Biomedical subjects

R Szlávik

Publications and source records attributed to R Szlávik.

4 recordsLinked to original sources

PubMed2003

Parathyroid surgical failures with misleading falls of intraoperative parathyroid hormone levels.

According to earlier reports, a decrease below 50% of baseline of intraoperative PTH levels measured 5 min after resection of the parathyroid adenoma predicts a cure of hyperparathyroidism. To reveal previously unrecognized pitfalls of intraoperative PTH measurements, we reviewed surgical failures in our series of parathyroidectomies combined with intraoperative PTH sampling. PTH measurements were performed in 251 patients with primary hyperparathyroidism (PHPT) between November 1999 and December 2002. PHPT due to parathyroid hyperplasia were found in 8 cases, double parathyroid adenomas in 6 cases, parathyroid carcinoma in 1 case and single parathyroid adenomas in 236 cases, all confirmed by histological examination. Of the 236 cases of single adenomas, initial surgery failed to cure PHPT in 4 patients. In 3 patients a false-positive decrease of intraoperative PTH (from 269 to 40 pg/ml, from 211 to 27 pg/ml, and from 140 to 59 pg/ml) was observed, whereas in the fourth patient a true-negative decrease of intraoperative PTH (from 758 to 401 pg/ml) was mistakenly interpreted as indication for a cure of PHPT. In each of the 4 patients in whom initial surgery failed the intervention included thyroid surgery and reoperative parathyroid surgery resulted in a permanent cure of PHPT. These observations support the possibility that thyroid surgery may compromise the blood supply of parathyroid adenomas resulting in a misleading drop of intraoperative PTH levels. Therefore, a careful evaluation of intraoperative PTH levels and, perhaps, other intraoperative aids such as histological evaluation of frozen sections are recommended when parathyroid surgery is combined with simultaneous thyroid intervention.

Adenoma↗

PubMed2001

[New intraoperative diagnostic methods in parathyroid surgery: intraoperative measurement of parathyroid hormone].

In thirty-seven patients undergoing parathyroidectomy from November 1999 to July 2000 with diagnosis of primary hyperparathyroidism the intraoperative intact parathyroid hormone level were studied. Preoperative samples of blood were taken from a peripheral vein before the beginning the operation. The second sample was taken 5 minutes after removal of parathyroid adenoma. The plasma intact parathyroid hormone concentration was measured by quick IRMA method. The preoperative high PTH levels reduced after excision of adenoma to the mean 18%. 33 patients had normal PTH levels after 5 minutes of removing. The total measuring time of quick PTH assay was about 30 minutes. The QPTH assay was a quantitative adjunct for the surgeon to ensure a successful parathyroidectomy. When the intraoperative QPTH level is not reduced to 50%, then the exploration should be continued and the probability of reoperation is decreased. They propose the application of the routine intraoperative measurement of QPTH level in all parathyroidectomy.

Adenoma↗

PubMed1999

Laparoscopic adrenalectomy. New experiences.

Authors have performed 23 laparoscopic adrenalectomies between 03.04.1997 and 02.04.1999. They have removed 16 cortical adenomas, 2 nodular hyperplasias, 2 cysts, 1 carcinoma, 1 pheochromocytoma and 1 myolipoma. The operation time was 90-260 minutes that gradually has been decreased by using "Ultracision" ultrasonic shear. They have made simultaneously two cholecystectomies and one liver wedge biopsy. During removing pheochromocytoma they have not detected extremely high blood pressure data. They had one intraoperative complication, the perforation of the diaphragm which required a temporary thoracic suction drainage. All operations were completed laparoscopically. Patients have been released on the 2nd-3rd postoperative day. Their experiences confirm the literary data that the laparoscopic approach to adrenalectomy is the method of choice today.

Adrenal Cortex Neoplasms↗

PubMed1994

Pancreatic pseudocysts causing compression symptoms.

The authors survey the surgical treatment of duodenal or choledochal stenosis which were detected during the operation of 991 pancreatic pseudocysts in the period of 5 years, from 1987 to 1992, at 850 patients. They found that in the case of common occurrence of mechanical jaundice and pancreatic pseudocyst in 40% of cases the drainage or resection of pseudocyst was enough to ensure the free biliary passage. In case of combined operation the stenosis of choledochus was solved in 64% of cases with sphincteroplasty. In case of common occurrence of duodenal stenosis and pancreatic pseudocyst the drainage of pseudocyst was enough in 69% of cases to ensure the free gastroduodenal passage and at 31% was necessary the combined operation.

Cholestasis↗