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A review of the diagnosis and treatment of primary hyperparathyroidism in 10,136 patients
Scientific Session—Tuesday
Methods: In a prospective study, 10 patients (64 ⫾ 7 years; 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. 9:16
AM
A Review of the Diagnosis and Treatment of Primary Hyperparathyroidism in 10,136 Patients James Ruda BS (presenter); Christopher Hollenbeak PhD; Brendan C Stack Jr MD Hershey PA; Hershey PA; Hershey PA
Objectives: Primary hyperparathyroidism is a disease which occurs with a prevalence of 1 in 1000 individuals, often aging in their fifth or sixth decades. As suggested by numerous publications in the literature, this disease typically involves a solitary adenoma in 80% to 90% of cases with multiple gland disease and parathyroid carcinoma comprising 10% to 20% and ⬍1% of cases, respectively. Diagnosed biochemically, by ultrasonography or Tc-99m-sestamibi scanning, historically, this condition has been treated utilizing a unilateral neck exploration, by a bilateral neck exploration, or via a minimally invasive approach to achieve curative normocalcemia. To date, no study has collectively analyzed the multiple diagnostic modalities, surgical strategies, or glandular pathologies associated with primary hyperparathyroidism. We performed a retrospective review of the literature in an attempt to analyze the complete reported experience in preparation for further study by decision analysis. Methods: We performed a retrospective review of the literature from 1995-2002 on MEDLINE for the following terms: primary hyperparathyroidism, ultrasonography, radionuclide, sestamibi, sestamibi/ SPECT, bilateral neck exploration, unilateral neck exploration, MIRP, and minimally invasive neck exploration. 375 papers were published in this time interval and 143 were reviewed.
Results: Solitary adenomas and multiple adenomas were 83.8% and 16%, respectively. Tc-99m-sestamibi and ultrasound localization for single and multiple gland disease was 86.1%/80.2% and 40%/30%, respectively. Conclusions: Exhaustive review of the very large parathyroid literature since the widespread use of the Tc-99-sestamibi and high-resolution ultrasound reveals a lower percentage of solitary adenomas than is typically quoted. Localization studies may also be less accurate then perceived. An increased attention to the possibility of multiple gland disease may therefore be warranted.
Room OCCC 109A •
Scientific Sessions: Pediatric Otolaryngology Toni M Ganzel MD; Michael D Poole MD PhD (moderators)
8:00
AM
Effect of Adenotonsillectomy for Obstructive Sleep Apnea on Obese Children Ron B Mitchell MD (presenter) Albuquerque NM
Objectives: To use preoperative and postoperative polysomnography to assess changes in the respiratory distress index (RDI) following adenotonsillectomy for obstructive sleep apnea (OSA) in obese children. Methods: A prospective study was undertaken in a tertiary-care children’s hospital. A total of 24 males and 2 females were included. All had an RDI greater than 1 and a body mass index (BMI) over the 90th percentile matched for age and gender. The mean age was 9.6 years (range, 3-17). Children with craniofacial, neurological, and chromosomal abnormalities were excluded. The intervention was adenotonsillectomy, and RDI was measured by full-night polysomnography before and after surgery. Results: The mean preoperative RDI for the children was 31 (range, 2-118). The mean preoperative BMI was 29.4. The mean duration between completion of the two polysomnograms was 7.8 months (range, 3.2-18.6 months). The mean postoperative RDI was 14.8 (range, 1-92). The mean postoperative BMI was 29.3. The results of a paired Student t test show that the postoperative RDI is significantly different than the preoperative RDI (P ⫽ 0.03), while there was no significant difference between the preoperative and postoperative BMI (P ⫽ 0.15). Conclusions: Adenotonsillectomy in obese children produces a significant improvement in OSA as measured by RDI without a change in BMI. However, adenotonsillectomy does not eliminate OSA and additional therapies including weight reduction and use of nocturnal continuous positive airway pressure (CPAP) may be required.
TUESDAY
P124
Otolaryngology– Head and Neck Surgery August 2003
Methods: In a prospective study, 10 patients (64 ⫾ 7 years; 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. 9:16
AM
A Review of the Diagnosis and Treatment of Primary Hyperparathyroidism in 10,136 Patients James Ruda BS (presenter); Christopher Hollenbeak PhD; Brendan C Stack Jr MD Hershey PA; Hershey PA; Hershey PA
Objectives: Primary hyperparathyroidism is a disease which occurs with a prevalence of 1 in 1000 individuals, often aging in their fifth or sixth decades. As suggested by numerous publications in the literature, this disease typically involves a solitary adenoma in 80% to 90% of cases with multiple gland disease and parathyroid carcinoma comprising 10% to 20% and ⬍1% of cases, respectively. Diagnosed biochemically, by ultrasonography or Tc-99m-sestamibi scanning, historically, this condition has been treated utilizing a unilateral neck exploration, by a bilateral neck exploration, or via a minimally invasive approach to achieve curative normocalcemia. To date, no study has collectively analyzed the multiple diagnostic modalities, surgical strategies, or glandular pathologies associated with primary hyperparathyroidism. We performed a retrospective review of the literature in an attempt to analyze the complete reported experience in preparation for further study by decision analysis. Methods: We performed a retrospective review of the literature from 1995-2002 on MEDLINE for the following terms: primary hyperparathyroidism, ultrasonography, radionuclide, sestamibi, sestamibi/ SPECT, bilateral neck exploration, unilateral neck exploration, MIRP, and minimally invasive neck exploration. 375 papers were published in this time interval and 143 were reviewed.
Results: Solitary adenomas and multiple adenomas were 83.8% and 16%, respectively. Tc-99m-sestamibi and ultrasound localization for single and multiple gland disease was 86.1%/80.2% and 40%/30%, respectively. Conclusions: Exhaustive review of the very large parathyroid literature since the widespread use of the Tc-99-sestamibi and high-resolution ultrasound reveals a lower percentage of solitary adenomas than is typically quoted. Localization studies may also be less accurate then perceived. An increased attention to the possibility of multiple gland disease may therefore be warranted.
Room OCCC 109A •
Scientific Sessions: Pediatric Otolaryngology Toni M Ganzel MD; Michael D Poole MD PhD (moderators)
8:00
AM
Effect of Adenotonsillectomy for Obstructive Sleep Apnea on Obese Children Ron B Mitchell MD (presenter) Albuquerque NM
Objectives: To use preoperative and postoperative polysomnography to assess changes in the respiratory distress index (RDI) following adenotonsillectomy for obstructive sleep apnea (OSA) in obese children. Methods: A prospective study was undertaken in a tertiary-care children’s hospital. A total of 24 males and 2 females were included. All had an RDI greater than 1 and a body mass index (BMI) over the 90th percentile matched for age and gender. The mean age was 9.6 years (range, 3-17). Children with craniofacial, neurological, and chromosomal abnormalities were excluded. The intervention was adenotonsillectomy, and RDI was measured by full-night polysomnography before and after surgery. Results: The mean preoperative RDI for the children was 31 (range, 2-118). The mean preoperative BMI was 29.4. The mean duration between completion of the two polysomnograms was 7.8 months (range, 3.2-18.6 months). The mean postoperative RDI was 14.8 (range, 1-92). The mean postoperative BMI was 29.3. The results of a paired Student t test show that the postoperative RDI is significantly different than the preoperative RDI (P ⫽ 0.03), while there was no significant difference between the preoperative and postoperative BMI (P ⫽ 0.15). Conclusions: Adenotonsillectomy in obese children produces a significant improvement in OSA as measured by RDI without a change in BMI. However, adenotonsillectomy does not eliminate OSA and additional therapies including weight reduction and use of nocturnal continuous positive airway pressure (CPAP) may be required.
TUESDAY
P124
Otolaryngology– Head and Neck Surgery August 2003