Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia.

CONTEXT: Osteoporosis and/or bone fractures are indications of parathyroidectomy in primary hyperparathyroidism (PHPT), especially in women. However, the benefit of surgery in patients with osteopenia remains unclear. OBJECTIVE: To evaluate bone mineral density (BMD) and bone remodeling biomarkers changes 1 year after parathyroidectomy in women with PHPT. DESIGN: In the prospective, monocentric, observational prospective cohort with primary hyperparathyroidism patients (CoHPT) cohort, women operated for sporadic PHPT since 2016 with ≥1 year follow-up were included. BMD (dual-X ray absorptiometry) and bone remodeling biomarkers [cross-linked C-telopeptide (CTX), procollagen type 1 N-terminal propeptide (P1NP), and bone-specific alkaline phosphatases] were assessed before and 1 year after parathyroidectomy. SETTING: Referral center. PATIENTS: A total of 177 women with PHPT (62.5 ± 13.3 years, 83.1% menopausal, 43.9% osteopenic, and 45.1% osteoporotic) were included. INTERVENTION: Parathyroidectomy. MAIN OUTCOME MEASURE: BMD change between before and 1 year after parathyroidectomy. RESULTS: Parathyroidectomy resulted in significant increase in BMD and decrease in serum bone remodeling biomarker concentrations. In the 72 patients with baseline osteopenia, mean BMD significantly increased at the lumbar spine [+0.05 g/cm2 (95% confidence interval [CI], 0.03-0.07)], the femoral neck [+0.02 g/cm2 (95% CI 0.00-0.04)], the total hip [+0.02 g/cm2 (95% CI 0.01-0.02)], and the forearm [+0.01 (95% CI 0.00-0.02)], comparable to osteoporotic patients. Among osteopenic patients, those with individual BMD gain (>0.03 g/cm2) at ≥1 site had higher preoperative serum CTX, P1NP, and urine calcium concentrations than those without improvement. CONCLUSION: Parathyroidectomy significantly improved BMD and remodeling biomarkers in women with osteopenia, thereby supporting the benefit of parathyroidectomy in these patients. Preoperative serum CTX and P1NP concentrations could be useful to predict expected BMD gain.

Do men improve their bone mineral density 1 year after parathyroidectomy for primary hyperparathyroidism? Results of a prospective study.

BACKGROUND: The impact of parathyroidectomy on bone mineral density in men with primary hyperparathyroidism is poorly known. This study aimed to evaluate the bone mineral density and bone remodeling biomarker changes in men with primary hyperparathyroidism 1 year after parathyroidectomy. METHODS: Men operated for sporadic primary hyperparathyroidism between 2016 and 2022, enrolled in a monocentric prospective cohort, were analyzed. Patients with follow-up <1 year or missing data were excluded. Bone mineral density (dual X-ray absorptiometry) was measured before and 12 months after parathyroidectomy. Bone mineral density change ≥0.03g/cm2 was deemed significant. Bone remodeling biomarkers were serum cross-linked C-telopeptide, procollagen type 1 N-terminal propeptide, and bone-specific alkaline phosphatases. RESULTS: Forty-five men were included (mean age 58.8 ± 13.1 years). Before surgery, 49% had osteopenia, and 11% had osteoporosis. Mean serum calcium and median serum parathyroid hormone levels decreased significantly after surgery (P < .0001). One year after parathyroidectomy, the mean bone mineral density increased significantly at the lumbar spine (+0.04g/cm2 [0.01;0.70], P = .0054), femoral neck (+0.04g/cm2 [0.03;0.05], P < .0001) and total hip (+0.02g/cm2 [0.01;0.03], P = .0002). Considering significant bone mineral density gain (+1 point) and loss (-1 point) at each site, 29/45 patients (64% [95% CI 49;78]) improved. Bone remodeling biomarker concentrations significantly decreased (P < .001). CONCLUSION: Parathyroidectomy positively affects bone mineral density in men with primary hyperparathyroidism, supporting osteopenia as a surgical indication in these patients.

Delaying Surgery After Neoadjuvant Chemotherapy Affects Survival in Patients with Colorectal Peritoneal Metastases: A BIG-RENAPE Network Multicentric Study.

BACKGROUND: Multimodal treatment for patients with peritoneal metastases (PM) from colorectal cancer (CRC), including perioperative chemotherapy (CT) plus complete resection, is associated with prolonged survival. The oncologic impact of therapeutic delays is unknown. OBJECTIVE: The aim of this study was to assess the survival impact of delaying surgery and CT. METHODS: Medical records from the national BIG RENAPE network database of patients with complete cytoreductive (CC0-1) surgery of synchronous PM from CRC who received at least one neoadjuvant CT cycle plus one adjuvant CT cycle were retrospectively reviewed. The optimal interval between the end of neoadjuvant CT to surgery, surgery to adjuvant CT, and total interval without systemic CT were estimated using Contal and O'Quigley's method plus restricted cubic spline methods. RESULTS: From 2007 to 2019, 227 patients were identified. After a median follow-up of 45.7 months, the median overall survival (OS) and progression-free survival (PFS) was 47.6 and 10.9 months, respectively. The best cut-off period was 42 days in the preoperative interval, no cut-off period was optimal in the postoperative interval, and the best cut-off period in the total interval without CT was 102 days. In multivariate analysis, age, biologic agent use, high peritoneal cancer index, primary T4 or N2 staging, and delay to surgery of more than 42 days (median OS 63 vs. 32.9 months; p = 0.032) were significantly associated with worse OS. Preoperative delay of surgery was also significantly associated with PFS, but only in univariate analysis. CONCLUSION: In selected patients undergoing complete resection plus perioperative CT, a period of more than 6 weeks from completion of neoadjuvant CT to cytoreductive surgery was independently associated with worse OS.

Parathyroidectomy for primary hyperparathyroidism: effect on quality of life after 3 years - a prospective cohort study.

BACKGROUND: The impact of parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT) on long-term quality of life (QoL) remains controversial. The study evaluated QoL changes 1 and 3 years after PTX. MATERIALS AND METHODS: Patients undergoing PTX for PHPT between 2016 and 2022 ( n =329) were enrolled in this monocentric, prospective cohort study. QoL was evaluated using the SF-36 questionnaire before, 1 year, and 3 years after PTX and compared with an age-matched and sex-matched French reference population. Only patients with 1-year and 3-year follow-up and complete evaluation (serum calcium, phosphorus, parathyroid hormone) were included. RESULTS: A total of 159 patients were included (mean age: 62.6±12.7 years, 79.2% females). Mean serum calcium (2.66±0.20 mmol/l) and median parathyroid hormone (96.4 [76.9-126.4] pg/ml) levels improved significantly after PTX. Before surgery, PHPT patients had impaired physical (44.6±8.9 vs. 47.6±6.8 in the reference population, P <0.001) and mental (42.3±10.9 vs. 48.9±6.8, P <0.001) component scores. The mean physical component score increased significantly at 1 and 3 years and was no longer different from the reference population (ratio: 0.94±0.15 preoperatively vs. 0.99±0.15 at 3 years, P <0.01). The mean mental component score increased significantly at 1 and 3 years, but remained significantly lower than the reference population. Before surgery, a lower physical component score and younger age were significantly associated with a 3-year physical component score increase on multiple linear regression analysis. CONCLUSION: A significant improvement in QoL is associated with PTX for PHPT at 1 year and is sustained for at least 3 years after surgery.

Thyroid liposarcoma: a case report.

Objectives: Thyroid liposarcoma is a rare tumor. Its low prevalence accounts for the scarcity of data in the literature, which consists mostly of small studies and case reports. Case presentation: We present the case of a 60 years old male with no past medical or past surgical history and presented with neck discomfort and a large left thyroid nodule. Thyroid ultrasound and CT scan were performed and confirmed the existence of a thyroid nodule most probably inside the left inferior thyroid lobe. In the posterior mediastinum, two fatty formations were found. To complete, an MRI was performed, showing a mixed lesion, of the lower neck and upper chest. The patient underwent an extended resection which consisted of an en bloc resection of the lesion (left thyroid lobectomy and isthmus resection) by an anterior transverse cervical incision and a sternotomy. Tracheal and laryngeal shaving and esophageal shaving with resection of the esophageal muscularis was performed as well. The pathological evaluation of the specimen showed a grade II dedifferentiated liposarcoma with an inflammatory component. Conclusions: Thyroid liposarcoma is a rare lesion of the thyroid. Its management requires an exhaustive workup followed by an en bloc resection of the lesion. Depending on the histology, postoperative radiation therapy may or may not be necessary.

Precocious puberty related to Leydig cell testicular tumor: the diagnostic imaging keys.

BACKGROUND: We report the challenging case of a 6-year-old boy with precocious puberty related to histologically proven Leydig cell tumor. CASE PRESENTATION: Multiparametric ultrasound and magnetic resonance imaging (MRI) was performed. Interesting findings were scarcely or never reported in children and differed from adults Leydig cell tumors s such as the hyperechogenic halo surrounding the lesion and the dominant central vascularization using ultrasensitive Doppler. MRI revealed an enlarged testicle with strong enhancement of a tumor, a tumor apparent diffusion coefficient (ADC) of 600 × 10-3 mm2/s and a lower ADC value of the non-tumor parenchyma compared to the contralateral testis (ADC = 800 × 10-3 mm2/s vs 1100 × 10-3 mm2/s), attributed to the spermatogenesis induced by hormonal impregnation. CONCLUSION: We illustrate multiparametric US and MRI findings of a pediatric Leydig cell tumor, including the imaging changes attributed to local hormone secretion, which may be helpful in similar cases.

Hypoparathyroidism: Consequences, economic impact, and perspectives. A case series and systematic review.

BACKGROUND: Postoperative hypoparathyroidism (PH) is the most common complication after total thyroidectomy. Incidence varies from 2% to 83%, depending on the definition. OBJECTIVE: We performed a systematic review of the literature to determine the medico-economic effects of PH and update understanding of long-term consequences, morbidity, and quality of life related to hypoparathyroidism. METHODS: We considered relevant articles published between 2000 and 2020 concerning long-term consequences of PH and quality of life. All studies concerning the medico-economic assessment of PH were included. We compared data from 2018 to results in the literature. RESULTS: A proportion of 64/403 (16.8%) patients presented with transient PH during 2018, and 7/403 (1.7%) had permanent PH. Seven patients needed supplementation with alfacalcidol at 6-month follow-up. Factors predicting the need for alfacalcidol were age <45, thyroidectomy for goiter, and lymph node dissection. Additional therapy costs related to PH were €9781.10, and additional hospital costs were €230,400. We qualitatively synthesized 41 studies. Most were retrospective studies and only a few reported costs. No series assessed direct or indirect costs of postoperative PH. CONCLUSION: To our knowledge, no previous studies reported the medico-economic impact of PH. Decreasing PH associated with fluorescence usage should be considered, particularly concerning cost-effectiveness.

Intra-Arterial Image Guidance With Optical Frequency Domain Reflectometry Shape Sensing.

Intra-arterial liver cancer therapies, such as trans-arterial chemoembolization, are the preferred therapeutic approaches for advanced hepatocellular carcinoma. However, these palliative techniques are challenging for delivering therapeutic agents selectively in the tumor without real-time 3-D visualization of the catheter within the hepatic arteries. The objective of this paper is to develop and evaluate in pre-clinical tests an advanced interventional guidance platform using a distributed strain sensing device based on optical frequency-domain reflectometry (OFDR) to track the tip and shape of a catheter. The scattering properties of a fiber triplet are enhanced by focusing an ultraviolet beam on these fibers, producing a fully distributed strain sensor, which avoids interpolation errors observed with traditional shape tracking systems. A 3-D roadmap of the hepatic arteries is obtained from a combined fully convolutional and residual networks trained on MR angiography and combined with a 4-D flow dynamic sequence enabling to map blood flow velocities. An anisotropic curvature matching method is proposed to map the sensed data onto pre-operative MR and using 3-D ultrasound to correct for non-rigid deformations. Experiments were conducted in a controlled environment setting as well as in both synthetic phantoms and in five porcine models to assess the performance for device navigation, yielding satisfactory tracking accuracy with 3-D mean errors of 2.8 ± 0.9 mm. We present the first pilot study of MR-compatible UV-exposed OFDR optical fibers for non-ionizing device guidance in intra-arterial procedures, with the potential of avoiding multiple hospitalizations required to perform invasive selective chemoembolizations.

Foetal exposure to mitotane/Op'DDD: Post-natal study of four children.

OBJECTIVE: Mitotane/Op'DDD is used in the treatment of adrenocortical carcinoma and for other causes of hypercortisolism. Mitotane inhibits cortisol secretion and displays adrenolytic and antitumor actions. This compound is a metabolite of the pesticide and endocrine disruptor DDT (dichlorodiphenyltrichloroethane) and is classified among teratogenic compounds worldwide. However, little is known about its effects on human development. DESIGN: The outcome of four children exposed to mitotane during their intrauterine life was examined. PATIENTS: Patients having conceived while taking mitotane, or with detectable mitotane plasma levels, were retrospectively recruited via the French COMETE and FIRENDO networks. MEASUREMENTS: Mitotane in maternal plasma, adrenocortical hormones in children. RESULTS: Three women treated with mitotane gave birth to four children. During early pregnancy, all patients had detectable mitotane plasma levels (0.9, 2.4 and 6.7 mg/L, respectively). During pregnancy, no foetal malformations were detected. The four exposed newborns presented at birth with apparently normal adrenal function and genitalia. One twin female had a low birthweight. Evaluation at birth and after 3 months, 2 years and 7 years of follow-up showed no significant neurological abnormality. Evaluation of adrenocortical functions showed no cortisol deficiency. CONCLUSIONS: Unexpectedly, exposure of these four children to mitotane during foetal life seemed to have no clear teratogenic effect. However, considering the sub-therapeutic mitotane concentrations used here, the small number of cases, and because long-term follow-up is unknown, we strongly advise not to take mitotane during pregnancy and still recommend avoiding pregnancy, at least as long as mitotane plasma levels remain detectable.

Risk of low birth weight and micronutrient deficiencies in neonates from mothers after gastric bypass: a case control study.

BACKGROUND: An increased risk of small-for-gestational-age infants after maternal bariatric surgery has been shown. The risk of micronutrients deficiencies in these neonates is unclear. OBJECTIVE: To screen for micronutrients deficiencies in newborns of mothers with gastric bypass. SETTINGS: University hospital in Angers, France. METHODS: This study compared the clinical and cord blood biological characteristics of 56 newborns of mothers with prior Roux-en-Y gastric bypass (RYGB) and 56 newborns of nonobese healthy mothers after normal pregnancy (controls), followed between January 3, 2008 and October 31, 2012. Cord blood micronutrients concentrations from controls were used for establishing normative data. After RYGB, the women took daily micronutrients supplements. RESULTS: RYGB mothers lost 18.1±6.3 kg/m2 of body mass index (BMI) in the 11-69 months between surgery and pregnancy onset (percentage of excess weight loss 79±20%), reaching BMI of 30.1±6.0 kg/m2 compared with 22.3±4.0 kg/m2 in the controls (P<.05). Neonates born to RYGB mothers were small-for-gestational-age in 23% of cases versus 3.6% in the control group (P<.01). A higher percentage of RYGB neonates had cord blood concentrations below the 2.5 percentile for calcium (19% versus 2%), zinc (13% versus 3%,), iron (19% versus 2%), and vitamin A (13% versus 3%), and over the 97.5 percentile for magnesium (13% versus 3%), vitamin E (16% versus 3%), 25-hydroxy-vitamin D (13% versus 2%), and vitamin B12 (14% versus 2%) (P<.05 for all comparisons). CONCLUSION: Neonates from RYGB mothers showed cord blood micronutrient differences compared with neonates from healthy mothers. The comparison with neonates from morbidly obese women is still to be done.

Geometric modeling of hepatic arteries in 3D ultrasound with unsupervised MRA fusion during liver interventions.

PURPOSE: Modulating the chemotherapy injection rate with regard to blood flow velocities in the tumor-feeding arteries during intra-arterial therapies may help improve liver tumor targeting while decreasing systemic exposure. These velocities can be obtained noninvasively using Doppler ultrasound (US). However, small vessels situated in the liver are difficult to identify and follow in US. We propose a multimodal fusion approach that non-rigidly registers a 3D geometric mesh model of the hepatic arteries obtained from preoperative MR angiography (MRA) acquisitions with intra-operative 3D US imaging. METHODS: The proposed fusion tool integrates 3 imaging modalities: an arterial MRA, a portal phase MRA and an intra-operative 3D US. Preoperatively, the arterial phase MRA is used to generate a 3D model of the hepatic arteries, which is then non-rigidly co-registered with the portal phase MRA. Once the intra-operative 3D US is acquired, we register it with the portal MRA using a vessel-based rigid initialization followed by a non-rigid registration using an image-based metric based on linear correlation of linear combination. Using the combined non-rigid transformation matrices, the 3D mesh model is fused with the 3D US. RESULTS: 3D US and multi-phase MRA images acquired from 10 porcine models were used to test the performance of the proposed fusion tool. Unimodal registration of the MRA phases yielded a target registration error (TRE) of [Formula: see text] mm. Initial rigid alignment of the portal MRA and 3D US yielded a mean TRE of [Formula: see text] mm, which was significantly reduced to [Formula: see text] mm ([Formula: see text]) after affine image-based registration. The following deformable registration step allowed for further decrease of the mean TRE to [Formula: see text] mm. CONCLUSION: The proposed tool could facilitate visualization and localization of these vessels when using 3D US intra-operatively for either intravascular or percutaneous interventions to avoid vessel perforation.