The nonutility of chest roentgenographic examination in asymptomatic patients with positive tuberculin test results

To determine the value of chest roentgenograms in the management of asymptomatic persons with positive tuberculin skin test results, we undertook a retrospective review of all tests administered by our Employee Health Service, North Shore University Hospital, Manhasset, NY, between July 1, 1983 and November 1, 1987. Of 5200 tests, 247 results were positive. Two hundred twenty-one of these charts were reviewed for roentgenographic results and the presence of symptoms. All persons were asymptomatic. Chest roentgenograms revealed the following: normal, 188; unrelated abnormalities, 24; apical pleural thickening, 5; granulomas, 2; calcified hilar node, 1; and calcified node plus granuloma, 1. We noted no active tuberculosis, nor did the chest roentgenographic results influence recommendations for isoniazid prophylaxis. We conclude that chest roentgenograms are of value in 0% to 1.3% of asymptomatic people with positive tuberculin test results. A larger study should be undertaken to further define the usefulness of chest roentgenograms in this population.     

Cerebral blood flow changes in normal aging: Spect measurements

Global and regional cerebral blood flow (CBF) were evaluated with single photon emission computerized tomography (SPECT) utilizing both ¹³³Xenon (¹³³Xe) (47 subjects, 47–82 years old) and ⁹⁹Tc-hexamethylpropyleneamine oxime (⁹⁹Tc-HMPAO) (27 subjects, 47–80 years old). The ¹³³Xe results showed: among total subjects, no age-related decline in global CBF, but a significant regional decline in the occipital lobe (p < 0.05); among men, significant age-related declines in global, frontal, temporal, occipital and right hemisphere CBF (all p < 0.05); among women, no age-related decline in global or regional CBF. The ⁹⁹Tc-HMPAO results showed no age-related decline in either global or regional perfusion among total subjects, men or women. These results suggest that age-related global and regional (including frontal lobe) CBF declines do not occur in healthy control subjects after the age of 45 years. However, gender differences in age-related CBF changes warrant further study.     

Cortical potentials related to voluntary and passive finger movements recorded from subdural electrodes in humans

Movement-related potentials were recorded from subdural electrodes placed on the precentral and postcentral cortex in 3 patients undergoing operation for intractable epilepsy. With self-initiated index finger movement, a negative potential of 25 to 50 microvolts in amplitude, preceding onset of the electromyographic activity by 60 to 95 ms (or onset of movement by 150 to 230 ms), was recorded from the hand somatosensory postrolandic area in all 3 patients. A similar potential preceding the movement was recorded from the precentral hand motor area in one subject who was the only patient in whom the precentral electrodes were placed on the hand motor area. Following active and passive movements, a clearly defined positivity (18 to 32 ms after a photometer trigger) that reversed phase across the central fissure was recorded. The premovement potentials are most probably generated by pyramidal tract neurons and motor-function-related neurons located in the post- and prerolandic areas. The postmovement positivity is most probably due to short-latency kinesthetic reafferent activation of the posterior bank of the central fissure (equivalent to P2 of the somatosensory evoked potentials).     

Primary hyperparathyroidism. Pathogenesis--diagnosis--therapy]

A report is given on 33 patients with primary hyperparathyroidism who underwent surgical treatment in our institution in the period from 1980 to 1989. In 57 per cent of the cases a hypercalcaemic syndrome was present. The primary hyperparathyroidism manifested itself in 75 per cent at the kidneys in the form of nephrolithiasis. One third of the patients showed a renal manifestation form exclusively. Remarkable is the relatively high number of exclusively gastrointestinal manifestations (11 per cent). In all patients the diagnosis was established on the coincidence of hypercalcaemia and increased parathormone in the serum. Preoperative localization diagnostics by means of parathyroid sonography, computed tomography and scintigraphy yielded unsatisfactory results. A satisfactory accuracy with regard to the lateral localization of the hyperfunctioning parathyroid tissue can presently be achieved only by selective catheterization of the cervical vein with determination of the parathormone. 35 patients clinically suspected of having primary hyperparathyroidism were subjected to a total of 44 operative interventions, i.e., apart from 35 primary operations, 7 secondary and 2 tertiary interventions. Of the 35 primary operations, 10 (28.6 per cent) were without success. This was due to 2 misdiagnoses and 8 cases with insufficient intraoperative exploration and premature discontinuation of the operation. In 67 per cent of the cases, there was a predominance of the solitary parathyroid adenoma, which was chiefly located at the dorsal lower thyroid poles. In order to reduce the number of unsuccessful primary interventions, a surgically-tactical approach is recommended.     

Lethal enhancement of therapeutic doses of acetaminophen by alcohol

Summary A 47-year-old man undergoing supervised alcohol detoxification developed severe liver disease after receiving small doses of acetaminophen. Autopsy revealed extensive hepatic necrosis. Proposed mechanisms for alcohol potentiation of acetaminophen hepatotoxicity are described. We feel acetaminophen should not be routinely used for patients with active alcoholism unless its safety can be established.