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Identifying hospital and provider variation in surgical cost is a potent method for controlling rising healthcare expenditure and delivering cost-effective care. The purpose of this study was to examine the variation of hospital cost by providers for parathyroidectomy in a single academic institution.We retrospectively evaluated 894 consecutive parathyroidectomies under 8 surgeons in our institution...
Medullary thyroid cancer portends poor survival once liver metastasis occurs. We hypothesize that Notch3 overexpression in medullary thyroid cancer liver metastasis will decrease proliferation and growth of the tumor.TT cells were modified genetically to overexpress Notch3 in the presence of doxycycline, creating the TT-Notch3 cell line. Mice were injected intrasplenically with either TT-Notch3 or...
Little is known about the long-term recurrence risk for primary hyperparathyroidism after immediately “curative” parathyroidectomy. This study aimed to evaluate the risk of recurrent hyperparathyroidism in the 10 years after operation.We retrospectively identified patients with sporadic primary hyperparathyroidism undergoing initial parathyroidectomy between November 1, 2000 and June 30, 2005. Recurrence...
Epstein-Barr virus is associated with lymphoid and epithelial malignancies and has been reported to infect thyroid cells. The Epstein-Barr virus protein, EBNA2, regulates viral and cellular promoters by binding to RBP-jκ. Similarly, NOTCH1, a tumor suppressor protein in thyroid epithelial cells, competes with EBNA2 for binding to overlapping sites on RBP-jκ. EBNA2 activates a subset of NOTCH-responsive...
Parathyroidectomy (PTX) is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), PTX can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of PTX in patients with posttransplant 3HPT with the advent of cinacalcet.We evaluated renal transplant patients between January 1,...
The purpose of this study is to determine the incidence of a secondary imaging modality (SIM) in the workup of adrenal masses and the usefulness of this additional imaging in changing surgical management.A retrospective analysis of our adrenalectomy database was performed on adult patients who underwent ≥1 imaging study before surgery. A multivariate logistic regression model was then constructed...
Parathyroid carcinoma is a rare cancer. Unlike other more common malignancies, the importance of lymph node (LN) status remains controversial. The purpose of this study was to determine the relative importance of LN metastases in disease-specific survival (DSS).A retrospective review of the Surveillance, Epidemiology, and End Result database was performed on parathyroid carcinoma cases diagnosed between...
Tertiary hyperparathyroidism (3HPTH) patients who undergo parathyroidectomy (PTX) are often managed with calcium lowering medications such as cinacalcet (Sensipar) before surgery. Here, we assess how cinacalcet treatment influences intraoperative parathyroid hormone (IOPTH) kinetics and surgical findings in 3HPTH patients undergoing PTX.We reviewed retrospectively 113 patients 3HPTH who underwent...
Intraoperative parathyroid hormone (ioPTH) monitoring during focused parathyroidectomy for primary hyperparathyroidism (PHPT) is used commonly, but some argue that ioPTH adds little if a normal ipsilateral parathyroid gland (IPG) is visualized. This hypothesis was tested for validity.The prospective databases of consecutive patients with PHPT undergoing initial parathyroidectomy with ioPTH at two...
Cervical hematoma can be a potentially fatal complication after thyroidectomy, but its risk factors and timing remain poorly understood.We conducted a retrospective, case-control study identifying 207 patients from 15 institutions in 3 countries who developed a hematoma requiring return to the operating room (OR) after thyroidectomy.Forty-seven percent of hematoma patients returned to the OR within...
The timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism (PHPT) has not been well characterized.This prospective study involved administering a questionnaire to patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire evaluated the frequency of 18 symptoms of PHPT on a 5-point Likert scale and was administered preoperatively...
Previous abdominal surgery may present a challenge to safely completing laparoscopic adrenalectomy. We evaluated the impact of previous ipsilateral upper abdominal surgery on laparoscopic adrenalectomy outcomes.A retrospective analysis of prospective databases was performed for patients that underwent laparoscopic transabdominal adrenalectomy at 2 tertiary centers between 2001 and 2011. Patients with...
Intrathyroidal parathyroid adenomas (ITPAs) are a rare entity. The aim of this study is to describe the experience of 2 endocrine surgery centers and to distinguish characteristics of intrathyroidal parathyroid adenoma and nonintrathyroidal parathyroid adenomas.We included patients who had undergone operations for primary hyperparathyroidism who had intrathyroidal parathyroid adenomas. Patients with...
Primary hyperparathyroidism can be associated with symptoms related to GERD, but it is unclear which symptoms of GERD improve after parathyroidectomy. Our goal was to assess prospectively for changes in specific GERD symptoms after parathyroidectomy using a validated questionnaire.Using the GERD health-related quality of life (GERD-HRQL) questionnaire, symptoms of heartburn were prospectively assessed...
Same-day thyroidectomy has not gained widespread acceptance owing to concerns of life-threatening complications. The aim of this study is to describe a single institution same-day thyroidectomy results.We included patients who underwent thyroid surgery between 2005 and 2011 by a single surgeon. The outcomes of patients who underwent inpatient (IP) and same-day thyroidectomy were compared. Routine...
The durability of minimally invasive parathyroidectomy (MIP) has been questioned, and some advocate for routine open parathyroidectomy (OP). This study compared outcomes between patients treated with MIP compared with OP for primary hyperparathyroidism (PHPT).A retrospective review was performed to identify cases of PHPT with single adenomas (SA) between 2001 and 2011. Operations were classified as...
Recent guidelines suggest pharmacologic deep vein thrombosis (DVT) prophylaxis in all patients undergoing major surgical procedures to minimize the risk of postoperative DVT and pulmonary embolism (PE). Pharmacologic DVT prophylaxis perioperatively might increase the risk of bleeding complications. Our goal was to study the risk/benefit ratio of DVT prophylaxis in patients who undergo thyroidectomy...
During the last 10 years, the number of endocrine procedures performed in the United States has increased significantly. We sought to determine whether this has translated into an increase in operative volume for general surgery and otolaryngology residents.We evaluated records from the Resident Statistic Summaries of the Residency Review Committee (RRC) for U.S. general surgery and otolaryngology...
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