PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1-6 cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Adenoma ; Adrenalectomy* ; Angiomyolipoma ; Hemorrhage ; Humans ; Hyperplasia ; Kidney ; Length of Stay ; Mortality ; Nephrectomy ; Prone Position ; Subcutaneous Emphysema

We describe a case of traumatic aortic dissection associated with cardiac compression in a patient with anaphylactic cardiac arrest who underwent cardiopulmonary resuscitation (CPR). A 54-year-old man who was scheduled to undergo surgery for gastric cancer went into cardiac arrest caused by an anaphylactic reaction to prophylactic antibiotics in the operating room. Veno-arterial extracorporeal membrane oxygenation (ECMO) was performed. CPR, including chest compressions, was performed for 35 minutes, and the patient was transferred to the intensive care unit (ICU) after spontaneous circulation returned. The patient received ECMO for 9 hours until confirmation of normal cardiac function on transthoracic echocardiography. Twenty days after cardiac arrest, an aortic dissection and fractures in the left fourth and fifth ribs due to chest compression were detected by abdominal computed tomography. The DeBakey type III aortic dissection extended from the distal arch of the thoracic aorta to the proximal level of the renal artery, involving the celiac trunk. It was considered an uncomplicated type B aortic dissection with no sign of malperfusion of the major vessels. This case demonstrates the potential traumatic injuries that can occur after CPR and encourages proper management of mechanical complications in cardiac arrest survivors.
Anaphylaxis ; Anti-Bacterial Agents ; Aorta, Thoracic ; Cardiopulmonary Resuscitation* ; Echocardiography ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Intensive Care Units ; Middle Aged ; Operating Rooms ; Renal Artery ; Ribs ; Stomach Neoplasms ; Survivors* ; Thorax ; Tomography, Spiral Computed

PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1?? cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21 cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Adenoma ; Adrenalectomy* ; Angiomyolipoma ; Hemorrhage ; Humans ; Hyperplasia ; Kidney ; Length of Stay ; Mortality ; Nephrectomy ; Prone Position ; Subcutaneous Emphysema

PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1?? cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21 cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Adenoma ; Adrenalectomy* ; Angiomyolipoma ; Hemorrhage ; Humans ; Hyperplasia ; Kidney ; Length of Stay ; Mortality ; Nephrectomy ; Prone Position ; Subcutaneous Emphysema

No abstract available.
Blood Pressure* ; Body Mass Index*

No abstract available.
Prune Belly Syndrome*

No abstract available.
Lymphoma* ; Trachea*

Aortic regurgitation is a common valvular heart disease, usually the result of rheumatic fever, or syphilis, and rarely of congenital origin. It is frequently associated with other valvular heart disease, especially mitral valve disease. It can be diagnosed by the presence of pulse pressure widening, a Corrigan pulse, and an early decreascendo diastolic murmur at the left sternal border between the second and third intercostal spaces. After the clinical application of cineaortography in the diagnosis of valvular disease, Segal et al (1964) first reported rheumatic aortic regurgitation without an audible murmur in patients having mitral valve disease. The importance of discovering aortic reguritation in patients with predominent mitral disease has begun to be appreciated recently, especially as commisurotomies for the relief of mitral stenosis are performed more frequently. Nowadays eventhough the severity of aortic regurgitation is often not evident preoperatively, aortic regurgitation can become very evident when mitral stenosis is relieved. This study was comprised of seventeen patients with silent aortic regurgitation which was confirmed by cineaortography at Severance Hospital from January, 1970 to August, 1976. 1. Of the seventeen patients, 12 patients were associated with mitral stenosis, 4 with mitral steno-insufficiency, and 1 with mitral insufficiency. 2. Silent aortic regurgitation was suggested from the accompanying clinical features such as chest pain, apical heaving, and left ventficular hypertrophy pattern on both roentgenogram of the chest and electrocardiogram. 3. The severity of the aortic regurgitation was mild to moderate; 7 of the 17 patients being grade I, and 10 patients being grade II on cineaortogram.
Aortic Valve Insufficiency* ; Blood Pressure ; Chest Pain ; Diagnosis ; Electrocardiography ; Heart Murmurs ; Heart Valve Diseases ; Humans ; Hypertrophy ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Rheumatic Fever ; Syphilis ; Thorax

Osteomalacia is a disorder in which the mineralization of the organic matrix of the skeleton is defective. Proximal muscular weakness is a common symptom of osteomalacia. A 27-year-old woman reported the gradual onset of gait disturbance and bone pain in the thigh. Her height shortened during 10 months. On neurological examinations, proximal muscular weakness of the extremities was disclosed. Serum phosphorus was 1.8 mg/dl (normal 2.5~4.5), alkaline phosphatase was 1045 IU/L (normal 70~290), and 1,25 (OH)2 vitamin D3 was 18 pg/ml (normal 20~60). On roentgenography, multiple pseudofracture lines of the rib and erosion of the head of the right femur were demonstrated. A bone scan showed multiple hot spots on the ribs and right femur. She was medicated with calcitriol and phosphorus and she recovered most of her strength and experienced decreased bone pain after 3 months. We report a case that confirms osteomalacic myopathy by an endocrinological test in patients who experienced gradual proximal muscular weakness and bone pain.
Adult ; Alkaline Phosphatase ; Calcitriol ; Cholecalciferol ; Extremities ; Female ; Femur ; Gait ; Head ; Humans ; Muscle Weakness ; Muscular Diseases* ; Neurologic Examination ; Osteomalacia ; Phosphorus ; Radiography ; Ribs ; Skeleton ; Thigh

Nutrition therapy is challenging in critically ill patients. Critical illness is associated with a state of catabolic stress, in which stress hormones and inflammatory mediators are activated, resulting in proteolysis. The aim of nutrition therapy in critically ill patients is to preserve lean body mass, to preserve immune function, and to avoid metabolic complications. Enteral nutrition is preferred over parenteral nutrition. Enteral nutrition should be initiated within 24 to48 hours of intensive care unit admission. However, enteral nutrition should be withheld until the patient is fully resuscitated. If enteral nutrition is not feasible within several days, supplementary parenteral nutrition is necessary. In the acute phase, energy requirements should not be over 20 to 25 kcal/kg/d, and protein should be supplemented in the range of 1.2 to 2.0 g/kg/day. Monitoring tolerance is very important in critically ill patients with artificial nutrition to avoid complications. Immunonutrition such as glutamine and omega-3 fatty acid is helpful to modulate effects on the immune system in critically ill patients. Implementation of a feeding protocol and the involvement of a nutrition support team can systemize nutrition therapy. Together, these steps will hopefully enable the integration of evidence-based guidelines into practice, leading to improvements in nutrition performance so that patients' chances of a good outcome are optimized.
Critical Illness ; Enteral Nutrition ; Glutamine ; Humans ; Immune System ; Intensive Care Units* ; Nutrition Therapy* ; Parenteral Nutrition ; Protein-Energy Malnutrition ; Proteolysis