Single Gland Research Articles

Vitamin D deficiency is associated with single gland parathyroid disease

BackgroundPrimary hyperparathyroidism (PHPT) with low preoperative vitamin D levels is thought to be related to 4-gland hyperplasia. We reviewed final parathyroid pathology in relationship to preoperative vitamin D levels. MethodsA retrospective review was performed for all PHPT patients undergoing parathyroidectomy from 2001 to 2019. Patient demographics, laboratory studies, and final pathology were reviewed. Results2230 patients were included in the analysis, 78.1% were female with a mean age of 59 years. Patients were stratified into 3 groups based on their preoperative 25-hydroxy vitamin D levels; “deficient” (<20 ng/mL) (n = 319), “insufficient” (20–30 ng/mL) (n = 1108), or “sufficient” (>30 ng/mL) (n = 803). Patients with deficient vitamin D had a higher frequency of single adenoma (71%) compared to sufficient vitamin D patients (62%) (p < 0.001) and fewer hyperplastic glands (19%) compared to sufficient vitamin D level patients (25%) (p < 0.001). ConclusionsVitamin D deficiency is more strongly associated with single-gland parathyroid disease than 4-gland hyperplasia. Further investigation into the complex interplay between vitamin D levels and autonomous parathyroid function is warranted.

Application of Contrast-Enhanced Ultrasound Combined with Elastic Imaging Technology in Differential Diagnosis of Salivary Gland Tumors.

This paper proposes the effect of contrast-enhanced ultrasound combined with real-time elastic imaging technology in the differential diagnosis of salivary gland tumors. 200 patients were selected, including 120 males and 60 females. The age ranged from 9 to 83 years, with an average of 55.4 years. Among the 200 cases, there were 90 cases of single parotid gland on the right, 77 cases of single parotid gland on the left, 2 cases of bilateral (single parotid gland on each side), 2 cases of multiple parotid gland on the right (2 lesions), 1 case of 2 lesions on the left and 1 lesion on the right, and 1 case of multiple parotid gland on the left (4 lesions). 135 cases were located in the superficial lobe (78%) and 38 cases (22%) in the deep lobe of parotid gland. The ARIETTA 70 color Doppler ultrasound diagnostic instrument is used. The equipment is equipped with high-frequency contrast probe, real-time elastic imaging technology, and related software. The results showed that the detection rate of salivary gland tumors by ultrasound was 100% and the diagnostic coincidence rate was 71% (123/173). Ultrasound can not only identify the tumors in and around the parotid gland but also identify the location, size, and internal structure of the tumors. Combined with CDFI, it can make qualitative diagnosis of most benign and malignant salivary gland tumors and provide help for clinical treatment and operation plan. It is proved that contrast-enhanced ultrasound and real-time elastic imaging technology have advantages over gray-scale ultrasound in differentiating benign and malignant superficial enlarged lymph nodes, and the combined use can effectively improve the diagnostic efficiency.

Atypical parathyroid adenomas as a rare cause of primary hyperparathyroidism: In an academic institution experience

Background: Primary Hyperparathyroidism (pHPT) is caused by benign and malignant conditions. Most commonly by Typical Adenoma/ single gland disease (PA) - this is 80-85% cases of pHPT. Parathyroid hyperplasia or multiple gland disease accounts for 10-15% of cases of PHPT. Atypical Parathyroid Adenoma (APA) and Carcinoma (PC) - very rare conditions - are both responsible for pHPT in approximately 0,5 - 1,5% of cases. Objectives: To estimate occurrence of atypical parathyroid adenoma, parathyroid carcinoma and parathyroid hyperplasia along with characterize them based on their etiology, clinical presentation, diagnosis and treatment. Methods: We performed a retrospective study and enrolled 1,019 patients with primary hyperparathyroidism undergoing parathyroidectomy at academic Department of General and Endocrine Surgery between 1983 and 2018. Results: Out of 1,019 cases of primary hyperparathyroidism, 850 (83.4%) cases were due to typical Parathyroid Adenoma (PA), 135 (13.2%) cases were due to parathyroid hyperplasia, 29 (2.8%) cases were due to parathyroid carcinoma (PC), and 5 (0.5%) cases were due to Atypical Parathyroid Adenoma (APA).

Expansion of Gastric Intestinal Metaplasia with Copy Number Aberrations Contributes to Field Cancerization.

This study contributes to our understanding of gastric intestinal metaplasia as a risk factor for gastric adenocarcinoma via their multifocal expansion and acquisition of CNAs and somatic mutations.

Small molecules facilitate single factor-mediated sweat gland cell reprogramming

BackgroundLarge skin defects severely disrupt the overall skin structure and can irreversibly damage sweat glands (SG), thus impairing the skin’s physiological function. This study aims to develop a stepwise reprogramming strategy to convert fibroblasts into SG lineages, which may provide a promising method to obtain desirable cell types for the functional repair and regeneration of damaged skin.MethodsThe expression of the SG markers cytokeratin 5 (CK5), cytokeratin 10 (CK10), cytokeratin 18 (CK18), carcino-embryonic antigen (CEA), aquaporin 5 (AQP5) and α-smooth muscle actin (α-SMA) was assessed with quantitative PCR (qPCR), immunofluorescence and flow cytometry. Calcium activity analysis was conducted to test the function of induced SG-like cells (iSGCs). Mouse xenograft models were also used to evaluate the in vivo regeneration of iSGCs. BALB/c nude mice were randomly divided into a normal group, SGM treatment group and iSGC transplantation group. Immunocytochemical analyses and starch-iodine sweat tests were used to confirm the in vivo regeneration of iSGCs.ResultsEDA overexpression drove HDF conversion into iSGCs in SG culture medium (SGM). qPCR indicated significantly increased mRNA levels of the SG markers CK5, CK18 and CEA in iSGCs, and flow cytometry data demonstrated (4.18 ± 0.04)% of iSGCs were CK5 positive and (4.36 ± 0.25)% of iSGCs were CK18 positive. The addition of chemical cocktails greatly accelerated the SG fate program. qPCR results revealed significantly increased mRNA expression of CK5, CK18 and CEA in iSGCs, as well as activation of the duct marker CK10 and luminal functional marker AQP5. Flow cytometry indicated, after the treatment of chemical cocktails, (23.05 ± 2.49)% of iSGCs expressed CK5+ and (55.79 ± 3.18)% of iSGCs expressed CK18+, respectively. Calcium activity analysis indicated that the reactivity of iSGCs to acetylcholine was close to that of primary SG cells [(60.79 ± 7.71)% vs. (70.59 ± 0.34)%, ns]. In vivo transplantation experiments showed approximately (5.2 ± 1.1)% of the mice were sweat test positive, and the histological analysis results indicated that regenerated SG structures were present in iSGCs-treated mice.ConclusionWe developed a SG reprogramming strategy to generate functional iSGCs from HDFs by using the single factor EDA in combination with SGM and small molecules. The generation of iSGCs has important implications for future in situ skin regeneration with SG restoration.

A Retrospective Analysis of Multiple Affected Salivary Gland Diseases: Diagnostic and Therapeutic Benefits of Interventional Sialendoscopy.

Multiple affected salivary gland diseases are rare compared to single gland diseases and represent a major diagnostic challenge. These cases are commonly neglected in the scientific literature, despite the considerable suffering of these patients. The aim of this retrospective study was to report disease characteristics, diagnostic pathways, and therapeutic options, including sialendoscopic treatment of multiple affected salivary gland disorders. Patients experiencing multiple affected salivary gland diseases treated between 2013 and 2020 were consecutively identified. Data regarding demographics, clinical presentation, disease characteristics, treatment, complications, and follow-up were analyzed retrospectively. In total, 71 patients were identified with these diseases and included obstructive disease without sialolithiasis (n = 22), inflammation (n = 15), immune disease (n = 19), radioiodine-induced sialadenitis (RAI) (n = 5), sialadenosis (n = 2), and juvenile recurrent parotitis (JRP) (n = 8). Diagnostic and therapeutic sialendoscopy was performed on 113 salivary glands in 42 patients, leading to completely (n = 27, 64.3%) or partially (n = 11, 26.2%) improved symptoms in most cases. In total, 4 patients did not improve after interventional therapy. Multiple affected salivary gland diseases are rare and diagnostically challenging. Interventional sialendoscopy offers an effective and safe therapeutic option and should be considered in this specific cohort.

Can we justify using Parathyroid Ultrasound Scan as a sole preoperative localisation study for patients undergoing surgery for Primary Hyperparathyroidism?

Abstract Introduction Currently we offer unilateral neck exploration parathyroidectomy (UNE-PTX) only to patients with concordant ultrasound (USS) and nuclear medicine (NM) scans. Objective To compare potential cure rate from UNE-PTX to any patient with a single gland identified on USS with the current practice of dual concordant scans. Methods Case ascertainment; patients undergoing successful parathyroidectomy 2008 to 2018 by a single surgeon. Electronic patient records reviewed for imaging, operative records and pathology. Results 331 patients underwent surgery, 325 (98.2%) were cured. 288 (88.6%) had a single adenoma (PA), 37 (11.4%) had multi-gland disease (MGD) All patient had either USS or NM. 320 underwent US &amp; 315 NM scans. 309 patients had dual imaging. Sensitivity and specificity respectively were 72.3% &amp; 60.5% for US and 65.8% &amp; 62.2% for NM scans. USS accuracy was not influenced by the radiologist having prior access to NM report (kappa 0.4 vs 0.44). Concordant imaging; 141 patients. Of these 135 had a confirmed PA. 127 underwent UNE-PTX, 14 required bilateral neck exploration (BNE). US localised single gland; 217 patients. Of these 51(20.6%) had no uptake on NM scans. Based on US localisation alone if all 217 were offered UNE-PTX, 205/217 (94.5%) of patients with adenoma would be cured; 12 /217 (4.5%) with MGD recognisable at operation would have to be converted to BNE. Conclusion In our patients with a single adenoma using USS alone would have avoided 20.6% unnecessary BNE This has financial benefits to the health service as it avoids another investigation and hospital visit.

Efficacy of surgeon performed ultrasound scan in localization of parathyroid adenomas in patients with primary hyperparathyroidism

Abstract Introduction The success of minimally invasive parathyroid surgery is largely based on accurate preoperative localization of parathyroid adenomas. In the U.K, NICE guidance recommends either ultrasound scanning alone or combined with sestamibi scintigraphy to help guide surgery. In the recent past, surgeon performed ultrasound (SUS) has been adopted in North America and Australia for preoperative localization with a sensitivity of 63–91%. This was equivalent or superior to radiology performed ultrasound (RUS). In comparison, data from the U.K for surgeon performed imaging is sparse. In this study, we investigate the efficacy of surgeon performed ultrasound in localization of parathyroid disease and discuss its cost benefits. Methods This is a prospective study with data collected from November 2019 to June 2021. All patients had primary hyperparathyroidism and underwent either MIBI, radiology performed ultrasound or both. A single experienced surgeon performed ultrasound on all patients under general anaesthesia. The intraoperative findings were used to determine the accuracy of all imaging techniques. Results A total of 46 patients underwent surgery and were found to have single gland disease. The categories were: Double imaging (n=17), MIBI (n=34), RUS (n=22), SUS(n=46), no imaging (n=9). MIBI, radiology performed ultrasound and surgeon performed ultrasound had sensitivities of 58%, 55% and 81% respectively. 8 patients had ectopic glands and were not included in the sensitivity analysis of ultrasound scans. Conclusion Surgeon performed ultrasound by an experienced provider is effective in localizing parathyroid adenomas and guides minimally invasive surgery. It could significantly reduce costs associated with outpatient radiology performed ultrasound scanning

Abstract 139: Cystic parathyroid adenoma with Mayer Rokitansky Kuster Hauser syndrome: Association or coincidence?

Introduction: Majority of cases of primary hyperparathyroidism (PHPT) are due to single gland adenoma. Cystic parathyroid adenomas are very rare. We report an unusual case of PHPT due to a cystic adenoma with Mayer Rokitansky Kuster Hauser (MRKH) Syndrome.Case Presentation: A 30-year-old woman with primary amenorrhoea presented with polyuria and bilateral renal stone disease. Biochemical investigations showed corrected calcium of 13mg/dl and parathormone (PTH) levels of 418 pg/ml. Ultrasonography of neck showed solid cystic nodule and Sestamibi scan showed nonMIBI-avid hypodense nodule in right thyroid lobe. Intracystic fluid aspirated from the lesion showed PTH of >2000 pg/ml. The lesion was surgically excised and patient achieved surgical remission. Evaluation of primary amenorrhea showed normal gonadotropins and hypoplastic uterus and upper two-thirds of vagina on magnetic resonance imaging of pelvis which was consistent with MRKH syndrome. Since literature review showed HNF1B to be associated with genitourinary abnormalities and PHPT, after patient consent sample for HNFIB mutation was sent and is awaited.Conclusion: Possibility of cystic parathyroid adenoma should be kept while localizing for PHPT as it poses a diagnostic challenge. Concurrent MRKH syndrome could be a true association or a mere coincidence.

A reproducible and sensitive method for generating high-quality transcriptomes from single whitefly salivary glands and other low-input tissues.

Transcriptomic studies are an important tool for understanding the molecular pathways underlying host plant use by agricultural pests, including vectors of damaging plant pathogens. Thus far, bulk RNA-Seq has been the main approach for non-model insects. This method relies on pooling large numbers of whole organisms or hundreds of individually dissected organs. The latter approach is logistically challenging, may introduce artifacts of handling and storage, and is not compatible with biological replication. Here, we tested an approach to generate transcriptomes of individual salivary glands and other low-input body tissues from whiteflies (Bemisia tabaci MEAM1), which are major vectors of plant viruses. By comparing our outputs to published bulk RNA-Seq datasets for whole whitefly bodies and pools of salivary glands, we demonstrate that this approach recovers similar numbers of transcripts relative to bulk RNA-Seq in a tissue-specific manner, and for some metrics, exceeds performance of bulk tissue RNA-Seq. Libraries generated from individual salivary glands also yielded additional novel transcripts not identified in pooled salivary gland datasets, and had hundreds of enriched transcripts when compared with whole head tissues. Overall, our study demonstrates that it is feasible to produce high quality, replicated transcriptomes of whitefly salivary glands and other low-input tissues. We anticipate that our approach will expand hypothesis-driven research on salivary glands of whiteflies and other Hemiptera, thus enabling novel control strategies to disrupt feeding and virus transmission.

A Retrospective Cohort Study of the Utility of Ultrasound, 99mTc-Sestamibi Scintigraphy, and Four-Dimensional Computed Tomography for Pre-Operative Localization of Parathyroid Disease To Facilitate Minimally Invasive Parathyroidectomy.

BackgroundThis study investigated the utility of ultrasound (US), 99mTc-Sestamibi scintigraphy (Sestamibi), and four-dimensional computed tomography (4DCT) for pre-operative localization of a single abnormal parathyroid gland prior to minimally invasive parathyroidectomy (MIP) to determine the optimum pre-operative scans to facilitate a MIP.MethodsPatients with primary hyperparathyroidism who underwent curative parathyroidectomy at Broomfield Hospital, Mid and South Essex NHS Foundation Trust between 2009 and 2018 were included. Diagnostic performance parameters and the agreement between US, Sestamibi, and 4DCT were evaluated. Cohen’s κ was used to assess the strength of agreement between imaging modalities.ResultsAt localizing pathology to the correct side of the neck, Sestamibi had the highest sensitivity (87%), followed by US (76%) and 4DCT (64%). 4DCT had a positive predictive value (PPV) of 95%, similar to Sestamibi (96%), but higher than US (92%). Amongst patients who underwent both US and Sestamibi, the abnormal parathyroid gland was localized to the same area by both imaging modalities in 77% of patients (Cohen’s κ: 0.383). Following an inconclusive US or Sestamibi scan, or discordance between the two modalities, 4DCT was correct at localization in 63% of patients.ConclusionSestamibi has the highest sensitivity and PPV for accurately localizing parathyroid pathology. The addition of US to a positive Sestamibi scan adds little additional value. 4DCT is the preferred imaging modality following an inconclusive Sestamibi or US.

Autophagy, not apoptosis, plays a role in lumen formation of eccrine gland organoids.

Background:Sweat secreted by eccrine sweat glands is transported to the skin surface through the lumen. The eccrine sweat gland develops from the initial solid bud to the final gland structure with a lumen, but how the lumen is formed and the mechanism of lumen formation have not yet been fully elucidated. This study aimed to investigate the mechanism of lumen formation of eccrine gland organoids (EGOs).Methods:Human eccrine sweat glands were isolated from the skin for tissue culture, and the primary cultured cells were collected and cultured in Matrigel for 14 days in vitro. EGOs at different development days were collected for hematoxylin and eosin (H&E) staining to observe morphological changes and for immunofluorescence staining of proliferation marker Ki67, cellular motility marker filamentous actin (F-actin), and autophagy marker LC3B. Western blotting was used to detect the expression of Ki67, F-actin, and LC3B. Moreover, apoptosis was detected using a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) apoptosis assay kit, and the expression of poly (ADP-ribose) polymerase and Caspase-3 was detected by Western blot. In addition, 3-methyladenine (3MA) was used as an autophagy inhibitor to detect whether the formation of sweat glands can be effectively inhibited.Results:The results showed that a single gland cell proliferated rapidly and formed EGOs on day 4. The earliest lumen formation was observed on day 6. From day 8 to day 14, the rate of lumen formation in EGOs increased significantly. The immunofluorescence and Western blot analyses showed that the expression of Ki67 gradually decreased with the increase in days, while the F-actin expression level did not change. Notably, the expression of autophagy marker LC3B was detected in the interior cells of EGOs as the apoptosis signal of EGOs was negative. Compared with the control group, the autophagy inhibitor 3MA can effectively limit the formation rate of the lumen and reduce the inner diameter of EGOs.Conclusion:Using our model of eccrine gland 3D-reconstruction in Matrigel, we determined that autophagy rather than apoptosis plays a role in the lumen formation of EGOs.

Expression of spidroin proteins in the silk glands of golden orb-weaver spiders.

The expression of spidroins in the major ampullate, minor ampullate, flagelliform, and tubuliform silk glands of Trichonephila clavipes spiders was analyzed using proteomics analysis techniques. Spidroin peptides were identified and assigned to different gene products based on sequence concurrence when compared with the whole genome of the spider. It was found that only a relatively low proportion of the spidroin genes are expressed as proteins in any of the studied glands. In addition, the expression of spidroin genes in different glands presents a wide range of patterns, with some spidroins being found in a single gland exclusively, while others appear in the content of several glands. The combination of precise genomics, proteomics, microstructural, and mechanical data provides new insights both on the design principles of these materials and how these principles might be translated for the production of high-performance bioinspired artificial fibers.

Lipoadenoma of the parathyroid: characteristics of a rare cause of hyperparathyroidism.

Parathyroid Lipoadenoma (PLA) contains abundant mature adipose tissue and is a rare cause of hyperparathyroidism. This study aimed to investigate the clinical features of PLA in nine patients with primary hyperparathyroidism, including two men and seven women, with ages ranging from 45-84 years (median 60 years). PLA accounted for 0.5% of all parathyroid tumors during the study period. One patient presented with anorexia due to hypercalcemia; however, the other eight patients were asymptomatic. The median preoperative serum intact-parathyroid hormone (iPTH) and calcium levels were 143 pg/mL (range, 102-378) and 10.8 mg/dL (range, 10.3-11.3), respectively. PLA was difficult to identify using ultrasonography (US) as it appears as a moderately hyperechoic nodule and is difficult to distinguish from the surrounding adipose tissues. Only 33% of the lesions (three out of nine lesions) were accurately identified. However, they could be distinctly differentiated from the surrounding tissue using computed tomography (CT). All PLAs were also detected using the sesta-methoxyisobutylisonitrile single-photon emission-computed tomography (SPECT). All the patients were treated by a single gland extirpation. The median size and weight of the PLA were 14 mm (range, 10-22) and 567 mg (range, 200-1,533), respectively. In conclusion, the clinical manifestations of PLA are similar to those of ordinal parathyroid adenomas, except for their unique US and CT images. PLA should be considered as a potential etiologic factor in cases of hyperparathyroidism when the lesions are demonstrated as hyperechoic nodules or unidentified by US but detected by CT or SPECT imaging.

Integrative transcriptome and proteome analyses provide deep insights into the molecular mechanism of salt tolerance in Limonium bicolor.

Integrative transcriptome and proteome analyses revealed many candidate members that may involve in salt secretion from salt glands in Limonium bicolor. Limonium bicolor, a typical recretohalophyte, protects itself from salt damage by excreting excess salt out of its cells through salt glands. Here, to provide an overview of the salt-tolerance mechanism of L. bicolor, we conducted integrative transcriptome and proteome analyses of this species under salt treatment. We identified numerous differentially expressed transcripts and proteins that may be related to the salt-tolerance mechanism of L. bicolor. By measuring the Na+ secretion rate, were found that this cation secretion rate of a single salt gland was significantly increased after high salinity treatment compared with that in control and then reached the maximum in a short time. Interestingly, transcripts and proteins involved in transmembrane transport of ions were differentially expressed in response to high salinity treatment, suggesting a number of genes and proteins they may play important roles in the salt-stress response. Correlation between differentially expressed transcript and protein profiles revealed several transcripts and proteins that may be responsible for salt tolerance, such as cellulose synthases and annexins. Our findings uncovered many candidate transcripts and proteins in response to the salt tolerance of L. bicolor, providing deep insights into the molecular mechanisms of this important process in recretohalophytes.

Differentiated approach to surgical treatment of adrenal glands tumors

Objective – to improve the results of treatment of adrenal tumors by optimizing a differentiated approach based on the analysis of the results of various surgical invasions. The paper analyzed the results of treatment of 145 patients with various adrenal tumors, which were divided into 2 groups: І (n=71) - patients after adrenalectomies, II (n=74) – after adrenal resections. Organ-preserving invasions showed better results during the early and long-term postoperative period in patients with corticosteromas, pheochromocytomas and incidentalomas by reducing the severity of fluctuations in hemodynamic parameters and the frequency of adrenal insufficiency. Due to the introduction of the treatment algorithm, the number of adrenal resections increased by 26.6% in patients with neoplasms more than 4,0 cm in diameter (p=0.0001). The choice of surgical invasion should be individualized, taking into account the clinical features of the disease, hormone indicator parameters, the size of tumors, the comprehensiveness of the adrenal gland lesion and the ratio of the latter to nearby organs and structures. Adrenal insufficiency was detected 14.2% more often after adrenalectomies (р=0.044) compared to adrenal resections. Treatment according to the developed algorithm reduced the incidence of adrenal insufficiency by 5.8% (p=0.028). In the long-term postoperative period, contralateral gland tumors occurred with the same frequency (4.8%) among patients after adrenalectomies and resections. Relapse of the neoplasm after resections was detected in 3 (7.1%), as a result of which 2.4% underwent repeated operations with the final removal of the gland. An increase in the size of a single adrenal gland was more common by 21.4% after adrenalectomies.

How and when is multiglandular disease diagnosed in sporadic primary hyperparathyroidism?

BackgroundIn total, ∼15% of patients with sporadic primary hyperparathyroidism have multiglandular disease, which may be suspected preoperatively but can only be confirmed intra or postoperatively. The study aim is to determine how and when patients are diagnosed with multiglandular disease and to what extent different modalities contribute. MethodsConsecutive cases of sporadic primary hyperparathyroidism (2013–2019) undergoing initial exploration were reviewed from a single-institution prospective database. Preoperative single-photon emission tomography/computed tomography and neck ultrasound were routinely performed to help direct either bilateral or unilateral exploration guided by intraoperative parathyroid hormone monitoring using the dual criteria. Multiglandular disease was defined as either resection of >1 enlarged parathyroid or hypercalcemia at ≥6 months after single gland resection. ResultsOf 1,890 patients with sporadic primary hyperparathyroidism, multiglandular disease was identified in 254 (13.4%); 244 (96.1%) were diagnosed intraoperatively and 10 (3.9%) postoperatively. In these multiglandular disease patients, single gland disease was suggested on single-photon emission tomography/computed tomography in 54.0%, ultrasound in 49.2%, and both were concordant for single gland disease in 29.4%. Intraoperative multiglandular disease diagnosis was prompted by an inadequate intraoperative parathyroid hormone monitoring drop in 38.5%, by surgeon interpretation of imaging in 38.1%, by observing ipsilateral gland enlargement in 11.0%, by finding an initial gland <200 mg in 10.3%, and 2.0% had unexpected multiglandular disease during thyroidectomy. Multiglandular disease was diagnosed by postoperative hypercalcemia in 10 of 254 patients (4.9%). ConclusionTo avoid failure at parathyroidectomy for primary hyperparathyroidism, expert surgeons use multiple approaches to diagnose and manage multiglandular disease. Preoperative localization studies alone are insufficient, missing multiglandular disease in at least 30% of cases. All examined adjuncts are informative, including intraoperative parathyroid hormone monitoring, imaging, and intraoperative visual cues.

Outcomes of surgical treatment for isolated adrenal metastasis from non-small cell lung cancer.

ObjectiveLong-term survival of patients who undergo surgical resection of isolated adrenal metastasis instead of nonsurgical treatment has shown higher values than those described for stage IVA. The primary endpoint was to evaluate overall survival (OS) of patients with single adrenal metastasis from non-small cell lung cancer (NSCLC), who underwent surgical treatment. The secondary endpoint was to evaluate and compare the OS and disease-free survival (DFS) according to: pathological lung tumour size, histology, lymph node involvement, type of metastasis at the time of diagnosis and laterality of the metastasis according to the primary lung tumour.MethodsFrom August 2007 to March 2020, 13 patients with isolated adrenal gland metastasis were identified. We performed a descriptive observational study including patients with diagnosed single adrenal gland metastasis of resectable primary lung cancer and no history of other malignant disease. Clinical data obtained included patient demographics, metastases characteristics, laterality of the metastasis, time between surgeries, length of follow-up, survival status, pathological lung tumour size, histology and lymph node involvement. The variables analysed were OS and DFS.ResultsMedian global OS was 31.9 months (interquartile range (IQR), 19.1–51.4). The 2- and 5-year OS estimated was 54% (95% CI: 29.5%–77.4%) and 36% (95% CI: 13.4%–68.1%), respectively. In patients with NSCLC without mediastinal lymph node involvement, we obtain a median OS of 40 months (IQR, 27.4–51.4) and a 2- and 5-year OS estimated of 75% (95% CI: 43.2%–92.2%) and 50% (95% CI: 18.7%–81.2%), respectively. Recurrence was detected in five patients with a median DFS of 11.9 months (IQR, 6–34.2).ConclusionThe resection of the adrenal metastasis should be considered if the primary lung cancer is resectable. Presence of mediastinal lymph node involvement should be ruled out through invasive staging of the mediastinum before performing adrenal and lung surgery. Proper selection of patients who would benefit from surgery is essential to obtain better survival results.

Number of cells in parathyroid tissue in primary hyperparathyroidism cases and its relationship with serum calcium value.

Background:The relationship between serum calcium (Ca) level to serum parathyroid hormone (PTH), phosphorus (P) levels and tissue properties of the parathyroid gland is unknown in primary hyperparathyroidism cases. Revealing this relationship may be useful for understanding the etiopathogenesis of primary hyperparathyroidism and determining the time of treatment.Methods:Ninety patients (71 females, 19 males, age range; 27–73 years, average age; 46) who underwent single gland excision with the diagnosis of primary hyperparathyroidism were studied. The patients were divided into 2 groups as serum Ca level <12 and serum Ca level ≥12. Age and sex of the patients, mean cell number of the gland, mean volume of the gland, serum levels of PTH, P, and histopathologic type of hyperplasia were evaluated.Results:The mean cell number per cubic centimeter is 22.9 (10–220 range) million in all glands. Serum Ca level was <12 in 82 (91.1%) of the patients, and ≥12 in 8 (8.9%) cases. Mean cell number of the gland, mean volume of the gland, existence of cystic hyperplasia of the gland, serum levels of PTH and P were statistically significant between the 2 groups (P < .001, P < .001, P < .05, P < .001, P < .05 respectively).Conclusion:In primary hyperparathyroidism cases serum Ca level is not related to age and sex but directly related to proportionals to the cell number and volume of the gland and serum levels of PTH, inversely related to cystic hyperplasia and serum levels of P. Early surgical intervention should be planned since the serum Ca level will be high in large adenomas with a noncystic radiological appearance.

Parathyroid Gland Autofluorescence Characteristics in Patients With Primary Hyperparathyroidism.

Near-infrared imaging for intraoperative parathyroid gland (PG) detection has recently commanded significant attention. The PTeye (Medtronic, Minneapolis, MN) is a probe-based system for near-infrared autofluorescent evaluation of PGs. This study was designed to evaluate the capabilities of the PTeye in the setting of surgery for primary hyperparathyroidism. Prospective, Cohort study. This single-institution, prospective cohort study included all patients undergoing parathyroidectomy for primary hyperparathyroidism with presumed single gland disease from June 2020 to December 2020. Absolute intensity and intensity ratios, with the thyroid as the control tissue, were obtained for the adenoma, ipsilateral normal PG, and adjacent tissue. The ability of the PTeye to function when not in direct contact with tissue was measured. Twenty-two patients were included. The median intensity ratio for the in situ adenomas was 4.38 (interquartile range [IQR]: 2.03-5.87), ipsilateral normal PGs 6.17 (IQR: 3.83-7.67), strap muscle 0.47 (IQR: 0.30-0.60), and fat 0.20 (IQR: 0.17-0.47). All normal PGs and 21/22 adenomas demonstrated autofluorescence above the detection threshold. The PTeye functioned at a maximum distance of separation of 10 mm through saline medium and 6 mm through clear solid medium. This study confirms the PTeye's ability to recognize PGs with a high degree of precision. The device was found to function properly even with the probe not in direct contact with the tissue. Although adenomatous PGs appear to demonstrate altered autofluorescent properties from normal PGs, additional research is required to determine if these differences are clinically useful. 3 Laryngoscope, 132:715-721, 2022.