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.
Lymphoma* ; Trachea*

No abstract available.
Prune Belly Syndrome*

Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.
Aged ; Critical Illness* ; Delayed Diagnosis ; Headache ; Humans ; Intensive Care Units ; Male ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome* ; Postoperative Period ; Seizures

Anaphylactic reaction during the perioperative period typically exhibits rapid onset, varying clinical manifestations, and an expected mortality rate of 1.5-9%. Neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Here, we report a severe case of anaphylaxis that developed in a 66-year-old man due to cisatracurium administration. And he was successfully managed by extracorporeal membrane oxygenation. Cardiopulmonary resuscitation was performed by extracorporeal membrane oxygenation, and the patient was successfully weaned off 24 hours later.
Aged ; Anaphylaxis* ; Cardiopulmonary Resuscitation ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Humans ; Mortality ; Neuromuscular Blocking Agents ; Perioperative Period

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