Hypercalcemia Associated With Severe Dysphagia in a Patient With Parathyroid Adenoma and Significant Cervical Spondylophytes.

Background/Objective: Severe dysphagia is a rare presenting symptom of primary hyperparathyroidism, whereas the most common hypercalcemia-related causes include gastrointestinal symptoms, such as anorexia, constipation, and pancreatitis. This case presentation aimed to describe swallowing difficulty as a leading symptom of hypercalcemia. Case Report: A 62-year-old man experienced vomiting, dysphagia bordering with aphagia, and 20-kg weight loss in a 2-month period. The parathyroid hormone and serum calcium levels were 102 pmol/L (reference range, 1.8-7.9 pmol/L) and 4.12 mmol/L (reference range, 2.14-2.53 mmol/L), respectively. Ultrasound-guided exploration of the neck revealed a large, rounded hypoechoic mass inferior to the left thyroid lobe, which contained parathyroid tissue on fine-needle aspiration cytology examination. Contrast-enhanced neck computed tomography revealed a mass measuring 3.6 × 2.6 × 2.5 cm behind the left thyroid lobe, alongside massive ventral spondylophytes of the cervical spine at the level of the postcricoid segment of the hypopharynx. Magnetic resonance imaging confirmed ventral tissue displacement due to spondylophyte size and location. Surgical exploration of the left side of the neck was performed, and the left lower parathyroid gland weighing 9.07 g was excised. Pathohistologic findings verified a parathyroid gland adenoma. The postoperative values showed parathyroid hormone and serum calcium levels at 4.54 pmol/L and 2.25 mmol/L, respectively. Discussion: The pathophysiology of dysphagia in hypercalcemia is not fully elucidated. In this case, the patient's improvement after surgery implies a plausible connection between hypercalcemia and dysphagia, suggesting a causal relationship. Conclusion: Although aphagia is not a typical presenting symptom of parathyroid adenoma, it should be noted in the differential diagnosis.

Proton pump (H+/K+-ATPase) expression in human larynx.

OBJECTIVE: The goal of our study was to investigate and to identify the existence of proton pump in different parts of larynx. The presence of acidic content in this area is known to be connected to several laryngeal diseases. It is mostly developed by upward recurrence of acidic gastric content, but there are some signs that the acid can be produced in the larynx as well, because of the proton pump activity in laryngeal mucosa. METHODS: The study was performed on two types of specimens: (1) 50 cadaver larynges and (2) 11 surgical larynges obtained after laryngectomy. Samples were taken from supraglottis, glottis and subglottic areas and immunohistochemistry for the beta subunit of the proton pump was done. RESULTS: The presence of proton pump was proved in seromucous glands in laryngeal supraglottic area, but it was also, for the first time, found in human chondrocytes in the thyroid and epiglottic cartilage. CONCLUSION: These new findings could encourage further research that would illuminate better the etiopathogenesis not only of laryngopharyngeal reflux, but also the pathophysiology of cartilaginous disorders.

[Indications for tonsillectomy in children aged under 16 years in ENT Department of Sestre Milosrdnice Clinical Hospital]. / Indikacije za tonzilektomiju u djece do 16 godina u Klinici za otorinolaringologiju i kirurgiju glave i vrata KB "Sestre milosrdnice".

AIM OF THE STUDY: To study frequency and type of indications for tonsillectomy in ENT Department of "Sestre milosrdnice" Clinical Hospital, distribution of operations according to the age and sex of the patients. To present history of tonsillectomies. METHODS: Retrospective study, information collected by clinical documentation review (anamnesis, physical findings). RESULTS: In the nine-year period 1995 - 2003 the total number of operations was 4704, 2527 male, 2177 female patients. There were 2692 tonsillectomies, 2011 adenotomies and 1 tonsillectomy "a chaud". The most frequent indication for tonsillectomy was recurrent tonsillitis (72%), followed by adenotonsillar hypertrophy (13%), chronic tonsillitis (12%), focaloses (1%) and peritonsillar abscess (2%). Distribution according to the surgeon: 80% of the operations were performed by specialists, 20% by residents. According to the age of patient: operations were most often performed at the age of 4 (800 patients). CONCLUSION: According to this study the most frequent indication for tonsillectomy was recurrent tonsillitis. Indications for tonsillectomy are clearly defined and as such should be followed.