Objective:To discuss the computed tomography (CT) and magnetic resonance (MR) imaging features of primary adrenal cortical carcinoma (PACC) and improve the imaging diagnostic level of primary adrenocortical carcinoma.Methods:The imaging features of 15 patients with biopsy or pathology confirmed PACC were retrospectively analiezed. There were 12 patients underwent CT examination, 7 patients underwent MR examination, and 4 patients underwent CT and MR exminations.Results:All of 15 PACCs were unilateral (10 on the right, 5 on the left). The maximum diameters of the lesions ranged from 4.4 to 15.1 (8.9±3.3)cm. The shape of the tumor was oval in 6 cases and irregular in 9 cases. CT findings: 1 cases showed homogeneous density and 11 cases were heterogeneous attenuation (including 2 cases with hemorrhage and 1 case with fat) on plain scan. The CT values of triple-phase of PACC ranged from 28.8 to 62.0(39.2±8.5)HU, 32.7 to 83.4(52.5±14.4)HU and 43.4 to 86.4(61.1±15.0)HU respectively. All cases showed mild (7 cases) and moderate (4 cases) gradual enhancement, only one case excluded. MRI findings: inhomogeneous mild and moderate enhancement were detected in 6 cases and homogeneneous enhancement was found in 1 case. The solid parts of PACC showed iso-signal intensity in T1WI, hyper-signal intensity in T2WI and diffusion limited in the diffusion weighted imaging (DWI). There were 14 cases of vascular shadow in 15 patients, and 3 cases of involvement and metastasis of surrounding tissues and organs.Conclusions:PACC often present as a big solitary heterogenous mass with necrotic area, hemorrhage and intratumoral vascular. The mild to moderate heterogenous gradual enhancement can be seen after the contrast.

Objective To investigate the analgesic effects of parecoxib sodium combined with patient controlled epidural analgesia (PCEA) after orthopedic subarachnoid block anesthesia surgery.Methods Two hundred patients undergone orthopedic subarachnoid block anesthesia surgery were randomly and equally divided into two groups:Group P (treated intravenously with 40 mg parecoxib sodium combined with PCEA at the end of operation) and Group C ( treated intravenously with 0.5 g tramadol combined with PCEA at the end of operation).The visual analog scale (VAS) was performed at 6,12,24,48 and 72 hours postoperatively in two groups.Meanwhile,the press frequency of analgesic pump,effective frequency,side effects and satisfaction degree were recorded. Results The VAS sore of Group P was lower than that of Group C at 6,12,24,48 and 72 hours postoperatively ( P ＜ 0.05 ).Group P showed a less number in aspects of the press frequency of analgesic pump,effective frequency,and side effects at 12 and 24 hours,but a higher satisfactory degree,compared with Group C (P ＜0.05). Conclusion Combined use of parecoxib sodium and PCEA can exert a better analgesic effect and have a low incidence rate of side effects following orthopedic subarachnoid block anesthesia.