Normocalcemic parathormone elevation after successful parathyroidectomy: long-term analysis of parathormone variations over 10 years.

Background: The long-term significance of normocalcemic parathormone elevation (NPE) after successful parathyroidectomy for sporadic primary hyperparathyroidism remains unclear.

Method: Of 239 consecutive patients who underwent targeted parathyroidectomy with intraoperative parathormone monitoring, 96 were followed for ≥ 10 years. NPE was defined as a normal serum calcium level and parathormone (PTH) above the normal reference range ≥ 6 months after successful parathyroidectomy.

Emerging transparent electrodes based on thin films of carbon nanotubes, graphene, and metallic nanostructures.

Transparent electrodes are a necessary component in many modern devices such as touch screens, LCDs, OLEDs, and solar cells, all of which are growing in demand. Traditionally, this role has been well served by doped metal oxides, the most common of which is indium tin oxide, or ITO. Recently, advances in nano-materials research have opened the door for other transparent conductive materials, each with unique properties.

Operative failure in the era of focused parathyroidectomy: a contemporary series of 845 patients.

Hypothesis: Focused parathyroidectomy guided by intraoperative parathyroid hormone monitoring (IPM) may lead to higher failure rates because of missed multiglandular disease.

Design: Retrospective review of prospectively collected data.

Setting: Tertiary referral center.

Focused parathyroidectomy guided by intra-operative parathormone monitoring does not miss multiglandular disease in patients with sporadic primary hyperparathyroidism: a 10-year outcome.

Background: There remains concern that focused parathyroidectomy guided by intra-operative parathormone monitoring (IPM) will miss multiglandular disease (MGD) leading to a higher recurrence rate. This study reports the 10-year outcome of patients with sporadic primary hyperparathyroidism treated by focused parathyroidectomy guided by IPM.

Methods: From 1993 to 1998, 173 consecutive patients with sporadic primary hyperparathyroidism underwent focused parathyroidectomy guided by IPM.

Surface-modified nanotube anodes for high performance organic light-emitting diode.

In this work, we reported high performance OLED devices with transparent and conductive carbon nanotube anodes after modification. The modifications include IMRE proprietary PEDOT:PSS composite top coating (PS(C)), concentrated HNO(3) acid soaking, and polymer encapsulation. For PS(C)-modified nanotube thin film anode, we achieved maximum luminescence of approximately 9000 cd/m(2), close to ITO-based OLED device performance, and high efficiency of approximately 10 cd/A, similar with ITO-based OLED device.

Continuous and scalable fabrication of transparent conducting carbon nanotube films.

We report an industrially scalable, fast, and simple process for the large scale fabrication of optically transparent and electrically conducting thin films of single-walled carbon nanotubes (SWNT). Purified, pristine HiPco SWNTs were dispersed in water at high concentrations with the help of surfactants, rod-coated into uniform thin films, and doped by various acids. We show how to combine different surfactants to make uniform dispersions with high concentration of SWNTs and optimal rheological behavior for coating and drying, including preventing dewetting and film rupture that has plagued earlier attempts.

Sporadic primary hyperparathyroidism in young individuals: different disease and treatment?

Background: Younger individuals with hyperparathyroidism may experience severe disease with a higher incidence of multigland disease (MGD) and operative failure, thereby requiring subtotal parathyroidectomy. This study examines the characteristics and surgical outcome of younger compared with older patients with sporadic primary hyperparathyroidism (SPHPT).

Methods: Prospectively collected data of 1101 patients with SPHPT who underwent parathyroidectomy at a single institution were retrospectively reviewed.

Long-term outcome of patients with intraoperative parathyroid level remaining above the normal range during parathyroidectomy.

Background: Criterion requiring intraoperative parathyroid hormone (IOPTH) drops >50% from the highest, preincision or preexcision level, 10 minutes after the abnormal gland's excision predicts operative success with 98% accuracy. The purpose of this study is to correlate IOPTH dynamics with recurrent hyperparathyroidism (RecHPT) and eucalcemia with high PTH (HPTH).

Methods: We followed 383 consecutive patients with parathyroidectomy guided by IOPTH monitoring using the above criterion for >6 months.

Role of intraoperative parathormone monitoring during parathyroidectomy in patients with discordant localization studies.

Background: Many patients with sporadic primary hyperparathyroidism (SPHPT) have discordant preoperative Tc-99m-sestamibi (MIBI) and ultrasonography studies prior to focused parathyroidectomy (PTX). This study examines the usefulness of intraoperative parathormone monitoring (IPM) during PTX in patients with discordant preoperative localization studies.

Methods: A retrospective series of 225 consecutive SPHPT patients with MIBI scans and surgeon performed ultrasonography (SUS) prior to focused parathyroidectomy were studied.

Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism.

Hypothesis: Untreated long-term elevated parathyroid hormone (PTH) levels after successful parathyroidectomy may predict recurrent hyperparathyroidism (HPT). Although elevated PTH levels have been reported in eucalcemic patients after parathyroidectomy for sporadic primary HPT, the long-term clinical significance of this finding remains unclear.

Design: Retrospective case series.

Does histopathology predict parathyroid hypersecretion and influence correctly the extent of parathyroidectomy in patients with sporadic primary hyperparathyroidism?

Background: Parathyroid histopathology has been used to predict single or multiglandular disease (MGD). "Hyperplasia" implies MGD, whereas "adenoma" suggests single gland involvement. Intraoperative parathyroid hormone (PTH) monitoring (IPM) guides parathyroidectomy based on function.

Consequences of parathyroidectomy in patients with "mild" sporadic primary hyperparathyroidism.

Background: The use of a targeted, less-invasive approach is changing the operative indications in sporadic primary hyperparathyroidism (SPHPT). Now, patients with "mild" HPT are offered parathyroidectomy. However, the operative findings and outcome of these patients are unknown.

Intra-operative parathyroid hormone monitoring in patients with parathyroid cancer.

Background: Intra-operative parathyroid hormone (PTH) monitoring (IPM) is 97% accurate in predicting postoperative eucalcemia in sporadic primary hyperparathyroidism (SPHPT). However, its usefulness in parathyroid cancer has not been demonstrated. This study reports IPM accuracy during surgical resections for parathyroid cancer.

Are we training our residents to perform open gall bladder and common bile duct operations?

Introduction: In the new era of resident work hour restrictions and an emphasis on minimally invasive surgery, experience in performing open biliary surgery is diminishing. We sought to review our resident operative experience to determine if it appears adequate for a well-trained general surgeon.

Methods: The case logs of the General Surgery, Oncology, and Trauma/Emergency General Surgery (EGS) services were reviewed for a 1-year period.

Long-term results of parathyroidectomy for hypercalcemic crisis.

Hypothesis: Hypercalcemic crisis is a rare complication of severe calcium intoxication usually caused by sporadic primary hyperparathyroidism that requires prompt diagnosis and definitive surgical treatment. Parathyroidectomy is essential for long-term successful treatment of hypercalcemic crisis.

Design: Retrospective case series.

Consequences of targeted parathyroidectomy guided by localization studies without intraoperative parathyroid hormone monitoring.

Background: After excision of an abnormal gland, the dynamics of intraoperative parathyroid hormone (PTH) levels signal whether or not more hypersecreting tissue is present. This quantitative assurance of operative success has led to targeted exploration of the hyperfunctioning gland(s). Some have questioned the need for intraoperative PTH monitoring (IPM) in the presence of positive nuclear scanning.

Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism.

Background: With a secure diagnosis of hyperparathyroidism, preoperative localization of abnormal glands is the initial step toward limited parathyroidectomy. Nuclear scanning and ultrasonography done by third parties are costly. We investigated whether ultrasonography performed by the operating surgeon (SUS) could be the initial and only preoperative localization study in patients with sporadic primary hyperparathyroidism.

Surgeon-performed ultrasound improves localization of abnormal parathyroid glands.

With a secure diagnosis of hyperparathyroidism, preoperative localization of abnormal glands is the initial step toward limited parathyroidectomy (LPX). We investigated whether ultrasonography in the hands of the surgeon (SUS) could improve the localization of abnormal parathyroids when sestamibi scans (MIBI) were negative or equivocal. One hundred eighty patients with sporadic primary hyperparathyroidism (SPHPT) underwent preoperative SUS and MIBI scans before LPX guided by intraoperative parathormone assay.

Recurrent disease after limited parathyroidectomy for sporadic primary hyperparathyroidism.

Background: Limited parathyroidectomy guided by intraoperative parathyroid hormone (PTH) assay (QPTH) is highly successful (97% to 99%) in predicting postoperative eucalcemia, usually with less extensive dissection when compared with bilateral neck exploration. Because fewer glands are excised when resection is guided by QPTH as opposed to resection guided by gland size, a higher recurrence rate may occur. Recurrence rate after bilateral neck exploration is 0.

Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome.

Intraoperative parathyroid hormone (PTH) assay (QPTH) has made possible less invasive operative approaches in the treatment of primary hyperparathyroidism with stated advantages. When compared to the traditional bilateral neck exploration (BNE), only the targeted, hypersecreting gland is excised, leaving in situ non-visualized but normally functioning parathyroids. The QPTH-guided limited parathyroidectomy (LPX) must be able to identify multiglandular disease (MGD), predict a successful outcome, and have a low recurrence rate.

Surgeon-performed ultrasound in the management of thyroid malignancy.

Surgeon-controlled real-time ultrasound (US) is a new adjunct in the management of patients with thyroid malignancy. The introduction of US as a routine evaluation tool has increased the recognition of nonpalpable thyroid cancers and cervical lymph node metastases. We report our experience and the change in management of patients with thyroid cancer due to the use of US.