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BACKGROUND: The incidental discovery of an adrenal mass poses the problem of distinguishing between the frequent benign masses and the infrequent malignant ones that require surgery. Univocal guidelines to approach this problem are unavailable. OBJECTIVE: To perform a survey of the clinical management of incidentally discovered adrenal masses (ie, adrenal incidentalomas). DESIGN: A multicentric retrospective analysis of hospital medical records of adrenal incidentalomas diagnosed during a 5-year period; the medical records were scrutinized for demographic data and clinical details by means of a specifically tailored questionnaire. SETTING: The major surgical and medical centers of Piedmont, a northern Italian region with approximately 4 million inhabitants. The recruitment pattern of these centers was unselected. PATIENTS: The definition of adrenal incidentaloma was limited to patients with a physical examination and a clinical history unindicative of adrenal disease. Exclusion criteria also included hypertension of suspected endocrine origin and a history of neoplasms known to metastasize frequently in the adrenal glands. Two hundred twenty-four medical records were collected, and 210 were analyzed (14 excluded a posteriori). RESULTS: Most patients were in their 50s and 60s, and women were predominantly affected. The frequency of adrenocortical cancer was 13% among patients operated on. The tumor diameter was highly correlated with the risk of cancer; a cutoff at 5 cm had a sensitivity of 93% with a specificity of 64% in discriminating between benign and malignant cortical lesions. CONCLUSIONS: The occurrence of adrenocortical carcinoma among adrenal incidentalomas is not rare. The evaluation of the mass size is a simple and effective method for selecting patients at risk for cancer. The indication for surgery of masses larger than 5 cm, or of masses of any diameter that have suspicious imaging characteristics, limits unnecessary operations and costs. 相似文献
3.
E. Smith 《Journal of Materials Science》1993,28(4):880-884
The criterion for crack growth instability in an elastic-softening material that is subjected to displacement control loading conditions is examined. A theoretical analysis of the model of a solid containing two symmetrically situated deep cracks and with tensile loading of the remaining ligament, defines the criterion for crack growth instability. The criterion is expressed in terms of the material's softening characteristics and the solid's geometrical parameters. The analysis covers the complete spectrum of material behaviour from the case where the softening zone is very small to the case where instability does not occur until the softening zone traverses the ligament between the crack tips. 相似文献
4.
Intense irradiation (25–40 A/cm2) at intermediate energy (400 keV) has been found to cause “metallisation” of tungsten oxide and titanium niobate crystal surfaces. The possible mechanisms and the likely consequences for high-resolution imaging of clean oxide surfaces are briefly discussed. 相似文献
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Hydroelectric generators of less than 20 kilowatts can be in remote areas served only by a single-phase line. For high efficiency and low cost, a three-phase induction generator should be used. This three-phase generator can operate with balanced voltages and currents when the ``phase-splitting' circuit uses two capacitors connetted to two different single-phase voltage sources. 相似文献
7.
An improved accelerated cable life test is described. Through the use of programmable logic controllers (PLCs), very precise and consistent control of the accelerated aging process has been achieved. A computer has been utilized to make continuous real-time acquisition and storage of key operating parameters possible. This precise control and monitoring methodology has permitted the study of the synergistic effects of voltage and temperature on the accelerated aging of full-sized cables in the laboratory 相似文献
8.
Koichi Itagaki Md. Mortuza Ali Hiroshi Kitamura Takeo Maruyama 《Electrical Engineering in Japan》1992,112(2):1-10
Several sealed-off triggered vacuum gaps are connected in series to improve hold-off voltage. The characteristics of impulse breakdown voltage of these series-connected gaps are investigated experimentally. The sum hold-off voltage of series-connected gaps decreases to a unit hold-off voltage when the maximum value of voltage division ratio across the gaps increases to unity. Self-breakdown probability of the series-connected gaps is always higher than that of a single gap under the same conditions. Hence, stage efficiency of the multistage gap decreases with increasing number of stages. Its value is 90 percent with 2-stage gap and 75 percent with 5-stage gap, respectively, under the same voltage division ratio and the same gap length (2.0 mm) in each stage. Triggered breakdown voltage of 2- or 3- stage gap is several hundred volts when all gaps are triggered simultaneously at the peak of the main impulse wave and a working voltage range is nearly 100 percent in this case. The working voltage range decreases with number of stages. Its value is 45 percent with 3-stage gap and 15 percent with 5-stage gap, respectively, when one triggered gap is fired for switching. 相似文献
9.
V. Elliott Smith John M. Spurr John C. Filkins Jody J. Jones 《Journal of Great Lakes research》1985,11(3):231-246
Organochlorine analysis was performed on carcasses of 13 diving ducks from a 1981 wintering population that foraged on contaminated sediments in the lower Detroit River. Mean total PCB concentrations were 10 mg/kg for seven lesser scaups (Aythya affinis), 11 mg/kg for three greater scaups (A. marila), and 7.6 mg/kg for three goldeneyes (Bucephala clangula). Highest mean levels of other residues were measured for hexachlorobenzene (1.7 mg/kg) in goldeneyes, and transnonachlor (0.33 mg/kg) and 4,4’-DDE (1.3 mg/kg) in greater scaup. Quantitative analysis of 72 PCB congeners also was applied to water, seston, sediment, benthie oligochaetes, and carp from the same site. Principal congeners in most of the samples included some of the more toxic and persistent PCBs. Results of a multivariate analysis indicated that ratios of more conservative to less conservative PCBs did not vary significantly among ducks (α = .05), but differed from those in carp, oligochaetes, and sediment. For the February through March period of fat mobilization, concentrations of total PCB in lipid were inversely correlated with percent lipid (r = 0.76) in ducks. The percentage of conservative PCBs increased slightly. The distribution and partitioning of organochlorines, including toxic PCB congeners, varied considerably within this water column-sediment-fauna ecosystem. Estimates of toxic exposure based on total PCB values may be unreliable. 相似文献
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