scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Postsurgical hypoparathyroidism: current treatments and future prospects for parathyroid allotransplantation

2021 ◽  
Vol 184 (5) ◽  
pp. R165-R175
Author(s):  
Radu Mihai ◽  
Rajesh V Thakker
Keyword(s):  
Thyroid Surgery ◽  
Case Reports ◽  
Prospective Trial ◽  
Significant Proportion ◽  
Parathyroid Tissue ◽  
Major Complication ◽  
Neck Surgery ◽  
Parathyroid Cell ◽  
Healthcare Provision ◽  
Complex Needs

Background Permanent postsurgical hypoparathyroidism (POSH) is a major complication of anterior neck surgery in general and of thyroid surgery in particular. Depending on diagnostic criteria, up to 10% of patients undergoing bilateral thyroid surgery develop POSH. This leads to a multitude of symptoms that decrease the quality of life and burden the healthcare provision through complex needs for medication and treatment of specific complications, such as seizures and laryngospasm. Methods Narrative review of current medical treatments for POSH and of the experience accumulated with parathyroid allotransplantation. Results In most patients, POSH is controlled with regular use of calcium supplements and active vitamin D analogues but a significant proportion of patients continue to experience severe symptoms requiring repeated emergency admissions. Replacement therapy with synthetic PTH compounds (PTH1-34, Natpara® and PTH1-84, teriparatide, Forsteo®) has been assessed in multicentre trials, but the use of this medication is restricted by costs and concerns related to the risk of development of osteosarcoma. Based on recent case reports of successful allotransplantation of parathyroid tissue between siblings, there is renewed interest in this technique. Data on selection of donors, parathyroid cell preparation before allotransplantation, site and timing of transplantation, need for immunosuppression and long-term outcomes are reviewed. Conclusion A prospective trial to assess the efficacy of parathyroid allotransplantation in patients with severely symptomatic protracted post-surgical hypoparathyroidism is warranted.

scholarly journals Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
S. Helme ◽  
A. Lulsegged ◽  
P. Sinha
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Parathyroid Tissue ◽  
Neck Surgery ◽  
Safe Procedure ◽  
Preclinical Phase ◽  
Abnormal Parathyroid Gland ◽  
Parathyroid Disease ◽  
History Of

Aim. Despite an incidence of parathyroid “incidentalomas” of 0.2%–4.5%, only approximately 135 cases have been reported in the literature. We present eight patients in whom an incidental abnormal parathyroid gland was found during routine thyroid surgery. We have reviewed the literature and postulate whether these glands could represent further evidence of a preclinical stage of primary hyperparathyroidism. Methods. A retrospective analysis of all 236 thyroid operations performed by a single surgeon was performed to identify patients in whom abnormal parathyroid tissue was removed at surgery. Results. 8/236 patients (3.39%) had a single macroscopically abnormal parathyroid gland removed and sent for analysis. Seven patients were found to have histological evidence of a parathyroid adenoma or hyperplasia. None of the patients had abnormal serum calcium detected preoperatively. Postoperatively, four patients had normal calcium, three had temporary hypocalcaemia and one refused followup. No patients had recurrent laryngeal nerve impairment. Conclusions. Despite the risk of removing a histologically normal gland, we believe that when parathyroid “incidentalomas” are found during surgery they should be excised and sent for histological analysis. We have found this to be a safe procedure with minimal morbidity to the patient. As the natural history of primary hyperparathyroidism is better understood, these glands found in normocalcaemic patients may in fact represent the early or preclinical phase of the disease. By removing them at the original operation, the patient is saved redo neck surgery with its high complication rate as or when clinically apparent primary hyperparthryoidism develops in the future.

Does Rapid Intraoperative Parathyroid Hormone Analysis Predict Cure in Patients Undergoing Surgery for Primary Hyperparathyroidism?

2006 ◽  
Vol 95 (1) ◽  
pp. 28-32 ◽  
Author(s):  
F. S. Nilsen ◽  
E. Haug ◽  
M. Heidemann ◽  
S. J. Karlsen
Keyword(s):  
Parathyroid Hormone ◽  
False Negative ◽  
Parathyroid Tissue ◽  
Neck Surgery ◽  
Anatomical Location ◽  
Negative Results ◽  
Sestamibi Scintigraphy ◽  
False Negative Results ◽  
Intraoperative Pth ◽  
Intraoperative Parathyroid Hormone

Background and Aims: Preoperative 99mTc-sestamibi scintigraphy is used by many surgeons to identify the anatomical location of pathological parathyroid glands in patients undergoing surgical treatment for hyperparathyroidism. However, false negative results do occur. It has been suggested that intraoperative parathyroid hormone (PTH) analysis may enhance the possibility of performing successful focused, unilateral neck surgery in these patients. This study aimed to evaluate whether an adequate fall in intraoperative parathyroid hormone values predicts the removal of all hyperfunctioning parathyroid tissue and postoperative normocalcemia. Material and Methods: One hundred consecutive patients undergoing surgery for hyperparathyroidism had preoperative 99mTc-sestamibi scintigraphy and intraoperative parathyroid hormone (PTH) analysis. A fall in intraoperative PTH value by more than 50% of baseline value ended the procedure. This prospective study presents the clinical and biochemical results. Results: The overall sensitivity of the 99mTc-sestamib scintigraphy was 88% and for single adenomas 95%. The scintigraphy failed to detect the correct pathology in all cases with multiglandular disease (7 patients). A fall in intraoperative PTH value by more than 50% of baseline value was achieved in all patients. The combination of intraoperative PTH analysis and 99mTc-sestamibi scintigraphy enabled us to limit the operation to a focused, unilateral operation in 87 of the 100 patients. All patients were normocalcemic postoperatively. Conclusions: A fall in intraoperative PTH value more than 50 % of baseline value seems to predict postoperative normocalcemia and the removal of all hyperfunctioning parathyroid tissue. Bilateral neck exploration is avoided in the majority of patients.

Calcium-activated proteases in the bovine parathyroid gland: potential role in degradation of parathyroid hormone to peptide fragments

1995 ◽  
Vol 15 (1) ◽  
pp. 61-71 ◽  
Author(s):  
P H Watson ◽  
S T Mortimer ◽  
K K W Wang ◽  
D E Croall ◽  
D A Hanley
Keyword(s):  
Parathyroid Hormone ◽  
Parathyroid Tissue ◽  
Area Under The Curve ◽  
Molar Ratio ◽  
Cell Protein ◽  
Parathyroid Cell ◽  
Peptide Fragments ◽  
Intracellular Degradation ◽  
Peak Areas

ABSTRACT Our studies suggest that protein kinase C is involved in low calcium (Ca2+)-stimulated secretion of parathyroid hormone (PTH) but not directly in high Ca2+-stimulated intracellular degradation of PTH to secreted carboxyl-terminal fragments (C-PTH), an important component of Ca2+-regulated PTH secretion. The present study was undertaken to determine the presence of calciumactivated proteases, 84 kDa (micro)-calpain and 80 kDa (milli)-calpain, in the bovine parathyroid, and whether they could degrade PTH to C-terminal fragments. Immunocytochemistry of bovine parathyroid tissue using antibodies raised against bovine heart micro- and milli-calpain detected both isoforms of calpain. Western blotting of total bovine parathyroid cell protein prepared from primary cell cultures confirmed the presence of both isoforms of calpain, demonstrated by specific milli- and micro-calpain bands. Purified bovine PTH (bPTH) was incubated in vitro with human erythrocyte micro-calpain and the cleavage products were separated by reverse-phase HPLC. Eluant fractions were assayed with an RIA with equimolar sensitivity to C-PTH and bPTH, and peak areas integrated. Micro-calpain produced a C-PTH peak from bPTH which co-eluted with the major C-PTH secreted by parathyroid cells in culture. C-PTH production by micro-calpain, expressed as per cent area under the curve, increased from 0% in the absence of either micro-calpain or Ca2+, to 71·5% when a 5:1 molar ratio of bPTH to calpain was used. Amino acid sequencing and analysis of the immunoreactive PTH cleavage products indicated the presence of two fragments of bPTH in the C-PTH peak, bPTH47–84 and bPTH69–84. In summary, both isoforms of calpain are present in the bovine parathyroid and calpains may play a role in the Ca2+-dependent degradation of PTH to secreted C-terminal fragments.

scholarly journals Tracheoesophageal groove: a reliable landmark

2019 ◽  
Vol 5 (3) ◽  
pp. 545
Author(s):  
Nitika Gupta ◽  
Rohan Gupta ◽  
Inderpal Singh ◽  
Sunil Kotwal
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Head And Neck ◽  
Thyroid Surgery ◽  
Neck Surgery ◽  
Laryngeal Nerve ◽  
Posterior Half ◽  
Vocal Cords ◽  
Important Landmark ◽  
Tracheoesophageal Groove ◽  
The Brain

<p class="abstract"><strong>Background:</strong> Galen first described the recurrent laryngeal nerve (RLN) as a nerve that descended from the brain to the heart, then reversed the course and ascended to the larynx and caused the vocal cords to move. Tracheoesophageal groove is useful for identifying the RLN. In the present study we studied the course of RLN in tracheoesophageal groove and its anatomical position, in patients undergoing thyroid surgery.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in the Department of ENT and Head and Neck Surgery, SMGS Hospital, for a period of two years, on the patients who underwent thyroid surgeries. Tracheoesophageal groove was considered first landmark to identify RLN position and only after meticulous dissection in the groove, the nerve could be identified. The nerve was carefully dissected and its position evaluated in relation with trachea and esophagus.  </p><p class="abstract"><strong>Results:</strong> Trajectory of the nerves studied in the patients was mostly in the tracheoesophageal groove (TEG), seen in 113 (69.75%) nerves. 16.05% of the nerves were seen in the posterior half of the trachea while 4.94% of the nerves were seen to travel from TEG to anterior half of trachea and 1.85% from TEG to posterior half of trachea. 6.17% of nerves travelled from oesophagus to the TEG.</p><p class="abstract"><strong>Conclusions:</strong> A uniform dissection procedure should be followed and the recurrent laryngeal nerve must be first looked for in the TEG, which serves as important landmark and later any deviation must be considered.</p><p class="abstract"> </p>

Hematoma after Head and Neck Surgery—A Major Complication?

1978 ◽  
Vol 86 (2) ◽  
pp. ORL-171-ORL-175 ◽  
Author(s):  
Jonas T. Johnson ◽  
Charles W. Cummings
Keyword(s):  
Head And Neck ◽  
Major Complication ◽  
Wound Dehiscence ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Major Infection ◽  
Hematoma Formation ◽  
Postoperative Hematoma ◽  
Clot Evacuation

The role of hematoma formation in the development of complications after major head and neck surgery is surveyed retrospectively. An incidence of 4.2% was encountered. In all cases, the hematoma was identified within 12 hours postoperatively. Prompt surgical clot evacuation and reinstitution of drainage did not adversely affect the patient's subsequent course. Failure to adequately drain the hematoma resulted in increased wound dehiscence, major infection, and fistula. When properly treated, postoperative hematoma formation offers only the risks attendant with a second anesthesia; no subsequent related morbidity need be anticipated.

scholarly journals Thrombotic Thrombocytopenic Purpura Following Honeybee Envenomation: A Case Report

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Zahra Khalighi ◽  
Golnaz Azami ◽  
Elham Shafiei ◽  
Ali Sahebi ◽  
Aliashraf Mozafari
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Case Reports ◽  
Major Complication ◽  
The Body ◽  
Severe Thrombocytopenia ◽  
Thrombocytopenic Purpura ◽  
Toxic Reaction ◽  
Bee Sting ◽  
Life Threatening ◽  
Underlying Diseases

Background: Thrombotic Thrombocytopenic Purpura (TTP) is a rare and life-threatening disorder characterized by severe thrombocytopenia, microangiopathic hemolytic anemia, fever, renal dysfunction, and neurological deficient. TTP leads to the formation of blood clots in small blood vessels throughout the body. TTP is associated with many risk factors such as pregnancy, HIV, cancer, lupus, and infections. Recently there have been few published case reports of bee sting associated TTP.Methods: A 67-year-old man from a rural area of the Southwest Province of Iran, Ilam, was referred to the academic general hospital because of fever, chills, sweating, vomiting and dizziness following the honeybee sting on his body. Results: this study showed that,multiple co-morbidities including CVD and diabetes, along with coagulation abnormalities after honeybee stings, seriously exacerbated patient hemodynamic status.Conclusion: TTP, as a major complication due to the toxic reaction of a large number of bee stings with underlying diseases in patients, should be given more attention.

scholarly journals Adverse Events of Acupuncture: A Systematic Review of Case Reports

2013 ◽  
Vol 2013 ◽  
pp. 1-15 ◽  
Author(s):  
Shifen Xu ◽  
Lizhen Wang ◽  
Emily Cooper ◽  
Ming Zhang ◽  
Eric Manheimer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Safety Assessment ◽  
English Language ◽  
Case Reports ◽  
Major Complication ◽  
The West ◽  
Source Of Infection ◽  
Skin Contact ◽  
Needle Technique ◽  
Main Complication

Acupuncture, moxibustion, and cupping, important in traditional Eastern medicine, are increasingly used in the West. Their widening acceptance demands continual safety assessment. This review, a sequel to one our team published 10 years ago, is an evaluation of the frequency and severity of adverse events (AEs) reported for acupuncture, moxibustion, and cupping between 2000 and 2011. Relevant English-language reports in six databases were identified and assessed by two reviewers. During this 12-year period, 117 reports of 308 AEs from 25 countries and regions were associated with acupuncture (294 cases), moxibustion (4 cases), or cupping (10 cases). Country of occurrence, patient’s sex and age, and outcome were extracted. Infections, mycobacterial, staphylococcal, and others, were the main complication of acupuncture. In the previous review, we found the main source of infection to be hepatitis, caused by reusable needles. In this review, we found the majority of infections to be bacterial, caused by skin contact at acupoint sites; we found no cases of hepatitis. Although the route of infection had changed, infections were still the major complication of acupuncture. Clearly, guidelines such as Clean Needle Technique must be followed in order to minimize acupuncture AEs.

Severe Agoraphobia: A Controlled Prospective Trial of Behaviour Therapy

1966 ◽  
Vol 112 (484) ◽  
pp. 309-319 ◽  
Author(s):  
M. G. Gelder ◽  
I. M. Marks
Keyword(s):  
Effective Treatment ◽  
Single Case ◽  
Case Reports ◽  
Prospective Trial ◽  
Antidepressant Drugs ◽  
Behaviour Therapy ◽  
Acetyl Choline ◽  
Small Series ◽  
Intensive Psychotherapy ◽  
Retrospective Investigation

Severe agoraphobia is difficult to treat. Encouraging immediate results have been reported with diverse treatments, including intensive psychotherapy (Friedman, 1959), acetyl choline injections (Sim, 1964), antidepressant drugs (King, 1962) and more recently with behaviour therapy (Wolpe, 1958). It is this latter claim which this paper examines. Early reports (e.g. Meyer, 1957; Wolpe, 1958) suggested that behaviour therapy might prove to be a rapid and effective treatment, but a small series studied by Meyer and Gelder (1963) demonstrated that results were not always as effective as single case reports suggested, and showed clearly that the treatment was often lengthy, taking 80 hours on the average. A retrospective investigation of a larger series (Marks and Gelder, 1965; Cooper, Gelder and Marks, 1965) again failed to support the early claims, although it was shown that behaviour therapy is an effective treatment for circumscribed phobias such as fears of animals and insects.

scholarly journals Vertical Transmission of SARS-CoV-2: A Systematic Review of Systematic Reviews

Viruses ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 1877
Author(s):  
Salihu S. Musa ◽  
Umar M. Bello ◽  
Shi Zhao ◽  
Zainab U. Abdullahi ◽  
Muhammad A. Lawan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vertical Transmission ◽  
Systematic Reviews ◽  
Case Reports ◽  
Mode Of Delivery ◽  
Significant Proportion ◽  
Neonatal Outcomes ◽  
Global Public Health ◽  
Case Control Studies ◽  
Mother To Child

The COVID-19 pandemic has hugely impacted global public health and economy. The COVID-19 has also shown potential impacts on maternal perinatal and neonatal outcomes. This systematic review aimed to summarize the evidence from existing systematic reviews about the effects of SARS-CoV-2 infections on maternal perinatal and neonatal outcomes. We searched PubMed, MEDLINE, Embase, and Web of Science in accordance with PRISMA guidelines, from 1 December 2019 to 7 July 2021, for published review studies that included case reports, primary studies, clinical practice guidelines, overviews, case-control studies, and observational studies. Systematic reviews that reported the plausibility of mother-to-child transmission of COVID-19 (also known as vertical transmission), maternal perinatal and neonatal outcomes, and review studies that addressed the effect of SARS-CoV-2 infection during pregnancy were also included. We identified 947 citations, of which 69 studies were included for further analysis. Most (>70%) of the mother-to-child infection was likely due to environmental exposure, although a significant proportion (about 20%) was attributable to potential vertical transmission of SARS-CoV-2. Further results of the review indicated that the mode of delivery of pregnant women infected with SARS-CoV-2 could not increase or decrease the risk of infection for the newborns (outcomes), thereby emphasizing the significance of breastfeeding. The issue of maternal perinatal and neonatal outcomes with SARS-CoV-2 infection continues to worsen during the ongoing COVID-19 pandemic, increasing maternal and neonatal mortality, stillbirth, ruptured ectopic pregnancies, and maternal depression. Based on this study, we observed increasing rates of cesarean delivery from mothers with SARS-CoV-2 infection. We also found that SARS-CoV-2 could be potentially transmitted vertically during the gestation period. However, more data are needed to further investigate and follow-up, especially with reports of newborns infected with SARS-CoV-2, in order to examine a possible long-term adverse effect.

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