Challenges in the Management of Ectopic Parathyroid Pathologies: A Case Series of Five Patients.

In primary hyperparathyroidism (PHPT) the diagnosis and treatment of ectopic parathyroid adenomas (EPTA) is a challenging process for head and neck surgeons. We present five patients with EPTA in different locations, along with an in-depth discussion of imaging modalities. We used sestamibi scintigraphy (MIBI) and ultrasound as first line imaging tools in asymptomatic hypercalcemia and PHPT. Single photon emission computed tomography (SPECT) was combined with MIBI or computed tomography (CT) if a parathyroid pathology was not localized initially. Four-dimensional parathyroid CT (4D-CT) was the last imaging modality preferred to localize the ectopic parathyroid gland. We performed focused unilateral neck exploration (FUNE) with intraoperative frozen section analysis as a routine procedure for imaging-detected lesions. Bilateral neck exploration was performed for re-exploration cases and imaging-negative cases. Histopathology confirmed EPTA and postoperative serum calcium normalized in all cases. 4D-CT is promising for ectopic parathyroid gland localization if all other imaging modalities fail. Despite the advancements in imaging, surgical experience continues to play the central role in the management of ectopic parathyroid pathologies.

Factors That May Affect Rating and Liking Scores of Septorhinoplasty Videos on YouTube.

BACKGROUND: Despite the increasing use of videos on social media platforms such as YouTube that inform patients about conditions and procedures, it is an enigma how patients benefit from these videos. Although professional healthcare providers play an important role in this regard, there are no data on video characteristics that make a video useful, or likable by the audience. We aimed to investigate that factors make a septorhinoplasty video posted on YouTube successful. MATERIALS AND METHODS: Video demographics, including type, source, length, and viewers' comments, were evaluated. Three researchers independently assessed videos on septorhinoplasty for attractiveness. Nine criteria, including preoperative nasal congestion, snoring, nasal deformity (visuality), surgical treatment, postoperative nasal congestion, bruising\swelling, pain, patient satisfaction, and medical treatment, were examined. RESULTS: The number of likes for the videos with preoperative nasal deformity data (visuality) was found to be significantly higher than that for the videos without preoperative nasal deformity (visuality) data. For the videos with surgical treatment data, the number of likes, the number of dislikes, the number of comments, and the total number of views were found to be significantly higher than those for the videos without surgical treatment data (p values 0.007, 0.016, 0.006, and 0.003 respectively). Videos with medical treatment data had a significantly higher number of comments than those without medical treatment data. CONCLUSION: The attractiveness of a video on septorhinoplasty increases when it contain both medical and surgical treatment data. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .