Adrenal myelolipomas (AMLs) are rare, benign neoplasms of the adrenal gland with varied clinical presentations. The rarity of these tumors precludes any case-controlled or randomized study into their management. The available literature is limited to case reports and short series from referral centers. This review is an effort to put the available literature into perspective such that clinical decision making can be done with some clarity. The PubMed and Cochrane databases were searched with key words Adrenal Myelolipoma, Adrenal Incidentaloma (AI) and Adrenal Collision Tumor (ACT). From over 1300 search results, 547 relevant publications dating from 1954 to 2014 were reviewed. Details of about 1231 AMLs in the indexed literature were analyzed. Increasing usage of imaging studies has significantly increased the discovery of AMLs. Although AMLs are benign tumors, those measuring larger than 6 cm are prone to rupture and hemorrhage. Thorough endocrine work-up may benefit a selected group of patients, especially those who are hypertensive, diabetic/pre-diabetic, young patients (<50 years) and those with bilateral AML. Regular observation is needed for AML patients who are being treated non-operatively, as many of them may require surgery during follow-up. Although the AACE/AAES guidelines for AI (2009) exclude AML from mandatory metabolic work-up for a newly discovered AI, we feel that a significant number of patients with AML would benefit from metabolic work-up. In the literature, endocrine dysfunction in AML is 7% as compared with 11% in AI. Endocrine dysfunction in AML is probably underdiagnosed.

No abstract

Background: Cystic Echinococcosis is a zoonosis with worldwide geographical distribution caused by dog tapeworm. Cystic echinococcosis most frequently involves only one organ by forming a solitary cyst. Hydatid disease commonly involves the liver (75%) and lungs (15%), followed by other regions of the body (10-15%). Multi-organ abdominal HD is the most serious form and is potentially fatal.Methods: It is a retrospective study for a duration of 3 years. The recorded data of all the patients undergoing treatment has been collected and analyzed.Results: A total of 30 patients were identified. Most common organ involved was liver followed by spleen, pancreas and kidney. Cysts are more commonly seen in right lobe. All the patients underwent surgical treatment. 17 patients underwent open surgery, while 13 patients were treated by laparoscopy. Cysto biliary communication was identified in 3 patients, all in laparoscopy and a primary closure was done. All the patients were started on albendazole 400 mg twice daily per oral at least 15 days prior to surgery and this treatment was continued for 3 months post-operatively.Conclusions: Hydatid disease is endemic in sheep farming and cattle farming areas of Asia. Most patients remain asymptomatic for years. Diagnosis is by imaging techniques. Echinococcal infection usually requires multimodality treatment and the best treatment is always individualized. Surgery along with anti-helminthic treatment holds the best curative measure at present.

Background: Liver hydatidosis is a common health problem in endemic areas. Cystobiliary communication is the most common complication of liver hydatid.Methods: Cases of liver hydatid operated during the period June 2012 to July 2018 were retrospectively assessed. Patients diagnosed with cystobiliary communication (preoperatively, intraoperatively or postoperatively) were analysed. Demographics, laboratory tests were noted. Computed tomographic (CT) findings including size, location, Gharbi’s type, presence of intrahepatic biliary radical dilatation, CHD and CBD dilatation were noted. Intraoperative findings were noted. Postoperative outcomes and any intervention if done were noted. Results were analysed.Results: Around 108 patients with liver hydatid underwent surgical intervention. Of which 20 (18.5%) patients were found to have cystobiliary communication. Mean cyst size was 8cms. Location of cyst in segment IV and V commonly. 8 patients were diagnosed preoperatively by elevated bilirubin and alkaline phosphatase and on contrast enhanced computerized tomography. Out of 8, 4 patients underwent preop ERCP and stenting, followed by surgery and the other 4 underwent direct surgery with CBD exploration. 4 were diagnosed intraoperatively and the fistula site sutured. But 2 patients had postop biliary fistula which required postop ERC and stenting. Remaining 8 presented postoperatively with biliary fistula. Of 8 patients, 2 had major and 6 had minor fistulas. Postoperative mortality was 0%.Conclusions: Cystobiliary communication is more common in males with large cyst size, located in the central segments of liver close to biliary confluence, Gharbi type IV cysts. Timely diagnosis and appropriate management decrease the morbidity and mortality.

No abstract