RESUMO
Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by hypercalcemia and elevated or abnormally normal parathyroid hormone (PTH) levels, due to excessive secretion of PTH by 1 or more parathyroid glands. In this report, we discuss the diagnostic and therapeutic challenges posed by ectopic parathyroid adenomas, a rare but atypical presentation of PHPT. We present the case of a 36-year-old female with PHPT due to an ectopic parathyroid adenoma located in the submandibular region. The patient presented with bone pain and was initially evaluated with routine imaging studies, which were negative. [18F] F-choline positron emission tomography (PET)/Computed tomography revealed the ectopic adenoma, leading to successful surgical management. Ectopic parathyroid adenomas are rare but can occur in various locations, and functional imaging modalities such as choline PET can aid in their detection. Surgical resection remains the definitive treatment for parathyroid adenomas, with intraoperative PTH monitoring guiding the extent of resection. Proper evaluation and management of PHPT is essential to avoid significant morbidity. Our case adds to the growing body of literature on the importance of considering ectopic locations of parathyroid adenomas in patients with PHPT.
RESUMO
Laser laryngectomy is a minimally invasive surgical technique that offers advantages such as precise and limited resections, magnification of the surgical field by microscopy, and improved patient outcomes. However, it is not without risks, and intraoperative complications have been reported, including cervical-cutaneous emphysema. This case report presents a rare complication of cervical-cutaneous emphysema after laser laryngectomy occurring in a 57-year-old patient with glottic carcinoma. The patient underwent laser cordectomy, and after an uneventful procedure, the patient experienced an intense coughing episode followed by swelling and progressive emphysema. The patient was kept under surveillance in the intensive care unit and received ampicillin sulbactam, protective orotracheal intubation, and voice rest. The patient had a good clinical evolution, and the emphysema resolved within 8-10 days. This case highlights the importance of prompt recognition and management of complications that can arise from laser laryngectomy. Although this technique offers several advantages, it is not risk-free, and intraoperative complications can occur. As such, careful consideration and patient selection are important to minimize the risks and achieve successful outcomes.
RESUMO
BACKGROUND: The prognostic factors for tumor recurrence and mortality of patients diagnosed with Papillary Thyroid Carcinoma (PTC) with immediate surgery in Colombia has not been reported. OBJECTIVE: To retrospectively evaluate the risk factors for recurrence and survival at 10 years in patients with the diagnosis of PTC treated at Fundación Santa Fe deBogota (FSFB). METHODS: A total of 486 patients with thyroid surgery accompanied by medical follow-up were recruited. Demographic, clinical, and pathological variables were followed-up for a median period of 10 years. RESULTS: The most significant variables for recurrence were tumors with > 4 cm of size (hazard ratio [HR] = 8.1; 95% confidence interval [CI] = 1.7-55) and extrathyroidal spread (HR = 26.7; 95% CI = 3.1-228). CONCLUSION: PTC in our population has low rates of mortality (0.6%) and recurrence (9.6%), with an average time of recurrence of 3 years. Size of the lesion, positive surgical margins, extrathyroidal spread, and high postoperative serum thyroglobulin (Tg) level act as prognostic factors that determine the likelihood of recurrence. Unlike other studies, the influence of age and gender does not act as a prognostic factor.