Cause Of Failed Surgery Research Articles

Abstract #1373163: A Rare Case of Ectopic Parathyroid Adenoma in the Left Axillary Region

A parathyroid adenoma is a benign neoplasm that arises from parathyroid parenchymal cells. Parathyroid adenomas are the most common cause of primary hyperparathyroidism (PHPT). Ectopic parathyroid adenomas arise within the parathyroid glands located at the four poles of the thyroid [2]. Ectopic parathyroid adenomas result from aberrant migration of the gland during the early stages of development and can be identified in up to 16% of cases of PHPT [3]. They are commonly found in the mediastinum, within the thyroid, and along the path of the vagus or recurrent laryngeal nerves [4]. 45% of ectopic parathyroid adenomas are found in the paraesophageal region, 25% in the cervical thymus, 20% in the cervical mediastinum, 5% in the anterior portion of the mediastinum, and 5% at the level of the thymus [5]. A 64-year-old man with a past medical history of over 20-year history of recurrent nephrolithiasis, type II diabetes mellitus, dyslipidemia, hypertension, and pancreatic cancer presented to our outpatient endocrine clinic for evaluation of hyperparathyroidism. Further investigation of his history revealed that he had struggled with several bouts of urinary calculi throughout his life. These episodes required multiple surgical interventions to treat, including left nephrectomy and ureteral stenting. He had been evaluated for high serum calcium in the past and was diagnosed with PHPT by his urologist, who referred him to our clinic. Also complicating his health was a recent diagnosis of prostate cancer for which, he was undergoing radiation treatment. He had a family history of thyroid disorder in his mother but no family history of parathyroid disorders. Physical examination was unremarkable. Laboratory investigations revealed high serum calcium and high serum parathyroid hormone. Parathyroid scintigraphy with 99mTc-sestamibi revealed a subtle persistent focal region of increased uptake in the left axilla with no other areas of increased uptake, raising the suspicion for parathyroid adenoma in the left axilla. As discussed earlier, ectopic parathyroid adenomas result from aberrant migration of parathyroid tissue during embryological development. Additionally, ectopic parathyroid adenomas are a cause of failed surgery for hyperparathyroidism as well as persistent and recurrent hyperparathyroidism [3, 7-9]. Ectopic parathyroid tissue has a prevalence of 2-43% in anatomic series and has been detected in up to 16% of patients undergoing evaluation for hyperparathyroidism [3, 7, 10]. Ectopic parathyroid adenomas arising within the axilla may present with hypercalcemia and associated skeletal and renal involvement [11, 12]. The case that has been reported had a presentation of PHPT with recurrent nephrolithiasis. As mentioned earlier, 45% of ectopic parathyroid lesions are found in the paraesophageal region with 38% arising within the thymus [7, 10]. However, in this case, the patient presented with a possible ectopic parathyroid adenoma localized to the left axilla and no other areas of increased uptake on tc99m-sestamibi parathyroid scintigraphy.

The Effectiveness of a Simultaneous Medial Spindle Procedure for Involutional Punctal Ectropion With Lid Laxity in Patients Who Require Endonasal Dacryocystorhinostomy Instead of External Dacryocystorhinostomy to Prevent Pump Failure

The aim of this study was to determine the effectiveness of a concurrent medial spindle procedure (MS) to address involutional punctal ectropion and the proportion of combined surgery in patients who need endonasal dacryocystorhinostomy (DCR) instead of external dacryocystorhinostomy to prevent pump failure. We conducted a retrospective, interventional study on endonasal DCR and MS procedures performed between March 2004 and January 2009 by a single surgeon (S.H.B.). Patient age, sex, the results of a medial distraction test, the surgical procedure, follow-up duration, and cause of failed surgery were recorded. The indication for the medial spindle procedure was punctal eversion on slit lamp biomicroscopic examination with classifications of grades 2 and 3 on the medial distraction test. Endonasal DCRs were performed on 169 eyes in 121 patients, and DCR and MS (D + M) were performed on 23 eyes in 17 patients. The proportion of combined surgery to total DCR was 13.6%. Our primary success rate was 86.9% in the combined surgery group and 87.2% in the DCR group (P = 0.39). The MS for correction of punctal ectropion concurrently performed with endonasal DCR will be an effective tool to manage epiphora caused by complex situations, such as nasolacrimal duct obstruction and involutional punctal ectropion. We recommend careful examination of the punctum, which is invisible in normal conditions, under slit lamp biomicroscopy before endonasal DCR.

The Effectiveness of Simultaneous Lateral Tarsal Strip With Endonasal Dacryocystorhinostomy for the Treatment of Nasolacrimal Duct Obstruction and Lower Lid Laxity

The aim of this study was to evaluate the effectiveness of simultaneous lateral tarsal strip procedure (LTS) and endonasal dacryocystorhinostomy (DCR) for the treatment of nasolacrimal duct obstruction and lower lid laxity. We conducted a retrospective, interventional study of concurrent DCR with LTS for patients with nasolacrimal duct obstruction and lower lid laxity performed between March 2009 and July 2011 by a single surgeon (S.H.B.). Patient age, sex, the results of dacryoscintigraphy, time of tube removal, follow-up duration, and cause of failed surgery were recorded. Lower eyelid laxity was evaluated by a medial distraction test. A total of 29 eyes in 17 patients were included in the study. The mean age was 61.1 ± 11.8 years (range 41 to 81 years). The mean degree of lower lid laxity was 2.4 ± 0.5. Dacryoscintigraphy showed presac delay in 22 eyes (75.9%). The tube was removed after 11.3 ± 1.9 weeks. The primary anatomical success rate was 89.5% (27 eyes) and the functional success rate was 86.2% (25 eyes). Membranous obstructions were the cause of failed surgery in 2 patients, but both patients remained symptom free after revision surgery with a diode laser. Concurrently performed DCR with LTS can be an effective tool for the treatment of nasolacrimal duct obstruction and lower lid laxity. It is recommended for examining lid laxity carefully using lid distraction test in patients with epiphora.

Ultrasound Evaluation of Primary Hyperparathyroidism

Summary: Primary hyperparathyroidism is caused by parathyroid adenomas, hyperplasia, or carcinoma. Ultrasound can visualize these enlarged glands and locate them for subsequent surgical removal. Ectopic glands, an important cause of failed surgery, can be visualized with ultrasound provided that the examiner is aware that these glands may be found in the upper mediastinum, the carotid sheath, above the carotid bifurcation, around the esophagus, and within the thyroid gland. An ultrasound-directed aspiration for cytology and parathyroid hormone analysis can be performed on suspicious lesions to confirm an abnormal parathyroid. Intraoperative ultrasound is especially useful in reoperation on patients with previously failed surgeries in which dense scar tissue obliterates the normal tissue planes and makes dissection tedious and hazardous.

Silicone-oil injection during closed microsurgery for diabetic retinal detachment

A beneficial visual outcome was achieved in 16 (38%) of 42 eyes into which silicone oil was injected after difficulties were encountered during closed microsurgery for severe diabetic retinal detachment. Without recourse to oil injection, most if not all of the eyes would have remained blind and many would have deteriorated into rubeotic glaucoma or phthisis. The main cause of failed surgery was rhegmatogenous retinal detachment associated with residual or reparative epiretinal fibrosis, and silicone oil appeared to be of value in preventing rubeosis iridis in such cases. Cataract was a significant problem in the successfully treated eyes.