Tsang-Pai Liu

Quality of Life After Surgery or Surveillance for Asymptomatic Primary Hyperparathyroidism: A Meta-Analysis of Randomized Controlled Trials

Abstract A number of studies have investigated the effects of surgery on symptoms and quality of life in patients with hyperparathyroidism. However, the results are inconsistent. We conducted this meta-analysis to quantitatively assess changes in quality of life among patients with asymptomatic primary hyperparathyroidism. Different databases were searched for randomized controlled trials comparing surgery with surveillance. Quality of life was measured by the Short Form-36 general health survey. The pooled random-effects estimates of standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated. Three trials involving 294 participants were included. At 1 year, patients undergoing parathyroidectomy had significantly better physical role functioning (SMD, 0.31; 95% CI 0.04–0.57; P = 0.02) and emotional role functioning (SMD, 0.29; 95% CI 0.02–0.55; P = 0.03). At 2 years, the surgery group had significantly better emotional role functioning (SMD, 0.35; 95% CI 0.02–0.67; P = 0.04) than the surveillance group. Furthermore, compared with baseline, emotional role functioning improved after surgery (SMD, 0.31; 95% CI 0.02–0.60; P = 0.04), whereas emotional role functioning tended to get worse in patients assigned to medical surveillance (SMD, −0.27; 95% CI −0.55 to 0.02; P = 0.07). Although Short Form-36 is a generic instrument, our results suggest that parathyroidectomy may be associated with better quality of life, especially in the emotional aspects of well-being.

Effect of Perioperative Intravenous Lidocaine Infusion on Acute and Chronic Pain after Breast Surgery: A Meta-Analysis of Randomized Controlled Trials

Intravenous lidocaine infusion has been shown to reduce postoperative pain among patients undergoing abdominal surgery. This study aimed to evaluate the effects of perioperative lidocaine administration in breast surgery.

Negative Association between Serum Parathyroid Hormone Levels and Urinary Perchlorate, Nitrate, and Thiocyanate Concentrations in U.S. Adults: The National Health and Nutrition Examination Survey 2005–2006

Objectives Perchlorate, nitrate, and thiocyanate are well-known inhibitors of the sodium-iodide symporter and may disrupt thyroid function. This exploratory study investigated the association among urinary perchlorate, nitrate, and thiocyanate concentrations and parathyroid hormone (PTH) levels in the general U.S. population. Methods We analyzed data on 4265 adults (aged 20 years and older) from the National Health and Nutrition Examination Survey in 2005 through 2006 to evaluate the relationship among urinary perchlorate, nitrate, and thiocyanate concentration and PTH levels and the presence of hyperparathyroidism cross-sectionally. Results The geometric means and 95% confidence interval (95% CI) concentrations of urinary perchlorate, nitrate, and thiocyanate were 3.38 (3.15–3.62), 40363 (37512–43431), and 1129 (1029–1239) ng/mL, respectively. After adjusting for confounding variables and sample weights, creatinine-corrected urinary perchlorate was negatively associated with serum PTH levels in women (P = 0.001), and creatinine-corrected urinary nitrate and thiocyanate were negatively associated with serum PTH levels in both sex groups (P = 0.001 and P<0.001 for men, P = 0.018 and P<0.001 for women, respectively). Similar results were obtained from sensitivity analyses performed for exposure variables unadjusted for creatinine with urinary creatinine added as a separate covariate. There was a negative relationship between hyperparathyroidism and urinary nitrate and thiocyanate [odds ratio (95% CI) = 0.77 (0.60–0.98) and 0.69 (0.61–0.79), respectively]. Conclusions A higher urinary concentration of perchlorate, nitrate, and thiocyanate is associated with lower serum PTH levels. Future studies are needed to determine the pathophysiological background of the observation.

Transcriptome analysis of papillary thyroid cancer harboring telomerase reverse transcriptase promoter mutation

Telomerase reverse transcriptase (TERT) promoter mutations have recently been identified as an important prognostic factor in thyroid cancer. Studies suggest that TERT may have noncanonical functions beyond telomere maintenance.

Laparoscopic Repair of Obturator Hernia

Obturator hernias are rare, and most cases present as incarcerated hernias. They can be repaired either transabdominally or extraperitoneally, by the conventional open method or a laparoscopic approach. We report our technique of transabdominal laparoscopic direct repair using a running barbed suture in 2 cases. Old age and bowel distention are not contraindications to laparoscopic repair.

Delayed Traumatic Rupture of Splenic Angiosarcoma

Primary angiosarcoma of the spleen is a rare and aggressive neoplasm with a high tendency to rupture and metastasize. We report a 74-year-old woman who presented with delayed splenic rupture one week after a minor blunt abdominal trauma. Computed tomography showed hemoperitoneum from splenic tumor rupture and multiple hepatic metastases. Superselective splenic artery embolization was attempted but failed. The patient underwent splenectomy uneventfully. Histologic study of the resected spleen confirmed the diagnosis of angiosarcoma. Our case underscores the importance of taking pathological spleen rupture into consideration when abdominal trauma is minor or the onset of rupture is delayed.