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- 저자 : Russell Murphy (검색결과 2 건)
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Kyle Irvine,Russell Murphy,Dimitrios Coutsinos 대한내분비외과학회 2023 The Koreran journal of Endocrine Surgery Vol.23 No.4
Primary hyperparathyroidism is a common cause of hypercalcemia but is rarely caused by a parathyroid carcinoma. Supernumerary glands are also uncommon in the setting of recurrent disease. We present a case of an 87-year-old female who presented in a hypercalcemic crisis due to recurrent primary hyperparathyroidism. Imaging studies showed a large parathyroid adenoma in the superior mediastinum believed to be a supernumerary gland. She was taken for a joint operation with ear, nose and throat and thoracic surgery where she underwent a thoracoscopic resection of the gland. The lesion appeared to be locally invasive involving the mediastinal fat and azygous vein. Intraoperative parathyroid hormone (PTH) levels showed an appropriate drop and post-operative calcium levels normalised. Final pathology showed a 5 cm parathyroid adenoma which in the setting of her significantly elevated PTH and locally aggressive lesion would be consistent with a supernumerary parathyroid carcinoma.
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Thomas B. Russell,Peter L. Labib,Paula Murphy,Fabio Ausania,Elizabeth Pando,Keith J. Roberts,Ambareen Kausar,Vasileios K. Mavroeidis,Gabriele Marangoni,Sarah C. Thomasset,Adam E. Frampton,Pavlos Lykou 한국간담췌외과학회 2024 Annals of hepato-biliary-pancreatic surgery Vol.28 No.1
Backgrounds/Aims: After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes. Methods: Data were extracted from the Recurrence After Whipple’s study, a retrospective multicenter study of PD outcomes. Results: In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was “enteral only,” “parenteral only,” and “enteral and parenteral” in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN. Conclusions: A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.
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