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Objective:To compare the changes of serum calcium level before and after surgical resection in patients with primary hyperparathyroidism.Methods:Two hundred and seventy-one patients with primary hyperparathyroidism were enrolled from Dec 1992 to Dec 2020 in Beijing Jishuitan Hospital. Serum calcium concentrations were measured before operation, 20 min during surgery, then 2 weeks 1-6 months , 7-12 months and 1 year respectively after operation. The baseline data of postoperative serum calcium such as sex, age, other genetic endocrine diseases, osteopathia and urolithiasis were calculated. The generalized estimation equation was used to analyze the changes of serum calcium in different types of patients before and after operation.Results:The most common postoperative hypocalcemia occurred within 2 weeks, and it occurred frequently half a year after surgery. There was no significant difference in blood calcium between male patients ( t=0.875, P=1.000) and patients with bone lesions ( t=0.034, P=3.049) from 1 to 6 months after surgery and 2 weeks after surgery. Blood calcium level in patients aged 15-35 years old from 1 to 6 months ( t=0.239, P=1.000) , from 7 to 12 months ( t=1.380, P=0.935) and 2 weeks after surgery was not statistically different. The change of bone mineral density was correlated with the change of blood calcium after operation ( F=6.895, P=0.004). Conclusions:The incidence of hypocalcemia was the highest in patients with hyperparathyroidism 2 weeks after surgery, and the blood calcium level was stable within the normal range 1 year later. The blood calcium value of male patients was still at a lower level than that of female patients within six months after surgery. In patients with bone disease, the blood calcium value was lower and recovered slowly 2 weeks after surgery. The blood calcium value of patients aged 15-35 was at a low level within 1 year after surgery.
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Objective:To analyze the clinical and pathological features of asymptomatic primary hyperparathyroidism (PHPT) .Methods:A retrospective analysis was carried out in terms of the clinical characteristics and pathological data in 30 patients with asymptomatic PHPT and 86 patients with typical PHPT hospitalized in the Department of Endocrinology and General Surgery of Beijing Jishuitan Hospital from Jan. 2013 to Dec. 2018. There were 7 males (23.3%) and 23 females (76.7%) , with a male to female ratio of 1:3.3. The average age was 56.9±13.3 years. In typical PHPT group, there were 32 males (37.2%) and 54 females (62.8%) , with the average age of 46.4±17.0 years. Bone metabolism indicators included bone density and bone biochemical markers (parathyroid hormone, 25-hydroxyvitamin D and alkaline phosphatase) . The t test was used to compare normally distributed variables, the Mann-Whitney rank sum test was used to compare skewed distributed variables, and the χ 2 test was used to compare enumeration data. Results:The median serum parathyroid hormone and alkaline phosphatase were 144.2 (108.1, 207.0) pg/ml and 80.0 (53.7, 105.5) IU/L respectively, the average serum concentration of calcium was 2.80±0.20 mmol/L, which were significantly lower than those of the classic group ( P<0.05) . The median serum 25-hydroxyvitamin D was 12.14 (7.87, 14.38) ng/ml, which was higher than that of the classic group ( P<0.001) . Ten patients (33.3%) developed osteoporosis, and the incidence was lower than that of the classic group ( P< 0.001) . The median tumor weight was 0.80 (0.25, 1.98) g, significantly smaller than that in the classical group ( P=0.003) . There were 26 cases (86.7%, including 2 atypical parathyroid adenomas) of parathyroid adenomas and 4 cases (13.3%) of hyperplasia. Conclusions:The asymptomatic PHPT has the same sex ratio as the classic type, mainly female, but the average age is significantly higher than that in the classic type. Although asymptomatic PHPT in this study are all benign lesions, abnormal bone biochemical indicators, especially vitamin D deficiency, are common, which also lead to osteoporosis.
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Objectiv:To evaluate ultrasound, radionuclide imaging and CT in preoperative localization diagnosis of primary hyperparathyroidism (PHPT).Method:A total of 170 PHPT patients admitted to the hospital between Jan 1992 and Dec 2020 were analyzed retrospectively. The preoperative localization diagnostic efficacy of ultrasonography, radionuclide and CT alone and in combination was compared in groups.Results:The overall sensitivity of ultrasound, radionuclide and CT were 82.13%,80.43% and 75.74%. For normal positioned parathyroid adenoma: as for sensitivity of location diagnosis, ultrasound (86.67%) was higher than radionuclide (81.82%, P<0.05) and CT (80.59%, P<0.05), ultrasound/CT parallel test (94.70%, P<0.05) was higher than ultrasound alone. For specificity of location diagnosis, radionuclide (97.78%) was higher than ultrasound (91.62%) and CT (93.39%), both ultrasound/radionuclide series tests (99.00%, P<0.001)and ultrasound/CT series tests (96.94%, P<0.001) were higher than ultrasound alone. In case of ectopic parathyroid adenoma and parathyroid hyperplasia: the sensitivity and specificity of radionuclide seemed higher than ultrasound and CT. Conclusions:Ultrasound is the first choice for preoperative location diagnosis of PHPT. Ultrasound combined with radionuclide or CT can significantly improve the diagnostic efficiency of parathyroid lesions.
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Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) represents the most common mode by which children acquire HBV infection. For pregnant women with high viral load and positive hepatitis B e antigen (HBeAg), antiviral therapy during late pregnancy combined with timely and standardized inoculation of neonatal hepatitis B immunoglobulin and hepatitis B vaccine can minimize the possibility of MTCT of HBV. This review focuses on using and withdrawing antiviral drugs during pregnancy, managing postpartum hepatitis, and breastfeeding issues to further optimize the combined immunization and antiviral treatment strategies and seek the optimal solution to preventing MTCT of HBV.
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Hyperparathyroidism is a secondary or primary endocrine disorder.In recent years,the incidence of hyperparathyroidism in China is increasing.Clinical manifestations tend to be multi-systemic injuries,which poses challenges for patients and clinicians.At the same time,with the advancement of medical science and technology,new detection means and innovative therapies are emerging.In this paper,recent progress of diagnosis and treatments is reviewed to provide basis for clinical work.
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Objective To explore the effect of thrombolysis with anticoagulation treatment for early stage of posttraumatic and postoperative deep vein thrombosis of lower extremity. Methods The clinical data of 38 palients with early stage of posttraumatic and postoperative deep vein thrombosis(DVT) of lower extemity treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results The thrombolytic effect was significant. After the treatment, the deep veins were recanalization without regorging in 71.0% of patients. The total effective rate was 100%. Only one patient had hemorrhagic complication, two patients had symptomatic pulmonary embolism,but none of the patients died. Conclusions Thrombolysis with anticoagulation is an effective and safe method for posttraumatic and postoperative DVT in the early stage.