Giant bilateral adrenal myelolipoma with congenital adrenal hyperplasia.

Myelolipomas are rare and benign neoplasms, predominant of the adrenal glands, consisting of adipose and mature hematopoietic tissue, commonly discovered incidentally with increased use of radiologic imaging. Few cases of giant bilateral adrenal masses are reported, especially in the setting of congenital adrenal hyperplasia (CAH). We report the case of a 39-year-old male with a history of CAH secondary to 21-α hydroxylase deficiency on steroids since childhood, self-discontinued during adolescence, presenting with abdominal distension, fatigue, decreased libido, and easy bruising. Imaging revealed giant bilateral adrenal masses. He subsequently underwent bilateral adrenalectomy found to be myelolipomas measuring 30 × 25 × 20 cm on the left and weighing 4.1 kg and 25 × 20 × 13 cm on the right and weighing 2.7 kg. Adrenal myelolipomas are found to coexist with many other conditions such as Cushing's syndrome, Addison's disease, and CAH. We discuss the association with high adrenocorticotropic hormone (ACTH) states and review the studies involving ACTH as proponent leading to myelolipomas. Massive growth of these tumors, as in our case, can produce compression and hemorrhagic symptoms. We believe it is possible that self-discontinuation of steroids, in the setting of CAH, may have resulted in the growth of his adrenal masses.

A scarless technique of umbilical hernia repair in the adult population.

BACKGROUND: Umbilical hernias are common in adults during their 30s-60s. Most umbilical hernias result in increased intraabdominal pressure and prompt repair is advised. The technique described here involves dissection of the hernia sac from the subcutaneous tissue with a horizontal fascial closure in a tension-free procedure. METHODS: Records of 57 patients treated for umbilical hernia in a 7-year period were reviewed retrospectively. Data were collected regarding sex, age, follow up, and complications. RESULTS: All patients were treated successfully. Postoperatively, eight complications were noted (one wound infection, three seromas, and four cases of cellulitis). Follow up ranged from 1 week to 3 months. CONCLUSIONS: The technique described here is based on one used in the pediatric population. Our repair is applied to adults with hernias of less than 2 cm in diameter. At the final follow up no scar can be seen as it has been buried within the umbilicus.

Surgical repair of redundant intra-thoracic stomach after Ivor Lewis esophagectomy.

We present two patients with low esophagogastric anastomosis, redundant intrathoracic stomach, and markedly symptomatic reflux and regurgitation after Ivor Lewis esophagectomy. The diagnosis, technique of surgical revision, and outcome is discussed.

Morphologic and histologic abnormalities in female and male rats treated with anabolic steroids.

A two-part study was performed to determine the effects of high doses of anabolic steroids on weight, appetite, and organ histology. Initially, 30 white Wistar rats, 15 males and 15 females, were treated weekly with either 0.52 cc of physiologic saline or nandrolone decanoate. After 6 weeks, female treated and control rats had comparable weight gains, but male treated rats were significantly lighter than controls. Rats were sacrificed and organs dissected for histologic preparation. Treated male livers had less lipid than control males. The uteri of treated females displayed abnormal vacuolization, stromal edema, and peliosis. In Part II, 12 male rats, 6 treated and 6 control, were given the drug or saline in a manner identical to that in Part I. Treated rats had lower weights from Weeks 1 through 6 and ate less than controls. Upon sacrifice, treated rats' kidneys were heavier, and testes and liver were lighter compared to controls. Roentgenographic studies of tibias from Parts I and II showed no significant differences in tibial length or height of growth plate between treated and control groups. In summary, when anabolic steroid use is studied in the rat model, numerous pathological and anatomical changes occur.