Tissue Parathyroid Hormone Washout: A Reliable Method for the Localization and Exclusion of Parathyroid Adenomas.

Background and objective Accurate identification of parathyroid adenoma (PA) is essential for minimally invasive treatment of primary hyperparathyroidism (PHPT). The aim of this study is to evaluate the results of parathyroid hormone (PTH) assay in aspirates of suspicious neck lesions and to clarify its reliability in determining whether the lesion is of parathyroid origin. Methods A total of 134 lesions (104 imaging-suspected PA and 30 concomitant thyroid nodules as a control group) of 101 patients were retrospectively analyzed. Patients with positive, negative, or never scintigraphy were included in our study. Ultrasound (US) was performed again and US-guided tissue fine needle aspiration with PTH washout (PTH-WO) was performed from suspicious lesions. A PTH-WO level higher than the patient's serum PTH levels is proposed for a positive test, and a PTH-WO level lower than the upper limit of the laboratory PTH level is proposed for a negative test. A definitive diagnosis was made postoperatively histopathologically. Results PTH-WO levels (median (IQR)) were significantly higher in the positive group (n = 93, 5000 (1600) ng/L) compared to the negative group (n = 11, 17 (13.1) ng/L) and thyroid nodule aspirate group (n = 30, 14 (4.3) ng/L) (p < 0.001). Among 93 PTH-WO-positive lesions, 42 lesions (45.1%) were not identified by parathyroid scintigraphy (PS), 20 (21.5%) lesions were suspiciously PS, and 33 lesions (35.4%) were negative or suspicious by first US findings. Of the 93 patients localized with PTH-WO, two were cystic PAs ablated by aspiration. The final pathology result of 91 operated patients proved PA. The sensitivity, specificity, negative predictive value, and positive predictive value of the PTH-WO were observed as 1.00, 0.82, 0.09, and 0.91, respectively. Conclusion Comprehensive repeated US and PTH-WO from the lesion increase the accurate localization of PAs. PTH-WO is a highly reliable method for differentiating parathyroid lesions from other cervical lesions.

The effect of living at high altitude on carotid intima-media thickness in the elderly: a comparative study.

BACKGROUND: Previous studies have shown that high altitude may have a protective effect on cardiovascular diseases. However, the effects of high altitude on carotid atherosclerosis have been less evidenced. PURPOSE: To compare the effect of altitude on atherosclerosis by using carotid artery ultrasonography (CAU) findings. MATERIAL AND METHODS: A total of 180 patients aged >60 years, who had proper recorded data of ultrasonography and blood tests, and who resided in the same city for at least five years were included. Patients with anemia, hyperlipidemia, diabetes mellitus, hypertension, and those who did not meet the inclusion criteria were excluded. Patients were divided into two groups: high altitude group (HAG) and sea level group (SLG). CAU findings of each patient-including common carotid artery intima-media thickness (CIMT) ≥1 mm and < 1 mm, internal carotid artery (ICA) stenosis rate, and plaque types-were recorded and compared between the two groups. Blood test parameters and lipid profiles were additionally recorded. RESULTS: Prevalence of patients with CIMT ≥1 mm was significantly higher in the SLG (SLG: 50%, HAG: 15.6%; P < 0.001). Carotid stenosis was found to be significantly different in both groups (HAG: 9.96% ± 23.27%, SLG: 29.83% ± 23.30%; P < 0.001). RBC, HGB, HDL values, and HDL/LDL ratio were found to be significantly higher in the HAG (P < 0.001) whereas LDL, TG, and TC values were significantly higher in the SLG (P < 0.001). CONCLUSIONS: People who reside at high altitudes have significantly lower rate of carotid stenosis, lower CIMT values, and less atherogenic lipid profile values, all of which indicate protective effect of high altitude on atherosclerosis.

A new treatment modality in piriformis syndrome: Ultrasound guided dry needling treatment.

Piriformis syndrome is a painful entrapment neuropathy caused by compression of the sciatic nerve under piriformis muscle for structural or acquired reasons. Myofascial pain syndrome is the most common cause. There are physical therapy modalities, stretching exercises, injection therapies and medical treatment approaches.In this case, we planned to demonstrate a different perspective to the treatment of piriformis syndrome with the ultrasound-guided dry needling treatment.