Intraoperative radio-guided identification of parathyroid adenomas with the gamma probe: initial experiences in a community hospital.

Previous radiological imaging studies for identification of parathyroid adenomas have generally been unreliable. Currently, preoperative administration of Tc-99m sestamibi improves detection of parathyroid adenomas. Combining preoperative administration of sestamibi radionuclide with the gamma probe intraoperatively can successfully identify the exact location of parathyroid adenomas in a community hospital setting and facilitate a safe and efficient operation. A team approach, including surgeon, radiologist, and technologist, is recommended to facilitate mastery of the learning curve.

Social services for battered women: are they adequate, accessible, and appropriate?

During the past 20 years a network of services, including official state agencies and statewide grassroots domestic violence coalitions, has developed across the country to meet the problem of woman abuse. Although state agencies have gained access to diverse federal funds; have developed additional, more-creative ways to fund programs; and have established regulatory mechanisms to ensure quality of services, respondents agree that the existing services would not have been developed without the committed energy and effective lobbying of grassroots coalitions. However, these coalitions are now struggling with internal conflicts and are concerned that emerging social problems will eclipse them and capture the scant funds available. Without these coalitions, the network of social services may return the problem of woman abuse to the private arena of family life, where it is treated by therapy. This article surveys both state agencies and coalitions and discusses implications for services to abused women.

The effect of Hb F and alpha-thalassemia on the red cell indices in sickle cell anemia.

This study examines the effect of different levels of fetal hemoglobin (Hb F) and the presence or absence of genes for alpha-thalassemia on the red cell indices and degree of anemia among 102 patients with homozygous sickle cell disease (S/S) between the ages of 15 and 62 years. Patients were divided into those with an average Hb F of less than 10 gm/L ("low" Hb F group) and those with greater than 10 gm/L ("high" Hb F group). alpha-Thalassemia was assessed by restriction enzyme analysis of DNA by the Southern blotting technique. Homozygosity for the beta(s) gene was confirmed by restriction enzyme analysis of DNA using the enzyme Mst II. There were 51 patients with four alpha-globin genes, 28 of whom had "high" and 23 "low" Hb F levels. Fifty-one patients had alpha-thalassemia, 38 of whom were heterozygous and 13 homozygous for the 3.7 kb alpha-thalassemia deletion. Nine had "high" and 31 had "low" Hb F. Irrespective of alpha-globin genotype, patients in the high Hb F group had a higher mean Hb, Hct, MCV, and MCH than those in the low HB F group. In patients without alpha-thalassemia Hb F was positively correlated with MCV and MCH (p less than 0.001), patients with high Hb F levels having macrocytosis confirmed by microhematocrit studies. Patients with alpha-thalassemia had a lower MCHC than patients with four alpha-globin genes and this was not significantly affected by the level of Hb F. The combination of alpha-thalassemia and high levels of Hb F appears to result in a distinctive S/S phenotype that is similar to the type of S/S disease described in Southern India.