Byoung Yoon Ryu

GIANT MULTILOCULAR PROSTATIC CYSTADENOMA

A 57-year-old man presented with a 1-year history of a lower abdominal mass and dysuria. Excretory urography showed an anteriorly displaced bladder compressed by a large pelvic mass on lateral view. However, examination of the upper urinary tract was normal. Computerized tomography of the abdomen and pelvis revealed a large multiseptated pelvic mass with thickened irregular walls displacing the bladder and rectum. Different attenuations were in each loculus, and there was contrast material enhancement of the internal septa. Magnetic resonance imaging (MRI) of the pelvis demonstrated a large multiseptated pelvic mass with different signal intensities in each loculus, suggesting hemorrhagic or proteinaceous fluid components. Sagittal T1weighted image showed effects of the mass on the bladder and rectum (fig. 1). Exploration of the retroperitoneum revealed a large cystic mass apparently arising in the pelvic floor between the rectum and bladder. The mass was compressing and displacing the bladder anterolaterally and adhering to the bladder wall. The specimen was an approximately 15 3 10 3 8 cm. tan cystic mass weighing 300 gm. with a rough, shaggy surface. Cut section revealed multilocular cysts filled with brown, rusty appearing fluid. In several cysts there was transparent serous fluid. Size varied from minute to several cm. Microscopically, the cysts were lined by double layers of epithelium, reminiscent of prostate tissue (fig. 2). The larger cysts had flattened epithelium. The lining was focally multilayered or squamous metaplasia. The luminal borders of the glands stained positive with periodic acid-Schiff and alcian blue at pH 2.5. The epithelial cells were immunoreactive for prostate specific antigen. The stroma surrounding the glands was hypocellular and focally markedly hyalinized. No atypical feature was noted in the glandular or stromal component of the mass. The pathological findings were consistent with multilocular prostatic cystadenoma.

Colonoscopic Diagnosis of Appendiceal Intussusception : A Case Report

Intussusception of the appendix is an uncommon condition and the diagnosis is rarely made preoperatively. Intussusception of the appendix may mimic a neoplastic lesion. Colonoscopy is a valuable tool for diagnosis of the appendiceal intussusception. A 17-yr-old female admitted with repeated abdominal pain, nausea, vomiting and febrile sensation. We diagnosed as appendiceal intussusception by colonoscopy, which showed a polypoid tumor (about 1.5 cm) in the cecum. This sessile polypoid mass looks like foreskin or glans. We present colonoscopic finding of appendiceal intussusception and review the literature.

Two Complications of Tracheal Intubation in a Neonate Gastric Perforation and Lung Collapse

A N infant delivered in a private hospital after 33 weeks’ gestation weighed 2,050 g, had persistent tachypnea, and had associated hypoxia requiring intubation. After three esophageal intubations, the neonate’s trachea was successfully intubated. Despite mechanical ventilation, the infant had persistent tachycardia, hypoxemia (80–90% oxygen saturation) and a distended abdomen. A preoperative radiograph of this child shows the endotracheal tube tip in the right main bronchus (arrow A), atelectasis of the entire left lung (arrow B), pneumoperitoneum (white arrows), and increased abdominal gas. At surgery, a 1.5-cm perforation of the anterior wall of the lesser curvature of the stomach was identified and repaired. The radiograph emphasizes critical complications that can occur during airway management of a neonate. Inadvertent esophageal intubation is one of the most common causes of neonatal intubation failure, which can lead to catastrophic consequences. This condition can be rapidly detected by using end-tidal carbon dioxide monitoring, because it is the single most useful method in confirming endotracheal tube position. In this neonate, gastric perforation likely occurred as a result of distension associated with positive pressure ventilation after esophageal intubation. Endobronchial intubation is another common problem associated with airway management in a neonate. This child’s atelectasis likely developed after main stem intubation, when the endotracheal tube depth was noted to be 11 cm. As a guide to proper tracheal placement of an endotracheal tube, 1-, 2-, or 3-kg babies are intubated to a depth of 7, 8, or 9 cm, respectively. These two complications reinforce the need for specialized training and experience in neonatal airway management.

Acute, fatal postoperative myocardial infarction after laparoscopic cholecystectomy in a cardiac patient -A case report-

This report presents the case of a 63-year-old man who had a myocardial infarction leading to coronary artery bypass graft 2 years earlier who subsequently underwent elective laparoscopic cholecystectomy. After an uneventful operation, the patient developed an acute postoperative myocardial infarction in the recovery room and died 19 days postoperatively. Anesthesiologists should be aware of the rare possibility of acute, fatal postoperative myocardial infarction and consider this complication when they perform the preoperative risk evaluation, anesthesia, and postoperative care for cardiac patients undergoing noncardiac surgery.