Preoperative High-Resolution Ultrasound for the Assessment of Malignant Central Compartment Lymph Nodes in Papillary Thyroid Cancer.

Background: The identification and removal of malignant central compartment lymph nodes (MCLN) is important to minimize the risk of persistent or recurrent local disease in patients with papillary thyroid cancer (PTC). While the diagnostic accuracy of preoperative ultrasound for the assessment of lateral compartment node metastases is well recognized, its role in the identification of central compartment node metastases in patients with PTC is less established. This study delineates the utility of high-resolution ultrasound (HUS) for the assessment of MCLN in patients with PTC.

No Need to Abandon Focused Unilateral Exploration for Primary Hyperparathyroidism with Intraoperative Monitoring of Intact Parathyroid Hormone.

Background: We investigated the rate of persistent and recurrent hyperparathyroidism after focused unilateral exploration (UE) with intraoperative monitoring of intact parathyroid hormone (IOPTH).

Study Design: A prospective cohort of 915 patients with primary hyperparathyroidism (PHP) underwent parathyroid surgery by a single surgeon from January 2003 to September 2013. A total of 556 patients with at least a single positive preoperative localization by ultrasound (US) and/or sestamibi scan (STS) underwent UE with IOPTH.

The utility of 4-dimensional computed tomography for preoperative localization of primary hyperparathyroidism in patients not localized by sestamibi or ultrasonography.

Background: To determine the sensitivity and clinical application of 4-dimensional computed tomography (4D CT) for the localization of patients with primary hyperparathyroidism when ultrasonography (US) and sestamibi scans (STS) are negative.

Methods: We compiled a database of 872 patients with primary hyperparathyroidism who underwent parathyroid operation by a single surgeon from January 2003 to September 2013. Seventy-three patients who failed to have positive localization by US or STS were identified.

Image-guided ablation of postsurgical locoregional recurrence of biopsy-proven well-differentiated thyroid carcinoma.

Purpose: To evaluate the clinical outcomes of ultrasound-guided percutaneous radiofrequency (RF) ablation and percutaneous ethanol injection (PEI) as salvage therapy for locoregional recurrence after resection of well-differentiated thyroid carcinoma.

Materials And Methods: There were 42 locoregional, biopsy-proven, papillary and follicular thyroid carcinoma lesions (0.5-3.

Level VI lymph node dissection does not decrease radioiodine uptake in patients undergoing radioiodine ablation for differentiated thyroid cancer.

Background: In patients with well-differentiated thyroid cancer, the incidence of pathologic central compartment lymph node metastases is reported to be approximately 50%. Recently level VI lymph node dissection has been advocated as a means of reducing recurrence rates in these patients, even if there are no clinically apparent nodal metastases. This study investigates whether level VI lymph node dissection decreases the percent radioiodine uptake when patients undergo radioiodine ablation.

Dynamic MDCT for localization of occult parathyroid adenomas in 26 patients with primary hyperparathyroidism.

Objective: The objective of our study was to evaluate the accuracy of dynamic contrast-enhanced 4D MDCT in the preoperative identification of parathyroid adenomas in patients with primary hyperparathyroidism (PHPT) and a history of failed surgery or unsuccessful localization on standard imaging.

Materials And Methods: Thirty-four patients with PHPT underwent 4D CT. Retrospective blinded review of the 4D CT examinations was performed by three radiologists for the presence and location of a suspected parathyroid adenoma or adenomas.

Normalization of 2-week postoperative parathyroid hormone values in patients with primary hyperparathyroidism: four-gland exploration compared to focused-approach surgery.

Background: Elevation of parathyroid hormone (PTH) levels is commonly seen in patients with primary hyperparathyroidism (PHPT) who have undergone parathyroidectomy. This study evaluates differences in 2-week postoperative PTH levels in patients having focused-approach surgery versus four-gland exploration.

Methods: Over 6 years, patients at Rhode Island Hospital (RIH) and the Cleveland Clinic (CCF) who had PHPT and underwent localization studies suggestive of single adenoma were analyzed.

Does failure to perform prophylactic level VI node dissection leave persistent disease detectable by ultrasonography in patients with low-risk papillary carcinoma of the thyroid?

Background: There is controversy regarding the need for prophylactic level VI central node dissection in patients with low-risk papillary thyroid carcinoma (PTC). This study focuses on the incidence of persistent level VI nodal disease in low-risk PTC without prophylactic central node dissection.

Methods: PTC was known at the time of thyroidectomy in 304 of the 761 patients who had initial thyroid surgery from 2001 to 2007.

Limited value of adrenal biopsy in the evaluation of adrenal neoplasm: a decade of experience.

Objective: To determine the value of percutaneous adrenal biopsy in the evaluation of adrenal neoplasm.

Design: Retrospective review.

Setting: Tertiary referral center.

Primary hyperparathyroidism: is there an increased prevalence of renal stone disease?

Objective: Parathyroid adenomas cause hypercalcemia and are culprits in the development of renal stone disease. With serum assays available, early detection of parathyroid tumors is possible. We performed this retrospective review to determine whether the prevalence of nephrocalcinosis and nephrolithiasis is still increased in patients with primary hyperparathyroidism compared with those not affected by the disorder in view of the early detection of parathyroid adenomas.

Re-operative neck surgery for well-differentiated thyroid cancer of follicular origin.

This review focuses on the pathologic criteria for completion thyroidectomy in well differentiated thyroid cancer as well the diagnosis and treatment of recurrent disease. The roles of ultrasound in the diagnosis of a cervical recurrence, its value in determining the extent of lymph node dissection in the lateral compartment, and the importance of intra-operative ultrasound in re-operative thyroid surgery are discussed.

Use of the round ligament of the liver to decrease pancreatic fistulas: a novel technique.

Background: The reported pancreatic anastomosis fistula rate for pancreaticoduodenectomy, distal pancreatectomy, or enucleation is 2% to 27%. We hypothesized that reinforcement with a vascular pedicle would decrease the number of fistulas. We report a novel technique: the use of the round ligament of the liver to reinforce the pancreatic anastomosis after resection.

Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma.

Objective: To assess the long-term efficacy of radiofrequency ablation (RFA) and percutaneous ethanol (EtOH) injection treatment of local recurrence or focal distant metastases of well-differentiated thyroid cancer (WTC).

Background: RFA and EtOH injection techniques are new minimally invasive surgical alternatives for treatment of recurrent WTC. We report our experience and long-term follow-up results using RFA or EtOH ablation in treating local recurrence and distant focal metastases from WTC.

Life-threatening hypercalcemia from a hepatocellular carcinoma secreting intact parathyroid hormone: localization by sestamibi single-photon emission computed tomographic imaging.

Objective: To describe a patient with severe hypercalcemia and elevated intact parathyroid hormone (iPTH) levels associated with a hepatocellular carcinoma.

Methods: We present a case report, detailing the laboratory, surgical, and sestamibi scanning findings. Moreover, the literature relating to paraneoplastic ectopic production of iPTH is reviewed.

Reassessment of parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism after 2 preoperative localization studies.

Hypothesis: For patients with primary hyperparathyroidism and patients with 2 localization studies showing the same single location of parathyroid disease, use of intraoperative parathyroid hormone (IOPTH) measurement does not significantly increase the success of minimally invasive parathyroidectomy.

Design: Retrospective cohort study.

Setting: Experience of 2 academic centers over 5 years (at Brigham and Women's Hospital, Boston, Mass) and almost 4 years (at Rhode Island Hospital, Providence).

Randomized clinical trial comparing regional and general anaesthesia in minimally invasive video-assisted parathyroidectomy.

Background: This randomized clinical trial was performed in a single institution to compare the results of minimally invasive video-assisted parathyroidectomy (MIVAP) conducted under regional anaesthesia (RA) or general anaesthesia (GA).

Methods: Fifty-one patients undergoing MIVAP for primary hyperparathyroidism were assigned randomly to either RA (26 patients) or GA (25). RA involved a bilateral deep cervical block, and local infiltration of the incision site with a mixture of 0.

Normocalcemic hyperparathyroidism in patients with osteoporosis.

Background: Diagnosing primary hyperparathyroidism (PHP) in patients with osteoporosis is important because of the benefits of surgery. Screening patients with osteoporosis for PHP with only total serum calcium level will fail to diagnose PHP in patients with intermittent or no elevation of the total calcium level.

Methods: This is a retrospective study of 140 patients who had a preoperative bone density study of the 223 patients who had surgery for PHP from January 1995 to June 1999.

Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy.

Objective: To correlate sonographic and color Doppler characteristics of thyroid nodules with the results of sonographically guided fine-needle aspiration biopsy to establish the relative importance of these features in predicting risk for malignancy.

Methods: We retrospectively analyzed the sonographic features of 34 malignant and 36 benign thyroid nodules with respect to size, echogenicity, echo structure, shape, border, calcification, and internal vascularity. Individual features and combinations of features were analyzed for their correlation with benign or malignant disease.

Mutational analyses of RB and BRCA2 as candidate tumour suppressor genes in parathyroid carcinoma.

Objective: Strong evidence indicates that at least one key tumour suppressor gene important for the development of malignant parathyroid tumours is located on chromosome 13, but the critical target gene remains unknown. Importantly, the region of acquired DNA loss includes two established tumour suppressor genes, the retinoblastoma gene, RB (RB1) and BRCA2. Resolution of whether RB or BRCA2 is the critical 13q tumour suppressor gene in parathyroid cancer requires analysis of these genes' sequences for intragenic inactivating mutations.