Fracture incidence in postmenopausal women with primary hyperparathyroidism.

BACKGROUND: The association of bone loss and increased fractures in postmenopausal women with minimally symptomatic hyperparathyroidism has not been clearly defined. This study was done to determine the frequency of fractures in postmenopausal women with hyperparathyroidism. METHODS: Forty-six postmenopausal women who had undergone parathyroidectomy for hyperparathyroidism during a 5-year period (1986 to 1991) were interviewed, and their medical records were examined to determine their fracture history. Forty-four postmenopausal women without hyperparathyroidism were contacted by random digit dialing and interviewed as controls. RESULTS: The groups were comparable with regard to age, weight, height, race, and age at menopause. Medical conditions and medication use were also similar, except for more reports of hypothyroidism in the hyperparathyroidism group (p = 0.05). Only 13% of women presented for treatment because of bone concerns, either fractures (9%) or low bone density (4%). However, on interview, 48% of the patients with hyperparathyroidism reported fractures compared with 25% of the controls (p = 0.02), a difference that remained even when those presenting with bone disease were excluded (p = 0.05). Of those with fractures, multiple fractures occurred in 36% of patients with hyperparathyroidism compared with 9% of controls and generally occurred after minor rather than major trauma (92% versus 45%, p = 0.002). Appendicular skeletal sites were reported for 86% of hyperparathyroidism group's and 92% of control group's fractures. Moreover, 50% of patients with hyperparathyroidism reported height loss compared with 27% of the control group (p = 0.05). CONCLUSIONS: This study shows that postmenopausal women with hyperparathyroidism reported more fractures and height loss than the control group, even when patients with hyperparathyroidism who presented because of bone disease were excluded.

Preliminary assessment of a scientific curriculum in a surgical residency program.

A structured, basic science curriculum was instituted for surgical residents of the University of Connecticut (Farmington) Integrated Residency Program during the 1990-1991 academic year in concordance with American Board of Surgery guidelines. The impact of the new program was measured by comparing performance on monthly basic science examinations, the in-training examination, and "mock" oral examinations for the 1990-1991 academic year with that of the preceding academic year. While monthly examination scores improved for the entire group of residents (67.7 vs 64.6), in-training and oral examination scores did not change significantly. Categorical residents generally demonstrated superior performance and greater improvement than did preliminary residents. Data analysis suggested that the new curriculum was an effective educational device and that university-designed monthly examinations were valid testing instruments, but there was an apparent incongruity between the goals of the curriculum and the American Board of Surgery In-Training Examination.

Gastrointestinal complications of metastatic malignant melanoma.

In a retrospective search of over 450 patients with melanoma, 13 were identified as having gastrointestinal metastatic disease. The clinical symptoms are nonspecific. The histology was either superficial spreading or nodular, and the depth of invasion was highly variable. The average survival of patients who underwent surgical treatment for symptomatic gastrointestinal (GI) metastatic disease was 14 months. We conclude that a subset of patients with malignant melanoma will present with symptomatic GI involvement, especially those with primary lesions of Clark Level III or deeper. Operative intervention in this group of symptomatic patients can be safe, and palliation for prolonged periods has been obtained. The authors encourage an aggressive diagnostic and therapeutic approach.

Preoperative percutaneous intraluminal balloon catheter control of major arterial hemorrhage.

Preoperative percutaneous balloon catheter control of major arterial hemorrhage is a useful technique when the damaged vessel is difficult or dangerous to expose. We report two cases, one with a gunshot wound to the internal carotid artery and one with a ruptured splenic artery aneurysm, in whom this approach was successfully employed to stop hemorrhage, control shock, and allow a precise, controlled vascular exposure and repair.

Hyperparathyroidism in the elderly.

Primary hyperparathyroidism seems to be increasing in incidence in elderly patients. Their symptoms are somewhat different from those encountered in younger patients, the most striking difference being the increase in the number of patients with mental changes. Twenty-nine patients, 23 women and 6 men, were treated at two community hospitals. Surgery was successful in all instances with no postoperative mortality and a low rate of complications. When properly evaluated, elderly patients tolerate parathyroid exploration very satisfactorily.

Pelvic fractures: an anatomic guide to severity of injury. Review of 100 cases.

A series of 100 cases of pelvic fracture secondary to violent trauma were reviewed and divided into two anatomic groups, those with pure anterior arch fractures (57 patients) and those with posterior fractures (43 patients). By this classification, mortality and associated injury are shown to be markedly increased in those patients with posterior fractures. A detailed study of the major complications has shown that a conservative approach to these injuries is probably the safest for the patient. Major blood loss is the rule rather than the exception and restoration of an adequate circulating volume by transfusion should precede operative attempts to control continuing retroperitoneal hemorrhage.