Bailey and Love's Short Practice of Surgery parathyroid disease anatomy hyperparathyroidism overview

"Hyperparathyroidism, Primary"[MeSH Terms] AND "parathyroidectomy"[MeSH Terms]

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surgical anatomy diagram parathyroid glands posterior thyroid inferior thyroid artery recurrent laryngeal nerve

https://www.ncbi.nlm.nih.gov/books/NBK537203

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mkdir -p "/tmp/workspace/parathyroid_applied_anatomy/src" "/tmp/workspace/parathyroid_applied_anatomy/output" && python - <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.shapes import MSO_AUTO_SHAPE_TYPE from pptx.enum.text import MSO_AUTO_SIZE from pptx.oxml.xmlchemy import OxmlElement from pptx.oxml.ns import qn from pathlib import Path OUT=Path('/tmp/workspace/parathyroid_applied_anatomy/output/Applied_Anatomy_Parathyroid_and_Diseases.pptx') prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(13,35,59); TEAL=RGBColor(0,126,132); AQUA=RGBColor(83,190,183); GOLD=RGBColor(238,174,62); RED=RGBColor(196,65,64); BG=RGBColor(247,250,252); INK=RGBColor(31,45,61); MUTED=RGBColor(93,108,122); PALE=RGBColor(229,243,243); WHITE=RGBColor(255,255,255); GREEN=RGBColor(47,143,94); PURPLE=RGBColor(117,83,166) def fill(shape,color): shape.fill.solid(); shape.fill.fore_color.rgb=color; shape.line.color.rgb=color def textbox(slide,x,y,w,h,text,size=18,color=INK,bold=False,align=PP_ALIGN.LEFT, font='Aptos', margin=.06): tb=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin); tf.vertical_anchor=MSO_ANCHOR.MIDDLE p=tf.paragraphs[0]; p.alignment=align; r=p.add_run(); r.text=text; r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return tb def rect(slide,x,y,w,h,color=WHITE,r=True, line=None): sh=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if r else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h)); fill(sh,color if line is None else color); if line: sh.line.color.rgb=line return sh def circle(slide,x,y,d,color): sh=slide.shapes.add_shape(MSO_SHAPE.OVAL, Inches(x), Inches(y), Inches(d), Inches(d)); fill(sh,color); return sh def line(slide,x1,y1,x2,y2,color=TEAL,width=2, arrow=False): sh=slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2)); sh.line.color.rgb=color; sh.line.width=Pt(width) if arrow: sh.line.end_arrowhead='triangle' return sh def header(slide,title,kicker, n): bg=slide.background.fill; bg.solid(); bg.fore_color.rgb=BG rect(slide,0,0,13.333,.18,TEAL,False) textbox(slide,.62,.36,11.5,.34,kicker.upper(),10,TEAL,True) textbox(slide,.62,.70,11.7,.55,title,27,NAVY,True) textbox(slide,12.13,.42,.58,.28,f'{n:02}',11,TEAL,True,PP_ALIGN.RIGHT) def foot(slide,source='Bailey & Love, 28e, Ch 56: The parathyroid glands'): line(slide,.62,7.08,12.72,7.08,RGBColor(213,223,228),1) textbox(slide,.62,7.15,10.5,.20,source,7.5,MUTED) textbox(slide,11.6,7.15,1.12,.20,'Teaching deck',7.5,MUTED,False,PP_ALIGN.RIGHT) def bullet_list(slide,x,y,w,h,items,size=17,color=INK): tb=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=Inches(.08); tf.margin_top=Inches(.04) for i,item in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=item; p.font.name='Aptos'; p.font.size=Pt(size); p.font.color.rgb=color; p.space_after=Pt(8); p.level=0; p.text='• '+item return tb def flow_box(slide,x,y,w,h,txt,color=WHITE,accent=TEAL,sz=13): sh=rect(slide,x,y,w,h,color,True,accent); sh.line.width=Pt(1.25); textbox(slide,x+.08,y+.07,w-.16,h-.14,txt,sz,INK,True,PP_ALIGN.CENTER); return sh def arrow(slide,x1,y1,x2,y2): line(slide,x1,y1,x2,y2,TEAL,1.8,True) # 1 title s=prs.slides.add_slide(blank); s.background.fill.solid(); s.background.fill.fore_color.rgb=NAVY # motif for x,y,d,c in [(10.4,1.0,1.55,TEAL),(11.1,2.05,.92,AQUA),(9.65,2.55,.78,GOLD),(10.6,3.4,1.15,TEAL),(11.8,4.05,.60,GOLD)]: circle(s,x,y,d,c) textbox(s,.75,.76,7.8,.35,'SURGICAL ENDOCRINOLOGY',12,AQUA,True) textbox(s,.75,1.38,8.2,1.2,'Applied anatomy of the\nparathyroids',34,WHITE,True) textbox(s,.79,2.84,7.6,.4,'Disease patterns, localisation and operative decision-making',18,RGBColor(211,232,234)) rect(s,.78,3.7,3.2,.38,TEAL,True); textbox(s,.92,3.74,2.9,.22,'Based primarily on Bailey & Love',10,WHITE,True,PP_ALIGN.CENTER) textbox(s,.79,6.6,7,.26,'For undergraduate and postgraduate surgical teaching',10,RGBColor(180,205,210)) # 2 objectives s=prs.slides.add_slide(blank); header(s,'Learning objectives','Roadmap',2) items=[('1','Recognise normal and ectopic gland locations'),('2','Relate embryology to operative search strategy'),('3','Interpret calcium-PTH patterns in disease'),('4','Plan localisation and parathyroid surgery safely')] for i,(num,tx) in enumerate(items): y=1.55+i*1.18; circle(s,.82,y,.55,TEAL if i<2 else GOLD); textbox(s,.82,y+.10,.55,.25,num,16,WHITE,True,PP_ALIGN.CENTER); rect(s,1.58,y,9.95,.58,WHITE,True,RGBColor(214,226,231)); textbox(s,1.88,y+.12,9.3,.28,tx,18,INK,True) textbox(s,.82,6.45,11.4,.36,'Anchor principle: embryology predicts ectopia; anatomy determines safe dissection.',16,NAVY,True) foot(s) # 3 normal anatomy diagram s=prs.slides.add_slide(blank); header(s,'Normal surgical anatomy','Four small glands with large operative consequences',3) # central thyroid posterior view rect(s,4.9,1.55,3.42,4.45,RGBColor(224,176,157),True,RGBColor(181,112,100)); textbox(s,5.52,3.42,2.2,.32,'Posterior thyroid\nview',16,NAVY,True,PP_ALIGN.CENTER) # lobes divide line(s,6.61,1.72,6.61,5.82,RGBColor(177,99,92),2) # trachea rect(s,6.18,5.70,.86,.55,RGBColor(202,220,226),True,RGBColor(140,170,180)); textbox(s,6.2,5.82,.8,.16,'Trachea',8,INK,True,PP_ALIGN.CENTER) # glands for x,y,label in [(5.22,2.28,'L sup'),(7.68,2.28,'R sup'),(5.22,4.75,'L inf'),(7.68,4.75,'R inf')]: circle(s,x,y,.34,GOLD); textbox(s,x-.3,y-.27,.95,.18,label,8,INK,True,PP_ALIGN.CENTER) # rlns line(s,5.68,5.72,5.92,2.1,RED,3); line(s,7.55,5.72,7.30,2.1,RED,3) textbox(s,1.0,1.55,3.25,.32,'Key relations',17,NAVY,True) bullet_list(s,1.0,2.0,3.3,3.35,['Usually four glands, yellow-brown, about 30 mg each','Superior gland: posterior thyroid, near cricothyroid junction','Inferior gland: lower pole, often in thyrothymic fat','Both usually supplied by branches of inferior thyroid artery'],14) textbox(s,9.2,1.55,3.2,.32,'Operative landmark',17,NAVY,True) rect(s,9.18,2.05,3.18,1.52,PALE,True,TEAL); textbox(s,9.4,2.23,2.75,1.1,'Superior gland lies near\nthe junction of the inferior\nthyroid artery and RLN',15,NAVY,True,PP_ALIGN.CENTER) line(s,9.18,3.72,7.65,2.55,TEAL,1.6,True) textbox(s,9.25,4.28,3.0,.5,'Red lines = recurrent\nlaryngeal nerves',12,RED,True,PP_ALIGN.CENTER) foot(s) # 4 embryology s=prs.slides.add_slide(blank); header(s,'Embryology explains ectopia','Migration pathway = search map',4) flow_box(s,.75,1.52,2.55,.9,'3rd pharyngeal pouch\nInferior parathyroid + thymus',PALE,TEAL,15) flow_box(s,.75,4.40,2.55,.9,'4th pharyngeal pouch\nSuperior parathyroid',RGBColor(245,239,255),PURPLE,15) arrow(s,3.35,1.97,5.1,3.25); arrow(s,3.35,4.85,5.1,3.72) # neck body rect(s,5.15,1.45,3.3,4.55,RGBColor(224,176,157),True,RGBColor(181,112,100)); textbox(s,5.8,3.25,2,.30,'Thyroid',18,NAVY,True,PP_ALIGN.CENTER) rect(s,6.42,5.72,.78,.48,RGBColor(202,220,226),True); textbox(s,6.43,5.84,.76,.13,'trachea',7,INK,True,PP_ALIGN.CENTER) circle(s,5.42,2.3,.28,PURPLE); circle(s,7.87,2.3,.28,PURPLE); circle(s,5.42,4.7,.28,GOLD); circle(s,7.87,4.7,.28,GOLD) rect(s,5.8,6.05,2,.38,RGBColor(173,216,190),True); textbox(s,5.87,6.13,1.85,.13,'Thymic tongue',8,INK,True,PP_ALIGN.CENTER) textbox(s,9.05,1.6,3.25,.30,'Applied implications',17,NAVY,True) bullet_list(s,9.05,2.04,3.2,3.9,['Inferior glands have a longer descent and more variable position.','Search inferior gland from lower pole into thyrothymic ligament and cervical thymus.','Potential ectopia: intrathyroidal, carotid sheath, retro-oesophageal, mediastinal.','Supernumerary glands account for some persistent disease.'],14) foot(s) #5 physiology s=prs.slides.add_slide(blank); header(s,'PTH maintains extracellular calcium','Feedback loop and target organs',5) flow_box(s,.65,3.05,2.2,.84,'↓ Ionised Ca²⁺',RGBColor(255,242,226),GOLD,18); arrow(s,2.9,3.47,4.05,3.47); flow_box(s,4.12,2.62,2.45,1.7,'Parathyroid chief cells\n↑ PTH secretion',PALE,TEAL,17); arrow(s,6.65,3.47,7.52,2.1); arrow(s,6.65,3.47,7.52,3.52); arrow(s,6.65,3.47,7.52,4.94) for y,lab,desc,col in [(1.58,'Bone','↑ resorption (via RANKL)',PURPLE),(3.0,'Kidney','↑ Ca reabsorption\n↓ phosphate reabsorption',TEAL),(4.42,'Kidney → vitamin D','↑ 1α-hydroxylase\n↑ intestinal Ca absorption',GREEN)]: flow_box(s,7.62,y,2.23,.84,lab+'\n'+desc,WHITE,col,12) arrow(s,9.92,2.0,11.08,3.45); arrow(s,9.92,3.42,11.08,3.45); arrow(s,9.92,4.84,11.08,3.45); flow_box(s,11.15,2.92,1.55,1.05,'↑ Serum\nCa²⁺',RGBColor(232,248,239),GREEN,16); arrow(s,11.14,4.05,5.35,5.72) textbox(s,3.7,5.82,3.4,.35,'Negative feedback suppresses PTH',11,MUTED,True,PP_ALIGN.CENTER) textbox(s,.72,6.55,11.8,.24,'PTH excess produces hypercalcaemia, hypophosphataemia and increased bone turnover. PTH deficiency has the opposite biochemical pattern.',12,NAVY,True,PP_ALIGN.CENTER) foot(s) #6 hyperPT types s=prs.slides.add_slide(blank); header(s,'Hyperparathyroidism: classify before localising','Biochemistry is diagnostic. Imaging is for operative planning.',6) cols=[('Primary','Autonomous PTH secretion','Usually single adenoma\nLess often hyperplasia\nRarely carcinoma','↑ Ca | PTH not suppressed\n↓ phosphate',TEAL),('Secondary','Appropriate compensatory PTH','CKD, vitamin D deficiency, malabsorption','↓/normal Ca | ↑ PTH\nphosphate varies with cause',GOLD),('Tertiary','Autonomy after longstanding secondary HPT','Usually CKD-related multigland hyperplasia','↑ Ca | markedly ↑ PTH',PURPLE)] for i,(title,sub,a,b,c) in enumerate(cols): x=.65+i*4.2; rect(s,x,1.55,3.7,4.72,WHITE,True,c); textbox(s,x+.22,1.82,3.25,.3,title,22,c,True,PP_ALIGN.CENTER); textbox(s,x+.22,2.35,3.25,.32,sub,12,INK,True,PP_ALIGN.CENTER); line(s,x+.32,2.85,x+3.38,2.85,RGBColor(219,230,232),1); textbox(s,x+.35,3.05,3.0,.85,a,15,INK,False,PP_ALIGN.CENTER); textbox(s,x+.35,4.5,3.0,.82,b,15,NAVY,True,PP_ALIGN.CENTER) textbox(s,.72,6.6,11.7,.28,'Do not diagnose primary hyperparathyroidism solely from a high PTH: interpret calcium, renal function, vitamin D and urinary calcium together.',13,NAVY,True,PP_ALIGN.CENTER) foot(s) #7 diagnosis flowchart s=prs.slides.add_slide(blank); header(s,'Diagnostic pathway for raised calcium','Confirm the phenotype before referring for surgery',7) flow_box(s,.72,1.36,2.45,.72,'Raised total calcium',RGBColor(255,242,226),GOLD,17); arrow(s,3.18,1.72,4.00,1.72); flow_box(s,4.04,1.36,2.62,.72,'Repeat / correct for albumin\nor measure ionised Ca²⁺',WHITE,TEAL,13); arrow(s,6.68,1.72,7.52,1.72); flow_box(s,7.57,1.36,2.25,.72,'Measure intact PTH',PALE,TEAL,16) arrow(s,8.67,2.12,8.67,2.72); line(s,8.67,2.72,5.1,2.72,TEAL,1.8,True); line(s,8.67,2.72,11.45,2.72,TEAL,1.8,True) flow_box(s,3.75,3.02,2.7,.88,'PTH suppressed\nPTH-independent hypercalcaemia',RGBColor(255,234,233),RED,14); flow_box(s,10.02,3.02,2.65,.88,'PTH normal/high\nPTH-dependent hypercalcaemia',PALE,TEAL,14) arrow(s,5.1,3.93,5.1,4.55); arrow(s,11.34,3.93,11.34,4.55) flow_box(s,3.47,4.62,3.3,1.12,'Consider malignancy, vitamin D excess, granulomatous disease, drugs',WHITE,RED,13); flow_box(s,9.72,4.62,3.25,1.12,'25-OH vitamin D, eGFR, phosphate, 24-h urinary Ca / Ca:Cr clearance ratio',WHITE,TEAL,12) textbox(s,.85,6.35,11.6,.43,'Primary HPT: high calcium with an inappropriately non-suppressed PTH. Exclude familial hypocalciuric hypercalcaemia when the clinical setting suggests it.',14,NAVY,True,PP_ALIGN.CENTER) foot(s) # 8 localisation s=prs.slides.add_slide(blank); header(s,'Localisation studies','Not diagnostic tests: they guide an operative approach',8) items=[('Ultrasound','No radiation; identifies thyroid co-pathology','Operator-dependent; less sensitive for ectopia',TEAL),('99mTc-sestamibi ± SPECT/CT','Functional imaging; useful concordance','May miss multigland disease',GOLD),('4D-CT','High spatial resolution; ectopic/re-operative utility','Radiation and iodinated contrast',PURPLE),('18F-fluorocholine PET/CT','Problem-solving in selected cases','Availability / cost',GREEN)] for i,(a,b,c,col) in enumerate(items): y=1.42+i*1.18; circle(s,.8,y+.08,.42,col); textbox(s,1.4,y,2.45,.28,a,17,NAVY,True); textbox(s,3.82,y,4.15,.48,b,13,INK); textbox(s,8.15,y,3.75,.48,c,13,MUTED); line(s,.75,y+.79,12.35,y+.79,RGBColor(219,230,232),1) textbox(s,.82,6.48,11.55,.32,'Concordant imaging in sporadic single-gland disease supports focused parathyroidectomy. Negative imaging does not exclude surgically curable disease.',14,NAVY,True,PP_ALIGN.CENTER) foot(s) # 9 indications s=prs.slides.add_slide(blank); header(s,'When to operate in primary HPT','Symptoms, target-organ injury and risk modify the decision',9) rect(s,.72,1.42,3.65,4.82,RGBColor(234,247,241),True,GREEN); textbox(s,1.0,1.75,3.1,.32,'Surgery is standard for',20,GREEN,True,PP_ALIGN.CENTER); bullet_list(s,1.02,2.32,3.12,2.95,['Symptomatic hypercalcaemia','Renal stones / nephrocalcinosis','Skeletal disease or fragility fracture','Marked neuro-muscular symptoms'],16) rect(s,4.85,1.42,3.65,4.82,RGBColor(255,247,232),True,GOLD); textbox(s,5.13,1.75,3.1,.32,'Consider surgery when',20,GOLD,True,PP_ALIGN.CENTER); bullet_list(s,5.14,2.32,3.12,2.95,['Substantial calcium elevation','Osteoporosis by DXA','Reduced kidney function','Hypercalciuria / stone risk','Age <50 years'],16) rect(s,8.98,1.42,3.65,4.82,RGBColor(242,238,252),True,PURPLE); textbox(s,9.26,1.75,3.1,.32,'If non-operative',20,PURPLE,True,PP_ALIGN.CENTER); bullet_list(s,9.27,2.32,3.12,2.95,['Monitor calcium and renal status','Assess bone density','Correct vitamin D carefully','Consider antiresorptive / calcimimetic therapy in selected patients'],15) foot(s,'Bailey & Love, 28e, Ch 56; International Workshop guidance should be consulted locally') #10 operation s=prs.slides.add_slide(blank); header(s,'Parathyroidectomy: anatomy-driven conduct','Focused operation versus bilateral exploration',10) flow_box(s,.78,1.35,2.35,.72,'Biochemically confirmed PHPT',WHITE,TEAL,15); arrow(s,3.15,1.71,4.0,1.71); flow_box(s,4.05,1.35,2.25,.72,'Pre-operative localisation',PALE,TEAL,15); arrow(s,6.35,1.71,7.2,1.71); flow_box(s,7.25,1.35,2.36,.72,'Concordant single focus?',WHITE,TEAL,15) line(s,8.43,2.08,6.0,2.72,TEAL,1.8,True); line(s,8.43,2.08,10.8,2.72,TEAL,1.8,True); textbox(s,5.85,2.28,.35,.2,'No',10,MUTED,True); textbox(s,10.42,2.28,.4,.2,'Yes',10,MUTED,True) flow_box(s,4.12,3.0,3.62,1.12,'Bilateral exploration\nIdentify all glands; search expected ectopic sites',RGBColor(245,239,255),PURPLE,15); flow_box(s,9.0,3.0,3.32,1.12,'Focused parathyroidectomy\nConsider intra-operative PTH',RGBColor(234,247,241),GREEN,15) arrow(s,5.95,4.18,5.95,4.88); arrow(s,10.68,4.18,10.68,4.88) flow_box(s,3.9,4.95,4.08,1.0,'Protect RLN and preserve vascular pedicle to normal glands',WHITE,RED,15); flow_box(s,8.62,4.95,4.12,1.0,'Failure to fall in PTH: reassess for multigland or missed ectopic disease',WHITE,GOLD,14) foot(s) #11 postoperative s=prs.slides.add_slide(blank); header(s,'Postoperative hypocalcaemia','Recognise early, distinguish transient from hungry bone syndrome',11) flow_box(s,.8,1.38,2.3,.76,'After neck surgery',WHITE,TEAL,16); arrow(s,3.15,1.76,4.05,1.76); flow_box(s,4.1,1.38,2.55,.76,'Check symptoms + Ca²⁺\n(consider Mg and phosphate)',PALE,TEAL,14); arrow(s,6.7,1.76,7.58,1.76); flow_box(s,7.63,1.38,2.2,.76,'Hypocalcaemia?',WHITE,TEAL,16) line(s,8.73,2.14,5.45,2.75,TEAL,1.8,True); line(s,8.73,2.14,11.2,2.75,TEAL,1.8,True); textbox(s,5.37,2.3,.3,.2,'No',10,MUTED,True); textbox(s,10.82,2.3,.35,.2,'Yes',10,MUTED,True) flow_box(s,3.82,3.05,3.32,.95,'Routine observation\nEducate on paraesthesia / cramps',WHITE,GREEN,14); flow_box(s,9.65,3.05,3.05,.95,'Assess severity and mechanism\nPTH, Mg, phosphate, ALP',RGBColor(255,242,226),GOLD,14) arrow(s,11.16,4.1,11.16,4.75); flow_box(s,9.25,4.8,3.88,1.05,'Oral calcium ± calcitriol if mild. IV calcium for severe symptoms, ECG changes or tetany.',RGBColor(255,234,233),RED,14) textbox(s,.85,6.4,11.55,.3,'Hungry bone syndrome: rapid skeletal uptake of calcium after removal of a high-turnover PTH source; anticipate in severe bone disease.',13,NAVY,True,PP_ALIGN.CENTER) foot(s) #12 hypopara s=prs.slides.add_slide(blank); header(s,'Hypoparathyroidism','Low PTH, low calcium, high phosphate',12) rect(s,.72,1.38,3.55,4.85,WHITE,True,TEAL); textbox(s,1.0,1.75,3.0,.3,'Aetiology',21,TEAL,True,PP_ALIGN.CENTER); bullet_list(s,1.0,2.35,3.0,3.25,['Post-thyroidectomy or neck surgery','Autoimmune destruction','Genetic / developmental disorders','Severe hypomagnesaemia'],16) rect(s,4.9,1.38,3.55,4.85,WHITE,True,GOLD); textbox(s,5.18,1.75,3.0,.3,'Clinical features',21,GOLD,True,PP_ALIGN.CENTER); bullet_list(s,5.18,2.35,3.0,3.25,['Perioral tingling, cramps','Carpopedal spasm, tetany','Seizures, laryngospasm','Prolonged QT interval'],16) rect(s,9.08,1.38,3.55,4.85,WHITE,True,GREEN); textbox(s,9.36,1.75,3.0,.3,'Management',21,GREEN,True,PP_ALIGN.CENTER); bullet_list(s,9.36,2.35,3.0,3.25,['Acute IV calcium if severe','Oral calcium + active vitamin D','Correct magnesium deficit','Monitor calcium, phosphate, renal complications'],15) foot(s) #13 carcinoma familial s=prs.slides.add_slide(blank); header(s,'Unusual but important disease patterns','When the phenotype suggests more than a sporadic adenoma',13) for i,(title,col,pts) in enumerate([('Parathyroid carcinoma',RED,['Very high calcium and PTH','Palpable neck mass or RLN palsy can be warning signs','En bloc resection if suspected: avoid capsular disruption']),('MEN1 / familial HPT',PURPLE,['Earlier onset and multigland disease','Think family history and syndromic features','Bilateral exploration is usually needed']),('HPT-jaw tumour syndrome',GOLD,['CDC73-associated disorder','Parathyroid carcinoma risk','Genetic assessment where suspected'])]): x=.7+i*4.18; rect(s,x,1.48,3.62,4.95,WHITE,True,col); textbox(s,x+.22,1.8,3.18,.52,title,19,col,True,PP_ALIGN.CENTER); line(s,x+.35,2.55,x+3.25,2.55,RGBColor(219,230,232),1); bullet_list(s,x+.32,2.88,2.98,2.9,pts,15) foot(s) #14 high-yield s=prs.slides.add_slide(blank); header(s,'High-yield surgical takeaways','A rapid recall slide',14) notes=[('Embryology','Inferior glands travel with thymus from the 3rd pouch, so they are the more variable glands.',TEAL),('Landmark','Superior gland is most consistently near the inferior thyroid artery-RLN junction.',GOLD),('Diagnosis','Primary HPT is a biochemical diagnosis: high calcium plus non-suppressed PTH.',PURPLE),('Imaging','Localisation selects the operation. It does not establish the diagnosis.',GREEN),('Safety','Preserve a vascularised remnant of normal parathyroid and protect the RLN.',RED)] for i,(a,b,c) in enumerate(notes): y=1.35+i*1.02; rect(s,.8,y,1.95,.62,c,True); textbox(s,.94,y+.15,1.66,.2,a,14,WHITE,True,PP_ALIGN.CENTER); textbox(s,3.02,y+.07,9.3,.48,b,15,INK,False) foot(s) #15 sources s=prs.slides.add_slide(blank); header(s,'References and attribution','Primary teaching source',15) textbox(s,.8,1.35,11.6,.42,'Core reference',20,TEAL,True) rect(s,.8,1.9,11.6,.76,PALE,True,TEAL); textbox(s,1.08,2.09,11.0,.34,"Williams NS, O'Connell PR, McCaskie A, eds. Bailey & Love's Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapter 56: The parathyroid glands.",15,NAVY,True) textbox(s,.8,3.1,11.6,.42,'Supplementary sources used for cross-checking',18,TEAL,True) bullet_list(s,.95,3.58,11.2,1.65,['Schwartz’s Principles of Surgery, 11th ed. Parathyroid section.','Sabiston Textbook of Surgery. Endocrine surgery and familial hyperparathyroidism sections.','Ilahi A, Muco E, Ilahi TB. Anatomy, Head and Neck, Parathyroid. StatPearls, updated 2023.'],15) textbox(s,.84,5.65,11.4,.5,'All diagrams and flowcharts in this deck were created for teaching from the above sources. Clinical decisions must follow local protocols and specialist guidance.',13,MUTED,False,PP_ALIGN.CENTER) textbox(s,.84,6.45,11.4,.28,'Recent evidence check: MEN1 surgical extent systematic review and meta-analysis, PMID 40891326 (2025).',11,MUTED,False,PP_ALIGN.CENTER) foot(s,'Reference slide') # slide numbers and speaker notes metadata omitted prs.save(str(OUT)) print(OUT) PY python - <<'PY' from pptx import Presentation p='/tmp/workspace/parathyroid_applied_anatomy/output/Applied_Anatomy_Parathyroid_and_Diseases.pptx' prs=Presentation(p) print('slides',len(prs.slides),'size',__import__('os').path.getsize(p)) for i,s in enumerate(prs.slides,1): t=' '.join(sh.text.replace('\n',' ') for sh in s.shapes if hasattr(sh,'text_frame') and sh.text.strip()) print(i, t[:95]) PY

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/parathyroid_applied_anatomy/output/Applied_Anatomy_Parathyroid_and_Diseases.pptx') prs=Presentation(str(p)) assert len(prs.slides)==15 assert p.stat().st_size > 50000 # ensure titles and reference strings are present full='\n'.join(sh.text for s in prs.slides for sh in s.shapes if hasattr(sh,'text_frame')) for phrase in ['Applied anatomy of the','Bailey & Love','Diagnostic pathway','Parathyroidectomy','References and attribution']: assert phrase in full, phrase print('PASS: 15 slides,', p.stat().st_size, 'bytes') PY

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"Hyperparathyroidism, Primary"[MeSH Terms] AND "Practice Guideline"[Publication Type]

primary hyperparathyroidism clinical practice guideline diagnosis calcium PTH surgery 2025

~/parathyroid_applied_anatomy/

~/parathyroid_applied_anatomy/output