ABSTRACT
A patient with acute primary hyperparathyroidism treated with mithramycin preoperatively, underwent neck exploration and two enlarged parathyroid glands were excised: one huge adenoma (6g) and another smaller gland. Mithramycin was administered preoperatively to lower life-threatening hypercalcaemia, and parathyroid slices from the huge adenoma removed at surgery were submitted in vitro to various calcium concentrations in the media to determine the influence of calcium on parathyroid adenoma secretory pattern in acute primary hyperparathyroidism. Mithramycin induced a significant decline in calcium levels and significant elevations of calciotrophic hormones (intact PTH, mid-region specific PTH, calcitonin and calcitriol). Significant suppression in PTH output in vitro was achieved by increasing calcium levels in the media. These results exclude autonomous PTH secretion (non-calcium dependent) as a possible aetiology of acute primary hyperparathyroidism. We suggest that a sudden increase in the set-point of the diseased parathyroid cells in the presence of a huge cell mass accounts, in large part, for both the marked hypercalcaemia and elevated PTH levels in this patient.
Subject(s)
Hypercalcemia/metabolism , Hyperparathyroidism/metabolism , Parathyroid Glands/metabolism , Parathyroid Hormone/metabolism , Acute Disease , Aged , Aged, 80 and over , Calcium/metabolism , Female , Humans , Hypercalcemia/drug therapy , Hyperparathyroidism/drug therapy , Plicamycin/therapeutic useABSTRACT
Two patients with familial polyposis coli were treated by total abdominal colectomy, endorectal mucosal stripping, and ileoanal anastomosis. About 24 months after operation, both patients had four to five soft-formed stools daily with good anal sphincter control. Because of its physical and emotional advantages and the fact that possible precancerous lesions are treated completely, we believe that this operation is superior to those generally used today.
