Primary hyperparathyroidism and coexisting nephrogenic diabetes insipidus: rapid postoperative correction.

Shortly after diagnosis of primary hyperparathyroidism, a patient had serum hyperosmolality, polyuria, isosthenuria, profound potassium depletion, and elevated plasma antidiuretic hormone levels, all consistent with nephrogenic diabetes insipidus. After parathyroidectomy, serum calcium and serum osmolality levels fell concurrently. Profound potassium deficits did not recur. We propose that (1) hypercalcemia produced a concentrating defect and polyuria; (2) renal tubular acidosis and polyuria combined to produce severe potassium depletion; (3) hypokalemia potentiated the nephrogenic diabetes insipidus caused by hypercalcemia; and (4) postoperative disappearance of the diabetes insipidus confirmed its reversible, purely metabolic causes.

Osteosarcoma of the spermatic cord.

Malignant tumors of the spermatic cord are rare but the vast majority of these tumors are sarcomas. We report on a patient with osteosarcoma arising in the spermatic cord. Left radical orchiectomy with high dissection of the spermatic cord was performed, and the patient remains free of recurrence 2 years postoperatively. We could find no previous discussion or report of this tumor.

Malignant fibrous histiocytoma (MFH) arising within a cholecystectomy incision: a cause-and-effect relationship is possible between previous surgery and the development of a malignant fibrous histiocytoma within the operative site.

We present a report of a patient who, after an uneventful cholecystectomy, developed an incisional mass that proved to be a malignant fibrous histiocytoma and had to be excised. Five months later, the patient developed a similar incisional mass, which was shown to be a malignant fibrous histiocytoma and again had to be excised. The rarity of such a case and the details of the patient's case history are reported. The implications of a possible relationship between previous surgery, the patient's healing response, and the development of these tumors are discussed.

Isolated Crohn's disease of the appendix. Two case reports and a review of the literature.

Two patients were diagnosed and treated at St Elizabeth Hospital Medical Center, Youngstown, Ohio, for isolated Crohn's disease of the appendix. Including these two patients, 75 such patients have been described in the world literature from 1953 to July 1986, to our knowledge. Crohn's disease of the appendix should be considered in patients who are in their second and third decades of life, who have pain and tenderness in the right lower quadrant of the abdomen, and whose symptoms are protracted (longer than three days) and/or recurrent. Intraoperatively, if the appendiceal wall appears hypertrophic, thickened, and chronically inflamed, a frozen section may confirm the diagnosis. Crohn's disease of the appendix is a diagnosis of exclusion. Appendectomy may be performed safely and has a low morbidity and mortality. The incidence of enterocutaneous fistula and the recurrence rate are much lower than for Crohn's disease of the small and large bowel.

Defective response to social cues in Möbius' syndrome.

A case of Möbius' syndrome is presented, with the mask-like facies and poor social relationships consistent with this diagnosis. Previous thought has implicated the inability to transmit facial cues as a cause for impoverished social functioning. The authors hypothesize that the inability to transmit is related to an inability to receive cues. They repeated a paradigm used previously to test ability to interpret facial cues. The otherwise intelligent patient could not perform a task previously performed by approximately 300 other subjects. These findings suggest that the rehabilitation of Möbius patients should include education in interpreting social cues.