Primary Hyperparathyroidism: The Continuing Saga of Surgical Problems

Continuing problems in the management and surgical treatment of primary hyperparathyroidism include the localization of the elusive single tumor, the recognition and management of multiple gland involvement, prompt confirmation and operative treatment for hypercalcemic crisis, delineation of a liberal but selective policy relative to surgery for apparent uncomplicated hyperparathyroidism in the elderly, and recognition of the surgeon\u27s responsibility to determine the extent of the operation on the basis of operative findings, realizing that histologic study may not confirm apparent gross abnormalities despite subsequent clinical recovery. When all four glands are involved in primary hyperparathyroidism, subtotal parathyroidectomy is recommended except for patients with multiple endocrine neoplasia, type I (MEN I), in which cases, with great enlargement of all glands, total parathyroidectomy and autotransplantation appear justified. Selective removal of parathyroid glands is indicated for multiple involvement affecting fewer than four glands. Recent experience emphasizes the importance of benign familial hypocalciuric hypercalcemia, the late appearance of primary hyperparathyroidism after radiation therapy to the neck, and the association of primary hyperparathyroidism with a number of other clinical entities

Serum Immunoglobulins in the Differential Diagnosis Between Intrahepatic Viral Jaundice and Extrahepatic Obstructive Jaundice

Serum immunoglobulin levels are reported in 75 patients with jaundice: 32 with jaundice due to virus hepatitis and 43 with jaundice due to obstruction. The degrees and variations of serum immunoglobulins (Ig), (IgM, IgG and IgA) in virus hepatitis (IH and SH) with jaundice are compared with those found in obstructive jaundice. In 32 of the patients with jaundice from virus hepatitis, serum IgM (100%) and IgG (75%) were elevated above 2 Standard Deviations from the mean values. Neither IgM nor IgG levels were elevated above 2 Standard Deviations from the mean values in 33 of 43 patients (76.7%) with obstructive jaundice. In the other 10 patients, serum IgM (21%) and IgG (7%) were elevated above 2 Standard Devituions from the mean values. Case histories are presented of the five of nine patients, with obstructions and IgM elevations who had inflammatory reactions about the biliary tract

Chronic Idiopathic Thrombocytopenic Purpura: Effective preoperative preparation and long-term results of splenectomy

A retrospective review of 98 patients seen at Henry Ford Hospital from 1953 through 1977 demonstrated that splenectomy for chronic idiopathic thrombocytopenic purpura provided a good response which usually was sustained on long-term follow-up (72% at 15 years). Although splenectomy for this condition had a low mortality, morbidity was significant in patients older than 40 years. When compared to patients whose response to splenectomy was sustained, patients who relapsed had significantly lower platelet counts preoperatively both when they were untreated (mean: 9,194 per cc versus 18,524 per-cc) and/or when they were treated with steroids (mean: 85,647 per cc versus 142,590 per cc). Another significant risk factor for relapse was a longer interval from splenectomy to the maximum postoperative platelet count. In the immediate preoperative preparation of the patient for splenectomy, corticosteroids temporarily increased the platelet count, but high doses were necessary in many patients. A platelet count of greater than 40,000/cc usually was achieved with a dose of 60 to 80 mgs of prednisone per day for several days. Platelet infusion rarely was needed if patients were prepared adequately with steroids. There should be no hesitation to give large doses of steroids for a few days, and a delay in proceeding with the operation, once indicated, should be avoided. Because the response of the platelet count to splenectomy may be variable or fluctuating and late relapses can occur, patients should be re-evaluated periodically

Bulge growth through disk instabilities in high-redshift galaxies

The role of disk instabilities, such as bars and spiral arms, and the associated resonances, in growing bulges in the inner regions of disk galaxies have long been studied in the low-redshift nearby Universe. There it has long been probed observationally, in particular through peanut-shaped bulges. This secular growth of bulges in modern disk galaxies is driven by weak, non-axisymmetric instabilities: it mostly produces pseudo-bulges at slow rates and with long star-formation timescales. Disk instabilities at high redshift (z>1) in moderate-mass to massive galaxies (10^10 to a few 10^11 Msun of stars) are very different from those found in modern spiral galaxies. High-redshift disks are globally unstable and fragment into giant clumps containing 10^8-10^9 Msun of gas and stars each, which results in highly irregular galaxy morphologies. The clumps and other features associated to the violent instability drive disk evolution and bulge growth through various mechanisms, on short timescales. The giant clumps can migrate inward and coalesce into the bulge in a few 10^8 yr. The instability in the very turbulent media drives intense gas inflows toward the bulge and nuclear region. Thick disks and supermassive black holes can grow concurrently as a result of the violent instability. This chapter reviews the properties of high-redshift disk instabilities, the evolution of giant clumps and other features associated to the instability, and the resulting growth of bulges and associated sub-galactic components.Comment: 37 pages, 9 figures. Invited refereed review to appear in "Galactic Bulges", E. Laurikainen, D. Gadotti, R. Peletier (eds.), Springe

Structural changes in commercial agriculture

The basic idea of the conference on Structural Changes in Commercial Agriculture was planted in the spring of 1964 by Earl 0. Heady. He outlined for the North Central Farm Management Research Committee his concern about the kind and amount of response to both current and prospective structural changes in the commercial farm firm. Many changes represent adjustments to technological and other innovations originating in marketing, research, and educational agencies serving farmers.https://lib.dr.iastate.edu/card_reports/1025/thumbnail.jp

Chinese organized crime and situational context: comparing human smuggling and synthetic drugs trafficking

This article criticizes the 'ethnic' conception of organized crime and puts forward an alternative view that does not put ethnicity first, but rather social networks and situational context. It focuses upon Chinese organized crime, a phenomenon where the preoccupation with ethnicity is paramount, and compares findings from extensive research into two different transnational criminal activities that are carried out by Chinese offenders in the Netherlands. The first topic, human smuggling, is well researched, whereas research into the second topic, trafficking in precursors (the basic ingredients for the production of synthetic drugs), is largely lacking. The article highlights the major theoretical and empirical similarities and differences between these two criminal activities and discusses the relevance of the main findings for theory and research