James M. Ruda

A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003.

OBJECTIVE: To systematically review the current preoperative diagnostic modalities, surgical treatments, and glandular pathologies associated with primary hyperparathyroidism. STUDY DESIGN: A systematic literature review. RESULTS: Of the 20,225 cases of primary hyperpara-thyroidism reported, solitary adenomas (SA), multiple gland hyperplasia disease (MGHD), double adenomas (DA), and parathyroid carcinomas (CAR) occurred in 88.90%, 5.74%, 4.14%, and 0.74% of cases respectively. Tc99m-sestamibi and ultrasound were 88.44% and 78.55% sensitive, respectively, for SA, 44.46% and 34.86% for MGHD, and 29.95% and 16.20% for DA, respectively. Postoperative normocalcemia was achieved in 96.66%, 95.25%, and 97.69% of patients offered minimally invasive radio-guided parathyroidectomy (MIRP), unilateral, and bilateral neck exploration (BNE). Intraoperative PTH assays (IOPTH) were helpful in approximately 60% of bilateral neck exploration conversion (BNEC) surgeries. CONCLUSION: The overall prevalence of multiple gland disease (MGD and DA) was lower than often suggested by conventional wisdom. Furthermore, preoperative imaging was less accurate than it is often perceived for accurately imaging MGD. MIRP and UNE were more successful in achieving normo-calcemia than is typically quoted. IOPTH was a helpful but not “fool-proof” adjunct in parathyroid exploration surgery. SIGNIFICANCE: These results support a greater role for the treatment of primary hyperparathyroidism using less invasive approaches. EMB rating: B-3.

Fusaric acid: a novel agent and mechanism to treat HNSCC.

OBJECTIVE: A new class of carboxylic acids has tumoricidal activity for head and neck squamous cell cancer (HNSCC). Fusaric acid (FA) can chelate divalent cations, especially zinc, and inactivate zinc finger proteins involved in DNA repair and protein synthesis. METHODS: 2 squamous carcinoma lines were utilized for in vitro and in vivo portions of this study. Cell counting and flow cytometry were used to analyze cells in culture in treatment and control groups over 96 hours. HNSCC subcutaneous implants were created in treatment and control groups of BALB-c nude mice (N = 30). RESULTS: In vitro studies demonstrated significant changes in cell numbers and cell cycle. In vivo studies of daily intralesional therapy for 1 month also showed reduced onset of growth and overall growth compared to controls. CONCLUSION: FA appears to have a tumoristatic/tumoricidal effect on HNSCC. Further nude mice studies are needed to optimize dosing and administration regimens for FA in anticipation of clinical trials.

A review of the diagnosis and treatment of primary hyperparathyroidism in 10,136 patients

8 male and 2 female) with neurogenic dysphagia (due to stroke/ head trauma IIIo) were included. These patients had undergone a tracheostomy due to the dysphagia 2 weeks before the examination was started. The swallowing frequency (over 5 minutes) was assessed as major parameter over 5 consecutive days with/ without tracheostomy tube inserted. Results: The swallowing frequency of all patients was significantly increased after removal of the tracheostomy tube from 0.4 (mean) to 1.65. These findings did not influence the early rehabilitation (Bartel’s) index, the EFA (Early Functional Abilities), or the CRS (coma remission scale) in these patients. However, over the 5-day period, the frequency of swallowing was continuously increased. Conclusions: Tracheostomy tubes decisively influence the swallowing behavior of patients with neurogenic dysphagia. This phenomenon could be based on an improved sensibility of the pharyngeal mucosa after normal exspiration following the removal of the tracheostomy tube. We strongly favor removing or deflating the cuff of the tracheostomy tube in the conservative management of those patients, ie, in FEES therapy.