Primary hyperparathyroidism: a retrospective study over 18 years in an oncology center

Aim: To study primary hyperparathyroidism (pHPT) in an oncology center, including its possible association with malignancy and ionizing radiation. Methods: Retrospective analysis of 188 patients with sporadic pHPT treated with parathyroidectomy between 2000 and 2018. We studied the etiology, clinical and biochemical features of pHPT, history of malignancies and exposure to radiotherapy. Results: pHPT was caused by parathyroid adenoma in 90.4%, hyperplasia in 5.3% and carcinoma in 4.3%. Cure and recurrence rates of pHPT were 99 and 4.3%, respectively. Median follow-up time was 19 months. Prevalence of malignancies was 30%, mostly thyroid and breast cancer. Radiotherapy of the head, neck or thorax (8.5%) was not associated with worse hypercalcaemia or recurrence. Males had larger adenomas, higher calcium and parathyroid hormone (p < 0.01). Conclusion: Prevalence of parathyroid carcinoma and other malignancies was higher than reported in other studies. Ionizing radiation exposure was unrelated with pHPT severity. Men had more severe pHPT. High cure and low recurrence rates were achieved.

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Cured primary hyperparathyroidism after fine-needle aspiration biopsy-induced parathyroid disappearance

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-17-0125 ◽

2017 ◽

Vol 2017 ◽

Cited By ~ 1

Author(s):

Elda Kara ◽

Elisa Della Valle ◽

Sara De Vincentis ◽

Vincenzo Rochira ◽

Bruno Madeo

Keyword(s):

Primary Hyperparathyroidism ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Complete Disappearance ◽

List Type ◽

Fine Needle ◽

Time Period ◽

History Of

Summary Spontaneous or fine-needle aspiration (FNAB)-induced remission of primary hyperparathyroidism (PHPT) may occur, especially for cystic lesions. However, the disease generally relapses over a short time period. We present a case of PHPT due to an enlarged hyperfunctioning parathyroid that underwent long-term (almost 9 years) clinical and ultrasonographic remission after the disappearance of the lesion following ultrasound (US)-assisted FNAB. A 67-year-old woman with PHPT underwent biochemical and US examinations that confirmed the diagnosis and showed a lesion suggestive for parathyroid adenoma or hyperplasia. US-FNAB of the lesion confirmed its parathyroid nature by means of elevated levels of parathyroid hormone within the needle washing fluid. At the second visit, the patient referred slight neck swelling that resolved spontaneously in the days after the US-FNAB. At subsequent follow-up, the enlarged parathyroid was not found; it was visible neither with US nor with magnetic resonance imaging. Biochemical remission persists after 9 years. This is the first reported case of cure of PHPT after US-FNAB performed on a hyperfunctioning parathyroid resulting in its complete disappearance over a period of 9 years of negative biochemical and ultrasonographic follow-up. Learning points: Spontaneous or fine-needle aspiration-induced remission of primary hyperparathyroidism can occur. Both circumstances may present disease relapse over a variable time period, but definite remission is also possible even though long-term periodic follow-up should be performed. Parathyroid damage should be ruled out in case of neck symptomatology after parathyroid fine-needle aspiration or spontaneous symptomatology in patients with history of primary hyperparathyroidism.

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Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-0950-9892 ◽

2019 ◽

Vol 128 (10) ◽

pp. 693-698

Author(s):

Sabine Dillenberger ◽

Detlef K. Bartsch ◽

Elisabeth Maurer ◽

Peter Herbert Kann

Keyword(s):

Primary Hyperparathyroidism ◽

Multiple Endocrine Neoplasia ◽

University Hospital ◽

Primary Surgery ◽

Endocrine Neoplasia ◽

Single Centre Experience ◽

Significant Difference ◽

History Of ◽

The University

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

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Risk for intravesical recurrence of bladder cancer stratified by the results on two consecutive UroVysion fluorescence in situ hybridization tests: a prospective follow-up study in Japan

International Journal of Clinical Oncology ◽

10.1007/s10147-020-01634-9 ◽

2020 ◽

Vol 25 (6) ◽

pp. 1163-1169

Author(s):

Atsushi Ikeda ◽

Takahiro Kojima ◽

Koji Kawai ◽

Shiro Hinotsu ◽

Naoto Keino ◽

...

Keyword(s):

Bladder Cancer ◽

Positive Result ◽

Recurrence Rates ◽

Follow Up Study ◽

Negative Results ◽

Negative Findings ◽

History Of ◽

Muscle Invasive ◽

Positive Results

Abstract Background A previous comparative study in Japan has demonstrated that the two consecutive UroVysion tests are useful tools to detect the presence of bladder cancer during follow-up after transurethral resection, but they also presented their high rates of false-positive results. Here, we aimed to evaluate the relationship between the UroVysion tests and subsequent intravesical recurrence. Methods In the previous study, patients without bladder cancer during the first analysis showed the same examination set repeated 3 months later as the second analysis. In this follow-up study, 326 patients showed negative findings confirmed on cystoscopy during the second UroVysion test. Recurrence-free survival was assessed using a median follow-up of 27 months. Results In the two consecutive UroVysion tests, 214 patients (65.6%) showed negative UroVysion results in both tests, whereas 91 presented a positive result on either tests and 21 patients presented positive results in both tests. During the follow-up, 40 patients (12.3%) had an intravesical recurrence with non-muscle-invasive bladder cancer. The recurrence rates in patients with negative results in both tests, those with one positive result in either tests, and those with positive results in both tests were 8.4%, 16.5%, and 33.3%, respectively. The multivariate analysis indicated that the history of bladder cancer and the consecutive UroVysion test pattern were independent risk factors for recurrence. Conclusions Our data confirmed the effectiveness of two consecutive UroVysion tests in predicting intravesical recurrence after TURBT. Further prospective studies would help determine an appropriate interval for cystoscopy follow-up.

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Squamous Cell Carcinoma (SCC) and Chronic Radiation Dermatitis Associated with Childhood Ionizing Radiation Exposure: Case Report with Review of the Literature

Journal of Skin and Stem Cell ◽

10.5812/jssc.119360 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Kai-Lou C. Yue ◽

Isabelle Lombardi ◽

Lohit Sodagum ◽

Dennis Porto

Keyword(s):

Squamous Cell Carcinoma ◽

Skin Cancer ◽

Ionizing Radiation ◽

Cell Carcinoma ◽

Squamous Cell ◽

Radiation Dermatitis ◽

Chronic Radiation ◽

History Of ◽

High Index Of Suspicion ◽

Ionizing Radiation Exposure

Introduction: Squamous cell carcinoma (SCC) is one of the most common types of skin cancer in Caucasians, but the role played by ionizing radiation (IR) exposure in its etiology is unclear. Case Presentation: This study presents a patient with SCC, actinic keratoses, and radiation dermatitis of the feet with a distant history of IR exposure from a shoe-fitting fluoroscope. It is likely the fluoroscope’s IR contributed to the etiology of these manifestations. Conclusions: Patients with a history of repeated IR exposure, particularly from older, unregulated sources such as a shoe-fitting fluoroscope, should be monitored with a high index of suspicion for skin cancer and other related problems.

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Watchful Waiting for Ventral Hernias: A Longitudinal Study

The American Surgeon ◽

10.1177/000313481408000319 ◽

2014 ◽

Vol 80 (3) ◽

pp. 245-252 ◽

Cited By ~ 23

Author(s):

Charles F. Bellows ◽

Celia Robinson ◽

Robert J. Fitzgibbons ◽

Larry S. Webber ◽

David H. Berger

Keyword(s):

Natural History ◽

Repeated Measures ◽

Watchful Waiting ◽

Recurrence Rates ◽

Safe Option ◽

Sf 36 ◽

History Of ◽

The Mean ◽

Ventral Hernias

Ventral hernias are a common clinical problem. Immediate repair is recommended for most ventral hernias despite significant recurrence rates. This practice may be related to a lack of understanding of the natural history of ventral hernias. The purpose of this study was to determine the natural history of ventral hernias and to determine if watchful waiting is an acceptable and safe option. Forty-one patients with ventral hernias were enrolled in a longitudinal cohort study of watchful waiting. Primary outcomes were functional impairment resulting from hernia disease as measured by the Activities Assessment Scale (AAS) and changes from baseline to two years in the physical and mental component score of the SF-36 Health Survey. Secondary outcomes included complications such as incarceration. Mixed-effects model for repeated measures and Student's t tests were used to evaluate scale performance. The mean age of enrollees was 64 years, and the mean hernia size was 239 cm2. Eleven patients were lost to follow-up, and seven patients died of other causes. All remaining patients were followed for two years. There was one incarceration during the follow-up period. There was no deterioration in the AAS score (baseline vs 24 months = 28 vs 25, P = 0.60). There was deterioration of the physical functioning dimension of the SF-36 (baseline vs 24 months = 40 vs 32, P < 0.01), but the mental functioning dimension was improved (45 vs 51; P = 0.01). Watchful waiting was a safe option for patients in this study with ventral hernias.

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Primary Hyperparathyroidism: Redefining Cure

The American Surgeon ◽

10.1177/000313481908500231 ◽

2019 ◽

Vol 85 (2) ◽

pp. 214-218 ◽

Cited By ~ 2

Author(s):

Anatoliy V. Rudin ◽

Travis J. McKenzie ◽

Roberta Wermer ◽

Geoffrey B. Thompson ◽

Melanie L. Lyden

Keyword(s):

Primary Hyperparathyroidism ◽

Inclusion Criteria ◽

Cure Rate ◽

Tertiary Hyperparathyroidism ◽

Gland Weight ◽

Significant Difference ◽

Intraoperative Pth ◽

Multiple Endocrine Neoplasia Syndrome ◽

History Of

Primary hyperparathyroidism is the most common cause of hypercalcemia. Follow-up can be resource-intensive and costly. The aim of this study was to determine if there is a subset of patients who can be defined cured earlier than six months. This was a retrospective study of patients who underwent parathyroidectomy between January 2012 and March 2014. Patients with a history of multiple endocrine neoplasia syndrome, and secondary or tertiary hyperparathyroidism were excluded. Patients with normal preoperative calcium and parathyroid hormone (PTH) and those without six months follow-up were excluded. Patients were divided into two groups: cured and not cured. Data analysis was performed between the two groups. A total of 509 patients were screened, and 214 met our inclusion criteria: 202 in the cured category and 12 in the not cured category (94% cure rate). There was no significant difference between age, gland weight, or pre-operative PTH. There was a statistically significant difference between final intraoperative PTH (IOPTH) (37 vs 55, P = 0.008) and per cent PTH decrease (69 vs 43%, P < 0.0001). There was a significant difference between intraoperative cure rate (P < 0.0006), imaging concordance (P = 0.0115), and solitary versus multiglandular disease (P = 0.0151). Subgroup analysis in patients with concordant imaging, solitary parathyroid adenoma, and IOPTH decrease by 50 per cent to normal or near-normal correlated with a six-month cure rate of 97 per cent. Patients with primary hyperparathyroidism with concordant imaging, single-adenoma pathology, and IOPTH decrease by 50 per cent to normal or near-normal levels (15–65 pg/mL) can be considered cured and may need less frequent follow-up.

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Utilization of Diagnostic Imaging and Ionizing Radiation Exposure—Has the Tide Already Turned?

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz220 ◽

2019 ◽

Vol 26 (6) ◽

pp. 907-908

Author(s):

Sebastian Zundler

Keyword(s):

Ionizing Radiation ◽

Diagnostic Imaging ◽

Radiation Exposure ◽

Case Control Study ◽

Management Of Complications ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Ionizing Radiation Exposure ◽

Control Study

Abstract Inflammatory bowel diseases require repetitive abdominal imaging for diagnosis, follow-up, or management of complications. This editorial comments on the large incident-based case–control study on utilization of diagnostic imaging and ionizing radiation exposure by Nguyen and colleagues published in this issue.

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Recurrent Hemorrhoids—Efficacy, Utility and Initial Experience with the Use of Stapled Hemorrhoidopexy in Recurrent Hemorrhoids

Journal of Coloproctology ◽

10.1055/s-0041-1730262 ◽

2021 ◽

Author(s):

Ajaz Ahmed Wani ◽

Suhail Khuroo ◽

Vikas Kumar Heer ◽

Saurabh Kumar Jain ◽

Deepak Rajput ◽

...

Keyword(s):

Case Series ◽

Standard Technique ◽

Treatment Modalities ◽

Stapled Hemorrhoidectomy ◽

Recurrence Rates ◽

Pain Scores ◽

History Of ◽

Prospective Case Series ◽

First Time

Abstract Overview Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods The present prospective case series enrolled a total of 87 patients (54 male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. A modification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results Stapled hemorrhoidectomy (SD) was performed in 13 patients who had history of previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD.

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POLYMORPHISM OF DNA REPAIR GENE XPD Lys751Gln AND CHROMOSOME ABERRATIONS IN LYMPHOCYTES OF THYROID CANCER PATIENTS EXPOSED TO IONIZING RADIATION DUE TO THE CHORNOBYL ACCIDENT

Experimental Oncology ◽

10.31768/2312-8852.2016.38(4):257-260 ◽

2016 ◽

Vol 38 (4) ◽

pp. 257-260 ◽

Cited By ~ 4

Author(s):

V M Shkarupa ◽

O Yu Mishcheniuk ◽

S O Henyk-Berezovska ◽

V O Palamarchuk ◽

S V Klymenko

Keyword(s):

Dna Repair ◽

Thyroid Cancer ◽

Ionizing Radiation ◽

Radiation Exposure ◽

Chromosome Aberrations ◽

Minor Allele ◽

Repair Gene ◽

Dna Repair Gene ◽

History Of ◽

Ionizing Radiation Exposure

The aim of this work was to analyze the relationship between polymorphisms of DNA repair gene XPD Lys751Gln and frequency and spectrum of chromosome aberrations in the culture of peripheral blood lymphocytes of thyroid cancer (TC) patients having been exposed to ionizing radiation due to the Chornobyl accident. Materials and Methods: XPD Lys751Gln polymorphisms were detected by polymerase chain reaction in 102 TC patients including 38 patients exposed to ionizing radiation due to Chornobyl disaster (Chornobyl recovery workers, evacuees, and the residents of contaminated areas), 64 patients without history of ionizing radiation exposure and 45 healthy residents of Ukraine as control group. Results: In homozygous carriers of the minor allele XPD Gln751Gln, exposed to ionizing radiation, the significantly increased risk of TC (odds ratio = 3.66; p = 0.03; 95% confidence interval 1.04–12.84) was found. Among evacuees and residents of contaminated areas, homozygous carriers of the minor allele variants of XPD gene were characterized by the high level of spontaneous chromosome aberrations. TC patients without history of ionizing radiation exposure, being homozygous carriers of the allele XPD Lys751Lys, had significantly reduced frequency of chromosome-type aberrations. Conclusions: The carriage of homozygous minor allele of DNA repair gene XPD Gln751Gln is a risk factor for TC in persons from Ukrainian population exposed to ionizing radiation and is associated with the increased levels of chromosomal instability. This article is a part of a Special Issue entitled “The Chornobyl Nuclear Accident: Thirty Years After”.

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RE-OPERATIVE SURGERY FOR RECURRENT PRIMARY HYPERPARATHYROIDISM ASSOCIATED WITH OLIGOMENORRHEA

Journal of Surgical Sciences ◽

10.33695/jss.v2i3.124 ◽

2015 ◽

Vol 2 (3) ◽

pp. 140-143

Author(s):

Ana Valea ◽

V. Muntean ◽

Andra Morar ◽

Mara Carsote ◽

Cristina Căpățînă ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Female Patient ◽

Clinical Symptoms ◽

Major Incident ◽

Operative Surgery ◽

Parathyroid Adenomas ◽

History Of ◽

Normal Calcium

Recurrent primary hyperparathyroidism is characterized by typical symptoms and biochemical recurrence of hypercalcemia after more than 6 months of normal calcium levels after surgery. We report the case of a 39-year-old female patient presenting with menses disturbances who was diagnosed with primary hyperparathyroidism caused by a left inferior parathyroid adenoma at the age of 35. Postoperative 6-month follow-up showed normalization of biochemical and hormonal profiles, with significant improvement of clinical symptoms, dominated by muscle weakness, weight loss and oligomenorrhea. The 18-month follow-up showed elevated PTH and serum calcium levels. Imaging confirmed recurrence of primary hyperparathyroidism by highlighting a right upper parathyroid adenoma. Surgery was performed again and no major incident was seen. The particularity of this case consists in the recurrence of primary hyperparathyroidism in a young patient with no family history of the disease due to asynchronous parathyroid adenomas that were successfully removed in a female patient who in addition to classic complications such as calyceal microlithiasis and osteoporosis presented oligomenorrhea which was resolved spontaneously after the correction of hypercalcemia.

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