Background: The association of hyperparathyroidism (HPT) with thyroid disease has long been known, but the mechanisms underlying such an association have not yet been clari®ed. Objective: To elucidate the main factors determining this combination of endocrine diseases, in a retrospective multicenter study. Methods: We retrospectively reviewed all patients referred for parathyroid scintigraphy in the period 1990±1999. A total of 487 patients in the age range 17±65 years were selected for the analysis (339 women and 148 men); group A included 241 patients with primary and group B 246 patients with secondary HPT. Results: A total of 124/241 patients in group A (51.5%), but only 92/246 patients in group B (38.2%) had thyroid disorders (notably nodular goiter) associated with HPT P 0X0035X Thyroid disorders were evenly distributed throughout the entire 17±65 years age range in group A, but 17± 40-year-old patients in group B had signi®cantly fewer thyroid disorders than the older patients of the same group (15.5% compared with 43.3%, P , 0X002), as expected in a general population. In patients with primary HPT there was no difference in the prevalence of thyroid disease between women and men, whereas the ratio of women to men in secondary HPT patients with thyroid disease was about 3:1.Conclusions: These results demonstrate an increased prevalence of nodular goiter in patients with primary rather than secondary HPT, and are consistent with a possible role of increased endogenous calcium concentrations (a hallmark of primary, but not of secondary, HPT) as a goitrogenic factor in patients with HPT.

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Intravenous immunoglobulin (IVIG) may be a therapeutic adjunct to antibiotic treatment of neonatal infections. We examined the pharmacokinetics and safety of IVIG in human neonates. Thirty neonates with suspected sepsis were randomly assigned either to a treatment (receiving either 250, 500, or 1,000 mg/kg of IVIG plus antibiotics) or control (antibiotics alone) group. The 500 mg/kg dose produced a rise in total IgG for >8 and in group B streptococcus (GBS) type-specific IgG for > 4-14 days. The type-specific antibody elevation varied with the amount of pathogen-specific antibody and dose of IVIG. Pharmacokinetic analysis suggests a Vd(ss) of 42 ml/kg, Cl of 3.0ml/kg/day, a biphasic elimination curve, and a terminal elimination half-life of 24.2 days. No toxicity was observed. These data may be valuable in determining optimal dosing schedules for IVIG in treating or preventing neonatal infections.

Intravenous immunoglobulin (IVIG) may be a therapeutic adjunct to antibiotic treatment of neonatal infections. We examined the pharmacokinetics and safety of IVIG in human neonates. Thirty neonates with suspected sepsis were randomly assigned either to a treatment (receiving either 250, 500, or 1,000 mg/kg of IVIG plus antibiotics) or control (antibiotics alone) group. The 500 mg/kg dose produced a rise in total IgG for greater than 8 and in group B streptococcus (GBS) type-specific IgG for greater than 4-14 days. The type-specific antibody elevation varied with the amount of pathogen-specific antibody and dose of IVIG. Pharmacokinetic analysis suggests a Vdss of 42 ml/kg, Cl of 3.0 ml/kg/day, a biphasic elimination curve, and a terminal elimination half-life of 24.2 days. No toxicity was observed. These data may be valuable in determining optimal dosing schedules for IVIG in treating or preventing neonatal infections.

IST(~RICALLY, the diagnosis of neonatal intracranial hemorrhage (ICH) has been made either at autopsy' or after the sudden, catastrophic, clinical deterioration of a critically ill infant.' Recent technical advances in intracranial imaging techniques represent a significant improvement in the clinician's ability to diagnose neonatal ICH.3.4 With the introduction of computerized tomography (CT), both the diagnosis and localization of ICH have been greatly simplified.-' The development of two-dimensional ultrasonography further enhances this capability.4.5Although cranial ultrasound has become a frequently used diagnostic tool in premature infants,4-8 its application in the full-term infant has received less attention. We have recently encountered an otherwise healthy term infant who presented with only subtly suggestive clinical findings: a single episode of apnea on the first day of life and mild episodes of bradycardia. During diagnostic evaluation, two-dimensional ultrasonography revealed an extensive intracranial hemorrhage. Neither the history nor physical examination suggested a lesion of the magnitude found on ultrasound examination.Transfontanel cranial ultrasonography is a relatively simple, noninvasive procedure. As our experience with this infant suggests, it may be helpful in evaluating the full-term infant for suspected central nervous system pathology. Case ReportThe patient was a 3650-gram male infant born, after a 40-week gestation, by spontaneous vaginal delivery to a 23-year-old primagravida woman. The pregnancy, labor, and delivery were uncomplicated. Apgar scores were 8 and 9 at I and 5 minutes, respectively. Routine Vitamin K (I mg 1M) was ad-ministered in the delivery room. The initial physical and neurologic examinations were normal. At 6 hours of age, the infant suddenly became cyanotic with no visible respiratory effort. Vigorous tactile stimulation and administration of oxygen by facemask led to a prompt return of normal color and good respiratory effort. The entire episode lasted less than 60 seconds. No further ventilatory support was needed.A diagnostic evaluation was begun at the local level I hospital. Serum electrolytes revealed a sodium of 137 mEq/l, potassium 4.1 mEq/1, and chloride 103 mEq/1. The BUN was 22 mg/dl and the glucose 97 mg/ dl. Cultures of the blood, urine, and cerebrospinal fluid (ultimately reported as no bacterial growth) were obtained. The lumbar puncture produced grossly bloody spinal fluid; protein and glucose were not recorded. No organisms were seen on Gram stain. Parenteral ampicillin (100 mg/kg/day) and gentamicin (5 mg/kg/day) were started. The infant was transferred to Madigan Army Medical Center (MAMC) Neonatal Intensive Care Unit for further evaluation.Upon arrival at MAMC, a small right cephalohematoma was the only notable physical finding. A complete neurologic examination was normal. Serial examinations during the infant's hospitalization failed to demonstrate any focal neurologic signs. Arterial blood gases and serum calcium were normal. No fracture...