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.

scholarly journals Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Claudio Casella ◽  
Alessandro Galani ◽  
Luigi Totaro ◽  
Silvia Ministrini ◽  
Silvia Lai ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Parathyroid Tissue ◽  
Total Parathyroidectomy ◽  
Efficacy And Safety ◽  
Single Center ◽  
Medical Treatments ◽  
Anterior Compartment ◽  
Single Center Experience ◽  
Persistent Hyperparathyroidism ◽  
Group 2

Introduction. Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hypercalcemia. The aim of this study is to compare the efficacy and safety of total parathyroidectomy with subcutaneous forearm autotransplantation with total parathyroidectomy with intramuscular forearm autotransplantation. Materials and Methods. A single-center retrospective cohort study of total parathyroidectomy with forearm autotransplantation from January 2002 to February 2013 was performed. According to the surgical technique, patients were divided into an intramuscular group (Group 1) and a subcutaneous group (Group 2). 38 patients with secondary hyperparathyroidism were enrolled; 23 patients were subjected to total parathyroidectomy with parathyroid tissue replanting in the subcutaneous forearm of the upper nondominant limb, while 15 patients were subjected to replanting in the intramuscular seat. Results. A total of 38 patients (56 ± 13 years) were enrolled. In both groups, the preoperative iPTH value was markedly high, 1750 ± 619 pg/ml in the intramuscular autotransplantation group and 1527 ± 451 pg/ml in the subcutaneous autotransplantation group (p=0.079). Transient hypoparathyroidism was shown in 7 patients, and 1 patient showed persistent hypoparathyroidism (p=0.387). 2 patients showed persistent hyperparathyroidism (p=0.816), and in 2 others was found recurrent hyperparathyroidism (p=0.816); 3 of them underwent autograftectomy. The anterior compartment of the forearm nondominant limb was sacrificed in 1 case of intramuscular autotransplantation with functional arm deficit. Conclusions. The efficacy and safety of parathyroid tissue autotransplantation in the subcutaneous forearm of the upper nondominant limb is confirmed with a good rate of tissue engraftment and with a comparable number of postsurgical transient and persistent hypoparathyroidism and hyperparathyroidism incidence in both techniques. Furthermore, this technique preserves arm functionality in the case of autograftectomy. Consequently, it is our opinion that total parathyroidectomy with subcutaneous forearm autotransplantation is currently the best choice.

scholarly journals Total parathyroidectomy and autotransplantation of parathyroid tissue for secondary hyperparathyroidism

1988 ◽  
Vol 21 (1) ◽  
pp. 67-76
Author(s):  
Harumitsu Kumagai ◽  
Atsumi Harada ◽  
Hideki Hirakata ◽  
Takashi Inenaga ◽  
Kazumasa Simamatsu ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Parathyroid Tissue ◽  
Total Parathyroidectomy

scholarly journals Parathyroid carcinoma arising from auto-transplanted parathyroid tissue after Total Parathyroidectomy in chronic kidney disease patient: a case report

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ho-Ryun Won ◽  
Jae Yoon Kang ◽  
In Ho Lee ◽  
Jin-Man Kim ◽  
Jae Won Chang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Parathyroid Tissue ◽  
Adjuvant Radiation ◽  
Total Parathyroidectomy ◽  
Pharmacologic Treatment ◽  
Remarkable Case

Abstract Background Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease that requires vigilant treatment due to its high mortality rate. Pharmacologic therapy is recommended as an initial treatment; if there is no response, a total parathyroidectomy is performed. In some cases, surgery is accompanied by auto-transplantation of parathyroid tissue. Case presentation The patient was diagnosed with chronic kidney disease and received a kidney transplant. However, due to rejection of the transplanted kidney, medical nephrectomy was carried out and routine hemodialysis was initiated and observed. At this time, secondary hyperparathyroidism with elevated parathyroid hormone and hyperphosphatemia developed and pharmacologic treatment was applied. However, there was no response to pharmacologic treatment; therefore, total parathyroidectomy with auto-transplantation was performed. Eight years after surgery, a growing mass was observed in the transplantation site, accompanied by an elevation of parathyroid hormone. A complete resection of the mass was performed, and the patient was diagnosed with parathyroid carcinoma. Additional adjuvant radiation therapy was ordered, and the patient is being monitored. Conclusions This is a rare but remarkable case of parathyroid carcinoma arising from auto-transplanted parathyroid tissue after total parathyroidectomy in a patient with secondary hyperparathyroidism. We suggest caution should be taken when choosing to auto- transplant parathyroid tissue and that careful postoperative observation should be performed.

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