Effect of parathyroid surgery on cartilage calcification

The incidence of chondrocalcinosis in 4 locations (knees, wrists, lumbar discs, and symphysis pubis) has been compared on x-rays made before and after parathyroid surgery in patients operated on for primary and secondary hyperparathyroidism. Before parathyroid surgery, the overall incidence of chondrocalcinosis in primary and secondary hyperparathyroidism is comparable. However, the distribution by age, the number of joints affected, and the locations are different. Parathyroid surgery changes neither the incidence nor the severity of chondrocalcinosis, in patients with primary or secondary hyperparathyroidism.

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Resumen La persistencia de la condrocalcinosis después de cirugía paratiroidea para hiperparatiroidismo primario ha sido informada en escasas publicaciones sobre reducidos grupos de casos. Además, a nuestro saber, ningún estudio ha enfocado la evolución de la condrocalcinosis después de paratiroidectomía para hiperparatiroidismo secundario a falla renal crónica. La incidencia de condrocalcinosis en 4 ubicaciones (rodillas, muñecas, discos lumbares, y sínfisis pubis) ha sido comparada sobre radiografías realizadas antes y después de cirugía paratiroidea en pacientes operados por hiperparatiroidismo primario y secundario. Antes de la cirugía paratiroidea, la incidencia global de condrocalcinosis en el hiperparatiroidismo primario y en el secundario es comparable. La distribución por edad, el número de articulaciones afectadas, la ubicación, son, sin embargo, diferentes. La cirugía paratiroidea no cambia la incidencia ni la severidad de la condrocalcinosis, tanto en el hiperparatiroidismo primario como el secundario.

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Résumé La fréquence de la chondrocalcinose a été étudiée sur clichés radiographiques dans quatre localisations (genoux, poignets, colonne lombaire, et symphyse pubienne) et comparée avant et après parathyroïdectomie pour hyperparathyroïdie primaire et secondaire. Avant parathyroïdectomie, la fréquence globale de la chondrocalcinose est semblable dans l'hyperparathyroïdie primaire et secondaire. La fréquence en fonction de l'âge, le nombre d'articulations atteintes, et les localisations sont différentes dans les deux groupes. La cure chirurgicale de l'hyperparathyroïdie, primaire et secondaire, ne modifie ni la fréquence, ni la gravité de la chondrocalcinose.

     

Increased intestinal permeability: Implications for thoracoabdominal aneurysm repair

Coagulopathy and massive bleeding plays a major role in the mortality of thoracoabdominal aneurysm repair. Increasing supraceliac aortic cross-clamp time from 0 to 90 minutes increases the degree of disseminated intravascular coagulation, which occurs as a result of occlusion and reperfusion of the superior mesenteric artery. The purpose of this study was to investigate the mechanism of the superior mesenteric artery reperfusion disseminated intravascular coagulation. Twenty dogs were divided into four groups: cross-clamp time of 30 minutes; cross-clamp time of 60 minutes; cross-clamp time of 90 minutes; and control. Permeability was determined by lactulose/mannitol absorption. The venous effluent was sampled for endotoxin, potassium, bacteria, and pH every hour and urine was collected for six hours. Lactulose absorption was significantly higher in all of the experimental groups. There was increased permeability in the 60 and 90 minute groups which correlated significantly with time. Venous endotoxin, potassium, and blood cultures for bacteria did not change significantly. The pH was significantly lower every hour for six hours in the 90 minute group. These data suggest that intestinal permeability is increased with supraceliac aortic clamping and can be kept to a minimum for clamp times of under one hour.Presented at the Fifth Annual Meeting of the Eastern Vascular Society.     

Papillary Serous Carcinoma with Basophilic Cytoplasmic Granules

Case History

A 69-year-old white female presented with vaginal bleeding and abdominal distention. A uterine cervical biopsy revealed adenocarcinoma. A laparotomy was performed, with a hysterectomy, bilaterial salpingo-oophorectomy, and multiple omental and abdominal lymph node biopsies. The tumor was present in the endometrium and endocervix with deep myometrial invasion, in both ovaries, numerous peritoneal nodules, and multiple retroperitoneal lymph nodes. Despite postoperative chemotherapy, the patient developed bowel obstruction and died 4 months after surgery. No autopsy was performed

Study the figures without reading the legends and make your diagnosis     

Utilization of outpatient mental health services after inpatient alcoholism treatment

It is generally agreed that use of aftercare services following discharge from alcoholism treatment is optimum for patients to achieve long-term recovery. However, the quantity and duration of utilization of such services in non-experimental settings are generally unknown. Using secondary data sources, we studied 5,635 alcoholics completing formal extended inpatient treatment and 1,860 alcoholics discharged from brief inpatient hospitalizations in Department of Veterans Affairs medical centers. Weekly use of outpatient mental health services (OPMH) prior to hospital admission was equally low for both patient groups (approximately 2–3% of patients) until four weeks prior to admission, at which time OPMH use increased, particularly for the extended treatment group. In the four weeks after discharge, use of OPMH services was substantially higher for patients with extended treatment compared to those with brief hospitalizations (40% vs. 18%), with 22% of patients completing treatment utilizing such services in the first week after discharge. Utilization steadily decreased until only 8% and 4% of both groups, respectively, were using OPMH services at the end of six months after discharge. Study results suggest the need to examine barriers to outpatient mental health utilization after discharge as well as interventions to increase compliance with long-term aftercare. This study was supported by grants R01-AA08732 (all authors) and P50-AA07378 (Dr. Blow) from the National Institute on Alcohol Abuse and Alcoholism.     

Systemic-to-pulmonary venous shunt in a haemodialysis patient

A 56-year-old haemodialysis patient was admitted for dysarthriain September 2003. He had been treated by haemodialysis sincethe     

Bromocriptine Treatment for Cocaine Addiction

In an open trial of bromocriptine in seven outpatients with cocaine addiction, most patients experienced reduced dysphoria and craving but none achieved abstinence. These results may suggest limitations of the dopamine agonist approach. Cautious interpretation is required because this may have been a treatment-refractory sample.