Classic Primary Hyperparathyroidism Versus Normocalcemic and Normohormonal Variants: Do They Really Differ?

BACKGROUND: Normocalcemic (NCpHPT) and normohormonal (NHpHPT) variants have been recognized primary hyperparathyroidism entities that pose serious challenges. We sought to define the differences among them in a series of surgically treated patients. PATIENTS AND METHODS: Between 2011 and 2015, 149 patients were enrolled into three groups: CpHPT (Ca > 10.2 mg/dL, PTH > 65 pg/mL), NCpHPT (normal Ca, PTH > 65 pg/mL) and NHpHPT (Ca > 10.2 mg/dL, normal PTH). Descriptive statistics and inter-group differences were computed, whereas multiple logistic/linear regression tests were used for further analysis. RESULTS: Of these patients 125 were female and 24 male, mean age 56.3 years (range 8-83). A total of 115 (77.2%) patients presented with CpHPT, 23 (15.4%) with NCpHPT and 11 (7.4%) with NHpHPT. MGD was found in 25 (16.8%) patients and SGD in 124 (83.2%); multivariate analysis failed to reveal statistically significant association of MGD with any pHPT variant (CpHPT 16.5% vs NCpHPT 21.7% vs NHpHPT 9.1%, p = 0.726). Conversely, NCpHPT patients exhibited statistically significant smaller adenoma weight (p = 0.023). Moreover, U/S in these patients had smaller positive predictive value (p = 0.278), whereas concordance between U/S and MIBI was also lower (p = 0.669). The utility of MIBI and U/S differed significantly (p < 0.001); more frequent use of U/S was observed for all groups. However, their predictive values did not differ significantly (p = 0.832). CONCLUSIONS: NCpHPT is more similar than different to CpHPT. NCpHPT constitutes the most challenging entity: it is associated with smaller adenoma weight, whereas U/S exhibited lower positive predictive value and lower concordance rate with MIBI. A trend for higher MGD presence in this group of patients was observed, though without statistical significance.

Respiratory disease related mortality and morbidity on an island of Greece exposed to perlite and bentonite mining dust.

A morbidity and mortality study took place, focused on Milos Island, where perlite and bentonite mining sites are located. Official data concerning number and cause of deaths, regarding specific respiratory diseases and the total of respiratory diseases, for both Milos Island and the Cyclades Prefecture were used. Standardized Mortality Ratios (SMRs) were computed, adjusted specifically for age, gender and calendar year. Tests of linear trend were performed. By means of a predefined questionnaire, the morbidity rates of specific respiratory diseases in Milos, were compared to those of the municipality of Oinofita, an industrial region. Chi-square analysis was used and the confounding factors of age, gender and smoking were taken into account, by estimating binary logistic regression models. The SMRs for Pneumonia and Chronic Obstructive Pulmonary Disease (COPD) were found elevated for both genders, although they did not reach statistical significance. For the total of respiratory diseases, a statistically significant SMR was identified regarding the decade 1989-1998. The morbidity study revealed elevated and statistically significant Odds Ratios (ORs), associated with allergic rhinitis, pneumonia, COPD and bronchiectasis. An elevated OR was also identified for asthma. After controlling for age, gender and smoking, the ORs were statistically significant and towards the same direction.

Psychometric evaluation of Patient Scar Assessment Questionnaire following thyroid and parathyroid surgery.

BACKGROUND: The Patient Scar Assessment Questionnaire (PSAQ) was constructed to evaluate the effect of any surgical therapy with a linear scar. This study aims to demonstrate reliability and validity of Appearance and Consciousness subscales of PSAQ in patients who underwent thyroidectomy or parathyroidectomy. METHODS: Patients who underwent a thyroidectomy or parathyroidectomy between 2000 and 2010 were administered the aforementioned subscales of the PSAQ. Each subscale was separately evaluated for its psychometric performance according to established criteria. Acceptability, reliability, and internal validity analysis were conducted. RESULTS: There were 696 patients (mean age=51.6 years) who participated in this study. Cronbach's alpha acceptable levels were demonstrated for the Appearance (α=0.79) and Consciousness (α=0.85) subscales. Reliability was also supported for the Appearance (Intraclass Correlation Coefficient [ICC]=0.79) and Consciousness subscales (ICC=0.81) by performing test-retest reliability analysis. Individual subscale items' correlations with all subscale scores were acceptable for the Appearance (0.31 to 0.78) and Consciousness (0.23 to 0.81) subscales. Internal validity was supported by evaluating correlations between the global assessment item of each subscale and both summary subscale scores (Appearance: 0.42 to 0.72, Consciousness: 0.66 to 0.67). CONCLUSIONS: The Appearance and Consciousness subscales of the PSAQ are both reliable and valid for the assessment of a linear scar following thyroid or parathyroid surgery, independent of the minimally invasive approach being used.