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Parathyroid tumours and cysts are rare and, when presenting as neck masses, can be clinically misdiagnosed as thyroid lesions. Symptoms may be caused by compression of the surrounding structures or hormonal overactivity. This paper describes a patient with recurrent hoarseness owing to the pressure effects of a parathyroid cyst on the recurrent laryngeal nerve.

A case of rapidly progressive necrotizing fascitis and gas gangrene due to Clostridium difficile that responded very well to surgical intervention is described.

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The host defects that increase either the frequency or the severity of certain infections in older persons are reviewed briefly. The major defect is in the functioning of the lymphocyte-macrophage system; this is expressed as deficits in cutaneous reactivity and T cell response after antigenic stimulation. A review of induced infections in experimental animals shows results generally consistent with the data in humans. Infections due to Listeria monocytogenes, Salmonella typhimurium, and Toxoplasma gondii all appear to be worse in senescent mice; each of these organisms is dealt with primarily by the lymphocyte-macrophage system. We have recently completed studies on aged mice infected with Staphylococcus aureus, an organism dealt with primarily by polymorphonuclear leukocytes rather than the lymphocyte-macrophage system. Surprisingly, staphylococcal infections were much worse in older animals. These studies suggest that in older mice there may also be a defect either in polymorphonuclear leukocyte mobilization and/or function or in the ability of older mice to resist the lethal effects of staphylococcal toxins.

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Background:Abdominal tuberculosis (TB) is an uncommon condition in the United States (US) except for patients with human immunodeficiency virus (HIV). An increasing number of cases have been reported in western countries amongst immigrants. It is important to be aware of the data and clinical characteristics in the immigrant population.Aims:The purpose of this study is to determine the epidemiologic characteristics of abdominal TB among immigrants in the US and to review the clinical presentations of abdominal TB with a focus particularly on unusual features.Materials and Methods:In a community teaching hospital in New Jersey, patients diagnosed with abdominal TB were examined and included in this report. All nine patients were immigrants from countries with high prevalence of TB and a majority had resided in the US for at least 5 years. None had clinical evidence of HIV and those that were tested were not found to be positive for HIV. Initial examination, diagnostic workup, and response to therapy were all pertinent to the management and diagnosis of these patients.Results:Three patients had atypical clinical presentations with normal chest X-rays and either negative or unknown tuberculin tests leading to delayed diagnosis and inappropriate therapy in at least one patient. With antituberculous therapy, all except for one patient had satisfactory outcomes. Immigrant patients with a diagnosis of abdominal TB had no evidence of HIV infection or other associated conditions in contrast to native-born individuals.Conclusion:Atypical presentations may cause diagnostic difficulties. Failure to perform appropriate tests may lead to inappropriate therapy with adverse outcomes. Although there is a decline in the number of TB cases in the US and screening for latent pulmonary infection in foreigners has been implemented effectively, the diagnosis of abdominal TB continues to be under diagnosed.