Primary hyperparathyroidism: clinical diagnosis

During the period from June, 1959 to September 1983, 177 patients with primary hyperparathyroidism (PHPT) were treated in our Department. On the basis of this experience, a retrospective study has been made on the clinical diagnosis of PHPT. Repeated measurement of serum calcium, serum ionized calcium, serum phosphorus and %TRP was most useful for detecting patients with PHPT, in addition to careful observation of the many symptoms and disorders caused by PHPT. On the contrary, it is also stressed that PHPT can not be excluded even when a single measurement of any of the above stated items reveals a normal value.     

Pontine Infarction With Diffuse Myelin Destruction

A 5 7–year-old man with clinical symptoms of dementia and spastic paraplegia revealed pathologically scattered cerebral arteriosclerotic changes and diffuse myelin destruction in the basis pontis. The latter was characterized by comcomitances with an eminent fibrous gliosis and a neuronal as well as an axonal loss. Pontine infarction and the following fibrous gliosis possibly caused a wide area of myelin destruction resembling cpm.     

An autopsied case of Eisenmenger syndrome complicated by recurrent thromboembolic phenomena in postpartal period.

Dyspnea, back pain, edema, and cyanosis developed suddenly in a 23-year-old woman during the last trimester of her first pregnancy. Although she had been noticed to have the enlarged heart and exertional shortness of breath to a slight degree, she had been apparently in good condition without any significant heart murmurs. Clinically, recurrent episodes of disseminated intravascular coagulation, including pulmonary thrombosis, were thought to be superimposed to Eisenmenger syndrome associated with toxemia of pregnancy. Anticoagulant and fibrinolytic treatments were tried, but their effectiveness was limited by hemorrhagic diathesis. She died of respiratory and circulatory failure after delivery of a moribund baby. Autopsy revealed Eisenmenger complex (a defect in the membranous portion of the interventricular septum and pulmonary vascular disease) and many fresh hemmorrhages in both lungs with a lot of new and organized thrombi. Fresh thrombi were also seen in the heart, the pancreas and the kidneys. The high peripartal mortality in Eisenmenger syndrome could be attributed to pulmonary thrombosis, which may be related to DIC, as well as to peripartal changes in circulatory function.