INTRODUCTION Minimally invasive parathyroidectomy (MIP) is performed via a short incision (≤3cm). Previous studies have employed multiple imaging modalities including ultrasonography, sestamibi imaging and/or intraoperative parathyroid hormone assay. We present our eight-year experience of MIP using ultrasonography alone. METHODS One hundred parathyroidectomies performed by a single surgeon between April 2004 and December 2012 were identified in a prospectively maintained database. All patients underwent ultrasonography including preoperative marking of the lesion by a single radiologist. No other localising diagnostic tests were performed. RESULTS Of the 100 patients (69% female) who underwent parathyroidectomy, 93 had MIP. The median age of all cases was 58 years (range: 19-90 years). All patients exhibited an elevated parathyroid hormone level (median: 19pmol) in the presence of hypercalcaemia (median: 2.86mmol/l, range: 2.54-3.94mmol/l). Conventional surgery was indicated in seven patients owing to the need for concurrent thyroidectomy. The median operative time was 30 minutes (range: 10-130 minutes). Ultrasonography localised parathyroid tumour position correctly in 98% of patients who underwent MIP, and in 97% across both MIP and non-MIP groups. Postoperative complications requiring treatment included pancreatitis and symptomatic hypocalcaemia. Follow-up review at 6-8 weeks demonstrated that 86% of open cases (6/7) and 94% of MIP cases (87/93) were rendered normocalcaemic. CONCLUSIONS Our study is the first to demonstrate that the sole use of ultrasonography including preoperative marking can localise parathyroid tumours correctly in 98% of cases suitable for MIP.

Objectives: Spontaneous embolisation (SE) detected using Transcranial Doppler (TCD) after a Transient Ischaemic Attack (TIA)/Minor stroke is an independent predictor of recurrent stroke. There are, however limited data on the differential prevalence of SE in the first few days/weeks after onset of symptoms.Method: 156 consecutive patients (symptomatic n ϭ 123, asymptomatic n ϭ 33) underwent Carotid Endarterectomy (CEA) during an 18 month period and had an accessible window permitting 30 min of preoperative TCD monitoring. A prospective study was conducted with assessors blinded to clinical status.Results: Spontaneous embolisation was detected in 31 symptomatic patients (25%) of which 1/1 (100%), 14/35 (40%), 8/37 (22%) and in 8/50 (16%) patients presented within 48 h, 3-7 days, 8 -14 days and Ͼ14 days respectively from the index clinical event. SE occurred in only 6% of asymptomatic patients. Out of 31 symptomatic patients with SE, seven (22.6%) suffered recurrent cerebrovascular events following admission as opposed to 11/92 patients (11.9%) who had no evidence of spontaneous embolisation after admission (OR 2.2 (95% CI 0.8 -6.1))(P ϭ 0.2) Conclusion: Patients presenting for CEA in the hyperacute period after onset of TIA/Minor stroke have a high incidence of SE. Patients with SE had a 23% risk of recurrent cerebrovascular events. These data support the current drive towards expedited CEA in recently symptomatic patients. Proximal Common Carotid Artery Lesions: Endovascular and Open RepairLinni K., Aspalter M., Ugurluoglu A., Hölzenbein T.Eur J Vasc Endovasc Surg 2011;41:728-34.

Background: Primary dysmenorrhea (PD) is a highly prevalent health related problem because of its effects on different aspects of physical and mental health. Objectives: To find association of primary dysmenorrhea with depression. Methodology: A correlational study was conducted at Royal group of colleges Gujranwala, Pakistan. Ninety-nine female students with confirmed diagnosis of primary dysmenorrhea were included with age range between 16-25 years. The data was collected through non-probability convenience sampling technique. The data was collected using numeric pain rating scale, daily record of severity of problems (DRSP) and patient health questionnaire (PHQ-9) for depression. Linear regression and chi square test have been used to observe association between variables. Results: The mean age was 21.06+2.59 years, age at menarche 13.15+1.03 years. The results showed significant association among pain, depression and severity of symptoms associated with primary dysmenorhhea (p≤0.00). Conclusion: The intensity of pain and associated symptoms was moderate in majority of subjects. There is positive association of pain and symptoms of dysmenorrhea with depression level. Increasing depression can cause difficulty in work, getting along with others and take care of other things. Keywords: Primary dysmenorrhea, depression, DRSP, Numeric pain rating scale, PHQ-9.