Giant parathyroid adenoma presenting with multiple pathologic fractures: A case report.

Key Clinical Message: Hyperparathyroidism is a common endocrine disorder, which must be suspected in patients presenting with fatigue, history of pathologic fracture and the diagnosis can be confirmed by elevated calcium and PTH levels, and the preferred treatment option. Abstract: Primary hyperparathyroidism (PHPT), a common endocrine condition, with elevated parathormone production causes increased blood calcium levels. Parathyroid adenomas cause the majority of PHPT cases. Significant hypercalcemia can result from giant parathyroid adenomas. A calcium crisis may not always arise in these individuals, despite enormous parathyroid adenomas and high parathyroid hormone levels, and the masses may first be mistaken for a thyroid mass. In this article, we discuss the case of a 57-year-old Iranian man who suffered from PHPT due to a massive parathyroid adenoma and had a history of extreme fatigue and several traumatic fractures. As specialists, we should have a strong clinical suspicion of giant parathyroid adenoma as reason of hyperparathyroidism. In patients with multiple bone problems such as pain and multiple pathological fractures and elevated levels of calcium and PTH, the diagnosis of GPA must be considered and their preferred treatment is surgery.

Comparison of vestibular rehabilitation on balance function in cochlear implant recipients.

Cochlear Implantation (CI) is an effective surgical approach to rehabilitate the deaf patients. However, the insertion of an electrode into the cochlea may have an adverse effect on vestibular receptors, resulting in vertigo or dizziness. The present study is aimed to investigate the impacts of vestibular rehabilitation therapy (VRT) exercises on dizziness symptoms of patients who underwent CIlimb.

Investigating the Effects of Vestibular Rehabilitation on Balance Function in Cochlear Implant Recipients.

BACKGROUND: Cochlear Implantation (CI) is an effective surgical approach to rehabilitate the severe to profound hearing-impaired patients. However, the insertion of CI electrodes into the cochlea may adversely affect vestibular receptors, resulting in vertigo or dizziness. The present study aimed to investigate the impacts of Vestibular Rehabilitation Therapy (VRT) exercises on dizziness symptoms of patients who underwent CI. METHODS: A total of 21 consecutive patients (age range: 28 to 61 years) with profound sensorineural hearing loss undergoing CI operation participated. The VRT therapy plan consisted of a habituation and adaptation exercises in combination with gait and balance exercises. The handicapping influences of dizziness was measured using a Dizziness Handicap Inventory (DHI) scale to measure the level of respondent's performance on physical, emotional, and functional dimensions. Visual Analogue Scale (VAS) was also conducted to assess the severity of dizziness symptoms. The DHI and VAS scales were conducted before VRT and at "oneweek", "two-week", and "four-week" following the last rehabilitation session. RESULTS: A repeated-measure analysis of variance demonstrated a significant decrement and a consequent improvement in DHI scores after vestibular exercises in all emotional, physical and functional domains (p < 0.001). We also found that the influence of implanted ear (p=0.076) and gender (p=0.094) variables on DHI scores were not statistically significant. The mean VAS score was 5.87 ± 2.27 at baseline stage and it reduced significantly during the course of the therapy (second week, 2.02 ±1.75, p < 0.001; and forth week, 1.51 ± 1.29, p < 0.001). CONCLUSION: The findings of this study showed that vestibular rehabilitation therapy has a positive impact on the symptoms of the patients who underwent CI surgery. These exercises lead to an improvement in balance and postural stability, and a reduction in the self-report measure of handicaps. These findings provide the basis for better pre-operative counseling and postoperative vestibular rehabilitation to CI recipients.

Prevalence of rhinovirus and respiratory syncytial virus among patients with chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common chronic illnesses, but the etiology and pathogenesis of CRS are not well understood. Few studies have been carried out on the role of viruses in patients with chronic sinusitis so far. OBJECTIVES: Regarding the high number of patients, we intended to evaluate the prevalence of rhinovirus and respiratory syncytial virus in patients with CRS. Doing so, we may pave the way for definitely achieving the causes and factors of the disease and consequently definite treatment of this debilitating disease in future studies. PATIENTS AND METHODS: This cross-sectional study was carried out on 76 patients. Sample of the study consisted of patients with CRS who were candidates for functional endoscopic sinus surgery (FESS). The specimens were collected during FESS between February 2013 and December 2013. For this purpose, after entering into sinuses, the specimens were collected from their mucus. They were then placed in Dulbecco's modified Eagle's viral transport medium (DMEM). They were transferred to the virology lab of the university in a cold chain. The specimens were maintained in -70°C before examination. Reverse transcriptase-polymerase chain reaction (RT-PCR) was applied to explore the presence of rhinovirus and respiratory syncytial virus. RESULTS: In this study, 76 patients with rhinosinusitis underwent FESS as qualified candidates. The sample of the study consisted of 48 males (63.2%) and 28 females (36.8%) with the mean age of 44.3 years and an age range of 19-76 years. Among the 76 patients, 53 were with polyps and 23 without polyps. Among the patients, 66 were candidates of FESS for the first time. Other 11 patients had previously undergone the surgery. The results from PCR indicated that 22 (28.94%) patients had rhinovirus and 9 (11.84%) had respiratory syncytial virus (RSV). A total of 25 patients (32.89%) had one of the two viruses. In 6 (7.89%) specimens, both viruses were reported. CONCLUSIONS: CRS is a common disease with negative effects on the quality of patients' lives. This study showed the high prevalence of these two common respiratory viruses in patients with CRS.

Can clonidine as a pre-anaesthetic drug decrease bleeding during rhinoplasty surgery?

Clonidine is an antihypertensive drug which acts through facilitation of Alph-2 post-synaptic receptors and in addition to its antihypertensive, anti-anxiety and analgesic effects, its beneficial effects in reducing the bleeding during Neurosurgery and Orthopedics surgeries, delicate surgeries of ear and nasal and sinus endoscopy have been proved. In this study we discuss the effects of this drug in reducing bleeding during rhinoplasty surgery. A double-blinded clinical trial 80 patients have been conducted 40 patients received 5 µg/Kg of oral Clonidine, and 40 patients where placebo. The patients after surgery were divided into 4 groups according to the number of bloody standard gauzes during the surgery. Group 1(less than 2 bloody gauzes), group 2(2-3 bloody gauzes), group 3(4-5 bloody gauzes), group 4(more than 5 bloody gauzes). All the graded achieved results were analyzed using Chi-Square test and Fisher test. Mean and standard deviation (SD) of the amount of bleeding in the group who were receiving Clonidine were less than the witness group. Number of the patients in groups 3 and 4 for those who were receiving Clonidine was obviously fewer (1.8 ± 0.04 vs. 3.1 ± 0.05), (P < 0.05). Oral Clonidine as a pre-anesthetic drug causes decrease in bleeding during rhinoplasty surgery.

Sinonasal headaches and post-operative outcomes after septoplasty in patients with nasal septal deviation.

INTRODUCTION: Investigators believe that anatomical abnormalities in the sinonasal region can be the cause of some chronic and refractory headaches that may respond well to surgical intervention. This study presents the prevalence of headache in patients with nasal septal deviation and their response to surgical treatment over a 2-year follow-up period. MATERIALS AND METHODS: This descriptive and prospective study was conducted on 98 patients with nasal septal deviation who underwent septoplasty surgery in the Imam Hospital in Ahwaz. Preoperative information was acquired by asking the patients and by completing SNOT-20 questionnaires by patients. After the surgery, information about changes in the quality of headache in patients with dominant contact points in preoperative nasal endoscopy whose headache responded to topical anaesthesia with lidocaine 2%+naphazoline 0.5% was collected over a 2-year follow-up. Final data were analyzed by SPSS and descriptive statistics. RESULTS: Ninety-eight patients were studied, comprising 58.2% men and 41.8% women. They ranged in age between 18 and 46 years (mean=24). Nasal obstruction (72.4%), snoring (58.1%), headache (46%) and epistaxis (17.3%) were the most frequent preoperative symptoms. The most common site of the headache was the frontal region (68.8%). Patients' headache was bilateral in 71.1% of cases. In 82.2% of patients, headache lasted less than four hours a day. The headache was pulsatile in 53.3%, sharp in 31.2% and compressive in 15.5% of cases. In the post-operative assessment, despite gradual decline in the referral patients for follow-up, a notable and gradual recovery in patients' headache was seen with 82.8% of the patients reporting complete or partial recovery of the headache at the end of the 2-year follow-up. CONCLUSION: Headache is one of the most common symptoms in patients with nasal anatomical abnormalities such as septal deviation and usually responds well to surgical treatment. More studies with long-term follow-ups seems to be inevitable to determine the relationship between headaches and nasal anatomical abnormalities, accurate surgical results in patients' recovery and the recurrence rate of headaches.

Pathologic fractures: a neglected clinical feature of parathyroid adenoma.

The pattern of clinical presentation of primary hyperparathyroidism (pHPT) has changed dramatically from a severe disease to an asymptomatic condition in Western countries. The story is completely different in Eastern countries. Bone and joint related sign and symptoms like bone pain and multiple fractures are common in these patients. Imaging and nuclear medicine studies will be helpful specially in patient who candidate for surgical removal of the abnormal parathyroid gland. Here, we present a 48-year-old man with multiple typical fractures in long bones and a single adenoma in his right inferior parathyroid gland. pHPT is a severe, symptomatic disease with serious complications and high morbidity in Iran. Advanced skeletal disease is the most common pattern of presentation.

Foreign body aspirations in infancy: a 20-year experience.

OBJECTIVE: Foreign body aspirations comprise the majority of accidental deaths in childhood. Diagnostic delay may cause an increase in mortality and morbidity in cases without acute respiratory failure. We report our diagnostic and compare the relevant studies available in literature to our results. METHODS: In our Hospital, bronchoscopy was performed on 1015 patients with the diagnosis of foreign body aspirations (from 1998 to 2008). Of these cases, 63.5% were male and 36.5% female. Their ages ranged from 2 months to 9 years (mean 2.3 years). Diagnosis was made on history, physical examination, radiological methods and bronchoscopy. RESULTS: Foreign bodies were localized in the right main bronchus in 560 (55.1%) patients followed by left main bronchus in 191 (18.8%), trachea in 173 (17.1%), vocal cord in 75 (7.4%) and both bronchus in 16 (1.6%). Foreign body was not found during bronchoscopy in 48 cases (8.7%). The majority of the foreign bodies were seeds. Foreign bodies were removed with bronchoscopy in all cases. Pneumonia occurs in only 2.9% (29/1015) patients out of our cases. CONCLUSION: Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications. Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory.