ABSTRACT
We studied retrospectively 25 cases of primary aldosteronism which had presented at Siriraj Hospital between 1980 and 1993. There were 10 males and 15 females (M:F = 1:1.5), aged from 26-64 years old (average 43 years). The duration of the illness varied from 1 to 20 years (5.64 + 4.48 years). The presenting symptoms were proximal muscle weakness of extremities, 16 cases (64%) ; headache, 9 cases (36%) ; unable to stand up after sitting, 6 cases (24%) ; exertional dyspnea, 5 cases (20%) ; nocturia, 3 cases (12%) ; orthopnea, 1 case (4%) and arrhythmia with fainting, 1 case (4%). The patients with cardiac arrhythmia had a very low level of serum potassium (1.8 mEq/L). Physical examination revealed left ventricular hypertrophy in only 5 cases (20%). There was very little change in the ocular fundi but every case had high blood pressure ranging from 150-240/100-150 mm.Hg. (average 176.67 + 24.50/114.26 + 12.46 mm.Hg). Serum sodium varied from 134-152 mEq/L (average 145.58 + 4.42 mEq/L). Serum potassium was 1.3-3.3 mEq/L (average 2.11 + 0.48 mEq/L). Serum bicarbonate was high, 25-50 mEq/L (average 31.84 + 5.81 mEq/L). No significant change in BUN and creatinine was observed. Potassium in a twenty four hours urine specimen was 11.04-78 mEq/day (average 40.84 + 5.81 mEq/day). To confirm the diagnosis and localize and lesion a CT scan of the adrenal gland was performed and tumor masses were found on the right, 9 cases (36%) and on the left, 16 cases (64%). Surgical removal was carried out in only 20 cases. Golden yellowish tumours were excised varying in size from 1*0.3 – 3.5*2 cms. Pathological studies revealed 18 cases (90%) of adenoma and 2 cases (10%) of hyperplasia. Of those with adenoma, blood pressure in 13 cases (72.22%) returned to normal after surgery but the other 5 cases (27.78%) still had high blood pressures still needed antihypertensive treatment. Serum potassium returned to normal in both groups of patients, adenoma and hyperplasia.
ABSTRACT
An electron microscopic study was carried out on eleven surgical liver biopsy specimens obtained from patients with cholangiocarcinoma associated with opisthorchiasis. The tumor cells of histologically well differentiated cholangiocarcinoma had few cytoplasmic organelles. They contained relatively large nuclei, abundant free ribosomes and numerous groups of fine fibrils. Each cell was surrounded by a basement membrane. Numerous long microvilli were seen projecting into the glandular lumen. The moderately differentiated cholangiocarcinomatous cells exhibited increased organelle content, marked variation in the shape of the nuclei with deep cytoplasmic invagination into the nuclear membrane; there were small intranuclear pseudoinclusions, and shorter microvilli. The tumor cells showed intracellular microvillus-lined spaces, abundant free ribosomes, many fine fibrils and their surrounding basement membranes were incomplete. The ultrastructure of the poorly differentiated cholangiocarcinoma was similar to that of the moderately differentiated tumor, except for fewer microvilli, abundant cytoplasmic organelles, and ill-defined or absent basement membrane.