Ablation of mediastinal parathyroid adenomas by superselective embolization of the internal mammary artery with alcohol

Two young patients (20 and 21 years) had recurrent hyperparathyroidism following neck exploration. Non-invasive investigations failed to localize a parathyroid adenoma. In both cases selective catheterization of the internal mammary arteries combined with digital angiography demonstrated hypervascular mediastinal adenomas. Using a coaxial catheterization technique (Tracker 18 and 10), both branch arteries of the internal mammary supplying the adenoma were selectively catheterized. In one case absolute alcohol and the other a mixture of Lipiodol and absolute alcohol were used to effect the ablation. The procedures were uneventful and serum calcium levels have subsequently returned to within normal limits. The follow-up in these two cases extends to 2 1/2 years in one and 10 months in the other case.     

Closed intramedullary femoral osteotomy. Shortening and derotation procedures

Closed osteotomy and nailing were performed on 37 patients for leg-length inequality or rotational deformities. Shortening operations were performed in 31 patients, derotation in six. Preoperatively, the leg-length discrepancy ranged from 2 to 6.6 cm. All femoral shortenings resulted in correction to less than 1 cm. Preoperatively, rotational deformities averaged 58 degrees; all were corrected to within 5 degrees of normal. Follow-up observation averaged 3.3 years. There were no nonunions or infections. All patients regained preoperative joint range of motion (ROM). Thirteen patients were Cybex tested one year or more postoperatively; all had quadriceps and hamstring strength equal to or greater than the contralateral leg, except for two patients who had suffered additional trauma to the shortened femur. Closed femoral osteotomy is an effective, safe, and reproducible means to obtain lower limb length correction in patients with leg-length inequality or rotational abnormality.     

The modification of hemoglobin by citrate

Citrate, when activated by a water-soluble carbodiimide, covalently modifies hemoglobin. At pH values near neutrality, complete modification of the N-terminal valine residues of alpha- and beta-globin chains can be accomplished with a high degree of specificity. These groups react at a much more rapid rate than a slower reacting set of functional groups. Modification of hemoglobin with citrate alters the oxygen affinity of the protein. Although the p50 is not changed, the cooperative nature of oxygen binding is greatly decreased. Hemoglobin S modified with citrate is more soluble than unmodified hemoglobin S. The time taken for deoxygenated hemoglobin S to come out of solution in concentrated phosphate solutions is increased by citrate modification.     

Chronic obstructive pulmonary disease: role of bronchiolar mast cells and macrophages

Chronic obstructive pulmonary disease (COPD) is considered to be caused in part by smoking-induced inflammation, but it is unknown which inflammatory cells within the small airways are associated with the obstruction. We investigated the inflammatory infiltrate in the small airways of 16 current or ex-smokers with COPD (FEV1 < or = 75% predicted) and 15 without COPD (FEV1 > or = 85% predicted) in pneumectomy specimens that were removed for lung cancer. Mast cells, macrophages, neutrophils, eosinophils, T cells, and B cells were identified using immunohistochemistry on formalin-fixed, paraffin-embedded specimens. These cells were quantified in the epithelium and the remainder of the airway wall. The number of mast cells and macrophages in the epithelium, but not in the remainder of the airway wall, was significantly increased in patients with COPD. Neutrophil and T cell numbers did not differ between the groups. Only few B cells and eosinophils were present in both groups. Smoking history, perioperative steroid usage, tumor localization, or reversibility in the FEV1 to salbutamol could not account for the observed differences. We conclude that the number of epithelial mast cells and macrophages is increased in the bronchioli in smokers with airflow limitation, suggesting a role in development of COPD.     

Multifocal choroiditis: clinicopathologic correlation

Many of the white dot syndromes are considered to have a granulomatous pathogenesis. The histopathologic characteristics of this case of multifocal choroiditis seen within 15 months of apparent clinical onset show that the white dot lesions were nongranulomatous perivascular choroidal infiltrates, consisting mainly of B lymphocytes. Early choroidal neovascularization was also seen.     

Reliability of coding of diagnoses recorded in the computerized information system at primary health care centers

OBJECTIVE: To find the reliability of the coding of diagnoses in the doctor's note in this computer system and to analyse where there are most discrepancies. DESIGN: An observational study. The concordance between the reason for consultation, codified by an external assessor, and the coding of the main diagnosis. SETTING: Health Districts 17 (Murcia/Barrio del Carmen) and 66 (Molina de Segura/La Ribera) in the Autonomous Community of Murcia. PATIENTS: A sub-sample of 228 consultations, belonging to a larger study of 1,904 general medical consultations (total: 98,768 consultations). MEASUREMENTS AND MAIN RESULTS: There were discrepancies between the coding of the reason for consultation and the diagnosis in 23% of the consultations recorded. The reason for consultation was not correctly recorded in 12.3%. The diagnostic group or section with the highest level of agreement was number XVIII or the supplementary section; and with the least agreement in XVII (injuries and adverse side-effects) and Number V covering mental disorders. CONCLUSIONS: Quality control of information and its validation enables errors and problems in the systems to be identified and corrected. This study points to the need to improve the filling-out of the reason for consultation and activity carried out, in order to obtain afterwards a more reliable coding of the diagnosis.