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In this paper I argue that large defense firms can successfully diversify into civilian markets if innovators gain complementary knowledge and power to promote new civilian innovations. For such firms, diversification is neither easy nor impossible, but requires that new product teams overcome barriers based on bureaucracy, changing managerial regimes, and state policies that discourage diversification. Political barriers to diversification, based on managerial choices and government policies, exist both within and outside the firm. Although specialization hurdles based on knowledge can be overcome, political barriers are more challenging, and limit the rate of civilian spin-offs in large military hub firms.

An electron microscopy study of Argentine plantago virus (APlaV)-infected plants has revealed that the virus induces crystal-like inclusions in both the cytoplasm and the nucleus of infected cells, in addition to the charcteristic aggregates of virus particles formed by most potexviruses. These crystals are produced in different plants and in tissue at different stage of development and they can be readily detected by leaf dip preparations. We conclude that the crystalline inclusions are virus-specific, and therefore can be regarded as a characteristic feature of APlaV infections. ZusammenfassungKristalline Strukturen, die mit der Infektion des Potexvirus Argentine plantago virus (APlaV) assoziiert sind Einc elektronenmikroskopische Untcrsuchung von Argentine plantago virus (APlaV)-infizierten Pflanzen zeigte, das das Virus kristallahnliche Einschlusse im Zytoplasma und im Zellkern der infizierten Zellen induzicrte sowie die fur Potexviren charakteristischen Aggregate von Viruspartikeln gebildet wurden. Die.se Kristalle wurden in unterschiedlichen Pflanzen und lm Gewebe bci unterschiedlichen Entwicklungsstadicn produziert und konnten durch Bktteintauchpraparate leicht ermittelt werdeti. Daraus schliesen wir, das die kristallinen Einschlusse virusspezifisch sind und daher als ein charakteristisches Merkmal von APlaV-Infektionen angesehen werden konnen.

Inducing general anesthesia often involves mask ventilation using high fresh gas flow (FGF) to administer anesthetic vapor prior to endotracheal intubation. A common practice is to turn the vaporizer off when the mask is removed from the patient's face to avoid room contamination (VAPOff). An alternative approach is to leave the vaporizer on and turn the FGF to minimum to reduce the amount of vapor laden gas that can enter the room (FGFOff). The objective of this study is to compare the relative induction times and vapor costs associated with each induction strategy.Each induction method was simulated using Gasman (MedMan Simulations, Chestnut Hill, MA) for Windows assuming a 70 kg patient. To simulate a period of mask ventilation with anesthetic vapor prior to intubation, the FGF was set to 6 l/min and the isoflurane vapor concentration to 1.2% (1 MAC) for three minutes with an alveolar ventilation of 5 l/min and cardiac output of 5 l/min. For the first simulation of the intubation period (FGFOff), FGF was turned to 150 ml/min, minute ventilation was set to zero and the vaporizer setting unchanged for one minute. Initial settings were then restored and the rate of change of anesthetic vapor concentration in the circuit (Vckt) and alveolus (Valv) followed for 10 minutes along with the cost of delivered vapor (V(S)). For the second simulation (VAPOff), after the initial three minutes of vapor delivery, the vaporizer was set to zero, minute ventilation was set to zero and the FGF left unchanged for one minute. The initial settings were then restored and Vckt, Valv and V(S) followed for ten minutes. The cost calculation was based upon a 100 ml bottle of Isoflurane at $72/bottle. Actual gas flow was measured at the y-piece of a circle system for fresh gas flows from 0.15 to 6 l/min.At the end of the simulated intubation period (minute 4), Vckt was unchanged with the FGFOff method whereas it had fallen by more than half with the VAPOff method. Using VAPOff, it took until the 6-minute mark for Vckt to return to the same concentration that existed prior to intubation at minute three. Throughout the 10 minute simulated induction, Valv using FGFOff exceeded Valv using VAPOff although the difference became small at the end of the period. V(S) was essentially identical at all time points. No flow into the room was measured at the minimum fresh gas flow whereas higher fresh gas flows resulted in a significant portion of the fresh gas flowing into the, room.The strategy of turning the FGF to minimum and leaving the vaporizer on during intubation does not contaminate the room and speeds induction by fostering a greater alveolar concentration than the VAPOff method. Cost savings are derived using FGFOff since a higher alveolar concentration is achieved at the same vapor cost. Additional cost savings are demonstrated since a low flow technique is possible immediately after intubation when using FGFOff. The practice of turning off the vaporizer during endotracheal intubation while FGF remains high should be abandoned.

To determine if Robust Sensor Fusion (RSF), a method designed to fuse data from multiple sensors with redundant heart rate information can be used to improve the quality of heart rate data. To determine if the improved estimate of heart rate can reduce the number of false and missed heart rate alarms.A total of 85 monitoring periods were investigated, 12 from the operating room, 60 from adult ICU and 13 from pediatric ICU. The operating room periods began with induction of anesthesia and ended at the completion of the anesthetic. For the ICU data, four hour blocks of time were studied. For each monitoring period, HR values were recorded at 5 second intervals or less from the ECG, SpO2 and IAC using a SpaceLabs Medical Gateway connected to a SpaceLabs Medical PC2. Fused estimates of HR were derived for every time point using RSF and all results accepted regardless of confidence value. Data were annotated manually to identify the "reference" HR (that HR value most likely to be correct) at all time points. All HR values from the sensors and the fused estimate that were different from the reference HR by more than +/- 5 beats/min were considered inaccurate. For each monitoring period, the total time per hour that data were either inaccurate or unavailable was calculated for each sensor as well as the fused estimates. The total time of false and missed HR alarms was found for all sensors and the fused estimate by comparing the data to thresholds for both high and low HR alarms at 150 bpm, 130 bpm, 110 bpm and 50 bpm, 40 bpm, 30 bpm respectively.The fused estimate of HR was consistently as good or better than the estimate available from any individual sensor. The fused estimates also consistently reduced the incidence of false alarms compared with individual sensors without an unacceptable incidence of missed alarms.Redundancy in sensor measurements can be used to improve HR estimation in the clinical setting. Methods like RSF which improve the quality of monitored data and reduce nuisance alarms will enhance the value of patient monitors to clinicians.

Physiologic data measured in the clinical environment is frequently corrupted causing erroneous data to be displayed, periods of missing information or nuisance alarms to be triggered. To date, the possibility of combining sensors with similar information to improve the quality of the extracted data has not been developed. The objective of this work is to develop a method for combining heart rate measurements from multiple sensors to obtain: (i) an estimate of heart rate that is free of artifact; (ii) a confidence value associated with every heart rate estimate which indicates the likelihood that an estimate is correct; (iii) a more accurate estimate of heart rate than is available from any individual sensor.The essence of the method is to discriminate between good and bad sensor measurements and combine only the good readings to derive an optimal heart rate estimate. Past estimates of heart rate are used to derive a predicted value for the current heart rate that is also fused along with the sensor measurements. Consensus between sensor measurements, the predicted value and physiologic credibility of the readings are used to distinguish between good and bad readings. Three sensor measurements and the predicted value are evaluated yielding 16 possible hypotheses for the current state of the available data. A Kalman filter uses the most likely hypothesis to derive the fused estimate. Statistical measures of the sensor error and rate of change of heart rate are adaptively estimated when data are sufficiently reliable and used to enhance the hypothesis selection process.The method of sensor fusion presented has been documented to perform well using clinical data. Limitations of the technique and the assumptions employed are discussed as well as directions for future research.

There are seven published cases of ileal carcinoid tumor misdiagnosed and treated as Crohn's disease. We evaluated 176 consecutive ileal carcinoid patients to determine the frequency with which this occurs. Clinical, hormonal, and radiographic data of those patients misdiagnosed were also analyzed to determine whether there were clinical lessons to be learned.Records of 176 patients with ileal carcinoid tumors were retrospectively reviewed. It was determined whether patients were diagnosed and treated for Crohn's before the diagnosis of carcinoid was established. Radiographic, hormonal, and clinical data were reviewed and comparison was made to those who were correctly diagnosed as having carcinoid.Of 176 ileal carcinoid patients, 4 were initially diagnosed and treated as having Crohn's; their mean age was 51.5 +/- 8.9 yr. The hormonal data of patients treated as Crohn's was indistinguishable from patients with known carcinoid. Two of four patients had colonoscopy performed, neither had terminal ileal intubation. None responded to medical therapy and all required surgery for diagnosis. The mean time from symptom onset to the establishment of the correct diagnosis was 24 +/- 6.9 months with a range of 6 to 45 months.Although rare, ileal carcinoid tumors may be misdiagnosed as Crohn's disease. In our study approximately 2.3% of patients with ileal carcinoid were initially diagnosed and treated as having Crohn's disease. The presence of disease refractory to medical therapy should alert clinicians to this possibility and urinary 5-HIAA levels should be obtained as a screening test.

This study was designed to evaluate the effect of Paremyd, a combination of 1.0 percent hydroxyamphetamine hydrobromide and 0.25 percent tropicamide, on pupil size during binocular indirect ophthalmoscopy (BIO) upon 164 subjects of various skin pigmentation, iris color, and age.Pupillary dilation and ease of performing BIO were measured after 30 minutes following instillation of a single drop of either Paremyd or tropicamide (1.0 or 0.5 percent) to an eye. Subjects were assigned to one of three groups; either Paremyd OU, or Paremyd OS and tropicamide (either 0.5 or 1.0 percent) OD, or Paremyd OD and tropicamide OS. Pupillary dilation was measured during BIO performed at a set illumination using a near point card.Results indicate that Paremyd is a significantly more effective dilator than either concentration of tropicamide alone. BIO was rated good to excellent for all dilating agents. As could be expected (based upon data from previous experiments), there was a small, but significant, negative correlation between dilation and age, skin pigmentation, and iris pigmentation.Paremyd, because of its superior effect upon dilation without side effects, can be the preferred agent used for routine single-drop dilation in all patients, independent of age, iris color, or skin color.

A 30-yr-old female with a carcinoid tumor of the ampulla of Vater is discussed. This rare tumor presented in an unusual fashion with isolated pancreatitis in the absence of cholestasis. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsies. Surgical removal led to complete resolution of symptoms. The importance of considering less common structural lesions such as ampullary carcinoids in the differential diagnosis of pancreatitis in patients without identifiable risk factors is stressed.

Our goal was to describe the abdominal CT findings in 52 patients with midgut carcinoid tumors and correlate these findings with their biochemical profiles.Abdominal/pelvic CTs of 52 patients with midgut carcinoid tumors were reviewed retrospectively for the presence of liver metastases, mesenteric and peritoneal disease, bowel changes, lymphadenopathy, and the presence of the primary tumor. Logistic regression models were used to evaluate the association between these findings and the serum and platelet serotonin and urine 5-hydroxyindolacetic acid levels.The most common finding was hepatic metastases (34/52). Nonspecific mesenteric soft tissue stranding was present in 26 of 52 and a discrete mesenteric mass was present in 25 of 52. These masses had linear, radiating soft tissue spokes in 16 of 25 and contained calcification in 10 of 25. Retroperitoneal and mesenteric lymphadenopathy was present in 14 of 52 and 11 of 52 cases, respectively. Carcinomatosis was present in 11 of 52. Bowel wall thickening was seen in 9 of 52. Six patients had a small bowel obstruction. Elevated serum serotonin, platelet serotonin, and urine 5-hydroxyindolacetic acid levels were significantly associated with the presence of liver metastases (p = 0.0032, 0.0098, and 0.0450, respectively). Elevated platelet serotonin levels were also significantly associated with the presence of a mesenteric mass (p = 0.0101).In our population, the most common findings of a midgut carcinoid tumor are liver metastases, nonspecific mesenteric soft tissue changes, a discrete mesenteric mass with radiating soft tissue spokes, often containing calcification, and lymphadenopathy. As expected, liver metastases correlate strongly with the presence of elevated biochemical levels. A new observation is the correlation of elevated platelet serotonin levels and mesenteric masses. We hypothesize that platelet serotonin may be the factor that stimulates stromal cells to produce mesenteric fibrosis and mass formation.

Hypercalcemia was found in a dog examined for episodic weakness and disorientation. A right adrenal mass identified on abdominal ultrasonographic examination was diagnosed as a pheochromocytoma based on increased 1231-metaiodobenzylguanidine uptake and characteristic histopathological features. Serum intact parathyroid hormone (iPTH), total serum calcium, and ionized serum calcium were increased prior to surgery. Although both total and ionized serum calcium concentrations decreased to within normal reference ranges following surgery through postoperative day 17, subsequent high concentrations with increased serum iPTH concentrations confirmed concurrent primary hyperparathyroidism. A right parathyroid tumor was suspected based on a technetium-99m-sestamibi (99mTc-sestamibi) scan.

Detection of abnormal catecholamine levels and localization of tumor mass are important factors in the diagnosis and treatment of pheochromocytoma. Iodine 131-labeled metaiodobenzylguanidine scintigraphy was performed in 64 patients with suspected pheochromocytoma if their urinary catecholamine levels were borderline or elevated, or if the clinical suspicion for pheochromocytoma was high in spite of normal urinary catecholamine determinations. The 131I-metaiodobenzylguanidine scans were evaluated for abnormal localization of tracer. Twenty-four-hour urine collections were analyzed for vanillylmandelic acid, homovanillic acid, dopamine, epinephrine, and norepinephrine. Thirty of the 64 patients had pheochromocytomas. The 131I-metaiodobenzylguanidine scan had a sensitivity and a specificity of 88%. The 24-hour urine vanillylmandelic acid and norepinephrine measurements had the best sensitivity (97%), while the vanillylmandelic acid and homovanillic acid measurements had the best specificity (91%). In patients in whom the vanillylmandelic acid measurement and the 131I-metaiodobenzylguanidine scan were normal, no pheochromocytomas were found. In patients in whom the vanillylmandelic acid measurement and 131I-metaiodobenzylguanidine scan were abnormal, a pheochromocytoma was always present. The 131I-metaiodobenzylguanidine scan often documents the presence or absence of a pheochromocytoma and provides localization of the tumor in the preoperative evaluation of these patients.

Carcinoid liver metastases may be more easily detected by radionuclide liver-spleen studies (RN imaging study) than by computed tomography (CT). While multiple studies have suggested that CT is a more sensitive test than the Tc-99m sulfur colloid study for the detection of most types of liver metastases, carcinoid tumors appear to be an exception. The results of 23 pairs of CT and RN imaging studies that were obtained within one month of each other in patients with proven carcinoid tumors are reported. Comparison of the initial reports of the studies as well as a blinded reinterpretation of the studies suggest that in this group of patients the RN imaging study appeared to be superior to CT in the evaluation of the response to therapy.

To determine whether measurement of serotonin in urine would give useful complementary information to the usual measurement of 5-hydroxyindoleacetic acid (5-HIAA) in urine and platelet serotonin in platelets, I measured these analytes in 75 consecutive patients with carcinoid tumors, and found that 75% had above-normal urinary 5-HIAA excretion, 64% had above-normal serotonin excretion, and 64% had above-normal platelet serotonin concentration. Six patients had increased urinary serotonin, but 5-HIAA excretion and platelet serotonin concentration were normal. Only two of a further 50 patients with solid noncarcinoid tumors--and none of 55 patients with flushing or diarrhea, who did not prove to have a carcinoid tumor--had increased urinary serotonin. Ingestion of four bananas (a food rich in serotonin) increased urinary 5-HIAA but not urinary serotonin excretion of seven normal subjects. Evidently, measurement of urinary serotonin excretion is helpful in the evaluation of patients with suspected carcinoid tumors.

Six patients with the carcinoid syndrome (C.S) had serum luteinizing hormone (LH) concentrations that were greater than age and sex matched control subjects. The serum follicle stimulating hormone (FSH) and testosterone concentrations of the groups did not differ. Four of the 5 C.S. patients tested had an increase in serum testosterone after human chorionic gonadotropin administration and 5 of the 5 subjects tested had an increase in serum LH after clomiphene citrate administration. One of the 4 subjects treated with the tryptophan hydroxylase inhibitor parachlorophenylalanine (PCPA) had a reduction in serum testosterone. He was also receiving methysergide. The other 3 subjects treated with PCPA did not have any persistent alterations in serum testosterone.

A theoretical formulation for studying limb motions and joint kinetics by multiaxial accelerometry is developed. The technique is designed to study the swing phase of human gait, modeling the lower leg as a rigid body. Major advantages of the approach are that acceleration information needed for the calculation of forces and moments is generated directly, and that the method automatically generates its own initial conditions. Results of validation experiments using both artificial and experimental data demonstrate that the method is theoretically valid, but that it taxes available instrumentation and requires further development before it can be applied in a clinical setting.

A virus causing a severe disease of tomatoes in Argentina was identified as a strain of eggplant mosaic virus (EMV). It resembles the type, Abelia latent and various Andean potato latent strains of EMV in its host range and its transmissibility at allow rate by Epitrix sp. It differs from these strains, however, serologically and in some of its cytopathic effects. In serological agar gel double diffusion tests it proved to be closely related to the tomato white necrosis isolate of EMV studied by Barradas (1983) in Brazil.

To examine the role of kallikrein in the etiology of flushing in the carcinoid syndrome, chromogenic substrates specific for kallikrein were used to measure two isoenzymes of this substance. The plasma and glandular kallikrein levels were determined in 20 carcinoid patients and in 17 controls. Kallikrein levels were not significantly different between these two groups. Twelve carcinoid patients and six controls were given alcohol and the kallikrein activity was measured before and at 2, 5, and 10 minutes after alcohol ingestion; kallikrein activity did not change significantly. Kallikrein was absent from the primary tumors of seven patients with carcinoids. These studies, therefore, indicate that kallikrein with subsequent induction of bradykinin formation is not solely responsible for the flushing in the carcinoid syndrome.

The relationship between the dietary lipid-induced growth of the R3230AC mammary tumor and prostaglandin E2 (PGE2) levels as well as the effect of the prostaglandin synthetase inhibitor indomethacin (Ind) on these parameters was examined. F344 rats fed a high-fat (HF) diet containing 20% corn oil demonstrated more rapid tumor growth and higher tumor and plasma PGE2 levels than rats fed a 20% hydrogenated cottonseed oil (HCTO) diet. Addition of 0.004% Ind to the HF diet markedly reduced tumor and plasma PGE2 levels. However, Ind had no effect on tumor growth. Neither the fatty acid composition nor the insulin-binding capacity of the tumor plasma membranes was affected by Ind. Membranes from animals fed HF diets with or without Ind bound more 125I-labeled insulin than membranes from HCTO-fed rats. The results suggest that, for the R3230AC mammary tumor, reduction in both tumor and plasma PGE2 levels by Ind did not result in reduced tumor growth in animals fed diets high in polyunsaturated fatty acids.

This study determines if one could distinguish foregut from midgut carcinoid tumors by quantitative measurement of the monoamine oxidase (MAO) and diamine oxidase (DAO) activities in homogenates of tumors. The MAO activity of 16 foregut carcinoid tumors (1850 +/- 342 pmol/mg/minute) was significantly higher than the MAO activity of 11 midgut carcinoid tumors (407 +/- 43 pmol/mg/minute, P less than 0.01) with no overlap between the groups. Although all ten of the midgut carcinoids had measurable DAO activity (720 +/- 190 pmol/mg/minute), with the exception of one duodenal carcinoid tumor (33 pmol/mg/minute) the nine foregut carcinoid tumors evaluated did not have detectable DAO activity. The MAO activity of all of the foregut carcinoids was higher than that of 6 islet cell tumors, 28 paragangliomas, and 12 medullary carcinomas of the thyroid. Quantitative MAO and DAO activity may be useful in distinguishing foregut carcinoid tumors from other related tumors.

Our patient had a left suprarenal mass. His blood pressure was normal, but his urinary catecholamines (CA), vanillylmandelic acid (VMA), total metanephrines (TMn) and 5-hydroxyindolacetic acid (5HIAA) were elevated. In addition, he had elevated, nonsuppressible urinary 17-ketosteroids (17KS) and androsterone, but his urinary 17-hydroxycorticoids (17OHCS) and free cortisol were normal, as were his plasma cortisol and ACTH. After resection of the suprarenal mass, the patient's urinary hormone values reverted to normal. The mass contained a pheochromocytoma and an adrenocortical adenoma. The pheochromocytoma was unusual in that it contained very little norepinephrine (NE) and dopamine (DA) and an abundance of epinephrine (E) despite normal enzyme concentrations. Electron micrographs showed primarily E granules with few of the NE-type. The immunoperoxidase histochemical stains for vasoactive intestinal peptide (VIP) and serotonin (S) were strongly positive. The patient's blood pressure may have been normal because his pheochromocytoma secreted E, VIP, or S. The associated adrenocortical adenoma produced no symptoms and was probably coincidental.

Iodine-131 metaiodobenzylguanidine ([131I]MIBG) is concentrated in pheochromocytomas and can be detected by external imaging. We administered [131I]MIBG to 23 patients with carcinoid tumors to determine if it would be useful in scanning patients with these tumors. The carcinoid tumors of 14 of the 23 patients (61%) were visualized. Iodine-131 MIBG was concentrated most avidly by tumors of midgut origin (ileum, cecum); it was concentrated less avidly by some tumors of foregut origin (pancreas, stomach); it was not significantly concentrated by other tumors of foregut origin (bronchus). We conclude that 131I is a useful imaging agent for carcinoid tumors.

Prior studies indicate that the monoamine oxidase inhibitors (MAOI) harmine and iproniazide inhibit N-acetyltransferase activity from liver. In this report we have demonstrated that harmine and harmaline are potent inhibitors of N-acetyltransferase, purified from hamster and rat liver. However, other MAOI such as deprenyl, clorgyline, methysergide, cyproheptadine, phenelzine, pargyline, methyltryptamine and tranylcypromine have either no effect, or only trivial effects on N-acetyltransferase. There is no correlation between a compound's properties as an MAO and N-acetyltransferase inhibitor. One must consider the inhibitory effect of harmine and harmaline on both MAO and N-acetyltransferase when evaluating the effects of these compounds on physiological processes.

The importance of estrogens in the dietary lipid alteration of R3230AC mammary carcinoma growth and insulin binding was studied. Animals were divided into three groups [intact, ovariectomized, and ovariectomized treated with estradiol valerate (EV)] and were fed diets containing either 0% fat (fat free), 0.5% corn oil (low fat), or 20% corn oil (high fat). An alteration of tumor burden between animals fed high-fat versus either low-fat or fat-free diets was observed and appeared to be influenced by the estrogen status of the animal. The difference in tumor burden attributed to dietary lipid seen in intact rats was less in ovariectomized rats and greater in ovariectomized rats treated with EV, despite the fact that absolute tumor burden was reduced by this treatment. A similar relationship was observed for dietary lipid-induced differences in insulin binding to plasma membranes from these tumors. Reduction of tumor growth resulting from estrogen treatment was greater in low-fat- and fat-free-fed animals than in high-fat-fed rats. Again, tumor growth behavior appeared to be related to the reduction of insulin binding induced by estrogen treatment; insulin binding to plasma membranes from animals fed a low unsaturated lipid diet was decreased to a greater extent by EV treatment than in membranes from high-fat-fed rats. Altered tumor growth and membrane insulin binding, resulting from dietary perturbations and/or EV treatment, were not invariably related to serum insulin levels, nor to differences in membrane preparation, as reflected by 5'-nucleotidase activity, nor to membrane fatty acid composition or uptake of proline. Taken together, these results suggest a potential role of estrogens and insulin receptors as mediators of the dietary lipid alterations of growth of the R3230AC mammary carcinoma.

This article reviews the clinical manifestations, diagnostic techniques, and therapy of carcinoid and other metabolically active tumors that occur in the elderly. These tumors secrete monoamine and polypeptide hormones into the vascular compartment. Because these hormones may produce symptoms early in the course of the illness and are amenable to measurement, physicians have the opportunity to make a prompt diagnosis.

We determined the effect of a lying/standing test on 22 patients with medullary carcinoma of the thyroid (MCT), seven patients with pheochromocytoma (six of whom also had MCT), six healthy first-degree family members of patients with MCT, and nine normal subjects who did not have a family history of MCT. The purpose of the study was to determine if the patients with MCT had an altered noradrenergic response to standing and to determine if this test would be useful in screening MCT patients for the presence of pheochromocytoma. All of the patients with MCT, as well as all of the healthy family members, had normal urinary excretion of catecholamines and their metabolites. Plasma norepinephrine (NE) concentrations, plasma cortisol levels, and blood pressure (BP) were determined during the lying/standing test. The plasma NE concentration showed the expected increase with a change in posture; the plasma cortisol concentration did not change. There was no significant difference in the plasma NE, plasma cortisol, and BP response in the four study groups. Only one of the seven patients with pheochromocytoma had a hypertensive episode in response to standing. We conclude that there is probably a normal noradrenergic response to standing in patients with MCT, and the standing/lying test, as performed in this study, is of limited value in screening for the presence of pheochromocytoma.