Relationship between parathyroid adenoma size, weight and histological subtypes with perioperative serum levels.

AIMS: This study aims to identify associations between parathyroid adenoma (PTA) characteristics (histology, weight and size) with the change in parathyroid hormone (PTH) and calcium levels. METHODS: A historical cohort study was conducted on adult patients with solitary PTA removed in the Gold Coast Health Precinct, Australia, between 2017 and 2022. RESULTS: PTA weight is correlated with the change in day 1 PTH level (r=0.26, p=0.036), the change in day 1 corrected calcium level (r=0.20, p=0.033), and the change in follow-up corrected calcium level (r=0.47, p<0.001). The largest dimension (size) of PTA is also correlated with the change in day 1 PTH (r=0.30, p=0.011) and the change in follow-up corrected calcium level (r=0.40, p<0.001). Adjusted for age and gender, a statistically significant negative correlation was found between day 1 PTH level and adenoma size, resulting in a 0.5% change in size for every percentage change in PTH level (equating to a 5.0% increase in variance explained, p=0.038). Similarly, a negative correlation was identified in day 1 corrected calcium levels and weight, with a 4.7% change in weight for every percentage of change in day 1 corrected calcium level (an increase of 5.6% variance explained, p=0.010). In addition, a negative correlation was identified, where every 3.1% change in size (an increase of 17.4% variance explained, p<0.001) and 7.6% change in weight (an increase of 22.7% variance explained, p<0.001) was seen with every percentage change in follow-up corrected calcium levels. Clear-cell PTA had the most significant percentage fall in day 1 corrected calcium levels compared with other PTA subtypes (p=0.007). CONCLUSIONS: Preoperative calcium and PTH levels correlate with PTA weight and size. The degree of change in postoperative corrected calcium levels behaved differently in the clear-cell subtype.

Benign paroxysmal positional vertigo in a young child.

A girl in her early childhood presented to a regional otolaryngology outpatient clinic with classic signs of benign paroxysmal positional vertigo (BPPV). She reported episodic dizziness when rolling in a supine position. She did not convey any other associated audiovestibular symptoms. A bedside Dix-Hallpike test confirmed geotropic rotational nystagmus indicative of lateral canal BPPV. Due to her young age, limited communicative abilities and concerns for more sinister underlying pathology, a complete neurological examination, MRI and pure tone audiometry were performed. After two sessions of Epley's manoeuvre, she was symptom-free. At her 3-month follow-up, the patient denied any recurrent episodes of vertigo.

An unusual case of abdominal compartment syndrome from a massive faecaloma.

Severe constipation is a frequent presentation but progression into a life-threatening acute compartment syndrome (ACS) is few and far between. This case highlights the typical physiological manifestations of ACS and the immediate benefits of correcting these physiological imbalances through the disimpaction of a massive faecaloma. Furthermore, in adult patients with a history of colonic dysmotility, adult Hirschsprung's disease should be considered.

A case series of bread clip ingestions.

The bread clip is one of the most insidious foreign body ingested. The bread clip poses a serious medical danger to patients yet may often fail to manifest itself clinically on initial ingestion. We present a case series of three patients with bread clips ingestions that were managed in the Gold Coast University Hospital, Queensland, Australia between 2020 and 2021. Bread clips are not always readily identifiable depending on imaging and the management of these patients will often require a multidisciplinary approach between the surgeons, gastroenterologists and radiologists.

An approach to olfactory impairments in the general practice setting.

BACKGROUND: Olfactory impairment is a common condition, particularly in the geriatric population, which can be underrecognised as a result of clinician and patient unfamiliarity. OBJECTIVE: The aim of this article is to bring awareness to olfactory impairment, describe the common aetiologies and provide a framework for its diagnosis and management in the general practice setting, including advice about when to refer. DISCUSSION: A thorough history and examination can often elucidate the common causes, which include rhinosinusitis, upper respiratory tract viral illnesses and head trauma. Rhinosinusitis is the most readily managed aetiology in the general practice setting, with other causes often requiring multidisciplinary input. Chronic olfactory impairment is often irreversible and can be a debilitating condition, causing disability in day-to-day living and impairing quality of life.