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PubMed1989

[Parathyroidectomy and autotransplantation in renal hyperparathyroidism. II. Morphologic and functional studies in transplant-dependent recurrence].

Corresponding to predefined macroscopic criteria indicating morphological and functional characteristics, fragments of a type 1a-gland were used after total parathyroidectomy for auto-transplantation in 16 hemodialyzed patients with drug-resistant renal hyperparathyroidism (rHPT). Fragments of a type 1b-gland were used in two, fragments of a type 2-gland in 17 patients, respectively. The clinical and biochemical follow-up three to 84 months postoperatively showed one patient (3%) with graft-dependent hypocalcemia (type 1a-graft) and in two patients (6%) with type 2-grafts histological examinations confirmed graft-dependent recurrent hyperparathyroidism. Thus the estimated cumulative success (= normal parathyroid metabolism; Kaplan Meier) was 78 +/- 12% 5 years postoperatively. Comparing the estimated cumulative function rate of type 1a- and type 2-autotransplants, a better course was found in typ 1a-grafts three years postoperatively (Breslow: p = 0.0724; Mantel-Cox: p = 0.0677). The morphological examinations of the removed enlarged fragments of different size (between 0.2 cm and 0.9 cm) showed signs of an expansive, but never invasive growth. The chief and oxyphilic cells were intermixed and arranged in a follicular pattern as in the former glands selected for grafting. Mitoses could be found more often in larger fragments, thus correlating with a tendency to proliferation and a bad in vitro suppressibility. The results of the studies confirm the conclusions of an in vitro study, showing that the diffuse hyperplastic type 1a-parathyroids are most suited for autotransplantation. Glands or gland areas without fat-cells (type 1b) or nodules of type 2-glands which can be identified intraoperatively using a stereomagnifier should not be used.

Adult↗
PubMedDate not supplied

[Parathyroidectomy in children with renal failure. Retrospective study of 17 cases].

Parathyroidectomy (PTX) is rarely needed in children with end-stage renal disease and the new forms of vitamin D decrease its frequency. We report 17 cases of patients (14 with dialysis and 3 with functional renal graft) suffering from renal insufficiency in the pediatric age group who required a PTX. The surgical indications and techniques (partial PTX, total PTX with or without graft) varied with time and circumstances. After partial PTX, 3/10 patients were reoperated on. After PTX + graft one patient needed a second graft and another a graft curettage. Whatever the method, we noted normalization of clinical and radiological signs and a decrease in biological signs. The growth rate improved in most children during puberty, but outside of this period, no effect was noted. There is a definite indication for a PTX in cases with tertiary hyperparathyroidism. The indication seems questionable in cases with secondary hyperparathyroidism which can now be effectively treated with 1 alpha-hydroxylated forms of vitamin D. When necessary, total PTX with or without graft should be performed.

Adolescent↗
PubMed1977

Secondary hyperparathyroidism and parathyroidectomy in terminal chronic renal failure.

Subtotal parathyroidectomy was performed on 34 patients with severe renal insufficiency. The indications were grave clinical symptoms (pruritus, bone pains and mental disturbances), gastric ulcer and radiological abnormalities (metastatic calcifications, osteoporosis, fractures and subperiostal resorption). The serum calcium level was elevated in eight cases. The serum parathormone value was determined in 13 cases, it was elevated in all cases. Less than 500 mg tissue was removed in 12, between 500 and 6000 mg in 19 and over 6000 mg in 3 cases. Nodular hyperplasia was demonstrated in 11 and diffuse hyperplasia in 23 patients. The serum calcium and parathormone levels fell markedly after the operation, and pruritus, bone pains and mental disturbances were markedly alleviated. Complete recovery was achieved only by a successful renal transplantation, but the operation had often a favourable effect on the grave symptoms.

Adolescent↗
PubMed1987

A community hospital experience with total parathyroidectomy and autotransplantation for renal hyperparathyroidism.

This study was undertaken to determine the success of surgical treatment of advanced secondary (renal) hyperparathyroidism. From 1978 to 1985, total parathyroidectomy and autotransplantation (TPA) were performed for secondary hyperparathyroidism in 23 patients who had had dialysis for a mean of 6.5 years preoperatively. Indications for surgery included hypercalcemia, bone pain and pathologic fractures, metastatic calcification, and pruritus. Four glands were found and removed in all patients; 100-150 mg of diced tissue were autotransplanted to one forearm. Two patients died of myocardial infarction in the first postoperative week. Bone pain, present in 19 of 23 patients, was relieved almost immediately postoperatively and relief was sustained to death (of unrelated causes) or most recent follow-up in 13 patients. All fractures healed. All patients had markedly elevated serum parathormone (PTH) preoperatively and 14 of 23 were hypercalcemic. The group mean values of serum calcium, alkaline phosphatase, and PTH all fell to and remained in a normal range by 1 year postoperatively in that subset of patients who did not suffer recurrence. Six patients were reoperated on after 12 to 37 months with partial graft excision for recurrent bone pain and hypercalcemia. Bone pain in two of these patients was due to aluminum-associated bone disease and the diagnosis of recurrent secondary hyperparathyroidism was erroneous. The actual recurrence rate was thus 19 per cent. Consistent technical success, with no late hypocalcemia, was achieved and most patients were restored to medical manageability.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Severe primary hyperparathyroidism in a neonate with two hypercalcemic parents: management with parathyroidectomy and heterotopic autotransplantation.

A neonate with severe primary hyperparathyroidism was successfully managed by parathyroidectomy and heterotopic autotransplantation (one third of one gland of the infant was implanted in the forearm). In vitro studies of parathyroid tissue from the infant revealed a severe defect in parathyroid suppressibility. Postoperatively, the infant had modest hypercalcemia, normal serum immunoreactive parathyroid hormone levels, hypermagnesemia, and relative hypocalciuria. The parents were related and both had asymptomatic hypercalcemia with mean serum immunoreactive parathyroid hormone levels that were within the normal range. Similar to the findings in the infant postoperatively, relative hypocalciuria in the presence of hypercalcemia was found in the mother; in contrast, the father had hypercalciuria. The presumed dominantly transmitted hypercalcemia in this kindred is consistent with familial hypocalciuric hypercalcemia with a confounding factor of ethanol possibly accounting for the hypercalciuria in the father.

Acute Disease↗
PubMedDate not supplied

[Radiologic surveillance of uremic osteodystrophy after parathyroidectomy].

Partial parathyroidectomy (PTX) was carried out 20 times in 15 dialitic patients with chronic renal failure. The operation was suggested by marked radiological abnormalities due to severe secondary hyperparathyroidism, that developed despite aggressive medical and dietetic management. The skeletal x-ray examination showed significant improvement following PTX, that was clearly visible already one month postoperatively at the level of the second and third phalanges of the hands. The improvement of the skeletal osteodystrophic patterns was always associated to a fall of parathyroid hormone and plasma alkaline phosphatase levels. The radiological examination of the hands may represent a usefull and simple method in the follow-up of patients after surgery to assess the efficacy of PTX.

Adult↗
PubMed1986

[Parathyroidectomy and autotransplantation].

Total parathyroidectomy, immediate heterotopic autotransplantation and cryopreservation of parathyroid tissue was introduced in the surgical treatment of drug-resistant renal hyperparathyroidism (rHPT) in 1980 and was performed in 36 patients. During 34 initial bilateral cervical explorations including transcervical thymectomy 142 glands were removed (orthotopic localization: 84%; heterotopic localization: 16%). Supernumerary glands were found in 6 patients (18%; thymus: 3; cervical fatty tissue: 4). The elevated parathyroid metabolism was successfully corrected, in all, but one patient in whom only three glands were removed. Biochemical and clinical follow-up examinations showed a restitution of the symptoms in 88% 3 to 79 months postoperatively. Graft-dependent recurrence of rHPT was diagnosed in one patient. Normocalcemia was reestablished by partially excising the grafted tissue under local anesthesia. Graft-dependent hypoparathyroidism was suspected in one patient because of low levels of serum calcium and parathyroid hormone. Late graft failure was not observed during the follow-up period. None of the patients required delayed autotransplantation of cryopreserved tissue.

Adolescent↗
PubMed1985

[Voice disorder following parathyroidectomy].

We report two patients with voice disorders after parathyroidectomy without thyroidectomy and paresis of the recurrent nerve. The connection between hypoparathyroidismus and laryngeal tetany is discussed.

Female↗
PubMed1979

Effect of parathyroidectomy on anemia in chronic renal failure.

Fourteen patients with chronic renal failure underwent parathyroidectomy. Postoperatively, seven patients exhibited a rise in hematocrit reading, but seven others did not. Responders had more severe bone disease and lower initial hematocrit values than did nonresponders. Marrow fibrosis was slightly more prominent in responders. Current concepts of marrow erythropoietic inhibition in renal failure suggest a toxic serum factor as the cause. This report fails to support parathyroid hormone as the toxic agent directly responsible for marrow inhibition. Rather, parathyroid hormone may contribute to anemia in renal failure by causing marrow fibrosis, a process sometimes reversible by successful therapy of hyperparathyroidism.

Anemia↗
PubMed1979

[Parathyroidectomy for secondary hyperparathyroidism: anatomo-surgical observations on experience in 16 treated cases].

The authors, on personal experience, based on parathyroidectomies for secondary hyperparathyroidism, relate the surgical anatomic findings after a brief discussion on indications. They relate beside some atypical seats of parathyroid glands, observed in 11 glands of the 59 removed. Finally they emphasize the importance of accuracy of surgical exploration because that cannot be helped by instrumental methods or by gross pathologic observation.

Adult↗
PubMed1977

Maternal primary hyperparathyroidism of pregnancy. Successful treatment by parathyroidectomy.

Primary hyperparathyroidism of pregnancy may result in spontaneous abortion, neonatal hypocalcemia, or neonatal tetany if appropriate treatment is not instituted. Of great importance in prevention of these complications is an awareness by physicians that this disease exists and is of clinical importance. Parathyroidectomy performed during the second trimester of pregnancy offers the best chance for fetal and neonatal survival. This operation results in little risk to either the mother or the fetus. Normal calcium homeostasis is restored to the fetus and the risk of hypocalcemia in the neonatal period is virtually eliminated.

Adult↗
PubMed1977

[Subtotal parathyroidectomy. Indications and technic].

A close examination of recent views concerning metabolic diseases connected with uraemia is followed by an account of the therapeutic efficacy of subtotal parathyroidectomy, its indications, and the best technique to employ. A personal series is described.

Adult↗
PubMed1978

[Recurrent hyperparathyroidism following subtotal parathyroidectomy].

Recurrent hyperparathyreoidism occurred in 3 of 9 patients in terminal renal failure from 9 months to 2 years after an initially successful subtotal parathyroidectomy. In all cases we find temporary remission of clinical signs of hyperparathyreoidism after surgery. Our clinical experience provided by followup in these patients showed an insufficient biochemical and clinical control. We find recurrence in 3 cases and repeat neck exploration was indicated for 2 patients.

Humans↗
PubMed1984

[Unilateral parathyroidectomy--a new surgical strategy in hyperparathyroidism due to solitary adenoma].

Unilateral parathyroidectomy (UPTX) was applied as surgical principle for parathyroid adenoma 102 consecutive patients. Intraoperative oil-red-O staining was used for distinction between autonomous and suppressed chief cells. UPTX without contralateral exploration was achieved in 43 patients. In 45 patients two microscopically normal parathyroids were found at the first side and UPTX was performed contralaterally where the adenoma was located. In 14 patients non-UPTX was performed. If more than one, macroscopically, normal parathyroid was found one was removed for histopathology. The intended gland identification was achieved in 93-97%. Supernumerary glands were found in seven patients. Postoperative hypocalcemia was more pronounced after "atypical" operations than UPTX following bilateral exploration. All patients were followed up at least one year. None has developed hypercalcemia. Vitamin D-requiring hypocalcemia is present in two "atypically" operated patients. Removal of one, macroscopically, normal gland, preferably from the adenoma side is advocated. If UPTX can be performed at the first side explored, the contralateral need no exploration.

Adenoma↗
PubMed1984

Parathyroidectomy for primary hyperparathyroidism: early discharge.

With increasing awareness of cost-containment measures, early discharge after parathyroidectomy for primary hyperparathyroidism is to be evaluated. This report concerns the Cleveland Clinic experience with the last 70 consecutive patients treated for primary hyperparathyroidism from June 1981 to June 1983. The mean postoperative hospital stay was 1.4 days. Most patients were discharged on the morning of the second postoperative day receiving oral calcium supplements for 3 weeks. Three patients were discharged on the morning of the first postoperative day. The overall mortality rate was 0%. Morbidity included two patients (2.9%) who developed symptoms of mild tetany after discharge that responded to an increased dose of oral calcium. The usual practice of most surgeons of delaying hospital discharge after neck exploration for primary hyperparathyroidism for 5 to 7 days in fear of symptomatic hypocalcemia is unnecessary. Considerable cost containment can be achieved by sparing patients from 3 to 5 extra days of hospitalization.

Adenoma↗
PubMed1984

[Total parathyroidectomy with autotransplantation in secondary hyperparathyroidism].

Five patients with chronic renal failure were undergone total parathyroidectomy and immediate autotransplantation into the muscle of the forearm. All patients had relief of symptoms and restoration of PTH levels to normal. This technique of parathyroid transplantation offers the surgeon versatility in managing patients with hyperparathyroidism.

Adult↗
PubMed1984

Hyperparathyroidism in patients with X-linked dominant hypophosphatemic rickets--application of the calcium infusion test as an indicator for parathyroidectomy.

Two children with X-linked dominant hypophosphatemic rickets treated with vitamin-D metabolites and phosphate supplementation, for prolonged periods, developed hyperparathyroidism with nephrocalcinosis. Calcium infusion tests were performed in both. In one patient, the initial test was done two weeks after all treatment was stopped. Only moderate decrease in the degree of the phosphaturia was recorded. However, a repeat test, performed after all medications were withheld for another four weeks, showed normal anti-phosphaturic response, and she continued to be treated conservatively. In the other patient, the test was done five weeks after withholding treatment. Failure to suppress the phosphaturia provided strong support for the diagnosis of tertiary hyperparathyroidism. He underwent total parathyroidectomy and the parathyroid histology confirmed the diagnosis. In both, control of parathyroid activity stopped the deterioration in kidney function and improved the response of the basic disorder to treatment. It is concluded that in patients with X-linked dominant hypophosphatemic rickets, the calcium infusion test is useful for the differentiation between secondary-reversible and tertiary-irreversible hyperparathyroidism. To avoid continued stimulation of the parathyroid glands by phosphate administration, we recommend that such calcium infusion test be performed and interpreted after at least six weeks have elapsed without phosphate or vitamin-D administration.

Adolescent↗
PubMed1983

Effect of parathyroidectomy on Sodium metabolism in DOCA-NaCl treated and spontaneously hypertensive rats.

Parathyroidectomy (PTX) lessens hypertension if performed on young SHR, and on Sprague-Dawley rats, one week before DOCA + NaCl treatment. PTX also increases diuresis and possibly sodium excretion. In this work, sodium balance was investigated during the onset of hypertension, since in SHR and DOCA + NaCl rats, sodium metabolism is related to the level of hypertension. Results show that sodium excretion is enhanced in PTX-DOCA rats immediately after DOCA treatment but lowered in PTX-SHR for 11 weeks. Nevertheless after PTX, sodium balance remains unchanged throughout the experiment. It appears that PTX does not lessen hypertensive development in both models via a decreased sodium balance.

Animals↗