[Schedule of national minimum fees].
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Biomedical subjects
Publications and source records attributed to F Rubino.
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Incidental radiologic diagnosis of clinically silent adrenal masses is reported with increasing rates. Between 1981 and 1994 we observed 30 patients with "incidentaloma": for each of them a careful hormonal and instrumental evaluation was obtained. 24 patients were surgically treated. No significant biochemical alterations were observed; ETG, TC and RMN had a sensitivity of 86%, 93% and 83%, respectively. At seleno-cholesterol scintigraphy 5 incidentalomas (all adenomas) had a concordant pattern and 5 (none of these adenoma) had a discordant pattern. MIBG scintigraphy showed an uptaking ganglioneuroma. The observed histotypes were: 10 adenomas, 3 cysts, 1 hematoma, 1 myelolipoma, 1 angiomyolipoma, 1 ganglioneuroma, 1 ganglioneurofibroma, 1 paraganglioma, 1 aspecific granulomatous necrosis, 4 cortical carcinoma and 3 metastatic lesions. We did not observe any postoperative acute adrenal failure. The main problem raised by incidentalomas is to define their nature; hence the need of a careful hormonometabolic, morpho-functional and instrumental evaluation. The available diagnostic procedures, even when combined, cannot always define if an incidentaloma is a benign or a malignant lesion: in the current clinical practice, the size of the mass is still the most important criterion to define a therapeutic approach. Surgical excision is mandatory in presence of an hormonal production, even subclinic, and/or a large size of the mass (over 5 cm). If the tumor size is less than 5 cm, an aggressive strategy may be chosen in selected low-risk patients, because of the low morbidity of adrenalectomy. In our experience, the transperitoneal subcostal approach has been adopted routinely with good results.
The authors, after an examination of the literature on the subject, present the results of a retrospective study in which the incidence of varicocele among selected young soldiers population called up at SARVAM (Viterbo) from May 1993 until October 1995 is evaluated.