Age and gender distribution of primary hyperparathyroidism and incidence of surgical treatment in a European country with a particularly high life expectancy.

OBJECTIVE: Primary hyperparathyroidism (PHPT) is a frequently encountered endocrine disease in the elderly, but little is known about ist epidemiology in the aging European population. This study investigates the age- and sex-dependence of PHPT and the incidence of parathyroidectomy (PTX) in Switzerland, a country with a particularly high life expectancy. DESIGN: A population-based study was performed using data from the Swiss Federal Statistical Office covering years 2000 to 2004. Anonymised hospital discharge codes for PHPT and PTX were analysed, and the hospitalisation rate for PHPT and incidence of PTX were calculated. RESULTS: The mean annual hospitalisation rate of patients with PHPT was 8.3/100,000 inhabitants. The rate was approximately three times higher in women than in men, with the highest estimate found in women > or = 80 years (63.7/ 100,000). The population-adjusted annual incidence of PTX was 3.8/100,000 inhabitants. PTX incidence was higher in individuals > or = 50 years than in younger persons (8.7/100,000 vs 1.3/100,000), with a peak in patients aged 70-74 years. CONCLUSIONS: In a European population with high life expectancy, the hospitalisation rate of PHPT is higher in women and increases continuously with age. Incidence of PTX is highest in patients aged 70-74 years. These findings underscore the need for further research on the impact of population aging on the treatment patterns of PHPT.

Role of MIF/CD74 signaling pathway in the development of pleural mesothelioma.

Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine implicated in acute and chronic inflammatory diseases. MIF is overexpressed in various tumors. It displays a number of functions that provide a direct link between the process of inflammation and tumor growth. Our group recently identified the MIF-receptor CD74 as an independent prognostic factor for overall survival in patients with malignant pleural mesothelioma.In the present study, we compared the levels of expression of MIF and CD74 in different human mesothelioma cell lines and investigated their physiopathological functions in vitro and in vivo.Human mesothelioma cells expressed more CD74 and secreted less MIF than non tumoral MeT5A cells, suggesting a higher sensitivity to MIF. In mesothelioma cells, high MIF levels were associated with a high multiplication rate of cells. In vitro, reduction of MIF or CD74 levels in both mesothelioma cell lines showed that the MIF/CD74 signaling pathway promoted tumor cell proliferation and protected MPM cells from apoptosis. Finally, mesothelioma cell lines expressing high CD74 levels had a low tumorigenic potential after xenogeneic implantation in athymic nude mice.All these data highlight the complexity of the MIF/CD74 signaling pathway in the development of mesothelioma.

Imaging requirements in the practice of pulmonary metastasectomy.

The primary imaging modality for the detection of pulmonary metastases is computed tomography (CT). Ideally, a helical CT scan with 3- to 5-mm reconstruction thickness or a volumetric thin section scanning should be performed within 4 weeks of pulmonary metastasectomy. A period of observation to see whether further metastases develop does not seem to allow better patient selection. If positron emission tomography is available, it may identify the extrathoracic metastatic sites in 10 to 15% of patients. Despite helical CT scan, palpation identifies the metastases not detected by imaging in 20 to 25% of patients and remains the standard. No data define the optimal interval for follow-up surveillance imaging.

The puzzling coexistence of different histological changes in the same transplanted lung.

Large fragments of a transplanted lung from living lung recipients are rarely available. The case presented is that of a patient who underwent lingulectomy after a gunshot trauma. We describe the patchy panel of histological findings encountered in the resected specimen, ranging from normal lung to zones of acute and chronic rejection. Such contrasting findings have already been described, but should prompt us to exercise caution when interpreting histological results of routine transbronchial biopsies.

Survival according to the site of bronchial microscopic residual disease after lung resection for non-small cell lung cancer.

OBJECTIVE: We performed a retrospective study evaluating the effect on survival of different sites of microscopic residual disease at the bronchial resection margin after surgical intervention for non-small cell lung cancer. METHODS: Survival of patients with different sites of residual disease was compared with survival of patients with curative resections, taking the pathologic TNM stage of the tumor into consideration. RESULTS: There was a trend for patients with stage I and II non-small cell lung cancer with residual disease limited to the epithelium and with peribronchial invasion to behave like patients with complete resections (61% and 41% five-year survival for stage I and II disease, respectively). This contrasts with patients with submucosal invasion and lymphatic infiltration, among whom there were no survivors at 5 years. There was no difference in survival between curative resections and residual disease of any type when the tumor was stage III or IV. CONCLUSIONS: In patients with stage I and II disease, when residual disease consists of submucosal invasion or lymphatic infiltration, specific and aggressive treatments to clear residual margins might be contemplated because of their possible adverse effect on survival. This contrasts with patients with stage III and IV disease, in whom survival is more related to the stage of the primary tumor than to residual disease.

Neuroendocrine proliferation after lung transplantation.

There have been few reports of neuroendocrine proliferation and tumors developing after transplantation. We report the first two of such cases encountered after lung transplantation and review the literature on these rare tumors after solid-organ transplantation. In the general population, these are indolent and rare tumors, as opposed to neuroendocrine carcinoma, and their behavior is unknown in transplant recipients.

Increase in bone mineral density after successful parathyroidectomy for tertiary hyperparathyroidism after renal transplantation.

BACKGROUND: Few studies have reported changes of bone mineral density (BMD) after parathyroidectomy in patients with persistent hyperparathyroidism after renal transplantation (3 HPT). PATIENTS AND METHODS: We retrospectively analyzed 14 patients who underwent successful parathyroidectomy for 3 HPT and who had available BMD data before and after parathyroidectomy. RESULTS: Median follow-up time was 26 months (IQR: 16.8-40.2). Serum calcium levels decreased significantly after parathyroidectomy (2.32 +/- 0.09 versus 2.66 +/- 0.16 mmol/l; p < 0.01), as did PTH levels (5.1 +/- 3.0 versus 27.8 +/- 23.7 pmol/l; p < 0.01). Nine patients (64%) had a steroid-free immunosuppression at follow-up. Mean increase in BMD was 9.5 +/- 8.0% for the spine and 9.5 +/- 7.9% for the hip (p < 0.01 for both sites). Patients with osteoporosis (T-score

Survival after parathyroidectomy in patients with end-stage renal disease and severe hyperparathyroidism.

BACKGROUND: Patients with end-stage renal disease (ESRD) and secondary hyperparathyroidism (SHPT) are at high risk of mortality. Whether an increased risk of death persists after a parathyroidectomy (PTX) is not clearly established. SUBJECTS AND METHODS: The survival of 40 patients with ESRD and SHPT who underwent PTX was compared with that of 664 ESRD patients. RESULTS: From first dialysis, a lower mortality rate was found in the group of patients who underwent PTX than in the nonoperated ESRD group (hazard ratio: 0.23; 95% CI: 0.14-0.37). The patients who underwent PTX were younger, had a longer time on dialysis, and had a higher prevalence of kidney transplantation. The mean number of comorbidities was lower (Charlson score 4.2 +/- 2.1 versus 6.4 +/- 2.9, p < 0.001). Then, we randomly selected two matched controls for each PTX case (80 controls, 40 PTX) who had at least an equivalent mean duration of dialysis between the first dialysis and PTX of the PTX group. In a univariate model, there was a trend for PTX being associated with prolonged survival. The mortality was higher both among those at an advanced age and those with a high Charlson score. Adjustments for these covariates made the effect of PTX no more significant. CONCLUSIONS: The risk of death of patients with severe SHPT leading to PTX differed from that of nonoperated subjects. The apparent differences in survival may be related to the number and severity of associated comorbidities. ESRD patients who undergo PTX may represent a subset of healthier subjects.

Primary hyperparathyroidism: can parathyroid carcinoma be anticipated on clinical and biochemical grounds? Report of nine cases and review of the literature.

BACKGROUND: Parathyroid carcinoma (PC) mimics benign primary hyperparathyroidism (PHP), but the diagnosis of PC is seldom available at the time of the first operation. Because PC is plagued by recurrences usually beyond cure, one may wonder whether some of these could be prevented by more extensive resections initially, i.e., if the diagnosis of PC were available at that time. METHODS: Over a 25-year period, 311 consecutive patients with PHP underwent operation in our department: 302 had benign disease (adenomas or hyperplasias), and 9 had PC. Several clinical parameters, serum calcium and parathyroid hormone (PTH) levels, and the weight of the parathyroid tumor removed were compared in both groups. Receiver operating characteristic curves and logistical regression analyses were used to distinguish PC from benign PHP. RESULTS: Eight of 9 patients with PC had symptoms, versus 238 (79%) of 302 with benign PHP (not significant). In the PC subgroup, serum calcium and PTH levels and the tumor weights of the parathyroid glands removed were significantly higher than in the benign PHP cohort, even if these three parameters were regularly flawed by low positive predictive values (14%, 20%, and 15%, respectively). CONCLUSIONS: Serum calcium, PTH levels, and tumor weights were significantly greater in the PC subgroup, even if not invariably in a discriminatory way. However, when PTH is <4 times the upper limit of normal and tumor weight is <1.9 g, the probability of PC is nil.

Early prediction of acute pancreatitis: prospective study comparing computed tomography scans, Ranson, Glascow, Acute Physiology and Chronic Health Evaluation II scores, and various serum markers.

The aim of this study was to assess the predictability of the outcome of acute pancreatitis using the Ranson, Glascow, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, the computed tomography (CT) scan, and several serum markers. Altogether, 137 consecutive patients with acute pancreatitis confirmed by CT scan were prospectively included. Blood samples were obtained daily for 6 days. The predictive value of each parameter was studied by univariate and multivariate analyses comparing mild and severe pancreatitis. A total of 111 attacks were graded as mild (81%) and 26 as severe (19%). Ranson (p = 0.3) and APACHE II (p = 0.049) scores appeared insufficiently predictive in the univariate analysis. Pancreatic imaging by CT scan was insufficiently predictive (p > 0.05), whereas the presence of extrapancreatic fluid collections was more indicative of outcome (p <0.05). With the univariate analysis, the four most reliable serum markers were pancreatic amylase (p <0.001), neutrophil elastase (p <0.05), albumin (p <0.002), and C-reactive protein (p <0.001). Results became homogeneous when the CT results were added; serum albumin plus extrapancreatic fluid collections (negative predictive value 92%-96% and positive predictive value 67%-100%) comprised the best indicator of severity. None of the parameters tested achieved sufficient predictability when used alone. Serum albumin plus extrapancreatic fluid collections comprise the best indicator of severity at the time of admission.