Introduction. Primary hyperparathyroidism (PHP) is characteristically determined by high levels of calcium and high or inappropriate levels of parathyroid hormone (PTH). Technological advances have dramatically changed the surgical technique over the years once intraoperative parathyroid hormone (IOPTH) assay had allowed for focused approaches.Objective. To evaluate our 10-year experience in employing a rapid intraoperative PTH assay for PHP.Methods. A prospective cohort of 91 PHP-operated patients in a tertiary institution in São Paulo, Brazil, from June 2000 to April 2011.Results. We had 85 (93.4%) successful parathyroidectomies, 6 (6.6%) failed parathyroidectomies in 91 previous unexplored patients, and 5 (100%) successful remedial surgeries. The IOPTH was true-positive in 88.5%, true-negative in 7.3%, false-positive in 2.1%, and false-negative in 2.1% of the procedures. IOPTH was able to obviate additional exploration or to ask for additional exploration in 92 (95.8%) procedures.Conclusion. The IOPTH revealed to be an important technological adjunct in the current parathyroid surgery for PHP.

Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder that occurs when one or more parathyroid glands produces excessive parathyroid hormone (PTH). PHPT is typically treated with surgery, and it remains the only definitive therapy, whose techniques have evolved over previous decades. Advances in preoperative localization exams and the intraoperative PTH monitoring have become the cornerstones of recent parathyroidectomy techniques, as minimally invasive techniques are appropriate for most patients. Nevertheless, these techniques, are not suitable for PHPT patients who are at [...] ABSTRACT Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder that occurs when one or more parathyroid glands produces excessive parathyroid hormone (PTH). PHPT is typically treated with surgery, and it remains the only definitive therapy, whose techniques have evolved over previous decades. Advances in preoperative localization exams and the intraoperative PTH monitoring have become the cornerstones of recent parathyroidectomy techniques, as minimally invasive techniques are appropriate for most patients. Nevertheless, these techniques, are not suitable for PHPT patients who are at

Background: The symptomatic (swelling and pain) salivary gland obstructions are caused by sialolithiasis and salivary duct stenosis, negatively affecting quality of life (QOL), with almost all candidates for clinical measures and minimally invasive sialendoscopy. The impact of sialendoscopy treatment on the QOL has been little addressed nowadays. The objective is to prospectively evaluate the impact of sialendoscopy on the quality of life of patients undergoing sialendoscopy due to benign salivary obstructive diseases, measured through QOL questionnaires of xerostomia degree, the oral health impact profile and post sialendoscopy satisfaction questionnaires. Result: 37 sialendoscopies were included, most young female; there were 64.5% sialolithiasis and 35.4% post-radioiodine; with 4.5 times/week painful swelling symptoms and 23.5 months symptom duration. The pre- and post-sialendoscopy VAS values were: 7.42 to 1.29 (p < 0.001); 86.5% and 89.2% were subjected to sialendoscopy alone and endoscopic dilatation respectively; 80.6% reported improved symptoms after sialendoscopy in the sialolithiasis clinic (p < 0.001). The physical pain and psychological discomfort domain scores were mostly impacted where sialendoscopy provided relief and improvement (p < 0.001). We found a positive correlation between sialendoscopy and obstructive stone disease (p < 0.001) and no correlation in sialendoscopy satisfaction in xerostomia patients (p = 0.009). Conclusions: We found improved symptoms with overall good satisfaction after sialendoscopy correlated with stones; and a negative correlation between xerostomia. Our findings support the evident indication of sialendoscopy for obstructive sialolithiasis with a positive impact on QOL and probably a relative time-dependent indication for stenosis/other xerostomia causes that little improved QOL satisfaction. Level of evidence: 2b—Prospective non-randomized study. Trial registration: WHO Universal Trial Number (UTN): U1111-1247-7028; Brazilian Clinical Trials Registry (ReBeC): RBR-6p8zfs.

Introduction: Surgical treatment of hyperparathyroidism related to chronic kidney disease is a challenging procedure even for experienced parathyroid surgeons. Over the years, adjuvant techniques have been developed to assist the medical team to improve surgical outcomes. However, medical staff in poor countries have less access to these techniques and the effectiveness of surgery in this context is unclear. Objective: verify the effectiveness of surgery for treatment of hyperparathyroidism related to chronic kidney disease without adjuvant techniques. Methods: Over a 5-years period, patients with hyperparathyroidism that had clinical therapeutic failure were evaluated for surgical treatment. Total parathyroidectomy with autograft or subtotal resection were the selected procedures. Surgeries were performed in a tertiary hospital in Brazil without the assistance of some of the adjuvant techniques that are usually applied, such as frozen section, nerve monitoring, and gamma probe. Intraoperative PTH and localization pre-operative exams were applied, but with huge restrictions. Results: A total of 518 patients with hyperparathyroidism (128 secondary and 390 tertiary) were surgically treated. Total parathyroidectomy were performed in 81.5%, subtotal in 12.4%, and 61% of patients had a surgical failure. Of all failures, only 1.4% needed a second surgery totaling 98.6% of successful initial surgical treatment. Neck hematoma and unilateral focal fold paralysis occurred in 1.9% and 1.5%, respectively. Conclusion: parathyroidectomy is a safe and reproducible surgical procedure even in the absence of adjuvant techniques.

To investigate the prognostic factors to developing parotid and neck metastasis in locally advanced and relapsed Cutaneous Squamous Cell Carcinoma (CSCC) of the head and neck region. Single-center retrospective cohort study enrolling consecutive patients with advanced CSCC from 2009 to 2019. Seventy-four cases were identified. Study variables demographic data, clinical skin tumor stage, neck stage, parotid stage (P stage), surgical treatment features, and parotid, regional, and distant metastases. Survival measures: Overall Survival (OS) and Disease-Specific Survival (DSS). The study group included 72.9% men (median age, 67 years); 67.5% showed T2/T3 tumors, 90.5% comorbidities, 20.2% immunosuppressed, with median follow-up: 35.8 months. The most frequent skin primary were auricular and eyelid regions, 75% underwent primary resection with flap reconstruction. Parotid metastasis was present in 50%, 32.4% showing parotid extracapsular spread, multivariate analysis found OR = 37.6 of positive parotid metastasis evolving into positive neck metastasis, p = 0.001. Occult neck metastasis, neck metastasis, and neck extracapsular spread were observed in 13.5%, 51.3%, and 37.8%, respectively. Kaplan–Meier survival: Clinical T4 versus T1, p = 0.028, P1 stage: 30% and 5% survival at 5 and 10 years, P3 stage: 0%, p = 0.016; OS and DSS showed negative survival for the parotid metastasis group, p = 0.0283. Our outcomes support a surgically aggressive approach for locally advanced and relapsed CSCC, with partial parotidectomy for P0, total parotidectomy for P1–3, selective I–III neck dissection for all patients and adjuvant radiochemotherapy to appropriately treat these patients with advanced CSCC of the head and neck region. II b – Retrospective Cohort Study – Oxford Centre for Evidence-Based Medicine (OCEBM).

Key words: Biochemical markers of bone turnover; parathyroid-related disorders; DXA; PTH; osteoporosis