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.
Background: Surgical site infection (SSI) is a major problem associated with open abdominal surgery and is related to increased morbidity, mortality and healthcare costs. A subcutaneous negative pressure drain reduces dead space in subcutaneous tissue by preventing accumulation of fluid. The aim of present study was to establish the efficacy of a subcutaneous negative pressure for preventing SSI following exploratory laparotomy.Methods: A total of eligible 76 patients who underwent emergency abdominal surgical procedure, between October 2016 to March 2018, were randomized into subcutaneous drainage (DG) and no drainage group (NDG). Antibiotic prophylaxis was applied to each patient. The diagnosis of superficial SSI was made and was graded according to Southampton Grading System.Results: 5 patients in drain group (40) and 25 patients in no drain group (36) had incisional SSI with statistical difference (p<0.05). No statistical difference between groups was observed for age, sex, hospital stay (p>0.05).Conclusions: Subcutaneous negative pressure prevents post-operative surgical site infection significantly. Subcutaneous negative pressure drainage reduces hospital stay in a patient undergone emergency laparotomy, compared to patients in whom negative pressure drain was not placed.
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