Laparoscopic adrenalectomy for suspected adrenal mass in lung cancer: ganglioneuroma.

BACKGROUND: Adrenalectomy is the gold standard for the treatment of primary adrenal ganglioneuroma. Preoperative differential diagnosis of ganglioneuroma is difficult and histopathologic examination is required to confirm the diagnosis. PATIENT: A 61-year-old woman, who was followed and treated by the medical oncology department because of lung carcinoma pathology squamous cell T4N0Mx, presented to our clinic due to a 15×8-mm nodule with a calculated relative wash-out rate of 40% in the right adrenal gland lateral edge, which was observed on computed tomography examination. CONCLUSION: Adrenal ganglioneuroma is a rarely seen, hormonally inactive, benign tumor. Final diagnosis can be made with histopathologic examination. Adrenalectomy is the standard treatment preferred for ganglioneuroma. Knowing the clinical appearance and good pathologic specialization are important adjunct matters in diagnosis. Laparoscopic adrenalectomy has become the gold standard in most patients with adrenal tumors.

Efficacy of levobupivacaine infiltration to nephrosthomy tract in combination with intravenous paracetamol on postoperative analgesia in percutaneous nephrolithotomy patients.

PURPOSE: To evaluate the efficacy of intraoperative local anesthetic infiltration in combination with intravenous paracetamol infusion on postoperative pain management in patients who underwent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Sixty adult patients were randomized into three groups with 20 cases in each: Group SP, 20 mL saline was infiltrated through the whole nephrostomy tract intraoperatively and this was followed by intravenous paracetamol (4 × 1 g) infusion postoperatively; group LP, 20 mL of 0.25% levobupivacaine infiltration to the nephrostomy tract followed by intravenous paracetamol infusion; Group LS, 20 mL of 0.25% levobupivacaine infiltration to the nephrostomy tract followed by intravenous saline infusion. In the postoperative period, the pain status of patients was evaluated at postoperative 6 and 24 hours by using the visual analogue scale (VAS). In patients who did not completely respond, meperidine (1 mg/kg intramuscularly) was administered as an additional "rescue" analgesic. Patient satisfaction from the postoperative analgesia management was assessed by a 5 point scale. RESULTS: There was no statistically significant difference between the three groups regarding the demographic characteristics, surgical complications, and postoperative hospital stay. Our findings revealed that in group LP, the amount and frequency of opioid used and related side effects was lesser, VAS score was lower, time to full mobilization was shorter, and the patient satisfaction score was higher when compared with the other two groups. CONCLUSION: Levobupivacaine infiltration through the nephrostomy tract in combination with intravenous paracetamol infusion was shown to be safe and efficacious as an analgesia method after PCNL.