A rare case of virilizing adult ectopic adrenal tumor.

Ectopic adrenal gland is an atypical medical condition with a prevalence of less than 1%. It occurs due to an abnormal gland development during embryonic life and can be found in different parts of the body. Rarely, these ectopic glands can be hormonally active and present as bulky masses. Herein we report a case of a patient who underwent laparoscopic surgery for a large myelolipoma associated with an androgen producing adenoma in an ectopic adrenal gland.

Mirizzi Syndrome Type IV: a challenging diagnosis

Mirizzi Syndrome type IV is an extremely rare condition, which is confused with the diagnosis of cholangiocarcinoma in many cases. This report describes a case of a forty-three-year old patient, who was forwarded to our department of general surgery with a high suspicion of a choledochal neoplasic lesion. During the hospitalization he was diagnosed with Mirizzi Syndrome type IV. We concisely describe the case and the literature review about this pathology

Vascularização temporária de membros isquêmicos por meio de shunt arteriomedular: trabalho experimental / Temporary vascularization on ischemic limbs through arterial-medullar shunt: an experimental work

CONTEXTO: Os autores idealizaram um shunt temporário entre a artéria femoral e o canal medular de ossos longos para manter a viabilidade dos membros agudamente isquêmicos, enquanto não é possível estabelecer um tratamento definitivo. OBJETIVO: Avaliar a perviedade de shunts temporários arteriomedulares e a perfusão dos membros, durante duas horas em cães de experimentação, que tiveram a artéria femoral ligada. MÉTODOS: Alocaram-se aleatoriamente dois grupos, com três cães no Grupo Controle e seis no Grupo Intervenção. Os controles tiveram a artéria femoral comum direita ligada. O Grupo Intervenção, além da ligadura da artéria, recebeu um shunt. Após duas horas, realizou-se a medida de pH dos membros isquêmicos; avaliação do fluxo arterial por meio de um sonar Doppler; avaliação da coloração do sangramento na extremidade distal do membro e foram retirados em bloco torácico os pulmões para análise anatomopatológica. RESULTADOS: A média do pH do sangue capilar das extremidades do membros no Grupo Controle foi de 6,97 (±0,39); no Grupo Intervenção o pH foi de 7,25 (±0,46), com p<0,001; a coloração do sangue no Grupo Intervenção manteve-se com aspecto rutilante em todos os animais. Os shunts necessitaram, em média, três irrigações com solução salina heparinada para manterem-se pérvios. A avaliação macroscópica e microscópica do tecido pulmonar não evidenciou embolia gordurosa. CONCLUSÃO: O shunt arterio-osteal ou arteriomedular apresentou viabilidade técnica em laboratório.

BACKGROUND: The authors idealized a temporary shunt between the femoral artery and the medullar canal on long bones to keep the viability of acutely ischemic limbs, while waiting for a definitive treatment. OBJECTIVE: To assess the flow on temporary shunts between the femoral artery and the marrow canal of the tibia during two hours in experimental dogs, which had the femoral artery interrupted. METHODS: Two groups with three dogs on the Control Group and six on the Intervention Group were allocated at random. The controls had the right femoral common artery interrupted. The Intervention Group received a shunt between the iliac external artery and the medullar canal of the right tibia in addition. After two hours, the measure of the pH, blood coloration, blood flow in sonar Doppler on the ischemic limbs were performed. The lungs were withdrawn in thoracic block for anatomic-pathologic analyses. RESULTS: The capillary blood pH average of the limb extremities in the Control Group was 6.97 (±0.39) and in the Intervention Group was 7.25 (±0.46), with p<0.001, and the blood coloration in the Intervention Group kept the bright aspect in all animals. The shunts needed in average three irrigations with saline heparin solution to be kept unobstructed. The macroscopic and microscopic evaluation of the pulmonary tissue did not evidence fat emboli. CONCLUSION: The artery osseous or artery medullar (marrow) shunt showed to be feasible on the technical point of view in the laboratory.