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BACKGROUND Primary hyperparathyroidism (PHPT) results in reduction of bone mineral density (BMD) and an increased risk of pathological fractures. Curative surgery does improve BMD; however, the magnitude of rise and predictive factors are highly variable amongst the hitherto available studies. OBJECTIVES To quantify the magnitude of improvement in BMD after curative surgery in patients with symptomatic PHPT and dissect out the possible clinical and biochemical parameters predicting the BMD rise. METHODS We conducted a retrospective study of symptomatic PHPT patients undergoing surgery between August 2016 and July 2018. Patients achieving biochemical cure with pre- and post-operative (at least 1 year after surgery) dual-energy X-ray absorptiometry scans performed were included in the study. RESULTS After exclusion, 63 patients were included in the study (M:F = 2:5; mean age = 44.8 years). At a median interval of 15 months, the median per cent change in BMD (ΔBMD) at lumbar spine (LS), total hip (TH), femoral neck (FN) and one-third distal radius (forearm) was 6.5%, 7.0%, 8.1% and 6.9%, respectively. Following multiple linear regression analysis, baseline BMD was found to inversely predict ΔBMD at LS, TH and forearm. Pre-operative iPTH positively predicted ΔBMD at LS and FN. Interestingly, 82.5% of the patients had a gain in body weight following curative surgery and change in body weight emerged as a significant positive predictor of ΔBMD at all sites. CONCLUSIONS Curative surgery improves BMD at all sites in patients with symptomatic PHPT. Weight gain following surgery can be used as a positive clinical predictor of BMD rise.

We report a 62-year-old woman who presented with chronic watery diarrhea and weight loss. During evaluation, she was found to have pneumobilia in the absence of gallstones, raising the suspicion of bilioenteric communication. Computed tomography demonstrated adherence of the gallbladder to the adjacent transverse colon. Hepatobiliary scintigraphy demonstrated the presence of a cholecystocolic fistula. A planned uneventful open cholecystectomy with resection of fistulous tract and closure of colonic opening was performed, resulting in the complete resolution of clinical symptoms.

Background No objective assessment of delayed gastric emptying is carried out in patients undergoing Whipple's procedure. All definitions and criteria along with evaluation of incidence of delayed gastric emptying are based on subjective assessment of the patient with clinical overview, so this study was carried out for an objective and accurate assessment of delayed gastric emptying in post Whipple's patients using gastric scintigraphy. Methods Twenty-one patients undergoing Whipple's procedure performed by a single surgeon in a tertiary referral centre were included in the study. Gastric scintigraphy was performed preoperatively and on post-operative 10th and 21st days. Preoperative and post-operative gastric scintigraphy findings were used for the diagnosis of delayed gastric emptying and it was correlated with the incidence of clinical diagnosis of delayed gastric emptying. Results Thirteen out of 21 patients had clinical delayed gastric emptying. When compared with clinical delayed gastric emptying, the sensitivity, specificity, positive and negative predictive values of post-operative 10th day gastric scintigraphy were 61.53, 100, 100 and 61.53%, respectively (P = 0.004). The sensitivity, specificity, positive and negative predictive values of post-operative 21st day gastric scintigraphy were 38.46, 100, 100 and 50%, respectively (P = 0.04). Reflux across the gastrojejunal anastomosis was noted in 28.5% on dynamic scintigraphy with the severity of clinical symptoms related directly with the degree of reflux. No correlation was seen between delayed gastric emptying and variables such as diabetes mellitus, hypertension and pancreaticojejunal anastomotic leaks. Conclusions Gastric scintigraphy may be used to diagnose delayed gastric emptying more objectively in post Whipple's patients.