Prevalence and diagnostic workup of primary aldosteronism: new knowledge and new approaches

No Abstract

New perspectives on the role of aldosterone excess in cardiovascular disease

1. Evidence from recent experimental and clinical studies suggests that excessive circulating levels of aldosterone can bring about adverse cardiovascular sequelae independent of the effects on blood pressure. Examples of these sequelae are the development of myocardial and vascular fibrosis in uninephrectomized, salt-loaded rats infused with mineralocorticoids and, in humans, an association of aldosterone with left ventricular hypertrophy, impaired diastolic and systolic function, salt and water retention causing aggravation of congestion in patients with established congestive cardiac failure (CCF), reduced vascular compliance and an increased risk of arrhythmias (resulting from intracardiac fibrosis, hypokalaemia, hypomagnesaemia, reduced baroreceptor sensitivity and potentiation of catecholamine effects). 2. These sequelae of aldosterone excess may contribute to the pathogenesis and worsen the prognosis of CCF and hypertension. 3. The heart and blood vessels may be capable of extra-adrenal aldosterone biosynthesis, raising the possibility that aldosterone may have paracrine or autocrine (and not just endocrine) effects on cardiovascular tissues. 4. The high prevalence of CCF, which is associated with secondary aldosteronism, and primary aldosteronism (PAL; recently recognized to be a much more common cause of hypertension than was previously thought) argue for an important role for aldosterone excess as a cause of cardiovascular injury. 5. The recognition of non-blood pressure-dependent adverse sequelae of aldosterone excess raises the question as to whether normotensive individuals with PAL, who have been detected as a result of genetic or biochemical screening among families with inherited forms of PAL, are at excess risk of cardiovascular events. 6. Provided that patients are carefully investigated in order to permit the appropriate selection of specific surgical (laparoscopic adrenalectomy for PAL that lateralizes on adrenal venous sampling) or medical (treatment with aldosterone antagonist medications) management and safety considerations for the use of aldosterone antagonists are kept in mind, the appreciation of a widening role for aldosterone in cardiovascular disease should provide a substantially better outlook for many patients with CCF and hypertension.

Weketrema gen.n., a new genus for Weketrema hawaiiense (Yamaguti, 1970) comb. n. (Digenea : Lecithasteridae) recently found in Australian marine fishes

A new genus, Weketrema, is erected in the family Lecithasteridae for the species hitherto known as Lecithophyllum hawniiense. Weket, ema hawaiiense (Yamaguti, 1970) comb, n. is redescribed from Scolopsis bilineatus (Bloch) (Perciformes: Nemipteridae) from Lizard Island and Heron Island, Queensland, Plectorhinchus gibbosus (Lacepede) (Perciformes: Haemulidae) from Heron Island and Cheilodactylus nigripes Richardson (Perciformes: Cheilodactylidae) and Latridopsis forsteri (Castelnau) (Perciformes: Latridae) from Stanley, northern Tasmania. The new genus is distinguished from related members of the family Lecithasteridae by its complete lack of a sinus-sac. Although placed in the subfamily Lecithasterinae pro tem, its true subfamily position is not entirely clear. Comment is made on its unusual distribution, both in terms of zoogeography and hosts.

The dorsomedial visual areas in New World and Old World monkeys: homology and function

The extrastriate cortex near the dorsal midline has been described as part of an 'express' pathway that provides visual input to the premotor cortex. This pathway is considered important for the integration of sensory information about the visual field periphery and the skeletomotor system, especially in relation to the control of arm movements. However, a better understanding of the functional contributions of different parts of this complex has been hampered by the lack of data on the extent and boundaries of its constituent visual areas. Recent studies in macaques have provided the first detailed view of the topographical organization of this region in Old World monkeys. Despite differences in nomenclature, a comparison of the visuotopic organization, myeloarchitecture and connections of the relevant visual areas with those previously studied in New World monkeys reveals a remarkable degree of similarity and helps to clarify the subdivision of function between different areas of the dorsomedial complex. A caudal visual area, named DM or V6, appears to be important for the detection of coherent patterns of movement across wide regions of the visual field, such as those induced during self-motion. A rostral area, named M or V6A, is more directly involved with visuomotor integration. This area receives projections both from DM/V6 and from a separate motion analysis channel, centred on the middle temporal visual area (or V5), which detects the movement of objects in extrapersonal space. These results support the suggestion, made earlier on the basis of more fragmentary evidence, that the areas rostral to the second visual area in dorsal cortex are homologous in all simian primates. Moreover, they emphasize the importance of determining the anatomical organization of the cortex as a prerequisite for elucidating the function of different cortical areas.

Occurrence and histopathogenesis of a didymozoid trematode (Gonapodasmius epinepheli) in pond-reared orange-spotted grouper, Epinephelus coioides

A didymozoid trematode encapsulated in the gills of orange-spotted grouper, Epinephelus coioides Hamilton, was observed in October 1997 and September 1999 among pond-reared fish in the Philippines. Capsule prevalence was 33% and 18% and mean intensity 2 and 1, respectively. The opaque-white and yellowish capsules were found only on the first gill arch and were attached lengthwise along the posterior surface of the primary gill filaments. When the capsules were opened, long thread-like worms were revealed, which were identified as Gonapodasmius epinepheli Abdul-Salam, Sreelatha and Farah. The parasites were encapsulated between the basement membrane of the epithelium and the efferent artery of the gill filament. The response of the host included mild hyperplasia of the interlamellar epithelium and an increase in the number of mucous cells. (C) 2001 Elsevier Science B.V. All rights reserved.

A new wavelet-based method for the solution of the population balance equation

A new wavelet-based method for solving population balance equations with simultaneous nucleation, growth and agglomeration is proposed, which uses wavelets to express the functions. The technique is very general, powerful and overcomes the crucial problems of numerical diffusion and stability that often characterize previous techniques in this area. It is also applicable to an arbitrary grid to control resolution and computational efficiency. The proposed technique has been tested for pure agglomeration, simultaneous nucleation and growth, and simultaneous growth and agglomeration. In all cases, the predicted and analytical particle size distributions are in excellent agreement. The presence of moving sharp fronts can be addressed without the prior investigation of the characteristics of the processes. (C) 2001 Published by Elsevier Science Ltd.

New chlorinated peptides from the tropical marine sponge Dysidea sp.

Five new chlorinated peptides (5)-(9) have been isolated from a Dysidea sp. and identified by two-dimensional NMR spectroscopy. The absolute stereochemistry of the metabolites was deduced by chemical correlation with S-(-)-4,4,4-trichloro-3-methylbutanoic acid (10) and with an alcohol (11). (C) 2001 Elsevier Science Ltd. All rights reserved.

Four new species of Macropodinium (Ciliophora : Litostomatea) from Australian wallabies and pademelons

Samples of Macropodinium spp. were collected from 3 new macropodid species: from 21 of 28 (75%) black-striped wallabies (Macropus dorsalis); 10 of 11 (91%) swamp wallabies (Wallabia bicolor); and 22 of 43 (51%) Tasmanian pademelons (Thylogale billardierii). The examination of ciliate morphology by silver impregnation and scanning electron microscopy led to the redescription of the genus Macropodinium and the description of 4 new species: Ma. tricresta sp. nov. and Ma. spinosus sp. nov. from M. dorsalis; Ma. maira sp. nov. from T. billardierii; and M. bicolor sp. nov. from W. bicolor; each species was strictly host specific. Cellular orientation was reinterpreted on the basis of vestibular morphology and it is concluded that Macropodinium spp. are laterally rather than dorso-ventrally compressed. The striated groove is thus dorso-ventral rather than lateral. Oral ciliation consisted of up to three bands: an adoral band composed of oblique kineties; a vestibular band of longitudinal kineties; and a preoral band of longitudinal kineties. Somatic ciliation occurred in two longitudinal bands: a dense band composed of several parallel kineties on the left side of the dorso-ventral groove; and a sparse band composed of a single kinety on the right internal side of the dorso-ventral groove. Few structures were homologous to those of other litostome ciliates, and thus the relationship of Macropodinium to other litostomes cannot yet be clearly defined.

Dendromonocotyle colorni sp n. (Monogenea : Monocotylidae) from the skin of Himantura uarnak (Dasyatididae) from Israel and a new host record for D-octodiscus from the Bahamas

Dendromonocotyle colorni sp. n. (Monogenea: Monocotylidae) is described from the dorsal skin surface of two specimens of Himantura uarnak (Forsskal) kept at the Eilat Underwater Observatory in Israel. Dendromonocotyle colorni is distinguished from the other eight species in the genus by the morphology of the terminal papillar sclerite on the haptor, the distal portion of the male copulatory organ and the morphology of the vagina. The development of the male copulatory organ is detailed for D. colorni and the adaptations of species of Dendromonocotyle to life on the dorsal skin surface of rays are discussed. Dendromonocotyle octodiscus Hargis, 1955 was identified from the dorsal skin surface of the southern stingray Dasyatis americana Hildebrand et Schroeder off Bimini, Bahamas and represents a new host record.