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PubMed1976

A prevalence study of oral mucosal lesions in an adult Swedish population.

The prevalence of oral mucosal lesions in Sweden is virtually unknown. Available prevalence figures concern but a few types of lesions and relate to highly selected, special populations. Investigations on general populations are sparse also in other countries. The aim of the present study was to survey the occurrence of oral mucosal lesions in a relatively large general population in Sweden. The study was performed in collaboration with a health screening organization in the middle of Sweden. The populations of two municipalities in the County of Uppsala were investigated. A mobile health screening group visited several places in the selected area and during the time of the present investigation a total of 30,118 persons, aged 15 years or above, were summoned. Of these, 62% or 18.659 individuals attended and were examined. The non-participants became the subject of a special investigation for which every fifth individual, or 2.292 persons, was randomly sampled. After a second summons, 933 persons presented for examination. Through personal contact, an additional 741 individuals were examined in private homes, places of work, hospitals, old age homes and other institutions. The final non-participation, representing 10.3% of the total population, was considered to have but a marginal influence on the results of the study. The diagnostic procedure was based on clinical criteria set forth especially for the investigation. The validity of the final diagnoses was evaluated by, for instance, inter-examiner tests and comparisons between clinical diagnoses and histologic descriptions and was found to be acceptable. Tests of the reliability were, among else, undertaken through re-examinations and indicated, that underregistration apparently occurred for a few of the lesions investigated. The prevalences of about 60 oral mucosal lesions were recorded and compared with previous findings. Notably high prevalences were found for focal epithelial hyperplasia (0.11%), leukoedema (49.07%), geographic tongue (8.45%) and lichen planus (1.85%). For some lesions prevalence figures are difficult to compare with findings from previous studies. This includes lesions which are directly or indirectly related to local etiologic factors such as denture status and tobacco habits. As regards these factors basic information has been collected and will be used for further analyses. The collected total material has also been designed to form the basis for longitudinal studies of, for example, precancerous lesions.

Adolescent↗
PubMed1982

Acquired amegakaryocytic thrombocytopenic purpura: a syndrome of diverse etiologies.

The possible pathogenetic mechanisms responsible for the production of acquired amegakaryocytic thrombocytopenic purpura (AATP) were investigated in a group of patients with this disorder. Absence of megakaryocytes and small platelet glycoprotein-bearing mononuclear cells, as determined by immunochemical staining of patient marrows with an antisera to platelet glycoproteins, suggested that the defect in AATP occurs in an early progenitor cell of the megakaryocytic lineage. Using an in vitro clonal assay system for negakaryocytic progenitor cells or megakaryocyte colony-forming units (CFU-M), the proliferative capacity of AATP marrow cells was then assessed. Bone marrow cells from three of four patients formed virtually no megakaryocyte colonies, suggesting that in these individuals the AATP was due to an intrinsic defect in the CFU-M. Bone marrow cells from an additional patient, however, formed 12% of the normal numbers of colonies, providing evidence for at least partial integrity of the CFU-M compartment in this patient. Serum specimens from all six patients were screened for their capacity to alter in vitro megakaryocyte colony formation. Five of six sera enhanced colony formation in a stepwise fashion, demonstrating appropriately elevated levels of megakaryocyte colony-stimulating activity. The serum of the patient with partial integrity of the CFU-M compartment, however, stimulated colony formation only at low concentrations. At higher concentrations, this patient's serum actually inhibited the number of colonies cloned, suggesting the presence of a humoral inhibitor to CFU-M. Serum samples from all patients were further screened for such humoral inhibitors of megakaryocyte colony formation using a cytotoxicity assay. The patient whose serum was inhibitory to CFU-M at high concentrations was indeed found to have a complement-dependent serum IgG inhibitor that was cytotoxic to allogeneic and autologous marrow CFU-M but did not alter erythroid colony formation. These-studies suggest that AATP can be due to at least two mechanisms: either an intrinsic effect at the level of the CFU-M or a circulating cytotoxic autoantibody directed against the CFU-M.

Adult↗
PubMed2000

Characterization of beta-galactosidase in leukocytes and fibroblasts of GM1 gangliosidosis heterozygotes compared to normal subjects.

OBJECTIVES: Characterization of beta-galactosidase in leukocytes and fibroblasts of heterozygotes for GM1 type I. DESIGN AND METHODS: Leukocyte and fibroblast beta-galactosidase activity was determined fluorimetrically using 4-methylumbelliferyl-beta-D-galactoside as an artificial substrate. Optimum pH, Km, Vmax and thermostability of the enzyme at 42 degrees C were determined. RESULTS: The leukocyte and fibroblast enzyme of heterozygotes have an optimum pH of 4.0 and 4.2, respectively. In normal subjects, the optimum pH was 4.2 in both cells, according to previous studies. The Km of the enzyme of heterozygotes was determined to be 0.65 mM in leukocytes and 0.59 mM in fibroblasts. The Vmax was determined in 167.21 nmol/h/mg of protein in heterozygotes leukocytes and 541.2 nmol/h/mg of protein in heterozygotes fibroblasts compared to 291.7 and 1768.1 nmol/h/mg of protein in controls leukocytes and fibroblasts, respectively. When leukocyte and fibroblast heterozygote beta-galactosidase was preincubated at 42 degrees C, after 80 min the residual activity was determined to be 25 to 30% of the initial activity. These results are similar to the control group. CONCLUSIONS: We have found significant differences between the two groups in some investigated parameters. Both fibroblasts and leukocytes showed a virtually similar level of reliability as source of enzyme for the detection of heterozygotes.

Cells, Cultured↗
PubMed2004

Long-term follow-up of patients with suspected deep vein thrombosis of the upper extremity: survival, risk factors and post-thrombotic syndrome.

BACKGROUND: The outcome of upper extremity thrombosis in terms of morbidity, mortality and arm functionality is virtually unknown. We investigated mortality, risk factors, recurrent thrombosis and post-thrombotic syndrome (PTS) in patients with suspected upper extremity thrombosis. METHODS: Consecutive patients suspected of having deep vein thrombosis (DVT) of the upper extremity were followed for up to 53 months (mean 21 months). Venography and/or ultrasonography was used for diagnosis. Risk factors were identified from history and thrombophilia laboratory screening. PTS was assessed using a scoring system. Death, recurrent thrombosis and PTS were primary outcome measures. RESULTS: DVT of the upper extremity was diagnosed in 50 of 116 consecutive patients (43%). Malignancy and/or central venous lines were present in 37 of 50 (74%) patients with thrombosis. Inherited thrombophilia was diagnosed in 6 of 30 (20%) and 4 of 33 (12%) of the investigated patients with and without thrombosis, respectively (not significant). Twenty-five patients (50%) with thrombosis died during the follow-up period; this was associated with cancer in 84% of the deaths. Recurrent thrombosis was observed in four patients (8%) during follow-up. Symptoms of PTS were present in 4 of 22 patients (18%) with thrombosis and in 14 of 36 patients (39%) in whom thrombosis was excluded. CONCLUSIONS: Malignancy and central venous lines are major risk factors of upper extremity thrombosis. Thrombophilia seems to be unrelated to the presence or absence of upper extremity thrombosis. Thrombosis in combination with malignancy predicts poor survival. A scoring system can be used to assess the severity of PTS, but it does not discriminate PTS from other causes of arm complaints.

Journal Article↗
PubMed2006

In-situ surfactant/surfactant-nutrient mix-enhanced bioremediation of NAPL (fuel)-contaminated sandy soil aquifers.

SCOPE AND BACKGROUND: Contamination of soils, aquifers and groundwater by nonaqueous phase liquid (NAPL) pollutants constitutes a major environmental issue of concern, worldwide. The residual (biodegradation-resistant) hydrophobic fuel hydrocarbons entrapped in the soil porous matrix, possess a particular bioremediation challenge due to their becoming virtually immobile, nor desorbable, or water dispersible. Consequently, they are not available as substrates to the micro-organism-based biodegradation. MATERIALS AND METHODS: Our research involves the development of economically feasible, surfactant/surfactant-nutrient mix (SSNM)-enhanced bioremediation methodologies for sustainable, in situ bioremediation of fuel-contaminated aquifers. This requires, methodologically, (a) the optimization, via in vitro 'flow' (columns) lab experiments and screening processes, of an effective mixture for the intended SSNM-enhanced bioremediation; and (b) the study of the combined effect of the optimized SSNM on the solubilization/mobilization and biodegradation of NAPL (fuel) in in vitro site/aquifer-simulated bioremediation. RESULTS AND DISCUSSION: The essence of our findings: (1) kerosene's maximum enhanced mobilization - f = 3.6, compared with that of deionized water, was achieved with an SSNM having the composition of linear alkylbenzene sulfonate (LABS): coco-amphodiacetate (containing N): surfactant-nutrient X (containing both N and P) = 0.15: 0.15: 0.05 g/L, respectively; (2) 62-64% of the initial amount of kerosene in the initially saturated soil matrix, 'packed' in a column, has been eluted from it during approximately 30 days, compared with 68% of kerosene biodegradation in 'vessel' settings, in 21 days. CONCLUSIONS: (1) The indigenous microorganisms present in th vadose zones of fuel-contaminated sandy soil aquifers are potentially capable of unassisted removal of approximately 80% of the initially contained fuel (kerosene), during a period of about 42 days; (2) the major effects of the SSNM addition are (a) enhanced mobilization of the bulky NAPL; and (b) enhanced desorbtion/ solubilization/dispersion of the entrapped NAPL which, in turn, facilitate their enhanced biodegradation. RECOMMENDATIONS AND PERSPECTIVE: Our findings suggest that pre-optimized, biodegradable SSNM is essential for surfactants-based bioremediation of NAPL-contaminated aquifers, in order to make this in-situ methodology both technologically and economically feasible.

Biodegradation, Environmental↗
PubMed1993

Human lung expresses unique gamma-glutamyl transpeptidase transcripts.

gamma-Glutamyl transpeptidase (EC 2.3.2.2, gamma GT) is a membrane-bound ectoenzyme that plays an important role in the metabolism of glutathione. It is composed of two subunits, both of which are encoded by a common mRNA. We examined the expression of gamma GT in human lung tissue by Northern blot analysis and screening a cDNA library made from human lung poly(A)+ RNA. Our results show that there are two gamma GT mRNA populations in human lung tissue. We define these as group I (2.4 kb) and group II (approximately 1.2 kb) transcripts. In the present communication, we characterize the unique lung transcript. Sequence analysis of representative clones shows that group I transcripts are virtually identical to those previously isolated from liver and placenta but possess a unique 5' untranslated region. In marked contrast, group II transcripts appear to be human-lung-specific. Group II transcripts appear on Northern blots probed with full-length or 3'-biased gamma GT cDNA. Sequence analysis of group II clones shows them to be homologous with group I clones in the region that encodes the reading frame for the light chain; however, they possess a series of unique 5' untranslated regions, which suggests that they arise from lung-specific message processing. Additionally, approximately 50% of the isolated group II clones contain 34 nt substitutions compared with the "wild-type" gamma GT transcripts. These data indicate that human lung expresses unique gamma GT transcripts of unknown function as well as the classical form. The abundant group II transcripts may encode part of a heterodimer related to gamma GT or represent processed lung-specific pseudogenes.

Amino Acid Sequence↗
PubMed1982

Congenital hip dislocation: an increasing and still uncontrolled disability?

A study of 178 cases of congenital dislocation of the hip in babies born between 1965 and 1978 in Southampton health district showed that the incidence had virtually doubled over this period. Established cases (persisting beyond the first birthday) had risen to around two cases per 1000 per live births. One-third of these were first diagnosed after the age of 1 year and one-fifth after 18 months. The findings are particularly disappointing as there were opportunities after the neonatal period for earlier diagnosis. Thus, neonatal screening appears to have failed to make a substantial impact on the morbidity of the disease, probably because of a combination of inherent difficulties in the neonatal screening test as well as failure in its proper application. Much greater vigilance is needed during the first year of life if congenital dislocation of the hip is to be detected and treated as early as possible. Perhaps this could be achieved if all health professionals were more aware of the problem and were encouraged to examine hips at every opportunity and health authorities periodically audited their results.

Child, Preschool↗
PubMed1997

CT colonoscopy of colorectal neoplasms: two-dimensional and three-dimensional virtual-reality techniques with colonoscopic correlation.

OBJECTIVE: The aim of this study was to compare the diagnostic accuracy of two-dimensional (2D) CT colonography and three-dimensional (3D) virtual colonoscopy with conventional colonoscopy in patients who have suspected colorectal neoplasms. SUBJECTS AND METHODS: Twenty patients were studied (eight women and 12 men; mean age, 53 years; range, 42-85 years). All patients had findings on conventional colonoscopy suggestive of colorectal carcinoma and underwent colonic CT within 3 hr of endoscopy. Two-dimensional CT colonography and 3D virtual colonoscopy images were generated from the same data set that was obtained from thin-section helical CT of the abdomen and pelvis after rectal insufflation of room air. Three-dimensional virtual colonoscopy images were obtained by downloading CT data to a workstation equipped with commercially available software. Volume- and perspective-rendering techniques were used to achieve interactive, 3D virtual "fly-through" examinations of the colonic mucosa. The results of 2D CT colonography and 3D virtual colonoscopy were compared with the findings of conventional colonoscopy and correlated with surgical and pathologic outcome where possible. RESULTS: Twenty masses (defined as intraluminal projections 2 cm or larger in diameter) and 15 polyps (defined as projections smaller than 2 cm in diameter) were identified in our study group. All masses and 14 of 15 polyps were successfully shown on 2D colonography. Three findings of polyps on 2D colonography were false-positive, and one was false-negative. Three-dimensional virtual colonoscopy revealed 19 of 20 masses and 13 of 15 polyps. On conventional colonoscopy, all 20 masses and 13 of 15 polyps were identified, with one false-positive finding of a malignant stricture in a normal colon. Complete examination of the colon was possible in 18 of 20 patients using the 2D technique and in 17 of 20 patients using 3D virtual colonoscopy, whereas conventional colonoscopy showed the entire colon in only 12 of 20 patients. CONCLUSION: Two-dimensional CT colonography and 3D virtual colonoscopy are complementary and effective techniques for examining the colon in patients with suspected colorectal carcinoma. CT techniques offer several advantages over conventional colonoscopy including the ability to detect abnormalities proximal to obstructing carcinomas, accurate localization of abnormalities within the colon, and good patient tolerance. These CT techniques may play an important role in future diagnosis of colorectal cancer and for screening patients at risk.

Colonic Polyps↗
PubMed1996

Characterization and sequence analysis of the human homeobox-containing gene GBX2.

Polymerase chain reaction (PCR) was used to amplify portion of homeobox genes present in a human 11-week fetal brain cDNA library. One of these PCR products was determined by sequencing to be the Gastrulation and brain specific-2 gene (GBX2). Screening this human fetal brain cDNA library with probes specific for GBX2 led to the identification of a 2151-bp cDNA clone. The nucleotide sequence of the cDNA clone encodes for a protein of 347 amino acid residues. The amino acid sequence of the GBX2 homeodomain is identical (100%) to the that of homologous gene, Gbx2, expressed in the developing mouse embryo and virtually identical (97%) to a gene expressed in the developing chicken embryo, CHox7. The 5' end of the GBX2 gene contains a CpG island in the untranslated region and a trinucleotide (CCG)8 repeat in the coding region. The amino-terminal end of the GBX2 protein is proline-rich, with 30 proline residues in one stretch of 120 amino acids. A single 2.2-kb transcript was detected by Northern analysis in the developing human CNS as well as in other tissues. The human genomic clone for GBX2 was also isolated, characterized, and mapped to 2q36(d)-q37 by somatic cell hybrid analysis and fluorescence in situ hybridization. These studies provide a framework for designing future experiments that are needed to determine the functional significance of this gene in CNS development.

Amino Acid Sequence↗
PubMedDate not supplied

A rapid procedure for the screening and quantitation of barbiturates, diazepam, desmethyldiazepam and methaqualone.

A procedure is presented for the concomitant identification and quantitation of certain commonly abused weak acid and natural drugs from whole blood. This procedure offers several advantages over other procedures in that: (A) a means of extraction of the drugs from blood using a very inexpensive source of diatomaceous earth (Celite 560) is presented, (B) the addition of three internal standards allows the quantitation of several drugs from blood with just one extraction of the blood sample, (C) the extracts are virtually free of any contaminants from biological sources or from biologically inert drug metabolites, and (D) the barbiturates and desmethyldiazepam are derivatized to enhance their limits of detection and reduce peak tailing frequently observed when using the nitrogen-phosphorous detector and gas chromatography (NPD/GC). Some 1000 positive driving-under-the-influence cases have been quantitated by this method.

Barbiturates↗
PubMed2005

Colonography by computed tomography.

Computed tomographic colonography ('virtual colonoscopy') has shown promising results in the detection of large (> or = 10 mm) polyps in populations with a high prevalence of polyps. Recent studies in low prevalence populations, however, show variable results in sensitivity, ranging from 55% to 94% for the detection of patients with polyps measuring 10 mm or longer. Therefore questions have been raised about computed tomographic colonography as a screening method, probably the most valuable use of this technique. This article describes possible causes of these remarkable differences as well as advances in computed tomographic colonography.

Attitude to Health↗
PubMedDate not supplied

Increased incidence of cervical intraepithelial neoplasia in young women in the Mitte district, Berlin, Germany.

OBJECTIVE: To investigate whether the incidence of cervical intraepithelial neoplasia (CIN), in particular of high grade CIN, increased in Berlin during the period 1970-1989 and whether the ages of women with CIN had decreased. STUDY DESIGN: In the former German Democratic Republic, which had a highly centralized public health system, all gynecologic operations performed on women living in the Mitte district of Berlin were carried out during the period 1970-1989 (when the Berlin Wall fell) in the gynecologic clinic of the Charité Hospital. RESULTS: The incidence of all CIN increased from year to year over the observation period: 0.04% (1970-1971), 0.10% (1980-1981), 0.39% (1988-1989). There was a particularly high increase in the incidence of high grade intraepithelial neoplasms (CIN 3): 0.016% (1970-1971), 0.056% (1980-1981), 0.25% (1988-1989). With a virtually unchanged age distribution for women in the Mitte district of Berlin, the median age of women with CIN 3 decreased significantly from 1970 to 1989, from 39.5 (1970) to 33 (1989) (P < .001). CONCLUSION: The increase in the incidence of CIN, especially of high grade CIN, as well as the reduction in age for onset of the disease, makes high participation in screening necessary, above all among young women.

Adult↗
PubMed2004

Prevention of colorectal cancer through the use of COX-2 selective inhibitors.

Colorectal cancer is a major cause of morbidity and mortality accounting for an estimated 550,000 deaths annually worldwide. Colonic neoplasia develops in a stepwise fashion progressing from normal mucosa to adenomatous polyps to carcinoma, a process that takes years, thereby providing a prime opportunity for intervention. Although early detection by fecal occult blood testing and sigmoidoscopy can decrease the risk of cancer-related death by 20-30%, most persons never undergo appropriate screening. Population-based studies have previously determined that long-term ingestion of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) leads to a 40-50% reduction in mortality. from colorectal cancer. These observational studies fueled subsequent mechanistic investigations that led to the identification of a molecular target, cyclooxygenase-2 (COX-2). COX-2 has tumor-promoting properties. Expression of COX-2 is virtually undetectable in normal intestinal mucosa, but is increased in approximately 50% of colonic adenomas and in 90% of colorectal carcinomas. Experimental studies in mice have revealed that genetic ablation or pharmacologic inhibition of COX-2 attenuates the number and size of intestinal polyps that develop in animals harboring a mutation in Apc, which confers an increased risk for intestinal neoplasia. Recent clinical studies using specific COX-2 inhibitors have shown that these compounds can: (1) reduce intestinal polyp burden in patients with familial adenomatous polyposis; (2) prevent the occurrence and/ or recurrence of colorectal adenomas and cancers; and (3) negatively regulate angiogenesis in colorectal cancer liver metastases. Compared to nonselective NSAIDs, COX-2 specific inhibitors cause substantially fewer gastrointestinal side effects. These findings indicate that a widely used and relatively safe class of drugs may represent a viable and effective anticancer strategy for a disease that causes over a half-million deaths per year.

Animals↗
PubMed1992

Electron microscopic features of skin in neurometabolic disorders.

Skin biopsy may contribute to the clinical diagnosis of neurometabolic disorders. It is an easy and much less traumatic procedure than brain, rectal, peripheral nerve and skeletal muscle biopsies. The method is informative and not too time-consuming for an experienced examiner. Differential diagnosis is possible in most storage disorders since the ultrastructure of the storage is virtually typical in lysosomal and in nonlysosomal diseases. The storage has a particular distribution with characteristic ultrastructural patterns in the various cell types. Skin biopsy plays a major diagnostic role when clinical features are atypical for a storage disorder, to discover new phenotypic variants of known enzymatic deficiencies or when the biochemical defect has not yet been determined. It can be used as a screening procedure to orientate the investigations, to suggest specific biochemical assays on cultured fibroblasts or other tissues or body fluids. It can be applied to detect "presymptomatic" patients in affected families. Other disorders of the nervous system should be investigated in the future to ascertain whether skin biopsies could possibly be used for diagnostic purposes. Thorough knowledge of the morphological features of these disorders may also improve the understanding of their pathogenesis, shed some light on the underlying basic defects and control the results of therapy.

Animals↗
PubMedDate not supplied

Dark-adapted thresholds at 10- and 30-deg eccentricities in 10-week-old infants.

We tested the hypothesis that the dark-adapted sensitivity of the near central retina is lower than that of peripheral retina in 10-week-old infants. A spatial two alternative forced-choice psychophysical method was used to estimate the threshold for 2-deg spots presented 10 deg and 30 deg from the center of a screen. Each 10-week-old infant (n = 11) and adult (n = 5) subject was tested at both eccentricities. Every infant's threshold at 10 deg is higher than that at 30 deg. The median difference between the infants' thresholds at 10 deg and 30 deg is about 0.5 log unit. Whereas the scotopic thresholds of adults at 10 deg and 30 deg are virtually identical, the thresholds of infants' near central retina are higher than those in more peripheral retina. Delayed maturation of the near central rod outer segments with consequent lower quantum catch may be the primary determinant of this infantile sensitivity pattern.

Adolescent↗
PubMed2006

Susceptibility to induced visual discomfort during the menstrual cycle while viewing a visual display unit.

PURPOSE: Consistent variations in reports of visual discomfort during the female menstrual cycle are found when virtual reality headsets are used to display moving images. Because little is known about the influence of this cycle on susceptibility to visual discomfort in other situations, we performed a laboratory study using an intensive visual task. METHODS: Twelve female participants, with normal-length menstrual cycles, completed the study. This required them to play a computer game for 30 minutes while viewing the screen through -2.00-D lenses. Questionnaires were used to record symptom changes; visual acuity and near points of accommodation (NPA) and convergence (NPC) were also recorded both before and after the game. The participants performed this task on designated days (5, 12, 19, and 26) of their menstrual cycle chosen because they fall in line with peaks and troughs of ovarian hormone levels. Cycle phase was confirmed by the measurement of salivary estradiol and progesterone levels. RESULTS: The task performed produced clear changes in all metrics examined. Visual discomfort first increased, on average, after 6 minutes; VA declined on average by 0.02 logarithm of the minimum angle of resolution and NPC and NPA both receded by just over 1 cm. However, none of these changes differed significantly at any stage of the menstrual cycle. CONCLUSIONS: We conclude that visual discomfort, generated by providing increased accommodative demand while viewing a visual display unit, does not vary significantly during the menstrual cycle.

Accommodation, Ocular↗
PubMed1994

Serum tumour markers in lung cancer: history, biology and clinical applications.

The association of biological markers with cancer has been recognized for many decades. Current interest in markers for cancer arose in the mid 1960s, with the discoveries of alpha-fetoprotein and carcinoembryonic antigen. They were called oncofetal proteins, because of their presence in high concentrations during embryonic development, their virtual disappearance in the neonatal period, and their reappearance with cancers of specific cell types. Essentially, any molecular species may be produced in abnormal amounts or under abnormal circumstances by a tumour, and thereby become useful as a tumour marker. Several tumour markers have been studied in lung cancer. Unfortunately, none of these appear to be sufficiently sensitive and specific to be reliable for screening and diagnostic purposes. However, there is a body of evidence which proves that at least some of these substances may be useful in the evaluation of the course and prognosis of the disease. This review presents data concerning the most studied and interesting tumour markers in lung cancer.

Antigens↗
PubMed1999

Physiologic tailoring of therapy for resistant hypertension: 20 years' experience with stimulated renin profiling.

Renin profiling to assist in management of hypertension was first proposed about 27 years ago. However, it is still not widely used, perhaps because it was initially emphasized for management of primary hypertension, which is usually relatively easy to manage. Our experience in more than 4000 patients with referral hypertension screened since 1977 suggests that this approach, which I call "Physiologic Tailoring" of management, is particularly helpful in resistant hypertension, especially in cases of adrenocortical hypertension. Three cases of resistant hypertension spanning the 20 years of the clinic's existence, are presented to illustrate the contribution of renin profiling to the diagnosis and management of adrenocortical hypertension. It is suggested that adrenocortical hypertension is virtually always due to bilateral hyperplasia and that true curable solitary nodules may not exist if patients are followed long enough; and that adrenocortical hyperplasia is much more common in blacks and patients of African origin. A study to test the cost-utility of a renin-based algorithm for management of resistant hypertension is recommended.

Adrenal Cortex Diseases↗