Journal of the American College of Surgeons
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The effect of subspecialty programs on associated general surgery programs is largely undocumented. This study examined the effect of new pediatric surgery fellowship (PSF) programs on the pediatric surgical experience of residents in the associated general surgery programs. ⋯ Establishment of a new PSF program results in a significant decline in the pediatric surgery experience as surgeon for residents in the associated general surgery program. This outcome should be carefully weighed in the decision to establish a new PSF program.
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Patients with primary aldosteronism undergo imaging of the adrenal glands after confirmation of the disease. Adrenal venous sampling (AVS) is a useful adjunct to imaging, and advocates believe that AVS should be performed before surgical management. Others argue that patients with unilateral lesions on imaging do not require AVS. Although AVS accuracy has been established, few studies have evaluated how AVS alters management. Our study aimed to determine how AVS affected management of these patients. ⋯ Adrenal venous sampling can delineate the source of aldosterone hypersecretion, and often this is not concordant with cross-sectional imaging. We found that many patients avoided a potentially non-curative operation due to AVS. Adrenal venous sampling frequently alters the management of aldosteronomas and should be highly considered in patients before surgical intervention.