Relationship between autonomic neuropathy and hypertension--are we underestimating the problem?

BACKGROUND: Cardiac autonomic neuropathy (CAN) is associated with significant morbidity and mortality in diabetes and the risk is even greater in those with hypertension. AIMS: The aim of our study was to investigate the relationship between CAN and 24-h blood pressure profile in normoalbuminuric patients with Type 2 diabetes mellitus. METHODS: Seventy patients with Type 2 diabetes (31 without CAN, 39 with CAN), who had no history of hypertension, and 29 healthy volunteers underwent five standard cardiovascular reflex tests to assess autonomic function and 24-h ambulatory blood pressure monitoring. RESULTS: Twenty-four-hour mean systolic blood pressure, blood pressure load and hyperbaric impact values were significantly higher in diabetic patients with CAN compared with control subjects and diabetic patients without CAN (P < 0.05). In spite of normal clinic blood pressures, 54% of diabetic subjects with CAN and 29% without CAN were hypertensive (systolic blood pressure load > 20%, P < 0.05). In the diabetes group as a whole, Valsalva ratio, postural systolic blood pressure changes and diastolic blood pressure responses during sustained handgrip correlated significantly and negatively with 24-h mean systolic blood pressure (P < 0.01, P < 0.001, P < 0.05) and blood pressure load (P < 0.05, P < 0.001, P < 0.05). CONCLUSIONS: Cardiovascular autonomic neuropathy is independently associated with hypertension in normoalbuminuric Type 2 diabetic patients with no history of hypertension. Relying on clinic blood pressures in subjects with CAN could lead to a failure to diagnose hypertension in over half of cases. All normotensive patients with CAN should be screened for hypertension using ambulatory blood pressure monitoring in order to institute early aggressive interventions to improve their long-term outlook.

Correlation between polarimetric retinal nerve fiber layer thickness and retinal sensitivity determined with frequency-doubling technology.

BACKGROUND AND OBJECTIVE: Correlation between polarimetric retinal nerve fiber layer thickness measured with variable corneal compensation and retinal sensitivity measured with frequency-doubling technology (FDT) and standard automated perimetry (SAP) was investigated. PATIENTS AND METHODS: Twenty-four consecutive patients with chronic open-angle glaucoma and 17 healthy control subjects (1 randomly selected eye for each subject) were evaluated. RESULTS: For all subjects, quadrant scanning laser polarimetry parameters correlated positively with both FDT and SAP mean sensitivity of the opposite hemifield (P< .001). Global scanning laser polarimetry parameters correlated positively with FDT-mean sensitivity, SAP-mean sensitivity, and FDT-mean deviation, and negatively with SAP-mean deviation (in SAP, mean deviation is positive in case of sensitivity loss) (P < or = .02). The nerve fiber indicator also correlated with FDT-pattern standard deviation and SAP-corrected loss variance (P < or = .01). Using un-logged sensitivity values, no further correlations were found. CONCLUSION: Our results show that a similar structure-function relationship exists between polarimetric retinal nerve fiber layer thickness determined with variable corneal compensation and retinal sensitivity measured with SAP and FDT.

Prevalence of physiological and pathological electrocardiographic findings in Hungarian athletes.

UNLABELLED: In Hungary, ECG is a keystone of routine athletic screening. Its significance is based on simplicity, quickness and high informative value as well as the fact that appearance of pathological ECG signs can precede the formation of structural heart diseases. During screening of healthy athletes, we studied the incidence of athletic ECG changes and pathological ECG abnormalities. METHODS: We performed detailed analysis of 12-lead ECG recordings of asymptomatic elite, non-elite and master athletes and controls. RESULTS: 227 athletes (male: 180, age: 27.2 ± 8.7 years) and 89 controls (male: 57, age: 28.1 ± 6.8 years) were examined. Benign ECG signs: sinus bradycardia, early repolarization and isolated Voltage criteria of left ventricular hypertrophy were common and more often in athletes compared to controls. Potentially pathological ECG signs: ST- (6.6% vs. 1.1%, p < 0.05) and T-wave (15.0% vs. 5.6%, p < 0.05) changes and signs of pathological left ventricular hypertrophy (5.3% vs. 0%, p < 0.05) occurred more frequently in athletes compared to controls. CONCLUSIONS: Signs of pathological left ventricular hypertrophy and repolarization abnormalities are more often in athletes. No structural heart disease could be verified in the background of the disorders. However, athletes having pathological ECG should be kept under tight cardiology control. Exact definition and widespread knowledge of pathological ECG changes is essential in early recognition of high risk athletes.

Lack of association between interleukin-1 receptor antagonist protein gene polymorphism and bone mineral density in Hungarian postmenopausal women.

The major determinant for risk of osteoporosis in later life is bone mineral density (BMD) attained during early adulthood. Bone mineral density is a complex trait that is presumably influenced by multiple genes. Interleukin-1 receptor antagonist protein (IL-1RN) is an attractive candidate gene for osteoporosis susceptibility, because IL-1RN completely inhibits the stimulatory effects of interleukin-1 (IL-1) on bone resorption in organ cultures and has been implicated in the pathogenesis of osteoporosis. In addition, the IL-1RN gene contains a variable-number tandem repeat polymorphism (VNTR) in intron 2 with three potential protein-binding sites. Recently, an association has been found between this polymorphism and postmenopausal bone loss in the spine. In this study, we use the previously described IL-1RN polymorphism to test for an association between this polymorphism and bone mineral density in our population of postmenopausal women. There was no correlation between alleles or genotypes and BMD in the 286 subjects. Dividing subjects into osteoporotic and healthy groups (osteoporotics and controls), we found no difference in the distribution of alleles or genotypes between groups. We found no association between IL-1RN alleles or genotypes and BMD either at the lumbar spine or the femoral neck within groups. Our data do not support the hypothesis that this IL-1RN gene VNTR polymorphism has an impact on bone mass in postmenopausal women.

Vitamin D and estrogen receptor gene polymorphisms in type 2 diabetes mellitus and in android type obesity.

OBJECTIVE: We studied the significance of BsmI restriction enzyme polymorphism of the vitamin D receptor (VDR) gene and the XbaI and PvuII polymorphisms of the estrogen receptor (ER) gene in patients with type 2 diabetes (n=49), android type obesity with normal carbohydrate metabolism (n=29) and healthy controls (n=138). METHODS: The distribution of genotypes in the study groups, as well as their relationship to fasting and 1 h postprandial serum C-peptide levels were analyzed. RESULTS: Postprandial serum C-peptide levels of BB genotypes were significantly higher in the diabetes and obese groups (6.18+/-5.09 ng/ml) compared with other genotypes (2.71+/-2.45 vs. 1.72+/-1.97 ng/ml, respectively, P=0.05). Among patients with type 2 diabetes and obese subjects, the XX allelic variant of the ER gene was more frequent (P=0.00015). Postprandial C-peptide levels of subjects exhibiting XX genotype were significantly lower compared with those with Xx genotype (1.67+/-2.16 vs. 3.8+/-3.72 ng/ml, P=0.021). The BBXx allelic combination of the VDR/ER receptor genes was less frequent in diabetic patients than in healthy subjects or in obese patients. The BBXx genotype was associated with significantly elevated postprandial C-peptide levels in all subjects compared with other combinations (9.65+/-3.14 vs. 1.35+/-2.82 ng/ml, P=0.003). No difference was found in the distribution of the PvuII polymorphism of the ER gene or in the association with the C-peptide levels among study groups. CONCLUSION: Polymorphisms of the VDR/ER receptor genes might play a role in the pathogenesis of type 2 diabetes by influencing the secretory capacity of beta-cells.

Effects of methysergide, bromocriptine and naloxone on prolactin, growth hormone and TSH release induced by D-Met2,Pro5-enkephalinamide in man.

D-Met2,Pro5-enkephalinamide (EA) 10 mg, given SC, induced a dramatic rise in serum prolactin (PRL) and growth hormone (GH) levels in healthy male volunteers. The TSH content was also moderately elevated. Naloxone 0.8 mg administered IV abolished these effects. Bromocriptine 2.5 mg given per os also antagonized EA-induced PRL and TSH release but potentiated the GH surge. Methysergide 2.0 mg administered orally partially reversed EA-elicited PRL release, further augmented GH liberation and did not modify TSH output. The data indicate that inhibition of the dopaminergic tone and/or activation of certain serotonergic mechanisms play an important role in the EA-induced release of PRL and TSH. However, primarily other neurotransmitters might mediate the GH liberation elicited by this opioid peptide.

Scanning laser polarimetry of the retinal nerve fibre layer in primary open angle and capsular glaucoma.

AIMS: To evaluate the clinical value of scanning laser polarimetry with the nerve fibre analyser type II in primary open angle glaucoma (POAG) and capsular glaucoma. METHODS: Scanning laser polarimetry was performed on one eye of 30 patients suffering from POAG, 25 patients suffering from capsular glaucoma, and on 35 healthy control subjects. The retinal nerve fibre layer (RNFL) thickness values were compared among the groups. Reproducibility of the measurements was calculated and the influence of pilocarpine induced miosis on the results was investigated. RESULTS: RNFL thickness in the superior and inferior sectors, as well as along the total circumference was significantly lower in both glaucoma groups than in the control eyes (p < 0.05). None of the thickness values differed between the two glaucoma groups. Reproducibility was comparable in all groups; the coefficient of variation varied between 3.0% and 8.9% for the different sectors investigated. Miosis had no significant impact either on the thickness values or on the reproducibility (p > 0.05). CONCLUSION: The results suggest that scanning laser polarimetry is a useful method for nerve fibre layer analysis in glaucoma, and that it is not influenced by the pupil size.

Influence of post-LASIK corneal healing on scanning laser polarimetric measurement of the retinal nerve fibre layer thickness.

AIM: To investigate the influence of laser assisted in situ keratomileusis (LASIK) on the values for retinal nerve fibre layer thickness (RNFLT) as measured with scanning laser polarimetry (SLP) during the healing process of the cornea after LASIK. METHODS: SLP with the GDx instrument was performed on 20 consecutive healthy subjects without any eye disease undergoing LASIK for ametropia correction. The SLP measurements were performed before the surgery, and at 1 and 3 days, as well as at 3 months, after LASIK. Thickness data from images of one randomly selected eye per subject were analysed using the ANOVA and Duncan multiple comparison tests. Correlation coefficients between RNFLT data and the treatment parameters were also calculated. RESULTS: Somewhat similar results were found for the different retinal areas. The measured values for superior average RNFLT decreased significantly at all time points compared to the preoperative baseline (p<0.003, Duncan test), but increased significantly between postoperative day 1 and the final visit at 3 months (p=0.025, Duncan test). Inferior average RNFLT in the early postoperative days was significantly smaller than at 3 months after LASIK (p<0.05, Duncan test), and tended to be smaller than at baseline. The thickness values before surgery and at the final visit, however, showed no significant difference (p=0.698, Duncan test) in this region. Ellipse average RNFLT was significantly smaller in the early postoperative days than the baseline value before LASIK. However, the measured value had significantly increased again by the time of the final visit (p<0.02, Duncan test). This value at the final visit showed no difference from the baseline value (p=0.46, Duncan test). The changes in the nasal average and temporal average RNFLT were not statistically significant. No correlation was found between the change in the SLP measured thickness values and central corneal thickness at baseline and its change after surgery, nor with the change in cylindrical correction due to LASIK, or the length of the suction time during surgery (p>0.05 for all correlations). CONCLUSION: The SLP technique is sensitive to the corneal optical properties, and RNFLT as measured with SLP shows changes after LASIK. Most of these changes, however, diminish with time after surgery, and the values tend to return to the preoperative results during the first 3 months of corneal healing following uncomplicated LASIK. It appears that in uncomplicated cases the transient RNFLT changes are artefacts and do not imply pathological thickness alterations due to LASIK.

Scanning laser polarimetry in corneal haze after excimer laser refractive surgery.

PURPOSE: We evaluate the technique of retinal nerve fiber layer thickness measurement using scanning laser polarimetry in cases of central corneal haze due to photorefractive keratectomy. METHODS: Nerve fiber layer thickness was measured using a Nerve Fiber Analyzer II (Laser Diagnostic Technologies, Inc., San Diego, CA, U.S.A.) in eight eyes of eight individuals with mild to pronounced corneal haze owing to earlier excimer laser refractive surgery, and in nine eyes of nine control volunteers. RESULTS: Neither total and sectorial nerve fiber layer thickness values, nor superior/ inferior quadrant thickness ratio differed in a statistically significant manner between the two groups (unpaired t test, p > 0.05). Reproducibility in the "haze" and control groups was 4.3% and 3.4%, respectively, for mean nerve fiber layer thickness calculated from all quadrants around the disc. The figures were 4.9% and 5.2%, respectively, for the superior quadrant thickness; 8.2% and 8.8%, respectively, for the temporal thickness values; 5.4% and 4.6%, respectively, for the inferior thickness values; and 4.1% and 5.0%, respectively, for the nasal quadrant thickness values. For the superior/inferior quadrant thickness ratio the reproducibility was 4.4% and 6.8%, respectively. None of the corresponding values for reproducibility differed significantly between the two groups (F-test, p > 0.05). CONCLUSIONS: Corneal haze did not cause an artificial increase of the thickness values measured with scanning laser polarimetry and did not diminish the reproducibility of the measurement. The results suggest that scanning laser polarimetry may be a suitable method for the precise measurement of the nerve fiber layer thickness even in eyes with persistent corneal haze after excimer laser refractive surgery.

Involvement of selection and amplification mechanisms in hormone receptor development in a unicellular model system.

It was demonstrated earlier, that long lasting exposure of Tetrahymena to a hormone (histamine) resulted in an increased responsiveness to a later re-exposure. However, it was difficult to establish whether selection or amplification plays a role in receptor differentiation. As diiodotyrosine (T2) enhances the growth of Tetrahymena, in the present experiment the effect of T2-treatment on a long-term culture of Tetrahymena pyriformis was analysed by mathematical-statistical methods to differentiate the effects of selection and amplification mechanisms on hormone receptor development. Although continuous and periodic treatment with T2 enhanced cell division equally, the resulting populations differed in structure. On continuous treatment the population tended to become inhomogenous. The variance tended to increase for 9 days and decreased afterwards without, however, returning to the control level. On periodic treatment the variance was the same as in the control group, but the second and third exposure were significantly more effective than the first treatment, suggesting that the primary encounter with the hormone had given rise to lasting alterations (hormonal imprinting). It follows that continuous exposure involves a selection process which does not, however, account for a steady increase of the growth rate; for initial amplification, taking place also in this condition, and selection which takes effect later, compensate one another's effects. Regarding the unicellular experimental system as a phylo- and ontogenetic model, the conclusion lies close at hand that the selection and amplication mechanisms promote hormone receptor development by joint rather than alternate action.

Chemical reception mechanisms at a low level of phylogeny. Influence of polypeptide hormones and non-hormone polypeptides on the growth of Tetrahymena.

The polypeptide hormones insulin, glucagon, thyrotropin (TSH), pregnant mare serum gonadotropin (PMSG) and adrenocorticotropin (ACTH) stimulated the growth of the Tetrahymena, and the non-hormone polypeptides (bovine serum albumin (BSA), protamine) had a similar effect. Re-exposure after 24 h accounted for a greater growth stimulation than pre-exposure alone in cultures treated with TSH and PMSG, and re-exposure after 7 days had such effect in all polypeptide-treated cultures. It follows that the non-hormone polypeptides had a similar imprinting potential to the polypeptide hormone. The non-hormone polypeptides were also able to cross-imprint for one another, i.e. pre-exposure to one enhanced the binding capacity of the cells for the other on re-exposure, and vice versa. A single treatment with a polypeptide hormone or a non-hormone polypeptide did in itself stimulate the growth of the Tetrahymena for as long as 1 week.

Influence of hormone treatment applied or begun in different phases of the cell cycle on hormonal imprinting in Tetrahymena.

Primary exposure to a hormone (hormonal imprinting) alters--in the case of the Tetrahymena increases--cellular response to re-exposure(s) to the same hormone. The intensity of hormonal imprinting depends on the phase of the cell cycle in which the primary exposure has taken place. The effect of imprinting was greater on the cells exposed to the hormone in phase G1 than on those exposed in phase S or G2. The response pattern of the progeny generations corresponded to that of the primarily exposed (imprinted) ancestor cell, irrespective of their own pre-exposure in phase G1, G2 or S of their cycle.

Influence of low and high temperature on diiodotyrosine imprinting in Tetrahymena.

Hormonal imprinting takes place at the primary interaction between target cell and hormone, and alters cellular response to the hormone for lifetime (at the unicellular level in many subsequent generations). Imprinting induced in Tetrahymena cells by diiodotyrosine at the optimum temperature of 25 degrees C took effect on re-exposure to the hormone at 25 degrees C and 15 degrees C, but failed to take effect if the cells were first exposed to the hormone at 15 degrees C or 32 degrees C.

[Serum osteocalcin levels in healthy males and females in relation to age]. / Egészséges nök és férfiak szérum osteocalcin értékei az életkor függvényében.

The measurement of serum osteocalcin is a new sensitive and specific method in the evaluation of calcium metabolism disorders. We established the normal values of healthy adult Hungarian women (n = 111, age: 20-86 yrs, mean: 47 yrs) and men (n = 70, age: 20-88 yrs, mean: 42 yrs) by radioimmunoassay method developed at our institute. Serum osteocalcin levels are constant between 20-50 yrs (7,8 +/- 2,4 ng/ml) while the values are significantly higher after 50 yrs of age (11,0 +/- 4,6 ng/ml) and remain constant afterwards. A correlation might be supposed between this elevation around 50 and bone loss around menopause. Serum osteocalcin values of men are constant with aging (11,0 +/- 3,9 ng/ml).

[The significance of hypocitruria in calcium oxalate induced nephrolithiasis]. / A hypocitraturia jelentösége kalcium oxalát okozta veseköbetegségben.

The citrate concentration of the daily collected urine was measured by citrate lyase method in 25 untreated patients with recurrent calcium stone disease (10 hypercalciuric and 15 normocalciuric) and in 11 patients with stone disease treated with hydrochlorothiazide and in 16 healthy controls. We found a great variancy of the results what rather looks like biological than methodic type. The concentration (1.99 +/- 1.33 mmol/l in normocalciuric and 2.77 +/- 1.62 in hypercalciuric stone formers but 5.06 +/- 2.81 in controls) and the daily output of the urinary citrate (2.74 +/- 1.38 mmol/d and 4.24 +/- 1.69 vs. 4.41 +/- 1.85) but not the citrate/creatinine ratio was significantly less in about the half of stone formers. The hypocitraturia was frequent in the normocalciuric and very rare in the hypercalciuric group of the renal stone patients. Measurement of the urine citrate concentration is more sensitive tool in the diagnosis of hypocitraturic state than daily citrate output while the latter is more characteristic for the patient, so common study of the two parameters is recommended.

[The role of estrogen receptor, vitamin D receptor and calcium receptor genotypes in the pathogenesis of colorectal cancer]. / Osztrogén-, D-vitamin- és kalcium-érzékeló receptorok genotípusainak szerepe a colorectalis daganatok patogenezisében.

In this study, the Xbal polymorphisms of the estrogen-, the Bsml polymorphism of the vitamin D- as well as the A986S polymorphism of the calcium-sensing receptor genes were investigated in 56 patients with colorectal cancer. The expression of erbB-2, epidermal growth factor receptor, ras, p53 and their relationship to estrogen-, vitamin D- and calcium-sensing receptor genotypes were also studied. In subjects exhibiting XX genotype of the estrogen receptor gene or bb genotype of the vitamin D receptor gene, erbB-2 expression was significantly lower compared to those with xx, Xx or BB, Bb (6/56 and 11/56 vs. 31/56 and 26/56; p = 0.0043 and 0.041). The presence of the XX alleles of estrogen receptor gene significantly correlated with the overexpression of the epidermal growth factor receptor expression in tumors, whereas in xx and Xx genotypes, significantly higher expression was seen (7/56 vs. 30/56; p = 0.049). Analyzing the combinations of the two gene allelic variants, we have found XXbb genotype to be associated with a significantly lower erbB-2 expression, compared to other combinations (Xxbb, XxBb, XXBb) (2/7 vs. 7/7, 4/5, 4/5; p = 0.0011). Patients with AA calcium-sensing receptor genotype were in higher UICC stages at the time of discovery of their disease than those with AS genotype. The AA allelic variant of the calcium-sensing gene was more frequent among patients with colorectal cancer compared to controls (36/56 vs. 36/112; p = 0.0004). Our observations raise the possibility that estrogen-, and vitamin D receptor gene polymorphisms accompanied with variable oncogene expression might influence the pathogenic processes resulting in the development of colorectal cancer. The A986S polymorphism of calcium-sensing receptor might also be a prognostic marker of the disease.

[Morphological parameters of breast cancers detected by mammography with and without organized screening; a comparative study]. / Mammográfiával felismert rákok morphologiai paramétereinek összehasonlítása a területileg szervezett szürés során és alkalomszerüen vizsgáltaknál.

Some pathological findings and prognostic indices recorded in breast cancer cases, detected, on one hand, by a provider-initiated mammography screening program (Group 1), and, opportunistically, in self-referred symptomatic women (Group 2) on the other, are compared. In 8877 symptom-free women, aged 50-65 years, individually invited to attend the screening offered for the residents of the III., XII. and XIII. districts of Budapest, 67 cancer cases were detected (7.5 in 1000 screenees), in accordance with the cancer detection rate of the first, "prevalence" round of organised screening programmes. In the other group of 1593 symptomatic, self-referred women of the same age, 113 cancer cases were diagnosed by mammography. As far as the pathological parameters are concerned, the number of cases with invasive cancer less than 15 mm in diameter, and those with axillary nodes present was found to be significantly higher in the screened group as compared to the self-referred one (p < 0.01). In "small" cancers (i.e. less than 15 mm in diameter), no significant difference was found in the proportion of histologic grade III tumours among the two groups. In screen-detected cancers both the morphometric prognostic index (as calculated by Baak et al.) and the Nottingham Prognostic Index (NPI) proved to be more favourable, as compared to those in the self-referred group. The p-value as determined by Mann-Whithey test was 0.000003 in the screened group, and 0.000015 in the other one. These findings provide convincing evidence in support of the public health importance of provider-initiated, organised mammography screening for breast cancer, therefore, the introduction on service basis of organised breast screening into the health care system in Hungary is strongly recommended by the authors.

Diagnostic accuracy of nerve fibre layer, macular thickness and optic disc measurements made with the RTVue-100 optical coherence tomograph to detect glaucoma.

PURPOSE: To evaluate the diagnostic accuracy of retinal nerve fibre layer thickness (RNFLT), ganglion cell complex (GCC), and optic disc measurements made with the RTVue-100 Fourier-domain optical coherence tomography (OCT) to detect glaucoma in a Caucasian referral population. METHODS: One randomly selected eye of 286 Caucasian patients (93 healthy, 36 ocular hypertensive, 46 preperimetric glaucoma, and 111 perimetric glaucoma eyes) was evaluated. RESULTS: Using the software-provided classification, for the total population sensitivity did not exceed 73.6% for the optic nerve head parameters, and 62.7% for the other parameters. Specificity was high (94.6-100%) for most RNFLT and GCC parameters, but low (72.0-76.3%) for the optic disc parameters. Positive predictive value varied between 98.1 and 100% for the main RNFLT parameters, 92.6 and 100% for the 16 RNFLT sectors, 92.4 and 99.0% for the GCC parameters, but did not exceed 86.3% for any of the optic disc parameters. Positive likelihood ratio (PLR) was higher than 10 for average, inferior and superior RNFLT (25.5 to infinite), 12 of the 16 RNFLT sectors (12.6 to infinite), and three of the four GCC parameters (40.0 to 48.6). No optic disc parameter had a PLR higher than 3.0. CONCLUSIONS: RNFLT and GCC parameters of the RTVue-100 Fourier-domain OCT showed moderate sensitive but high specificity, positive predictive value and PLR for detection of glaucoma. The optic disc parameters had lower diagnostic accuracy than the RNFLT and GCC parameters.

Health anxiety in a non-population-based, pre-publicised glaucoma screening exercise.

OBJECTIVE: To investigate whether anxiety plays a role in self-recruitment for non-population-based glaucoma screening. METHODS: In a non-population-based pre-publicised trial, self-recruited Caucasian participants were screened for glaucoma, and also completed the Trait Anxiety Inventory and Shortened Health Anxiety Inventory questionnaires. In pre-publicity for the trial, information on risk factors for glaucoma was given. Participants classified as possible glaucoma cases later underwent a detailed glaucoma investigation. RESULTS: Of the 120 total participants (72 females, 48 males), 12 were considered glaucoma suspects at the screening, although only three (2.5%) were ultimately diagnosed with glaucoma. Health anxiety showed significant correlation with trait anxiety (r=0.525, P<0.001). Trait anxiety was similar for both the genders; this score was significantly below the normal Hungarian population value in women (P<0.001) and at the normal population level in men (P=0.560). In contrast, health anxiety was significantly higher than for both the 'normal' and 'anxious' reference groups (P<0.001), although smaller than that for hypochondriacs (P<0.001). Participants with pre-existing ocular symptoms, and those who attended because of fear of blindness, had significantly higher trait- and health-anxiety scores (P<0.05 for all comparisons). CONCLUSION: In this screening trial, the health anxiety of the self-recruited participants was significantly above normal, whereas the prevalence of glaucoma was within the usual range for a Caucasian population. This suggests that providing pre-publicity information on risk factors for glaucoma does not necessarily increase the prevalence of glaucoma among self-recruited participants in non-population-based screening, as some individuals may participate on account of elevated health anxiety, rather than because of higher potential risk for glaucoma.