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At least 1,009 records · Page 56Linked to original sources
PubMed1994

Chronic renal failure: diagnostic measures before parathyroidectomy.

To investigate whether conventional criteria suffice to differentiate between hyperparathyroid and aluminum (Al)-related bone disease, we obtained bone biopsies from 7 patients with chronic renal failure (CRF) at the time of PTX and 3.5-36 months later. All had hypercalcemia and elevated mid-region parathyroid hormone levels and 3 had bone pain at PTX. Bone histomorphometry revealed that 5 patients had hyperparathyroid bone disease at PTX, while 2 had osteomalacia and skeletal Al deposits. Retrospective determination of intact PTH showed normal levels at PTX in the latter two. PTX effectively reduced all indices of parathyroid hyperactivity, but the two patients with Al-related bone lesions did not improve clinically nor histologically after PTX. Intact PTH and/or bone biopsy prior to PTX could have deterred surgery in those with Al-related bone disease.

Aluminum↗
PubMed1993

[Effect of parathyroidectomy (PTX) on aluminum (Al) induced bone disease].

Al-treated or untreated decalcified sections of bone matrix were implanted subcutaneously into the abdominal wall of parathyroidectomized (PTX) or control rats for 21 or 28 days. The bone remodeling and Al, Ca content in the implants were measured by using histomorphometry and atomic absorption spectrum method. The results showed that bone area, osteoclast number, osteoblast number and bone mineralization rate of Al-treated or untreated bone in PTX rats and of Al-treated bone in control rats were significantly lower than those of untreated bone in control rats (P < 0.05). There was no marked difference between these parameters of Al-treated bone in control rats and untreated bone in PTX rats (P > 0.05), and these of Al-treated bone in PTX rats were the lowest (P > 0.05- < 0.05). Ca contents were consistent with the histological parameters. Bone Al removing rate between PTX and control rats was not markedly different. In conclusion, both PTX and Al impair bone formation and mineralization, bone biopsy and removal of Al from bone is necessary before PTX treatment in uremic patients with secondary hyperparathyroidism.

Aluminum↗
PubMed1996

Preoperative needle-localized parathyroidectomy for persistent secondary hyperparathyroidism.

Several preoperative localization techniques have been developed to assist the surgeon, with varying degrees of accuracy, in identifying the offending gland during reoperative parathyroid surgery. This is a case report of persistent secondary hyperparathyroidism that was treated with preoperative, computed tomography-guided needle localization followed by surgery. The patient underwent successful resection of a hyperplastic fifth parathyroid gland, and her calcium level decreased appropriately postoperatively. This case demonstrates a perioperative localization scheme that reduces operative time, reduces the risk of injury to surrounding structures, and helps to assure cure.

Aged↗
PubMed1997

[Parathyroidectomy under local anesthesia. First two cases in Lebanon and review of the literature].

The routine use of automated techniques to measure serum calcium levels have made disease states of the parathyroid gland a common endocrinologic problem. Because of the low sensitivity and specificity of early radiologic techniques to identify enlarged parathyroid glands, and because skilled endocrine surgeons report success rates of > 95% in identifying abnormal parathyroid glands, historically most parathyroid glands surgery consisted in a large cervicotomy under general anesthesia without preoperative localization. However, the development of sophisticated imaging techniques has now made it possible to identify the abnormal gland in a significant number of patients, leading some surgeons to choose unilateral neck exploration under local anesthesia for primary hyperparathyroidism. The success of the procedure is ascertained by measuring PTH peroperatively. We report the first two Lebanese patients, presenting with a solitary parathyroid adenoma, who underwent this easy, safe and cost-effective surgical technique.

Adenoma↗
PubMed1997

Patient, nurses, and physicians collaborating in the management of a patient following autotransplant parathyroidectomy.

The nephrology nurses in collaboration with the nephrologist worked closely to avoid severe symptomatology related to calcium phosphorus imbalance. The surgical team support was discontinued 48 hours after the removal of the autotransplant. The patient exhibited classic signs of secondary hyperparathyroidism, as indicated by laboratory tests, anemia, and pruritus. Despite the level of anemia, the patient did not complain of fatigue or dyspnea. A hypocalcemic crisis was avoided by the ongoing assessment and intervention the patient received from the nursing staff. Four of the five stated goals were met. The patient is free of disability as evidenced by steady gait, normal range of motion, and adequate muscle strength. The calcium and phosphorus levels and the calcium phosphorus product are within acceptable ranges (see Figure 1). J.I. has always had information about diet and medication management but has demonstrated variable adherence to the regimen. However, the nephrology nurses plan to continue with counseling and education as needed.

Adult↗