Surgical management of hyperparathyroidism.

OBJECTIVE: To determine the efficacy of focused parathyroidectomy for adenoma and total parathyroidectomy with forearm autotransplantation for hyperplasia in maintaining serum calcium levels. STUDY DESIGN: Observational case series. PLACE AND DURATION OF STUDY: Department of General Surgery (Ward-2), Jinnah Postgraduate Medical Centre, Karachi, from January, 2002 to December, 2004. PATIENTS AND METHODS: Sixteen patients were admitted in this time period. Eleven of these patients had primary hyperparathyroidism and 4 had secondary hyperparathyroidism due to chronic renal failure. Pre-operative localization was done with Sestamibi scan and ultrasound of neck while methylene blue was used for intra-operative localization. All patients with primary hyperparathyroidism had single gland disease and were treated with focused parathyroidectomy. In 4 patients with parathyroid hyperplasia, total parathyroidectomy with forearm autotransplantation was done. RESULTS: In the postoperative period, 3 patients developed hypocalcemia but they were managed on oral calcium and vitamin-D supplements. All of the remaining patients became normocalcaemic and there were no major complications. Mean hospital stay was 7-days. CONCLUSION: Focused parathyroidectomy for single gland disease and total parathyroidectomy with forearm auto-transplantation for hyperplasia was a satisfactory treatment for patients in this series.

Ileosigmoid knotting.

Ileosigmoid knotting or compound volvulus is a very uncommon cause of intestinal obstruction, which is associated with significant morbidity and mortality. A case of compound volvulus is reported in a 24 years old male patient who presented with diagnostic dilemma.