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Fourteen consecutive patients with the clinical diagnosis of primary hyperparathyroidism had computed tomography (CT) preoperatively to evaluate the use of CT in localizing parathyroid adenomas. The patients were scanned from above the level of the thyroid cartilage to the bifurcation of the trachea. Computed tomography correctly identified, prospectively, the site of the adenoma in 7 of 14 patients, including one adenoma that was ectopic in location. Nine of these patients also had barium esophagrams, and this study was accurate in only three of the nine. Our study suggests that CT may be beneficial in the preoperative localization of parathyroid adenomas, particularly those in ectopic locations.

CT studies of the abdomen performed on 72 patients with small-cell carcinoma of the lung were retrospectively reviewed to assess the role of abdominal CT in staging. Forty-four of the 72 patients had extensive disease, defined as disease extending beyond the confines of one hemithorax, plus or minus mediastinal or ipsilateral supraclavicular disease or ipsilateral pleural effusion. Initial-staging abdominal CT revealed one or more sites of metastatic disease in 26 (59%) of these 44 patients, while 18 patients had normal initial CT examinations. Statistical analysis of patients with extensive disease revealed a significant increase in complete therapeutic response (p = .0054) and in the length of survival (p = .001) among those who had extensive disease without abdominal metastases as compared with those who had abdominal metastases on their initial abdominal CT examination. The development of new or recurrent abdominal metastases in general or in specific organs on follow-up scans obtained in 35 patients did not significantly decrease their survival time as compared with that of patients without such metastases. Our findings suggest that CT of the abdomen is beneficial in the initial staging of patients with small-cell carcinoma of the lung and provides prognostic information concerning response to therapy and length of survival.

In a nine-year-old girl with renal hypertension and a urinary infection, angiographic studies of the left kidney suggested an intrarenal pheochromocytoma. After nephrectomy, the kidney was found to contain only a cystic lesion characterized by multiple small, friable excrescences. Under the light microscope these appeared to be formed by granulovacuolated macrophages. Electron microscopy showed intracytoplasmic inclusion identified as Michaelis-Gutmann bodies in various stages of formation. Images suggestive of degraded bacteria were also observed within phagolysosomes.

A 33-year-old normotensive white women was rejected as a kidney donor because arteriography disclosed medial fibroplasia of the right renal artery. 44 months later she became hypertensive and arteriography revealed progression of the lesion. When renal venous renin assay demonstrated lateralization, a saphenous vein aortico-distal right renal arterial bypass graft was done; her blood pressure has been normal for more than 2 years since. Such patients should not donate kidneys because the course of renal arterial dysplastic lesions cannot be predicted.

Twenty-six of 43 patients (60.5%) with classic rheumatoid arthritis (RA) participating in a controlled, prospective study were found to have maximal midexpiratory flow rates (MMEFs) suggestive of obstructive pulmonary disease. Cigarette smokers with RA had significantly lower MMEFs than either nonsmokers with RA or smokers with degenerative joint disease. There was an increased prevalence of the Pi phenotype MS among the RA patients. Interstitial fibrosis, tobacco smoking, and protease inhibitor deficiencies were all significant factors in producing airway obstruction in patients with RA.