Operative strategy in primary hyperparathyroidism.
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Adenoma↗
Biomedical subjects
H Johansson
Publications and source records attributed to H Johansson.
Histopathological diagnosis of hyperparathyroidism.
In the histopathological diagnosis of parathyroid gland pathology there has been a lack of well defined and generally acceptable criteria for differentiating between a normal and a slightly hyperplastic gland, and in many cases also between an adenoma and hyperplasia. This has meant that the histological evaluation of the parathyroid tissue has often been subjective depending on individual assessment of different pathologists. In recent years research in this area has yielded experience which should contribute towards a more reliable diagnosis. Two methods - the determination of the glandular parenchymal cell mass and the evaluation of the intracellular fat content - have been found to be particularly important in the histological diagnosis. The present paper describes the histology of normal and abnormal parathyroid glands and the application of parenchymal cell mass estimation and intracellular fat staining do assist diagnosis.
Adenocarcinoma↗
Parathyroid autotransplantation. An investigation of parathyroid autograft function.
During a four-year period, 27 patients underwent total parathyroidectomy with autotransplantation of parathyroid tissue to the forearm. In order to minimize the risk of persistent or recurrent hyperparathyroidism (HPT), a routine thymic resection and a wide excision of fat tissue around the parathyroids was performed to ensure excision of possible supernumerary glands or rudimentary parathyroid tissue. The indications for operation were HPT secondary to chronic renal failure in 24 patients (22 of whom had hypercalcaemia) and persistent or recurrent primary HPT in 2 cases. One further patient, who had a multiple endocrine neoplasia syndrome type I, underwent this procedure at the primary parathyroid operation. Preoperative hypercalcaemia was reversed in all patients but three during the first postoperative days, concomitantly with a fall in the parathyroid hormone (PTH) level. Fourteen patients showed marked hypocalcaemia postoperatively, necessitating calcium or vitamin D supplementation. This medication could later be discontinued in all of them. Thirteen patients, including two of those with primary HPT, never required any supplemental therapy. Survival of the grafts was documented by several observations. In all patients normal serum calcium values were being maintained without supplemental therapy at follow-up. During induced hypocalcaemia a PTH secretory response was demonstrated in all eight studied patients with a gradient between the grafted and non-grafted arm. In two patients in whom the grafts were examined histologically 19 and 28 months after the transplantation, viable parathyroid tissue was observed. In the initial part of the study excised tissue was cryopreserved. Since persistent hypocalcaemia did not occur in our patients, we have now abandoned this safety precaution. Thus, total parathyroidectomy with autotransplantation of parathyroid tissue is a valuable method for restoring long-term parathyroid function in patients with secondary HPT and uraemia. It also appears of value in selected cases of primary HPT.
Adolescent↗
Nodular goiter--is thyroxine medication of any value?
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Adolescent↗
Extradural pethidine with and without adrenaline during labour: wide variation in effect.
The pain-relieving effect of a single extradural dose of pethidine 25 mg with and without adrenaline was studied in 20 healthy women during labour. The study was open regarding the effects of pethidine but double-blind regarding the addition of adrenaline. In 14 of 19 women good or excellent analgesia was achieved for a period of 50-160 min. Pethidine with adrenaline 25 micrograms was not more effective than pethidine alone. Eight of the 14 women showed signs of regional analgesia to pin-prick and temperature discrimination. The patients had small (45-188 ng ml-1) concentrations of pethidine in plasma. In eight patients the plasma concentrations of pethidine were maintained for at least 1.5 h. Extradural pethidine thus induces analgesia of short and variable duration. Repeated doses may be needed, resulting in accumulation of the drug in plasma with the risk of respiratory depression in mother or child.
Anesthesia, Epidural↗
Central blood pooling as an explanation for lowered FRC during anaesthesia? Thigh volume measurements by plethysmography.
Segmental volumes of the thigh and the upper arm were measured by means of an air-filled plethysmograph before and during various anaesthesias. A small but significant fall in segmental volume was seen with the induction of anaesthesia with thiopentone. A further fall was observed during neurolept anaesthesia but not with halothane. Epidural and spinal anaesthesias caused no change in segmental thigh volume. The results suggest a redistribution of 50-150 ml blood from the extremities to the trunk during general anaesthesia. This redistribution may contribute to the well-known fall in FRC with general anaesthesia.
Abdomen↗
Experimental hyperparathyroidism and its effect on serum gastrin, gastrin cells and antral gastrin in the rat.
Parathyroid glands from inbred rats were transplanted to rats of the same strain. The transplantation resulted in hyperparathyroidism and persistent hypercalcaemia. These hypercalcaemic animals were compared with the hypocalcaemic donors and with untreated controls. No significant differences in serum gastrin values were found between the different groups. In all three groups, one series of animals was killed 6 weeks after the transplantation (6w series) and another after 14 weeks (14w series). Quantitative studies of the antral gastrin cells showed an increase in the number of these cells per unit volume in the 6w series in the hyperparathyroid recipient animals. The number of gastrin cells per unit segment was also higher in the recipient animals than in the parathyroidectomized and untreated groups in both the 6w and 14w series. The amount of gastrin extracted from antral mucosa did not differ between the different groups. The findings show that an experimentally induced hyperparathyroidism in the rat gives a transient increase in the number of antral gastrin cells but no changes in the antral gastrin or serum gastrin levels.
Animals↗
Vitamin-D-induced hypercalcaemia and its effect on serum gastrin, gastrin cells and antral gastrin in parathyroidectomized rats.
Nineteen rats were parathyroidectomized by electrocauterization, resulting in pronounced hypocalcaemia. Seven of these rats were then given vitamin D3 in a dose causing hypercalcaemia, while 7 received a dose which normalized serum calcium and 5 received no vitamin D. Ten further animals were sham-operated and were not given any extra vitamin D. The experimental period was 16 weeks. No significant differences in serum gastrin values were found between the different groups. Quantitative studies of the antral gastrin cells showed no difference in the number of gastrin cells per unit volume or unit segment between the different groups of vitamin-D-treated animals and sham-operated animals. However, the number of gastrin cells per unit segment was significantly higher in the hypocalcaemic animals than in the sham-operated animals, as a result of an increase in mucosal thickness. The amount of antral mucosal gastrin did not differ between the different groups. Thus the results of this study indicate that experimentally induced hypercalcaemia in parathyroidectomized rats does not influence the serum gastrin, the number of gastrin cells or antral gastrin.
Animals↗
An intracellular study of rubrospinal and rubro-bulbospinal control of lumbar gamma-motoneurones.
The actions elicited by electrical stimulation of the rubrospinal path in NR (nucleus ruber), and by stimulation of the rubro-bulbospinal path in MesADC (mesencephalic area for dynamic control), were studied with intra-, juxta- or extracellular recordings in lumbar gamma-motoneurones of cats anaesthetized with chloralose. The results were obtained during a series of experiments in which reflex effects from muscle, skin and joint afferents were also investigated. 90 cells tested with stimulation both in NR and in MesADC were classified (cf. Appelberg 1981) as dynamic (influenced from MesADC) or static (not influenced). 84 of these gamma-cells responded to stimulation in the red nucleus. The same response pattern was found for dynamic and static gamma-cells. For flexor cells, excitation was by far predominant while equal numbers of extensor cells showed excitatory and inhibitory effects. The shortest route to both static and dynamic gamma-cells was disynaptic. With stimulation of the rubro-bulbospinal path, excitatory effects were more than twice as frequent as inhibitory effects. No clearcut difference was seen between extensor and flexor cells. The segmental latency for rubro-bulbospinally mediated excitatory effects could be measured for only one cell, and it is tentatively suggested that the pathway to this dynamic gamma-motoneurone involves one or two interneurones more than in the rubrospinal pathway. Spontaneous activity was significantly more common among the dynamic cells, but the axonal conduction velocities of dynamic and static cells did not differ. The similarities between rubro-spinal effects on alpha-motoneurones and both classes of gamma-motoneurones indicate that the rubrospinal tract has the ability to coactivate alpha- and gamma-motoneurones (Granit 1955, 1979). The comparison of the properties of the population of gamma-cells classified as dynamic or static showed marked differences strengthening the reliability of the previously introduced classification method.
Afferent Pathways↗
Fusimotor reflexes in triceps surae elicited by natural stimulation of muscle afferents from the cat ipsilateral hind limb.
1. Experiments were performed in forty-one cats anaesthetized with chloralose.2. The aim of the study was to investigate whether activity in stretch-sensitive muscle receptors may cause reflex effects in fusimotor neurones.3. Activity in fusimotor neurones was studied indirectly by recording from primary and secondary muscle spindle afferents of the triceps surae muscle. The mean rate of firing of the afferents as well as either dynamic index (during ramp extension) or modulation (during sinusoidal extension) was determined. This was done under control conditions, with the posterior biceps-semitendinosus muscles relaxed, and under test conditions, with the same muscles extended.4. All together, seventy-one primary afferents were studied quantitatively. Pure or predominantly dynamic effects were observed in twenty-two, pure or predominantly static effects in nine and no statistically significant effects in forty of the units. Amongst seven secondary afferents studied, two showed weak fusimotor activation, the other five were not influenced.5. Electrical stimulation of the posterior biceps-semitendinosus or medial gastrocnemius nerves at group II strength was observed to cause dynamic fusimotor reflexes on a number of occasions.6. The reflex effects observed were, on many occasions, recorded in spinalized preparations.7. The reflex effects were not accompanied by any detectable e.m.g. activity in triceps, as judged from surface e.m.g. recordings. The reflex effects observed are therefore tentatively ascribed to activation of gamma-motoneurones, yet a contribution from beta-motoneurones cannot wholly be excluded.8. On the basis of available evidence concerning reflex connexions to gamma-motoneurones from various muscle afferents, it is suggested that the effects observed were caused by activation of muscle spindle secondary endings.
Animals↗
Treatment with cimetidine in patients with primary hyperparathyroidism.
Treatment with cimetidine (1000 mg daily in four divided doses) was given for 3--30 weeks to 10 patients with primary hyperparathyroidism (HPT). All patients had hypercalcaemia and raised serum concentrations of parathyroid hormone (PTH). During treatment no consistent effects were noted on neither serum calcium or PTH and normalization did not occur in any case. Hypergastrinaemia was demonstrated in 6 patients and was also unaffected by therapy while in the 4 patients with normal pre-treatment gastrin values a slight increase was seen. This study does not support the view that cimetidine can be of use for the treatment of primary HPT.
Adult↗
Regulation of parathyroid hormone release in primary and secondary hyperparathyroidism - studies in vivo and in vitro.
The effects of calcium on parathyroid hormone (PTH) release were studied in vivo and in vitro in primary hyperparathyroidism (HPT) and in vitro in secondary HPT. In vivo the serum PTH was clearly reduced by intravenous calcium infusion in all the examined patients with primary HPT caused by adenoma. In vitro the release of PTH from dispersed parathyroid cells was likewise suppressed by raising the calcium concentrations in the incubation media, though in all cases a basal release of PTH still persisted even at high calcium concentrations. The degree of suppressibility in vitro varied, but in both primary HPT with adenoma and in secondary HPT it was inversely related to the patients' serum calcium values. These results suggest that the secretion of PTH in patients with primary and secondary HPT is not autonomous either in vivo or in vitro. Furthermore, the non-suppressible basal release of PTH indicates that a major cause for the increased secretion of PTH is the increased number of parenchymal cells. However, the degree of suppressibility of the individual cells rather than the absolute number of cells, seems to be of great importance for the individual serum calcium values in HPT.
Adenoma↗
Computherm. A new device for measurement of coronary blood flow using the continuous thermodilution technique.
A new device for an automatic determination of coronary sinus blood flow using the thermodilution technique is presented. The measuring equipment consists of four main parts; a thermal dilution-catheter with two signal amplifiers of analogue type, an analogue/digital converter controlled by a microcomputer system, a pump for the control of the rate of injection flow and a control panel and display. The device has been tested in a model test with flow levels between 75 and 200 ml/min. The error between a number of measurements with all parameters unchanged except minor variations in temperatures was less than 5 per cent.
Computers↗
A clinical study of 30 gastric carcinoids.
The clinical picture in 30 patients operated on for gastric carcinoids was studied retrospectively. There were 12 men and 18 women, with an age range of 32-79 years (mean 57 years). The tumours were located in the corpus area of the stomach in more than half of the patients and in one-third were relatively small (less than or equal to 1 cm). Four patients had multiple tumours. Metastases were found in eight patients, mostly those with larger primary tumours. In no case was the carcinoid syndrome present. The patients presented symptoms simulating those of more common affections of the stomach, such as polyps, ulcer and carcinoma. Barium contrast study and gastroscopy did not reveal the true nature of the gastric disease and even biopsy of the stomach failed to give a correct preoperative diagnosis in four of five patients. Since six patients had achylia preoperatively, it is emphasized that the possibility of a gastric carcinoid, especially in the corpus area, is more likely in association with this condition.
Adult↗
Evaluation of parathyroid function in patients with hypergastrinaemia and pernicious anaemia.
In order to evaluate the possible causal relationship between raised serum gastrin levels and the development of primary hyperparathyroidism (HPT) which is suggested from experimental studies we evaluated parathyroid function in a group of 32 patients with hypergastrinaemia and pernicious anaemia. The values for serum calcium and parathyroid hormone were determined as well as the fasting urinary excretions of cyclic AMP and calcium. There was no relationship between the serum gastrin levels and any of the other studied parameters and there was no consistent pattern suggesting parathyroid hyperfunction. A retrospective analysis of hospital records from 441 patients operated for primary HPT showed a prevalence of pernicious anaemia of 1.8%. This figure is higher than that found in the unselected age-matched population (0.31%). However, taken together this study does not support the hypothesis that hypergastrinaemia is of particular importance for the pathogenesis of primary HPT.
Adult↗
Parathyroid surgery in chronic renal insufficiency. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation to the forearm.
During the period 1970 to 1980 48 parathyroidectomies were performed in 46 patients with chronic renal insufficiency. Thirty patients underwent 31 subtotal parathyroidectomies and 17 patients underwent total parathyroidectomy with parathyroid autotransplantation to the forearm. Ten patients were on conservative renal treatment, 26 were on chronic haemodialysis and 12 had functioning kidney transplants at the time of parathyroid surgery. The indication for parathyroidectomy were clinical symptoms such as pruritus, bone and joint pain, neuromuscular disorders and radiological skeletal abnormalities pointing to hyperparathyroidism (HPT). Hypercalcaemia was present in 38 patients. The clinical symptoms and radiological findings were favourably affected by parathyroid surgery but vascular calcification was not affected by the operation in any of the patients. Normocalcaemia was achieved after surgery in all patients except one, who had residual parathyroid tissue in the neck. Vitamin D substitution was required in about 30% of the patients regardless of the type of operation that was performed. Recurrent HPT occurred in 9% with similar rates after both types of surgery. However, recurrence was more easily managed after a total parathyroidectomy with autotransplantation to the forearm than after a subtotal parathyroidectomy.
Adolescent↗
Analgesia during labour with pethidine epidurally.
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Anesthesia, Epidural↗
Parenchymal cell mass determination in parathyroid glands and its application in a material of hyperparathyroidism.
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Adenoma↗