[Development of a troublesome behavior scale (TBS) for elderly patients with dementia]

A rating scale for assessing troublesome behavior associated with dementia illnesses was developed. This instrument, named the troublesome behavior scale (TBS), is designed to be completed by family and professional caregivers. It is comprised of 14 questions assessing a variety of types of disruptive or burdensome behavior. Two of the 14 questions differ in their assessment for outpatients and that for inpatients. Each of the 14 items is rated with 5 possible responses corresponding to the frequency of the behavior in the preceding month (from 0 = never, to 4 = once every day or more). Thus, higher scores indicate more disturbance. The TBS was administered to 146 outpatients and 167 inpatients with dementia based on the DSM III-R criteria in order to test its reliability and validity. The data were analyzed separately for outpatients and inpatients. The reliability of the scale, based on calculation of perfect agreement rates and kappa values, indicated high test-retest and inter-rater reliability for both samples. Validity, by confirmatory factor analysis of the data from the outpatients, revealed three main factors, namely, "behavior toward caregivers", "self-absorbed behavior" and "elaborate behavior". The same analysis of data from inpatients resulted in a different set of three factors: "behavior interfering with care work", "behavior necessitating watchful protection" and "behavior resulting in missing articles". From these findings TBS appears to be a reliable and valid instrument for assessing troublesome behavior of patients with dementia.

Expression of HIV-1 and interleukin-6 in lumbosacral dorsal root ganglia of patients with AIDS

We examined the immunopathology and the expression of human immunodeficiency virus type 1 (HIV-1) in lumbosacral dorsal root ganglia (DRGs) from 16 patients with acquired immunodeficiency syndrome (AIDS) and 10 HIV-1-seronegative controls. Using in situ hybridization, we detected HIV-1 RNA in a few perivascular cells in DRGs from five of 16 AIDS patients (31%). In addition, using polymerase chain reaction, we detected HIV-1 DNA more frequently in DRGs from four of five AIDS patients (80%) examined. We detected interleukin-6 (IL-6) immunoreactivity in endothelial cells in DRGs from seven of 16 AIDS patients (44%) but from none of 10 HIV-1-seronegative controls (0%). We found more nodules of Nageotte, CD8+ T lymphocytes, and intercellular adhesion molecule-1 (ICAM-1)-positive endothelial cells and mononuclear cells in DRGs from AIDS patients than in DRGs from controls. Increased numbers of nodules of Nageotte in DRGs of AIDS patients were associated with detection of HIV-1 RNA by in situ hybridization and detection of IL-6 by immunohistochemistry. We conclude that low levels of replication of HIV-1, through cytotoxic T lymphocytes or expression of cytokines, may play a role in the subclinical degeneration of sensory neurons frequently observed in DRGs of AIDS patients.

Verotoxin induces hemorrhagic lesions in rat small intestine. Temporal alteration of vasoactive substances

E. coli O157:H7 produces a cytotoxin active against Vero cells that has been termed verotoxin. In this study, we demonstrated that local intraarterial injection of verotoxin induced a decrease in blood flow and an increase in hemorrhagic lesions in rat small intestine. Significant increases in the area of hemorrhagic lesions were observed at 120 min after verotoxin injection. These lesions were produced by either verotoxin 1 or 2, but verotoxin 2 produced more extensive lesions. The temporal alteration of vasoactive substances in microcirculatory beds was determined after the administration of culture filtrate of E. coli O157:H7. Tissue-type plasminogen activator activity in regional plasma was significantly elevated as early as 30 min, suggesting that local fibrinolytic activation mediated by microvascular endothelium occurred. There was also early elevation of platelet-activating factor content in the ileal mucosa and its level remained significantly elevated thereafter. Intestinal blood flow, as determined by a laser Doppler flowmeter, started to decrease at about 45 min. The platelet-activating factor antagonist CV6209 was shown to attenuate the decrease in blood flow as well as the development of hemorrhagic lesions, demonstrating that platelet-activating factor is an important mediator for the microcirculatory damage. Accumulation of neutrophils demonstrated by myeloperoxidase activity in the intestinal mucosa and overproduction of oxygen-radicals from neutrophils of the mesenteric veins determined by the luminol-dependent chemiluminescence assay were observed at 60 min, corresponding with the decreased blood flow. Platelet-activating factor may be closely involved in the process of leukocyte accumulation and increased oxygen radical generation, because CV6209 also significantly attenuated these changes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Adrenal hepatoid carcinoma producing alpha-fetoprotein: a case report]

A case of left adrenal hepatoid carcinoma is reported. The patient was a 57-year-old male and his chief complaint was general fatigue. Preoperative laboratory data showed markedly increased levels of alpha-fetoprotein (AFP) (30,500 ng/ml) and PIVKA-II (3.01 AU/ml). Both computed tomography (CT) and magnetic resonance computed tomography (MRCT) showed left adrenal tumor (8 x 5 cm). Angiography showed hypervascular tumor over the upper pole of the left kidney. Thoracoabdominal nephro-adrenalectomy was performed. Histological examination demonstrated hepatoid carcinoma of the left adrenal gland. AFP was positive in the tumor cells. The levels of both AFP and PIVKA-II dropped to the normal range postoperatively. Hepatoid carcinoma in the urological field is very rare. As hepatoid carcinoma in the Japanese literature in the urological field, there were only 4 cases of renal tumor, 2 cases of renal pelvic tumor, 2 cases of retroperitoneal space and 1 case of urachal tumor. This is the first report of adrenal hepatoid carcinoma in Japan.

Involvement of 5-HT3 receptors in the initiation of pharyngeal reflex

Activation of peripheral serotonin (5-HT) receptors, classified as 5-HT3, was shown to elicit the pharyngeal reflex in anesthetized rats. Intravenous bolus injection of 5-HT (6.25-50 micrograms/kg) evoked rhythmic bursts in the efferent pharyngeal branch of the vagus nerve in a dose-related manner, whereas afferent superior laryngeal nerve activity was not altered by even a high dose of 5-HT. The pharyngeal branch response was blocked by pretreatment with a selective 5-HT3-receptor antagonist YM060 (1 and 10 micrograms/kg). A 5-HT3-receptor agonist, 2-methyl-5-HT, also produced a rhythmic burst in the pharyngeal branch, and this effect was blocked by YM060. Intrapharyngeal pressure was rhythmically increased by both 5-HT (12.5-50 micrograms/kg) and 2-methyl-5-HT (6.25-50 micrograms/kg) in a dose-related manner. Both of these effects were antagonized by YM060 (10 micrograms/kg). In addition, a neuromuscular blocking agent vecuronium (1 mg/kg iv) completely inhibited the 5-HT-induced increase in pharyngeal pressure. After a bilateral vagotomy was performed below the nodose ganglia, the 5-HT-induced increase in pharyngeal branch activity was abolished, whereas a bilateral sectioning of the superior laryngeal nerve did not alter the 5-HT-induced increase in pharyngeal branch activity. Retrograde tracing with fluorescent dye (fast blue) was used to identify the cell bodies of the pharyngeal branch. Pharyngeal motoneuron cell bodies were distributed along the entire length of the nucleus ambiguus. Our results suggest that exogenous 5-HT-induced increases in pharyngeal branch activity and intrapharyngeal pressure may be initiated by the peripheral 5-HT3-receptors of the vagal nervous system and that this may be a viscerosomatic reflex.

Expression of cytokines in brain lesions in subacute sclerosing panencephalitis

We analyzed frozen brain specimens from three patients with subacute sclerosing panencephalitis (SSPE) for the presence of interleukin (IL)-1 beta, IL-2, IL-6, tumor necrosis factor (TNF), lymphotoxin (LT), and interferon (IFN)-gamma using immunocytochemical techniques. We detected these cytokines in SSPE brain lesions demonstrating extensive cellular infiltrates, demyelination, and gliosis. Double-label immunocytochemistry, using cell-specific markers, showed that positive immunoreactivity for these cytokines was present on both infiltrating cells and resident brain cells. We also found IL-6, TNF, and IFN-gamma at lower levels in brain tissue from a patient with progressive multifocal leukoencephalopathy. In contrast, normal control brain sections showed no reactivity for any of the cytokines. These findings indicate that IL-1 beta, IL-2, IL-6, TNT, LT, and IFN-gamma may be produced in SSPE lesions and may be involved in the lesion pathogenesis of SSPE.

Dietary polydextrose affects the large intestine in rats

We compared the effects of dietary polydextrose with those of dietary fibers on the luminal pH and morphology of the large intestine in rats. In Experiment 1, animals were fed diets supplemented with two levels (5 and 10 g/100 g) of polydextrose or dietary fiber (cellulose or galactomannan derivatives) for 52 d. Polydextrose and galactomannan derivatives significantly lowered large intestinal pH and increased the cecal weight and surface area compared with cellulose. However, the thickness of the cecal muscular layer was significantly less in the polydextrose-fed groups than in the cellulose-fed groups. In Experiment 2, rats were fed either a fiber-free diet or a diet containing 5, 10 or 20 g/100 g polydextrose for 92 d. Dietary polydextrose significantly acidified the cecal contents and promoted cecal mucosal growth but thinned the cecal muscular layer. The shape of colonic mucosa of the group fed the 20 g/100 g polydextrose diet was clearly different from that of the group fed the fiber-free diet. These findings indicate that the effect of polydextrose on the morphology of the large intestine is different from the effect of dietary fibers.

Analyses of metal ions in spider venoms in relation to insecticidal activity of clavamine

To elucidate insecticidal activity of spider toxins, metal ions in venoms and in the bodies were determined by thin layer chromatography, spark source mass spectrometry, ion chromatography, inductively coupled plasma emission spectrometry and atomic absorption spectrometry. Two kinds of spiders were used, Nephila clavata and Nephila maculata. Metals from their venom glands were extracted with hydrochloric acid and the metal concentrations were almost the same in the two species. Many kinds of metals, Fe, Zn, Pb, Cu, Ca, Mg, Na, P and S were found at higher levels in the venoms at concentrations higher than in the bodies. The contents of metal ions were low in the dragonfly and the cicada which are considered to be preys. Clavamine, the main insecticidal component in N. clavata, was effective on larvae of a mosquito with Ca2+, Fe3+ or Pb2+, but ineffective with Mg2+, Zn2+, Fe2+ or Cu2+. It is suggested that the metal chelates play an important role in the intoxication and detoxication of the spider toxins.

Chromosome studies in 70 brain tumors with special attention to sex chromosome loss and single autosomal trisomy

Chromosome analysis was performed on 70 brain tumors. Thirty-six tumors showed clonal karyotypes characterized by many autosomal abnormalities; 20 meningiomas revealed monosomy 22 as a consistent abnormality, and 12 gliomas showed various abnormalities frequently involving chromosomes 3, 7, and 22. Of the remaining 34 tumors, 24 had normal karyotypes and 10 had clonal cells with loss and/or an extra sex chromosome with single trisomy of chromosomes 3, 6, 7, or 14. Sex chromosome aneuploidy was mostly due to loss of the Y or an X chromosome and was observed in 25 tumors, usually together with autosomal abnormalities. In these tumors the average frequency of cells with sex chromosome aneuploidy was 52%, with a range from 12% to 100%. Loss of the Y was found significantly more frequently in tumors of aged patients. Chromosome analysis in materials subcultured for a long period showed a tendency for cellular selection in which clonal cells with many autosomal abnormalities disappeared rapidly and karyotypes having loss or an extra sex chromosome and/or trisomy 7 were present in an increasing proportion with advance of cell generations in vitro. We infer that the cells having loss of one sex chromosome or trisomy 7 have a proliferative advantage. And that cells bearing only these abnormalities may exist in normal brain tissue more abundantly than in any other body tissue. The possibility of tissue-specific aneuploid mosaicism in the normal tissue would allow an alternative interpretation for simple autosomal trisomy in solid tumors.

Structures of novel bufadienolides in the eggs of a toad, Bufo marinus

In this paper, we report chemical structures of five compounds including four novel polyhydroxylated cardiac steroids in the eggs of a toad, Bufo marinus. These cardiac steroids were purified by high-performance liquid chromatography, and their structures were determined to be 11 alpha,19-dihydroxy-telocinobufagin (I), 11 alpha-hydroxytelocinobufagin (II), 11 alpha,19-dihydroxymarinobufagin (III), 11 alpha-hydroxymarinobufagin (IV) and 19-hydroxytelocinobufagin (V) on the basis of spectral data of nuclear magnetic resonance and mass spectroscopy. All the five compounds showed biological activity, as tested by inhibition of Na+,K(+)-ATPase activity and of [3H]ouabain binding to the receptor on Na+,K(+)-ATPase. This is the first finding of bufadienolides as cardiac steroids in animal eggs.

The functional role of opioid receptors in acetylcholine release in the rat adrenal medulla

The functional role of opioid receptors in acetylcholine release from splanchnic nerve terminals in the adrenal medulla was investigated in halothane-anesthetized rats. The extracellular acetylcholine level was measured by a newly developed in vivo adrenal microdialysis method. The potassium (K+)-evoked acetylcholine release from the splanchnic nerve terminals was inhibited by morphine (10 microM), a mu-opioid receptor agonist, and [D-Pen2,D-Pen5]enkephalin (DPDPE, 1 and 10 microM), a delta-opioid receptor agonist. These inhibitory effects of morphine and DPDPE were significantly abolished by naltrexone (9 mg/kg i.p.), a mu-opioid receptor antagonist, and naltrindole (9 mg/kg i.p.), a delta-opioid receptor antagonist, respectively. 5 alpha,7 alpha-beta-(-)- N-methyl-N-[7-(1-pyrrolidinyl)-1-oxaspiro(4,5)dec-8-yl]benzene acetamide (U69593, 10 microM), a kappa-opioid receptor agonist, had no influence on the K(+)-evoked acetylcholine release. The findings suggest that both mu- and delta-opioid receptors might have a functional role in acetylcholine release from splanchnic nerve terminals in the adrenal medulla of the rat. The present study indicates that adrenal microdialysis is a useful method for studying the control mechanism of adrenomedullary function in the rat in vivo.

mu-Opioid receptors modulate noradrenaline release from the rat hippocampus as measured by brain microdialysis

The modulation of noradrenaline (NA) release via presynaptic opioid receptors in the hippocampus of freely moving rats was studied by the use of brain microdialysis. Extracellular levels of NA were estimated by assaying its concentrations in the perfusion fluid using high-performance liquid chromatography (HPLC) with electrochemical detection (ECD). Spontaneous NA levels were reduced by tetrodotoxin (1 microM) co-perfusion and were increased by peripheral administration of desipramine (5 and 10 mg/kg, i.p.). Addition of potassium (K+, 60 and 120 mM) to the perfusion fluid evoked a concentration-dependent release of NA. K+ (120 mM)-evoked NA release was markedly reduced by removal of calcium (Ca2+) from the perfusion fluid. These results indicate that both the spontaneous and the K(+)-evoked NA release measured by the use of brain microdialysis coupled with HPLC-ECD can be used as indices of neuronal release from the noradrenergic nerve terminals. A mu-opioid receptor agonist, morphine (0.01-10 microM), when co-perfused with K+ (120 mM), produced a reduction of K(+)-evoked NA release in a concentration-dependent manner. Neither co-perfusion with a high concentration of [D-Pen2, D-Pen5]-enkephalin (DPDPE) (10 microM), an agonist selective for delta-opioid receptors, nor with U-69593 (10 microM), an agonist selective for kappa-opioid receptors, modified the K+ (120 mM)-evoked release of NA. Morphine-induced (1 microM) inhibition of NA release was blocked by a mu-opioid receptor antagonist, naltrexone (3 and 9 mg/kg, i.p). Naltrexone by itself did not alter the spontaneous NA levels or the K(+)-evoked NA release.(ABSTRACT TRUNCATED AT 250 WORDS)

[Development of an assessment of basic care for the demented (ABCD)]

A rating scale measuring care status related to assistance with basic ADL for demented patients was developed. This instrument, named the ABCD, is designed to be completed by family and professional caregivers, and consists of two subscales assessing the level of difficulty of help with the ADL (difficulty scale) and the reasons why assistance is needed (reason category). In the difficulty scale, each of 6 items is rated with 4 possible responses corresponding to the degree of physical assistance from the caregiver and of the patient's cooperation with the assistance. In the reason category, for 5 activities excluding voiding, the reason is assessed with the following three possible responses: A; physical disability, B; disability in motivation and/or so-called apraxia, C; a combination of A and B. The ABCD was administered to 124 outpatients and 203 inpatients with dementia based on the DSM III-R criteria in order to test its reliability and validity. The data from the out- and inpatient samples were analyzed separately. The reliability study of the two subscales based on calculation of perfect agreement rates and kappa values indicated high test-retest and inter-rater reliability for both samples. The Cronbach alpha values of the difficulty scale were also high. As to the validity of the difficulty scale, there was a significantly high correlation between the score obtained with this scale and the results of two established assessment instruments. For the outpatients, logistic regression analysis revealed that the score obtained with this scale was the only predictor of institutionalization and mortality within 1 year after the baseline examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of a previously unknown compound as 2'-deoxycytidine found in the plasma of breast cancer patients under combined chemotherapy

In an attempt to find an end-point for cancer chemotherapy, this study was designed to measure the adenine compounds in the plasma of breast cancer patients using HPLC with a selective reagent for adenine bases. The patients were treated by chemotherapy using cyclophosphamide, methotrexate and 5-fluorouracil. Blood was collected in tubes containing EDTA, the plasma separated by centrifugation and analysed by HPLC. An early peak due to the fluorescent derivative of an unknown compound reacted with bromoacetoaldehyde and its concentration appeared proportional to the chemotherapeutic courses of treatment. The compound in its native state without fluorescent derivatization was efficiently purified by using columns of DEAE- and CM-Sephadex. Its UV spectrum revealed maxima at 271, 280 and 272 nm in solutions of pH 7, pH 3 and pH 12, respectively. The electrophoretograms showed that it was neutral, positively and negatively charged at pH 7, pH 3 and pH 12, respectively. Thin-layer chromatograms showed that it had the same Rf as 2'-deoxycytidine (dCyd) which was confirmed by a positive reaction for deoxyribose. It was concluded that bromoacetoaldehyde formed a weakly fluorescent product with dCyd which gave rise to the early peak in the anion exchange chromatograms. From the calculation of the recovery obtained by the purification process, the cancer patients undertaking more than 12 courses had a dCyd level of approximately 20 mM while the corresponding figure in normal volunteers was less than 1 mM. These results may be useful in assessing the status of the cancer patients.

Neurochemical profiles in cerebrospinal fluid of stroke-prone spontaneously hypertensive rats

The purpose of the present study was to evaluate stroke-prone spontaneously hypertensive rats (SHRSP) neurochemically by determining the cerebrospinal fluid (CSF) levels of acetylcholine (ACh), norepinephrine (NE) and serotonin (5-HT) as an index of central neuronal activity. The CSF ACh levels of 15- to 20-week-old SHRSP were significantly lower than those of age-matched Wistar Kyoto rats (WKY) both under the urethane/alpha-chloralose anesthesia and in freely moving conditions. The difference in the CSF ACh levels between SHRSP and WKY was more marked at 30-40 weeks. Sustained changes were not observed in the CSF NE and 5-HT levels. Thus, the progressive dysfunction in the central cholinergic system may characterize the pathophysiological state of this animal model with cerebral lesions caused by continuous high blood pressure.

The relationship between the sialic acid concentrations in the serum and whole saliva in rats with naturally occurring gingivitis

Pocket probing depth was correlated with the amount of salivary sialic acid in pilocarpine-stimulated saliva in ODU plaque-susceptible rats (ODUS/Odu) (r = 0.657, P < 0.01), but not with the content of serum sialic acid. There was no difference in the amount of serum sialic acid content between ODUS/Odu and plaque-resistant rats. These results suggest that the amount of sialic acid in the saliva can be a useful index of the severity of periodontal disease.

Sleep disturbance of end-stage renal disease

Sleep disturbance of patients with end-stage renal disease was examined in a sample of 127 patients receiving hemodialysis (HD) therapy. The results indicate that sleep disturbance occurs quite often. Especially, there was a high incidence of sleep disturbance with prolonged HD therapy and with advancing age, and that somatic complications due to long-term HD indirectly influence sleep disturbance. On the effect of drug therapy, levodopa produced significant clinical effects on RLS compared to ordinary hypnotics. Carbamazepine equally tended to produce favorable clinical effects on RLS.

Influence of fatty acid absorption on bidirectional release of immunoglobulin A into intestinal lumen and intestinal lymph in rats

Effects of absorption of long and middle chain fatty acids on IgA secretion into the intestinal lumen and intestinal lymph and the factors which evoke changes in IgA secretion during the absorptive process were examined in rat small intestine. Bidirectional secretion of IgA from the intestinal mucosa into the intestinal lumen and intestinal lymph was continuously observed in the control condition. Perfusion of oleic acid (a long-chain fatty acid) micelle into the jejunal loop induced a significant increase in IgA output into the intestinal lymph. In contrast, lymphatic output of IgA was significantly decreased when oleic acid micelle was administered intraduodenally. Absorption of octanoic acid, a middle-chain fatty acid, did not produce any significant changes in IgA output into either direction. CR1505, a CCK-receptor antagonist, significantly attenuated the oleic acid-induced increase in IgA secretion into the intestinal lumen, but did not affect the oleic acid-induced decrease in lymphatic IgA secretion. Pluronic L-81, an inhibitor of chylomicron formation and secretion, significantly attenuated the decrease in IgA output into the intestinal lymph during oleic acid absorption without affecting the luminal IgA output. The rate of release of IgA into the intestinal lumen is stimulated by absorption of long-chain fatty acids possibly through the influence of locally released CCK, while the transport process of IgA into lymphatics is controlled by a different mechanism which is closely correlated with the intracellular formation and secretion of chylomicron.

[Stellate ganglion blocks as the suspected route of infection in a case of cervical epidural abscess]

Spinal epidural abscess is a comparatively rare disease. Its prognosis reportedly depends on degree and duration of the neurological symptoms before the treatment. Thus, the importance of early diagnosis and prompt surgical treatment has been emphasized repeatedly. In the case reported here stellate ganglion blocks were considered to be involved in the etiology of a cervical epidural abscess. <Case> The 47-year old woman complained of tinnitus and vertigo and repeatedly underwent stellate ganglion blocks over a period of 10 months. In August, 1991, the patient complained of back pain and developed fever. A few days later she noticed motor weakness and sensory disturbances in the legs. Ten days after the onset of these neurological symptoms she complained of rapidly progressive tetraplegia and was referred to this hospital for admission. On admission, she was fully conscious but febrile. Neurologically, she presented tetraplegia, hypesthesia below level of C7 and slight cervical rigidity. Bladder and bowel dysfunction were also observed. MRI examination showed an epidural mass behind vertebral bodies C6-7 compressing the spinal cord. Antibiotic therapy was initiated immediately and emergency surgical decompression was performed through an anterior approach. Intraoperative findings showed a discitis and yellowish liquid pus in the epidural space. Culture of the pus revealed staphylococcus aureus. In this case repeated stellate ganglion blocks before onset of the symptoms were the suspected route of infection. Postoperative MR images confirmed satisfactory decompression of the spinal cord and motor power was gradually recovered after surgery. Approximately 4 months after surgery she could walk independently. Cervical epidural abscess has been rarely reported as a complication of stellate ganglion block.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognosis in esophageal carcinoma with cervical lymph node metastases

BACKGROUND

The purpose of this study was to assess cervical lymph node (C-LN) metastases and to examine whether the site of the C-LN metastasis impacts on survival of the patient with thoracic esophageal cancer.

METHODS

Transthoracic esophagectomy and three-field dissection (mediastinal, abdominal, and C-LN) followed by esophageal reconstruction were performed on 68 patients with squamous cell carcinoma of the thoracic esophagus who were seen at our institution from 1983 to 1990.

RESULTS

C-LN metastasis was seen in 20 (29.4%) patients, and the survival curve of the 20 patients with positive C-LN metastasis was not significantly different from that of the 48 patients without positive C-LN metastasis. The survival curve of patients (n = 7) with positive node limited to recurrent laryngeal nerve chain node (RLN group) was significantly better than that of patients (n = 13) with positive internal jugular nodes including supraclavicular nodes (IJN group) (p = 0.010; generalized Wilcoxon). This was because there were more patients in the IJN group (84.6%) than in the RLN group (28.6%) (p = 0.022) who had five or more positive nodes in the three fields.

CONCLUSIONS

The results suggest that RLN should not be defined as M1 but as N1 in thoracic esophageal cancer.

Adrenomedullary hyperplasia associated with cortisol producing adenoma

We report a case of a 58-year-old man with adrenal medullary hyperplasia associated with cortisol producing adenoma. Preoperative examination showed both adrenocortical and adrenomedullary hyperfunction. No Cushingoid sign was present and pheochromocytoma-like symptoms were predominant. Abdominal computerized tomography revealed a left adrenal tumor stained by contrast medium. Histologically, the adrenal tumor was found to be a cortical adenoma, and medullary hyperplasia was observed in the remaining parenchyma.