Supranumerary or ectopic parathyroid glands are the main cause of persistent hyperparathyroidism (HPT) in patients with end stage renal disease (ESRD) submitted to parathyroidectomy (PTx). PURPOSE: To evaluate the prevalence and location of parathyroid glands in these patients. METHODS: Thirty-five patients with ESRD and severe secondary hyperparathyroidism (HPT2) had been submitted to total PTx at HUCFF from December 2001 to July 2005. Surgery was always performed by the same surgeon, who described in details the location of the glands. RESULTS: Sixteen patients (45.7%) had ectopic glands, which were also extranumerary in five of them (14.3%). The most common locations were the thyroid parenchyma (33.3%), thyroid-thymus conduit (18.5%), and thymus (14.8%). Before PTx, the sensibility of ultrasonography and scintigraphy with technetium-99m Sestamibi was low (48.3% and 35.3%, respectively). Moreover, 51.4% of the nodules found at US were thyroid nodules. However, 99mTc-Sestamibi was useful to identify ectopic glands in those two patients with persistent HPT after PTx. CONCLUSION: The presence of extranumerary and ectopic parathyroid glands in HPT2 is sufficiently important to justify their exhaustive search. As the preoperative image exams present low sensibility to locate them, it is necessary to develop an exploratory routine embracing the most common sites of location.

Brown tumors are relatively uncommon but they are serious complications of renal osteodystrophy. We describe a 31-year-old woman with end-stage renal disease who had undergone hemodialysis for nine years and developed severe secondary hyperparathyroidism and a maxilla brown tumor despite increasing doses of oral calcitriol and calcium carbonate. The fast increase of the right maxillary bone tumor led to indication of parathyroidectomy (PTx). Despite normalization of serum PTH there was a slow regression of the mass and the patient still complained about her appearance after two-years of follow-up. Excision of the maxillary mass followed by recontouring of the maxilla was then performed, with adequate masticator rehabilitation. Tumores marrons são relativamente incomuns mas constituem sérias complicações da osteodistrofia renal. Descrevemos o caso de uma paciente, 31 anos, com doença renal em estágio terminal, em hemodiálise há nove anos, que desenvolveu severo hiperparatireoidismo secundário com tumor marrom em maxila apesar de doses crescentes de calcitriol oral e carbonato de cálcio. O rápido aumento do tumor marrom em maxila levou à indicação de paratireoidectomia (PTx). Apesar da normalização dos níveis de PTH sérico, a regressão da massa tumoral foi lenta e a paciente questionava sobre sua aparência após dois anos de seguimento. A excisão da massa maxilar foi seguida da reconstrução com adequada função mastigatória. BROWN TUMORS ARE EROSIVE bony lesions caused by rapid osteoclastic activity and peritrabecular fibrosis due to hyperparathyroidism (HPT) resulting in a local destructive phenomenon. Actually they represent a reparative cellular process rather than a true neoplasia (1,2). They are known to occur only in the setting of HPT, and are considered the most pathognomonic skeletal changes that accompany this disease. For years, these lesions have been recognized in primary hyperparathyroidism (HPT1) (3). However, brown tumors have also been reported in patients with severe hyperparathyroidism secondary to chronic renal failure (HPT2), especially those on long-term hemodialysis (4,5).

Purpose. To compare the effects of aquatic and land plyometric training on the vertical jump (VJ) and delayed onset muscle soreness (DOMS) in soccer players. Methods. Twenty-four male soccer players aged 16-18 years (16.53 ± 0.5 years) were randomly divided into three groups: aquatic plyometric training (APT) (n = 8; age: 16.4 ± 0.4 years; body mass: 68.3 ± 7.54 kg; height: 179.75 ± 8.13 cm); land plyometric training (LPT) (n = 8; age: 16.5 ± 0.5 years; body mass: 68.2 ± 7.8 kg; height: 177.0 ± 7.4 cm); and control group (n = 8; age: 16.7 ± 0.6 years; body mass: 61.2 ± 6.5 kg; height: 171.43 ± 5.75 cm), not performing any jump program. An identical training program was applied for 6 weeks, totalling 944 jumps. The VJ was evaluated on a leap jump platform and the Visual Analogue Scale measured the change in DOMS perception.Results. There was a significant increase in the VJ height in both experimental groups (LPT and APT) (p < 0.05). A significant reduction in DOMS perception was verified for the APT group in comparison with the LPT group (p < 0.05) between the first and last week of training. The foot contact time significantly decreased (p < 0.05) in the APT group from pre-to posttest. Significant improvements (p < 0.05) were observed in the flight time and jump speed from pre-to post-test in both LPT and APT groups. Conclusions. APT can increase the VJ height and reduce DOMS perception in soccer players.

There are several equations to predict maximum oxygen consumption (VO2max) from ergometric test variables on different ergometers. However, a similar equation using ventilatory thresholds of ergospirometry in a submaximal test on a cycle ergometer is unavailable. The aim of the present study was to assess the accuracy of VO2max prediction models based on indicators of submaximal effort. Accordingly, 4,640 healthy, nonathlete women ages 20 years and older volunteered to be tested on a cycle ergometer using a maximum incremental protocol. The subjects were randomly assigned to 2 groups: group A (estimation) and group B (validation). From the independent variables of weight in kilograms, the second workload threshold (WT2), and heart rate of the second threshold (HRT2), it was possible to build a multiple linear regression model to predict maximal oxygen consumption (VO2max = 40.302 - 0.497 [Weight] - 0.001 [HRT2] + 0.239 [WT2] in mL O2/kg/min(-1); r = 0.995 and standard error of the estimate [SEE] = 0.68 mL O2/kg/min(-1)). The cross-validation method was used in group B with group A serving as the basis for building the model and the validation dataset. The results showed that, in healthy nonathlete women, it is possible to predict VO2max with a minimum of error (SEE = 1.00%) from submaximal indicators obtained in an incremental test.

A 72-yr-old acromegalic man, who presented with pain in the left femur, was found to have a metastatic osteosarcoma. Only three cases describing the coexistence of acromegaly and osteosarcoma have been reported by the literature. As the patient didn't have other risk factors for osteosarcoma, the hypothesis that accelerated rate of bone turnover caused by long-term exposure to high GH and IGF-I could act as a predisposing factor in the development of this malignant bone tumor is discussed.