Management of severe and symptomatic primary hyperparathyroidism in the first trimester of unplanned pregnancy.

Summary: Primary hyperparathyroidism (PHP) is the most common aetiology for hypercalcaemia. The incidence of PHP in pregnant women is reported to be 8/100 000 population/year. It presents a threat to the health of both mother (hyperemesis, nephrolithiasis) and fetus (fetal death, congenital malformations, and neonatal severe hypocalcaemia-induced tetany). However, there is a lack of clear guidance on the management of primary hyperparathyroidism in pregnancy. In this study, we describe the case of a 26-year-old female patient who presented with severe hypercalcaemia secondary to PHP and underwent successful parathyroid adenectomy under local anaesthesia. Learning points: Primary hyperparathyroidism is a rare complication in pregnancy, but the consequences for mother and fetus can be severe. A perceived risk of general anaesthesia to the fetus in the first trimester has resulted in a general consensus to delay parathyroid surgery to the second trimester when possible - although the increased risk of fetal loss may occur before planned surgery. If the patient presents with severe or symptomatic hypercalcaemia, minimally invasive surgery under local anaesthetic should be considered regardless of the gestational age of the pregnancy.

Incidence and predictive factors for positive 75SeHCAT test: improving the diagnosis of bile acid diarrhoea.

AIMS: To determine the value of 75SeHCAT retention in determining bile acid diarrhoea (BAD), treatment response and predictors of a positive result. METHODS: Retrospective casenote review of consecutive patients undergoing 75SeHCAT from 2008 to 2014, including gender, age, history, clinical, and laboratory parameters. This included diseases associated with Type 1 BAD (ileal resection, Crohn's disease) and Type 3 BAD. Chi-squared test and logistic regression determined factors predictive of BAD. Subjective response to treatment with bile acid sequestrants (BAS) was analysed with respect to the 75SeHCAT result. RESULTS: Of 387 patients, 154 (39.7%) were male and average age was 50 years. Ninety-five patients (24.5%) were investigated for Type 1 BAD, 86 (22.2%) for Type 3, and 206 patients (53.2%) for Type 2 or idiopathic BAD. There was a large increase in the number performed with time but no difference in percentage positive tests. One hundred and seventy-nine patients (46.2%) had BAD. Positive result was commonest in possible Type 1 and they had most severe BAD. Ninety-nine patients had severe BAD (<5% 75SeHCAT retention), 47 moderate BAD (5% to <10% retention), and 33 mild BAD (10% to <15% retention). Predictors of a positive 75SeHCAT were right hemicolectomy (OR 4.88), cholecystectomy (OR 2.44), and Crohn's (OR 1.86). A positive 75SeHCAT predicted a good or partial response to BAS of 66.7% (mild), 78.6% (moderate), or 75.9% (severe BAD). CONCLUSION: 75SeHCAT test use increased in 2008-2014, with high positive results throughout. Ileal resection, Crohn's, and cholecystectomy independently predict BAD. 75SeHCAT predicted response to BAS.

Recreational surfing injuries in Cornwall, United Kingdom.

OBJECTIVE: To analyze the nature of surfing injuries in Cornwall in order to identify trends and inform clinical management. METHODS: The details of patients presenting (with injuries sustained while surfboard/bodyboard riding) to the Emergency Department (ED) of the Royal Cornwall Hospital, Truro (UK), from September 2004 until August 2006 were recorded prospectively. The notes were then retrospectively reviewed by a senior ED physician. The records of each visit were scrutinized for date, age, sex, injury type, and injury severity and outcome; in addition, the patient's residential status (Cornish resident or visitor) was recorded. RESULTS: A total of 212 patient episodes were collected. Male patients represented 80% of injuries. The average age was 27 years (range, 11-66 years). Nonresident surfers represented 57% (121) of the patients, and 43% (91) of patients were local Cornwall residents. Of the total injuries, 90% (n = 190) were injuries that were minor/moderate (allowing for discharge after treatment). Lacerations accounted for 38% (n = 73) of injuries, and bruising and laceration to the head represented 37% (n = 71) of injuries in this group. Sprains to the neck and back represented 53% (21/40) of all sprains. Fractures of the facial bones represented 6 of the 8 fractures to the head region; the other 2 fractures involved teeth. Fractures to the upper and lower limbs were equally frequent (6 cases of each). Anterior shoulder dislocations accounted for 10% (n = 19) of injuries not requiring hospital admission. Injuries requiring hospital admission represented 10% (n = 22). These injuries were a more disparate group, with fractures of the cervical spine and skull accounting for 32% (n = 7) and fractures of the lower limb 27% (n = 6) of the total. A total of 77% (n = 168) of all injuries presented in the summer months (April through September). The greatest number of presentations occurred in August, with 33% (n = 69) of the total surf-related injuries for the year. CONCLUSIONS: Surfing injuries were most common in young adult men. Most injuries presenting to the ED were minor/moderate injuries and did not require hospital admission. The overall pattern of injuries was similar to those found in studies from other countries where surfing is popular; however, there was a higher-than-expected incidence of shoulder dislocation. The trends identified in this study could be used to inform education focused on prevention of the most common injuries. Increased use of protective headwear should be considered.