Acute presentation of a giant intrathyroidal parathyroid adenoma: a case report.

BACKGROUND: We report the case of a giant intrathyroidal parathyroid adenoma weighing 59 g in a young woman presenting acutely with severe hypercalcemia requiring correction and adequate preoperative management prior to surgery. Parathyroid adenomas account for 85 % of cases of primary hyperparathyroidism. Those weighing more than 3.5g are classified as giant parathyroid adenomas. There are only 25 cases of parathyroid adenomas weighing over 30g reported in the literature. With the wide availability of biochemical screening tests in Western countries, mildly elevated calcium levels are often discovered incidentally. Our case is unusual for the extreme level of hypercalcemia, the patient's young age, and the weight of the adenoma, particularly in a developed country. CASE PRESENTATION: A 21-year-old Irish woman presented with a 3-week history of an enlarging right-sided neck mass. There was no dysphagia, stridor, or symptoms of hyperthyroidism or hypercalcemia. On examination, there was a firm painless swelling in the right lobe of her thyroid. Her thyroid function tests were normal. Corrected serum calcium was markedly elevated at 3.96 mmol/L with hypophosphatemia of 0.35 mmol/L. She was treated with bisphosphonates and fluids administered intravenously. Her parathyroid hormone level was over 20 times the upper limit of normal. Ultrasound revealed a solid and cystic nodule in the lower pole of the right lobe of her thyroid. Parathyroid scintigraphy demonstrated a 5×4 cm lesion which concentrated tracer. A right-sided parathyroidectomy, right thyroid lobectomy, and level VI neck dissection were performed. An encapsulated multiloculated solid cystic mass weighing 59 g was removed. There was no definite infiltration of the capsule and MIB1 count was low at 1 % thus the specimen lacked the diagnostic features of carcinoma. On the third postoperative day, hungry bone syndrome developed and calcium replacement administered intravenously was required. At 1-year postoperative, she was weaned off calcium and alfacalcidol. A follow-up ultrasound showed unremarkable residual thyroid. CONCLUSIONS: Any patient with an isolated hypercalcemia warrants a thorough work-up. Hungry bone syndrome is a potentially avoidable condition; thus the clinician should be highly attuned to the risk of hungry bone syndrome post-parathyroidectomy, which correlates with the weight of the adenoma resected.

Patterns of Internet and smartphone use by parents of children attending a pediatric otolaryngology service.

OBJECTIVES: To assess Internet use and the influence of smartphones on health-information seeking by parents and carers of children with ENT conditions. METHODS: A paper-based questionnaire was circulated to parents attending otolaryngology services in both the out-patient and day-case settings at a tertiary referral centre. RESULTS: 79.5% of questionnaires were returned. 29.9% had consulted the Internet for ENT-related information. Factors associated with increased rates of ENT-related online activity included younger age, university education, and access to a smartphone (all p ≤ 0.001). 65.7% and 57.7% had found the information which they had found online to be understandable and helpful, respectively; however, just 25.5% felt that it had influenced the medical decisions they had made for their child. 50.3% had previously or intended to discuss information found online with their surgeon. 9.2% had searched online for information regarding their child's surgeon; 19.6% of these said that this had been a factor in choosing that particular surgeon. On ranking 8 information sources in terms of importance (scale 0-5), the ENT Surgeon ranked as most important (mean=4.63), whilst the Internet ranked lowest (3.10). 48.6% of respondents or their partners had an Internet-enabled smartphone; 45.2% said they would definitely use an iPhone app regarding their child's condition if one was available. 36.1% reported they would definitely use the Internet in the future. CONCLUSIONS: Whilst online sources must increasingly be considered in the dialogue with parents, it is clear that parents still rate the clinical team as most important for information gathering. Clinician-provided websites and smartphone applications may be the key to ensuring the provision of quality information into the future.

Primary hyperparathyroidism in a patient with familial hypocalciuric hypercalcaemia due to a novel mutation in the calcium-sensing receptor gene.

We describe the clinical and genetic findings in pedigree with a novel mutation in the calcium sensing receptor (CaSR) gene and the unusual coexistence of primary hyperparathyroidism (HPT) and familial hypocalciuric hypercalcaemia (FHH) and its clinical management. The occurrence of both FHH and primary HPT in the same patient has been described rarely. Our pedigree has a novel mutation in the CaSR gene. Parathyroidectomy led to a reduction, but not normalization of the calcium levels in the patient identified as having HPT. The coexistence of HPT and FHH was considered in this patient as her calcium and PTH levels were rising with time. Surgical resection of her parathyroid adenoma resulted in reduction of her calcium levels to above normal and significant reduction in her symptoms of fatigue and low mood.

Laryngeal cancer: quantitative and qualitative assessment of research output, 1945-2010.

OBJECTIVES/HYPOTHESIS: To provide an in-depth evaluation of research yield in laryngeal cancer from 1945 to 2010, using large-scale data analysis, employment of bibliometric indicators of production and quality, and density equalizing mapping. STUDY DESIGN: Bibliometic analysis incorporating the Web of Science Database. METHODS: The search strategy employed was as follows; "TS = ((Laryngeal Neoplasm$) OR (Larynx Neoplasm$) OR (Larynx Cancer$) OR (Laryngeal Cancer$))." Author and journal data and cooperation networks were computed following analysis of combinations of countries and institutions that registered cooperation during the study period. Mapping was performed as described by Groneberg-Kloft in 2004. RESULTS: A total of 8,658 items relating to laryngeal cancer were published over the study period, accounting for 139,700 citations. The United States was the most prolific country, accounting for 28.83% (n = 2,496) of total output. Other prolific nations included Italy (n = 794) and Germany (n = 792). There were 973 items published as a consequence of international cooperation; this practice increased steadily over time and accounted for 15.58% (88 of 565) of output in 2010. There were 1,073 different journals publishing articles on laryngeal cancer, although the top 20 (1.8%) most prolific titles were together responsible for more than 43% of the total output; these were led by Laryngoscope (n = 368) and Head and Neck, Journal of the Scientific Specialties (n = 364). A total of 24,682 authors contributed to the literature on laryngeal cancer; the leading author by output was Alfio Ferlito (n = 120); Carlo La Vecchia recorded the highest h-index (h = 32). CONCLUSIONS: This work represents the first attempt to provide quantitative and qualitative analysis of laryngeal cancer research output, whilst in tandem identifying the key bibliometric benchmarks to which those involved in the production of that output might aspire.

The effectiveness of a voice treatment approach for teachers with self-reported voice problems.

SUMMARY: Teachers are considered the professional group most at risk of developing voice-problems, but limited treatment effectiveness evidence exists. We studied prospectively the effectiveness of a 6-week combined treatment approach using vocal function exercises (VFEs) and vocal hygiene (VH) education with 20 teachers with self-reported voice problems. Twenty subjects were randomly assigned to a no-treatment control (n = 11) and a treatment group (n = 9). Fibreoptic endoscopic evaluation was carried out on all subjects before randomization. Two self-report voice outcome measures were used: the Voice-Related Quality of Life (VRQOL) and the Voice Symptom Severity Scale (VoiSS). A Voice Care Knowledge Visual Analogue Scale (VAS), developed specifically for the study, was also used to evaluate change in selected voice knowledge areas. A Student unpaired t test revealed a statistically significant (P < 0.05) improvement in the treatment group as measured by the VoiSS. There was not a significant improvement in the treatment group as measured by the V-RQOL. The difference in voice care knowledge areas was also significant for the treatment group (P < 0.05). This study suggests that a voice treatment approach of VFEs and VH education improved self-reported voice symptoms and voice care knowledge in a group of teachers.

Detection of bone marrow micrometastases in the rib marrow of head and neck cancer patients: a prospective pilot study.

Flow cytometry has been validated as an objective method of demonstrating and quantifying micrometastases. Micrometastases within bone marrow indicate a poor prognosis in patients with upper gastrointestinal, colorectal and breast epithelial tumours. We prospectively sought to assess the feasibility of testing rib marrow for bone marrow micrometastases in head and neck cancer and to report their frequency in a cohort of patients. Nine patients were enrolled in the study. Bone marrow was obtained before manipulation of the primary tumour. Micrometastatic cells were detected by staining contaminant cytokeratin-18 positive cells and using the twin techniques of immuncytochemistry and flow cytometry. Cellular marrow was retrieved in 100% of cases. Micrometastases were detected in one out of nine epithelial tumours on both flow cytometry and immunocytochemistry. The detection rate appeared to be independent of TN staging. We were unable to culture the cells. Preoperative detection of bone marrow micrometastases may reflect transient shedding of cells, metastatic potential or residual disease. This prospective study confirms the feasibility of using rib marrow in future studies investigating micrometastases in head and neck cancer.

Sclerosing polycystic sialadenopathy: a rare cause of recurrent tumor of the parotid gland.

We present a case report of a woman with a recurrent parotid mass that was histologically confirmed to be sclerosing polycystic sialadenopathy, a rarely reported cause of salivary gland tumor. This tumor measured 11.8 x 6 cm, the largest such lesion yet reported. Histologic analysis revealed foci of atypical intraductal acinic cell proliferation and necrosis severe enough to amount to intraductal carcinoma in situ. Despite its large size, it was successfully excised, leaving the patient with only moderate facial nerve dysfunction postoperatively.

Predictors of survival in early oral cancer.

OBJECTIVE: Despite the substantial rate of neck conversion reported among patients with early oral cancer, a policy of routine elective neck dissection has been criticized on the grounds that it confers little survival advantage while subjecting many to potentially avoidable morbidity. However, the identification of factors predictive of survival may allow for the identification of those patients who are more likely to benefit from elective neck treatment. STUDY DESIGN AND SETTING: The clinical and histologic material of 71 patients with stage I or II squamous carcinoma of the oral cavity were reviewed. Patients were followed up for a minimum of 3 years after their surgery, and the impact of these variables on 3-year survival was assessed. RESULTS: Increased tumor thickness was significantly predictive of decreased survival (P = 0.030). Although having no prognostic value alone, when combined with thickness, both pattern of invasion and gender increased the significance of the latter in predicting outcome. Conclusion and significance Measuring tumor thickness and pattern of invasion in patients with early oral cancer may allow for the identification of those patients with more aggressive disease who are more likely to benefit from elective neck treatment.

Results of type 1 tympanoplasty in children and parental perceptions of outcome of surgery.

The goals of tympanoplasty in children include improvement in hearing, prevention of ear infections, and elimination of the need for water precautions. However, tympanoplasty in children is a controversial subject. In the present study the outcome of tympanoplasty in children is examined with regard to its success in achieving these goals and to the level of parental satisfaction with its outcome. Fifty-four children undergoing 62 tympanoplasties at our institution were included in the study. The surgical success rate was 72.5 per cent. Fifty per cent of parents reported that their child's hearing had improved (p = 0.181 for association with surgical success), 78 per cent reported a decrease in ear infections (p = 0.023), 45 per cent reported their child to be participating in activities previously refrained from (p = 0.003), and 79 per cent of parents were satisfied with the overall surgical outcome (p<0.001). Our findings show that successful tympanoplasty my confer benefits on children and may help guide parents' expectations of the surgery.