Severe hyperparathyroidism versus parathyroid carcinoma: a clinical dilemma

No clinical or laboratory data allow a preoperative diagnosis of parathyroid carcinoma and only occasionally does a definitive finding differentiate an adenoma from a carcinoma. We present a case of primary hyperparathyroidism presenting with severe elevation of parathyroid hormone and serum calcium as well as complications. We go on to discuss the case in the light of a literature review. The severity of the elevation of the parathyroid hormone, other biochemical alterations, the presence of skeletal and renal complications and of a neck mass should alert the clinician to a possible parathyroid carcinoma. Radical surgery is the only effective therapy for parathyroid carcinoma, and should always be performed if a preoperative suspicion is entertained

Comparative analysis and interobserver variation of unenhanced computed tomography and intravenous urography in the diagnosis of acute flank pain

The purpose of this study was to compare unenhanced computed tomography [UECT] to intravenous urography [IVU] for detecting urinary tract calculi, signs of obstruction and non-renal causes in the assessment of acute flank pain, and in their interobserver agreement. In this prospective study, carried out at a university hospital over a period of 1 year, 36 patients [27 males and 9 females] participated. Mean age was 44 +/- 15 years [range: 14-73 years].The patients presented with acute flank pain and underwent UECT and IVU. The images were blindly evaluated by 2 experienced radiologists and the two techniques compared using the two-tailed McNemar's test for matched pairs; p values <0.05 were considered significant. UECT detected stones in 11 [30.6%] patients, while IVU found them in only 8 [22.2%]. The increased detection by UECT was due to its ability to detect smaller stones [<6 mm]. UECT was also found to be better than IVU in determining calculus position, in detecting primary or secondary signs of obstruction and in identifying non-urinary causes of flank pain. The overall average of agreement as indicated by kappa values, was 0.88 for UECT and 0.61 for IVU. UECT showed better detectability and interobserver agreement than IVU, suggesting that UECT could replace IVU as the first imaging modality in the evaluation of acute renal colic