Intramuscular injection of parathyroid autografts is a viable option after total parathyroidectomy.

INTRODUCTION: Surgical transplantation of parathyroid gland into muscle is an established technique after total parathyroidectomy for renal hyperparathyroidism. However, no study has examined the role of injecting parathyroid tissue in these patients. We compared the outcome of surgical transplantation of parathyroid glands by implantation ("implant") versus that of intramuscular injection ("inject"). METHODS: Patients who had total parathyroidectomy for tertiary hyperparathyroidism due to chronic renal failure from 2001-2008 are included in this study. For the implant group, a parathyroid gland is divided into 10-12 pieces (each of 2-mm in diameter) before embedding into the deltoid or brachioradialis muscle. Patients in the inject group, each had a finely minced gland injected into the deltoid. Postoperatively, the graft is deemed to be functioning if 1) serum PTH is normal, or 2) serum calcium is normal in the absence of calcium supplements or reduced dosage requirements; these assays are performed at least 1 month after initial surgery. Recurrence is defined by the presence of hyperparathyroidism requiring autograft excision. RESULTS: A total of 66 patients (23 men, 43 women) were included in the study. The implant group comprised 31 patients (mean age 49.9 +/- 14.0), and the inject group had 35 patients (mean age 49.2 +/- 10.4; P = 0.80). The mean follow-up period for implant was longer at 40.1 months compared with 16.2 months for inject (P = 0.001). Operative time for implant was slightly longer at 111 min versus 106 min for inject (P = 0.51). Graft function was achieved in 27 (87.1%) implant patients and 20 (69%) inject patients (P = 0.08). Recurrence was seen in four (12.9%) implant patients compared with one (2.9%) inject patient, after a mean period of 28.8 months. This difference was not statistically significant (P = 0.18). CONCLUSIONS: Intramuscular injection of parathyroid tissue is a feasible alternative to surgical transplantation by implantation after total parathyroidectomy in tertiary hyperparathyroidism. The injection method was slightly faster to perform. However, injection achieved a slightly lower graft function rate but the risk of autograft hyperplasia also was lower.

Acute abdominal pain secondary to retroperitoneal bleeding from a giant adrenal lipoma with review of literature.

Adrenal lipomas are rare, non-functioning benign tumours, which are primarily detected during autopsy or imaging, as asymptomatic incidentalomas. Occasionally, they can present with abdominal pain due to their large size. Imaging studies help to determine the origin, volume, composition of the lesion and presence of bleeding. Histopathology, however, is necessary to differentiate an adrenal lipoma from other fatty tumours such as myelolipoma, angiomyolipomas, teratomas and liposarcomas. We report a case of spontaneous bleeding from a giant adrenal lipoma that presented as an acute abdomen, and was initially mistaken on imaging for the more common myelolipoma. The literature is reviewed to discuss the clinical, pathological and radiological features, and the optimum therapeutic management.

Laparoscopic partial adrenalectomy for bilateral cortisol-secreting adenomas.

Bilateral cortisol-secreting adenomas are a rare cause of Cushing's syndrome. We report a case of a 35-year-old woman who presented with ACTH-independent Cushing's syndrome and bilateral adrenal adenomas. Adrenal venous sampling confirmed both adenomas to be hyper-secreting cortisol. She underwent bilateral laparoscopic adrenalectomy; total right and partial left adrenalectomies. At 2-year follow-up, she is maintained on low-dose fludrocortisone and hydrocortisone, and without recurrence of hypercorticolism. Laparoscopic partial adrenalectomy is a feasible option for this rare condition; however, long-term follow-up is needed to determine her total independence from steroid usage.

Well-differentiated epithelial thyroid cancer management in the Asia Pacific region: a report and clinical practice guideline.

CONTEXT: Thyroid cancer is among the 10 most common malignancies in populations in the Asia Pacific region, where access to various relevant health care resources varies widely. OBJECTIVE: An expert consensus conference was held to define regional patterns of practice and guidelines for optimal management of well-differentiated epithelial thyroid carcinomas. RESULTS: Practice patterns vary from country to country, as would be anticipated form their variety of ethnic and racial populations, health care systems, economies, and cultures. Thyroid cancer care is provided by a number of medical and surgical specialists, usually including endocrinologists. The thyroid surgical skills, experience, and outcomes vary widely in the region. Radioiodine is available, to a greater or lesser extent, is almost all countries. Laboratory services for thyroid function monitoring are universally accessible; thyroglobulin assays are available in most countries. Recombinant thyrotropin is approved for use in only two countries, but can be accessed in some others on a "named patient" compassionate need basis. Access to advanced imaging, for exampke, positron emission tomography (PET) scanning, is limited to a few countries. CONCLUSIONS: In light of these realities, appropriate strategies for initial treatment and postoperative monitoring of patients with thyroid cancer have been defined, and these are presented and discussed.