scholarly journals The Efficiency of Parathyroidectomy and the Comparison of the Complications of Surgical Procedures in Dialysis Patients

2011 ◽  
Vol 3 (3) ◽  
pp. 103-106
Author(s):  
Çağlayan Kasım ◽  
Bülent Güngör ◽  
Bülent Koca ◽  
Hamza Çınar ◽  
Zafer Malazgirt ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Patient Characteristics ◽  
Total Parathyroidectomy ◽  
Test Results ◽  
Subtotal Parathyroidectomy ◽  
Laboratory Test Results ◽  
Surgical Methods ◽  
Before And After ◽  
Calcium Phosphorus ◽  
Type Of Surgery

ABSTRACT Secondary hyperparathyroidism is the hyperplasia and hyperfunctioning of the parathyroid gland in chronic renal failure. The aim of our study was to evaluate the efficiency and complications of surgical methods for secondary hyperparathyroidism in patients requiring dialysis. Forty-one patients operated for secondary hyperparathyroidism before renal transplantation were retrospectively analysed. The efficiency and complications of types of surgery in relation with age, gender, duration of dialysis, symptoms, laboratory test results before and after surgery were evaluated. Mean duration of dialysis was 6.2 ± 3.98 years. Patient's calcium, phosphorus and parathormone levels before surgery were 9.83 ± 1.25 mg/dl, 5.73 ± 2.15 mg/dl, 1847, 0.02 ± 666.602 pg/ml and, after surgery, were 7.85 ± 1.36 mg/dl, 4.5 ± 1.55 mg/dl, 288.05 ± 404.09 pg/ml. The differences betweeen preoperative and postoperative values were statistically significant (p < 0.05) recognizing the efficiency of surgery. The age of patients, the duration of dialysis and the type of surgery were not significantly effective on this difference (p > 0.05). Fifteen patients had subtotal parathyroidectomy, 25 patients had total parathyroidectomy with autotransplantation and one patient had total parathyroidectomy. The incidence of complications did not differ with age, gender, duration of dialysis and type of surgery (p > 0.05). The type of surgery did not possess difference in the improvement in levels of calcium, phosphorus and parathormone and also in the incidence of complications in secondary hyperparathyroidism. Surgeon's experience and individual patient characteristics seem to be more important in determining the type of surgery.

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 Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients.

1992 ◽  
Vol 3 (4) ◽  
pp. 1008-1017 ◽  
Author(s):  
E R Gagné ◽  
P Ureña ◽  
S Leite-Silva ◽  
J Zingraff ◽  
A Chevalier ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Great Majority ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Total Parathyroidectomy ◽  
Short Term ◽  
Subtotal Parathyroidectomy ◽  
Surgical Methods ◽  
Long Term Follow Up

A retrospective study was performed in chronic hemodialysis patients comparing total parathyroidectomy (PTX) followed by immediate autografting (IA) (total PTX+IA) with subtotal parathyroidectomy (subtotal PTX). One hundred six patients with severe, uncontrolled hyperparathyroidism were referred to this center and underwent surgery during the period from 1980 to 1990. Long-term follow-up after PTX was available in 49 of them: 28 patients had total PTX+IA and 21 had subtotal PTX. The two surgical methods were evaluated with respect to preoperative severity of hyperparathyroidism, immediate postoperative results, and long-term parathyroid status, as evaluated by an RIA measuring intact immunoreactive parathyroid hormone (intact iPTH; normal values, 15 to 65 pg/mL). The initial degree of hyperparathyroidism was comparable in the two groups. An excellent short-term control of hyperparathyroidism was achieved in the great majority (95%) of patients with either surgical procedure. However, long-term normalization of parathyroid gland activity was achieved in only one third of patients whereas 33% had elevated intact iPTH levels (> 130 pg/mL; i.e., higher than twice the upper range of normal) and 32% had low intact iPTH levels (< 15 pg/mL), consistent with permanent hypoparathyroidism. No difference was found in the immediate failure rates: 0 of 28 cases after total PTX+IA compared with 2 of 21 cases after subtotal PTX. Similarly, long-term intact iPTH levels were comparable: 400 +/- 105 versus 212 +/- 82 pg/mL (mean +/- SE; P = not significant). Interestingly, long-term serum intact iPTH levels were higher in patients with nodular (N = 18) than with diffusely (N = 26) hyperplastic glands: 556 +/- 146 versus 126 +/- 52 pg/mL (P < 0.001) and recurrence of hyperparathyroidism was more frequent with nodular hyperplasia (11 of 18) than with diffuse hyperplasia (4 of 26) (P < 0.02). In conclusion, although excellent short-term results were obtained with both procedures, satisfactory long-term control of parathyroid gland function was achieved in only one third of the patients, the other two third remaining either hypoparathyroid or developing recurrent hyperparathyroidism. Last, the histological subtype of parathyroid glands was partially predictive of the recurrence of hyperparathyroidism.

Secondary Hyperparathyroidism

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

Secondary Hyperparathyroidism

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

scholarly journals Use of Percutaneous Ethanol Injection Therapy for Recurrent Secondary Hyperparathyroidism after Subtotal Parathyroidectomy

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Walter G. Douthat ◽  
Gabriela Cardozo ◽  
Gabriela Garay ◽  
Santiago Orozco ◽  
Carlos Chiurchiu ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Therapeutic Option ◽  
Percutaneous Ethanol Injection ◽  
Injection Therapy ◽  
Subtotal Parathyroidectomy ◽  
Ethanol Injection ◽  
Percutaneous Ethanol Injection Therapy ◽  
Calcium Phosphorus ◽  
Ethanol Injection Therapy ◽  
Esrd Patients

We evaluated the efficacy of percutaneous ethanol injection therapy (PEIT) as a therapeutic option for recurrence of secondary hyperparathyroidism after subtotal parathyroidectomy in ESRD patients. Six patients underwent PEIT. A mean of 1.3 ± 0.8 ethanol injections was performed. Nodular volume was 1.5 ± 1.7 cm3, and 2.8 ± 2.8 cm3of ethanol was injected per patient. After ethanol injection PTH decreased significantly (1897 ± 754 to 549 ± 863 pg/mL (P<.01)). There was also a reduction in serum calcium, phosphorus and calcium-phosphorus product. A positive and significant correlation was found between nodular volume with ethanol injected and time from parathyroidectomy. Only one patient required hospitalization due to severe hypocalcaemia. In other two cases, local discomfort and temporary mild dysphonia were registered. PEIT is an effective treatment to control recurrences of secondary hyperparathyroidism postsubtotal parathyroidectomy.

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