Recurrent nerve palsy due to parathyroid cyst.

Cysts of the parathyroid gland are uncommon neck masses and difficult to diagnose. They can cause symptoms by endocrinological function or by pressure on surrounding structures. A case of recurrent nerve palsy due to a parathyroid cyst is presented.

Follicular carcinoma of the thyroid following radioactive iodine treatment for Graves' disease.

A 67 year old man presented with a well differentiated follicular carcinoma of the thyroid 17 years after he had been given radioactive iodine for Graves' disease. As this was insufficient to cure him he had continued to take propylthiouracil regularly. The tumour, which had completely replaced the thyroid, was apparently maintaining thyrotoxicosis.

A new approach to the surgical management of paralysis of the laryngeal nerve after thyroidectomy.

Recurrent nerve palsy, immediate or delayed, or unilateral or bilateral, is a recognized complication of operations upon the thyroid gland and is not considered to be remediable as a presumed consequence of division of the nerve (or nerves). Removal of sutures and neurolysis of the nerve have met with variable success in restoration of function. In a prospective study over a period of 14 years, paralysis after thyroidectomy was assessed in 31 patients.

Parathyroid carcinoma presenting as tertiary hyperparathyroidism.

A case of malignant transformation in established secondary hyperparathyroidism presenting as tertiary hyperparathyroidism is reported. Although rare, this occurrence has important medical and surgical implications.

Intravital methylene blue staining of parathyroid glands and tumours.

Previous intravital staining techniques for parathyroid localisation have met with variable success and complications. Modification of these techniques, employing a more consistent dose, combined with a prolonged infusion time has provided more uniform staining of normal and abnormal parathyroid tissue, other tissues showing little or no colour change. Locally induced oedema, not previously described, was found to be a great asset in the dissection of glands.

Duodenal ulcer perforation whilst on cimetidine therapy.

Nine cases of perforation whilst patients received cimetidine therapy were identified and followed prospectively. There was a high correlation with the other major complications of duodenal ulceration: pyloric stenosis and haemorrhage. Initially, three of the nine patients had simple suture of the perforation, but eventually all required truncal vagotomy and a drainage procedure.

Combined preoperative antibiotic therapy and intraoperative topical povidone-iodine. Reduction of wound sepsis following emergency appendectomy.

Single doses of clindamycin hydrochloride and gentamicin sulfate given preoperatively, combined with intraoperative topical application of povidone-iodine were given to patients with perforated or gangrenous appendicitis. The incidence of wound sepsis was reduced from 36% to 5%; severe infections were reduced from 25% to 0% when compared with a control untreated group of patients. When used alone, povidone-iodine had little effect in these patients.

Can nocturnal emergency surgery be reduced?

A prospective study of emergency operations was performed over three months in a district general hospital. Before starting surgery surgeons completed a questionnaire recording clinical details together with time of admission and were asked to state whether in their opinion the case could be safely deferred until the next morning assuming operating time was available. Of 251 operations performed, forms were completed for 244.

Delayed spontaneous recanalization of the vas deferens.

Eight patients were identified who had undergone successful vasectomy a mean of 4.6 years previously and in whom all were microscopically shown to have recurrent motile spermatozoa in their ejaculate. All had been referred following a pregnancy in their wives, and all agreed to undergo repeat vasectomy.

Porcine dermal collagen repair of incisional herniae.

Dermal collagen implants have been used to repair large incisional hernias in 11 patients (7 women, 4 men). The youngest was 37 years and the oldest 67, with a mean age of 49.9 years.