Primary Hyperparathyroidism With Undetectable Intact Parathyroid Hormone.

Hypercalcemia can result from either hyperparathyroidism or non-parathyroid conditions. When hypercalcemia is accompanied by undetectable parathyroid hormone (PTH) levels, hyperparathyroidism is rarely considered the diagnosis. Herein, we report the case of a 65-year-old Caucasian woman referred to our hospital for further evaluation of hypercalcemia. Her symptoms included fatigue and brain fog, with undetectable PTH levels. A comprehensive workup, including a series of laboratory and imaging tests, excluded common non-parathyroid causes such as malignancy and familial hypocalciuric hypercalcemia. Ultrasound identified a likely enlarged parathyroid gland, which was further confirmed by a sestamibi scan. After 2 weeks of cinacalcet treatment, the patient's calcium levels decreased, indicating the parathyroid gland as the likely source of hypercalcemia. Parathyroidectomy was subsequently performed, revealing a 1927 mg adenoma. Postoperatively, the patient's calcium levels normalized, PTH levels became detectable within the normal range, and her symptoms resolved, with a marked improvement in energy. This case demonstrates that primary hyperparathyroidism can present with hypercalcemia and undetectable PTH. A genetic mutation in the PTH gene within the adenoma may explain the undetectable PTH levels preoperatively.

This case report discusses a 65-year-old woman who was found to have high calcium levels in her blood, a condition known as hypercalcemia. Typically, hypercalcemia can result from either a condition where the parathyroid glands produce too much parathyroid hormone (PTH) or from other non-parathyroid-related issues like cancer. However, when hypercalcemia occurs with undetectable levels of PTH, it is unusual for hyperparathyroidism to be the cause. In this patient's case, she experienced symptoms like fatigue and brain fog, but her initial tests showed undetectable PTH levels. Further tests ruled out other common causes of high calcium, such as cancer or a genetic condition called familial hypocalciuric hypercalcemia. An ultrasound and a special scan called a sestamibi scan revealed an enlarged parathyroid gland, suggesting the presence of a parathyroid adenoma, a non-cancerous tumor. To confirm this, the doctors gave the patient a medication called cinacalcet, which is known to lower calcium levels if the parathyroid glands are involved. After two weeks of treatment, her calcium levels dropped, indicating that the parathyroid gland was indeed the source of the problem. The patient underwent surgery to remove the adenoma, which weighed nearly two grams. Following the surgery, her calcium levels returned to normal, and her PTH levels became detectable again within the normal range. Her symptoms, including fatigue, improved significantly, and she reported feeling more energetic. This case is unusual because it demonstrates that primary hyperparathyroidism can still be the cause of hypercalcemia even when PTH levels are initially undetectable. The doctors suspect that a genetic mutation in the adenoma might explain why PTH levels were undetectable before surgery. This case emphasizes the importance of thorough clinical evaluation, even when initial test results are not typical.

Racial disparities in thyroid cancer outcomes: A systematic review.

INTRODUCTION: Racial disparities in surgical outcomes are well described, but a paucity of literature exists examining trends in outcomes of thyroid cancer. We performed a systematic review of studies on thyroid cancer outcomes to better delineate the impact of race. METHODS: A comprehensive search strategy was performed in several academic databases for articles on thyroid cancer and surgical outcomes in accordance with PRISMA guidelines. A total of 1771 abstracts were reviewed. Abstracts were screened by two independent reviewers with disagreements resolved by a third. Studies that were based in the United States, included single center, unique data, focused on outcomes of differentiated thyroid cancer, were performed on adults >18 years old, and reported race in their results were included. Chi square statistics with Yates correction were calculated on the compiled data. The protocol was registered on PROSPERO (CRD42022300021). RESULTS: Twelve studies met inclusion criteria with data on 7,221patients. Among the included studies, our study consists of 67 â€‹% White patients, 22 â€‹% Black patients, 7 â€‹% Hispanic patients, and 3 â€‹% Asian patients. Extrathyroidal extension was observed in 8.4 â€‹% (n â€‹= â€‹13) of White patients. In comparison to White patients, Black (18.4 â€‹%, n â€‹= â€‹21, p â€‹= â€‹0.024) and Hispanic patients (28.3 â€‹%, n â€‹= â€‹30, p â€‹< â€‹0.001) had a higher incidence of extrathyroidal extension, while a similar incidence was observed in Asian patients (14.0 â€‹%, n â€‹= â€‹8, p â€‹= â€‹0.336). Compared to White patients (22.2 â€‹%, n â€‹= â€‹34), Black (12.4 â€‹%, n â€‹= â€‹13, p â€‹= â€‹0.065), Hispanic (16.0 â€‹%, n â€‹= â€‹15, p â€‹= â€‹0.301), and Asian (18.4 â€‹%, n â€‹= â€‹9, p â€‹= â€‹0.709) patients had a similar incidence of T1a stage. White patients had 10.1 â€‹% (n â€‹= â€‹54) recurrence rates, and Black (13.5 â€‹%, n â€‹= â€‹7, p â€‹= â€‹0.595), Hispanic (10.5 â€‹%, n â€‹= â€‹2, p â€‹= â€‹1.000), and Asian (11.1 â€‹%, n â€‹= â€‹3, p â€‹= â€‹1.000) patients had similar recurrence rates. CONCLUSIONS: Race is seldom reported in outcomes on studies of thyroid cancer. From our analysis we conclude that non-White patients may have a higher risk of more advanced local disease at presentation. More data with granular detail on race is necessary to better understand racial disparities in thyroid cancer outcomes and how to alleviate them.

National Institutes of Health Funding Among Society of Asian Academic Surgery Members.

INTRODUCTION: External funding is fundamental to surgeon-scientists and many Society of Asian Academic Surgeons (SAAS) members have received funding through National Institutes of Health (NIH) grants. The amount of funding through NIH awards amongst SAAS members has yet to be evaluated. Our objective was to quantify the amount and type of NIH funding among SAAS members. METHODS: A list of all active SAAS members was compiled. The NIH Research Portfolio Online Reporting Tool's Expenditure and Results was queried to identify NIH funding among active members. RESULTS: Among 585 active SAAS members, 165 (28%) received NIH funding during their career. Of these, 110 members (66.6%) were male and 55 members (33.3%) were female. A total of 420 NIH grants have been awarded totaling $518.7 million in funding. There are currently 47 active grants totaling $34.1 million in funding. When analyzing by type, there were 226 R research grants, 63 K career development awards, 53 T and F research training and fellowships awards, and 78 other awards. Of the 63 members who received a K award, 35 members (55%) have subsequently received an R award. CONCLUSIONS: SAAS members are highly funded with 28% of members having received NIH funding totaling $518.7 million. SAAS' mission is to foster the personal and professional development of academic surgeons and we found that many SAAS members have the experience to mentor other surgeon-scientists through the process of obtaining NIH funding. Participation in organizations like SAAS can help nurture the success of future generations of surgeon-scientists.

Incidental Thyroid Nodules on Computed Tomography: A Systematic Review and Meta-Analysis Examining Prevalence, Follow-Up, and Risk of Malignancy.

Background: The increased utilization of computed tomography (CT) has led to a higher detection rate of thyroid incidentalomas. Currently, there are no widely agreed-upon guidelines for managing these incidentalomas. This study aims to investigate the prevalence, follow-up practices, and malignancy rates of thyroid incidentalomas detected by CT. Methods: We conducted a comprehensive search of PubMed, Embase, and Cochrane databases to identify relevant studies published before April 12, 2024 (PROSPERO #42024535501). Studies reporting on the prevalence, follow-up, and risk of malignancy (ROM) of thyroid incidentalomas detected by CT were included. Combined outcomes were analyzed using pooled proportion with a random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Newcastle-Ottawa Scale tool. Subgroup analyses were conducted based on characteristics including size of the incidentaloma, CT area, and age of the study population. Results: Thirty-eight studies involving 195,959 patients were included in the prevalence analysis, revealing a prevalence of thyroid incidentalomas on CT of 8.3% (confidence interval [CI], 7.4-9.3). The prevalence was higher in neck CT (16.5%, CI, 11.0-22.1) compared with chest CT (6.6%, CI, 5.3-7.9). Multiple incidentalomas were found in 27.0% (CI, 12.9-41.1) of patients. Of the nodules, 46.3% (CI, 32.3-60.3) were ≥1 cm, and 28.6% (CI, 19.9-37.3) were ≥1.5 cm. Thyroid ultrasounds, biopsies, and surgeries were performed in 34.9% (CI, 26.1-43.7), 28.4% (CI, 19.9-36.9), and 8.2% (CI, 2.1-14.4) of cases, respectively. Additionally, 25 studies with 6272 patients reported a ROM of 3.9% (CI, 3.0-4.9) for thyroid incidentalomas detected on CT. A higher ROM was observed in incidentalomas ≥1 cm (11.7%, CI, 3.9-19.4) and ≥1.5 cm (24.9%, CI, 0-52.7) compared with those <1 cm (0.1%, CI, 0-0.8) and <1.5 cm (0%, CI, 0-0.2). Conclusions: Most thyroid incidentalomas identified on CT are benign. Implementing a collaborative protocol between radiologists and thyroid specialists to manage high-risk thyroid incidentalomas can ensure appropriate follow-up and optimal patient care.

A natural language processing-informed adrenal gland incidentaloma clinic improves guideline-based care.

INTRODUCTION: Adrenal gland incidentalomas (AGIs) are found in up to 5% of cross-sectional images. However, rates of guideline-based workup for AGIs are notoriously low. We sought to determine if a natural language processing (NLP)-informed AGI clinic could improve the rates of indicated biochemical evaluation and adrenal-specific imaging. METHODS: An NLP algorithm was created to detect clinically significant adrenal nodules from radiology reports of cross-sectional images at an academic institution. The NLP algorithm was applied to scans occurring between June 2020 and July 2021 to form a baseline cohort. The NLP algorithm was re-applied to scans from August 2021 to February 2023 and identified patients were invited to join an outpatient clinic dedicated to AGIs. Patients evaluated in the clinic from March 2022 to February 2023 were included in the intervention cohort. Statistical analysis utilized chi-square, t-test, and a multivariable logistic regression. RESULTS: The baseline and intervention cohorts included 1784 and 322 unique patients, respectively. Patients in the intervention cohort were more likely to be female (59% vs. 51%, p = 0.01), be younger (60 ± 13.1 vs. 64 ± 13.2 years, p < 0.001), have smaller nodules (1.7 cm, IQR 1.4-2.1 vs. 1.8 cm, IQR 1.4-2.5 cm, p = 0.017), have had biochemical workup (99% vs. 13%, p < 0.001), and have had adrenal-specific imaging (40% vs. 11%, p < 0.001). In a multivariable analysis, intervention cohort patients were significantly more likely to have had biochemical workup (odds ratio ,OR 1209, confidence interval ,CI 434-5117, p < 0.001) and adrenal-specific imaging (OR 8.89, CI 6.42-12.4, p < 0.001). CONCLUSION: The implementation of an NLP-informed AGI clinic was associated with a seven-fold increase in biochemical workup and a three-fold increase in adrenal-specific imaging in participating patients.

From routine to rescue: Thyroidectomy for life-threatening thyrotoxicosis.

BACKGROUND: Thyroidectomies are routinely same-day elective procedures. The aim of this study was to investigate outcomes in patients who underwent uncommon urgent thyroidectomy. METHODS: We retrospectively reviewed patients diagnosed with thyrotoxicosis at a quaternary medical center between 2011 and 2023. Included patients were admitted nonelectively with thyroidectomies performed during same hospital stay. Patient demographics, comorbidities, hospital course, and operative outcomes were analyzed. RESULTS: Thirty patients met the inclusion criteria. The majority were female (60%) and Black (60%) with a mean age of 41 ± 14 years. At admission, 76.6% had undetectable thyrotropin levels (<0.01 µU/mL) and 26.7% were diagnosed with thyroid storm. Common presenting comorbidities included atrial fibrillation (53.3%), heart failure (40%), and liver failure (16.7%). Graves' disease was diagnosed in 83.3% of patients, while 13.3% had amiodarone-induced thyrotoxicosis. Median hospital stay before surgery was 8 days (interquartile range: 4-16). Indications for surgery were adverse medication events (30%), inadequate therapeutic effect by medication (30%), and worsening heart failure (26.7%). Postoperatively, 6.7% required reoperation for neck hematoma, 13.3% experienced temporary hypoparathyroidism, and 6.7% had hoarseness. Following surgery, 50% of patients with atrial fibrillation experienced resolution and 50% with heart failure with reduced ejection fraction showed ultrasonic improvement. Within 30 days, 20% visited the emergency department, none due to thyroidectomy complications, and 13.3% were readmitted for comorbidities. One patient (3.3%) died from liver failure. CONCLUSIONS: Patients who require an urgent thyroidectomy often have life-threatening comorbidities particularly cardiac disease. Performing thyroidectomy in these patients can potentially create clinical homeostasis for further management of their comorbidities.

Same-day parathyroidectomy for primary hyperparathyroidism -an over 20-year practice.

INTRODUCTION: There has been a shift in recent years toward same-day parathyroidectomies due to the decrease in mutual costs with few significant differences in postoperative morbidity or mortality. We sought to determine if demographics, preoperative patient risk factors, or comorbidities were associated with a patient's likelihood of having same-day or inpatient surgery. MATERIALS AND METHODS: A prospective database of parathyroid operations from 2001 to 2022 (n = 2948 patients) was reviewed for surgeries completed for primary hyperparathyroidism. Patients were categorized as same-day or inpatient surgery; demographics, risk factors, and co-morbidities were examined and differences across practice patterns during the 21-year period were studied and also analyzed in a subset of patients from 2013 to 2022. RESULTS: In a recent subset of patients from 2013 to 2022, patients having inpatient surgery were more likely to be Black and use anticoagulation or antiplatelet therapy. Multivariable regression confirmed increased odds of aging and black patients requiring inpatient parathyroidectomy. Compared to 2001-2003, there was a significantly increased proportion of patients undergoing same-day surgery; compared to 2010-2012, there was a similar proportion of patients undergoing outpatient surgery between 2013 and 2018, and there was an increased proportion from 2019 through 2022. CONCLUSION: Same-day parathyroidectomies have been shown to be safe and has become the typical practice for high-volume parathyroid surgeons over the last decade. Complications such as postoperative hematoma or hypocalcemia were previously shown to be incompletely mitigated by increased LOS or inpatient surgery, although demographics are considered to increase the odds of inpatient parathyroidectomy.

Effect of Delayed Parathyroidectomy on Risk of Future Cardiovascular and Nephrolithiasis Interventions in Adults with Primary Hyperparathyroidism [Original Study].

OBJECTIVE: To determine whether the timing of parathyroid surgery impacts the risk of renal stone retreatment and cardiovascular interventions. SUMMARY BACKGROUND DATA: Long-term, untreated primary hyperparathyroidism is associated with significant morbidity including nephrolithiasis and cardiovascular disease. METHODS: We conducted a Population-based Cohort study of New York and California state-wide data from 2000-2020. Adult patients who underwent renal stone treatment and subsequently diagnosed with primary hyperparathyroidism (pHPT) and underwent parathyroidectomy (PTX) were included. Patients were excluded if PTX was prior to index stone procedure, they underwent second stone treatment within 6 months, with stage V CKD, with secondary or tertiary hyperparathyroidism, with prior kidney transplant or hemodialysis, or with prior cancer diagnosis. Rate of renal stone retreatment and cardiovascular interventions after PTX in pHPT patients with nephrolithiasis who underwent parathyroid surgery at ≤ 2 years and >2 years after index stone procedure was measured. RESULTS: We identified 2,093 patients who underwent first-time stone treatment and subsequent PTX. The median time to PTX was 560 days (IQR 187-1477) and follow-up was 7.4 years (IQR 4.5-13.1). Delaying PTX for more than 2 years increased the risk of renal stone retreatment by 59% (HR 1.59; P<0.001), increased the risk of experiencing coronary disease or associated interventions by 118% (HR=2.18; P=0.01), and increased the risk of experiencing an overall cardiovascular event by 52% (HR 1.52; P<0.01). CONCLUSIONS AND RELEVANCE: In symptomatic pHPT, delaying PTX significantly increases the risk of requiring future stone retreatment and cardiac/vascular surgical interventions. This highlights the importance of early surgical referral and multidisciplinary approaches to optimize outcomes and resource utilization in pHPT.

Representation of online LGBTQ+ support in general surgery residency programs.

BACKGROUND: Lesbian, Gay, Bisexual, Transgender, Queer, and more(LGBTQ+) trainees are underrepresented in medicine, and their experiences in surgery have not been well studied. We sought to examine the practices of general surgery residency programs by region regarding representation of LGBTQ+ â€‹support online. METHODS: Retrospective, two-person review of 100 general surgery residency programs stratified by Electronic Residency Application Service(ERAS) region comparing data on Diversity, Equity, and Inclusion(DEI) and LGBTQ+ â€‹-specific webpages. RESULTS: The Middle Atlantic and South Atlantic regions had 20% of programs each, with fewer programs found in other regions. Of the 100 institutions, 92% had DEI webpages, and 43% had LGBTQ+ â€‹-specific webpages. There was a significant difference in the likelihood of a program being an Human Rights Campaign(HRC) LGBTQ+ â€‹leader when compared by region(p â€‹< â€‹0.01). CONCLUSIONS: Few general surgery residency programs share LGBTQ+-specific DEI content online with no regional difference observed. Recommendations such as updating websites to highlight LGBTQ+ â€‹inclusion should aid recruitment of a diverse, surgical residency as well as create a welcoming environment for prospective residents.

Adrenal Referral Pattern: Management of Patients With an Adrenal Incidentaloma.

INTRODUCTION: Adrenal incidentalomas (AIs) are found in 3%-4% of abdominal computed tomography scans. Timely evaluation of their functional status and malignant potential is necessary to guide nonoperative surveillance or surgery. This study aims to evaluate the adherence of referring service patterns to the American Association of Endocrine Surgeons and American Association of Clinical Endocrinologists guidelines for the biochemical workup of AIs at a tertiary surgical clinic. METHODS: We conducted a retrospective study of 125 patients evaluated for AIs at the endocrine surgery clinic between 2017 and 2022. Information on patient demographics, referral source, and reasons for referral was collected. The appropriateness of the biochemical workup for AIs by referring physicians was assessed. Statistical analyses included chi-square and Kruskal-Wallis tests. RESULTS: Referrals came from endocrinologists (44.8%), other subspecialists (31.2%), and primary care physicians (PCPs) (19.2%). Among 125 patients, diagnoses included benign adrenal masses (52.8%), aldosteronomas (10.4%), cortisol-secreting tumors (15.2%), pheochromocytomas (12.8%), and metastatic masses (4.0%). Endocrinologists were more likely to conduct a complete biochemical workup compared to other subspecialties and PCPs (P < 0.001). Eighty-three (66.4%) patients underwent adrenalectomy, with those referred by endocrinologists more likely to undergo surgery than those referred by other subspecialties and PCPs (P < 0.001). There was no significant difference in the time from the initial clinic visit to surgery by referral source (P > 0.05). CONCLUSIONS: Over half of AIs referrals to the endocrine surgery clinic came from subspecialists and PCPs rather than endocrinologists. Familiarizing all referring physicians with American Association of Endocrine Surgeons/Association of Clinical Endocrinologists guidelines may reduce undiagnosed functional AI cases and facilitate timely surgical management.

Trends in Operative Case Logs of Chief Residents in Surgery by Sex and Race: A 5-year National Study.

OBJECTIVE: To examine case logs reported by general surgery residents and identify potential disparities in operative experience. BACKGROUND: A recent study of 21 institutions noted significant differences between the number of cases reported during general surgery residency by trainees who are underrepresented in medicine (URiM) versus trainees who are not URiM (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time these data have been examined nationally. METHODS: We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t tests for female versus male and URiM versus non-URiM overall case numbers. RESULTS: A total of 6458 residents submitted case logs from 319 accredited programs. Eight-hundred fifty-four (13%) were URiM and 5604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD ± 160.57) major cases versus 1115.96 (±160.53) for non-URiM residents (difference = 19 cases, P = 0.001). Case logs were submitted by 3833 (60.1%) male residents and 2625 (39.9%) female residents over the 5-year study period. Male residents reported 1128.56 (SD ± 168.32) cases versus 1091.38 (±145.98) cases reported by females (difference = 37.18, P < 0.001). When looking at surgeon chief and teaching assistant cases, there was no significant difference noted between cases submitted by URiM versus non- URiM residents. However, male residents reported significantly more in both categories than their female peers ( P < 0.001). CONCLUSIONS: Overall, URiM residents submitted fewer cases in the 5-year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30 to 40 cases can amount to 1 to 3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions.

Bibliometric Insight Into Thyroid Cancer Research: A Comprehensive Review and Future Directions.

INTRODUCTION: In the past 3 decades, thyroid cancer research has surged, becoming the leading topic in clinical thyroidology. Despite this, there's a lack of data identifying key articles, authors, and journals. This study aims to provide insights for authors, physicians, and research labs by highlighting the most influential journals, authors, and research topics in thyroid cancer. METHODS: A comprehensive search was conducted using the Scopus database, employing the medical subject heading (MeSH) terms "Thyroid" and "Cancer" in the titles, abstracts, or keywords of articles. The search was limited to English articles in academic medicine journals published between January 1993 and December 2021. RESULTS: The search yielded 21 472 articles across 3076 journals, authored by 13 974 senior authors. The number of journals publishing on thyroid cancer expanded from 29 in 1993 to 733 in 2021, marking an average annual growth of 14%. Article output on the topic increased from 54 in the initial year to 1580 by 2021, with an annual growth rate of 16%. A thematic analysis revealed 369 articles mentioning "BRAF" since 2004, 479 articles on "ultrasound" techniques, 325 on "ablation" methods, and 453 articles focusing on "genetics" in thyroid cancer. The Journal of Clinical Endocrinology and Metabolism emerged as the most prolific, publishing 1017 articles over the 29-year period. CONCLUSION: This study guides resource allocation towards impactful journals for thyroid cancer researchers, helps identify key contributors for collaboration or mentorship, and provides a framework for similar analyses in other fields.

Normocalcemic primary hyperparathyroidism: From pathophysiology to clinical management.

Normocalcemic primary hyperparathyroidism (NPHPT), a variant of primary hyperparathyroidism (PHPT) characterized by persistently elevated parathyroid hormone (PTH) levels and normal serum calcium, has gained recognition as a substantial subset of PHPT cases. Despite its increasing prevalence, the precise pathophysiology and natural progression of NPHPT remain enigmatic. This in-depth literature review explores recent advancements in our understanding of NPHPT, encompassing pathophysiology, clinical presentation, diagnostic approaches, medical and surgical management options. By synthesizing this wealth of information, this review aims to contribute to a more nuanced and informed approach to the treatment of patients grappling with NPHPT. As our understanding of the condition continues to evolve, the knowledge gathered from this review has the potential to significantly enhance the quality of care and outcomes for individuals afflicted with NPHPT, ultimately improving their overall well-being and prognosis.

Exploring Disparities in Pancreatic Ductal Adenocarcinoma Outcomes among Asian and Pacific Islander Subgroups.

Pancreatic ductal adenocarcinoma (PDAC) is a challenging malignancy with known disparities in outcomes across ethnicities. Studies specifically investigating PDAC in Asian populations are sparse, overlooking the rich diversity within this group. This research seeks to fill that gap by examining survival differences across the broad spectrum of Asian ethnicities, acknowledging the complexity and varied experiences within these communities. Utilizing the National Cancer Database from 2004 to 2019, we categorized patients into East Asian, Southeast Asian, South Asian, and Pacific Islander groups. Non-Asians or Pacific Islanders were excluded. Overall survival was analyzed using a Cox hazards model. The study consisted of 13,254 patients. Most patients were East Asian (59.4%, n = 7,866). Southeast Asians exhibited the poorest survival in unadjusted analysis (HR, 1.32; 95% confidence interval, 1.23-1.42; P < 0.001) compared with South Asians who exhibited the best survival. Multivariable analysis revealed significantly worse survival for East Asians and Pacific Islanders relative to South Asians, whereas Southeast Asians' results were not significantly different. Asian subgroup differences notably affect PDAC outcomes. Research on genetic and cultural aspects, especially in Southeast Asians, and tackling health disparities are crucial for enhancing survival in this diverse disease. SIGNIFICANCE: This study highlights the significant survival disparities among Asian subgroups with pancreatic cancer, utilizing a large national database. By differentiating among East Asian, Southeast Asian, South Asian, and Pacific Islander groups, it underscores the need for tailored research and healthcare approaches. Addressing these differences is essential for developing culturally sensitive interventions and potentially improving outcomes in a disease that uniquely affects these diverse populations.

Risk of neuropsychiatric disorders in primary hyperparathyroidism: Parathyroidectomy versus nonoperative management.

BACKGROUND: Neuropsychiatric disorders frequently manifest in primary hyperparathyroidism (PHPT), yet evidence of parathyroidectomy's benefit remains mixed. We sought to compare the incidence of neuropsychiatric disorders among patients treated with parathyroidectomy versus nonoperative management. METHODS: We retrospectively reviewed our institutional administrative database for patients with PHPT. Patients with secondary hyperparathyroidism were excluded. The date of biochemical diagnosis of PHPT was designated as day 0 and new-onset neuropsychiatric disorders were defined as conditions diagnosed after this date. The risk of new-onset neuropsychiatric disorders in propensity score-matched surgical and nonsurgical patients was compared using the Cox regression over a median follow-up of 4.2 years. RESULTS: Our cohort included 3728 patients, predominantly female (78%) and white (63.9%), with a mean (± Standard deviation) age of 62 ± 14 years. Of these, 1704 (45.7%) underwent parathyroidectomy. After propensity score matching and adjusting for clinical characteristics, patients who had parathyroidectomy showed a reduced hazard ratio (HR) for new-onset cognitive impairment (HR: 0.65, 95% CI: 0.47-0.91), somnolence (HR: 0.45, 95% CI: 0.23-0.9) and schizophrenia (HR: 0.08, 95% CI: 0.01-0.6), but not for anxiety (HR: 1.07, 95% CI: 0.83-1.37), depression (HR: 1.02, 95% CI: 0.77-1.36) or suicidal ideation (HR: 0.31, 95% CI: 0.04-2.71). Additionally, surgical patients were less likely to require inpatient care (0.3% vs. 1.8%, p < 0.001) for neuropsychiatric disorders. CONCLUSIONS: Parathyroidectomy is associated with lower risks of new-onset cognitive impairment, schizophrenia, or somnolence, indicating potential benefit of operative management in improving neuropsychiatric symptoms in patients with PHPT.

Complex Primary Hyperparathyroidism: Hereditary and Recurrent Disease.

Primary hyperparathyroidism can be sporadic or part of a genetic syndrome, such as MEN1 or HPT-JT. Diagnosis of hereditary HPT requires a thorough history and physical. Parathyroidectomy is curative with greater than 95% success. However, some patients have persistent or recurrent disease requiring reoperation. Reoperative parathyroidectomy is technically challenging, and localizing the pathologic gland can difficult. Patients needing reoperation should undergo evaluation by a high-volume surgeon. Care should be taken to obtain all of the preoperative workup and operative note from the initial surgery. Radioguided parathyroidectomy can be safely and effectively performed in patients with hereditary HPT or undergoing reoperative surgery.

Resident perspectives on the role of gender in operative experience during general surgery residency training: A mixed-methods study.

BACKGROUND: It remains unclear why female general surgery residents perform fewer cases than male peers. This exploratory study investigated possible contributors to gender-based disparities and solutions for improving equity in operative experience. METHODS: Surveys, including Likert scale and free-text questions, were distributed to 21 accredited general surgery residency programs. RESULTS: There were 96 respondents, of whom 69% were female. 22% of females personally experienced barriers to operative experience versus 13% of males (p â€‹= â€‹0.41), while 52% of female residents believed operative training was affected by gender (p â€‹= â€‹0.004). Inductive analysis revealed the most common barrier to operating room participation was floor work/clinical tasks. The most common barrier for female residents was perceived sexism/gender bias, with subthemes of "misidentification," "feeling unwelcome," and "poor trust/autonomy." To improve parity, residents proposed structured program-level review, feedback, and transparent expectations about case assignments. CONCLUSION: Female general surgery residents believe gender bias impacts training. Further mixed-methods research is crucial to determine the cause of gender-based disparities in operative experience.