A Documented Clinical Case of Pre-Cushing's Syndrome

A 64-year-old woman was referred to our unit for an incidentally discovered right adrenal mass. She had no clinical features of Cushing's syndrome. She had normal serum cortisol and ACTH, but the cortisol diurnal rhythm was absent, and plasma cortisol was not suppressed by loperamide test or by overnight low (1 mg) and high (8 mg) dose dexamethasone. 131I-Norcholesterol scintigraphy showed abnormal uptake of the radiotracer in the region of the right adrenal gland. After right adrenalectomy, adrenal insufficiency developed that required cortisol replacement for 10 months. At the end of this period, there was full recovery of the hypothalamic-pituitary adrenal axis, and scintigraphy revealed normal uptake of the previously suppressed left adrenal gland. We conclude that 'pre-Cushing's syndrome' is a real clinical entity, and preoperative diagnosis will alert the clinician to the possibility of unanticipated adrenal crisis if the mass is removed

The informed consent in aesthetic plastic surgery [il consenso informato in chirurgia plastica estetica]

Chemical and physical features of polybutester synthetic monofilament (Novafil®) nonabsorbable suture were evaluated by a comparative study vs polypropylene. A random study on fiftyfive patients who underwent plastic surgery was performed. Our evaluations concerned specific features of the suture such as elasticity, resistance, knot rundown, knot security, knot tying, suppleness and more general features such as tissue reactivity and traumaticity. Our experience with the polybutester suture in plastic surgery has been satisfactory, being especially useful for intradermal sutures