Citations

What disease states are occasionally associ ated with hypogarathyraidisna? Is there any explanation for the association of moniliasis or steatorrhea in the syndrome re ported ? Is there a familial incidence of the syndrome of hypoparathyroidism, Addison's disease and moniliasis?

Medical and surgical emergencies occasionally present as ruptured abdominal aortic aneurysms (RAAA). To assess benefits of laparotomies and adverse effects of unnecessary operations, the authors reviewed their experience. Thirteen patients, 9 women, 4 men (mean age: 72 years, range: 41-85) underwent emergency laparotomy between 1988 and 1996 for presumed RAAA and were found to have other surgical or medical emergencies. All the patients presented with hypotension, 12 had abdominal or back pain, four had pulsatile abdominal mass. Rupture was not excluded by computed tomography scan in three or by ultrasonography in two patients. Laparotomy disclosed intact abdominal aorta in all, but seven patients had abdominal aortic aneurysm. Of five surgical emergencies, laparotomy was indicated in four: three for ruptured visceral artery aneurysms, one for perforated duodenal ulcer. The fifth patient required thoracotomy for ruptured thoracic aneurysm. Four of eight medical emergencies were myocardial infarctions. One iatro genic complication required reoperation for bleeding. Mean hospital stay was 18 days; mean hospital charges were $40,771. Seven (54%) early deaths occurred; none were caused directly by the operation. Laparotomy was indicated in one third of deceptive emergencies that present as RAAA. Although mortality, morbidity, and costs were high, iatrogenic surgical complica tions were rare and deaths were not caused by unnecessary operations.

The hazard of rupture of asymptomatic splenic artery aneurysms in preg nancy is well known. Arterial dysplasia is an important etiologic basis of splenic artery aneurysms in women of child-bearing age, as exemplified by the two cases described. In one patient, multiple splenic artery aneurysms oc curred in association with hypoplasia of the aorta and visceral arteries. In another patient, a false aneurysm of the splenic artery occurred with coexisting fibromuscular dysplasia of the renal arteries.

Background: Although angina is a chronic disease, most clinical trials evaluating antiangi nal therapy are of a few weeks or months in duration. Methods and Results: To evaluate the effects of nicardipine, a second-generation dihydro pyridine calcium channel blocker, as long-term therapy, patients with chronic stable angina were treated for 1 year with open-label nicardipine. Anginal symptoms were controlled with 20 mg tid in 24%, 30 mg tid in 34%, and 40 mg tid in 42%. Of 72 patients completing the 1-year trial, only 14 (19%) had required the addition of long-acting nitrates for control of symptoms. The remaining 57 patients, who had anginal symptoms controlled with nicar dipine alone, were continued into the 3-week, double-blind period and were randomized to continue their usual dose of nicardipine or placebo. Throughout the 1-year, open-label treatment period, the number of anginal episodes and exercise parameters of angina were significantly reduced with nicardipine. Conclusions: During the double-blind period, the patients who continued on nicardipine had significantly greater exercise time and time to onset of angina than patients who were randomized to placebo. The exercise parameters in the patients randomized to placebo were improved over baseline after 1 year of therapy; however, the improvement with nicar dipine was significantly greater.

Parents' major concerns were bicycle and car accidents, head injuries, abduction, exposure to environmental poisons, appropriate discipline, values and morals, affection, finances, too much television, and eating properly. Schoolchildren's concerns differed from their parents' and, for boys, included having to eat food they did not like, finances, people telling lies about them, and other issues about failure and criticism. Girls were more concerned about such dangers as abduction, burglars, strange people following them, and death. Major concerns shared by both sexes were looking foolish, people telling lies about them, being in a big crowd, and failing tests. Parents have many often unfounded or exaggerated fears about their children that are fanned by news media. This has led to the speculation that parents' insecurity about raising children has made them less effective. Continued reassurances by health professionals are needed to help parents believe more in themselves and become more secure in bringing up their children.