[18F]Fluorocholine Uptake of Parathyroid Adenoma Is Correlated with Parathyroid Hormone Level.

PURPOSE: The aim of the study was to investigate the relationship between [18F]fluoromethyl-dimethyl-2-hydroxyethylammonium ([18F]FCh) positron emission tomography (PET) parameters, laboratory parameters, and postoperative histopathological results in patients with primary hyperparathyroidism (pHPT) due to parathyroid adenomas. PROCEDURES: This retrospective study was conducted in 52 patients with biochemically proven pHPT. [18F]FCh-PET parameters (maximum standardized uptake value: SUVmax) in early phase (after 2 min) and late phase (after 50 min), metabolic volume, and adenoma-to-background ratio (ABR), preoperative laboratory results (PTH and serum calcium concentration), and postoperative histopathology (location, size, volume, and weight of adenoma) were assessed. Relationship of PET parameters, laboratory parameters, and histopathological parameters was assessed using the Mann-Whitney U test and Spearman correlation coefficient. MRI characteristics of parathyroid adenomas were also analyzed. RESULTS: The majority of patients underwent a PET/MR scan, 42 patients (80.7 %); 10 patients (19.3 %) underwent PET/CT. We found a strong positive correlation between late-phase SUVmax and preoperative PTH level (r = 0.768, p < 0.001) and between late-phase ABR and preoperative PTH level (r = 0.680, p < 0.001). The surgical specimen volume was positively correlated with the PET/MR lesion volume (r = 0.659, p < 0.001). No significant association was observed between other [18F]FCh-PET parameters, laboratory parameters, and histopathological findings. Cystic adenomas were larger than non-cystic adenomas (p = 0.048). CONCLUSIONS: [18F]FCh uptake of parathyroid adenomas is strongly correlated with preoperative PTH serum concentration. Therefore, the preoperative PTH level might potentially be able to predict success of [18F]FCh-PET imaging in hyperparathyroidism, with higher lesion-to-background ratios being expected in patients with high PTH. PET/MR is accurate in estimating the volume of parathyroid adenomas.

Preoperative duplex ultrasound parameters predicting male fertility after successful varicocelectomy.

OBJECTIVES: To assess duplex ultrasound (DUS) parameters, and predicti the outcome of varicocele ligation in male infertility.  METHODS: This retrospective and follow up study was conducted at Dr. Sulaiman Al Habib Hospital, AlQassim, Saudi Arabia between January 2011 and December 2012. Eighty-two patients were selected, who presented with clinical/subclinical varicocele and male infertility. All these patients had DUS of the scrotum and underwent for low ligation varicocelectomy. These patients were followed for a period of 12-24 months after surgery for the occurrence of paternity. We reviewed pre-operative scrotal DUS of these 82 patients for the testicular size and volume, pampiniform veins caliber and duration of reflux in the dilated veins at rest, and after valsalva maneuver. These DUS parameters were correlated with the postoperative paternity rate.   RESULTS: Postoperative paternity was achieved in 18 patients (31.6%) with normal-sized testes, and in 3 patients (12%) with small size testes. The positive paternity rate was higher (38.5%) in patients with clinically detected varicocele, compared with only 16.7% of patients with subclinical varicocele (detected by ultrasound only). In addition, postoperative paternity was significantly higher in patients with bilateral varicocele (70.6%), with shunt-type varicocele (71.4%), and patients with a permanent grade of venous reflux (62.5%).   CONCLUSION: Selection of patients for the successful paternity after varicocele repair depends mainly on DUS parameters, which includes normal size testicles with shunt type of bilateral varicocele and continuous reflux.

Congenital unilateral nasal aperture stenosis.

Congenital nasal aperture stenosis is an unusual cause of upper airway obstruction among neonates, and rarely presents as unilateral. Most commonly presents as choanal atresia. A CT evaluation is essential to confirm the diagnosis. Both surgical and conservative management can be applied, based on the severity of the associated clinical presentation; however, the very rare unilateral condition is usually treated conservatively. We present a case of a 30-day-old male baby (second twin, preterm 29 weeks pregnancy, and birth weight 1.070 kg) with difficult breathing since birth. The baby was referred for an ENT consultation. He was on a nasal cannula, not in respiratory distress, with no stridor, nor tachypnea. There were decreased breathing sounds in the left nostril. Nasogastric tubes size 8 French (Fr) and 6 Fr could not be introduced through the left nostril, which looked obstructed more anteriorly.