RESUMO
Context: Autologous implantation of parathyroid tissue is frequently utilized after parathyroidectomy in patients with heritable forms of primary hyperparathyroidism (PHPT). Data on long-term functional outcome of these grafts is sparse. Objective: To investigate long-term outcomes of parathyroid autografts. Methods: Retrospective study of patients with PHPT who underwent parathyroid autografts from 1991 to 2020. Results: We identified 115 patients with PHPT who underwent 135 parathyroid autografts. Median follow-up duration since graft was 10 (4-20) years. Of the 111 grafts with known functional outcome, 54 (49%) were fully functional, 13 (12%) partially functional, and 44 (40%) nonfunctional at last follow-up. Age at time of graft, thymectomy prior to autograft, graft type (delayed vs immediate), or duration of cryopreservation did not predict functional outcome. There were 45 (83%) post-graft PHPT recurrences among 54 fully functional grafts at a median duration of 8 (4-15) years after grafting. Surgery was performed in 42/45 recurrences, but cure was attained in 18/42 (43%) only. Twelve of 18 (67%) recurrences were graft-related while remaining 6 (33%) had a neck or mediastinal source. Median time to recurrence was 16 (11-25) years in neck or mediastinal source vs 7 (2-13) years in graft-related recurrences. Median parathyroid hormone (PTH) gradient was significantly higher at 23 (20-27) in graft-related recurrence vs 1.3 (1.2-2.5) in neck or mediastinal source (P = .03). Conclusions: Post-graft recurrence of PHPT occurs frequently within the first decade after graft and is challenging to localize. Time to recurrence after graft is significantly shorter and PTH gradient higher for graft-related recurrence. Clinical Trial Number: NCT04969926.
RESUMO
PURPOSE: Personal narratives are common in children's conversations, recommended as the appropriate genre for early writing by educators, and part of many high-stakes tests, possibly because they tend to be better formed than fictional narratives. However, current practice in the field of speech-language pathology employs fictional narratives in assessment, intervention, and study of children with impaired language development. This article explored performance on personal versus fictional narratives by children with language impairment (LI), hypothesizing that performance on the former would be better and a minimal relationship between performances in the 2 genres. METHOD: Twenty-seven children age 7;0-9;9 (years;months) with LI orally produced personal and fictional narratives (responses to a wordless picture book). Narratives were analyzed by raters blind to experimental hypotheses using high-point analysis and an analysis derived from scoring of a high-stakes composition for 4th grade. RESULTS: High-point ratings of personal significantly exceeded those of fictional narratives. Disproportionate fictional stories did not meet minimal narrative criteria. However, more personal narratives than would be expected by chance did. The analyses were significantly correlated. Quality of a child's performance of personal was minimally related to that of fictional narratives. CONCLUSIONS: Clinicians may want to consider functional aspects of personal narratives.