Biochemical changes that had appeared after subtotal parathyroidectomy (PTx) in 26 patients with end-stage renal failure were observed. The volume of excised parathyroid glands was also measured. Serum calcium and inorganic phosphorus levels fell after PTx; only to rise in due course. Serum alkaline phosphatase levels rose after PTx, reaching a peak by the 14th post-operative day. These elevated levels returned to normal range at about three months after PTx. Strong correlation was noted among the degree of post-operative hypocalcemia, and increase in serum alkaline phosphatase, but not between absolute pre or post-operative alkaline phosphatase levels and changes in serum calcium or phosphorus concentrations. Nevertheless, significant correlation was seen between pre-PTx levels of alkaline phosphatase and its short-lived post-operative rise, indicating hastened osteoblastic activity.

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SummaryAvoidable deaths from asthma continue, even in hospital. Since the management ofacute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge.An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors' levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.