Giant Parathyroid Adenoma: A case Report.

Giant parathyroid adenoma (GPA) is a large tumor weighing more than 3.5 g but can weigh as much as 110 g as compared to parathyroid adenomas which usually weigh in the vicinity of 1 g and measure around 1-2 cm. These mainly present with primary hyperparathyroidism. We describe an interesting case and clinical course of a young woman with giant parathyroid adenoma. A 30-year-old Indian female presented with acute pancreatitis and acute kidney injury and was found to have hypercalcemia and hyperparathyroidism on further evaluation. Her physical examination revealed firm, non-tender, and mobile swelling of size 5 × 2 cm on the left side of her neck. USG neck showed a large heterogenous hypoechoic lesion in the left lower pole region of the left thyroid gland measuring 50 × 24 × 29 mm with a volume of 18 ccs. A parathyroid scan was performed using 99Tc Sesta MIBI tracer which was suggestive of a large adenoma in relation to the left lobe of the thyroid gland. She underwent minimally invasive parathyroidectomy with excision of left parathyroid adenoma under general anesthesia. Intraoperative frozen section confirmed the specimen to be parathyroid tissue. Her parathyroid hormone (PTH) level decreased from 1900 pg/ml in the pre-operative level to 242 pg/ml in the immediate postoperative period.

Laser-Assisted Sialolithotripsy: A Correlation of Objective and Subjective Outcomes.

OBJECTIVE: To analyze the long-term symptomatic results of laser-assisted sialolithotripsy (LAS) in cases of obstructive sialolithiasis and correlate with objective criteria using diagnostic sialendoscopy (DS) as a method of examination. METHODS: This is a retrospective study comprising 50 consecutive patients who underwent holmium-YAG LAS and completed follow-up of at least 6 months. Symptom scoring and endoscopic scoring were done at 6 weeks and 6 months intervals for further study purposes. RESULTS: At the end of 6 weeks post-LAS, 70% patients were asymptomatic (A-sym) and only 30% had residual symptoms (Sym). However, obstructed duct (OB-duct) was observed on endoscopic scoring in 88% due to stenosis, residual stones, or both stenosis and residual stones. The obstructed ducts were treated in outpatient clinic and followed up over time, leading to 98% of patients being in A-sym group at the end of study period of 6 months. At the end of study, 82% of patients had clear duct (CL-duct). CONCLUSION: Holmium LAS is a viable option for the management of intermediate-sized stones. LAS if used judiciously, and in properly selected cases, has high rate of stone fragmentation and symptom resolution. A vigilant postoperative protocol taking into account residual mealtime symptoms and altered salivary characteristics combined with early DS can help identify and treat patients with residual stone fragments and ductal stenosis. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2344-2349, 2022.

Evaluation of Association of Allergic Rhinitis with Bronchial Asthma.

Allergic rhinitis represents a global health problem. It is a common disease worldwide affecting about 10-50 % of the population and its prevalence is increasing. Although allergic rhinitis is not a fatal disease, it alters the social life of patients, affecting learning performance and work productivity. Moreover, the costs incurred by allergic rhinitis are substantial. In recent years allergic rhinitis has been recognized to be an important risk factor for asthma. The concept of "One Airway, One Disease" was highlighted in the 'Allergic rhinitis and its Impact on Asthma 'guidelines and has arisen as a result of the now well-established link between the upper and lower airways. The aim of this study was to evaluate the association between allergic rhinitis and bronchial asthma by determining the incidence of bronchial asthma in patients of allergic rhinitis and the incidence of allergic rhinitis in patients of bronchial asthma. 83 diagnosed cases each of allergic rhinitis and bronchial asthma were recruited from patients attending Otorhinolaryngology and pulmonary department of the institute. All patients were subjected to detail ENT and pulmonary examination and investigated for nasal and bronchial allergy. In the allergic group, which consisted of 83 diagnosed patients of allergic rhinitis, 49 (59.03 %) were diagnosed to have bronchial asthma, whereas in the bronchial asthma group, which consisted of 83 diagnosed patients of bronchial asthma 61 (78.20 %) were diagnosed to have comorbid allergic rhinitis. It was observed that patients with allergic rhinitis were likely to develop bronchial asthma, and patients of allergic rhinitis should be evaluated for bronchial asthma, for early detection and treatment of the co morbid condition.