Complications after bilateral adrenalectomy for phaeochromocytoma in multiple endocrine neoplasia type 2 - A plea to conserve adrenal function

Objective: To evaluate the complications of the adrenocortical supplementation that is needed after bilateral adrenalectomy for phaeochromocytoma in patients with multiple endocrine neoplasia (MEN) type 2 syndrome. Design: Retrospective study. Setting: University hospital, The Netherlands. Materials: 28 patients with MEN 2 who underwent total adrenalectomy for phaeochromocytoma between 1972 and 1996. Main outcome measures: Perioperative morbidity and mortality, histopathological findings, complications of adrenocortical supplementation therapy. Results: 22 patients had bilateral phaeochromocytomas on histopathological examination (79%) and 6 patients had initially unilateral phaeochromocytomas There was no operative mortality or substantial morbidity except for one splenic injury that necessitated splenectomy. During a mean follow-up period of 14 years (range 1-26) nine patients (32%) had a total of 19 Addisonian crises that necessitated admission to hospital. One patient died of an unrecognised Addisonian crisis. Conclusion: Complications of adrenocortical supplementation therapy are considerable, but they can be reduced when unilateral adrenalectomy is done for a unilateral phaeochromoytoma in patients with MEN 2 syndrome, provided that they are carefully followed up

A surgical resident course:Five years' experience in the Netherlands

In the Netherlands surgical residency training in the hospitals is supplemented by courses organized on a national basis. In the first 2 years of training theoretical courses have to be followed and examinations have to be passed. During the last 4 years of training participation in the so-called Surgical Course is obligatory. The organization, design and formats of the course are described. During the course at least half of the time is spent in interactive sessions. The issues presented in the last 5 years cover a wide range of biomedical aspects (80%), psychological-communicative aspects (10%) and aspects which regard the relation of the surgeon and surgery with finance and society. The authors conclude that the surgical course meets nearly all the 'crises criteria'