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ABSTRACT: Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol injection therapy (PEIT) in treating these patients.
To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure.
From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications.
Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was -1.2 ± 0.9 and after treatment was -0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was -1.2 ± 1.0 and after treatment was -0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022).
Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism.
Annals of surgery 04/2011; 253(4):786-90. · 7.90 Impact Factor
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Emergency Medicine Journal 03/2011; 28(3):180. · 1.44 Impact Factor
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ABSTRACT: Calcium pyrophosphate dihydrate deposition disease (CPPD), also known as pseudogout or chondrocalcinosis, is a variety of metabolic arthropathy caused by the deposition of calcium pyrophosphate dihydrate crystals in and around joints. Despite many case reports, extra-articular CPPD often goes unrecognized. Here, we report a unique case of pancreatic tail pseudocyst and CPPD of the spleen. To the best of our knowledge, CPPD of the spleen has not been reported in the literature.
American journal of surgery 08/2010; 200(2):e28-9. · 2.36 Impact Factor
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ABSTRACT: Sarcoidosis is a multiorgan granulomatous disease, the most common head and neck manifestation of which is cervical lymphadenopathy. Only the presentation of sarcoidal granuloma in cervical lymph nodes without typical manifestations of systemic sarcoidosis poses a diagnostic difficulty. We describe the case of a 39-year-old male who had a 2-month history of a progressively increasing mass with soreness in his right neck. The biopsy from the neck mass demonstrated non-caseating epithelioid cell granuloma of the lymph nodes. The differential diagnoses of mycobacterial or fungal infections were excluded. Thoracic evaluations, including chest X-ray and high-resolution computed tomography, revealed no abnormal findings. Treatment with systemic corticosteroids resulted in improved clinical symptoms. No recurrence of the neck mass or other signs of systemic sarcoidosis were noted during 1.5 years of follow-up. Although our patient's definitive diagnosis could not be determined, the case highlights 2 important issues: sarcoidal granuloma in lymph nodes may be a precursor of sarcoidosis, even in the absence of pulmonary or other systemic involvement; and regular follow-up is recommended in such cases.
Journal of the Chinese Medical Association 08/2005; 68(7):339-42. · 0.79 Impact Factor
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Urology 10/2004; 64(3):585-6. · 2.43 Impact Factor
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ABSTRACT: Benign smooth muscle tumor, leiomyoma, can occur throughout the whole body, including the most common sites of the genitourinary and gastrointestinal tracts, less frequently in the skin, and rarely in the deep soft tissue or uveal tract. A 23-year-old Chinese woman presented with a 4 month history of a pigmented ciliary body mass in her left eye. The tumor's clinical appearance and ancillary data were initially consistent with malignant melanoma. However, instead of enucleation, sclerotomy with a tumor biopsy was performed because of the patient's young age and the possibility of benign tumors. Under light microscopy, tumor cells were short spindle- or ovoid-shaped with fine nuclear chromatin and fibrillary cytoplasmic processes resembling neural tissue. Although the tumor displayed neurogenic morphology, it showed strong reactivity for alpha-smooth muscle-specific actin and h-caldesmon, and was negative for neurogenic markers, except CD56, by immunohistochemistry. Primary mesectodermal leiomyoma of the ciliary body was diagnosed because of both the myogenic and neurogenic characteristics. The tumor biopsy or intraoperative frozen section is suggested for accurate pathological diagnosis before enucleation. In a review of the literature, only 14 cases have been reported. Seven cases (50%) were subjected to enucleation and eventually showed a benign mesectodermal leiomyoma. This case report provides novel expression of h-caldesmon and CD56 by the tumor cells of mesectodermal leiomyoma.
Pathology International 06/2004; 54(5):337-42. · 1.62 Impact Factor
