Laparoscopic right adrenalectomy for a large ganglioneuroma in a 12-year-old.

INTRODUCTION: Laparoscopic adrenalectomy is well established as the standard technique for all indications of adrenalectomy except adrenal carcinoma; however, some also consider large adrenal masses a relative contraindication. We present a video of a laparoscopic excision of a large ganglioneuroma and right adrenalectomy in a 12-year-old female. METHODS: Our patient was noted to have a right suprarenal mass on a computed tomography scan following complaints of back and abdominal pain. Upon surgical consultation, she underwent a magnetic resonance imaging, which showed a 7.9 x 4.4 x 5.6 cm heterogeneously enhancing suprarenal lesion that was either arising from or compressing the right adrenal gland. The patient's preoperative work-up included normal urinary metanephrines, alpha-fetoprotein, and beta-HCG. After discussion with the patient and family, the decision was made to proceed with laparoscopic excision of the mass. RESULTS: The patient underwent successful laparoscopic excision of the suprarenal mass and right adrenalectomy and was discharged from the hospital on postoperative day 2. During the procedure, retraction was achieved by using a combination of 5-mm grasping instruments, Endokittner dissectors (Ethicon Endosurgery Cincinnati, OH), and a suction irrigator to provide traction and counter traction. A flexible 5-mm liver retractor (Mediflex; Velmed, Inc., Wexford, PA) was placed directly through the abdominal wall without a trocar in order to elevate the liver from the area of the right adrenal and retroperitoneum. This enabled us to "rotate" the lesion out from behind the vena cava and from along the vertebral bodies. The pathology revealed an 8.5 x 7.0 x 3.0 cm ganglioneuroma, with primarily neural and Schwann cell-type tissue with interspersed large, prominent ganglion cells, and a normal adrenal gland. CONCLUSIONS: As demonstrated by our video, large adrenal masses in the pediatric population can be successfully excised laparoscopically with appropriate surgeon comfort and experience.

Data mining for correlations between diet and Crohn's disease activity.

Crohn's disease is a debilitating condition that affects the entire gastrointestinal tract and often requires aggressive and invasive therapies. Several studies have suggested dietary triggers for disease activity. We have created a web-based tool to allow participants to record both daily food intake and wellness (i.e., disease-specific quality of life). We seek to determine if measurable correlations exist between these events in patients with Crohn's disease. Advanced data mining techniques are employed to find such correlations and the efficacies of chosen techniques are assessed. We tested our web-based system in a pilot study involving 7 participants, and we found that traditional statistical techniques identified diet and disease activity correlations in short-term data sets.

Surgical textbooks: past, present, and future.

The Sabiston Textbook of Surgery and other classic textbooks have been invaluable resources for generations of surgeons. Although they play an important role in medical education, printed textbooks often cannot meet the daily information needs of practicing surgeons because they are inaccessible, incomplete, unstructured, and out of date. Advances in communication technology have radically changed the creation and distribution of medical information. Many clinicians now seek evidence to support clinical decisions on the Internet and handheld devices. This article describes the evolution of surgical textbooks from printed volumes to versatile collections of knowledge that serve as both comprehensive resources and question-answering tools.