Biochemical parameters will not accurately predict the size of a parathyroid adenoma. The size of a parathyroid adenoma does not correlate with postoperative calcium levels and is therefore not useful as a predictor of postoperative hypocalcaemia.

Chronic pancreas transplant rejection with enteric exocrine drainage can lead to significant longterm complications. We report a case of a 47-year-old male insulin-dependent diabetic who survived the complications of peripancreatic abscess, enterocutaneous fistula, and arterioenteric fistula related to pancreas transplantation. To avoid these long-term complications, we now recommend elective removal of nonfunctioning, enterically drained pancreas allografts.Bladder drainage has become the most common technique for diversion of pancreas transplant exocrine secretions (1,2). Urologic complications develop in over 50% of these patients (3). In an attempt to decrease the morbidity and cost of pancreas transplantation, we utilized enteric exocrine drainage for the most recent simultaneous pancreas kidney transplants (4). The 1-year pancreas graft survival rate using this technique was 87% in a recently reported series (5). The long-term complications of enteric drainage will require further study. We report herein a nearly fatal complication after pancreas transplantation with enteric drainage.The patient was a 47-year-old white man with insulin-dependent diabetes mellitus since the age of 5. When he was 36 years old, he developed chronic renal failure secondary to diabetic glomerulosclerosis. After 9 months on hemodialysis, in December 1982, an uneventful cadaveric renal transplant was performed with anastomosis of the donor vessels to the right external iliac artery and vein of the recipient. Cyclosporine and prednisone immunosuppression were maintained after renal transplantation. In March 1983, he was the recipient of a pancreaticoduodenal transplant with enteric drainage to the recipient jejunum. The donor spleen was initially transplanted with the pancreas allograft; however, the patient developed a hemolytic anemia, and a splenectomy was performed on postoperative day 6. The details of this pancreaticoduodenal transplant were reported previously (6). He remained euglycemic for 14 months until the pancreas suddenly failed, and a left lower quadrant extraperitoneal abscess was identified and surgically drained. In July 1985, the patient received his second pancreas transplant through a midline abdominal incision. The allograft was based on both the celiac axis and the superior mesenteric artery, which were anastomosed to the left common iliac artery in an end-to-side fashion using a common Carrel patch. The portal vein was anastomosed to

Head and neck (H&N) cancer affects approximately 8–15 per 100,000 of the UK population. It has been suggested that the delay in diagnosing cancer has been a major factor in the poorer survival rates in the UK compared with some other countries in Europe.

We read with interest the article by Bohl et al. titled 'Donor origin of BK virus in renal transplantation and role of HLA C7 in susceptibility to sustained BK viremia' (Am J Transplant 2005; 5: 2213-2221. The authors' observations on the HLA C7 locus prompted us to examine the HLA typing data on our own patients with BKV nephropathy, who presented 11 ± 6.8 months after transplantation. On a retrospective review, data on HLA Cw loci were available in 31 recipients (23 Caucasians, 8 African Americans), of which 14 (45%) patients (12 Caucasians, 2 African Americans) typed as HLA C7. Donor HLA type was available for 16 patients (13 Caucasians, 3 African Americans), and 7 (44%) (6 Caucasians, 1 African American) carried an HLA C7 allele. By comparison, HLA-Cw7 is reported in 24% of healthy Caucasian subjects. Bohl et al.'s study noted absence of HLA C7 in 10 of 11 recipients with BK viremia, and 11 of 11 donors were also HLA C7 negative. Our data indicate that absence of HLA C7 is neither required nor a sufficient condition for the development of BKV nephropathy. The relationship between HLA genotype and the natural history of infection can presumably be modulated by other parameters such as the degree of immunosuppression, presence of specific cytokine gene polymorphisms, and participation by both innate and acquired immunity. It should be noted that the patients described by Bohl et al. represent self-limited episodes of BKV viremia, whereas our patients developed biopsy proven nephropathy.

Endolymphatic sac tumours are rare lesions of the petrous temporal bone. Although benign, they can be locally destructive. At present, there is no consensus regarding the management and long-term follow up of these tumours. Surgical resection is usually favoured, although treatment with radiotherapy and gamma knife surgery has also been reported.