Biopsy needle, thyroid gland, 74 technique, Bone hunger syndrome, 23

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1 The following figures were reproduced by permission, courtesy of the Mayo Clinic: Figures 2-7, 2-l4a, 2-l5a, 2-l5c, 2-l6a, 2-l8a, 3-l5a, 3-21a The following figure was slightly modified and reproduced by permission, courtesy of Dr. James C. Melby: Figure 3-17 Picture Credits

2 Accessory adrenal tissue, chromaffin, 127 Adenoma aldosterone-producing, 143, surgical excision, 150 unilateral adrenalectomy, ISO-lSI causing Cushing's syndrome, 152 islet cell, enucleation of, technique, 237 of endocrine pancreas, treatment, 226 parathyroid, cervical exploration and removal, 26 thyroid,70 Adrenalectomy adrenal tumor, postoperative management, 162 aldosterone-producing adenoma, ISO-lSI bilateral, Cushing's disease, indications, 161 postoperative complications, 161 breast carcinoma, metastatic, comparison with combination drug tberapy, 171 comparison with hypophysectomy, 171 predicting response to, factors involved, 166 idiopathetic adrenocortical hyperplasia, preoperative preparation, 150 operative techniques anterior approach for pheochromocytoma, posterior approach, thoracoabdominal approach for carcinoma, pheochromocytoma, intraoperative drug management, cardiac arrhythmias, 140 hypertension, hypotension, 140 postoperative management, preoperative preparation, 137 hypotension, 141 prostatic carcinoma, metastatic, 172 steroid replacement therapy after, 172 Aldosterone-producing adenoma, excision or adrenalectomy, 151 postoperative management, 15 I preoperative preparation, 150- lsi spironolactone and potassium, ISO nonoperative treatment, lsi spironolactone, lsi Anaplastic carcinoma, op~rative strategy, Anatomy, surgical adrenal gland, accessory adrenal tissue, blood supply, 126 normal anatomic relationships, 124 endocrine pancreas, 21 I blood supply, islets of Langerhans, normal anatomic relationships, 211 para anatomic location, 2-4 gross appearance,s red herrings,s supernumerary, 1-2 anatomic relationships, blood supply, 62 lymphatic drainage, 63, 65 nerve supply, sites of possible nerve injury during operation, Biopsy needle,, 74 technique, Bone hunger syndrome, 23 Calcitonin, radioimmunoassay, 72 Carcinoma adrenal gland, 143, 152, 156, 160, causing Cushing's syndrome, tumor, breast, metastatic, adrenalectomy, compared with combination drug therapy, 171 compared with hypophysectomy, 171 predicting response to, 166 endocrine pancreas gastrinoma, metastatic, 253 gastrectomy, 153 streptozotocin, 253 islet cell, 216 parathyro id causing primary HPT, 6-7 differentiation from HPT, 13 anaplastic, follicular, medullary, nonoperative therapy, 88 papillary, postoperative thyroid hormone therapy, 87 prostate gland, metastatic, 172 Cervical exploration parathyroid adenoma removal, operative technique, Cervical sympathetic nerves relationships to, 63 sites of possible injury during thyroidectomy, 64 Chemotherapy metastatic carcinoma of the breast, 171 thyroid cancer, 77 Chromaffin tissue, 127, 141 Diarrhea clinical features of ZES, 247 watery diarrhea syndrome, Duodenal wall gastrinoma, 253 Index

3 272 INDEX Follicular carcinoma,, operative strategy, 82 Gastrectomy Total, gastric factor and tumor regression after, monitoring progression or regression of tumor, 254 overall survival in ZES, 254 operative technique anastomosis of esophagus and jejunum, Hunt-Lawrence pouch, 260 incision, 255 mobilization of stomach, 256 Gastric factor and tumor regression after total gastrectomy, 253 Gastrinoma operative strategy, duodenal wall, 253 metastatic, 253 pancreatic, Goiter adenomatous, nodular, 66 clinical characteristics, evaluation for malignancy, indications for surgery, 66 substernal, removal of, operative technique, treatment, operative strategy, thyroid hormone suppressive therapy, 76 Grave's disease clinical features, 88, 90 nonoperative treatment antithyroid drugs, 93 radioiodine, 94 subtotal thyroidectomy, postoperative management, hypocalcemia, paresthes ia, 97 thyroid crisis, 98 Hunt-Lawrence pouch, gastrectomy, 260 Hyperglycemia, postoperative, management, 226 Hyperparathyroidism biologic syndrome, 10 causes, 6 clinical features, 8 ectopic or pseudo, 13 hypercalcemic crisis, 8 syndrome, 10 localization techniques, 21 MEN syndrome, II peptic ulcer, II primary, manifestations of, 8, 13 treatment asymptomatic, 21 indications for operation, normocalcemic, 22 operative strategy, secondary, 24 tertiary, hypercalcemia, 25 Hyperplasia adrenal, bilateral, causing Cushing's syndrome, adrenocortical, idiopathic, 150 bilateral total adrenalectomy, 150 chief cell, 24 para parathyroidectomy for, operative technique, 48 Hypertension intraoperation, adrenalectomy, 138 postadrenalectomy for pheochromocytoma, 142 primary aldosteron ism, 144 Hypocalcemia bone hunger syndrome, 23 calciferol therapy, 24 causes of, 12, 13 postparathyroidectomy, 23, 66, 97 secondary, HPT with chief cell hyperplasia, 24 symptoms, 23 treatment, Hypoglycemia fasting, causes of, 217 manifestations of insulinoma, 213, 216 pathophysiology of, 217 Hypoparathyroidism differentiation from bone hunger, 19 Hypophysectomy breast carcinoma, metastatic, indications for, Cushing's syndrome, indications for, 162 H ypotens ion postadrenalectomy, management, 141 Hypothyroidism after radioiodine therapy, 94 after subtotal thyroidectomy, 95 Laboratory studies adrenogenital syndrome, 164 aldosteronism, carcinoma of the breast, metastatic, Cushing's syndrome ACTH, plasma levels, 159 stimulation test, 159 cortisol secretion rate, 158 excretion of free cortisol and metabolites, plasma cortisol and diurnal rythm, insulinoma blood glucose: immunoreactive insulin ratio, hr fast, 218 insulin antibodies, pro insulin, 219 provocative tests, 219

4 INDEX 273 parath yro id calcium, serum, 12 urinary excretion, 15 magnesium, 15 parathyroid hormone, diagnosis of HPT in borderline hypercalcemia, 16 differential diagnosis of hypercalcemia, 16 parathyroid localization, preoperative, 16 radioimmunoassay, pheochromocytoma, plasma catecholamine, 133 pharmacologic tests, 133 urinary catecholamine, vanillyl mandelic acid, metanephrines, 132 calcitonin, radioimmunoassay, 74 echography, hyperthyroidism, needle biopsy, technique, X-ray studies, 73 Zollinger-Ellison syndrome gastrin secretory studies, 250 serum levels, immunoassay, pancreatic arteriography, X-ray studies, Laryngeal nerves recurrent, palpation and dissection, 38 relationship to thyroid, sites of possible injury during surgery, 64, 97 Lobectomy, anaplastic carcinoma, 85 indications for, 78, 85 subtotal, operative technique, total, operative technique, Localization studies adrenocortical adenoma, arteriography, 160 adrenogenital syndrome, angiography and aldosterone assay, imaging, 150 aldosteronism, Cushing's syndrome adrenal imaging, adrenal venography, 159 intravenous pyelography and nephrotomography, 159 roentgenography, 159 insulinoma arteriography, pancreatic, celiac axis, 222 scintiscanning, 222 toludidine blue staining, intraoperative, 222 para, tumors, cervical and mediastinal, new technique for localizing, pheochromocytoma, arteriography, intravenous pyelogram and nephrotomography, 134 Medullary carcinoma,, operative strategy, MUltiple endocrine neoplasia syndrome, 233, 247 Neck dissection,, indications, 80 medullary carcinoma, 82 modified operative technique, Needle biopsy,, technique, Nonoperative treatment, adrenal tumor, o,p' -DOD, 162 aldosteronism, spironolactone, 151 Cushing's disease, o,p' -DOD, 162 ectopic ACTH syndrome, aminoglutethmide, 163 gastrinoma, streptozotocin, 253 Grave's disease, antithyroid drugs, 93 radioiodine, 94 insulin producing beta cell tumors, streptozotocin, 253 insulinoma, diazepoxide', 226 streptozotocin, 227 pheochromocytoma, alpha-methyl-para-tyrosine, 142 phenoxybenzamine, 142 thyroid cancer, chemotherapy, 88 nodules, thyroid hormone, 76 radiation therapy, 88 watery diarrhea syndrome, streptozotocin, 262 Oophorectomy, advanced carcinoma of the breast, indications, 188 Operative techn iques adrenalectomy, anterior approach, pheochromocytoma, posterior approach, thoracoabdominal approach, resection of right andrenal carcinoma, biopsy of, needle, cervical exploration, removal of parathyroid adenoma, "difficult" case, "easy" case, "routine" case, gastrectomy, total, for ZES, anastomosis of esophagus and jejunum, Hunt-Lawrence pouch, 260 incision, 255 mobilization of stomach, 256 insulinoma, surgical approach, islet cell adenoma enucleation, 237 mediastinal exploration for parathyroid tumor, neck dissection, modified, thyroid carcinoma, pancreatectomy, subtotal (80-90 percent), 242 pancreatic resection, distal (75 percent), pancreatoduodenectomy, 243 parathyroidectomy for carcinoma, 47 hyperplasia, subtotal, 46 peptic duct injury, repair, 238 lobectomy, removal of substernal goiter, subtotal,

5 274 INDEX Pancreatectomy, im,ulinoma, indications, 225 long-term results, 226 operative technique, subtotal (80-90 percent), 242 Pancreatic resection, distal (75 percent), Pancreatoduodenectomy, 243 Papillary carcinoma,, operative strategy, Parathyroidectomy correction of hypercalcemia in ZES, 252 recovery of parathyroid function postoperatively, 66 Parathyroid hormone assays, uses of, radioimmunoassay of. 16 Pathology adrenal gland, aldosteronism, Cushing's syndrome, pheochromocytoma, cndocrine pancreas, insulinoma, 215 watery diarrhea syndrome, 261 Zollinger - Ellison syndrome, para, primary hyperparathyroidism, 6-8, Grave's disease, 88,90 nodular goiter and carcinoma, 66 Peptic ulcer in Zollinger-Ellison syndrome, 246 Phenoxybenzamine, nonoperative treatment of pheochromocytoma, 142 preoperative preparation in pheochromocytoma, 137 Pheochromocytoma adrenalectomy for, intraoperative drug management, 138 postoperative management, preoperative preparation, phenoxybenzam inc, 137 propanolol, 137 adrenal imaging, 136 arteriography, 135 characteristics, 127 clinical features, diagnostic tests, 135 extraadrenal, 129 genetically associated diseases, 131 histology, malignant, 142 nonoperative treatment alpha-methyl-para-tyrosine, 142 phenoxybenzamine, 142 Plummer's disease, clinical features, subtotal thyroidectomy, 100 thyroid function tests, Propanolol, during radioiodine therapy, 95 preoperative preparation, Grave's disease, 96 pheochromocytoma, 137 Radiation therapy Cushing's disease, 161 thyroid cancer, 88 Radioiodine Grave's disease, 94 hyperthyroidism, after, 94 postthyroidectomy for carcinoma, '1',7 Thyroidectomy indications, I, 66 anaplastic carcinoma, 85 follicular carcinoma, 82 medullary carcinoma, 84 papillary carcinoma, 78 radioiodine therapy after, 87 subtotal, Grave's disease, 95 postoperative complications, Thyroiditis, 70 Vocal cord paresis, after parathyroid surgery, 24 thyroidectomy Watery diarrhea syndrome, pathology and diagnosis, 261 operative or nonoperative therapy, 262 Whipple's triad,