THE VOLUME OF SOLITARY PARATHYROID ADENOMA IS RELATED TO PREOPERATIVE PTH AND 25OH-D3, BUT NOT TO CALCIUM LEVELS

Purpose

To correlate the volume of parathyroid adenomas with the hormonal and metabolic profile at patients diagnosed with primary hyperparathyroidism (pHPTH).

Patients and Methods

Cross-sectional multicentric study, enrolling 52 patients with pHPTH from two medical institutions. Serum calcium and PTH were evaluated in all patients before surgery, whereas 25OHD3 was measured only in the 33 patients recruited form one medical unit. The volume of parathyroid adenoma was measured by using the formula of a rotating ellipsoid.

Results

We observed a significant correlation of the volume of parathyroid adenomas with PTH at patients from the two units and in the whole group (p < 0.0001), but not with serum calcium (p = 0.494). Twenty-five out of the 33 patients at whom 25OHD3 was measured had levels in the range of deficiency. 25OHD3 was not correlated with PTH or calcium levels, but was negatively correlated to the adenoma volume and positively to the PTH/volume ratio (p = 0.041 and p = 0.048, respectively).

Conclusions

The volume of parathyroid adenoma seems to be related to preoperative PTH and 25OHD3, but not to calcium level. Vitamin D deficiency is frequently found at patients with pHPTH and may contribute to particular disease profiles, including larger parathyroid adenomas.

[Rare caecal pseudotumours]

Among the rarely caecal pseudotumours are those caused by a coagulation disorder. The clinical course of caecal pseudotumours is highly variable. Most patients are diagnosed with acute appendicitis, but the real diagnosis is confirmed after laboratory investigation and histopathologic exam. Our patient presented the symptoms of an inferior digestive bleeding. The persistence of the clinical symptoms and the haematological degradation determined the surgical intervention. Intraoperative were found two caecal tumours. The hystological exam, biochemical and haematological analysis worked up the final diagnosis: a caecal pseudotumour in the context of Antithrombin III deficiency.

RARE ASSOCIATION BETWEEN HASHITOXICOSIS, BASEDOW DISEASE AND PAPILLARY THYROID CARCINOMA

We present the case of a 32 yeas old male, diagnosed 7 years ago with Graves disease, with numerous recidives which needed anti-thyroid medication, with poor response (hypo to hyper-thyroid status, with high variations of TSH and FT4) whom after a period of remission (8 months, no treatment) came in for a polymorphic symptomatology sugestive for hyperthyroidism. The hyperthyroid state was confirmed he had high TRAb (31 UI/ml vs. <1.75 UI/ml) - on his last check in the detection rate of TRAb was under 0.3 UI/ml. The thyroid ultrasound revels on the left lobe a small mass of 0.8/0.8 cm, with EU-TIRADS score of 4, that was newly diagnosed. Postoperative histopathology revealed papillary microcarcinoma developed on Hashitoxicosis- pT1aN0, of 1 mm in the middle of left thyroid lobe. The particularity of this case consists in a long evolution of Graves disease with numerous relapses, the appearance of a thyroid nodule after 7 years in which they identified a papillary microcacinoma associated with Hashimoto thyroiditis and also the postoperative recovery that was slowed by the parathyreoprive tetany.

[Radical neck dissection in advanced thyroid cancer]

We try to ascertain whether total thyroidectomy with radical neck dissection offers a survival and recurrency advantage for thyroid cancer. Between January 2000 and September 2009 in the 3rd Surgical Unit of the "Sf. Spiridon" Hospital of Iaşi 189 operations were performed for malign thyroid disorders, 164 (86,77%) of which were performed for the papillary or foliculary cancer. The diagnosis was confirmed by hystopathological examination. The patients had a medium age of 51,48 (extremes 19 - 81 years). Women had a greater proportion, as expected (sex ratio F:M = 2,85:1). 59 total thyroidectomy with radical or modified radical neck dissection were performed. There were immediate (6 bleedings which needed reoperation for haemostasis, 7 unilateral recurrent laryngeal nerve injury) and late complications (8 cases of recurrency in the first 2 years). Total thyroidectomy with radical neck dissection became the ellective method for advanced thyroid cancer (the best results were for papillary cancer, female and age over 55).

[Distal pancreatectomy with spleen preservation in a pseudopapillary pancreatic tumor case]

Pseudopapillary pancreatic tumors represent about 1-2% of all exocrine pancreatic tumors, studies in the literature about this type of tumor is limited. We present a female patient of 18 years hospitalized for nonspecific abdominal symptoms, diagnosed with corporeal pancreatic tumor approximately 3-4 cm. It takes practice surgical distal pancreatectomy with spleen preservation, pathological examination revealing a pseudopapillary pancreatic tumor. Postoperative evolution was favorable. Distal pancreatectomy with spleen preservation was indicated due to patient age.