ABSTRACT
UNLABELLED: We present the case of a patient with metastatic parathyroid carcinoma whose hypercalcaemia was medically managed through two pregnancies. The diagnosis was made when the patient presented with chronic knee pain and radiological findings consistent with a brown tumour, at the age of 30. Her corrected calcium and parathyroid hormone (PTH) levels were significantly elevated. Following localisation studies, a right parathyroidectomy was performed with histology revealing parathyroid carcinoma, adherent to thyroid tissue. Aged 33, following biochemical recurrence of disease, the patient underwent a second operation. A subsequent CT and FDG-PET revealed bibasal pulmonary metastases. Aged 35, the patient was referred to our unit for treatment of persistent hypercalcaemia. The focus of treatment at this time was debulking metastatic disease using radiofrequency ablation. Despite advice to the contrary, the patient conceived twice while taking cinacalcet. Even though there are limited available data regarding the use of cinacalcet in pregnancy, both pregnancies continued to term with the delivery of healthy infants, using intensive medical management for persistent hypercalcaemia. LEARNING POINTS: Parathyroid carcinoma is a rare cause of primary hyperparathyroidism.Hypercalcaemia during pregnancy can result in significant complications for both the mother and the foetus.The use of high-dose cinacalcet in pregnancy has been shown, in this case, to aid in the management of resistant hypercalcaemia without teratogenicity.
ABSTRACT
A simple method of treating spontaneous pneumothorax by direct aspiration is described. For patients in whom this method was considered suitable the average stay in hospital was only three days and the discomfort and inconvenience of an intercostal tube were avoided.
Subject(s)
Pneumothorax/surgery , Humans , Length of Stay , SuctionABSTRACT
This study investigates the diagnostic value of fibrinogen degradation products (FDP) in pleural fluid and serum. Thirty patients with pleural effusions due to a variety of causes were investigated. The concentration of FDP in pleural fluid was significantly higher in patients with malignancy, infection and pulmonary embolus than in patients with congestive cardiac failure. The concentration of FDP in serum was not significantly different between any of the groups. We conclude that estimation of the concentration of FDP in pleural fluid, a simple biochemical procedure, has some value in differential diagnosis of pleural effusion and complements existing tests.
