Scan-directed mini-incision focused parathyroidectomy: how accurate is accurate enough?

INTRODUCTION Mini-incision focused parathyroidectomy (MI-FP) is advocated as an alternative to bilateral neck exploration (BNE), owing to its reduced morbidity. The site and side of the affected gland is identified preoperatively using a combination of ultrasound and sestamibi scans. However, the acceptable degree of inter-scan concordance required to prompt MI-FP without compromising accuracy is undetermined. METHODS Accuracy of preoperative imaging was determined both individually and in combination for all parathyroidectomies (2007-2014). A grading system (excellent, good, poor) was devised to describe the interscan concordance, which was validated by the operative and histological findings. RESULTS Eighty-nine patients (17 male, 68 female) underwent parathyroidectomy (MI-FP 44, BNE 45). The accuracy of scans interpreted individually was 53% for ultrasound and 60% for sestamibi, with no difference according to surgical technique (P = 0.43, P = 1, respectively). The proportion of interscan concordance was: excellent - 35%, good - 40%, poor 25%. Combined accuracy was 100% for both excellent and good grades but only 13% for those graded poor. Similar rates of normocalcaemia were observed for MI-FP and BNE, while postoperative hypocalcaemia was five times higher in those undergoing BNE. CONCLUSIONS Reduction in the inter-scan concordance from excellent to good does not compromise accuracy. MI-FP could be successfully performed in up to 75% of patients - 25% higher than recommended in national guidelines. Focused parathyroidectomy does not compromise surgical and endocrinological outcomes but boasts a far superior complication rate.

The superior and inferior salivatory nuclei in the rat.

The locations of the inferior and superior salivatory nuclei in the rat were determined by bathing the tympanic branch of the glossopharyngeal nerve and the chorda tympani with horseradish peroxidase (HRP) in different series of rats. The results demonstrated that the salivatory nuclei extend from the rostral medulla through the caudal pons. The inferior salivatory nucleus is composed of small to medium-sized neurons located in the ventrolateral portion of the reticular formation. It extends from a level at the rostral border of the nucleus ambiguus to the caudal part of the genu of the facial nerve. The superior salivatory nucleus differs in that it is composed of small to medium-sized neurons located in the dorsolateral portion of the reticular formation. It extends from a level at the caudal border of the facial nucleus through the genu of the facial nerve.

Device for helical marking of cylindrical specimens.

A device is described for holding and scratching to variable depth, small diameter wires extruded from soft metals. Drawings and relative dimensions are shown. Adescription of the helical guide strips used in the device is also contained.