Intrathyroidal parathyroid glands can be a cause of failed cervical exploration for hyperparathyroidism.

Background: The incidence of intrathyroidal parathyroid glands remains controversial. The purpose of this study was to determine the incidence in a series of patients with hyperparathyroidism.

Methods: Three hundred nine patients underwent parathyroidectomy.

Reexploration and angiographic ablation for hyperparathyroidism.

Objective: Persistent and recurrent hyperparathyroidism remains a challenging clinical problem. The purposes of this study were to determine the causes of initial failure, the accuracy of preoperative localization tests, the role of angiographic parathyroid ablation, and the safety and efficacy of reexploration for hyperparathyroidism.

Design: A retrospective review of 42 patients undergoing reexploration or angiographic ablation for hyperparathyroidism was done, with a mean follow-up of 3 years, 7 months (range, 1 month to 13 years).

Parathyroid anatomy in hyperplasia.

Pathologically enlarged parathyroid glands offer the surgeon a vital medium for studying parathyroid anatomy. The advantages include gland magnification, rapid-section diagnosis to aid dissections, and postoperative clinical and laboratory responses to check for "missed" or supernumerary glands. In this series, each of 71 patients had at least four hyperplastic glands.

Spontaneous bile duct rupture in pregnancy.

Spontaneous bile duct rupture occurred in a 23-year-old who required emergency Cesarean section for fetal distress. This condition has not been reported in association with pregnancy. Only forty cases of spontaneous bile duct perforation in adults have been previously reported.

The tiny parathyroid adenoma.

In the past 11 years we have operated on three patients with "tiny" parathyroid adenomas (less than 60 mg). Two of these adenomas were virtually indistinguishable visually from the normal glands. (The third adenoma was found only after fixation and permanent sections.

Endoscopic jejunal feeding tube through decompressing gastrostomy.

A simple technique is presented to provide rapid, accurate placement of a jejunal feeding tube through a decompressing gastrostomy using readily available supplies. Transgastrostomy feeding tube placement avoids prolonged nasal intubation and this endoscopic technique allows easy changing of the feeding tube should the need arise.

A preliminary study of the relationship between preoperative depression and weight loss following surgery for morbid obesity.

Fifty-two consecutive morbidly obese patients were evaluated psychiatrically before they were scheduled to undergo gastroplasty and again an average of twenty-six months later. Ten patients did not undergo surgery; six patients who did undergo gastroplasty were unavailable for follow up. In the remaining thirty-six patients, there was a statistically significant correlation between the degree of clinically estimated preoperative depression and the percent of body weight lost following surgery.

Psychiatric evaluation in gastric surgery for obesity.

Gastroplasty, a newer form of surgery for morbid obesity, produces physical and psychosocial benefits equivalent to those of jejunoileal bypass, but with fewer complications. As interest in this approach to intractable obesity has increased, surgeons have looked to psychiatrists to help them to assess psychiatric risk associated with undergoing surgery. Drawing on a review of the literature and long-term experience with patients requesting gastroplasty, this review addresses the benefits of gastroplasty and offers suggestions about when and how to perform preoperative psychiatric evaluations in patients requesting surgery for obesity.

The anatomy of parathyroid hyperplasia.

Parathyroid hyperplasia aids the surgeon in studying parathyroid anatomy for several reasons: (a) Nature magnifies the glands in hyperplasia; (b) there is a strong clinical imperative to find all glands; (c) histologic controls help guide the dissections; and (d) postoperative clinical and laboratory responses help determine the presence of supernumerary glands. In this study of parathyroid hyperplasia we found four glands in each of 34 patients (136 glands total--37 operations). Six patients (18%) had parathyroid glands totally covered by thyroid tissue, five patients (15%) had mediastinal glands, one patient (3%) had a retroesophageal gland, and one (3%) had a "kissing pair.

Modified subtotal thyroidectomy for Graves' disease: a two-institution study.

In an effort to decrease the large number of patients who develop hypothyroidism after operations for Graves' disease, an identical modification of the conventional subtotal thyroidectomy (CST) was independently designed and tested in a prospective study at two institutions. The modified subtotal thyroidectomy (MST) essentially consists of leaving an accurately measured 5 gm thyroid remnant and an intact inferior thyroid artery on each side of the neck. By use of MST, euthyroidism, as demonstrated by serial clinical and thyroid function tests, has been achieved in 92% of a combined group of 107 patients followed longer than 2 years (average 62.

The thyrotoxicosis/thrombocytopenia connection.

The association between thrombocytopenia and thyrotoxicosis is well documented in the medical literature. The theories for this relationship include a common immunologic cause and a thyrotoxic-induced decrease in platelet survival. Twenty-two months ago, we performed a subtotal thyroidectomy on a young woman with both disorders who was referred to us for splenectomy with the sole diagnosis of idiopathic thrombocytopenic purpura (ITP).

Traumatic thrombosis of the inferior vena cava.

A case of a 21-year-old male with blunt abdominal trauma and subsequent acute thrombosis of the inferior vena cava, presenting as abdominal pain, is reported. The apparent mechanism of proximal inferior vena cava thrombosis with distal extension into the iliac veins differs from that suggested in earlier reports. Resolution of symptoms was achieved by heparinization and bedrest alone, in spite of thrombus in the suprarenal vena cava.

Limited subtotal thyroidectomy for Graves' disease.

Limited subtotal thyroidectomy was performed in 42 of 43 patients with Graves' disease. Twenty of 23 patients (87%) who were followed up for an average of 54 months after operation remained euthyroid. Only one patient (4.

Solitary thyroid nodules.

A study was made of 67 patients with solitary thyroid nodules in which strict criteria to eliminate the probability of cancer, including a history of radiation to the neck, were used. Twelve (17.9%) were found to have histologic malignancy.

Cholecystectomy with and without surgical drainage.

Thirty-seven patients who met specific criteria had cholecystectomy without drainage, and thirty-seven matched control patients had cholecystectomy with drainage. This study suggests that surgical drainage after every uncomplicated cholecystectomy is unnecessary and may be unwise. Such drainage may result in an increased incidence of postoperative morbidity and prolonged hospital stay.