Nicotine-substitute gum-induced milk alkali syndrome: a look at unexpected sources of calcium.

Objective: This report describes a 64-year-old woman with recurrent hypercalcemia. Her laboratory evaluation was consistent with milk-alkali syndrome. It was eventually discovered that the source of the excessive calcium consumption was nicotine-replacement chewing gum and carbonated water.

Anterior mediastinotomy for parathyroidectomy.

Background: Approximately 2% of ectopic parathyroid glands reside within the mediastinum in a location that requires a thoracic approach.

Methods: All patients with mediastinal parathyroid tumors who underwent anterior mediastinotomy were included in this review.

Results: Over the course of 16 years, 10 patients with primary hyperparathyroidism underwent anterior mediastinotomy.

Diabetes care in hospitalized noncritically ill patients: More evidence for clinical inertia and negative therapeutic momentum.

Background: Little is known about management of hyperglycemia in inpatients.

Objective: To gain insight into caring for hospitalized patients with hyperglycemia.

Design: Retrospective analysis.

When a thyroid abnormality is palpable. What it means and what you should do.

Clinicians faced with a palpable thyroid abnormality should ascertain whether there is evidence of thyroid dysfunction, concern for malignancy, and symptoms of obstruction. In the vast majority of cases, laboratory assessment of the thyroid with an sTSH assay establishes the presence or absence of thyroid dysfunction. In a nodular thyroid gland, fine-needle aspiration biopsy is the method of choice for determining whether malignancy is present.

Treatment of established postmenopausal osteoporosis with raloxifene: a randomized trial.

Raloxifene is a selective estrogen receptor modulator that in experimental animals acts as an estrogen receptor antagonist in breast and endometrium but as an estrogen receptor agonist in the skeletal and cardiovascular systems. We conducted a 1-year prospective, randomized, double-blind trial in 143 postmenopausal osteoporotic women (mean +/- SD age, 68.4+/-5.

Coccidioidal infection of the thyroid.

Infection of the thyroid gland with Coccidioides immitis, the causative agent of coccidioidomycosis, is very rarely recognized antemortem. We report 2 recent cases, one immunosuppressed by corticosteroid treatment of sarcoidosis and the other without any recognized impairment of host defenses. In the first case, thyroid gland involvement was but 1 indication of disseminated infection.

Pamidronate: an unrecognized problem in gastrointestinal tolerability.

Pamidronate (aminohydroxypropylidine bisphosphonate, APD) is an effective agent for treatment of Paget's disease of bone, and it has also been thought to be effective for treatment of osteoporosis. We desired to study a newer, time-release preparation of pamidronate, and carried out a placebo-controlled, double-masked study of postmenopausal osteoporosis. The original formulation was in a rapidly dissolving gelatin capsule.

Resection of select mediastinal parathyroid adenomas through an anterior mediastinotomy.

Two patients who had undergone thorough surgical exploration of the neck were found to have adenomas of fifth parathyroid glands within the mediastinum. After localization with computed tomographic scanning or thallium-technetium imaging, or both, these tumors were resected through a parasternal approach (anterior mediastinotomy); thus, median sternotomy was obviated. This approach has not been described previously for the removal of mediastinal parathyroid tumors.

Insulinoma in a patient with annular pancreas.

Intraoperative ultrasonography has facilitated the localization of insulinomas. In this report, we describe a patient who was found to have an insulinoma in association with an annular pancreas. Because such tumors can be in close approximation to major pancreatic ductal structures, intraoperative ultrasonography can be useful for not only localizing the lesion but also delineating the related anatomic features.