Cushing’s Syndrome in a Young Woman: A Rare Presentation of Adrenocortical Carcinoma.

Cushing’s Syndrome is rarely caused by a malignant adrenal tumor. We report the case of a 24-year-old female patient with Cushing’s syndrome caused by a functioning adrenocortical carcinoma and recovered after adrenalectomy.

Primary squamous cell carcinoma of the renal pelvis masquerading as pyonephrosis: a case report.

Squamous cell carcinoma of the renal pelvis is a rare tumor, which is usually associated with nephrolithiasis. It is rarely associated with pyonephrosis. We report the case of a 69-year-old man who presented with features of pyonephrosis and underwent nephrectomy. The postoperative histological evaluation revealed an unsuspected squamous cell carcinoma of renal pelvis with a concomitant pyonephrosis. The rarity of this tumor in the absence of renal calculi and its association with pyonephrosis is highlighted.

Randomized Controlled Trial of Conventional Carbon Dioxide Pneumoperitoneum versus Gasless Technique for Laparoscopic Cholecystectomy

Concerns about pathophysiologic changes and disadvantages associated with carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy have led to the introduction of gasless laparoscopy employing abdominal wall lifting (AWL) method. However, AWL has been criticized for its complexity and technical difficulty. We have used AWL method for gasless laparoscopic cholecystectomy and compared it with laparoscopic cholecystectomy with respect to operation performance, postoperative course, and pathophysiologic changes. During a four-month period, 40 consecutive patients with symptomatic gallstones were randomly assigned to receive laparoscopic cholecystectomy with conventional CO2 pneumoperitoneum (PP group; N=20) or the AWL method (AWL group; N=20). Operative results and operative time were recorded. Cardiopulmonary and ventilatory functions were assessed during the surgery. Postoperative pain and presence of nausea and vomiting were assessed for 48 hours after surgery. Postoperative time to recovery of flatus, tolerance to a full oral diet, and full activity were also determined. The intraoperative cardiopulmonary and ventilatory functions deteriorated significantly less in the AWL group. The preparation time for surgery and total operative time were significantly greater in the AWL group. None of the patients in either group required conversion to open surgery. Technique related morbidity was minimal and there was no mortality in either group. Although AWL method required a longer operation time, our results suggest that the technique is valuable in high-risk patients with cardiorespiratory disease. AWL technique of laparoscopic cholecystectomy is a feasible, safe and effective alternative to CO2 pneumoperitoneum. It probably costs less and is therefore, more useful in developing countries.

Hirschprung’s Disease: A Rare Cause of Intestinal Obstruction in Adults

Hirschprung’s disease (aganglionosis) in the adult is a rare condition but needs to be considered as a diagnosis in any case of intractable constipation.We report a case of twenty-year-old woman with adult hirschprung’s disease, presenting as intestinal obstruction. Diagnosis is discussed and operative management evaluated.

Pedicled Ileal Seromuscular Flap-A New Technique for Protection of Intestinal Anastomosis in Patients with Peritonitis

Pedicled ileal seromuscular flap- a new technique for protection of intestinal anastomosis in patients with peritonitis. This method involves raising a seromuscular flap on a pedicle from the stump of intestine to be anastomosed. The anastomosis is performed, and then covered with seromuscular flap. The submucosa due to its inherent properties, promotes better healing and reduces the tension on the anastomosis. There has been no previous study to assess the usefulness of this technique. We used a pedicled ileal seromuscular flap in twenty consecutive patients with peritonitis who required an ileo-ileal or an ileo-colic anastomosis. Anastomotic leak occurred in two out of twenty patients. The safety and efficacy of this technique involving autologous tissues to reinforce intestinal anastomosis has been demonstrated.