The effect of successful parathyroid surgery on left ventricle function in patients with primary hyperparathyroidism evaluated with strain echocardiography.

BACKGROUND: Hyperparathyroidism (PHP) is the most common cause of hypercalcemia in outpatients. It is characterized by many cardiac complications including chronic cardiac arrhythmia, hypertrophy, and diastolic insufficiency. However, there are insufficient data about the cardiac systolic function in PHP. Data regarding the positive effects of surgical treatment on cardiac complications are limited and inadequate. The aim of this study was to evaluate the postoperative changes in the left ventricle functions of patients with PHP using strain echocardiography (STE) instead of traditional echocardiographic evaluation. METHODS: This prospective study included 29 patients with PHP. Detailed echocardiographic evaluations were made including conventional and STE' ventricle function preoperatively and at 6 months after surgery. Then, preoperative and postoperative STE changes, global longitudinal (GLS) and circumferential strain (GCS), were compared. Patients with recurrent surgery, poor echogenicity, and comorbid conditions affecting STE were excluded. RESULTS: No significant change was determined in ejection fraction in the period from preoperative to 6 months postoperative (P > .05). The GLS value increased from 18.53 ± 3.06 to 20.25 ± 3.89, to a statistically significant level (P = .004). The other echocardiographic parameters remained unchanged for the same patients. CONCLUSION: Despite normal 2D echocardiography data, it was determined that the GLS values deteriorated preoperatively and improved by the 6th postoperative month. The detection of early disorders in PHP that cannot be detected on 2D echocardiography, even in asymptomatic patients, may suggest a new treatment indication. For asymptomatic PHP patients, strain echocardiography may be more valuable than 2D echocardiographic evaluation to determine myocardial dysfunction. The recent literature is insufficient, and there is a need for further, more extensive studies with longer follow-up periods.

Bilateral Lumbar Hernia: A Case Report.

Lumbar hernias are a relatively uncommon occurrence, with two main categories: congenital and acquired. Some acquired hernias are spontaneous, while others are the result of secondary factors such as trauma and surgery. Bilateral primary lumbar hernia is a much rarer occurrence. Abdominal computed tomography is the gold standard for differential diagnosis of bilateral primary lumbar hernia. The treatment plan entails the closure of the defect through either open or laparoscopic methods, accompanied by the use of a suitable mesh to provide support. Nevertheless, no surgical method has yet been identified as the standard procedure for reducing the risk of relapse. We present the case of a 73-year-old female patient who presented with complaints of swelling in the left lumbar region and abdominal pain. The patient exhibited bilateral lumbar hernia. The hernial sac on the left side contained intra-abdominal organs. The diagnosis was confirmed by computed tomography. The defect on the left was subsequently closed with mesh following the dissection of the hernia sac. In this study, we present a case of bilateral lumbar hernia in the context of existing literature. The objective of this study was to assist clinicians in accurately diagnosing and appropriately managing this condition.

Hepatolithiasis: clinical series, review and current management strategy.

OBJECTIVES: Hepatolithiasis (HL) continues to be a problem due to its local and systemic complications, insufficiency in treatment modalities and high risk of recurrence. There are various surgical options available, ranging from endoscopic interventions to a small segment resection and ultimately to transplantation. In this article, patients with the diagnosis of HL and our treatment strategies were evaluated in the light of literature. MATERIAL AND METHODS: The patients diagnosed with HL in our clinic between 2014-2019 were evaluated retrospectively by examining the patient files. Demographic characteristics of the patients, causes of the disease, complications and treatment options were evaluated. RESULTS: 17 patients were included into the study. Mean age of the patients was 64.3 years (range 32-89 years). Seven patients had previous cholecystectomies. Stenosis was found to be developed in hepaticojejunostomy (HJ) site in three patients (two had HJ due to bile duct injury and one had HJ following the Whipple procedure), and in hepaticoduodenostomy site in one patient who had the history of biliary tract injury during cholecystectomy. Two patients with HL without previous cholecystectomies had no gallbladder stones. Nine patients underwent surgery. Left hepatectomy was performed in two patients and lateral sector resection was performed in 2 patients. Two patients with anastomotic stenosis underwent HJ revision and two patients with anastomotic stenosis and one patient with stent ingrowth underwent bifurcation resection and neo-hepaticojejunostomy. Eight patients were followed-up nonoperatively with medical and endoscopic approaches. CONCLUSION: Hepatolithiasis is a serious condition that needs to be treated with a multimodal approach. Stenting and anastomotic stenosis facilitate the development of hepatolithiasis and increase the risk of its occurrence. In particular, by performing functional hepaticojejunostomy, the development of this complication will be decreased.