Clinical value of 11C-methionine positron emission tomography in persistent primary hyperparathyroidism-A case report with a mediastinal parathyroid adenoma.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by pathologic growth of one or more of the parathyroid glands. Parathyroidectomies (PTX) in patients with PHPT are procedures with low morbidity, few complications, and a high cure rate. However, the parathyroid glands may be found at various anatomical locations and occasionally they are intrathoracic. CASE PRESENTATION: We present a 57-year-old patient with PHPT. Before the first and second operation, the preoperative imaging indicated pathologic parathyroid tissue in the neck. Due to postoperative persistent hypercalcemia we performed a 11C-methionine positron emission tomography (11C-MET-PET/CT). The scan showed a focus with increased activity in the mediastinum. Due to persistent disease, an ectopic parathyroid gland in the mediastinum was suspected. At a third operation, the parathyroid adenoma was resected through an anterolateral thoracotomy. Biochemical values normalized and bone mineral density improved postoperatively. Hence, an ectopic localization of a parathyroid gland should be considered during the preoperative planning of a PTX, especially in the re-operative setting. A multidisciplinary effort is necessary to address an intrathoracic adenoma. CONCLUSION: Ectopic parathyroid glands should be suspected when positive sestaMIBI uptake is seen in the mediastinum and other types of imaging (e.g. contrast enhanced CT scan or PET-CT) may confirm the finding of an ectopic parathyroid adenoma. From the present case and previous studies we found 11C-MET-PET/CT valuable in difficult PHPT cases.

McIndoe procedure for congenital vaginal agenesis: complications and results.

In the period 1972-1992, 26 women had surgery for congenital vaginal agenesis, with a modified McIndoe's technique, in Aarhus University Hospital. Their medical records were reviewed and 23 of the patients were evaluated clinically. Complications comprised lack of skin graft take, bleeding, urethrovaginal fistula, perforation of the rectum, rectovaginal fistula and vaginal stricture. All complications were treated and the final results were satisfactory, i.e. complete graft take, satisfactory dimensions of the vagina and no strictures or fistulas giving symptoms. Of 23 patients reviewed, 18 reported satisfactory sexual relationships and vaginal intercourse was anatomically possible in a further 3 patients. We conclude that the McIndoe procedure is simple and, though the course of treatment is often protracted, serious complications are few and the final results are good.

[Merkel cell carcinoma]. / Merkel-cellekarcinom.

Eight patients with Merkel cell carcinoma are reported to document their response to surgery and/or radiotherapy. Four patients who initially underwent surgery without postoperative radiation therapy all had local recurrence. Two patients were treated with postoperative radiation therapy and two were treated with radiation therapy without excision of the tumour. None of these four patients had local recurrence. Five patients developed regional recurrence. Recurrence was seen in one patient in the irradiated field. Metastatic disease was not seen in any case. These results combined with a review of the literature suggest that radiation therapy postoperatively to both the surgical bed and the draining lymph nodes may improve local regional tumour control.

Endoscopic electrocoagulation--an alternative to operative hemostasis in active gastroduodenal bleeding?

Endoscopic electrocoagulation was considered in 69 patients with active gastroduodenal bleeding including 60 patients with peptid ulcer. Permanent hemostasis was achieved in 56 patients (81%), including 16 patients with clinical indication for surgical intervention. Electrocoagulation failed or could not be applied in 13 patients, requiring operative hemostasis in 11 patients. Though no replacing emergency, endoscopic electrocoagulation can be successful, especially if it is applied in quiescent phase of massive, life-threatening hemorrhage, and should be considered before a possible emergency operation, especially in patients with no previous ulcer disease, in the presence of some other severe illness, or in patients of advanced age.

Post-irradiation total cystectomy for bladder cancer.

Treatment with radiotherapy (6000 rad) followed by total cystectomy was carried out in 125 patients with T1-T3 bladder cancer, the tumour being poorly differentiated (grade III-IV) in 115 cases. Survival was significantly better, if the irradiation had resulted in complete tumour regression before cystectomy, and if the tumour at the initial examination was of category T1. The relative cumulative survival after 5 years for patients with T1-tumours was 60%, as opposed to 40% for patients with T3-tumours. 4 patients (2.4%) died within 30 days of the cystectomy, but 13 patients (10%) died within 3 years from complications of the treatment regime. 83 patients (66%) experienced non-fatal complications such as infected cavity and urinary or intestinal stenosis. 3 years after the cystectomy 62 patients (50%) were dead from recurrent tumour or from other causes.

The haemostatic effect of purse-string suture in transvesical prostatectomy: a controlled clinical trial.

In a series of 64 consecutive cases of transvesical prostatectomies it is shown that the use of a purse-string suture at the bladder neck significantly reduces the postoperative blood loss. A follow-up 3 months after operation has shown that the suture did not increase the number of either bladder neck stenoses, urinary incontinences, urinary infections or secondary lithiases.