Role of cervical ultrasonography in primary hyperparathyroidism.

AIM: To evaluate the role of USG in the preoperative localization of parathyroid adenomas in patients with symptomatic hyperparathyroidism and to compare its usefulness with that of scintigraphy scan and postoperative findings. MATERIAL AND METHODS: Twenty-five patients with symptomatic primary hyperparathyroidism were subjected to USG of the neck and nuclear scintigraphy, followed by surgery. The results were independently analyzed and compared with per-operative findings. RESULTS: The 25 patients had a total of 28 abnormal glands: 22 solitary adenomas, and 6 multiple adenomas (two each in three patients). USG detected 20 out of 22 solitary adenomas and three out of six multiple adenomas. USG missed five abnormal glands, two of which were in the neck and three in the mediastinum. Scintigraphy was positive in 26 abnormal glands, out of which 22 were single and four were multiple. Two abnormal glands were missed: one in the neck and one in the mediastinum. CONCLUSION: As limited neck dissection for primary hyperparathyroidism becomes increasingly popular, USG has been found to be a sensitive, specific, and easily available noninvasive investigation for parathyroid localization. It can be easily offered to patients as a method for preoperative localization prior to limited parathyroid surgery outside tertiary care settings.

Comparison of postoperative pulmonary function tests after cholecystectomy performed through Kocher's incision and mini-incision.

Comparative pulmonary function after cholecystectomy performed through Kocher's incision and mini-incision were evaluated. One hundred patients were included and systematically divided into two groups of 50 each. The first group underwent conventional cholecystectomy and the second group underwent mini-cholecystectomy. Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), and peak expiratory flow rate (PEFR) were determined on the preoperative day and on postoperative days 1, 2, and 3. The percentage of reduction of VC on postoperative day 1 (P < 0.01), 2 (P < 0.01), and 3 (P < 0.01) after Kocher's incision was more than the percentage of reduction after mini-incisions on the corresponding day, respectively (P < 0.01, P < 0.01, and P < 0.01). The percentage of reduction of FVC (P = 0.0001, 0.0001, and 0.0001) was lesser after mini-incision cholecystectomy than after Kocher's incision cholecystectomy on the three corresponding postoperative days. The percentage of reduction of FEV1 after mini-incision was lesser than after Kocher's incision cholecystectomy on the three corresponding postoperative days (P = 0.001, 0.000, and 0.000). There was no significant difference in PEFR between the two groups on the three corresponding postoperative days (P = 0.731, 0.652, and 0.393). It is observed that min-incision cholecystectomy is followed by superior postoperative pulmonary function to that seen after Kocher's incision.