Hyperparathyroidism: retrospect and prospect

The history of hyperparathyroidism is outlined and the diagnosis and treatment of its various causes reviewed with reference to a series of 153 patients operated on for hyperparathyroidism in the past 20 years. In 119 cases the condition was primary, being due to a tumour or hyperplasia. Future developments in this field are briefly considered.

Radiology in Mendelson's syndrome

Four cases of Mendelson's syndrome (acid pulmonary aspiration) are presented. They all demonstrate an acute diffuse alveolar filling pattern. This appearance is by no means specific. However, in the absence of other causes for this pattern and of evidence of left ventricular failure the radiologist may alert the clinician to the correct diagnosis. Early recognition of this syndrome will result in prompt treatment which differs significantly from that of other causes of this radiographic appearance. The differential diagnosis is discussed.

Occurrence of other endocrine tumours in primary hyperparathyroidism

In a review of a hundred and nineteen patients with primary hyperparathyroidism an unexpectedly high number (17.5%) were found to have evidence of associated endocrine disease and were deemed to have multiple endocrine adenomatosis (M.E.A.). The clinical pattern of hypercalcaemia in no way distinguished these patients from other hyperparathyroid patients. M.E.A. was most commonly found in patients with several diseased parathyroid glands.

Persistent and recurrent hyperparathyroidism

During the past 11 years at Hammersmith Hospital 11 patients have had parathyroid operations following a previous neck exploration. Six had persistent hyperparathyroidism and 5 had recurrent hyperparathyroidism with a “lucid interval” of biochemical normality of from 5 months to 11 years. Sucessful results were obtained in 9 of the 11 patients after a total of 29 operations, 4 of which were combined with sternotomy. The reasons for failure at operation and the medical and surgical management of these patients are reviewed.

Prostatectomy and deep-vein thrombosis

In a study of 50 patients who had undergone prostatectomy the incidence of deep-vein thrombosis was measured, using the 125I-fibrinogen test. Of these, 12 (24 per cent) developed deep-vein thrombosis. This preliminary study showed that in patients who had had a transurethral resection the incidence of deep-vein thrombosis was 6·8 per cent, while in patients who had had a retropubic prostatectomy it was 47·6 per cent.

Thyroid lymphography

A simple method is described for demonstrating the lymphatic architecture and drainage of the thyroid gland, and has been applied to study patients with hyperthroidism, ultinodular goitre, and clinically solitary nodules.

Multifocal fibrosclerosis

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Combined thyroxine and triiodothyronine for thyroid replacement therapy

Tablets containing 50mug. of thyroxine and 15mug. of triiodothyronine have been used to treat patients with hypothyroidism of varied aetiology. Following total thyroidectomy a daily dose of three tablets-that is, 150mug. of thyroxine and 45mug. of triiodothyronine-maintained patients in a euthyroid state and produced a protein-bound iodine level within the normal range. The preparation is preferable to dried thyroid because of uniformity of activity and speed of action, and when the patient is clinically euthyroid the P.B.I. falls within the normal range.

A case of mild hyperparathyroidism in childhood

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Familial multiple endocrine adenopathy (primary hyperparathyroidism and Zollinger-Ellison syndrome) in two siblings

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Thyroid carcinoma and its treatment

Thyroid cancer is a rare disease. Aetiological factors are increased secretion of TSH and exposure of the growing gland to ionizing radiation. Pathological classification is in two main groups: differentiated and undifferentiated. Differentiated is subdivided into papillary, follicular and medullary.

Papillary and medullary carcinomas occur in young patients, grow slowly, spread by lymphatics. Treatment is surgical excision of thyroid and affected nodes plus thyroid hormone replacement. Follicular carcinoma spreads by blood to lungs and bones. Treatment is total thyroidectomy and radioiodine therapy of the metastases followed by thyroid hormone replacement.

Undifferentiated tumours occur in old patients. They are identified by drill biopsy and treated with radiotherapy.