Association of nodular hyperplasia with resistance to cinacalcet therapy for secondary hyperparathyroidism in hemodialysis patients

There have been few long-term prospective studies investigating the effect of cinacalcet on secondary hyperparathyroidism with or without nodular hyperplasia. We examined whether the effect of cinacalcet on secondary hyperparathyroidism differed between patients with or without nodular hyperplasia. Stable hemodialysis patients with secondary hyperparathyroidism resistant to conventional treatment received cinacalcet for 12 months. Based on ultrasonography findings, patients were divided into group S (gland < 500 mm(3) without nodular hyperplasia) and group L (gland ≥ 500 mm(3) with nodular hyperplasia). Serum levels of intact parathyroid hormone, bone-specific alkaline phosphatase, osteocalcin, and cross-linked N-terminal telopeptide of type 1 collagen were measured. Thirty-one patients completed the study. The changes of parameters from the baseline did not differ significantly between the two groups after 6 months. However, the percentage reduction of each parameter was significantly smaller in group L compared with group S after 12 months. Nodular hyperplasia is associated with resistance to cinacalcet therapy in patients on chronic dialysis with secondary hyperparathyroidism.     

Parathyroid Gland Ultrasound Patterns and Biochemical Findings After One-year Cinacalcet Treatment for Advanced Secondary Hyperparathyroidism

Cinacalcet efficacy is limited in severe secondary hyperparathyroidism (SHPT) and its effect on parathyroid gland (PTG) volume and morphology have not been sufficiently investigated. We evaluated the effect of cinacalcet treatment for one year on the laboratory parameters of calcium–phosphorus metabolism and PTG ultrasound (US) patterns in hemodialysis (HD) patients with severe SHPT and US results indicative of nodular hyperplasia. Thirteen HD patients with severe SHPT (intact parathyroid hormone >700 pg/mL), US/scintigraphic evidence of at least one PTG with a diameter >7 mm, and high surgical risk or refusal of surgery were included. The patients were treated with cinacalcet. The initial dose of 30 mg was increased up to 180 mg once daily. At baseline and after one year of cinacalcet treatment a neck US was performed, providing data on 22 parathyroid glands in eight patients. The mean diameter at baseline and at one year was 12.6 ± 5.9 and 13.0 ± 5.3 mm, respectively (P = 0.46). Similarly, the mean volume at baseline and at one year was 513.4 ± 416.3 and 556.8 ± 480.8 mm³, respectively (P = 0.18). The US structural score remained unchanged in 16 parathyroid glands and increased in 6 (P < 0.03), while the vascular score remained unchanged in 16 parathyroid glands and decreased in 6 (P = 0.25). Thus it can be concluded that cinacalcet treatment for one year in HD patients with severe SHPT is not associated with significant changes in parathyroid gland US patterns.     

Influence of morbid obesity on parathyroidectomy outcomes in primary hyperparathyroidism

Background

We sought to evaluate the influence of morbid obesity in patients undergoing parathyroidectomy for primary hyperparathyroidism (pHPT).

Methods

All patients with pHPT who underwent parathyroidectomy at a single institution between July 2002 and October 2008 were included. Body mass index (BMI), laboratorie vlaues, operative findings, and outcomes were examined.

Results

Two hundred thirteen of the 776 patients identified (28%) were morbidly obese (BMI ≥35 kg/m²). When compared with nonmorbidly obese patients, the morbidly obese patients were younger, had higher preoperative intact parathyroid hormone (iPTH) levels, heavier parathyroids, and required overnight stay more often (P <.05 for all). However, the rates of complications, eucalcemia, and recurrence were similar for all patients.

Conclusion

In this study, more than a quarter of the patients who underwent parathyroidectomy for pHPT were morbidly obese and had significantly higher preoperative iPTH levels, heavier parathyroids, and longer hospital stay but similar rates of complications and operative success.     

缺血性卒中二级预防药物依从性研究

目的 评估卒中单元医疗模式的建立后,卒中二级预防措施的成效。方法回顾性分析获得完整资料152例缺血性卒中患者;对比前瞻性分析2004年11月至2005年12月期间获得完整资料138例。电话随访所收集的患者出院后3个月的二级预防药物使用情况,包括抗栓药、他汀类药物。结果传统治疗组与卒中单元组相比,抗栓药使用比例由69．1％上升至87．7％,他汀类使用比例由17．1％上升至56．5％,差异有显著的统计学意义。结论卒中单元医疗模式的启动后,卒中二级预防的药物治疗情况有了一定的改善,但是临床实践和二级预防的指南之间仍存在明显的差距。     

Secondary appendiceal tumors: a review of 139 cases

Background/Aims

This study evaluated the clinicopathologic characteristics of patients with secondary appendiceal tumors (SATs).

Methods

We performed a single-center, retrospective study of patients with pathologically confirmed SATs.

Results

Among 180 cases of appendiceal malignancies diagnosed between 2000 and 2007, 139 cases (77.2%, 46 male) were SATs. The median age at SAT diagnosis was 55 years. The most common primary origin was the ovary. The mode of appendiceal involvement was metastasis in 122 and invasion in 17 patients. Extra-appendiceal involvement was present in 134 patients. The only manifestation that could be attributed to the SAT itself was appendicitis (n=8). Serosal involvement was predominant. The median survival after diagnosis of SAT was 22.6 months. In the Cox regression analysis, chemotherapy included in the treatment was the only factor associated with prolonged survival (hazards ratio, 0.12; 95% confidence interval, 0.06-0.23; p<0.001). Complete resection of the SAT had no influence on survival.

Conclusions

SATs accounted for 77.2% of all pathologically diagnosed appendiceal malignancies. The most common origin was the ovary. SATs were usually associated with widespread disease, and the median survival after SAT diagnosis was 22.6 months. Complete resection of the SAT had no influence on survival.     

早期兔原发性甲状旁腺机能亢进动物模型的建立

目的 研究早期原发性甲状旁腺机能亢进(PHPT)动物模型的血生化和病理特点.方法 将60只成年白兔随机分为6组,每组10只.并设对照组和实验组各30只,对照组以正常饮食(Ca∶P,1∶0.7)喂养.实验组以高磷饮食(Ca∶P,1∶7)喂养,分别在喂养前1周及喂养后第1、2、3个月末,对所有动物做血钙、血磷、血甲状旁腺素测定,并在高磷饮食喂养后第1、2、3个月末,对照组与实验组动物行甲状旁腺组织学检查,观察甲旁腺的增生程度.同时对所有动物的肾脏进行病理学检查,观察肾脏的病理学改变.结果 在第1、2、3个月末,实验组血钙水平明显下降(分别为t=6.184,t=9.329,t=13.842,P＜0.05),血甲状旁腺素(PTH)水平明显高于对照组(分别为t=-7.665,t=-16.033,t=12.877,P＜0.05),而血磷水平略下降,但差异无统计学意义(分别为t=0.611,t=1.041,t=1.941,P＞0.05).甲状旁腺组织学检查,在1个月时无变化,在2个月末,实验组中的10例有6例显示甲状旁腺组织轻度增生,3个月末10例有9例显示甲状旁腺组织中度增生.而肾脏组织学检查,在1个月时肾脏无病理改变,但在2个月和3个月末,发现肾实质内炎症性改变,并伴钙盐沉积.结论 高磷饮食可成功建立兔早期原发性甲状旁腺机能亢进动物模型,且该模型具有较好的稳定性与重复性.     

中医对面瘫的认识和诊治的误区及对策

在对面瘫的病因及治疗方法进行分析的基础上,结合中医治疗面瘫的误区提出了相应的治疗对策,旨在为临床上中医治疗面瘫提供理论基础数据。     

恶性血液病继发骨髓纤维化69例

目的探讨继发性骨髓纤维化（SMF）患者的临床及骨髓病理学特征。方法对69例SMF患者的临床表现、外周血涂片、骨髓涂片及骨髓活检情况进行回顾性分析,对不同疾病骨髓纤维化程度与巨核细胞数目进行相关性分析。结果69例SMF患者原发病分别为慢性粒细胞白血病（CML）20例（29．0％）,淋巴瘤14例（203％）,急性髓系白血病（AML）、骨髓增生异常综合征（MDS）各10例（14．5％）,急性淋巴细胞白血病（ALL）6例（8．7％）,多发性骨髓瘤（MM）4例（5．8％）,骨髓增殖性肿瘤（MPN）3例（4．3％）,慢性淋巴细胞白血病（CLL）2例（2．9％）。病理骨髓纤维化程度与巨核细胞数之间无相关性（r=0．024,P=0．848）。结论临床上多种血液系统疾病可以引起SMF。初诊的造血系统恶性疾病患者应同时行骨髓活检,特别是脾大、骨髓“干抽”的患者要考虑SMF的可能,骨髓病理学检查对临床诊断和鉴别诊断具有重要意义。