Melvin A. Block

Acute pancreatitis related to grossly minute stones in a radiographically normal gallbladder.

Summary and conclusions1. The unusual association of a few grossly minute gallstones, not detected by usual radiographic technics, with recurrent acute pancreatitis is recorded for 6 patients.2. Acute pancreatitis does not recur if biliary tract lithiasis is eradicated in these patients. In addition to cholecystectomy, exploration of the common bile duct of these patients usually is required.3. The finding of microspheroliths, cholesterol crystals, and calcium bilirubinate pigment by diagnostic biliary drainage provides support in deciding for biliary tract surgery for these patients.4. Biliary tract surgery including cholecystectomy is justified for patients suffering from recurrent acute pancreatitis, in whom abnormal inclusions are found in diagnostic biliary drainage, and in whom alcoholism and other causes of pancreatitis are absent. Cholecystectomy should be done even though the gallbladder appears normal on repeated cholecystograms, and is normal to palpation at the time of operation.

99mTc Pertechnetate Scanning of Salivary Glands

The usefulness of the ability of the salivary glands to concentrate pertechnetate has been explored by scanning the salivary glands of 19 patients. Six who were undergoing scans of brain or thyroid with technetium pertechnetate served as controls; in 13 cases scans were carried out solely for the demonstration of suspected abnormalities of a salivary gland. Picker five-inch Magnascanners equipped with 3-inch fine focus 163-hole collimators are used. The window is set to count radiation between 120 and 160 keV. The range differential is set 10 per cent above the reading if on the 3k scale, 20 per cent above the reading if on the 3k × 2 scale, and 30 per cent above if on the 10k scale. The scanner is operated at approximately 50 counts∕cm (300 counts∕cm2). The time constant is 0.01 second, the dot factor 8, and 6 lines per cm are recorded. Initially a dose of 1 mCi of technetium was given intravenously. More recently 3 mCi is administered, resulting in better definition. In one patient 0.4 mg of atropine su...

Management of Primary Hyperparathyroidism in the Elderly

Of 166 surgical patients for whom the diagnosis of primary hyperparathyroidism was established over a 20‐year period, about one‐third were over 60 years of age. For an additional 9 patients, no operation was advised, usually because of other life‐endangering disease and the presence of only a mild degree of hypercalcemia without complications. In recent years, nearly 50 per cent of the patients did not have renal calculi or osteitis fibrosa cystica; this was unrelated to age. Most of the patients with management problems were seen since 1965. Age alone was not a dominant factor in relation to serious complications from hypercalcemia, the presence of other critical disease increasing the risk of operation, or the development of major postoperative complications. The only death from primary hyperparathyroidism occurred in a 74‐year‐old patient who refused re‐operation and died from an acute hypercalcemic crisis. A liberal, but selective, policy of surgical treatment is justified for primary hyperparathyroidism in the elderly. Patients for whom the diagnosis of primary hyperparathyroidism is established may be separated into three groups: those for whom early operation is indicated, those for whom operation should be delayed to permit recovery from other life‐endangering acute disease, and those for whom operation is unjustified because of minimal uncomplicated hypercalcemia and other serious disease greatly limiting life expectancy. These categories encompass all age groups and are not restricted to the elderly. All patients require periodic re‐evaluation.