Primary aldosteronism due to bilateral micronodular hyperplasia and concomitant subclinical Cushing’s syndrome:A case report

BACKGROUND Adrenal incidentaloma(AI)has been frequently encountered in the clinical setting.It has been shown that primary aldosteronism(PA)or subclinical Cushing’s syndrome(SCS)are the representative causative diseases of AI.However,the coexistence of PA and SCS has been reportedly observed.Recently,we encountered a case of AI,in which PA and SCS coexisted,confirmed by histopathological examinations after a laparoscopic adrenalectomy.We believe that there were some clinical implications in the diagnosis of the present case.CASE SUMMARY A 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg.A subsequent computed tomography scan revealed right ureterolithiasis,which was the cause of right abdominal pain,and right AI measuring 22 mm×25 mm.After the disappearance of right abdominal pain,subsequent endocrinological examinations were performed.Aldosterone-related evaluations,including adrenal venous sampling,revealed the presence of bilateral PA.In addition,several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma.A laparoscopic right adrenalectomy was then performed.The histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma,while CYP11B2 immunoreactivity was absent in this adenoma.However,in the adjacent nonneoplastic adrenal,multiple CYP11B2-positive adrenocortical micronodules were detected,showing the presence of aldosterone-producing adrenocortical micronodules.CONCLUSION Careful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.

Huge urinoma caused by spontaneous ureteral rupture secondary to ureteral obstruction due to prostate cancer

Dear editor,Spontaneous ureteral rupture(SUR)due to prostate cancer is very rare.The most common cause is calculus.To the best of our knowledge,SUR secondary to ureteral obstruction caused by prostate cancer was first reported by Deng et al.[1],so this case may be the second report.We report a case of a huge urinoma caused by SUR secondary to prostate cancer that was difficult to treat.This case is significant because the long-term presence of urinomas has never been reported.

Experimental confirmation of physical metal penetration generation and press casting production considering molten metal's pressure control

This paper presents a technique for controlling the pressure of a molten metal when using a new type of iron casting method called sand mold press casting to realize high productivity and obtain high-quality products.The past test results using this method showed a casting yield of 90% to 95%,while conventional methods only show a casting yield of 60% to 70%.Although the press casting method does not require a sprue cup or runner channel casting defects such as metal penetration are often caused by the high pressure in the high-velocity pressing part of this casting process.Therefore,we proposed a pressure control method with a mathematical model of molten metal pressure,and with it we achieved experimental confirmation of the successful production of brake drums at different pressing temperatures.Results show that the proposed pressing control method can realize sound,penetration-free casting production.However,the theoretical analysis and design of this pressing process had not previously been studied sufficiently,and therefore this paper presents the theoretical design algorithm for the process as well as its experimental confirmation.