Influence of adrenal subclinical hypercortisolism on hypertension in patients with adrenal incidentaloma.

OBJECTIVE: The purpose of our study was to clarify whether subtle cortisol-producing tumors, such as not only subclinical Cushing's syndrome (SubCS) but also subclinical hypercortisolism (SH), influence the prevalence of hypertension, since numerous basic research studies have noted that glucocorticoid excess influences blood pressure. METHODS: 80 patients with adrenocortical adenomas (39 women and 41 men; mean age 62.1 years) were enrolled. SubCS was diagnosed using a diagnostic criteria, and SH was diagnosed as the presence of a serum cortisol level greater than 50 nmol/L following 1-mg dexamethasone suppression test (DST). RESULTS: SubCS, SH, or non-functioning adrenocortical adenoma (NF) was diagnosed in 14, 13, or 53 patients, respectively. The prevalence of hypertension differed significantly among the diagnoses (SubCS, 78.6%; SH, 84.6%; NF, 39.6%; P=0.002), whereas no differences in other clinical characteristics such as age, sex, or waist girth were observed. The patients with SH had an 11.7-fold increased risk (95% confidence interval: 1.9-72.7, P=0.009) and those with SubCS had a 9.5-fold increased risk (95% confidence interval: 1.9-48.3, P=0.007) for hypertension compared to those with NF using a multivariate analysis. CONCLUSION: We demonstrated that subtle cortisol-producing tumors, such as SH as well as SubCS, were an independent risk factor for hypertension. The cut-off value of the 1-mg DST would be appropriate to predict the development of hypertension.

[Change of cardiovascular risk factors after eradication therapy of Helicobacter pylori].

We studied the effect of eradication of Helicobacter pylori (H.P.) on several cardiovascular risk factors in patients with peptic ulcer disease. 205 H.P.-positive patients with peptic ulcer disease were successfully eradicated. Body weight (BW), body mass index (BMI), total cholesterol (TC), triglycerides (TG). LDL-cholesterol (LDL), HDL-cholesterol, gamma-GTP, uric acid and plasma glucose of those were measured before eradication, one year after, and two years after eradication. As a control, same parameters were measured in 430 subjects without gastroenterological disease including both H.P.-positives and H.P.-negatives. Those eradicated patients showed a significant increase in BW, BMI, TC, LDL, TG and gamma-GTP over the first one year and two years after eradication. No significant difference of any parameters were observed between control groups both with and without H.P. No significant difference was observed over one year in both control groups. It is suggested that those cardiovascular risk factors should be regarded carefully to prevent the acceleration of life-style disease after H.P. eradication therapy.

Radial keratotomy to treat myopic refractive error after cataract surgery.

PURPOSE: To assess the predictability and effectiveness of radial keratotomy in patients with myopic refractive error and unacceptable anisometropia after cataract surgery. SETTING: A prospective multicenter study. METHODS: This study comprised 40 eyes of 40 Japanese patients who had had cataract surgery. Radial keratotomy was performed, and the 6 month postoperative data were analyzed. RESULTS: Mean patient age was 71.0 years +/- 7.4 (SD) (range 51 to 84 years) and mean preoperative anisometropia -3.41 +/- 1.69 D (range -1.25 to -7.75 D). The surgery decreased mean anisometropia to -1.01 +/- 0.94 D (P < .000001, Wilcoxon signed-rank test), a mean reduction of 2.22 +/- 1.23 D (range 0.75 to 5.88 D). Postoperative anisometropia ranged from 0.81 to -3.13 D. The surgical effects were overestimated by the nomograms developed for the correction of naturally occurring myopia in the eyes of white patients. Multiple regression analysis revealed that optical zone size and number of incisions were significantly correlated with the amount of myopic correction, and the regression equation (R2 = 0.77) was expressed as follows: Effects = (-1.45 x optical zone size) + (0.24 x incision number) + 7.60. A new nomogram was derived based on this equation. CONCLUSIONS: Radial keratotomy was a safe and efficient procedure to treat myopic refractive error in pseudophakic eyes. Separate nomograms are necessary for white and Asian populations.

Arcuate keratotomy to treat corneal astigmatism after cataract surgery: a prospective evaluation of predictability and effectiveness.

OBJECTIVE: Although several nomograms are available for the incisional keratotomy to correct naturally occurring astigmatism, astigmatic keratotomy in eyes after cataract surgery has not been well analyzed. The predictability and effectiveness of arcuate keratotomy in pseudophakic eyes were studied. DESIGN: A prospective, multicenter study. PARTICIPANTS: One hundred four eyes of 86 patients with residual corneal astigmatism of 1.5 diopters (D) or more after cataract surgery were examined. INTERVENTION: Arcuate keratotomy was performed in nine centers by nine surgeons. MAIN OUTCOME MEASURES: The amount of astigmatic correction was calculated using the vector analysis of preoperative and 6-month postoperative refractive cylinder results. RESULTS: Multiple regression analysis showed that optical zone size, number of incisions, and incision length had significant correlations with the amount of astigmatic correction. The regression equation was expressed as effects = (-0.643 x optical zone size) + (0.998 x incision number) + (0.057 x incision length) + 2.356. The parameter of predictability (r2: 35%) was lower than that reported for congenital astigmatism (48 to approximately 56%). A new nomogram was derived based on the multiple regression equation. CONCLUSIONS: Astigmatic keratotomy in pseudophakic eyes is less predictable than that in eyes with idiopathic astigmatism, but the procedure is sufficiently effective in reducing the residual astigmatism after cataract surgery. Individual nomograms are necessary for astigmatic keratotomy in eyes with naturally occurring and postsurgical astigmatism.

Using Healon to identify the lumen of the sac in dacryocystorhinostomy.

Sodium hyaluronate (Healon) injected into the lacrimal sac, facilitates a full-thickness cut of the lacrimal sac in cases in which it is difficult to identify the lumen of the sac. The sodium hyaluronate does not stain tissues, is effective for hemostasis, and is easily irrigated. A full-thickness cut of the lacrimal sac is required to ensure exact mucosal suturing in dacryocystorhinostomy. However, in cases involving a hypertrophic sac wall, a small lumen of the sac, or earlier perforation of the sac, it is sometimes difficult to identify the lumen during surgery. We describe how sodium hyaluronate, injected into the sac via a canaliculus, can facilitate identifying the lumen in this situation.

Cortico-cortical projections from the prefrontal cortex to the superior temporal sulcal area (STs) in the monkey studied by means of HRP method.

Cortico-cortical connections from the prefrontal cortex to the superior temporal sulcal cortex (STs area) were studied in the monkey by means of retrograde axonal transport of horseradish peroxidase (HRP). After injections of 0.15-0.6 microliter of 50% HRP into the STs area, labeled cells were found in various cortical regions. In the prefrontal-STs projections, main features of topographic correlation were revealed; the posterior part of the STs area receives fibers from the superior frontal convexity (areas dorsal to the principal sulcus) and areas 8 and 6, whereas the anterior part of the STs area receives fibers from the inferior frontal convexity (areas ventral to the principal sulcus) and the frontal pole (area FD). The principal sulcus sends fibers to the entire STs area except for its ventral wall of the posterior part. A small cortical area adjacent to the inferior ramus of the arcuate sulcus (area 45 of ref. 41) sends fibers to the entire STs area. In addition, the orbitofrontal cortex projects mainly to the rostral part of the STs area, and the parahippocampal gyrus (areas TF and TH) projects to the deeper part of the entire STs area.

Corticocortical projections to the monkey temporal lobe with particular reference to the visual processing pathways.

Cortico-cortical connections occurring within the temporal lobe and afferent projections to the temporal cortex particularly from the prefrontal and parahippocampal areas were studied in the monkey by means of retrograde axonal transport of horseradish peroxidase (HRP) or wheat-germ-agglutinin-conjugated HRP (WGA-HRP). In particular, 0.1-0.3 microliter of 50% HRP or 5% WGA-HRP was injected into various parts of the temporal cortex, i.e. the rostral (TEr), the caudal (TEc), and the most caudal (TEO) parts of the inferotemporal cortex, the superior temporal gyrus, and the temporal pole (TG), and in the upper bank of the inferior arcuate sulcus in the frontal lobe. Labeled cells, which represent cells of origin of association fibers projecting to the injection site, appeared in various cortical regions. The main findings of the present study are the following. The temporal pole (TG) receives fibers almost exclusively from the most rostral part of the TE. The rostral part of the TE receives many fibers from both the caudal part of the TE and the TEO. The caudal part of the TE receives fibers from the TEO, and the TEO from the prestriate cortex (OA and OB). Taking these findings together, the morphological basis of the "step-wise" progression of visual impulses from the prestriate cortex to the TEO, TE and finally to the TG is clearly presented. The superior temporal gyrus (TA or area 22) receives most fibers from the dorsolateral frontal gyrus, while the inferotemporal cortex (TE or areas 21 and 20) receives most fibers from the ventrolateral frontal gyrus (inferior frontal convexity). Both the temporal pole (TG) and the inferotemporal cortex (TE) receives a fair number of fibers from the parahippocampal region (TH and TF).

Projections of extraocular muscle primary afferent neurons to the trigeminal sensory complex in the cat as studied with the transganglionic transport of horseradish peroxidase.

The central projections of extraocular muscle primary afferent neurons were examined in the cat by means of transganglionic axonal transport of wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP). Injections of the extraocular muscle with WGA-HRP resulted in transganglionic terminal labeling within the ipsilateral trigeminal sensory complex. Although the density of trigeminal projections varied among cases, labeled axons and terminals were heavily and consistently found within the rostroventral portion of the pars oralis of the spinal trigeminal nucleus. The caudal part of the trigeminal principal sensory nucleus occasionally contained moderate labeling but very few deposits of HRP reaction product were noted in the pars interporalis and pars caudalis of the spinal trigeminal nucleus.