P1428PERSISTENT HUNGRY BONE SYNDROME AND HYPOPARATHYROIDISM AFTER PARATHYROIDECTOMY FOR SECONDARY HYPERPARATHYROIDISM: ARE THERE RISK FACTORS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ekaterina Parshina ◽  
Aleksei Zulkarnaev ◽  
Konstantin Novokshonov ◽  
Pavel Kislyy ◽  
Alexey Tolkach ◽  
...  
Keyword(s):  
Risk Factors ◽  
Secondary Hyperparathyroidism ◽  
Ipth Level ◽  
Hungry Bone Syndrome ◽  
Postoperative Hypoparathyroidism ◽  
Dialysis Vintage ◽  
Significant Difference ◽  
Hungry Bone ◽  
Type Of Surgery

Abstract Background and Aims Hungry bone syndrome (HBS) and postoperative hypoparathyroidism both are important postoperative complications after parathyroidectomy (PTx) for severe secondary hyperparathyroidism (SHPT). There is still a lack of data in the literature concerning associated risk factors of the prolonged HBS and hypoparathyroidism after PTx. We aimed to explore the risk factors for HBS and postoperative persistent hypoparathyroidism development in a long-term period after surgery. Method We performed a retrospective analysis of 55 severe SHPT patients who underwent subtotal PTx or total PTx+AT in our clinic between 2011 and 2015 with follow-up period not less than 12 months. A general cohort was divided into subgroups according to their laboratory parameters in a year after PTx. Prolonged HBS was defined as a total serum calcium concentration less than 2,1 mmol/l after 1 year from surgery. Postoperative hypoparathyroidism was defined as a iPTH value less than 10 pg/mL after one year from surgery. Results In terms of prolonged HBS persistence a general cohort of 55 patients was divided into two subgroups: a HBS group of 27 patients (49,1%) with mean age of 45,6 ± 9,02 years and a non-HBS group of 49,6 patients (50,9%) with mean age of 45,6 ± 10,8 years. Mean dialysis vintage for HBS and non-HBS groups was 107,8 ± 52,4 and 97,4± 54,5 months, respectively. The PTH level dropped significantly in both groups on the 1st day after surgery when compared with preoperative values: from 134 [92,7-186] to 5,0 [2,1–17,7] pmol/l in non-HBS group (p<0,001) and from 126 [101-223] to 4,1 [1,5-14,5] pmol/l in HBS group (p<0,001). The immediate ionized calcium levels also decreased significantly in both groups: from 1,26 [1,2-1,3] to 0,89 [0,79-1,09] in non-HBS group (p<0,001), and from 1,2 [1,11-1,29] to 0,88 [0,8-1,0] in HBS group (p<0,001). In univariate analysis the postoperative iPTH showed no significant difference between the HBS and non-HBS groups (p= 0,614) as well as ionized Ca level (p= 0,5653), difference of PTH before/after surgery (ΔPTH) (p= 0,9133), age (p= 0,2575) and dialysis vintage (p= 0,6165). Neither gender (RR 0,75 [0,44; 1,277]; p = 0.4088), nor type of surgery (RR 0,81 [0,45; 1,456]; p = 0.5815) were associated with the long-term HBS persistence. For 51 patients data of iPTH level in a 1 year after PTx were available; 21 patients (41,2 %) were included in the postoperative persistent hypoparathyroidism-positive group (hypoPT-positive), and 30 patients (58,8%) were included in the postoperative persistent hypoparathroidism-negative (hypoPT-negative) group. In both hypoPT-positive and hypoPT-negative groups postoperative iPTH levels were decreased after surgery with significant difference being compared between groups (1,0 [0,8-2,5] vs 12,6 [3,7-17,7] pmol/l, respectively; p= 0,0001). We observed a moderate positive correlation between iPTH levels on the 1st postoperative day and in a 1 year after PTx (ρ=0,548 [95% CI 0,314; 0,72]; p<0,0001). Type of surgery was not associated with increased risk of prolonged hypoparathyroidism (RR=1.03 [0,569; 1,866]; p=0.922). Conclusion Prolonged persistence of HBS and postoperative hypoparathyroidism are common after PTx in patients with SHPT regardless the type of surgery. Neither laboratory (postoperative iPTH, ΔPTH, ionized Ca), nor demographic (gender, age, dialysis vintage) factors were not associated with HBS persistence in a long-term period after PTx. Only serum iPTH level on the 1st day after PTx is associated with prolonged hypoparathyroidism after surgery.

scholarly journals Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism

Renal Failure ◽  
2020 ◽  
Vol 42 (1) ◽  
pp. 1118-1126
Author(s):  
Kittrawee Kritmetapak ◽  
Sawinee Kongpetch ◽  
Wijittra Chotmongkol ◽  
Yutapong Raruenrom ◽  
Sakkarn Sangkhamanon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Secondary Hyperparathyroidism ◽  
Hungry Bone Syndrome ◽  
Hungry Bone

Hungry bone syndrome: biochemical and clinical risk factors

2019 ◽  
Vol 55 (1) ◽  
pp. 43-48
Author(s):  
Ewa Kozłowska ◽  
Olga Ciepiela
Keyword(s):  
Risk Factors ◽  
Term Therapy ◽  
Large Tumor ◽  
Efficient Treatment ◽  
Tumor Mass ◽  
Hungry Bone Syndrome ◽  
Efficient Control ◽  
Long Term Therapy ◽  
Hungry Bone

Primary hyperparathyroidismremains the first cause of hypercalcaemia. Parathyroid surgery is the most efficient treatment of primary hyperparathyroidism, however surgery entails risk of development of a Hungry Bone Syndrome (HBS) – rapid, profound, and prolonged hypocalcaemia. The risk factors of HBS are significantly elevated calcium and PTH concentration in plasma, large tumor mass, previously diagnosed osteoporosis and age over 61 years old before surgery. Pre-surgery supplementation of vitamin D3 and long-term therapy with bisphosphonate allows for more efficient control of hypocalcemia and bone metabolism after surgery.

Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: risk factors, prognosis, and literature review

2020 ◽  
Vol 133 (5) ◽  
pp. 1450-1459
Author(s):  
Yu Chen ◽  
Li Ma ◽  
Junlin Lu ◽  
Xiaolin Chen ◽  
Xun Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Phase ◽  
Moyamoya Disease ◽  
Disease Risk ◽  
Propensity Score Analysis ◽  
Postoperative Hemorrhage ◽  
Posterior Circulation ◽  
Short Term ◽  
Significant Difference

OBJECTIVEPostoperative hemorrhage during the acute phase is rarely observed after revascularization surgery for moyamoya disease (MMD) but can have severe complications. Its risk factors and outcomes are still unclear. The aim of this study was to investigate the predictors of postoperative hemorrhage during the acute phase in MMD and examine the outcomes of the hemorrhage.METHODSThe authors reviewed the preoperative clinical characteristics and radiographic features of 465 consecutive MMD cases (518 procedures) that had undergone direct or combined bypass surgery at their institution between 2009 and 2015. Patients with postoperative intracerebral hemorrhage (ICH) or ICH plus intraventricular hemorrhage (IVH) during the acute phase were screened, and then the incidence, location, and risk factors of hemorrhage in these patients were analyzed. Short-term and long-term outcomes (modified Rankin Scale scores) for these patients were also collected. Outcomes were compared between patients with and those without postoperative ICH using propensity score analysis to reduce the between-group differences in baseline characteristics.RESULTSPostoperative hemorrhage occurred in 11 (2.1%; ICH = 9, IVH = 2) of 518 procedures (mean patient age 39.82 ± 8.8 years). Hemorrhage occurred in the first 24 hours after the operation in 8 cases (72.7%). In the ICH group, most of the hemorrhage sites (77.8%) were located beneath the anastomosed area, and the mean hematoma volume was 16.98 ± 22.45 ml (range 3–57 ml). One case from the ICH group required hematoma evacuation. Among the adult patients (463 procedures [89.4%]), preoperative hypertension (p = 0.008), CT perfusion (CTP) stage > III (p = 0.013), and posterior circulation involvement (p = 0.022) were significantly associated with postoperative ICH. No significant differences between the postoperative ICH group and the no-hemorrhage group were detected in terms of postoperative neurofunctional status at discharge (p = 0.569) or at the last follow-up (p = 1.000). Neither was there a significant difference in future stroke risk (p = 0.538) between these two groups.CONCLUSIONSPreoperative hypertension, CTP stage > III, and posterior circulation involvement are independent risk factors for postoperative ICH after direct or combined revascularization for MMD. After appropriate perioperative management, postoperative ICH has no significant correlations with the postoperative short-term and long-term neurofunctional status.

Sepsis associated new onset atrial fibrillation; risk factors and long term outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Moosavi ◽  
M Paymard ◽  
R Ebrahimi ◽  
T Harvey ◽  
N Parkes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Major Bleeding ◽  
Rate Control ◽  
Statistical Significance ◽  
Significant Difference ◽  
All Cause Mortality ◽  
New Onset

Abstract Background Atrial fibrillation (AF) is commonly encountered in the setting of systemic inflammation or infection. The optimal management of AF in this cohort and their long-term AF-related clinical outcome are unknown. Purpose The aims of our study were to evaluate the traditional and non-traditional AF risk factors and long-term AF-related clinical outcomes in patients who were diagnosed with new onset AF in the setting of sepsis. Methods In this retrospective cohort study, we used the medical records to identify patients who were diagnosed with the new onset AF during hospitalization for sepsis at our centre between 2013 and 2017. The primary clinical outcomes included 24-month risk of ischaemic stroke, major bleeding (gastrointestinal or intracranial bleeding), the recurrence of AF and the all-cause mortality. The patients with known AF or those who died during the index admission were excluded from the analysis. Results 5598 patients were admitted to our hospital between 2013 and 2017 with sepsis. Of this cohort, 126 patients (mean age 69.7 years, 62.7% male) developed new onset AF during the index hospital admission (72.2% required ICU admission). 38 patients (30.1%) died during the initial hospitalisation while 88 patients (69.9%) were discharged from hospital (32% anticoagulated). 14 patients (16%) died within 24 months. Hypertension (59%), CKD (30%), diabetes (21%), and CCF (17%) were the most common risk factors. Mean CHA2DS2VASC score was 2.56±1.4 and mean HAS BLED score was 2.5±1.3. Mean CRP and WCC were 228±119 and 12.3±9.1 respectively. Comparing risk factors, only HASBLED score showed statistical significance on 24 months mortality (p=0.036, 95% CI 0.43–1.52). The composite incidence of all-cause mortality and ischaemic stroke was three times lower in anticoagulated patients compared with those who did not receive anticoagulation even though this did not reach statistical significance (7.1% v 21.6% respectively, p=0.07; RR=0.32; 95% CI=0.79–1.36). There was no statistically significant difference between the two groups for major bleeding events (3.5% v 3.3% respectively, p=0.68; RR=1.07; 95% CI=0.10–11.3). Rhythm and rate control therapies showed no significant difference on the composite outcome of all-cause mortality, ischaemic stroke and recurrence of AF (28.0% v 28.9%, p=0.92; RR=0.96, 95% CI=0.49–1.88), however, there was a trend towards less recurrence of AF in patients who received rate or rhythm control therapies (12% vs 18% respectively p=0.44; RR=0.67; 95% CI=0.24–1.85). Conclusions Our study suggests that anticoagulation therapy in patients with sepsis associated new onset AF may decrease composite of all-cause mortality and ischaemic stroke without increasing major bleeding risk. Rhythm and rate control strategies did not decrease all-cause mortality, ischaemic stroke or risk of recurrence of AF. These findings can provide benchmarks for design of randomized control trials. Funding Acknowledgement Type of funding source: None

Development of hungry bone syndrome after rapid lowering of PTH with intravenous maxacalcitol therapy in a patient with non-uremic secondary hyperparathyroidism

2003 ◽  
Vol 60 (11) ◽  
pp. 369-371 ◽  
Author(s):  
J.J. Kazama ◽  
K. Suzuki ◽  
A. Yokoseki ◽  
A. Oyanagi ◽  
S. Goto ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Hungry Bone Syndrome ◽  
Hungry Bone

Long Term Follow-Up of Pediatric Sickle Cell Disease Patients with Conditional Velocities on Transcranial Doppler (TCD).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2338-2338
Author(s):  
Lena Coïc ◽  
Suzanne Verlhac ◽  
Emmanuelle Lesprit ◽  
Emmanuelle Fleurence ◽  
Francoise Bernaudin
Keyword(s):  
Risk Factors ◽  
Color Doppler ◽  
Significant Risk ◽  
Biological Data ◽  
Treatment Intensification ◽  
Significant Difference ◽  
History Of ◽  
The Mean

Abstract Abnormal TCD defined as high mean maximum velocities > 200 cm/sec are highly predictive of stroke risk and justify long term transfusion program. Outcome and risk factors of conditional TCD defined as velocities 170–200 cm/sec remains to be described. Patients and methods Since 1992, 371 pediatric SCD patients (303 SS, 44 SC, 18 Sß+, 6 Sß0) were systematically explored once a year by TCD. The newborn screened cohort (n=174) had the first TCD exploration between 12 and 18 months of age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. Biological data were assessed at baseline, after the age of 1.5 years and remotely of transfusion or VOC. We report the characteristics and the outcome in patients (n=43) with an history of conditional TCD defined by mean maximum velocities ranging between 170 and 200 cm/s in the ACM, the ACA or the ICA. Results: The mean follow-up of TCD monitoring was 5,5 years (0 – 11,8 y). All patients with an history of conditional doppler were SS/Sb0 (n=43). Mean (SD) age of patients at the time of their first conditional TCD was 4.3 years (2.2) whereas in our series the mean age at abnormal TCD (> 200 cm/sec) occurrence was 6.6 years (3.2). Comparison of basal parameters showed highly significant differences between patients with conditional TCD and those with normal TCD: Hb 7g4 vs 8g5 (p<0.001), MCV 82.8 vs 79 (p=0.047). We also had found such differences between patients with normal and those with abnormal TCD (Hb and MCV p< 0.001). Two patients were lost of follow-up. Two patients died during a trip to Africa. Conditional TCD became abnormal in 11/43 patients and justified transfusion program. Mean (SD) conversion delay was 1.8 (2.0) years (range 0.5–7y). No stroke occurred. 16 patients required a treatment intensification for other indications (frequent VOC/ACS, splenic sequestrations): 6 were transplanted and 10 received HU or TP. Significant risk factors (Pearson) of conversion to abnormal were the age at time of conditional TCD occurrence < 3 y (p<0.001), baseline Hb < 7g/dl (p=0.02) and MCV > 80 (p=0.04). MRI/MRA was performed in 31/43 patients and showed ischemic lesions in 5 of them at the mean (SD) age of 7.1 y (1.8) (range 4.5–8.9): no significant difference was observed in the occurrence of lesions between the 2 groups. Conclusions This study confirms the importance of age as predictive factor of conditional to abnormal TCD conversion with a risk of 64% when first conditional TCD occured before the age of 3 years. TCD has to be frequently controled during the 5 first years of life.

scholarly journals Early identification of risk factors for refractory secondary hyperparathyroidism in patients with long-term renal replacement therapy

2004 ◽  
Vol 19 (5) ◽  
pp. 1168-1173 ◽  
Author(s):  
F. H. Jorna ◽  
T. J. M. Tobe ◽  
R. M. Huisman ◽  
P. E. de Jong ◽  
J. T. M. Plukker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Secondary Hyperparathyroidism ◽  
Replacement Therapy ◽  
Early Identification

Cardiotoxicity and related risk factors in long-term trastuzumab (T) administration for metastatic breast cancer (MBC): A retrospective analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11616-e11616
Author(s):  
Barbara Pistilli ◽  
Andrea Marcellusi ◽  
Michele Valeri ◽  
Umberto Torresi ◽  
Dania Nacciarriti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cardiac Disease ◽  
Cox Regression ◽  
Significant Risk ◽  
Concomitant Chemotherapy ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
History Of

e11616 Background: Continuing T beyond progression has become a common strategy in the treatment of human epidermal growth receptor 2- overexpressing (HER2) MBC. However, T administered for several years with concomitant chemotherapy elicits concern about cardiac safety especially in patients (pts) with risk factors. Methods: Cardiac events (CEs) and survival of HER2 MBC pts treated with T +/- chemotherapy at our institution from Dec 2003 to Jun 2012 were evaluated. CEs were graded by NCI-CTCAE v 3.0. Risk factors assessed for cardiotoxicity were: age, body mass index, antihypertensive therapy, history of cardiac disease, diabetes, hypothyroidism, smoking, prior radiotherapy on the chest wall, prior cumulative dose of anthracycline(A), interval between last A dose and first T dose, baseline LVEF, continued/interrupted T exposure, concomitant chemotherapy. Chi-square test was used to compare distribution of CEs over different times of T exposure (p≤ 0.05). Univariate and multivariate Cox regression analysis were used to assess the effect of risk predictors. Results: Sixty-two pts assessable. Median age 52 years (range, 29 to 76), median cumulative time receiving T 29.5 months (range, 3 to 99 months); 40 pts (64.5%) received T without interruption and 19 pts (30.6%) were treated for more than 36 months. CEs occurred in 11 out of all pts (17.7%): grade 1 in 3 pts (4.8%), grade 2 in 5 (8.1%) and grade 3 in 3 (4.8%). The rate of CEs showed no statistically significant difference in pts receiving T for up to 36 months and over: 7/43 (16.3%) and 4/19 (21%), respectively, (p =0.724). In univariate Cox regression analysis significant risk factors were: history of cardiac disease (HR 6,814, 95% CI: 1,384-33,542) and smoking (HR 5,228, 95% CI: 1,403-19,491). In multivariate analysis smoking was the only independent predictor (HR 5,886, 95% CI: 1,479-23,247). Median survival from MBC diagnosis was 50 months (range, 6 to 101 months). Conclusions: Despite the limited sample size, our analysis suggests that cardiotoxicity does not hamper a long-term use of T, since the rate of CEs did not increase in pts treated over 36 months. Moreover, smoking appears to be a predictive factor of T cardiotoxicity.

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