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PubMed2004

Three-year financial analysis of minimally invasive radio-guided parathyroidectomy.

Minimally invasive radio-guided parathyroidectomy (MIRP) has had a high success rate in correcting hypercalcemia, along with a low morbidity rate and high patient satisfaction. Our study was conducted in an attempt to analyze the cost-effectiveness of MIRP in patients treated for primary hyperparathyroidism. We conducted a retrospective study of the total charges of three groups of patients undergoing surgery for previously untreated hyperparathyroidism in a single health care system. The three study groups included patients undergoing traditional bilateral neck exploration, MIRP, and neck exploration guided by intraoperative parathormone (PTH) assay. Charges were stratified into preoperative, intraoperative, and postoperative categories. The average total charge was $8,512 for MIRP, $12,723 for traditional neck exploration, and $13,011 for bilateral neck exploration with PTH assay. The decreased charge for MIRP was due to reduced operating room time, anesthesia costs, length of hospitalization, and an avoidance of the use of intraoperative tissue analysis and PTH assay. There was a greater than $4,000 savings with MIRP as compared with the more extensive neck exploration. These savings more than compensate for the cost of technology (preoperative sestamibi scan and intraoperative gamma probe) necessary to perform radio-guided parathyroidectomy.

Cost-Benefit Analysis↗
PubMed2005

[Characteristics of the patients who received parathyroidectomy within 5 years after the initiation of hemodialysis].

Thirteen patients, who received parathyroidectomy within 5 years after the initiation of hemodialysis, were discussed on their clinical characteristics and their prognoses. 204 patients received the first parathyroidectomy due to secondary hyperparathyroidism in our department, 13 of which were selected on dialysis duration. 9 patients were female and origin of CRF were analgesics-induced interstitial nephritis in 2 and prune-belly syndrome in 1. There were 2 patients who suffered from renal disease more than 30 years. Concomitant primary hyperparathyroidism was suspected in 1 case. In all cases, PTx achieved adequate control of 2HPT after the operation.

Adult↗
PubMed2006

Influence of parathyroidectomy on blood pressure and function of the transplanted kidney in patients with tertiary hyperparathyroidism.

BACKGROUND: Tertiary hyperparathyroidism is one of the causes of bone demineralisation, nephrolithiasis and a potential risk factor influencing blood pressure and excretory graft function in patients after kidney transplantation (Tx). The aim of the study is to analyse the influence of parathyroidectomy (PTx) on graft function and blood pressure control in these patients. METHODS: 392 subsequent patients after kidney Tx were included into this analysis. Records of 84 patients (21.4%) with elevated plasma calcium concentration (> 2.6 mmol/l) during observation were reviewed. In 39 patients (9.9%) calcaemia remained elevated for over 1 year after kidney Tx. Eleven patients (2.81%) were referred for PTx. In 2 cases PTx were performed within the first 6 months, while the 9 others undergone surgery between 16 and 36 months after Tx. We have evaluated the influence of PTx on renal allograft excretory function, blood pressure and the number of antihypertensive drugs in kidney transplant patients. RESULTS: In 7 out of 11 patients the indication for PTx was renal osteodystrophy, while in other cases the indication was the asymptomatic hypercalcaemia. Shortly after surgery normalisation of calcaemia was observed in all cases. However the creatinine clearance did not changed shortly after PTx (64 +/- 12 vs. 63 +/- 16 ml/min), and a slight deterioration of transplanted kidney excretory function was observed in 2 patients. 12 months after PTx deterioration of GFR (5320 ml/min) of borderline significance was found. All patients before PTx suffered from arterial hypertension, ten of them were receiving antihypertensive drugs (average 1.6 medicine per patient). Two weeks after PTx a transient decline of both systolic and diastolic blood pressures (-13 +/- 14 mmHg; p = 0.02 and -46 mmHg; p = 0.06, respectively) was observed. However there was a negative correlation between initial plasma calcium concentration and decline of diastolic blood pressure (R = -0.884; p = 0.0003). Six and twelve months after PTx blood pressure values were at the same magnitude as before PTx. CONCLUSIONS: (1) Parathyroidectomy and normalisation of calcaemia did not influence significantly the excretory allograft kidney function. (2) Patients benefit from PTx only with the transient improvement of their blood pressure control.

Adult↗
PubMed2006

[Efficiency of total parathyroidectomy and autotransplantation in 31 patients with uremic hyperparathyroidism].

OBJECTIVE: To analyse the efficacy of total parathyroidectomy with autotransplantation (total PTX + AT) in treating uremic secondary hyperparathyroidism and to discuss the relevant medical treatment used. METHODS: The clinical data of 31 patients with uremic SHPT admitted into our hospital from 1996-2005 were analysed with respect to total PTX + AT. RESULTS: The period of hemodialysis were for the patients was on the average 9.2 years. There were 22 male and 9 female with an average age of 42.4 (31 - 67) years. The clinical manifestations consisted of osteoarticular pain in 83.9%, fractures in 35.5%, soft tissue and vascular calcification in 45.2% and pruritus in 80.6%. Laboratory examination yielded the following results: haematocrit 0.25 +/- 0.04, serum Ca (2.61 +/- 0.35) mmol/L, serum P (2.14 +/- 0.31) mmol/L, plasma total alkaline phosphatase (AKP) (885 +/- 335) U/L and parathyroid hormone (iPTH) (1811 +/- 879) ng/L (700 - 2500 ng/L). Cervical ultrasonography and/or emission computed tomography showed 2 - 4 hyperplastic glands. All of the patients showed no response to medical treatment including vitamin D. Total PTX + AT was performed on the 31 cases. Clinical symptoms and signs markedly improved after operation in 1 to 2 weeks. However, fracture and ectopic calcification showed no improvement. Plasma iPTH decreased rapidly (< 200 ng/L) postoperatively in 1 to 2 days. Serum Ca and P returned to normal. AKP was corrected in 1 to 3 months. CONCLUSION: Total parathyroidectomy with autotransplantation is an effective treatment for severe uremic secondary hyperparathyroidism patients.

Adult↗
PubMed1991

Recurrent hyperparathyroidism after total parathyroidectomy and autotransplantation in patients with long-term hemodialysis.

From 1986 to 1990, we performed total parathyroidectomy with simultaneous autotransplantation (TPX with AT) of parathyroid tissue into the forearm in 13 patients on chronic maintenance hemodialysis with severe secondary hyperparathyroidism. The indications for surgery included persistent hypercalcemia, hyperphosphatemia, roentgenological signs of renal osteopathy, soft tissue calcifications and severe pruritus. The parathyroidectomy was performed by an experienced surgeon who removed all four parathyroid glands and transplanted 10 mm3 of parathyroid tissue into the brachioradialis muscle. After an average postoperative period of 33.5 months, 10 of 13 patients developed recurrent clinical and biochemical hyperparathyroidism requiring reoperation. Seven of these patients underwent removal of the autograft. In 5 patients, however, the success was minimal. Four of these patients had a second autograft resection, but only transient improvement resulted. Our recurrence rate after TPX with AT is very high. The histological aspect of the resected autograft is similar to tumor-like growth and this may account for the results. A therapeutic alternative to TPX with AT appears to be necessary.

Calcitriol↗
PubMed1991

The natural history of renal stone disease after parathyroidectomy for primary hyperparathyroidism.

The evolution of renal stone disease has been followed, before and after parathyroidectomy, in 197 patients with primary hyperparathyroidism. Before operation, 120 patients had had a previous history of renal colics or stones, or both, demonstrated on roentgenograms of the urinary tract. In 36 patients with stones that had been passed or removed before exploration of the neck, no recurrence of lithiasis has been observed. In 84 patients who still had stones at the time of the operation, the stones dissolved and disappeared within ten years in 88 per cent of those with urolithiasis and in 77 per cent with nephrocalcinosis. The rate of stone disappearance was similar in those with or without preoperative urinary tract infection and in patients operated upon for adenoma of the parathyroid gland or primary hyperplasia. This rate was slower for patients with a postoperative urinary infection. The frequency of renal colics, 0.66 per patient per year before parathyroidectomy, decreased to 0.02 per patient per year after the first postoperative year.

Adult↗
PubMed1990

Severe primary hyperparathyroidism in a neonate having a parent with hypercalcemia: treatment by total parathyroidectomy and simultaneous heterotopic autotransplantation.

Neonatal primary hyperparathyroidism is a life-threatening disease because of marked hypercalcemia and severe respiratory distress caused by the hypoplastic thorax and occasional rib fractures. We report a 29-day-old girl treated by total parathyroidectomy and simultaneous autotransplantation of parathyroid tissue (one fifth of each of the two glands) in the femoral quadriceps muscle near the groin. At the time of operation, all four of the parathyroid glands were markedly enlarged, and their total weight was 900 mg. Part of the resected parathyroid tissue was cryopreserved for further autotransplantation should hypoparathyroidism develop. Two years six months after surgery, the infant was well and had normal levels of serum calcium and immunoreactive parathyroid hormone in the absence of any supplementary treatment. Asymptomatic hypercalcemia in the presence of abnormally low fractional excretion of calcium was found in the father. Based on our experience and review of the literature, we recommend total parathyroidectomy, autotransplantation, and cryopreservation for the neonate with primary hyperparathyroidism.

Calcium↗
PubMed1990

[The effect of thyroid- and parathyroidectomy on stress-induced changes in the primary humoral immune response of white rats].

The influence of the immobilization stress (24 h) was studied on male white rats of Wistar strain, examining the primary humoral immune response on the background of thyroid- and parathyroidectomy. It was established that parathyroidectomy induced immunodepression, but the effect of immobilization stress, used just next to immunization with sheep erythrocytes intensified immunodepression. Furthermore application of stress after immunization with sheep erythrocytes (during the effective phase of the immune response) induced immunostimulation. These differences in stress-induced immunological changes could be explained by the peculiarities of neuroendocrine and immunological status during the variants of stress action.

Animals↗
PubMed1995

Does subclinical pancreatic inflammation occur after parathyroidectomy?

Pancreatitis is accepted as an uncommon complication of parathyroid surgery, but it has been suggested that up to 35% of patients may experience hyperamylasaemia after parathyroidectomy indicating subclinical inflammation of the pancreas. A series of 26 patients undergoing parathyroidectomy were studied by preoperative biochemical analyses repeated 24 and 48 h postoperatively allowing changes in calcium metabolism and serum and urinary amylase levels to be documented. Of the patients, 21 also underwent a CT scan of the pancreas between 24 and 48 h after operation. Despite highly significant changes in serum parathormone, calcium and phosphate levels postoperatively, there was no evidence in any patient of acute pancreatic inflammation or hyperamylasaemia. Twenty-one patients underwent unilateral neck exploration, and we suggest that the absence of any detectable amylase elevation supports the suggestion that such elevation may reflect an increase in salivary isoamylase as a result of extensive neck dissection, rather than reflecting a subclinical pancreatitis. The development of postparathyroidectomy pancreatitis appears to be an all or nothing phenomenon of unknown aetiology.

Acute Disease↗
PubMedDate not supplied

[Surgical treatment of secondary hyperparathyroidism in chronic kidney failure. Results of total parathyroidectomy with parathyroid autotransplantation].

Between 1978 and 1990, 68 patients, operated on for secondary hyperparathyroidism (HPT), received a forearm intramuscular free autologous parathyroid graft (37 women and 31 men--mean age: 43 +/- 16 years). The transplantation (Wells technique) was performed in the same time as the total parathyroidectomy and the remaining parathyroid material after surgical resection was cryopreserved. The results were evaluated in term of clinical and/or radiological and/or biological response respectively 3 or 5.5 years later, depending of the realisation of a renal transplantation (n = 27) or not. Four patients were lost to follow-up and 4 died post-operatively, including a wrong diagnosis (60 patients evaluated). Mortality rate was 12% (5 cases out of 7 related to chronic renal insufficiency). In 3 patients (5%) the transplanted gland had to be removed because of recurrent HPT (1 graft hyperplasia; 2 wrong diagnosis: 1 cervical gland left over and 1 aluminium intoxication). Second cervicotomy was performed in 3 cases (5%) for remaining cervical parathyroid gland (2 cases) and false-positive Tallium-Technetium scan (1 case). Overall results were good or very good in 51 cases (85%). A review of the literature indicate that subtotal parathyroidectomy in not superior to the Wells technique and the latter remain the landmark technique in the authors' hands in order to treat secondary HPT.

Adolescent↗
PubMed1993

Total parathyroidectomy and presternal subcutaneous implantation of parathyroid tissue for renal hyperparathyroidism.

When hyperparathyroidism recurs in patients previously treated by total parathyroidectomy and intramuscular parathyroid autotransplantation, excision of the graft is not always technically easy and it is often necessary to resect the portion of the muscle containing the implants. During November 1986, we began a program to test the feasibility of presternal subcutaneous autotransplantation of parathyroid tissue. We hoped this technique would make removal of the grafts simpler. Thirty-six patients with renal hyperparathyroidism (RHPT) received subcutaneous parathyroid implants. Persistent or recurrent hyperparathyroidism was observed in three patients during the follow-up period. The presence of active parathyroid tissue was demonstrated after some time in all the patients. The parathyroid implants were easily excised in three instances (one persistent RHPT and two recurrences). Microscopic examination of the resected specimens did not show any sign of malignant transformation. We conclude that presternal subcutaneous implantation of parathyroid tissue after total parathyroidectomy is a quick, safe and efficient surgical procedure in the treatment of RHPT.

Adult↗
PubMed1996

[Medical parathyroidectomy. Its efficacy in treatment of lower maxillary brown tumor].

A patient with end-stage renal disease, hemodialysis treatment, severe secondary hyperparathyroidism and mandibular brown tumor received increasing doses of oral calcitriol (3.5 to 9 micrograms/week) and calcium carbonate (10 g/day). Nineteen months after the treatment, clinical, radiological and humoral improvement were observed. The present case demonstrates the effectiveness of medical parathyroidectomy for the control of severe secondary hyperparathyroidism--brown tumor--in chronic hemodialysed patients. This procedure should be considered as choice treatment keeping surgical parathyroidectomy for cases in which it is contraindicated such as hyperphosphoremia and/or controlled hypercalcemia or failure of the former procedure.

Administration, Oral↗
PubMed1998

Reversal of the histology of bone after parathyroidectomy in patients with hyperparathyroidism.

Hyperparathyroidism is commonly seen in patients with end-stage renal disease and less commonly in the primary form. The skeletal manifestations of hyperparathyroidism are the same in both forms and are well described in the literature. We treated a patient from each category. Multiple bony lesions and pathologic fractures were observed. The clinical presentations and radiologic and histologic findings confirmed the diagnosis of hyperparathyroidism and osteitis fibrosa cystica in both patients. Subtotal excisions of the parathyroid glands were done in both patients. Appropriate treatment of the bony lesions and pathologic fractures resulted in healing. Histologic evaluation of the bony lesions indicated an osteoblastic or healing response. The reversal of the histologic pattern in just 5 days and 16 days after parathyroidectomy was noted. In treating such patients, physicians should consider parathyroidectomy as an aid in the overall management of patients.

Adult↗
PubMed1998

Hungry bone syndrome following parathyroidectomy.

Hyperparathyroid-associated bone disease is known to affect quality of life and contribute to premature morbidity in the end stage renal disease (ESRD) population. Failure to adequately suppress parathyroid hormone secretion with medical management often warrants parathyroidectomy. Hypocalcemia frequently occurs after parathyroidectomy. A state of marked and prolonged hypocalcemia is termed "hungry bone syndrome." Biochemical and clinical criteria associated with development of hungry bone syndrome assist with identification of those at risk and facilitates postoperative management.

Adult↗
PubMed1980

Total parathyroidectomy and autotransplantation in secondary hyperparathyroidism.

Sixteen patients with chronic renal failure and symptomatic secondary hyperparathyroidism underwent total parathyroidectomy. Sixteen to 25 fragments of parathyroid tissue measuring 1 cu mm were autotransplanted into the brachioradial muscle. Evidence of "take" of the autotransplant was present in all patients, although four patients still have hypocalcemia and require calcium and vitamin D supplementation. Three patients have experienced late diminution of autotransplant function. Symptomatic improvement occurred promptly in 15 of the 16 patients. Two patients with persistently elevated parathormone levels were treated by partial excision of the implant, and one patient whose autograft functioned inadequately was successfully treated by implantation of cryopreserved autologous parathyroid tissue. Total parathyroidectomy with autotransplantation of parathyroid fragments to the forearm is the preferred surgical procedure for secondary hyperparathyroidism.

Adolescent↗
PubMed1977

Parathyroidectomy: extent of resection and late results.

Opinion is divided as to the necessary extent of parathyroid resection in primary hyperparathyroidism. Some surgeons urge that subtotal parathyroidectomy be performed routinely, while others reserve subtotal resections for patients with parathyroid hyperplasia. In a review of 102 patients treated by parathyroidectomy for primary hyperparathyroidism and subsequently followed up for an average of 6 years, there were 73 patients with parathyroid adenoma, 26 with hyperplasia and 3 with carcinoma. The adenoma was not found at the first operation in only 3 cases; in the other 70 after removal of the adenoma no further hypercalcaemia was observed during the follow-up period. Persistent or recurrent hypercalcaemia was a problem in 9 out of the 26 patients with primary hyperplasia who had inadequate resection at the first operation, and also in the 3 patients with carcinoma. Experience shows that peroperative biopsy with frozen section of all the parathyroids is useful in confirming their identity and can be a guide to the type of disease present and the appropriate extent of resection.

Adenoma↗
PubMed1981

Subtotal parathyroidectomy: normalization of circulating parathormone.

Subtotal parathyroidectomy was performed in 52 consecutive patients with primary hyperparathyroidism. The postoperative results, 6-24 months following the operation, were evaluated according to a calcium-parathormone normogram. In 48 patients the values returned to the normal zone. Two patients had persistent hypercalcemia. The other two patients remained in the hyperparathyroid zone of the normogram, with moderate elevations of serum parathormone, in spite of normocalcemia. The significance of the failure to achieve normal circulating parathormone levels in patients with postoperative eucalcemia is discussed. The importance of serum parathormone and calcium relationship in the evaluation of patients following parathyroidectomy is emphasized.

Calcium↗
PubMed1988

Effect of parathyroidectomy on arterial hypertrophy, vascular lesions, and aortic calcium content in deoxycorticosterone-induced hypertension.

Parathyroidectomy (Px) did not prevent the development of deoxycorticosterone (DOC)-induced hypertension inasmuch as the systolic blood pressure at 4 weeks did not differ from that of parathyroid intact, DOC-treated rats. Px, however, ameliorated the percent incidence and severity index of hypertension-induced vascular lesions in the heart and kidney. There was less hyaline change in the coronary artery and renal arteriole and fewer scars in the myocardium of Px + DOC rats than in DOC-treated animals. Arterial hypertrophy in aorta, coronary artery, renal interlobular artery, and renal arteriole in hypertensive animals was not affected by Px. The aortic content of total calcium in the Px-hypertensive rats was reduced significantly as compared to parathyroid-intact hypertensive rats. The abdominal aorta in the Px + DOC group showed a greater reduction in calcium than the thoracic aorta. We conclude that calcium may not be essential in mediating hypertension-induced vascular hypertrophy. Parathyroidectomy permitted a separation of high blood pressure-hypertrophy from hyaline vascular lesions in DOC-induced hypertensive rats, likely acting upon endothelial cells to prevent movement of plasma proteins (hyaline change) from the vascular lumen into the media-subendothelial space of blood vessels.

Animals↗