Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

2001 ◽  
pp. 63-69 ◽  
Author(s):  
F Lumachi ◽  
M Ermani ◽  
S Basso ◽  
P Zucchetta ◽  
N Borsato ◽  
...  
Keyword(s):  
Ct Scan ◽  
Cost Effective ◽  
Population Based ◽  
Preoperative Localization ◽  
Factors Affecting ◽  
Parathyroid Adenomas ◽  
Magnetic Resonance Imaging Mri ◽  
Parathyroid Tumours ◽  
Double Adenomas ◽  
Subtraction Scintigraphy

A series of 253 consecutive patients with proved primary hyperparathyroidism due to parathyroid tumours was reviewed. There were 68 (26.9%) men and 185 (73.1%) women, with a median age of 57 years (range 13-82 years). All patients, prior to successful parathyroidectomy, underwent one or more preoperative localization procedures such as: neck ultrasonography (US) in 191 (75.5%), (201)Tl/(99m)Tc-pertechnetate subtraction scintigraphy (TPS) in 144 (56.9%), CT scan in 92 (36.4%), (99m)Tc-sestamibi/(99m)Tc-pertechnetate subtraction scintigraphy (MPS) in 90 (35.6%), selective venous sampling (SVS) with parathyroid hormone (PTH) assay in 30 (11.9%), and magnetic resonance imaging (MRI) in 6 (2.4%) patients. The results were compared with operative and histological findings that showed 235 (92.9%) solitary parathyroid adenomas, 13 (5.1%) carcinomas and 5 (2.0%) double adenomas. Sensitivity and positive predictive value were 82.9% and 93.8% for US, 83.6% and 91.8% for TPS, 81.3% and 98.7% for CT scan, 85.1% and 96.1% for MPS, 65.4% and 80.9% for SVS, and 80.0% and 80.0% for MRI respectively. No different results (P=NS) were found using US, TPS, MPS or CT scan, whereas SVS and MRI sensitivity was lower (P<0.05). The combination of MPS and US was 94.0% sensitive (P<0.05) but when TPS, CT scan or MRI were also used overall sensitivity did not improve significantly (P=NS). In conclusion, MPS should be used as the starting preoperative localization procedure, while US and MPS together represent the most reliable noninvasive localization tool. If MPS and US are negative or not in agreement, further studies are not cost-effective and the patient should undergo bilateral neck exploration.

scholarly journals Factors affecting immunization coverage in urban slums of Odisha, India: implications on urban health policy

2013 ◽  
Vol 1 (2) ◽  
pp. 18 ◽  
Author(s):  
Santosh K. Prusty ◽  
Bhuputra Panda ◽  
Abhimanyu S. Chauhan ◽  
Jayanta K. Das
Keyword(s):  
Child Survival ◽  
Immunization Coverage ◽  
Cost Effective ◽  
Population Based ◽  
Urban Slums ◽  
Drop Out ◽  
Factors Affecting ◽  
Effective Interventions ◽  
Immunization Services ◽  
Local Decision

Infectious diseases are major causes of morbidity and mortality among children. One of the most cost-effective interventions for improved child survival is immunization, which has significant urban-rural divides. Slum dwellers constitute about one-third of Indian population, and most children still remain incompletely immunized. The main purpose of this study was to understand the factors behind partial or non-immunization of children aged 12-23 months in slum areas of Cuttack district, India. Session-based audit and a population-based survey were conducted in the urban slums of Cuttack city, April-June 2012. Total 79 children were assessed and their mothers were interviewed about the nature and quality of immunization services provided. Children fully immunized were 64.6%. Antigen-wise immunization coverage was highest for Bacillus Calmette-Gu&eacute;rin (BCG) (96.2%) and lowest for Measles (65.8%), which indicates high instances of late drop-out. Frequent illnesses of the child, lack of information about the scheduled date of immunization, frequent displacement of the family and lack of knowledge regarding the benefits of immunization were cited as the main factors behind coverage of immunization services. The study showed that there is an urgent need to revise the immunization strategy, especially for urban slums. District and sub-district officials should reduce instances of early and late dropouts and, in turn, improve complete immunization coverage. Community participation, intersectoral co-ordination and local decision making along with supportive supervision could be critical in addressing issues of drop-outs, supply logistics and community mobilization.

Value of Ultrasonography, CT and MR Imaging in the Diagnosis of Primary Hyperparathyroidism

1996 ◽  
Vol 37 (3P2) ◽  
pp. 720-726 ◽  
Author(s):  
C. Tziakouri ◽  
E. Eracleous ◽  
S. Skannavis ◽  
A. Pierides ◽  
P. Symeonides ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Primary Hyperparathyroidism ◽  
Detection Rate ◽  
Cost Effective ◽  
Clinical Results ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Confirmatory Test ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid

Purpose: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgical outcome in patients with primary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in 87% of these patients. Conclusion: US, CT and MR imaging followed by surgery performed by an experienced surgeon provided good clinical results in 39 patients with primary hyperparathyroidism. Preoperative localization was especially useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the root of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery.

scholarly journals A novel body circumferences-based estimation of percentage body fat

2018 ◽  
Vol 119 (6) ◽  
pp. 720-725 ◽  
Author(s):  
Yair Lahav ◽  
Yoram Epstein ◽  
Ron Kedem ◽  
Haggai Schermann
Keyword(s):  
Body Fat ◽  
Field Research ◽  
Cost Effective ◽  
Population Based ◽  
Reliable Estimate ◽  
Study Cohort ◽  
Anthropometric Measures ◽  
Percentage Body Fat ◽  
Health Club ◽  
Body Circumferences

AbstractAnthropometric measures of body composition are often used for rapid and cost-effective estimation of percentage body fat (%BF) in field research, serial measurements and screening. Our aim was to develop a validated estimate of %BF for the general population, based on simple body circumferences measures. The study cohort consisted of two consecutive samples of health club members, designated as ‘development’ (n 476, 61 % men, 39 % women) and ‘validation’ (n 224, 50 % men, 50 % women) groups. All subjects underwent anthropometric measurements as part of their registration to a health club. Dual-energy X-ray absorptiometry (DEXA) scan was used as the ‘gold standard’ estimate of %BF. Linear regressions where used to construct the predictive equation (%BFcal). Bland–Altman statistics, Lin concordance coefficients and percentage of subjects falling within 5 % of %BF estimate by DEXA were used to evaluate accuracy and precision of the equation. The variance inflation factor was used to check multicollinearity. Two distinct equations were developed for men and women: %BFcal (men)=10·1−0·239H+0·8A−0·5N; %BFcal (women)=19·2−0·239H+0·8A−0·5N (H, height; A, abdomen; N, neck, all in cm). Bland–Altman differences were randomly distributed and showed no fixed bias. Lin concordance coefficients of %BFcal were 0·89 in men and 0·86 in women. About 79·5 % of %BF predictions in both sexes were within ±5 % of the DEXA value. The Durnin–Womersley skinfolds equation was less accurate in our study group for prediction of %BF than %BFcal. We conclude that %BFcal offers the advantage of obtaining a reliable estimate of %BF from simple measurements that require no sophisticated tools and only a minimal prior training and experience.

scholarly journals Factors Affecting the Lut Desert Tourism in Iran: Developing an Interpretive-Structural Model

2021 ◽  
Vol 13 (13) ◽  
pp. 7245
Author(s):  
Beniamino Murgante ◽  
Mohammad Eskandari Sani ◽  
Sara Pishgahi ◽  
Moslem Zarghamfard ◽  
Fatemeh Kahaki
Keyword(s):  
Sampling Method ◽  
Structural Model ◽  
Tourism Development ◽  
Cost Effective ◽  
Structural Modeling ◽  
Interpretive Structural Modeling ◽  
Factors Affecting ◽  
Purposive Sampling ◽  
Interpretive Structural Model ◽  
Lut Desert

The Lut desert is one of the largest and most attractive deserts in Iran. The value of desert tourism remains unclear for Iran’s economy and has only recently been taken into consideration by the authorities, although its true national and international value remains unclear. This study was aimed at investigating the factors that influence tourism development in the Lut desert. Data collected through the purposive sampling method was analyzed using Interpretive Structural Modeling and the MICMAC Analysis. According to the results, cost-effective travel expenses, security, and safety provided in the desert, together with appropriate media advertising and illustration of the Lut desert (branding) are the leading factors that influence tourism in the Lut desert in Iran. This paper highlighted the importance of desert tourism, especially in this region.

A Population-Based Study of Factors Affecting the Use of Radiotherapy for Endometrial Cancer

2012 ◽  
Vol 24 (8) ◽  
pp. e113-e124 ◽  
Author(s):  
T.P. Hanna ◽  
H. Richardson ◽  
Y. Peng ◽  
W. Kong ◽  
J. Zhang-Salomons ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Population Based ◽  
Population Based Study ◽  
Factors Affecting
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