Measuring muscle mass is an important component of the nutritional assessment examination and a suggested index of this body space is the 24-h urinary excretion of creatinine. The method originated from studies in a variety of animal species in whom early workers found a parallelism between total body creatine and urinary excretion of creatinine. Assuming that nearly all creatine was within muscle tissue, that muscle creatine content remained constant and that creatinine was excreted at a uniform rate, an obvious "corollary" was that urinary creatinine was proportional to muscle mass. The so-called "creatinine equivalence" (kg muscle mass/g urinary creatinine) ranged experimentally from 17 to 22. One of the limiting factors in firmly establishing this constant and its associated variability was (and is) the lack of another totally acceptable noninvasive technique of measuring muscle mass to which the creatinine method could (or would) be compared. An improved understanding of creatine metabolism and a variety of clinical studies in recent years has tended to support the general validity of this approach. However, specific conditions have also been established in which the method becomes either inaccurate or invalid. While creatinine excretion may serve as a useful approximation of muscle mass in carefully selected subjects, there remains a need for accurate and practical indices of muscle mass for use in the individuals in whom the method cannot be reliably applied.

ver the past 2 decades, minimally invasive parathy roidectomy has been widely adopted because of improved preoperative imaging and routine use of in traoperative parathyroid hormone monitoring (1). The rationale for this surgical approach is that most patients with primary hyperparathyroidism have a single, benign parathyroid adenoma (up to 88%) (2). Compared with bilateral neck exploration, minimally invasive parathy roidectomy is associated with lower complication rates, shorter operation times, reduced costs, and improved cosmetic results while it maintains similar cure rates (3). Accurate preoperative localization of a single para thyroid adenoma is critically important to the success of minimally invasive parathyroidectomy because it directs the surgeon to the adenoma, without which minimally invasive parathyroidectomy becomes a problematic surgi cal approach (4,5). Conversely, negative or equivocal pre operative imaging directs the surgeon to the less focused bilateral neck exploration. With a variety of imagingbased localization mo dalities available and different acquisition protocols within a given modality, to our knowledge there is no current consensus regarding the optimal localization procedure and imaging protocol (6). The choice often depends on regional imaging capabilities, radiologist expertise, and surgeon preference. Many institutions

; for the International CONNsortium study group IMPORTANCE In addition to biochemical cure, clinical benefits after surgery for primary aldosteronism depend on the magnitude of decrease in blood pressure (BP) and use of antihypertensive medications with a subsequent decreased risk of cardiovascular and/or cerebrovascular morbidity and drug-induced adverse effects. OBJECTIVE To evaluate the change in BP and use of antihypertensive medications within an international cohort of patients who recently underwent surgery for primary aldosteronism. DESIGN, SETTING, AND PARTICIPANTS A cohort study was conducted across 16 referral medical centers in Europe, the United States, Canada, and Australia. Patients who underwent unilateral adrenalectomy for primary aldosteronism between January 2010 and December 2016 were included. Data analysis was performed from August 2017 to June 2018. Unilateral disease was confirmed using computed tomography, magnetic resonance imaging, and/or adrenal venous sampling. Patients with missing or incomplete preoperative or follow-up data regarding BP or corresponding number of antihypertensive medications were excluded. MAIN OUTCOMES AND MEASURES Clinical success was defined based on postoperative BP and number of antihypertensive medications. Cure was defined as normotension without antihypertensive medications, and clear improvement as normotension with lower or equal use of antihypertensive medications. In patients with preoperative normotensivity, improvement was defined as postoperative normotension with lower antihypertensive use. All other patients were stratified as no clear success because the benefits of surgery were less obvious, mainly owing to postoperative, persistent hypertension. Clinical outcomes were assessed at follow-up closest to 6 months after surgery. RESULTS On the basis of inclusion and exclusion criteria, a total of 435 patients (84.6%) from a cohort of 514 patients who underwent unilateral adrenalectomy were eligible. Of these patients, 186 (42.3%) were women; mean (SD) age at the time of surgery was 50.7 (11.4) years. Cure was achieved in 118 patients (27.1%), clear improvement in 135 (31.0%), and no clear success in 182 (41.8%). In the subgroup classified as no clear success, 166 patients (91.2%) had postoperative hypertension. However, within this subgroup, the mean (SD) systolic and diastolic BP decreased significantly by 9 (22) mm Hg (P < .001) and 3 (15) mm Hg (P = .04), respectively. Also, the number of antihypertensive medications used decreased from 3 (range, 0-7) to 2 (range, 0-6) (P < .001). Moreover, in 75 of 182 patients (41.2%) within this subgroup, the decrease in systolic BP was 10 mm Hg or greater. CONCLUSIONS AND RELEVANCE In this study, for most patients, adrenalectomy was associated with a postoperative normotensive state and reduction of antihypertensive medications. Furthermore, a significant proportion of patients with postoperative, persistent hypertension may benefit from adrenalectomy given the observed clinically relevant and significant redu...

Background Hashimoto’s thyroiditis (HT) is an organ –specific autoimmune disease characterized by production of antibodies such as anti-thyroperoxidase (TPO), which leads to destruction of the thyroid gland and a decrease in normal thyroid function. Thyroidectomy is performed when the patient presents with symptoms or when potential neoplastic degeneration occurs; however, surgery can be difficult due to the dense inflammatory process around the thyroid gland. We hypothesized that patients with HT may have a higher rate of complications following thyroid surgery. Methods We identified 1791 consecutive patients who underwent thyroidectomy from May 1994 to December 2009. Patients with HT were compared to without HT with regard to outcomes with ANOVA and Chi-squared (SPSS, Inc.). Results Patients with HT were significantly younger and more likely to be female. There was no significant difference between the two groups in the rate of malignancy. However, patients undergoing thyroidectomy with HT had a significantly higher postoperative complication rate. Specifically, the rates of overall complications, transient complications, and permanent complications were all increased in HT patients. Conclusion Patients with HT had a higher rate of complications after thyroidectomy when compared to patients without HT. Therefore, careful consideration must be taken prior to pursuing operative treatment in patients with HT including providing adequate informed consent regarding the increased risks of surgery.