Uso combinado de estimulación eléctrica funcional y entrenamiento mediante perturbaciones para el tratamiento del equilibrio en una persona con accidente cerebrovascular: un estudio de caso / Combined use of functional electrical stimulation and unexpected perturbations for balance training in a person with stroke: A case study

Antecedentes El accidente cerebrovascular (ACV) es una patología frecuente que conlleva diferentes secuelas, entre las que se encuentran la afectación de la movilidad del tobillo y las alteraciones del equilibrio. Existen diversas opciones terapéuticas para tratar estos déficits, entre ellas la estimulación eléctrica funcional (FES) y el entrenamiento de la marcha con perturbaciones. Objetivo Analizar los resultados de una intervención combinada de FES y entrenamiento de la marcha con perturbaciones, así como comprobar las repercusiones en la ejecución de actividades de la vida diaria y la participación de la persona. Metodología Se estudió el caso de un varón con hemiparesia izquierda a consecuencia de un ACV. El protocolo de rehabilitación constó de 20 sesiones de 50min (2sesiones/semana) donde se combinó el entrenamiento del equilibrio y la marcha con Balance Tutor™ y FES con Fesia Walk. Se evaluaron los resultados con las escalas: 10Meter Walk Test, Five Times Sit to Stand Test, Timed Up and Go, Balance Evaluation Systems Test (BESTest) y Activities-Specific Balance Confidence (ABC). Resultados Se observaron mejoras clínicas en las escalas valoradas, especialmente en el BESTest y el ABC. Conclusiones Se trata de una prueba de concepto satisfactoria de la combinación de dos técnicas, y es necesaria más investigación sobre ello en personas con ACV y otras patologías neurológicas (AU)

Introduction Stroke is a frequent disease that entails different sequelae, among which are the affectation of ankle motion and balance disorders. Various therapeutic can be used to treat these deficits, including functional electrical stimulation (FES) and disturbance gait training. Objective To analyse the results of a combined intervention of FES and gait training with disturbances, as well as to verify the repercussions on the execution of activities of daily living and the person's participation. Methods The case of a man with left hemiparesis because of a stroke was studied. The rehabilitation protocol consisted of 20 sessions of 50min (2sessions/week) where balance and gait training were combined with Balance Tutor™ and FES with Fesia Walk. The results were evaluated with the scales: 10Meter Walk Test, Five Times Sit to Stand Test, Timed Up and Go, Balance Evaluation Systems Test (BESTest) and Activities-Specific Balance Confidence (ABC). Results Clinical improvements were observed in the assessed scales, especially in the BESTest and the ABC. Conclusions This is a satisfactory proof of concept of the combination of two techniques, and more research is needed on it in people with stroke and other neurological diseases (AU)

Prevalencia de consumo de benzodiacepinas en un grupo de población militar / Prevalence of consumption of benzodiacepines in a group of military population

Antecedentes: Las benzodiacepinas constituyen un grupo de fármacos depresores del Sistema Nervioso Central, usados como ansiolíticos, hipnóticos, relajantes musculares y anticonvulsivantes. El consumo con alcohol o asociación con otras sustancias puede provocar interacciones toxicológicas importantes. Al igual que el consumo prolongado puede provocar alteraciones y generar de-pendencia y tolerancia a estas. Objetivo: Determinar la prevalencia del consumo de Benzodiacepinas y sus análogos en una muestra de población militar atendida en el Laboratorio de la Armada en San Fernando, durante los años 2013, 2014 y 2015. Material y métodos: Se realizó un estudio descriptivo transversal retrospectivo donde se investiga consumo de Benzodiacepinas entre el personal militar atendido en Laboratorio, durante los años 2013, 2014 y 2015. Las variables recogidas fueron el sexo y las benzodiacepinas o análogos consumidos siete días antes de acudir al Laboratorio. Para la identificación de las sustancias se utilizó un listado según la clasificación ATC (Anatomical Therapeutic Chemical Classification System) de la Organización Mundial de la Salud (OMS). Resultados: En 2013, habían utilizado una benzodiacepina o análogo 138 personas (en siete habían consumido dos tipos de benzo-diacepinas). En 2014 se observaron 130 (seis habían consumido dos tipos) y en 2015 se observó 169 (de los cuales trece consignaban dos y en una persona tres tipos benzodiacepinas). En 2013 la prevalencia total fue de 1,8%, siendo las mujeres un 3,4% y hombres un 1,6%. En 2014 la prevalencia total fue 1,9%, siendo las mujeres un 5,2% y los hombres 1,5%. En 2015 la prevalencia total fue de 2,4%, siendo las mujeres un 5,9% y los hombres 2,1%. Las benzodiacepinas más consumidas en 2013 se correspondían con Diazepam (39%),Tetrazepam (17%) y Alprazolam (16%). En 2014 fueron Diazepam (44%), Alprazolam (25%) y Bromazepam (9%). En 2015 fueron Diazepam (44%), Alprazolam (22%) y Bromazepam (13%). Conclusiones: Al igual que en las encuestas nacionales el consumo es superior en mujeres que en hombres. Se observa un aumento progresivo del consumo en ambos grupos a lo largo de los años analizados aunque la prevalencia en nuestro estudio fue menor (AU)

Backgound: Benzodiazepines constitute a depressant drugs group of Central Nervous System, used as anxiolytics, hypnotics, muscle relaxants and anticonvulsants. Consuming alcohol or associating them with other substances can cause significant toxicological interactions. As a prolonged use can cause disturbances and lead into dependence and tolerance to these. Objective: To determine benzodiazepines prevalence and its analogs in a sample of population served in the Navy Laboratory in San Fernando during the years 2013, 2014 and 2015. Material and methods: A descriptive transversal retrospective study. It was made, and was completed with the personal attended during the years 2013-2015. The variables were sex and Benzodiazepines or analogues consumed seven days before. We have used for the identification of substances listed at the ATC (Anatomical Therapeutic Chemical Classification System) classification of WHO. Results: In 2013, 138 had used benzodiazepines or analogue (In seven had consumed two benzodiazepines). In 2014 they had used benzodiazepines 130 (six had consumed two) and 2015 was observed in 169 (of which 13 had consumed two and one had consumed three benzodiazepines).In 2013 the prevalence was of 1,8%, with it was a 3,4% women and 1,6% men.In 2014 the global prevalence was of 1,9%, with it was a 5,2% women and 1,5% men.In 2015 the global prevalence was of 2,4%, with it was a 5,9% women and 2,1% men. Benzodiazepines most consumed in 2013 are Diazepam (39%), Tetrazepam (17%) and Alprazolam (16%). A 44% of Diazepam in 2014, a 25% of Alprazolam and a 9 % of Bromazepam. In 2015 of Diazepam were a 44%, a 22 % of Alprazolam and a 13% of Bromazepam. Conclusions: As in national surveys, consumption is higher in woman than in men. It is also observed a progressive increase in consumption in both groups over the analyzed years, although the prevalence in our study was lower (AU)

Estabilidad de metabolitos del cannabis y cocaína en orina conservada a -20 °C en laboratorio de Armada (San Fernando), durante un periodo de tiempo superior a 1 año / Stability of cannabis metabolites and cocaine in urine preserved at -20ºC in Armada (San Fernando) laboratory over a period of time of more than 1 year

Antecedentes: El consumo de drogas constituye un problema en el medio militar, siendo el cannabis y la cocaína, las drogas ilegales con una mayor prevalencia de consumo. Los laboratorios situados en establecimientos farmacéuticos son los encargados de la realización del análisis preliminar de cribado de muestras, como lo marca la Instrucción Técnica 1/2012 de IGESAN, siendo confirmados los resultados positivos de estos, en el Instituto de Toxicología de la Defensa. Las muestras cuyos resultados sean positivos a drogas de abuso se conservarán durante seis meses (excepto Orden Judicial o expediente disciplinario en curso) a -20 °C, por si se requiere repetir la determinación. Los metabolitos presentes en la orina pueden deteriorarse durante su almacenamiento y conservación, obteniendo resultados distintos si reanalizamos la muestra. Así, es importante para el laboratorio conocer la estabilidad de los metabolitos presentes en dichas muestras. Objetivo: Estudiar la estabilidad de los metabolitos del cannabis y cocaína en orina, después de haber sido conservadas a -20 °C durante más de un ano. Material y métodos: 91 muestras de orina que resultaron positivas (65 a metabolitos del cannabis, 25 a metabolitos de cocaína y 1 a cannabis y cocaína), utilizando el analizador Cobas Integra 400 plusR (método semicuantitativo-cualitativo que usa una técnica inmunológica, con puntos de corte de 50 ng/ml para cannabis y 300 ng/ml para cocaína). Fueron conservadas en tubos de plástico a -20 °C durante mas de un ano. Tras descongelar y agitar suavemente para homogeneizarlas, se reanalizaron con el mismo analizador. Resultados: De los 66 muestras positivas a metabolitos de cannabis se produjo una disminución media respecto a los valores iniciales de -22,89% (rango +43,15 a -73,36). De las 26 muestras positivas a metabolitos de cocaína se produjo una disminución media respecto a los valores iniciales de -4,02% (rango de +7,03 a -49,01). Conclusiones: Observamos que los metabolitos del cannabis presentes en las orinas congeladas durante mas de un ano, disminuyen en mayor medida que los de la cocaina. Resultaron porcentajes similares a los obtenidos por otros autores en el caso de cannabis, aunque no asi en caso de cocaína (AU)

Antecedents: drug consumption constitutes a problem in the military milieu, being cannabis and cocaine the illegal drugs with a highest prevalence of consumption. Laboratories situated in pharmaceutical establishments are responsible for carrying out the preliminary analysis of screening samples, as it is shown by the I.T. 1/2012 of IGESAN, which confirmed the positive results of these in the Toxicology Institute of Defense. Samples whose results are positive to abused drugs would be kept for six months at -20 oC, if required by repeating the test. Metabolites which are present in urine could be deteriorated during storage and conservation, getting different results when the sample is revised. For laboratories it is important to know the stability of the metabolites present in the samples. Objective: to investigate cannabis and cocaine metabolite stabilities in urine, after having been kept at -20 oC for more than a year. Material and methods: 91 urine samples turned out positive (65 to cannabis, 25 to cocaine and 1 to both), using the analyzer Cobas Integra 400 plusR (semiquantitative-qualitative method using an immunological technique, with cutoffs of 50 ng/ml for cannabis and 300 ng/ml for cocaine). They were stored in plastic tubes at -20 °C for more than a year. After defrosting and shaking them softly to homogenize, they were reanalyzed with the same analyzer. Results: for the 66 positive samples of cannabis metabolites the average decrease from initial values was of -22, 89% (range -73.36% to +43.15%).For the 26 positive samples of cocaine metabolites the average decrease from initial values was of -4.02% (range -49.01% to +7.03%). Conclusions: It was reported that cannabis metabolites present in frozen urine for more than a year decreased to a greater extent than those of cocaine. Cannabis percentages were similar to those obtained by other authors, whereas this was not the case of cocaine metabolites (AU)

Administración de metamizol, insuficiencia renal y constricción intrauterina del conducto arterioso. Una asociación poco conocida / Administration of metamizol, renal failure and intrauterine ductus arteriosus constriction. An uncommon association

El metamizol, o dipirona magnésica, es un antiinflamatorio no esteroideo (AINE) ampliamente utilizado en Europa como analgésico y antipirético. Como con la indometacina y el ibuprofeno, se han descrito casos de oligoamnios, insuficiencia renal y cierre intrauterino del conducto arterioso fetal después del uso de metamizol en el tercer trimestre de la gestación, aunque su asociación con estos efectos adversos es menos conocida que con otros AINE. En el presente artículo presentamos un caso de hidropesía fetal con oligoamnios y constricción intrauterinaductal, que cursó con insuficiencia renal e hipertensión pulmonar, en el hijo de una madre que había recibido metamizol en el contexto de una pielonefritis aguda. Asimismo, se discutirá la fisiopatología de esta entidad y se revisará la bibliografía científica existente sobre el tema(AU)

The metamizole or magnesium dipyrone is a nonsteroidal anti-inflammatory drugs (NSAIDs) widely used in Europe as an analgesic and antipyretic. As with indomethacin and ibuprofen cases of oligohydramnios, renal failure and intrauterine closure of ductus arteriosus after its use in the third trimester of pregnancy have been reported, although its association with these adverse effects is less well known than other NSAIDs. In this article we present a case of hydrops fetalis with oligohydramnios and intrauterine ductal constriction with pulmonary hypertension and renal failure in the child of a mother who had received metamizole in the context of an acute pyelonephritis. We also will discuss the pathophysiology of this entity and review the existing scientific literature on this topic(AU)

Tissue array analysis for the differentiation of gliosis from gliomas.

The aim of this study was to provide a methodology to make a clear distinction between malignant tumors and morphologically similar benign processes, by examining the expression of EGFR, VEGF, HIF1-α, survivin, Bcl-2 and p53 proteins. Four groups of patient samples were studied: group 1, low-grade astrocytomas (WHO grades I-II) (n=6); group 2, peripheral area of high-grade astrocytomas (WHO grades III-IV) (n=5); group 3, gliomatosis cerebri (n=11); and group 4, reactive gliosis (n=6). Tissue arrays (TAs) were designed to study apoptosis, angiogenesis and invasion-related proteins by immunohistochemistry (IHC). By means of non-parametric analysis (Mann-Whitney U test), EGFR staining was shown to be significantly lower in reactive gliosis than in the low- and high-grade astrocytomas (p=0.015 and p=0.030, respectively); Bcl-2 immunoreactivity was significantly higher in the gliomatosis cerebri samples than in the reactive processes (p=0.005); and finally, Bcl-2 presented significantly lower expression levels in reactive gliosis compared to the peripheral areas of high-grade astrocytomas (p=0.004). The results indicate that Bcl-2 and EGFR may be useful in conducting differential diagnosis between the above groups, while the expression of the remaining antibodies does not appear to aid in distinguishing between the samples analyzed. The use of TAs to identify the protein expression profiles of biological markers related to different pathways was verified, and its potential as a discriminatory technique for everyday pathology procedures was demonstrated.

Linfomas gástricos MALT en estadio precoz: erradicación de H.Pylori y evolución / Early-stage gastric MALT lymphomas: eradication of H.Pylori and out come

Antecedentes y objetivo: se ha visto que los linfomas gástricos de bajo grado de malignidad desarrollados en el tejido linfoide asociado a mucosas (MALT) y diagnosticados en un estadio precoz desaparecen tras la erradicación de Helicobacter pylori (HP) en un alto porcentaje, variable según distintos estudios. De hecho muchos autores consideran éste el tratamiento de elección en estos casos. El objetivo de este estudio es describir retrospectivamente la respuesta al tratamiento erradicador y su evolución en pacientes con estos linfomas desde la introducción de las exploraciones ecoendoscópicas en el Servicio de Enfermedades Digestivas del Hospital Juan Canalejo de La Coruña. Materiales y métodos: hemos realizado una revisión retrospectiva de los casos observados en nuestro centro, desde junio 1997 a diciembre 2001 de linfomas gástricos MALT de bajo grado en estadio EI1, diagnosticados por biopsia y estadificados con ecoendoscopia. El HP fue erradicado en estos pacientes con triple terapia. Se les realizó controles endoscópicos con biopsias a los dos, tres, seis meses y después anualmente. Resultados: en este periodo 14 pacientes fueron diagnosticados de linfoma gástrico del MALT en los que la exploración ecoendoscópica demostró afectación sólo hasta la submucosa (estadio EI1). La edad mediana fue 65 años y 57 por ciento fueron mujeres. La erradicación de HP se consiguió en todos los pacientes con uno o dos ciclos (en 2 pacientes) de tratamiento. Con este tratamiento se obtuvo una remisión completa del linfoma en 10 pacientes (71,4 por ciento),en una mediana de tiempo de 4,5 meses. El resto precisó quimioterapia por falta de respuesta, por recidiva o como terapéutica inicial (un caso); en todos ellos consiguiendo también una remisióncompleta. Se realizó seguimiento en 9 pacientes, una mediana de tiempo de 20 meses, tras el cual todos permanecen sin evidencia de enfermedad. Conclusiones: los linfomas B MALT de bajo grado en estadioprecoz (EI1) tienen una tasa de respuesta alta al tratamiento erradicador de HP. La estadificación por ecoendoscopia nos permite distinguir este grupo de pacientes que se beneficiarán de un tratamiento más conservador. Aún así es preciso un seguimiento pues queda por establecer si esta remisión se mantiene a largo plazo, así como estudiar los factores que se asocian a recidivas (AU)

Early-stage gastric MALT lymphomas: eradication of H. pylori and outcome.

BACKGROUNDS AND OBJECTIVE: Lymphomas of mucosa-associated lymphoid tissue are special because of their indolent course. Low-grade early-stage tumors resolve after Helicobacter pylori (HP) eradication in a high percentage of cases. The aim of this study was to evaluate this regression in our patients with EI1 stage-low-grade B gastric lymphomas after eradication therapy since the introduction of echoendoscopic examinations in the Gastroenterology Department of 'Juan Canalejo' Hospital. MATERIAL AND METHODS: A retrospective study of all cases of low-grade MALT gastric lymphomas in EI1 stage, diagnosed by histological and echoendoscopic examination, from June 1997 to December 2001. After eradication of HP with triple therapy, patients have been followed-up with endoscopic examinations at 2, 3 and 6 months, and yearly afterwards. RESULTS: There were 14 patients in this period with low-grade EI1 stage gastric MALT B cell lymphoma. The median age was 65 years, and 57% were females. HP was eradicated in all cases with first- or second-line (2 patients) antibiotic treatment. Complete remission was observed in 10 patients (71.4%) in a median time of 4.5 months. The other 4 patients needed chemotherapy because of non-remission or early relapse, and also as initial treatment. Complete remission was also obtained in these patients. Only 9 patients have been followed up in our unit for a median time of 20 months, period after which all remain free of disease. CONCLUSIONS: Low-grade early-stage MALT gastric B-cell lymphomas have a high rate of response to HP eradication therapy. Echoendoscopic staging helps in distinguishing the group of patients who will benefit from conservative treatment. These patients must be followed up as it remains unclear whether remission is maintained in the long term, and to know what factors could be associated with lymphoma relapse.

[The determination of monoclonality in B-cell lymphomas using the polymerase chain reaction technic on paraffin-embedded material]. / Determinación de monoclonalidad en linfomas B utilizando la técnica de reacción en cadena de la polimerasa semiacotada sobre material de parafina.

BACKGROUND: Clonal rearrangements of immunoglobulin are useful in the diagnosis of B-cell lymphomas. The value of the polymerase chain reaction (PCR) with consesuated primers in the variable (V) and joining (J) region is now well established. METHODS: Forty cases of B-cell lymphomas and 10 patients with reactive lymphoid proliferations have been studied. All cases were studied with two different semiacotated techniques, with similar primers in the J region (LJH and VLJH) and changing the primers of the V region (Fr2A and Fr3A). RESULTS: A 100% specificity and positive predictive value were obtained with both techniques. The sensitivity was 90% with Fr2A and 82% with Fr3A, but in 20% of the studies with Fr2A the extracted DNA was insufficient to perform the study while it could be done with Fr3A in all cases. The negative predictive value was 76% with Fr2A and 58% with Fr3A. CONCLUSIONS: Both techniques showed a good sensitivity, optimal specificity and positive predictive value, with low negative predictive value. Although the results are somewhat higher with Fr2A, this technique needs well preserved DNA and it can be an important set back when we deal with formaldehyde fixed, paraffin embedded tissues.

Effect of environmental factors on PCR-DNA analysis from dental pulp.

This study was designed to observe the results of DNA typing on teeth subjected to aging, different temperatures and various environmental factors. A total of 570 teeth were studied. The study included the analysis of the PCR-based polymorphisms HLA DQA1, D1S80, HUMTH01, HUMFES/FPS and the XY homologous gene amelogenin. In general the best results were obtained with the XY homologous gene amelogenin, followed by the two STRs studied (HUMTH01 and HUMFES/FPS). The small fragment sizes and the method of detection used after PCR amplification are the main factors explaining this fact. In general, teeth submerged in water gave the poorest results. Teeth exposed to outdoor conditions provided better results than teeth buried in sand or soil, but even in these cases good results were obtained. Up to 4 degree C, temperature had only a slight influence on the results. Positive results were obtained in most cases at high temperatures (400 degrees C for 2 min) which are rarely reached in practical casework. Positive typing results for the XY homologous gene amelogenin and the STRs were obtained from teeth 10-30 years old. The usefulness of dental pulp for identification purposes is exemplified in some actual cases.

[Bone metaplasia in colorectal carcinoma]. / Metaplasia ósea en carcinoma colorectal.

We report two cases of osseous metaplasia in the polypoid areas of colorectal carcinomas. This is an extremely rare condition with no more than 30 cases published, that has to be recognized to avoid misinterpretations on biopsies or surgical specimens. The pathogenesis is unknown and it does not change the biological behaviour of these tumors.

[Epidemiological approach to acute poisoning in Asturias]. / Aproximación epidemiológica a las intoxicaciones agudas en Asturias.

Two hundred and twenty cases of acute overdoses are revised using a specific protocol. We have found a larger number of cases of overdoses to exist in women (62.73%), at an average of 32 years of age, the typical deviation being that of 15.8. Intentional overdoses are predominant (80%), 55.1% using benzodiazepines. The abuse of one sole drug (67.3%) is greater in comparison to combining drugs sole drug (67.3%) is greater in comparison to combining drugs with alcohol (10.2%). The treatment most often used was stomach pumping (49.5%), being effective in 76.1% of the cases Hospitalizations total 16.8%, with 30% remaining in observation. A comparison of our study is made with available Spanish sources, demonstrating: a) The smaller number of acute overdoses. b) The increasing importance of the acute overdoses caused by benzodiazepines and derivatives of opium, thus the interest in the use of antidotes such as Naloxone and Flumazenil which improve the prognosis of these patients. In our series in particular, there is a 0% death rate.

Pancreatic mucinous cystadenocarcinoma with pseudosarcomatous mural nodules. A report of a case with immunohistochemical study.

A case of pancreatic mucinous cystadenocarcinoma (PMC) with two pseudosarcomatous mural nodules (PMN) is described. These nodules have not been previously described in this type of tumor. In ovarian mucinous tumors (OMT), similar nodules have been reported, the nature of which has been discussed in detail. Here the similarity between the tumor described here and ovarian tumors is stressed. The immunohistochemical study carried out disclosed in the nodules strong positive staining for vimentin and moderate positivity for keratin and epithelial membrane antigen. These findings, along with histologic details, favor the epithelial nature of the nodules. It was concluded that the nodules are foci of anaplastic carcinoma with high proliferative cell rate, which could explain the coexpression of vimentin and keratin.

[Significance of flumazenil in acute benzodiazepine poisoning]. / Importancia del flumacenil en la intoxicación benzodiacepínica aguda.

Thirty-five patients over 14 years of age were evaluated, with the common feature of benzodiazepine poisoning, either as a single drug or associated with others and/or with ethanol, and who had a Glasgow score lower than 10 at admission. These patients were treated with flumazenil as a competitive antagonist drug. The results were very satisfactory. Subsequently, the possible relationship between the effect of flumazenil and the pharmacokinetic benzodiazepine profile was evaluated, and a significant relationship between the half life and the degree of resedation of the patients was found.

[Carcinoma of the gallbladder. Presentation of the findings on a series of surgical samples and autopsy cases]. / Carcinoma de vesícula biliar. Presentación de los hallazgos de una serie de piezas quirúrgicas y casos de autopsia.

We present the clinical and pathologic features of gallbladder carcinomas in a review of surgical and autopsy cases from the Hospital "Juan Canalejo", La Coruña. Out of 713 cholecystectomies performed in the last 30 months we found 13 primary (frequency 1.8%) and 3 metastatic tumors. All primary tumors were carcinomas, most of them well differentiated. The age ranged from 60 to 91 years (median of 73.6) and the female to male ratio was 2.2 to 1. The clinical diagnosis of carcinoma previous to the laparotomy was established only in one case. Cholelithiasis was associated in 11 cases. The staging of the tumors varied considerably, but it was rather advanced. In the review of 1,617 adult autopsies done in the last 14 years, 11 cases had a primary gallbladder carcinoma (frequency 0.61%). The median age was 70.4 years with extremes from 56 to 84. Female to male ratio was 1.2:1 and carcinomatosis, usually from unknown primary, was the form of presentation. Only in two cases the gallbladder had been suspected as the primary site of the tumor. Cholelithiasis was present in 6 cases. Both groups are compared in their clinical and pathologic features.

[Bilateral adrenal gland metastasis of adenocarcinoma of the kidney]. / Metástasis suprarrenal bilateral por adenocarcinoma renal.

We report on a 52-year old male with simultaneous bilateral adrenal metastases from renal adenocarcinoma. The patient was submitted to radical nephrectomy, including the ipsilateral adrenal, and contralateral adrenalectomy, and received coadjuvant steroid replacement therapy. The patient died 11 months post-operatively. Similar cases previously reported in the literature are reviewed.