Comparison of endoscopic versus focused parathyroidectomy in surgical management of single-gland primary hyperparathyroidism: a randomized clinical trial.

BACKGROUND: Over recent years, various advanced minimally invasive techniques have been developed for parathyroidectomy, and there was a universal acceptance of these less invasive procedures by surgeons. This study is designed to compare overall outcomes between endoscopic versus focused, single gland parathyroidectomy using intraoperative rapid parathyroid hormone (ioPTH) changes under general anesthesia in primary hyperparathyroidism (PHPT) patients. METHOD: In this randomized clinical trial, 96 patients diagnosed with PHPT were randomly assigned into two groups endoscopic and focused parathyroidectomy. Baseline clinical and demographical data were collected along with perioperative features. The success rate was evaluated based on ioPTH changes. RESULTS: The ioPTH levels after five minutes in the endoscopic group were significantly lower than the focused group (P = 0.005). The success rate for endoscopic and the focused method was 95.3% and 77.1% during the first five minutes (P = 0.013) and 100% in both groups after ten minutes. A decrease in parathyroid hormone levels was significant in each group but not between each other. Postoperative calcium levels were significantly lower in the focused method (P = 0.042). The focused group also had a significantly shorter operation time than the endoscopic group (P < 0.001). Patient satisfaction with cosmetic outcome was significantly higher in the endoscopic group compared to the focused group. CONCLUSION: The endoscopic technique was superior to the unilateral focused neck exploration parathyroidectomy in the management of single-gland PHPT. Influencing aspects included higher postoperative calcium levels, more rapid success achievement, and satisfactory cosmetic outcomes in the endoscopic group. However, patient selection and accurate adenoma localization are vital in this method.

Outcome of delayed brachial artery repair in patients with traumatic brachial artery injury: prospective study.

A large proportion of patients with traumatic brachial artery injury have delayed referral for arterial repair in Iran. In this paper, we review the early outcome of delayed surgical repair of these patients. Patients with traumatic brachial artery injury who had been referred later than 24h from occurrence of trauma were selected from May 2003 to October 2004. Presence of mottling was the main exclusive criterion. Pre- and post-operative data were registered in data sheets. Among 27 patients who entered the study, the mechanism of trauma was stabbings in 74% of cases. End-to-end anastomosis (n=14) and interposition graft with saphenous vein (n=12) were the techniques used. Amputation was inevitable due to progressing infection in one case. Upper limbs were saved in the remaining 26 cases (96%). Based on these data we recommend arterial repair in patients with traumatic brachial artery injury even after golden time of arterial repair.