Symptomatic primary hyperparathyroidism: a retrospective analysis of fifty one cases from a single centre

OBJECTIVE

Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic primary hyperparathyroidism in India. We analysed fifty one consecutive patients of primary hyperparathyroidism managed at our centre. All of them were symptomatic.

DESIGN

Retrospective analysis.

MATERIAL AND METHODS

Fifty one consecutive cases of symptomatic primary hyperparathyroidism, presenting to our centre from January 1994 to May 2007 were retrospectively analyzed. Clinical presentation, biochemical, radiological and details of underlying parathyroid lesion were noted.

RESULTS

A total of 51 cases of primary hyperparathyroidism were studied. Mean age was 39.5 +/- 11.5 yrs (Range 13 to 70 years, Female: Male 2:1). Mean duration of symptoms was 35.8 + 29.1 months. Bone pains and painful proximal myopathy were the commonest presentation (24/51), followed by pathological fractures in 12 cases. Distal Renal tubular acidosis was diagnosed in 4 cases, 3 of whom normalized after surgery. At initial evaluation, twenty one patients had elevated alkaline phosphatase with normal calcium levels indirectly suggesting associated vitamin D deficiency. Low serum levels of 25-hydroxy vitamin D were documented in five of them. Parathyroid carcinoma was diagnosed in 3 patients. Ectopic parathyroid adenoma was seen in 7 cases (3 mediastinal, 3 intrathyroidal, 1 near left carotid sheath). All the cases responded well to surgical excision.

CONCLUSION

Lack of universal screening for hypercalcemia, normocalcemia contributed by associated vitamin D deficiency and lack of awareness about unusual presentations of primary hyperparathyroidism led to delayed diagnosis in our patients. Delayed diagnosis and associated vitamin D deficiency in our patients contributed to greater severity of symptomatic primary hyperparathyroidism.

Esophageal bronchus: case report and review of the literature

Communicating bronchopulmonary foregut malformation (CBPFM) is a rare abnormality that is characterized by persistent communication between the bronchial tree and the gastrointestinal tract. We report a case of CBPFM in a young girl, with a description of the imaging and surgical details and a short review of the relevant literature.

Significant enhancement of hole mobility in [110] silicon nanowires compared to electrons and bulk silicon

Utilizing sp3d5s* tight-binding band structure and wave functions for electrons and holes we show that acoustic phonon limited hole mobility in [110] grown silicon nanowires (SiNWs) is greater than electron mobility. The room temperature acoustically limited hole mobility for the SiNWs considered can be as high as 2500 cm2/V s, which is nearly three times larger than the bulk acoustically limited silicon hole mobility. It is also shown that the electron and hole mobility for [110] grown SiNWs exceed those of similar diameter [100] SiNWs, with nearly 2 orders of magnitude difference for hole mobility. Since small diameter SiNWs have been seen to grow primarily along the [110] direction, results strongly suggest that these SiNWs may be useful in future electronics. Our results are also relevant to recent experiments measuring SiNW mobility.

Ectopic parathyroid adenoma--the hidden culprit

Primary Hyperparathyroidism is known to present with protean manifestations leading to misdiagnosis in the initial stages of the disease. Inability to locate the adenoma in an ectopic parathyroid gland may further delay the diagnosis of these cases. Aberrant migration during development may lead to intrathyroidal or other ectopic locations of parathyroid glands. This may lead to their misdiagnosis as a thyroid nodule or failure to locate parathyroids during surgery. Similarity in cytological picture between thyroids and parathyroids may further complicate diagnosis by fine needle aspiration cytology. Nuclear imaging scintigraphy accurately localizes the tumor in 90% of cases and simplifies the surgical management. We encountered three such cases with the parathyroid gland adenomas in ectopic locations in which pre-operative nuclear imaging played a major role.

An outbreak of E. coli O157 associated with a swimming pool: an unusual vehicle of transmission

Escherichia coli O157 causes a range of illnesses from mild diarrhoea to haemolytic uraemic syndrome (HUS) which carries a mortality rate of 3.7%. Infection is more common in the under-5s. Between 1995 and 2000, 106 outbreaks of E. coli O157 were reported in England and Wales. Recreational water is well documented as a transmission route for infectious diseases worldwide. In the United Kingdom there have been very few reported outbreaks associated with swimming pools due to the relative susceptibility of E. coli O157 to adequate levels of free chlorine. This report describes the investigation of an outbreak associated with a local leisure centre pool and makes recommendations about the safe management of such facilities.