The usefulness of dual phase 99mTC sestamibi parathyroid scintigraphy in pre-operative localization of parathyroid adenomas

Pre-operative localization of abnormal parathyroid tissue helps in deciding whether surgery begins with a neck or mediastinal exploration. In this study we aimed to evaluate the usefulness of parathyroid scintigraphy in pre-operative localization of parathyroid adenomas and treatment. From February 2006 to October 2008, patients with signs and symptoms of hyperparathyroidism were recruited to join the study. The study group consisted of 3 males and 8 females. All subjects had a pre-operative parathyroid scintigraphy with Tc99m Sestamibi followed by parathyroidectomy. Ten patients had a positive scintigraphic finding which correlated to the actual location of the adenoma determined during the operation. Almost all patients (10 out of 11) underwent minimally invasive parathyroidectomy (MIP) while only one patient underwent bilateral neck dissection. The average incision length was 3.73 + 0.65 cm. Only one patient had an adverse event (transient hypocalcemia and bleeding necessitating a drain) which resolved later. The average hospital stay was 2.5 + 0.7 days. Parathyroid Tc99m-sestamibi scan is a reliable, non-invasive, and cost effective imaging modality in pre-operative localization of parathyroid adenomas for first time parathyroidectomy. This can help and guide surgeons to perform focused parathyroid surgery with minimal incision, successful localization, less complications, and shorter hospital stays.

Clinical utility of dacryoscintigraphy in the assessment of nasolacrimal duct obstruction

Epiphora, or pathological overflow of tear due to obstruction in the nasolacrimal drainage system, is a common problem encountered in ophthalmology. The ophthalmologist relies mainly on symptoms to guide further diagnosis and therapy. However, there appears to be a discrepancy between the degree of discomfort experienced by the patient and the severity of pathological finding. The purpose of this study was to determine the clinical utility of dacryoscintigraphy in the assessment of nasolacrimal duct (NLD) obstruction. We retrospectively reviewed the records of 27 patients who underwent dacryoscintigraphy between July-January 2007. Thirty-six eyes in these patients had epiphora. Three eyes (8%) showed partial obstruction. On the other hand, 33/36 eyes (92%) had complete obstruction in different areas of the NLD system. Patients with complete obstruction were treated by dacryocystorhinostomy and silicon tube insertion. Patients with partial nasolacrimal duct obstruction were treated medically. Dacryoscintigraphy is a simple, non-invasive, safe and non-traumatic procedure in assessing NLD obstruction. It demonstrates anatomical pathway of tear by physiological drainage. This can aid the surgeon in localizing the site of obstruction and guide him in choosing the appropriate treatment.