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The surgical treatment of hyperparathyroidism has become controversial with the recent advent of reliable preoperative imaging modalities. This study examines the efficacy and economy of using preoperative imaging studies to localize the pathology and allow for unilateral neck exploration. From January 1990 to May 1996, a total of 91 patients with primary hyperparathyroidism were treated at Swedish Medical Center in Seattle, WA, by 2 surgeons. Eighty-six nuclear scintigraphy studies were performed, of which 44 were technetium 99m sestamibi (Tc-99m-sestamibi) scans and 42 were thallium 99m technetium (Th-99m-Tc) scans. The overall sensitivity for Tc-99m-sestamibi was 91% (40/44), and that for Th-99m-Tc scans was 81% (34/42). Ultrasound examination revealed a sensitivity of 80% (66/82). There was a statistically significant difference in surgical time between the unilateral and bilateral neck explorations (45 minutes, P < 0.0001). Unilateral neck exploration for hyperparathyroidism has been successful in curing hypercalcemia 93% (85/91) of the time with the use of preoperative imaging studies. Tc-99m-sestamibi is a reliable tool for planning the initial unilateral neck exploration for treatment of primary hyperparathyroidism.

The nm23 gene has been implicated as a suppressor gene involved in the control of the metastatic process of malignant cells. Reduced levels of nm23 gene product have been found in tumor cells with high metastatic potential such as several types of rodent tumors and human breast, colorectal, and lung carcinoma. This pilot study examines the expression of the nm23 gene product compared with nodal status in 70 consecutive patients with squamous cell carcinomas of the head and neck. Immunohistochemical staining was carried out on these tumor tissues with a monoclonal antibody to nm23-H1 peptide sequence. The tissues were scored from 0 to 2 by 2 independent observers. Reduced immunoreactivity, grades 0 and 1, was observed in 30 patients with positive nodal status (N = 34, 88%). Strong immunoreactivity, grade 2, was observed in 20 patients with negative nodal status (N = 36, 56%). Reduced expression of nm23 gene product was observed in patients with positive lymph node metastasis (P = 0. 0006, chi(2)). However, no significant differences in survival of these groups based on nm23 expression could be shown with the Kaplan-Meier analysis. This initial finding in the difference of nm23 gene product expression in patients with differing lymph node status is exciting but must be further validated with future studies.

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