Operative monitoring of parathyroid gland hyperfunction

Article Abstract:

Hyperparathyroidism is an glandular condition in which hyperactivity leads to excessive secretion of parathyroid hormone from of any of the four parathyroid glands. This causes resorption (removal) of calcium from bones and increased absorption of calcium by the kidneys and intestinal system. Hypercalcemia causes dysfunction of most of the body systems and can result in kidney failure, fragile and painful bones, pancreatitis, ulcers, and neurologic impairment. Techniques used to preoperatively identify the hypersecreting gland are only partially successful. Successful surgery is dependent on the surgeon's experience and his correct assessment at the time of operation. Excision of hyperfunctioning parathyroid tissue is usually based on the actual size of the glands seen. However, more than 20 percent of patients have more than one enlarged gland, which may be unrecognized at the time of surgery. Over the past 20 years, the authors have performed more than 700 operations with a consistent failure rate of about 7 percent. A technique is described for a quick test that can be performed during surgery. This technique, which modifies an already commercially available radiologic assay for intact parathyroid hormone, is performed on blood samples obtained 10 minutes after the gland is excised. The results are available within 15 minutes and confirm significant changes in circulating levels of intact parathyroid hormone. A report is presented of the test results of 21 patients who underwent surgery for hyperparathyroidism. The quick test showed that 19 of 21 patients had all hyperfunctioning parathyroid tissue removed. The test correctly identified two patients with inadequate glandular excision and who required more extensive tissue removal. For another two patients, the results of this test avoided unnecessary bilateral neck exploration. This quick test for intraoperative evaluation of parathyroid hormone levels will be helpful to the surgeon and will improve operative success rates. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Parathyroid hormone, Parathyroid hormones, Hyperparathyroidism, Parathyroid glands, Parathyroidectomy, Head and neck tumors

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Role of radiation after operative palliation in cancer of the proximal bile ducts

Article Abstract:

Improvements in imaging techniques have increased the preoperative diagnosis of tumors in the hilar region of the liver, where the bile ducts are located. But there is no consensus of opinion concerning the best method of treatment for cancer of the proximal bile ducts of the liver. A review is presented of 51 patients with proximal bile duct cancer who were treated surgically. The average patient age was 60. The most common symptoms were jaundice (94 percent), weight loss (59 percent), and abdominal pain (57 percent). In 30 patients the tumor was confined to the hilar area of the liver, but 21 patients had extensive tumor involvement of the liver or distant metastasis (cancer spread to other parts of the body). All patients underwent biopsy to confirm the diagnosis. Six patients had no further surgery because of extensive metastasis. One patient underwent surgical resection of the tumor; the remaining 44 patients underwent palliative surgery (intended to reduce discomfort rather than cure the cancer). The death rate from surgery was 14 percent, and 18 patients had postoperative complications. The 44 conservatively treated patients were studied further. Average survival was 6.1 months in the 16 patients who had metastatic disease, and for these patients the use of postoperative radiation therapy did not improve survival. For patients without either metastasis or advanced local disease, the use of external beam radiation significantly increased survival from an average of 4.5 to 12.2 months. It is concluded that use of external beam radiation appears to improve survival in patients with localized cancer undergoing palliative surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Radiotherapy, Liver cancer, Gallbladder cancer

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Operative therapy of gallbladder disease in patients with cystic fibrosis

Article Abstract:

Cystic fibrosis is an inherited disease which leads to progressive lung degeneration, hardening of the bile ducts which carry bile from pancreas and gallbladder to the intestines, and loss of function of the pancreas which secretes insulin and enzymes needed to digest proteins. Twenty patients with cystic fibrosis who underwent surgery for disease of the gallbladder during a 13 year period were evaluated. Generally there was a long delay of more than seven months between the onset of symptoms and diagnosis of the disease. This delay was attributed to the masking of the symptoms of gallbladder disease by the other symptoms which cystic fibrosis patients experience. There was a notable lack of disease of the common bile duct which combines secretions passing from the gallbladder and the pancreas. This finding, also reported in similar studies, may be due to a combination of factors: increased smoothness of flow (viscosity) of the mucus in the duct, the small caliber of the bile duct and gallbladder, and the high ability of the tissue of the gallbladder to absorb water. X-ray of the bile ducts during surgery is not recommended in patients with cystic fibrosis and disease of the gallbladder. Cholecystectomy , the removal of the gallbladder, can be performed on patients with cystic fibrosis with relative safety if appropriate care is provided before and after the operation. Surgery soon after diagnosis is recommended in these patients.

Analysis, Complications and side effects, Gallbladder diseases, Lung diseases, Cystic fibrosis, Cholecystectomy

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