[Evaluation of the localizing procedures of primary aldosteronism].

The validity of preoperative localizing procedures was studied in 36 patients with primary aldosteronism due to adrenal adenoma, all of whom were confirmed surgically. Adrenalectomy resulted in normalization of blood pressure and serum potassium. Furthermore, we reviewed the correlation between mass size and some clinical parameters as well as the accuracy of localization procedures. Adopted localization procedures included imaging techniques such as abdominal ultrasonography, computed tomography (CT), adrenal scintiscan, magnetic resonance imaging (MRI) and adrenal venography, and as a functional diagnostic procedure, adrenal venous sampling. Among imaging procedures, CT was the most effective to detect adrenal mass with as high accuracy as 88%, adrenal venography following with 83%. The correct localization was obtained in 60% by adrenal scintiscan and only 39% by ultrasonography. Although MRI was performed only in 2 cases, the smallest adenoma could be detected only by MRI, suggesting that MRI might be useful to detect microadenoma by increased signal intensity. Although adrenal scintiscan had been considered to be useful because of its functional diagnostic characteristics, the correct localization was as low accuracy as 60%, which was not improved by the administration of dexamethasone. To assess the accuracy of lateralization for adrenal venous sampling, we calculated the ratio of aldosterone concentration in adrenal vein to inferior vena cava. When the ratio was more than 10 or less than 1, the correct localization was made.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cloverleaf skull syndrome with occipital bone cristae. Report of two cases].

Two cases of cloverleaf skull syndrome are reported. The patients were born with trilobed deformity of the skull associated with synostosis of the lambdoidal, coronal, and sagittal sutures in Case 1 and of the lambdoidal suture in Case 2. Both patients had hydrocephalus, low-set ears, and ocular hypertelorism. Ventriculoperitoneal shunting had been performed for hydrocephalus in both cases in early infancy. Thereafter, the skull anomaly caused mental and physical retardation and elevated intracranial pressure. In both cases, surgery was successful in terms of cosmetic and neurological improvement. Both cases involved prominent midline crista formation of the skull over the posterior fossa, which steadily progressed during the first year of life and produced hydrocephalus, apparently by compressing or obstructing the aqueduct and/or the ostia of the fourth ventricle. Twenty-four cases of surgery for cloverleaf skull syndrome have been reported to date. Only Partington's types II and III were treated surgically, and patients with type III had more favorable outcomes than those with type II. However, these reports provide no clear-cut data that surgery significantly influences the outcome. The experience with the two cases reported here suggests the benefits of early shunting followed later by radical surgery.