Adrenal Tumors in Young Adults: Case Reports and Literature Review.

The current high detection rate of adrenal tumors (4-10% of general population) is attributable to a widespread use of variety of imaging studies, especially a computed tomography. Most of them represent clinically silent and biologically indolent incidentalomas, but some adrenal tumors may pose a significant clinical challenge. Thus, in every patient with an adrenal tumor, a decision on further management is made after careful hormonal and radiological evaluation. All hormonally active tumors and those with radiological features suggesting malignancy are qualified for surgery. Approximately 80% of adrenal tumors are adrenocortical adenomas, hypertrophy, or nodular adrenocortical hyperplasia. Other histopathological diagnoses include pheochromocytoma, adrenocortical carcinoma, metastases, mesenchymal tumors, lymphomas, cysts, and ganglioneuromas. Adrenal tumors are more commonly diagnosed and better studied in elderly patients. In younger patients, under 40 years old, focal adrenal lesions are relatively rare, and histological distribution of diagnoses differs from that in elderly individuals. Younger patients are more likely to display endocrine symptoms, which raise the suspicion of an adrenal mass. In the current study, we present a case series of seven adrenal tumors occurring in young patients. The cases presented below, along with the literature review, demonstrate that the diagnosis and treatment of adrenal tumors are crucial due to endocrinopathy-derived complications and a potential risk of malignancy.

The Incidence of Radial Artery Occlusion in Critically Ill Patients after Cannulation with a Long Catheter.

Cardiac output monitoring is a common practice in critically ill patients. The PiCCO (pulse index continuous cardiac output) method requires artery cannulation. According to the manufacturer, the cannula in the radial artery should be removed after three days. However, longer monitoring is sometimes necessary. The aim of this study was to assess the incidence of radial artery occlusion (RAO) after three days of cannulation and to check whether five-day cannulation is related to a higher occlusion rate. An additional assessment was made to verify the presence of occlusion three, fourteen and thirty days after decannulation. The PiCCO cannula was inserted into the radial artery after the Barbeau test and Doppler assessment of blood flow. It was left for three or five days. Doppler was performed immediately after its removal and at three, fourteen and thirty days following decannulation. Thirty-seven patients were randomly assigned for three or five days of cannulation, and twenty-three of them were eligible for further analysis. RAO was found in thirteen (56.5%) patients. No statistical difference was found between the RAO rate for three and five day cannulations (p = 0.402). The incidence of RAO was lower when the right radial artery was cannulated (p = 0.022; OR 0.129). Radial artery cannulation with a PiCCO catheter poses a risk of RAO. However, the incidence of prolonged cannulation appeared to not increase the risk of artery occlusion. ClinicalTrials.gov ID NCT02695407.

MRI in the evaluation of the azoospermic male.

PURPOSE We aimed to show the usefulness of magnetic resonance imaging (MRI) in the evaluation of infertile men and its ability to distinguish obstructive from nonobstructive azoospermia. METHODS Between April 2015 and February 2018, 45 azoospermic men underwent scrotal MRI. We evaluated the images with an emphasis on signal characteristics of the testis and morphologic changes typical for obstruction. Testicular volume (TV), apparent diffusion coefficient (ADC) value, T1 and T2 signal ratios (testis/muscle) were measured for every testis. On the basis of histologic results, patients were divided into two groups: obstructive azoospermia (OA) and nonobstructive azoospermia (NOA). RESULTS Testes of patients in the OA group had significantly lower ADC values (mean 0.876±101 ×10-3 mm2/s) than in the NOA group (mean, 1.114±147 ×10-3 mm2/s). TV was significantly higher in patients with OA (median, 17.61 mL; range, 11.1-38.4 mL) than in those with NOA (median, 10.5 mL; range, 5.2-22.2 mL). ROC analysis showed that both TV and ADC values were highly predictive for distinguishing between OA and NOA patients, with an area under the ROC curve of 0.82 and 0.92 respectively. A cutoff value of ≥12.4 mL could distinguish obstructive from nonobstructive azoospermia with a sensitivity of 92% and specificity of 63%, whereas for ADC measurements a cutoff value of ≥0.952 ×10-3 mm2/s exhibited a sensitivity of 81% and specificity of 90% There was no statistically significant difference in T1 and T2 signal ratios between both groups. Abnormalities typical for obstruction of the male reproductive tract (e.g., dilatation of ejaculatory ducts, prostatic or seminal vesicle cysts) were found in 78% of patients (14/18) in the obstructive group. CONCLUSION Scrotal MRI is a very effective tool for the evaluation of azoospermic men and may provide important information facilitating interventional treatment of infertility.