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Background/Objective: Standard laparoscopic adrenalectomy requires early control of the main adrenal vein; however, the small retroperitoneal working space is challenging for beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes. Methods: A total of 38 RLAs were performed for the patients with PHA. The patients were placed in true lateral position with mild bending to expand the surgical field. Instead of attempting to control the main adrenal vein initially, we adopted a technical modification that manipulating and freeing the gland first before controlling the main adrenal vein. Results: The RLAs were successfully performed in all but one case, which was converted to open surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss was 74 ml. Mean maximal fluctuation of systolic blood pressure was 29 mmHg. For the right-side RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2 ml) were noted compared with the left-side procedure. Postoperative complications included cerebrovascular accident in one patient, one surgical site hematoma, and two patients had postoperative fever. Potassium level returned to normal in all patients and 70% of the patients reduced their antihypertensives. Conclusion: Technical modification RLA for PHA without initial control of the main adrenal vein is a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted. No vascular injury occurred. Moreover, the right-side procedure became easier.

A rare case of combined unilateral adrenal hyperplasia and paraganglioma is reported. A 27-year-old woman presented with hypertension, palpitation, dizziness, and headache for about 3 months. Elevated plasma aldosterone with low renin and a high level of urine vanillylmandelic acid (VMA) were found. Computed tomography showed a microadenoma of the left adrenal gland and a well demarcated left retroperitoneal para-aortic mass. Adrenal vein sampling for aldosterone and renin levels suggested left adrenal lesion. Surgical removal of the left adrenal gland and para-aortic mass was performed. Pathologic examination of the resected left adrenal gland showed adrenal cortical hyperplasia and the left retroperitoneal para-aortic mass showed a paraganglioma. Postoperatively, blood pressure, plasma renin, aldosterone and urine VMA all returned to within normal ranges. The possible relationship of these two diseases is discussed.

We present a case involving a 24-year-old woman who developed anterior spinal cord infarction with paraplegia but preserved posterior column sensation shortly after her first surfing lesson. The clinical presentation and magnetic resonance imaging findings were compatible with anterior cord infarction from T11 to conus medullaris. However, a thorough diagnostic workup revealed no predisposing factors of ischemia. Like previously reported cases of surfer's myelopathy, our patient was inexperienced and lacked trained back muscles, though none of the previously related cases were reported to have anterior cord infarction. In this case report, we discuss the probable relationship between surfing and ischemic myelopathy. Non-traumatic myelopathy in surfing is a relatively new entity thought to occur in surfers while paddling their boards in a hyperextended position and perform the Valsalva maneuver while attempting to stand up on the boards, which may increase intra-spinal pressure. Increased awareness of this injury may make it possible to recognize its early symptoms and prevent further injury., (Copyright © 2010 Elsevier B.V. All rights reserved.)