Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma.

In primary hyperaldosteronism, discriminating bilateral adrenal hyperplasia (BAH) from an aldosterone-producing adenoma (APA) is important because adrenalectomy, which is usually curative in APA, is seldom effective in BAH. We analyzed the results from our most recent 7-yr series to evaluate the predictive value of preoperative noninvasive tests compared with adrenal vein sampling (AVS). Forty-eight patients with hypertensive hyperaldosteronism underwent bedside testing, computed tomography (CT) imaging, and AVS. Those in whom the results of AVS indicated APA underwent adrenalectomy. Twelve (30%) and 14 (34%) of 41 patients with APA had paradoxical falls with ambulation in plasma aldosterone concentration (PAC) and 18-hydroxycorticosterone (18-OH-B), respectively. Twenty-nine (70%) and 26 (65%) APA patients had a rise in PAC and 18-OH-B, respectively, as did all 8 BAH patients. Significant identifiers of BAH were supine PAC values less than 15 ng/dL (P: = 0.04), an increase greater than 60% (P: = 0.02) in PAC with ambulation, and supine 18-OH-B values less than 60 ng/dL (P: = 0.04). CT imaging alone was not predictive for BAH or APA. In our population, patients with a positive bedside test result (e.g. a fall in PAC and/or 18-OH-B) and a unilateral adrenal nodule on CT (10 of 41 patients) could have proceeded directly to adrenalectomy for APA. However, a positive bedside test result with a negative CT or a negative bedside test result regardless of CT findings required AVS to confirm the diagnosis and site of disease.

Purtscher's retinopathy secondary to pancreatitis. Aspects of the topography of retinal abnormalities.

A 22-year-old man with acute pancreatitis developed sudden bilateral blindness with funduscopic features of Purtscher's retinopathy. The topography of retinal abnormalities has been ascribed to the properties of the retinal capillary network. However, the similarity between the distribution of the retinal abnormalities and the density of the nerve fiber layer suggests that the observed topography may, in fact, result from the anatomical characteristics of the nerve fiber layer.

[Effect of alpha 1-protease inhibitor (alpha 1-antitrypsin) on the intensity of phytohemagglutinin stimulated lymphocyte transformation]. / Vliianie al'fa l-proteaznogo ingibitora (al'fa 1-antiripsina) na intensivnost' transformatsii limfotsitov, stimulirovannykh fitogemaggliutininom.

alpha 1-Antitrypsin (alpha 1-AT) decreases the intensity of human peripheral blood lymphocyte transformation stimulated by phytohemagglutinin. The degree of inhibition is influenced by the antiprotease activity of alpha 1-AT. It is shown that maximal inhibition of transplantation is 50%. Participation of alpha 1-AT in the control of biological activity of lymphoid tissue cells is suggested.

[Property of a heat- and acid-stable inhibitor of serine proteinases from the blood serum to inhibit lymphcyte transformation stimulated by mitogens]. / Svoistvo termo- i kislotostabil'nogo ingibitora serinovykh proteinaz iz syvorotki krovi tormozit' transormatsiiu limfotsitov, stimulirovannykh mitogenami.

Thermo- and acid-stable serine proteases inhibitor from the rabbit blood serum (TASPI) was shown to inhibit the human peripheral blood lymphocytes transformation stimulated by phytohemagglutinin (PHA) or concanavalin A. The extent of inhibition depended on the concentration of the preparation and its specific activity. The maximal inhibition of lymphocytes proliferation constituted 50 to 70%. TASPI displayed no cytotoxic activity. Considerably more effective inhibition was demonstrated by TASPI addition to the culture medium 24 hours after the addition of PHA. The antiprotease activity of crude human serum and that inactivated under different conditions is described. The results obtained suggest the participation of TASPI in the control of biological activity of the lymphoid tissue cells.