THE VOLUME OF SOLITARY PARATHYROID ADENOMA IS RELATED TO PREOPERATIVE PTH AND 25OH-D3, BUT NOT TO CALCIUM LEVELS.

PURPOSE: To correlate the volume of parathyroid adenomas with the hormonal and metabolic profile at patients diagnosed with primary hyperparathyroidism (pHPTH). PATIENTS AND METHODS: Cross-sectional multicentric study, enrolling 52 patients with pHPTH from two medical institutions. Serum calcium and PTH were evaluated in all patients before surgery, whereas 25OHD3 was measured only in the 33 patients recruited form one medical unit. The volume of parathyroid adenoma was measured by using the formula of a rotating ellipsoid. RESULTS: We observed a significant correlation of the volume of parathyroid adenomas with PTH at patients from the two units and in the whole group (p < 0.0001), but not with serum calcium (p = 0.494). Twenty-five out of the 33 patients at whom 25OHD3 was measured had levels in the range of deficiency. 25OHD3 was not correlated with PTH or calcium levels, but was negatively correlated to the adenoma volume and positively to the PTH/volume ratio (p = 0.041 and p = 0.048, respectively). CONCLUSIONS: The volume of parathyroid adenoma seems to be related to preoperative PTH and 25OHD3, but not to calcium level. Vitamin D deficiency is frequently found at patients with pHPTH and may contribute to particular disease profiles, including larger parathyroid adenomas.

ATYPICAL PRIMARY HYPERPARATHYROIDISM DUE TO HYPOVITAMINOSIS D.

Vitamin D deficiency is nowadays very common in the general population and also in patients with primary hyperparathyroidism. Hypovitaminosis D may modify the clinical features and the severity of primary hyperparathyroidism. We present the case of a 75-year-old woman with a 10 year history of nephrolithiasis and severe osteoporosis, with multiple fragility fractures. Her bone and kidney status required a more thorough metabolic assessment. Despite minimal changes in serum calcium and phosphate levels, parathyroid hormone (PTH) level was markedly elevated. Ultrasound and specific Sesta-MIBI scintigraphy diagnosed and localized a left parathyroid adenoma. Vitamin D assessment showed levels in the range of hypovitaminosis. Vitamin D deficiency may mask hypercalcemia despite high serum PTH levels, and does not seem to diminish but on the contrary increases the risk of kidney lithiasis, as well as the deleterious effects of hyperparathyroidism on bone.

[Distal pancreatectomy with spleen preservation in a pseudopapillary pancreatic tumor case]. / Pancreatectomia corporeocaudala cu prezervarea splinei intr-un caz de tumora solida pseudopapilara de pancreas.

Pseudopapillary pancreatic tumors represent about 1-2% of all exocrine pancreatic tumors, studies in the literature about this type of tumor is limited. We present a female patient of 18 years hospitalized for nonspecific abdominal symptoms, diagnosed with corporeal pancreatic tumor approximately 3-4 cm. It takes practice surgical distal pancreatectomy with spleen preservation, pathological examination revealing a pseudopapillary pancreatic tumor. Postoperative evolution was favorable. Distal pancreatectomy with spleen preservation was indicated due to patient age.

[Radical neck dissection in advanced thyroid cancer]. / Disectia radicala a gâtului in cancerul tiroidian avansat.

We try to ascertain whether total thyroidectomy with radical neck dissection offers a survival and recurrency advantage for thyroid cancer. Between January 2000 and September 2009 in the 3rd Surgical Unit of the "Sf. Spiridon" Hospital of Iasi 189 operations were performed for malign thyroid disorders, 164 (86,77%) of which were performed for the papillary or foliculary cancer. The diagnosis was confirmed by hystopathological examination. The patients had a medium age of 51,48 (extremes 19 - 81 years). Women had a greater proportion, as expected (sex ratio F:M = 2,85:1). 59 total thyroidectomy with radical or modified radical neck dissection were performed. There were immediate (6 bleedings which needed reoperation for haemostasis, 7 unilateral recurrent laryngeal nerve injury) and late complications (8 cases of recurrency in the first 2 years). Total thyroidectomy with radical neck dissection became the ellective method for advanced thyroid cancer (the best results were for papillary cancer, female and age over 55).

[Rare caecal pseudotumours]. / Pseudotumora cecala de cauza rara.

Among the rarely caecal pseudotumours are those caused by a coagulation disorder. The clinical course of caecal pseudotumours is highly variable. Most patients are diagnosed with acute appendicitis, but the real diagnosis is confirmed after laboratory investigation and histopathologic exam. Our patient presented the symptoms of an inferior digestive bleeding. The persistence of the clinical symptoms and the haematological degradation determined the surgical intervention. Intraoperative were found two caecal tumours. The hystological exam, biochemical and haematological analysis worked up the final diagnosis: a caecal pseudotumour in the context of Antithrombin III deficiency.