Correlation between biochemical features and outcomes of preoperative imaging (SPECT-CT and Ultrasound) in primary hyperparathyroidism.

Background: Primary hyperparathyroidism is the third most common endocrine disorder, diagnosed by elevated parathyroid hormone (PTH) in hypercalcaemia. Several biochemical factors have been described to suggest severity of disease and may be correlated with preoperative imaging. Methods: This was a retrospective study of patients who underwent parathyroidectomy over a 3-year period. Preoperative calcium, PTH, vitamin D levels, ALP (alkaline phosphatase), vitamin D, serum phosphate and US and SPECT-CT positivity was noted. Results: 176 patients underwent parathyroidectomy and these were divided into 4 groups based on preoperative calcium. Overall, 61% of patients showed concordance between imaging and operative findings. Severe hypercalcaemia was associated with higher PTH levels, lower vitamin D levels, an increased rate of abnormal ALP levels, lower phosphate, male gender and highest rate of imaging concordance. Imaging positivity was associated with severe hypercalcaemia and elevated PTH levels. Level of PTH >125 pmol/L and hypercalcaemia >2.8 mmol/L are the most accurate cut-off levels for scan positivity. Conclusion: Biochemical factors associated with severity of the disease are directly correlated with positivity of preoperative imaging while ALP and vitamin D did not influence the preoperative imaging positivity but are associated with disease adversity. Serum phosphate level independently predicted results of parathyroid US.

Changing pattern of pheochromocytoma and paraganglioma in a stable UK population.

CONTEXT: Pheochromocytomas and paragangliomas (PCC/PGLs) are diagnosed variously with increasing incidence and changing clinical and pathology pattern. OBJECTIVE: The aim was to further characterize PCC/PGLs in a stable population. METHODS: A retrospective, single institution study analysed adrenalectomies for PCC/PGLs between January 2010 - January 2019. Demographics, symptoms, blood pressure, preoperative hormones, imaging, histology, hospital stay, complications and three subgroups [based on the modality of diagnosis - incidentaloma group (IG), genetic group (GG) and symptomatic group (SG)] were noted. RESULTS: 86 patients included IG 51 (59.3%), GG 10 (11.62%) and SG 25 patients (29.06%). Incidence was 5.30 cases/1 million population. 33.34% of the IG had a delayed diagnosis with a mean interval of 22.95 months (4-120 months). Females presented more often with paroxysmal symptoms (PS) (p=0.011). Patients with PS and classic symptoms were younger (p=0.0087, p=0.0004) and those with PS required more inotropes postoperatively (p=0.014). SG had higher preoperative hormone levels (p=0.0048), larger tumors (p=0.0169) and more likely females. GG are younger compared with those from the IG (p=0.0001) or SG (p= 0.178). CONCLUSION: Majority of patients had an incidental and delayed diagnosis. If symptomatic, patients are more likely to be young females with higher hormone levels and larger tumors.

Consistent and reproducible staining of glia by a modified Golgi-Cox method.

BACKGROUND: Golgi-Cox staining is a powerful histochemical approach which has been used extensively to visualize the morphology of neurons and glia. However, its usage as a first-choice method is hindered by its uncertain nature, diminished consistency and lengthy staining duration. The FD Rapid GolgiStain™ Kit (FD Neurotechnologies, Inc., USA) has been developed by employing the Golgi-Cox approach. It is a simple, reliable and reproducible way of performing Golgi impregnation for the analysis of neuronal morphology. NEW METHOD: We report here simple modifications to the manufacturer's protocol which enable reproducible and reliable staining of glial cells. RESULTS: Exposure of brain tissue to 4% paraformaldehyde (PFA) during perfusion followed by postfixation with 8% glutaraldehyde in 4% PFA led to only glial cells being stained, whereas in the absence of postfixation both neurons and glia were stained with unclear morphology. Additionally, we found that impregnation at 26°C±1 was critical to attain uniform staining. COMPARISON WITH EXISTING METHOD: Our modified Golgi-Cox approach is consistent and reproducible and affords uniform glial staining throughout the brain. CONCLUSION: As this protocol stains only a small percentage of cells, it is suitable for the analysis of individual cells.

Comparing ascitic aspirate and tissue biopsy in the diagnosis of ovarian malignancy.

The objective of this retrospective study was to assess the role of tissue biopsy in ovarian cancer where a diagnosis had been made from cytological assessment of ascites. A total of 63 women had been coded for ovarian carcinoma during the period; 48 had undergone cytological or histological investigation, of which six had undergone tissue biopsy, despite having had a cytological diagnosis. In all six cases (100%), the tissue biopsy concurred with the original diagnosis. We conclude that, where a clinically- and radiologically-correlated cytological diagnosis is made, the benefits of an invasive procedure to obtain tissue samples do not outweigh the risks to the patient.

Superficial palmar arch aneurysm after carpal tunnel decompression, a rare complication: a case report.

False aneurysms of the palmar arteries are rare. They are usually associated with traumatic injuries to the hand vasculature. We present a case of superficial palmar arch aneurysm (SPAA), complicating carpal tunnel decompression which presented as a pulsatile mass at the site of previous surgery. Initial diagnosis was made on clinical examination and confirmed on doppler ultrasound (US) and computed tomographic angiography (CTA). The feeding vessel of the aneurysm was subsequently occluded using coil embolization.

Diagnostic scanning for suspected scaphoid fractures: an economic evaluation based on cost-minimisation models.

OBJECTIVE: To compare, the costs of diagnosing suspected scaphoid fractures using various protocols with various scanning techniques. DESIGN: Analysis of the cost-minimisation models. The models were prepared after an audit of the existing protocol for suspected scaphoid fractures. SETTING: Departments of Accident and Emergency and Orthopaedics, Leighton General Hospital, Crew, Cheshire, UK. SUBJECTS: A total of 124 patients presenting to A&E with suspected scaphoid fractures between 1 December 1999 and 1 May 2000. MAIN OUTCOME MEASURES: Costs to the hospital budget in ruling out or diagnosing scaphoid fractures in these patients. RESULTS: The cost using an existing protocol that does not routinely involve scanning was pounds 15,554. Projected costs for many (but not all) of the alternative protocols involving routine use of scanning procedures were found to be lower or comparable. CONCLUSIONS: Protocols based on diagnostic scanning for suspected scaphoid fractures can be comparable to a protocol which does not rely on scanning techniques because they can avoid repeated radiographs, clinical appointments and plaster cast changes. However, any such protocol must be tailored on the basis of the workload, and the availability of resources.

Creative writing workshops for medical education: learning from a pilot study with hospital staff.

A course in creative writing was designed as a possible tool in medical education. Twelve volunteers (six doctors and six non-medical staff) participated in seven workshops held weekly. Four aims were identified: to help put thoughts onto paper; to facilitate interpretation of narrative; to encourage expression of emotions related to illness and death, and to encourage creativity. The course was evaluated using participant observational analysis and two questionnaires. This paper discusses the outcomes in relation to these aims, but identifies additional issues raised by the development.Only six of the 12 participants produced a final piece of written work, with lack of self discipline being cited as the chief reason. There was a strong tendency for self reflection in the group, which needed appropriate support. How creativity can be encouraged remains unclear. The value of multidisciplinary learning in this context was identified.The value of creative writing for medical education remains difficult to measure, but the participants agreed unanimously that the course would be an enjoyable way of encouraging medical students in its stated aims.

Maximum entropy and drug absorption.

The application of maximum entropy to the calculation of drug absorption rates was introduced in an earlier paper. Here it is developed further, and the whole procedure is presented as a problem in scientific inference to be solved using Bayes' theorem. Blood samples do not need to be taken at equally spaced intervals, and no smoothing, interpolation, extrapolation, or other preprocessing of the data is necessary. The resulting input rate estimates are smooth and physiologically realistic, even with noisy data, and their accuracy is quantified. Derived quantities such as the proportion of the dose absorbed, and the mean and median absorption times, are also obtained, together with their error estimates. There are no arbitrarily valued parameters in the analysis, and no specific functional form, such as an exponential or polynomial, is assumed for the input rate functions.

Maximum entropy and its application to the calculation of drug absorption rates.

A new method is presented for calculating the rate at which a drug enters the bloodstream after dosing, given the concentration of the drug in blood at various times. The method is based on the principle of maximum entropy, which has not been applied previously to pharmacokinetic problems. The resulting input rate functions are smooth and physiologically realistic, free of spurious oscillations yet still showing small-scale structure where there is evidence for it in the data. Blood samples do not need to be taken at equal intervals, and no preliminary smoothing or interpolation of the data is required.