Acute Extensor Tenosynovitis due to Disseminated Gonococcal Infection.

Infections from Neisseria gonorrhoeae (N. gonorrhoeae) are on the rise. Disseminated gonorrhea infections have the unique propensity for causing extensor tenosynovitis of the hand, a topic which has not recently been discussed in the plastic surgery literature. We therefore present a case report of a patient with extensor tenosynovitis of the hand from disseminated gonorrhea and review the literature. A 78-year-old man arrived in the Emergency Department with extensor tenosynovitis of the wrist, dermatitis, and polyarthralgias. He was taken to the operating room for washout of his extensor tendons at the wrist and was subsequently diagnosed with disseminated N. gonorrhoeae and treated with a third-generation cephalosporin. The patient ultimately recovered and regained normal active range of motion of the wrist. With the increasing incidence of N. gonorrhoeae, it is important for hand surgeons to recognize and treat the infection early in its course. This article serves to alert hand surgeons of the unique clinical patterns of N. gonorrhoeae infection, specifically focusing on presentations that include extensor tenosynovitis of the hand.

Incidence and prevalence of primary hyperparathyroidism in a racially mixed population.

CONTEXT: The epidemiology of primary hyperparathyroidism (PHPT) has generally been studied in Caucasian populations. OBJECTIVE: The aim was to examine the incidence and prevalence of PHPT within a racially mixed population. DESIGN: A descriptive epidemiologic study was performed. PATIENTS/SETTING: The study population included 3.5 million enrollees within Kaiser Permanente Southern California. METHODS: All patients with at least one elevated serum calcium level (>10.5 mg/dL, 2.6 mmol/L) between 1995 and 2010 were included. Cases of PHPT were identified by electronic query of laboratory values using biochemical criteria, after exclusion of secondary or renal and tertiary hyperparathyroidism cases. The incidence and prevalence rates of PHPT were calculated according to sex, race, age group by decade, and year. RESULTS: Initial case finding identified 15,234 patients with chronic hypercalcemia, 13,327 (87%) of which had PHPT as defined by elevated or inappropriately normal parathyroid hormone levels. The incidence of PHPT fluctuated from 34 to 120 per 100,000 person-years (mean 66) among women, and from 13 to 36 (mean 25) among men. With advancing age, incidence increased and sex differences became pronounced (incidence 12-24 per 100,000 for both sexes younger than 50 y; 80 and 36 per 100,000 for women and men aged 50-59 y, respectively; and 196 and 95 for women and men aged 70-79 y, respectively). The incidence of PHPT was highest among blacks (92 women; 46 men, P < .0001), followed by whites (81 women; 29 men), with rates for Asians (52 women, 28 men), Hispanics (49 women, 17 men), and other races (25 women, 6 men) being lower than that for whites (P < .0001). The prevalence of PHPT tripled during the study period, increasing from 76 to 233 per 100,000 women and from 30 to 85 per 100 000 men. Racial differences in prevalence mirrored those found in incidence. CONCLUSIONS: PHPT is the predominant cause of hypercalcemia and is increasingly prevalent. Substantial differences are found in the incidence and prevalence of PHPT between races.

Risk of advanced papillary thyroid cancer in obese patients.

OBJECTIVE To determine whether increasing body mass index (BMI) is associated with more aggressive disease and adverse surgical outcomes in patients with papillary thyroid cancer (PTC). DESIGN Retrospective review of a prospective database. SETTING Single academic tertiary care center. PATIENTS A total of 443 patients older than 18 years who underwent total thyroidectomy for PTC from January 1, 2004, through March 31, 2011, were included in the analysis. Patients were organized into 4 BMI (calculated as weight in kilograms divided by height in meters squared) groups: normal (18.5-24.9), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40). MAIN OUTCOME MEASURES Disease stage at presentation, histologic subtype, duration of anesthetic induction and extubation, duration of surgery, surgical complications, length of hospital stay, and American Society of Anesthesiologists (ASA) class. RESULTS Ages ranged from 18 to 89 years. Greater BMI was associated with more advanced disease stage at presentation (P < .001) and more aggressive PTC histopathologic subtype (P = .03). Morbidly obese patients presented more frequently with stage III or IV disease (odds ratio, 3.67; P < .001). Greater BMI was also associated with longer duration of anesthetic induction (P < .001), increased length of stay (P < .001), and higher ASA class (P < .001). Duration of surgery was not associated with BMI. There was a trend toward larger tumors with increasing BMI (P = .06). Obese BMI was associated with more preoperative vocal cord paralysis due to local invasion (odds ratio, 9.21; P = .001). CONCLUSIONS Obese patients present with more advanced stage and more aggressive forms of PTC. This finding suggests that obese patients should be screened for thyroid cancer.