Adrenal myelolipomas are uncommon benign tumors, composed of mature adipose tissue and haematopoietic elements in varying proportions. They are usually asymptomatic, non-functioning adrenal incidentalomas, but there have been a few reports of myelolipomatous masses associated with adrenocortical hypersecretion. We report two cases of large mixed adrenal tumors, with heterogeneous appearance and areas of fat density in imaging techniques, and with autonomous cortisol production leading to Cushing's syndrome. Both underwent adrenalectomy and the histological study showed an adrenocortical adenoma with widespread myelolipomatous metaplasia. Hypercortisolism resolved in the one patient that could be evaluated after surgery. We review all the previous reported cases of hypercortisolism associated with adrenal myelolipomas. We also discuss the recommended diagnostic approach and therapeutic management of adrenal masses of lipomatous appearance.
La trombosis venosa profunda (TVP) de los miembros inferiores es una grave enfermedad con una incidencia aproximada de un caso/1.000 habitantes/año (1-3). Su curso clínico puede complicarse por la aparición de tasas significativas de embolias pulmonares (EP), hemorragias, TVP recurrentes y el desarrollo de graves secuelas postrombóticas (4,5). Resulta, por tanto, sorprendente que la mayor parte de los numerosos estudios realiza-dos en los últimos quince años, se hayan centrado sobre sus complicaciones a corto plazo, mientras sus consecuencias tardías, pero no menos graves, como el síndrome postrombótico (SPT), hayan recibido tan poca atención en la literatura (6). Pero todavía es más sorprendente, si cabe, que, actualmente, su único factor de riesgo identificado sea la TVP recurrente ipsilateral (4). Su resultado lógico ha sido que, hasta el presente, el médico no pueda proporcionar a los pacientes con TVP una información individualizada sobre el pronóstico de su enfermedad (6).45 [0212-7199 (2003) 20: 9; pp 483-492] ANALES DE MEDICINA INTERNA
The diagnosis of the deep vein thrombosis (DVT) based exclusively on its symptomatology and on the examination clinic is of few usefulness due to its small sensibility and especificity. However, its adequate combination with the presence of risk factors for the thrombosis, and the existence or not of an alternative diagnosis, it can be employed it to classify to the patients according to the forecast model clinic of DVT of Wells in two categories: high or probability decrease of suffering it. Their utilization in urgencies together with the determination of the D dimer (DD) will indicate us the need or not of accomplishing an echo -- Doppler, currently the complementary election test. The phlebography is maintained as "the gold test", though is reservation for certain cases. Unless exceptions, the heparins of under molecular weight have displaced the heparins not fractioned in the treatment of the disease, due to the series of inconvenients that present: complications hemorrhagics, thrombocytopenia, need of hospitalization and of biological control. It is possible, that in a future most or less next new antithrombotics, as the fondaparinux or the ximelagatran change substantially the treatment of the DVT. The indication of the thrombolysis is little accepted, due to the fact that the relationship risk -- benefit is not satisfactory. Though they are not exempt of complications, exist clean-looking situations in those which is indicated the placement of a filter in the inferior vein cava. An exception, they would be the thrombosis massive veins with gangrene risk phlegmasia cerulea dolens, in patient with under risk hemorrhagic. Finally, in the cases that developed ischemia venous, that generally appear in the occlusions most proximals -- iliac and inferior vein cava --, an effective option to re-establish the venous permeability would be the thrombectomy venous.
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