Recommendations after non-localizing sestamibi and ultrasound scans in primary hyperparathyroid disease: order more scans or explore surgically?
Non-localizing preoperative scans may result from ectopic parathyroid adenoma or presence of a multinodular goiter in PHPT. When presented with negative preoperative studies, we propose that the patient be scheduled for bilateral neck examination with intraoperative PTH assay rather than for additional preoperative studies. The surgeon's level of experience with four gland exploration and a thorough understanding of normal and aberrant positioning of parathyroid glands are imperative for patient safety and treatment, especially when localization studies have failed.
Warfarin therapy in the United States is managed inappropriately because most laboratories do not report INRs and the variability in thromboplastin sensitivity produces misleading prothrombin time ratio results. Additionally, recent research may require reexamination if INR or ISI data were not provided.