Treatment of the Perinatally Diagnosed Asymptomatic Adrenal Gland Mass

Recently, the incidence of perinatally detected asymptomatic adrenal gland masses has increased because of widespread use of radiological diagnostic tools. However, optimal treatment of these masses has not been determined. The aim of this study is to elucidate the treatment guideline of perinatally diagnosed adrenal gland masses. The authors retrospectively reviewed the medical records of the 11 patients with asymptomatic adrenal gland mass, detected perinatally, between 1999 and 2004. Six cases were detected by prenatal ultrasound and 5 cases were incidentally detected by postnatal ultrasound. Six patients (surgery group) underwent mass excision. The pathologic diagnoses were neuroblastoma (n=4), adrenocortical adenoma (n=1) and adrenal pseudocyst (n=1). The indications for operation were suspicion of neuroblastoma (n=5) or absence of size decrease during observation (n=1). Three of the 5 suspicious cases of neuroblastoma and one case under observation were proven to be neuroblastoma. There was no surgical complication in the urgery group. All neuroblastoma patients have been well during the follow up period (24.4+/-14.4 month) without evidence of recurrence. Five cases (observation group) were closely observed because of the benign possibility or size decrease in follow up ultrasound. During the observation period (39+/-21 week), 4 cases showed complete spontaneous resolution and 1 case showed markedly decreased size of the mass but could not be followed up completely. Surgical resection of the perinatally diagnosed asymptomatic adrenal gland mass is a safe treatment method especially in case of suspicion of neuroblastoma, but closed observation can be applied.

Un problema de diagnóstico perinatal: pacientes serológicamente negativos pero infectados por el VIH / A perinatal diagnostic problem: HIV infected patients who are serologically negative

A 142 pacientes se les realizó ELISA, Inmuno blot de IgG, Inmuno blot de IgA (en los menores de 24 meses), determinación de antígeno en plasma, aislamiento viral por cultivo de detección de genoma viral por amplificación con la reacción de polimerasa en cadena (PCR). El diagnóstico integral demostró que 10 por ciento (14 pacientes) que resultaron negativos o indeterminados para detección de anticuerpos IgG anti-VIH-1, estaban infectados por el virus. Once de estos pacientes tienen entre 2 y 24 meses de edad; dos, entre 4 y 6.5 años, y uno, 30 años. El diagnóstico se emitió en cuatro de los casos por presencia de antígeno en plasma; en cinco por amplificación por PCR de ADN proviral presente en células mononucleares periféricas; en cuatro casos por PCR positivo e inmunofluorescencia (IF) del cultivo, y el último caso, presentó Inmuno blot positivo e IF del cultivo. Dichos casos presentan el problema de resultados falsos negativos por serología de anticuerpos anti-VIH, especialmente en niños menores de 24 meses

Comprehensive HIV diagnosis of 142 patients was done by ELISA, IgG immunoblot, IgA immunoblot (in patients under 24 months), plasma antigen determination, viral isolation by culture and genome detection by polymerasa chain reaction (PCR) amplification. Results showed that 14 patients (10%) with negative or indefinite results for anti-HIV-1 IgG antibody were in fact infected by the virus. Eleven of these patients were between 2 and 24 months of age, two between 4 and 6.5 years and one was 30 years old. Diagnosis was obtained by antigen positivity in four of them; by PCR amplification of peripheral mononuclear cells of proviral DNA in five of them; by PCR and immunofluorescence (II) of cultured cells in four cases, and the last diagnosis was made by IgG immunoblot and IF of the viral culture. These cases pose a problem because of false negative HIV serology, particularly in patients under 24 months of age.