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- 저자 : Joel Lau (검색결과 3 건)
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Manju Chandran,John P.Bilezikian,Nurshazwani Mat Salleh,Hao Ying,Joel Lau,James Lee,Mechteld C. deJong,Aye Chan Maung,Rajeev Parameswaran 대한골다공증학회 2022 Osteoporosis and Sarcopenia Vol.8 No.1
Objectives: We sought to assess the incidence of hungry bone syndrome (HBS) following parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT) in a cohort of multi-ethnic patients from a developed country in the Asia Pacific. Methods: One hundred and sixty-four patients who underwent PTX for PHPT between 2012 and 2019 at the 2 largest public hospitals in Singapore were identified. HBS was defined as serum albumin-adjusted calcium ≤ 2.1 mmol/L with normal or raised serum intact parathyroid hormone (iPTH) levels, manifesting on or after the 3rd day, or persisting for more than 3 days post-operatively. Results: Chinese constituted 73.8%, Malays 12.2%, Indians 9.8%, and other races 4.3%. HBS developed in 4 patients (2.4%) (95% CI, 0.8%-6.5%). HBS patients had significantly longer in-hospital stays; 20 days [IQR:15-22] vs 2 days [IQR:1-3]; P < 0.001in those who did not develop HBS. There was no difference in the incidence of HBS stratifying for age, sex, vitamin D status, or use of preoperative anti-resorptive medication use. For every 10 unit increase in iPTH and alkaline phosphatase (ALP) levels, the risk of HBS increased by 14% and 11%; RR (95% CI), 1.14 (1.05-1.21) and 1.11 (1.03-1.18), respectively. Conclusions: The low incidence of HBS in multi-ethnic patients undergoing PTX by multiple surgeons for PHPT at the 2 largest public hospitals that see the most such patients in Singapore, a developed country, is consistent with the asymptomatic/milder form of presentation of PHPT in the developed world.
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Lee Wynne Yu,Pang Xin Ler,Oh Han Boon,Lau Joel Wen Liang,Cheah Wei Keat,Tang Man Hon 대한내분비외과학회 2024 Journal of Endocrine Surgery Vol.24 No.2
Purpose: Parathyroidectomy is the definitive treatment for patients with primary hyperparathyroidism (PHPT), and the use of intra-operative parathyroid hormone (IoPTH) assay has led to high clinical success rates. However, it also resulted in longer operative duration as well as high false negative rates. This is a retrospective study of operative cases of PHPT performed in our institution. The aim is to audit the turnover time and evaluate the feasibility of omitting routine IoPTH in selected cases. Methods: All patients from Ng Teng Fong General Hospital who underwent parathyroidectomy for PHPT from 2015 to 2023 were included. All patients had routine IoPTH assessment based on Miami criteria. Patients were stratified into groups based on concordance of pre-operative imaging. Results: Forty-five patients were included in this study. Thirty-one (68.9%) patients had concordant pre-operative imaging. The 87.1% had adequate IoPTH reduction in this group and only one case (2.22%) had dual parathyroid adenoma. The remaining 14 (31.1%) patients had non-concordant imaging, of which 78.6% had adequate IoPTH reduction in this group with 2 cases (14.3%) of dual parathyroid adenoma. Patients with larger parathyroid adenoma (P=0.02) and higher PTH levels (P=0.008) are more likely to have concordant pre-operative imaging. The average additional wait time for IoPTH turnover is 36 minutes. Conclusion: Despite our limited study population, we believe it is safe and time effective to omit routine IoPTH for focused parathyroidectomy performed by experienced endocrine surgeons in cases with concordant imaging. However, IoPTH should still be recommended for patients with non-concordant imaging.
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Liu Gabriel Ka-Po,Tan Jiong Hao,Kong Jun Cheong,Tan Yong Hao Joel,Kumar Nishant,Liang Shen,Shawn Seah Jing Sheng,Ting Chiu Shi,Lim Lau Leok,Dennis Hey Hwee Weng,Kumar Naresh,Thambiah Joseph,Wong Hee-K 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.6
Study Design: A retrospective cohort study of patients with surgically treated thoracolumbar fractures.Purpose: This study aimed to describe the incidence of adverse events (AEs) after surgical stabilization of thoracolumbar spine injuries and to identify predictive factors for the occurrence of AEs. Overview of Literature: Thoracolumbar spine fractures are frequently present in patients with blunt trauma and are associated with significant morbidity. AEs can occur due to the initial spinal injury or secondary to surgical treatment. There is a lack of emphasis in the literature on the AEs that can occur after operative management of thoracolumbar fractures.Methods: We performed a retrospective review of 199 patients with surgically treated thoracolumbar fractures operated between January 2007 and January 2018. The potential risk factors for the development of AEs as well as the development of common complications were evaluated by univariate analysis, and a multivariate logistic regression analysis was performed to identify independent risk factors predictive of the above.Results: The overall rate of AEs was 46.7%; 83 patients (41.7%) had nonsurgical AEs, whereas 24 (12.1%) had surgical adverse events. The most common AEs were urinary tract infections in 43 patients (21.6%), and hospital-acquired pneumonia in 21 patients (10.6%). On multivariate logistic regression, a Thoracolumbar Injury Classification and Severity (TLICS) score of 8–10 (odds ratio [OR], 6.39; 95% confidence interval [CI], 2.33–17.51), the presence of polytrauma (OR, 2.64; 95% CI, 1.17–5.99), and undergoing open surgery (OR, 2.31; 95% CI, 1.09–4.88) were significant risk factors for AEs. The absence of neurological deficit was associated with a lower rate of AEs (OR, 0.47; 95% CI, 0.31–0.70).Conclusions: This study suggests the presence of polytrauma, preoperative American Spinal Injury Association score, and TLICS score are predictive of AEs in patients with surgically treated thoracolumbar fractures. The results might also suggest a role for minimally invasive surgical methods in reducing AEs in these patients.
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