Browsing by Author "Jovanovic, Milan D. (57210477379)"

Parathyroid carcinoma is extremely rare in pediatric population. The authors report a case of 15-year-old girl with extremely elevated serum calcium (4.1 mmol/L) and parathyroid hormone (1170 pg/mL), with palpable neck mass. After en bloc resection, the patient remained normocalcemic within the next 2 years. To the best of our knowledge, this is the fourteenth documented case of parathyroid carcinoma in patients younger than 16 years. Even though parathyroid carcinoma is very uncommon in children with good prognosis, this diagnosis has to be considered when a child has severe hypercalcemia, elevated parathyroid hormone and palpable neck mass. © 2019

Objective: Medullary thyroid carcinoma (MTC) can be very aggressive, and early diagnosis is based on routine measurement of serum calcitonin (CT) and RET genetic testing for hereditary forms. Basal serum CT (bCT) concentrations are useful in the early detection of MTC, although it is still unclear whether they can also be used for the differential diagnosis between MTC and C-cell hyperplasia (CCH). Since false-positive results can be obtained with the basal measurement of CT, a provocative test to evaluate stimulated CT (sCT) is often needed. The objective of this study was to investigate the utility of a calcium gluconate test for CT in distinguishing MTC from CCH, a precancerous condition in hereditary forms of MTCs but with unclear significance in sporadic MTCs. Methods: A total of 74 patients underwent the calcium loading test before thyroidectomy, and bCT and sCT levels were compared with histologic results by receiver operating characteristic plot analyses. Results: A peak CT level of 388.4 pg/mL after stimulation with calcium gluconate was able to significantly distinguish patients with MTC from those with CCH and those without C-cell pathology, with 81.8% sensitivity and 36.5% specificity. A bCT level of 16.1 pg/mL was able to distinguish between these 2 groups of patients with a sensitivity of 90%. Conclusion: High-dose calcium test is an effective procedure that can be applied for differential diagnosis of MTC and CCH. Reference ranges for calcium sCT levels and CT thresholds in different groups of patients have been identified. © 2021 AACE

Objective: Medullary thyroid carcinoma (MTC) can be very aggressive, and early diagnosis is based on routine measurement of serum calcitonin (CT) and RET genetic testing for hereditary forms. Basal serum CT (bCT) concentrations are useful in the early detection of MTC, although it is still unclear whether they can also be used for the differential diagnosis between MTC and C-cell hyperplasia (CCH). Since false-positive results can be obtained with the basal measurement of CT, a provocative test to evaluate stimulated CT (sCT) is often needed. The objective of this study was to investigate the utility of a calcium gluconate test for CT in distinguishing MTC from CCH, a precancerous condition in hereditary forms of MTCs but with unclear significance in sporadic MTCs. Methods: A total of 74 patients underwent the calcium loading test before thyroidectomy, and bCT and sCT levels were compared with histologic results by receiver operating characteristic plot analyses. Results: A peak CT level of 388.4 pg/mL after stimulation with calcium gluconate was able to significantly distinguish patients with MTC from those with CCH and those without C-cell pathology, with 81.8% sensitivity and 36.5% specificity. A bCT level of 16.1 pg/mL was able to distinguish between these 2 groups of patients with a sensitivity of 90%. Conclusion: High-dose calcium test is an effective procedure that can be applied for differential diagnosis of MTC and CCH. Reference ranges for calcium sCT levels and CT thresholds in different groups of patients have been identified. © 2021 AACE

Objective: To investigate the incidence and identify risk factors for the occurrence of intraoperative hypertension (IOH) during surgery for primary hyperparathyroidism (pHPT). Subjects and Methods: The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. IOH was defined as an increase in systolic blood pressure ≥20% compared to baseline values which lasted for 15 min. The investigated influence were demographic characteristics, surgical risk score related to physical status (based on the American Society of Anesthesiologists [ASA] classification), comorbidities, type and duration of surgery, and duration of anesthesia on IOH occurrence. The investigated factors were obtained from the patients' medical history, anesthesia charts, and the daily practice database. Logistic regression analysis was done to determine the predictors of IOH. Results: Of the 269 patients, 153 (56.9%) had IOH. Based on the univariate analysis, age, body mass index, ASA status, duration of anesthesia, and preoperative hypertension were risk factors for the occurrence of IOH. Multivariate analysis showed that independent predictors of IOH were a history of hypertension (OR=2.080, 95% CI: 1.102-3.925, p=0.024) and age (OR=0.569, 95% CI: 0.360-0.901, p=0.016). Conclusion: In this study, a high percentage (56%) of the patients developed IOH during surgery for pHPT, which indicates that special attention should be paid to these patients, especially to the high-risk groups: older patients and those with a history of hypertension. Further, this study showed that advanced age and hypertension as a coexisting disease prior to parathyroid surgery were independent risk factors for the occurrence of IOH. © 2017 2017 S. Karger AG, Basel.

The thyroid gland disease incidence in hyperparathyroidism (HPT) is higher than the incidence of thyroid disease in general population. Likewise, HPT is more frequent in patients primary admitted due to thyroid disease, than in general population. The aim of this study was to determine the incidence and clinical characteristics of concomitant HPT and thyroid disease, based on a single center experience. From 2009 to 2014, a total of 4882 patients underwent thyroidectomy and/or parathyroidectomy at the Center for Endocrine Surgery, Belgrade. We reviewed the database to find out indications for surgery, clinical characteristics, operative and histopathological findings. Out of 4033 patients, who underwent thyroidectomy, in 114 cases (2.8 %) parathyroidectomy was simultaneously performed. Out of these 114 patients, 42 patients (37 %) had normocalcemic HPT. Among 849 patients primary operated due to HPT, thyroid gland disease that required surgery was found in 224 (26.4 %). In patients primary seen for HPT, thyroid cancer was found in 22 (9.8 %), Hashimoto’s thyroiditis in 41 (18.3 %) and micropapillary carcinoma in 36 cases (16.1 %). Due to residual or recidivant HPT, 16 patients (15 who primary underwent parathyroidectomy and 1 primary seen for thyroid disease) needed a reoperation. There are a considerable number of patients with concomitant thyroid and parathyroid disease; this justifies the routine analyses of calcemia and PTH level in patients preparing for thyroidectomy, and sets up the ground for the thyroid investigations in HPT. © 2016, Springer-Verlag Berlin Heidelberg.

Introduction: Since thyroid gland disorders are present in a considerable percentage of the world population and thyroidectomy represents the most commonly performed endocrine surgical procedure world-vide, medical teams involved in surgical treatment of these patients can face a series of complications, out of which some might be life-threatening. Materials and methods: The paper analyzes the most difficult complications that can arise during and after thyroidectomy, presents risk factors for their development and contemporary literature concepts regarding this topic. Results: Understanding the mechanisms which lead to their occurrence and methods of their prevention, along with adequate and timely application of therapeuthic measures represent basic strategies that should be employed in order to reduce the rate of these complications. Conclusion: Adequate preoperative preparation of patients, experienced surgical team and the meticulous technique, early recognition and urgent treatment of complications by the anaesthesiologist, along with multidisciplinary approach, are the basic preconditions for successful treatment in thyroid surgery.

Patients undergoing carotid endarterectomy and carotid artery stenting are susceptible to the development of adverse cardiac events. Perioperative myocardial injury – an entity characterized by increased values of cardiac troponins – is strongly associated with the occurrence of both short- and long-term cardiac adverse events, non-cardiac complications, poor treatment outcomes, and increased mortality. The silent nature of this condition, in most cases, emphasizes the significance of perioperative troponin measurement, which is reflected in its diagnostic, prognostic, and risk stratification value. Thus, the possible benefits of troponin screening represent the main aim of numerous studies in non-cardiac surgery patients. Still, this issue has not been sufficiently explored in patients undergoing carotid revascularization. Questions regarding the superiority of routine/selective screening, one troponin essay over the other, preoperative/postoperative/perioperative evaluation, the appropriate timing and duration of troponin measurement, the predictors of its elevation and patient-specific risk factors, the impact of different anesthesia techniques and methods of carotid revascularization, the predictive role of perioperatively elevated troponin, secondary preventive strategies, therapeutic measures, and its cost-effectiveness mostly remain unanswered. The present review provides a comprehensive overview of the current knowledge regarding the value of troponin measurement in patients undergoing carotid revascularization, critically appraises the up-to-date literature, and marks directions for future research in this area. © 2024 EDIZIONI MINERVA MEDICA.