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Metolazone-induced acute pancreatitis and hypercalcemia are described in a 58-year-old woman with severe congestive cardiac failure. Her symptoms and laboratory abnormalities rapidly resolved upon discontinuation of metolazone. Both clinical and laboratory findings make other etiologies for the patient's pancreatitis extremely unlikely. The pathophysiology of thiazide-related hypercalcemia and pancreatitis is reviewed. To our knowledge, neither hypercalcemia nor the combination of acute pancreatitis with hypercalcemia has been reported previously in association with metolazone therapy, and the association of pancreatitis and metolazone has been noted previously only once.

The authors factor analyzed DSM-III-based post-traumatic stress disorder symptom ratings made on 131 Vietnam-veteran PTSD patients. Five factors--termed Intrusive Thoughts and Their Effects, Increased Arousal, Impoverished Relationships, Guilt, and Cognitive Interference--emerged. The factor structure gave more support to Laufer, Brett and Gallops' conceptualization of PTSD than to the Horowitz, DSM-III, or DSM-III-R systems. It also generated suggestions for future editions of the diagnostic manual.

This paper describes the PTSD Interview (PTSD-I). It was developed to meet four specifications: (a) close correspondence to DSM-III standards; (b) binary present/absent and continuous severity/frequency outputs on each symptom and the entire syndrome; (c) administrable by trained subprofessionals; and (d) substantial reliability and validity. It was written to meet the first three criteria. It demonstrated very high internal consistency (alpha = .92) and test-retest reliability (Total score r = .95; diagnostic agreement = 87%). It correlated strongly with parallel DIS criteria (Total score vs. DIS diagnosis rbis = .94, sensitivity = .89, specificity = .94, overall hit rate = .92, and kappa = .84). Earlier studies revealed correlations with a military stress scale and Keane et al.'s MMPI PTSD subscale. It is apparently the only PTSD instrument that meets all of the above criteria.

It has not been universally agreed upon that there is an optimum treatment for multinodular goiter and that use of thyroxine postoperatively in preventing recurrence is effective. We have studied a group of 185 patients who underwent thyroid gland operations and who were observed for a mean period of 10.25 years. Of these, 171 patients received postoperative thyroxine in a dose of 100 micrograms per day and a small group (14 patients) received no medication. In the group receiving no thyroxine, there were six recurrences, and in the group that received postoperative prophylactic thyroxine, there were nine recurrences, which is statistically significant (p = 0.003 per cent). When recurrences did occur in the thyroxine treated group they were small and easily managed by increasing the dose of thyroxine. No patient who took thyroxine postoperatively continuously underwent a second thyroidectomy. We conclude that, in this series, our policy of resecting only macroscopically pathologic thyroid tissue and prescribing prophylactic postoperative thyroxine is successful in preventing recurrent nodular goiter.

The correlations of the Keane, Malloy, and Fairbank (1984) MMPI PTSD scale with DSM-III-based post-traumatic stress disorder symptom, section, and factor score ratings, and with combat history, were studied to determine what aspects of the disturbance it measures (N = 61). The scale's correlations with the various symptom criteria were both substantial and strikingly consistent. However, its relationships with trauma history measures were modest and frequently nonsignificant. The data suggest that the scale is a moderately strong measure of the various PTSD symptoms, but is related only weakly to trauma history.

This study was designed to determine the potential benefit or toxicity of an immunomodulator, Corynebacterium parvum vaccine, when it is given after severe burn injury. Forty conditioned beagles received a 33% total body surface 3-degree flame burn and were resuscitated with Ringer's lactate solution (3 ml/kg/% burn). Wounds were treated daily for 10 days with silver sulfadiazine cream. Two days and nine days after burn, 21 of the animals received C. parvum vaccine (10 mg/kg IV) in a saline infusion, while 19 control animals were given only saline infusion according to a double-blind protocol. Serial measurements were made of temperature, weight, food intake, hematocrit, hemoglobin, red blood count, white blood count, differential, platelet count, fibrin degradation products, activated partial thromboplastin time, clot retraction, C3, blood cultures, neutrophil function, monocyte function, opsonic index, Na, K, Cl, BUN, glucose creatinine, total protein albumin, albumin/globulin ratio, alkaline phosphatase, SGPT, and SGOT. During 45 days of observation, only 16% of the saline control dogs survived compared to 47% of the treated animals. Total white counts and neutrophil function were the only values which were significantly better in animals receiving C. parvum. However, their correlation with increased survival was marginal This preclinical trial suggests that C. parvum is an effective immunodulator for prevention of fatal infection following burn injury. There were no demonstrable toxic effects of the material in this study.

Alcaptonuria is a rare, hereditary disorder of amino acid metabolism, secondary to lack of homogentisic acid oxydase . As a consequence, there is an accumulation of homogentisic acid, which is excreted in the urine and deposited in the connective tissues. This deposition results in ochronotic pigmentation and arthropathy, of which some characteristic radiological findings are demonstrated.