scholarly journals Focused parathyroidectomy using accurate preoperative imaging and intraoperative PTH: Tertiary care experience

2019 ◽  
Vol 23 (3) ◽  
pp. 347
Author(s):  
Roma Pradhan ◽  
Sushil Gupta ◽  
Amit Agarwal
Keyword(s):  
Tertiary Care ◽  
Preoperative Imaging ◽  
Care Experience ◽  
Intraoperative Pth ◽  
Focused Parathyroidectomy

scholarly journals Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Loredana De Pasquale ◽  
Eleonora Lori ◽  
Antonio Mario Bulfamante ◽  
Giovanni Felisati ◽  
Luca Castellani ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Preoperative Imaging ◽  
Multiglandular Disease ◽  
Single Adenoma ◽  
Single Center Experience ◽  
Disease Outcomes ◽  
Main Challenge ◽  
Intraoperative Pth ◽  
Focused Parathyroidectomy ◽  
Parathyroid Localization

Background. The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80–85% of the cases) or by a multiglandular disease (15–20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the literature, to perform focused parathyroidectomy, avoiding intraoperative parathormone assay (ioPTH). The most known are the CaPTHUS test and the Wisconsin index. We applied them to our experience. Methods. A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. Only patients affected with benign PHPT and neck ultrasound performed at our institution were included. Both patients for whom preoperative imaging agreed with the localization of a single diseased parathyroid and those with only ultrasound or scintigraphy positive for parathyroid localization underwent Mini-Invasive Video-assisted parathyroidectomy. In all cases, ioPTH assay was performed. The conversion to bilateral neck exploration was decided based on the drop in ioPTH. CaPTHUS score and the Wisconsin index (Win) were applied to the series. CaPTHUS score ≥3 and Win index >1600, according to the original studies of the literature, were considered at high probability of monoglandular disease. Outcomes in these two groups were examined. Results. 236 patients were eligible for the study. The pathology resulted in multiglandular disease in 24 patients (10.2%). Among these, 18 (75.0%) obtained a CaPTHUS score ≥3, and 20 (83.3%) had a Win index>1600. Intraoperative PTH allowed to identify multiglandular disease in 16 of 18 cases with CaPTHUS ≥3 and in 18 of 20 cases with win >1600, who could have been lost, based only on the results of these 2 tests. Conclusion. Based on our experience, CaPTHUS test and Wisconsin index were not so useful in predicting multiglandular disease as ioPTH.

Clinical spectrum of colonic diverticulosis: a tertiary care experience in Saudi Arabia

2020 ◽  
pp. 1
Author(s):  
Abed AlLehbi ◽  
Abdullah AlMtawa ◽  
Adel Alqutub ◽  
Khalid Alsayari ◽  
Ahmed Alomair ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Tertiary Care ◽  
Clinical Spectrum ◽  
Colonic Diverticulosis ◽  
Care Experience

scholarly journals A review of the etiology and clinical presentation of non-cystic fibrosis bronchiectasis: A tertiary care experience

2018 ◽  
Vol 137 ◽  
pp. 35-39 ◽  
Author(s):  
Ozlem Satırer ◽  
Ayse Mete Yesil ◽  
Nagehan Emiralioglu ◽  
Gökcen Dilsa Tugcu ◽  
Ebru Yalcın ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Care Experience

Abstract 13087: Are All Patients Equal in Response to Intra-Aortic Balloon Counterpulsation?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
David A Baran ◽  
Marc Cohen ◽  
Gautam K Visveswaran ◽  
Michael DiVita ◽  
Ahmed Seliem ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Chart Review ◽  
Tertiary Care ◽  
Balloon Catheter ◽  
Binary Response ◽  
Ventricular Assist ◽  
Care Experience ◽  
Intra Aortic Balloon Counterpulsation ◽  
Balloon Counterpulsation ◽  
Hemodynamic Measurements

Background: Intra-Aortic Balloon Counterpulsation (IABC) with a 50 cc (MEGA 50™) balloon catheter is associated with an average increase of 0.5- 0.7 liters/min in cardiac output. However, some patients (pts) have a much more dramatic response. We retrospectively analyzed our single center tertiary care experience with 150 consecutive pts undergoing IABC. Methods: Chart review for demographic, procedural, and hemodynamic data was collected for 150 pts of whom 64 had both pre and 4 hour post IABC hemodynamic measurements. The responder (R) group was defined by any positive change in cardiac output (CO) and cardiac index (CI) between baseline prior to IABC and 4 hours post initiation. Non-responders (NR) were defined as those with a decline in CO or no change. Results: IABC with a 50 cc balloon was associated with a significant improvement in CO of 0.7 L/min for the overall cohort (Pre-IABC mean CO 3.9±1.4 vs post 4.6 ±1.6 L/Min, paired t-test p=.0004). There were 38 pts in the R group (60 %) and 26 in the NR group. The CO / CI post-IABC improved significantly: CO 3.5±1.3 to 5.0±1.7 L/Min and CI 1.8±0.6 vs 2.6±0.7 L/min/M 2 ) (p<0.0001). For NR pts, CO dropped from 4.5±1.3 to 3.9±1.2 L/Min (p<0.0001) and CI from 2.2±0.6 to 2.1±0.5 L/min/M 2 (p=0.1). Interestingly, systemic vascular resistance varied significantly between groups (R: 1568±657 vs NR 1218±461 (dyne*sec)/cm 5 (p=0.02). Nominal logistic regression identified pre-IABC CO as a significant predictor of response. Conclusion: Among a cohort of pts receiving IABC, there appears to be a binary response with “responders” augmenting CO by 1.5 L/min which is close to that provided by percutaneous ventricular assist catheters such as Impella. Patients with lower pre-IABC CO and higher SVR appear to have the most favorable response to IABC. This binary response may have influenced prior neutral clinical outcome trials of IABC.

scholarly journals Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

2015 ◽  
Vol 97 (8) ◽  
pp. 603-607 ◽  
Author(s):  
OA Mownah ◽  
G Pafitanis ◽  
WM Drake ◽  
JN Crinnion
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Frozen Section ◽  
Lateral Approach ◽  
Preoperative Imaging ◽  
Surgical Cure ◽  
Focused Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Iopth Measurement

Introduction Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement. Methods Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment. Results Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia. Conclusions This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.

Epidemiology of sepsis, based on ICD-9 coding, a tertiary care Experience from Pakistan

2021 ◽  
Author(s):  
Amber Sabeen Ahmed ◽  
Erfan Hussain ◽  
Sohail Haleem ◽  
Naila Ahmed ◽  
Asad Latif
Keyword(s):  
Tertiary Care ◽  
Care Experience
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