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Total Parathyroidectomy (total + parathyroidectomy)
Selected AbstractsCalcium supplement necessary to correct hypocalcemia after total parathyroidectomy for renal osteodystrophyINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2000Masayuki Nakagawa Abstract Background: Prediction of the extent of calcium supplement will facilitate safe and efficient management of hypocalcemia in the early postoperative stage of total parathyroidectomy with autotransplantation (PTXa) in patients with renal osteodystrophy. Methods: The correlation between the extent of calcium deficiency, estimated by the amount of calcium supplement over 48 h after PTXa and using various parameters such as carboxy terminal parathyroid hormone (c-PTH), intact PTH (i-PTH), alkaline phosphatase (ALP), serum calcium, serum phosphorus, duration of hemodialysis, total weight of resected parathyroid glands and degree of subperiosteal resorption of the middle phalanx was examined in 49 patients who underwent PTX with subcutaneous autotransplantation. Bone mineral density (BMD) was also determined before, 3 months and 1 year after PTXa with dual energy X-ray absorptiometry (DEXA) in 13 patients. Results: There was a positive correlation between pre-operative i-PTH level (r = 0.56, P < 0.0005) or ALP level (r = 0.50, P < 0.0005) and the amount of calcium supplement over 48 h after PTXa in these patients. Furthermore, the degree of subperiosteal resorption, determined by Jensen's classification, was significantly correlated with the amount of calcium supplement after PTX (P < 0.05). Bone mineral density 3 months after (P < 0.0005) and 1 year after PTXa (P < 0.001) significantly increased compared with BMD before PTXa in all patients examined. Conclusion: These findings suggest that the pre-operative determination of i-PTH, ALP levels and degree of subperiosteal resorption allow the management of hypocalcemia safely and efficiently in renal osteodystrophy patients after PTXa. [source] Radioguided Parathyroidectomy for Recurrent Hyperparathyroidism Caused by Forearm Graft Hyperplasia,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2003Rebecca S Sippel Abstract One of the surgical options for symptomatic secondary hyperparathyroidism is a total parathyroidectomy with forearm implantation. Recurrence can occur and is most likely caused by hyperplasia of the small fragments of parathyroid tissue implanted in the forearm muscle. Forearm graft hyperplasia can be detected using Tc-99m sestamibi scanning of the forearm, which can show abnormal enhancement at the former graft site. In this report, we present the case of a 49-year-old gentleman with recurrent hyperparathyroidism caused by hyperplasia of forearm graft fragments. Unfortunately, no sutures or clips were placed at his initial surgery to identify the location of the parathyroid tissue in the forearm. Thus, we describe the first reported use of radioguided techniques using Tc-99m sestamibi injection and intraoperative gamma probe to localize parathyroid fragments in the forearm muscle. During our initial exploration, we found that injection of the tracer in the operative arm leads to prohibitively high levels of background activity. During a second exploration, the tracer was injected in the lower extremity, minimizing the background in the forearm and allowing the gamma probe to clearly identify two areas of abnormal parathyroid tissue. The intraoperative radioprobe allowed quick identification and removal of the abnormal parathyroid tissue in a case that was made particularly challenging by the absence of marking sutures. [source] Outcome of parathyroidectomy for patients with renal disease and hyperparathyroidism: predictors for recurrent hyperparathyroidismANZ JOURNAL OF SURGERY, Issue 5 2009Tsu-Hui (Hubert) Low Abstract Background:, A small group of patients with renal disease-related secondary or tertiary hyperparathyroidism require surgical parathyroidectomy. Among them, 5,20% require further re-exploration and excision of parathyroid tissue because of recurrent disease. The aims of the present study were to review the characteristics and outcomes of patients undergoing parathyroidectomy for renal disease related hyperparathyroidism and to identify the risk factors for recurrent hyperparathyroidism. Methods:, Review of data from a dedicated head and neck database at Royal Prince Alfred Hospital between 1988 and 2004. Results:, There were 115 patients of whom 68 (59%) patients were treated with subtotal parathyroidectomy (STP), 43 (37%) were treated with total parathyroidectomy (TP) and 4 (3%) were treated with TP with autotransplant. Of those, 11 (9.6%) patients developed recurrent hyperparathyroidism (9 had STP, 1 had TP and 1 had TP with autotransplant). On re-exploration, persistent hyperplastic parathyroid tissue was located at the site of partially excised parathyroid gland (64%), autotransplanted parathyroid tissue (9%), anterior mediastinum (18%) and intrathyroidal parathyroid (9%). Predictors for recurrent hyperparathyroidism are STP (P= 0.049), preoperative symptom of calciphylaxis or calcinosis (P= 0.024), elevated preoperative calcium level (P= 0.007) and elevated post-operative PTH levels (P= 0.014). Post-operative PTH levels less than 10 pmol/L has a positive predictive value of 97.5% for cure (P= 0.02). Conclusion:, More aggressive surgical approach could be indicated in patients with preoperative hypercalcaemia and calcinosis/calciphylaxis. Post-operative PTH can be utilized as a marker for cure after parathyroidectomy in hyperparathyroidism of renal disease. [source] HN08P AUDIT OF 115 CONSECUTIVE PARATHYROIDECTOMIES IN PATIENTS WITH RENAL HYPERPARATHYROIDISMANZ JOURNAL OF SURGERY, Issue 2007T. H. Low Objectives To review the characteristics and outcomes of patients undergoing parathyroidectomy for renal (secondary and tertiary) hyperparathyroidism. Methods Review of prospectively collected data from a dedicated head and neck database at RPAH between 1988 and 2004. A total of 115 patients underwent exploratory parathyroidectomy. Results Common indications for parathyroidectomy included hypercalcaemia, renal osteodystrophy, calciphylaxis and calcinosis, bone or joint pain, and pruritus. Sixty-nine patients had subtotal parathyroidectomy (STP), 47 had total parathyroidectomy (TP) of which 4 had total parathyroidectomy with autotransplant (TPA). Ten patients required re-exploration for recurrent hyperparathyroidism at a median time to reoperation of 55 months. Of those, 8 had STP, 1 had TP, and 1 had TPA. Predictors of recurrent hyperparathyroidism included higher post operative PTH level (median of 22.5 pmol/L vs 3.4 pmol/L) and higher total parathyroid weight (median of 7.75 gm vs 2.9 gm). 97% of patients reported resolution of symptoms on follow-up. The average length of hospital admission was 4.4 days. Morbidity of this series included wound infection (0.8%), temporary vocal cord paralysis (0.8%), seizure due to severe hypocalcaemia (0.8%) and neck haematomas requiring evacuation (0.8%). Conclusions Parathyroidectomy is effective in the management of renal hyperparathyroidism. Subtotal parathyroidectomy is associated with a higher re-exploration rate. Predictors for recurrent hyperparathyroidism include total parathyroid weight and post-operative PTH level. [source] | ||||||||||