scholarly journals Giant parathyroid adenoma: differential aspects compared to parathyroid carcinoma

2017 ◽  
Vol 2017 ◽  
Author(s):  
Marta Araujo Castro ◽  
Ainhoa Abad López ◽  
Luz Martín Fragueiro ◽  
Nuria Palacios García
Keyword(s):  
Differential Diagnosis ◽  
Width Ratio ◽  
List Type ◽  
Parathyroid Adenomas ◽  
Before And After ◽  
Parathyroid Lesions ◽  
Histological Characteristics ◽  
Learning Points ◽  
Parathyroid Lesion

Summary The 85% of cases of primary hyperparathyroidism (PHPT) are due to parathyroid adenomas (PA) and less than 1% to parathyroid carcinomas (PC). The PA usually measure <2 cm, weigh <1 g and generate a mild PHPT, whereas the PC usually exceeds these dimensions and are associated with a severe PHPT. However, giant PA (GPA), which is defined as those larger than 3 g, has been documented. Those may be associated with very high levels of PTH and calcium. In these cases, their differentiation before and after surgery with PC is very difficult. We present a case of severe PHPT associated with a large parathyroid lesion, and we discuss the differential aspects between the GPA and PC. Learning points: In parathyroid lesions larger than 2 cm, the differential diagnosis between GPA and PC should be considered. Pre and postsurgical differentiation between GPA and PC is difficult; however, there are clinical, analytical and radiographic characteristics that may be useful. The depth/width ratio larger or smaller than 1 seems to be the most discriminatory ultrasound parameter for the differential diagnosis. Loss of staining for parafibromin has a specificity of 99% for the diagnosis of PC. The simultaneous presence of several histological characteristics, according to the classification of Schantz and Castleman, is frequent in PC and rare in GPA.

scholarly journals Accidental transdermal methanol poisoning presenting to a regional emergency department

CJEM ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 435-437
Author(s):  
Chelsea R. Beaton ◽  
Clinton Meyer
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Metabolic Acidosis ◽  
Laboratory Testing ◽  
Clinical Findings ◽  
Anion Gap ◽  
List Type ◽  
Emergency Physicians ◽  
Clinical Presentations ◽  
Learning Points

Learning Points:•Know and identify clinical presentations of toxic alcohols.•Understand the differential diagnosis of high anion gap metabolic acidosis.•Appreciate the importance of history and clinical findings in establishing methanol toxicity diagnoses, especially in centres where laboratory testing is unavailable.•Recognize the value of provincial poison centres in supporting emergency physicians in the diagnosis and management of poisonings and overdoses.

scholarly journals Acute obstruction of a mechanical aortic valve in a young woman: case report and review of the literature

2014 ◽  
Vol 2 (1) ◽  
pp. K1-K5 ◽  
Author(s):  
Ashraf Roshdy ◽  
Georgios T Karapanagiotidis ◽  
Mazin A I Sarsam ◽  
Simon N Fletcher
Keyword(s):  
Differential Diagnosis ◽  
Aortic Valve ◽  
List Type ◽  
Pannus Formation ◽  
Acute Obstruction ◽  
Review Of The Literature ◽  
Management Options ◽  
Diagnostic Modalities ◽  
Learning Points

SummaryAcute aortic valve obstruction is a medical and surgical emergency necessitating intensive care unit admission. The differential diagnosis includes thrombosis, pannus formation or vegetations. The diagnosis should be obtained as soon as possible, with possible orientation towards the cause. Different diagnostic modalities exist nowadays. Notably, the transesophageal echocardiography (TEE) offers a diagnosis and a guide for management. Surgical treatment remains of choice despite growing evidence about a benefit of combined thrombolytic and anticoagulation line of management.Learning pointsAcute management and resuscitation of acute valvular obstruction.Differential diagnosis and role of echo in the diagnosis.Management options.

scholarly journals Two cases of spontaneous remission of primary hyperparathyroidism due to auto-infarction: different management and their outcomes

2019 ◽  
Vol 2019 ◽  
Author(s):  
Peter Novodvorsky ◽  
Ziad Hussein ◽  
Muhammad Fahad Arshad ◽  
Ahmed Iqbal ◽  
Malee Fernando ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Spontaneous Remission ◽  
Calcium Excretion ◽  
List Type ◽  
Tertiary Centre ◽  
Parathyroid Adenomas ◽  
Severe Hypercalcaemia ◽  
Parathyroid Lesion

Summary Spontaneous remission of primary hyperparathyroidism (PHPT) due to necrosis and haemorrhage of parathyroid adenoma, the so-called ‘parathyroid auto-infarction’ is a very rare, but previously described phenomenon. Patients usually undergo parathyroidectomy or remain under close clinical and biochemical surveillance. We report two cases of parathyroid auto-infarction diagnosed in the same tertiary centre; one managed surgically and the other conservatively up to the present time. Case #1 was a 51-year old man with PHPT (adjusted (adj.) calcium: 3.11 mmol/L (reference range (RR): 2.20–2.60 mmol/L), parathyroid hormone (PTH) 26.9 pmol/L (RR: 1.6–6.9 pmol/L) and urine calcium excretion consistent with PHPT) referred for parathyroidectomy. Repeat biochemistry 4 weeks later at the surgical clinic showed normal adj. calcium (2.43 mmol/L) and reduced PTH. Serial ultrasound imaging demonstrated reduction in size of the parathyroid lesion from 33 to 17 mm. Twenty months later, following recurrence of hypercalcaemia, he underwent neck exploration and resection of an enlarged right inferior parathyroid gland. Histology revealed increased fibrosis and haemosiderin deposits in the parathyroid lesion in keeping with auto-infarction. Case #2 was a 54-year-old lady admitted with severe hypercalcaemia (adj. calcium: 4.58 mmol/L, PTH 51.6 pmol/L (RR: 1.6–6.9 pmol/L)) and severe vitamin D deficiency. She was treated with intravenous fluids and pamidronate and 8 days later developed symptomatic hypocalcaemia (1.88 mmol/L) with dramatic decrease of PTH (17.6 pmol/L). MRI of the neck showed a 44 mm large cystic parathyroid lesion. To date, (18 months later), she has remained normocalcaemic. Learning points: Primary hyperparathyroidism (PHPT) is characterised by excess parathyroid hormone (PTH) secretion arising mostly from one or more autonomously functioning parathyroid adenomas (up to 85%), diffuse parathyroid hyperplasia (<15%) and in 1–2% of cases from parathyroid carcinoma. PHPT and hypercalcaemia of malignancy, account for the majority of clinical presentations of hypercalcaemia. Spontaneous remission of PHPT due to necrosis, haemorrhage and infarction of parathyroid adenoma, the so-called ‘parathyroid auto-infarction’, ‘auto-parathyroidectomy’ or ‘parathyroid apoplexy’ is a very rare in clinical practice but has been previously reported in the literature. In most cases, patients with parathyroid auto-infarction undergo parathyroidectomy. Those who are managed conservatively need to remain under close clinical and biochemical surveillance long-term as in most cases PHPT recurs, sometimes several years after auto-infarction.

scholarly journals Ultrasound elastography score and strain index in different parathyroid lesions

2019 ◽  
Vol 8 (12) ◽  
pp. 1579-1590
Author(s):  
Bekir Cakir ◽  
F Neslihan Cuhaci Seyrek ◽  
Oya Topaloglu ◽  
Didem Ozdemir ◽  
Ahmet Dirikoc ◽  
...  
Keyword(s):  
Parathyroid Adenoma ◽  
Ultrasound Elastography ◽  
Parathyroid Hyperplasia ◽  
Strain Index ◽  
Median Serum ◽  
Parathyroid Adenomas ◽  
Parathyroid Lesions ◽  
Atypical Parathyroid Adenoma ◽  
Thyroid Parenchyma ◽  
Parathyroid Lesion

Background Despite significant improvement in imaging quality and advanced scientific knowledge, it may still sometimes be difficult to distinguish different parathyroid lesions. The aims of this prospective study were to evaluate parathyroid lesions with ultrasound elastography and to determine whether strain index can help to differentiate parathyroid lesions. Methods Patients with biochemically confirmed hyperparathyroidism and localised parathyroid lesions in ultrasonography were included. All patients underwent B-mode US and USE examination. Ultrasound elastography scores and strain index of lesions were determined. Strain index was defined as the ratio of strain of the thyroid parenchyma to the strain of the parathyroid lesion. Results Data of 245 lesions of 230 patients were analysed. Histopathologically, there were 202 (82.45%) parathyroid adenomas, 26 (10.61%) atypical parathyroid adenomas, and 17 (6.94%) cases of parathyroid hyperplasia. Median serum Ca was significantly higher in atypical parathyroid adenoma patients than parathyroid hyperplasia patients (P = 0.019) and median PTH was significantly higher in APA compared to PA patients (P < 0.001). In 221 (90.2%) of the parathyroid lesions, USE score was 1 or 2. The median SI of atypical parathyroid adenomas was significantly higher than parathyroid adenomas and hyperplasia lesions (1.5 (0.56–4.86), 1.01 (0.21–8.43) and 0.91 (0.26–2.02), respectively, P = 0.003). Conclusion Our study revealed that SI of parathyroid lesions as well as serum calcium, parathyroid hormone levels, and B-mode US features may help to predict the atypical parathyroid adenoma. Ultrasound elastography can be used to differentiate among parathyroid lesions and guide a surgical approach.

Classification of papillary thyroid carcinoma histological images based on deep learning

2021 ◽  
pp. 1-11
Author(s):  
Yaning Liu ◽  
Lin Han ◽  
Hexiang Wang ◽  
Bo Yin
Keyword(s):  
Neural Network ◽  
Differential Diagnosis ◽  
Deep Learning ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Image Features ◽  
Papillary Thyroid ◽  
Histological Image ◽  
Histological Images

Papillary thyroid carcinoma (PTC) is a common carcinoma in thyroid. As many benign thyroid nodules have the papillary structure which could easily be confused with PTC in morphology. Thus, pathologists have to take a lot of time on differential diagnosis of PTC besides personal diagnostic experience and there is no doubt that it is subjective and difficult to obtain consistency among observers. To address this issue, we applied deep learning to the differential diagnosis of PTC and proposed a histological image classification method for PTC based on the Inception Residual convolutional neural network (IRCNN) and support vector machine (SVM). First, in order to expand the dataset and solve the problem of histological image color inconsistency, a pre-processing module was constructed that included color transfer and mirror transform. Then, to alleviate overfitting of the deep learning model, we optimized the convolution neural network by combining Inception Network and Residual Network to extract image features. Finally, the SVM was trained via image features extracted by IRCNN to perform the classification task. Experimental results show effectiveness of the proposed method in the classification of PTC histological images.

scholarly journals Cooperation & Liaison between Universities & Editors (CLUE): recommendations on best practice

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Elizabeth Wager ◽  
◽  
Sabine Kleinert
Keyword(s):  
Peer Review ◽  
Best Practice ◽  
Research Integrity ◽  
Decision Makers ◽  
Publication Ethics ◽  
List Type ◽  
Research Institutions ◽  
Academic Journals ◽  
Before And After ◽  
Published Research

Abstract Background Inaccurate, false or incomplete research publications may mislead readers including researchers and decision-makers. It is therefore important that such problems are identified and rectified promptly. This usually involves collaboration between the research institutions and academic journals involved, but these interactions can be problematic. Methods These recommendations were developed following discussions at World Conferences on Research Integrity in 2013 and 2017, and at a specially convened 3-day workshop in 2016 involving participants from 7 countries with expertise in publication ethics and research integrity. The recommendations aim to address issues surrounding cooperation and liaison between institutions (e.g. universities) and journals about possible and actual problems with the integrity of reported research arising before and after publication. Results The main recommendations are that research institutions should: develop mechanisms for assessing the integrity of reported research (if concerns are raised) that are distinct from processes to determine whether individual researchers have committed misconduct; release relevant sections of reports of research integrity or misconduct investigations to all journals that have published research that was investigated; take responsibility for research performed under their auspices regardless of whether the researcher still works at that institution or how long ago the work was done; work with funders to ensure essential research data is retained for at least 10 years. Journals should: respond to institutions about research integrity cases in a timely manner; have criteria for determining whether, and what type of, information and evidence relating to the integrity of research reports should be passed on to institutions; pass on research integrity concerns to institutions, regardless of whether they intend to accept the work for publication; retain peer review records for at least 10 years to enable the investigation of peer review manipulation or other inappropriate behaviour by authors or reviewers. Conclusions Various difficulties can prevent effective cooperation between academic journals and research institutions about research integrity concerns and hinder the correction of the research record if problems are discovered. While the issues and their solutions may vary across different settings, we encourage research institutions, journals and funders to consider how they might improve future collaboration and cooperation on research integrity cases.

scholarly journals The local structure of the free boundary in the fractional obstacle problem

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Matteo Focardi ◽  
Emanuele Spadaro
Keyword(s):  
Hausdorff Dimension ◽  
Free Boundary ◽  
Hausdorff Measure ◽  
Local Structure ◽  
Obstacle Problem ◽  
List Type ◽  
Minkowski Content ◽  
Local Finiteness ◽  
Lower Dimensional

AbstractBuilding upon the recent results in [M. Focardi and E. Spadaro, On the measure and the structure of the free boundary of the lower-dimensional obstacle problem, Arch. Ration. Mech. Anal. 230 2018, 1, 125–184] we provide a thorough description of the free boundary for the solutions to the fractional obstacle problem in {\mathbb{R}^{n+1}} with obstacle function φ (suitably smooth and decaying fast at infinity) up to sets of null {{\mathcal{H}}^{n-1}} measure. In particular, if φ is analytic, the problem reduces to the zero obstacle case dealt with in [M. Focardi and E. Spadaro, On the measure and the structure of the free boundary of the lower-dimensional obstacle problem, Arch. Ration. Mech. Anal. 230 2018, 1, 125–184] and therefore we retrieve the same results:(i)local finiteness of the {(n-1)}-dimensional Minkowski content of the free boundary (and thus of its Hausdorff measure),(ii){{\mathcal{H}}^{n-1}}-rectifiability of the free boundary,(iii)classification of the frequencies and of the blowups up to a set of Hausdorff dimension at most {(n-2)} in the free boundary.Instead, if {\varphi\in C^{k+1}(\mathbb{R}^{n})}, {k\geq 2}, similar results hold only for distinguished subsets of points in the free boundary where the order of contact of the solution with the obstacle function φ is less than {k+1}.

Detection of Vigil And Fatigue States During The Execution of Laparoscopic Tasks Based On EEG Patterns

2021 ◽  
Author(s):  
Yeremi Pérez ◽  
Roberto Borboa-Gastelum ◽  
Luz Maria Alonso-Valerdi ◽  
David I. Ibarra-Zarate ◽  
Eduardo A. Flores-Villalba ◽  
...  
Keyword(s):  
Medical Students ◽  
Individual Component ◽  
Support Vector ◽  
Patient Death ◽  
Professional Activities ◽  
Health Area ◽  
Before And After ◽  
Lack Of Sleep ◽  
Eeg Signal Processing

Abstract Fatigue decreases performance in several professional activities. Fatigue can lead to commit technical mistakes which consequences might be lethal, such as in health area, where a surgical error due to the absence of rest can provoke the patient death. Therefore, this study aims to detect vigil and fatigue (due to lack of sleep) states in medical students through the classification of electroencephalographic (EEG) patterns. The EEG signals of 18 physician students were analyzed within theta band (4 - 8 Hz) over front-central recording sites, and alpha band (8 - 13 Hz) rhythms over temporal and parieto-occipital recording sites during the execution of laparoscopic tasks before and after their medical duties. The EEG signal processing pipeline consisted in pre-processing based on individual component analysis, absolute band power estimates, and Support Vector Machine classification. The F-score to differ between vigil and fatigue states was 90.89%, where the first class was slightly more identifiable reaching a sensitivity of 90.18%. Based on this outcome, the detection of fatigue in medical students while their laparoscopic training seems achievable and feasible to diminish technical mistakes that could be lethal in health area. For this purpose, EEG recording are provided.

Study on Effect of Spheroidization on Hazardous Classification of ADN

2021 ◽  
Vol 881 ◽  
pp. 71-76
Author(s):  
Jian Yang ◽  
Hong Bin Li ◽  
Song Tao Ren ◽  
Peng Gang Jin ◽  
Zan Gao
Keyword(s):  
Temperature Stability ◽  
Impact Sensitivity ◽  
Classification Method ◽  
Ammonium Dinitramide ◽  
Classification Procedure ◽  
Research Results ◽  
Before And After ◽  
Hazard Classification ◽  
Friction Sensitivity

In order to determine the influence of spheroidization process of Ammonium dinitramide’s hazard grade, the hazardous division of Ammonium dinitramide before and after spheroidization is studied by using hazard classification procedure for combustible and explosive substances and articles standard (WJ20405) and hazard classification method and criterion for combusitible and explosive substances and articles standard (WJ20404). The research results show that spheroidization process can significantly improve the temperature stability of Ammonium dinitramide and significantly reduce friction sensitivity and impact sensitivity of Ammonium dinitramide. So spheroidization process can reduce the hazardous of Ammonium dinitramide and improve the safe character of Ammonium dinitramide.

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