William W. Daniel

Treatment of secondary hyperparathyroidism in patients with chronic renal failure by total parathyroidectomy and parathyroid autograft.

Sixty-one patients with chronic renal failure and secondary hyperparathyroidism underwent total parathyroidectomy and parathyroid autograft. Symptoms relieved by parathyroidectomy included bone pain, pruritus, soft tissue calcification, muscle weakness and healing of fractures. Serum parathormone levels measured before and after operation in 48 patients returned to normal in all but two patients. Serum alkaline phosphatase levels also returned toward normal after operation, except in one patient with a retained parathyroid gland. Complete radiographic studies before and after operation were available in 30 of 61 patients. Twenty-three of 24 patients with osteitis fibrosa had evidence of healing, and in one patient no change occurred. Osteosclerosis noticed in 23 patients improved slightly in eight patients, did not change in 14 and became worse in one. Pathologic examinations revealed 45 patients to have diffuse hyperplasia and 16 nodular hyperplasia. There were two early postoperative deaths, in the first 30 days, and 16 late postoperative deaths, from four months to four years afterward. In no case did the operation contribute to the death. Some patients required the administration of supplemental calcium after operation, but in no instance did profound hypocalcemia occur. No patient developed recurrent hyperparathyroidism.

The surgical treatment of cancer of the cervix uteri

Abstract 1. 1. The record is presented of a program devised and followed to evaluate what modern surgery alone can accomplish as primary treatment for cancer of the cervix. 2. 2. This evaluation is based upon a consecutive series of 348 patients with cancer of the cervix in Stages I, II, III, and IV, admitted to the outpatient clinic, ward and private services. Recurrent cases are excluded. The results of surgery for radioresistant cervix cancers and for recurrences after radiation have been reported elsewhere.4 3. 3. Modern surgery is an effective method of treating cancer of the cervix and may be considered to have re-emerged from purported obsolescence. Under favorable circumstances and with skilled operators, patients may be given about an 80 per cent chance for “cure” if the disease is localized to the cervix. The over-all 5 year salvage among 348 patients with cancer of the cervix in Stages I, II, III, and IV was 55 per cent. Even if pelvic lymph node metastases are present, appropriate modern surgical attack can offer an appreciable chance for “cure” (26 per cent among 99 patients in all stages in this series). 4. 4. It appears that no categorical statement can be made as to whether radiation or modern surgery is over-all the better primary treatment for cancer of the cervix. Which method is to be employed will depend upon the facilities available in each locality as to radiation therapy equipment and talent on the one hand, and surgical interest and talent on the other hand. Both methods of therapy may be highly effective under favorable circumstances. 5. 5. It is important that a “base line” be obtained to show what modern surgery alone can accomplish in a series of minimally selected patients. This article is a progress report of an attempt to secure such fundamental data.

Pelvic exenterations for advanced carcinoma of the vulva

Abstract Carcinoma of the vulva occurs more frequently in the advanced age groups than in relatively young subjects, although in the latter it is not unusually rare. These neoplasms arise in skin and mucosa that have already undergone definite alteration (kraurosis, leukoplakia, etc.). When the disease has encroached upon the urethra, the floor of the bladder (anterior vaginal wall), and the anus, a total pelvic exenteration is necessary to encompass the disease and afford an opportunity for palliation-and even prolonged survival. If the disease involves the vulva, urethra, and anterior vaginal wall (base of the bladder), an anterior exenteration may suffice. If the posterior vulva, vaginal wall, anal and perianal regions are involved, a posterior exenteration may be indicated. The purpose of this report is to record an experience with the exenteration operations in 27 patients with advanced vulvar cancer in whom a type of exenteration operation was carried out. The only contraindication to operation was clinical evidence that the disease had already spread beyond the contemplated area of operation. This series is entirely based upon unselected cases . The techniques for anterior and total pelvic exenterations have been previously described 1 and were followed in this group of patients.