Publications (2)6.98 Total impact
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Article: Secondary and tertiary hyperparathyroidism: role of preoperative localization.
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ABSTRACT: The usefulness of both technetium Tc-99m sestamibi (MIBI) scintigraphy and ultrasonography (USG) scan for the detection of enlarged parathyroid glands secondary to renal hyperparathyroidism is rarely addressed. A retrospective study from July 1999 to June 2005 was carried out on patients with secondary and tertiary hyperparathyroidism to determine the role of preoperative localization. In the 5 years, 73 patients with renal hyperparathyroidism underwent initial bilateral neck exploration with total parathyroidectomy. Four patients underwent neck exploration with parathyroidectomy for persistent hyperparathyroidism. Two patients underwent neck exploration with parathyroidectomy for recurrent hyperparathyroidism. For patients with initial secondary/tertiary hyperparathyroidism, MIBI scintigraphy correctly showed 101 of 276 (36.6%) surgically confirmed enlarged parathyroids, whereas USG scan showed 99 of 276 (35.9%) surgically confirmed enlarged parathyroids. For persistent or recurrent secondary/tertiary hyperparathyroidism, MIBI scintigraphy and USG scan had sensitivity of 100 and 50%, respectively. In conclusion, preoperative localization studies have a limited value when used before first neck exploration in secondary/tertiary hyperparathyroidism because of the poor results in identifying all parathyroid glands. In persistent/recurrent hyperparathyroidism, it may play a useful role in localization of the missed or ectopic parathyroid gland.ANZ Journal of Surgery 11/2007; 77(10):880-2. · 1.25 Impact Factor -
Article: Hypodensity of >1/3 middle cerebral artery territory versus Alberta Stroke Programme Early CT Score (ASPECTS): comparison of two methods of quantitative evaluation of early CT changes in hyperacute ischemic stroke in the community setting.
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ABSTRACT: The one third middle cerebral artery territory ((1/3) MCA) method and the Alberta Stroke Program Early CT Score (ASPECTS) were used to detect significant early ischemic changes (EIC) on CT brain of acute stroke patients. We sought to compare the reliability of the 2 methods in routine clinical practice. Eighty consecutive patients admitted to a community hospital in Hong Kong with suspected acute ischemic stroke and a CT brain scan performed within 6 hours of symptom onset were included. Five blinded observers (1 neurologist, 2 general radiologists, and 2 neuroradiologists) independently evaluated the scans, using the ATLANTIS/CT Summit criteria for >(1/3) MCA involvement, and ASPECTS <or=7. Kappa statistics were used to determine interobserver agreement. Significant EIC were present in 11.4% of the scans with the (1/3) MCA method, and 19.4% with ASPECTS. For >(1/3) MCA involvement, all observers agreed in 57 cases (71%), with moderate interobserver agreement (kappa=0.49). For ASPECTS <or=7, all observers agreed in 34 cases (42%), with fair interobserver agreement (kappa=0.34). After prevalence and bias adjustments, substantial (prevalence-adjusted bias-adjusted kappa [PABAK]=0.74) and moderate (PABAK=0.44) agreements were found for the (1/3) MCA method and ASPECTS respectively. The (1/3) MCA method was more reliable in detecting significant EIC on CT brain within 6 hours of stroke onset in routine clinical practice, whereas ASPECTS was able to detect significant EIC in a higher proportion of these early scans.Stroke 05/2003; 34(5):1194-6. · 5.73 Impact Factor
