PSEUDOTUBERCULOUS AXILLARY LYMPH‐ADENITIS CAUSED BY CORYNEBACTERIUM PSEUDOTUBERCULOSIS

This series was not randomly selected and is certainly biased; for example, many patients with renal colic had serum calcium estimations ordered, and this is doubtless a major cause for the large number of patients with renal colic in groups 2, 3 and 4. Also it is not usual in this hospital for serum calcium levels to be determined in cases of fracture, which may be why only one patient with hypercalcremia due to immobilization was found. However, it does indicate the probable frequency and cause of hypercalcremia in an adult teaching hospital, and it seems reasonable to conclude that about one-third of patients with hypercalcremia will have a neoplasm, and over 80% of. these neoplasms will have obviously spread to bone. The incidence of hypercalcremia in carcinoma has been frequently recorded (Swyer et alii, 1950; Warwick et alii, 1961; Bower and Gordon, 1965), but there are very few series in which the relative frequency of hypercalcremia due to carcinoma has been recorded. Boonstra and Jackson (1965) screened all patients attending a large clinic and found that out of 25,847 consecutive patients examined the commonest cause of hypercalcremia was primary hyperparathyroidism (31 patients) with neoplasia next (17). There may be several patients with hyperparathyroidism amongst the 11 in group 4 with symptoms of renal stones and pancreatitis; on the other hand, the incidence of hyperparathyroidism in our series was increased by the affected family found during this period. However, Boonstra and Jackson found that most of their patients with hyperparathyroidism had vague, non-specific symptoms, and their condition would not have been diagnosed if the survey had not been in operation. Patients in our hospital with similar symptoms may not have had a serum calcium determination. If the true incidence of hyperparathyroidism in our hospital population is similar to that reported by these authors, then we may be missing 50 cases of primary hyperparathyroidism a year, a most distressing thought. The most significant finding of the study was the number of abnormal results which apparently were not appreciated by the medical officer concerned. We have reason to believe that this is not limited to this hospital. The factors responsible are several and probably vary from hospital to hospital, but are beyond the scope of this report.