has been a recent interest at performing thyroid procedures robotically through an axillary approach. Although the technique for a unilateral thyroid lobectomy has been well established, there are controversies about whether a unilateral or bilateral axillary approach should be used for total thyroidectomy. Furthermore, there also questions as to whether a robotic total thyroidectomy would be oncologically equivalent to the traditional procedure.

Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules.

Background: There is scant data concerning surgeon-performed thyroid fine-needle aspiration (FNA), and controversy regarding its accuracy in larger nodules. This study aimed to specifically assess accuracy of surgeon-performed ultrasound (US)-guided FNA on a per-nodule basis, with a subanalysis of nodule size.

Methods: Data of 1,000 surgeon-performed US-guided thyroid FNAs at a single institution from 2000 to 2010 were prospectively collected.

Insulin glargine use during pregnancy.

Objective: To review the literature regarding the use of insulin glargine during pregnancy, specifically addressing the issues and concerns surrounding mitogenicity, placental transfer, and maternal and fetal safety.

Methods: We performed a systematic literature search using MEDLINE and BIOSIS Previews up to March 2011. Additional studies were identified by hand-searching reference lists from original articles.

Laparoscopic resection of abdominal paragangliomas.

Paragangliomas are rare catecholamine-secreting tumors arising from chromaffin tissue of the autonomic nervous system. Although they can arise anywhere along the paravertebral axis, the majority is intra-abdominal in location. Frequently, these tumors are closely associated with major vascular structures, necessitating open techniques for resection.

Robotic thoracoscopic mediastinal parathyroidectomy for persistent hyperparathyroidism: case report and review of the literature.

Recurrent and persistent primary hyperparathyroidism remains a significant surgical challenge. Abnormal, hypersecreting parathyroid glands are found in ectopic locations in up to 15% to 20% of patients. A small portion of these ectopic glands will be found in the mediastinum at a location that precludes removal through the traditional cervical incision.

Laparoscopic radiofrequency thermal ablation of neuroendocrine hepatic metastases: long-term follow-up.

Background: Since our first report 13 years ago, laparoscopic radiofrequency ablation has been incorporated into the treatment algorithm of patients with neuroendocrine liver metastases. The aim of this study is to report long-term oncologic results.

Methods: Eighty-nine patients with neuroendocrine hepatic metastases underwent 119 laparoscopic radiofrequency ablation sessions within 13 years.

Approach to a low TSH level: patience is a virtue.

Confronted with a low serum level of thyrotropin (thyroid-stimulating hormone, TSH), physicians should not jump to the conclusion that it is due to a hyperthyroid state, as other conditions and some drugs can be associated with a TSH level that is slightly low (0.1-0.4 microIU/mL) or frankly suppressed (< 0.

Clinical characteristics and outcome of familial nonmedullary thyroid cancer: a retrospective controlled study.

Background: Familial nonmedullary thyroid cancer (FNMTC) is a disease defined by clustering of thyroid cancers of follicular cell origin, and it is estimated to account for 5% of all thyroid cancers. Several studies found FNMTC to be more aggressive than sporadic disease, whereas others found them to have a similar course and outcome. The purpose of this study was to determine whether FNMTC is more aggressive than sporadic thyroid cancer.

Spontaneous cerebrospinal fluid rhinorrhea as the initial presentation of growth hormone-secreting pituitary adenoma.

Patients with acromegaly usually present with characteristic clinical features or comorbidities associated with excess insulinlike growth factor 1 (IGF-1)/growth hormone (GH) or may come to medical attention secondary to mass effects causing visual field distortions. Herein, we report a case of spontaneous cerebrospinal fluid (CSF) rhinorrhea as the presenting symptom of acromegaly. A 68-year-old man presented to an outside facility with a 2-day history of headache associated with nausea, vomiting, dizziness, and clear nasal discharge and underwent 2 attempted repairs of a sphenoid sinus CSF leak.

Robotic versus laparoscopic resection of liver tumours.

Background: There are scant data in the literature regarding the role of robotic liver surgery. The aim of the present study was to develop techniques for robotic liver tumour resection and to draw a comparison with laparoscopic resection.

Methods: Over a 1-year period, nine patients underwent robotic resection of peripherally located malignant lesions measuring <5 cm.

Circulating thyrotropin receptor mRNA as a novel marker of thyroid cancer: clinical applications learned from 1758 samples.

Objectives: Since thyroglobulin, no new blood tests for differentiated thyroid cancer (DTC) have been introduced into routine clinical practice. In initial studies, the detection of circulating DTC cells by thyrotropin receptor (TSHR) mRNA measurement distinguished benign from malignant thyroid diseases. This prospective validation study tests the ability of TSHR mRNA to diagnose DTC preoperatively and to detect cancer recurrence.

Techniques of radiofrequency-assisted precoagulation in laparoscopic liver resection.

Background: Although radiofrequency-assisted (RF) precoagulation has been described for open resections, there is little data evaluating precoagulation options in laparoscopic liver resection. The purpose of this study is to provide an algorithm for the use of monopolar and bipolar RF devices in laparoscopic liver resection.

Methods: Patients undergoing laparoscopic liver resection utilizing precoagulation during the period 2007-2009 were identified from a prospectively maintained, institutional review board-approved database.

A rare case of chronic lymphocytic leukemia/small lymphocytic lymphoma presenting in the thyroid gland.

Background: Lymphoma involving the thyroid gland is rare. Diffuse large B-cell lymphoma and mucosa-associated lymphoid tissue lymphoma are the two most common histologic subtypes of primary thyroid lymphoma. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) presenting initially as a thyroid abnormality is extremely rare, with very few reported cases in the literature.

Robotic posterior retroperitoneal adrenalectomy: operative technique.

Objective: To describe a robotic technique for posterior retroperitoneal (PR) adrenalectomy.

Design: Prospective study.

Setting: Academic hospital.

Robotic transaxillary thyroidectomy: report of 2 cases and description of the technique.

Various techniques for minimally invasive thyroid surgery have been described over the last decade. These techniques have significant limitations owing to 2-dimensional view and awkward endoscopic instrumentation. Robotic surgical technology was developed to overcome these limitations.

The risk of overall mortality in patients with type 2 diabetes receiving glipizide, glyburide, or glimepiride monotherapy: a retrospective analysis.

Objective: Sulfonylureas have historically been analyzed as a medication class, which may be inappropriate given the differences in properties inherent to the individual sulfonylureas (hypoglycemic risk, sulfonylurea receptor selectivity, and effects on myocardial ischemic preconditioning). The purpose of this study was to assess the relationship of individual sulfonylureas and the risk of overall mortality in a large cohort of patients with type 2 diabetes.

Research Design And Methods: A retrospective cohort study was conducted using an academic health center enterprise-wide electronic health record (EHR) system to identify 11,141 patients with type 2 diabetes (4,279 initiators of monotherapy with glyburide, 4,325 initiators of monotherapy with glipizide, and 2,537 initiators of monotherapy with glimepiride), >or=18 years of age with and without a history of coronary artery disease (CAD) and not on insulin or a noninsulin injectable at baseline.

Detection of disease recurrence in differentiated thyroid cancer.

Thyroid cancer is the most common malignancy of the endocrine system, with an incidence that has been increasing for several decades. Differentiated thyroid carcinomas, which account for more than 90% of thyroid cancers, are generally indolent tumors with excellent long-term prognosis. However, the recurrence rates of differentiated thyroid cancers are high.