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PHÆOCHROMOCYTOMA: Advances in Accuracy of Diagnosis and Safety of Treatment in the Past Decade: a Report of Three Cases
Author(s) -
Siegel Jerald,
Stackpole Robert H.,
Lattimer John K.
Publication year - 1965
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1965.tb09668.x
Subject(s) - medicine , blood pressure , anesthesia , norepinephrine , safer , surgery , urinary system , computer security , computer science , dopamine
SUMMARY Three patients with phæochromocytoma operated upon at the Kingsbridge Veterans Administration Hospital are reported, as a comparison of methods available in 1949, 1951, and 1962. The first patient was operated upon in 1949 for a single adrenal phæochromocytoma. The second patient had bilateral lumbocostal incisions, in the prone position, for a right adrenal phæochromo‐cytoma in 1951. The third patient had a bilateral adrenal phæochromocytoma excised in 1962. During the thirteen‐year period, advances and refinements in technique have taken place. These changes have been described and include:–1 More accurate diagnostic tests, namely:(a) Twenty‐four‐hour urinary catecholamine determination. (b) Urinary and serum VMA.2 Better and safer techniques for the localisation of tumours by using carbon dioxide via the presacral route for retroperitoneal pneumography and nephrotomography. 3 Safer anaesthetic management. 4 Successful blood‐pressure regulation during and after operation with the use of:(a) Regitine for controlling hypertension. (a) Norepinephrine for controlling hypotension.As a result of our study, supported by the experience at the Presbyterian Hospital, it is our opinion that a transverse, transperitoneal incision be utilised. The prone position should be avoided because of poor exposure of the great vessels and Regitine should not be given in the immediate pre‐operative period. We feel that careful regulation of blood‐pressure is essential for a favourable prognosis. Anaesthetic agents which cause cardiac complications such as cyclopropane and chloroform are to be avoided.