Background. Secondary hyperparathyroidism (sHPT) is frequently encountered in patients on hemodialysis (HD) for end stage renal disease (ESRD). In spite of improved medical therapy, parathyroidectomy is still frequentely indicated for patients with medically refractory secondary and tertiary hyperparathyroidism. The aim of this study is to analyse the impact of parathyroidectomy, regardless of the surgical procedure, on perioperative and follow-up clinical symptoms and biochemistry tests. Material and method. We studied 29 patients who underwent parathyroidectomy for sHPT due to ESRD, at the Second Department of Surgery, Emergency Mures County Hospital, between February 2010 and May 2013. Outcome parameters included symptoms relieving (bone pains, pruritus, etc) and laboratory data (intact parathyroid hormone (iPth), total calcium and phosphorus, serum alkaline phosphatase (AlkPhos), hematocrit and hemoglobin), assesed before, shortly after and then at short-medium term follow-up. Results. The majority of our patients had significant improvement of the symptoms during the follow-up period. The iPTH values considerably decreased after the operation. The postoperative calcemia mean value decreased and we have identified statistically significant differences between the monthly calcemia average values (p-0.008). The mean phosphorus level in the first 2 postoperative months decreased significantly (p-0.001) and we recorded statistically significant decreases (p-0.0007) in AlkPhos level after the operation. Both hematocit and hemoglobin levels experienced a statistical significant growth in the follow-up period. Persistent HPT was encountered in two patients (6.89%), and we had 8 patients who developed mild hypocalcaemia in the first month after the operation (“hungry bones” syndrome). We had few minor and transient postoperative complications and we did not encountered postoperative mortality in our series. Conclusions. Parathyroidectomy, regardless of the technical procedure, is feasible, safe and effective for patients with refractory secondary and tertiary hyperparathyroidism.
Background: Neurofibromatosis type 1 is an autosomal dominant disorder associated with multiple neoplasms particularly those of ectodermal origin. Various endocrine pathologies are often present, among them, hyperparathyroidism and follicular thyroid lesion are very rare described and their coincidence in the same patient has not been described in the literature reviewed.
Subject: A 59-years-old woman with clinical manifestation of neurofibromatosis type 1 developed dysphagia, dysphonia, choking sensation. Physical and imagistic examination revealed a multinodular goiter with microfollicular lesion on fine needle aspiration biopsy (FNAB), elevated parathormone levels and severe osteoporosis. The surgically removed thyroid contained a nodule with follicular architecture of uncertain malignant potential; the parathyroid tissue appeared normal.
Discussion and conclusion: This case serves as a reminder to look for non-neurogenic tumors in patients with neurofibromatosis. Clinicians must be aware of the diverse clinical features of this genetic disorder.
Lymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion. The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.
Secondary hyperparathyroidism (sHPT) occurs most commonly in the setting of chronic renal failure (CRF) being frequently referred to as “renal” hyperparathyroidism The “classical” medical treatment with oral calcium and vitamin D supplementation is generally sufficient to lower parathyroid hormone levels in the majority of these patients. However, we frequently encounter cases of severe refractory sHPT, a state in which even recently available therapeutic agents, i.e. calcimimetics, new phosphate binders, vitamin D analogues, remain inefficient, thus parathyroidectomy and/or renal transplant becoming necessary. Three types of surgeries have been proposed in sHPT: two of them are grouped as remnant-conserving techniques, i.e. subtotal parathyroidectomy (sPtx) and total parathyroidectomy with autotransplantation (tPtx+AT), the third one being total parathyroidectomy without autotransplantation (tPtx). There was a continuous debate concerning the best surgical approach in renal hyperparathyroidism, starting very soon after those techniques were described; without pretending to solve these controversies, this paper aims to review the surgical treatment options in sHPT, based on our 5-year experience in dealing with the disease.
Introduction: Extrahepatic portal vein thrombosis (EPVT) is the most frequent cause that leads to portal hypertension in non-cirrhotic patients. This condition is related to systemic and local risk factors (such as inflammatory lesions, injuries to portal venous system by surgery, vascular procedures).
Case presentation: A case of extended extrahepatic portal vein thrombosis and simultaneous thrombosis of left common iliac vein and inferior vena cava, appeared after abdominal surgery in a hypertensive, diabetic, 50 y.o. man is presented. An acute episode of abdominal pain was interpreted as an emergency and a surgical (initially laparoscopic and then open) procedure was planned in order to perform an appendectomy. Discharge diagnosis was hemoperitoneum secondary to iatrogenic rupture of sigmoid mesocolon provoked by trocar manipulation. Repeated imaging studies performed later revealed the thrombosis of portal vein with extension into right portal branch associated with superior mesenteric thrombosis and free-floating thrombus into left common iliac vein extended towards inferior vena cava. Surgical manoeuvres are considered as triggers of these thrombotic events. After 4 weeks of parenteral anticoagulation a partial recanalization of thrombi was identified, without bleedings.
Conclusions: Acute EPVT needs a carefully management. Case is linked to abdominal surgery and requires prolonged anticoagulation related to simultaneous portal and iliac vein thrombosis. Associated conditions (hypertension and diabetes mellitus) must have an appropriate approach. After our knowledge this is the first case published in literature.