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首页> 外文学位 >'Operating on shadows': Evolving perceptions of the incidentally discovered adrenal mass, 1982--2002.
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'Operating on shadows': Evolving perceptions of the incidentally discovered adrenal mass, 1982--2002.

机译：“在阴影下操作”：对偶然发现的肾上腺肿块的认识不断发展，1982--2002年。

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摘要

Computed tomography (CT) scanning is an integral component of 21 st-Century medical practice, and physicians have become increasingly reliant on this imaging modality for diagnosing disease and planning operative treatment. Following its introduction in the 1970s, CT scanning proved especially valuable for studying the organs of the abdominal cavity. However, with the rapid rise in the number of abdominal CT scans came an unanticipated problem: the identification of clinically silent adrenal tumors of unknown significance. The recognition of these asymptomatic, incidentally discovered adrenal tumors, dubbed "incidentalomas" by George Washington University surgeon Glenn Geelhoed in 1982, compelled physicians to embark on extensive hormonal workups, order further radiographic studies, and, in many cases, perform operations of questionable benefit.;In this paper I provide a historical analysis of adrenal incidentaloma from its initial recognition in 1982 until the National Institutes of Health-mandated consensus conference dedicated solely to its management in 2002. First, I explore the circumstances and historical context surrounding the early reports of adrenal incidentaloma, and describe how this entity received its name. Next, I trace the efforts of three separate classes of physicians (endocrinologists, radiologists, and surgeons) to characterize these tumors and formulate rational guidelines for their treatment. Finally, I reflect upon the impact that adrenal incidentaloma has made upon medical thought and practice during its relatively short existence. Throughout this paper I show how adrenal incidentaloma has transformed the traditional diagnostic algorithms of adrenal disease, altered definitions of illness and wellness in subtle but significant ways, and forced physicians to come to terms with uncertainty in a practice environment that increasingly expects them to provide unassailable, error-free care.
机译：计算机断层扫描（CT）扫描是21世纪医学实践必不可少的组成部分，并且医生越来越依赖于这种成像方式来诊断疾病和计划手术治疗。自1970年代问世以来，CT扫描被证明对研究腹腔器官特别有价值。然而，随着腹部CT扫描数量的迅速增加，出现了一个无法预料的问题：鉴定临床意义不明的无声肾上腺肿瘤。 1982年，乔治华盛顿大学的外科医生格伦·盖埃尔霍德（Glenn Geelhoed）将这些无症状，偶然发现的肾上腺肿瘤称为“偶发性腺瘤”，这迫使医生着手进行广泛的荷尔蒙检查，进行进一步的影像学检查，并在许多情况下，进行了可疑获益的手术。;本文提供了从1982年最初认识到肾上腺偶发瘤直到2002年美国国立卫生研究院（National Institutes of Health）专门致力于其管理的共识会议的历史分析。首先，我探讨了早期报道的情况和历史背景。肾上腺偶发瘤，并描述该实体如何获得其名称。接下来，我追踪了三类不同的医师（内分泌医师，放射医师和外科医生）的努力，以表征这些肿瘤并制定合理的治疗指南。最后，我回顾一下肾上腺偶发瘤在相对较短的生存期中对医学思想和实践的影响。在整篇文章中，我展示了肾上腺偶发瘤如何以微妙但重要的方式改变了传统的肾上腺疾病诊断算法，改变了疾病和健康的定义，并迫使医生在实践环境中陷入不确定性，越来越多地期望他们提供无懈可击的治疗，无错误的照顾。

著录项

  • 作者

    Shen, Wen T.;

  • 作者单位

    University of California, San Francisco.;

  • 授予单位 University of California, San Francisco.;
  • 学科 Health Sciences Medicine and Surgery.;History of Science.
  • 学位 M.A.
  • 年度 2009
  • 页码 57 p.
  • 总页数 57
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 自然科学史;
  • 关键词

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