Antihypertensive therapy and male sexual dysfunction.
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Antihypertensive Agents↗
Biomedical subjects
M J Hogan
Publications and source records attributed to M J Hogan.
Constitutional delay of growth and adolescence.
In order to evaluate possible abnormalities among males with constitutional delay of growth and adolescence, hormonal responses and interrelationships have been extensively evaluated in a young man with a documented history of this condition and compared with young men with a history of normal puberty as controls. Normal hypothalamic-pituitary sensitivity to circulating sex steroids and a normal end-organ response (nitrogen and phosphorus retention) to testosterone stimulation were found. There was, however, a decreased gonadal (testosterone) response to gonadotropin (HCG) stimulation and a decreased pituitary response to clomiphene stimulation. These decreased responses could explain the observed adolescent delay in growth and maturation observed in these individuals.
Adult↗
A computerized paramedical approach to the outpatient management of essential hypertension.
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Adolescent↗
Pigment epithelial ensheathment and phagocytosis of extrafoveal cones in human retina.
The association between extrafoveal cone outer segments and pigment epithelial cells was studied by transmission electron microscopy in three human retinas; ages 5,45 and 60. The pigment epithelial apical surface from a fourth human retina, age 38,was viewed in the scanning electron microscope. Multiple villous-like apical processes protrude from the pigment epithelium into the space above each cone. Sometimes one or more of these processes is sheet-like in form and contains a wealth of intracellular organelles, including mitochondria. One or more of the villous-like procesess reaches the cone and expands to ensheath the upper one-third of the outer segment. Llike vertebrate rods, extrafoveal human cones shed their terminal disks in packets and these packets are phagocytosed by the ensheathing apical processes. The phagosomes then ascend in the processes toward the pigment epithelia soma. Digestion of phagosomes appears to begin in the apical processes.
Adult↗
Concurrent hypercortisolism and hypermineralocorticoidism.
Hypertension and hypokalemia occur in patients with Cushing's syndrome whereas aldosterone production is normal and plasma renin activity is usually normal or increased. A normal aldosterone level in the face of suppressed plasma renin activity is unusual and suggests excess mineralocorticoid hormone activity. Our patient, who had Cushing's syndrome due to adrenocortical adenoma, can be classified as having low renin hypertension (suppressed renin and normal aldosterone levels). The mineralocorticoid hormone in excess was deoxycorticosterone which suppressed renin. The aldosterone production was normal and was produced solely by the adenoma. Contralateral adrenal gland suppression of both the zona glomerulosa by deoxycorticosterone via renin, and of the fasciculata by cortisol via ACTH was demonstrated after removal of the adenoma. Normal adrenal function was gradually restored.
Adenoma↗
Management of small elevated pigmented choroidal lesions.
The diagnosis of small choroidal melanomas may be difficult, and the natural history of these small tumours is poorly understood. We followed up 20 patients with the diagnosis of small choroidal melanomas for from 2 to 20 years. In 11 of these patients the melanoma was observed to grow. Nine of these patients have undergone enucleation. Eight of the eyes contained spindle B melanomas and one contained a melanoma of mixed cell type. None of the 20 patients has developed detectable metastatic disease. From this series and others reported it appears that close serial examinations without therapeutic intervention is safe in patients with small melanomas until growth is observed, and that there is little evidence to suggest that photocoagulation or radiotherapy is of greater benefit in those patients than close serial examination.
Adult↗
Interpersonal problem solving: a theoretical perspective and methodology for the evaluation of residency education and its' relationship to health care processes and outcomes.
The study conceptualizes and implements an interaction model of interpersonal problem solving in the clinical milieu. This method of representing the interpersonal problem solving process and its relation to patient adherence is shown as an important tool for the evaluation of residency programs.
Evaluation Studies as Topic↗
Clinical problem solving: the relationship of cognitive abilities to PMP performance.
The relationship between patterns of individual differences on PMP performance and selected Gulford's Structure of Intellect test of cognitive abilities is shown. The groups were interpretable using the Guilford tests and confirm the use of the individual differences model.
Clinical Competence↗
Location of aldosterone-producing adenomas with 131I-19-iodocholesterol.
We used 131I-19-iodocholesterol as an adrenal-imaging agent in 27 hypertensive patients who had biochemical evidence of abnormalities in the renin-angiotensin-aldosterone system. In 10 of 12 patients in whom the biochemical findings suggested the presence of an aldosterone-producing adenoma the adrenal uptake was asymmetric. The adenoma was subsequently confirmed in all eight patients in this group who underwent operation. In contrast, the adrenal uptake was asymmetric in only one of 13 patients with biochemical evidence of iodopathic hyperaldosteronism or low-renin essential hypertension. Two patients with adrenal carcinoma causing primary aldosteronism did not concentrate the isotope in their tumors. When metabolic studies suggest an aldosterone-producing adenoma, adrenal imaging with 131I-19-iodocholesterol may locate the tumor before operation.
Adenoma↗
Correlation between degree of malignancy and the radioactive phosphorus uptake test in ocular melanomas.
Twenty-nine patients who had undergone enucleation for ocular malignant melanoma were studied. The results of the radioactive phosphorus uptake (32P) tests were correlated with histopathologic observations. There was a positive correlation between the 32P test results and the histologic degree of malignancy. Mixed cell melanomas were more frequent in the patients ranked with higher 32P test results. Spindle cell melanomas occurred more frequently in patients with lower 32P test results. Mitoses per field and degree of malignancy correlated positively with 32P test results when ranked in a masked manner by two ocular pathologists. Tumor volume and clinical factors did not correlate with the 32P test results. While patients with mixed cell melanomas had higher mean 32P test results than those with spindle cell melanomas, a large variance was noted. Because of this the 32P test is unreliable in predicting the histopathology of a tumor in individual cases.
Aged↗
Jules Stein, MD.
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History, 19th Century↗
Immunosuppressive treatment of uveitis.
Ten out of 31 cases of severe corticosteroid-resistant uveitis showed a good clinical response to systemic chlorambucil therapy. Cases of Behcet's syndrome, sympathetic ophthalmia, chronic cyclitis, and rheumatoid sclerouveitis seem to be in the most favorable categories to be considered for cytotoxic-immunosuppressive therapy.
Chlorambucil↗
Presumed chronic ocular histoplasmosis syndrome: a clinical-pathologic case report.
An eye of a patient with clinically typical presumed ocular histoplasmosis was studied by light microscopy, electron microscopy and immuno-fluorescence techniques. There was clinical and pathological evidence of anterior segment involvement. The posterior segment showed granulomatous and nongranulomatous chorioretinal lesions with and without subretinal neovascularization. Immunohistopathological staining for histoplasma antigens revealed positive staining at sites of lymphoid inflammation. Organisms were not identified.
Adult↗
Salzmann's nodular degeneration of the cornea.
Eleven corneal specimens from nine patients with Salzmann's nodular degeneration of the cornea, together with all available clinical information, were collected for this study. The specimens were examined by light and electron microscopy. An antecedent keratitis was diagnosed by history and microscopic findings in every case. The corneal epithelium showed degenerative changes, its thickness varied, and in nodular areas it often consisted of only a single layer of flattened epithelial cells by light microscopy. Bowman's membrane was missing over the nodules, and in this zone there was excessive secretion of a basement membrane-like material. Hyaline degeneration of collagen, cellular debris, and electron-dense hyaline deposits were seen in the collagen of the nodules. The number of fibrocytes in the nodules varied from many that were active to a few that were degenerating. External irritation because of poor epithelial protection was interpreted as a causative factor, although other tissue repair mechanisms may also have played a role.
Basement Membrane↗
Lens changes in a galactosemic fetus.
The first child of a Spanish-American couple died presumbably from galactosemia. Early in the mother's fourth pregnancy, the parents' red blood cell levels of galactose 1-phosphate uridyl transferase were measured and both parents were found to be heterozygous (carriers) for transferase deficiency. A prenatal diagnosis of galactosemia in the fetus was made with the aid of amniocentesis and tissue culture. Abortion was induced when the fetus was 5 months old. Biochemical studies of lung and liver tissues confirmed the diagnosis of galactosemia. Cataractous changes were found by electron microscopy in both fetal eyes. Lens epithelial cells showed degenerative changes and a tendency to proliferate into two cell layers. Edema, liquefaction, and a variation in density characterized the lens cells.
Abortion, Induced↗
Ocular reticulum cell sarcoma.
In four of eight cases of reticulum cell sarcoma with ocular involvement diagnosis was made by craniotomy when the signs of a brain tumor developed. A fifth case had an isolated intraocular tumor. Of the other three, two were diagnosed by vitreous aspiration and one by cerebrospinal fluid cytology. Ocular reticulum cell sarcoma frequently accompanies or precedes brain involvement. In this form of the disease the ocular lesion is usually a tumor cell infiltrate of the retina. The associated retinochoroiditis leads to marked vitreous clouding and eventual retinal detachment and glaucoma may occur. On the other hand, when intraocular reticulum cell sarcoma occurs in association with the systemic lymph node visceral form of the disease, choroidal involvement is the rule. Vitreous aspiration may confirm the diagnosis at an early stage when clinical and laboratory evaluation reveal no disease outside the globe. The retinal tumor foci are radiosensitive and local radiation, although not curative, may restore visual acuity. Immunosuppressive therapy given in low doses for anti-inflammatory effect may exacerbate the disease.
Aged↗
Observation of Kolmer's crystalloid outside the retina. Presence in the corneal endothelium in various conditions.
A structure similar to Kolmer's crystalloid, an organelle found in the horizontal cells of the retina, was observed in endothelial cells of the cornea from four patients (one case of hyperparathyroidism and three cases of corneal dystrophy). Based on a morphological analysis it is concluded that the structures in the present cases are identical with the cytoplasmic structure of the horizontal cell, and that the membranous tubes probably constitute a special form of rough surfaced endoplasmic reticulum, eventually involved in transport and/or a specialized protein synthesis.
Cell Membrane↗
Inflammation and its effect on the vitreous.
The role of the vitreous in inflammatory diseases of the eye is now more clearly defined because of improved methods of examination and surgery. Inflammatory diseases of various aetiology produce opacification, liquefaction, and shrinkage. Additional changes include cellular proliferation and transformation leading to fibrosis in cases of prolonged inflammation. In some eyes the fibrosis is primarily cortical while in others it is extensive. Those inflammations with outpouring of a fluid exudate lead to detachment of the vitreous from the posterior eye and extensive shrinkage. In such eyes the vitreous becomes heavily organized and opaque in the central eye behind the lens, obscuring the view of the posterior fundus. In young eyes vitreo-retinal adhesions often form at the sites of inflammation, leading to traction on the retina and ciliary body; retinal tears may result from the traction. Exudate in many inflammatory vitreal inflammations tends to collect at the vitreous base where it organizes into scar tissue. The scar is formed by the retina and ciliary body, but there are also fibrosis-produced monocytes that become transformed into fibroblasts. Shrinkage of the new-formed scar can lead to disinsertion or peripheral tears of the retina. Specific inflammations such as chronic cyclitis and toxoplasmosis produce characteristic changes in the vitreous that can be recognized on clinical examination. Melanomas and reticulum cell sarcomas also produce a characteristic vitreous opacification.
Eye Diseases↗