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Parathyroid Surgery (parathyroid + surgery)
Selected AbstractsIn reference to Thyroid Surgery: Changing Patterns of Practice and Emerging Trends in the Performance of Parathyroid SurgeryTHE LARYNGOSCOPE, Issue 1 2008Luc G. T. Morris No abstract is available for this article. [source] Evolution of maxillofacial brown tumors after parathyroidectomy in primary hyperparathyroidismHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2008Jaime Alonso Reséndiz-Colosia MD Abstract Background. Brown tumor occasionally affects the facial bones. Clinically, these lesions can be mistaken for a neoplasm. Opinions are divided on the course of management of the bony lesions once parathyroidectomy has been carried out. Methods. We treated 22 patients with primary hyperparathyroidism and osteitis fibrosa cystica and observed their clinical and biochemical recovery. Results. Fifteen patients (68.2%) had brown tumors in mandible, and 7 (31.8%) in maxilla. After parathyroidectomy, 21 patients had normal total serum calcium values. All brown tumors presented a spontaneous progressive regression; in 18cases, regression was total, with a mean time period of 10months. Two patients had partial regression after nearly 2years. Another 2 patients were lost to follow-up. Conclusions. After successful parathyroid surgery, the bony lesions tended to regress spontaneously, either partially or completely. However, if the lesion is disfiguring or symptomatic, surgical excision may be indicated. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Oral calcium supplementation associated with decreased likelihood of nephrolithiasis prior to surgery for hyperparathyroidismINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2007Matthew R Cooperberg Abstract: We aimed to assess the impact of oral calcium supplementation (OCS) on the prevalence of nephrolithiasis among a cohort of patients undergoing surgery for primary hyperparathyroidism (PHPT). There were 339 patients undergoing surgery for PHPT with detailed past medical history data that were analyzed. 73 patients (22%) had a history of nephrolithiasis prior to parathyroid surgery. Nephrolithiasis was more common among men than women (40% vs 15%, P < 0.001), despite the predominance of women (73% of patients) with hyperparathyroidism. 83 patients (25%) used OCS. OCS was associated with a lower prevalence of nephrolithiasis (9.6% vs 25.4% without OCS, P = 0.002). This protective effect included both men and women (rates of nephrolithiasis with and without supplements: men 19% vs 46%, P = 0.027; women 7% vs 17%, P = 0.04). The mechanism for the apparent protective effect of OCS on rates of nephrolithiasis is unclear, and further research is required to elucidate the variable penetrance of nephrolithiasis among PHPT patients. [source] Chondrosarcoma in Association With Primary Hyperparathyroidism,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2004Ajay Bhatia Abstract We describe two female patients, 66 and 36 years of age, with both primary hyperparathyroidism and chondrosarcoma. Case 1 had a chondrosarcoma of the right scapula, and case 2 had chondrosarcoma of the left proximal tibia. Both patients underwent surgical resection of their chondrosarcoma and subsequent parathyroid surgery. Histological analysis of the excised parathyroid in case 1 showed a parathyroid carcinoma and in case 2 showed a parathyroid adenoma. Including these two patients, there is now a total of six cases that have been reported in the literature describing the association between hyperparathyroidism and bone malignancy. We believe that this small number makes it unlikely that there is an association between these two conditions, although we speculate that there may be an underlying genetic basis. [source] Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical featuresJOURNAL OF INTERNAL MEDICINE, Issue 1 2005J. P. BILEZIKIAN Abstract. Primary hyperparathyroidism (PHPT) is characterized most commonly now as an asymptomatic disorder with hypercalcaemia and elevated levels of parathyroid hormone (PTH). The elevation in PTH is detected by both the standard immunoradiometric assays (IRMA) and a more recent IRMA that detects only the 1,84 full-length PTH molecule. The serum calcium concentration is usually <1 mg dL,1 above normal. Recently, another variant of PHPT (normocalcaemic PHPT) has been described in which the serum calcium is normal but the serum PTH is elevated, in the absence of any secondary cause for PTH elevation. Although usually sporadic, PHPT also occurs in inherited syndromes. Skeletal manifestations are appreciated by densitometry showing a typical pattern in which cancellous bone of the lumbar spine is reasonably well preserved whilst the cortical bone of the distal third of the radius is preferentially reduced. Although reduced in incidence, renal stones remain the most common overt complication of PHPT. Other organs are theoretical targets of PHPT such as the neurobehavioural axis and the cardiovascular system. Vitamin D looms as an important determinant of the activity of the PHPT state. The 2002 NIH Workshop on asymptomatic PHPT has led to revised guidelines to help doctors determine who is best advised to have parathyroid surgery and who can be safely followed without surgery. New information about the natural history of PHPT in those who did not undergo surgery has helped to define more precisely who is at-risk for complications. At the NIH workshop, a number of items were highlighted for further investigation such as pharmacological approaches to controlling hypercalcaemia, elevated PTH levels and maintaining bone density. [source] In reference to parathyroid surgery and methylene blue: A review with guidelines for safe intraoperative useTHE LARYNGOSCOPE, Issue 2 2010Ken Gillman MD No abstract is available for this article. [source] Minimally invasive parathyroidectomy for recurrent or persistent hyperparathyroidism using carbon track localizationANZ JOURNAL OF SURGERY, Issue 10 2003Robert J. Kennedy Background: The present study documents the use of carbon tracking to localize parathyroid adenomas in three patients with persistent or recurrent parathyroid disease. Methods: Three patients requiring second or third operations for hyperparathyroidism were operated upon after the parathyroid lesion had been localized preoperatively using a suspension of carbon particles in water. The enlarged parathyroid glands were identified by using one or more of the following: computed axial tomography, magnetic resonance imaging, ultrasound or Sestamibi nuclear scan. The lesion was then localized with ultrasound or computed axial tomography and a carbon track was inserted from the lesion to the skin, leaving a small skin tattoo as a marker for the surgeon. Each patient underwent a minimally invasive parathyroid operation. Results: For each of the three patients the recurrent or persistent parathyroid adenoma was successfully identified and removed via a small incision. Conclusion: Minimally invasive techniques for primary hyperparathyroidism are changing our approach to parathyroid surgery. However, a minimally invasive technique is less applicable when the disease is persistent or recurrent. Although, when the recurrent or persistent parathyroid adenoma can be identified, localization and carbon tracking have proved useful in allowing the surgeon to remove the lesion via a minimally invasive technique. [source] Initial experience of vocal cord evaluation using grey-scale, real-time, B-mode ultrasoundANZ JOURNAL OF SURGERY, Issue 12 2001Stan Sidhu Background:, To evaluate whether grey-scale, real-time, B-mode ultrasound (US) is a reliable alternative to nasopharyngoscopy for assessing vocal cord function post-thyroid and post-parathyroid surgery. Methods:, A prospective validation study was undertaken comparing grey-scale, real-time, B-mode vocal cord US with the standard of nasopharyngoscopy in 100 consecutive patients undergoing thyroid and parathyroid surgery between 1 February 1999 and 31 August 1999, with seven patients with known cord palsy. The sensitivity and specificity of grey-scale, real-time vocal cord US for the detection of vocal cord palsy when compared to the standard of nasopharyngoscopy was analysed. Results:, In the postsurgical group, there were six nerves (3.2% of the nerves at risk) transient and no permanent vocal cord palsies. US identified four of six transient palsies and reported two false negatives and three false positives. US identified four of seven cord palsies in the non-surgical group with known cord palsy. Analysis of the 107 combined patients showed US had sensitivity of 62% (8/13), specificity of 97% (91/94), a positive predictive value of 73% (8/11) and a negative predictive value of 95% (91/96) for detecting cord paralysis compared to the standard of nasopharyngoscopy. Conclusion:, Despite the enthusiasm of earlier reports, our initial experience with grey-scale, real-time, B-mode US suggests it is not a reliable alternative to nasopharyngoscopy for assessing vocal cord function post-thyroid and post-parathyroid surgery. Further recruitment of patients with known vocal cord palsy is required to confirm or refute these initial impressions. [source] Letter 1: Focused parathyroid surgery with intraoperative parathyroid hormone measurement as a day-case procedure (Br J Surg 2004; 91: 78,82)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2004G. Materazzi No abstract is available for this article. [source] Letter 2: Focused parathyroid surgery with intraoperative parathyroid hormone measurement as a day-case procedure (Br J Surg 2004; 91: 78,82)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2004W.T. Ng No abstract is available for this article. [source] What steps should be considered in the patient who has had a negative cervical exploration for primary hyperparathyroidism?CLINICAL ENDOCRINOLOGY, Issue 5 2009Barney Harrison Summary The key to cure of the patient with persistent primary hyperparathyroidism is a clear understanding of the investigations, operative procedure and pathology related to the initial procedure. Reinvestigation and subsequent surgery should be performed in a specialist unit. A logical pathway of increasingly sophisticated localization studies (MIBI, ultrasound, CT/MRI, selective venous catheterization for PTH) will usually guide the surgeon to the missing parathyroid gland/s. Improved preoperative localization can facilitate the use of a minimally invasive small incision approach. The surgeon must have a detailed knowledge of the nuances of parathyroid embryology and a meticulous surgical technique, not only to identify and safely remove the retained gland/s but also do so without causing unnecessary morbidity. Results of re-operation (84,98% cure) from centres of excellence are highly commendable, yet the use of ,new' technology (that includes intra-operative PTH) has not translated into improved outcomes in all cases. Some parathyroid glands are extremely difficult to find! Re-operative parathyroid surgery is a challenge, sometimes easy, and on other occasions extremely difficult. [source] Neonatal severe hyperparathyroidism associated with a novel de novo heterozygous R551K inactivating mutation and a heterozygous A986S polymorphism of the calcium-sensing receptor geneCLINICAL ENDOCRINOLOGY, Issue 3 2007Judit Tőke Summary Introduction, Neonatal severe hyperparathyroidism (NSHPT) is induced by inactivating mutations of human calcium-sensing receptor (CaSR). Only three heterozygous de novo inactivating mutations of CaSR causing NSHPT have been described. We report the case of a now 11-year-old boy with NSHPT and we characterize a novel inactivating mutation along with the results of some functional analyses. Patient and methods, As a neonate the patient presented the clinical syndrome of NSHPT. At 6 years of age persisting hypercalcaemia without clinical symptoms was documented, and the patient remained completely symptom free without parathyroid surgery until his present age of 11 years. The entire coding region of the CaSR gene of the patient and his family members was sequenced. Functional investigation was performed in HEK-293 cells, transiently transfected with wild type and mutant CaSR plasmid constructs. Results, Sequence analysis revealed a novel de novo heterozygous mutation at codon 551 (AGG,AAG), predicting a change of arginine to lysine (R551K) and a known heterozygous polymorphism (A986S) on the same allele, which was inherited from the father. We demonstrated that the novel R551K mutation significantly reduced the calcium sensitivity of CaSR (EC50: from 3·38 ± 0·62,6·10 ± 0·83 mmol/l), which was not alleviated by the simultaneous presence of A986S polymorphism. Conclusions, We present the fourth NSHPT case induced by a novel de novo heterozygous inactivating mutation (R551K) of the CaSR gene. The disease gradually reverted to a symptomless, benign condition resembling familial hypocalciuric hypercalcaemia without any surgical intervention. [source] A randomised controlled trial of routine suction drainage after elective thyroid and parathyroid surgery with ultrasound evaluation of fluid collectionCLINICAL OTOLARYNGOLOGY, Issue 1 2007S. Ahluwalia Objective:, To determine the need for suction drainage after elective thyroid and parathyroid surgery. Design:, Randomised controlled trial. Setting:, University teaching hospital. Participants:, Patients requiring elective thyroid or parathyroid surgery were recruited and informed consent was obtained (n = 100). Before wound closure, patients were randomised into either group A (to remain without suction drainage) or group B (to receive suction drainage). Excluded patients were those requiring associated neck dissection and those with bleeding diatheses, all of whom would necessarily require drainage in our unit. Main outcome measures:, Primary , ultrasound evaluation of any collection in the thyroid bed, performed 1-day postoperatively. Secondary , postoperative complications; length of in-patient stay. Results:, One hundred patients completed the study, and groups A and B comprised 50 patients each. Patients in each group exhibited a mean age of 49 years, and a male to female ratio of 1 : 9. Both groups were also well-matched regarding type of operation, size of tumour and histopathological diagnosis. Modal and median postoperative neck collection volume on ultrasound examination was 0 and 0 cm3 respectively (range 0,16 cm3) in group A and was 0 and 0 cm3 (range 0,70 cm3) in group B. This difference was not statistically significant, but three patients with a haematoma were all in the suction drainage group. Difference in complication rates between groups was also not statistically significant. Modal and median length of in-patient stay was 2 and 2 days respectively (range 2,3 days) in group A and 3 and 3 days (range 2,4 days) in group B, and this difference was statistically significant (P = 0.0006). Conclusion:, Routine suction drainage after uncomplicated elective thyroid and parathyroid surgery appears unnecessary, and prolongs in-patient stay. 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