The authors report a case of a gas-filled epidural cyst communicating with the mastoid air cells, causing fluctuating but progressive amaurosis. No prior report of a similar finding could be found in the literature.

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A total of 220 patients have undergone cervical exploration for hyperparathyroidism by the author. A review of 125 cases was published in 1991. An additional 95 patients have been explored in the subsequent four years. Subtotal parathyroidectomy was performed in 39 patients with chronic renal failure. Exploration was successful in over 97% of the 181 patients diagnosed with primary hyperparathyroidism. Single adenomas were found in 146, double adenomas in 11, and multiple gland hyperplasia in 19 patients. Two of the five patients in whom cervical exploration failed were ultimately diagnosed with benign familial hypocalciuric hypercalcemia. Twenty-four adenomas were ectopic. Preoperative thallium-technetium scans and ultrasound correctly localized only 61% of the adenomas. Technetium sestamibi scans were correct in two of four adenomas. Only 47% of ectopic adenomas were correctly localized by isotope scanning and 29% by ultrasound. All four glands should be examined at initial exploration. Because of the occurrence of double adenomas, contralateral exploration is always indicated regardless of whether an enlarged gland and a normal one are found on the first side. All enlarged parathyroids should be removed when dealing with single or multiple adenomas; subtotal parathyroidectomy (3-1/2 glands) should be performed in multiple gland hyperplasia. Frozen section confirmation of excised parathyroid tissue is essential. If exploration is unsuccessful, ectopic locations, such as the retroesophageal areas, thymus, anterior and posterior mediastinum, carotid sheath and thyroid lobe, must be examined carefully. Preoperative localization studies are not as reliable as an experienced parathyroid surgeon.

Nasal obstruction as the only clinical manifestation of a pituitary tumor is rare. A case is reported of a 58-year-old white male with obstruction of the nose and nasopharynx due to a massive pituitary tumor, which recurred 21 years after primary radiation treatment. At autopsy, extensive destruction of the sphenoid and base of the skull was noted. Final pathologic diagnosis was Chromophobe Adenoma. Common clinical features of chromophobe adenomas are discussed.

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A total of 54 patients underwent surgical exploration for primary hyperparathyroidism from 1980 to 1988. Beginning in November 1984 nearly all patients were evaluated with preoperative radionuclide and ultrasound imaging studies. Ultrasound correctly localized 76% of the adenomas removed at surgery, whereas the success rate with radionuclide imaging was 74%. Localization of hyperplastic glands was less successful with the use of either technique. Correct preoperative localization studies in cases of single adenoma reduced the operative time an average of 32 minutes when compared with those cases with no localization studies. Cost-effectiveness was studied based on current charges for operating room time, anesthesia, and the preoperative localization studies. An average cost savings of $124 per case was achieved when results of both localization studies were correct. These localization studies are quick, noninvasive, relatively inexpensive, and associated with no morbidity. Because it is possible to reduce operative time and overall costs, we recommend that radionuclide and ultrasound studies be routinely used in patients with primary hyperparathyroidism.

Collagen biosynthesis, as measured by conversion of 3–4 3H‐proline to 3H‐hydroxyproline, was studied in excised gingival samples utilizing an in vitro tissue slice incubation technique. Samples of clinically normal gingiva and gingiva affected by periodontitis were studied in ten mongoloid patients and eleven non‐mongoloid mentally normal patients. High 3H‐proline uptakes were found in all samples of mongoloid gingiva indicating a high level of collagen synthesis. A possible metabolic block in collagen maturation is suggested as an etiologic factor in the severe form of periodontitis observed.

Two hundred twenty cases of carcinoma of the tongue were reviewed. The three‐year determinant survival of 178 cases was 32.5 percent. The five‐year determinant survival of 169 cases was 29 percent. Only five patients of 41 who developed late node metastasis survived five years. Sixtynine of 79 patients treated for cure by X‐ray therapy developed recurrence. Thirteen were salvaged by secondary treatment. Twenty‐eight of 44 patients treated surgically developed recurrences. Eight were saved by secondary treatment. Because of a high percentage of recurrences at the primary site and a poor salvage of these recurrences, combined therapy is felt to offer the best hope for improved survivals.