Comparison of different parathyroid autograft project after total parathyroidectomy in patients with secondary hyperparathyroidism

Ectopic or supernumerary parathyroid glands (PTg) can be the reason of surgical failure in treat- ment of secondary hyperparathyroidism in patients, who underwent dialysis. The aim of this study is to estimate the number and localization of PTgs in patients with secondary hyperparathyroidism. We included 165 patients, who underwent total parathyroidectomy with heterotopic autotransplantation of parathyroid gland tissue or subtotal parathyroidectomy. All identified PTgs were separated in two groups: eutopic and ectopic. Preoperative localization was performed by multispiral computed tomog- raphy of neck and mediastinum, neck ultrasonography, two-isotope Tc99 MIBI of PTgs. In postopera- tive period, we estimated the level of parathyroid hormone in the serum and performed morphological verification. There were found 659 PTgs. 12 (7,2%) patients had 3 parathyroid glands, and 11 (6.7%)had 5 PTgs. 4 Ptgs were found in 142 (86,1%) patients. 520 (78,9%) PTgs were eutopic, 139 (21,1%) - ectopic. The most common ectopic place for upper PTgs were paraesophageal and retrotracheal spaces, carotid sheath. Ectopic lower PTgs were most commonly located in the horns of the thymus. All super- numerary PTg were ectopic and often located in area between lower pole of the thyroid lobe and the thymus.Conclusion. During the operation in case when ectopy is suspected, upper PTgs should be located in in paraesophageal and paratracheal areas or in carotid sheath, if it necessary. If lower PTgs is absence, surgery should be completed cervical thymectomy.

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Comparison of Different Parathyroid Autograft Project after Total Parathyroidectomy in Patients with Secondary Hyperparathyroidism

10.21203/rs.3.rs-127808/v1 ◽

2020 ◽

Author(s):

mengjia FEI ◽

dong XU ◽

yi LAI ◽

yanan XU ◽

jingwen ZHANG ◽

...

Keyword(s):

Secondary Hyperparathyroidism ◽

Parathyroid Tissue ◽

Total Parathyroidectomy ◽

Intact Parathyroid Hormone ◽

Remarkable Difference ◽

Recurrence Rates ◽

Biochemical Characteristics ◽

Parathyroid Function ◽

Simple Alternative ◽

Autograft Group

Abstract Objective To evaluate the feasibility and efficacy of total parathyroidectomy followed by modified needle-quantified injection of parathyroid autograft compared with classic incision and transplantation.Methods We conducted a retrospective study of 171 patients with secondary hyperparathyroidism treated by hemodialysis or peritoneal dialysis. These patients were included in our study from April 2006 to December 2016,who had undergone total parathyroidectomies with autotransplantation . Patients were divided into classic incision for transplantation of parathyroid autograft group and modified needle-quantified injection group. Clinical and biochemical characteristics, including preoperative and postoperative intact parathyroid hormone levels were recorded and compared between two group patients. Results To compare the techniques of modified needle-quantified injection and classic incision and transplantation, pre- and postoperative biochemistry and length of operation was recorded and analyzed. Preoperative biochemistry was similarly in both groups. However, autograft function achieved was significantly faster in the group with modified needle-quantified injection compared with classic incision and transplantation (P = 0.03). Median time to parathyroid function regain was 3 months for injection compared with 7 months for classic incision. There was no remarkable difference in the recurrence rates between the two groups.Conclusion The modified needle-quantified injection of parathyroid tissue is a feasible and simple alternative to the more commonly used method of classic incision and transplantation.

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Impact of Dexmedetomidine On Secondary Hyperparathyroidism Recurrence In Uremic Patients Who Received Parathyroidectomy With Auto-Transplantation: A Retrospective Propensity-Matched Study

10.21203/rs.3.rs-1115740/v1 ◽

2021 ◽

Author(s):

Yun Wu ◽

Wei Han ◽

Peikun Li ◽

Xianwen Hu ◽

Ye Zhang

Keyword(s):

Quality Of Life ◽

Propensity Score ◽

Secondary Hyperparathyroidism ◽

Propensity Score Matching ◽

Mechanism Of Action ◽

Control Group ◽

Total Parathyroidectomy ◽

Uremic Patients ◽

The Difference

Abstract Background: Recurrence of secondary hyperparathyroidism (SHPT) remains a big challenge in uremic patients who underwent total parathyroidectomy with auto-transplantation (tPTX-AT). However, the relationship between perioperative intervention and recurrence of SHPT remains unclear. Dexmedetomidine has been used safely and effectively in uremic patients’ anesthesia. The aim of the study was to explore the effect of dexmedetomidine on the recurrence of SHPT and speculate the possible mechanism of action.Methods: Records of patients who underwent tPTX-AT between 2017 and 2018 were retrospectively analyzed. The study consisted of patients who received dexmedetomidine intra-operatively and the controls were patients who did not receive dexmedetomidine. The primary endpoint was the difference in the recurrence of SHPT one year after surgery between the two groups. The secondary endpoint was health-related quality of life scores. Analysis included propensity score matching and multivariable logistic regression. Results: Of 354 patients, 133 patients received dexmedetomidine intraoperatively, and the total recurrence rate of SHPT was 10.2%. After propensity score matching, patients who received dexmedetomidine had a 3.80-fold decreased risk of SHPT recurrence (odds ratio, 0.263; 95% confidence interval, 0.081 to 0.854; P=0.026) and exhibited a better quality of life in terms of physical functioning and general health, and less emotional role limitations compared with those in control group.Conclusion: In uremic patients who received tPTX-AT, there was an association between dexmedetomidine use and decreased risk of SHPT recurrence. Further studies are needed to accurately assess the effects and mechanism of action of dexmedetomidine on the prognosis of this population.

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Secondary Hyperparathyroidism

10.2310/7800.16040 ◽

2019 ◽

Author(s):

Anna C Beck ◽

Sonia L Sugg

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Secondary Hyperparathyroidism ◽

Total Parathyroidectomy ◽

Indications For Surgery ◽

Subtotal Parathyroidectomy ◽

Diagnostic Work ◽

Work Up ◽

Hungry Bone ◽

Diagnostic Work Up

Secondary hyperparathyroidism is defined and its pathophysiology, delineated. Key components of the diagnostic work-up, medical management, and indications for surgery are described. The operative approach and controversy on extent of parathyroidectomy are discussed. This review contains 3 figures, 1 tables, and 24 references. Key Words: autotransplantation, calciphylaxis, chronic renal failure, cryopreservation, hungry bone syndrome, hypocalcemia, secondary hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy

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Secondary Hyperparathyroidism

10.2310/cgso.16040 ◽

2019 ◽

Author(s):

Anna C Beck ◽

Sonia L Sugg

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Secondary Hyperparathyroidism ◽

Total Parathyroidectomy ◽

Indications For Surgery ◽

Subtotal Parathyroidectomy ◽

Diagnostic Work ◽

Work Up ◽

Hungry Bone ◽

Diagnostic Work Up

Secondary hyperparathyroidism is defined and its pathophysiology, delineated. Key components of the diagnostic work-up, medical management, and indications for surgery are described. The operative approach and controversy on extent of parathyroidectomy are discussed. This review contains 3 figures, 1 tables, and 24 references. Key Words: autotransplantation, calciphylaxis, chronic renal failure, cryopreservation, hungry bone syndrome, hypocalcemia, secondary hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy

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Risk Factors for Elevated Preoperative Alkaline Phosphatase in Patients with Refractory Secondary Hyperparathyroidism

The American Surgeon ◽

10.1177/000313481708301220 ◽

2017 ◽

Vol 83 (12) ◽

pp. 1368-1372 ◽

Cited By ~ 1

Author(s):

Meng Yang ◽

Ling Zhang ◽

Linping Huang ◽

Xiaoliang Sun ◽

Haoyang Ji ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Secondary Hyperparathyroidism ◽

Calcium Supplementation ◽

Univariate Analysis ◽

Total Parathyroidectomy ◽

Postoperative Hypocalcemia ◽

Preoperative Serum ◽

Significant Independent Risk Factor ◽

Risk Patients ◽

Optimal Cutoff Point

Elevated preoperative levels of alkaline phosphatase (ALP) in patients with refractory secondary hyperparathyroidism are correlated with postoperative hypocalcemia and mortality. The aim of this study was to identify the predictors of preoperative ALP in patients with secondary hyperparathyroidism. From April 2012 to December 2015, 220 patients with refractory secondary hyperparathyroidism undergoing total parathyroidectomy without autotransplantation were reviewed. A total of 164 patients presented with elevated preoperative ALP. Univariate analysis showed that patients with elevated ALP were significantly younger. The elevated ALP group had significantly higher levels of preoperative parathyroid hormone (PTH), lower preoperative serum calcium, higher preoperative phosphorus, lower postoperative hypocalcemia, and a longer hospital stay. Logistic regression analysis showed that elevated preoperative PTH was a significant independent risk factor for elevated preoperative ALP (P = 0.000), and its value of 1624 pg/mL was the optimal cutoff point. Factors predictive of elevated preoperative ALP in patients with secondary hyperparathyroidism include preoperative PTH. Earlier surgery, aggressive calcium supplementation, and more careful or aggressive postoperative care for high-risk patients are needed.

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