Hypercalcemia associated with Wegener's granulomatosis and hyperparathyroidism: etiology and management.

We report a case of hypercalcemia in a patient with coexisting hyperparathyroidism and Wegener's granulomatosis. Parathyroidectomy with removal of an adenoma resulted in a low parathyroid hormone level but high calcitriol levels and hypercalcemia persisted. In various granulomatous diseases, hypercalcemia has been shown to be the result of overproduction of 1,25-dihydroxy-vitamin D by disease-activated macrophages.

Adjustments of distributive and clinical pharmacy services to financial constraints.

The effects of hospital budget constraints on a pharmacy department's ability to provide distributive and clinical services are described, and the development and use of workload-monitoring systems to match resources with demand is discussed. In 1980, the pharmacy department at Grace Hospital, a 402-bed community hospital in Detroit, Michigan, began quantifying workload by using five drug distribution indicators. After the pharmacy began providing clinical services in 1981, workload elements were measured in a pilot program for ASHP's Hospital Pharmacy Management Information System.