Parathyroidectomy for primary hyperparathyroidism: early discharge.

With increasing awareness of cost-containment measures, early discharge after parathyroidectomy for primary hyperparathyroidism is to be evaluated. This report concerns the Cleveland Clinic experience with the last 70 consecutive patients treated for primary hyperparathyroidism from June 1981 to June 1983. The mean postoperative hospital stay was 1.4 days. Most patients were discharged on the morning of the second postoperative day receiving oral calcium supplements for 3 weeks. Three patients were discharged on the morning of the first postoperative day. The overall mortality rate was 0%. Morbidity included two patients (2.9%) who developed symptoms of mild tetany after discharge that responded to an increased dose of oral calcium. The usual practice of most surgeons of delaying hospital discharge after neck exploration for primary hyperparathyroidism for 5 to 7 days in fear of symptomatic hypocalcemia is unnecessary. Considerable cost containment can be achieved by sparing patients from 3 to 5 extra days of hospitalization.

Critical analysis of jejunoileal bypass.

This study analyzed a group of morbidly obese patients who underwent jejunoileal bypass over a 10 year period. Patients underwent either a Payne or Scott procedure. Weight loss was reported in terms of percent of excessive weight loss. Results showed that patients who had a Payne bypass had an average excess weight loss of 75 percent, whereas those with the Scott bypass had an average excess weight loss of 61 percent. All patients lost weight. Complications in this series were lower than what has been traditionally reported. The problem that occurred most often was kidney stones (8 percent of the patients). There has been only one death to date. The low incidence of complications can be attributed to the fact that the patients were evaluated, operated on, supervised, and followed by one doctor and his associated nurses. Thus, it is proposed that jejunoileal bypass, compounded with good patient care and careful patient selection, can produce positive results with a minimum number of problems.

A Golgi study of the opossum ventral basal complex.

The morphology of neurons in the ventral basal complex (VBC) of the adult opossum (Didelphis virginiana) is described from thick coronal brain sections, using Golgi-, horseradish peroxidase (HRP)-, and Nissl-staining methods. Soma cross-sectional area, dendritic field shape, and the number of appendages (spines) in a defined major branch zone (MBZ) are quantified and statistically analyzed. Results indicate that neurons in opossum VBC have relatively large cell bodies, dendrites which branch in a tufted pattern, and numerous dendritic appendages. These neurons are designated as relay cells because of (1) their tufted dendritic branch patterns, considered characteristic of thalamic relay cells (Ramon-Moliner, '62), and (2) the similarity of their soma sizes with HRP-labeled somata after somatosensory cortical injections. Neurons with traditionally described interneuron morphology do not appear to be present in the VBC of this animal, and, in this respect, the neuronal morphology of opossum VBC is similar to that in rat (McAllister and Wells, '81). Based on statistical analysis of the structural features observed, the presumed relay cells in opossum VBC do not show significant differences in morphology, and consequently are not subdivided into classes. Opossum VBC neurons are recognized as forming a single category in which broad and continuous variations in morphology are indicated. Recognition of a singular class of relay cell is consistent with descriptions for rat and cat VBC (Scheibel and Scheibel, '66), but at variance with a previous report for the primate Galago VBC (Pearson and Haines, '80) subdividing thalamic relay cells into Types I, II, and intermediate categories.

Hypothyroidism and acquired von Willebrand disease.

A 15-year-old female with acquired von Willebrand disease associated with hypothyroidism is presented and discussed. The patient was initially seen for right lower quadrant abdominal pain and menorrhagia. Once hypothyroidism was diagnosed and treated her coagulation abnormality resolved.

Thoracic outlet syndrome.

The diagnosis of thoracic outlet syndrome rests on clinical findings. A study of 21 patients with the syndrome is reported. Six of the patients underwent surgery and the remainder were treated conservatively. Surgery completely eliminated the symptoms in five patients; one patient had minor symptoms after surgery. In the patients managed conservatively, half had partial relief of symptoms and the other half did not respond to therapy. Physical therapy is initially recommended in most patients.

Recurrent pneumococcal bacteremia: 34 episodes in 15 patients.

Thirty-four episodes of pneumococcal bacteremia were identified in 15 patients over 5 years in 10 hospitals in Franklin County, Ohio. Twelve patients each had 2 episodes of pneumococcal bacteremia, 2 had 3, and 1 had 4. All patients had predisposing conditions, with lymphoma, multiple myeloma, and chronic obstructive pulmonary disease being the most frequent. The mean interval between the first and second episode was 268 days. Serotyping and genotyping were performed on 29 isolates. The same serotypic and genotypic patterns were found for sequential isolates from four patients; three of these patients had a recurrence between 22 and 90 days after a previous episode. Seven (24%) of the 29 isolates were serotype 23F; four isolates (14%) were not susceptible to penicillin. All of our patients received appropriate antimicrobial therapy and appeared to be clinically cured of their initial infection. For patients with recurrent pneumococcal disease, alternate preventive measures such as immunization with conjugate pneumococcal vaccine and/or prophylactic antibiotic therapy should be considered.