Application of carbon nanoparticles in localization of parathyroid glands during total parathyroidectomy for secondary hyperparathyroidism

2020 ◽  
Vol 220 (6) ◽  
pp. 1586-1591 ◽  
Author(s):  
Wei Li ◽  
Bingyang Liu ◽  
Chengxiang Shan ◽  
Zhiyong Liu ◽  
Qiang Wang ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Carbon Nanoparticles ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy

scholarly journals SURGICAL ANATOMY OF PARATHYROID GLANDS IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

2015 ◽  
Vol 7 (3) ◽  
pp. 23-28 ◽  
Author(s):  
K Yu Novokshonov ◽  
Y N Fedotov ◽  
V Y Karelin ◽  
T S Pridvizhkin ◽  
R A Chernikov ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Surgical Anatomy ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Thyroid Lobe ◽  
Subtotal Parathyroidectomy ◽  
Carotid Sheath ◽  
Treat Ment ◽  
Gland Tissue ◽  
Surgical Failure

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.

scholarly journals Surgical Treatment of Secondary Hyperparathyroidism at Ectopic Parathyroid Gland in Anterior-Superior Mediastinum (Literature Review and Clinical Case)

2020 ◽  
Vol 5 (4) ◽  
pp. 84-89
Author(s):  
E. A. Ilyicheva ◽  
D. A. Bulgatov ◽  
A. V. Zharkaya ◽  
V. N. Makhutov ◽  
E. G. Grigoryev
Keyword(s):  
Chronic Kidney Disease ◽  
Surgical Treatment ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Clinical Case ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Special Equipment ◽  
Superior Mediastinum

Parathyroidectomy is the leading treatment for drug-refractory secondary and tertiary hyperparathyroidism in patients with chronic kidney disease. Difficulties in performing this surgery are mainly associated with the anatomical features of the parathyroid glands, in particular with the variability of their number and topographic anatomy. Ectopic parathyroid glands are one of the most common causes of persistence or recurrence of secondary hyperparathyroidism after surgery. One of the common variants of ectopia is the localization of the parathyroid gland in the anterior-superior mediastinum. The article discusses the features of surgical treatment of secondary hyperparathyroidism in patients with end-stage chronic kidney disease with this ectopia. A new method of treating hyperparathyroidism in patients with an atypical location of the parathyroid gland in the anterior-superior mediastinum is presented. This method is characterized by low invasiveness of access, ease of implementation without using special equipment and instruments. The proposed method was used in the treatment of a patient with secondary hyperparathyroidism due to chronic renal failure as a result of chronic glomerulonephritis. The duration of hemodialysis at the time of the surgery was more than 17 years. In the presented clinical case, ectopia of one of the pathologically altered parathyroid glands in the anterior-superior mediastinum was found at the preoperative stage. As a method of surgical treatment, we carried out total parathyroidectomy with autotransplantation of a fragment of parathyroid tissue into the brachioradialis muscle. Thanks to this method, it was possible to remove the atypically located parathyroid gland from the cervicotomy access and to discharge the patient within the standard terms for a given volume of surgery.

scholarly journals Surgical treatment of patients with secondary hyperparathyroidism in chronic renal failure

2003 ◽  
Vol 49 (6) ◽  
pp. 36-41
Author(s):  
V. N. Smorshchok ◽  
N. S. Kuznetsov ◽  
A. M. Artemova ◽  
L. Ya. Rozhinskaya ◽  
D. G. Beltsevich
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Secondary Hyperparathyroidism ◽  
Clinical Laboratory ◽  
Intraoperative Ultrasound ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Subtotal Parathyroidectomy ◽  
Ultrasound Study ◽  
Made In

The purpose of the study was to define indications for surgical treatment and its scope in patients with secondary hyperparathyroidism in the presence of end-stage chronic renalfailure. The authors examined 80 patients who had a history of long-term procedures of hemo- or peritoneal dialysis. The patients’ mean age was 47±3.2 years. Measurements of the levels of alkaline phosphatase, ionized and total calcium, phosphorus, parathyroid hormone, ultrasound of the parathyroid glands, densitometry and X-ray study were made in all the patients. All the patients received alfacalcidole therapy during different periods of time. Clinical, laboratory, and morphological correlations were made to establish indications for surgical treatment. The sensitivity ofpreoperative ultrasonography was 72.5% and that of intraoperative ultrasound study was as high as 98.4%. The sensitivity of intraoperative revision was 75%. Sixteen of the 20 patients operated on underwent total parathyroidectomy by autografting a fragment of one of the least glands into the muscle. Subtotal parathyroidectomy was made in 3 patients; 3 parathyroid glands were removed in 1. Emergency and planned studies were performed in all the patients. The duration of the patients operated on averaged 14 months. Three patients undergone total parathyroidectomy with autografiing developed signs of hyperparathyroidism following 6, 12, and 13 months, in this connection graft resection was made in these patients. In the follow-up periods of 3 to 6 months, the level of parathyroid hormone became normal after resurgery in 2 of these patients, hypoparathyroidism developed in one patient. Two months after surgery, recurrent secondary hyperthyroidism was detected in 2 of the 3 patients who had undergone subtotal parathyroidectomy (4 and 7 months after the occurrence of signs of transient hypoparathyroidism) and in 1 patient in whom 3 parathyroid glands had been removed. Four of the 20 patients operated on were observed to have hypoparathyroidism that was compensated by calcium preparations and active forms of vitamin D3. Thus, a good result was noted in 70% of the patients after surgical treatment.

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

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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