One case report of patient with repeated kidney stone and urine crystal was cured after strengthening calcium supplementation / 中华内分泌外科杂志

The lifetime prevalence of nephrolithiasis is 15% for men, with a 5-year recurrence rate of 35% to 50% after an initial event. Although it was initially recommended to limit calcium intake in these patients, a number of studies have reported association between lower total dietary calcium intake and increased risk of incident kidney stones, and that increased calcium intake might reduce the risk of incident kidney stones. We report a 35-year-old male who presented recurrent 8-years of nephrolithiasis and urine crystal with calcium intake restriction, and had no recurrence after 5 years of follow-up after intensive calcium and vitamin D supplementation.

Concern about the prevention and treatment of parathyroid hyperfunction or hyperparathyroidism associated metastatic vascular calcification or calcinosis universalis / 中华内分泌外科杂志

Metastatic vascular calcification and calcinosis universalis, as severe complications of parathyroid hyperfunction and hyperparathyroidism, have attracted more attention in patients with renal secondary hyperparathyroidism and primary hyperparathyroidism. But, they are of little concern in patients with long-term negative calcium balance related parathyroid hyperfunction or hyperparathyroidism caused by calcium and/or vitamin D insufficiency (CVI). CVI is common in the population. Relatively low level of serum calcium and negative calcium balance caused by long-term CVI result in parathyroid hyperfunction or hyperparathyroidism, which may cause secretion of PTH beyond the physiological level, leading to bone absorption and release of a large amount of bone calcium into the blood. It may not only cause bone loss and osteoporosis, but also form metastatic vascular calcification or calcinosis universalis presented by cardiovascular diseases and other multi-organ lesions. Early calcium deposition can gradually fade after reasonable treatment, but middle arterial calcification is not easy to fade once it occurs. Therefore, vascular calcification and calcium deposition should be actively prevented and early screened and diagnosed. The early prevention, diagnosis and treatment of parathyroid hyperfunction or hyperparathyroidism can prevent, delay, or even reverse the occurrence and development of metastatic vascular calcification and calcinosis universalis, which is significant for disease prevention and protecting the patients' health influenced by these diseases.

Prevention and treatment of parathyroid hyperfunction or hyperparathyroidism associated osteoporosis / 中华内分泌外科杂志

Osteoporosis (OP) is a common systemic bone disease which has become a serious public health problem in China. In clinical practice, we found that some primary osteoporosis may be due to parathyroid hyperfunction (subclinical hyperparathyroidism) or hyperparathyroidism which is the result of negative calcium balance and hypocalcemia caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency, which is preventable and controllable. Therefore, we call this kind of osteoporosis parathyroid hyperfunction or hyperparathyroidism associated osteoporosis. The daily calcium intake of Chinese people is generally insufficient, and vitamin D deficiency/insufficiency is also a worldwide public health problem. Parathyroid hyperfunction or hyperparathyroidism associated osteopenia and osteoporosis which are results of hypocalcemia and negative calcium balance caused by long-term insufficient calcium intake and/or vitamin D deficiency/insufficiency exist extensively in clinical practice. Its prevention and treatment can effectively prevent and treat osteopenia and osteoporosis, so as to effectively prevent and treat diseases such as short stature, rachiokyphosis, backache, fatigue, bone pain, fracture, metastatic vascular calcification and systemic calcinosis, improve people’s health and help achieve the goal of "Healthy China 2030" .

Strengthening the prevention and treatment of hungry bone syndrome, parathyroid hyperfunction and hyperparathyroidism of thyroid cancer patients after thyroidectomy / 中华内分泌外科杂志

Differentiated thyroid cancer is one of the most common endocrine malignant tumors, and thyroidectomy is its basic treatment measures. Insufficient attention is paid to its postoperative bone hungry syndrome and parathyroid hyperfunction or hyperparathyroidism, which will seriously affect the patient’s life quality and prognosis. This paper will explore the etiology, dangers, diagnosis, prevention, and treatment for hungry bone syndrome, parathyroid hyperfunction and hyperparathyroidism of thyroid cancer patients after thyroidectomy.

Disfunción tiroidea y diabetes mellitus tipo 1 / Thyroid dysfunction and type 1 diabetes mellitus

Introducción: La diabetes mellitus tipo 1 es una enfermedad autoinmunitaria que se relaciona con alteraciones tiroideas. Objetivo: Describir la relación que existe entre diabetes mellitus tipo 1 y enfermedad tiroidea autoinmune. Métodos: Se realizó una revisión de la literatura nacional e internacional de los últimos 15 años en bases de datos, en español y en inglés. Se utilizaron las siguientes palabras clave: diabetes mellitus tipo 1, autoinmunidad, enfermad tiroidea autoinmune, disfunción tiroidea y anticuerpos antitiroideos. Análisis e integración de la información: La alteración más frecuente es el hipotiroidismo subclínico y se presenta con mayor frecuencia en el sexo femenino, por lo que se sugiere realizar periódicamente el perfil tiroideo a estos pacientes. Conclusiones: Se debe tener en cuenta en la práctica clínica estas implicaciones para brindar un tratamiento oportuno, mejorar complicaciones derivadas como las enfermedades cardiovasculares y disminuir las cifras de morbilidad y mortalidad(AU)

Introduction: Type 1 diabetes mellitus is an autoimmune disease that is related to thyroid abnormalities. Objective: Describe the relationship between type 1 diabetes mellitus and autoimmune thyroid disease. Methods: A review of the national and international literature of the last 15 years was carried out in databases, in Spanish and in English. The following keywords were used: type 1 diabetes mellitus, autoimmune, autoimmune thyroid disease, thyroid dysfunction and antithyroid antibodies. Analysis and integration of information: The most common alteration is subclinical hypothyroidism and it occurs most often in the female sex, so it is suggested to periodically perform the thyroid profile to these patients. Conclusions: These implications should be taken into account in clinical practice to provide timely treatment, improve complications such as cardiovascular disease and reduce morbidity and mortality figures(AU)

Prevention and treatment of calcium and/or vitamin D insufficiency associated parathyroid hyperfunction and hyperparathyroidism / 中华内分泌外科杂志

Hyperparathyroidism is a common endocrine disease that seriously affects human health, depending on its etiology, which can be divided into three types: primary, secondary and tertiary. In clinical practice, we found that some primary hyperparathyroidism may be secondary or tertiary hyperparathyroidism caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency, and become a common type of hyperparathyroidism. The daily calcium intake of Chinese people is generally insufficient. Vitamin D can promote the absorption of calcium, but vitamin D deficiency/insufficiency is also a worldwide public health problem. Long-term hypocalcemia will stimulate parathyroid hyperplasia and secrete excessive parathyroid hormone, resulting in parathyroid hyperfunction (pre-hyperparathyroidism) and then secondary hyperparathyroidism, both of which may damage bone and release calcium into blood, leading to diseases of multiple organs and tissues. The detection of bone metabolism indexes such as calcium, magnesium, phosphorus, parathyroid hormone and vitamin D may be helpful for the early diagnosis of pre-hyperparathyroidism and hyperparathyroidism. Supplementation of calcium and vitamin D in early stage can control the development of the disease and change "unpreventable and uncontrollable" into "preventable and controllable" . The health screening of bone metabolism indexes and parathyroid ultrasonography should be advocated, and the prevention and treatment of calcium and/or vitamin D insufficiency associated parathyroid hyperfunction and hyperparathyroidism should be strengthened, so as to greatly improve the bone health, urinary calculus, metastatic vascular calcification and systemic abnormal calcium migration and precipitation in the population.

Factores predisponentes de la disfonía por hiperfunción laríngea en pacientes adultos: Hospital Universitario Dr. Luis Gómez López / Predisposing factors of laryngeal hyperfunction dysphonia in adult patients: Dr. Luis Gómez López University Hospital

Se realizó un estudio retrospectivo de revisión de 95 historias clínicas con el objetivo de determinar los factores predisponentes a la disfonía por hiperfunción laríngea en pacientes adultos que asistieron a la consulta de Otorrinolaringología del Hospital Universitario Dr. Luis Gómez López durante el lapso enero-diciembre 2016 a Junio 2017. Entre los resultados se encontró una predominancia del sexo masculino (82,4%) y una edad entre 37 a 44 años en 96,8% de los casos; 38% de los pacientes son profesionales expuestos a contaminación ambiental, 25% son profesionales de la voz; 79% no refiere tener hábito tabáquico; 38% refirió abusar de la voz, siendo las principales causas el hablar en exceso, cantar y gritar. El 67,4% de los pacientes están expuestos a vapores tóxicos, 86,3% al humo del tabaco y 82,1% al humo de la leña. El grado de disfonía más frecuente diagnosticado por nasofibrolaringoscopía fue grado II (60%). Es importante la detección temprana de los factores predisponentes asociados a la disfonía por hiperfunción laríngea de forma de implementar acciones que favorezcan las condiciones laborales y ambientales y mitiguen su influencia en la fisiología de la voz(AU)

A retrospective review of 95 medical charts was carried out with the objective of determining the predisposing factors for laryngeal hyperfunction dysphonia in adult patients attending the otorhinolaryngology consult of the Hospital Universitario Dr. Luis Gómez López, during the period January-December 2016 to June 2017. The results show a male predominance (82.4%) and an age between 37 to 44 years in 96.8% of cases; 38% of patients are professionals exposed to environmental pollution and 25% are voice professionals; 79% of patients don't smoke; 38% of cases abuse voice by speaking frequently, singing and shouting. 67.4% of patients have been exposed to vapors, 86.3% to tobacco smoke and 82.1% to firewood. Degree of dysphonia diagnosed by nasofibrolaryngoscopy was grade II (60%). Early detection of predisposing factors associated to laryngeal hyperfunction dysphonia is important in order to implement environmental actions to mitigate their influence in voice physiology(AU)

Síndrome de Cushing provocado por carcinoma suprarrenal gigante. Caso clínico

We report a previously healthy 34-year-old woman, presenting with a seven-month history of arterial hypertension, amenorrhea, weight gain, facial edema, acne, hirsutism and low back pain. A CT scan showed a right adrenal mass of 18 × 13 × 12.5 cm, and multiple vertebral and rib fractures. The hormonal study confirmed Cushing's Syndrome. Ketoconazole, spironolactone, cotrimoxazole, calcium / vitamin D were started. An adrenalectomy with a right nephrectomy were performed. The excised tumor measured 16 cm and weighed 1.55 kg. There was tumor embolism and a 4 mm soft tissue involvement (pT3NxMx). The right kidney was free of tumor. The patient was treated with chemotherapy (etoposide plus cisplatin). Study of vertebral fractures with magnetic resonance (MRI) showed crush fractures, without images of metastatic bone lesions. One year after surgery, a CT scan showed no signs of tumor recurrence. The patient was lost from follow-up thereafter.

Effect of modified inferior oblique anterior transposition on dissociated vertical strabismus patients with inferior oblique muscle hyperfunction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of anterior transposition of inferior oblique muscle on the treatment of dissociated vertical deviation(DVD)in children with inferior oblique overaction(IOOA)and unequal inferior oblique transposition of the treatment of IOOA with the eyes of the asymmetry of DVD efficacy, associated with the lower oblique hyperfunction DVD patients to provide more effective treatment. <p>METHODS: Eighty patients with hyperfunction who were treated in our hospital from January 2014 to December 2015 were randomly selected and treated with anterior transposition of inferior oblique muscle. Patients were followed up for 1 to 30mo. We compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations, and the correlation between the two. We also compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations in 30 eyes(20 patients)with bilateral asymmetry DVD and IOOA who received unequal inferior oblique transposition. The incidence of antielevation syndrome(AES)was observed after operations. <p>RESULTS: The mean prism diopters(PD)at 5m before operations was 19.5±0.15, the average PD after operations was 3.5±0.18, at 5m the original incline was 16±0.21PD. The mean PD at 33cm was 18.6±0.20 before operation, 4.5±0.26 after operations, and 14.1±0.16 at 33cm the original incline, the difference was statistically significant(<i>P</i><0.05). Preoperatively, inferior oblique muscle hyperfunction +2 and +3 was 50 eyes, + 1 was 20 eyes, and 12 eyes still showed inferior oblique muscle hyperfunction after operation, but the degree of hyperactivity was +1. There was a significant positive correlation between the degree of IOOA and the vertical inclination(33cm: <i>r</i>=0.554, <i>P</i><0.01; 5m: <i>r</i>=0.454, <i>P</i> <0.01). There were significant differences(<i>P</i><0.05)in the vertical incline in 20 patients(30 eyes)with bilateral asymmetry DVD and IOOA and the degree of IOOA was significantly lower. In contrast, 18 patients(24 eyes)underwent anterior transposition of the inferior oblique muscle had AES in different degrees, which had statistically significant difference(<i>P</i><0.05)compared with patients(30 eyes)with IOOA treated with unequal inferior oblique transposition. <p>CONCLUSION: Anterior transposition of the inferior oblique muscle has a good therapeutic effect on isolated vertical strabismus patients with inferior oblique hyperfunction. While the incidence of postoperative AES is low in patients received unequal inferior oblique muscle transposition.

Hipertireoidismo em pediatria / Hyperthyroidism in Pediatrics

Trata-se de revisão/atualização do tema, iniciando com uma enumeração de suas principais causas, apresentando o quadro clinico com sintomatologia e os exames laboratoriais indicados para o diagnóstico, exames complementares e tratamento. Neste particular, é abordado o emprego das drogas antitireoideanas, com suas contra-indicações e efeitos colaterais, a radioterapia e a cirurgia, com indicações absolutas e relativas. O trabalho finaliza citando algumas curiosidades relacionadas à patologia.

The distribution and clinical significance of D-dimer positive patients / 国际检验医学杂志

Objective To investigate the distribution and clinical significance of D‐Dimer positive patients .Methods 1 003 D‐di‐mer positive patients were enrolled in the study ,which were measured by latex enhanced immune turbidimetry .Results The total positive rate of ICU ,cardiology ,respiratory medicine ,orthopedics ,general surgery ,liver disease ,neurosurgery ,obstetrics and gyne‐cology ,oncology departments was 44 .1% .The numbers of D‐dimer positive patients with diffuse intravascular coagulation ,deep vein thrombosis ,pulmonary embolism ,heart cerebrovascular disease ,liver disease ,malignant tumor were 86 ,34 ,26 ,24 ,18 and 12 , respectively .Conclusion The determination of plasma D‐dimer could be used in thrombotic disease prevention and monitoring .

Establishment and evaluation of a rat model of immunosuppression and immune hyperfunction induced by cyclophosphamide / 中国实验动物学报

Objective The aim of this study was to establish rat models of immunosuppression and immune hyper-function.Methods Sixty-four SPF Sprague-Dawley rats were randomly divided into groups A, B, and C.All rats were immunized with intraperitoneal injection of 100 μg ovalbumin ( OVA) .The group A was used as control.At 6 hours after immunization, the rats of group B were injected with different doses of cyclophosphamide (Cy) at different time points.The rats of group C were injected with Cy in different ways at 3 days before immunization.Results Immunosuppressed rats were successfully induced by Cy (125 mg/kg or 100 mg/kg) at 6 h after immunization and also by injection of 225 mg/kg Cy at 3 days before immunization with ovalbumin.Small dose (20 mg/kg) of Cy injected once or a smaller dose (5 mg/kg/d) injected once a day for consecutive 3 days can also result in immune hyperfunction.Conclusions Rat models of immunosuppression and immune hyperfunction are successfully established, which provide methodological and data support for establishment of such animal models and useful reference for related research.

Adenoma cortical suprarrenal, hipercortisolismo, cardiomiopatía y bazo accesorio intrapancreático en un lactante / Cortical adrenal adenoma, hypercortisolism, cardiomyopathy, and intra-pancreatic accessory spleen in a 3-month-old infant

Introducción. El síndrome de Cushing es el resultado de concentraciones elevadas de glucocorticoides en la circulación, su presentación en lactantes es poco común. Caso clínico. Presentamos un caso de hipercortisolismo endógeno en un niño de 3 meses de edad, secundario a un adenoma suprarrenal congénito. El paciente manifestó polifagia, aumento de peso y alteraciones en el patrón del sueño; al examen físico se observó hirsutismo frontal, cara en "luna llena", abultamiento visible en región cervico-dorsal ("giba de búfalo"), hipertensión arterial; el cortisol plasmático fue de 163 pg/dL, y el ultrasonido abdominal reveló tumoración suprarrenal izquierda. Durante el período de hospitalización, el niño cursó con dificultad respiratoria y taquicardia; la radiografía de tórax mostró cardiomegalia. Después de un procedimiento quirúrgico simple (venodisección), el paciente desarrolló choque cardiogénico y falleció. En la autopsia se encontró, además de la tumoración suprarrenal, cardiomiopatía hipertrófica y bazo accesorio intrapancreático. Conclusión. La causa más común del síndrome de Cushing en todos los grupos de edad, excepto en lactantes, es hipercortisolismo exógeno; la asociación de patologías aquí presentadas es muy raro.

Introduction. Cushing syndrome is associated with high levels of glucocorticoids in the circulation and is infrequently in infants. Case report. We present a case of congenital cortical adrenal adenoma-associated endogenous hypercortisolism in a 3-month-old infant. The patient manifested polyphagia, weight gain, and changes in sleep patterns. During physical examination we found a full-moon face, bulkiness in the cervico-dorsal "buffalo-hump" region, high blood pressure, and serum cortisol of 163 pg/dL. Abdominal ultrasound revealed left adrenal tumor. During hospitalization, the patient experienced respiratory difficulty and tachycardia, and thoracic X- ray revealed cardiomegaly. After a simple surgical procedure (venous dissection), the patient developed cardiogenic shock and died. At autopsy, adrenal tumor was found in addition to hypertrophic cardiomyopathy and intrapancreatic accessory spleen. Conclusion. The most common cause of Cushing syndrome in all age groups is exogenous hypercortisolism, except in infants. The associated pathologies described in this article are rare.

Relationship between the Metabolic Syndrome and Abdominal Tension / 日本東洋医学雑誌

Metabolic syndrome develops because of an accumulation of intra-abdominal fat. In Kampo medicine, an abdominal examination is commonly performed for the diagnosis of diseases. Thus, we examined the relationship between metabolic syndrome and abdominal tension. Our subjects were 999 people (619 males and 380 females) who underwent regular physical check-ups. Metabolic syndrome was diagnosed in 14.5% (21.3% of males and 3.4% of females) and the prevalence rate of subjects with metabolic and pre-metabolic syndromes was 40.8% (55.9% of males and 16.3% of females). In addition, abdominal examinations detected 19.1% of hyperfunction, 64.6% of intermediate function, and 16.3% of hypofunction. Almost subjects with abdominal hyperfunction were classified as metabolic or pre-metabolic syndrome, and neither metabolic nor pre-metabolic syndrome was present in subjects with abdominal hypofunction. In conclusion, assessment of abdominal tension may become an additional valuable screening method for metabolic syndrome.

Cellular and molecular abnormalities of a macronodular adrenal hyperplasia causing beta-blocker-sensitive Cushing's syndrome

Cushing's syndrome due to ACTH-independent macronodular adrenal hyperplasia (AIMAH) can be associated with abnormal responses of aberrantly expressed adrenocortical receptors. This study aimed to characterize in vitro the pathophysiology of hypercortisolism in a b-blocker-sensitive Cushing's syndrome due to AIMAH. Cortisol secretion profile under aberrant receptors stimulation revealed hyperresponsiveness to salbutamol (beta2-adrenoceptor agonist), cisapride (5-HT4 receptor agonist), and vasopressin in AIMAH cultured cells, but not in normal adrenocortical cells. By RT-PCR, AIMAH tissues revealed beta2-adrenoceptor overexpression rather than ectopical expression. MC2R expression was similar in both AIMAH and normal adrenocortical tissues. Curiously, cortisol levels of AIMAH cells under basal condition were 15-fold higher than those of control cells and were not responsive to ACTH. Analysis of culture medium from AIMAH cells could detect the presence of ACTH, which was immunohistochemically confirmed. Finally, the present study of AIMAH cells has identified: a) cortisol hyperresponsiveness to catecholamines, 5-HT4 and vasopressin in vitro, in agreement with clinical screening tests; b) abnormal expression of beta2-adrenoceptors in some areas of the hyperplastic adrenal tissue; c) autocrine loop of ACTH production. Altogether, the demonstration of aberrant responses to hormonal receptors and autocrine hormone production in the same tissue supports the assumption of multiple molecular alterations in adrenal macronodular hyperplasia.

A síndrome de Cushing secundária à hiperplasia adrenal macronodular independente de ACTH (AIMAH) pode estar associada com respostas anômalas a estímulos sobre receptores hormonais expressos de maneira aberrante no córtex adrenal. O objetivo deste trabalho foi caracterizar a fisiopatologia do hipercortisolismo in vitro na síndrome de Cushing responsiva a beta-bloqueadores decorrente de AIMAH. Em cultura de células, a secreção de cortisol apresentou resposta aumentada ao salbutamol (agonista beta2-adrenérgico), à cisaprida (agonista de receptor 5-HT4) e à vasopressina, na AIMAH mas não no córtex adrenal normal. O estudo de receptores aberrantes por RT-PCR demonstrou que o gene do receptor beta2-adrenérgico estava superexpresso (e não expresso ectopicamente) nos fragmentos da AIMAH quando comparado ao tecido normal. A expressão de MC2R foi semelhante em ambos. Curiosamente, o nível basal de secreção de cortisol pelas células da AIMAH foi 15 vezes superior às células normais, não havendo resposta das células AIMAH ao estímulo com ACTH. A análise do meio de cultura das células AIMAH revelou a presença de ACTH, que foi confirmada por estudo imuno-histoquímico. Em suma, este estudo demonstrou: a) aumento dos níveis de cortisol in vitro em resposta a catecolaminas, 5-HT4 e vasopressina, correspondendo aos resultados dos testes clínicos para pesquisa de receptores aberrantes; b) expressão anormal de receptores beta2-adrenérgicos em algumas áreas de hiperplasia; c) produção autócrina de ACTH. Estes resultados envolvendo ativação de receptores aberrantes e estímulo hormonal autócrino no mesmo tecido favorecem a hipótese da existência de alterações moleculares múltiplas na hiperplasia adrenal macronodular.

Rate of Identification of Eight-principle Pattern and Physiological Activity in Women with Climacteric Symptoms in Japanese Kampo Medicine / 日本東洋医学雑誌

Women with undefined climacteric period complaints often have multiple symptoms. To identify the characteristics of and to provide treatment tailored to each patient, Sho diagnosis based on an eight-principle pattern of identification is needed. Furthermore, identification of abnormalities in Ki, Ketsu and Sui, which are the basic elements of all physiological activity, are of great importance in clinical practice.<br>We determined identification rates of these principles in women with climacteric symptoms using Kampo medicine. Eight hundred and ninety-nine climacteric patients, aged 43-58 years: 52.1±2.4yr, were recruited for this study. We detected heat-or cold-syndrome, and hyper-or hypofunction patterns using the eight-principles with conventional, traditional Japanese Kampo medicine diagnostic procedures as well as disorders of Ki, Ketsu, and Sui metabolism according to the Terasawa score, in retrospective fashion. Ketsu stagnation (36.5%) was found to be the most frequent condition. Ki regurgitation (25.9%) and Ki stagnation (24.8%) were found to be relatively frequent pathological conditions. In women with headache, hot flushes, and dizziness as the principal menopausal symptom, disorders of the Sui metabolism (48.8%), Ketsu stagnation (48.1%), and disorders of the Sui metabolism (48.0%) were the most frequent conditions, respectively.<br>These results indicate that although climacteric symptoms are diverse in nature, identification of Ki-Ketsu-Sui patterns often makes it possible to obtain a coherent diagnostic picture, leading to a better understanding of the conditions seen in climacteric women. When dealing with climacteric women with undefined complaints, it seems particularly important for physicians to be able to prescribe Kampo preparations precisely for Ketsu stagnation (the most frequently observed) so that the health of these women can be restored. It is also important that physicians perform Sho diagnosis carefully, bearing in mind the finding that Ki-Ketsu-Sui patterns were complex in patients exhibiting hot flushes (one of the main symptoms), although half of these presented with Ketsu stagnation. Incorporating Kampo medicine into therapeutic approaches to the treatment of such patients therefore seems advisable.

Clinical Study of Adrenal Incidentaloma in Korea

BACKGROUND: This study was designed to evaluate the clinical, endocrinological and histological characteristics of adrenal incidentalomas. METHODS: Eighty patients (41, males; 38, females; age range 17-80 years) who were diagnosed with adrenal incidentaloma at Korea University Hospital from 1992 to 2003 were studied retrospectively. RESULTS: Endocrinological investigation revealed 16 pheochromocytomas (20%), nine Cushing's syndromes (11%), eight primary aldosteronism (10%) and 46 non-functioning tumors (58%). Forty-four patients received operations, and biopsies were performed on two patients. Pathologic examination revealed 16 adrenocortical adenomas (20%), five carcinomas (6%), 13 pheochromocytomas (16%), three metastatic cancers (4%), and other tumors (10%). The diameter of the carcinomas (mean: 10.8 cm, range: 5-19 cm) were significantly larger than the diameter of benign adenomas (mean: 2.84 cm, range: 1-6 cm) (p=0.002). According to the receiver operating charactenstic (ROC) curve analysis, the cut-off value of tumor size for discriminate malignant tumor was 4.75 cm (sensitivity 90%, specificity 58%). Twenty-four patients with non-functioning tumors were followed up for a period of 3 to 72 months. During the follow up period, two patients showed an increase in tumor size of more than 1 cm, and one patient developed Cushing's syndrome. Changes in mass size and function were observed only between 10 and 26 months after the initial diagnosis. CONCLUSIONS: These data show that an endocrine evaluation should be performed in all adrenal incidentalomas, and an adrenalectomy is recommended for tumors 5 cm or greater or tumors with adrenocortical hyperfunction. In addition, these tumors should be monitored for changes in mass size and function for a follow up period of approximately 26 months.

Miectomía con cauterización de los extremos versus visualización directa / Myectomy with cauterization of the extremitates versus direct visualization

Se realizó un estudio descriptivo, retrospectivo de 71 pacientes con hiperfunción de oblicuo inferior bilateral que acudieron al Servicio de Oftalmología Pediátrica y Estrabismo del Hospital Oftalmológico Docente "Ramón Pando Ferrer", de ellos 26 intervenidos con la técnica quirúrgica de miectomía con cauterización de los extremos y un segundo grupo donde se aplicó la técnica de miectomía bajo visualización directa con 45 pacientes, que fueron operados desde enero de 1998 hasta enero de 2003. A todos se les realizó una valoración preoperatoria y posoperatoria de la hiperfunción del oblicuo inferior. El 72 % se agrupó en un rango de edad de 1 a 10 años, el 55 % tenía diagnóstico de esotropía con hipertopía; no hubo recidiva en los pacientes intervenidos de miectomía con cauterización de los extremos bajo visualización directa.

A descriptive and retrospective study of 71 patients with hyperfunction of the bilateral inferior oblique that received attention at the Service of Pediatric Ophthalmology and Strabismus of "Ramón Pando Ferrer" Ophthalmological Hospital was conducted. 26 of them underwent myectomy with cauterization of the extremitates, whereas in the other 45 myectomy under direct visualization was performed. They were operated on from January 1998 to January 2003. A preoperative and postoperative assessment of the hyperfunction of the inferior oblique was made. 72 % were grouped in an age range from 1 to 10 years old, and 55 % had a diagnosis of esotropia with hypertropia. No relapse was observed in the patients that underwent myectomy with cauterization of the extremitates under direct visualization.

Persistent Autonomic Hyperfunction Following Hypertensive Intracerebral Hemorrhage

Persistent autonomic hyperfunction is not well-recognized disease entity. Recently the authors experienced one case following hypertensive intracerebral hemorrhage in the basal ganglia. It was manifested as storms of hypertension, tachycardia, hyperthermia, severe diaphoresis, hyperventilation and decerebrate posture. Extensive investigations on infection, pheochromocytoma or status epilepticus revealed no abnormalities. Medications including antibiotics, antipyretics and antiepileptic agents were administered, but in vain. However, intravenous morphine infusion managed to stabilize his conditions. To our knowledge, the present case is the first one to be thermographed, and is the second case next to Rossitch's report of autonomic dysfunction following intracerebral hemorrhage.