Takashi Nishi

A Case of Hyperparathyroidism due to a Large Intrathyroid Parathyroid Adenoma with Recurrent Episodes of Acute Pancreatitis

We report a case of a 66-year-old woman who developed hyperparathyroidism due to a large intrathyroid parathyroid adenoma with episodes of acute pancreatitis. She had previously been treated for acute pancreatitis twice. Serum calcium was 12.4 mg/dL, and intact parathyroid hormone was 253 pg/dL. Ultrasonography and computed tomography of the neck with contrast enhancement revealed a soft tissue mass (28 mm transverse diameter) within the left lobe of the thyroid. 99mTc-MIBI scintigraphy demonstrated focal accumulation due to increased radiotracer uptake in the left thyroid lobe. Left hemithyroidectomy was performed. Histopathology showed no signs of invasion, and this is consistent with parathyroid adenoma. Immunostaining was positive for expression of chromogranin A and parathyroid hormone. The patient had no episode of pancreatitis after the operation. In a patient with recurrent episodes of pancreatitis, the possibility of complication with hyperparathyroidism should be considered.

A CASE REPORT OF SPONTANEOUS RUPTURE OF THE ESOPHAGUS CURED BY TRANSABDOMINAL MEDIASTINAL DRAINAGE

A 66-year-old woman who developed spontaneous rupture of the esophagus caused by vomiting after drinking has been successfully cured by transabdominal mediastinal drainage and gastrostomy. Though over 200 cases of the disease had been reported in Japan, it still remains in a severe one in which delayed diagnosis and treatment lead to life-threatening condition. For this disease thoracotorny is usually applied, and a few cases might be cured by only mediastinal drainage like this case. If the rupture occurred at lower part of the esophagus and the pleura mediastinalis was intact, transabdominal approach should be considered as an appropriate procedure. Chest X-ray film and esophagogram are particularly important for diagnosis. Moreover, a factor XIII preparation was effective for postoperative tracheo-esophageal fistula in this case. Some reports, which demonstrated the clinical availability of the preparation in failure of the sutures after primary suture at the ruptured part of the esophagus, also support that active use of the preparation is recommended for cases with declined factor XIII.