Optimization of minimally invasive radio-guided parathyroidectomy: the importance of neck ultrasonography and intraoperative parathyroid hormone assay.

Objective: To determine whether close collaboration between a neck ultrasound-certified endocrinologist and a skilled endocrine surgeon can optimize minimally invasive radio-guided parathyroidectomy (MIRP) surgical outcomes.

Methods: Outcome data were collected on patients with primary hyperparathyroidism whom we intended to treat with MIRP at the induction of anesthesia between October 1, 2005, and December 31, 2007. Patients underwent preoperative gamma camera sestamibi scanning (GCSS), intraoperative gamma probe sestamibi scanning (IOSS), and preoperative neck ultrasonography.

Nonequivalent results of tetrofosmin and sestamibi imaging of parathyroid tumors.

Objective: To report the case of a patient with a large parathyroid carcinoma missed by dual-phase technetium Tc 99m tetrofosmin (TETRO) parathyroid scanning.

Methods: We present the clinical findings, laboratory results, imaging studies, and surgical pathology report in a man with parathyroid carcinoma and review the literature regarding the use of TETRO scintigraphy in patients with hyperparathyroidism.

Results: In an 83-year-old man with hyperparathyroidism, severe hypercalcemia developed in the context of nephrolithiasis.

LactoSorb plates for rotator cuff repair.

Purpose: We present our preliminary studies using LactoSorb plates (Lorenz/Biomet, Warsaw, IN) for rotator cuff repair in humans. The use and application of this plate are described as an adjunct to prevent hole migration in trough-tunnel repairs of rotator cuff tears.

Methods: Fifty patients with rotator cuff tears documented by magnetic resonance imaging underwent arthroscopic subacromial decompression followed by a mini-open repair of the rotator cuff.

Stasis ulcers: the role of compliance in healing.

The goal in treating a stasis ulcer is rapid and permanent reepithelialization of the ulcer bed. The patient can reach this goal by strict compliance with a program taught and continually reinforced by the physician. The program teaches about the effects of the force of gravity on the flow of blood and lymph in the lower extremities in various positions.

Antimicrobial monitoring and evaluation.

Effective antimicrobial use is an essential component of patient care. Drug use evaluation should include the prophylactic, therapeutic, and empiric use of antimicrobials. The infection control practitioner has the unique knowledge and skills in epidemiology to be effective in the monitoring and evaluation process.