The effect of parathyroidectomy on patients' symptoms in tertiary hyperparathyroidism.

BACKGROUND: The efficacy of parathyroidectomy for primary and secondary hyperparathyroidism is well-established but evidence in tertiary hyperparathyroidism is lacking. We examined parathyroidectomy's effect in tertiary hyperparathyroidism. METHODS: Patients with tertiary hyperparathyroidism who underwent parathyroidectomy were followed up for 12 months. A modification of the 13-item parathyroid symptoms list developed by Pasieka was administered at 0, 1, 3, 6, and 12 months post-surgery. We also examined if preoperative factors would predict symptom improvement post-surgery. RESULTS: Ninety-one patients were included. Survey response rates at 1, 3, 6, and 12 months post-surgery were 97.8%, 90.1%, 82.4%, and 80.2%, respectively. Mean preoperative Pasieka parathyroid score (PSS) was 6.3 ± 2.7. At first month, PSS decreased to 2.9 ± 2.0 (P < .001) and was sustained at 3, 6, and 12 months (2.7 ± 2.1, P < .001, 2.3 ± 1.6, P < .001 and 3.4 ± 2.5, P < .001). The degree of PSS reduction at 1-month post-parathyroidectomy correlated strongly with preoperative symptom severity (Pearson's coefficient: 0.690, P < .001). CONCLUSIONS: Parathyroid symptoms unequivocally improve post-parathyroidectomy. The greatest degree of improvement was observed in early postoperative period up to 6 months.

Perineal impalement injury by steel bar - A near miss.

Adult perianal impalement injuries are uncommon but can carry high morbidity and mortality. We report a case of a penetrating perineal trauma in a construction worker highlighting an innovative use of a Sengstaken tube to control his pelvic bleeding, as well as the operative management of his sphincteric injury. This article illustrates principles of effective acute care and discusses a diagnostic approach to evaluating a potentially complex injury, as well as the decision-making process with regard to fecal diversion and choice of sphincteric repair.

Subcutaneous injection is a simple and reproducible option to restore parathyroid function after total parathyroidectomy in patients with secondary hyperparathyroidism.

BACKGROUND: Secondary hyperparathyroidism is a common clinical problem seen in patients with end-stage renal disease (ESRD) undergoing hemodialysis. In patients with severe persistent hyperparathyroidism, parathyroidectomies are often required. OBJECTIVES: We sought to evaluate the feasibility and efficacy of total parathyroidectomy followed by subcutaneous injection of parathyroid autograft compared with surgical implantation. METHODS: We conducted a retrospective study of 132 patients with confirmed diagnoses of ESRD treated with hemodialysis or peritoneal dialysis, with secondary hyperparathyroidism who had undergone total parathyroidectomies. Clinical and biochemical characteristics, including preoperative and postoperative intact parathyroid hormone levels were recorded and compared between patients who had undergone subcutaneous injection or surgical implantation of autograft. RESULTS: From February 2005 to February 2012, 132 patients who had undergone total parathyroidectomies were included in our study. To compare the techniques of subcutaneous injection and surgical implantation, pre- and postoperative biochemistry was recorded and analyzed. Preoperative biochemistry was comparable in both groups. However, autograft recovery was significantly faster in the group with subcutaneous injection compared with surgical implantation (P = .03). Median time to parathyroid recovery was 2 months for injection compared with 9 months for implantation. There was no remarkable difference in the recurrence rates between the 2 groups. CONCLUSION: Subcutaneous injection of parathyroid tissue is a feasible and simple alternative to the more commonly used method of surgical implantation.