Management of concomitant hyperparathyroidism and thyroid lesions

The coexistance of thyroid diseases with hyperparathyroidism [HPT] can present a challenge in clinical diagnoses and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with HPT, and to analyze the clinical features, diagnosis and treatment of these patients. Thirty patients with hyperparathyroidism were diagnosed and studied in El-Menofia University Hospital in the period from October 2000 to October 2006. Laboratory investigations including serum calcium and parathormone level were established, again localization with neck U/S and technetium-99-Sestamibi. Scan concomitant thyroid disease was also detected. Surgical management was done. Sixteen cases of a total of 30 HPT patients who had synchronous thyroid and parathyroid pathology were managed in this study. Fifteen of them were treated surgically by thyroidectomy and parathyroidectomy and one of them was treated with parathyroidectomy only. During surgery two other thyroid pathology were discovered and two parathyroid found to be intrathyroidal, so we have 19 thyroidectomies; five hemithyroidectomy [26.3%], 13 subtotal thyroidectomy [68.4%] and one total thyroidectomy [5.3%] the pathological diagnosis of concomitant thyroid lesions were nodular goitre in 11 cases [36.7%], follicular adenoma in 2 cases [6.7%] grave's disease in one case [3.3%], one case of thyroiditis [3.3%] and follicular carcinoma in one patient [3.3%]. These result were discussed. we conclude that there is high incidence of concomitant lesions in cases of hyperparathyroidism and we recommend simultaneous ultrasound and TC[99m] Sestamibi scan for better diagnosis and management

Experience with vascular delay in unipedicled transverse rectus abdominis myocutaneous flap breast reconstruction

The transverse rectus abdominis myocutaneous flap [TRAM] is a popular method of autologous breast reconstruction that results in a soft, natural looking ptotic breast and does not need addition prosthetic volume replacement giving an excellent cosmetic result, however, ischaemic related complications including partial-or total flap loss and fat necrosis continue to occur. In this report we describe our experience in TRAM flap breast reconstruction using vascular delay in high-risk patients in an effort to decrease ischaemic related flap complications. Nineteen patients underwent unilateral breast reconstruction using a unipedicled vascular delay TRAM flap between March, 1997 and May, 2000. All patients had one or more risk factors including obesity, previous irradiation, chronic cigarette smoking,diabetes or abdominal scars. Eleven cases had mastectomy with vascular delay then reconstruction while 8 had reconstruction done- after completion of their.adjuvant therapy There. Were nmo cases with total flap loss. We had one case with partial flap loss needing debridment and secondary sutures and one with a patch of epidermal sloughing which responded to conservative measures. Minimal fat necrosis was seen in one case. There was no mortality in our cases and the cosmetic results and patient satisfaction ranged from satisfactory to excellent. We believe that vascular delay and unipedicled TRAM flap reconstruction of the breast in high-risk patients is a simple, reliable procedure with a predictable outcome and satisfactory results. Its only drawback is the need for 2 surgical procedures which is a small price to pay especially in high-risk patients who have a very high flap complication rate using other methods of reconstruction