Asymptomatic primary hyperparathyroidism

With the advent of automated equipment for blood chemistry determinations, many patients are presenting with asymptomatic or “biochemical” hyperparathyroidism. In the present series, of 136 patients operated on for hyperparathyroidism, fifty-three were considered asymptomatic. In fifty-one patients, parathyroid pathologic conditions were found; in one patient, it is probable that an adenoma had been missed, and in the other, it is presumed that an error in diagnosis was made. We recommend that surgical exploration be considered as an acceptable alternative to watchful waiting for patients with asymptomatic hyperparathyroidism.     

Ejection fraction derived using dye dilution and angiographic methods

Ventriculographically derived ejection fraction (EF-V) is the most frequently used method to measure left ventricular (LV) function. However, significant error may result in the measurement of end-systolic volume (ESV), which is used to calculate EF-V. This error is ascribed to the variable, irregular, nonellipsoidal geometry of the end-systolic ventricular chamber. Since stroke volume (SV) is determined more accurately by dilution methods than by ventriculography, an improved measure of ESV can be calculated by subtracting green dye determined SV from the ventriculographic determined end-diastolic volume (EDV). The purpose of this study was to measure a corrected ejection fraction (EF-C) using EDV by ventriculography and SV derived using green dye. In eight anesthesized dogs cardiac outputs (COs) were calculated by green dye and left ventriculography. CO determined by ventriculography was greater than that measured by green dye (p < 0.005). EF-V (55 ± 15%) was always greater than EF-C (32 ± 12%) (p < 0.005). These studies (1) may partially explain the discrepancy in CO calculated from the use of dilution methods and ventriculography and (2) present a method to improve the calculation of LV ejection fraction.     

Sepsis associated with decubitus ulcers

Among 21 patients with sepsis attributed solely to decubitus ulcers, bacteremia was documented in 16 (76 per cent). Bacteremia involved obligate anaerobes in eight patients (50 per cent) and was polymicrobial in eight patients (50 per cent). Twelve of 17 patients who received appropriate antibiotics had persistent bacteremia; in five patients, bacteremia was terminated only after surgical debridement. Ten of these 21 patients died, eight despite appropriate antibiotics. Among 14 patients who underwent surgical debridement, only four patients died. Surgical debridement and antibiotics effective against aerobic as well as anaerobic bacteria are both important in the treatment of this serious complication.     

Bacteroidaceae bacteremia with disseminated intravascular coagulation

Three patients with Bacteroidaceae bacteremia and disseminated intravascular coagulation (DIC) are described. The association of DIC with this anaerobic infection has been infrequently reported. Septic shock due to Bacteroidaceae appears to involve endotoxin as in aerobic gram-negative bacillary sepsis. Similarly, endotoxin may be the trigger mechanism for initiating DIC in both aerobic and anaerobic gram-negative bacillary sepsis.     

Familial hypokalemia associated with renal interstitial fibrosis

Two brothers with persistent hypokalemia and elevated plasma renin levels were evaluated. No other consistent abnormalities of their blood chemistries or renal function were noted. The elder brother had symptomatic fatigue and muscle cramps, and complained of nausea and intermittent vomiting. He was also unable to conserve sodium when adhering to a low sodium diet. On a high sodium diet and triamterene, his potassium level returned to normal. Aldosterone levels were slightly elevated. On kidney biopsy, there was focal interstitial fibrosis and proximal tubular degeneration, but the juxtaglomerular apparatus appeared normal. The younger brother was asymptomatic and was able to retain sodium when placed on a sodium-restricted diet.A review of familial and nonfamilial causes of hypokalemia did not reveal a similar disease state. Three additional family members also had elevated plasma renin levels and/or decreased plasma potassium levels. It is possible that these brothers and their siblings represent a previously undescribed form of familial hypokalemia. The Inability to retain sodium while on a restricted diet with a normal glomerular filtration rate and elevated aldosterone levels suggests a possible defect in the proximal tubules as the fundamental abnormality in these patients.     

Control of connective tissue metabolism by lasers: Recent developments and future prospects

Various laser modalities are currently in extensive use in dermatology and plastic surgery, particularly for treatment of vascular and pigmented lesions. A relatively new area of laser utilization involves the possible biologic effects of the lasers. In this overview, we are summarizing our recent studies, which indicate that lasers at specific wavelengths and energy densities modulate the connective tissue metabolism by skin fibroblasts both in vitro and in vivo. Specifically, the neodymium-yttrium-aluminum-garnet (Nd: YAG) laser was shown to selectively suppress collagen production both in fibroblast cultures and in normal skin in vivo, thus suggesting that this laser modality may be useful for the treatment of fibrotic conditions such as keloids and hypertrophic scars. Furthermore, two low-energy lasers, helium-neon (He-Ne) and gallium-arsenide (Ga-As), were shown to stimulate collagen production in human skin fibroblast cultures, suggesting that these lasers could be used for enhancement of wound healing processes. These experimental approaches illustrate the future possibilities for applying lasers for the modulation of various biologic functions of cells in tissues and attest to the potential role of lasers in the treatment of cutaneous disorders.     

Myelolipoma of the adrenal gland. Angiographic findings and review of the literature.

Myelolipoma of the adrenal gland is a rare tumor. It has been surgically excised in only five cases, including the one described in this report. However, review of the literature reveals a total of one hundred thirty cases. Although more than 96 per cent of these lesions were found incidentally at autopsy and more than half could be appreciated only microscopically, it is clear that these tumors can grow sufficiently to become symptomatic, undergo hemorrhage, and require operation. The clinical angiographic and pathologic features of myelolipoma are described. Although endocrine function of this tumor has never been demonstrated, related experimental evidence of others is summarized because it suggests that complete endocrinologic evaluation of patients with suspected myelolipoma is indicated. Despite the rarity of the tumor, we believe that the radiologic and clinical features of myelolipoma that we have described may allow preoperative diagnosis in the future.