The density test for the intraoperative differentiation of single or multigland parathyroid disease

The differentiation between parathyroid adenoma and hyperplasia can be difficult even for the experienced pathologist working with definitive material. The surgeon must make this distinction at the time of surgery so that the extent of the resection can be determined.A simple density test has been used in 100 patients undergoing neck explorations for parathyroid disease. Eight tests were invalid for various technical reasons, leaving 92 for analysis. On the basis of the density test, 65 were graded as single gland disease and 27 as multi-gland disease. The extent of the resection was in accord with the density test findings. The follow-up period ranges from 9 to 64 months (mean 31.7 months). There has been 1 case of persistent hypercalcemia, but the remainder are normocalcemic. Of interest is the discrepancy between the density test grading and the histological report. To date the clinical outcome favors the density test result rather than the histological diagnosis.

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Resumen La diferenciación entre adenoma paratiroideo e hiperplasia puede ser difícil aún para el patólogo experimentado trabajando con material definitivo. El cirujano se ve obligado a realizar tal diferenciación en el momento de la operación, con el objeto de definir la magnitud de la resección que debe efectuar.Una sencilla prueba de densidad ha sido utilizada en 100 exploraciones cervicales para enfermedad paratiroidea. Ocho casos fueron invalidados del estudio por diversas razones técnicas, lo cual dejó 92 casos para análisis. Con base en la prueba de densidad, 65 casos fueron clasificados como enfermedad de glándula única, y 27 como enfermedad multiglandular. La magnitud de la resección fue definida en relación a los hallazgos en la prueba de densidad. El período de seguimiento varió entre 9 y 64 meses (promedio 31,7 meses). Se ha presentado un caso de hipercalcemia persistente; el resto se halla normocalcémico.Es de interés la discrepancia entre la gradación de la Prueba de Densidad y el informe histopatológico. Hasta el momento la evolución clínica favorece a la Prueba de Densidad sobre el diagnóstico histológico.

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Résumé La distinction entre adénome parathyroïdien et hyperplasie parathyroïdienne peut être difficile, même pour un pathologiste expérimenté disposant du matériel adéquat. Le chirurgien doit pourtant être informé de la différence au moment de l'intervention pour déterminer l'importance de la résection qu'il doit effectuer.Un test simple densitométrique a été employé dans 100 cas. Huit fois le test ne put être retenu du fait de raisons techniques mais dans 92 cas le test fut utilisable. Sur la base de ce test particulier il fut possible d'affirmer que l'hyperparathyroïdisme était le fait d'une lésion unique dans 65 cas et de lésions multiples dans 27 cas. L'étendue de la résection fut en accord avec les données du test. L'évolution postopératoire fut suivie pendant une période allant de 9 à 64 mois (31,7 mois en moyenne). Au cours de cette période un seul cas d'hypercalcémie persistante fut observé.Il est intéressant de constater la différence en faveur du test de densité par rapport aux données histologiques, l'évolution postopératoire plaidant en faveur du premier.

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Presented at the International Association of Endocrine Surgeons at Hamburg, September 1983.     

Improving Coping Skills for Self-management of Treatment Side Effects Can Reduce Antiretroviral Medication Nonadherence among People Living with HIV

Background

Human immunodeficiency virus (HIV) treatment side effects have a deleterious impact on treatment adherence, which is necessary to optimize treatment outcomes including morbidity and mortality.

Purpose

To examine the effect of the Balance Project intervention, a five-session, individually delivered HIV treatment side effects coping skills intervention on antiretroviral medication adherence.

Methods

HIV+ men and women (N?=?249) on antiretroviral therapy (ART) with self-reported high levels of ART side effect distress were randomized to intervention or treatment as usual. The primary outcome was self-reported ART adherence as measured by a combined 3-day and 30-day adherence assessment.

Results

Intent-to-treat analyses revealed a significant difference in rates of nonadherence between intervention and control participants across the follow-up time points such that those in the intervention condition were less likely to report nonadherence. Secondary analyses revealed that intervention participants were more likely to seek information about side effects and social support in efforts to cope with side effects.

Conclusions

Interventions focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects.     

Multiple Familial Pilomatrixomas in Three Generations: An Unusual Clinical Picture

Pilomatrixomas are benign cutaneous tumors derived from hair matrix cells of unclear etiology. Pilomatrixomas commonly demonstrate somatic mutations in CTNNB1, a gene coding β‐catenin, a protein involved with hair follicle development. Multiple familial pilomatrixomas rarely occur and are most often associated with autosomal dominant conditions such as myotonic dystrophy and familial adenomatous polyposis (FAP). Nine families with multiple familial pilomatrixomas and no demonstrable underlying association have been reported in the literature. We present a tenth family in which five members spanning three generations grew multiple pilomatrixomas in the absence of any previously reported associations. No evidence of myotonic dystrophy, FAP, or other known associations was found. Extreme tiredness, behavioral problems, and sensory disturbances were common features across three generations but bore no temporal relation to the pilomatrixomas. The existence of a germline mutation in CTNNB1 to explain these symptoms has yet to be shown. Pilomatrixomas are potentially cutaneous markers of significant underlying pathologies. Patients presenting with multiple or familial pilomatrixomas should be thoroughly assessed for other pathologies and offered genetic screening to ensure that important diagnoses are not overlooked.     

Subcutaneous Implantable Cardioverter Defibrillator in a Patient with Pectus Excavatum

Sudden cardiac arrest in young healthy adults has concerned the medical and social communities due to its fatal effect. Implantable cardioverter defibrillator (ICD) has been demonstrated to be an effective measure for prevention of sudden death in patients at risk of ventricular arrhythmia. Subcutaneous ICD has been developed to overcome some problems associated with transvenous leads in the conventional ICD. In this case report, we describe the use of completely subcutaneous ICD for a young patient with pectus excavatum following presentation with out‐of‐hospital VF arrest with no complication in device or lead positioning. (PACE 2013; 36:e138–e139)