Pattern of Intraoperative Parathyroid Hormone and Calcium in the Treatment of Tertiary Hyperparathyroidism

Objective Tertiary hyperparathyroidism, an autonomous hyperproduction of parathyroid hormone (PTH), has a challenge in its treatment. This study asked whether the intraoperative PTH and calcium drop can confirm the resection of all parathyroid tissues. Study Design Case series with planned data collection. Setting Tertiary referral medical center. Subjects and Methods The study assessed patients with tertiary hyperparathyroidism who were treated at the Hospital of the State University of Campinas from 2007 to 2015. All patients underwent total parathyroidectomy with autotransplantation of parathyroid fragments. PTH and calcium were collected during the preoperative period; at 10, 20, and 240 minutes after resection of the glands; and at 1 year after the procedure. Data were analyzed by analysis of variance and logistic regression analysis with statistical values of P < .05. Results Thirty-five patients were assessed: 17 women (48.57%) and 18 men (51.43%). The percentage of PTH drop was statistically significant at all times, unlike the calcium analysis, but only PTH collected at 20 minutes was able to confirm the removal of all parathyroid tissues ( P = .029). Based on the receiver operating characteristic curve, the 71.2% drop obtained high sensitivity and specificity ( P = .028). Conclusions Treatment success can be predicted by analyzing the decrease of intraoperative PTH and not by calcium. The 71.2% PTH drop at 20 minutes after parathyroidectomy had high sensitivity and specificity to predict surgical cure.

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Central Venous Sampling for Intraoperative Parathyroid Hormone Monitoring: Are Peripheral Guidelines Applicable?

The American Surgeon ◽

10.1177/000313480707300716 ◽

2007 ◽

Vol 73 (7) ◽

pp. 712-716 ◽

Cited By ~ 1

Author(s):

James T. Broome ◽

Jason J. Schrager ◽

Dean Bilheimer ◽

Eugene P. Chambers ◽

J. Kenneth Jacobs ◽

...

Keyword(s):

Parathyroid Hormone ◽

Characteristic Curve ◽

Parathyroid Tissue ◽

Area Under The Curve ◽

Interquartile Range ◽

Central Venous ◽

Parathyroid Hormone Monitoring ◽

Intraoperative Pth ◽

The Difference ◽

Intraoperative Parathyroid Hormone

Intraoperative parathyroid hormone (PTH) monitoring has become an integral adjunct to minimally invasive parathyroidectomy. Guidelines for predicting therapeutic excision of all hyperactive parathyroid tissue have been routinely based on peripheral blood samples drawn at various time intervals. Whether these same guidelines can be used to predict success based on central blood draws has not been established. The authors wanted to evaluate whether peripheral criteria were applicable when PTH levels were drawn from a central location. Simultaneous peripheral venous (PV) and central venous (CV) PTH samples were drawn from 64 patients undergoing cervical exploration for primary hyperparathyroidism. Median preexcision PTH was significantly higher centrally at 165 pg/mL (interquartile range [IQR], 101–391 pg/mL) versus peripherally 102 pg/mL (interquartile range, 73–156 pg/mL, P < 0.0001). Postexcision PTH was slightly greater in CV (38 pg/mL; IQR, 24–62) than in PV (29 pg/mL; IQR, 22–51; P < 0.0001). The decrease in intraoperative PTH was compared after excision of an initial gland. Fifty-four of the 64 patients had all hyperfunctioning parathyroid tissue removed after initial gland resection. Pre- to postexcision ratios for CV and PV were compared using receiver operating characteristic curve methods, and summarized by area under the curve (AUC). PV (AUC = 0.85) appears to be a slightly more sensitive discriminator than CV (AUC = 0.83), although the difference is not statistically significant ( P = 0.5). Despite higher absolute values for CV, both peripheral and central sample sites accurately predict outcomes based on established guidelines for intraoperative PTH monitoring.

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Intraoperative serum parathyroid hormone level is an indicator of hypocalcaemia in total thyroidectomy patients

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v38i3.14331 ◽

2013 ◽

Vol 38 (3) ◽

pp. 84-89 ◽

Cited By ~ 2

Author(s):

MS Islam ◽

T Sultana ◽

D Paul ◽

AHMZ Huq ◽

AA Chowdhury ◽

...

Keyword(s):

Parathyroid Hormone ◽

Total Thyroidectomy ◽

Predictive Value ◽

Clinical Pathology ◽

High Sensitivity ◽

Intraoperative Pth ◽

Serum Pth ◽

Sensitivity Specificity ◽

Postoperative Hypocalcaemia ◽

Pth Level

Postoperative hypocalcaemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose or to predict hypocalcaemia immediately after total thyroidectomy for minimizing complications. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Microbiology & Immunology, Department of Surgery, Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Otolaryngology, Dhaka Medical College & Hospital (DMC&H), Dhaka, during the period of September 2010 to August 2011 to evaluate intraoperative (20 minutes after total thyroidectomy) parathyroid hormone (PTH) measurement as a predictor of post thyroidectomy hypocalcaemia. Total 65 patients were enrolled in this study those came for total thyroidectomy. Postoperative hypocalcaemia developed in 25 cases. Intraoperative PTH was assessed and significant correlation was found between intraoperative PTH level and development of hypocalcaemia. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of intraoperative serum PTH for prediction of post total thyroidectomy hypocalcaemia were 84.0%, 85.0%, 84.6%, 77.8%, and 89.5% respectively. Because of the high sensitivity, specificity and accuracy of intraoperative serum PTH of this study, the early prediction of hypocalcaemia could be made by single assay of intraoperative serum PTH level at 20 minutes after total thyroidectomy. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14331 Bangladesh Med Res Counc Bull 2012; 38(3): 84-89 (December)

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Effects of Parathyroidectomy on Normocalcemic Primary Hyperparathyroidism and the Role of Intraoperative PTH Measurement

The American Surgeon ◽

10.1177/00031348211048844 ◽

2021 ◽

pp. 000313482110488

Author(s):

Ehab Alameer ◽

Mahmoud Omar ◽

Marcus Hoof ◽

Hosam Shalaby ◽

Mohamed Abdelgawad ◽

...

Keyword(s):

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Cure Rate ◽

Tertiary Hyperparathyroidism ◽

Intraoperative Pth ◽

Intraoperative Parathyroid Hormone ◽

Cure Rates ◽

Current Guidelines ◽

Normocalcemic Hyperparathyroidism

Background Normocalcemic primary hyperparathyroidism (NCpHPT) and normohormonal primary hyperparathyroidism (NHpHPT) are recently recognized variants of primary hyperparathyroidism. Current guidelines for the management hyperparathyroidism recognize NCpHPT as one of the areas that are recommended for more research due to limited available data. Methods A retrospective review of patients who had parathyroidectomy between 2014 and 2019. We excluded patients with multiple endocrine neoplasia syndromes and secondary and tertiary hyperparathyroidism. Included patients were classified based on the biochemical profile into classic or normocalcemic hyperparathyroidism group. Collected data included demographics, preoperative localizing imaging, intraoperative parathyroid hormone levels, and postoperative cure rates. Results 261 patients were included: 160 patients in the classic and 101 patients in the normocalcemic group. Patients in the normocalcemic group had significantly more negative sestamibi scans (n = 58 [8.2%] vs 78 [51.3%], P = <.01), smaller parathyroid glands (mean weight 436.0 ± 593.0 vs 742.4 ± 1109.0 mg, P = .02), higher parathyroid hyperplasia rates (n = 51 [50.5%] vs 69 [43.1%]), and significantly higher intraoperative parathyroid hormone at 10 minutes (78.1 ± 194.6 vs 43.9 ± 62.4 1, P = .04). Positive predictive value of both intraoperative parathyroid hormone and cure rate was lower in the normocalcemic group (84.2% vs 95.7%) and (80.5% vs 95%), respectively. Conclusion Normocalcemic hyperparathyroidism is a challenging disease. Surgeons should be aware of the lower cure rate in this group, interpret intraoperative parathyroid hormone with caution, and have a lower threshold for bilateral neck exploration and 4 glands visualization.

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Predictive Levels of CD24 in Peripheral Blood Leukocytes for the Early Detection of Colorectal Adenomas and Adenocarcinomas

Disease Markers ◽

10.1155/2015/916098 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Sarah Kraus ◽

Shiran Shapira ◽

Dina Kazanov ◽

Inna Naumov ◽

Menachem Moshkowitz ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Peripheral Blood ◽

Medical Center ◽

High Sensitivity ◽

Normal Subjects ◽

Colorectal Adenomas ◽

Average Risk ◽

Peripheral Blood Leukocytes ◽

Multicenter Studies ◽

Blood Leukocytes

CD24 is expressed in 90% of colorectal adenomas and adenocarcinomas. Colorectal cancer (CRC) can be mostly prevented but average risk population screening by stool testing or colonoscopy faces many hurdles. Blood testing is clinically needed. We aimed to evaluate the utility of CD24 expression in peripheral blood leukocytes (PBLs). Two independent case studies were conducted in eligible individuals undergoing colonoscopy. Protein extracted from PBLs was subjected to immunoblotting using anti-CD24 monoclonal antibodies. CD24 sensitivity and specificity were determined using receiver operating characteristic (ROC) analysis. Initially, 150 subjects were examined: 63 had CRC, 19 had adenomas, and 68 had normal colonoscopies. The sensitivity and specificity of CD24 for distinguishing CRC from normal subjects were 70.5% (95% CI, 54.8–83.2%) and 83.8% (95% CI, 74.6–92.7%) and for adenomas 84.2% (95% CI, 60.4–96.4%) and 73.5% (95% CI, 61.4–83.5%), respectively. In the second trial (n= 149), a similar specificity but higher sensitivity was achieved: 80.0% (95% CI, 63.1–91.6%) for CRC and 89.2% (95% CI, 74.6–97%) for adenomas. A simple noninvasive blood test evaluating CD24 levels has high sensitivity and specificity for detecting colorectal adenomas and cancer in patients undergoing colonoscopy at an urban medical center. Larger multicenter studies are warranted to establish the potential of this promising test.

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Abstract 127: The Effect of Cutoff Frequency Range on Amplitude Spectrum Area Performance in Predicting Defibrillation Outcome

Circulation ◽

10.1161/circ.138.suppl_2.127 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Xiaobo Wu ◽

Weilun Quan ◽

Jennifer Bradley ◽

Mary Ann Peberdy ◽

Joseph Ornato ◽

...

Keyword(s):

Cardiac Arrest ◽

Sensitivity And Specificity ◽

Characteristic Curve ◽

Amplitude Spectrum ◽

Sampling Rate ◽

Cutoff Frequency ◽

Experimental Studies ◽

High Sensitivity ◽

Frequency Range ◽

Spectrum Area

Introduction: Both clinical and experimental studies have demonstrated that ventricular fibrillation (VF) waveform-based amplitude spectrum area (AMSA) predicts defibrillation outcome with high sensitivity and specificity. A commonly used cutoff frequency range for calculation of AMSA is 4-48 Hz, but the median VF frequency in patients is less than 7 Hz. In the present study, we investigated whether the AMSA performance in predicting defibrillation outcome may be affected by different cutoff frequency ranges. Hypothesis: A selected cutoff frequency range would affect AMSA performance in predicting defibrillation outcome in patients. Methods: A total of 450 segments (179-defibrillation success and 271-defibrillation failure) of VF waveforms from patients with out-of-hospital cardiac arrest were analyzed. Each 4.096-s segment prior to defibrillation was acquired with a sampling rate of 250 Hz. Using MATLAB (MathWorks, Natck, MA), the AMSA of each segment of VF waveform was calculated with five cutoff frequency ranges (Shown in Figure 1). Sensitivity and specificity were calculated when defibrillation success rate was 50% which was estimated by a logistic regression curve. Area under the receiver operating characteristic curve (AUC) was used to evaluate AMSA performance within different cutoff frequency ranges. Results: AMSA threshold was decreased from 20.5 to 6.5 mV·Hz when the cutoff frequency range was changed from 3-48 Hz to 3-10 Hz (Figure 1). Sensitivity of AMSA in 3-10 Hz was increased by 81.3% compared with that of AMSA in 3-48 Hz. Specificity of AMSA in 3-10 Hz was decreased by 8.1% compared with that of AMSA in 3-48 Hz. The corresponding AUC was increased from 0.724 (3-48 Hz) to 0.768 (3-10 Hz). Conclusions: A cutoff frequency range of 3-10 Hz significantly increases the sensitivity of AMSA for predicting defibrillation success in patients with cardiac arrest with a slight decrease in specificity.

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Abstract TP232: Initial Experience With a Fully Autonomous Robotic Transcranial Doppler System for Patent Foramen Ovlae Detection in Cryptogenic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp232 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ruchir A Shah ◽

Thomas Devlin

Keyword(s):

High Risk ◽

Sensitivity And Specificity ◽

Transcranial Doppler ◽

Cryptogenic Stroke ◽

Case Series ◽

High Sensitivity ◽

High Risk Patients ◽

Number Of Patients ◽

Risk Patients ◽

Pfo Closure

Background: Right to Left shunting (RLS) through a PFO is a known risk factor for ischemic stroke and commonly screened in cases of ESUS. With emerging evidence linking the significance of PFO closure for reduction of recurrent stroke, there is a need for broader access to accurate, easily repeatable tools to identify high-risk patients considered for transcatheter PFO closure. The use of a Transcranial Doppler (TCD) bubble study has proven to be a valuable, non-invasive tool due to its high sensitivity and specificity in detecting and grading a PFO. In this case series, we evaluate a fully autonomous rTCD to perform bubble studies in ESUS population to assess the presence of PFOs. Methods: A total of 34 patients were diagnosed with ESUS. All patients received rTCD bubble study using the Lucid Robotic System to autonomously search, insonate and monitor bilateral Middle Cerebral Artery signals. A Transthoracic Echocardiogram (TTE) with a bubble was completed in 29 of 34 patients. A Transesophageal Echocardiogram (TEE) with a bubble was completed in 5 of 34 patients. All studies were performed at rest and with a Valsalva maneuver. Some patients were selected for an rTCD bubble after a positive TTE bubble study. Results: A PFO was detected in 65% (22 of 34) of the patient population. Both rTCD and TTE were performed in 19 of 22 patients. We identified 9 patients (47%) that had a positive rTCD bubble study which went undetected by a TTE bubble study. In these 9 patients, 56% had an ICC grade 3, 33% had grade 2, and 11% had grade 1 shunt. Conclusion: The high sensitivity and specificity of a TCD bubble study for the detection of a PFO provide a valuable, underutilized tool to accurately screen for high-risk patients benefiting from a PFO closure. This is highlighted by the 9 patients where a PFO went undetected by a TTE. The implementation of a fully autonomous rTCD allowed for broader access to perform TCD bubble studies, resulting in greater patient management and workflow efficiency. With the small number of patients in this case series, further research is recommended.

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The Role of Genioglossus Activity in Predicting Uvulopalatopharyngoplasty Outcomes

Otolaryngology ◽

10.1177/0194599819889346 ◽

2019 ◽

Vol 162 (2) ◽

pp. 255-260

Author(s):

Di Zhao ◽

Yanru Li ◽

Yue Qu ◽

Junbo Zhang ◽

Xin Cao ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Success Rate ◽

Medical Center ◽

Characteristic Curve ◽

Sleep Onset ◽

Case Series ◽

Surgical Success ◽

Obstructive Sleep

Objective The aim of this study was to evaluate the association between genioglossus activity during sleep onset and the outcome of uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea. Study Design Case series with planned data collection. Setting Sleep medical center. Subjects and Methods Forty-four patients with obstructive sleep apnea underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) with intraoral electrodes. In addition, all patients underwent revised UPPP with uvula preservation and were followed up with polysomnography at least 3 months after surgery. Results Twenty-five patients (56.8%) were responders. Multiple regression analysis revealed that increasing tonsil size (odds ratio [OR], 0.086; P = .038) and higher sleep-onset GGEMG (OR, 0.664; P = .04) were significant predictors for surgical success. The area under the receiver operating characteristic curve was 0.942 (OR, 0.040; P < .001) for those predictors, 0.884 for GGEMG, and 0.848 for tonsil size. Moreover, all patients were divided into 4 groups according to tonsil size and sleep-onset GGEMG. The success rate of patients with tonsil size III or IV and sleep-onset GGEMG >11.20% (maximal GGEMG) was optimal (92.9%, 13 of 14), while the success rate of patients with tonsil size I or II and sleep-onset GGEMG ≤11.20% was 0% (0 of 10). Conclusions Sleep-onset GGEMG and tonsil size are both important in deciding outcomes of UPPP. Patients with tonsil size III or IV and higher sleep onset may be more suitable candidates for UPPP because of the higher probability of surgical success.

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Fast diagnostic test for familial Mediterranean fever based on a kinase inhibitor

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-218366 ◽

2020 ◽

Vol 80 (1) ◽

pp. 128-132

Author(s):

Flora Magnotti ◽

Tiphaine Malsot ◽

Sophie Georgin-lavialle ◽

Fatima Abbas ◽

Amandine Martin ◽

...

Keyword(s):

Familial Mediterranean Fever ◽

Sensitivity And Specificity ◽

Kinase Inhibitor ◽

Gene Dosage ◽

Characteristic Curve ◽

High Sensitivity ◽

Inflammasome Activation ◽

Clinical Criteria ◽

Healthy Donors ◽

Mediterranean Fever

Background and objectiveFamilial Mediterranean fever (FMF) is the most frequent hereditary autoinflammatory disease. Its diagnosis relies on a set of clinical criteria and a genetic confirmation on identification of biallelic pathogenic MEFV variants. MEFV encodes pyrin, an inflammasome sensor. Using a kinase inhibitor, UCN-01, we recently identified that dephosphorylation of FMF-associated pyrin mutants leads to inflammasome activation. The aim of this study was to assess whether quantifying UCN-01-mediated inflammasome activation could discriminate FMF patients from healthy donors (HD) and from patients with other inflammatory disorders (OID).MethodsReal-time pyroptosis and IL-1β secretion were monitored in response to UCN-01 in monocytes from FMF patients (n=67), HD (n=71) and OID patients (n=40). Sensitivity and specificity of the resulting diagnostic tests were determined by receiver operating characteristic curve analyses.ResultsInflammasome monitoring in response to UCN-01 discriminates FMF patients from other individuals. Pyroptosis assessment leads to a fast FMF diagnosis while combining pyroptosis and IL-1β dosage renders UCN-01-based assays highly sensitive and specific. UCN-01-triggered monocytes responses were influenced by MEFV gene dosage and MEFV mutations in a similar way as clinical phenotypes are.ConclusionsUCN-01-based inflammasome assays could be used to rapidly diagnose FMF, with high sensitivity and specificity.

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