Evaluation of preoperative localization of parathyroid adenoma using [99m]tc-sestamibi scintigraphy as a single diagnostic modality for patients with primary hyperparathyroidism

This- study was designed to evaluate the diagnostic yield of Technetium-99m hexakis methoxyisobutylisonitrile [Tc-99m-MIBI] scintigraphy in patients with primary hyperparathyroidism [PHPT] for identification of the site of parathyroid adenoma compared versus operative and histopathological findings. The study included 23 cases with PHPT; 5 nales and 8 females with mean age of 56.5 +/- 10.3; range: 39-69 years. Preoperative scanning using [99m]Tc-sestamibi was done. All patients underwent surgical exploration after methylene blue transfusion. Imaging data were compared with intraoperative finding. All identified and excised glands were sent for histopathological examination. Preoperative sestamibi scan defined a case with mediastinal parathyroid gland and another active cervical gland in 2 patients with persistent and recurrent hypercalcaemia, respectively. Preoperative sestamibi scan defined 6 cases with single parathyroid adenoma in each case, while surgical exploration defined 7 parathyroid adenomata; 5 cases had solitary adenoma and one case had adenoma in 2 parathyroid glands both stained blue after methylene blue infusion. Thus, sestamibi scan defined solitary parathyroid adenomas with an accuracy rate of 83.3%. However, sestamibi scan defined 3 cases with adenoma in 2 parathyroid glands and 2 cases had adenoma in 3 glands. Surgical exploration defined adenoma that confirmed histopathologically in 9 glands of the 12 identified by sestamibi scan; 4 cases had 2 adenomas and one case had one solitary adenoma, the other 3 glands showed only hyperplasia without adenoma formation. Thus, sestamibi scan defined multiple parathyroid adenomos with an accuracy rate of 75%. It could be concluded that preoperative localization of parathyroid gland depending on preoperative sestamibi scan could identify ectopic active glands with accuracy 100% and active cervical glands with an overall accuracy rate of 79.2% and concomitant intraoperative methylene blue localization allowed detection of active glands missed by preoperative sestamibi scan

Non-operative managementof blunt hepatic trauma :results of a prospective trial

Background: It has been shown that bleeding from injured liver cancease spontaneously, in the majority of blunt hepatic trauma. The aim ofthe study was to evaluate the criteria of non-operative management forpatients with blunt hepatic injury

Study design:Thirty five patients with blunt hepatic trauma were selected for non-operative management from January 2003 to October2005. All patients were hemodynamically stable and admitted to the Intensive Care Unit [ICU] for the first 24-72 hours. They were subjected toresuscitation, close observation, serial laboratory investigations and scanning assessment

Results: Thirty five patients with liver injuries were classified according to CT findings into grade I in 2 patients [6%], grade II in 11 patients[31%], grade III in 12 patients [34%] and grade IV in 10 patients [29%]. CTscan revealed minor hemoperitoneum in 8 patients [22.8%], moderate he-moperitoneum in 10 patients [28.6%] and major hemoperitoneum in 10 patients [28.6%]. Liver enzymes ALT and AST levels at admission weresignificantly correlated to the grade of the hepatic injury. Non-operativemanagement succeeded in 28 patients [80%] of patients with blunt hepatic trauma while 3 patients [8.6%] required laparotomy after initial successof non-operative management. Percutaneous guided drainage was required for 4 patients [11.4%] with localized collection. The mortality ratewas 2.8%

Conclusion: Minimal intervention is the policy of treating blunt hepaticinjuries in hemodynamically stable patients. It requires strict clinical,hemdynamic, and scanning monitoring, in a centre with intensive care facilities and immediate access to the operating room