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186 records · Page 11Linked to original sources
PubMedDate not supplied

[Validity, limitations and indications of intraoperative dosage of parathyroid hormone (I-PTH) in the surgical treatment of primary hyperparathyroidism].

INTRODUCTION: Recently new methods have been experienced to achieve the best surgical results in complete removal of pathological parathyroid tissue; serum I-PTH (1-84) rapid dosage is the most interesting and reliable method. MATERIAL AND METHODS: In a group of 11 patients with IPP, diagnosed by high levels of I-PTH, total and ionized serum calcium, 7 were paucisymptomatic, 3 presented nephrolityasis, 1 acute pancreatitis and severe hypercalcemic crisis. No MEN were found. A systemic research of all parathyroid glands was always performed, then 10, 20, 30 and any 30 minutes after each parathyroidectomy serum I-PTH rapid dosage was made (rapid IRMA method) until the end of surgical treatment. RESULTS: Eight single adenomas parathyroid were diagnosed, 1 double adenoma and 2 hyperplasia. All patients had high levels of serum I-PTH during pathologic parathyroid removal. The decrement of I-PTH level to 40% 10 min after parathyroidectomy, and 50% after 20 minutes confirmed the efficacy of surgery. DISCUSSION: Intraoperative rapid dosage of I-PTH associated with anatomopathologic results leads to a successful diagnosis and therapy. Sometimes in multiglandular disease serum level of PTH decreases after first parathyroidectomy as in a single adenoma: this underlines the importance of systematic surgical research of all glands in any case. CONCLUSION: In our experience serum I-PTH rapid dosage in IPP would be applied by specialized surgical equipments only in selected patients, such as reoperation or those few cases of first surgical treatment when ectopy is suspected.

Adenoma↗
PubMed1997

[Intraoperative serum parathyroid hormone measurement in the surgical treatment of hyperparathyroidism].

BACKGROUND: PTH(1-84) short half life permits us to monitor parathyroidectomy efficacy, confirming complete resection after unilateral surgical approach in some cases of primary hyperparathyroidism. Nevertheless, this utility has been tested in controlled clinical trials and there is no agreement regarding the extraction of samples, their processing and interpretation of results. PATIENTS AND METHODS: In 18 consecutive patients operated on for primary or secondary hyperparathyroidism, serum PTH(1-84) concentrations were assessed at different times before, during and after partial (in 11 patients with multiglandular illness) and total resections. RESULTS: Initial PTH(1-84) concentrations very largely in different pre-resection samples, and these variations significantly affect post-resection percentage reduction. Plasmatic clearance of PTH(1-84) after incomplete resection follows a decreasing exponential curve towards new equilibrium concentrations. The difference is significant comparing with concentrations following complete resection only 5 minutes after, but the 95% intervals with a confidence level of 90% of confidence are exclusive only for determinations after 120 minutes. CONCLUSIONS: The decrement of serum PTH(1-84) concentrations to 20% of the preresection levels 120 minutes after an adenomectomy confirms the complete removal of all pathologic parathyroid tissue. A less sharp decrement must be investigated and may justify an early surgical revision.

Biomarkers↗
PubMed1997

Surgical treatment for primary hyperparathyroidism.

OBJECTIVE: To document the recent surgical results in the treatment of primary hyperparathyroidism (HPT) at Queen Mary Hospital. METHODS: From 1995 to 1996, 30 patients underwent 31 operations for primary HPT. The data of 11 men and 19 women with ages ranging from 19 to 86 years (median: 57 years) were prospectively recorded with emphasis on the need of preoperative localization. RESULTS: Symptoms of hypercalcemia were present in 20 (67%) and complications in 17 (57%) patients, respectively. Seventy-seven localization studies were performed in 28 patients (average: 2.6 tests/patient). Localization was accurate in 12 of 23 (52%) ultrasonographies, 11 of 26 (42%) CT scans and 16 of 27 (59%) scintigraphies. Twenty-six patients had a single adenoma excised while 3 patients with multiple endocrine neoplasia type I (MEN I) had subtotal parathyroidectomy for multiglandular hyperplasia during cervical exploration. Immediate normocalcemia was achieved in 29 patients. One patient had persistent hypercalcemia due to a supernumerary fifth gland in the superior mediastinum that was successfully excised in a second operation. One patient had a unilateral vocal cord paralysis and 4 patients needed calcium supplement on discharge. During a median follow-up of 5 months, all patients were normocalcemic with one requiring calcium supplements. CONCLUSION: Surgical treatment for primary HPT is a safe procedure and is associated with a high success rate. In our experience routine preoperative localization study is not cost-effective.

Adenoma↗
PubMed1998

Successful minimally invasive surgery in primary hyperparathyroidism after combined preoperative ultrasound and computed tomography imaging.

The hypothesis that due to the high prevalence of solitary adenoma and the accuracy of modern imaging techniques it should be possible to cure a considerable number of patients by direct adenomectomy through a minimally invasive approach was tested in a consecutive series of 66 patients with primary hyperparathyroidism. Preoperative parathyroid imaging consisted of a combination of (Doppler) ultrasound and spiral computed tomography with cine-loop reconstruction potentiality. If only one parathyroid adenoma was identified preoperatively, a minimally invasive approach was advised. If more than one adenoma was located, or when the imaging results were equivocal, the patient was advised to undergo a conventional bilateral neck exploration. Sixty-six patients (54 female, 12 male) with a median age of 60 years and a median serum calcium of 2.90 mmol L(-1) were studied. Fifty-one of these patients underwent minimally invasive surgery, which was successful in 49 patients, while conversion to conventional neck exploration was necessary in two patients. Conventional neck exploration was chosen for the other 15 patients. Six of these proved to have multiglandular disease or a retro-sternal adenoma, while in nine patients only one parathyroid adenoma was found. All patients became normocalcaemic postoperatively. Morbidity consisted of a transient unilateral vocal cord paralysis in one patient. These results support the original hypothesis: successful minimally invasive surgery was possible in 74% (49 of 66) of patients, thus avoiding conventional neck exploration. This strategy further simplifies the operative treatment of primary hyperparathyroidism without loss of efficiency.

Female↗
PubMed1998

[Surgery under hypnosedation. A new therapeutic approach to hyperparathyroidism].

The elective unilateral approach, sometimes under local anaesthesia, offers many advantages in terms of less invasive and faster surgical approach compared to the conventional surgery under general anaesthesia. Nevertheless this approach is restricted to patients unsuspected of multiglandular disease, free from thyroid disease and for whom localization studies are contributive. Surgery under hypnosedation offers the same advantages and provides the possibility of not only exploring the four glands but also of performing a partial thyroidectomy if needed. In our experience 21 patients underwent a cervicotomy under hypnosedation for primary hyperparathyroidism (HPT). No conversion to general anaesthesia was needed; mean operative time was 52 +/- 16 min. In 17 cases, HPT was due to a single adenoma, in 3 cases to hyperplasia (among them a MEN-1 case), and in one last case to a double adenoma. The four glands were identified in 85%. With a follow-up running from 4 to 45 months, all patients are cured. Hypnosedation offers the same medical and economic advantages than the unilateral access under local anaesthesia. Moreover indications are not restricted to selected patients.

Adult↗
PubMedDate not supplied

Pediatric thyroid nodules: insights in management.

BACKGROUND: Multiple diagnostic studies are utilized to unveil malignancy in pediatric thyroid nodules and determine whether surgical therapy is needed. PURPOSE: The aim of this report was to determine whether management of pediatric thyroid nodules has changed with the current use of diagnostic modalities such as ultrasonography (US), radionuclear scans (RNS) and fine needle aspiration biopsy (FNAB). MATERIAL/METHODS: Twenty-four children with thyroid nodules managed during a ten-year period comprised the study group. Demographic characteristics, clinical manifestations, US and RNS imaging findings, FNAB results, surgical therapy, complications and pathological reports were retrospectively reviewed. US, RNS and FNAB results were categorized as either benign, malignant, suspicious or insufficient. RESULTS: Females outnumbered males by a five to one ratio. Mean age was 14.9 years. Nineteen nodules were benign (79%) and five malignant (21%). All children were euthyroid. Benign nodules were soft, movable, solitary and nontender. Malignant nodules were characterized by localized tenderness, a multiglandular appearance, and fixation to adjacent tissues. US and RNS gave no clue toward management since cystic and hot nodules figured among malignant cases respectively. US achieved 86% accuracy, 80% sensitivity and 88% specificity; RNS showed 26% accuracy, 80% sensitivity and 11% specificity; FNAB achieved 80% accuracy, 60% sensitivity and 90% specificity. Suppressive thyroid hormone therapy was useless in the few cases tried. Physical examination findings, persistence of the nodule, progressive growth and cosmetic appearance where the most common indications for surgery. CONCLUSIONS: Present diagnostic modalities played a minor role in the decision to withhold surgery. US was useful for aiming aspiration of cystic nodules. RNS decided the functionality of the nodule, but its accuracy was far from ideal. FNAB is a safe procedure whose greatest help was to resolve in case of suspicious or malignant cytology that a more radical procedure is needed. Clinical judgement as determined by serial physical findings and suspicion continues to be the most determinant factors in the management of thyroid nodules in children.

Adenoma↗