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Sample records for ectopic mediastinal parathyroid

  1. Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue

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    Salman, Rida; Sebaaly, Mikhael G. [American University of Beirut Medical Center, Department of Diagnostic Radiology (Lebanon); Wehbe, Mohammad Rachad; Sfeir, Pierre; Khalife, Mohamad [American University of Beirut Medical Center, Department of General Surgery (Lebanon); Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb [American University of Beirut Medical Center, Department of Diagnostic Radiology (Lebanon)

    2017-06-15

    Ectopic parathyroid is found in 16% of patients with hyperparathyroidism. 2% of ectopic parathyroid adenomas are not accessible to standard cervical excision. In such cases, video-assisted thoracoscopic resection is the recommended definitive treatment. We present a case of mediastinal parathyroid adenoma localized preoperatively by injecting methylene blue within a branch of the internal mammary artery that is supplying the adenoma. Intra-arterial methylene blue injection facilitated visualization and resection of the adenoma. The preoperative intra-arterial infusion of methylene blue appears to be an effective and safe method for localization of ectopic mediastinal parathyroid adenomas and allows rapid identification during thoracoscopic resection.

  2. Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue.

    Science.gov (United States)

    Salman, Rida; Sebaaly, Mikhael G; Wehbe, Mohammad Rachad; Sfeir, Pierre; Khalife, Mohamad; Al-Kutoubi, Aghiad

    2017-06-01

    Ectopic parathyroid is found in 16% of patients with hyperparathyroidism. 2% of ectopic parathyroid adenomas are not accessible to standard cervical excision. In such cases, video-assisted thoracoscopic resection is the recommended definitive treatment. We present a case of mediastinal parathyroid adenoma localized preoperatively by injecting methylene blue within a branch of the internal mammary artery that is supplying the adenoma. Intra-arterial methylene blue injection facilitated visualization and resection of the adenoma. The preoperative intra-arterial infusion of methylene blue appears to be an effective and safe method for localization of ectopic mediastinal parathyroid adenomas and allows rapid identification during thoracoscopic resection.

  3. A Case of Ectopic Parathyroid Adenoma at an Unexpected Location

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    Halil ibrahim Tasci

    2015-03-01

    Full Text Available Ectopic parathyroid tissue can be seen at any location from the mandibula to the mediastinum. The main problem in parathyroid surgery are determination of these ectopic parathyroid tissues' location and their resection. About 1-2% of patients with hyperparathyroidism have a deep mediastinal located parathyroid and transsternal or transthoracic approach should have to be employed most of the time. A 63-year-old female patient, presenting with widespread joint pain and fatigue complaints going on for about a year, was diagnosed with parathyroid adenoma in the mediastinal area as shown by the results of analyses conducted upon the detection of high levels of calcium and parathormone. Accordingly she was taken into surgery with a cervical incision and adenoma in a posterior localization in the carotid artery sheath on the upper mediastinum was seen. The patient, whose calcium, phosphor, and parathormone levels returned to normal levels following the surgery, was discharged with no problems on post-op day 2. Consequently, parathyroid is a tissue whose atypical localization is quite frequent. Nevertheless, atypical localized parathyroid surgeries can be performed by experienced surgeons without having to resort to a secondary procedure with minimally invasive methods with the contribution of localization studies before and/or during the procedure. [Cukurova Med J 2015; 40(Suppl 1: 127-130

  4. Concomitant occurrence of primary hyperparathyroidism (PHPT) due to mediastinal parathyroid adenoma and sublingual thyroid gland: the role of parathyroid technetium-99m-MIBI scintigraphy.

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    Choukry, Sara; Benouhoud, Jaafar; Cherkaoui Salhi, Ghofrane; Taleb, Sara; Guensi, Amal; Choukry, Karim

    2017-11-01

    The concomitant appearance of a sublingual thyroid and primary hyperparathyroidism due to parathyroid mediastinal adenoma is not common. This co-occurrence can lead to a misdiagnosis by morphological imaging methods alone. This case emphasizes the role of 99mTc-MIBI scintigraphy in the detection of parathyroid ectopic adenoma in a patient with an ectopic thyroid gland. This more accurate location of parathyroid scintigraphy is of great benefit to the surgeon for surgical excision.

  5. Adenoma paratiroideo ectópico mediastinal: Diagnóstico por sonda de detección gamma y resección por videotoracoscopia Ectopic mediastinal parathyroid adenoma: Detection with a radioisotopic probe and resolution with videothoracoscopy

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    Daniel Moncet

    2006-10-01

    Full Text Available Presentamos el caso de una mujer de 66 años con diagnóstico de hiperparatiroidismo primario por adenoma paratiroideo ectópico mediastinal realizado por gammagrafía paratiroidea con 99mtc-metoxi-isobutil-isonitrito (Tc99-MIBI. Fue intervenida exitosamente mediante la técnica de videotoracoscopia. Durante el procedimiento se utilizó la medición de parathormona y a los 10 minutos de extirpado el adenoma se obtuvo un descenso mayor del 50% del basal. La sonda de detección gamma no fue efectiva in situ por la superposición del radioisótopo con el miocardio pero confirmó la radioactividad dentro del quirófano una vez extirpado el adenoma. La paciente normalizó los valores de calcemia y parathormona en el postoperatorio y permaneció normocalcémica luego de 9 meses de seguimiento. En nuestro caso, la localización prequirúrgica y el monitoreo de parathormona intraoperatoria fueron de gran utilidad para el éxito quirúrgico, la sonda detectora marcada con Tc99-MIBI no fue efectiva in situ pero confirmó la radioactividad una vez extirpado el adenoma. El tratamiento quirúrgico endoscópico por videotoracoscopia fue bien tolerado, menos doloroso que la toracotomía y acortó el tiempo de internación.We report a 66 years old woman with a diagnosis of primary hyperparathyroidism. Localization to mediastinum was obtained with parathyroid scintigraphy using 99mtc-methoxy-isobutyl-isonitrite (Tc99-MIBI. The patient was successfully operated upon by means of a videothora-coscopic approach. During the procedure serum parathormone was measured before and 10 minutes after adenomectomy, showing a more than 50% reduction from the basal level. An attempt to detect the precise site of the adenoma with a Tc99-MIBI probe was unsuccessful because of its proximity to the myocardium, but radioactivity was confirmed on the surgical specimen after resection. The patient's calcemia and parathormone levels became normal during the postoperative course and she

  6. ectopic parathyroid glands in hyperparathyroidism surgery

    African Journals Online (AJOL)

    Introduction: The ectopic parathyroid is the most common cause of failure of hyperparathyroidism surgery, resulting often in reo- perations. Its preoperative topographic diagnosis remains difficult despite advances in various imaging studies. The intraoperative diagnosis should be guided by a reference strategy of dissection.

  7. Management of mediastinal parathyroid adenoma via minimally invasive thoracoscopic surgery: Case report

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    Saulat Hasnain Fatimi

    2017-01-01

    Conclusion: Symptomatic hypercalcemia and high level of PTH without local PA should alert physicians to search for ectopic locations through imaging. VATS is a safe and effective minimally invasive procedure for the resection of ectopic mediastinal PA and it should be considered as the first line approach for resection of these ectopic tumors.

  8. Ectopic pancreas tissue appearing in a mediastinal cyst

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    Szabados Sandor

    2012-03-01

    Full Text Available Abstract Heterotopia of pancreatic tissue is a common developmental anomaly. Although ectopic pancreatic tissue is mostly found in the gastrointestinal tract, localization in the mediastinum is extremely rare. We report a 32-year-old male patient who had an urgent thoracotomy two years ago due to a thoracic surgery. During the thoracotomy fragments of a partly necrotic cystic mass in the right thorax were removed and decortication was performed. Two years later the patient was hospitalized again because of haemoptoe and atypical chest pain. A residual cystic mass was detected between the right hilum and the ascending aorta connecting to the pericardium, the superior vena cava and the aorta on the chest CT. After the operation a mediastinal cyst was diagnosed, with a pancreatic tissue by histology.

  9. Resection of a large ectopic parathyroid adenoma: A case report

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    Seijiro Sato

    2016-01-01

    Discussion and conclusions: Parathyroid adenomas and parathyroid carcinomas have disparate natural histories, but they can be difficult to differentiate on the basis of preoperative clinical characteristics. We believe that long-term follow-up of these cases is required because there have been few reports on the postoperative natural history of large parathyroid adenomas.

  10. Bilateral cervical ectopic thymic nodules with accessory thyroid tissue and an ectopic parathyroid in the neck region

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    Wea-Lung Lin

    2011-03-01

    Full Text Available Some remnants of thymic tissue may be deposited along the pathway of the descent of the neck during embryologic development of the thymus. Ectopic thymic tissue is usually deposited along the pathway from the mandibular angle to the manubrium of the sternum. Most reported cases of an ectopic thymus occurred in children, and cases are less common in adults. We report a 26-year-old woman, who was incidentally found to have 2 neck nodules on the posterior side of the bilateral upper pole of the thyroid gland while undergoing a subtotal thyroidectomy. The left-side neck nodule showed accessory thyroid follicles intermixed with ectopic thymic tissue, and the right-side neck nodule was ectopic parathyroid tissue together with ectopic thymic tissue.

  11. Mediastinal ectopic benign colloid goitre detected using iodine-131 whole body scintigraphy and single-photon emission computed tomography-computed tomography.

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    Kamaleshwaran, Koramadai Karuppusamy; Rajan, Firoz; Asokumar, Premkumar; Mohanan, Vyshak; Shinto, Ajit Sugunan

    2015-01-01

    Ectopic thyroid tissue primarily occurs along the course of the embryologic migration of the thyroid gland. Mediastinal thyroid may be differentiated into primary and secondary form. Primary mediastinal goiters are quite rare, occurring in <1% of all goiters. We present findings of 29-year-old female, case of papillary carcinoma of the thyroid who underwent iodine-131 whole body scintigraphy after total thyroidectomy showed a primary mediastinal mass lesion along with residual thyroid. She underwent mediastinal mass excision through sternotomy and biopsy confirmed as ectopic nodular colloid goiter with no malignancy.

  12. A rare arterial branch distributing to the thymus, ectopic intrathymic parathyroid, and thyroid glands which passed ventral to the right common carotid artery: a case report.

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    Watanabe, Yuko; Terashima, Toshio; Arakawa, Takamitsu

    2017-06-01

    The intrathymic parathyroid has been reported that this variation might be related with the hyperthyroidism. In this study, the arterial pattern supplying the intrathymic parathyroid was examined in detail in the human cadaver (67-year-old, female, right side). The ectopic parathyroid was only detected on the right side, but not on the left side. This ectopic intrathymic parathyroid was supplied by the supernumerary arterial branch that originated from the inferior thyroid artery and passed ventral to the common carotid artery. This supernumerary branch further divided into two thin branches: (1) the one distributing the intrathymic parathyroid and the right lobe of the thyroid gland and (2) the other descending toward the thoracic cavity to supply the mediastinum organs. Other arteries supplying the thyroid gland and thymus of both sides were normal. In the surgical resection of the ectopic intrathymic parathyroid, physicians should pay attention to arteries ventral to the common carotid artery. This supernumerary branch distributing to the intrathymic parathyroid may be caused by incomplete division into the primordium for the inferior parathyroid and the primordium for the thymus on the developmental process.

  13. Distribution of mediastinal ectopic thymic tissue in patients without thymic disease

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    Behnam Sanei

    2015-01-01

    Conclusion: Because of high incidence of ectopic thymic tissue in mediastinum in patients without thymic disease, we recommend wide excision of thymus gland and all of adipose tissue in patients with myasthenia gravis.

  14. Distribution of mediastinal ectopic thymic tissue in patients without thymic disease.

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    Sanei, Behnam; Tabatabie, Seid Abbas; Bigdelian, Hamid; Hashemi, Seid Mozafar; Davarpanah, Amir Hossein; Jafari, Hamid Reza; Sanei, Mohammad Hossein

    2015-01-01

    Different approaches to treat myasthenia gravis showed variable outcomes probably because of remained ectopic thymic tissue. The aim of this study is to determine incidence of thymic tissue in cases without any thymic disease. Seventy-two patients scheduled for open heart surgery during 2000 and 2007 without thymic disease that were enrolled in the study at Chamran Hospital. Intraoperative biopsies were taken form aortopulmonary window, aortocaval groove and left and right pericardiophrenic regions. Finally, the distribution of ectopic thymic tissue was evaluated in above regions. Thymic tissue was found overall in 70.85% of patients. The most common sites for thymic tissue were left pericardiophrenic (50%) and right pericardiophrenic (31.9%) regions. Frequencies of ectopic thymus in aortopulmonary window and aortocaval groove were 19.4% and 12.5%, respectively. Because of high incidence of ectopic thymic tissue in mediastinum in patients without thymic disease, we recommend wide excision of thymus gland and all of adipose tissue in patients with myasthenia gravis.

  15. Causes of discordant or negative ultrasound of parathyroid glands in treatment naïve patients with primary hyperparathyroidism

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    Chandramohan, Anuradha, E-mail: anuradhachandramohan@gmail.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632004 (India); Sathyakumar, Kirthi, E-mail: kirthi86s@yahoo.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632004 (India); Irodi, Aparna, E-mail: aparnashyam@gmail.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632004 (India); Abraham, Deepak, E-mail: abrahamdt@gmail.com [Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu 632004 (India); Paul, M.J., E-mail: mjpaul@cmcvellore.ac.in [Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu 632004 (India)

    2012-12-15

    Objectives: To describe causes of discordant or negative parathyroid ultrasound and to assess factors influencing them. Materials and methods: Retrospective review of patients who underwent parathyroidectomy between 2000 and 2012 was done. Imaging findings were compared with operative findings and pathology to identify discrepant (n = 60; 32 negative, 28 incorrect) parathyroid ultrasounds. Results: Fifty (83.3%) patients had parathyroid adenoma, of which 10 (16.6%) were ectopic and three were double adenomas; 8 (13.3%) had multigland hyperplasia and two had parathyroid carcinoma. Discrepant reports were due to incorrect localisation in 8 (13.3%); difficulty in differentiating thyroid from parathyroid lesion in 12 (20%); large and small size in two and three patients, respectively; overcall in 5 (8.3%) and satisfaction of search in 7 (11.7%) patients. There was significant correlation between presence of multi-nodular goitre and incorrect reports (χ{sup 2} = 4.112, p = 0.04). Experience of ultrasound operators performing initial and second look ultrasound was significantly different (p < 0.0001). Second look ultrasound was concordant with surgical findings in 39(65%) patients; 21 (66%) patients with initially negative ultrasound and four out of five extra-mediastinal ectopic lesions. Ten patients with negative initial ultrasound had elongated parathyroid lesion. Scintigraphy was concordant in 44 (73.3%) patients and nine were ectopic. Conclusion: Second look ultrasound performed by experienced operator for negative or discordant initial ultrasound of parathyroid is a useful strategy which will improve the accuracy of parathyroid ultrasound. Being able to differentiate thyroid from parathyroid lesion is a factor which will influence performance of parathyroid ultrasound.

  16. Functional metastatic parathyroid adenocarcinoma in a dog

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    Kishi, Erin N.; Holmes, Shannon P.; Abbott, Jeffrey R.; Bacon, Nicholas J.

    2014-01-01

    A 12-year-old dachshund dog was presented for persistent hypercalcemia and hyperparathyroidism despite bilateral parathyroidectomy. Magnetic resonance imaging of the head, neck, and cranial mediastinum identified an increased number of cranial mediastinal lymph nodes with heterogeneous signal intensity. Hypercalcemia and hyperparathyroidism resolved after surgery to remove multiple cranial mediastinal lymph nodes, one of which contained presumed metastatic parathyroid tissue.

  17. Surgical treatment of persistent tertiary hyperparathyroidism induced by parathyroid adenomas in the aortopulmonary window

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    Elena Alekseevna Ilyicheva

    2014-09-01

    Full Text Available Background. Aortopulmonary window is a rare localization of ectopic parathyroid glands. This localization is the difficulty in diagnosis and surgical treatment, especially in conditions of the heavy somatic pathology that develops with prolonged of kidney replacement therapy. Persistence of tertiary hyperparathyroidism after cervical revision does not give in medical treatment, accompanied by the progression of bone and systemic symptoms of the disease, including death.Materials and Methods. Illustrates a case successful diagnosis and surgical treatment this rare disease. We discuss the treatment and diagnostic tactics. Female patient (age 66 had the experience of peritoneal dialysis for 6 years. She underwent cervical parathyroidectomy. Ectopic mediastinal paratiroma detected by gamma scintigraphy (from 99mTc-MIBI. Determination of the exact tumor location proved to be impossible before the surgery due to bad mental condition of the patient. Localization of adenomas was defined on the surgery after a sternotomy. Results. Operation efficiency proved decrease parathyroid hormone from 2095 pg / ml (before operation to 10 pg / ml (1.5 months after surgery. After surgery, there was a mediastinal hematoma. The patient was discharged 21 days after surgery healed by.Conclusions. The use a sternotomy leads to the removal of the tumor. This access may be used when an unknown location. This access is a forced for tertiary hyperparathyroidism.

  18. Mediastinal tumor

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    ... contains the heart, large blood vessels, windpipe (trachea), thymus gland, esophagus, and connective tissues. The mediastinum is divided into 3 sections: Anterior (front) Middle Posterior (back) Mediastinal ... Cancer Read more A.D.A.M., Inc. ...

  19. Sensitive detection of a small parathyroid adenoma using fluorocholine PET/CT: A case report

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    Padinhare-Keloth, Thanseer N. T. K.; Bhadada, Sanjay K.; Sood, Ashwani; Kumar, Rajender; Behera, Arunanshu; Radotra, Bishan D.; Mittal, Bhagwant R. [PGIMER, Chandigarh (India)

    2017-06-15

    Primary hyperparathyroidism is caused by parathyroid adenoma in the majority of cases and diagnosis is usually made biochemically. Pre-surgical localization of parathyroid adenoma is essential to limit the extent of surgery and avoid missing them at ectopic sites. Anatomical and functional imaging are used for the localization, but may fail to identify the small and ectopic parathyroid adenoma. We present a case of small sized ectopic parathyroid adenoma at unusual location detected by F-18 fluorocholine (FCH) PET/CT, where other imaging modalities failed. The post-operative histopathology confirmed the diagnosis of ectopic parathyroid adenoma.

  20. Mediastinal parathyroidectomy with the da Vinci robot.

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    Van Dessel, Els; Hendriks, Jeroen M H; Lauwers, Patrick; Ysebaert, Dirk; Ruyssers, Natacha; Van Schil, Paul E Y

    2011-07-01

    Mediastinal parathyroid glands are often located in a position which is inaccessible through a cervical approach. Because of the significant morbidity of open surgery, the need for minimal invasive approaches is high. More recently, robotic systems have been introduced to refine the dissection and optimize the view in the mediastinal region. We present two cases. The first case is a 34-year-old woman who was diagnosed with primary hyperparathyroidism. Because a bilateral neck dissection disclosed no parathyroid adenoma, we performed a parathyroid sestamibi scan and computed tomographic scan of neck and mediastinum to look for aberrant parathyroid glands. Both showed a parathyroid adenoma in the mediastinum on the left side. The second case is a 66-year-old man. A sestamibi scan showed a parathyroid adenoma of 3 cm in the superior mediastinum which was confirmed by and computed tomographic scan. In both cases, we performed a parathyroidectomy with the da Vinci robotic system through a left-sided approach. Three thoracoports were inserted around the mammary gland for the robot and a fourth auxiliary port was positioned in between. Single-lung ventilation was installed, and the mediastinum was entered by opening the parietal pleura along the left phrenic nerve. The upper margin for dissection was the left brachiocephalic vein that was followed until the right pleura. All the tissue in front of the pericardium was dissected en bloc. The sinking test of the nodule and a preoperative frozen section analysis confirmed the diagnosis of parathyroid adenoma, which was also proven by rapid parathyroid hormone analysis. The resection of a parathyroid adenoma from the aortopulmonary window represents an ideal case for robotic surgery.

  1. PARATHYROID CANCER OCCURRING IN RELAPSING SECONDARY HYPERPARATHYROIDISM

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    I. V. Kotova

    2016-01-01

    Full Text Available We present a clinical case of parathyroid cancer in a patient with relapsing secondary hyperparathyroidism at 4 years after subtotal parathyroidectomy. Its unique character is related to the combination of relapsing secondary hyperparathyroidism, parathyromatosis, ectopic of an adenomatous hyperplastic parathyroid gland into the thyroid gland, and parathyroid cancer. Several most complicated aspects of parathyroid surgery are disclosed, such as the choice of strategy for surgical intervention in secondary hyperparathyroidism, complexity of morphological and cytological diagnostics of this disorder.

  2. A Novel Mediastinal Drainage Tube for Mediastinitis

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    Jun Ho Yhang

    2015-10-01

    Full Text Available Mediastinitis is a life-threatening disease, and effective drainage is needed to treat mediastinitis with abscess formation. We recommend an alternative drainage method using chest tube binding with a Silastic Penrose drainage tube. The use of a Silastic Penrose drainage tube may help to manage mediastinitis with abscess formation. This method facilitates effective draining and prevents tissue adhesion.

  3. evaluation of mediastinal masses

    African Journals Online (AJOL)

    mediastinal masses were the most common (63.8%) fol- lowed by posterior mediastinal masses (22.9%). Middle mediastinal masses made up the remaining (13.3%). The most common primary mediastinal tumour was lymphoma. (21.9%) next to which were thymus gland neoplasia and thymus cysts/hyperplasia (18.1 %).

  4. The Essentials of Parathyroid Hormone Venous Sampling

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    Taslakian, Bedros, E-mail: btaslakian@gmail.com [NYU Langone Medical Center, Department of Radiology, NYU School of Medicine (United States); Trerotola, Scott O., E-mail: streroto@uphs.upenn.edu [Perelman School of Medicine of the University of Pennsylvania, Department of Radiology (United States); Sacks, Barry, E-mail: bsacks@bidmc.harvard.edu [Beth Israel Deaconess Medical Center, Department of Interventional Radiology (United States); Oklu, Rahmi, E-mail: oklu.rahmi@mayo.edu [Mayo Clinic, Department of Interventional Radiology (United States); Deipolyi, Amy, E-mail: deipolya@mskcc.org [Memorial Sloan Kettering Cancer Center, Department of Radiology (United States)

    2017-01-15

    Hyperparathyroidism is an excess of parathyroid hormone in the blood due to over-activity of one or more parathyroid gland. Localization of abnormal glands with noninvasive imaging modalities, such as technetium sestamibi scan and cross-sectional imaging, has a high success rate. Parathyroid venous sampling is performed for patients with persistent or recurrent disease after previous parathyroid surgery, when repeat noninvasive imaging studies are negative or discordant. The success of invasive localization studies and results interpretation is dependent on the interventional radiologist’s understanding of the normal and ectopic anatomic locations of parathyroid glands, as well as their blood supply and venous drainage. Anatomic and technical considerations for selective parathyroid venous sampling are reviewed.

  5. Interest of scintigraphic imaging in Madagascar for the diagnosis of ectopic parathyroid adenoma, about one case; Interet de l'imagerie scintigraphique, a Madagascar, dans le diagnostic de l'adenome parathyroidien ectopique - a propos d'un cas

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    Andriantsoa, J.; Andriamanalina, T.; Ramamonjy, A.; Ranivontsoarivony, M. [Universite d' Antananarivo, Service de Medecine Nucleaire, Antananarivo(Madagascar); Ramahandridona, G. [CHU d' Antananarivo, Service d' Endocrinologie, Antananarivo (Madagascar); Razafindramboa, H. [Polyclinique d' Ilafy, Service de chirurgie, Antananarivo (Madagascar); Gizy Ratiambahoaka, D. [CHU d' Antananarivo, Service d' Anatomopathologie, Antananarivo (Madagascar)

    2008-11-15

    This study reports the first case of ectopic parathyroid adenoma, diagnosed in the Department of Nuclear Medicine in Antananarivo. This clinical vignette illustrates the interest of the MIBI-Tc-99 m scan in locating this adenoma and its diagnostic confirmation after six years of erratic diagnosis. A whole body bone scintigraphy has also allowed to assess the state of bone metabolism and study outbreaks of fracture. The parathyroid scintigraphy was carried out after intra-venous administration of 666 MBq of MIBI-{sup 99m}Tc. Dynamic images, static early and late static were acquired with a gamma camera E-Cam Siemens. The whole body bone scan was carried out after administration of 555 MBq of M.D.P.-Tc-99 m. The results evidenced the presence of an para-aortic increased uptake area pointing to a left parathyroid adenoma. The persistence of a late left sub maxillary increased uptake area raises, however, a reservation about the existence of a second adenoma. The bone scan displayed global skeletal remodeling, non suggestive of metastases, as it was mentioned with the CT-scan. In a diagnostic tools limited environment, skeletal pain refractory to pain-killers, a chronic hypercalcemia associated with an increased parathyroid hormone level, should trigger the scintigraphic exploration in order to avoid bone and renal complications.

  6. Primary mediastinal goiters.

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    Oueriachi, Fayçal El; Hammoumi, Mohamed Massine El; Arsalane, Adil; Slaoui, Omar; Diouri, Hicham; Kabiri, El Hassane

    2014-01-01

    Primary mediastinal goiters (PMG) are very uncommon; few cases were reported in the literature. We report here two cases of mediastinal goiters that met all criteria of PMG. Transternal approach was necessary for complete removal and pathological diagnoses confirmed their adenomatous goiter nature. The rarity of their occurrence, their clinical characteristics and surgical management were discussed. PMG is part of the differential diagnoses of mediastinal masses. Safe excision is ensured through transthoracic approach.

  7. Parathyroid carcinoma

    DEFF Research Database (Denmark)

    Qvist, N; Krøll, L; Ladefoged, C

    1986-01-01

    Parathyroid carcinoma is a slow growing tumor, and the patients most often die from complications to the hypercalcemia. Therefore, any attempt should be made to remove local recurrence and metastasis surgically, as medical treatment is disappointing. A case treated with extensive vascular surgery...

  8. Clinical Features and Treatment Outcomes of 41 Dogs with Sublingual Ectopic Thyroid Neoplasia

    National Research Council Canada - National Science Library

    Broome, M.R; Peterson, M.E; Walker, J.R

    2014-01-01

    ... cervical location results in ectopic cranial mediastinal, heart base thyroid tissue, or both. Thyroid tumors in dogs are relatively common, representing approximately 1–3% of all neoplasia in the dog. Tumors arising from ectopic thyroid tissue are considered relatively rare, but such ectopic thyroid neoplasia has been documented in ...

  9. Ectopic Pregnancy

    Science.gov (United States)

    ... woman is pregnant. If you have an ectopic pregnancy, the fertilized egg grows in the wrong place, ... tubes. The result is usually a miscarriage. Ectopic pregnancy can be a medical emergency if it ruptures. ...

  10. Ectopic pregnancy.

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    Zorn, J R; Risquez, F; Cedard, L

    1992-04-01

    During the last two decades, the incidence of ectopic pregnancy was shown to be rising. At the same time, ectopic pregnancy became less lethal due to improvements in diagnostic procedures, which are now able to confirm the ectopic implantation before the occurrence of life-threatening hemorrhagic complications. Earlier diagnosis has also offered the possibility of conservative surgical and medical treatments.

  11. Mediastinal teratoma and trichoptysis.

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    Guibert, Nicolas; Attias, David; Pontier, Sandrine; Berjaud, Jean; Lavialle-Guillautreau, Virginie; Didier, Alain

    2011-07-01

    We report the case of a 22-year-old woman suffering from mature mediastinal teratoma, revealed by trichoptysis, which is an exceptional, but pathognomonic symptom of intrathoracic teratomas. Only eight cases of trichoptysis are reported, none of them involved a mediastinal localization. We present the endoscopic and radiologic presentation, its surgical management, and histologic particularities. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Retropharyngeal thymus and parathyroid gland: a case report.

    Science.gov (United States)

    Schramm, Jordan C; Perry, Deborah A; Sewell, Ryan K

    2014-01-01

    Cervical ectopic thymus occurs when thymic tissue arrests during its embryologic descent through the neck to the upper mediastinum. Most often it presents as an asymptomatic neck mass. Rarely does it present with airway compromise, particularly in neonates. A neonate presented with a retropharyngeal mass causing dynamic upper airway obstruction, mimicking a venolymphatic malformation. Ultimately this proved to be aberrant ectopic thymus with an associated parathyroid gland. While there have been isolated reports of thymus or parathyroid in the retropharyngeal space, none of the prior reports found both within the same patient. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  13. Cranial mediastinal carcinomas in nine dogs.

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    Liptak, J M; Kamstock, D A; Dernell, W S; Ehrhart, E J; Rizzo, S A; Withrow, S J

    2008-03-01

    Nine dogs were diagnosed with cranial mediastinal carcinomas. Based on histological and immunohistochemical analysis, four dogs were diagnosed with ectopic follicular cell thyroid carcinomas, one dog with ectopic medullary cell thyroid carcinoma, two dogs with neuroendocrine carcinomas and two dogs with anaplastic carcinomas. Clinical signs and physical examination findings were associated with a space-occupying mass, although one dog was diagnosed with functional hyperthyroidism. Surgical resection was attempted in eight dogs. The cranial mediastinal mass was invasive either into the heart or into the cranial vena cava in three dogs. Resection was complete in six dogs and unresectable in two dogs. All dogs survived surgery, but four dogs developed pulmonary thromboembolism and two dogs died of respiratory complications postoperatively. Adjunctive therapies included pre-operative radiation therapy (n=1) and postoperative chemotherapy (n=3). Three dogs had metastasis at the time of diagnosis, but none developed metastasis following surgery. The overall median survival time was 243 days. Local invasion, pleural effusion and metastasis did not have a negative impact on survival time in this small case series.

  14. Steroid induced huge mediastinal lipomatosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jang Min; Chung, Suk Tae; Kang, Eun Young; Suh, Won Hyuck [Korea University College of Medicine, Seoul (Korea, Republic of)

    1990-04-15

    Mediastinal lipomatosis induced by steroid is an unusual byproduct of such therapy and has been reported after prolonged and large doses of steroid therapy. The radiologic findings of mediastinal lipomatosis in simple chest film are nonspecific, but with the advent of CT scan, differentiation the fatty lesion from other mediastinal decreases can be made easily. Recently we expended steroid induced huge mediastinal lipomatosis and report the case with review including radiologic findings.

  15. [Isolated mediastinal cystic lymphangioma].

    Science.gov (United States)

    Melo, Iury Andrade; Camargo, José de Jesus Peixoto; Gomes, Bruno de Moraes; Cabrera, Giovana Abero; Machuca, Tiago Noguchi

    2009-01-01

    A 59 years old female patient, asymptomatic, with the incidental finding of an ovarian tumor in her routine gynecological evaluation, and during the preoperative examinations it was incidentally found an isolated mediastinal tumor, and then routed to diagnostic evaluation of the lesion, which later proved to be a cystic lymphangioma. The cystic hygroma of the mediastinum is a benign tumor and very infrequent, representing only 0.7 to 4.5% of all mediastinal tumors, and of these, only 1% is exclusively mediastinal in location. The definitive diagnosis is only possible by pathological examination, and the recommended treatment consists of complete surgical resection. Cases are described in isolated reports or series with few patients, and their readiness or synchronicity with other tumors, unknown, and to the best of out knowledge, not reported yet.

  16. Mediastinitis after cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Noedir A. G. Stolf

    2000-05-01

    Full Text Available OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6% of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years and 10 (83.3% patients were males. Seven (58.3% patients showed sternal stability on palpation, 4 (33.3% patients had pleural empyema, and 2 (16.7% patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7% patients. Staphylococcus epidermidis was identified in 2 (16.7% patients, Enterococcus faecalis in 1 (8.3% patient, and the cause of mediastinitis could not be determined in 1 (8.3% patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7% patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3% patient. Out of this series, 5 (41.7% patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3% patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

  17. Spontaneous Atraumatic Mediastinal Hemorrhage

    Directory of Open Access Journals (Sweden)

    Morkos Iskander BSc, BMBS, MRCS, PGCertMedEd

    2013-04-01

    Full Text Available Spontaneous atraumatic mediastinal hematomas are rare. We present a case of a previously fit and well middle-aged lady who presented with acute breathlessness and an increasing neck swelling and spontaneous neck bruising. On plain chest radiograph, widening of the mediastinum was noted. The bruising was later confirmed to be secondary to mediastinal hematoma. This life-threatening diagnostic conundrum was managed conservatively with a multidisciplinary team approach involving upper gastrointestinal and thoracic surgeons, gastroenterologists, radiologists, intensivists, and hematologists along with a variety of diagnostic modalities. A review of literature is also presented to help surgeons manage such challenging and complicated cases.

  18. Primary mediastinal atypical meningioma: Report of a case and literature review

    Directory of Open Access Journals (Sweden)

    Mogi Akira

    2012-01-01

    Full Text Available Abstract Meningiomas are common neoplasms arising from the central nervous system meninges. On the other hand, primary ectopic meningiomas are extremely rare and usually limited to the head and neck region or to the paravertebral soft tissues. Their occurrence in the mediastinum is even rarer. Until now, only 4 cases of primary mediastinal meningioma have been reported in the literature searched on Medline. Because of its rarity and intriguing pathogenesis, we report here a case of primary mediastinal meningioma that was treated by surgical resection. The clinical features, treatment, pathological findings, and prognosis are analyzed, and the literature on ectopic meningioma is reviewed.

  19. Primary Mediastinal Liposarcoma

    African Journals Online (AJOL)

    MDM2 positive, confirming a well-differentiated liposarcoma grade 1 (according FNLCC). The immediate post-operative period was marked by an infection of the surgical site without mediastinitis. This was managed locally and with antibiotics. Adjuvant radiotherapy is ongoing. Written informed consent was obtained from ...

  20. Cervical carcinoma and ectopic hyperparathyroidism.

    Science.gov (United States)

    Hoeg, J M; Slatopolsky, E

    1980-04-01

    Profound hypercalcemia can impose both diagnostic and therapeutic difficulties. First, profound hypercalcemia can be life-threatening as well as difficult to control. Second, the use of mithramycin in the treatment of severe hypercalcemia is emphasized. Third, hypercalcemia of hyperparathyroidism cannot be absolutely distinguished from that of malignancy. In the present case, the tubular reabsorption of phosphate, serum calcium levels, and measurement of immunoreactive parathyroid hormone (iPTH) suggested primary hyperparathyroidism, yet ectopic iPTH from a cervical carcinoma was the probable cause of the hypercalcemia.

  1. An Infected Mediastinal Cyst

    Directory of Open Access Journals (Sweden)

    Lindsay M Lawson

    2000-01-01

    Full Text Available The authors describe a 43-year-old patient who had a mediastinal mass that became infected after a transbronchial needle aspirate biopsy. A paraspinal, extrapleural window with a saline-lidocaine mixture was created that allowed the placement of a percutaneous drainage catheter into the infected lesion. This procedure resulted in an excellent clinical outcome, and obviated the need for a thoracotomy and more invasive surgical management.

  2. Ectopic Pregnancy

    Science.gov (United States)

    ... see if there are early signs of a pregnancy. Test your blood to detect the hormone human chorionic ... is produced when a woman is pregnant. The test may be repeated to check the levels of hCG. What treatment is available for ectopic pregnancy? There are two methods used to treat an ...

  3. Cryopreservation of Parathyroid Glands

    Directory of Open Access Journals (Sweden)

    Marlon A. Guerrero

    2010-01-01

    Full Text Available The risk of permanent hypoparathyroidism following thyroid and parathyroid surgery is around 1% in the hands of experienced endocrine surgeons. Although this complication is rare, rendering a patient permanently aparathyroid has significant consequences on the health and quality of life of the patient. Immediate autotransplantation of parathyroid glands that are injured or unintentionally removed offers the best possibility of graft viability and functionality. However, since the majority of cases of hypoparathyroidism are transient, immediate autotransplantation can complicate postoperative surveillance in certain patients, especially those with primary hyperparathyroidism. Cryopreservation of parathyroid tissue is an alternate technique that was developed to treat patients with permanent hypoparathyroidism. This method allows for parathyroid tissue to be stored and then autotransplanted in a delayed fashion once permanent hypoparathyroidism is confirmed. This article provides a contemporary review on cryopreservation of parathyroid tissue and its current role in thyroid and parathyroid surgery.

  4. Medullary Thyroid Carcinoma with Ectopic Adrenocorticotropic Hormone Syndrome

    Directory of Open Access Journals (Sweden)

    Hong Seok Choi

    2014-03-01

    Full Text Available Ectopic adrenocorticotropic hormone (ACTH syndrome is caused most frequently by a bronchial carcinoid tumor or by small cell lung cancer. Medullary thyroid carcinoma (MTC is a rare etiology of ectopic ACTH syndrome. We describe a case of Cushing syndrome due to ectopic ACTH production from MTC in a 48-year-old male. He was diagnosed with MTC 14 years ago and underwent total thyroidectomy, cervical lymph node dissection and a series of metastasectomies. MTC was confirmed by the pathological examination of the thyroid and metastatic mediastinal lymph node tissues. Two years after his last surgery, he developed Cushingoid features, such as moon face and central obesity, accompanied by uncontrolled hypertension and new-onset diabetes. The laboratory results were compatible with ectopic ACTH syndrome. A bilateral adrenalectomy improved the clinical and laboratory findings that were associated with Cushing syndrome. This is the first confirmed case of ectopic ACTH syndrome caused by MTC in Korea.

  5. About the Parathyroid Glands

    Science.gov (United States)

    ... Glands Parathyroid conditions Treatment The body has four parathyroid glands that are located just behind the thyroid gland (which is the center of the neck at the front). They have nothing to do with the function of the thyroid. (PARA is derived from a ...

  6. Parathyroid Hormone Injection

    Science.gov (United States)

    ... have any questions about how to inject this medication.Parathyroid hormone injection comes in a cartridge to be mixed in ... and vitamin D while you are taking this medication.Parathyroid hormone injection controls hypoparathyroidism but does not cure it. Continue ...

  7. Ectopic Kidney

    Directory of Open Access Journals (Sweden)

    John Costumbrado

    2017-07-01

    Full Text Available History of present illness: A 50-year-old male with no past medical history presented to the emergency department with a chief complaint of right flank pain after stretching. His vital signs were within normal limits and physical exam was significant for tenderness to palpation over the right lateral chest wall. Chest X-ray was unremarkable. Due to the patient’s uncertainty of the exact mechanism of injury, additional trauma could not be ruled out and a bedside focused assessment with sonography in trauma (FAST scan was performed, which was negative for free fluid, but notable for an absence of a right kidney. The patient was sent for a computed tomography (CT abdomen/pelvis to evaluate the etiology of symptoms and to address the absence of visualized kidney on ultrasound. Significant findings: CT of the abdomen and pelvis revealed a normal left kidney and an ectopic, malrotated right kidney located in the pelvis (see white arrow. Discussion: Renal ectopia is described as a malposition of the kidney, due to faulty migration from the fetal pelvis during early embryonic development. Evidence suggests an incidence ranging from 1:900 to 1:12,000.1-3 While most cases are asymptomatic and do not require intervention, complications include vesicoureteral reflux, urinary tract infections, hydronephrosis, and renal calculi.4,5 Ultrasonography is indicated for the evaluation of free fluid in the abdomen and pelvis in the setting of trauma. In this case, the right upper quadrant ultrasound was negative for both free fluid and a right kidney, even with appropriate repositioning techniques.7 The absence of the right kidney on ultrasound in the setting of pain prompted the decision for further diagnostic imaging, which revealed an ectopic right kidney. The absence of a kidney on FAST exam should prompt the clinician to consider surgical (eg, nephrectomy or congenital (eg, renal ectopy explanations. Furthermore, pathophysiologic processes (eg, pyelonephritis

  8. Parathyroid transplantation in thyroid surgery

    Science.gov (United States)

    Gołkowski, Filip; Nawrot, Ireneusz

    2017-01-01

    Permanent hypoparathyroidism following thyroid surgery is rare. Its prevalence is reported to be below 1–2% if surgery is performed by experienced thyroid surgeons. Parathyroid identification and preservation in situ with good vascular supply is the mainstay of safe thyroid surgery. However, if the parathyroid glands are damaged, autotransplantation should be undertaken to preserve their function. Parathyroid transplantation can be considered in three distinct modes of application: (I) fresh parathyroid tissue autotransplantation during thyroidectomy in order to reduce the risk of permanent hypoparathyroidism; (II) cryopreserved parathyroid tissue autotransplantation in patients with permanent hypoparathyroidism; (III) parathyroid allotransplantation in patients with permanent hypoparathyroidism when cryopreserved parathyroid tissue is not available for grafting. Nowadays, allotransplantation of cultured parathyroid cells without immunosuppression should be taken into consideration in selected patients as an alternative to calcium and vitamin D3 supplementation in management of permanent hypoparathyroidism. This paper is aimed to provide a review of current status of various parathyroid transplantation techniques in thyroid surgery. PMID:29142845

  9. Ectopic pregnancy (image)

    Science.gov (United States)

    An ectopic pregnancy is one in which the fertilized egg implants in tissue outside of the uterus and the placenta ... common site is within a Fallopian tube, however, ectopic pregnancies can occur in the ovary, the abdomen, and ...

  10. Parathyroid scintigraphy findings in chronic kidney disease patients with recurrent hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Hindie, Elif [Universite Paris 7, Nuclear Medicine, Hopital Saint Louis, Paris (France); Hopital Saint-Louis, Service de Medecine Nucleaire, Paris (France); Zanotti-Fregonara, Paolo; Keller, Isabelle [Universite Paris VI, Nuclear Medicine, Hopital Saint Antoine, Paris (France); Just, Pierre-Alexandre; Toubert, Marie-Elisabeth; Moretti, Jean-Luc [Universite Paris 7, Nuclear Medicine, Hopital Saint Louis, Paris (France); Sarfati, Emile [Universite Paris 7, Endocrine Surgery, Hopital Saint Louis, Paris (France); Melliere, Didier [Universite Paris XII, Endocrine Surgery, Hopital Henri Mondor, Creteil (France); Jeanguillaume, Christian [Universite d' Angers, Centre Paul Papin, Angers (France); Urena-Torres, Pablo [Clinique du Landy, Service de Nephrologie-Dialyse, Saint Ouen (France)

    2010-03-15

    Parathyroidectomy (PTX), either subtotal or total with forearm autografting, is a well-established treatment for refractory renal hyperparathyroidism (RHPT). However, 20-30% of patients develop persistent or recurrent disease. Obtaining accurate localization before reoperation is difficult. The study group comprised 21 consecutive adult patients (18 undergoing haemodialysis and 3 with a renal graft) imaged using {sup 99m}Tc-sestamibi/{sup 123}I subtraction scintigraphy. Of the 21 patients, 12 had undergone one previous PTX and the other 9 between two and four parathyroid operations. All patients had symptoms and signs of severe RHPT. The mean serum PTH level was 1,142 pg/ml. {sup 99m}Tc-Sestamibi and {sup 123}I images were recorded simultaneously. Imaging views comprised a planar view of the neck and mediastinum, followed by a magnified pinhole view over the thyroid bed area. If parathyroid ectopy was detected, SPECT or SPECT-CT was performed. The forearm was imaged in case of autograft. Parathyroid scintigraphy was negative in one patient and positive in the other 20 (sensitivity 95.2%). One patient had uptake corresponding to two unresected parathyroid glands. Recurrence at the site of the partially resected gland or autograft was seen in 11 patients. However, six of them had a second {sup 99m}Tc-sestamibi focus corresponding to a supernumerary parathyroid gland. Seven other patients had a supernumerary parathyroid gland as the sole cause of relapse. Three of the supernumerary glands showed major ectopy (intrathyroidal, low mediastinal, undescended within the vagus nerve). One patient had parathyromatosis with multiple parathyroid nodules scattered over the left side of the neck. Reoperation was possible in 13 patients, with no false-positive findings. Many patients referred with the hypothesis of hyperplasia of a subtotally resected parathyroid gland or autograft were found to harbour a supernumerary parathyroid gland missed at the initial surgery. (orig.)

  11. Scintigraphy of parathyroids in secondary hyperparathyroidism; Scintigraphie des parathyroides dans l`hyperparathyroidie secondaire

    Energy Technology Data Exchange (ETDEWEB)

    Hublo, D.; Beauchat, V.; Pattou, F.; Lecomte-Houcke, M.; Prangere, T.; Ziegels, P.; Carnaille, B.; Proye, C.; Marchandise, X.; Steiling, M. [Medecine Nucleaire, Chirurgie Endocrinienne et Anatomie et Cytologie Pathologiques - CHU de Lille - 59037 Lille cedex (France)

    1997-12-31

    Use of pre-surgery imaging of parathyroids is still questioned. The goal of this study is to evaluate the sensitivity of the scintigraphy in the detection of secondary parathyroid anomalies with renal insufficiency. Thirty two patients (20 F, 12 M) of 14 - 74 years old were operated of secondary hyperparathyroidism with renal insufficiency. It was a matter of re-intervention in 9 cases. The acquisitions were achieved 20 min and 2 h after injection of 550 MBq of MIBI-{sup 99m}Tc or of Tetrofosmine - {sup 99m}Tc and 2 h after injection of 5.5 MBq of iodine 123. Eighty seven glands of 28 to 3820 mg were pulled out in 23 first surgeries while the parathyroid tissue was found in thymic prolongations in 5 of these patients. The masses of 41 glands, positive by scintigraphy (from 69 to 3829 mg), were significantly higher (Wilcoxon`s test, p < 10{sup -8}) than the 46 not-seen (from 28 to 1050 mg). The sensitivity of total detection is 47%, of 85% for the 33 glands of 500 mg or more and of 24% for the 54 glands of less than 500 mg. In 9 re-interventions, 12 abnormal glands were pulled out: 11 of 430 to 4500 mg were positive by scintigraphy, while only one gland of 80 mg was not seen. In conclusion, the scintigraphy realised before first surgery for secondary hyperparathyroidism with renal insufficiency presents low sensitivity, related partly, at least, to the low mass of glands and justifies itself only by search for positive ectopic parathyroids. Instead, it appears performing and indispensable in case of re-intervention

  12. [Tissue engineering of parathyroid gland].

    Science.gov (United States)

    Iovino, F; Armano, G; Auriemma, P P; Sergio, R; De Sena, G; Capuozzo, V; Rosso, F; Marino, G; Papale, F; Grimaldi, A; Barbarisi, A

    2010-01-01

    The postoperative hypoparathyroidism is a not rare complication after total thyroidectomy and/or total parathyroidectomy. Attempts to transplant parathyroid tissue began in 1975 with the work of Wells, but still today results are disappointing. However, with the development of tissue engineering techniques, some experimental approaches to build artificial parathyroid are been made. Bioengineered device, actively secreting PTH, for transplant in patients with iatrogenic hypoparathyroidism is unavailable. Parathyroid cells were obtained from three chronic uremic patients in hemodialysis, operated for secondary hyperparathyroidism. Cell cultures in RPMI medium were subsequently seeded on collagen scaffold (three-dimensional matrix with slow biodegradation). Collagen is the major component of the extracellular matrix and thus is a good substrate for cell adhesion and growth. Culture media, with a low calcium concentration, were optimised to physiologically stimulate parathyroid hormone secretion. Cell cultures were morphologically observed in optical and electron (ESEM) microscopy and metabolically assayed by MTT method until the tenth week. Besides, concentration of parathyroid hormone in the culture medium has been measured for several weeks. After 24 hours of culture in RPMI, cells extracted from human parathyroid glands were nearly all adherent and organised in clusters to resemble the glandular organization. The cellular population consisted predominantly of parathyroid cells (90-95%). On collagen scaffolds, cells maintains an epithelial-like morphology also after 10 weeks, colonizing the scaffold surface and keeping a good proliferative rate with a discrete production of parathyroid hormone. The use of parathyroid cells extracted from patients with secondary hyperparathyroidism was certainly an appropriate choice that enabled us to achieve these results, that albeit partial bode well for the experimental in vivo animal model. The bioengineered scaffolds when

  13. Parathyroid transplantation in thyroid surgery

    OpenAIRE

    Barczyński, Marcin; Gołkowski, Filip; Nawrot, Ireneusz

    2017-01-01

    Permanent hypoparathyroidism following thyroid surgery is rare. Its prevalence is reported to be below 1–2% if surgery is performed by experienced thyroid surgeons. Parathyroid identification and preservation in situ with good vascular supply is the mainstay of safe thyroid surgery. However, if the parathyroid glands are damaged, autotransplantation should be undertaken to preserve their function. Parathyroid transplantation can be considered in three distinct modes of application: (I) fresh ...

  14. Parathyroid scintigraphy during hypocalcaemia in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Øgard, Christina G; Vestergaard, Henrik; Thomsen, Jørn Bo

    2005-01-01

    Minimally invasive parathyroid surgery in patients with primary hyperparathyroidism (PHPT) demands high imaging accuracy. By increasing blood flow to the parathyroid adenoma before injection of a perfusion marker, we intended to improve the parathyroid scintigraphy. We have named the technique...

  15. The history of parathyroid endocrinology

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra

    2013-01-01

    Full Text Available The parathyroid glands are now recognized as being essential for life. Their structure and function is well delineated, and their disease and dysfunction, well characterized. Diagnosis and management of parathyroid disease has improved in the past few decades. The path of parathyroid science, however, has been far from smooth. This paper describes the early history of parathyroid endocrinology. In doing so, it focuses on major events and discoveries, which improved the understanding and practice of our specialty. Contribution in anatomy, physiology, pathology, medicine, surgery and biochemistry are reviewed.

  16. Parathyroid carcinoma in tertiary hyperparathyroidism.

    Science.gov (United States)

    Kim, Byung Seup; Ryu, Han Suk; Kang, Kyung Ho; Park, Sung Jun

    2016-10-01

    Parathyroid carcinoma is a rare disease of unknown etiology. This study presents a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Despite a successful kidney transplantation, the intact parathyroid hormone (iPTH) level of the patient was elevated consistently and could not be controlled by medical therapy. Due to the development of tertiary hyperparathyroidism with bone pain and osteoporosis, subtotal parathyroidectomy was performed 4 months after the kidney transplantation. Histological evaluation revealed that one of four parathyroid lesions was a parathyroid carcinoma, while the others were diffuse hyperplasia. Postoperative laboratory studies indicated a decreased level of iPTH. A positron emission tomography-computed tomography performed 6 months after the operation revealed no evidence of local recurrence or distant metastasis. Copyright © 2013. Published by Elsevier Taiwan.

  17. Broad ligament ectopic pregnancy

    OpenAIRE

    Rama C; Lepakshi G; Raju SN

    2015-01-01

    Pregnancy in the broad ligament is a rare form of ectopic pregnancy with a high risk of maternal mortality. Ultrasonography may help in the early diagnosis but mostly the diagnosis is established during surgery. We report the case of a patient with broad ligament ectopic pregnancy diagnosed intraoperatively. The patient had uneventful postoperative recovery.

  18. Management of descending necrotizing mediastinitis.

    Science.gov (United States)

    Fu, Y L; Fahn, H J; Shi, H S; Wu, Y C; Huang, M H; Wang, L S

    1998-09-01

    Descending necrotizing mediastinitis (DNM) is uncommon, and may be lethal if not treated adequately and promptly. Delayed diagnosis of the disease is sometimes encountered in clinical practice. Eight consecutive patients with acute DNM were identified between 1991 and 1995, including five men and three women. The mean age was 45.8 years (range, 22-71 years). The infectious sources consisted of six esophageal perforations, one cervical cutting injury and one tonsillitis. The clinical presentations were evaluated. Diagnostic procedures including chest radiograph, sonogram and computerized tomography scans of the chest and neck were examined. Diagnosis and treatment, including culture results from drained fluids and debrided tissues, and antibiotic and supportive therapies were reviewed. Six patients who underwent aggressive surgical treatment recovered well. Two patients who received supportive treatment died of sepsis alone. The cultured bacteria included: Klebsiella oxytoca, Staphylococcus aureus, Trichosporum and other mixed oral cavity flora. Early diagnosis and adequate antibiotic and support therapies are essential to achieve good patient outcomes in acute descending mediastinitis. Adequate drainage and debridement, appropriate antibiotic therapy, and sufficient nutritional and respiratory support are the main treatment elements.

  19. A thymoma as a cause of true ectopic hyperparathyroidism.

    Science.gov (United States)

    Rizzoli, R; Pache, J C; Didierjean, L; Bürger, A; Bonjour, J P

    1994-09-01

    Ectopic tumoral secretion of authentic PTH is rare, as only four cases have been convincingly documented by demonstrating the presence of PTH messenger ribonucleic acid in tumor tissue. We report the case of a 25-yr-old male with biochemical alterations typical of primary hyperparathyroidism (elevated calcemia and renal tubular reabsorption of calcium, decreased phosphatemia and maximal tubular reabsorption of phosphate, and increased intact PTH serum levels). Extensive cervical exploration did not reveal any abnormally enlarged parathyroid tissue, but excision of a palpable superior retrosternal mass led to the correction of all abnormal biochemical values. Histological analysis showed a predominantly epithelial thymoma, without any detectable parathyroid gland on serial slices. Tumor extracts contained immunoreactive PTH material, with serial dilutions paralleling PTH standards in an immunoradiometric assay. By contrast, immunoreactive PTH-related protein was absent. Furthermore, on Northern blot analysis, there was a PTH messenger ribonucleic acid transcript with a size similar to that found in parathyroid adenoma or hyperplasia. The thymoma epithelial cells stained positively with antiserum against PTH-(1-34), but negatively with antichromogranin-A antiserum. These results support the ectopic production of authentic PTH by a thymoma and indicate a novel tumoral cause of primary hyperparathyroidism.

  20. Mediastinitis

    Science.gov (United States)

    ... Worldwide in 2015 (News) Plan an Allergy-Safe Halloween for Your Child (News) Survival Odds Improving for ... in 2015 News HealthDay Plan an Allergy-Safe Halloween for Your Child News HealthDay Survival Odds Improving ...

  1. Mediastinitis

    Science.gov (United States)

    ... lungs, liver, eyes, skin, or other tissues ( sarcoidosis ) Tuberculosis Breathing in anthrax Cancer Risk factors include: Disease of the esophagus Diabetes mellitus Problems in the upper gastrointestinal tract Recent ...

  2. Non-neoplastic mediastinal cysts.

    Science.gov (United States)

    Zambudio, Antonio Ríos; Lanzas, Juan Torres; Calvo, María José Roca; Fernández, Pedro J Galindo; Paricio, Pascual Parrilla

    2002-11-01

    The non-neoplastic mediastinal cysts (NNMCs) form a group of uncommon benign lesions of a congenital origin. The significant controversy regarding these cysts is whether to manage with observation or surgical resection. The aim of this study is to analyse the utility of thoracic computed axial tomography (CT) in imaging diagnosis of the NNMCs and the results of surgery in these lesions. Twenty NNMCs underwent surgery between 1980 and 2000. The preoperative study of mediastinal cystic masses includes a complete blood test, chest radiography (CR) and, for the last 15 years, a thoracic CT and/or nuclear magnetic resonance. All the patients underwent surgery in our thoracic surgery department and were reviewed in outpatients at 1 month, 6 months, 1 year and biannually thereafter. The form of manifestation, clinical features, imaging techniques, surgical operation, morbidity, mortality and follow-up are analysed. Ten corresponded to bronchogenic cysts, the most common symptom of which was chest pain. CR showed a mass in the anterior-superior mediastinum in nine cases, and CT (five cases) revealed a cystic tumour in the anterior mediastinum. All were removed surgically, with three patients presenting with mild complications. Seven corresponded to pleuro-pericardial cysts, four being asymptomatic. CR showed a right paracardial mediastinal tumour, which was confirmed by CT (four cases). All were removed surgically, with two patients presenting with mild complications. Three corresponded to enteric cysts. CR showed a tumour in the posterior mediastinum, with CT confirming its cystic nature (two cases). Excision of the cyst was done in all cases, which corresponded to duplication cysts: two oesophageal and one gastric. All the patients are asymptomatic and recurrence-free after a follow-up of 11 +/- 10 years. NNMCs are benign lesions in which the lesions in which the surgery can be done with a low morbidity and mortality rate, enables us to rule out malignancy and offers a

  3. [The diagnostic value of computerized tomography in mediastinal diseases depending on their localization].

    Science.gov (United States)

    Sommer, B; Doppman, J L; Stelter, W; Mayr, B; Rienmüller, R; Lissner, J

    1981-04-01

    The diagnostic ranking and importance of computerised tomography was examined in 116 patients with abnormal findings in the mediastinal region, and was compared with conventional, non-invasive x-ray examinations. This method also yielded significant CT-specific additional information in the anterior mediastinum in 74.4% of the cases, in the mesomediastinum in 69.1%, in the posterior mediastinum in 79.2% in the upper thoracic aperture in 94.4% and in the paracardial region in 100% of the cases. The hilar region is an exception; in 68.8% of the cases, both methods were rated equal, whereas in 28.1% of the cases assessment via the CT method was even inferior. The specific additional information furnished by the CT method justifies a wider application of CT in solving the following problems concerning the mediastinum. -- clarification of a suspected but not yet established space-occupying growth in the mediastinum, before using invasive diagnostic methods such as mediastinoscopy and angiography; -- staging of an already identified primary mediastinal tumor of malignant lymphoma; -- in case of suspected changes in the large mediastinal vessels before employing angiography; -- on-target in the following diseases: bronchogenic carcinoma (because of improved pretherapeutic staging according to the TNM system), myasthenia gravis and identification of thymoma, hyperparathyroidism with suspected dystopic parathyroid glands.

  4. Ectopic Thyroid Tissue in the Mediastinum Characterized by Histology and Functional Imaging with I-123 SPECT/CT

    Directory of Open Access Journals (Sweden)

    Jed Hummel

    2017-01-01

    Full Text Available Ectopic thyroid tissue is a rare entity and when discovered it is typically along the pathway of embryologic migration of the thyroid. We present a case of incidental finding of ectopic thyroid tissue within mediastinum in a 61-year-old female patient with a history of total thyroidectomy for thyroiditis and nodules. The patient presented to emergency room with cough and right chest pain and underwent a chest computed tomographic angiogram (CTA to exclude pulmonary embolism as part of chest pain workup. One right paratracheal mediastinal soft tissue nodule was visualized on the images of CTA. This right paratracheal soft tissue mass was found to be ectopic benign thyroid tissue by histological analysis of the biopsied tissue samples. The function of this ectopic thyroid tissue was characterized by I-123 radioiodine uptake and single photon emission computed tomography/computed tomography (SPECT/CT imaging. This case illustrates that ectopic thyroid tissue should be included for differential diagnosis of a hyperdense soft tissue mass located within mediastinum. I-123 SPECT/CT is useful for guiding tissue biopsy of ectopic thyroid tissue distant from orthotopic thyroid gland and functional and anatomic characterization of mediastinal ectopic thyroid tissue for surgical resection when it is medically necessary.

  5. Mediastinal impalement with a fibreglass sheet.

    Science.gov (United States)

    Wimalachandra, Welege Samantha Buddhika; Asmat, Atasha

    2014-09-01

    Mediastinal impalement injuries are uncommon and often fatal. There have been very few reported cases of survival following mediastinal impalement. Patients who present with these injuries always undergo operative intervention regardless of their underlying haemodynamic status or associated injuries. We herein present a case of mediastinal impalement injury, where a sheet of fibreglass had fractured the manubrium and entered the anterior mediastinum with no associated great vessel injury. The fibreglass sheet was removed via a partial sternotomy and the patient made an uneventful postoperative recovery.

  6. Genetics Home Reference: parathyroid cancer

    Science.gov (United States)

    ... directly due to the tumor. In hormonally nonfunctional parathyroid cancer , the cause of death is typically related to the tumor itself, such as its impact on the function of nearby structures or its spread to other ...

  7. Parathyroid hormone (PTH) blood test

    Science.gov (United States)

    ... gov/ency/article/003690.htm Parathyroid hormone (PTH) blood test To use the sharing features on this page, ... to measure the amount of PTH in your blood. How the Test is Performed A blood sample is needed. How ...

  8. Cornual ectopic pregnancy

    National Research Council Canada - National Science Library

    Montes-Hernández, Diego; López-Franco, Adriana; Hernández-Valencia, Marcelino

    2014-01-01

    ... colic type in hypogastrium. It was carried out laparotomy, finding ectopic pregnancy in right horn, being carried out miometrial incision and trophoblast aspiration, with presence of multiple endometriosic focuses in later face of uterus...

  9. [Ectopic intraligamentary pregnancy].

    Science.gov (United States)

    Audifred Salomón, Jorge Ramón; Herrera Ortiz, Alejandra; González Medrano, María Gloria; Estrada Rivera, Silvia Fabiola

    2013-04-01

    Intraligamentary pregnancy is a rare form of ectopic pregnancy and a type of abdominal pregnancy, preoperative diagnosis is very difficult. This paper describes the case of a 24-year-old woman with a history of uterine curettage uncomplicated; she consulted due to abdomina pain in the right lower quadrant of seven days of duration, which gradually increased in intensity being 10/10 visual scale analogous (VAS). Obstetrical ultrasound was performed reporting: ectopic localization to annex right of 15.2 weeks gestational age, with heart rate of 152 beats per minute. The patient was admitted and underwent to emergency exploratory laparotomy, which found right paratubaric ectopic pregnancy. The histopathology report was of broad ligament ectopic pregnancy. Specimen of 9 x 8 x 7.5 cm and 200 grams.

  10. Scar Ectopic Pregnancy

    OpenAIRE

    Patel, Madhuri Arvind

    2015-01-01

    Scar ectopic pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world. This is a life-threatening form of abnormal implantation of embryo within the myometrium and fibrous tissues in a previous scar on the uterus, especially following caesarean section. With the increasing rate of caesarean section, there is a substantial increase in this condition with better understanding of this disease. The early and accurate diagnosis with timely management...

  11. Concurrent intrathyroidal thymus and parathyroid in a patient with papillary thyroid carcinoma: a challenging diagnosis

    Directory of Open Access Journals (Sweden)

    Georgios Velimezis

    2017-06-01

    Full Text Available During embryogenesis, the thymus and inferior parathyroid glands develop from the third pharyngeal pouch and migrate to their definite position. During this process, several anatomic variations may arise, with the thyroid being one of the most common sites of ectopic implantation for both organs. Here, we report the case of a young female patient, who underwent total thyroidectomy for papillary carcinoma of the thyroid. The patient’s history was remarkable for disorders of the genitourinary system. Histologic examination revealed the presence of well-differentiated intrathyroidal thymic tissue, containing an inferior parathyroid gland. While each individual entity has been well documented, this is one of the few reports in which concurrent presentation is reported. Given the fact that both the thymus and the inferior parathyroid are derivatives of the same embryonic structure (i.e. the third pharyngeal pouch, it is speculated that the present condition resulted from a failure in separation and migration during organogenesis.

  12. Primary mediastinal leiomyma mimicking a giant mediastinal cyst: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Yeong Uk; Kim, Su Young; Lee, Byung Hoon; Hwang, Yoon Joon; Lee, Ji Young; Kim, You Sung; Kim, Han Seong [Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)

    2016-08-15

    Primary mediastinal leiomyoma is an extremely rare benign tumor of smooth muscle. Most common radiographic appearance is a well circumscribed heterogeneous solid mass. We reported a case of giant cyst-like lesion at the middle mediastinum, which was pathologically confirmed as a primary mediastinal leiomyoma.

  13. New trends in parathyroid scintigraphy.

    Science.gov (United States)

    Giordano, A; Rubello, D; Casara, D

    2001-09-01

    The paper focusses on the recent advances in parathyroid imaging in both diagnostic and surgical fields which justify the present favourable trend towards a considerable expansion of nuclear medicine applications in this area. The main methodological advances in parathyroid scintigraphy are the rebirth of the dual-tracer (subtraction) technique with technetium-99m sestamibi, the possibility of also using 99mTc-tetrofosmin within a dual-tracer (subtraction) methodology and the more extensive use of single-photon emission tomography, which the authors believe will become the standard methodology. The indications for parathyroid scintigraphy have been affected by advances in hyperparathyroidism surgery, including wider use of unilateral neck exploration and of minimally invasive radioguided surgery. As these techniques can only be performed in hyperparathyroid patients with a single adenoma, careful pre-operative assessment is required, and parathyroid scintigraphy undoubtedly is the most accurate localisation method. To date, the majority of papers have also demonstrated the cost-effectiveness of scintigraphically guided limited neck surgery. The authors conclude that: (1) parathyroid scintigraphy can be recommended not only in persistent or recurrent hyperparathyroidism but also in hyperparathyroid patients prior to first surgery; (2) scintigraphy should always be performed by applying the most accurate technique available because reliable scintigraphy gains or reinforces the surgeon's trust, reliably guides cost-effective operative strategies and justifies the recognition of new potential diagnostic indications.

  14. Ruptured Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Valentina Park

    2016-09-01

    Full Text Available History of present illness: A 21-year-old female presented with sudden onset suprapubic abdominal pain associated with dysuria. The patient also experienced near syncope during bowel movements three times three days ago without falling or losing consciousness. She denied fever, nausea, and vomiting. She stated that she was five weeks pregnant by last menstrual period. She had an ultrasound a few weeks before that showed no intrauterine pregnancy, but she had not followed up for additional testing. Significant findings: The patient’s serum beta-hCG was 5,637 mIU/mL. The transvaginal ultrasound showed an empty uterus with free fluid posteriorly in the pelvis and Pouch of Douglas (00:00. A 4.5 cm heterogeneous mass was visible in the left adnexa concerning for an ectopic pregnancy (00:10. Discussion: Ectopic pregnancies are a leading cause of maternal morbidity and mortality, as well as decreased fertility.1,2 Differentiating between an ectopic pregnancy and a normal early pregnancy may be difficult, since ultrasound and quantitative beta-hCG may show inconclusive results.3,4 Patients who have used fertility treatment may further complicate the picture because they are at risk for heterotypic pregnancies.5 Ectopic pregnancies most commonly implant in the fallopian tube, but may alternatively implant in the ovary, cervix, abdomen, or uterine cornua.4 Ultrasonography may show an empty uterus, adnexal mass, pelvic free fluid, or an extra-uterine gestational sac, yolk sac, and/or embryo.6 Treatment options for ectopic pregnancy include surgery or methotrexate.2,4 Some patients may be candidates for close outpatient surveillance if the diagnosis is unclear or in very limited cases for early, non-ruptured ectopic pregnancies.2,4

  15. Ectopic lingual thyroid.

    Science.gov (United States)

    Benhammou, A; Bencheikh, R; Benbouzid, M A; Boulaich, M; Essakali, L; Kzadri, M

    2006-01-01

    Ectopic lingual thyroid is an uncommon embryological aberration characterised by the presence of thyroid tissue located in a site other than the normal, pretracheal region. The tongue is the most frequent ectopic location of the thyroid gland; the clinical incidence of lingual thyroid varies between 1:3000 and 1:10,000. We present a new case of lingual thyroid in a 10-year-old child who presented dysphagia. The radiological findings and the biopsy confirmed the diagnosis. As the mass was well tolerated, surgery was not indicated. At this time, there are no signs of complications or malignant transformation.

  16. Atrial Ectopics Precipitating Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2015-04-01

    Full Text Available Holter monitor tracing showing blocked atrial ectopics and atrial ectopic precipitating atrial fibrillation is being demonstrated. Initially it was coarse atrial fibrillation, which rapidly degenerated into fine atrial fibrillation.

  17. Thoracoscopic excision of mediastinal cysts in children

    Directory of Open Access Journals (Sweden)

    Jain Prashant

    2007-01-01

    Full Text Available Aim: Thoracoscopy offers great advantages when compared with open surgery in terms of postoperative pain and pulmonary complications. Considering the benign nature of most of the mediastinal cysts, thoracoscopy is safe and feasible with minimal morbidity. The purpose of this article is to review our experience with four cases of mediastinal cysts resected successfully within a period of one year by thoracoscopy. Materials and Methods:The cases of mediastinal cysts operated by thoracoscopic excision in K.E.M. Hospital, Mumbai from November 2005 to December 2006 were reviewed. The age varied from six months to 10 years. The patients presented with respiratory distress or recurrent lower respiratory tract infection. All patients underwent Chest X-ray and CT scan thorax to delineate the location of the cyst and its relationship with adjacent vital structures. Two patients had anterior and two had posterior mediastinal cyst. The ports were placed depending on the location of the cyst on the CT scan, following the principles of triangularization. The cysts were excised mainly by blunt dissection. Results: All the patients were successfully managed by thoracoscopic surgery. None of them had intraoperative complications. Dissection in patient with history of recurrent respiratory tract infection was difficult because of adhesions. Intercostal drain was removed within 48hrs and the patients were discharged on the fourth postoperative day. Conclusions: Thoracoscopy in mediastinal cysts is a safe and effective procedure with low morbidity and a shorter hospital stay.

  18. Hypervascular mediastinal masses: Action points for radiologists

    Energy Technology Data Exchange (ETDEWEB)

    Cabral, Fernanda C.; Trotman-Dickenson, Beatrice; Madan, Rachna, E-mail: rmadan@partners.org

    2015-03-15

    Highlights: •An algorithm combining clinical data and radiology features of hypervascular mediastinal masses is proposed to determine further evaluation and subsequently guide treatment. •Characteristic features and known association with syndromes and genetic mutations assists in achieving a diagnosis. •MRI and functional imaging can be very helpful in the evaluation of hypervascular mediastinal masses. •Identification of hypervascularity within mediastinal masses should alert the radiologist and clinician and an attempt should be made to preferably avoid percutaneous CT guided biopsies and attempt tissue sampling surgically with better control of post procedure hemorrhage. -- Abstract: Hypervascular mediastinal masses are a distinct group of rare diseases that include a subset of benign and malignant entities. Characteristic features and known association with syndromes and genetic mutations assist in achieving a diagnosis. Imaging allows an understanding of the vascularity of the lesion and should alert the radiologist and clinician to potential hemorrhagic complications and avoid percutaneous CT guided biopsies. In such cases, pre-procedure embolization and surgical biopsy maybe considered for better control of post procedure hemorrhage. The purpose of this article is to describe and illustrate the clinical features and radiologic spectrum of hypervascular mediastinal masses, and discuss the associated clinical and genetic syndromes. We will present an imaging algorithm to determine further evaluation and subsequently guide treatment.

  19. Management of large mediastinal masses: surgical and anesthesiological considerations

    NARCIS (Netherlands)

    Li, Wilson W. L.; van Boven, Wim Jan P.; Annema, Jouke T.; Eberl, Susanne; Klomp, Houke M.; de Mol, Bas A. J. M.

    2016-01-01

    Large mediastinal masses are rare, and encompass a wide variety of diseases. Regardless of the diagnosis, all large mediastinal masses may cause compression or invasion of vital structures, resulting in respiratory insufficiency or hemodynamic decompensation. Detailed preoperative preparation is a

  20. Ectopic pregnancy after tubal sterilization.

    Directory of Open Access Journals (Sweden)

    Shah J

    1991-01-01

    Full Text Available We report 13 cases of ectopic pregnancy following tubal ligation out of 287 ectopic pregnancies seen during a six year period (1984-1989. These findings suggest that tubal sterilization does not invariably confer infertility. Ectopic pregnancy must not be disregarded in women who have undergone tubal ligation, especially if two or more years have elapsed since the sterilization.

  1. Cryptogenic organising pneumonia presenting with bilateral hilar and mediastinal lymphadenopathy.

    Science.gov (United States)

    Kahraman, Hasan; Tokur, Mahmut; Sayar, Hamide; Inci, Mehmet Fatih

    2013-06-10

    Cryptogenic organising pneumonia is not considered in the differential diagnosis of bilateral hilar and mediastinal lymphadenopathy. We submitted a patient presenting with bilateral hilar and mediastinal lymphadenopathy. We suspected diagnosis of sarcoidosis, but the patient was diagnosed as cryptogenic organising pneumonia with the histological result. This is the second case report of cryptogenic organising pneumonia presenting with bilateral hilar and mediastinal lymphadenopathy.

  2. Parathyroid diseases and animal models

    Directory of Open Access Journals (Sweden)

    Yasuo eImanishi

    2012-06-01

    Full Text Available Circulating calcium and phosphate are tightly regulated by 3 hormones: the active form of vitamin D (1,25-dihydroxyvitamin D, fibroblast growth factor (FGF-23, and parathyroid hormone (PTH. PTH acts to stimulate a rapid increment in serum calcium and has a crucial role in calcium homeostasis. Major target organs of PTH are kidney and bone. The oversecretion of the hormone results in hypercalcemia, caused by increased intestinal calcium absorption, reduced renal calcium clearance, and mobilization of calcium from bone in primary hyperparathyroidism. In chronic kidney disease, secondary hyperparathyroidism of uremia is observed in its early stages, and early stages, and this finally develops into the autonomous secretion of PTH during maintenance hemodialysis. Receptors in parathyroid cells, such as the calcium-sensing receptor, vitamin D receptor, and FGF receptor (FGFR-Klotho complex have crucial roles in the regulation of PTH secretion. Genes such as Cyclin D1, RET, MEN1, HRPT2, and CDKN1B have been identified in parathyroid diseases. Genetically engineered animals with these receptors and the associated genes have provided us with valuable information on the patho-physiology of parathyroid diseases. The application of these animal models is significant for the development of new therapies.

  3. Octreotide Uptake in Parathyroid Adenoma

    Directory of Open Access Journals (Sweden)

    Seyhan Karaçavuş

    2012-08-01

    Full Text Available The patient with a history of bone pain and muscle weakness, was thought to have oncogenic osteomalacia as a result of biochemical investigations and directed to Nuclear Medicine Department for a whole-body bone scintigraphy and 111In-octreotide scintigraphy. There was no focal pathologic tracer uptake, but generalized marked increase in skeletal uptake on bone scintigraphy. Octreotide scintigraphy showed accumulation of octreotide in the region of the left lobe of the thyroid gland in the neck. Thereafter, parathyroid scintigraphy was performed with technetium-99m labeled metroxy-isobutyl-isonitryl (99mTc-MIB and MIBI scan demonstrated radiotracer uptake at the same location with octreotide scintigraphy. The patient underwent left inferior parathyroidectomy and histopathology confirmed a parathyroid adenoma. Somatostatin receptor positive parathyroid adenoma may show octreotide uptake. Octreotide scintigraphy may be promising and indicate a possibility of using somatostatin analogues for the medical treatment of somatostatin receptor positive parathyroid tumors. (MIRT 2012;21:77-79

  4. Parathyroid Hormone Levels and Cognition

    Science.gov (United States)

    Burnett, J.; Smith, S.M.; Aung, K.; Dyer, C.

    2009-01-01

    Hyperparathyroidism is a well-recognized cause of impaired cognition due to hypercalcemia. However, recent studies have suggested that perhaps parathyroid hormone itself plays a role in cognition, especially executive dysfunction. The purpose of this study was to explore the relationship of parathyroid hormone levels in a study cohort of elders with impaied cognition. Methods: Sixty community-living adults, 65 years of age and older, reported to Adult Protective Services for self-neglect and 55 controls matched (on age, ethnicity, gender and socio-economic status) consented and participated in this study. The research team conducted in-home comprehensive geriatric assessments which included the Mini-mental state exam (MMSE), the 15-item geriatric depression scale (GDS) , the Wolf-Klein clock test and a comprehensive nutritional panel, which included parathyroid hormone and ionized calcium. Students t tests and linear regression analyses were performed to assess for bivariate associations. Results: Self-neglecters (M = 73.73, sd=48.4) had significantly higher PTH levels compared to controls (M =47.59, sd=28.7; t=3.59, df=98.94, pcognitive measures. Conclusion: Parathyroid hormone may be associated with cognitive performance.

  5. The role of menin in parathyroid tumorigenesis.

    LENUS (Irish Health Repository)

    Davenport, Colin

    2009-01-01

    Primary hyperparathyroidism is a common disorder that involves the pathological enlargement of one or more parathyroid glands resulting in excessive production of parathyroid hormone (PTH). The exact pathogenesis of this disease remains to be fully understood. In recent years interest has focussed on the interaction between menin protein and the transforming growth factor (TGF)-beta\\/Smad signalling pathway. In vitro experimentation has demonstrated that the presence of menin is required for TGF-beta to effectively inhibit parathyroid cell proliferation and PTH production. This observation correlates with the almost universal occurrence of parathyroid tumors accompanying the inactivation of menin in multiple endocrine neoplasia Type 1 (MEN1) syndrome and the high rate of somatic menin gene mutations seen in sporadic parathyroid adenomas. This chapter aims to review the role of menin in primary hyperparathyroidism and parathyroid hormone-regulation, including the influences of MEN1 gene mutations on parathyroid cell proliferation, differentiation and tumorigenesis.

  6. Parathyroid ectopia evidenced by {sup 99m}Tc-sestamibi scintigraphy: Case report; Ectopie parathyroidienne objectivee par la scintigraphie au {sup 99m}Tc-MIBI: a propos d'un cas

    Energy Technology Data Exchange (ETDEWEB)

    Ghfir, I.; Ben Rais, N. [Hopital Ibn-Sina, Service de Medecine Nucleaire (Morocco)

    2007-08-15

    Introduction The presence of an ectopic parathyroid gland is the most frequent cause of persistent hyperparathyroidism. Its detection constitutes a source of topographic diagnostic difficulties particularly for purely morphological explorations. The goal of this work is to elucidate the interest of scintigraphy using {sup 99m}Tc-sestamibi in the diagnosis and the therapeutic orientation of ectopic parathyroid. Case report A 50-year-old patient was followed for persistent hyperparathyroidism after subtotal para thyroidectomy. The clinical examination was without particularity contrasting with an always high parathormone rate. Echography, computed tomography and magnetic resonance imaging were not conclusive. Scintigraphy carried out after intravenous injection of 740 MBq of sestamibi-Tc{sup 99m} with acquisition of static images at 20 min and 2 h showed an area of high uptake in projection of the right upper mediastinum. The diagnosis of an ectopic parathyroid localization was retained. Resection and pathologic examination of the surgical specimen revealed parathyroid adenoma tissue. The evolution was marked by a normalisation of the rate of parathormone. Discussion {sup 99m}Tc-sestamibi scintigraphy is a functional exploration with a higher sensitivity than the other morphological imaging techniques for preoperative topographic determination of ectopic parathyroid. It significantly contributes to an elective and more rapid surgical resection of these lesions. (authors)

  7. Ectopic corticotroph syndrome

    OpenAIRE

    Penezić Zorana; Savić Slavica; Vujović Svetlana; Tatić Svetislav B.; Ercegovac Maja; Drezgić Milka

    2004-01-01

    INTRODUCTION Endogenous Cushing's syndrome is a clinical state resulting from prolonged, inappropriate exposure to excessive endogenous secretion of Cortisol and hence excess circulating free cortisol, characterized by loss of the normal feedback mechanisms of the hypothalamo-pituitary-adrenal axis and the normal circadian rhythm of cortisol secretion [2]. The etiology of Cushing's syndrome may be excessive ACTH secretion from the pituitary gland, ectopic ACTH secretion by nonpituitary tumor,...

  8. Mediastinal staging of lung cancer: novel concepts

    NARCIS (Netherlands)

    Tournoy, Kurt G.; Keller, Steven M.; Annema, Jouke T.

    2012-01-01

    Clinical TNM staging is the standard method used to decide treatment for patients with non-small-cell lung cancer. Although integrated fluorodeoxyglucose (FDG) PET CT increases the accuracy of staging, it only guides direct tissue sampling. Histological assessment of mediastinal lymph nodes has

  9. Mediastinal goiter diagnosed by functional imaging

    African Journals Online (AJOL)

    2012-01-19

    Jan 19, 2012 ... Hardy RG, Bliss RD, Lennard TW, Balasubramanian SP,. Harrison BJ. Management of retrosternal goitres. Ann R Coll. Surg. 2009; 91: 8Б11. 2. Madjar S, Weissberg D. Retrosternal goiter. Chest. 1995; 108: 78Б82. 3. Rives JD. Mediastinal aberrant goiter. Ann Surg. 1947; 126: 797Б810. *Guido Michels.

  10. Radiological case: subcutaneous and mediastinal enfisema

    OpenAIRE

    Nascimento, J.; Gomes, M.; Moreira, C.; Macedo, F.

    2012-01-01

    ABSTRACT We present the case of a 5 year old asmathic girl admitted to the hospital for acute non traumatic edema and crepitus of the face, neck and upper thorax. Thoracic x-ray (not shown) and thoracic and neck CT were performed, showing extensive subcutaneous and mediastinal enfisema. These are rare complications of asthma. The imaging features are described.

  11. PRESENTATION OF PRIMARY MEDIASTINAL MASSES IN IBADAN ...

    African Journals Online (AJOL)

    hi-tech

    2003-09-09

    Sep 9, 2003 ... Patients: All patients with primary mediastinal masses referred for evaluation and treatment. Main outcome ... chest radiography (6, 11) have allowed earlier diagnosis of these tumours. ... series were chest pain/fullness dyspnoea and weight loss. ..... Post operative evaluation with MR imaging. Radiology.

  12. A large ruptured mediastinal cystic teratoma.

    Science.gov (United States)

    Machuca, Jenny S; Tejwani, Dimple; Niazi, Masooma; Diaz-Fuentes, Gilda

    2010-07-01

    A 51-year-old woman presented with a 2-month history of intermittent cough and precordial chest pain associated with shortness of breath. Initial chest-x-ray revealed a large well-circumscribed mass in the left perihilar region and consolidation of left lower lobe. Computed tomography scan of the chest revealed a large irregular fluid-filled mass occupying the left hemithorax, causing a mediastinal shift to the right, and a left pleural effusion. A pigtail was inserted; pleural fluid was exudative without evidence of malignant cells. Left thoracotomy revealed an anterior mediastinal mass of 20 cm in diameter adherent to the pericardium, pleura, and lung. Pathologic examination showed a variety of cell lines consisting of respiratory mucosa, mucous glands, cartilage, smooth muscle, adipose tissue, and pancreatic tissue, results consistent with a mature teratoma. Mature cystic teratomas are usually benign in nature and represent 60% to 70% of mediastinal germ cell tumors; they are found most commonly in young adults. The anterior mediastinum is the most common site for these types of tumors. Rupture of a mediastinal cystic teratoma is a rare event and can be a life-threatening condition. The treatment is mainly surgical, with an excellent prognosis such as in our patient.

  13. Parathyroid Scintigraphy in Renal Hyperparathyroidism

    Science.gov (United States)

    Taïeb, David; Ureña-Torres, Pablo; Zanotti-Fregonara, Paolo; Rubello, Domenico; Ferretti, Alice; Henter, Ioline; Henry, Jean-François; Schiavi, Francesca; Opocher, Giuseppe; Blickman, Johan G.; Colletti, Patrick M.; Hindié, Elif

    2015-01-01

    Secondary hyperparathyroidism (sHPT) is a major complication for patients with end-stage renal disease on long-term hemodialysis or peritoneal dialysis. When the disease is resistant to medical treatment, patients with severe sHPT are typically referred for parathyroidectomy (PTx), which usually improves biological parameters as well as clinical signs and symptoms. Unfortunately, early surgical failure with persistent disease may occur in 5%–10% of patients and recurrence reaches 20%–30% at 5 years. Presently, the use of parathyroid scintigraphy in sHPT is usually limited to the management of surgical failures after initial PTx. This review describes the strengths and limitations of typical 99mTc-sestamibi imaging protocols, and highlights the potential benefits of using parathyroid scintigraphy in the initial workup of surgical patients. PMID:23751837

  14. Restoration of parathyroid function after change of phosphate binder from calcium carbonate to lanthanum carbonate in hemodialysis patients with suppressed serum parathyroid hormone.

    Science.gov (United States)

    Inaba, Masaaki; Okuno, Senji; Nagayama, Harumi; Yamada, Shinsuke; Ishimura, Eiji; Imanishi, Yasuo; Shoji, Shigeichi

    2015-03-01

    Control of phosphate is the most critical in the treatment of chronic kidney disease with mineral and bone disorder (CKD-MBD). Because calcium-containing phosphate binder to CKD patients is known to induce adynamic bone disease with ectopic calcification by increasing calcium load, we examined the effect of lanthanum carbonate (LaC), a non-calcium containing phosphate binder, to restore bone turnover in 27 hemodialysis patients with suppressed parathyroid function (serum intact parathyroid hormone [iPTH] ≦ 150 pg/mL). At the initiation of LaC administration, the dose of calcium-containing phosphate binder calcium carbonate (CaC) was withdrawn or reduced based on serum phosphate. After initiation of LaC administration, serum calcium and phosphate decreased significantly by 4 weeks, whereas whole PTH and iPTH increased. A significant and positive correlation between decreases of serum calcium, but not phosphate, with increases of whole PTH and iPTH, suggested that the decline in serum calcium with reduction of calcium load by LaC might increase parathyroid function. Serum bone resorption markers, such as serum tartrate-resistant acid phosphatase 5b, and N-telopeptide of type I collagen increased significantly by 4 weeks after LaC administration, which was followed by increases of serum bone formation markers including serum bone alkaline phosphatase, intact procollagen N-propeptide, and osteocalcin. Therefore, it was suggested that LaC attenuated CaC-induced suppression of parathyroid function and bone turnover by decreasing calcium load. In conclusion, replacement of CaC with LaC, either partially or totally, could increase parathyroid function and resultant bone turnover in hemodialysis patients with serum iPTH ≦ 150 pg/mL. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  15. Parathyroid Diseases and Animal Models

    OpenAIRE

    Imanishi, Yasuo; Nagata, Yuki; Inaba, Masaaki

    2012-01-01

    Circulating calcium and phosphate are tightly regulated by 3 hormones: the active form of vitamin D (1,25-dihydroxyvitamin D), fibroblast growth factor (FGF)-23, and parathyroid hormone (PTH). PTH acts to stimulate a rapid increment in serum calcium and has a crucial role in calcium homeostasis. Major target organs of PTH are kidney and bone. The oversecretion of the hormone results in hypercalcemia, caused by increased intestinal calcium absorption, reduced renal calcium clearance, and mobil...

  16. Parathyroid Hormone Levels and Cognition

    Science.gov (United States)

    Burnett, J.; Smith, S.M.; Aung, K.; Dyer, C.

    2009-01-01

    Hyperparathyroidism is a well-recognized cause of impaired cognition due to hypercalcemia. However, recent studies have suggested that perhaps parathyroid hormone itself plays a role in cognition, especially executive dysfunction. The purpose of this study was to explore the relationship of parathyroid hormone levels in a study cohort of elders with impaied cognition. Methods: Sixty community-living adults, 65 years of age and older, reported to Adult Protective Services for self-neglect and 55 controls matched (on age, ethnicity, gender and socio-economic status) consented and participated in this study. The research team conducted in-home comprehensive geriatric assessments which included the Mini-mental state exam (MMSE), the 15-item geriatric depression scale (GDS) , the Wolf-Klein clock test and a comprehensive nutritional panel, which included parathyroid hormone and ionized calcium. Students t tests and linear regression analyses were performed to assess for bivariate associations. Results: Self-neglecters (M = 73.73, sd=48.4) had significantly higher PTH levels compared to controls (M =47.59, sd=28.7; t=3.59, df=98.94, p<.01). There was no significant group difference in ionized calcium levels. Overall, PTH was correlated with the MMSE (r=-.323, p=.001). Individual regression analyses revealed a statistically significant correlation between PTH and MMSE in the self-neglect group (r=-.298, p=.024) and this remained significant after controlling for ionized calcium levels in the regression. No significant associations were revealed in the control group or among any of the other cognitive measures. Conclusion: Parathyroid hormone may be associated with cognitive performance.

  17. Ectopic corticotroph syndrome

    Directory of Open Access Journals (Sweden)

    Penezić Zorana

    2004-01-01

    Full Text Available INTRODUCTION Endogenous Cushing's syndrome is a clinical state resulting from prolonged, inappropriate exposure to excessive endogenous secretion of Cortisol and hence excess circulating free cortisol, characterized by loss of the normal feedback mechanisms of the hypothalamo-pituitary-adrenal axis and the normal circadian rhythm of cortisol secretion [2]. The etiology of Cushing's syndrome may be excessive ACTH secretion from the pituitary gland, ectopic ACTH secretion by nonpituitary tumor, or excessive autonomous secretion of cortisol from a hyperfunctioning adrenal adenoma or carcinoma. Other than this broad ACTH-dependent and ACTH-independent categories, the syndrome may be caused by ectopic CRH secretion, PPNAD, MAH, ectopic action of GIP or catecholamines, and other adrenel-dependent processes associated with adrenocortical hyperfunction. CASE REPORT A 31 year-old men with b-month history of hyperpigmentation, weight gain and proximal myopathy was refereed to Institute of Endocrinology for evaluation of hypercortisolism. At admission, patient had classic cushingoid habit with plethoric face, dermal and muscle atrophy, abdominal strie rubrae and centripetal obesity. The standard laboratory data showed hyperglycaemia and hypokaliemia with high potassium excretion level. The circadian rhythm of cortisol secretion was blunted, with moderately elevated ACTH level, and without cortisol suppression after low-dose and high-dose dexamethason suppression test. Urinary 5HIAA was elevated. Abdominal and sellar region magnetic resonance imaging was negative. CRH stimulation resulted in ACTH increase of 87% of basal, but without significant increase of cortisol level, only 7%. Thoracal CT scan revealed 14 mm mass in right apical pulmonary segment. A wedge resection of anterior segment of right upper lobe was performed. Microscopic evaluation showed tumor tissue consisting of solid areas of uniform, oval cells with eosinophilic cytoplasm and centrally

  18. Hypothyroidism associated with parathyroid disorders.

    Science.gov (United States)

    Mantovani, Giovanna; Elli, Francesca Marta; Corbetta, Sabrina

    2017-03-01

    Hypothyroidism may occur in association with congenital parathyroid disorders determining parathyroid hormone insufficiency, which is characterized by hypocalcemia and concomitant inappropriately low secretion of parathormone (PTH). The association is often due to loss of function of genes common to thyroid and parathyroid glands embryonic development. Hypothyroidism associated with hypoparathyroidism is generally mild and not associated with goiter; moreover, it is usually part of a multisystemic involvement not restricted to endocrine function as occurs in patients with 22q11 microdeletion/DiGeorge syndrome, the most frequent disorders. Hypothyroidism and hypoparathyroidism may also follow endocrine glands' damages due to autoimmunity or chronic iron overload in thalassemic disorders, both genetically determined conditions. Finally, besides PTH deficiency, hypocalcemia can be due to PTH resistance in pseudohypoparathyroidism; when hormone resistance is generalized, patients can suffer from hypothyroidism due to TSH resistance. In evaluating patients with hypothyroidism and hypocalcemia, physical examination and clinical history are essential to drive the diagnostic process, while routine genetic screening is not recommended. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Intrathyroidal parathyroid carcinoma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    You, Woo Young; Han, You Mie; Choi, Young Hee [Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Hwaseong (Korea, Republic of)

    2015-05-15

    Parathyroid carcinoma is an uncommon malignancy and a rare cause of primary hyperparathyroidism. Intrathyroidal parathyroid carcinoma is even rarer and only few cases have been reported previously. A 33-year-old woman presented with hypercalcemia. CT scan revealed a 5-cm sized intrathyroid nodule with a positive beak sign on the surface in contact with the thyroid gland. The patient underwent total thyroidectomy, and the histopathologic examination confirmed the diagnosis of parathyroid carcinoma. We report a case of intrathyroidal parathyroid carcinoma with brief literature review.

  20. Computed tomography of the mediastinal lesion

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ho Joon; Suh, Jung Hyek; Chun, Byung Hee; Suh, Soo Jhi [Kosin Mediacal College, Busan (Korea, Republic of)

    1984-09-15

    Authors retrospectively analyzed the CT findings of mediastinal lesions in surgically or clinically confirmed 37 cases at Kosin Medical College during recent 4 years from September 1979 to August 1983. 1. Among 37 caes, malignant lymphoma were 7 cases, thymoma and vascular lesion or anomaly were 5 cases respectively, benign teratoma and tuberculous mediastinal lymphadenitis and neurogenic tumor were 4 cases respectively, pericardial cyst were 2 cases, bronchogenic cyst, non-specific cyst, pancreatic pseudocyst, mesothelioma, Bochdalek hernia was 1 case respectively. 2. The sex ratio between male and female was about 1 : 1 and the majority of the patients with malignant lymphoma and teratoma was under 20 years old. 3. CT findings of the each mediastinal lesion. 1) Primary mediastinal malignant lymphoma. (1) A large, matted, continuous and midline-crossing mass was observed in the superior and the anterior mediastinums in all cases. (2) In 3 cases, irregular lower densities were seen in the center of the mass, representing the tumor necrosis. (3) CT was also able to show involvement of other mediastinal lymph nodes and adjacent structures such as pleura, anterior chest wall and lung parenchyma. (4) Involving pleura, homogeneous band-like shadows were seen along the pleura, appearing denser than the associated pleural effusion. (5) Involving lung parenchyma, irregular- shaped nodules and band-like densities were seen along the courses of the bronchi and the vessels. 2) Thyoma. (1) A discrete, soft tissue mass was seen in the superior and the anterior mediastinums (mainly posterior to manubrium and anterior to aortic arch) replacing the normal mediastinal fat. (2) In benign thymoma, the margin of the mass was smooth and the normal fat plane between the mass and the vascular structures was well preserved, but invasive thymoma showed obliteration of the normal fat plane, irregular and ragged tumor-lung interface, and irregular thickening of pleura and pericardium by

  1. Mediastinal Pseudocyst in Acute on Chronic Pancreatitis.

    Science.gov (United States)

    Mishra, Sushil Kumar; Jain, Pawan Kumar; Gupta, Sukhdev

    2016-03-01

    Pseudocyst is a common complication of Acute and chronic pancreatitis. However, its extension into the mediastinum is a rare entity. We present a case of 52 years male with acute on chronic pancreatitis (alcohol related) who presented with dysphagia and dyspnoea and was found to have a pancreatic pseudocyst extending upto the neck. Ultrasound fails to pick up mediastinal pseudocysts and requires additional imaging modalities - CT and MRI. Management of Mediastinal pseudocyst depends upon underlying etiology, ductal anatomy, size of the pseudocyst, and availability of expertise. Small pseudocysts in asymptomatic patients may resolve spontaneously, but requires prolonged conservative therapy with somatostatin or its analogue and Total Parenteral Nutrition. Ruptured pseudocyst in a symptomatic unstable patient requires surgical resection. Endoscopic ultrasound guided drainage (transmural or transpapillary) and Main Pancreatic Duct stenting are safe and effective treatment modality. © Journal of the Association of Physicians of India 2011.

  2. Primary mediastinal tuberculous abscess: Demonstration with MR

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, R.K.; Jena, A.; Prakash, R.; Sharma, B.K.; Talukdar, B.; Pant, K.

    1989-06-01

    An unusual case of primary mediastinal tuberculous abscess is presented in whom the diagnosis was obtained on magnetic resonance (MR) and ultrasound (US) guided aspiration cytology. Mycobacterium tuberculosis was isolated from direct smear as well as from culture of the 'pus'. Normal spine signal with MR and normal bone scintigraphy excluded any vertebral focus of infection. MR was helpful in defining the extent and characterising the abscess besides excluding a vertebral focus of infection.

  3. Computed tomography of the mediastinal tumor

    Energy Technology Data Exchange (ETDEWEB)

    Tohyama, Junko; Kono, Michio; Tauchi, Taneyasu; Mizutani, Masako; Mizutani, Hirokazu

    1984-12-01

    Forty-one cases of mediastinal tumor examined by computed tomography were reviewed. CT findings of the mediastinal malignancy were as follows: 1) inhomogeneous density on contrast CT, 2) equivocaton of fat plane surrounding the tumor, 3) irregular margin. Benign teratoma had smooth margin and included fat or calcification density. Mediastinal seminoma was observed as a lobulated mass with no calcification on CT. These findings were similar to the patterns of malignant thymoma or lymphoma. Consequently, it was very difficult to differentiate between malignant thymoma and malignant lymphoma by CT. According to our data, malignant thymoma tended to expand to only one side of the anterior mediastinum and to invade the anterior chest wall. On the other hand, malignant lymphoma of anterior medistinal type expanded into the trachea and the superior vena cava. In patients with sarcoidosis, the enlargement of bilateral hilar lymph nodes was commonly observed, on the contrary, unilateral hilar lymph nodes enlargement was recognized in some cases of malignant lymphoma. (author).

  4. Non-tubal ectopic pregnancy.

    Science.gov (United States)

    Parker, Victoria Louise; Srinivas, M

    2016-07-01

    11 per 1000 pregnancies are ectopic (NICE Guidelines, 2012) with 95 % of ectopic pregnancies being tubal in origin, and 80 % of these occurring within the ampulla (The Ectopic Pregnancy Trust). 5% therefore are non-tubal. In this review we aim to collate literature relevant to non-tubal ectopic pregnancy. Literature regarding cornual, ovarian, abdominal, interstitial, cervical and Caesarean scar ectopic pregnancy was reviewed using EMBASE and Medline databases. Non-tubal ectopic pregnancies are often overlooked, diagnosed late and are associated with higher maternal morbidity and mortality. Ultrasound remains the mainstay of diagnosis in corroboration with clinical features. Management may include medical treatment with methotrexate, surgery or expectancy. There is also an increasing interest in the use of minimally invasive radiological approaches. Non-tubal ectopic pregnancy is a rare but potentially life-threatening and often misdiagnosed condition. This is particularly pertinent for Caesarean scar ectopic pregnancies, the prevalence of which is increasing due to the rising proportion of women having Caesarean sections (Litwicka and Greco, 2011). Practitioners should be aware of non-tubal pregnancies to aid more efficient diagnosis, optimise management and increase patient safety.

  5. Sick sinus syndrome as a complication of mediastinal radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pohjola-Sintonen, S.; Toetterman, K.J.K.; Kupari, M. (Helsinki Univ. Central Hospital (Finland))

    1990-06-01

    A 33-year-old man who had received mediastinal radiation therapy for Hodgkin's disease 12 years earlier developed a symptomatic sick sinus syndrome requiring the implantation of a permanent pacemaker. The sick sinus syndrome and a finding of an occult constrictive pericarditis were considered to be due to the previous mediastinal irradiation. A ventricular pacemaker was chosen because mediastinal radiotherapy also increases the risk of developing atrioventricular conduction defects.

  6. Vitamin D receptors and parathyroid glands.

    Science.gov (United States)

    Landry, Christine S; Ruppe, Mary D; Grubbs, Elizabeth G

    2011-01-01

    To describe the function and metabolism of the vitamin D hormone and the role of the vitamin D receptor and the calcium-sensing receptor in the secretion of parathyroid hormone. A review of the literature was undertaken regarding the function and metabolism of vitamin D; the role of the vitamin D receptor and calcium-sensing receptor in the secretion of parathyroid hormone; and the contemporary research regarding the interaction of vitamin D and parathyroid hormone in patients with vitamin D deficiency, primary hyperparathyroidism, and secondary hyperparathyroidism. Over the last several years, great interest has been generated about the interaction of vitamin D and the parathyroid glands, gastrointestinal tract, kidney, and bone in relation to calcium and parathyroid hormone levels. Vitamin D has an important role in calcium and parathyroid hormone metabolism. Likewise, the vitamin D axis appears to be involved with the development of both primary and secondary hyperparathyroidism. The specific mechanism by which vitamin D interacts with the parathyroid gland to bring about observed effects is not yet fully understood. Future studies investigating the relationship of the vitamin D receptor, calcium-sensing receptor, and parathyroid glands are needed to enhance our knowledge of vitamin D deficiency and primary and secondary vitamin D deficiency.

  7. Determination of the functioning of autotransplanted parathyroid ...

    African Journals Online (AJOL)

    Twenty dialysis and renal transplant patients with parathyroid hyperplasia underwent a total parathyroidectomy and an autotransplantation in forearm muscle. Twelve patients were available for investigation of the function of the transplanted parathyroid tissue. Differential studies of the two arms revealed functioning of the ...

  8. Synchronous Parathyroid Adenoma and Papillary Thyroid Carcinoma

    African Journals Online (AJOL)

    Simultaneous existence of parathyroid adenoma and thyroid nonmedullary carcinoma is rarely observed. A 52‑year‑old female was diagnosed approximately. 4 years ago with primary hyperparathyroidism (PHPT) on the basis of hypercalcemia and elevated serum parathyroid hormone (PTH) level. Clinically,.

  9. Synchronous parathyroid adenoma and papillary thyroid carcinoma ...

    African Journals Online (AJOL)

    Simultaneous existence of parathyroid adenoma and thyroid nonmedullary carcinoma is rarely observed. A 52‑year‑old female was diagnosed approximately 4 years ago with primary hyperparathyroidism (PHPT) on the basis of hypercalcemia and elevated serum parathyroid hormone (PTH) level. Clinically, PHPT ...

  10. Parathyroid hormone-related protein blood test

    Science.gov (United States)

    ... ency/article/003691.htm Parathyroid hormone-related protein blood test To use the sharing features on this page, ... measures the level of a hormone in the blood, called parathyroid hormone-related protein. How the Test is Performed A blood sample is needed . How ...

  11. Multi drug resistant tuberculosis presenting as anterior mediastinal mass

    Directory of Open Access Journals (Sweden)

    Parmarth Chandane

    2016-01-01

    Full Text Available Enlargement of the mediastinal lymphatic glands is a common presentation of intrathoracic tuberculosis (TB in children. However, usually, the mediastinal TB nodes enlarge to 2.8 ± 1.0 cm. In this report, we describe a case of anterior mediastinal lymphnode TB seen as huge mass (7 cm on computed tomography (CT thorax without respiratory or food pipe compromise despite anterior mediastinum being an enclosed space. CT guided biopsy of the mass cultured Mycobacterium TB complex which was resistant to isoniazide, rifampicin, streptomycin ofloxacin, moxifloxacin, and pyrazinamide. Hence, we report primary multi drug resistant TB presenting as anterior mediastinal mass as a rare case report.

  12. [Paraneoplastic limbic encephalitis with positive anti-RI antibodies and mediastinal seminoma].

    Science.gov (United States)

    Launay, M; Bozzolo, E; Venissac, N; Delmont, E; Fredenrich, A; Thomas, P

    2008-01-01

    We report the case of a 49-year-old man who was admitted for progressive behaviorial disorders with frontal elements. There was no sensorial nor motor deficiency. Clinical examination revealed android obesity, cutaneous and mucous paleness, pubic and axillary depilation and gynecomastia. Encephalic MRI found a lesion of the left amygdalian region with high T2 intensity and low T1 intensity associated with gadolinium-enhancement. Cerebrospinal fluid analysis showed a lymphocytic meningitis. Panhypopituitarism was found on the endocrine investigations. Anti-RI antibodies were positive, leading to the diagnosis of paraneoplastic limbic encephalitis. The CT-scan showed a node of the lower part of the thymic area. Surgical resection revealed an ectopic mediastinal seminoma. The evolution consisted of paraneoplastic fever and crossed-syndrome with right hemiparesia and left common oculomotor nerve paralysis. Treatment was completed by two cycles of carboplatin, corticosteroids and substitutive opotherapy. Paraneoplastic fever disappeared, but behavioral disorders and palsy remain unchanged. The patient died two years later in a bedridden state. This case of paraneoplastic limbic encephalitis associated with positive anti-RI antibodies and mediastinal seminoma is exceptional and has not to our knowledge been described in the literature. Cancers usually associated with anti-RI antibody are breast and lung cancer. Paraneoplastic limbic encephalitis is not the classical clinical presentation, which usually is brainstem encephalitis. Hypothalamic involvement, uncommon in paraneoplastic limbic encephalitis is mainly associated with positive antineuronal anti-Ma2 antibodies. Finally, the gadolinium enhancement on encephalic MRI is unusual in paraneoplastic limbic encephalitis.

  13. Parathyroid hormone and bone healing

    DEFF Research Database (Denmark)

    Ellegaard, M; Jørgensen, N R; Schwarz, P

    2010-01-01

    , no pharmacological treatments are available. There is therefore an unmet need for medications that can stimulate bone healing. Parathyroid hormone (PTH) is the first bone anabolic drug approved for the treatment of osteoporosis, and intriguingly a number of animal studies suggest that PTH could be beneficial...... in the treatment of fractures and could thus be a potentially new treatment option for induction of fracture healing in humans. Furthermore, fractures in animals with experimental conditions of impaired healing such as aging, estrogen withdrawal, and malnutrition can heal in an expedited manner after PTH treatment...

  14. Extended esophagolaryngeal resection with parathyroid autotransplantation.

    Science.gov (United States)

    Kourias, E; Arkadopoulos, N; Kostopanagiotou, G; Kinoglou, G; Smyrniotis, V

    1999-01-01

    Esopharyngolaryngeal resection for carcinoma of the cervical esophagus must be accompanied by resection of the thyroid gland, parathyroid bodies, and regional lymph nodes. In order to reduce long-term morbidity associated with the procedure, we performed parathyroid autotransplantation in two patients who underwent esophagolaryngeal resections. Grafting of the upper two parathyroid glands into the sternocleidomastoid muscle was carried out successfully in both cases. Graft function was rapidly restored. During the third postoperative week, blood levels of intact parathormone (PTH) reached 20 pg ml(-1) in the first case and 15 pg ml(-1) in the second, and the patients were successfully weaned off calcium and vitamin D supplementation. Parathyroid autotransplantation should be attempted in all cases of esophagolaryngeal resections provided that parathyroid glands are free of malignancy.

  15. Clinical audit of ectopic pregnancy

    OpenAIRE

    Hamid, Alaa Aldin Abdel; Yousry, Almraghy; El Radi, Safwat Abd; Shabaan, Omar Mamdouh; Mazen, Elzahry; Nabil, Halal

    2017-01-01

    Objective The aim of this study was to determine the risk factors of ectopic pregnancy in cases presented to the Woman?s Health Hospital (WHH) in Assuit University, and to perform clinical audit on strategies for management of ectopic pregnancy in the WHH. Methods This descriptive hospital based study was conducted at the Woman?s Health Hospital (WHH) of Assuit University (Egypt). There were 210 patients who were admitted to the WHH with the diagnosis of ectopic pregnancy in the period betwee...

  16. Isolated petrous apex ectopic craniopharyngioma

    Directory of Open Access Journals (Sweden)

    Julius July

    2015-12-01

    Full Text Available Primary ectopic craniopharyngioma is a rare entity. Isolated petrous apex bone location has not been reported previously. This study reports a case of 26-year-old male with right abducent nerve palsy. CT and MRI imaging reveal right petrous apex cystic lesion. No sellar or suprasellar region involvement was found. Endoscopic endonasal transphenoid approach has been successfully performed. Histopathology examination confirms the diagnosis of adamantinomatous craniopharyngioma. So far, it’s probably the first case report of primary ectopic craniopharyngioma isolated in the petrous apex. This case report supports the premise that primary ectopic craniopharyngioma is a multifactorial process that starts with an error from migrated embryological cells.

  17. Mediastinal lymph node tuberculosis in an adult: a case report

    OpenAIRE

    Alireza Emami Naeini; Abdolali Foroozmehr; Abbas Tabatabae

    2006-01-01

    Mediastinal lymph node enlargement is an uncommon feature of intrathoracic tuberculosis in adults, whereas it is the rule in primary tuberculosis in children. Herein, we report a 56–year-old female with three-year history of non-productive cough, which was diagnosed as mediastinal lymph node tuberculosis.

  18. Short and long-term impact of parathyroid autotransplantation on parathyroid function after total thyroidectomy

    Science.gov (United States)

    George, Robert; Sywak, Mark

    2017-01-01

    The most common complication of total thyroidectomy is parathyroid insufficiency. Acute, transient, post-operative hypoparathyroidism increases length of hospitalization, morbidity and cost associated with total thyroidectomy. While permanent hypoparathyroidism poses a significant medical burden with lifetime medication, regular follow up and considerable disease burden related to chronic renal failure and other sequelae. Parathyroid autotransplantation has been demonstrated to result in biochemically functional grafts, leading to the procedures’ common use during total thyroidectomy. The clearest indications for parathyroid auto transplantation are inadvertently removed or devascularized parathyroid glands. Some centers utilize routine autotransplantation to reduce the risk of permanent hypoparathyroidism. Novel fluorescence techniques to aid in parathyroid detection during thyroid surgery are under evaluation. This review aims to define the role and impact of parathyroid autotransplantation undertaken during total thyroidectomy. PMID:29322025

  19. Ectopic pregnancy: a diagnostic dilemma

    OpenAIRE

    Saha Pradip Kumar; Gupta Pratiksha; Goel Poonam; Sehgal Alka; Huria Anju; Shailja Kataria; Rimpy Tandon

    2016-01-01

    Background: To study the etiology, varied clinical presentations and misdiagnosis in ectopic pregnancy. Methods: A retrospective analysis of all operated ectopic pregnancies over a 7 year period at Government Medical College and hospital, Chandigarh was done. Details of clinical findings and misdiagnosis were noted. Surgically confirmed cases were included in this study. Expectant management and Medical management cases were excluded in this study. Results: Two hundred eighty two ca...

  20. 'Ectopic', 'Extrasensory' and 'Pregnancy Test'

    Directory of Open Access Journals (Sweden)

    Christa Donner

    2014-01-01

    Full Text Available Ectopic, Extrasensory and Pregnancy Test are paper art collages that turn the idea of reproduction literally upside down. The possibility of not being physically able to reproduce are considered in 'Ectopic' and 'Extrasensory', while 'Pregnancy Test' poses the more emotional/spiritual question of is it possible to have children and maintain a strong artistic identity? Often site specific, these works are difficult to reproduce for our viewing.

  1. [Early diagnosis of ectopic pregnancy].

    Science.gov (United States)

    Belics, Zoran; Gérecz, Balázs; Csákány, M György

    2014-07-20

    Ectopic pregnancy is a high-risk condition that occurs in 2% of reported pregnancies. This percentage is fivefold higher than that registered in the 1970s. Since 1970 there has been a two-fold increase in the ratio of ectopic pregnancies to all reported pregnancies in Hungary and in 2012 7.4 ectopic pregnancies per thousand registered pregnancies were reported. Recently, the majority (80%) of cases can be diagnosed in early stage, and the related mortality objectively decreased in the past few decades to 3.8/10,000 ectopic pregnancies. If a woman with positive pregnancy test has abdominal pain and/or vaginal bleeding the physician should perform a work-up to safely exclude the possibility of ectopic pregnancy. The basis of diagnosis is ultrasonography, especially vaginal ultrasound examination and measurement of the β-subunit of human chorionic gonadotropin. The ultrasound diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intrauterine pregnancy. In some questionable cases the diagnostic uterine curettage or laparoscopy may be useful. The actuality of this topic is justified by practical difficulties in obtaining correct diagnosis, especially in the early gestational time.

  2. Parathyroid hypertension. A reversible disorder.

    Science.gov (United States)

    Diamond, T W; Botha, J R; Wing, J; Meyers, A M; Kalk, W J

    1986-09-01

    A retrospective study of 75 patients who were surgically cured of primary hyperparathyroidism from 1976 to 1984 was performed to evaluate the blood pressure and metabolic responses to parathyroid surgery. Published data on the population prevalence of hypertension (HT) in South Africa were used for comparison. The overall prevalence of HT before surgery was 47%, compared with 23% in the general population. Hypertension was most frequent in patients older than 60 years (62% vs 39% expected). Renal insufficiency was found in 13 of 35 hypertensive patients and in two of 40 normotensive patients. However, the prevalence of HT in patients with normal creatinine levels (37%) exceeded that expected. The frequency of urolithiasis and mean levels of serum and urine calcium and phosphate were similar in normotensive and hypertensive patients. Parathyroidectomy resulted in a substantial fall in both mean systolic and mean diastolic blood pressures in 54% of the hypertensive subjects, unrelated to improvement in renal function.

  3. Mediastinal Mature Teratoma Revealed by Empyema

    Directory of Open Access Journals (Sweden)

    Mohammed Raoufi

    2016-01-01

    Full Text Available Teratomas are germ cell tumors, manifested with a great variety of clinical features; the most common extragonadal site is the anterior mediastinum. In this case, we report the patient with a large mature mediastinal teratoma with several components of ectodermal and endothermal epithelium. A 24-year-old female patient presented with history of persistent chest pain and progressively aggravating dyspnea for the previous 3 months. A chest X-ray showed a large opacity of the entire left hemithorax. Transcutaneous needle aspiration revealed a purulent fluid. The tube thoracostomy was introduced and the effusion was evacuated. Some weeks later, patient was seen in emergency for persistent cough and lateral chest pain. CT scan revealed a mass of the left hemithorax. The mass showed heterogeneous density, without compressing mediastinum great vessels and left hilar structures. Lipase value was elevated in needle aspiration. The patient underwent a total resection of the mediastinum mass via a left posterolateral thoracotomy. Microscopy revealed a mature teratoma with cystic structures. The patient subsequently made a full recovery. This case provide benign mediastinal teratoma with total atelectasis of left lung and elevated lipase value in needle transcutaneous aspiration; this event is explained by pancreatic component in the cystic tumor. Total removal of the tumor is adequate treatment for this type of teratoma and the prognosis is excellent.

  4. Mediastinal Choriocarcinoma Masquerading as Relapsed Hodgkin Lymphoma

    Directory of Open Access Journals (Sweden)

    Selay Lam

    2011-10-01

    Full Text Available Primary mediastinal choriocarcinoma is a rare extragonadal germ cell malignancy. We describe the first case of a patient who developed mediastinal choriocarcinoma after treatment for Hodgkin lymphoma (HL. A 25-year-old man with classic HL, nodular sclerosis subtype, underwent treatment with splenectomy followed by radiation therapy. Unfortunately, his disease relapsed with a paraspinal mass, and he was subsequently treated with MOPP (mechlorethamine, Oncovin, procarbazine, and prednisone alternating with ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine. He achieved a complete remission after 6 cycles. Ten years after treatment, the patient presented with a persistent cough, haemoptysis, right supraclavicular lymphadenopathy, and weight loss. His chest X-ray showed opacification of the lower right hemithorax with a widened mediastinum. Given unresponsiveness to several antibiotics and lack of evidence for lung volume loss, there were concerns over lung infiltration with relapsed lymphoma. Transbronchial fine needle aspiration biopsy suggested recurrence of his HL. MOPP alternating with ABVD was again given. Due to disease progression, brachytherapy as well as a cocktail of dexamethasone, cytarabine, and cisplatin were also tried. However, on a subsequent excisional lymph node biopsy, it turned out that the tumour was in fact choriocarcinoma and not relapsed HL. Unfortunately, despite aggressive therapy, the patient’s disease rapidly progressed, and he died within 2 weeks.

  5. Sternal reconstruction after post-sternotomy mediastinitis

    Directory of Open Access Journals (Sweden)

    Pankaj Kaul

    2017-11-01

    Full Text Available Abstract Background Deep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be treated as varying expressions of a singular pathology for reasons explained in the text. Methodology and review This article reviews the definition, prevalence, risk factors, prevention, diagnosis, microbiology and management of deep sternal wound infections and mediastinitis after cardiac surgery. The role of negative pressure wound therapy and initial and delayed surgical management is discussed with special emphasis on plastic techniques with muscle and omental flaps. Recent advances in reconstructive surgery are presented. Conclusions Deep sternal wound complications no longer spell debilitating morbidity and high mortality. Better understanding of risk factors that predispose to deep sternal wound complications and general improvement in theatre protocols for asepsis have dramatically reduced the incidence of deep sternal wound complications. Negative pressure wound therapy and appropriately timed and staged muscle or omental flap reconstruction have transformed the outcomes once these complications occur.

  6. Nonfunctional Parathyroid Carcinoma: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sang Gyu [Dankook University College of Medicine, Cheonan (Korea, Republic of)

    2010-11-15

    Parathyroid carcinoma is a rare endocrine malignancy accounting for 0.5% to 4.0% of all cases of hyperparathyroidism and commonly present as hypercalcemia and parathyroid hormone (PTH) elevation. Nonfunctional parathyroid carcinoma does not show symptoms of hyperparathyroidism and only showed a vague indication of being pathologic, even when detected late. The optimal treatment is en bloc resection of the cancer, but frequent local recurrence after surgery has been reported. Adjuvant local treatment such as radiotherapy may improve the likelihood local control in cases with incompletely resected or microscopic residual tumor. The results of this study point to a case of nonfunctional parathyroid carcinoma treated by external beam radiotherapy after en-bloc resection of cancer.

  7. Synchronous Parathyroid and Papillary Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Shi-Dou Lin

    2005-02-01

    Full Text Available Concomitant thyroid disease is not unusual among patients with primary hyperparathyroidism. However, the simultaneous occurrence of parathyroid and thyroid carcinoma is extremely rare. We report a 38-year-old man with primary hyperparathyroidism who presented with osteitis fibrosa cystica complicated with pathologic femoral neck fracture. Preoperative investigation for exclusion of multiple endocrine neoplasia did not find evidence of medullary thyroid carcinoma or pheochromocytoma, but imaging studies revealed the presence of nodules in the right lobe and a parathyroid lesion over the left inferior pole of the thyroid gland. Total thyroidectomy, left parathyroidectomy, and bipolar hemiarthroplasty of the left hip were then performed simultaneously. The resected specimens were pathologically identified as papillary thyroid carcinoma and parathyroid carcinoma, respectively. After the operation, 131I ablation therapy was administered at a dose of 120 mCi. Additional doses of 30 mCi were given yearly as serum thyroglobulin level became elevated. Serum calcium level remained normal during yearly follow-up. Although parathyroid carcinoma is an uncommon cause of parathyroid hormone-dependent hypercalcemia, it should nonetheless be given due consideration because its surgical approach differs from that of parathyroid adenoma. As the coexistence of parathyroid and non-medullary thyroid carcinoma has previously been reported, the possibility of both malignancies must also be considered in the setting of primary hyperparathyroidism with thyroid nodules. If confirmed with preoperative parathyroid scintigraphic and other laboratory studies, an optimal outcome may be achieved with complete resection of both tumors at the time of initial operation, followed by adjunctive therapy.

  8. The history of the parathyroid surgery

    OpenAIRE

    Toneto, Marcelo Garcia; Prill, Shandi; Debon, Leticia Manoel; Furlan, Fernando Zucuni; Steffen, Nedio

    2016-01-01

    ABSTRACT The authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism. Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first de...

  9. A proteomic approach to study parathyroid glands.

    Science.gov (United States)

    Giusti, Laura; Cetani, Filomena; Ciregia, Federica; Da Valle, Ylenia; Donadio, Elena; Giannaccini, Gino; Banti, Chiara; Pardi, Elena; Saponaro, Federica; Basolo, Fulvio; Berti, Piero; Miccoli, Paolo; Pinchera, Aldo; Marcocci, Claudio; Lucacchini, Antonio

    2011-03-01

    Parathyroid tumours are heterogeneous and in some cases the diagnosis may be difficult using histological features. In this study we used a two-dimensional electrophoresis (2D)/mass spectrometry (MS)-based approach to examine the global changes of parathyroid adenoma tissues protein profile compared to the parathyroid normal tissues. Validation of protein expression was performed by immunoblotting using specific antibodies. Ingenuity software was used to identify the biological processes to which these proteins belong and to construct a potential network. A total of 30 proteins were found to be differentially expressed, of which 22 resulted in being over-expressed. Proteins identified by 2D/MS/MS proteomics were classified into functional categories and a major change (≥ 2-fold) in terms of expression was found in proteins involved in response to biotic stimuli, cell organization and signal transduction. After Ingenuity analysis, 14-3-3 ζ/δ appears to be a key protein in the network of parathyroid adenoma, where it is linked to other proteins such as annexin A2, B box and SPRY domain-containing protein (BSPRY), p53 and epidermal growth factor receptor (EGFR). Our results suggest that the proteomic approach was able to differentiate the protein profiles of normal parathyroid and parathyroid adenoma and identify a panel of proteins which are differentially expressed. The functional role of these proteins in the network of intracellular pathways is discussed.

  10. Parathyroid cysts: the Latin-American experience.

    Science.gov (United States)

    Román-González, Alejandro; Aristizábal, Natalia; Aguilar, Carolina; Palacios, Karen; Pérez, Juan Camilo; Vélez-Hoyos, Alejandro; Duque, Carlos Simon; Sanabria, Alvaro

    2016-12-01

    Parathyroid cyst is an infrequent and unsuspected disease. There are more than 300 hundred cases reported in the world literature, a few of them are from Latin America. The experience of our centers and a review of the cases are presented. Case report of a series of patients with parathyroid cyst from our institutions according to the CARE guidelines (Case Reports). A search of Medline, Embase, BIREME (Biblioteca Regional de Medicina) LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), Google Scholar and Scielo (Scientific Electronic Library on Line) databases and telephonic or email communications with other experts from Latin-America was performed . Six patients with parathyroid cyst were found in our centers in Colombia. Most of them were managed with aspiration of the cyst. Two of them required surgery. Only one case was functional. Twelve reports from Latin America were found for a total of 18 cases in our region adding ours. Parathyroid cysts are uncommonly reported in Latin America. Most of them are diagnosed postoperatively. Suspicion for parathyroid cyst should be raised when a crystal clear fluid is aspirated from a cyst. The confirmation of the diagnosis may be easily done if parathyroid hormone (PTH) level is measured in the cyst fluid.

  11. CT diagnosis of the fat containing mediastinal masses: Excluding teratoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soo; Chung, Sung Hoon; Im, Jung Gi [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1985-12-15

    Fat containing masses, except mediastinal lipomatosis, of the thorax are uncommon. In spite of uncommon occurrences, as CT can detect not only the fat content but also the presence and character of the non-fatty component of the mass, accurate preoperative diagnosis can usually be made in most cases of fat containing mediastinal masses. Authors report 6 cases of containing mediastinal masses, that were diagnosed preoperatively by CT scan, comprising 2 cases of limpoma (combined with plexiform neuofibroma in a case), 1 liposarcoma, 1 thymolipoma, and 2 cases of omental hernia through Morgagni foramen.

  12. Clinicoroentgenological diagnosis of mediastinal lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Vinner, M.G.; Khudyakov, L.M. (Sverdlovskij Meditsinskij Inst. (USSR))

    There was described a typical pulmonary picture (28 cases) and present differential diagnostic features permitting one to differentiate these patients from those with Hodgkin disease, sarcoidosis and tuberculous bronchadenitis. The main clinical signs that make it possible to establish a correct diagnosis are old age, chest pains and dry cough, accelerated ESR; the roentgenological signs are the unilateral enlargement of the peribronchial lymph nodes. Enlarged lymph nodes merge into a conglomerate with tuberous, ill defined contours. These lymph nodes are located or projected in the central mediastinum leaving the retroperitoneal space free. This outside compression often causes the narrowing of the main bronchi. Clinicoroentgenological diagnosis of mediastinal cancer is usually confirmed at biopsy. A small atypical group (9 cases) where the leading role in diagnosis is played by biopsy, is singled out.

  13. Liposarcoma gigante de mediastino Giant mediastinal liposarcoma

    Directory of Open Access Journals (Sweden)

    Manuel César Fontes Maestri

    2007-06-01

    Full Text Available El liposarcoma es, entre los sarcomas, el tumor maligno de los tejidos blandos más frecuente en el adulto. Se presenta un caso de liposarcoma situado en el mediastino, localización infrecuente, y que resultó ser un liposarcoma bien diferenciado. El paciente fue un hombre de 48 años de edad que ingresa en la Sala de Neumotisiología con disnea y una masa mediastínica situada hacia el hemitórax izquierdo. Se estudió con radiografía de tórax anteroposterior y lateral y, además, con tomografía axial computadorizada. Fue necesaria una toracotomía con urgencia relativa por la agudización del cuadro clínico mediastínico compresivo. La evolución fue buena durante la intervención quirúrgica y después de ella y actualmente ha concluido su tratamiento adyuvante (radioterapia y quimioterapia y se siente bienLiposarcoma is the most frequent malignant soft tissue tumor. This article presented a case of well-differentiated liposarcoma located in the mediastinum, which is a rare location. The patient was a 48 years-old man that was admitted to the pneumothysiology service because he was short of breath and had a mediastinal mass located near left hemithorax. He was studied using anteroposterior and lateral thoracic radiography in addition to computerized tomography. It was necessary to urgently perform thorachotomy due to his acute clinical picture with mediastinal compression. The patient evolved positively during surgery and afterwards; at present, he has finished his adjuvant treatment based on radiotherapy and chemotherapy and he feels good

  14. Heterochronic bilateral ectopic pregnancy after ovulation induction.

    Science.gov (United States)

    Zhu, Bo; Xu, Gu-feng; Liu, Yi-feng; Qu, Fan; Yao, Wei-miao; Zhu, Yi-min; Gao, Hui-juan; Zhang, Dan

    2014-08-01

    Ectopic pregnancy is identified with the widely-applied assisted reproductive technology (ART). Bilateral ectopic pregnancy is a rare form of ectopic pregnancy which is difficult to be diagnosed at the pre-operation stage. In this paper, we presented an unusual case of heterochronic bilateral ectopic pregnancy after stimulated intrauterine insemination (IUI), where there has been a delay of 22 d between the diagnoses of the two ectopic pregnancies. Literature was reviewed on the occurrence of bilateral ectopic pregnancy during the past four years in the MEDLINE database. We found 16 cases of bilateral ectopic pregnancy reported since 2008, and analyzed the characteristics of those cases of bilateral ectopic pregnancy. We emphasize that ovulation induction and other ARTs may increase the risk of bilateral ectopic pregnancy. Because of the difficulty in identification of bilateral ectopic pregnancy by ultrasonography, the clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operation inspection of both side fallopian tubes in any ectopic pregnancy case.

  15. Leptin Is Produced by Parathyroid Glands and Stimulates Parathyroid Hormone Secretion.

    Science.gov (United States)

    Hoang, Don; Broer, Niclas; Sosa, Julie A; Abitbol, Nathalie; Yao, Xiaopan; Li, Fangyong; Rivera-Molina, Felix; Toomre, Derek K; Roman, Sanziana A; Sue, Gloria; Kim, Samuel; Li, Alexander Y; Callender, Glenda G; Simpson, Christine; Narayan, Deepak

    2017-12-01

    We asked if leptin and its cognate receptor were present in normal and diseased parathyroid glands, and if so, whether they had any functional effects on parathyroid hormone (PTH) secretion in parathyroid neoplasms. The parathyroid glands acting through PTH play a critical role in the regulation of serum calcium. Based on leptin's recently discovered role in bone metabolism, we hypothesized these glands were the sites of a functional interaction between these 2 hormones. From July 2010 to July 2011, 96 patients were enrolled in a prospective study of leptin and hyperparathyroidism, all of whom were enrolled based on their diagnosis of hyperparathyroidism, and their candidacy for surgical intervention provided informed consent. Immediately after parathyroidectomy, 100 to 300 mg of adenomatous or hyperplastic diseased parathyroid tissue was prepared and processed according to requirements of the following: in situ hybridization, immunohistochemistry, immunofluorescence by conventional and spinning disc confocal microscopy, electron microscopy, parathyroid culture, whole organ explant, and animal model assays. Leptin, leptin receptor (long isoform), and PTH mRNA transcripts and protein were detected in an overlapping fashion in parathyroid chief cells in adenoma and hyperplastic glands, and also in normal parathyroid by in situ hybridization, qRT-PCR, and immunohistochemistry. Confocal microscopy confirmed active exogenous leptin uptake in cultured parathyroid cells. PTH secretion in explants increased in response to leptin and decreased with leptin receptor signaling inhibition by AG490, a JAK2/STAT3 inhibitor. Ob/ob mice injected with mouse leptin exhibited increased PTH levels from baseline. Taken together, these data suggest that leptin is a functionally active product of the parathyroid glands and stimulates PTH release.

  16. Mycoplasma hominis Induces Mediastinitis after a Tonsillar Abscess

    Directory of Open Access Journals (Sweden)

    Anna Grancini

    2016-01-01

    Full Text Available Mycoplasma hominis is commonly involved in genitourinary tract infections. We report a 59-year-old man who developed a M. hominis-associated mediastinitis following acute tonsillar infection.

  17. A case of mediastinitis accompanied with hyperosmolar nonketotic coma

    Directory of Open Access Journals (Sweden)

    Mazhar Muslum Tuna

    2016-06-01

    Full Text Available Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling. Keywords: Mediastinitis, Nonketotic hyperglycemic coma, Pleural effusion

  18. 135. Mediastinitis postoperatoria: factores de riesgo, supervivencia y estancia hospitalaria

    Directory of Open Access Journals (Sweden)

    L. Riesco de la Vega

    2010-01-01

    Conclusiones: La incidencia de mediastinitis en nuestra población de pacientes es de un 2,2%. Edad, EPOC, obesidad, uso de arteria mamaria y reintervención son factores de riesgo independientes de esta complicación. La mediastinitis es una complicación grave, con una alta mortalidad (25,4%, y que conlleva una prolongación de la estancia en UCI y hospitalaria, con el consecuente consumo de recursos sanitarios.

  19. Post-sternotomy mediastinitis in the modern era.

    Science.gov (United States)

    Goh, Siew S C

    2017-09-01

    Post-sternotomy mediastinitis is associated with significant mortality and morbidity. Despite surgical advances in cardiac surgery and improvements in perioperative care, mediastinitis remains a devastating post-operative complication. This study provides a comprehension review of post-sternotomy mediastinitis in the modern era, and discusses the incidence, risk factors, microbiology, prevention, and management of this complication. This review was based on a PubMed/MEDLINE literature search up until 9th March 2017 for publications relevant to mediastinitis post-cardiac surgery. The incidence of mediastinitis post-cardiac surgery varies between 0.3 and 3.4%, and is associated with an in-hospital mortality ranging from from 1.1 to 19%. The risk of developing post-operative mediastinitis is dependent on the patients' co-morbidities (diabetes, obesity, smoking, renal failure) and surgical techniques (bilateral pedicled internal mammary harvest, excessive cautery, long duration of surgery). Preventative measures including skin and nasal decontamination, antibiotic prophylaxis, strict glycemic control, and meticulous surgical techniques are crucial in reducing the risk. Treatment of post-operative mediastinitis include culture-directed antibiotic therapy, early wound exploration, and debridement followed by sternal reconstruction/closure. Vacuum-assisted therapy can be used as a single line therapy or as a bridge to eventual sternal reconstruction/closure. Post-sternotomy mediastinitis remains a potentially fatal complication of cardiac surgery despite the advancements in the perioperative care in the modern era. Management on preventative measures, prompt diagnosis, and managements are crucial in reducing associated mortality and morbidity. © 2017 Wiley Periodicals, Inc.

  20. Prolonged remission of hypercalcaemia due to parathyroid carcinoma with pamidronate.

    Science.gov (United States)

    Newrick, P G; Braatvedt, G D; Webb, A J; Sheffield, E; Corrall, R J

    1994-03-01

    Parathyroid carcinoma is rare and the associated hypercalcaemia is often resistant to all treatment. A case is described in which prolonged control of hypercalcaemia has been achieved by infrequent infusions of pamidronate despite continuing hypersecretion of parathyroid hormone.

  1. Prolonged remission of hypercalcaemia due to parathyroid carcinoma with pamidronate.

    OpenAIRE

    Newrick, P G; Braatvedt, G D; Webb, A. J.; Sheffield, E; Corrall, R J

    1994-01-01

    Parathyroid carcinoma is rare and the associated hypercalcaemia is often resistant to all treatment. A case is described in which prolonged control of hypercalcaemia has been achieved by infrequent infusions of pamidronate despite continuing hypersecretion of parathyroid hormone.

  2. Imaging in mediastinitis: a systematic review based on aetiology

    Energy Technology Data Exchange (ETDEWEB)

    Akman, C. E-mail: cakman11@superonline.com; Kantarci, F.; Cetinkaya, S

    2004-07-01

    Mediastinitis refers to inflammation of the tissues located in the middle chest cavity. It can be secondary to infectious or non-infectious causes and depending on the aetiology may be acute or chronic. The majority of cases of acute mediastinitis are secondary to oesophageal perforation and open chest surgery. Less common causes include tracheal, bronchial perforation or direct extension of infection from adjacent tissues. Chronic or slowly developing mediastinitis mostly arise from tuberculosis, histoplasmosis, other fungal infections, cancer, or sarcoidosis. In a minority of cases the aetiology is lymphatic obstruction or an autoimmune disease. Radiological imaging plays an essential role in the diagnosis and therapeutic approach to mediastinitis. Generally, the initial radiological work-up includes radiographic studies either with or without contrast material. However, conventional chest radiography may be misleading in the diagnosis of mediastinitis. Cross-sectional imaging techniques are generally required for diagnosis and evaluation of the site and extent of mediastinal involvement. Computed tomography and magnetic resonance imaging may also guide the choice of the optimal therapeutic approach.

  3. [Rare abnormalities of parathyroid gland function and parathyroid hormone receptor action].

    Science.gov (United States)

    Krysiak, Robert; Bartecka, Anna; Okopień, Bogusław

    2014-01-01

    The parathyroid glands, located near or within the posterior surface of the thyroid gland and secreting parathyroid hormone, are essential organs for the regulation of calcium and phosphate metabolism. As they are necessary to sustain life and maintain homeostasis, undetected or misdiagnosed parathyroid disorders may pose a significant threat to health outcomes, as their presence may increase morbidity and mortality in affected individuals. The clinical picture of some disorders associated with abnormal parathyroid hormone secretion and receptor action is sometimes complicated by coexisting abnormalities, and in these cases establishing the correct diagnosis is challenging. The remarkable progress of recent years in the area of hormonal assessment, imaging procedures and molecular biology, has resulted in a great improvement in the identification, differentiation and treatment of various parathyroid disorders and has made it possible to identify several new clinical entities. In this paper, we discuss the present state-of-art on the etiopathogenesis, clinical manifestations, diagnosis and treatment of chosen rare abnormalities of parathyroid gland function and parathyroid hormone receptor action.

  4. Magnesium modulates parathyroid hormone secretion and upregulates parathyroid receptor expression at moderately low calcium concentration.

    Science.gov (United States)

    Rodríguez-Ortiz, Maria E; Canalejo, Antonio; Herencia, Carmen; Martínez-Moreno, Julio M; Peralta-Ramírez, Alan; Perez-Martinez, Pablo; Navarro-González, Juan F; Rodríguez, Mariano; Peter, Mirjam; Gundlach, Kristina; Steppan, Sonja; Passlick-Deetjen, Jutta; Muñoz-Castañeda, Juan R; Almaden, Yolanda

    2014-02-01

    The interest on magnesium (Mg) has grown since clinical studies have shown the efficacy of Mg-containing phosphate binders. However, some concern has arisen for the potential effect of increased serum Mg on parathyroid hormone (PTH) secretion. Our objective was to evaluate the direct effect of Mg in the regulation of the parathyroid function; specifically, PTH secretion and the expression of parathyroid cell receptors: CaR, the vitamin D receptor (VDR) and FGFR1/Klotho. The work was performed in vitro by incubating intact rat parathyroid glands in different calcium (Ca) and Mg concentrations. Increasing Mg concentrations from 0.5 to 2 mM produced a left shift of PTH-Ca curves. With Mg 5 mM, the secretory response was practically abolished. Mg was able to reduce PTH only if parathyroid glands were exposed to moderately low Ca concentrations; with normal-high Ca concentrations, the effect of Mg on PTH inhibition was minor or absent. After 6-h incubation at a Ca concentration of 1.0 mM, the expression of parathyroid CaR, VDR, FGFR1 and Klotho (at mRNA and protein levels) was increased with a Mg concentration of 2.0 when compared with 0.5 mM. Mg reduces PTH secretion mainly when a moderate low calcium concentration is present; Mg also modulates parathyroid glands function through upregulation of the key cellular receptors CaR, VDR and FGF23/Klotho system.

  5. Association of parathyroid carcinoma and thyroid disorders: A clinical review.

    Science.gov (United States)

    Campennì, Alfredo; Giovinazzo, Salvatore; Pignata, Salvatore Antonio; Di Mauro, Francesca; Santoro, Domenico; Curtò, Lorenzo; Trimarchi, Francesco; Ruggeri, Rosaria Maddalena; Baldari, Sergio

    2017-04-01

    Parathyroid carcinoma is a rare malignancy, which usually occurs as a sporadic disease, and less frequently in the setting of genetic syndromes. Despite the association of parathyroid and thyroid disorders being quite common, the coexistence of parathyroid carcinoma and thyroid disease is rare. We reviewed the pertinent literature. The terms "parathyroid carcinoma" and "thyroid disease, hyperthyroidism, thyrotoxicosis, hypothyroidism, thyroid nodule(s), Graves' disease, autonomously functioning thyroid nodules" were used both separately and in reciprocal conjunction to search MEDLINE for articles published from January 2007 to March 2016. The search was prompted by the observation of a never reported association of autonomously functioning thyroid nodules and parathyroid carcinoma. Two hundred and twenty-one parathyroid carcinoma patients have been described during the last 10 years. Neck ultrasonography and parathyroid scintigraphy are the most common instrumental studies used in detecting parathyroid lesions. Serum parathyroid hormone and calcium levels are high in the majority of parathyroid carcinoma patients. Only 21 patients with parathyroid carcinoma and thyroid disorders were found. Our patient is the first casual association between parathyroid carcinoma and autonomously functioning thyroid nodules reported in literature and diagnosed using parathyroid and thyroid scintigraphies. Parathyroid carcinoma is a very rare endocrine tumor and association with thyroid disease is not frequent. Parathyroid carcinoma pre-operative diagnosis is often difficult also because available literature data are not homogenous and there is not a common operative guideline. Our case confirms the role of parathyroid scintigraphy, encouraging the association with thyroid scintigraphy, especially in the presence of (multi)-nodular goiter in order to address the most appropriate surgical management.

  6. Parathyroid hormone – possible future drug for orthopedic surgery

    OpenAIRE

    Aleksynienė, Ramūnė; Hvid, Ivan

    2004-01-01

    Parathyroid hormone naturally secreted by the parathyroid glands is a potent anabolic agent for bone. Parathyroid hormone is primarily thought of as a catabolic protein involved in the physiologic release of calcium from bone. Whereas during recent years, a number of animal studies and clinical trials have demonstrated that intermittent parathyroid hormone administration induces anabolic effects on both cancellous and cortical bone, enhances bone mass and increases mechanical strength of the ...

  7. The impact of recombinant parathyroid hormone on malignancies and mortality

    DEFF Research Database (Denmark)

    Bang, U C; Hyldstrup, L; Jensen, J E B

    2014-01-01

    We used Danish registers to identify patients with osteoporosis, who had been treated with parathyroid hormone and evaluated the probability of developing cancer. We did not find an increased risk of cancer among the patients treated with parathyroid hormone.......We used Danish registers to identify patients with osteoporosis, who had been treated with parathyroid hormone and evaluated the probability of developing cancer. We did not find an increased risk of cancer among the patients treated with parathyroid hormone....

  8. Clinical audit of ectopic pregnancy.

    Science.gov (United States)

    Hamid, Alaa Aldin Abdel; Yousry, Almraghy; El Radi, Safwat Abd; Shabaan, Omar Mamdouh; Mazen, Elzahry; Nabil, Halal

    2017-03-01

    The aim of this study was to determine the risk factors of ectopic pregnancy in cases presented to the Woman's Health Hospital (WHH) in Assuit University, and to perform clinical audit on strategies for management of ectopic pregnancy in the WHH. This descriptive hospital based study was conducted at the Woman's Health Hospital (WHH) of Assuit University (Egypt). There were 210 patients who were admitted to the WHH with the diagnosis of ectopic pregnancy in the period between February 1, 2015 through the end of October 2015. Data were analyzed by SPSS version 21, using descriptive statistics, Mann-Whitney U test, and Chi square. Ectopic pregnancy affects woman in the reproductive age. There are many risk factors that increase the chance of its occurrence; however, it may also occur in the absence of any risk factors (14.0%). Internal VD (72.5%) is the most frequent risk factor; other risk factors include history of abortion, previous CS, ovulation induction, history of infertility, or previous history of EP. Clinical audit is an important item of any adequate health care. As regards to the clinical audit of EP management, we are not adhering to the guidelines.

  9. The Flexibility of Ectopic Lipids.

    Science.gov (United States)

    Loher, Hannah; Kreis, Roland; Boesch, Chris; Christ, Emanuel

    2016-09-14

    In addition to the subcutaneous and the visceral fat tissue, lipids can also be stored in non-adipose tissue such as in hepatocytes (intrahepatocellular lipids; IHCL), skeletal (intramyocellular lipids; IMCL) or cardiac muscle cells (intracardiomyocellular lipids; ICCL). Ectopic lipids are flexible fuel stores that can be depleted by physical exercise and repleted by diet. They are related to obesity and insulin resistance. Quantification of IMCL was initially performed invasively, using muscle biopsies with biochemical and/or histological analysis. ¹H-magnetic resonance spectroscopy (¹H-MRS) is now a validated method that allows for not only quantifying IMCL non-invasively and repeatedly, but also assessing IHCL and ICCL. This review summarizes the current available knowledge on the flexibility of ectopic lipids. The available evidence suggests a complex interplay between quantitative and qualitative diet, fat availability (fat mass), insulin action, and physical exercise, all important factors that influence the flexibility of ectopic lipids. Furthermore, the time frame of the intervention on these parameters (short-term vs. long-term) appears to be critical. Consequently, standardization of physical activity and diet are critical when assessing ectopic lipids in predefined clinical situations.

  10. Shear wave elastography and parathyroid adenoma: A new tool for diagnosing parathyroid adenomas.

    Science.gov (United States)

    Azizi, Ghobad; Piper, Kelé; Keller, James M; Mayo, Michelle L; Puett, David; Earp, Karly M; Malchoff, Carl D

    2016-09-01

    This study prospectively determines the shear wave elastography characteristics of parathyroid adenomas using virtual touch imaging quantification, a non-invasive ultrasound based shear wave elastography method. This prospective study examined 57 consecutive patients with biochemically proven primary hyperparathyroidism and solitary parathyroid adenoma identified by ultrasound and confirmed by at least one of the following: surgical resection, positive Technetium-99m Sestamibi Scintigraphy (MIBI) scan, or fine needle aspiration biopsy with positive PTH washout (performed only in MIBI negative patients). Vascularity and shear wave elastography were performed for all patients. Parathyroid adenoma stiffness was measured as shear wave velocity in meters per second. The median (range) pre-surgical value for PTH and calcium were 58pg/mL (19, 427) and 10.8mg/dL (9.5, 12.1), respectively. 37 patients had positive MIBI scan. 20 patients had negative MIBI scan but diagnosis was confirmed with positive PTH washout. 42 patients underwent parathyroidectomy, and an adenoma was confirmed in all. The median (range) shear wave velocity for all parathyroid adenomas enrolled in this study was 2.02m/s (1.53, 2.50). The median (range) shear wave velocity for thyroid tissue was 2.77m/s (1.89, 3.70). The shear wave velocity of the adenomas was independent of adenoma size, serum parathyroid hormone concentration, or plasma parathyroid hormone concentration. Tissue elasticity of parathyroid adenoma is significantly lower than thyroid tissue. B-mode features and distinct vascularity pattern are helpful tools in diagnosing parathyroid adenoma with ultrasound. Shear wave elastography may provide valuable information in diagnosing parathyroid adenoma. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  11. Parathyroid hormone secretion in chronic renal failure

    DEFF Research Database (Denmark)

    Madsen, J C; Rasmussen, A Q; Ladefoged, S D

    1996-01-01

    The aim of study was to introduce and evaluate a method for quantifying the parathyroid hormone (PTH) secretion during hemodialysis in secondary hyperparathyroidism due to end-stage renal failure. We developed a method suitable for inducing sequential hypocalcemia and hypercalcemia during....../ionized calcium curves were constructed, and a mean calcium set-point of 1.16 mmol/liter was estimated compared to the normal mean of about 1.13 mmol/liter. In conclusion, we demonstrate that it is important to use a standardized method to evaluate parathyroid hormone dynamics in chronic renal failure. By the use...... of a standardized method we show that the calcium set-point is normal or slightly elevated, indicating normal parathyroid reactivity to calcium in chronic renal failure....

  12. Parathyroid hormone secretion in chronic renal failure

    DEFF Research Database (Denmark)

    Madsen, J C; Rasmussen, A Q; Ladefoged, S D

    1996-01-01

    /ionized calcium curves were constructed, and a mean calcium set-point of 1.16 mmol/liter was estimated compared to the normal mean of about 1.13 mmol/liter. In conclusion, we demonstrate that it is important to use a standardized method to evaluate parathyroid hormone dynamics in chronic renal failure. By the use...... of a standardized method we show that the calcium set-point is normal or slightly elevated, indicating normal parathyroid reactivity to calcium in chronic renal failure.......The aim of study was to introduce and evaluate a method for quantifying the parathyroid hormone (PTH) secretion during hemodialysis in secondary hyperparathyroidism due to end-stage renal failure. We developed a method suitable for inducing sequential hypocalcemia and hypercalcemia during...

  13. Ehlers-Danlos syndrome with parathyroid adenoma for excision ...

    African Journals Online (AJOL)

    Ehlers-Danlos syndrome (EDS) consists of a group of connective tissue disorders characterised by hyperelasticity of the skin and hypermobile joints. Parathyroid adenoma results in increased parathyroid hormone secretion. We report the case of a 20-year-old male patient with EDS and parathyroid adenoma, who ...

  14. Intrathyroidal parathyroid glands: small, but mighty (a Napoleon phenomenon).

    Science.gov (United States)

    Mazeh, Haggi; Kouniavsky, Guennadi; Schneider, David F; Makris, Konstantinos I; Sippel, Rebecca S; Dackiw, Alan P B; Chen, Herbert; Zeiger, Martha A

    2012-12-01

    Intrathyroidal parathyroid adenomas (ITPAs) are a rare entity. The aim of this study is to describe the experience of 2 endocrine surgery centers and to distinguish characteristics of intrathyroidal parathyroid adenoma and nonintrathyroidal parathyroid adenomas. We included patients who had undergone operations for primary hyperparathyroidism who had intrathyroidal parathyroid adenomas. Patients with single intrathyroidal parathyroid adenomas were also compared to age- and sex-matched controls with nonintrathyroidal parathyroid adenomas. Of 4,868 patients who underwent parathyroidectomy between January 2002 and June 2011, we identified 53 (1%) patients with intrathyroidal parathyroid adenoma. Sestamibi and ultrasound scans correctly identified the adenoma in 35 (70%) and 11 (61%) cases, respectively. Single adenomas were identified in 44 (83%) patients, double adenomas in 4 (8%) patients, and hyperplasia in 5 (9%) patients. Lobectomy was performed in 17 (32%) patients; enucleation was used in 36 (68%) patients. Cure was achieved in all patients and no patients experienced a recurrence. Patients with single intrathyroidal parathyroid adenomas had significantly smaller glands than patients with nonintrathyroidal parathyroid adenomas (325 ± 47 vs 772 ± 61 mg; P < .0001); however, no significant difference was identified between the groups with regard to demographics, symptoms, preoperative laboratory values, or outcomes. Single intrathyroidal parathyroid adenomas are smaller than nonintrathyroidal parathyroid adenomas, but patients with intrathyroidal parathyroid adenomas present with similar laboratory values and symptoms. Recognition of this rare entity can lead to a successful surgical outcome. Copyright © 2012 Mosby, Inc. All rights reserved.

  15. Parathyroid adenocarcinoma in a nephropathic Persian cat.

    Science.gov (United States)

    Cavana, Paola; Vittone, Valentina; Capucchio, Maria T; Farca, Anna M

    2006-10-01

    This report describes an uncommon clinical case of cystic parathyroid adenocarcinoma. A 17-year-old male Persian cat was presented for evaluation of a ventral cervical mass. The cat was inappetent and showed weight loss, polydipsia and vomiting. Serum biochemistry and urinalysis revealed moderate hypercalcaemia, a mild increase of creatinine, isosthenuria and proteinuria. Sodium dodecyl sulphate-agarose gel electrophoresis showed a mixed tubular proteinuric pattern, in accordance with histological examination that revealed interstitial nephritis and glomerulonephritis. Diagnosis of parathyroid carcinoma was based on histopathological findings.

  16. The reptilian thyroid and parathyroid glands.

    Science.gov (United States)

    Rivera, Sam; Lock, Brad

    2008-01-01

    The field of reptilian clinical endocrinology is still in its infancy. The thyroid and parathyroid glands are intimately involved with many basic metabolic functions. These glands have been the subject of extensive research studies in reptilian species; however, the effects of abnormal gland function have been poorly documented in clinical cases. These glands play a major role in maintaining physiologic homeostasis in all vertebrates. With the advent of more sensitive assays, it should be possible to measure the small amounts of hormones found in reptilian species. The purpose of this article is to review the literature regarding clinical endocrinology of the thyroid and parathyroid glands in reptiles.

  17. Magnetic Resonance Imaging of Thyroid and Parathyroid

    Directory of Open Access Journals (Sweden)

    Miguel GONZALO-DOMÍNGUEZ

    2017-05-01

    Full Text Available Introduction: The assessment of the thyroid and parathyroid pathology is usually achieved with ultrasounds. There are several systems of classification that are internationally accepted in neoplastic disease, such as TIRADS system, and there are well-defined patterns for ultrasound imaging in inflammatory disease. Material and methods: However, there are specific needs that require magnetic resonance imaging. We review the main indications of MRI in the evaluation of thyroid and parathyroid in 64 patients and determine which protocols are more appropriate and which sequences are better for a proper characterization. Results: Then we review the semiology obtained by this technique, making correlation with disease processes affecting these cervical structures.

  18. Upper thymic prolongation simulating mediastinal lymphadenomegaly

    Directory of Open Access Journals (Sweden)

    Cristiane Wosny

    2009-09-01

    Full Text Available The thymus is located in the anterior portion of the upper mediastinum, immediately behind the sternal manubrium, and extends to the anterior mediastinum, anteriorly to the pericardium. Two patients were evaluated due to nodulations at the transition from the cervical region to the anterior mediastinum, which simulated lymphadenomegaly. The first patient, a seven-year-old male, presented with a rhabdomyosarcoma of the masticatory space; during progressive follow-up, a nodule was noted with FDG uptake on the positron emission tomography coupled with the computed tomography (PET-CT. The second patient, a 51-year-old female, presented with a nodulation characterized on the magnetic resonance image for follow-up of a papilliferous carcinoma of the thyroid. In both cases, the nodulation displayed an upper prolongation of the thymus. These nodulations showed the same density on the computed tomography and the same signal intensity on the magnetic resonance image as the adjacent thymic tissue, and there was no adipose tissue layer between the nodulations and the thymus. Knowledge of the upper prolongation of the thymus as an anatomical variation is vital for differentiating it from mediastinal lymphadenomegaly, thus avoiding unnecessary biopsies or procedures.

  19. The management of acute parathyroid crisis secondary to parathyroid carcinoma: a case report

    Directory of Open Access Journals (Sweden)

    O'Malley Diarmuid

    2010-01-01

    Full Text Available Abstract Introduction Hypercalcaemic hyperparathyroid crisis is a rare but life-threatening complication of primary hyperparathyroidism. Parathyroid carcinoma is a rare malignancy with an incidence of 0.5% to 4% of all reported cases of primary hyperparathyroidism. Case presentation We report the case of a 60-year-old Caucasian man with hypercalcaemic hyperparathyroid crisis associated with parathyroid carcinoma. He presented with a classic hypercalcaemic syndrome and his serum calcium and parathyroid hormone levels were at 4.65 mmol/L and 1743 ng/L, respectively. He initially presented with a two-week history of weakness and lethargy and a one-week history of vomiting, polyuria and polydipsia. An emergency left thyroid lobectomy and left lower parathyroidectomy were performed. There was a prompt decrease in his parathyroid hormone level immediately after surgery. Histology revealed that our patient had a 4-cm parathyroid carcinoma. Conclusion In patients with parathyroid carcinoma, the optimal surgical treatment is en bloc resection with ipsilateral thyroid lobectomy and removal of any enlarged or abnormal lymph nodes. Surgery is the only curative treatment. In our patient, prompt surgical intervention proved successful. At six months the patient is well with no evidence of disease recurrence. This case highlights the importance of considering a hyperparathyroid storm in the context of a parathyroid carcinoma. Parathyroid carcinoma is a rare entity and our knowledge is mainly derived from case reports and retrospective studies. This case report increases awareness of this serious and life-threatening complication. This report also illustrates how prompt and appropriate management provides the best outcome for the patient.

  20. The management of acute parathyroid crisis secondary to parathyroid carcinoma: a case report.

    LENUS (Irish Health Repository)

    Rock, Kathy

    2010-01-01

    ABSTRACT: INTRODUCTION: Hypercalcaemic hyperparathyroid crisis is a rare but life-threatening complication of primary hyperparathyroidism. Parathyroid carcinoma is a rare malignancy with an incidence of 0.5% to 4% of all reported cases of primary hyperparathyroidism. CASE PRESENTATION: We report the case of a 60-year-old Caucasian man with hypercalcaemic hyperparathyroid crisis associated with parathyroid carcinoma. He presented with a classic hypercalcaemic syndrome and his serum calcium and parathyroid hormone levels were at 4.65 mmol\\/L and 1743 ng\\/L, respectively. He initially presented with a two-week history of weakness and lethargy and a one-week history of vomiting, polyuria and polydipsia. An emergency left thyroid lobectomy and left lower parathyroidectomy were performed. There was a prompt decrease in his parathyroid hormone level immediately after surgery. Histology revealed that our patient had a 4-cm parathyroid carcinoma. CONCLUSION: In patients with parathyroid carcinoma, the optimal surgical treatment is en bloc resection with ipsilateral thyroid lobectomy and removal of any enlarged or abnormal lymph nodes. Surgery is the only curative treatment. In our patient, prompt surgical intervention proved successful. At six months the patient is well with no evidence of disease recurrence. This case highlights the importance of considering a hyperparathyroid storm in the context of a parathyroid carcinoma. Parathyroid carcinoma is a rare entity and our knowledge is mainly derived from case reports and retrospective studies. This case report increases awareness of this serious and life-threatening complication. This report also illustrates how prompt and appropriate management provides the best outcome for the patient.

  1. Parathyroid hormone secretion in chronic renal failure

    DEFF Research Database (Denmark)

    Madsen, J C; Rasmussen, A Q; Ladefoged, S D

    1996-01-01

    /ionized calcium curves were constructed, and a mean calcium set-point of 1.16 mmol/liter was estimated compared to the normal mean of about 1.13 mmol/liter. In conclusion, we demonstrate that it is important to use a standardized method to evaluate parathyroid hormone dynamics in chronic renal failure. By the use...

  2. Maxillary brown tumour: unusual presentation of parathyroid ...

    African Journals Online (AJOL)

    This is a report of a maxillary brown tumour caused by primary hyperparathyroidism (HPT) secondary to parathyroid carcinoma. A 62-year-old man presented with a large swelling in the right maxilla, which caused right-sided nasal obstruction, intermittent bleeding and diplopia. A computed tomography scan demonstrated ...

  3. Cyclooxygenase 2 promotes parathyroid hyperplasia in ESRD.

    Science.gov (United States)

    Zhang, Qian; Qiu, Junsi; Li, Haiming; Lu, Yanwen; Wang, Xiaoyun; Yang, Junwei; Wang, Shaoqing; Zhang, Liyin; Gu, Yong; Hao, Chuan-Ming; Chen, Jing

    2011-04-01

    Hyperplasia of the PTG underlies the secondary hyperparathyroidism (SHPT) observed in CKD, but the mechanism underlying this hyperplasia is incompletely understood. Because aberrant cyclooxygenase 2 (COX2) expression promotes epithelial cell proliferation, we examined the effects of COX2 on the parathyroid gland in uremia. In patients with ESRD who underwent parathyroidectomy, clusters of cells within the parathyroid glands had increased COX2 expression. Some COX2-positive cells exhibited two nuclei, consistent with proliferation. Furthermore, nearly 78% of COX2-positive cells expressed proliferating cell nuclear antigen (PCNA). In the 5/6-nephrectomy rat model, rats fed a high-phosphate diet had significantly higher serum PTH levels and larger parathyroid glands than sham-operated rats. Compared with controls, the parathyroid glands of uremic rats exhibited more PCNA-positive cells and greater COX2 expression in the chief cells. Treatment with COX2 inhibitor celecoxib significantly reduced PCNA expression, attenuated serum PTH levels, and reduced the size of the glands. In conclusion, COX2 promotes the pathogenesis of hyperparathyroidism in ESRD, suggesting that inhibiting the COX2 pathway could be a potential therapeutic target. Copyright © 2011 by the American Society of Nephrology

  4. Ultrasound diagnosis of ectopic pregnancy

    OpenAIRE

    Winder, Simon; Reid, Shannon; Condous, George

    2015-01-01

    Abstract Ectopic pregnancy (EP) remains the number one cause of first trimester maternal death. Traditionally, laparoscopy has been the gold standard for diagnosis of EP. The advent of high?resolution transvaginal scan (TVS) means more clinically stable women with EPs are diagnosed earlier, well before surgery becomes necessary in many cases. Early diagnosis by TVS is therefore potentially life saving and can reduce surgical morbidity by allowing elective surgery or even non?surgical conserva...

  5. Mechanisms of ectopic gene conversion.

    Science.gov (United States)

    Hastings, P J

    2010-11-29

    Gene conversion (conversion), the unidirectional transfer of DNA sequence information, occurs as a byproduct of recombinational repair of broken or damaged DNA molecules. Whereas excision repair processes replace damaged DNA by copying the complementary sequence from the undamaged strand of duplex DNA, recombinational mechanisms copy similar sequence, usually in another molecule, to replace the damaged sequence. In mitotic cells, the other molecule is usually a sister chromatid, and the repair does not lead to genetic change. Less often a homologous chromosome or homologous sequence in an ectopic position is used. Conversion results from repair in two ways. First, if there was a double-strand gap at the site of a break, homologous sequence will be used as the template for synthesis to fill the gap, thus transferring sequence information in both strands. Second, recombinational repair uses complementary base pairing, and the heteroduplex molecule formed is a source of conversion, both as heteroduplex and when donor (undamaged template) information is retained after correction of mismatched bases in heteroduplex. There are mechanisms that favor the use of sister molecules that must fail before ectopic homology can be used. Meiotic recombination events lead to the formation of crossovers required in meiosis for orderly segregation of pairs of homologous chromosomes. These events result from recombinational repair of programmed double-strand breaks, but in contrast with mitotic recombination, meiotic recombinational events occur predominantly between homologous chromosomes, so that transfer of sequence differences by conversion is very frequent. Transient recombination events that do not form crossovers form both between homologous chromosomes and between regions of ectopic homology, and leave their mark in the occurrence of frequent non-crossover conversion, including ectopic conversion.

  6. Mechanisms of Ectopic Gene Conversion

    Directory of Open Access Journals (Sweden)

    P.J. Hastings

    2010-11-01

    Full Text Available Gene conversion (conversion, the unidirectional transfer of DNA sequence information, occurs as a byproduct of recombinational repair of broken or damaged DNA molecules. Whereas excision repair processes replace damaged DNA by copying the complementary sequence from the undamaged strand of duplex DNA, recombinational mechanisms copy similar sequence, usually in another molecule, to replace the damaged sequence. In mitotic cells the other molecule is usually a sister chromatid, and the repair does not lead to genetic change. Less often a homologous chromosome or homologous sequence in an ectopic position is used. Conversion results from repair in two ways. First, if there was a double-strand gap at the site of a break, homologous sequence will be used as the template for synthesis to fill the gap, thus transferring sequence information in both strands. Second, recombinational repair uses complementary base pairing, and the heteroduplex molecule so formed is a source of conversion, both as heteroduplex and when donor (undamaged template information is retained after correction of mismatched bases in heteroduplex. There are mechanisms that favour the use of sister molecules that must fail before ectopic homology can be used. Meiotic recombination events lead to the formation of crossovers required in meiosis for orderly segregation of pairs of homologous chromosomes. These events result from recombinational repair of programmed double-strand breaks, but in contrast with mitotic recombination, meiotic recombinational events occur predominantly between homologous chromosomes, so that transfer of sequence differences by conversion is very frequent. Transient recombination events that do not form crossovers form both between homologous chromosomes and between regions of ectopic homology, and leave their mark in the occurrence of frequent non-crossover conversion, including ectopic conversion.

  7. Place of the parathyroid scintigraphy in the preoperative detection of pathological parathyroid glands; Place de la scintigraphie parathyroidienne dans la detection preoperatoire des glandes parathyroides pathologiques

    Energy Technology Data Exchange (ETDEWEB)

    Rejeb, O.; Sellem, A.; Elbez, I.; Elkadri, N.; Hammami, H. [Service de medecine nucleaire, hopital militaire, Tunis, (Tunisia)

    2009-05-15

    The aim of this work is to evaluate the performances of the scintigraphy in the preoperative localization of pathological parathyroid glands. The parathyroid scintigraphy is a simple, non invasive technique that proved its performances in the preoperative detection of pathological parathyroid glands, mostly in the case of adenoma. It should be indicated in first intention in the topographic diagnosis of a hyperparathyroidism. (N.C.)

  8. Risk factors for mediastinitis after coronary artery bypass grafting surgery.

    Science.gov (United States)

    Sá, Michel Pompeu Barros de Oliveira; Soares, Evelyn Figueira; Santos, Cecília Andrade; Figueiredo, Omar Jacobina; Lima, Renato Oliveira Albuquerque; Escobar, Rodrigo Renda; de Rueda, Fábio Gonçalves; Lima, Ricardo de Carvalho

    2011-01-01

    Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. The aim of this study is to identify risk factors for mediastinitis in patients undergoing coronary artery bypass grafting (CABG), without the use of bilateral internal thoracic artery (ITA), at the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. A retrospective study of 500 consecutive patients operated on between May 2007 and April 2010. Ten preoperative variables, seven intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were performed. The incidence of mediastinitis was 5.6% (n=28), with a lethality rate of 32.1% (n=9). In multivariate analysis using logistic regression, five variables remained as independent risk factors: obesity (OR 2.60, 95% CI 1.11 to 6.68), diabetes (OR 2.71, 95% CI 1.18 to 6.65), smoking (OR 2.10, 95% CI 1.12 to 4.67), use of pedicled internal thoracic artery (OR 5.17, 95% CI 1.45 to 18.42) and on-pump CABG (OR 2.26, 95% CI 1.14 to 5.85). This study identified the following independent risk factors for mediastinitis after CABG: obesity, diabetes, smoking, use of pedicled ITA and on-pump CABG.

  9. Primary mediastinal seminoma - an unusual tumor of the anterior mediastinum

    Energy Technology Data Exchange (ETDEWEB)

    Sachs, M.; Ungeheuer, E.

    1988-10-01

    In this report we present an 18-year-old patient with a large primary mediastinal seminoma and lymphangitis carcinomatosa in the right lung. After surgical resection he was treated with radiation therapy and polychemotherapy. Approximately 150 cases with mediastinal seminoma have been documented in the literature. Mediastinal seminomas occur predominantly in young men at the age of 20-35 years. They are localized in the anterior mediastinum and usually protrude to one side of the mediastinum. Mediastinal seminomas may compress and occasionally infiltrate the adjacent structures. They tend to produce lymph node metastases and bony metastases. This tumor is histogically identical to the testicular seminoma (germinoma), however, the pathogenesis of the primary mediastinal seminoma is unknown. The treatment of choice is total surgical resection followed by radiation therapy (30-40 Gy). Early systemic chemotherapy (based on cisplatinum, bleomycin, and vinblastine) is also indicated to inhibit metastases and cure lymphangiosis carcinomatosa with a survival rate of 60-90% depending on the stage of the disease.

  10. Primary cranial mediastinal hemangiosarcoma in a young dog

    Science.gov (United States)

    2014-01-01

    Primary cranial mediastinal hemangiosarcomas are uncommon tumors. A 30-kg, 2-year-old, intact female German shepherd was presented for evaluation of cachexia and respiratory distress of a few days’ duration. Lateral radiographic projection of the thorax revealed significant pleural effusion. Computed tomography revealed a cranial mediastinal mass effect adjacent to the heart. On surgical exploration, a pedunculated mass attached to the esophagus, trachea, brachiocephalic trunk, left subclavian artery and cranial vena cava without attachment to the right atrium and auricular appendage was removed and debrided by use of blunt dissection and dry gauzes, respectively. Histopathology results described the cranial mediastinal mass as hemangiosarcoma. At 8 months and 5 days post-operatively, the patient died. Primary cranial mediastinal hemangiosarcomas, although a seemingly rare cause of thoracic pathology in young dogs, should be considered in the differential diagnosis for pleural effusion and soft tissue mass effect in the cranial mediastinum. This is the first case report in a dog to describe primary cranial mediastinal hemangiosarcoma. PMID:25089185

  11. Ectopic mammary tissue in vulva

    Directory of Open Access Journals (Sweden)

    Đorđević Momčilo

    2008-01-01

    Full Text Available Background. Ectopic mammary gland tissue is a residual tissue that persists during the embryologic development along ectodermal primitive milk streaks. Incomplete involution anywhere along the primitive milk streak can result in accessory or ectopic mammary tissue. Case report. A woman, 27-year old, admitted to Obstetrics and Gynecology Clinic Kragujevac for surgery, of goose-egg size, vulva tumor, of elastic consistency. Menarche started in 12 years of age, with the regular menstrual cycle, without previous gynecological diseases. The woman had one pregnancy terminated by cesarean section because of the multiple (twin pregnancy. Excision of the tumor was completely done in the total endotracheal anesthesia. Pathohistologic (PH findings was: Dysplasia fibrosa cystica simplex mammae, with focuses of sclerosing adenosis. Expression of estrogen (ER and progesterone receptors (PR were positive. Conclusion. Ectopic mammary tissue in vulva in adult period is very rarely seen, and can be changed pathologically as well as normally positioned breast tissue into benign cystic changes, benign tumors, adenomas and fibroadenomas and tumors. Cells with low ER/PR receptor level grow independently of estrogene stimulation and they could be resistant to hormonal therapy effects.

  12. Impact of image fusion and attenuation correction by SPECT-CT on the scintigraphic detection of parathyroid adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Ruf, J.; Denecke, T.; Stelter, L.; Felix, R.; Amthauer, H. [Campus Virchow-Klinikum, Charite-Universitaetsmedizin, Berlin (Germany). Klinik fuer Strahlenheilkunde; Seehofer, D.; Rayes, N. [Campus Virchow-Klinikum, Charite-Universitaetsmedizin, Berlin (Germany). Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie

    2007-07-01

    Aim: In addition to planar parathyroid scintigraphy, SPECT and image fusion with CT/MR improve adenoma detection in primary hyperparathyroidism (pHPT). This study evaluated the use of a hybrid SPECT-CT device concerning image fusion and attenuation correction (AC). Patients, methods: The data of 26 patients with pHPT, preoperatively examined by {sup 99m}Tc-sestamibi dual-phase scintigraphy plus SPECT-CT (low-dose CT), was retrospectively evaluated by two observers in a consensus reading. The images of planar scintigraphy, non-attenuation corrected SPECT (SPECT{sub NAC}), attenuation corrected SPECT (SPECT{sub AC}) and SPECT{sub AC}-CT were interpreted and compared to the results of surgery. The effect of AC on focus intensity was semiquantified by determination of the tumor-to-background (TB) ratio for SPECT{sub AC} and SPECT{sub NAC}. Finally, the TB{sub AC}/TB{sub NAC}-ratio was calculated for each focus and correlated to the distance of a focus from the body surface. Results: 20/26 (77%) patients were positive in planar scintigraphy. One focus was detected by SPECT only. AC of SPECT-data increased image contrast but had no impact on the detection rate. Additional SPECT{sub AC}-CT image fusion facilitated the localization of three mediastinal foci. In the semiquantitative analysis an increase in TB after AC was observed, although there was no strong correlation between depth of the focus (16-60 mm) and the TB{sub AC}/TB{sub NAC}-ratio (r = 0.213, p = 0.353). Conclusion: The detection rate of planar scintigraphy is only slightly improved by SPECT imaging. Due to the low spatial resolution of the CT component, the benefit of image fusion is limited to mediastinal foci. However, as TB and image contrast is measurably improved after AC there is a potential to improve the sensitivity of parathyroid SPECT. (orig.)

  13. Graves' disease in a mediastinal mass presenting after total thyroidectomy for nontoxic multinodular goiter: a case report.

    Science.gov (United States)

    Cunha, Filipe Manuel; Rodrigues, Elisabete; Oliveira, Joana; Saavedra, Ana; Vinhas, Luís Sá; Carvalho, Davide

    2016-03-31

    Thyrotoxicosis after total thyroidectomy is mostly iatrogenic. Rarely, a hyperfunctional thyroid remnant or ectopic tissue may be the cause. There are few cases of Graves' disease arising from thyroid tissue located in the mediastinum and none in which Graves' disease was diagnosed only after surgery. We report the case of a patient with Graves's disease in a mediastinal thyroid mass presenting 7 years after total thyroidectomy for nontoxic goiter. A 67-year-old Caucasian woman presented with palpitations, fatigue and weight loss. She had a history of total thyroidectomy for nontoxic multinodular goiter at the age of 60 without any signs of malignancy on microscopic examination. She had been medicated with levothyroxine 100 μg/day since the surgery without follow-up. She was tachycardic, had no cervical mass or eye involvement. Her thyroid-stimulating hormone levels were suppressed (0.000 μU/mL) and her free thyroxine (3.22 ng/dL) and free triiodothyronine (8.46 pg/mL) levels increased. Neither mediastinal enlargement nor trachea deviation was found on chest roentgenogram. Levothyroxine treatment was stopped but our patient showed no improvement on free thyroxine or free triiodothyronine 10 days later. Thyroglobulin was increased to 294 mg/mL. A cervical ultrasound scan revealed no thyroid remnant. Her anti-thyroid-stimulating hormone receptor antibodies were high (19.7 U/L). Corporal scintigraphy demonstrated increased intrathoracic radioiodine uptake. A computed tomography scan confirmed a 60 × 40 mm mediastinal mass. Methimazole 10 mg/day was started. Three months later, her thyroid function was normal and she underwent surgical resection. Microscopic examination showed thyroid tissue with no signs of malignancy. Although thyrotoxicosis after total thyroidectomy is mostly due to excessive supplementation, true hyperthyroidism may rarely be the cause, which should be kept in mind. The presence of thyroid tissue after total thyroidectomy in our patient may

  14. Unusual cause of massive hemothorax: spontaneous rupture of nonfunctioning mediastinal paraganglioma

    OpenAIRE

    Lin, Feng; Liu, Chengwu; Ma, Lin; Pu, Qiang; Zhu, Yunke; Xiao, Zhilan; Guo, Chenglin; Zhang, Xiaolong; Li, Chuan; Liu, Lunxu

    2016-01-01

    Mediastinal paraganglioma is a rare neurogenic tumor with a hypervascular feature. The spontaneous rupture of mediastinal paraganglioma is an unusual cause of massive hemothorax. Here we present a case of 39-year-old man with massive hemothorax due to the spontaneous rupture of a mediastinal paraganglioma. The man underwent successful resection of tumor and had an uneventful recovery. To our knowledge, this is the first reported case of spontaneous rupture of nonfunctioning mediastinal paraga...

  15. Therapeutic implications of mediastinal involvement in advanced Hodgkin's disease

    DEFF Research Database (Denmark)

    Specht, L; Nissen, N I; Walbom-Jørgensen, S

    1985-01-01

    47 patients with advanced Hodgkin's disease (stage IIIB or IV) and mediastinal involvement, treated during the period 1969-78 and followed till death or from 36 to 126 months after initiation of therapy, were analysed. All 47 patients had received combination chemotherapy (MOPP or equivalent...... regimens). 20 had also received additional radiotherapy to mediastinum (and in some cases to other involved areas as well). The 2 treatment groups did not differ significantly with regard to the more important prognostic factors. Both in the case of stages IV and IIIB patients in the group treated......'s disease and crude survival including all causes of death were significantly better for patients treated with combination chemotherapy plus mediastinal irradiation. Consequently, for patients with advanced Hodgkin's disease and mediastinal involvement a combined approach including radiotherapy as well...

  16. Recurrent Thoracic Duplication Cyst with Associated Mediastinal Gas

    Directory of Open Access Journals (Sweden)

    Hammad Al-Sadoon

    1998-01-01

    Full Text Available Mediastinal cysts are not uncommon in the pediatric age group. Presentation varies from an abnormality found on routine chest radiograph to severe respiratory distress and even respiratory failure. Presentation depends on the age of the patient, the location of the lesion, the extent and the size of the mass, and what structures are involved. The case of a six-year-old boy who presented with recurrence of a mediastinal mass associated with gas two years after surgical removal of an infected esophageal duplication cyst is described. No connection between the cyst and the esophagus to explain the presence of gas was documented. This appears to be the first reported case of esophageal duplication cyst associated with mediastinal gas.

  17. A case of mediastinitis accompanied with hyperosmolar nonketotic coma.

    Science.gov (United States)

    Tuna, Mazhar Muslum; Kilinc, Faruk; Pekkolay, Zafer; Soylu, Hikmet; Tuzcu, Alpaslan Kemal

    2016-06-01

    Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling.

  18. Different Sonographic Faces of Ectopic Pregnancy.

    Science.gov (United States)

    Chanana, Charu; Gupta, Nishant; Bansal, Itisha; Hooda, Kusum; Sharma, Pranav; Gupta, Mohit; Gandhi, Darshan; Kumar, Yogesh

    2017-01-01

    Vaginal bleeding in the first trimester has wide differential diagnoses, the most common being a normal early intrauterine pregnancy, with other potential causes including spontaneous abortion and ectopic pregnancy. The incidence of ectopic pregnancy is approximately 2% of all reported pregnancies and is one of the leading causes of maternal mortality worldwide. Clinical signs and symptoms of ectopic pregnancy are often nonspecific. History of pelvic pain with bleeding and positive β-human chorionic gonadotropin should raise the possibility of ectopic pregnancy. Knowledge of the different locations of ectopic pregnancy is of utmost importance, in which ultrasound imaging plays a crucial role. This pictorial essay depicts sonographic findings and essential pitfalls in diagnosing ectopic pregnancy.

  19. Diagnosing ectopic pregnancy in the emergency setting.

    Science.gov (United States)

    Lee, Robert; Dupuis, Carolyn; Chen, Byron; Smith, Andrew; Kim, Young H

    2017-08-19

    Ectopic pregnancy is the implantation of a fertilized egg outside the uterine endometrial cavity. For women presenting to the emergency department with abdominal pain and/or vaginal bleeding, ectopic pregnancy is an important diagnostic consideration. The diagnosis is made based on laboratory values and ultrasound imaging findings. The ultrasound appearance of both normal early pregnancy and ectopic pregnancy are variable and often subtle, presenting diagnostic challenges for radiologists. This pictorial essay describes and illustrates the sonographic findings of ectopic pregnancy and reviews the differential diagnoses that can mimic ectopic pregnancy on ultrasound. With the possibility of medical management, the value of early detection and prompt initiation of treatment has increased in improving clinical outcomes and preventing the complications of ectopic pregnancy.

  20. Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery.

    Science.gov (United States)

    Vidal Fortuny, J; Belfontali, V; Sadowski, S M; Karenovics, W; Guigard, S; Triponez, F

    2016-04-01

    Postoperative hypoparathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative parathyroid gland angiography in predicting normal parathyroid gland function after thyroid surgery. Angiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified parathyroid glands. Some 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized parathyroid gland could be demonstrated developed transient hypoparathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoparathyroidism. PTH levels on POD 1 were normal in all patients who had at least one well vascularized parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoparathyroidism. © 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

  1. Spontaneous oesophageal perforation due to mediastinal tuberculous lymphadenitis - atypical presentation of tuberculosis.

    Directory of Open Access Journals (Sweden)

    Desai C

    1999-01-01

    Full Text Available Spontaneous non-traumatic oesophageal perforation secondary to bursting of a mediastinal tuberculous abscess into the oesophagus is rare. The diagnosis is delayed, as perforation remains localised due to mediastinal lymph nodes. Patient can be effectively managed by paraoesophageal drainage of the mediastinal abscess and oesophageal diversion.

  2. A Case of Primary Hyperparathyroidism due to Intrathyroidal Parathyroid Cyst

    Directory of Open Access Journals (Sweden)

    Yavuz Yalcin

    2014-01-01

    Full Text Available Parathyroid cysts constitute 0.08–3.41% of all parathyroid masses. Intrathyroidal parathyroid cysts, however, are rare conditions with only a few cases being reported. Most of the parathyroid cysts are found to be nonfunctional and functional cysts are generally thought to be due to cystic degeneration of parathyroid adenomas. A cystic, smooth contoured lesion of 24 × 19 × 16 mm was observed in left thyroid lobe of a 76-year-old woman during ultrasonography which was performed as routine workup for primary hyperparathyroidism. It was defined as a cystic thyroid nodule at first. Tc99m sestamibi scintigraphy was performed to see any parathyroid lesions, but no radioactive uptake was observed. Intact parathormone (iPTH level was found to be >600 pg/mL in cyst aspiration fluid. Left lobectomy was performed, with a diagnosis of primary hyperparathyroidism due to functional parathyroid cyst. Serum iPTH level was decreased >50% postoperatively and histopathological evaluation was consistent with an encapsulated parathyroid adenoma with a cystic center. Parathyroid cysts are among rare causes of primary hyperparathyroidism. Diagnosis is made by markedly increased iPTH level in cyst fluid and observation of parathyroid epithelium lining the cyst wall.

  3. Intraoperative near-infrared autofluorescence imaging of parathyroid glands.

    Science.gov (United States)

    Ladurner, Roland; Sommerey, Sandra; Arabi, Nora Al; Hallfeldt, Klaus K J; Stepp, Herbert; Gallwas, Julia K S

    2017-08-01

    To identify parathyroid glands intraoperatively by exposing their autofluorescence using near-infrared light. Fluorescence imaging was carried out during minimally invasive and open parathyroid and thyroid surgery. After identification, the parathyroid glands as well as the surrounding tissue were exposed to near-infrared (NIR) light with a wavelength of 690-770 nm using a modified Karl Storz near-infrared/indocyanine green (NIR/ICG) endoscopic system. Parathyroid tissue was expected to show near-infrared autofluorescence, captured in the blue channel of the camera. Whenever possible the visual identification of parathyroid tissue was confirmed histologically. In preliminary investigations, using the original NIR/ICG endoscopic system we noticed considerable interference of light in the blue channel overlying the autofluorescence. Therefore, we modified the light source by interposing additional filters. In a second series, we investigated 35 parathyroid glands from 25 patients. Twenty-seven glands were identified correctly based on NIR autofluorescence. Regarding the extent of autofluorescence, there were no noticeable differences between parathyroid adenomas, hyperplasia and normal parathyroid glands. In contrast, thyroid tissue, lymph nodes and adipose tissue revealed no substantial autofluorescence. Parathyroid tissue is characterized by showing autofluorescence in the near-infrared spectrum. This effect can be used to distinguish parathyroid glands from other cervical tissue entities.

  4. Cutaneous Metastatic Undifferentiated Pleomorphic Sarcoma from a Mediastinal Sarcoma.

    Science.gov (United States)

    Jeong, Do Seon; Park, Dong Hwa; Kim, Chi Yeon

    2015-06-01

    Undifferentiated pleomorphic sarcoma, known as malignant fibrous histiocytoma, is a malignant neoplasm that arises in both soft tissue and bones. In 2002, the World Health Organization declassified malignant fibrous histocytoma as a formal diagnostic entity and renamed it 'undifferentiated pleomorphic sarcoma not otherwise specified.' It most commonly occurs in the lower extremities and rarely metastasizes cutaneously. We report a case of cutaneous metastatic undifferentiated pleomorphic sarcoma of the buttocks occurring in a 73-year-old man diagnosed with mediastinal sarcoma 4 years previously. He first noticed the mass approximately 2 months previously. Histological findings with immunomarkers led to a final diagnosis of cutaneous metastatic sarcoma from mediastinal undifferentiated pleomorphic sarcoma.

  5. Anterior mediastinal paraganglioma: A case for preoperative embolization

    Directory of Open Access Journals (Sweden)

    Shakir Murtaza

    2012-07-01

    Full Text Available Abstract Background Paraganglioma is a rare but highly vascular tumor of the anterior mediastinum. Surgical resection is a challenge owing to the close proximity to vital structures including the heart, trachea and great vessels. Preoperative embolization has been reported once to facilitate surgical treatment. Case presentation We report a case of anterior mediastinal paraganglioma that was embolized preoperatively, and was resected without the need for cardiopulmonary bypass and without major bleeding complications. Conclusion We make a case to further the role of preoperative embolization in the treatment of mediastinal paragangliomas.

  6. INTERSTITIAL ECTOPIC PREGNANCY-A REVIEW

    OpenAIRE

    Fateme parooei, Mahmood Anbari, Morteza Salarzaei *

    2017-01-01

    Introduction:. Interstitial ectopic pregnancy, in which rupture occurs much later than other forms of pregnancy, is a rare phenomenon that occurs in 2% of ectopic pregnancies; delayed rupture is due to the expandability of myometrium. Methods: In this review article, the databases Medline, Cochrane, Science Direct, and Google Scholar were thoroughly searched to identify the Interstitial ectopic pregnancy. In this review, the papers published until early January 2017 that were conducted ...

  7. Laparoscopic management of bladder ectopic pregnancy

    OpenAIRE

    Siraj, Shahul Hameed Mohamed; Chern, Bernard Su Min

    2016-01-01

    Ectopic pregnancy is a potentially life-threatening condition and still the major cause of maternal mortality in the first trimester of pregnancy. It accounts for approximately 10% of maternal deaths. The involvement of the urinary tract is rare, usually occurring after the rupture of an abdominal implanted ectopic embryonic sac. We herein present a case of an ectopic pregnancy implanted in the bladder and successful laparoscopic management. To the best of our knowledge, this is the first des...

  8. Different Sonographic Faces of Ectopic Pregnancy

    OpenAIRE

    Charu Chanana; Nishant Gupta; Itisha Bansal; Kusum Hooda; Pranav Sharma; Mohit Gupta; Darshan Gandhi; Yogesh Kumar

    2017-01-01

    Vaginal bleeding in the first trimester has wide differential diagnoses, the most common being a normal early intrauterine pregnancy, with other potential causes including spontaneous abortion and ectopic pregnancy. The incidence of ectopic pregnancy is approximately 2% of all reported pregnancies and is one of the leading causes of maternal mortality worldwide. Clinical signs and symptoms of ectopic pregnancy are often nonspecific. History of pelvic pain with bleeding and positive ?-human ch...

  9. Partial molar ectopic pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    Malihe Amirian

    2016-11-01

    Full Text Available Partial or complete mole affects one in 1000  pregnancies.Partial mole is a rare form of ectopic pregnancy. There was a married woman,gravid 4,parity 1,abortion 1,and she had past medical history 0f right ectopic pregnancy.she had left ectopic pregnancy and was treated by laparascopic left salpyngectomy after failure of intramascular methotrexate treatment.After surgery  the pathology exam showed partial mole

  10. CT findings of the mediastinal tumors -excluding mediastinal granuloma and primary carcinoma-

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soo; Im, Chung Kie; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1985-06-15

    Computerized Tomography can make accurate diagnosis in most of the mediastinal tumors and cysts by assessing their location, shape and internal architecture. Authors analysed and present CT findings of 89 surgically proven mediastinal tumors and cysts that were studied and treated in Seoul National University Hospital during recent 5 years. The results are as follows; 1. The most common tumor was teratoma (25 cases). Neurogenic tumor (20 cases), thymic tumor or cyst (16 cases), lymphoma (7 cases), bronchogenic cyst (6 cases), intrathoracic goiter (6 cases), pericardial cyst (3 cases) and cystic hygroma (2 cases) were next in order of frequency. 2. The most constant findings of teratoma was thick walled cystic area (100%), while pathognomonic fat and calcified density were seen only in 52% and 48% of cases, respectively. 22 cases were located in anterior mediastinum, 2 cases were in posterior mediastinum and a case is in middle mediastinum. 3. There were 20 cases of neurogenic tumor consisting of 6 neurilemmomas, 7 ganglioneuromas, 4 neurofibromas, 1 ganglioneuroblastoma, 1 neuroblastoma and 1 malignant schwannoma. Most of them were located in posterior mediastinum with exception of 2 neurilemmomas arising from left vagus nerve and left recurrent laryngeal nerve in middle mediastinum. Cystic change was seen in 2 cases of neurilemmoma and in a case of ganglioneuroma. Calcification was seen in 3 cases, of neuroblastoma, a neurilemmoma, and a ganglioneuroma. 4. There were 11 cases of thymoma showing homogeneous solid mass with speckeld calcification in 4 cases and irregular cystic change in 3 cases. 2 cases were invasive thymoma and myasthenia gravis was present in 4 cases. A cases of thymolipoma and a case of thymic cyst were included. 5. Lymphoma (2 Hodgkin's and 4 non-Hodgkin's) appeared as lobulated, matted mass in anterior mediastinum especially in prevascular area expanding bilaterally.

  11. Epidemiology of Ectopic Pregnancy in Hamadan Province

    Directory of Open Access Journals (Sweden)

    Fatemeh Shobeiri

    2012-04-01

    Full Text Available Background: The blastocyst implantation in any place other than uterus cavity endometrium is called ectopic pregnancy. The prevalence of ectopic pregnancy is different in various countries. This study has been conducted to investigate the epidemiology of ectopic pregnancy in Hamadan province during 2000-2010.Materials and Methods: The present study is a retrospective descriptive study. The data on 872 ectopic pregnancies were extracted by questionnaires from the files in the records department of hospitals and delivery centers in Hamadan province during 2000-2010. Data were analyzed using descriptive statistics and the obtained data were analyzed using SPSS-16 software.Results: The frequency of ectopic pregnancy in Hamadan province during 2000-2010 was averagely 2.6 per 1000 pregnancies. Tubal pregnancy with 95.2% is the most prevalent type of ectopic pregnancy most of which had occurred in the right tube (52.4%. Most ectopic pregnancies (52.2% were in the age group of 25-34.Conclusion: The prevalence of ectopic pregnancy in Hamadan province during the mentioned years has been 2.6 in 1000 pregnancies, which is lower compared to many existing data. However, the prevalence of ectopic pregnancy in this province has increased over time, so that it has become 3.3 times as much from 2000-2010.

  12. Parathyroid-specific epidermal growth factor-receptor inactivation prevents uremia-induced parathyroid hyperplasia in mice

    Science.gov (United States)

    Arcidiacono, Maria Vittoria; Yang, Jing; Fernandez, Elvira; Dusso, Adriana

    2015-01-01

    Background In chronic kidney disease (CKD), parathyroid hyperplasia contributes to high serum parathyroid hormone (PTH) and also to an impaired suppression of secondary hyperparathyroidism by calcium, vitamin D and fibroblast growth factor 23 (FGF23). In rats, systemic inhibition of epidermal growth factor receptor (EGFR) activation markedly attenuated uremia-induced parathyroid hyperplasia and vitamin D receptor (VDR) loss, hence restoring the response to vitamin D. Therefore, we propose that parathyroid-specific EGFR inactivation should prevent CKD-induced parathyroid hyperplasia. Methods A dominant-negative human EGFR mutant, which forms non-functional heterodimers with full-length endogenous EGFR, was successfully targeted to the parathyroid glands (PTGs) of FVB/N mice, using the 5′ regulatory sequence of the PTH promoter. The parathyroid phenotype and serum chemistries of wild-type (WT) and transgenic mice were examined after 14 weeks of either sham operation or 75% renal mass reduction (NX). Results Both genotypes had similar morphology and body weight, and NX-induction enhanced similarly serum blood urea nitrogen compared with sham-operated controls. However, despite similar serum calcium, phosphate and FGF23 levels in NX mice of both genotypes, parathyroid EGFR inactivation sufficed to completely prevent the marked increases in PTG enlargement, serum PTH and in parathyroid levels of transforming growth factor-α, a powerful EGFR-activator, and the VDR reductions observed in WT mice. Conclusion In CKD, parathyroid EGFR activation is essential for parathyroid hyperplasia and VDR loss, rendering this transgenic mouse a unique tool to scrutinize the pathogenesis of parathyroid and multiple organ dysfunction of CKD progression unrelated to parathyroid hyperplasia. PMID:25324357

  13. Parathyroid-specific epidermal growth factor-receptor inactivation prevents uremia-induced parathyroid hyperplasia in mice.

    Science.gov (United States)

    Arcidiacono, Maria Vittoria; Yang, Jing; Fernandez, Elvira; Dusso, Adriana

    2015-03-01

    In chronic kidney disease (CKD), parathyroid hyperplasia contributes to high serum parathyroid hormone (PTH) and also to an impaired suppression of secondary hyperparathyroidism by calcium, vitamin D and fibroblast growth factor 23 (FGF23). In rats, systemic inhibition of epidermal growth factor receptor (EGFR) activation markedly attenuated uremia-induced parathyroid hyperplasia and vitamin D receptor (VDR) loss, hence restoring the response to vitamin D. Therefore, we propose that parathyroid-specific EGFR inactivation should prevent CKD-induced parathyroid hyperplasia. A dominant-negative human EGFR mutant, which forms non-functional heterodimers with full-length endogenous EGFR, was successfully targeted to the parathyroid glands (PTGs) of FVB/N mice, using the 5' regulatory sequence of the PTH promoter. The parathyroid phenotype and serum chemistries of wild-type (WT) and transgenic mice were examined after 14 weeks of either sham operation or 75% renal mass reduction (NX). Both genotypes had similar morphology and body weight, and NX-induction enhanced similarly serum blood urea nitrogen compared with sham-operated controls. However, despite similar serum calcium, phosphate and FGF23 levels in NX mice of both genotypes, parathyroid EGFR inactivation sufficed to completely prevent the marked increases in PTG enlargement, serum PTH and in parathyroid levels of transforming growth factor-α, a powerful EGFR-activator, and the VDR reductions observed in WT mice. In CKD, parathyroid EGFR activation is essential for parathyroid hyperplasia and VDR loss, rendering this transgenic mouse a unique tool to scrutinize the pathogenesis of parathyroid and multiple organ dysfunction of CKD progression unrelated to parathyroid hyperplasia. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  14. Cervical SPECT Camera for Parathyroid Imaging

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2012-08-31

    Primary hyperparathyroidism characterized by one or more enlarged parathyroid glands has become one of the most common endocrine diseases in the world affecting about 1 per 1000 in the United States. Standard treatment is highly invasive exploratory neck surgery called Parathyroidectomy. The surgery has a notable mortality rate because of the close proximity to vital structures. The move to minimally invasive parathyroidectomy is hampered by the lack of high resolution pre-surgical imaging techniques that can accurately localize the parathyroid with respect to surrounding structures. We propose to develop a dedicated ultra-high resolution (~ 1 mm) and high sensitivity (10x conventional camera) cervical scintigraphic imaging device. It will be based on a multiple pinhole-camera SPECT system comprising a novel solid state CZT detector that offers the required performance. The overall system will be configured to fit around the neck and comfortably image a patient.

  15. Seminoma and parathyroid adenoma in a snow leopard (Panthera unica).

    Science.gov (United States)

    Doster, A R; Armstrong, D L; Bargar, T W

    1989-05-01

    A seminoma and parathyroid adenoma were diagnosed in an aged snow leopard. The ultrastructural appearance of the seminoma was similar to that described in the dog and in man. The lack of significant amounts of rough endoplasmic reticulum, Golgi complexes and free ribosomes in the parathyroid adenoma suggested that it was non-functional. Parathyroid adenoma has not been previously described in a large wild feline.

  16. Ectopic pregnancy experience in a tertiary health facility in South ...

    African Journals Online (AJOL)

    Celestine

    Background: Ectopic pregnancy is a life-threatening gynecological ... 330 women (95.7%) had ruptured ectopic pregnancies, and the remaining fifteen ... history of previous abortion, previous ectopic pregnancy, history of infertility, race, and ...

  17. Mediastinal restaging: EUS-FNA offers a new perspective

    NARCIS (Netherlands)

    Annema, Jouke T.; Veseliç, Maud; Versteegh, Michel I. M.; Willems, Luuk N. A.; Rabe, Klaus F.

    2003-01-01

    We hypothesized that transoesophageal endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has the potential to be a valuable and accurate new diagnostic technique for mediastinal restaging in non-small cell lung cancer (NSCLC) after induction chemotherapy. The current restaging modalities

  18. Mediastinitis in cardiac surgery: A review of the literature | Kunal ...

    African Journals Online (AJOL)

    Background: Postoperative mediastinitis is a serious complication in cardiac surgery that substantially increases morbidity and mortality. Aim: This study reviews the various prophylactic and therapeutic measures. Material and Method: Literature searches were done to identify relevant studies. Results: Various possible ...

  19. Giant Mediastinal Teratoma in the Left Hemithorax A Case Report

    African Journals Online (AJOL)

    TNHJOURNALPH

    RESULT. A 88-year-old male was admitted with a two -year history of chest pain; chronic cough with associated occasional hemoptysis; easy fatigability. Clinical signs of unexplained mediastinal shift to the contralateral side, and diminished vesicular breath sounds on the affected side were present. Radiologic studies.

  20. Invasive Esophageal Candidiasis with Chronic Mediastinal Abscess and Fatal Pneumomediastinum.

    Science.gov (United States)

    Aghdam, Mohammad Reza F; Sund, Ståle

    2016-07-08

    BACKGROUND Invasive candidiasis is a potential problem for patients receiving long-term immunosuppressive treatment. Psoriatic arthritis is one of many chronic diseases that can be successfully treated with immunosuppressive drugs, in spite of a documented and accepted risk for infectious complications. Critical awareness of possible infection must be part of the surveillance of such patients. CASE REPORT This is the case of a 68-year-old Norwegian male, treated with long-term immunosuppression for psoriatic arthritis, hospitalized with acute subcutaneous and mediastinal emphysema of unknown cause. He died of acute respiratory failure with circulatory collapse shortly after admission. The autopsy revealed mediastinal and subcutaneous emphysema and a mediastinal abscess containing Candida with probable entrance from the esophagus. CONCLUSIONS We consider invasive candidiasis of the esophagus to be the cause of both the chronic abscess and the acute mediastinal emphysema. This case illustrates the importance of awareness of invasive candidiasis as a possible complication in a patient with long-term immunosuppression.

  1. Giant Mediastinal Teratoma in the Left Hemithorax A Case Report ...

    African Journals Online (AJOL)

    They are composed of tissues derived from more than one germ cell line. Majority are benign and they present with different clinical ... Clinical signs of unexplained mediastinal shift to the contralateral side, and diminished vesicular breath sounds on the affected side were present. Radiologic studies (CXR & Chest CT); 2D ...

  2. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis

    NARCIS (Netherlands)

    Obdeijn, MC; de Lange, M.Y.; Lichtendahl, DHE; de Boer, Willem

    1999-01-01

    A new technique using vacuum-assist-ed closure was successfully applied in 3 patients with poststernotomy mediastinitis. After surgical debridement, this vacuum-assisted closure technique has made it possible to avoid the need for secondary surgical closure (including direct secondary surgical

  3. Voluminous post-traumatic mediastinal haematoma: late presentation in DEA

    Directory of Open Access Journals (Sweden)

    Luciano Cardinale

    2008-10-01

    Full Text Available Mediastinal haematoma in the settings of blunt chest trauma can produce potentially serious problems. Nonaortic sources include disruption of arch vessels, rupture of small mediastinal veins, fractures of ribs/sternum and injury to the intercostal and internal thoracic vessels. Rupture of the aorta and great vessels is less frequent. Mediastinal haematoma presents a dual threat to haemodynamic stability, both as source of blood loss and because of compression of vascular structures such as the heart and pulmonary arteries. The case presented here tells about a patient who was initially in good conditions and haemodynamically stable, with no radiologic abnormalities. Some hours later he developed chest pain with hypotension due to sudden growth of large mediastinal haematoma. Multiphase multi-detector CT (MDCT in our case allowed prompt detection of active bleeding in the arterial phase, a specific sign of arterial injury, with cardiac tamponade, which required immediate surgical treatment. MDCT is commonly considered the gold standard in severe thoracic trauma. Improvements in CT scanner technology have markedly shortened scanning times and now provide cardiac and vessels images of high quality during routine chest CT examinations.

  4. Ultrasound diagnosis of ectopic pregnancy

    Science.gov (United States)

    2015-01-01

    Abstract Ectopic pregnancy (EP) remains the number one cause of first trimester maternal death. Traditionally, laparoscopy has been the gold standard for diagnosis of EP. The advent of high‐resolution transvaginal scan (TVS) means more clinically stable women with EPs are diagnosed earlier, well before surgery becomes necessary in many cases. Early diagnosis by TVS is therefore potentially life saving and can reduce surgical morbidity by allowing elective surgery or even non‐surgical conservative treatment options. Combining transabdominal and transvaginal scanning confers no benefit over transvaginal scanning alone. Reports that reads “…empty uterus, ectopic pregnancy cannot be excluded” should be a thing of the past. Diagnosis of EP should be based upon the positive identification of an adnexal mass using TVS rather than the absence of an intra‐uterine gestational sac. A systematic approach to scanning the early pregnancy pelvis will diagnose the vast majority of EPs at the initial scan. Ultrasound, and in particular TVS, is fast becoming the new gold standard for diagnosis of all types of EP. In modern management, laparoscopy should be seen as the operative tool of choice while TVS the diagnostic tool of choice. PMID:28191110

  5. Dynamic MRI of parathyroid tumors in preoperative evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Seiji; Takano, Hideyuki; Ito, Hisao [Chiba Univ. (Japan). School of Medicine] [and others

    2000-08-01

    Dynamic MRI was compared to enhanced CT and Tc-99m MIBI, in detection of the parathyroid tumors. STIR MR images achieved higher detectability than enhanced CT or Tc-99m MIBI. Time intensity curves were also drawn in the dynamic MRI. A case of adenocarcinoma showed rapid increase and following gradual decrease in intensity, which pattern is considered as malignant in many tumors of the other organs. However, it was not easy to differentiate parathyroid adenomas from thyroid gland or tumors. MRI was considered as one of the useful methods in detection of the parathyroid tumors. MRI may be useful in searching of heterotopic parathyroid tumors. (author)

  6. FGF23 fails to inhibit uremic parathyroid glands.

    Science.gov (United States)

    Canalejo, Rocío; Canalejo, Antonio; Martinez-Moreno, Julio Manuel; Rodriguez-Ortiz, M Encarnacion; Estepa, Jose C; Mendoza, Francisco Javier; Munoz-Castaneda, Juan Rafael; Shalhoub, Victoria; Almaden, Yolanda; Rodriguez, Mariano

    2010-07-01

    Fibroblast growth factor 23 (FGF23) modulates mineral metabolism by promoting phosphaturia and decreasing the production of 1,25-dihydroxyvitamin D(3). FGF23 decreases parathyroid hormone (PTH) mRNA and secretion, but despite a marked elevation in FGF23 in uremia, PTH production increases. Here, we investigated the effect of FGF23 on parathyroid function in normal and uremic hyperplastic parathyroid glands in rats. In normal parathyroid glands, FGF23 decreased PTH production, increased expression of both the parathyroid calcium-sensing receptor and the vitamin D receptor, and reduced cell proliferation. Furthermore, FGF23 induced phosphorylation of extracellular signal-regulated kinase 1/2, which mediates the action of FGF23. In contrast, in hyperplastic parathyroid glands, FGF23 did not reduce PTH production, did not affect expression of the calcium-sensing receptor or vitamin D receptor, and did not affect cell proliferation. In addition, FGF23 failed to activate the extracellular signal-regulated kinase 1/2-mitogen-activated protein kinase pathway in hyperplastic parathyroid glands. We observed very low expression of the FGF23 receptor 1 and the co-receptor Klotho in uremic hyperplastic parathyroid glands, which may explain the lack of response to FGF23 in this tissue. In conclusion, in hyperparathyroidism secondary to renal failure, the parathyroid cells resist the inhibitory effects of FGF23, perhaps as a result of the low expression of FGF23 receptor 1 and Klotho in this condition.

  7. Laparoscopic management of ovarian ectopic pregnancy.

    Science.gov (United States)

    Hage, P S; Arnouk, I F; Zarou, D M; Kim, B H; Wehbeh, H A

    1994-05-01

    Ovarian ectopic pregnancy is a rare entity. Traditional therapy has been laparotomy with oophorectomy and, more recently, with ovarian wedge resection. We report the first case that was diagnosed and treated laparoscopically and retrieved intact. Laparoscopic treatment of ovarian ectopic gestations appears to be a safe and conservative approach in selected patients.

  8. Ectopic Pregnancy: Lagos University Teaching Hospital Experience ...

    African Journals Online (AJOL)

    Ectopic pregnancy remains one of the commonest gynaecological emergencies in developing countries. In a retrospective study of ectopic pregnancy carried out at Lagos University Teaching Hospital (LUTH), Lagos, Nigeria, over a five year period, 272 cases were managed with an incidence of 43.8/1000 deliveries.

  9. Right Ampullary Ectopic Pregnancy Following Bilateral Tubal ...

    African Journals Online (AJOL)

    Pregnancy is unlikely to occur in women who have undergone sterilization. However when it occurs, there is a substantial risk that it will be an ectopic pregnancy. We report a case of right unruptured ampullary ectopic gestation following tubal sterilization with spring clips 6 years prior to presentation. The likely aetiology ...

  10. Ectopic pregnancy in Sokoto, Northern Nigeria

    African Journals Online (AJOL)

    MALAWI MED JOLIRNAL;17(1): 14—16. June 2005. ORIGINAL ARTICLE. Ectopic pregnancy in Sokoto, ... dures, as well as medical and expectant forms of treatment, are increasingly being used in its management 3. This study was carried .... Miscarriage, ectopic pregnancy and tro- phoblastic disease. In: Edmond DK (ed).

  11. Ectopic fat depositions in obesity and diabetes

    NARCIS (Netherlands)

    Jonker, Jacqueline Thérèse

    2012-01-01

    The studies described in this thesis explored the effects of nutritional, exercise and pharmacological interventions on ectopic triglyceride accumulation in obese patients and/or patients with type 1 or type 2 diabetes mellitus (T2DM). Ectopic fat is defined as triglyceride (TG) storage in tissues,

  12. Minimally Invasive Management of Ectopic Pancreas.

    Science.gov (United States)

    Vitiello, Gerardo A; Cavnar, Michael J; Hajdu, Cristina; Khaykis, Inessa; Newman, Elliot; Melis, Marcovalerio; Pachter, H Leon; Cohen, Steven M

    2017-03-01

    The management of ectopic pancreas is not well defined. This study aims to determine the prevalence of symptomatic ectopic pancreas and identify those who may benefit from treatment, with a particular focus on robotically assisted surgical management. Our institutional pathology database was queried to identify a cohort of ectopic pancreas specimens. Additional clinical data regarding clinical symptomatology, diagnostic studies, and treatment were obtained through chart review. Nineteen cases of ectopic pancreas were found incidentally during surgery for another condition or found incidentally in a pathologic specimen (65.5%). Eleven patients (37.9%) reported prior symptoms, notably abdominal pain and/or gastrointestinal bleeding. The most common locations for ectopic pancreas were the duodenum and small bowel (31% and 27.6%, respectively). Three out of 29 cases (10.3%) had no symptoms, but had evidence of preneoplastic changes on pathology, while one harbored pancreatic cancer. Over the years, treatment of ectopic pancreas has shifted from open to laparoscopic and more recently to robotic surgery. Our experience is in line with existing evidence supporting surgical treatment of symptomatic or complicated ectopic pancreas. In the current era, minimally invasive and robotic surgery can be used safely and successfully for treatment of ectopic pancreas.

  13. Huge Parathyroid Adenoma with Dysphagia Presentation; A Case Report from Southern Iran

    OpenAIRE

    Bizhan Ziaeean; Sahar Sohrabi-Nazari

    2016-01-01

    Parathyroid adenoma is a benign tumor of the parathyroid glands. The cause of most parathyroid adenomas is unknown. Parathyroid adenoma increases the secretion of parathyroid hormone and results in primary hyperparathyroidism. High amounts of parathyroid hormone in the blood cause the imbalance of calcium, which leads to various complications such as kidney stones, depression, lethargy, nausea, vomiting, abdominal pain, myalgia, bone and joint pain, hoarseness, etc. Oropharyngeal dysphagia is...

  14. Cinacalcet HCl prevents development of parathyroid gland hyperplasia and reverses established parathyroid gland hyperplasia in a rodent model of CKD

    OpenAIRE

    Miller, Gerald; Davis, James; Shatzen, Edward; Colloton, Matthew; Martin, David; Henley, Charles M.

    2011-01-01

    Background. Secondary hyperparathyroidism (sHPT) represents an adaptive response to progressively impaired control of calcium, phosphorus and vitamin D in chronic kidney disease (CKD). It is characterized by parathyroid hyperplasia and excessive synthesis and secretion of parathyroid hormone (PTH). Parathyroid hyperplasia in uremic rats can be prevented by calcium-sensing receptor (CaSR) activation with the calcimimetic cinacalcet (Sensipar®/Mimpara®); however, it is unknown, how long the eff...

  15. Revisiting Ectopic Pregnancy: A Pictorial Essay

    Directory of Open Access Journals (Sweden)

    Artemis Petrides

    2014-01-01

    Full Text Available Ectopic pregnancies occur in approximately 1.4% of all pregnancies and account for 15% of pregnancy-related deaths. Considering the high degree of mortality, recognizing an ectopic pregnancy is important. Signs and symptoms of an ectopic pregnancy are nonspecific and include pain, vaginal bleeding, and an adnexal mass. Therefore, imaging can play a critical role in diagnosis. There are different types of ectopic pregnancies, which are tubal, cornual, cesarean scar, cervical, heterotopic, abdominal, and ovarian. Initial imaging evaluation of pregnant patients with pelvic symptoms is by ultrasonography, transabdominal, transvaginal or both. We review the sonographic appearance of different types of ectopic pregnancies that will aid in accurate and prompt diagnosis.

  16. Optimising the diagnosis of ectopic pregnancy.

    Science.gov (United States)

    Berry, Janet; Davey, Mark; Hon, Mei-See; Behrens, Renée

    2016-05-01

    This retrospective cohort study reviewed the diagnosis of all ectopic pregnancies within a district general hospital over a 5-year period after the establishment of a dedicated Early Pregnancy Assessment Unit (EPAU). Of 215 ectopic pregnancies identified, notes were available for 208 (97%). Two-hundred and two cases were determined to have been diagnosed and managed as ectopic pregnancies. Six cases were excluded as they were pregnancies of unknown location managed as such. Overall, 91% were diagnosed by ultrasound scan, 5% were diagnosed clinically and 3% were diagnosed on serial human chorionic gonadotrophin (hCG) levels. This study found that the introduction of a dedicated, multi-professional, EPAU with a stable workforce improved ultrasound visualisation of ectopic pregnancies at first ultrasound scan from 22% prior to its commencement, to 61% over this period. The improvement in positive scan diagnosis of ectopic pregnancy was associated with a reduction in negative laparoscopy rate from 13% to 6%.

  17. Cutting Edge in Thyroid Surgery: Autofluorescence of Parathyroid Glands.

    Science.gov (United States)

    Falco, Jorge; Dip, Fernando; Quadri, Pablo; de la Fuente, Martin; Rosenthal, Raul

    2016-08-01

    Identification of parathyroid glands may be challenging during thyroid and parathyroid surgery. Accidental resection of the glands may increase the morbidity of the surgery. The aim of this study was to evaluate accuracy in identification of autofluorescent parathyroid glands with the use of near infrared light in real time. Patients undergoing thyroid and parathyroid surgery between June and August 2015 were included in the study. During the procedure, the surgical field was exposed to near infrared laser light in order to analyze the intensity of the fluorescence of different tissues (parathyroid glands, thyroid glands, and background). Surgical images were recorded and analyzed. Twenty-eight patients were included in the study. Nineteen patients were women and 9 were men. Seven patients had primary hyperparathyroidism, 4 had hyperthyroidism, 3 had goiters, and 11 had thyroid cancer. Three patients had mixed pathologies, including 2 patients with thyroid cancer and primary hyperparathyroidism and 1 patient with goiter and primary hyperparathyroidism. Identification of autofluorescent parathyroid glands was achieved in all patients with near infrared light. The mean fluorescent intensity of parathyroid glands was 40.6 (±26.5), thyroid glands 31.8 (±22.3), and background 16.6 (±15.4). Parathyroid glands demonstrated statistically higher fluorescence intensity compared with the thyroid gland and background (p autofluorescent parathyroid glands with the use of near infrared light allows high rates of parathyroid gland identification and could be a safe, feasible, and noninvasive method for intraoperative identification of parathyroid glands in real time. Further clinical studies must be performed to determine the cost-effectiveness and clinical application of this method. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Cervical ectopic pregnancy: clinical review.

    Science.gov (United States)

    Starita, A; Di Miscia, A; Evangelista, S; Donadio, F; Starita, A

    2006-01-01

    Cervical pregnancy is a rare kind of intrauterine ectopic pregnancy. Diagnosis and treatment of cervical pregnancy have enormously changed in the last 15 years. Before 1980, diagnosis was made when dilation and curettage for presumed incomplete abortion resulted in sudden and uncontrollable hemorrhage. Hysterectomy was practiced in order to save the patient's life. Today, cervical pregnancy is diagnosed by ultrasound (US) during the Ist trimester of pregnancy, so that the patient's fertility can be preserved. Therefore any physician should consider the possibility of a cervical pregnancy in a woman with abdominal pain and vaginal bleeding during the first trimester of pregnancy. In this study we reviewed the literature on the epidemiology, etiology, diagnosis and treatments of cervical pregnancy.

  19. Sigmoid Microinvasion by an Ectopic Pregnancy.

    Science.gov (United States)

    Paquette, Joalee; Leboeuf, Mathieu; Gorak-Savard, Émilie

    2016-11-01

    Approximately 2.1% to 8.6% of all pregnancies after IVF with embryo transfer have been reported to be ectopic. In this report, we present a case of presumed intestinal microperforation caused by an ectopic pregnancy following IVF. A 29-year-old woman presented with rectal bleeding. She had previously been treated for an ectopic pregnancy for which she had received two doses of methotrexate. Colonoscopy and abdominal CT angiography were performed and showed that the ectopic pregnancy was attached to the sigmoid colon. Surgery was performed to remove the ectopic pregnancy. Because intestinal microperforations were suspected, the patient received intravenous antibiotic therapy during her hospitalization. In cases of intestinal bleeding, clinicians should consider the possibility of intestinal involvement of an ectopic pregnancy, even if the response to treatment for the ectopic pregnancy has been appropriate. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  20. [Evaluation of the function of autotransplanted parathyroid tissues].

    Science.gov (United States)

    Xu, Guo-hui; Zhang, Nai-song; Song, Yun-tao; Yu, Wen-bin; Wei, Wei; Sun, Jun-yong

    2012-08-01

    To evaluate the function autotransplanted parathyroid tissues in thyroid surgery. The control group comprised 120 volunteers with normal parathyroid glands in whom serum parathyroid hormone (PTH) levels in blood samples taken from the bilateral elbow head veins. The experimental group comprised 34 patients in whom the parathyroid glands, which were mistakenly cut or could not be preserved during thyroid surgery because of ischemia, were fragmented and autografted into the brachioradialis muscle of the nondominant forearm. On the day of surgery and at 3 days, 7 days, and 2 months postoperatively, contrast imaging and detection of serum PTH levels were performed to evaluate the function of the transplanted parathyroid tissues. In the control group, the mean value of the difference between the bilateral brachiocephalic vein PTH levels was (1.19 ± 0.98) ng/L (maximum 4.52 ng/L). In this study, twice the maximum value (9.04 ng/L) was taken as the effective standard. Based on the 9.04 ng/L effective value, the effective number was 26 patients and the effective rate was 76.5% at 2 months postoperatively in the 34 patients of the experimental group. The autotransplanted parathyroid tissues showed their functions in most patients, therefore, parathyroid gland autotransplantation is an effective method of preserving function of parathyroid glands that are free or severely ischemic in thyroid surgery.

  1. Parathyroid hormone in pediatric patients with β-thalassemia major ...

    African Journals Online (AJOL)

    Results: Thalassemic patients had significantly higher alkaline phosphatase and lower bone mineral density. Conclusion: Osteopenia in β-thalassemia major patients is multifactorial and is mainly predisposed by defective function of the parathyroid gland and excessive iron deposition. Keywords: Parathyroid; Thalassemia ...

  2. Hypercalcaemia and bony lesions in association with parathyroid ...

    African Journals Online (AJOL)

    Parathyroid carcinoma is a rare disease accounting for 0.1 - 5% of cases of primary hyperparathyroidismY The pre-operative differentiation between parathyroid carcinoma and benign forms of primary hyPerparathyroidism is difficult, as the presenting symptoms and signs are similar.' Postoperatively the diagnosis may ...

  3. Intra-operative parathyroid hormone measurements – experience of ...

    African Journals Online (AJOL)

    Primary hyperparathyroidism is usually caused by a single para- thyroid adenoma secreting excessive parathyroid hormone (PTH).1. The standard of care for symptomatic primary hyperparathyroid- ism is surgical removal of all hyperfunctioning parathyroid tissue. In experienced hands, parathyroidectomy by conventional ...

  4. Radionuclide imaging of parathyroid tumors: historical perspectives and newer techniques

    Energy Technology Data Exchange (ETDEWEB)

    Winzelberg, G.G.; Hydovitz, J.D.

    1985-04-01

    The increasing use of automated blood chemistry screens for serum calcium levels along with improved methods in measuring parathyroid hormone (PTH) levels have made the diagnosis of parathyroid disease a common clinical problem. Parathyroid adenomas account for the majority of primary hyperparathyroidism with diffuse hyperplasia and parathyroid carcinoma occurring less frequently. Early scintigraphic techniques to identify enlarged parathyroids used selenomethionine-75 which was considered to be incorporated into PTH. In general, the sensitivity of scanning the neck using this tracer was related to the size of the enlarged parathyroid, but in large series, the overall sensitivity was less than 50%. Recent work by Ferlin et al, using a Technetium-99m/Thallium-201 subtraction scintigraphic technique has yielded a sensitivity of 92% in identifying pathologically enlarged parathyroid glands. Winzelberg et al modified this technique to allow imaging the mediastinum plus simplifying the subtraction method. In a prospective study with high-resolution sonography, similar sensitivities and specificities were found with sonography and scintigraphy. Tl-201/Tc-99m pertechnetate subtraction scintigraphy appears to be an accurate technique in identifying pathologic parathyroid enlargement. Its ultimate role in the evaluation of patients with suspected hyperparathyroidism still needs to be determined. 37 references.

  5. 21 CFR 862.1545 - Parathyroid hormone test system.

    Science.gov (United States)

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test... is a device intended to measure the levels of parathyroid hormone in serum and plasma. Measurements of parathyroid hormone levels are used in the differential diagnosis of hypercalcemia (abnormally...

  6. [Allogeneic parathyroid: 2-year follow-up].

    Science.gov (United States)

    Hermosillo-Sandoval, José Manuel; Leonher-Ruezga, Karla Lisseth; Jiménez-Gómez, José Alfredo; Fuentes-Orozco, Clotilde; González-Ojeda, Alejandro; Ramírez-González, Luis Ricardo

    2015-01-01

    Hypoparathyroidism is one of the most frequent complications of neck surgery. The treatment is currently medical; however this involves several complications secondary to high doses of calcium and vitamin D, thus making parathyroid allotransplantation a good management option. Patients with hypoparathyroidism were selected in the April-December period of 2011 in the general surgical clinic. They were between 16 and 65 years, and ingested high doses of calcium. The donors were patients with primary and secondary hyperparathyroidism, and the transplants were performed in relation to blood group and human leucocyte antigen. Five parathyroid allografts were performed. All the patients had iatrogenic hypoparathyroidism, all women with a mean age of 49.8 years. The graft was implanted under local anaesthesia in the non-dominant forearm. Four of the patients are so far considered functional due to the increase in paratohormone, and demonstrating its function by scintigraphy with sestamibi. One of the patients showed no increase in paratohormone or imaging studies that demonstrate its functionality. After a two year follow up the graft remains functional but with with oral calcium intake at a lower dose than before transplantation. None of the patients had immunosuppression side effects. In this study, allogeneic unrelated living parathyroid transplant with an immunosuppressive regimen of six months has proven to be a safe alternative treatment to improve quality of life by decreasing the excessive calcium intake and improving physical activity with adequate graft survival at 24 months follow up. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  7. Parathyroid hormone binding to cultured avian osteoclasts

    Energy Technology Data Exchange (ETDEWEB)

    Teti, A.; Rizzoli, R.; Zambonin Zallone, A. (Univ. of Bari (Italy))

    1991-02-14

    Parathyroid hormone (PTH) increases serum calcium concentration via a controversial cellular mechanism. We investigated whether PTH binds avian osteoclasts. Isolated hypocalcaemic hen osteoclasts were incubated with ({sup 125}I)--bovine PTH (1-84). Specific binding of the hormone to the cells, which reached the equilibrium within 60 min, was observed. Half maximal binding was reached by 10 min. Binding was competitively inhibited by increasing doses of unlabeled PTH, and was about 55% displaced by adding, at the equilibrium, 10(-6) M unlabeled PTH. Autoradiography demonstrated specific label on the osteoclast. The cellular mechanism activated by the hormone remains to be elucidated.

  8. Secondary hyperparathyroidism and phosphate sensing in parathyroid glands.

    Science.gov (United States)

    Miyamoto, K; Ito, M; Segawa, H; Kuwahata, M

    2000-08-01

    Retention of inorganic phosphate (Pi) and associated hyperphosphatemia are important development of hyperparathyroidism secondary to renal failure. The beneficial effect of a low-Pi diet in the prevention of hyperparathyroidism can be attributed to the decrease in PTH secretion. This effect of Pi may be mediated by specific molecules in the parathyroid cell membrane. A complementary DNA encoding a Na(+)-Pi co-transporter, termed rat PiT-1, has been isolated from rat parathyroid. The amount of PiT-1 mRNA in the parathyroid is controlled by vitamin D and dietary Pi, which are the most important regulators of PTH secretion. The parathyroid Pi transporter may mediate the effects of extracellular Pi and PTH secretion in secondary hyperparathyroidism. In this study, we focus on the function of Na/Pi co-transporters in the parathyroid glands as inorganic Pi sensor.

  9. Parathyroid involvement in thyroid cancer: an unforeseen event

    Directory of Open Access Journals (Sweden)

    Chrisoulidou Alexandra

    2012-06-01

    Full Text Available Abstract Background Parathyroid metastatic disease from thyroid cancer has not been studied extensively, mainly due to the need for parathyroid preservation during thyroid surgery. Methods We reviewed files from 1,770 patients with thyroid cancer followed up in our department and 10 patients with parathyroid metastases (0.5% were identified. Patient and tumor characteristics were recorded. Results Six out of ten patients had metastases from papillary thyroid cancer, three from follicular thyroid cancer and one from anaplastic thyroid cancer. In nine patients parathyroid infiltration from thyroid cancer was found in direct contact with the thyroid cancer, and in one patient metastatic foci were observed not in continuity with the thyroid cancer. Conclusions Parathyroid involvement, although infrequent, may occur in thyroid cancer independently of patient age and tumor size. The clinical significance of such event is not clear. The influence on disease outcome remains to be elucidated.

  10. Cinacalcet HCl prevents development of parathyroid gland hyperplasia and reverses established parathyroid gland hyperplasia in a rodent model of CKD.

    Science.gov (United States)

    Miller, Gerald; Davis, James; Shatzen, Edward; Colloton, Matthew; Martin, David; Henley, Charles M

    2012-06-01

    Secondary hyperparathyroidism (sHPT) represents an adaptive response to progressively impaired control of calcium, phosphorus and vitamin D in chronic kidney disease (CKD). It is characterized by parathyroid hyperplasia and excessive synthesis and secretion of parathyroid hormone (PTH). Parathyroid hyperplasia in uremic rats can be prevented by calcium-sensing receptor (CaSR) activation with the calcimimetic cinacalcet (Sensipar®/Mimpara®); however, it is unknown, how long the effects of cinacalcet persist after withdrawal of treatment or if cinacalcet is efficacious in uremic rats with established sHPT. We sought to determine the effect of cinacalcet discontinuation in uremic rats and whether cinacalcet was capable of influencing parathyroid hyperplasia in animals with established sHPT. Discontinuation of cinacalcet resulted in reversal of the beneficial effects on serum PTH and parathyroid hyperplasia. In rats with established sHPT, cinacalcet decreased serum PTH and mediated regression of parathyroid hyperplasia. The cinacalcet-mediated decrease in parathyroid gland size was accompanied by increased expression of the cyclin-dependent kinase inhibitor p21. Prevention of cellular proliferation with cinacalcet occurred despite increased serum phosphorus and decreased serum calcium. The animal data provided suggest established parathyroid hyperplasia can be reversed by modulating CaSR activity with cinacalcet and that continued treatment may be necessary to maintain reductions in PTH.

  11. Functional and genetic studies of isolated cells from parathyroid tumors reveal the complex pathogenesis of parathyroid neoplasia

    Science.gov (United States)

    Shi, Yuhong; Hogue, Joyce; Dixit, Darshana; Koh, James; Olson, John A.

    2014-01-01

    Parathyroid adenomas (PAs) causing primary hyperparathyroidism (PHPT) are histologically heterogeneous yet have been historically viewed as largely monotypic entities arising from clonal expansion of a single transformed progenitor. Using flow cytometric analysis of resected adenomatous parathyroid glands, we have isolated and characterized chief cells, oxyphil cells, and tumor-infiltrating lymphocytes. The parathyroid chief and oxyphil cells produce parathyroid hormone (PTH), express the calcium-sensing receptor (CASR), and mobilize intracellular calcium in response to CASR activation. Parathyroid tumor infiltrating lymphocytes are T cells by immunophenotyping. Under normocalcemic conditions, oxyphil cells produce ∼50% more PTH than do chief cells, yet display significantly greater PTH suppression and calcium flux response to elevated calcium. In contrast, CASR expression and localization are equivalent in the respective parathyroid cell populations. Analysis of tumor clonality using X-linked inactivation assays in a patient-matched series of intact tumors, preparatively isolated oxyphil and chief cells, and laser-captured microdissected PA specimens demonstrate polyclonality in 5 of 14 cases. These data demonstrate the presence of functionally distinct oxyphil and chief cells within parathyroid primary adenomas and provide evidence that primary PA can arise by both clonal and polyclonal mechanisms. The clonal differences, biochemical activity, and relative abundance of these parathyroid adenoma subpopulations likely reflect distinct mechanisms of disease in PHPT. PMID:24510902

  12. Cinacalcet HCl prevents development of parathyroid gland hyperplasia and reverses established parathyroid gland hyperplasia in a rodent model of CKD

    Science.gov (United States)

    Miller, Gerald; Davis, James; Shatzen, Edward; Colloton, Matthew; Martin, David

    2012-01-01

    Background. Secondary hyperparathyroidism (sHPT) represents an adaptive response to progressively impaired control of calcium, phosphorus and vitamin D in chronic kidney disease (CKD). It is characterized by parathyroid hyperplasia and excessive synthesis and secretion of parathyroid hormone (PTH). Parathyroid hyperplasia in uremic rats can be prevented by calcium-sensing receptor (CaSR) activation with the calcimimetic cinacalcet (Sensipar®/Mimpara®); however, it is unknown, how long the effects of cinacalcet persist after withdrawal of treatment or if cinacalcet is efficacious in uremic rats with established sHPT. Methods. We sought to determine the effect of cinacalcet discontinuation in uremic rats and whether cinacalcet was capable of influencing parathyroid hyperplasia in animals with established sHPT. Results. Discontinuation of cinacalcet resulted in reversal of the beneficial effects on serum PTH and parathyroid hyperplasia. In rats with established sHPT, cinacalcet decreased serum PTH and mediated regression of parathyroid hyperplasia. The cinacalcet-mediated decrease in parathyroid gland size was accompanied by increased expression of the cyclin-dependent kinase inhibitor p21. Prevention of cellular proliferation with cinacalcet occurred despite increased serum phosphorus and decreased serum calcium. Conclusions. The animal data provided suggest established parathyroid hyperplasia can be reversed by modulating CaSR activity with cinacalcet and that continued treatment may be necessary to maintain reductions in PTH. PMID:22036941

  13. Zygomycotic Mediastinal Lymphadenitis in Beef Cattle with Ruminal Tympany

    Science.gov (United States)

    NISHIMURA, Maki; TOYOTA, Yumi; ISHIDA, Yoshikazu; NAKAYA, Hideki; KAMEYAMA, Kyohko; NISHIKAWA, Yoshifumi; MIYAHARA, Kazuro; INOKUMA, Hisashi; FURUOKA, Hidefumi

    2013-01-01

    ABSTRACT A 9-month-old steer was autopsied due to recurrent ruminal tympany. A macroscopic examination found an enlarged caudal mediastinal lymph node, and a section of the lymph node revealed necrosis with marked calcification, similar to tuberculous lymphadenitis. Histopathologically, the lesion consisted of multiple coagulative necrotic foci and fibrosis with macrophage, lymphocyte, eosinophil and multinucleated giant cell infiltration. Non-uniform width hyphae were detected in the necrotic area and within the cytoplasm of the multinucleated giant cells, and they were found to be anti-Rhizopus arrhizus antibody positive in an immunohistochemical examination. Therefore, the steer was diagnosed with necrotic caudal mediastinal lymphadenitis due to zygomycetes infection, and inhibition of eructation by the enlarged lymph node was the likely cause of the ruminal tympany. PMID:24018826

  14. Localization fibrosing mediastinitis causing pulmonary infraction: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Sur, Young Keun; Kim, Eun Young; Kang, Doo Kyoung; Park, Kyung Joo; Koh, Young Wha; Sun, Joo Sung [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2016-06-15

    A 44-year-old female patient visited our emergency room for hemoptysis and refractory chest wall pain of 2 months duration. She had no history of smoking or other medical conditions. Chest CT scan showed homogenously enhancing soft tissue mass without calcification at the left pulmonary hilum. Encasing and compression of the left lower pulmonary artery by the mass had resulted in pulmonary infarction in the left lower lobe. Laboratory tests for tuberculosis, fungus, and vasculitis were all negative. The patient underwent surgical biopsy and resection of infarcted left lower lobe that was histopathologically confirmed as fibrosing mediastinitis. Herein, we reported a rare case of surgically confirmed and treated localized fibrosing mediastinitis causing pulmonary infarction.

  15. Unusual Mediastinal Dumbbell Tumor Mimicking an Aggressive Malignancy

    Directory of Open Access Journals (Sweden)

    Sanyal Kumar

    2012-01-01

    Full Text Available Hydatid cyst is known to affect all possible anatomical locations of the human body. However, the mediastinal localization is extremely rare. This benign, commonly asymptomatic and incidentally detected disease, at times may simulate an aggressive malignancy by its potential to cause osseous destruction and intraspinal extension. A young female, farmer by occupation, presented with complaints of left chest pain and monoparesis of the left lower limb. Radiograph followed by computed tomography (CT of the chest demonstrated a cystic mass within the posterior mediastinum, eroding and scalloping overlying ribs and extending into the spinal canal by causing destruction of adjoining vertebra, and assuming a dumbbell shape. The serology was positive for echinococcosis. The patient underwent surgery and the postoperative histopathology confirmed the diagnosis of hydatid cyst. The patient recovered with no complications or recurrence. Hydatid cyst should always be considered in the differential diagnosis of mediastinal cystic lesions, however aggressive the lessions may appear.

  16. A case of necrotizing mediastinitis induced by acute pyoper icardium

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2016-09-01

    Full Text Available Deep neck infection is a potentially life-threatening disease, especially complicated with descending necrotizing mediastinitis (DNM. The mean age of DNM is 49–57.8 years old. The commonly seen causes are tonsillar, pharyngeal infection and odontogenic origins. When the deep neck infection extended to the mediastinal spaces, the pleural effusion or pericardial effusion may appear. Here is a rare young lady who had fever and sore throat for 2 weeks, and chest X-ray showed bilateral pleural effusion. After surgical drainage, the Escherichia coli grew over the culture of pericardial effusion. This case is rarely seen in the presence of Escherichia coli pyopericardium originating from DNM in the past. Overall mortality rate of DNM is around 11.2%–17% nowadays. We should keep in mind that for DNM, early diagnosis and aggressively surgical intervention with suitable drainage, and intensive postoperative care should be conducted to lower the morbidity and mortality.

  17. /sup 75/Se-selenomethionine scintigraphy in mediastinal diseases

    Energy Technology Data Exchange (ETDEWEB)

    Masaoka, A.; Kyo, S.

    1978-03-01

    Chest scanning with /sup 75/Se-selenomethionine was performed in 59 cases of mediastinal diseases. All cases of vascular diseases, cystic tumors, and benign neurogenic tumor were negatively scanned. Parenchymatous teratoma, thymoma, malignant lymphoma, Castleman's tumor, epithelial tumors, tuberculous lymphadenitis, and sarcoidosis showed high positive rates. In myasthenic thymus without thymoma two out of 15 cases were positive. The scan images of the resected specimens and preoperative chest scannings coincided.

  18. Kluyvera mediastinitis following open-heart surgery: a case report.

    OpenAIRE

    Sierra-Madero, J; Pratt, K.; Hall, G. S.; Stewart, R. W.; Scerbo, J J; Longworth, D L

    1990-01-01

    Reports of serious infections caused by Kluyvera spp. have been rare. A case of Kluyvera sp. mediastinitis and bacteremia in a man after open-heart surgery is described. The clinical significance of Kluyvera sp. isolates was debated in early descriptions of the organism. More recent reports, as well as the present case, suggest that the pathogenic potential of this organism is being increasingly recognized by clinicians and microbiologists.

  19. Kluyvera mediastinitis following open-heart surgery: a case report.

    Science.gov (United States)

    Sierra-Madero, J; Pratt, K; Hall, G S; Stewart, R W; Scerbo, J J; Longworth, D L

    1990-12-01

    Reports of serious infections caused by Kluyvera spp. have been rare. A case of Kluyvera sp. mediastinitis and bacteremia in a man after open-heart surgery is described. The clinical significance of Kluyvera sp. isolates was debated in early descriptions of the organism. More recent reports, as well as the present case, suggest that the pathogenic potential of this organism is being increasingly recognized by clinicians and microbiologists.

  20. Mediastinal Cystic Lymphangioma in a Patient with Situs Inversus Totalis

    Directory of Open Access Journals (Sweden)

    Teruya Komatsu

    2014-01-01

    Full Text Available We present a case of cystic lymphangioma of the mediastinum complicated with situs inversus totalis. The 70-year-old man underwent thoracoscopic resection of a mediastinal cystic tumor, which was diagnosed as cystic lymphangioma. Cystic lymphangiomas are congenital cystic abnormalities of the lymphatic system. The head and neck area is often involved while the mediastinum is rarely affected. The rarity of this case is further attributed to the coexistence of situs inversus totalis.

  1. Spontaneous chylothorax revealing a mediastinal and abdominal lymph node tuberculosis.

    Science.gov (United States)

    Amar, Jihen Ben; Zaibi, Haifa; Dahri, Besma; Aouina, Hichem

    2017-04-01

    Chylothorax is a rare manifestation of tuberculosis. We report a case of spontaneous chylothorax due to tuberculosis. A 62-year-old woman was admitted with fever, chest pain and dyspnea. Chest and abdominal computed tomography revealed a fluid collection with necrotic mediastinal and abdominal lymph nodes. Biopsy of lymph nodes by mediastinoscopy. The patient was treated with anti-tuberculosis medication. He is clinically improved and his pleural effusion also completely resolved. Copyright © 2016. Published by Elsevier B.V.

  2. Cervicofacial and mediastinal emphysema due to a dental procedure

    Directory of Open Access Journals (Sweden)

    Mityanand Ramnarine

    2017-01-01

    Full Text Available Dental procedures, though commonplace and usually very safe, are not without complications. We report on a case of extensive cervicofacial and mediastinal emphysema after a routine dental procedure, initially masquerading as an allergic reaction in an otherwise young and healthy woman. A review of the relevant literature on this clinical entity is presented, which serves to underscore the need for awareness by the treating clinician of this condition and its potential sequela.

  3. Vacuum-assisted closure system in treatment of postoperative mediastinitis.

    Science.gov (United States)

    Elawadi, Mohamed Ahmed; Oueida, Farouk

    2013-12-01

    Post-cardiac surgery mediastinitis is a serious complication with high morbidity and high financial costs. Using a vacuum-assisted closure system is the established line of treatment for mediastinitis, which improves outcome, especially in the high-risk group of patients. From January 2007 to April 2011, a retrospective study was carried out to evaluate the outcome of vacuum-assisted closure in the treatment of postoperative mediastinitis. There were 34 patients; 27 were male and 7 female. Mean time from infection to vacuum-assisted closure was 3.34 ± 1.10 days. The duration of vacuum-assisted closure was 6.51 ± 1.85 days (3-9 days). The mean amount of discharge was 759.60 ± 175.28 mL (range, 354-990 mL). Of the 34 patients, 21 (61.76%) had direct surgical wound closure and 13 (41.16%) had re-wiring. Two patients had bilateral pectoral flaps. One patient had chronic fistula formation, and one had a tear in the right ventricle. Mean hospital stay was 11.28 ± 2.09 days (range, 6-16 days). Vacuum-assisted closure therapy is a safe, reliable, and cost-effective modality of treatment for postoperative mediastinitis. It improves the outcome and can be combined with other modalities of conventional treatment, especially in high-risk groups such as the elderly or patients with diabetes.

  4. Dual-Phase 99MTc-MIBI Parathyroid Imaging Reveals Synchronous Parathyroid Adenoma and Papillary Thyroid Carcinoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Ming-Che Chang

    2008-10-01

    Full Text Available The possibility of a coincidental appearance of hyperparathyroidism and thyroid cancer is not often considered because of its low incidence. Here, we present a case of a 49-year-old woman with a parathyroid adenoma coexisting with two sites of papillary thyroid carcinoma. Dual-phase 99mTc-methoxyisobutylisonitrile (MIBI parathyroid imaging before the operation correctly visualized the site of the parathyroid adenoma. In addition, two papillary thyroid carcinomas showed faint uptake of 99mTc-MIBI on delayed image. Total thyroidectomy and parathyroidectomy of a solitary parathyroid adenoma were performed. The patient subsequently underwent radioiodine-131 ablation and was treated with T4 suppression. This case illustrates the need for clinical awareness of concomitant hyperparathyroidism and thyroid cancer. Dual-phase 99mTc-MIBI parathyroid imaging may be useful for detecting indolent thyroid cancer before it becomes a distinct disease.

  5. Automatic mediastinal lymph node detection in chest CT

    Science.gov (United States)

    Feuerstein, Marco; Deguchi, Daisuke; Kitasaka, Takayuki; Iwano, Shingo; Imaizumi, Kazuyoshi; Hasegawa, Yoshinori; Suenaga, Yasuhito; Mori, Kensaku

    2009-02-01

    Computed tomography (CT) of the chest is a very common staging investigation for the assessment of mediastinal, hilar, and intrapulmonary lymph nodes in the context of lung cancer. In the current clinical workflow, the detection and assessment of lymph nodes is usually performed manually, which can be error-prone and timeconsuming. We therefore propose a method for the automatic detection of mediastinal, hilar, and intrapulmonary lymph node candidates in contrast-enhanced chest CT. Based on the segmentation of important mediastinal anatomy (bronchial tree, aortic arch) and making use of anatomical knowledge, we utilize Hessian eigenvalues to detect lymph node candidates. As lymph nodes can be characterized as blob-like structures of varying size and shape within a specific intensity interval, we can utilize these characteristics to reduce the number of false positive candidates significantly. We applied our method to 5 cases suspected to have lung cancer. The processing time of our algorithm did not exceed 6 minutes, and we achieved an average sensitivity of 82.1% and an average precision of 13.3%.

  6. Differential points of mediastinal cystic lesion in chest computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Jin; Baek, Jang Mi; Song, Jang Hyeon; Seon, Hyun Ju [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Kim, Yun Hyeon [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2013-10-15

    To find differential diagnostic imaging findings of mediastinal cystic lesions in chest computed tomography. We retrospectively reviewed imaging findings of 70 patients with histopathologically proven mediastinal cystic lesions. They were 33 male and 37 female patients. Among 70 cases, 49 cases were in the anterior mediastinum, 12 cases were in the middle mediastinum, and 9 cases were in the posterior mediastinum. 19 patients had symptoms. Chest discomfort was the most common symptom. When the cystic lesion was located in the anterior mediastinum, and unilocular, the possibility of thymic cyst was the most likely (p < 0.0027). When the cystic lesion was located in the anterior mediastinum and was multilocular with a relatively thick wall, the possibility of a mature cystic teratoma was the most likely (p < 0.001). When the lesion was a high attenuation cystic lesion located around the air-way, the possibility of a bronchogenic cyst was the most likely (p < 0.001). Chest CT gives information about the location, loculation, wall thickness and internal attenuation of mediastinal cystic lesions. And certain details seen on CT imaging can help with the correct diagnosis, especially in the cases of thymic cyst, mature cystic teratoma and bronchogenic cyst.

  7. Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report

    Directory of Open Access Journals (Sweden)

    Spirou Spiros

    2003-06-01

    Full Text Available Abstract Background Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy has become the most popular method for performing a gastrostomy for long-term enteral feeding. It has been associated, however, with a lot of minor and major complications. Case presentation A case of mediastinitis with concominant sepsis caused by a masked esophageal perforation after percutaneous endoscopic gastrostomy in a multi-traumatized, brain-injured patient is presented. Ten – fourteen days after the procedure, the patient became febrile and gradually septic with tenderness of the sternum and upper abdomen. Computerized tomography of the thorax revealed mediastinitis. An urgent left thoracotomy and laparotomy were performed for drainage of the mediastinum, removal of the gastrostomy and insertion of a jejunostomy tube. The patient improved soon after the surgery. He was successfully weaned off the ventilator and was discharged from the Intensive Care Unit. Conclusion Perforating mediastinitis is a rare but potentially lethal complication of percutaneous endoscopic gastrostomy. When diagnosed and properly treated it may have a favourable outcome.

  8. Surgical Management of Bulky Mediastinal Metastases in Follicular Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Zainal Adwin

    2016-01-01

    Full Text Available Follicular thyroid adenoma and carcinoma are very common. Benign and malignant lesions are usually indistinguishable from cytology alone and often require confirmatory resection. The spread of follicular carcinoma is usually hematogenous and is treated with surgery and adjuvant radioactive iodine. Very rarely, metastases occur in the mediastinum. Patients usually present with severe compressive symptoms. With proper treatment and follow-up, the prognosis for these type of thyroid malignancies is excellent. In the case presented here, our patient presented to the Universiti Kebangsaan Malaysia Medical Center with a progressively enlarging anterior neck swelling. The swelling had started 10 years before his presentation. We diagnosed him with an advanced thyroid malignancy with bulky mediastinal metastases. After extensive investigations and counseling, we chose to treat the patient with tumor excision and mediastinal metastases resection. Typically, mediastinal resection involves the removal of the sternum and use of an acrylic implant to recreate the sternum. In this case, the sternum and ribs were removed with subsequent myocutaneous flap coverage for the wound defect. Our experience represents an alternative treatment option in cases where implant use is unsuitable.

  9. Pentalogy of Cantrell: Complete expression with mediastinal teratoma

    Directory of Open Access Journals (Sweden)

    Michał Błaszczyński

    2015-08-01

    Full Text Available Pentalogy of Cantrell (POC is a rare, and often fatal congenital disorder that is characterized by a pentad consisting of ectopia cordis, omphalocele, sternal cleft, congenital diaphragmatic hernia, and various intra-cardiac defects. Although the hallmark of POC consists of these five anomalies, only a handful of cases have been reported with the full spectrum of this disorder. This case report presents a full term female with complete expression of POC and a mediastinal teratoma. Two days after birth, this infant underwent correction of the omphalocele and diaphragmatic defect, with repositioning of the cardiac apex within the thoracic cavity. Three months later surgical correction of the intra-cardiac defects took place. At initiation of cardiac by-pass a mediastinal mass at the superior cavopulmonary junction was identified and excised. This mass on histopathology was a teratoma, which makes this case unique as the occurrence of POC and mediastinal teratoma is unreported. This infant has survived the series of corrective surgeries, and is now functioning well. Conclusion: when POC is suspected further investigation for associated anomalies is required for a planned multidisciplinary surgical approach combined with neonatal intensive care to afford the opportunity for a successful outcome.

  10. Ovarian ectopic pregnancy- a case report

    Directory of Open Access Journals (Sweden)

    Hiremath PB, Nidhi Bansal, SPArunkumar, Lavanya M, Sandhya Panjeta Gulia, Premaleela KGM, Reshma Hiremath

    2014-11-01

    Full Text Available Ectopic pregnancy (implantation anywhere outside the normal uterine cavity is the most common pregnancy complication leading to mortality. In the era of artificial reproductive techniques and liberated life style, ectopic pregnancy is not rare. However, ovarian pregnancy is an uncommonly encountered variety of ectopic pregnancy, and a definitive preoperative diagnosis is very challenging. Intraoperative findings and histopathology usually provide the final diagnosis. High serum beta human chorionic gonadotrophin levels, lack of an intrauterine gestational sac, tubo ovarian mass on ultrasonography (USG, patient’s risk factors, in addition to the Spiegelberg’s criteria gives a high probability of ovarian pregnancy. Management with surgical approach is required in all cases. We have made an attempt to present a case of ovarian pregnancy, consistent with Spiegelberg’s criteria. Our case demonstrates the difficulty in preoperative and intra operative diagnosis of ovarian ectopic, the final confirmation has been made by histopathology.

  11. Ectopic Axillary Breast during Systemic Lupus

    Directory of Open Access Journals (Sweden)

    Besma Ben Dhaou

    2012-01-01

    Full Text Available Many breast changes may occur in systemic lupus erythematosus. We report a 41-year-old woman with lupus who presented three years after the onset of lupus an ectopic mammary gland confirmed by histological study.

  12. Ectopic Thyroid Tissue With Hashimoto's Thyroiditis.

    Science.gov (United States)

    Garcia-Rodriguez, Laura; Dharia, Rahil; Massey, Becky

    2016-02-01

    Ectopic thyroid gland is a rare occurrence with a prevalence of 1 per 100,000 to 300,000 people. Hashimoto's thyroiditis involving ectopic thyroid tissue is particularly unusual. We describe the presentation, workup, surgical management, and brief review of the literature. Retroactive review of an 83-year-old white female patient record. As a case report, this project was exempt from institutional review board approval. We present a case of ectopic thyroid tissue located in the strap muscles with concurrent Hashimoto's thyroiditis. This tissue initially was believed to represent metastatic follicular thyroid carcinoma. Whenever ectopic thyroid tissue is encountered, the gravest concern is metastatic thyroid cancer. The possibility of benign thyroid tissue should not be excluded even if the thyroid histology initially appears to be malignant in nature.

  13. Predictors of Ectopic Fat in Humans.

    Science.gov (United States)

    Zamboni, Mauro; Rossi, Andrea P; Fantin, Francesco; Budui, Simona L; Zoico, Elena; Zamboni, Giulia A; Mazzali, Gloria

    2014-12-01

    In the last decade there has been increasing focus on body fat distribution, rather than on the degree of obesity. More recently, great interest has also been dedicated to ectopic fat deposition in overnourished individuals that reflects a failure of the system of intracellular lipid homeostasis, which, in normal conditions, prevents lipotoxicity in the organs, by confining lipid overload to cells specifically designed to store large quantities of surplus calories, the white adipocytes. Consequently, excess body weight leads to fat infiltration of multiple organs including liver, pancreas, skeletal muscle, and heart thus forming "ectopic fat". Although overfeeding is considered the main predictor of ectopic fat deposition, other factors may be also involved. The purpose of this review is to evaluate the current available data on the predictors of ectopic fat deposition in humans.

  14. Hypoplastic right kidney with ectopic nonduplicated ureter

    Energy Technology Data Exchange (ETDEWEB)

    Limbert, D.J.

    1975-09-01

    Hypoplastic kidney with an ectopic ureter can produce urinary incontinence with its known psychologic disturbances. By diligent urologic workup, the diagnosis may be made preoperatively and appropriate surgical correction undertaken.

  15. Simultaneous presentation of ectopic pregnancy and hyperthyroidism.

    Science.gov (United States)

    Lyall, H; Mahmood, T A

    2000-02-01

    Hyperthyroidism is known to occur uncommonly in pregnancy (about 0.5 per 1000). The incidence of ectopic pregnancy is approximately 9.6 per 1000 pregnancies. Both conditions, if unrecognised and untreated can have potentially fatal consequences. We describe a case of hyperthyroidism and ectopic pregnancy presenting concurrently, and highlight the difficulties encountered in diagnosis when two clinical conditions present with indistinguishable clinical signs.

  16. Ectopic pregnancy treatment by combination therapy

    OpenAIRE

    Cymbaluk-Płoska Aneta; Chudecka-Głaz Anita; Kuźniak Sławomir; Menkiszak Janusz

    2016-01-01

    Abstract Detectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients? future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients? general condition, ultrasono...

  17. CERVICAL ECTOPIC PREGNANCY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    bulent cakmak

    2013-06-01

    Full Text Available Cervical ectopic pregnancy which is implanted in the endocervical region, a rare condition characterized by high maternal morbidity and mortality. Early diagnosis and treatment can be life saving with preserving fertility in these patients. In this article, diagnosis and treatment of a cervical ectopic pregnancy case is presented with the review of the literature. [J Contemp Med 2013; 3(2.000: 108-111

  18. Molecular diagnostics and therapeutics for ectopic pregnancy.

    Science.gov (United States)

    Tong, Stephen; Skubisz, Monika M; Horne, Andrew W

    2015-02-01

    Ectopic pregnancies are a serious gynaecological emergency that can be fatal. As such, prompt diagnosis and safe timely treatment is essential. Here, we review the literature on the development of molecularly targeted diagnostics and therapeutics for ectopic pregnancy. A blood-based biomarker that accurately identifies an ectopic pregnancy could be used to offer early diagnostic certainty in cases where ultrasound cannot determine the location of the embryo ('a pregnancy of unknown location'). Molecules examined so far can be broadly grouped into biological themes of relevance to reproduction: (i) Fallopian tube (dys)function, (ii) embryo/trophoblast growth, (iii) corpus luteum function, (iv) inflammation, (v) uterine function and (vi) angiogenesis. While a sensitive and specific biomarker for ectopic pregnancy has yet to be identified, it is possible that improvements in platform technologies or a multi-modal biomarker approach may yield an accurate diagnostic biomarker test. Furthermore, with the advent of better imaging technology, the need for a blood-based biomarker test may be superseded by improvements in ultrasound or magnetic resonance imaging technology. There have been some recent preclinical studies describing molecularly targeted therapeutic approaches for ectopic pregnancy. Notably, bench-to-bedside studies have examined the use of combination gefitinib (orally available epidermal growth factor receptor inhibitor) and methotrexate. Preclinical studies suggest that combination gefitinib and methotrexate is highly effective in inducing placental cell death, and is significantly more effective than methotrexate alone. In early human trials, encouraging preliminary efficacy data have shown that combination gefitinib and methotrexate can rapidly resolve tubal ectopic pregnancies, and large extra-tubal ectopic pregnancies. If a large clinical randomized controlled trial confirms these findings, combination gefitinib and methotrexate could become a new

  19. Management of a posterior mediastinal Gardner fibroma causing critical airway stenosis in a resource limited setting

    Directory of Open Access Journals (Sweden)

    Katie Clouthier, DO

    2017-05-01

    Full Text Available In developed countries, surgeons and anesthesiologists approach the mediastinal mass causing airway compression with prudence and trepidation. Resource-limited settings provide unique challenges in the diagnosis and management of patients with critical airway compression. We report the successful treatment of a patient in Port-au-Prince, Haiti with a posterior mediastinal mass that filled the left chest cavity and caused critical airway stenosis. The pathology revealed a Gardner Fibroma, which is rarely associated with mediastinal airway obstruction.

  20. Mediastinal teratoma with hydrops fetalis in a newborn and development of chronic respiratory insufficiency

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    Simoncic Milanka

    2014-12-01

    Full Text Available Background. Mediastinal fetal teratoma can be detected as a mass in the chest during a routine prenatal ultrasound screening. Because of the pressure on mediastinal structures it can be the cause of non-immune hydrops fetalis and polyhydramnion. The development of hydrops fetalis leads to fetal death or premature delivery in most reported cases. Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period.

  1. Is this a mediastinal tumor? A case of Morgagni hernia complicated with intestinal incarceration mistaken for the mediastinal lipoma previously.

    Science.gov (United States)

    Komatsu, Teruya; Takahashi, Yutaka

    2013-01-01

    Morgagni's hernia is a congenital herniation of abdominal viscera into the thoracic cavity through a retrosternal diaphragmatic defect. We present a case of incarcerated Morgagni hernia in a 69-year-old woman. Three years previously, she had undertaken a video-assisted thoracoscopic resection (VATS) of a mediastinal mass, which had been mistaken for a lipoma. Following the primary repair of the hernia at emergency laparotomy, the patient was discharged home uneventfully. Irrespective of the radiologically characteristic findings of our case, the possibility of Morgagni hernia had not been entertained at the first operation. Thorough exploration around the diaphragm at the first VATS operation could have revealed the Morgagni hernia, ultimately avoiding the hernia-related complication such as an incarceration. Morgagni hernia as a differential diagnosis in case of anterior mediastinal mass should not be missed. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  2. ECTOPIC PREGNANCY: RISK FACTORS, DIAGNOSIS AND FERTILITY RESTORATION

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    Лариса Егоровна Фетищева

    2017-07-01

    Full Text Available Ectopic pregnancy is the most common pathology in gynecologic practice, leading to the reduction and loss of reproductive function. Diagnosis of ectopic pregnancy in cases of its occurrence interrupts and intra-abdominal bleeding does not provide significant difficulties. Of interest is the search for ectopic gestational sac located in rare forms of ectopic pregnancy. Although progress has been made in the diagnosis and treatment of ectopic pregnancy is not possible to achieve reduction of complications associated with it.

  3. Diagnosis and management of ectopic pregnancy.

    Science.gov (United States)

    Barash, Joshua H; Buchanan, Edward M; Hillson, Christina

    2014-07-01

    Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy-related deaths in the United States. When a pregnant patient presents with first-trimester bleeding or abdominal pain, physicians should consider ectopic pregnancy as a possible cause. The patient history, physical examination, and imaging with transvaginal ultrasonography can usually confirm the diagnosis. When ultrasonography does not clearly identify the pregnancy location, the physician must determine whether the pregnancy is intrauterine (either viable or failing) or ectopic. Use of the beta subunit of human chorionic gonadotropin (ß-hCG) discriminatory level, the ß-hCG value above which an intrauterine pregnancy should be visualized by transvaginal ultrasonography, may be helpful. Failure to visualize an intrauterine pregnancy when ß-hCG is above the discriminatory level suggests ectopic pregnancy. In addition to single measurements of ß-hCG levels, serial levels can be monitored to detect changes. ß-hCG values in approximately 99% of viable intrauterine pregnancies increase by about 50% in 48 hours. The remaining 1% of patients have a slower rate of increase; these patients may have pregnancies that are misdiagnosed as nonviable intrauterine or ectopic. After an ectopic pregnancy has been confirmed, treatment options include medical, surgical, or expectant management. For patients who are medically unstable or experiencing life-threatening hemorrhage, a surgical approach is indicated. For others, management should be based on patient preference after discussion of the risks, benefits, and monitoring requirements of all approaches.

  4. MR features of ectopic pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Tamai, Ken; Togashi, Kaori [Kyoto University, Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto (Japan); Koyama, Takashi [Kyoto University Hospital, Department of Radiology, Kyoto (Japan)

    2007-12-15

    Ectopic pregnancy (EP), in which a fertilized ovum implants outside the uterine cavity, is the leading cause of pregnancy-related death in the first trimester. EP is usually suspected by a positive pregnancy test and an empty uterus on transvaginal sonography (TVS). Although TVS is the initial modality of choice, it may occasionally fail to demonstrate the implantation site. When TVS findings are indeterminate, magnetic resonance imaging (MRI) may provide better delineation of the focus of EP owing to its excellent tissue contrast. The key MRI features of EP include gestational sac (GS)-like structures that typically appear as a cystic sac-like structure, frequently associated with surrounding acute hematoma of distinct low intensity on T2-weighted images. In tubal pregnancy, an enhanced tubal wall on postcontrast images may be another diagnostic finding. Ruptured EP is inevitably associated with acute hematoma outside these structures. In intrauterine EP, recognition of the relationship between GS-like structure and the myometrium can aid in differentiating from normal pregnancy. Diagnostic pitfalls include heterotopic pregnancy, decidual changes in endometrial cyst and theca lutein cysts mimicking GS-like structures. Knowledge of a spectrum of clinical and MRI features of EP is essential for establishing an accurate diagnosis and determining appropriate management. (orig.)

  5. Spontaneous Mediastinitis in a Ten-year-old Girl: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Kyung Eun; Kim, Ji Hong; Yoon, Choon Sik [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Mi Jung; Kim, Myung Joon [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2011-01-15

    Acute suppurative mediastinitis is an uncommon, life threatening condition with a mortality rate of up to 40%. It is mainly caused by esophageal perforation or post-operative complications, and acute mediastinitis not caused by trauma or surgery is rare. To the best of our knowledge, no cases of spontaneous mediastinal abscess in children have been reported in the English medical literature. We report here on a case of an acute mediastinal abscess in a ten-year-old girl and there was no demonstrable clinical or radiologic etiology for infection

  6. Risks and benefits in treatment of mediastinal abscess by endobronchial ultrasound-guided transbronchial needle aspiration.

    Science.gov (United States)

    Tian, Lei; Krimsky, William S; Wu, Qingchen; Sun, Jiayuan

    2017-07-01

    Mediastinal abscess is a fatal condition, treatment of mediastinal abscess is with antibiotics and sometimes surgery for debridement and drainage. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe assessment and candidate treatment method of mediastinal lesions. This study aimed to HYPERLINK "javascript:void(0);" discuss risks and benefits in treatment of mediastinal abscess by EBUS-TBNA. We noticed a 56-year-old man with developed bilateral pneumonia and sepsis after puncture of mediastinal abscess by EBUS-TBNA. The patient was successfully treated with a combination of systemic anti-infection treatment and intracavitary administration of antibiotics, antifungal and repeated drainage and lavage via EBUS-TBNA, in 1 year follow-up without recurrence. This study indicated infection spread risk of mediastinal abscess after EBUS-TBNA, and mediastinal abscess was successfully cured by combination of systemic anti-infection and local intervention through EBUS-TBNA. EBUS-TBNA is a potential effective minimally invasive treatment for mediastinal abscess, and it is necessary to be aware of clinical complications after puncture of mediastinal infectious lesions by EBUS-TBNA. © 2015 John Wiley & Sons Ltd.

  7. PRESENCE OF THYMIC TISSUE IN THE ANTERIOR MEDIASTINAL FATTY TISSUE AND ITS SIGNIFICANCE IN THYMECTOMY FOR MYASTHENIA GRAVIS PATIENT: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Athouba

    2016-03-01

    Full Text Available In 1970s, presence of thymic tissue in anterior mediastinal adipose tissue around the thymus was found. Here we report a case of ectopic thymic tissue in the mediastinum and the possible relevance of this distribution of thymic tissue outside thymus to the therapeutic yield of thymectomies in myasthenia gravis. A 30-year lady with myasthenia gravis (nonthymomatous presented with difficulty in swallowing and breathing for the last 1 years. She was under medical treatment but with little improvement. She underwent extended thymectomy, after which an en bloc resection of the anterior mediastinal fat tissues from pericardium and pleura, including the thymus, was performed. Grossly the soft tissue specimen taken from near left lateral area of heart was fibrofatty tissue. Microscopically isolated thymic tissues were seen interspersed among the fatty tissues composed of mature lymphocytes, epithelial cells and few Hassall's corpuscles were observed. Thymus specimen was within normal histological limits. To ensure complete removal, the adipose tissue at the anterior mediastinum as well as the gross thymus should be removed. Thymic tissue incidence in individual locations was as follows: Retrothyroid, 3(6%; peritracheal, 5 (10%; retrotracheal, 1 (2%; right phrenic nerve, 2 (4%; left phrenic nerve, 14 (28%; right recurrent laryngeal nerve, 2 (4%; left recurrent laryngeal nerve, 2 (4% and periaortic, 0. Trans-sternal thymectomy was found to be beneficial to all patients of mild-to-moderate myasthenia gravis with 70.2% patients showing improvement postoperatively.

  8. Near-infrared autofluorescence for the detection of parathyroid glands

    Science.gov (United States)

    Paras, Constantine; Keller, Matthew; White, Lisa; Phay, John; Mahadevan-Jansen, Anita

    2011-06-01

    A major challenge in endocrine surgery is the intraoperative detection of parathyroid glands during both thyroidectomies and parathyroidectomies. Current localization techniques such as ultrasound and sestamibi scan are mostly preoperative and rely on an abnormal parathyroid for its detection. In this paper, we present near-infrared (NIR) autofluorescence as a nonintrusive, real-time, automated in vivo method for the detection of the parathyroid gland. A pilot in vivo study was conducted to assess the ability of NIR fluorescence to identify parathyroid glands during thyroid and parathyroidectomies. Fluorescence measurements at 785 nm excitation were obtained intra-operatively from the different tissues exposed in the neck region in 21 patients undergoing endocrine surgery. The fluorescence intensity of the parathyroid gland was found to be consistently greater than that of the thyroid and all other tissues in the neck of all patients. In particular, parathyroid fluorescence was two to eleven times higher than that of the thyroid tissues with peak fluorescence occurring at 820 to 830 nm. These results indicate that NIR fluorescence has the potential to be an excellent optical tool to locate parathyroid tissue during surgery.

  9. Parathyroid carcinoma: an unusual presentation of a rare neoplasm

    Directory of Open Access Journals (Sweden)

    Shruti, Sharma

    2017-12-01

    Full Text Available Parathyroid carcinoma is an extremely rare malignant endocrine neoplasm that is very challenging in its diagnosis as well as its treatment. Clinically the disease is detected earlier in patients who present with hyperparathyroidism with signs of profound hypercalcemia. Differentiation between benign and malignant disease of the parathyroid is challenging both for the clinician and for the pathologist. Complete surgical resection at the time of first operation offers the best chance of cure. Even after radical excision which is the standard management, local recurrence and metastases are frequent. The disease usually has a slow indolent course and most patients suffer from complications of hypercalcemia rather than tumor invasion or metastasis.We report a case of a 31-year-old woman who presented with renal colic. Various hematological, biochemical and radiological investigations were performed and a slightly enlarged right parathyroid was found. A clinical diagnosis of parathyroid adenoma was made and a right parathyroidectomy was done. Intraoperatively the surgeon had no suspicion of malignancy but microscopically the lesion was malignant and a final diagnosis of parathyroid carcinoma was rendered based on the criteria of invasion. Since there is no gold standard, a multidisciplinary approach, including the entire clinical, biochemical, radiological and pathological profile of the disease aids in an accurate diagnosis. Here we are reporting a case of a functional parathyroid carcinoma presenting in a relatively young patient with all the biochemical and radiological investigations and findings pointing towards a benign parathyroid disease.

  10. Differential Findings of Tc 99m Sestamibi Dual Phase Parathyroid Scintigraphy Between Benign and Malignant Parathyroid Lesions in Patients with Primary Hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Miju; Choi, Joon Young; Chung, Jae Hoon; Lee, Ji Young; Cho, Sook Kyung; Yoo, Jang; Park, Soo Bin; Lee, Kyung Han; Kim, Byung Tae [Sungkyunkwan, Univ. School of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    This study aimed to investigate the differential findings in clinical and biochemical features, and Tc 99m sestamibi (MIBI) dual phase parathyroid lesions in patients with primary hyperparathyroidism. Subjects were 102 parathyroid lesions from 91 patients with primary hyperparathyroidism. Scintigraphic findings included radioactivity grade, uptake pattern, uptake contour lesion size on early and delayed images, and degree of washout. Clinical and biochemical features were also evaluated. Histopathology confirmed the final diagnosis for all the patients. Final diagnoses were 94 benign parathyroid lesions and 8 parathyroid carcinomas. The patients with parathyroid carcinoma were significantly older (p=0.002) and had significantly higher serum parathyroid hormone concentrations than those with benign parathyroid lesions (p<0.001). All malignant parathyroid lesions showed intense radioactivity similar to or greater than the submandibular gland activity on delayed images (p=0.007), and little radioactivity difference between early and delayed images (p=0.012). The cancer incidence for parathyroid lesions with both intense radioactivity and no washout was 17.0% (8/47). When parathyroid lesions with all of the above mentioned findings were regarded as malignant, the cancer incidence significantly increased from 17.0% to 33.3% (8/24, p<0.001). For Tc 99m MIBI dual phase parathyroid scintigraphy, uptake grade on delayed images and washout were significantly useful diagnostic criteria for differentiating benign from malignant parathyroid lesions, along with age and parathyroid hormone serum concentration.

  11. Benign Parathyroid Adenoma Presenting with Unusual Parathyroid Crisis, Anemia and Myelofibrosis

    OpenAIRE

    Shu-Chuan Huang; Vin-Cent Wu; Guan Chou; Tzu-Yu Huang; Shih-Yi Lin; Wayne Huey-Herng Sheu

    2007-01-01

    Although the clinical symptoms of patients with benign parathyroid adenoma are usually nonspecific and benign, a malignant presentation of the benign disease may sometimes occur. Here, we report a case of a 58-year-old woman who presented with aggravated sacrum pain, general malaise, and polydipsia. Initial laboratory findings revealed hypercalcemia, normocytic anemia, and impaired renal function. Acute hyper-calcemic crisis manifested and primary hyperparathyroidism was diagnosed together wi...

  12. Increased identification of parathyroid glands using near infrared light during thyroid and parathyroid surgery.

    Science.gov (United States)

    Falco, Jorge; Dip, Fernando; Quadri, Pablo; de la Fuente, Martin; Prunello, Marcos; Rosenthal, Raúl J

    2017-03-31

    Parathyroid gland (PG) identification during thyroid and parathyroid surgery is challenging. Accidental parathyroidectomy increases the rate of postoperative hypocalcaemia. Recently, autofluorescence with near infrared light (NIRL) has been described for PG visualization. The aim of this study is to analyze the increased rate of visualization of PGs with the use of NIRL compared to white light (WL). All patients undergoing thyroid and parathyroid surgery were included in this study. PGs were identified with both NIRL and WL by experienced head and neck surgeons. The number of PGs identified with NIRL and WL were compared. The identification of PGs was correlated to age, sex, and histopathological diagnosis. Seventy-four patients were included in the study. The mean age was 48.4 (SD ±13.5) years old. Mean PG fluorescence intensity (47.60) was significantly higher compared to the thyroid gland (22.32) and background (9.27) (p < 0.0001). The mean number of PGs identified with NIRL and WL were 3.7 and 2.5 PG, respectively (p < 0.001). The difference in the number of PGs identified with NIRL and WL and fluorescence intensity was not related to age, sex, or histopathological diagnosis, with the exception of the diagnosis of thyroiditis, in which there was a significant increase in the number of PGs visualized with NIRL (p = 0.026). The use of NIRL for PG visualization significantly increased the number of PGs identified during thyroid and parathyroid surgery, and the differences in fluorescent intensity among PGs, thyroid glands, and background were not affected by age, sex, and histopathological diagnosis.

  13. ANALYSIS OF RISK FACTORS ECTOPIC PREGNANCY

    Directory of Open Access Journals (Sweden)

    Budi Santoso

    2017-04-01

    Full Text Available Introduction: Ectopic pregnancy is a pregnancy with extrauterine implantation. This situation is gynecologic emergency that contributes to maternal mortality. Therefore, early recognition, based on identification of the causes of ectopic pregnancy risk factors, is needed. Methods: The design descriptive observational. The samples were pregnant women who had ectopic pregnancy at Maternity Room, Emergency Unit, Dr. Soetomo Hospital, Surabaya, from 1 July 2008 to 1 July 2010. Sampling technique was total sampling using medical records. Result: Patients with ectopic pregnancy were 99 individuals out of 2090 pregnant women who searched for treatment in Dr. Soetomo Hospital. However, only 29 patients were accompanied with traceable risk factors. Discussion:. Most ectopic pregnancies were in the age group of 26-30 years, comprising 32 patients (32.32%, then in age groups of 31–35 years as many as 25 patients (25.25%, 18 patients in age group 21–25 years (18.18%, 17 patients in age group 36–40 years (17.17%, 4 patients in age group 41 years and more (4.04%, and the least was in age group of 16–20 years with 3 patients (3.03%. A total of 12 patients with ectopic pregnancy (41.38% had experience of abortion and 6 patients (20.69% each in groups of patients with ectopic pregnancy who used family planning, in those who used family planning as well as ectopic pregnancy patients with history of surgery. There were 2 patients (6.90% of the group of patients ectopic pregnancy who had history of surgery and history of abortion. The incidence rate of ectopic pregnancy was 4.73%, mostly in the second gravidity (34.34%, whereas the nulliparous have the highest prevalence of 39.39%. Acquired risk factors, i.e. history of operations was 10.34%, patients with family planning 20.69%, patients with history of abortion 41.38%, patients with history of abortion and operation 6.90% patients with family and history of abortion was 20.69%.

  14. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography

    NARCIS (Netherlands)

    Jenssen, Christian; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin-Wu; Borst, Mathias Maximilian; Dietrich, Christoph Frank

    2015-01-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable

  15. Does the number of parathyroid glands autotransplanted affect the incidence of hypoparathyroidism and recovery of parathyroid function?

    Science.gov (United States)

    Su, Anping; Gong, Yanping; Wu, Wenshuang; Gong, Rixiang; Li, Zhihui; Zhu, Jingqiang

    2018-02-02

    The relationship between the number of parathyroid glands autotransplanted and hypoparathyroidism as well as recovery of parathyroid function is not understood fully. The aim was to ascertain whether the number of autotransplanted glands affected the incidence of hypoparathyroidism and recovery of parathyroid function in long-term follow-up after thyroidectomy. A retrospective cohort study included all patients with papillary thyroid carcinoma who underwent first-time total thyroidectomy with central neck dissection between June 2012 and June 2015. The patients were divided into 4 groups (0, 1, 2, and 3) on the basis of the number of parathyroid glands autotransplanted. Of the 766 patients, 283 (36.9%) had no gland autotransplanted, and 373 (48.7%), 97 (12.7%), and 13 (1.7%) had 1, 2, and 3 glands autotransplanted, respectively. More lymph nodes and more metastatic ones in the central compartment were retrieved in groups 2 and 3 (P  .05). The recovery rates of serum parathyroid hormone concentration were 84.7%, 82.2%, 82.0%, and 79.2% after 2-year follow-up (P > .05). Autotransplantation is an effective strategy for restoration of parathyroid function. Transient hypoparathyroidism is positively correlated to the number of autotransplanted parathyroid glands during total thyroidectomy with central neck dissection. There is no increase in permanent hypoparathyroidism in patients with a higher number of autotransplanted glands, despite more extensive lymph node disease. (Surgery 2018;161:XXX-XXX.). Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Ectopic pregnancy after infertility treatment

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    Madhuri Patil

    2012-01-01

    Full Text Available Early pregnancy complications are more common in women who conceive after infertility treatment. Most of these occur before 12 weeks of gestation and include miscarriage, vaginal bleeding, intrauterine hematoma, vanishing twin, and ectopic pregnancy (EP. The incidence of EPs following infertility treatment is much higher compared with that in spontaneous pregnancies. The occurrence of an EP is very distressing to an infertile couple, who has lots of hopes pinned on the treatment outcome, especially because of the cost incurred and the physical and mental trauma both have gone through during the treatment process. The association between infertility and EP is complex, as it can be a consequence of infertility as well as a cause. The two principal risk factors for an EP are genital tract infections and tubal surgeries. Though several etiologies are proposed, but patients with tubal factor infertility are at an increased risk of an EP. Earlier diagnosis of EP helps to improve prognosis and optimize subsequent fertility. It is pivotal to evaluate the likelihood of subsequent occurrence of an EP and be too vigilant when treating. The correct choice of the treatment modality should be made to prevent the recurrence. The early prediction of the pregnancy outcome therefore has great importance for both the couple and clinician. Today with the help of sensitive beta human chorionic gonadotropin (β-hCG assays and transvaginal sonography, one can diagnose an EP prior to symptoms, and conservative treatment for the preservation of the fallopian tube is possible. Conservative management in the form of expectant and medical management should be considered as a first-line treatment modality, provided that the overall clinical picture suggests that it is safe to do so. If not, laparoscopic management of EPs appears to be the favored approach of management as compared to laparotomy.

  17. Fragmentation of Care in Ectopic Pregnancy.

    Science.gov (United States)

    Stulberg, Debra B; Dahlquist, Irma; Jarosch, Christina; Lindau, Stacy T

    2016-05-01

    Ectopic pregnancy is an important cause of maternal morbidity and mortality. Women who experience fragmented care may undergo unnecessary delays to diagnosis and treatment. Based on ectopic pregnancy cases observed in clinical practice that raised our concern about fragmentation of care, we designed an exploratory study to describe the number, characteristics, and outcomes of fragmented care among patients with ectopic pregnancy at one urban academic hospital. Chart review with descriptive statistics. Fragmented care was defined as a patient being evaluated at an outside facility for possible ectopic pregnancy and transferred, referred, or discharged before receiving care at the study institution. Of 191 women seen for possible or definite ectopic pregnancy during the study period, 42 (22 %) met the study definition of fragmented care. The study was under-powered to observe statistically significant differences across groups, but we found concerning, non-significant trends: patients with fragmented care were more likely to be Medicaid recipients (65.9 vs. 58.8 %) and to experience a complication (23.8 vs. 18.1 %) compared to those with non-fragmented care. Most patients (n = 37) received no identifiable treatment prior to transfer and arrived to the study hospital with no communication to the receiving hospital from the outside provider (n = 34). Nine patients (21 %) presented with ruptured ectopic pregnancies. The fragmentation we observed in our study may contribute to previously identified socio-economic disparities in ectopic pregnancy outcomes. If future research confirms these findings, health information exchanges and regional coordination of care may be important strategies for reducing maternal mortality.

  18. Effects of Parathyroid Hormone on Immune Function

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    Abdallah Sassine Geara

    2010-01-01

    Full Text Available Parathyroid hormone (PTH function as immunologic mediator has become interesting with the recent usage of PTH analogue (teriparatide in the management of osteoporosis. Since the early 1980s, PTH receptors were found on most immunologic cells (neutrophils, B and T cells. The in vitro evaluations for a possible role of PTH as immunomodulator have shown inconsistent results mainly due to methodological heterogeneity of these studies: it used different PTH formulations (rat, bovine, and human, at different dosages and different incubating periods. In some of these studies, the lymphocytes were collected from uremic patients or animals, which renders the interpretation of the results problematic due to the effect of uremic toxins. Parathyroidectomy has been found to reverse the immunologic defect in patients with high PTH levels. Nonetheless, the clinical significance of these findings is unclear. Further studies are needed to define if PTH does have immunomodulatory effects.

  19. The history of the parathyroid surgery.

    Science.gov (United States)

    Toneto, Marcelo Garcia; Prill, Shandi; Debon, Leticia Manoel; Furlan, Fernando Zucuni; Steffen, Nedio

    2016-01-01

    The authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism. Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment. RESUMO Os autores fizeram uma revisão dos principais aspectos históricos da progressão do conhecimento sobre o tratamento cirúrgico do hiperparatireoidismo. Por meio de revisão bibliográfica, foram analisados artigos selecionados sobre a história da evolução do conhecimento anatômico, fisiológico, patológico e cirúrgico das glândulas paratireoides. Devido às suas características anatômicas peculiares, as paratireoides foram as últimas das glândulas endócrinas a serem descobertas, o que dificultou sobremaneira seu tratamento adequado até as primeiras décadas do Século XX. A evolução tecnológica ocorrida nos últimos 30 anos facilitou sobremaneira a localização das glândulas e a cirurgia do hiperparatireoidismo. Contudo, um cirurgião experiente e dedicado ao tratamento dessa enfermidade ainda é fundamental para a excelência do tratamento.

  20. Interrelated aldosterone and parathyroid hormone mutually modify cardiovascular mortality risk

    NARCIS (Netherlands)

    Tomaschitz, Andreas; Pilz, Stefan; Rus-Machan, Jutta; Meinitzer, Andreas; Brandenburg, Vincent M; Scharnagl, Hubert; Kapl, Martin; Grammer, Tanja; Ritz, Eberhard; Horina, Jörg H; Kleber, Marcus E; Pieske, Burkert; Kraigher-Krainer, Elisabeth; Hartaigh, Bríain Ó; Toplak, Hermann; van Ballegooijen, Adriana J; Amrein, Karin; Fahrleitner-Pammer, Astrid; März, Winfried

    2015-01-01

    BACKGROUND: Inappropriate aldosterone and parathyroid hormone (PTH) secretion is associated with increased cardiovascular risk. Accumulating evidence suggests bidirectional interplay between aldosterone and PTH. METHODS: We evaluated the cross-sectional relationship between plasma aldosterone

  1. Surgical anatomy of the thyroid and parathyroid glands.

    Science.gov (United States)

    Fancy, Tanya; Gallagher, Daniel; Hornig, Joshua D

    2010-04-01

    This article describes the anatomy and embryology of the thyroid and parathyroid glands and the recurrent laryngeal nerve, discussing how the anatomy affects function and dysfunction of the glands. Copyright 2010 Elsevier Inc. All rights reserved.

  2. Multiple organ dysfunction caused by parathyroid adenoma‑induced ...

    African Journals Online (AJOL)

    2013-04-21

    induced PHPT. Here, we describe a male patient with renal dysfunction, nephrolithiasis, bone disorders, and acute pancreatitis (AP) associated with hypercalcemia caused by parathyroid adenoma‑induced. PHPT. Case Report.

  3. Parathyroid Adenoma Presenting as a Brown Tumour of the Mandible

    Science.gov (United States)

    Amin, Kavit; Fu, Bertram; Barbaccia, Carmelo

    2012-01-01

    Background. Parathyroid adenoma is the commonest cause of primary hypercalcaemia and usually presents with symptoms/signs of hypercalcaemia. This paper highlights an unusual presentation. Case Report. A 27-year-old female presented with a painful left mandibular swelling, suspicious of neoplasia. A computed tomography (CT) guided biopsy was performed. Based on the histology result, serum calcium was carried out, confirming hypercalcaemia. A left inferior parathyroid adenoma was subsequently removed. CT mandible showed extensive erosive lesions at the left 2nd/3rd inferior molar roots with protrusion to adjacent soft tissues. USS revealed a hypoechoic lesion on the left inferior parathyroid gland. Sestamibi scan showed a focus of MIBI uptake and retention at the inferior aspect of the left thyroid lobe. Conclusion. This case highlights the importance of a thorough history and examination. Clinicians should always bear in mind atypical presentations of parathyroid adenomas, with the need to exclude this differential in the presence of hypercalcaemia. PMID:23251179

  4. Parathyroid Adenoma Presenting as a Brown Tumour of the Mandible

    Directory of Open Access Journals (Sweden)

    Kavit Amin

    2012-01-01

    Full Text Available Background. Parathyroid adenoma is the commonest cause of primary hypercalcaemia and usually presents with symptoms/signs of hypercalcaemia. This paper highlights an unusual presentation. Case Report. A 27-year-old female presented with a painful left mandibular swelling, suspicious of neoplasia. A computed tomography (CT guided biopsy was performed. Based on the histology result, serum calcium was carried out, confirming hypercalcaemia. A left inferior parathyroid adenoma was subsequently removed. CT mandible showed extensive erosive lesions at the left 2nd/3rd inferior molar roots with protrusion to adjacent soft tissues. USS revealed a hypoechoic lesion on the left inferior parathyroid gland. Sestamibi scan showed a focus of MIBI uptake and retention at the inferior aspect of the left thyroid lobe. Conclusion. This case highlights the importance of a thorough history and examination. Clinicians should always bear in mind atypical presentations of parathyroid adenomas, with the need to exclude this differential in the presence of hypercalcaemia.

  5. Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement

    OpenAIRE

    Rubin, Mishaela R.; Bilezikian, John P.

    2010-01-01

    OBJECTIVE: Hypoparathyroidism is a disorder in which parathyroid hormone is deficient in the circulation due most often to immunological destruction of the parathyroids or to their surgical removal. The objective of this work was to define the abnormalities in skeletal microstructure as well as to establish the potential efficacy of PTH(1-84) replacement in this disorder. SUBJECTS AND METHODS: Standard histomorphometric and µCT analyses were performed on iliac crest bone biopsies obtained fro...

  6. HISTOLOGICAL SEXUAL DIFFERENCES IN ADULT HUMAN PARATHYROID GLANDS

    OpenAIRE

    Fating Anita; Palikundwar Kiran

    2014-01-01

    CONTEXT (BACKGROUND): Increasing problems of calcium deficiency with physiological conditions like pregnancy, lactation etc. it becomes the need of time to focus attention towards these glands as one of the essential entity. Hence we have undertaken this study to have an idea about normal variation in the gland as per sex. AIMS: To reveal sexual differences in adult human parathyroid glands. METHODS AND MATERIAL: Parathyroid glands from 25 autopsied cases of 20 to 59 years...

  7. Role of Endoscopic Ultrasound-guided Fine-needle Aspiration in Lung and Mediastinal Lesions

    Directory of Open Access Journals (Sweden)

    Lien-Fu Lin

    2010-10-01

    Conclusion: EUS-FNA can diagnose lung cancer by confirmation of mediastinal lymph node metastasis, by direct puncture of lung tumor close to the esophagus. It is useful for lymph node (N stations 5, 7, 8 and metastasis (M staging in non-small cell lung cancer, and for the diagnosis of mediastinal mass of unknown etiology.

  8. [Early diagnosis of a newborn with a mediastinal mass].

    Science.gov (United States)

    Flores-Hernández, Salomón Sergio; Ahumada Mendoza, Héctor; Santana-Montero, Blanca Lilia; González Flores, María de Lourdes

    2005-01-01

    Neuroblastoma is an embryonal tumour that evolves from the neural crest cell. This neoplasm may arise at any site in the sympathetic nervous system, including the brain, the cervical region, the posterior mediastinum, the para-aortic sympathetic ganglia, the pelvis, and the adrenal medulla. The clinical presentation in neonatal age is rare and the differential diagnosis includes congenital lung malformations, pneumoniae, atelectasia, etc. The case of a newborn with a mediastinal neuroblastoma is presented. This case illustrates how a patient with an X-ray image compatible with a thoracic tumor should be studied.

  9. [Mediastinal abscess caused by self-mutilation of the hypopharynx].

    Science.gov (United States)

    Bak, Nikolaj Bolsing; Rasmussen, Niels

    2010-05-24

    A 44-year-old male with a non-specific psychological disturbance was diagnosed with septicemia. The patient had unsuccessfully tried to remove what he believed to be a fish bone from his throat. Computed tomography revealed a descending abscess in the mediastinum along with perforations in the pharynx and oesophagus to the mediastinum. He was treated with antibiotics and drainage of the abscess and discharged after six weeks without sequelae. Sharp foreign bodies in the pharynx should be removed professionally to avoid perforation and thus mediastinitis.

  10. Intraoperative parathyroid hormone assay-cutting the Gordian knot.

    Science.gov (United States)

    Tampi, Chandralekha; Chavan, Nitin; Parikh, Deepak

    2014-03-01

    Hyperparathyroidism is treated by surgical excision of the hyperfunctioning parathyroid gland. In case of adenoma the single abnormal gland is removed, while in hyperplasias, a subtotal excision, that is, three-and-a-half of the four glands are removed. This therapeutic decision is made intraoperatively through frozen section evaluation and is sometimes problematic, due to a histological overlap between hyperplasia and the adenoma. The intraoperative parathyroid hormone (IOPTH) assay, propogated in recent years, offers an elegant solution, with a high success rate, due to its ability to identify the removal of all hyperfunctioning parathyroid tissue. To study the feasibility of using IOPTH in our setting. Seven patients undergoing surgery for primary hyperparathyroidism had their IOPTH levels evaluated, along with the routine frozen and paraffin sections. All seven patients showed more than a 50% intraoperative fall in serum PTH after excision of the abnormal gland. This was indicative of an adenoma and was confirmed by histopathological examination and normalization of serum calcium postoperatively. The intraoperative parathyroid hormone is a sensitive and specific guide to a complete removal of the abnormal parathyroid tissue. It can be incorporated without difficulty as an intraoperative guide and is superior to frozen section diagnosis in parathyroid surgery.

  11. Intraoperative parathyroid hormone assay-cutting the Gordian knot

    Directory of Open Access Journals (Sweden)

    Chandralekha Tampi

    2014-01-01

    Full Text Available Background: Hyperparathyroidism is treated by surgical excision of the hyperfunctioning parathyroid gland. In case of adenoma the single abnormal gland is removed, while in hyperplasias, a subtotal excision, that is, three-and-a-half of the four glands are removed. This therapeutic decision is made intraoperatively through frozen section evaluation and is sometimes problematic, due to a histological overlap between hyperplasia and the adenoma. The intraoperative parathyroid hormone (IOPTH assay, propogated in recent years, offers an elegant solution, with a high success rate, due to its ability to identify the removal of all hyperfunctioning parathyroid tissue. Aim: To study the feasibility of using IOPTH in our setting. Materials and Methods: Seven patients undergoing surgery for primary hyperparathyroidism had their IOPTH levels evaluated, along with the routine frozen and paraffin sections. Results: All seven patients showed more than a 50% intraoperative fall in serum PTH after excision of the abnormal gland. This was indicative of an adenoma and was confirmed by histopathological examination and normalization of serum calcium postoperatively. Conclusion: The intraoperative parathyroid hormone is a sensitive and specific guide to a complete removal of the abnormal parathyroid tissue. It can be incorporated without difficulty as an intraoperative guide and is superior to frozen section diagnosis in parathyroid surgery.

  12. Several early interventions for ectopic maxillary canines.

    Directory of Open Access Journals (Sweden)

    Carlos Astorga

    2012-07-01

    Full Text Available Maxillary canine impactation is often encountered in orthodontic clinical practice and the aetiology is associated to genetic factors as well as local space factors. If preventive treatment is not started in ectopic maxillary canines, some possible consequences may occur, such as resorption of the roots of the neighboring permanent teeth, cysts, ankylosis and expensive surgical and orthodontic treatment. The aim of this review was to preset several early treatment modalities for ectopic maxillary canines based on recent scientific evidence. Four are the most important: Only extractions intervention, extraction of deciduous canines with cervical pull headgear, active intervention in late mixed dentition and active intervention in early mixed dentition. These different modalities showed a greater increasing the rate of normal eruption of ectopic canines ( 80-97%. The extraction of primary canine alone is still an effective method to prevent canine impactation, whose success rate would be increased if some other method interceptive is added.

  13. Ruptured ectopic pregnancy associated with tubal schistosomiasis

    Directory of Open Access Journals (Sweden)

    L Sahu

    2013-01-01

    Full Text Available Endemic in major parts of Africa and Middle East, Schistosoma haematobium is a common cause of recurrent urogenital infections and obstetric complications such as spontaneous abortions, ectopic pregnancies, and low birth weight babies. The involvement of fallopian tubes is not rare in endemic areas and may predispose to ectopic pregnancy and infertility. Indian subcontinent is a very lowrisk region for schistosoma infection. Tubal schistosomiasis is not exceptional in endemic zones, but is rarely found in India. The species most often isolated is S. haematobium. Contamination occurs via vascular anastomoses between the bladder and the genital organs. We report a case of tubal schistosomiasis presenting as ruptured ectopic pregnancy discovered on a surgical specimen after salpingectomy.

  14. Intrapulmonary ectopic liver after orthotopic heart transplantation.

    Science.gov (United States)

    Mehta, Rupal I; Lai, Chi K; Kee, Stephen; Fishbein, Michael C

    2010-07-01

    We report a case of a 54-year-old woman who was found to have multiple intrapulmonary nodules detected on imaging 33 months after orthotopic heart transplantation. Needle biopsy of 2 discrete nodules showed benign hepatic tissue, consistent with intrapulmonary foci of ectopic liver. In this report, the clinical, radiologic, microscopic, and fluorescent in situ hybridization results of 2 biopsied nodules are described. A brief review of the published information on ectopic liver is also presented. To our knowledge, multiple ectopic foci of the liver have never been reported at any site. Furthermore, this is the first reported case that involves a transplant recipient, thereby introducing additional, unique ramifications to this rare but intriguing entity.

  15. Molar Pregnancy Presents as Tubal Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Fatemeh Davari Tanha

    2011-01-01

    Full Text Available Hydatidiform moles are abnormal gestations characterized by the presence of hydropic changesaffecting some or all of the placental villi. Hydatidiform moles arise as a result of the fertilizationof an abnormal ovum. In this report, the patient was a 29 year old Asian woman who had inductionof ovulation with letrozol. Since the majority of molar gestations arise within the uterine cavitythus the occurrence of a hydatidiform mole within ectopic gestational tissue is rare. It is importantto differentiate a hydatidiform mole from a conventional ectopic pregnancy, particularly in infertilewomen who have a history of ovulation induction.

  16. Treatment of ectopic first permanent molar teeth.

    LENUS (Irish Health Repository)

    Hennessy, Joe

    2012-11-01

    Ectopic eruption of the first permanent molar is a relatively common occurence in the developing dentition. A range of treatment options are available to the clinician provided that diagnosis is made early. Non-treatment can result in premature exfoliation of the second primary molar, space loss and impaction of the second premolar. This paper will describe the management of ectopic first permanent molars, using clinical examples to illustrate the available treatment options. CLINICAL RELEVANCE: This paper is relevant to every general dental practitioner who treats patients in mixed dentition.

  17. [Ectopic pregnancy following in vitro fertilization and embryo transfer].

    Science.gov (United States)

    Sudik, R; Fliess, F R; Bernt, W D; Meissner, J; Kunkel, S

    1984-01-01

    A report is given about one case of ectopic pregnancy after in vitro fertilization and transfer of three embryos. Possible causes of ectopic pregnancies following embryo transfer and conclusions are discussed.

  18. Mediastinal cystic lymphangioma Linfangioma cístico do mediastino

    Directory of Open Access Journals (Sweden)

    Sandra Saleiro

    2006-11-01

    Full Text Available Mediastinal lymphangioma is a rare vascular neoplasm, accounting for 0.7 to 4.5% of all the mediastinum tumors. It is a benign tumor, generally occurring as a mediastinal mass of slow growth. Most patients are asymptomatic, being incidentally diagnosed after a routine chest radiograph. The best treatment consists of complete surgical resection. Prognosis depends on the degree of resecability degree, and recurrence is not expected if the lesion is totally removed.O linfangioma mediastínico é uma neoplasia vascular rara, correspondendo a 0,7 a 4,5% de todos os tumores do mediastino. É um tumor benigno, que ocorre geralmente como uma massa mediastínica de crescimento lento. A maioria dos doentes está assintomática, sendo diagnosticado incidentalmente, após a realização de uma radiografia torácica de rotina. O tratamento de eleição consiste na ressecção cirúrgica completa. O prognóstico depende do grau de ressecabilidade e, se a lesão for totalmente removida, não se esperam recidivas.

  19. Endobronchial ultrasound transbronchial needle aspiration in mediastinal and hilar lymphadenopathies.

    Science.gov (United States)

    Kheir, Fayez; Palomino, Jaime

    2012-12-01

    Endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) is a relatively noninvasive technique that allows sampling of mediastinal and hilar lymph nodes or masses under real-time and direct visualization, overcoming some of the problems associated with mediastinoscopy and blind TBNA. The goal of this study was to evaluate the yield of this technique in patients with and without malignant disease in a newly started EBUS program involving physicians not previously fully trained in interventional pulmonology. Between March 2010 and July 2011, 43 patients with enlarged lymph nodes (>1 cm on short axis) on chest computed tomography who underwent EBUS-TBNA were included in the study. Nondiagnostic results were confirmed with mediastinoscopy. The sensitivity, specificity, positive predictive value and negative predictive value of the technique were assessed. Among the 43 patients who underwent EBUS-TBNA, a correct diagnosis was made in 39 of the 43 patients (91%). The sensitivity, specificity, positive predictive value, and negative predictive values were 89%, 100%, 100%, and 67%, respectively. The success rate, complication rate, and 30-day mortality were 91%, 0%, and 0%, respectively. EBUS-TBNA is a safe and effective approach with high diagnostic yield and minimal complications for diagnosing and staging of mediastinal/hilar lymph nodes. Satisfactory results can be obtained immediately by pulmonologists experienced in conventional bronchoscopy with the provision of additional training on the technique.

  20. Giant Mediastinal Germ Cell Tumour: An Enigma of Surgical Consideration

    Directory of Open Access Journals (Sweden)

    Firdaus Hayati

    2016-01-01

    Full Text Available We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour.

  1. The role of mediastinoscopy for diagnosis of isolated mediastinal lymphadenopathies

    Directory of Open Access Journals (Sweden)

    Raluca Guteanu

    2017-11-01

    Full Text Available Mediastinoscopy is a diagnostic and/or therapeutic procedure through which it is realized visualization of the mediastinum contents, most times ending with a biopsy. Such procedure is often used in lung cancer for staging of the lymph nodes, or for a diagnosing purpose in several affections related to mediastinum (lymphoma or sarcoidosis. Morbidity is fairly low (0.2-0.5%, being encountered left recurrent laryngeal nerve injury, bleeding and pneumothorax. Contraindications are represented by previous mediastinoscopy, oncologic treatments (chemotherapy/ radiotherapy, due to development of mediastinal adhesions and fibrosis, or severe limitations in hyperextension of the neck (cervical arthritis, cutaneous tracheostomy. This paper presents the most important advantages and utility of mediastinoscopy, which proved during a long period of time to be safe, accurate and cost effective thoracic surgery technique. It minimizes the period of hospitalization and allows appropriate treatment to be immediately commenced upon diagnosis. Although there are a number of known complications of mediastinoscopy, it remains the ultimate diagnostic investigation for paratracheal and retrovascular enlarged mediastinal lymphnodes in centers where endo-bronchial ultrasound is absent or video assisted thoracoscopic surgery is not possible.

  2. [Cystic mediastinal schwannoma appended to the vagus nerve].

    Science.gov (United States)

    Dahdah, J; Validire, P; Grigoroiu, M; Lenoir, S; Gossot, D; Stern, J-B

    2016-05-01

    Schwannomas are a form of rare tumor, arising from neural tissue and representing 2 % of mediastinal tumors. They are usually located in the posterior mediastinum, most often in the paravertebral gutters and typically appended to intercostal nerves. We report two cases of unusual mediastinal schwannomas, appended to the vagus nerve. The schwannoma was located in the subcarinal region in the first case and in the right para-tracheal region in the second case. The lesions were thought to be bronchogenic cysts preoperatively in both cases because of a cystic appearance on preoperative CT scan and endobronchial ultrasonography. A surgical approach was adopted to remove the tumors. Video-assisted thoracoscopy was used in one case and robotic-assisted surgery in the second case, without any complication, allowing for complete resection and to establish a certain pathological diagnosis. Despite this location and cystic presentation being unusual, schwannoma should be considered as a possible cause of cystic lesions in the mediastinum. Minimally invasive surgery allows for complete resection and definitive pathological diagnosis. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  3. Cytomorphologic features distinguishing Bethesda category IV thyroid lesions from parathyroid

    Directory of Open Access Journals (Sweden)

    Simon Sung

    2017-01-01

    Full Text Available Background: Thyroid follicular cells share similar cytomorphological features with parathyroid. Without a clinical suspicion, the distinction between a thyroid neoplasm and an intrathyroidal parathyroid can be challenging. The aim of this study was to assess the distinguishing cytomorphological features of parathyroid (including intrathyroidal and Bethesda category IV (Beth-IV thyroid follicular lesions, which carry a 15%–30% risk of malignancy and are often followed up with surgical resection. Methods: A search was performed to identify “parathyroid” diagnoses in parathyroid/thyroid-designated fine-needle aspirations (FNAs and Beth-IV thyroid FNAs (follicular and Hurthle cell, all with diagnostic confirmation through surgical pathology, immunocytochemical stains, Afirma® analysis, and/or clinical correlation. Unique cytomorphologic features were scored (0-3 or noted as present versus absent. Statistical analysis was performed using R 3.3.1 software. Results: We identified five FNA cases with clinical suspicion of parathyroid neoplasm, hyperthyroidism, or thyroid lesion that had an eventual final diagnosis of the parathyroid lesion (all female; age 20–69 years and 12 Beth-IV diagnoses (11 female, 1 male; age 13–64 years. The following cytomorphologic features are useful distinguishing features (P value: overall pattern (0.001, single cells (0.001, cell size compared to red blood cell (0.01, nuclear irregularity (0.001, presence of nucleoli (0.001, nuclear-to-cytoplasmic ratio (0.007, and nuclear chromatin quality (0.028. Conclusions: There are cytomorphologic features that distinguish Beth-IV thyroid lesions and (intrathyroidal parathyroid. These features can aid in rendering correct diagnoses and appropriate management.

  4. Cervical ectopic pregnancy: Mersilene tape in surgical management ...

    African Journals Online (AJOL)

    Cervical ectopic pregnancy: Mersilene tape in surgical management. ... South African Journal of Obstetrics and Gynaecology ... In view of the rarity of cervical ectopic gestation and the potentially high morbidity that may be associated with its presentation and management, we report management of a case of cervical ectopic ...

  5. Case report - Ectopic molar pregnancy: A case report | Bousfiha ...

    African Journals Online (AJOL)

    The incidence of hydatidiform moles is 1 per 1,000 pregnancies. Ectopic pregnancy occurs in 20 per 1,000 pregnancies. Thus, the incidence of the ectopic molar gestation is very rare. We report a case of tubal molar pregnancy diagnosed at the systematic histology exam of an ectopic pregnancy. We report the case of 32 ...

  6. Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare ...

    African Journals Online (AJOL)

    Ectopic pregnancy is a common cause of morbidity and mortality in women of reproductive age especially in resource deprived areas worldwide. Cervical ectopic pregnancy is a rare, life threatening form of ectopic pregnancy which needs a high index of suspicion for diagnosis, thus adding a complex twist to the dilemma ...

  7. Ectopic decidual reaction mimicking irritable bowel syndrome: a case report.

    Directory of Open Access Journals (Sweden)

    Soraya Salehgargari

    2014-01-01

    Full Text Available Ectopic decidualization with gross involvement of the peritoneum is one of the rare findings in pregnant women particularly when ectopic decidualization disseminated as an asymptomatic intra-abdominal nodule. We present here a case of an ectopic decidualization in a 33-year-old pregnant woman with symptoms of irritable bowel syndrome during pregnancy.

  8. Hypoparathyroidism: Replacement Therapy with Parathyroid Hormone

    Directory of Open Access Journals (Sweden)

    Lars Rejnmark

    2015-12-01

    Full Text Available Hypoparathyroidism (HypoPT is characterized by low serum calcium levels caused by an insufficient secretion of parathyroid hormone (PTH. Despite normalization of serum calcium levels by treatment with activated vitamin D analogues and calcium supplementation, patients are suffering from impaired quality of life (QoL and are at increased risk of a number of comorbidities. Thus, despite normalization of calcium levels in response to conventional therapy, this should only be considered as an apparent normalization, as patients are suffering from a number of complications and calcium-phosphate homeostasis is not normalized in a physiological manner. In a number of recent studies, replacement therapy with recombinant human PTH (rhPTH(1-84 as well as therapy with the N-terminal PTH fragment (rhPTH(1-34 have been investigated. Both drugs have been shown to normalize serum calcium while reducing needs for activated vitamin D and calcium supplements. However, once a day injections cause large fluctuations in serum calcium. Twice a day injections diminish fluctuations, but don't restore the normal physiology of calcium homeostasis. Recent studies using pump-delivery have shown promising results on maintaining normocalcemia with minimal fluctuations in calcium levels. Further studies are needed to determine whether this may improve QoL and lower risk of complications. Such data are needed before replacement with the missing hormone can be recommended as standard therapy.

  9. Ectopic Pregnancy Following Interval Tubal Sterilization

    Directory of Open Access Journals (Sweden)

    Deepak Shrestha

    2017-11-01

    Full Text Available Introduction:  Tubal sterilization is a highly effective method of permanent contraception. However, pregnancy can still occur following a successful procedure. Published literatures report a failure rate of 0.13-1.3% and 15-33% of such pregnancies are likely to be ectopic. Case report: A 33 years para three lady with prior history of tubal ligation presented with generalized abdominal pain and several episodes of vomiting. Bimanual examination revealed a soft and mobile mass of 2 x 3 cm in right adnexa. Urine pregnancy test was positive and ultrasonogram showed a heterogeneous mass of 3.4 x 3.3 cm in right adnexa with empty uterine cavity. Culdocentesis resulted in aspiration of frank non-clotting blood. She then underwent emergency laparotomy with bilateral salpingectomy for ruptured ectopic pregnancy. Conclusion: Ectopic pregnancy after tubal sterilization though rare is not entirely impossible. All women who are offered this procedure should always be educated about its failure rate. And in women presenting with acute abdomen, a prior history of tubal sterilization doesn't preclude the possibility of ectopic pregnancy.

  10. Cornual Ectopic Pregnancy Complicated by Infected Hematoma.

    Science.gov (United States)

    O'Sullivan, Robert; Baltes, Emily C; Reid, Duncan; Shi, Veronica; Marcus, Peter

    2015-08-01

    Cornual ectopic pregnancies are rarely encountered in clinical practice. A diagnostic and therapeutic challenge, complications include hemorrhage and the presence of persistently elevated serum beta-hCG requiring administration of methotrexate. In this case, we present a patient whose postoperative course was complicated by an infected hematoma that responded to conservative management.

  11. Outpatient non -surgical management of unruptured ectopic ...

    African Journals Online (AJOL)

    Outpatient non -surgical management of unruptured ectopic pregnancy in a specialist hospital in Nigeria: a report of three cases. ... the traditional approach of an emergency exploratory laparotomy which puts a burden on available infrastructure, causes distortion of family dynamics and reduces reproductive potentials.

  12. Splenic rupture masquerading ruptured ectopic pregnancy | Kigbu ...

    African Journals Online (AJOL)

    ... pallor, abdominal tenderness, shifting dullness with positive pregnancy test gave a clinical diagnosis of ruptured ectopic pregnancy. At laparotomy, an intrauterine gestation with normal tubes and ovaries with complete splenic rupture were found. She had total splenectomy. Highland Medical Research Journal Vol.

  13. An Ectopic ACTH Secreting Metastatic Parotid Tumour

    Directory of Open Access Journals (Sweden)

    Thomas Dacruz

    2016-01-01

    Full Text Available A 60-year old woman presented with features of Cushing’s syndrome (CS secondary to an ectopic adrenocorticotropic hormone (ACTH secreting metastatic parotid tumour 3 years after excision of the original tumour. She subsequently developed fatal intestinal perforation and unfortunately died despite best possible medical measures. Ectopic ACTH secretion accounts for 5–10% of all patients presenting with ACTH dependent hypercortisolism; small cell carcinoma of lung (SCLC and neuroendocrine tumours (NET account for the majority of such cases. Although there are 4 previous case reports of ectopic ACTH secreting salivary tumours in literature, to our knowledge this is the first published case report in which the CS developed after 3 years of what was deemed as a successful surgical excision of primary salivary tumour. Our patient initially had nonspecific symptoms which may have contributed to a delay in diagnosis. Perforation of sigmoid colon is a recognised though underdiagnosed complication associated with steroid therapy and hypercortisolism. This case demonstrates the challenges faced in diagnosis as well as management of patients with CS apart from the practical difficulties faced while trying to identify source of ectopic ACTH.

  14. Disparities in the management of ectopic pregnancy.

    Science.gov (United States)

    Hsu, Jennifer Y; Chen, Ling; Gumer, Arielle R; Tergas, Ana I; Hou, June Y; Burke, William M; Ananth, Cande V; Hershman, Dawn L; Wright, Jason D

    2017-07-01

    Ectopic pregnancy is common among young women. Treatment can consist of either surgery with salpingectomy or salpingostomy or medical management with methotrexate. In addition to acute complications, treatment of ectopic pregnancy can result in long-term sequelae that include decreased fertility. Little is known about the patterns of care and predictors of treatment in women with ectopic pregnancy. Similarly, data on outcomes for various treatments are limited. We examined the patterns of care and outcomes for women with ectopic pregnancy. Specifically, we examined predictors of medical (vs surgical) management of ectopic pregnancy and tubal conservation (salpingostomy vs salpingectomy) among women who underwent surgery. The Perspective database was used to identify women with a diagnosis of tubal ectopic pregnancy treated from 2006-2015. Perspective is an all-payer database that collects data on patients at hospitals from throughout the United States. Women were classified as having undergone medical treatment, if they received methotrexate, and surgical treatment, if treatment consisted of salpingostomy or salpingectomy. Multivariable models were developed to examine predictors of medical treatment and of tubal conserving salpingostomy among women who were treated surgically. Among the 62,588 women, 49,090 women (78.4%) were treated surgically, and 13,498 women (21.6%) received methotrexate. Use of methotrexate increased from 14.5% in 2006 to 27.3% by 2015 (P<.001). Among women who underwent surgery, salpingostomy decreased over time from 13.0% in 2006 to 6.0% in 2015 (P<.001). Treatment in more recent years, at a teaching hospital and at higher volume centers, were associated with the increased use of methotrexate (P<.05 for all). In contrast, Medicaid recipients (adjusted risk ratio, 0.92; 95% confidence interval, 0.87-0.98) and uninsured women (adjusted risk ratio, 0.87; 95% confidence interval, 0.82-0.93) were less likely to receive methotrexate than

  15. Laparoscopic Resection of Cesarean Scar Ectopic Pregnancy.

    Science.gov (United States)

    Ades, Alex; Parghi, Sneha

    To demonstrate a technique for the laparoscopic surgical management of cesarean section scar ectopic pregnancy. Step-by-step presentation of the procedure using video (Canadian Task Force classification III). Cesarean section scar ectopic pregnancy is a rare form of ectopic pregnancy with an incidence ranging from 1:1800 to 1:2216. Over the last decade, the incidence seems to be on the rise with increasing rates of cesarean deliveries and early use of Doppler ultrasound. These pregnancies can lead to life-threatening hemorrhage, uterine rupture, and hysterectomy if not managed promptly. Local or systemic methotrexate therapy has been used successfully but can result in prolonged hospitalization, requires long-term follow-up, and in some cases treatment can fail. In the hands of a trained operator, laparoscopic resection can be performed to manage this type of pregnancy. Consent was obtained from the patient, and exemption was granted from the local Internal Review Board (The Womens' Hospital, Parkville). In this video we describe our technique for laparoscopic management of a cesarean scar ectopic pregnancy. We present the case of a 34-year-old G4P2T1 with the finding of a live 8-week pregnancy embedded in the cesarean section scar. The patient had undergone 2 previous uncomplicated cesarean sections at term. On presentation her β-human chorionic gonadotropin (β-hCG) level was 52 405 IU/L. She was initially managed with an intragestational sac injection of potassium chloride and methotrexate, followed by 4 doses of intramuscular methotrexate. Despite these conservative measures, the level of β-hCG did not adequately fall and an ultrasound showed a persistent 4-cm mass. A decision was made to proceed with surgical treatment in the form of a laparoscopic resection of the ectopic pregnancy. The surgery was uneventful, and the patient was discharged home within 24 hours of her procedure. Her serial β-hCG levels were followed until complete resolution

  16. Conservative Management of Cervical Ectopic Pregnancy.

    Science.gov (United States)

    Murji, Ally; Garbedian, Kimberley; Thomas, Jacqueline; Cruickshank, Barbara

    2015-11-01

    To evaluate the safety and effectiveness of conservative management for cervical ectopic pregnancies. We conducted a retrospective review of all cases of cervical ectopic pregnancy diagnosed at our tertiary care academic centre between January 2002 and July 2014. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound according to published criteria. Management decisions were made by individual clinicians. Cervical ectopic pregnancy was diagnosed in 27 women with a median age of 34 years. Two thirds of them were nulliparous, and 44% (12/27) reported infertility. The mean gestational age at diagnosis was seven weeks. The median serum human chorionic gonadotropin level was 11 300 IU/L (range 610 to 163 700). Fetal cardiac activity was present in 19 pregnancies (70%). Vaginal bleeding was the most common presentation, occurring in 23 cases (85%). Three women presented with acute life-threatening hemorrhage. All cases were successfully managed conservatively, allowing uterine preservation. Systemic methotrexate (single or multi-dose protocol) was the mainstay of therapy. Other minimally invasive interventions included ultrasound-guided injection of potassium chloride into the pregnancy, uterine artery embolization, vaginal ligation of cervical branches of the uterine arteries, and dilatation and curettage, with or without dilute vasopressin cervical infiltration and Foley catheter tamponade. Systemic methotrexate alone or in combination with other minimally invasive techniques can be effective conservative treatment for cervical pregnancies. A fertility-sparing approach is the optimal treatment for this patient population, which has high rates of infertility and nulliparity. We present a management algorithm based on our results to aid in standardizing the management of cervical ectopic pregnancies.

  17. Circulating parathyroid hormone and calcitonin in rats after spaceflight

    Science.gov (United States)

    Arnaud, Sara B.; Fung, Paul; Popova, Irina A.; Morey-Holton, Emily R.; Grindeland, Richard E.

    1992-01-01

    Parathyroid hormone and calcithonin, two major calcium-regulating hormones, were measured in the plasma of five experimental groups of rats to evaluate postflight calcium homeostasis after the 14-day Cosmos 2044 flight. Parathyroid hormone values were slightly higher in the flight animals (F) than in the appropriate cage and diet controls (S) (44 +/- 21 vs 21 +/- 4 pg/ml, P less than 0.05), but they were the same as in the vivarium controls (V), which had different housing and feeding schedules. The difference in F and V (22 +/- 11 vs 49 +/- 16 pg/ml, P less than 0.05) was most likely due to failure of circulating calcitonin in F to show the normal age-dependent increase which was demonstrated in age-matched controls in a separate experiment. Basal values for parathyroid hormone and calcitonin were unchanged after 2 wk of hindlimb suspension, a flight simulation model, in age-matched and younger rats. From a time course experiment serum calcium was higher and parathyroid hormone lower after 4 wk than in ambulatory controls. Postflight circulating levels of parathyroid hormone appear to reflect disturbances in calcium homeostasis from impaired renal function of undetermined cause, whereas levels of calcitonin reflect depression of a normal growth process.

  18. Increased parathyroid expression of klotho in uremic rats.

    Science.gov (United States)

    Hofman-Bang, Jacob; Martuseviciene, Giedre; Santini, Martin A; Olgaard, Klaus; Lewin, Ewa

    2010-12-01

    Klotho is a protein of significant importance for mineral homeostasis. It helps to increase parathyroid hormone (PTH) secretion and in the trafficking of Na+/K+-ATPase to the cell membrane; however, it is also a cofactor for fibroblast growth factor (FGF)-23 to interact with its receptor, FGFR1 IIIC, resulting in decreased PTH secretion. Studies on the regulation of parathyroid klotho expression in uremia have provided varying results. To help resolve this, we measured klotho expression in the parathyroid and its response to severe uremia, hyperphosphatemia, and calcitriol treatment in the 5/6 nephrectomy rat model of secondary hyperparathyroidism. Parathyroid klotho gene expression and protein were significantly increased in severely uremic hyperphosphatemic rats, but not affected by moderate uremia and normal serum phosphorus. Calcitriol suppressed klotho gene and protein expression in severe secondary hyperparathyroidism, despite a further increase in plasma phosphate. Both FGFR1 IIIC and Na+/K+-ATPase gene expression were significantly elevated in severe secondary hyperparathyroidism. Parathyroid gland klotho expression and the plasma calcium ion concentration were inversely correlated. Thus, our study suggests that klotho may act as a positive regulator of PTH expression and secretion in secondary hyperparathyroidism.

  19. The Role of Mast Cells in Parathyroid Bone Disease

    Science.gov (United States)

    Turner, Russell T; Iwaniec, Urszula T; Marley, Kevin; Sibonga, Jean D

    2010-01-01

    Chronic hyperparathyroidism (HPT) is a common cause of metabolic bone disease. These studies investigated the underlying cellular and molecular mechanisms responsible for the detrimental actions of elevated parathyroid hormone (PTH) on the skeleton. Bone biopsies from hyperparathyroid patients revealed an association between parathyroid bone disease and increased numbers of bone marrow mast cells. We therefore evaluated the role of mast cells in the etiology of parathyroid bone disease in a rat model for chronic HPT. In rats, mature mast cells were preferentially located at sites undergoing bone turnover, and the number of mast cells at the bone–bone marrow interface was greatly increased following treatment with PTH. Time-course studies and studies employing parathyroid hormone–related peptide (PTHrP), as well as inhibitors of platelet-derived growth factor-A (PDGF-A, trapidil), kit (gleevec), and PI3K (wortmannin) signaling revealed that mature mast cell redistribution from bone marrow to bone surfaces precedes and is associated with osteitis fibrosa, a hallmark of parathyroid bone disease. Importantly, mature mast cells were not observed in the bone marrow of mice. Mice, in turn, were resistant to the development of PTH-induced bone marrow fibrosis. These findings suggest that the mast cell may be a novel target for treatment of metabolic bone disease. © 2010 American Society for Bone and Mineral Research. PMID:20200965

  20. In vivo wide-band reflectance spectrometry during thyroid and parathyroid surgery

    NARCIS (Netherlands)

    Schols, R.M.; Wieringa, F.P.; Alić, L.; Bouvy, N.D.; Stassen, L.P.S.

    2013-01-01

    Distinguishing critical tissues can be challenging in (para-)thyroid surgery. As a first step towards intraoperative image contrast enhancement, we collected and analyzed spectral signatures (350-1830nm) of thyroid, parathyroid and recurrent laryngeal nerve in 10 patients.

  1. Recurrent ectopic pregnancy after ipsilateral partial salpingectomy: a case report.

    Science.gov (United States)

    Lee, D H

    2015-01-01

    Ectopic pregnancy is associated with maternal morbidity and mortality during early pregnancy. Ectopic pregnancy occurs in approximately 2% of all pregnancies, and the risk of ectopic pregnancy is increased by eight-fold in women with a history of eopic pregnancy. However, recurrent ectopic pregnancy after ipsilateral partial salpingectomy is quite rare. The authors experienced a case of recurrent ectopic pregnancy in the distal remnant after right partial salpingectomy. In this case report, they discuss this unusual case and provide a brief review of the literature.

  2. Mediastinal lipomatosis: A complication of high dose steroid therapy in children

    Energy Technology Data Exchange (ETDEWEB)

    Shukla, L.W.; Wagner, M.L.; Katz, J.A.

    1988-11-01

    Mediastinal lipomatosis has been described in adults and is a well recognized cause of mediastinal enlargement. Fatty accumulation in the mediastinum has been observed following extended usage of large doses of steroids, generally greater than 60 mg daily. Little documentation of this entity exists in pediatric patients. A 9-year-old male who received large doses of steroids for graft-versus-host disease following bone marrow transplantation for acute myelogenous leukemia developed mediastinal lipomatosis. Early qualification of this diagnosis is especially important in this group of patients, who are also at risk for a second neoplasm.

  3. Anesthetic management of a large mediastinal mass for tracheal stent placement

    Directory of Open Access Journals (Sweden)

    Suman Rajagopalan

    2016-04-01

    Full Text Available ABSTRACT The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.

  4. Ectopic ureterocele and ectopic ureter in pediatric patients; Ureterocele ectopico y ectopia ureteral en pacientes pediatricos

    Energy Technology Data Exchange (ETDEWEB)

    Lloret, M. T.; Ricart, V.; Muro, M. D.; Perez, D.; Martinez, I.; Brugger, S.; Romero, M. J.; Cortina, H. [hospital General Universitario La Fe. Valencia (Spain)

    2000-07-01

    To describe the radiological findings associated with ectopic ureterocele and ectopic ureter in pediatric patients. To assess the role of ultrasound (US), serial micturating cystourethrography (SM-CU) and intravenous urography (IVU) in the diagnosis of these two entities. The authors performed a retrospective study of 132 patients, 73 with ectopic ureterocele and 59 with ectopic ureter. The imaging studies used were US, SMCU, IVU and methods to determine renal function (diuretic renography and renal scintigraphy). The findings were confirmed during surgery in every case. The most common radiological findings in ectopic ureterocele were renal duplication (86,3%). vesicoureteral reflux (VUR) to the lower half of the kidney (46.6%), dilatation of the lower pole of the kidney (38.4%) and contralateral duplication (30.1%). In boys, the ectopic ureter entered via bladder neck and posterior urethra (73.7%) or into seminal vesicles (15.8%); in girls, it went to vagina (32.5%), bladder neck (30%) or urethra (22.5%). Renal duplication was associated in 64.4%, with VUR to the ectopic ureter in 21% while there was a single renal system in 35.6%, with VUR to the ectopic ureter in 57.1% and contralateral renal agenesis in 19%. Eighteen patients (13.6%) presented a single, dy plastic, nonfunctioning renal system (6 cases of ureterocele and 12 of ectopic ureter). Knowledge of the embryological development of ureteral duplication is essential for the understanding of these two entities and helps to differentiate between them, thus facilitating a sometimes complicated diagnosis. Ectopic ureters and ureteroceles accompanied by a single, dysplastic renal system are associated with a greater incidence of congenital anomalies and a higher rate of complications than the duplicate systems. A prenatal US examination enables early diagnosis. The anatomical information provided by US is, on occasion, more valuable than that resulting from IVU or SMCU, However, IVU is indispensable in girls

  5. Activator Protein 2α Mediates Parathyroid TGF-α Self-Induction in Secondary Hyperparathyroidism

    OpenAIRE

    Arcidiacono, Maria Vittoria; Cozzolino, Mario; Spiegel, Noah; Tokumoto, Masanori; Yang, Jing; Lu, Yan; Sato, Tetsuhiko; Lomonte, Carlo; Basile, Carlo; Slatopolsky, Eduardo; Dusso, Adriana S.

    2008-01-01

    In secondary hyperparathyroidism, enhanced expression of TGF-α in the parathyroid leads to its own upregulation, generating a feed-forward loop for TGF-α activation of its receptor, EGFR receptor (EGFR), which promotes parathyroid hyperplasia. These studies examined the role of activator protein 2α (AP2), an inducer of TGF-α gene transcription, in the upregulation of parathyroid TGF-α in secondary hyperparathyroidism. In rat and human secondary hyperparathyroidism, parathyroid AP2 expression ...

  6. Discordant results in Tc-99m tetrofosmin and Tc-99m sestamibi parathyroid scintigraphies

    OpenAIRE

    Duarte, Paulo Schiavom; Domingues, Fernanda C.; Costa, Michele Santi; Brandão, Cynthia; Oliveira, Marco A.C. de; Vieira, José G.H.

    2007-01-01

    Parathyroid scintigraphies have been used to detect pathological parathyroid glands either before as well as after the parathyroid resection surgery in patients with hyperparathyroidism. One of the most utilized techniques to perform the studies is the double-phase images with Tc-99m sestamibi, which has been shown to be very accurate in the localization of enlarged parathyroid glands. Similar to Tc-99m sestamibi, Tc-99m tetrofosmin is a radiopharmaceutical initially developed to perform myoc...

  7. Impact of ectopic pregnancy for reproductive prognosis in next generation.

    Science.gov (United States)

    Kårhus, Line Lund; Egerup, Pia; Skovlund, Charlotte Wessel; Lidegaard, Øjvind

    2014-04-01

    The impact of an ectopic pregnancy in the next generation is unknown. Our aim was to compare reproductive outcomes in daughters of women with and without ectopic pregnancy. Designed as a historical prospective controlled cohort study with data collected in four Danish registries from 1977-2009, women with ectopic pregnancy during 1977-1982 were age-matched to women without ectopic pregnancy. Daughters of these two cohorts were followed until 2009. We compared 5126 daughters of women with ectopic pregnancy with 19 928 daughters of women without ectopic pregnancy. The daughters of women with ectopic pregnancy had a 1.5-fold (95% confidence interval 1.2-1.9) increased risk of ectopic pregnancy, while for deliveries this was 1.0 (1.0-1.1), for miscarriages 1.1 (1.0-1.2), and for induced abortions 1.3 (1.2-1.4). Daughters of mothers with ectopic pregnancy have a 50% higher risk of ectopic pregnancy than daughters of women without an ectopic pregnancy, but a normal delivery rate. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  8. Minimizing Late Effects for Patients With Mediastinal Hodgkin Lymphoma

    DEFF Research Database (Denmark)

    Aznar, Marianne C.; Maraldo, Maja V.; Schut, Deborah A.

    2015-01-01

    PURPOSE: Hodgkin lymphoma (HL) survivors have an increased risk of cardiovascular disease (CD), lung cancer, and breast cancer. We investigated the risk for the development of CD and secondary lung, breast, and thyroid cancer after radiation therapy (RT) delivered with deep inspiration breath......: Twenty-two patients with early-stage mediastinal HL were eligible for the study. Treatment plans were calculated with both 3DCRT and IMRT on both DIBH and FB planning computed tomographic scans. We reported the estimated dose to the heart, lung, female breasts, and thyroid and calculated the estimated...... life years lost attributable to CD and to lung, breast, and thyroid cancer. RESULTS: DIBH lowered the estimated dose to heart and lung regardless of delivery technique (P

  9. Fatal mediastinal biopsy: How interventional radiology saves the day

    Directory of Open Access Journals (Sweden)

    Y Yaacob

    2012-01-01

    Full Text Available This was a case of a 35-year-old man with mediastinal mass requiring computed tomography (CT-guided biopsy for tissue diagnosis. A posterior approach with an 18-gauge biopsy needle was used to obtain tissue sample. Post biopsy, patient condition deteriorated and multiphase CT study detected active bleeding in arterial phase at the biopsy site with massive hemothorax. Subsequent angiography showed arterial bleeder arising from the apical branch of the right pulmonary artery. Selective endovascular embolization with NBCA (n-Butyl cyanoacrylate was successful. Patient survived the complication. The case highlighted a rare complication in a common radiology procedure and the value of the interventional radiology unit in avoiding a fatal outcome.

  10. Mediastinal abscess and esophageal stricture following voice prosthesis insertion.

    Science.gov (United States)

    Bozzo, Corrado; Meloni, Francesco; Trignano, Mario; Profili, Stefano

    2014-04-01

    The use of a tracheo-esophageal voice prosthesis is a well-established procedure to restore the voice in total laryngectomees. The insertion of the prosthesis is not a risk-free procedure, various complications having been reported especially in irradiated patients. Here described is a case of an esophageal rupture after secondary tracheo-esophageal puncture with mediastinal abscess in a patient previously treated with pharyngo-laryngectomy and subsequent radiotherapy for a left pyriform sinus carcinoma, which required immediate surgical drainage through a left cervical approach. Few weeks after surgical drainage an esophageal stricture at the site of the rupture developed, which was only temporarily resolved after the insertion of biodegradable esophageal stents, followed by re-stenosis once the reabsorption of the stent took place. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. Oral manifestations of parathyroid disorders and its dental management

    Directory of Open Access Journals (Sweden)

    Sanjeev Mittal

    2014-01-01

    Full Text Available Parathyroid hormone plays an important role in the metabolism of calcium and phosphorus, so, influence the mineralization of bone and teeth. Parathyroid disorder may lead to hyper or hyposecretion of hormone, which results in various oral manifestations. Common oral manifestations in patients with hyperparathyroidism (HPT are brown tumor, loss of bone density, soft tissue calcification, and dental abnormalities. In hypoparathyroidism, the dental abnormalities are a delay or cessation of dental growth and development, paresthesia of the tongue or lips and alteration of the facial muscles. Dentist can easily diagnose the parathyroid disorders owing to their particular oral manifestations and radiographic finding. Dental management of patients with HPT involves a higher risk of bone fracture, whereas in hypoparathyroidism the caries control is the main concern. It is the important that the dentist be aware of the risks and difficulties that may arise during the dental management of these patients.

  12. Anatomy of thyroid and parathyroid glands and neurovascular relations.

    Science.gov (United States)

    Mohebati, A; Shaha, A R

    2012-01-01

    Historically, thyroid surgery has been fraught with complications. Injury to the recurrent laryngeal nerve, superior laryngeal nerve, or the parathyroid glands may result in profound life-long consequences for the patient. To minimize the morbidity of the operation, a surgeon must have an in-depth understanding of the anatomy of the thyroid and parathyroid glands and be able to apply this information to perform a safe and effective operation. This article will review the pertinent anatomy and embryology of the thyroid and parathyroid glands and the critical structures that lie in their proximity. This information should aid the surgeon in appropriate identification and preservation of the function of these structures and to avoid the pitfalls of the operation. Copyright © 2011 Wiley-Liss, Inc.

  13. Painful ophthalmoplegia from metastatic nonproducing parathyroid carcinoma : Case study and review of the literature

    NARCIS (Netherlands)

    Eurelings, M; Frijns, CJM; Jeurissen, FJF

    Parathyroid carcinoma is an uncommon malignancy. Of the fewer than 400 cases reported, most have been cases of producing parathyroid carcinoma with accompanying hypercalcemia. Only 13 patients with nonproducing parathyroid carcinoma have been described. Nine of these 13 patients had metastatic

  14. The Incidental Thyroid Lesion in Parathyroid Disease Management

    Directory of Open Access Journals (Sweden)

    Uthman Alamoudi MD

    2017-03-01

    Full Text Available Objective The incidental thyroid lesion is a common finding during general imaging studies. Their management has been the subject of numerous studies and recommendations. Parathyroid disease workup necessitates imaging investigation of the adjacent thyroid gland and therefore provides a unique window to the perioperative management of thyroid incidentaloma. The specific prevalence of incidental thyroid lesions in the context of parathyroid disease is unknown. We seek to investigate its prevalence during parathyroid workup and surgery and to ascertain if there was a change in management of these patients. Study Design Five-year retrospective database review. Setting Tertiary care medical center. Subjects and Methods The source and indication for referral, preoperative investigation findings, and management of the incidental thyroid lesions were examined. The actual procedure performed and final pathology results were assessed. Results A total of 98 patients and 106 operations, including revision surgeries, were identified. There were 21 incidental thyroid lesions (21.4% detected, whereby 15 patients underwent fine-needle aspirations and 12 subsequently had diagnostic hemithyroidectomies. This decision was made preoperatively in 5 patients and intraoperatively in 7 patients at the time of parathyroid surgery. Along with other pathologies, there were 7 patients with micropapillary thyroid carcinoma identified. Conclusions In our series, the prevalence of incidental thyroid lesion and thyroid malignancy is comparable to the general population. The management of the initial parathyroid disease in our patients was altered by the imaging and cytological findings of these thyroid lesions. This has implications on perioperative counseling of the thyroid and parathyroid disease.

  15. Increased parathyroid expression of klotho in uremic rats

    DEFF Research Database (Denmark)

    Hofman-Bang, J.; Martuseviciene, G.; Santini, M.A.

    2010-01-01

    /6 nephrectomy rat model of secondary hyperparathyroidism. Parathyroid klotho gene expression and protein were significantly increased in severely uremic hyperphosphatemic rats, but not affected by moderate uremia and normal serum phosphorus. Calcitriol suppressed klotho gene and protein expression in severe...... secondary hyperparathyroidism, despite a further increase in plasma phosphate. Both FGFR1 IIIC and Na+/K+-ATPase gene expression were significantly elevated in severe secondary hyperparathyroidism. Parathyroid gland klotho expression and the plasma calcium ion concentration were inversely correlated. Thus......, our study suggests that klotho may act as a positive regulator of PTH expression and secretion in secondary hyperparathyroidism....

  16. Ectopic calcification following tibial fracture: property analysis

    Energy Technology Data Exchange (ETDEWEB)

    Saitoh, S.; Hata, Y.; Murakami, N.; Seki, H.; Miyauchi, S.; Takaoka, K. [Dept. of Orthopaedics, Shinshu University School of Medicine, Asahi (Japan)

    2000-10-01

    We present a patient whose ectopic calcification following deep posterior compartment syndrome was studied by electron microscopy, chemical analyses, and X-ray diffraction. The patient complained of a toe flexion deformity following a tibial fracture which he sustained 18 years earlier. Damage to the peroneal artery was demonstrated by magnetic resonance angiography, suggesting that the patient had had deep posterior compartment syndro-me in the past. A large radiopaque mass, identified in the flexor hallucis longus muscle by radiographs and computed tomography, was resected, resulting in a dramatic improvement of the toe deformity. The resected material was analyzed in detail. It included no osseous tissue, and was not birefringent under a polarizing microscope, being compatible with ectopic calcification rather than ossification. On electron microscopy the material was found to be an assembly of tiny rods. Chemical and X-ray diffraction analyses suggested a carbonate-containing apatite as the most probable substance. (orig.)

  17. [Obesity: ectopic fat distribution and the heart].

    Science.gov (United States)

    Müller-Wieland, Dirk; Knebel, Birgit; Haas, Jutta; Merkel, Martin; Kotzka, Jörg

    2010-05-01

    The metabolic syndrome is usually associated with insulin resistance and visceral fat distribution, which appear to play a direct role in the development of clinical criteria of metabolic syndrome, like elevation of arterial blood pressure and dyslipidemia. In this review, the authors will first introduce the concept, that insulin resistance and increased visceral adipose tissue are also regularly associated with an abnormal or ectopic accumulation of lipids in nonadipocytes, like steatosis hepatis. Then, they will provide some evidence that epicardial fat can be associated with insulin resistance in a similar fashion as visceral intraabdominal fat. Furthermore, epicardial fat might directly affect the vessels and function of the heart. Accordingly, ectopic accumulation of fat within cardiac muscle cells can impair their function and possibly be related to heart failure. These new relations between obesity, fat distribution and cardiac function might help to identify and treat individuals at risk earlier and more appropriately.

  18. An ectopic tooth concealing an odontogenic myxoma.

    Science.gov (United States)

    Singh, Parmjit; Davies, Huw Teifion

    2013-01-01

    This case report presents a 13-year-old girl who attended an orthodontic clinic for an ectopic UR5. After investigation, a diagnosis of an odontogenic myxoma was made and the tumour was excised. A panoramic radiograph taken almost two years earlier for another dental problem was found to show an ectopic UR5 associated with a subtle radiolucency. Odontogenic myxomas may be of higher frequency than once thought in the paediatric population and therefore should always be considered in the differential diagnosis of any intraosseous radiolucency. Any radiolucent area associated with an unerupted tooth should be investigated further or closely followed up. The odontogenic myxoma is a rare but potentially serious benign tumour of the jaws.

  19. Mediastinitis and pneumomediastinum in a preterm infant with iatrogenic esophageal perforation: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Ji; Kim, Ok Hwa [College of Medicine, Ajou University, Suwon (Korea, Republic of)

    2006-06-15

    Introgenic esophageal perforation is very rare in pediatric patients. Preterm infants or low birth weight babies are more susceptible to esophageal perforation due to performing frequent tracheal intubation and/or gastric tube installation. When perforation occurs, it may present as pneumothorax and pulmonary interstitial emphysema. However, isolated pneumomediastinum without pneumothorax is a rare finding. Furthermore, the mediastinitis after esophageal perforation is rare complication, but it can be a critical complication. Therefore, making an immediate and precise diagnosis as well as instituting proper treatment of esophageal perforation and mediastinitis are important. To the best of our kowledge, few reports have described mediastinitis after pneumomediastinum that was secondary to esophageal perforation. We describe here the radiologic findings of a rare case of mediastinitis after pneumomediastinum is a preterm infant with esophageal perforation.

  20. Surgical management of mediastinal liposarcoma extending from hypopharynx to carina: Case report

    Directory of Open Access Journals (Sweden)

    Morse Christopher R

    2010-03-01

    Full Text Available Abstract We describe the complete resection of a giant, well-differentiated mediastinal liposarcoma extending retropharynx to envelop the aortic arch, trachea and esophagus following preoperative radiotherapy.

  1. The value of cervical mediastinoscopy in the diagnosis of mediastinal lesions

    Directory of Open Access Journals (Sweden)

    Safwat A.M. Eldaboosy

    2015-07-01

    Conclusion: Cervical mediastinoscopy is a safe, accurate and cost effective procedure minimizing hospital stay and allowing appropriate treatment to be immediately commenced upon diagnosis. Mediastinoscopy is still the best diagnostic investigation of choice for paratracheal and retrovascular mediastinal pathology.

  2. 216. Experiencia con la terapia de aspiración continua como tratamiento de la mediastinitis

    Directory of Open Access Journals (Sweden)

    S. Ramis

    2010-01-01

    Conclusiones: La terapia VAC es un método seguro, que permite lograr una estabilidad torácica completa, logrando disminuir las complicaciones, tanto sépticas como respiratorias, en los pacientes con mediastinitis aguda.

  3. Can post-sternotomy mediastinitis be prevented by a closed incision management system?

    Directory of Open Access Journals (Sweden)

    Dohmen, Pascal M.

    2014-09-01

    Full Text Available [english] Post-sternotomy mediastinitis is a serious complication after cardiothoracic surgery and contribute significantly to post-operative morbidity, mortality, and healthcare costs. Negative pressure wound therapy is today’s golden standard for post-sternotomy mediastinitis treatment. A systematic literature search was conducted at PubMed until October 2012 to analyse whether vacuum-assisted closure technique prevents mediastinitis after clean surgical incisions closure. Today’s studies showed reduction of post-sternotomy mediastinitis including a beneficial socio-economic impact. Current studies, however included only high-risk patients, hence furthermore, larger randomised controlled trials are warranted to clarify the benefit for using surgical incision vacuum management systems in the general patient population undergoing sternotomy and clarify risk factor interaction.

  4. Benign giant mediastinal schwannoma presenting as cardiac tamponade in a woman: a case report

    Directory of Open Access Journals (Sweden)

    Sekiya Mitsuaki

    2011-02-01

    Full Text Available Abstract Introduction Mediastinal schwannomas are typically benign and asymptomatic, and generally present no immediate risks. We encountered a rare case of a giant benign posterior mediastinal schwannoma, complicated by life-threatening cardiac tamponade. Case presentation We report the case of a 72-year-old Japanese woman, who presented with cardiogenic shock. Computed tomography of the chest revealed a posterior mediastinal mass 150 cm in diameter, with pericardial effusion. The cardiac tamponade was treated with prompt pericardial fluid drainage. A biopsy was taken from the mass, and after histological examination, it was diagnosed as a benign schwannoma, a well-encapsulated non-infiltrating tumor, originating from the intrathoracic vagus nerve. It was successfully excised, restoring normal cardiac function. Conclusion Our case suggests that giant mediastinal schwannomas, although generally benign and asymptomatic, should be excised upon discovery to prevent the development of life-threatening cardiopulmonary complications.

  5. Predictors of Mediastinitis Risk after Coronary Artery Bypass Surgery: Applicability of Score in 1.322 Cases

    Science.gov (United States)

    Oliveira, Fabiana dos Santos; de Freitas, Letícia Delfino Oliveira; Rabelo-Silva, Eneida Rejane; da Costa, Laura Maggi; Kalil, Renato Abdala Karam; de Moraes, Maria Antonieta Pereira

    2017-01-01

    Background Mediastinitis is a severe surgical complication of low incidence, but high lethality. Scores used in the preoperative period to stratify the risk of postoperative mediastinitis may contribute to improve the results. Objective To test the applicability of the MagedanzSCORE in predicting the risk factors for mediastinitis in patients undergoing coronary artery bypass grafting at a cardiology reference hospital. Methods Historical cohort study with adult patients who underwent coronary artery bypass grafting. The analyzed variables were contemplated in the MagedanzSCORE: reoperation, chronic obstructive pulmonary disease (COPD), obesity, class IV unstable angina, polytransfusion therapy, mediastinitis and death as outcome variables. Results Of the 1.322 patients examined, 56 (4.2%) developed mediastinitis. Of these, 26 (46.4%) were classified as high risk for mediastinitis and 15 (26.8%) at very high risk for mediastinitis. Three of the five variables of the Magendanz Score showed statistically significant differences: reoperation, COPD and obesity. Class IV unstable angina and postoperative polytransfusion were not associated with mediastinitis after coronary artery by-pass grafting. The area under the ROC curve was 0.80 (CI 95% 0.73 - 0.86), indicating the model's satisfactory ability to predict the occurrence of mediastinitis. Conclusion The tool was useful in the preoperative assessment demonstrating the risk for mediastinitis in this population of intensive care patients. PMID:28832745

  6. Predictors of Mediastinitis Risk after Coronary Artery Bypass Surgery: Applicability of Score in 1.322 Cases

    Directory of Open Access Journals (Sweden)

    Fabiana dos Santos Oliveira

    2017-08-01

    Full Text Available Abstract Background: Mediastinitis is a severe surgical complication of low incidence, but high lethality. Scores used in the preoperative period to stratify the risk of postoperative mediastinitis may contribute to improve the results. Objective: To test the applicability of the MagedanzSCORE in predicting the risk factors for mediastinitis in patients undergoing coronary artery bypass grafting at a cardiology reference hospital. Methods: Historical cohort study with adult patients who underwent coronary artery bypass grafting. The analyzed variables were contemplated in the MagedanzSCORE: reoperation, chronic obstructive pulmonary disease (COPD, obesity, class IV unstable angina, polytransfusion therapy, mediastinitis and death as outcome variables. Results: Of the 1.322 patients examined, 56 (4.2% developed mediastinitis. Of these, 26 (46.4% were classified as high risk for mediastinitis and 15 (26.8% at very high risk for mediastinitis. Three of the five variables of the Magendanz Score showed statistically significant differences: reoperation, COPD and obesity. Class IV unstable angina and postoperative polytransfusion were not associated with mediastinitis after coronary artery by-pass grafting. The area under the ROC curve was 0.80 (CI 95% 0.73 - 0.86, indicating the model's satisfactory ability to predict the occurrence of mediastinitis. Conclusion: The tool was useful in the preoperative assessment demonstrating the risk for mediastinitis in this population of intensive care patients. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0

  7. Parathyroid carcinoma survival: improvements in the era of intact parathyroid hormone monitoring?

    Directory of Open Access Journals (Sweden)

    Steve R. Martinez

    2013-02-01

    Full Text Available The intact parathyroid hormone (iPTH assay is a critical test in the diagnosis and management of PTH-mediated hypercalcemia, including parathyroid carcinoma (PCa. We hypothesized that the survival of patients diagnosed with PCa has improved since adoption of the iPTH assay into clinical practice. We identified all confirmed cases of PCa within the Surveillance, Epidemiology and End Results database from 1973 to 2006. Patients were categorized into two eras based upon introduction of the iPTH assay: 1973 to 1997 (era I and 1997 to 2006 (era II, when the iPTH assay was in standard use. We estimated overall survival (OS and disease-specific survival (DSS using the Kaplan-Meier method, with differences among survival curves assessed via log rank. Multivariate Cox proportional hazards models compared the survival rates between treatment eras while controlling for patient age, sex, race/ethnicity, tumor size, nodal status, extent of disease, and type of surgery. Multivariate models included patients undergoing potentially curative surgery and excluded those with dis- tant metastases. Risks of overall and disease-specific mortality were reported as hazard ratios with 95% confidence intervals. Study criteria were met by 370 patients. Median survival was 15.6 years. Five-year rates of OS and DSS were 78% and 88% for era I and 82% and 96% for era II. On multivariate analysis, age, black race, and unknown extent of disease predicted an increased risk of death from any cause. Treatment era did not predict OS. No factor predicted PCa-specific mortality. In multivariate analysis, neither OS nor DSS have improved in the current era that utilizes iPTH for the detection and management of PCa.

  8. Dreams of my daughter: an ectopic pregnancy.

    Science.gov (United States)

    Lahman, Maria K E

    2009-02-01

    Autoethnographic narrative, personal journal excerpts, and artifacts were employed to narrate the story of my ectopic pregnancy and experiences with the medical field. The name "Doctor" is invoked as a way of objectifying yet protecting the anonymity of the doctor who objectified and did not protect me. A methodological discussion of the following tensions in autoethnography is presented: intimacy/professionality, art/science, showing/explaining.

  9. Chest wall ectopic synovial bursa cyst.

    Science.gov (United States)

    Michail, P; Filis, C; Pikoulis, E; Varelas, P; Kyrochristos, D; Mihail, S; Bastounis, E

    1999-11-01

    We report an unusual case of chest wall tumor in a 27-year-old patient. A complete resection was accomplished, and the patient had an excellent postoperative course. Histologically, the mass was confirmed to be an ectopic synovial bursa cyst. Although rare, synovial cysts should be considered in any case of a fluctuating chest wall mass. We also discuss the etiology and diagnostic approach of cystic masses of the chest wall.

  10. Retroperitoneal Ectopic Pregnancy: Diagnosis and Therapeutic Challenges

    OpenAIRE

    Salma Ouassour; Abdelhai Adib Filali; Mohamed Raiss; Rachid Bezad; Zakia Tazi; Mohamed Hassan Alami; Jihane Bennani; Rachida Dafiri

    2017-01-01

    Background. Retroperitoneal ectopic pregnancy is extremely rare. This unusual location represents a great challenge for clinicians due to the difficulties of diagnosis and high risk of life-threatening complications. Case Report. We report the case of a spontaneous early pregnancy of undetermined location in a patient with a history of previous laparoscopic surgery. Diagnosis steps using clinical examination, ultrasound, and magnetic resonance imaging led to the localization of the pregnancy,...

  11. Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy.

    Science.gov (United States)

    Sampson, Victoria; Mogekwu, Oluremi; Ahmed, Ammar; Bano, Farida

    2017-01-01

    Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART). Ultrasound (USS) and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation.

  12. Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Victoria Sampson

    2017-01-01

    Full Text Available Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART. Ultrasound (USS and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation.

  13. Simulation of Ectopic Pacemakers in the Heart: Multiple Ectopic Beats Generated by Reentry inside Fibrotic Regions.

    Science.gov (United States)

    Gouvêa de Barros, Bruno; Weber dos Santos, Rodrigo; Lobosco, Marcelo; Alonso, Sergio

    2015-01-01

    The inclusion of nonconducting media, mimicking cardiac fibrosis, in two models of cardiac tissue produces the formation of ectopic beats. The fraction of nonconducting media in comparison with the fraction of healthy myocytes and the topological distribution of cells determines the probability of ectopic beat generation. First, a detailed subcellular microscopic model that accounts for the microstructure of the cardiac tissue is constructed and employed for the numerical simulation of action potential propagation. Next, an equivalent discrete model is implemented, which permits a faster integration of the equations. This discrete model is a simplified version of the microscopic model that maintains the distribution of connections between cells. Both models produce similar results when describing action potential propagation in homogeneous tissue; however, they slightly differ in the generation of ectopic beats in heterogeneous tissue. Nevertheless, both models present the generation of reentry inside fibrotic tissues. This kind of reentry restricted to microfibrosis regions can result in the formation of ectopic pacemakers, that is, regions that will generate a series of ectopic stimulus at a fast pacing rate. In turn, such activity has been related to trigger fibrillation in the atria and in the ventricles in clinical and animal studies.

  14. Simulation of Ectopic Pacemakers in the Heart: Multiple Ectopic Beats Generated by Reentry inside Fibrotic Regions

    Directory of Open Access Journals (Sweden)

    Bruno Gouvêa de Barros

    2015-01-01

    Full Text Available The inclusion of nonconducting media, mimicking cardiac fibrosis, in two models of cardiac tissue produces the formation of ectopic beats. The fraction of nonconducting media in comparison with the fraction of healthy myocytes and the topological distribution of cells determines the probability of ectopic beat generation. First, a detailed subcellular microscopic model that accounts for the microstructure of the cardiac tissue is constructed and employed for the numerical simulation of action potential propagation. Next, an equivalent discrete model is implemented, which permits a faster integration of the equations. This discrete model is a simplified version of the microscopic model that maintains the distribution of connections between cells. Both models produce similar results when describing action potential propagation in homogeneous tissue; however, they slightly differ in the generation of ectopic beats in heterogeneous tissue. Nevertheless, both models present the generation of reentry inside fibrotic tissues. This kind of reentry restricted to microfibrosis regions can result in the formation of ectopic pacemakers, that is, regions that will generate a series of ectopic stimulus at a fast pacing rate. In turn, such activity has been related to trigger fibrillation in the atria and in the ventricles in clinical and animal studies.

  15. Mechanisms of Tolerance to Parental Parathyroid Tissue when Combined with Human Allogeneic Thymus Transplantation

    Science.gov (United States)

    Chinn, Ivan K.; Olson, John A.; Skinner, Michael A.; McCarthy, Elizabeth A.; Gupton, Stephanie E.; Chen, Dong-Feng; Bonilla, Francisco A.; Roberts, Robert L.; Kanariou, Maria G.; Devlin, Blythe H.; Markert, M. Louise

    2010-01-01

    Background The induction of tolerance toward third-party solid organ grafts with allogeneic thymus tissue transplantation has not been previously demonstrated in human subjects. Objective Infants with complete DiGeorge anomaly (having neither thymus nor parathyroid function) were studied for conditions and mechanisms required for the development of tolerance to third-party solid organ tissues. Methods Four infants who met criteria received parental parathyroid with allogeneic thymus transplantation and were studied. Results Two of three survivors showed function of both grafts but subsequently lost parathyroid function. They demonstrated alloreactivity against the parathyroid donor in mixed lymphocyte cultures. For these 2 recipients, parathyroid donor HLA class II alleles were mismatched with the recipient and thymus. MHC class II tetramers confirmed the presence of recipient CD4+ T cells with specificity towards a mismatched parathyroid donor class II allele. The third survivor has persistent graft function and lacks alloreactivity towards the parathyroid donor. All parathyroid donor class II alleles were shared with either the recipient or the thymus graft, with minor differences between the parathyroid (HLA-DRB1*1104) and thymus (HLA-DRB1*1101). Tetramer analyses detected recipient T cells specific for the parathyroid HLA-DRB1*1104 allele. Alloreactivity towards the parathyroid donor was restored with low-doses of IL-2. Conclusion Tolerance toward parathyroid grafts in combined parental parathyroid and allogeneic thymus transplantation requires matching of thymus tissue to parathyroid HLA class II alleles to promote negative selection and suppression of recipient T cells that have alloreactivity toward the parathyroid grafts. This matching strategy may be applied toward tolerance induction in future combined thymus and solid organ transplantation efforts. PMID:20832849

  16. Perforation of jejunal diverticulum with ectopic pancreas.

    Science.gov (United States)

    Shiratori, Hiroshi; Nishikawa, Takeshi; Shintani, Yukako; Murono, Koji; Sasaki, Kazuhito; Yasuda, Koji; Otani, Kensuke; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Ishihara, Soichiro; Fukayama, Masashi; Watanabe, Toshiaki

    2017-04-01

    Perforation of jejunal diverticulum is a rare complication. Here, we report a case of jejunal diverticulum penetration with surrounding ectopic pancreas. An 83-year-old female patient was admitted to our department with acute onset of severe abdominal pain lasting for half a day. Abdominal computed tomography showed outpouching of the small intestine that contained air/fluid, with multiple surrounding air bubbles in the mesentery of the small intestine. She was diagnosed with penetration of the small intestine, and an emergency laparotomy was indicated. The penetrated jejunal diverticulum was identified ~20-cm distal to the ligament of Treitz. Partial resection of the jejunum was performed, and her postoperative course was uneventful. The pathological findings confirmed diverticulum penetration into the mesentery and severe inflammation at the site, with surrounding ectopic pancreas. Furthermore, the pancreatic ducts were opened through the penetrated diverticulum. This rare case shows that the ectopic pancreas might have caused penetration of jejunal diverticulum owing to the pancreatic duct opening through the diverticulum.

  17. Junctional ectopic tachycardia after congenital heart surgery.

    Science.gov (United States)

    Cools, E; Missant, C

    2014-01-01

    In this literature review, we try to give anesthesiologists a better understanding about Junctional Ectopic Tachycardia (JET), a narrow complex tachycardia that frequently occurs during and after surgery for congenital heart disease. Information was found in the databases of Pubmed, Science Direct, Medline and the Cochrane Library, by using the mesh terms "Tachycardia, Ectopic Junctional", combined with "Diagnosis", "Etiology", "Physiopathology", "Complications" and "Therapy". The publication date of the articles ranged from 1990 to 2012. Risk factors for the development JET are surgery near the AV node, a duration of cardiopulmonary bypass longer than 90 minutes, young age, the use of inotropic drugs and hypomagnesaemia. The diagnosis of Junctional Ectopic Tachycardia can be made on a 12-lead ECG, demonstrating a narrow-complex tachycardia with inverted P-waves and VA dissociation. Adenosine administration and an atrial electrocardiogram can help to confirm the diagnosis. If JET has a minimal impact on the hemodynamic status of the patient, risk factors should be avoided and the adrenergic tonus should be reduced. Hemodynamic unstable JET can be treated by amiodarone, hypothermia and pacing. Extracorporeal membrane oxygenation (ECMO) and radiofrequency or cryoablation are treatment options for life-threatening and resistant JET. JET is the most frequent arrhythmia during and after congenital cardiac surgery. The ECG is the only available method to diagnose JET, demonstrating inverted P-waves and VA-dissociation. Amiodarone seems to be the most effective treatment option, because it can restore sinus rhythm and reduces the JET rate.

  18. Mediastinal liposarcoma in a 30-year-old woman with dyspnea and chest pain

    Directory of Open Access Journals (Sweden)

    Ana Fernández-Tena, PhD

    2017-01-01

    Full Text Available Mediastinal liposarcoma (ML is a rare mesenchymal tumor, accounting for less than 1% of mediastinal tumors. They have a slow growth, so they may not give symptoms for a long time, until the tumor produces compression of close structures. The treatment of choice is surgery, which can be combined with chemo-radiotherapy. We present a case in which the diagnosis of a ML was made in a 30-year-old woman with dyspnea and chest pain.

  19. Mediastinite descendente necrosante pós-angina de Ludwig Necrotizing descending mediastinitis afetr Ludwig angina

    Directory of Open Access Journals (Sweden)

    MARICÉLIA BROMMELSTROET

    2001-09-01

    Full Text Available A angina de Ludwig é uma infecção do espaço submandibular originada, em geral, da infecção do 2º ou 3º molar inferior. Como conseqüência, pode causar mediastinite descendente necrosante, que representa uma forma grave e rara de infecção mediastinal, a qual exige diagnóstico precoce e tratamento cirúrgico para reduzir a alta mortalidade associada a esta doença. Dois casos de mediastinite descendente necrosante pós-angina de Ludwig foram tratados com excelentes resultados em nosso hospital. A drenagem mediastinal transcervical está justificada em pacientes com doença limitada ao mediastino superior. Porém, sepse com comprometimento extenso do mediastino requer drenagem através de toracotomia sem demora.Ludwig's angina is an infection of the submandibular space generally caused by an infection of the 2nd or 3rd lower molar. As a consequence, descending necrotizing mediastinitis, a rare and severe form of mediastinal infection, may occur. The descending necrotizing mediastinitis represents a rare form of mediastinal infection. It presents a high mortality and to decrease that rate it is necessary prompt diagnosis and surgical treatment. Two cases of descending necrotizing mediastinitis due to Ludwig's angina were treated with excellent results in our hospital. The transcervical mediastinal drainage is justified in patients with disease limited to the upper mediastinum. Even so, when there is extensive involvement of the whole mediastinum it is suitable the accomplishment of a wide thoracotomy.

  20. Gata3-deficient mice develop parathyroid abnormalities due to dysregulation of the parathyroid-specific transcription factor Gcm2

    OpenAIRE

    Grigorieva, Irina V.; Mirczuk, Samantha; Gaynor, Katherine U.; Nesbit, M. Andrew; Grigorieva, Elena F.; Wei, Qiaozhi; Ali, Asif; Fairclough, Rebecca J.; Stacey, Joanna M.; Stechman, Michael J.; Mihai, Radu; Kurek, Dorota; Fraser, William D.; Hough, Tertius; Condie, Brian G.

    2010-01-01

    Heterozygous mutations of GATA3, which encodes a dual zinc-finger transcription factor, cause hypoparathyroidism with sensorineural deafness and renal dysplasia. Here, we have investigated the role of GATA3 in parathyroid function by challenging Gata3+/– mice with a diet low in calcium and vitamin D so as to expose any defects in parathyroid function. This led to a higher mortality among Gata3+/– mice compared with Gata3+/+ mice. Compared with their wild-type littermates, Gata3+/– mice had lo...

  1. CT-guided core-needle biopsy in the diagnosis of mediastinal lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Sklair-Levy, M.; Shaham, D.; Applbaum, Y.H.; Libson, E. [Dept. of Radiology, Hadassah University Hospital, Jerusalem (Israel); Polliack, A.; Gillis, S.; Ben-Yehuda, D. [Dept. of Haematology, Hadassah University Hospital, Jerusalem (Israel); Sherman, Y. [Dept. of Pathology, Hadassah University Hospital, Jerusalem (Israel)

    2000-05-01

    The advent of radiologic guidance techniques for percutaneous biopsy has changed the approach to the routine diagnosis of mediastinal lymphoma. The aim of the present study was to evaluate the diagnostic accuracy of CT-guided percutaneous core-needle biopsy (PCNB) in the clinical management of patients with mediastinal lymphoma. The results of 49 CT-guided PCNB of mediastinal lymphoma performed under local anesthesia in 42 ambulatory patients were analyzed. A positive diagnosis of lymphoma was obtained in 30 of 42 patients, with an overall success rate of 71.5 %. The technique was equally successful in the diagnosis of Hodgkin's and non-Hodgkin's lymphoma. There were no major complications. Percutaneous CT-guided CNB of mediastinal lymphoma is a quick, safe, accurate, and efficient alternative to open biopsy in the evaluation of mediastinal lymphoma, mainly at presentation. It should become the preferred initial diagnostic procedure for obtaining histologic samples in patients with suspected mediastinal lymphoma. (orig.)

  2. Endoscopic ultrasound with fine needle aspiration and biopsy in lung cancer and isolated mediastinal lymphadenopathy.

    LENUS (Irish Health Repository)

    Nadarajan, P

    2010-03-01

    Endoscopic ultrasound with fine-needle aspiration and biopsy (EUS-FNAB) is well established in diagnosing and staging lung cancer in patients with mediastinal adenopathy. EUS-FNAB is highly sensitive, less invasive and has lower complication rates when compared to surgical staging of mediastinal nodes. In this study we describe our experience of EUS-FNAB in lung cancer and other causes of mediastinal lymphadenopathy. EUS-FNAB was performed for assessment of PET positive mediastinal lymph nodes between January 2007 and March 2009 in AMNCH. The endpoints of our study were sensitivity and specificity of EUS-FNAB, morbidity and length of hospital stay. Thirty four patients underwent EUS-FNAB during the study period for both diagnosis and staging. Thirty patients had positive lymph node invasion and 4 had no evidence of malignant invasion. In these 4 patients negative cytology was confirmed on mediastinoscopy giving EUS-FNAB a sensitivity and specificity of 100%. EUS-FNAB upstaged the disease in 12 patients. EUS-FNAB is a reliable tool for mediastinal staging in lung cancer, significantly reducing the need for surgical staging procedures in patients with suspected mediastinal involvement.

  3. Parathyroid hormone-related peptide plasma concentrations in patients on hemodialysis

    DEFF Research Database (Denmark)

    Nordholm, Anders; Rix, M.; Olgaard, K.

    2014-01-01

    /paracrine function in the parathyroids, but it is still uncertain if PTHrP is a secretory product of the gland and thereby possess endocrine actions. In cells of severe adenomatous secondary hyperparathyroidism PTHrP and PTH have been found to be co-localized in the same secretory granules. PTH and PTHrP act through......BACKGROUND: Uremic patients develop hyperplasia of the parathyroid glands due to disturbances in the mineral metabolism. The hyperplastic parathyroids are associated with significant expression of parathyroid hormone (PTH)-related peptide (PTHrP). PTHrP has been shown to have an autocrine...... not derive from the uremic hyperplastic parathyroid glands...

  4. The secretory response of parathyroid hormone to acute hypocalcemia in vivo is independent of parathyroid glandular sodium/potassium-ATPase activity

    DEFF Research Database (Denmark)

    Martuseviciene, Giedre; Hofman-Bang, Jacob; Clausen, Torben

    2011-01-01

    The involvement of sodium/potassium-ATPase in regulating parathyroid hormone (PTH) secretion is inferred from in vitro studies. Recently, the α-klotho-dependent rapid recruitment of this ATPase to the parathyroid cell plasma membrane in response to low extracellular calcium ion was suggested......-treated parathyroid glands, indicating inhibition of the ATPase. As ouabain induced systemic hyperkalemia, the effect of high potassium on hormone secretion was also examined but was found to have no effect. Thus, inhibition of the parathyroid gland sodium/potassium-ATPase activity in vivo had no effect...

  5. Aldosterone and parathyroid hormone: a precarious couple for cardiovascular disease

    NARCIS (Netherlands)

    Tomaschitz, A.; Ritz, E.; Pieske, B.; Fahrleitner-Pammer, A.; Kienreich, K.; Horina, J.H.; Drechsler, C.; Marz, W.; Ofner, M.; Pieber, T.R.; Pilz, S.

    2012-01-01

    Animal and human studies support a clinically relevant interaction between aldosterone and parathyroid hormone (PTH) levels and suggest an impact of the interaction on cardiovascular (CV) health. This review focuses on mechanisms behind the bidirectional interactions between aldosterone and PTH and

  6. [Echographic diagnosis and localization of parathyroid gland adenomas].

    Science.gov (United States)

    Maier, W

    1981-04-01

    The sonographic morphology of adenomas is studied on the basis of 7 sonographically identified and surgically confirmed adenomas of the parathyroid gland, taking the available literature into consideration. Information is given on differential diagnosis against normal anatomical structures and pathological processes. A correlation is established between sonomorphological and pathologico-anatomical findings.

  7. Intra-operative parathyroid hormone measurements – experience of ...

    African Journals Online (AJOL)

    Background. Surgery is the treatment of choice for symptomatic primary hyperparathyroidism. The majority of research concerning intra-operative parathyroid hormone (ioPTH) measurements is conducted in university hospitals. Whether ioPTH measurements are feasible and useful in predicting the presence of remaining ...

  8. Multiple organ dysfunction caused by parathyroid adenoma‑induced ...

    African Journals Online (AJOL)

    We present a 27‑year‑old male with multiple organ dysfunction caused by parathyroid adenoma‑induced primary hyperparathyroidism (PHPT). Initially, the patient experienced a sudden onset of gastrointestinal symptoms, polyuria, polydipsia, bone pain, renal dysfunction, nephrolithiasis, and acute pancreatitis, symptoms ...

  9. Parathyroid adenoma with concurrent toxic thyroid adenoma: A rare ...

    African Journals Online (AJOL)

    Case summary: A 47-year-old female patient presented with non-specific complaints including fatigue and muscle cramps. Diagnostic workup revealed significantly elevated plasma calcium levels in association with hyperthyroidism. There was a considerable delay in measuring the parathyroid hormone levels which were ...

  10. Parathyroid cyst: often mistaken for a thyroid cyst.

    Science.gov (United States)

    Ujiki, Michael B; Nayar, Ritu; Sturgeon, Cord; Angelos, Peter

    2007-01-01

    Parathyroid cysts are rare but clinically significant lesions. They can be functional, mistaken for a thyroid cyst, and/or managed nonoperatively on occasion. We identified seven patients (1 male, 6 females) with the diagnosis of parathyroid cyst from 1998 to 2003. Altogether, 33% of the patients had functional cysts. Sestamibi scans were performed in three of the seven patients, including two with functional cysts; none showed focal uptake. In toto, six of the seven cysts (86%) were found in an inferior parathyroid gland. All of the cysts had crystal-clear aspirate. C-terminal parathormone (PTH) levels were obtained from the aspirate from five of the seven (71%) patients. The mean level was 269,736 pg/ml (1970-1,268,074 pg/ml). Surgery was performed in three of the seven (43%) patients. All patients who underwent surgery improved postoperatively based on symptoms and serum levels of calcium and PTH. The four patients (57%) who were treated nonoperatively were subjected to aspiration alone; three (75%) of those patients required multiple aspirations. Most parathyroid cysts are nonfunctional and are rarely symptomatic. They are usually located in an inferior gland. If aspirated, most of the cysts reaccumulate fluid. Operative management is usually straightforward and alleviates symptoms and any biochemical abnormalities caused by the cyst.

  11. Genital tuberculosis: an important cause of ectopic pregnancy in India.

    Science.gov (United States)

    Sharma, Jai B; Naha, Moumita; Kumar, Sunesh; Roy, Kallol K; Singh, Neeta; Arora, Raksha

    2014-10-01

    To assess the role of genital tuberculosis as an etiological factor for ectopic pregnancy. A total of eighteen women of ectopic pregnancy with concomitant female genital tuberculosis and a total of one hundred thirty six patients of ectopic pregnancy over a period of three years were enrolled. Mean age of patients with ectopic pregnancy and concomitant female genital tuberculosis was twenty-six and mean parity was 0.7. Most of these patients were in poor socio-economic group. Diagnosis of female genital tuberculosis was made by presence of granuloma in histopathological examination of endometrial aspirate or tubal specimen, positive acid fast bacilli in microscopy or culture, positive polymerase chain reaction in endometrial tissue and positive findings of genital tuberculosis during laparoscopy or laparotomy. Genital tuberculosis was responsible for 13.2% of all cases of ectopic pregnancy in the present study. Genital tuberculosis appears to be an important cause of ectopic pregnancy in India.

  12. Endobronchial Ultrasound Elastography for Diagnosing Mediastinal and Hilar Lymph Nodes

    Directory of Open Access Journals (Sweden)

    Hai-Yan He

    2015-01-01

    Full Text Available Background: Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound (EBUS elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration (EBUS-TBNA. The current study was conducted to investigate the diagnostic value of EBUS elastography for mediastinal and hilar lymph node metastasis in lung cancers. Methods: From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was performed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes. Results: Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes (P = 0.000. The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score (r = 0

  13. Preoperative localization of parathyroid lesions. Value of {sup 99m}Tc-MIBI tomography and factors influencing detection

    Energy Technology Data Exchange (ETDEWEB)

    Ansquer, C.; Carlier, T.; Kraeber-Bodere, F. [Hotel Dieu Univ. Hospital, Nantes (France). Nuclear Medicine Dept.; Mirallie, E. [Hotel Dieu Univ. Hospital, Nantes (France). Surgery Dept.; Abbey-Huguenin, H. [Rene Gauducheau Centre, Saint Herblain (France). Biostatistics Dept.; St Jacques Univ. Hospital, Nantes (France). PIMESP; Aubron, F. [Ultrasonography Centre, Nantes (France)

    2008-07-01

    The aim of our study was to assess retrospectively the value of {sup 99m}Tc-MIBI SPECT in the localization of parathyroid lesions in primary hyperparathyroidism and to determine the impact of PTH level, age, sex, characteristics of the lesions and thyroid nodules on the sensitivity of imaging. Patients, methods: Fifty nine patients who were cured after the resection of 60 lesions (50 adenomas, 9 hyperplasias and 1 carcinoma, 9 of them in ectopy) were selected. {sup 99m}TcO{sub 4}{sup -}, early and late {sup 99m}Tc-MIBI planar images (n=59), {sup 99m}Tc-MIBI SPECT (n=58) and ultrasound (n=50) performed preoperatively were analyzed. The imaging results were compared to surgical and histological findings and correlated to different factors suspected of influencing the imaging's sensitivity. Results: Sensitivity of double phase {sup 99m}Tc-MIBI/{sup 99m}TcO{sub 4}{sup -} scintigraphy was higher than that of early or late scintigraphy alone. SPECT increased the sensitivity of scintigraphy from 85% to 92% and was useful to confirm doubtful foci and to localize ectopic lesions. Ultrasound (US) had the lowest sensitivity (56%) and the highest rate of false-positive results (n=10), but identified 2 adenomas which were not detected by scintigraphy. Combining all imaging modalities, sensitivity reached 96%. Better sensitivities were observed when age <69 years, preoperative PTH level {>=}155 pg/ml, weight of the gland {>=}0.80 g and in the absence of thyroid nodules. US was more influenced by these factors than scintigraphy. Conclusion: Combination of US, double-phase {sup 99m}Tc-MIBI/{sup 99m}TcO{sub 4}{sup -} planar scintigraphy and SPECT is the most accurate method for the detection of parathyroid lesions and should be performed before minimally invasive surgery, especially when PTH level is low, in older patients and in cases of multinodular goiter. (orig.)

  14. Primary mediastinal large B-cell lymphoma arising from thyroid in a renal recipient with Hashimoto’s thyroiditis

    OpenAIRE

    Wu, Fang; Qu, Lu; Li, Dai-Qiang; Hu, Chun-Hong

    2015-01-01

    Primary mediastinal large B-cell lymphoma is a subtype of diffuse large B-cell lymphoma, arising in the mediastinum from putative thymic B-cell origin with distinctive clinical and genetic features. Generally, primary mediastinal large B-cell lymphoma is believed as only deriving in the mediastinum. The current study presents a rare case of primary mediastinal large B-cell lymphoma which arising from thyroid in a renal recipient with Hashimoto’s thyroiditis. Moreover, we devoted a discussion ...

  15. The impact of vacuum-assisted closure on long-term survival after post-sternotomy mediastinitis.

    Science.gov (United States)

    Sjögren, Johan; Nilsson, Johan; Gustafsson, Ronny; Malmsjö, Malin; Ingemansson, Richard

    2005-10-01

    Post-sternotomy mediastinitis after coronary artery bypass grafting is reported to be a strong predictor for poor late survival when using conventional wound-healing therapies. The aim of this study was to compare the long-term survival after vacuum-assisted closure treated mediastinitis following coronary artery bypass grafting with that of patients without mediastinitis. Another objective was to identify risk factors for developing mediastinitis. Forty-six patients were treated for mediastinitis, with vacuum-assisted closure but without additional tissue flaps, after isolated coronary bypass grafting between January 1999 and September 2004. During this period, 4,781 patients underwent isolated coronary bypass grafting without mediastinitis. Actuarial survival was compared with the log-rank test. Univariate and multivariate analysis were used to identify risk factors for mediastinitis. There was no difference in early or late survival between the mediastinitis group treated with vacuum-assisted closure and the control group (p = not significant). The survival at 1, 3, and 5 years was 92.9% +/- 4.0%, 89.2% +/- 5.2%, and 89.2% +/- 5.2%, respectively, in the vacuum-assisted closure group; and 96.5% +/- 0.3%, 92.1% +/- 0.5%, and 86.9% +/- 0.8%, respectively, in the control group. Diabetes mellitus, low left ventricular ejection fraction, obesity, renal failure, and three-vessel disease were identified as risk factors for developing mediastinitis. This study suggests that patients with vacuum-assisted closure treated mediastinitis may have similar long-term survival as patients without mediastinitis after coronary artery bypass grafting. The independent risk factors identified were similar to those found in previous studies. Our data support that vacuum-assisted closure therapy minimizes the negative effects of mediastinitis on late survival after coronary artery bypass grafting.

  16. Near infrared fluorescence imaging of rabbit thyroid and parathyroid glands.

    Science.gov (United States)

    Antakia, Ramez; Gayet, Pascal; Guillermet, Stephanie; Stephenson, Tim J; Brown, Nicola J; Harrison, Barney J; Balasubramanian, Saba P

    2014-12-01

    Near infrared fluorescence imaging using intravenous methylene blue (MB) is a novel technique that has potential to aid the parathyroid gland (PG) localization during thyroid and parathyroid surgery. The aim of this study was to examine MB fluorescence in the rabbit neck and determine the influence of MB dose and time following administration on fluorescence from thyroid and PGs. Thyroid and external PGs were exposed in six New Zealand white rabbits under anesthesia. Varying doses of MB (0.025-3 mg/kg) were injected through the marginal ear vein. Near infrared fluorescence from exposed tissues was recorded at different time intervals (10-74 min) using Fluobeam 700. Specimens of identified glands were then resected for histologic assessment. Histology confirmed accurate identification of all excised thyroid and PGs; these were the only neck structures to demonstrate significant fluorescence. The parathyroid demonstrated lower fluorescence intensities and reduced washout times at all MB doses compared with the thyroid gland. A dose of 0.1 mg/kg MB was adequate to identify fluorescence; this also delineated the blood supply of the external PGs. The study demonstrates that near infrared fluorescence with intravenous MB helps differentiate between thyroid and PGs in the rabbit. This has potential to improve outcomes in thyroid and parathyroid surgery by increasing the accuracy of parathyroid identification; however, the findings require replication in human surgery. The use of low doses of MB may also avoid the side effects associated with currently used doses in humans (3-7 mg/kg). Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Ultrasonographic diagnosis of unilateral ectopic ureter in a Labrador dog

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    P.A. Oglesby

    2003-07-01

    Full Text Available A 3-month-old, Labrador bitch presented with urinary incontinence. A unilateral, ectopic ureter was diagnosed with ultrasound without the aid of additional contrast radiographic techniques. Ipsilateral hydroureter and mild hydronephrosis were also present.At the level of the bladder trigone the ectopic ureter became intramural and this was clearly demonstrable with ultrasound. The opening of the ectopic ureter into the proximal urethra was, however, not visualised owing to its intrapelvic location.

  18. Cervical Ectopic Pregnancy following Assisted Reproductive Technology: A Case Report

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    Firoozeh Ahmadi

    2012-01-01

    Full Text Available Cervical ectopic pregnancy (EP is an infrequent, life-threatening form of ectopic gestationpregnancy that implants within the endocervical canal. With the increase in use of assistedreproductive technology (ART worldwide and more liberal use of transvaginal sonography (TVSduring early pregnancy, more cases of cervical ectopic pregnancy are being diagnosed. Earlydiagnosis of this condition by using ultrasound imaging allows for prevention of maternal morbiditydue to hemorrhage and leads to conservative management of this condition.We present the case ofa 38-year old woman (gravida 1, para 0 who was found to have acervical ectopic pregnancy at sixweeks of gestation.

  19. Ruptured ectopic pregnancy with a negative urine pregnancy test.

    Science.gov (United States)

    Hughes, Mallory; Lupo, Andrew; Browning, Adrianne

    2017-01-01

    Ectopic pregnancy is commonly seen as a differential diagnosis of first-trimester vaginal bleeding. Often the diagnosis is made based on a combination of exam findings, transvaginal ultrasound, and a positive pregnancy test. Our case describes a patient with a history of ectopic pregnancy treated with methotrexate and serial human chorionic gonadotropin measurements that were decreasing appropriately. At the time of evaluation, her urine pregnancy test was negative; however, she was confirmed to have a ruptured tubal ectopic pregnancy. This case highlights the variable presentation of ectopic pregnancies and the importance of combining exam findings with ultrasound and laboratory results.

  20. Current knowledge of the aetiology of human tubal ectopic pregnancy

    Science.gov (United States)

    Shaw, J.L.V.; Dey, S.K.; Critchley, H.O.D.; Horne, A.W.

    2010-01-01

    BACKGROUND An ectopic pregnancy is a pregnancy which occurs outside of the uterine cavity, and over 98% implant in the Fallopian tube. Tubal ectopic pregnancy remains the most common cause of maternal mortality in the first trimester of pregnancy. The epidemiological risk factors for tubal ectopic pregnancy are well established and include: tubal damage as a result of surgery or infection (particularly Chlamydia trachomatis), smoking and in vitro fertilization. This review appraises the data to date researching the aetiology of tubal ectopic pregnancy. METHODS Scientific literature was searched for studies investigating the underlying aetiology of tubal ectopic pregnancy. RESULTS Existing data addressing the underlying cause of tubal ectopic pregnancy are mostly descriptive. There are currently few good animal models of tubal ectopic pregnancy. There are limited data explaining the link between risk factors and tubal implantation. CONCLUSIONS Current evidence supports the hypothesis that tubal ectopic pregnancy is caused by a combination of retention of the embryo within the Fallopian tube due to impaired embryo-tubal transport and alterations in the tubal environment allowing early implantation to occur. Future studies are needed that address the functional consequences of infection and smoking on Fallopian tube physiology. A greater understanding of the aetiology of tubal ectopic pregnancy is critical for the development of improved preventative measures, the advancement of diagnostic screening methods and the development of novel treatments. PMID:20071358

  1. Biomarkers for Ectopic Pregnancy and Pregnancy of Unknown Location

    Science.gov (United States)

    Senapati, Suneeta; Barnhart, Kurt T.

    2013-01-01

    Early pregnancy failure is the most common complication of pregnancy, and 1–2% of all pregnancies will be ectopic. As one of the leading causes of maternal morbidity and mortality, diagnosing ectopic pregnancy and determining the fate of a pregnancy of unknown location are of great clinical concern. Several serum and plasma biomarkers for ectopic pregnancy have been investigated independently and in combination. The following is a review of the state of biomarker discovery and development for ectopic pregnancy and pregnancy of unknown location. PMID:23290746

  2. Treatment of Ectopic Mandibular Second Permanent Molar with Elastic Separators

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    R. Rajesh

    2014-01-01

    Full Text Available Ectopic eruption is a developmental disturbance in which the tooth fails to follow its normal eruption pathway. Ectopic eruption of the second molar is relatively rare. This paper presents the case of thirteen-year-old male with an ectopic mandibular second permanent molar. The condition was corrected with surgical exposure and placement of elastic separators. This case report lays emphasis on the practice of basic methods to obtain acceptable results rather than extensive surgical or orthodontic corrections. It is advised that ectopic teeth should not be neglected especially when it concerns developing caries and malocclusion.

  3. Massively dilated right atrium masquerading as a mediastinal tumor

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    Thomas Schroeter

    2011-04-01

    Full Text Available Severe tricuspid valve insufficiency causes right atrial dilatation, venous congestion, and reduced atrial contractility, and may eventually lead to right heart failure. We report a case of a patient with severe tricuspid valve insufficiency, right heart failure, and a massively dilated right atrium. The enormously dilated atrium compressed the right lung, resulting in a radiographic appearance of a mediastinal tumor. Tricuspid valve repair and reduction of the right atrium was performed. Follow up examination revealed improvement of liver function, reduced peripheral edema and improved New York Heart Association (NYHA class. The reduction of the atrial size and repair of the tricuspid valve resulted in a restoration of the conduit and reservoir function of the right atrium. Given the chronicity of the disease process and the long-standing atrial fibrillation, there is no impact of this operation on right atrial contraction. In combination with the reconstruction of the tricuspid valve, the reduction atrioplasty will reduce the risk of thrombembolic events and preserve the right ventricular function.

  4. PRIMARY MEDIASTINAL B LARGE CELL LYMPHOMA - CASE REPORT

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    Irena Ćojbašić

    2014-09-01

    Full Text Available Primary mediastinal large B cell lymphoma (PMLBCL has been recognized as a specific subtype of diffuse large B cell lymphoma with characteristic clinical, pathological and biological features. This paper presents a diagnostic and therapeutic approach in the treatment of patient with this disease. A patient aged 35 years visited a doctor because of the presence of B-symptoms and signs of the existence of superior vena cava syndrome. After the transbronchial biopsy of the tumor mass, the diagnosis PMLBCL was established. This case has been regarded as localized stage lymphoma with medium risk. The patient received induction therapy by R-MACOP-B protocol and achieved a clinical response of partial remission type. After that, radiotherapy of mediastinum was carried and salavage therapy was applied but no further reduction in tumor mass was observed. Treatment was continued by the application of autologous hematopoietic stem cell transplantation. Control PET/CT scan showed the absence of a viable tumor, thus it was concluded that clinical response of complete remission type was achieved. The optimal therapeutic approach in the treatment of patients with PMLBCL remains a matter of debate. The use of a therapeutic protocol MACOP-B in combination with mediastinum radiotherapy has been demonstrated to improve disease-free survival, while the importance of additional treatment with rituximab and the role of PET scan in the assessment of therapeutic response continue to be reviewed.

  5. Pulmonary infundibular stenosis following mediastinal radiation; Report of two cases

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    Horimoto, Masashi; Satoh, Fumihiko; Igarashi, Keiichi; Takenaka, Takashi; Fujiwara, Masafumi (Sapporo National Hospital, Hokkaido (Japan)); Takahashi, Wataru

    1993-07-01

    Two cases are reported in which pulmonary infundibular stenosis and valvular regurgitation developed after mediastinal irradiation. A 57-year-old woman received a total of 54 Gy of irradiation to the upper and lower parts of the mediastinum after radical mastectomy for breast cancer at the age of 43. Four years later, the patient began to have chest pain. Eleven years after irradiation, she developed angina of effort and pericardial effusion caused by chronic pericarditis. The other patient, a 61-year-old woman, received a total of 90 Gy of irradiation to the mediastinum after radical mastectomy at the age of 33 years. Twenty-seven years later, the patient developed acute inferior myocardial infarction. In both patients, pulmonary infundibular stenosis and valvular regurgitation were considered attributable to irradiation because of the lack of risk factors for coronary artery disease and the presence of cartilage necrosis of the sternum and rib corresponding to the irradiation field. Fibrotic thickness and contraction seemed to be responsible for the mechanism of pulmonary infundibular stenosis after irradiation. The findings in these patients were concordant with the previously reported findings, in that coronary artery lesions were confined to the origin or proximal part of the coronary artery. (N.K.).

  6. Primary Mediastinal Large B-Cell Lymphoma during Pregnancy

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    Cesar A. Perez

    2012-01-01

    Full Text Available Non-Hodgkin’s Lymphoma (NHL rarely presents during pregnancy and primary mediastinal large B-cell lymphoma (PMLBCL accounts for approximately 2.5% of patients with NHL. The case of a 22-year-old woman who was diagnosed with Stage IIA PMLBCL during week 13 of her intrauterine pregnancy is described. The staging consisted in computed tomography (CT of the chest and magnetic resonance imaging (MRI of the abdomen and pelvis. She was managed with R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone for a total of six cycles and, because of the early presentation during the second trimester, she received the entire chemotherapy course during the pregnancy. She delivered a healthy baby at 34 weeks of pregnancy and a 18FDG-PET/CT scan demonstrated complete remission after delivery. After 20 months of follow up she remains with no evidence of disease and her 1-year-old son has shown no developmental delays or physical abnormalities. PMLBCL, although an uncommon subgroup of DLBCL, may present during pregnancy and R-CHOP should be considered as one suitable option in this complex scenario.

  7. A Rare Case of Mediastinal Cyst: Thoracic Duct Cyst

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    Duygu Mergan

    2016-01-01

    Full Text Available Thoracic duct cysts are very rarely observed cysts of the mediastinum. These cysts, which can become established in the costovertebral sulcus or the visceral compartment, have generally been reported at the level of the 10th and 11th vertebrae; however, they can be observed at any location along the ductus [1]. A 37-year-old male patient complained of chest pain for the last 3 months that especially increased after meals. He complained of shortness of breath while walking or going up the stairs, for the last month. The lung graphy showed an increased darkening at a 5x6cm smooth (clean-cut, regular, orderly bordered shadow just behind the heart shadow. The patient%u2019s computed thorax tomography showed a retrocardiac-paravertebral, middle line positioned, 8.5x7x6 cm proportioned, regular bordered, thin walled, homogenous cystic bulk at the subcarinal level. The patient, who could not be relieved with medical treatment, was taken to surgery. The lesion was reached by right posterolateral thoracotomy, and drainage of lymph-containing cystic fluid and excision of the cyst walls were performed by incising the thoracic duct cyst with a mediastinal pleura incision. Mass ligation was then performed to the thoracic duct. We wanted to present our thoracic duct cyst case in this article due to the currently limited number of actual cases reported in the literature.

  8. Ozone therapy as an adjunct to vancomycin enhances bacterial elimination in methicillin resistant Staphylococcus aureus mediastinitis.

    Science.gov (United States)

    Gulmen, Senol; Kurtoglu, Tunay; Meteoglu, Ibrahim; Kaya, Selcuk; Okutan, Huseyin

    2013-11-01

    We aimed to investigate the influence of intraperitoneal ozone therapy on bacterial elimination and mediastinal inflammation in experimental Staphylococcus aureus mediastinitis. Forty Wistar-Albino rats were randomized into five groups (eight per group) as follows: uncontaminated group, untreated contaminated group, ozone group, vancomycin group, and vancomycin + ozone group. Uncontaminated group underwent upper median sternotomy. The remaining four groups were inoculated with 0.5 mL 10(8) colony-forming units/mL methicillin-resistant Staphylococcus aureus in the mediastinal and sternal layers. Untreated contaminated group had no treatment. Rats in the vancomycin group received intramuscular vancomycin (40 mg/kg/d), and ozone was administered intraperitoneally (70 μg/mL, 1 mg/kg/d) in the ozone group for the treatment of mediastinitis. Vancomycin + ozone group rats were treated by the combination of both methods. At the end of 10 d, quantitative bacterial cultures and sternal tissue samples were obtained for determination of bacterial counts and histologic degree of inflammation. Both the vancomycin and the ozone treatments caused significant reduction of bacterial counts in quantitative bacterial cultures. Combination of vancomycin and ozone treatments resulted in further reduction of bacterial counts in mediastinum and sternum. Histologic examination of tissue samples revealed significant reduction in severity of mediastinitis related inflammation in vancomycin and vancomycin + ozone groups compared with untreated contaminated group. Ozone therapy as an adjunct to vancomycin leads to enhanced bacterial elimination in infected sternal and mediastinal tissues in experimental methicillin-resistant Staphylococcus aureus mediastinitis. The benefit of adjuvant ozone therapy is suggested to be related to its bactericidal effect. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. MR diffusion imaging in mediastinal masses the differentiation between benign and malignant lesions

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    Youssriah Yahia Sabri

    2017-09-01

    Full Text Available Background: Diffusion-weighted imaging is a fundamental tool integrated in MR protocols useful in differentiating benign from malignant mediastinal masses, assessing mediastinal lymphadenopathy and investigating central bronchogenic carcinoma. This method is an excellent alternative to CT or PET/CT in the investigation of mediastinal masses. Current applications of diffusion MRI in malignancies include monitoring the treatment response and detecting recurrent cancer. Aim of the work: This study aims to assess the value of using MRI diffusion in differentiating benign and malignant mediastinal masses, differentiating central masses from post obstructive collapse and differentiating lymphoma versus sarcoidosis. Patients and methods: This study included 30 patients; 16 males and 14 females in the period from June 2013 to July 2014. The mean age was 49.3 ± 16.85 (range: 22–82 years.Cases were referred for MRI assessment and were approved by the ethical committee in our department.The complaints varied between dyspnea, chest pain, cough, hemoptysis, fatigue and loss of weight. A superconducting 1.5 T MRI machine with a four-channel body phased-array coil was used for the examination. Biopsy and histopathological assessment was done after that. Results: MRI examination with diffusion imaging was able to differentiate between benign and malignant mediastinal and hilar lesion confirmed by the biopsy and histopathology. Conclusion: MRI with diffusion weighted images can detect and stage lung cancer, differentiate benign from malignant mediastinal masses and differentiate lymphoma from sarcoidosis in mediastinal/hilar lymphadenopathy. Keywords: Magnetic resonance imaging, Diffusion, Sarcoidosis, Lymphoma, Bronchogenic carcinoma

  10. Mediastinal neoplasms in patients with Graves disease: a possible link between sustained hyperthyroidism and thymic neoplasia?

    Directory of Open Access Journals (Sweden)

    Boyd Jonathan D

    2012-07-01

    Full Text Available Abstract Background Anterior mediastinal masses are a rare but well documented finding in Graves disease. The vast majority of these lesions represents benign thymic hypertrophy and regress after treatment of the hyperthyroidism. A small percentage of these cases however represent neoplastic/malignant diseases which require further treatment. Cases 12 year old boy with one year history of refractory Graves disease was found to have an anterior mediastinal mass and underwent curative thyroidectomy for sustained hyperthyroidism. Cervical lymphadenopathy was detected during the procedure and biopsy was obtained. A 23 year old woman who presented with a one month history of hyperthyroid symptoms, was diagnosed with Graves disease and also was found to have an anterior mediastinal mass on imaging. Biopsy of the anterior mediastinal mass was obtained and subsequently the patient underwent robotic thymectomy. Histologic examination and immunophenotyping of the cervical lymph node in a 12 year old boy revealed neoplastic proliferation of T lymphoblasts diagnostic of T lymphoblastic leukemia/lymphoma. Examination of the anterior mediastinal mass biopsy in the 23 year old woman revealed type B1 thymoma which was confirmed after examination of the subsequent robotic thymectomy specimen. Conclusion This is the first reported case of T cell lymphoblastic lymphoma and the third reported case of thymoma associated with sustained hyperthyroidism due to Graves disease. These cases indicate that an anterior mediastinal mass in a patient with active Graves disease may be due to a neoplastic cause, which may require definitive treatment. Caution should be exercised when dismissing a mediastinal mass as benign thymic hyperplasia in patients with active Graves disease.

  11. Primary Hepatic Ectopic Pregnancy: A Case Report.

    Science.gov (United States)

    Tu, Jianchun; Wang, Erlei; Shen, Junkang

    2016-01-01

    Hepatic pregnancy is a very rare form of ectopic pregnancy, potentially life-threatening for the mother. A 33-year-old woman presented with intermittent pain in the upper abdomen of 5 days' duration. An abdominopelvic ultrasound scan was performed, which demonstrated hepatic pregnancy. Later, abdominal computed tomography (CT) and magnetic resonance imaging (MRI) in coronal and axial confirmed the findings and delineated exactly the regional anatomy before surgery. Laparotomy was successfully performed according to the preoperative diagnosis. The application of imaging techniques (ultrasound, CT, and MRI scan) is very useful in hepatic pregnancy for defining the regional anatomy in greater detail and is critical in minimizing surgical injury.

  12. Microscopic thymoma and parathyroid adenoma: rare combination of two distinct pathologies

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    Benjamin Walton

    2014-06-01

    Full Text Available While there is an intimate anatomical and embryological relationship between the inferior parathyroid gland and thymus, concurrent pathology is rare. Three cases have been reported in the literature of a parathyroid adenoma in conjunction with a thymoma. We present a case report of a 60-year-old female with a past medical history of hypercalcemia subsequently found to have primary hyperparathyroidism. Sestamibi scan of the parathyroid revealed increased uptake in the lower left neck consistent with a parathyroid adenoma. A standard transverse neck incision was performed with exploration of the lower left thyroid pole. Further dissection was required to identify the parathyroid gland which was intimately associated with thymic tissue in the superior mediastinum. Both thymic tissue and the parathyroid gland were sent for pathology. Permanent pathology subsequently revealed a parathyroid adenoma with an incidental spindle cell thymoma. The embryological relationship of the inferior parathyroid glands and the thymus is well known as both are derived from the third branchial pouch. However, there are only 3 other previous reports of parathyroid adenoma associated with a thymoma in the current literature. Interestingly, up to 16% of parathyroid adenomas are found in the mediastinum, and the current literature states the incidence of thymoma varies from 10-42%.

  13. Analysis Of Two Years Cases Of Ectopic Pregnancy.

    Science.gov (United States)

    Islam, Ansa; Fawad, Aneesa; Shah, Azmat Ali; Jadoon, Humaira; Sarwar, Iram; Abbasi, Aziz-Un-Nisa

    2017-01-01

    Ectopic pregnancy is the leading cause of pregnancy related deaths in the first trimester. The aim of this study was to evaluate the frequency of risk factors, clinical presentation, diagnostic methods and site of ectopic pregnancy. This descriptive cross sectional study was conducted in Gynaecology and Obstetrical Unit-A of Ayub Teaching Hospital Abbottabad from 1st October 2013 to 31st October 2015. All women diagnosed with ectopic pregnancy were included in the study. A predesigned proforma was used to record the details about demographic features, risk factors, clinical features at presentation, diagnostic methods and site of ectopic pregnancy. Out of total 6675 patients admitted during the study period, 45 cases of ectopic pregnancy were diagnosed with frequency of ectopic pregnancy to be 0.65%. Mean age of the patients was 28.98±5.525. Majority of patients were primigravida14 (31.3%), 9 (20.0%) gravida 2, 5 (11.1%) gravida 3, 4 (8.8%) gravida 4, 7 (15.5%) gravida 5, 6 (13.3%) found grand multi out of total 45 ectopic pregnancies, 45% of the patients had no identifiable risk factors, however history of infertility 20 (22.22%), history of Pelvic inflammatory disease (PID) 10 (22.22%), previous ectopic 2 (4.44%) and previous abdominal pelvic surgery 3 (6.67%) were identified as common risk factors of 45 ectopic pregnancies. Out of total 45 sufferers 23 (51.11%) were clinically diagnosed, 20 (44.44%) through abdominal ultrasound and 2 (4.44%) through transvaginal ultrasound. The most frequent clinical presentation was amenorrhea 30 (66.67%) followed by abdominal pain 28 (62.22%), irregular vaginal bleeding 18 (40.00%), asymptomatic patients with routine ultrasound 18 (40.0%) and 10 (22.22%) presented in shock. Twenty-eight (62.2%) of the ectopic pregnancies were found in right sided fallopian tube and 17(37.8%) were found in left sided fallopian tube. The commonest site of ectopic pregnancy was ampulla 29 (64.44%) followed by 11 (24.44%) Isthmus, 4 (8

  14. Near-Infrared Autofluorescence Image-Guided Parathyroid Gland Mapping in Thyroidectomy.

    Science.gov (United States)

    Kim, Sung Won; Lee, Hyoung Shin; Ahn, Yeh-Chan; Park, Chan Woo; Jeon, Seok Won; Kim, Chang Hoi; Ko, Jae Beom; Oak, Chulho; Kim, Yikeun; Lee, Kang Dae

    2017-11-06

    Studies to date have shown that near-infrared autofluorescence imaging (NIR) can detect the parathyroid gland during thyroidectomy. However, there are no reports that NIR imaging can identify the parathyroid gland when it's covered with fibrofatty tissue before identification by a surgeon's naked eye. In this study, we investigated the feasibility of parathyroid gland mapping to facilitate early identification of the parathyroid gland during thyroidectomy. Seventy parathyroid glands from 38 patients who underwent thyroidectomy for papillary thyroid cancer were included in this prospective study. Near-infrared with infrared illumination (NIR-IR) imaging using a 780-nm light-emitting diode was conducted at the predicted locations of the superior or inferior parathyroid glands. Parathyroid mapping was conducted in 3 stages. Stages P1, P2, and P3 were defined as imaging before identification of the gland by direct visualization, imaging after identification, and imaging in the removed specimen, respectively. Sixty-four parathyroid glands (92.8%) could be localized in stage P1 before surgical dissection and exposure of the gland. Five parathyroid glands that were not detected at stage P1 were identified in stages P2 (4 cases, 5.8%) and P3 (1 case, 1.4%). One parathyroid gland was not identified in either the NIR imaging or the pathologic examination. The sensitivity, specificity, and accuracy of parathyroid gland mapping in stages P1, P2, and P3 were all 100%. Parathyroid gland mapping using our NIR-IR imaging technique was feasible, with an excellent accuracy rate. This technique may be helpful for early identification of parathyroid glands during thyroidectomy. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Results of cryopreserved parathyroid autografts: a retrospective multicenter study.

    Science.gov (United States)

    Borot, Sophie; Lapierre, Valérie; Carnaille, Bruno; Goudet, Pierre; Penfornis, Alfred

    2010-04-01

    The functionality of cryopreserved parathyroid autotransplantation (CPAT) has been evaluated in few studies, mostly conducted by experienced single-institution centers that have reported different success rates ranging from 17% to 83%. In France, CPAT are rare and their functionality has never been evaluated. Moreover, French tissue banks are facing an accumulation of ungrafted samples. The aim of our work was to evaluate the implantation rate of cryopreserved parathyroid samples and the functionality of CPAT in a multicenter study. Data from 9 French tissue banks were analyzed. CPAT functionality was defined as fully functional (normal parathyroid hormone [PTH] and calcium levels without treatment), partially functional (normal PTH levels but need for treatment to maintain normocalcemia), and nonfunctional (low PTH levels and need for treatment). For dialyzed patients, CPAT was considered nonfunctional if the PTH level in the nongrafted arm was less than 20 pg/mL, partially functional if the PTH level was between 20 and 50 pg/mL, and fully functional if the PTH level was between 50 and 300 pg/mL. The 9 centers had cryopreserved 1376 samples of parathyroid tissue and only 22 (1.6%) had been autografted in 20 patients (65% renal hyperparathyroidism, 20% multiple endocrine neoplasia type 1, 15% "other") by 12 different surgical teams. The median duration of storage was 11.1 months (range, 0.4-28.5). Only 2 autografts (10%) were fully functional, 2 (10%) were partially functional, and 17 (80%) were nonfunctional at 26 months median follow-up. The reimplantation rate is low, and the functionality of CPAT is less than those published by experienced centers. Logistical and technical problems occurring in less experienced centers are probably the main reasons for nonfunctioning implants. Considering the results of this study, we suggest that cryopreservation of parathyroid glands should be abandoned when not performed in very large experimented centers, that CPAT should

  16. Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition

    LENUS (Irish Health Repository)

    Parissis, Haralabos

    2011-09-19

    Abstract Background To report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flaps Methods From February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve. Results Superficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol\\/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days. Conclusion Post cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.

  17. 42 CFR 136a.55 - Drugs and devices and termination of ectopic pregnancies.

    Science.gov (United States)

    2010-10-01

    ... and devices and termination of ectopic pregnancies. Federal funds are available for drugs or devices... termination of an ectopic pregnancy. ... 42 Public Health 1 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic...

  18. 42 CFR 136.55 - Drugs and devices and termination of ectopic pregnancies.

    Science.gov (United States)

    2010-10-01

    ... devices and termination of ectopic pregnancies. Federal funds are available for drugs or devices to... an ectopic pregnancy. ... 42 Public Health 1 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic...

  19. Ectopic pregnancy treatment by combination therapy

    Directory of Open Access Journals (Sweden)

    Cymbaluk-Płoska Aneta

    2016-01-01

    Full Text Available Detectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients’ future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients’ general condition, ultrasonographic evaluation and serum level of beta-hCG. A combination of laparoscopic and conservative systemic treatment was applied in 70% of cases. More rapid beta-hCG reduction was noted when laparoscopy and intra-oviductal injection of hyperosmolar glucose or methotrexate (MTX were combined with intramuscular administration of MTX at a dose of 50 mg/m2. Follow-up examination of 66 patients revealed that the greatest number of spontaneous pregnancies (48% resulted after this combination therapy. We conclude that this combination treatment is safe and provides satisfactory results in terms of future fertility.

  20. Ectopic pregnancy treatment by combination therapy.

    Science.gov (United States)

    Cymbaluk-Płoska, Aneta; Chudecka-Głaz, Anita; Kuźniak, Sławomir; Menkiszak, Janusz

    2016-01-01

    Detectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients' future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients' general condition, ultrasonographic evaluation and serum level of beta-hCG. A combination of laparoscopic and conservative systemic treatment was applied in 70% of cases. More rapid beta-hCG reduction was noted when laparoscopy and intra-oviductal injection of hyperosmolar glucose or methotrexate (MTX) were combined with intramuscular administration of MTX at a dose of 50 mg/m2. Follow-up examination of 66 patients revealed that the greatest number of spontaneous pregnancies (48%) resulted after this combination therapy. We conclude that this combination treatment is safe and provides satisfactory results in terms of future fertility.

  1. The Clinical and Ultrasonic Study of Clinically Suspected Ectopic Pregnancy: Laying Emphasis on 15 proven Ectopic Pregnancies

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Myung Ho; Chung, Yung Sun [Chonnam National University College of Medicine, Gwangju (Korea, Republic of)

    2010-05-15

    Ectopic preganacies are unsuccessful pregnancies that result from implantation of fertilized ovum occurring in an aberrant area. Aside from an emergency case, the early diagnosis of ectopic pregnancy is very difficult particularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces the danger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensable diagnostic tool in Obstetrics and Gynecology. In the authors' experience, clinical suspected ectopic pregnancy was one of the common indications for performing ultrasonography. Since Kobayashi at al. reported the appearances of ectopic pregnancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy have been reported by many authors. But, its accuracy and reliability in the diagnosis of ectopic pregnancy are still open to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L gray scale ultrasonography from Aug. 1982 to June. 1983. There were 29 confirmed cases, of which 15 were proved to have ectopic pregnancy and 14 were proved to have diseases other than ectopic pregnancy by surgical and histopathological study or by laparoscopy and follow up study. 29 confirmed cases were reviewed. The results were as follows: 1. Among 15 ectopic pregnancies, there were 12 ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregnancy. Among 14 cases of no ectopic pregnancy, there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma, H-mole and tubal hematoma due to previous tuball ligation, respectively. 2. The age distribution of ectopic pregnancy was from 22 to 41 years. The common clinical manifestations of ectopic pregnancy were lower abdominal pain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea (66.7%). 3. Positive result of urine immunologic pregnancy test was 28.6% in ectopic

  2. Apparent Diffusion Coefficient Measurement in Mediastinal Lymphadenopathies: Differentiation between Benign and Malignant Lesions

    Directory of Open Access Journals (Sweden)

    Fethi Emre Ustabasioglu

    2017-01-01

    Full Text Available Objectives: We aimed to prospectively assess the diagnostic value of apparent diffusion coefficient (ADC measurement in the differentiation of benign and malignant mediastinal lymphadenopathies. Materials and Methods: The study included 63 consecutive patients (28 women, 35 men; mean age 59.3 years with 125 mediastinal lymphadenopathies. Echoplanar diffusion-weighted magnetic resonance imaging of the mediastinum was performed with b-factors of 0 and 600 mm2/s before mediastinoscopy and mediastinotomy, and ADC values were measured. The ADC values were compared with the histological results, and statistical analysis was done. P < 0.05 was considered statistically significant. Results: The mean ADC value of malignant mediastinal lymphadenopathy (1.030 ± 0.245 × 10−3 mm2/s was significantly lower (P < 0.05 when compared to benign lymphadenopathies (1.571 ± 0.559 × 10−3 mm2/s. For differentiating malignant from benign mediastinal lymphadenopathy, the best result was obtained when an ADC value of 1.334 × 10−3 mm2/s was used as a threshold value; area under the curve 0.848, accuracy 78.4%, sensitivity 66%, specificity of 86%, positive predictive value 76.7%, and negative predictive value of 79.2%. Interobserver agreement was excellent for ADC measurements. Conclusions: ADC measurements could be considered an important supportive method in differentiating benign from malignant mediastinal lymphadenopathies.

  3. Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Guimaraes, Marcos Duarte; TyngI, Chiang Cheng; Bitencourt, Almir Galvao Vieira; Gross, Jefferson Luiz; Zurstrassen, Charles Edouard, E-mail: marcosduarte500@gmail.com [AC Camargo Cancer Center, Sao Paulo, SP (Brazil); Hochhegger, Bruno [Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), RS (Brazil). Dept. de Radiologia; Benveniste, Marcelo Felipe Kuperman; Odisio, Bruno Calazans [University of Texas, MD Anderson Cancer Center, Houston, TX (United States); Marchiori, Edson [Universidade Federal do Rio de Janeiro (UFRJ), Petropolis, RJ (Brazil)

    2014-11-15

    Objectives: to evaluate the preliminary results obtained using diffusion-weighted magnetic resonance imaging and the apparent diffusion coefficient for planning computed tomography-guided biopsies of selected mediastinal lesions. Methods: eight patients with mediastinal lesions suspicious for malignancy were referred for computed tomography-guided biopsy. Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient measurement were performed to assist in biopsy planning with diffusion/computed tomography fused images. We selected mediastinal lesions that could provide discordant diagnoses depending on the biopsy site, including large heterogeneous masses, lesions associated with lung atelectasis or consolidation, lesions involving large mediastinal vessels and lesions for which the results of biopsy using other methods and histopathological examination were divergent from the clinical and radiological suspicion. Results: in all cases, the biopsy needle was successfully directed to areas of higher signal intensity on diffusion weighted sequences and the lowest apparent diffusion coefficient within the lesion (mean, 0.8 [range, 0.6–1.1]610{sup -3} mm{sup 2}/s), suggesting high cellularity. All biopsies provided adequate material for specific histopathological diagnoses of four lymphomas, two sarcomas and two thymoma s. Conclusion: functional imaging tools, such as diffusion-weighted imaging and the apparent diffusion coefficient, are promising for implementation in noninvasive and imaging-guided procedures. However, additional studies are needed to confirm that mediastinal biopsy can be improved with these techniques. (author)

  4. Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment.

    Science.gov (United States)

    Sjögren, Johan; Gustafsson, Ronny; Nilsson, Johan; Malmsjö, Malin; Ingemansson, Richard

    2005-06-01

    The conventional treatment for poststernotomy mediastinitis usually involves surgical revision, closed irrigation, or reconstruction with omentum or pectoral muscle flaps. Recently, vacuum-assisted closure has been successfully used in poststernotomy mediastinitis. The aim of the present study was to compare the clinical outcome and survival in 101 patients undergoing vacuum-assisted closure therapy or conventional treatment for poststernotomy mediastinitis. One hundred one consecutive patients underwent treatment for poststernotomy mediastinitis: vacuum-assisted closure therapy (January 1999 through December 2003, n = 61) or conventional treatment (July 1994 through December 1998, n = 40). Follow-up was made in April 2004 and was 100% complete. Actuarial statistics were used to calculate the survival rates. The 90-days mortality was 0% in the vacuum-assisted closure group and 15% in the conventional treatment group (p vacuum-assisted closure and conventional treatment were 0% and 37.5%, respectively (p vacuum-assisted closure therapy or conventional treatment: 6.6% versus 5.0%, respectively. Overall survival in the vacuum-assisted closure group was significantly better (p vacuum-assisted closure therapy is a safe and reliable option in poststernotomy mediastinitis with excellent survival and a very low failure rate compared with conventional treatment.

  5. Impact of ectopic pregnancy for reproductive prognosis in next generation

    DEFF Research Database (Denmark)

    Kårhus, Line Lund; Egerup, Pia; Skovlund, Charlotte Wessel

    2014-01-01

    The impact of an ectopic pregnancy in the next generation is unknown. Our aim was to compare reproductive outcomes in daughters of women with and without ectopic pregnancy. Designed as a historical prospective controlled cohort study with data collected in four Danish registries from 1977...

  6. Ectopic pregnancy: an 18-year review of management and outcome ...

    African Journals Online (AJOL)

    Background: Technological advances have led to earlier diagnosis of ectopic pregnancy with a decline in morbidity and mortality in developed countries. The purpose of this study was to determine the pattern of presentation, management and outcome of ectopic pregnancy over an 18-year period. Methods: A retrospective ...

  7. Term tubal ectopic pregnancy delivered by laparotomy with a viable ...

    African Journals Online (AJOL)

    We describe an extremely rare medical phenomenon in a 28 year old who presented with undiagnosed tubal ectopic pregnancy at 41 weeks gestation and was delivered by laparotomy with linear salpingostomy at the Kenyatta National Hospital, Nairobi, Kenya. Key words: Term ectopic pregnancy, Ultrasound ...

  8. Non-invasive diagnosis and management of ectopic pregnancy

    NARCIS (Netherlands)

    van Mello, N.M.

    2013-01-01

    The work presented in this thesis begins with a focus on non-invasive diagnostic methods for ectopic pregnancy. The heterogeneity found in studies on diagnostic tests for ectopic pregnancy has led to an international recommendation on uniform definitions of early pregnancy complications. Hereafter,

  9. Spontaneous Live Twin Tubal Ectopic Pregnancy: A Case Report

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    R Benn

    2016-02-01

    Full Text Available We report the case of a 29-year old G3P1+1 woman with a spontaneously conceived live twin tubal ectopic pregnancy. Her history was significant for infertility for 11 years after an induced abortion. Pelvic ultrasound scan showed live twin ectopic pregnancy and a partial salpingectomy was done.

  10. Associations in ruptured ectopic pregnancy in Nnamdi Azikiwe ...

    African Journals Online (AJOL)

    This study investigated other known factors associated with ruptured ectopic pregnancy. Retrospective analysis of the medical records of women who were operated on for ruptured ectopic pregnancy at Nnamdi Azikiwe University Teaching Hospital, Nnewi from 1991 to 2003 was carried out. No patient was excluded and all ...

  11. Ectopic Pregnancies at the Ahmadu Bello University Teaching ...

    African Journals Online (AJOL)

    Background: Ectopic pregnancy continues to be a major surgical emergency in gynaecology. Objective: To determine the incidence, clinical pattern, surgical management, morbidity and mortality from ectopic pregnancy in a Nigerian tertiary health care center. Study Design, Setting and Subjects: The case files of 149 ...

  12. Cases of ectopic pregnancies as seen in Lagos State University ...

    African Journals Online (AJOL)

    Objective: To determine the prevalence rate, the major forms of ectopic pregnancy and to correct some of the inadequacies in filling of the laboratory forms. Materials and Methods: Relevant data on 91 ectopic pregnancy specimens received at the Lagos State University Teaching Hospital (LASUTH), Ikeja between May 1 ...

  13. Diagnosis of Ruptured Ectopic Pregnancy is still a Challenge in ...

    African Journals Online (AJOL)

    Erah

    This was a cross sectional prospective study carried out in Kassala Maternity Hospital, Eastern Sudan (2008-2011) to investigate the incidence rate and factors associated with delayed presentation in ruptured ectopic pregnancy. The total number of deliveries during the study period was 9578. The total number of ectopic ...

  14. Diagnosis and laparoscopic treatment of cornual ectopic pregnancy

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    Walid, M. Sami

    2010-01-01

    Full Text Available Cornual (interstitial ectopic pregnancy is an uncommon variant of ectopic pregnancy which often poses a diagnostic and therapeutic challenge with a significant risk of rupturing and bleeding. We present a ruptured right cornual pregnancy and explain how to deal with such a case laparoscopically.

  15. Case Report: Cervical Ectopic Pregnancy presenting as Cervical ...

    African Journals Online (AJOL)

    Cervical pregnancy is a rare but serious type of ectopic pregnancy in which the implantation site is within the cervical mucosa that lines the endocervical canal. This is a rare cervical ectopic pregnancy wrongly diagnosed as a cervical fi broid by clinicoradiological examination. The actual diagnosis was revealed by ...

  16. Role of transabdominal ultrasound in detection of ectopic pregnancy

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    Narayan Bikram Thapa

    2016-03-01

    Full Text Available Background & Objectives: Ectopic pregnancy is one of the common medical emergencies encountered in the clinical practice. Confirmation of diagnosis is usually done by urine pregnancy test and transabdominal sonography. Thus, the present study is carried out to determine the role of transabdominal ultrasonography in the diagnosis of ectopic pregnancy by comparing the ultrasonography findings with that of operative and histopathology and to evaluate clinical profile of the women with confirmed ectopic pregnancy. Materials & Methods: Transabdominal ultrasound record of patients referred for first trimester ultrasound, from January 2008 to December 2015, at radiology department of Kist medial college teaching hospital were reviewed to identify patients with ectopic pregnancy. Among these patients those who underwent surgery and histopathology confirmed ectopic pregnancies were identified and their medical records were retrieved. Ultrasound and clinical profile were recorded and statistically analyzed. Results: There were 19 patients with ultrasound diagnosis of ectopic pregnancy among 1480 first trimester ultrasound record. Among these patients, ectopic pregnancy was confirmed on 18 patients. Ultrasound diagnosis included adnexal mass with pelvic fluid in 15 (83.3% patients and pelvic fluid without adnexal mass in 4 (16.7% patients. The study result revealed that sensitivity of transabdominal ultrasonography was 100% and specificity was 99.9%. Positive predictive value and negative predictive value of transabdominal ultrasonography was 94% and 100%.Conclusion: The transabdominal ultrasound accurately diagnose ruptured ectopic pregnancy.JCMS Nepal. 2016;12(1:1-4.

  17. Tubal Ectopic Gestation Associated with Genital Schistosomiasis: A ...

    African Journals Online (AJOL)

    A case of a 25-year-old woman with 8 weeks amenorrhoea, lower abdominal pain and per vaginal bleeding was managed for ruptured ectopic pregnancy and discovered to have tubal infection by Schistosoma on histological examination is presented. Afr J Reprod Health 2014; 18[2]: 144-146). Keywords: Ectopic Gestation ...

  18. Cushing's syndrome caused by ectopic ACTH secretion from ...

    African Journals Online (AJOL)

    Ectopic adrenocorticotrophic hormone (ACTH) secretion accounts for 9 -18% of all causes of Cushing's syndrome.' The commonest source of the ectopic ACTH syndrome is carcinoma of the lung, with a smaller contribution from carcinoid tumours. While bronchial carcinoid tumours are reported to be responsible for 5 - 39% ...

  19. Case Report: The ectopic posterior pituitary gland | Mahomed ...

    African Journals Online (AJOL)

    An ectopic posterior pituitary gland is a rare condition and may present with an empty pituitary fossa, hypoplasia or absence of the infundibular stalk and resultant short stature due to growth hormone deficiency. The location of the ectopic lobe can vary, but it is most commonly situated along the median eminence in the floor ...

  20. Association of anti-Chlamydia antibodies with ectopic pregnancy in ...

    African Journals Online (AJOL)

    Background: Ectopic pregnancy remains a major public health problem especially in many developing countries where it is a significant contributor to pregnancy related morbidity and mortality. Objective: To determine the association between prior Chlamydia trachomatis infection and the risk of ectopic pregnancy. Methods: ...

  1. Case report - Ectopic molar pregnancy: A case report | Bousfiha ...

    African Journals Online (AJOL)

    The patient was followed with weekly quantitative ;-hCG titers until three successive ;-hCG levels were negative. It is pertinent that clinicians take routine histological examination of tubal specimens in ectopic pregnancy very seriously in order to diagnose cases of ectopic molar gestations early and mount appropriate post ...

  2. Bilateral extraluminal ectopic ureters in a Maine Coon cat

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    L.Z. Crivellenti

    2013-06-01

    Full Text Available Ectopic ureters are rarely observed in cats. Therefore, for a better chance of success in the corrective surgical procedure and survival of the patient, diagnosis should be confirmed early. This report illustrates the occurrence of bilateral ectopic ureters in a seven month old Maine Coon cat and describes the medical and surgical management adopted for correction of the abnormality.

  3. Trends in ectopic pregnancy in Ilorin, Nigeria | Aboyeji | Nigerian ...

    African Journals Online (AJOL)

    Objective: To determine the incidence, trends aetiological factors, clinical presentation and management of ectopic pregnancy at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Methods: Retrospective study of ectopic pregnancies at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Results: The incidence of ...

  4. Ectopic pregnancy experience in a tertiary health facility in South ...

    African Journals Online (AJOL)

    Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective: To determine the incidence, clinical presentation, risk factors and management outcomes of ectopic pregnancies in a tertiary health facility. Methods: A retrospective ...

  5. Ectopic Pregnancy in Lagos State University Teaching Hospital ...

    African Journals Online (AJOL)

    We set out to determine the socio-demographic factors,pattern of presentation and management of ectopic pregnancy in a University Teaching Hospital in Lagos, Nigeria. A retrospective descriptive analysis of all cases of ectopic pregnancy over a 2-year period was carried out. The case notes were retrieved from the ...

  6. [Thyroid ectopic tumour in the right ventricle of the heart].

    Science.gov (United States)

    Fennira, S; Mahfoudhi, H; Zairi, I; Ben Moussa, F; Slimane, M L; Kraiem, S; Thameur, H; Dellagi, K

    2011-08-01

    The intracardiac ectopic thyroid tumour is rare. We report the case of a woman who was admitted for exertional dyspnea. The echocardiography revealed an obstructive tumor in the right ventricular outflow tract. Histological examination of the removed tumour showed the ectopic follicular thyroid tissue. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  7. Right ectopic gestation following in vitro fertilisation: case report ...

    African Journals Online (AJOL)

    The management of ectopic gestation has in recent years transformed from the normally accepted laparotomy to the laparoscopic approach. The objective of this case report is to describe a rare occurrence of an ectopic gestation following in vitro fertilisation procedure. A 35-year-old para 0 + 0, presented with lower ...

  8. Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

    DEFF Research Database (Denmark)

    Puri, R.; Vilmann, P.; Sud, R.

    2010-01-01

    Patients with suspected tuberculosis without pulmonary lesions and with mediastinal lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate mediastinal and abdominal lesions. The aim...

  9. Minimal access mediastinal surgery: One or two lung ventilation?

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    Toolabi Karamollah

    2009-01-01

    Full Text Available Background : Minimal access mediastinal surgery (MAMS is usually performed under general anaesthesia with double lumen tubes (DLT. The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis. Methods : In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2, end-tidal Pco2 (ETPco2, times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications. Results : In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon′s opinion with regard to exposure were similar for both groups. Conclusion : Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.

  10. Mediastinal lymphadenopathy in patients undergoing cardiac transplant evaluation.

    Science.gov (United States)

    Pastis, Nicholas J; Van Bakel, Adrian B; Brand, Timothy M; Ravenel, James G; Gilbert, Gregory E; Silvestri, Gerard A; Judson, Marc A

    2011-06-01

    We evaluated the association between hemodynamic parameters of chronic congestive heart failure (CHF) and mediastinal lymphadenopathy (MLA) in heart transplantation (HT) candidates and the effect of HT on MLA. We also described the results of lymph node (LN) biopsies of MLA in the patients. Patients who underwent HT evaluation over an 8-year period and had chest CT scans were evaluated retrospectively. Data collected included LN sizes pre-HT and post-HT, echocardiographic measurements, radionuclide-derived ejection fraction, and right-sided heart catheterization hemodynamics. MLA was defined as LNs > 1 cm in smallest dimension. Of 118 patients, 53 patients had MLA. MLA had weak statistically significant correlations with elevated mean pulmonary artery pressure (MPAP), mitral regurgitation (MR), tricuspid regurgitation (TR), right atrial pressure (RAP), and pulmonary capillary wedge pressure (PCWP). Thirty-six patients with MLA underwent HT, and nine of the 36 had post-HT chest CT scans. All nine patients showed a decrease in LN size post-HT (mean LN diameter pre-HT = 1.16 ± 0.137 cm, post-HT = 0.75 ± 0.32 cm). Seven of 53 patients with MLA underwent biopsies. Four had benign LNs, one had sarcoidosis, and two had lung cancer. MPAP, MR, TR, RAP, and PCWP had weak statistically significant correlations with MLA. HT led to regression of MLA in patients who underwent CT scans post-HT, implying that MLA is related to CHF. However, we also identified clinically important causes of MLA; therefore, biopsy should be considered if enlarged LNs fail to regress after maximal medical management of CHF.

  11. A Matlab Tool for Tumor Localization in Parathyroid Sestamibi Scintigraphy

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    M. Đurović

    2015-11-01

    Full Text Available Submarine method for localization of parathyroid tumors (PT has proved to be effective in case of typical pitfalls of conventional scintigraphic methods (combined subtraction and double phase methods. It uses images obtained by standard dynamic parathyroid sestamibi scintigraphy suggested by European Association of Nuclear Medicine. This paper presents: 1 the developed Matlab interface that enables the implementation and evaluation of algorithms for the automatic application of Submarine method; 2 the algorithm for automatic extraction of the entire thyroid region from the background radioactivity using operations from mathematical morphology applied on dynamic scintigrams; 3 the results obtained by algorithm for localization and visualization of PTs based on estimation of exponential decreasing trend of time-activity curves. The algorithm was tested on a group of 20 patients with histopathologically proven PTs using developed Matlab interface.

  12. Transbronchial needle aspiration of hilar and mediastinal lymph nodes

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    Deborah Lannes

    2007-09-01

    Full Text Available Background: Besides clarifying the etiology of unidentified lymphadenomegaly, puncturing hilar and mediastinal lymph nodes by a flexible bronchoscopic needle is an aid in diagnosing and staging bronchogenic cancer or other metastatic cancers. Objective: Our study had the principal objective to evaluate the positivity of transbronchial needle aspiration (TBNA. Method: We evaluated retrospectively the effectiveness of all TBNA done in 74 consecutive patients. Forty-nine patients were male and the median age was 59. We used Wang-needles, 21-gauge (Bard, USA, and the same technique described for differents authors. Of the 74 patients evaluated, 11(15% showed mediastinal mass and 65 (85% hilar mass. We observed 76 endoscopics abnormalities. Results: According to the classification of the specimens, we had 32/74 (43% unsatisfactory specimens, 34/74 (46% satisfactory and diagnostic specimens, and 8/74(11% satisfactory and non-diagnostic specimens. Thirty four (46% of the examinations were found to be positive out of the total amount of specimens. Of the positive results, 30/34 specimens (88% contained malignant disease. Small-cell carcinoma was the most frequent finding, with 10/34 cases (29%; squamous cell carcinoma 7/34 (21%; adenocarcinoma 7/34 (21%, non--small cell carcinoma 6/34 (17%; sarcoidosis 2/34 (6% and tuberculosis 2/34 (6%. Conclusion: Our study indicated that this method is safe, easy to perform, with a minimum of complications and useful for the diagnosis and staging of pulmonary neoplasms. Resumo: Introdução: A punção com agulha através da broncofibroscopia (TBNA, além de ser útil no esclarecimento das linfodenomegalias hilares e mediastinais, é também de utilidade no diagnóstico e estadiamento do carcinoma brônquico e de outras neoplasias metastáticas. Objectivo: Avaliar restrospectivamente a eficácia das TBNA realizadas em 74 doentes consecutivos. Quarenta e nove deles do sexo masculino e com

  13. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months. METHODS: Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities...... of pregnancy for each group were calculated by the Kaplan-Meier estimator and compared by Cox regression analysis to control for potential confounders. MAIN OUTCOME MEASURES: Intrauterine pregnancy rates and recurrence rates of ectopic pregnancy after surgery for ectopic pregnancy. RESULTS: The cumulative...

  14. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    pathology, the chance of pregnancy was poor (hazard ratio 0.463) and the risk of recurrence was high (hazard ratio 2.25), assessed with Cox regression. The rate of persistent ectopic pregnancy was 8%. CONCLUSION: Conservative surgery is superior to radical surgery at preserving fertility. Conservative...... surgery is not followed by an increased risk of repeat ectopic pregnancy, but by the risk of persistent ectopic pregnancy, which should be taken into account when deciding on the operative procedure. Management in case of contralateral tubal pathology is disputed and should ideally be addressed......OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...

  15. Persistent ectopic pregnancy after milking procedure: Case report

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    Semra Kayataş

    2014-03-01

    Full Text Available Ectopic pregnancy is the settlement of the pregnancy product at any site other than the endometrium. The incidence of ectopic pregnancy have increased in the last 20 years. Increased frequency and early diagnosis has led to conservative treatment methods to become more favorable. Follow-up, medical management and surgical managements are considered as conservative methods. As salpingostomy is the most common conservative surgical method, milking is considered as an alternative conservative surgical method. The most important complication of the conservative surgery is the persistence of ectopic pregnancy because of the residual trophoblastic tissue. Since the prediction of the persistent ectopic pregnancy is difficult after the conservative surgery, β-HCG follow up is so important for early diagnosis. In this case report we have discussed the case of the patient who admitted to our clinic with persistent ectopic pregnancy with acute abdomen, after the treatment with milking procedure whom than treated by salpingectomy procedure.

  16. Near-infrared autofluorescence imaging to detect parathyroid glands in thyroid surgery.

    Science.gov (United States)

    Ladurner, R; Al Arabi, N; Guendogar, U; Hallfeldt, Kkj; Stepp, H; Gallwas, Jks

    2018-01-01

    Objective To identify and save parathyroid glands during thyroidectomy by displaying their autofluorescence. Methods Autofluorescence imaging was carried out during thyroidectomy with and without central lymph node dissection. After visual recognition by the surgeon, the parathyroid glands and the surrounding tissue were exposed to near-infrared light with a wavelength of 690-770 nm using a modified Karl Storz near infrared/indocyanine green endoscopic system. Parathyroid tissue was expected to show near infrared autofluorescence at 820 nm, captured in the blue channel of the camera. Results We investigated 41 parathyroid glands from 20 patients; 37 glands were identified correctly based on near-infrared autofluorescence. Neither lymph nodes nor thyroid revealed substantial autofluorescence and nor did adipose tissue. Conclusions Parathyroid tissue is characterised by showing autofluorescence in the near-infrared spectrum. This effect can be used to identify and preserve parathyroid glands during thyroidectomy.

  17. Homologous amino-terminal radioimmunoassay for rat parathyroid hormone.

    Science.gov (United States)

    Calvo, M S; Gundberg, C M; Heath, H; Fox, J

    1991-08-01

    Existing radioimmunoassays for parathyroid hormone (PTH) in rat plasma are based on cross-reactivity of rat PTH (rPTH) with heterologous antisera. We used the synthetic NH2-terminal fragment of rPTH [rPTH-(1-34)] to develop a homologous radioimmunoassay for circulating PTH. An antiserum to rPTH-(1-34) was raised in a goat (G-813), and the same peptide was used as radioligand (125I) and standard. Purification of the label by high-performance liquid chromatography (HPLC) increased specific binding greater than twofold and sensitivity by 50-100%. With a final antiserum dilution of 1:70,000, maximum specific binding of 30-33%, nonspecific binding of 1-5%, and 50-microliters sample additions, the assay detection limit was 1.8-2.5 pmol/l. A midregional fragment of human PTH did not displace 125I-labeled rPTH-(1-34). HPLC of extracts of rat parathyroid glands and hyperparathyroid plasma showed only a single peak of immunoreactivity that eluted 2 min after rPTH-(1-34). Dose dilution curves for rat parathyroid gland extracts, rPTH-(1-34) added to rat plasma, and endogenous rat plasma PTH all paralleled the standard curve. Immunoreactive PTH (irPTH) was detectable in greater than 90% of fasting normal rat plasma and changed appropriately in response to hyper- and hypocalcemia induced by low-calcium and vitamin D-deficient diets, injections of calcium and EDTA, and after thyroparathyroidectomy. The normal range for rat plasma irPTH was less than 2.0-12 pmol/l, in general agreement with bioassay results of others. Thus rPTH-(1-34) is an excellent immunogen for raising antisera to rPTH, and assays incorporating it may be of great value in studying rat parathyroid physiology.

  18. Predictive factors for failure of salpingostomy in ectopic pregnancy.

    Science.gov (United States)

    Kayatas, Semra; Demirci, Oya; Kumru, Pinar; Mahmutoglu, Didar; Saribrahim, Bahar; Arinkan, Sevcan Arzu

    2014-02-01

    The objective of this study was to review our experience with ectopic pregnancy management and to evaluate major predictive factors for failure of conservative linear salpingostomy. Seven hundred and ninety-seven cases that were treated for ectopic pregnancy in our clinic between October 2005 and September 2011 were analyzed retrospectively for incidence and treatment options. We defined failure as rising or plateauing postoperative serum β-hCG levels that required additional medical or surgical treatment after initial removal of the ectopic pregnancy by laparoscopy or by laparotomy. We examined the risk factors consisting of preoperative β-hCG, size and location of ectopic lesions, the presence of fetal heart beat and tubal condition that can influence the failure or success of conservative salpingostomy. In total, 403 patients were treated conservatively. These conservative managements consist of 334 salpingostomies performed by laparoscopy and 69 by laparotomy. Because of persistent ectopic pregnancy, 16 patients underwent medical treatment. In total, 387 patients were treated successfully with conservative management and 16 patients were treated unsuccessfully with conservative management. When variables of P ectopic pregnancy of 33.5 mm or greater and fimbrial and isthmic region ectopic pregnancies were significantly associated with the failure rate. The size of the ectopic pregnancy and fimbrial and isthmic region ectopic pregnancies were determinant of failure of conservative surgery. Our success rate in the ruptured group is not an underestimated value to dissuade patients wishing to maintain fertility by undergoing salpingectomy. So, the conservative approach to ectopic pregnancy should be undertaken after careful patient evaluation. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

  19. Mediastinal mature teratoma with rupture into pleural cavity due to blunt trauma.

    Science.gov (United States)

    Miyazawa, Masahisa; Yoshida, Kazuo; Komatsu, Kazunori; Kobayashi, Nobutaka; Haba, Yoshiaki

    2012-03-01

    We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Aberrant Pancreatic Tissue in a Mediastinal Enteric Duplication Cyst: A Rarity with Review of Literature.

    Science.gov (United States)

    Mansi, Meha; Mahajan, Nidhi; Mahana, Sonam; Gupta, C R; Mohta, Anup

    2017-01-01

    Mediastinal enteric duplication cysts are a rare congenital malformation encountered mainly in neonates and infants. It is a distinct entity within the family of foregut duplication cysts. It can present with respiratory distress due to mass effect and hence surgical excision is the preferred treatment. Histologically, it is characterised by a double layered smooth muscle wall with intestinal lining epithelium. We report a case of mediastinal enteric duplication cyst with aberrant pancreatic tissue in a neonate due to its rarity and early presentation. A neonate presented with respiratory distress and a cystic mass in the right posterior mediastinum. The lesion was excised and on histopathological analysis the diagnosis of mediastinal enteric duplication cyst was made. Also, aberrant pancreatic tissue which has been reported rarely was noted in this case. We discuss this case and review similar cases reported in literature.

  1. [Bronchoesophageal fistula secondary to mediastinal lymph node tuberculosis: a case report and review of the literature].

    Science.gov (United States)

    Liao, Li-yue; Wu, Hua; Zhang, Nuo-fu; Liu, Chun-li; Li, Shi-yue; Gu, Ying-ying; Chen, Rong-chang

    2013-11-01

    To analyze the clinical features of 1 case of bronchoesophageal fistula (BEF) secondary to mediastinal lymph node tuberculosis. The clinical, auxiliary examinational and pathological data of 1 case with BEF were presented, and the literatures were reviewed. The patient was a 19 year old female, who was admitted to hospital because of fever and cough associated with liquid intake. It was diagnosed by chest CT scan, endobronchial ultrasound biopsy of mediastinal lymph nodes, and clinical testing (methylene blue). The BEF was closed after anti-tuberculosis therapy and preventing contamination of the fistula by indwelling stomach tube. Bronchoesophageal fistula secondary to mediastinal lymph node tuberculosis is rare. Chest CT scan, fiberoptic bronchoscopy, and clinical testing (methylene blue) are useful diagnostic tools for BEF.

  2. Malignant versus benign mediastinal lesions: quantitative assessment with diffusion weighted MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Guemuestas, Sevtap; Inan, Nagihan; Sarisoy, Hasan Tahsin; Anik, Yonca; Arslan, Arzu; Ciftci, Ercuement; Akansel, Guer; Demirci, Ali [University of Kocaeli, Department of Radiology, School of Medicine, Umuttepe Kocaeli (Turkey)

    2011-11-15

    We aimed to evaluate the performance of diffusion-weighted magnetic resonance imaging in differentiating malignant from benign mediastinal lesions. Fifty-three mediastinal lesions were examined with T1- and T2-weighted (W) conventional images. Then, two diffusion-weighted images were obtained with b = 0 and 1000 s/mm{sup 2} values and apparent diffusion coefficients (ADC) were calculated. The statistical significance of differences between measurements was tested using the Student-t test. The mean ADC of malignant lesions was significantly lower than that of the benign masses (p < 0.001). The cut-off value of {<=} 1.39 x 10{sup -3} mm{sup 2}/s indicated a malignant lesion with a sensitivity of 95% and specificity of 87%. Diffusion-weighted imaging may be helpful in differentiating benign from malignant mediastinal masses. (orig.)

  3. Post-operative Aspergillus mediastinitis in a man who was immunocompetent: a case report

    Directory of Open Access Journals (Sweden)

    Orfanos Stylianos

    2010-09-01

    Full Text Available Abstract Introduction Aspergillus spp. infections mainly affect patients who are immunocompromised, and are extremely rare in immunocompetent individuals. Case presentation Aspergillus post-operative mediastinitis is considered to be a devastating infection, usually affecting patients undergoing cardiothoracic surgery with specific predisposing factors. We describe the case of an immunocompetent 68-year-old Caucasian man with severe chronic thromboembolic pulmonary hypertension, who underwent pulmonary thromboendarterectomy and developed post-operative mediastinitis due to Aspergillus flavus. The environmental control did not reveal the source of A. flavus infection and, despite combined antifungal therapy, our patient died as a result of septic shock and multiple organ failure. Conclusion Aspergillus mediastinitis mainly affects patients after cardiosurgery operations with predisposing factors, and it is unusual in patients who are immunocompetent. The identification of the Aspergillus spp. source is often difficult, and there are no guidelines for the administration of pre-emptive therapy in this population of at-risk patients.

  4. The surprising outcome of a giant primary mediastinal synovial sarcoma treated with neoadjuvant chemotherapy.

    Science.gov (United States)

    Balieiro, Marcos Alexandre; Lopes, Agnaldo José; Costa, Bruno Pinheiro; Veras, Gustavo Perissé Moreira; Perelson, Paulo Sergio; Acatauassú Nunes, Rodolfo; Saito, Eduardo Haruo

    2013-02-01

    There are only a few cases of primary mediastinal synovial sarcoma in the literature. Normally, they do not respond well to chemotherapy. In our case, a 30-year-old patient was admitted due to thoracic pain, dyspnea, orthopnea, cough, hoarseness and weight loss over a 3-month period as well as a dramatic worsening a week before the admission. A chest radiography showed a completely white left hemithorax and contralateral mediastinal shift; in addition, a chest tomography revealed a giant heterogeneous mediastinal mass, lung atelectasia and a small pleural effusion. The patient was submitted to Chamberlain procedure (biopsy) under local anesthesia and the diagnosis of a synovial sarcoma was obtained after immunohistochemical analysis. Due to his poor general condition, he received chemotherapy first, with a dramatic response, after what, the mass that had been reduced was removed surgically. After a 5-year- follow-up period there are no signs of disease recurrence.

  5. Pulmonary Artery Occlusion and Mediastinal Fibrosis in a Patient on Dopamine Agonist Treatment for Hyperprolactinemia

    DEFF Research Database (Denmark)

    Su, Junjing; Simonsen, Ulf; Carlsen, Jørn

    2017-01-01

    Unusual forms of pulmonary hypertension include pulmonary hypertension related to mediastinal fibrosis and the use of serotonergic drugs. Here, we describe a patient with diffuse mediastinal fibrosis and pulmonary hypertension while she was on dopamine agonist therapy. A young woman, who...... showed fibrosis and chronic inflammation. Subsequent investigations revealed that diffuse mediastinal fibrosis with concurrent pulmonary hypertension, and not CTEPH, was the most likely diagnosis and cabergoline and bromocriptine may have triggered the fibrotic changes. Both drugs are ergot...... was treated with cabergoline and bromocriptine for hyperprolactinemia, presented with progressive dyspnea over several months. Based on the clinical investigation results, in particular, elevated pulmonary arterial pressures and significant perfusion defects on computed tomography (CT) pulmonary angiography...

  6. Ga-67 SPECT finding in tuberculous pericarditis with mediastinal mass: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Eun; Hyun, In Young; Lee, Hong Lyeol; Kim, Hyung Jin; Chon, Won Sick [Inha University Hospital, Inchon (Korea, Republic of)

    2001-08-01

    We present a case of a 31 year-old male patient with tuberculous pericarditis with mediastinal mass that showed increased uptake on Gallium-67 image. Gallium-67 scan was performed to evaluate the activity of the superior mediastinal mass, which was detected on chest CT. A rim of Intense activity around the heart was observed, but increased uptake was not seen in the mediastinum. However, on maximal contrast-enhanced SPECT images, a small focus of faint uptake was observed in the superior mediastinum. This finding implied that there was an active tuberculosis in the pericardium and inflammation in the superior mediastinal mass. This case demonstrated that Gallium-67 scinitigraphy was helpful for the diagnosis of tuberculous pericarditis.

  7. Parathyroid function following total thyroidectomy using energy devices.

    Science.gov (United States)

    Ciftci, Fatih; Sakalli, Erdal; Abdurrahman, Ibrahim; Guler, Burak

    2016-07-01

    LigaSure precise (LP) and harmonic scalpel (HS) are two energy-based devices used in thyroidectomy surgery. We aimed to compare the effect of these two devices in patients who had undergone total thyroidectomy, by highlighting the post-operative parathyroid function. A total of 201 consecutive patients for whom total thyroidectomy had been planned were prospectively classified into two groups. There were 104 patients in LP group and 97 patients in HS group. Hypoparathyroidism was followed up by serially measuring the levels of intact parathyroid hormone (iPTH) and serum calcium. The early iPTH level was 29 (8-50) pg/mL in group LP, and 17 (4-43) pg/mL in group HS. The early iPTH level was significantly lower in the HS group (p parathyroid hormone levels impaired in the HS group more than LP group in the early period, these levels were in the normal limits in both groups. These levels were not significant between groups in the long time period.

  8. Parathyroid Adenoma, Gastric Adenocarcinoma, and Intraabdominal Schwannoma in One Patient

    Directory of Open Access Journals (Sweden)

    Gülşah Elbüken

    2016-09-01

    Full Text Available Intraabdominal schwannomas, which occur quite rarely, are usually benign tumors. They are often discovered coincidentally when abdominal scans are performed for other reasons. We also coincidentally detected an intraabdominal schwannoma in addition to primary hyperparathyroidism related to a parathyroid adenoma and a gastric adenoma which caused partial pyloric obstruction in a 69-year-old female patient who was admitted to our emergency room with vomiting while we were further investigating hypercalcemia that was found during laboratory workup. It is rare to diagnose multiple tumors concurrently in a single patient which are components of certain neuroendocrine syndromes themselves. It is more interesting to see a rare tumor such as intraabdominal schwannoma coexisting with a parathyroid adenoma that can be a component of multiple endocrine neoplasia syndromes. In the literature, there are few case reports of the coexistence of intraabdominal schwannomas with adenocarcinoma of the gastrointestinal tract. Here, we present an unusual case of intraabdominal schwannoma coexisting with parathyroid adenoma and gastic adenocarcinoma, all diagnosed in a single patient. To our best knowledge, this is the first case report of such a rare coexistence which makes it rather interesting.

  9. Mediastinal teratomas in children. Case reports and review of the literature.

    Science.gov (United States)

    Paradies, Guglielmo; Zullino, Francesca; Orofino, Antonio; Leggio, Samuele

    2013-01-01

    In the pediatric age, mediastinal teratomas are an infrequent observation, accounting for only 7%-11% of extragonadal teratomas. Mainly located in the anterior mediastinum arising from the thymic gland, or exceptionally, from ectopic thyroid tissue, they may rarely be observed in the posterior mediastinum, sometimes in a paravertebral position, simulating a neuroblastoma. The Authors have extrapolated, from their entire experience of teratomas, 3 cases, mostly operated as emergencies; 1 of them was treated just after birth. Aim of this paper is to report the clinical and pathologic findings, to evaluate the surgical approach and the long-term biological behaviour in these cases, in the light of survival and current insights reported in the literature. The Authors reviewed the most significant clinical, laboratory, radiologic and pathologic findings, surgical procedures, and early and long-term results in 3 children, 2 males and 1 female, suffering from extragonadal teratomas, located in the mediastinum, treated immediately after birth. In 1 of them the lesion was prenatally diagnosed by US scanning between the 2nd and 3rd trimester of pregnancy. All the infants were born by scheduled caesarean section in a tertiary care hospital and were then immediately referred to the N.I.C.U. because of a mostly acute clinical presentation. The 3 patients were referred to the surgical unit at different ages, namely 2 days, 10 years and 12.5 years, respectively. The initial clinical presentation was consistent with the site of the mass and/or its side-effects. The first patient, a female newborn, presented a worsening condition of respiratory distress, immediately after birth, that required mechanical ventilation and stabilization of the vital signs. Likewise, the presentation of case No. 2 was acute with dyspnea associated with an upper airways infection. Instead, the initial symptoms in case No. 3 were subacute and non-specific, characterized by worsening pain at the right

  10. Parathyroid enlargement at dialysis initiation in patients with chronic kidney diseases.

    Science.gov (United States)

    Nakai, Kentaro; Fujii, Hideki; Kono, Keiji; Goto, Shunsuke; Miura, Shuhei; Maeda, Atsuhiro; Takeda, Kazuhito; Nishi, Shinichi

    2013-02-01

    The kidney chiefly maintains homeostasis of water, electrolytes, and other solutions. When kidney function is reduced, mineral metabolism is disrupted. Mineral and bone disorder in patients with chronic kidney disease associates with increased cardiovascular risk and mortality; however, management of chronic kidney disease-mineral and bone disorder in predialysis patients remains controversial. This study investigates the association between parathyroid enlargement at dialysis initiation and hyperparathyroidism management in dialysis patients. We enrolled 72 patients at dialysis initiation in this study. Using parathyroid sonography, we categorized patients based on presence (detected group; N = 18) or absence (undetected group; N = 54) of enlarged parathyroid glands and assessed the clinical characteristics and laboratory findings. A literature review of ultrasound evaluations of secondary hyperparathyroidism was conducted. Ultrasonography revealed enlarged parathyroid glands in 18 patients (25%). Serum intact parathyroid hormone levels were high in patients with enlarged parathyroid glands; however, of the 29 patients with intact parathyroid hormone levels parathyroid glands. Eight of the 29 patients with serum phosphorus and calcium levels within the optimal range had enlarged parathyroid glands. Twenty of these 29 patients were followed up at 38 ± 17 months (at least 3 months): enlarged parathyroid glands were detected in 6. During follow-up, serum intact parathyroid hormone levels were significantly higher in the detected group compared with the undetected. In conclusion, enlarged parathyroid glands are frequently detected at dialysis initiation, potentially predicting the persistence of secondary hyperparathyroidism and the need for strict management. © 2012 The Authors. Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis.

  11. Induction of Tolerance to Parental Parathyroid Grafts Using Allogeneic Thymus Tissue in DiGeorge Anomaly

    OpenAIRE

    Chinn, Ivan K.; Markert, M. Louise

    2011-01-01

    DiGeorge anomaly can affect both thymic and parathyroid function. Although athymia is corrected by allogeneic thymus transplantation, treatment options for hypoparathyroidism have been unsatisfactory. Parathyroid transplantation offers the potential for definitive cure but remains challenging due to graft rejection. Some allogeneic parathyroid grafts have functioned in adult recipients in the context of immunosuppression for renal transplants. Other efforts have attempted to reduce the alloge...

  12. Expression, function, and regulation of the embryonic transcription factor TBX1 in parathyroid tumors.

    Science.gov (United States)

    Verdelli, Chiara; Avagliano, Laura; Guarnieri, Vito; Cetani, Filomena; Ferrero, Stefano; Vicentini, Leonardo; Beretta, Edoardo; Scillitani, Alfredo; Creo, Pasquale; Bulfamante, Gaetano Pietro; Vaira, Valentina; Corbetta, Sabrina

    2017-12-01

    Transcription factors active in embryonic parathyroid cells can be maintained in adult parathyroids and be involved in tumorigenesis. TBX1, the candidate gene of 22q11.2-DiGeorge syndrome, which includes congenital hypoparathyroidism, is involved in parathyroid embryogenesis. The study aimed to investigate expression, function, and regulation of the parathyroid embryonic transcription factor TBX1 in human parathyroid adult normal and tumor tissues. TBX1 transcripts were detected in normal parathyroids and were deregulated in parathyroid tumors. Using immunohistochemistry, TBX1 protein was detected, mainly at the nuclear level, in a consistent proportion of cells in normal adult parathyroids, whereas TBX1 immunoreactivity was absent in fetal parathyroids. TBX1-expressing cells were markedly reduced in about a half of adenomas (PAds) and two-thirds of carcinomas and the proportion of TBX1-expressing cells negatively correlated with the serum albumin-corrected calcium levels in the analyzed tumors. Moreover, a subset of TBX1-expressing tumor cells coexpressed PTH. TBX1 silencing in HEK293 cells, expressing endogenous TBX1, increased the proportion of cells in the G0/G1 phase of cell cycle; concomitantly, CDKN1A/p21 and CDKN2A/p16 transcripts increased and ID1 mRNA levels decreased. TBX1 silencing exerted similar effects in PAd-derived cells, suggesting cell cycle arrest. Moreover, in PAd-derived cells GCM2 and PTH mRNA levels were unaffected by TBX1 deficiency, whereas it was associated with reduction of WNT5A, an antagonist of canonical WNT/β-catenin pathway. WNT/β-catenin activation by lithium chloride inhibited TBX1 expression levels both in HEK293 and PAd-derived cells. In conclusion, TBX1 is expressed in adult parathyroid cells and deregulated in parathyroid tumors, where TBX1 deficiency may potentially contribute to the low proliferative nature of parathyroid tumors.

  13. Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging.

    Science.gov (United States)

    McWade, Melanie A; Paras, Constantine; White, Lisa M; Phay, John E; Solórzano, Carmen C; Broome, James T; Mahadevan-Jansen, Anita

    2014-12-01

    The inability to accurately localize the parathyroid glands during parathyroidectomy and thyroidectomy procedures can prevent patients from achieving postoperative normocalcemia. There is a critical need for an improved intraoperative method for real-time parathyroid identification. The objective of the study was to test the accuracy of a real-time, label-free technique that uses near-infrared (NIR) autofluorescence imaging to localize the parathyroid. The study was conducted at the Vanderbilt University endocrine surgery center. Patients undergoing parathyroidectomy and/or thyroidectomy were included in this study. To validate the intrinsic fluorescence signal in parathyroid, point measurements from 110 patients were collected using NIR fluorescence spectroscopy. Fluorescence imaging was performed on 6 patients. Imaging contrast is based on a previously unreported intrinsic NIR fluorophore in the parathyroid gland. The accuracy of fluorescence imaging was analyzed in comparison with visual assessment and histological findings. The detection rate of parathyroid glands was measured. The parathyroid glands in 100% of patients measured with fluorescence imaging were successfully detected in real time. Fluorescence images consistently showed 2.4 to 8.5 times higher emission intensity from the parathyroid than surrounding tissue. Histological validation confirmed that the high intrinsic fluorescence signal in the parathyroid gland can be used to localize the parathyroid gland regardless of disease state. NIR fluorescence imaging represents a highly sensitive, real-time, label-free tool for parathyroid localization during surgery. The elegance and effectiveness of NIR autofluorescence imaging of the parathyroid gland makes it highly attractive for clinical application in endocrine surgery.

  14. Epigenetic Methylation of Parathyroid CaR and VDR Promoters in Experimental Secondary Hyperparathyroidism

    OpenAIRE

    Hofman-Bang, Jacob; Gravesen, Eva; Olgaard, Klaus; Lewin, Ewa

    2012-01-01

    Secondary hyperparathyroidism (s-HPT) in uremia is characterized by decreased expression in the parathyroids of calcium sensing (CaR) and vitamin D receptors (VDR). Parathyroid hormone (PTH) is normalized despite low levels of CaR and VDR after experimental reversal of uremia. The expression of CaR in parathyroid cultures decreases rapidly. Methylation of promoter regions is often detected during epigenetic downregulation of gene expression. Therefore, using an experimental rat model, we exam...

  15. Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients.

    Science.gov (United States)

    Sá, Michel Pompeu Barros de Oliveira; Soares, Evelyn Figueira; Santos, Cecília Andrade; Figueiredo, Omar Jacobina; Lima, Renato Oliveira Albuquerque; Escobar, Rodrigo Renda; Rueda, Fábio Gonçalves de; Ferraz, Paulo Ernando; Lima, Ricardo Carvalho

    2011-01-01

    Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons. To identify risk factors for mediastinitis in diabetics undergoing CABG surgery with use of unilateral ITA in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Retrospective study of 157 diabetics operated between May 2007 and April 2010. Nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were applied. The incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). Variables associated with increased risk of mediastinitis were: use of pedicled ITA (OR 8.25, 95% CI 2.03 to 66.10, P=0.016), postoperative renal complications (OR 5.10, 95% CI 1.03 to 25.62, P=0.049) and re-operation (OR 7.45, 95% CI 1.24 to 42.17, P=0.023). In multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ITA (OR 7.64, 95% CI 1.95 to 61.6, P=0.048), in comparison to skeletonized ITA. We suggest that diabetics should be considered for strategies to minimize risk of infection. In diabetics that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Diabetics should always be considered for use of skeletonized ITA.

  16. Immediate Debridement and Reconstruction with a Pectoralis Major Muscle Flap for Poststernotomy Mediastinitis

    Directory of Open Access Journals (Sweden)

    Yu Jin Jang

    2012-01-01

    Full Text Available BackgroundPoststernotomy mediastinitis is a rare, but life-threatening complication, thus early diagnosis and proper management is essential for poststernotomy mediastinitis. The main treatment for mediastinitis is aggressive debridement. Several options exist for reconstruction of defects after debridement. The efficacy of immediate debridement and reconstruction with a pectoralis major muscle flap designed for the defect immediately after the diagnosis of poststernotomy mediastinitis is demonstrated.MethodsBetween September 2009 and June 2011, 6 patients were referred to the Department of Plastic and Reconstructive Surgery and the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital for poststernotomy mediastinitis. All of the patients underwent extensive debridement and reconstruction with pectoralis major muscle flaps, advanced based on the pedicle of the thoracoacromial artery as soon as possible following diagnosis. A retrospective review of the 6 cases was performed to evaluate infection control, postoperative morbidity, and mortality.ResultsAll patients had complete wound closures and reduced severity of infections based on the erythrocyte sedimentation rate and C-reactive protein levels and a reduction in poststernal fluid collection on computed tomography an average of 6 days postoperatively. A lack of growth of organisms in the wound culture was demonstrated after 3 weeks. There were no major wound morbidities, such as hematomas, but one minor complication required a skin graft caused by skin flap necrosis. No patient expired after definitive surgery.ConclusionsImmediate debridement and reconstruction using a pectoralis major muscle flap is a safe technique for managing infections associated with poststernotomy mediastinitis, and is associated with minimal morbidity and mortality.

  17. Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

    DEFF Research Database (Denmark)

    Puri, R.; Vilmann, P.; Sud, R.

    2010-01-01

    Patients with suspected tuberculosis without pulmonary lesions and with mediastinal lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate mediastinal and abdominal lesions. The aim...... of the present study was to evaluate the role of EUS-FNA in isolated mediastinal lymphadenopathy in patients suspected of having tuberculosis....

  18. Normocalcemia and persistent elevated serum concentrations of 1-84 parathyroid hormone after operation for sporadic parathyroid adenoma

    DEFF Research Database (Denmark)

    Vestergaard, Henrik; ØStergaard Kristensen, Lars

    2002-01-01

    Elevated serum concentrations of 1-84 parathyroid hormone (PTH) after operation for sporadic parathyroid adenoma have been reported in previous studies, years after operation for primary hyperparathyroidism (pHPT). The cause and significance of this finding have not been elucidated. Primary...... hyperparathyroidism was diagnosed in 195 patients from January 1987 to December 1998. Operation for pHPT was performed in 124 patients. To evaluate long-term effects of elevated serum 1-84 PTH, biochemical variables and pre- and postoperative diseases were investigated from hospital case records. Of the 124 patients...... operated on, 103 had a solitary adenoma. Among these patients, 60 had normal serum concentrations of 1-84 PTH and calcium postoperatively, 38 patients had follow-up for more than 12 months (range 12-207 months-group A). Persistent elevated serum concentrations of 1-84 PTH and normocalcemia were found in 23...

  19. [Contribution of intraoperative scintigraphy to the detection of intrathyroidal parathyroid adenoma].

    Science.gov (United States)

    Díaz-Expósito, R; Casáns-Tormo, I; Cassinello-Fernández, N; Ortega-Serrano, J; Mut-Dólera, T

    2014-01-01

    The intrathyroidal parathyroid adenomas (IPA) represent a rare cause of primary hyperparathyroidism whose location difficults appropriate surgical removal. We present the case of a patient diagnosed of parathyroid adenoma by presurgical scintigraphy in which finally during the parathyroidectomy, the lesion location was intrathyroidal. We consider that the intrasurgical parathyroid scintigraphy with (99m)Tc-MIBI by portable gammacamera is useful in the parathyroid adenomas removal and essential in the case of IPA. Copyright © 2013 Elsevier España, S.L. y SEMNIM. All rights reserved.

  20. Cystic parathyroid adenoma: Primary hyperparathyroidism without99mTc-MIBI uptake.

    Science.gov (United States)

    Oliver Guillén, J R; de la Cueva Barrao, L; Miguelena Bobadilla, J M; Giménez Maurel, T; Hernando Almudí, E; Casamayor Franco, M C

    Cystic parathyroid adenoma is a rare disease (<0.01% of all cervical masses) that associates primary hyperparathyroidism in 9% of cases. Parathyroid scintigraphy is essential for its diagnosis with uncommon false negative results. Hybrid SPECT/CT equipments allow a more accurate diagnosis. Functional cystic parathyroid adenomas are surgically treated. A case of a 64-year-old woman with diagnoses of hyperparathyroidism and a cystic parathyroid adenoma without uptake in scintigraphy is described. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  1. Ultrasonography of histologically normal parathyroid glands and thyroid lobules in normocalcemic dogs.

    Science.gov (United States)

    Liles, Sofija R; Linder, Keith E; Cain, Brandon; Pease, Anthony P

    2010-01-01

    The purpose of this study is to characterize the sonographic appearance of canine parathyroid glands using high-resolution ultrasonography. Ten cadaver dogs were studied after euthanasia for reasons not relating to the parathyroid. The cervical region was examined using a 13-5 MHz linear transducer in right and left recumbency. Ultrasonographic features of the parathyroid and thyroid glands were compared with the gross and histopathologic findings. Thirty-five structures were identified sonographically as parathyroid glands but only 26 of 35 glands (74% positive predictive value) were proven to be normal parathyroid glands histopathologically. Of the nine false positives, five (14%) were proven to be lobular thyroid tissue. The remaining four (11%) structures were visible grossly or found histopathologically. There were no statistical differences between ultrasonographic and gross measurements of the parathyroid glands. The average size as seen sonographically was 3.3 x 2.2 x 1.7 mm and the average gross size was 3.7 x 2.6 x 1.6 mm (length, width, height). The average size of the thyroid lobules assessed sonographically was 2.3 x1.6 x 0.8 mm (length, width, height). Normal parathyroid glands can be identified using high-resolution ultrasonography. But some thyroid lobules will be misinterpreted as parathyroid glands; this will result in false positives when identifying parathyroid glands with ultrasonography.

  2. Hybrid-fusion SPECT/CT systems in parathyroid adenoma: Technological improvements and added clinical diagnostic value.

    Science.gov (United States)

    Wong, K K; Chondrogiannis, S; Bowles, H; Fuster, D; Sánchez, N; Rampin, L; Rubello, D

    Nuclear medicine traditionally employs planar and single photon emission computed tomography (SPECT) imaging techniques to depict the biodistribution of radiotracers for the diagnostic investigation of a range of disorders of endocrine gland function. The usefulness of combining functional information with anatomy derived from computed tomography (CT), magnetic resonance imaging (MRI), and high resolution ultrasound (US), has long been appreciated, either using visual side-by-side correlation, or software-based co-registration. The emergence of hybrid SPECT/CT camera technology now allows the simultaneous acquisition of combined multi-modality imaging, with seamless fusion of 3D volume datasets. Thus, it is not surprising that there is growing literature describing the many advantages that contemporary SPECT/CT technology brings to radionuclide investigation of endocrine disorders, showing potential advantages for the pre-operative locating of the parathyroid adenoma using a minimally invasive surgical approach, especially in the presence of ectopic glands and in multiglandular disease. In conclusion, hybrid SPECT/CT imaging has become an essential tool to ensure the most accurate diagnostic in the management of patients with hyperparathyroidism. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  3. Iatrogenic perforation of hypopharynx as a cause of severe descending necrotizing mediastinitis: A case report.

    Science.gov (United States)

    Smolar, Marek; Dzian, Anton; Hamzik, Julian; Saniova, Beata; Laca, Ludovit

    2017-10-01

    The authors present a case report of severe descending necrotizing mediastinitis (DNM) etiologically of unrecognized traumatic endotracheal intubation with hypopharynx-esophageal junction perforation. Patient was treated inadequately for seven days in local hospital what was the cause of sepsis progression into the septic shock with multiorgan dysfunction syndrome. Patient was transferred to specialized hospital and was immediately operated in general anaesthesia - combined transcervical approach and lateral thoracotomy was used for mediastinal drainage and debridement. Combination of appropriate conventional and surgical therapy led to reversing of the unfavorable situation.

  4. Descending Necrotising Mediastinitis: A Case Report Illustrating a Trend in Conservative Management

    Directory of Open Access Journals (Sweden)

    B. A. P. Jayasekera

    2012-01-01

    Full Text Available The mortality rate from descending necrotising mediastinitis (DNM has declined since its first description in 1938. The decline in mortality has been attributed to earlier diagnosis by way of contrast-enhanced computed tomographic (CT scanning and aggressive surgical intervention in the form of transthoracic drainage. We describe a case of DNM with involvement of anterior and posterior mediastinum down to the diaphragm, managed by cervicotomy and transverse cervical drainage with placement of corrugated drains and a pleural chest drain, with a delayed mediastinoscopy and mediastinal drain placement. We advocate a conservative approach with limited debridement and emphasis on drainage of infection in line with published case series.

  5. MDCT assessment of tracheomalacia in symptomatic infants with mediastinal aortic vascular anomalies: preliminary technical experience

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Edward Y. [Children' s Hospital Boston and Harvard Medical School, Departments of Radiology and Medicine, Pulmonary Division, Boston, MA (United States); Mason, Keira P. [Children' s Hospital Boston and Harvard Medical School, Department of Anesthesiology, Boston, MA (United States); Zurakowski, David [Children' s Hospital Boston and Harvard Medical School, Department of Orthopedic Surgery, Boston, MA (United States); Waltz, David A. [Children' s Hospital Boston and Harvard Medical School, Department of Medicine, Division of Respiratory Diseases, Boston, MA (United States); Ralph, Amy; Riaz, Farhana [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Boiselle, Phillip M. [Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (United States)

    2008-01-15

    Mediastinal aortic vascular anomalies are relatively common causes of extrinsic central airway narrowing in infants with respiratory symptoms. Surgical correction of mediastinal aortic vascular anomalies alone might not adequately treat airway symptoms if extrinsic narrowing is accompanied by intrinsic tracheomalacia (TM), a condition that escapes detection on routine end-inspiratory imaging. Paired inspiratory-expiratory multidetector CT (MDCT) has the potential to facilitate early diagnosis and timely management of TM in symptomatic infants with mediastinal aortic vascular anomalies. To assess the technical feasibility of paired inspiratory-expiratory MDCT for evaluating TM among symptomatic infants with mediastinal aortic vascular anomalies. The study group consisted of five consecutive symptomatic infants (four male, one female; mean age 4.1 months, age range 2 weeks to 6 months) with mediastinal aortic vascular anomalies who were referred for paired inspiratory-expiratory MDCT during a 22-month period. CT angiography was concurrently performed during the end-inspiration phase of the study. Two pediatric radiologists in consensus reviewed all CT images in a randomized and blinded fashion. The end-inspiration and end-expiration CT images were reviewed for the presence and severity of tracheal narrowing. TM was defined as {>=}50% reduction in tracheal cross-sectional luminal area between end-inspiration and end-expiration. The presence of TM was compared to the bronchoscopy results when available (n = 4). Paired inspiratory-expiratory MDCT was technically successful in all five patients. Mediastinal aortic vascular anomalies included a right aortic arch with an aberrant left subclavian artery (n = 2), innominate artery compression (n = 2), and a left aortic arch with an aberrant right subclavian artery (n = 1). Three (60%) of the five patients demonstrated focal TM at the level of mediastinal aortic vascular anomalies. The CT results were concordant with the

  6. A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

    Directory of Open Access Journals (Sweden)

    Birkholz Torsten

    2010-01-01

    Full Text Available A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal-mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal-mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

  7. Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy.

    Science.gov (United States)

    Promberger, Regina; Ott, Johannes; Kober, Friedrich; Mikola, Barbara; Karik, Michael; Freissmuth, Michael; Hermann, Michael

    2010-12-01

    Thyroidectomy continues to pose the risk of typical complications, including postoperative hypocalcemia and permanent hypoparathyroidism. The strategic decision on how to preserve parathyroid hormone (PTH) secretion relies on assessing the viability of the parathyroid glands (PGs). The aim of this study was to assess parathyroid discoloration as an indicator for loss of parathyroid function. The prospective study included 29 patients (24 women, 5 men; age 53.2 ± 13.0 years) who underwent near-total or total thyroidectomy. An intra- and postoperative PTH and calcium monitoring was performed. The intraoperative situs of the PGs was documented by a study protocol. The patients were grouped in three categories: group A, 12 patients with four visualized and normally colored PGs; group B, 13 patients with four visualized and three or four discolored PGs; group C, 4 patients who had undergone autotransplantation of two PGs. Compared to group A, groups B and C showed sharper intraoperative PTH declines. PTH values recovered more quickly in group B than in group C. However, no significant differences in PTH kinetics were found in the general linear model for repeated measures (p = 0.132). However, a significantly higher incidence of protracted hypocalcemia-related symptoms for more than 14 postoperative days was found for group C (50.0%) than for groups A (0%) and B (0%; p = 0.011). None of the patients developed permanent hypoparathyroidism. The function of discolored PGs is only transiently impaired and recovers within a short time after surgery. Our observations do not support autotransplantation as a generally applicable first-line intervention for discolored PGs in the absence of other criteria for autotransplantation.

  8. Two Cases of Primary Ectopic Ovarian Pregnancy

    Directory of Open Access Journals (Sweden)

    Sonia Gon

    2011-04-01

    Full Text Available Primary ovarian pregnancy is one of the rarest varieties of ectopic pregnancies. Patients frequently present with abdominal pain and menstrual irregularities. Intrauterine devices have evolved as probable risk factors. Preoperative diagnosis is challenging but transvaginal sonography has often been helpful. A diagnostic delay may lead to rupture, secondary implantation or operative difficulties. Therefore, awareness of this rare condition is important in reducing the associated risks. Here, we report two cases of primary ovarian pregnancies presenting with acute abdominal pain. Transabdominal ultrasonography failed to hint at ovarian pregnancy in one, while transvaginal sonography aided in the correct diagnosis of the other. Both cases were confirmed by histopathological examinations and were successfully managed by surgery.

  9. Uterine artery embolization for cervical ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Qiao Zhou, MD

    2015-12-01

    Full Text Available A 36-year-old woman with 3 prior C-sections is diagnosed with a caesarean scar ectopic pregnancy. Despite receiving intramuscular and transvaginal methotrexate injection 2 months before presentation, the beta human chorionic gonadotropin was recorded to be 73 mIU/mL at the time of encounter. The patient complained of vaginal bleeding with a significant drop in hematocrit from 40% to 33%. Transvaginal ultrasound confirmed retroplacental hemorrhage and because of the patient's desire to retain fertility, interventional radiology was consulted to perform an uterine artery embolization. The uterine artery embolization was successful in achieving hemostasis and resulted in a decrease of betaHCG to 46 on postprocedure day 1 to <1 mIU/mL by postoperative week 3.

  10. Conservative Management for Lingual Thyroid Ectopic

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    Eder Alberto Sigua-Rodriguez

    2015-01-01

    Full Text Available Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc99m and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years.

  11. Medical management of an ovarian ectopic pregnancy: a case report.

    Science.gov (United States)

    Birge, Ozer; Erkan, Mustafa Melih; Ozbey, Ertugrul Gazi; Arslan, Deniz

    2015-12-20

    Primary ovarian ectopic pregnancy is a rare type of ectopic pregnancy which has an estimated prevalence ranging from 1:7000 to 1:70,000 accounting for almost 3 % of all ectopic cases. Here we report the case of a 25-year-old woman who presented to our clinic with abdominal pain, 6 weeks' delay of menstruation and 3 days of vaginal bleeding, whose transvaginal ultrasonography showed an ectopic gestational sac with yolk sac inside, in her right ovary. This case shows that early diagnosis is very important particularly in places like the Sub-Saharan region of Africa. A 25-year-old African woman was referred to our clinic with 6 weeks' delay of menstruation, frequent increasing abdominal pain and 3 days of vaginal bleeding. Her general condition was good and her vital signs were normal. She felt tenderness in an abdominal examination and had a small amount of vaginal bleeding. Transvaginal ultrasonography showed an ectopic gestational sac with yolk sac inside, in her right ovary. Our final diagnosis was ectopic ovarian pregnancy and we successfully treated her with methotrexate. After 3 weeks of methotrexate administration her beta human chorionic gonadotropin was negative and a sonographic examination was completely normal. Ectopic ovarian pregnancy is a very important medical situation. It should be diagnosed in its early stages otherwise it could be life-threatening and surgical treatment may be inevitable. Because of the importance of fertility, medical treatment is an acceptable option and can be feasible with early diagnosis.

  12. Cesarean Delivery and Risk for Subsequent Ectopic Pregnancy.

    Science.gov (United States)

    Bowman, Zachary S; Smith, Ken R; Silver, Robert M

    2015-07-01

    This study aims to examine the risk for subsequent ectopic pregnancy in women with prior cesarean delivery. Women with a history of at least one cesarean delivery in the state of Utah during 1996 to 2011 were identified and compared with women with vaginal delivery only. The primary outcome was subsequent ectopic pregnancy. Data were analyzed by multivariate logistic regression and stratified by first, second, or third live births. Model covariates included maternal age, ethnicity, marital status, education level, gravidity, and prior ectopic pregnancy. Overall, 260,249 women with at least one live birth were identified. After exclusions, 255,082, 154,930, and 70,228 women had at least one, two, and three prior live births that lead to 531, 199, and 62 subsequent ectopic pregnancies, respectively. Women who had one prior cesarean delivery were not at increased risk for subsequent ectopic pregnancy in relation to women with no prior cesarean delivery. However, women with two of two, two of three, or three of three prior cesareans had increased risk for subsequent ectopic pregnancy with odds ratios (95% confidence interval) of 1.54 (1.06-2.22), 3.50 (1.49-8.24), and 1.99 (1.00-3.98), respectively. History of two or three cesarean deliveries is associated with increased risk for subsequent ectopic pregnancy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. Risk Factors For Ectopic Pregnancy : A Case Control Study

    Directory of Open Access Journals (Sweden)

    Deshmukh J.S

    1999-01-01

    Full Text Available Research question: Which are the risk factors for ectopic pregnancy . Objective: To study the strength of association between hypothesised risk factors and ectopic pregnancy. Study design: Unmatched case- control study. Setting: Government Medical College, Hospital, Nagpur. Participants: 133 cases of ectopic pregnancy and equal number of controls (non pregnant women admitted to study hospital. Study variables : Pelvic inflammatory diseases, sexually transmitted diseases, IUD use at conception , past use of IUD, prior ectopic pregnancy, OC pills use at the time of conception, past use of OC pills, induced abortion, spontaneous abortion, infertility and pelvic and abdominal surgery. Statistical analysis: Odds ratios & their 95% CI, Pearson’s chi square test, unconditional logistic regression analysis and population attributable risk proportion. Results : Use of IUD at conception, prior ectopic pregnancy , pelvic inflammatory disease, sexually transmitted diseases, infertility, OC pills use at the time of conception, past use of IUD and induced abortion were found to be significantly associated with ectopic pregnancy. Conclusion: Identification of these risk factors for etopic pregnancy shall help in early detection and appropriate management in an individual case and it may help in devising a comprehensive preventive strategy for ectopic pregnancy

  14. The role of leukemia inhibitory factor in tubal ectopic pregnancy.

    Science.gov (United States)

    Krishnan, T; Winship, A; Sonderegger, S; Menkhorst, E; Horne, A W; Brown, J; Zhang, J-G; Nicola, N A; Tong, S; Dimitriadis, E

    2013-11-01

    Ectopic pregnancy is unique to humans and a leading cause of maternal morbidity and mortality. The etiology remains unknown however factors regulating embryo implantation likely contribute. Leukemia inhibitory factor (LIF) has roles in extravillous trophoblast adhesion and invasion and is present in ectopic implantation sites. We hypothesised that LIF facilitates blastocyst adhesion/invasion in the Fallopian tube, contributing to ectopic pregnancy. We immunolocalised LIF receptor (R) in tubal ectopic pregnancy (N = 5). We used an oviduct cell line (OE-E6/E7) to model Fallopian tube epithelial cells and a trophoblast spheroid co-culture model (HTR-8/SVneo cell line formed spheroids) to model blastocyst attachment to the Fallopian tube. We examined LIF signaling pathways in OE-E6/E7 cells by Western blot. The effect of LIF and LIF inhibition (using a novel LIF inhibitor, PEGLA) on first-trimester placental outgrowth was determined. LIFR localised to villous and extravillous trophoblast and Fallopian tube epithelium in ectopic pregnancy. LIF activated STAT3 but not the ERK pathway in OE-E6/E7 cells. LIF stimulated HTR-8/SVneo spheroid adhesion to OE-E6/E7 cells which was significantly reduced after PEGLA treatment. LIF promoted placental explants outgrowth, while co-treatment with PEGLA blocked outgrowth. Our data suggests LIF facilitates the development of ectopic pregnancy by stimulating blastocyst adhesion and trophoblast outgrowth from placental explants. Ectopic pregnancy is usually diagnosed after 6 weeks of pregnancy, therefore PEGLA may be useful in targeting trophoblast growth/invasion. LIF may contribute to the development of ectopic pregnancies and that pharmacologically targeting LIF-mediated trophoblast outgrowth may be useful as a treatment for ectopic pregnancy. Copyright © 2013. Published by Elsevier Ltd.

  15. Technique for the Laparoscopic Management of a Cornual Ectopic Pregnancy.

    Science.gov (United States)

    Mahmoud, Mohamad S

    2016-01-01

    To describe a technique for the laparoscopic management of a cornual ectopic pregnancy. Step-by-step explanation of the procedure using video (Canadian Task Force classification III). Cornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies, with a mortality range of 2.0% to 2.5%, and this accounts for 20% of all deaths caused by ectopic pregnancies. Both medical and surgical treatments have been reported. Although laparotomy hysterectomy and cornuectomy used to be the preferred surgical approaches, more cornual ectopic pregnancies are being managed with the laparoscopic approach through cornuostomy or cornuectomy in recent years. The main concern with surgical treatment is hemorrhage and the need for cornual reconstruction, which necessitate advanced laparoscopic skills and technique. In this video, we describe our technique for the treatment of a cornual ectopic pregnancy. We present the case of a 21-year-old G3P2002 (gravida 3 para 2002) with the finding of a right live cornual ectopic pregnancy with gestational age of 6 weeks on pelvic ultrasound along with an elevated human chorionic gonadotropin level at 7,192 and right pelvic pain. After counseling regarding treatment options, the patient agreed with proceeding with surgery and underwent a laparoscopic right cornuectomy. Her surgery was uneventful, and she was discharged home a few hours after surgery. She was completely recovered at her postoperative follow-up visit. Her serial serum human chorionic gonadotropin levels were followed until complete resolution a few weeks later. Laparoscopic cornuectomy is a safe and effective procedure for the management of cornual ectopic pregnancy. The use of hemostatic agents and suturing can help prevent hemorrhage and allows a safe removal of the ectopic pregnancy and repair of the uterine defect created. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  16. Current Nomenclature of Pseudohypoparathyroidism: Inactivating Parathyroid Hormone/Parathyroid Hormone-Related Protein Signaling Disorder.

    Science.gov (United States)

    Turan, Serap

    2017-12-30

    Disorders related to parathyroid hormone (PTH) resistance and PTH signaling pathway impairment are historically classified under the term of pseudohypoparathyroidism (PHP). The disease was first described and named by Fuller Albright and colleagues in 1942. Albright hereditary osteodystrophy (AHO) is described as an associated clinical entity with PHP, characterized by brachydactyly, subcutaneous ossifications, round face, short stature and a stocky build. The classification of PHP is further divided into PHP-Ia, pseudo-PHP (pPHP), PHP-Ib, PHP-Ic and PHP-II according to the presence or absence of AHO, together with an in vivo response to exogenous PTH and the measurement of Gsα protein activity in peripheral erythrocyte membranes in vitro. However, PHP classification fails to differentiate all patients with different clinical and molecular findings for PHP subtypes and classification become more complicated with more recent molecular characterization and new forms having been identified. So far, new classifications have been established by the EuroPHP network to cover all disorders of the PTH receptor and its signaling pathway. Inactivating PTH/PTH-related protein signaling disorder (iPPSD) is the new name proposed for a group of these disorders and which can be further divided into subtypes - iPPSD1 to iPPSD6. These are termed, starting from PTH receptor inactivation mutation (Eiken and Blomstrand dysplasia) as iPPSD1, inactivating Gsα mutations (PHP-Ia, PHP-Ic and pPHP) as iPPSD2, loss of methylation of GNAS DMRs (PHP-Ib) as iPPSD3, PRKAR1A mutations (acrodysostosis type 1) as iPPSD4, PDE4D mutations (acrodysostosis type 2) as iPPSD5 and PDE3A mutations (autosomal dominant hypertension with brachydactyly) as iPPSD6. iPPSDx is reserved for unknown molecular defects and iPPSDn+1 for new molecular defects which are yet to be described. With these new classifications, the aim is to clarify the borders of each different subtype of disease and make the classification

  17. Use of radioguided surgery with [111In]-pentetreotide in the management of an ACTH-secreting bronchial carcinoid causing ectopic Cushing's syndrome.

    Science.gov (United States)

    Grossrubatscher, E; Vignati, F; Dalino, P; Possa, M; Belloni, P A; Vanzulli, A; Bramerio, M; Marocchi, A; Rossetti, O; Zurleni, F; Loli, P

    2005-01-01

    Intraoperative [111In]-pentetreotide scintigraphy with a hand-held gamma detector probe has recently been proposed to increase the intraoperative detection rate of small neuroendocrine tumors and their metastases. We report a case of a 28-yr-old woman with ectopic Cushing's syndrome due to an ACTH-secreting bronchial carcinoid, in whom the use of radioguided surgery improved disease management. At presentation, radiolabeled pentetreotide scintigraphy was the only procedure able to detect the ectopic source of ACTH. After radiologic confirmation, the patient underwent removal of a bronchial carcinoid, with disease persistence. After surgery, pentetreotide scintigraphy showed pathologic uptake in the mediastinum not previously detected at surgery and only subsequently confirmed by radiologic studies. Despite a second thoracic exploration, hormonal, scintigraphic, and radiological evidence of residual disease persisted. Radioguided surgery was then performed using a hand-held gamma probe 48 h after iv administration of a tracer dose of radiolabeled [111In-DTPA-D-Phe1]-pentetreotide, which permitted detection and removal of multiple residual mediastinal lymph node metastases. Clinical and radiologic cure, with no evidence of tracer uptake at pentetreotide scintigraphy, was subsequently observed. The use of an intraoperative gamma counter appears a promising procedure in the management of metastatic ACTH-secreting bronchial carcinoids.

  18. Molar tubal ectopic pregnancy: Report of two cases.

    Science.gov (United States)

    Mbarki, Chaouki; Jerbi, Emna; Hsayaoui, Najeh; Zouari, Fatma; Ben Brahim, Ehsen; Oueslati, Hedhili

    2015-06-01

    Ectopic molar pregnancy is a rare occurrence and consequently not often considered as a diagnostic possibility. We report two cases of molar hydatidiform tubal pregnancy. Diagnosis of ectopic pregnancy was confirmed on clinical biological and sonographic investigations. Diagnosis of molar pregnancy was done on histopathology. The clinical course was favorable for both patients. Although rare, molar changes can occur at any site of an ectopic pregnancy. Clinical diagnosis of a molar pregnancy is difficult but histopathology is the gold standard for diagnosis. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  19. Four cases of lowered urethral pressure in canine ectopic ureter.

    Science.gov (United States)

    Koie, H; Yamaya, Y; Sakai, T

    2000-11-01

    To evaluate the function of the constrictor urethrae of dogs that had urinary incontinence and were diagnosed as having ectopic ureter, the urethral pressure profile (UPP) was measured by means of a microchip catheter transducer. The UPPs (14.5 +/- 3.3 mmHg) of the four dogs suffering from ectopic ureter were much lower (pdogs (35.3 +/- 5.7 mmHg). In the cases of ectopic ureter, it was shown that the UPP was lowered, and it was suggested that this would lead to the expression of urinary incontinence.

  20. Ectopic Neurohypophysis in Patient with Pituitary Dwarfism: A Case Report

    Directory of Open Access Journals (Sweden)

    İlhan Kılınç

    2008-09-01

    Full Text Available Ectopic neurohypophysis is an anomaly of the Pituitary gland whichmay be associated with short stature due to Growth hormone deficiency.MRI is the modality of choice in diagnosing this condition. We present acase of pituitary dwarfism and ectopic neurohypophysis with clinical andradiological findings. 21 year-old male admitted with short stature. Allhormones, except prolactin, of anterior hypophysis were low. Bright spotwas ectopically located at level of median eminence on enhanced MRI ofhypophysis and stalk of hypophysis was not observed. Ectopicneurohypophysis may be present with pituitary dwarfism. Cranial MRI maybe useful to investigate related pathologies in such cases.

  1. Retroperitoneal Laparoscopic Pyelolithotomy in an Ectopic Pelvic Kidney

    Science.gov (United States)

    Cirakoglu, Abdullah; Ozer, Serafettin

    2012-01-01

    Background and Objectives: Retroperitoneal laparoscopic pyelolithotomy was performed in an ectopic pelvic kidney with renal pelvis calculi. Methods and Results: Laparoscopic pyelolithotomy was successfully performed in an ectopic pelvic kidney by using the retroperitoneal route. The total operation time was 130 minutes, and the estimated blood loss was 50mL. The patient was discharged on the second postoperative day without any complications. Conclusion: Laparoscopic pyelolithotomy is an effective treatment option for management of stones in the pelvis of an ectopic pelvic kidney. The retroperitoneal route may help to avoid intraoperative and postoperative complications. PMID:23477189

  2. Ectopic thyroid mass in the right ventricle: A case report.

    Science.gov (United States)

    Tan, Yuying; Yu, Wei; Wang, Xiaocong; Gao, Yongsheng; Xu, Hui

    2017-07-01

    Ectopic thyroid is a rare congenital embryonic anomaly. Ectopic thyroid tissue can be located anywhere during its descent, but it is found primarily at the base of the tongue and in the mediastinum. It is very rarely found in the heart. Here, we report a rare case of cardiac ectopic thyroid tissue in a 53-year-old woman who presented with chest pain. Echocardiography revealed an intracardiac mass that was removed successfully. Histopathology confirmed that the mass was thyroid tissue without malignancy. © 2017, Wiley Periodicals, Inc.

  3. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... intrauterine pregnancy rate was significantly higher after tubotomy (88%) than after salpingectomy (66%) (log rank P treatments (16% vs 17%). In patients with contralateral tubal...... pathology, the chance of pregnancy was poor (hazard ratio 0.463) and the risk of recurrence was high (hazard ratio 2.25), assessed with Cox regression. The rate of persistent ectopic pregnancy was 8%. CONCLUSION: Conservative surgery is superior to radical surgery at preserving fertility. Conservative...

  4. A mathematical/physiological model of parathyroid hormone secretion in response to blood-ionized calcium lowering in vivo

    DEFF Research Database (Denmark)

    Momsen, G; Schwarz, P

    1997-01-01

    increased, probably due to the larger amount of parathyroid tissue in these patients. These observations reveal a striking functional similarity between abnormal and normal parathyroid tissue. Furthermore, an apparently linear relationship between the rate of parathyroid hormone elimination from the blood......The aim of the present study was to test a mathematical model of the biochemical processes in the parathyroid glands responsible for the secretion of parathyroid hormone resulting from extracellular calcium reduction. A double exponential curve described the parathyroid hormone secretion induced...... by rapid lowering of blood-ionized calcium in humans with normal as well as abnormal parathyroid tissue. Our data show that it was possible to establish a simple mathematical model of the parathyroid hormone response to blood-ionized calcium lowering, sufficient to fit experimental data obtained from...

  5. Calcification of all four parathyroid glands in a hemodialysis patient with secondary hyperparathyroidism revealed by computerized tomography.

    Science.gov (United States)

    Peces, R; Rodríguez, M; González, F; Ablanedo, P

    2001-09-01

    This report describes the parathyroid scan, computerized tomography and histologic findings in a young female hemodialysis patient with severe secondary hyperparathyroidism. These findings included hyperplasia and calcification of all four parathyroid glands.

  6. Giant mediastinal schwannoma located in the lower right side of the ...

    African Journals Online (AJOL)

    ... and was compressing the right lower lobe of the lung. Subsequently, the tumor was completely resected using a right posterior lateral thoracotomy approach. The patient had an uneventful postoperative course and had done well since discharge from the hospital. Keywords: Intraoperative hemostasis, mediastinal tumor, ...

  7. Surgical outcome of colon interposition by the posterior mediastinal route for thoracic esophageal cancer.

    Science.gov (United States)

    Motoyama, Satoru; Kitamura, Michihiko; Saito, Reijiro; Maruyama, Kiyotomi; Sato, Yusuke; Hayashi, Kaori; Saito, Hajime; Minamiya, Yoshihiro; Ogawa, Jun-ichi

    2007-04-01

    For thoracic esophageal cancer patients with a history of gastrectomy, esophageal reconstruction using segments of colon was often accomplished using the anterior mediastinal route to avoid fatal complications related to colon necrosis. Our aim was to review our experience with reconstruction by the posterior mediastinal route and assess the surgical outcomes. Between 1989 and August 2006, 34 esophageal cancer patients at Akita University Hospital underwent esophageal reconstruction accomplished by colon interposition by the posterior mediastinal route. Data from these patients were reviewed. Colon conduits consisted of left colon segments in 4 patients and right colon segments in 30. The grafts were supplied with blood by the left colonic artery in 13 patients, the middle colonic artery in 20, and the right colonic artery in 1. The esophagocolic (pharyngocolic) anastomosis was located in the neck in 33 patients (97%) and in the thorax in 1. No patient died during the initial hospital stay. There were no instances of colon necrosis. An anastomotic fistula occurred in 3 patients (9%). Proximal anastomotic strictures occurred in 2 patients (6%). No late graft redundancies resulting in significant dysphagia occurred. Reductions in body weight did not differ from those seen when the gastric tube was used for reconstruction, and alimentary function was good after surgery. The 1-, 2-, 3-, and 5-year survival rates were 66%, 52%, 48%, and 48%, respectively. Colon interposition by the posterior mediastinal route provides a good outcome and is considered the route of first choice.

  8. Postoperative mediastinitis in cardiovascular surgery postoperation. Analysis of 1038 consecutive surgeries.

    Science.gov (United States)

    Sá, Michel Pompeu Barros de Oliveira; Silva, Débora Oliveira; Lima, Erika Nibbering de Souza; Lima, Ricardo de Carvalho; Silva, Frederico Pires Vasconcelos; Rueda, Fábio Gonçalves de; Escobar, Rodrigo Renda de; Cavalcanti, Paulo Ernando Ferraz

    2010-01-01

    To report the incidence of mediastinitis in cardiovascular surgery postoperation. The records of all 1038 patients who underwent cardiovascular surgical procedures between May/2007 and June/2009 were reviewed. All operations were performed in Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. The complication occurred within, on average, 13 days after operation, in total of 25 (2.4%), eight (32%) deaths occurred. Several risk factors mediastinitis were identified: 56% diabetes, 56% smokers, 20% obeses, 16% with chronic obstructive pulmonary disease and 8% of chronic renal failure. Mediastinitis were reported in 21 (84%) cases of patients submitted to coronary artery bypass grafting, being associated to major risk of infection development (IC 3.448.30, P=0.0001). High rates of complications were observed: respiratory insufficiency (44%), stroke (16%), cardiogenic shock (12%), acute renal failure (28%), pulmonary infection (36%), multiple organs failure (16%) and esternal deiscence (48%). Bacterial cultures of exudates were positive in 84% of patients; Staphylococcus aureus was the most responsible pathogen (28.8%). Mediastinitis stays a serious surgical complication and difficult management in cardiovascular surgery postoperation. The disease stays with low incidence, but still with high lethality. Coronary bypass was associated to major risk of infection development.

  9. Mediastinal teratoma with hydrops fetalis in a newborn and development of chronic respiratory insufficiency.

    Science.gov (United States)

    Simoncic, Milanka; Kopriva, Silvo; Zupancic, Ziva; Jerse, Maja; Babnik, Janez; Srpcic, Matevz; Grosek, Stefan

    2014-12-01

    Mediastinal fetal teratoma can be detected as a mass in the chest during a routine prenatal ultra-sound screening. Because of the pressure on mediastinal structures it can be the cause of non-immune hydrops fetalis and polyhydramnion. The development of hydrops fetalis leads to fetal death or premature delivery in most reported cases. Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period. A 31-year-old gravida carrying twins, with spontaneous membrane rupture at 32 weeks gestation underwent urgent caesarean section after antenatal ultrasound revealed severe polyhydramnion and hydrops fetalis in geminus A. The child was intubated immediately after birth due to severe respiratory distress. Ultrasound and X-ray revealed a tumour mass in the right hemithorax. Tumour resection was performed at the age of 7 days. Histology examination revealed an encapsulated immature teratoma. The postoperative course was complicated with respiratory insufficiency which turned into chronic at the age of eight months. This is the fifth reported child with fetal mediastinal teratoma and severe hydrops fetalis that survived the neonatal period. Additional diagnostic search revealed abnormal course of both pulmonary arteries, which was probably one of the main causes of respiratory insufficiency.

  10. Concomitant mediastinal and extrarenal retroperitoneal angiomyolipomas in a patient who previously underwent ipsilateral radical nephrectomy

    Directory of Open Access Journals (Sweden)

    Carl Sheng-Chen Wen

    2014-12-01

    Full Text Available The association of the tuberous sclerosis complex with angiomyolipoma (AML arising from the retroperitoneum and mediastinum has not been reported in the literature. We present the first case in which a patient presented with a combined retroperitoneal extrarenal and posterior mediastinal AML. Interestingly, the ipsilateral retroperitoneal AML emerged 15 years after radical nephrectomy for the left renal AML.

  11. Reconstruction after esophagectomy for esophageal cancer: Retrosternal or posterior mediastinal route?

    Directory of Open Access Journals (Sweden)

    Mei-Lin Chan

    2011-11-01

    Conclusion: For patients with esophageal cancer who undergo an esophagectomy followed by gastric conduit reconstruction, the posterior mediastinal route is superior to the retrosternal route in regard to anastomotic leakage and hospital mortality. Adjuvant radiotherapy did not influence the postoperative functions of the gastric conduit used for reconstruction in either route.

  12. Normal mediastinal and hilar lymph nodes in children on multi-detector row chest computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Jong, Pim A. de; Nievelstein, Rutger-Jan A. [University Medical Center Utrecht and Wilhelmina Children' s Hospital, Department of Radiology, Utrecht (Netherlands)

    2012-02-15

    To study normal mediastinal and hilar lymph nodes on multi-detector chest computed tomography (CT). A cohort of 120 children aged 1-17 years underwent emergency CT, including the chest, after high-energy trauma. Axial 5-mm reconstructions were evaluated for lymph nodes at hilar and various mediastinal levels and the short-axis diameters were measured. At least one lymph node was found in 115 (96%) children, with subcarinal (69%), lower paratracheal (64%) and hilar (60%) nodes being most common. Up to 10 years of age most lymph nodes were smaller than or equal to 7 mm. In older children lymph nodes measuring up to 10-mm-short-axis diameter were found. Lymph nodes were rare along the mammary vessels, at lower oesophageal and at prevascular and posterior mediastinal levels in children. Mediastinal and hilar lymph nodes are more common than previously thought, probably because of increased detection by modern multi-detector CT. Lymph node location and age have to be taken into account when evaluating lymph nodes in the paediatric chest. (orig.)

  13. Impact of parenchymal tuberculosis sequelae on mediastinal lymph node staging in patients with lung cancer.

    Science.gov (United States)

    Lee, Seung Heon; Min, Joo-Won; Lee, Chang Hoon; Park, Chang Min; Goo, Jin Mo; Chung, Doo Hyun; Kang, Chang Hyun; Kim, Young Tae; Kim, Young Whan; Han, Sung Koo; Shim, Young-Soo; Yim, Jae-Joon

    2011-01-01

    Because tuberculous (TB) involvement of mediastinal lymph nodes (LN) could cause false positive results in nodal staging of lung cancer, we examined the accuracy of nodal staging in lung cancer patients with radiographic sequelae of healed TB. A total of 54 lung cancer patients with radiographic TB sequelae in the lung parenchyma ipsilateral to the resected lung, who had undergone at least ipsilateral 4- and 7-lymph node dissection after both chest computed tomography (CT) and fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT were included for the analysis. The median age of 54 subjects was 66 yr and 48 were males. Calcified nodules and fibrotic changes were the most common forms of healed parenchymal pulmonary TB. Enlarged mediastinal lymph nodes (short diameter > 1 cm) were identified in 21 patients and positive mediastinal lymph nodes were identified using FDG-PET/CT in 19 patients. The overall sensitivity and specificity for mediastinal node metastasis were 60.0% and 69.2% with CT and 46.7% and 69.2% with FDG-PET/CT, respectively. In conclusion, the accuracy of nodal staging using CT or FDG-PET/CT might be low in lung cancer patients with parenchymal TB sequelae, because of inactive TB lymph nodes without viable TB bacilli.

  14. [Spontaneous bilateral chylothorax revealing a mediastinal and abdominal lymph node tuberculosis].

    Science.gov (United States)

    El Hammoumi, M M; Drissi, G; Achir, A; Benchekroun, A; Kabiri, E H; Benosman, A

    2014-06-01

    Spontaneous chylothorax is a rare condition, lymph node tuberculosis is an exceptional etiology of chylothorax, we report an exceptional case of a patient with mediastinal and abdominal lymph node tuberculosis presenting with spontaneous bilateral chylothorax treated successfully by symptomatic medical treatment and antibacillary. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. A new case of Mycoplasma hominis mediastinitis and sternal osteitis after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rémi Le Guern

    2015-02-01

    Full Text Available We report a case of nosocomial mediastinitis and sternal osteitis due to M. hominis after open-heart surgery in an immuno-competent patient. This infection has been diagnosed by incubating the culture media for an extended period of time, and sequencing 16S rDNA directly from the clinical samples.

  16. Deep Neck Infection and Descending Mediastinitis as a Complication of Propionibacterium acnes Odontogenic Infection

    Directory of Open Access Journals (Sweden)

    Evgeni Brotfain

    2015-01-01

    Full Text Available Propionibacterium acnes is an anaerobic, Gram-positive bacterium which causes numerous types of infections. Isolated Propionibacterium acnes deep neck infections are very rare. We present an interesting case of deep neck infection complicated by descending mediastinitis of isolated Propionibacterium acnes infection.

  17. Deleterious Effects of Intermittent Recombinant Parathyroid Hormone on Cartilage Formation in a Rabbit Microfracture Model: a Preliminary Study

    OpenAIRE

    Feeley, Brian T.; Doty, Steven B.; Devcic, Zlatko; Warren, Russell F.; Lane, Joseph M.

    2010-01-01

    Intermittent parathyroid hormone administration can enhance fracture healing in an animal model. Despite the success of exogenous parathyroid hormone on fracture healing and spine fusion, few studies have examined the role of parathyroid hormone on cartilage formation. We determined the effects of intermittent parathyroid hormone on cartilage formation in a rabbit microfracture model of cartilage regeneration. Twelve rabbits were divided into three equal groups: (1) microfracture alone, (2) m...

  18. Phosphorylation of Ribosomal Protein S6 Mediates Mammalian Target of Rapamycin Complex 1?Induced Parathyroid Cell Proliferation in Secondary Hyperparathyroidism

    OpenAIRE

    Volovelsky, Oded; Cohen, Gili; Kenig, Ariel; Wasserman, Gilad; Dreazen, Avigail; Meyuhas, Oded; Silver, Justin; Naveh-Many, Tally

    2015-01-01

    Secondary hyperparathyroidism is characterized by increased serum parathyroid hormone (PTH) level and parathyroid cell proliferation. However, the molecular pathways mediating the increased parathyroid cell proliferation remain undefined. Here, we found that the mTOR pathway was activated in the parathyroid of rats with secondary hyperparathyroidism induced by either chronic hypocalcemia or uremia, which was measured by increased phosphorylation of ribosomal protein S6 (rpS6), a downstream ta...

  19. Fluorescence identification of parathyroid glands by aminolevulinic acid hydrochloride in rats.

    Science.gov (United States)

    Liu, Wei Wei; Li, Chun Qiao; Guo, Zhu Ming; Li, Hao; Zhang, Quan; Yang, An Kui

    2011-09-01

    In this study, we investigate the feasibility of the use of aminolevulinic acid hydrochloride (5-ALA)-induced fluorescence in the detection of parathyroid glands in rats. The intraoperative identification of parathyroid glands is difficult, which is one of the main reasons for postoperative hypoparathyroidism. An animal experiment was designed. Ten Sprague-Dawley (S-D) adult rats were injected intraperitoneally with a 300 mg/kg dosage of 5-ALA. Anesthesia and surgical dissection were performed to expose the thyroid gland 1 h later. Blue light with a wavelength of 405±3 nm was used to light the trachea bilaterally in order to detect parathyroid fluorescence by direct vision. Histology of the fluorescent tissue was performed to confirm parathyroid identification. Parathyroid gland fluorescence was visualized in all 10 S-D rats. The red fluorescence of the parathyroid glands was located on the posterolateral thyroid glands and could be seen with the naked eye. Histology of the fluorescent tissue confirmed the identification of parathyroid glands under light microscopy. 5-ALA induced fluorescence of parathyroid glands can clearly differentiate them from the surrounding tissue by direct vision alone. This method could be used intraoperatively and has potential clinical value.

  20. Actions of parathyroid hormone related peptide in mouse parietal endoderm formation

    NARCIS (Netherlands)

    Veltmaat, J.M.

    2001-01-01

    Summary Since about a decade, several reports have strongly suggested a role for parathyroid hormone related peptide (PTHrP) in the formation of parietal endoderm (PE) in the mouse embryo. This thesis is aimed first at elucidating the biological significance of parathyroid hormone related peptide