Clinical application of parathyroid autofluorescence imaging in endoscopic thyroid surgery / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the application value of near-infrared autofluorescence imaging in identifying and protecting parathyroid glands in endoscopic thyroid surgery. Methods:From May 2022 to February 2023, 158 patients who underwent endoscopic thyroid surgery in the Department of Thyroid and Breast Vascular Surgery of Guilin People's Hospital were selected. The endoscopic fluorescence camera system was used to monitor the parathyroid glands under autofluorescence during endoscopic thyroid surgery. A total of 214 pieces were collected, among which the first 15 cases that could not be preserved in situ during the operation needed to be autotransplanted or the tissue clamped parts that could not be clearly identified as parathyroid glands were sent to fast-frozen pathology to determine whether they were parathyroid glands. Results:Among the first 15 patients who could not be preserved in situ during the operation or whose anatomy could not be clearly defined, 23 parathyroid glands were detected by autofluorescence imaging, 21 parathyroid glands were confirmed by pathology, and 2 were adipose tissue, with an accuracy rate of 91.30%; 158 patients underwent surgery Blood calcium decreased 2 hours after operation compared with preoperative blood calcium（P<0.05）, decreased blood calcium 5 days after operation compared with preoperative blood calcium（P<0.01）, and increased slightly 5 days after the operation compared to blood calcium 2 hours after the operation, but the difference was not statistically significant（P>0.05）; while comparing parathyroid hormone（PTH）, PTH at 2 hours after operation decreased significantly compared with PTH before operation（P<0.01）, and PTH at 5 days after operation compared with PTH before operation PTH also decreased（P<0.01）, but increased compared with PTH 2 hours after operation（P=0.001）. Conclusion:In laparoscopic thyroid surgery, the application of near-infrared autofluorescence imaging technology can help surgeons quickly identify and protect parathyroid glands, and reduce the incidence of permanent hypoparathyroidism. Combining autofluorescence imaging, visual anatomy recognition under magnification of laparoscope, and intraoperative frozen pathological examination "trinity" method can improve the success rate of parathyroid gland recognition.

Responsividade paratireoideana à hipocalcemia após paratireoidectomia total com autoimplante em portadores de hiperparatireoidismo associado à doença renal crônica / Parathyroid responsiveness during hypocalcemia after total parathyroidectomy and autotransplantation in patients with renal hyperparathyroidism

Resumo Introdução: O hiperparatireoidismo é uma complicação frequente da doença renal crônica (DRC). A paratireoidectomia (PTX) total com autotransplante (AT) de tecido paratireoideano é uma opção terapêutica para os indivíduos que não respondem ao manejo clínico. Objetivo: Avaliar a resposta do tecido paratireoideano enxertado durante hipocalcemia induzida em pacientes portadores de DRC submetidos à PTX total com AT. Métodos: Dezoito pacientes portadores de hiperparatiroidismo associado à DRC foram submetidos à PTX total com AT de tecido paratireoideano selecionado por estereomicroscopia entre Abril e Outubro de 2008 em nosso serviço. Onze indivíduos (oito com transplante renal funcionante, 2 em diálise peritoneal e 1 em hemodiálise) apresentavam boa condição clínica e foram elegíveis para o teste. Induziu-se hipocalcemia por infusão de bicarbonato de sódio em 5 controles normais e nos pacientes 6-12 meses após a PTX. Resultados: A hipocalcemia determinou um aumento importante dos níveis de PTH intacto (iPTH) no grupo controle 4 minutos após a infusão de bicarbonato. Nos pacientes, houve uma redução significativa do cálcio ionizado [de 1,17 ± 0,12 para 1,09 ± 0,11 (media ± EP) mmol/L] no 4º minuto (p < 0,001) ilustrando o nadir do teste. No 10º minuto não houve elevação do cálcio ionizado comparado ao 4º minuto (p = 0,451). Os níveis de iPTH foram de 34,8 ± 18,6 para 34,1 ± 18,8 pg/mL (valor basal semelhante ao 4º minuto p = 0,087) e se mantiveram no 10º minuto (33,3 ± 19,6 pg/mL p = 0,693). Conclusão: Em pacientes portadores de DRC testados 6-12 meses depois da cirurgia, o enxerto de tecido paratireoideano revelou incapacidade de resposta à hipocalcemia induzida por bicarbonato sem mudança dos níveis de iPTH.

Abstract Introduction: Hyperparathyroidism is a frequent complication of chronic kidney disease (CKD). Total parathyroidectomy (PTX) with parathyroid tissue autotransplantation (AT) is a treatment option in those individuals that do not respond to clinical management. Objective: To evaluate grafted parathyroid tissue response during induced hypocalcemia among CKD patients who underwent total PTX with AT. Methods: Eighteen patients with renal hyperparathyroidism were submitted to total PTX with parathyroid AT selected by stereomicroscopy between April and October 2008. Eleven (eight with successful kidney transplantation, 2 in peritoneal dialysis and 1 in hemodialysis) were clinically stable and eligible for testing. Hypocalcemia was induced using sodium bicarbonate infusion in 5 healthy controls and in patients 6-12 months after surgery. Results: Among controls, hypocalcemia elicited a major rise in intact PTH (iPTH) levels 4 minutes after bicarbonate infusion. In patients, a significant decrease in ionized calcium concentration was observed [from 1.17 ± 0.12 to 1.09 ± 0.11 mean (± SE) mmol/L] in the 4th minute (p < 0.001) illustrating the nadir point. In the 10thminute, ionized calcium did not show a statistical increase compared to the 4th minute (p = 0.451). The iPTH levels ranged from 34.8 ± 18.6 to 34.1 ± 18.8 pg/mL (similar values between base line and 4thminute p = 0.087) and did not change in the 10th minute (33.3 ± 19,6 pg/ mL p = 0.693). Conclusion: Among CKD patients tested 6-12 months after surgery, grafted parathyroid tissue revealed a blunted secretory capacity during bicarbonate induced hypocalcemia with no changes in iPTH levels.

Successful parathyroid tissue autograft after 3 years of cryopreservation: a case report / Implante bem-sucedido de paratireoide criopreservada por 3 anos: relato de caso

After a total parathyroidectomy, well-established protocols for the cryopreservation of parathyroid tissue and for the delayed autograft of this tissue exist, especially in cases of secondary hiperparathyroidism (HPT) or familial or sporadic parathyroid hyperplasia. Although delayed autografts are effective, the published success rates vary from 10% to 83%. There are numerous factors that influence the viability, and therefore the success, of an autograft, including cryopreservation time. Certain authors believe that the tissue is only viable for 24 months, but there is no consensus on how long the parathyroid tissue can be preserved. A 63-year-old male who was diagnosed with sporadic multiple endocrine neoplasia type 1 and primary hyperparathyroidism, and was submitted to a total parathyroidectomy and an autograft in the forearm. The implant failed, and the patient developed severe hypoparathyroidism in the months following the surgery. Thirty-six months after the total parathyroidectomy, the cryopreserved autograft was successfully transplanted, and hypoparathyroidism was reversed (most recent systemic parathyroid hormone, PTH, of 36 pg/mL, and total calcium of 9.1 mg/dL; no oral calcium supplementation). The case presented here indicates that cryopreserved parathyroid tissue may remain viable after 24 months in storage, and may retain the capacity to reverse permanent postsurgical hypoparathyroidism. These data provide reasonable evidence that the time limit for cryopreservation remains undetermined and that additional research would be valuable. Arq Bras Endocrinol Metab. 2014;58(3):313-6.

O implante de tecido paratireoideano criopreservado após paratireoidectomia total é um procedimento bem estabelecido e, embora tenha sua eficácia comprovada, as taxas de sucesso variam de 10% a 83% na literatura. O tempo de criopreservação é um dos diversos fatores relacionados ao sucesso do implante. Alguns autores defendem que o tecido permanece viável até 24 meses de criopreservação, no entanto, não há consenso. Homem de 63 anos diagnosticado com neoplasia endócrina múltipla tipo I e hiperparatireoidismo primário foi submetido a paratireoidectomia total e autoimplante em membro superior. O implante falhou e o paciente desenvolveu hipoparatireoidismo. Após 36 meses da paratireoidectomia total, foi realizado o implante de paratireoide criopreservada, com sucesso. O hipoparatireoidismo foi revertido e o paciente permanece sem suplementação de cálcio e PTH sistêmico de 36 pg/mL e cálcio total de 9,1 mg/dL. O caso apresentado mostra que o tecido paratireoideano criopreservado pode permanecer viável após 24 meses e há possibilidade de reverter o hipoparatireoidismo pós-cirúrgico. Isso traz evidência de que o tempo limite de criopreservação permanece incerto e que novas pesquisas seriam de grande valia. Arq Bras Endocrinol Metab. 2014;58(3):313-6.

Definição de valores de corte para medida de PTH intraoperatório no tratamento cirúrgico do hiperparatiroidismo secundário e terciário / Intraoperative PTH cutoff definition to predict successful parathyroidectomy in secondary and tertiary hyperparathyroidism

Avaliamos medida de PTH intraoperatório (IO-PTH) no intuito de melhorar índices de sucesso no tratamento cirúrgico do hiperparatiroidismo associado à doença renal. MÉTODO: Oitenta e seis pacientes realizaram paratiroidectomia total com autoimplante em musculatura pré-esternal entre abril de 2000 e outubro de 2009 com 26,5 meses de seguimento em média, prospectivo. Foram divididos em dois grupos: hiperparatiroidismo secundário (HPS) - pacientes em diálise e hiperparatiroidismo terciário (HPT) - transplantados renais. Medido IO-PTH (Elecsys-PTH-Immunoassay/Roche) na indução anestésica (IOPTH-0') e 20 minutos (IOPTH-20') após a retirada das paratireoides. RESULTADOS: 80,2% (69/86) do total de pacientes apresentaram queda de 80% ou mais do IOPTH-20' e todos se curaram. Em 11/86 (12,7%) pacientes, foi observada queda entre 70-79%, sendo que dois (18,1%) deles evoluíram com falha cirúrgica. 6/86 (6,9%) pacientes apresentaram redução de IOPTH-20' menor do que 70%: dois foram curados; três apresentaram paratireoide supranumerária/ectópica que foi localizada e removida; um paciente evoluiu com persistência da doença após término da cirurgia com a retirada de quatro paratireoides. CONCLUSÃO: Queda do IOPTH-20' de 80% ou mais foi preditor de cura em todos os pacientes renais durante o período avaliado. Redução menor que 70% sugere paratireoide hiperfuncionante não reconhecida/supranumerária, sendo preditor de falha cirúrgica em 66.6%. A queda marginal de 70%-79% delega ao cirurgião experiente a decisão de continuar ou não o procedimento cirúrgico.

In order to improve success rates in surgery of renal hyperparathyroidism, we evaluated intraoperative PTH (IOPTH) measurement utility. METHOD: 86 patients underwent total parathyroidectomy with intramuscular presternal autotransplantation from 04/2000 to 10/2009 and were followed for 26.5 months on average (prospective cohort). Patients were divided in secondary (SHPT) and tertiary hyperparathyroidism (THPT). SHPT group was composed by patients under dialysis treatment, THPT group included renal grafted ones. IOPTH (Elecsys-PTH-Immunoassay/Roche) was measured at anesthesia induction (IOPTH-0') and 20 minutes (IOPTH-20') after parathyroidectomy. RESULTS: 80.2% (69/86) presented with 80% decrease or more in the IOPTH-20' and all were cured. In 11/86 patients (12.7%), a lower IOPTH-20' drop (70-79%) was observed, and 2 of them (18.1%) failed to cure. 6/86 (6.9%) patients presented IO-PTH-20' decrease of less than 70%: two were cured, in three a supernumerary/ectopic parathyroid was found and removed, and in one of these six patients, surgery was finished after 4-gland excision and the patient failure to cure. CONCLUSION: IOPTH-20' decrease of 80% or more compared to IOPTH-0' predicts cure in all renal patients throughout follow-up. A decay of less than 70% points to missed or hyperfunctioning supernumerary gland and is predictive of surgical failure in 66.6%. A marginal IOPTH drop of 70-79% leaves the decision whether or not surgery should be continued up to the experienced surgeon.

Caracterización de línea celular de paratiroides humana (RCPTH) y evaluación de tumorigenicidad en ratones NOD/SCID / Characterization of human parathyroid cell line (RCPTH) and tumorigenicity evaluation in NOD/SCID

Background: Cell therapy could be an alternative for the treatment of hypoparathyroidism. Therefore efforts have been made to establish a cell line of parathyroid cells. Aim: To establish a continuous functional and non-tumorigenic human parathyroid cell line. Material and Methods: Nineteen tissue samples from 15 patients subjected to parathyroidectomy due to primary or secondary hyperparathyroidism were obtained. Functional, morphological and tumorigenic properties of the obtained cells were analyzed. Results: After two months of culture in conditions of immortalization, cells had an exponential growth without experiencing senescence. Therefore, more than 200 sub cultures have been performed. The cell line was denominated RCPTH. Morphological characterization showed monolayer growth with contact inhibition and a duplication time of 30 hours. On light microscopy, pleomorphism and low number of mitoses were observed. Cells accumulated glycogen, expressed calcium sensing receptor and had positive PTH cytoplasmic clusters. The line secreted PTH initially but subsequently, PTH production became undetectable. The cell line did not have tumor or metastatic growth. Conclusions: A parathyroid cell line has been established. The lack of PTH production is a problem that will require the search for mechanisms to activate it.

Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.

Resultados funcionais do auto-implante de paratireóides em loja única no tratamento do hiperparatireoidismo secundário / Functional results of parathyroid autotransplantation in one single pocket for treatment of secondary hyperparathyroidism

OBJETIVO: Avaliar o funcionamento e tempo cirúrgico do auto-implante de paratireóide em loja única comparando-o ao implante realizado em cinco e vinte lojas. MÉTODOS: Pacientes submetidos à parotidectomia total com auto implante (Ptx-AI) por hiperparatireoidismo secundário e terciário foram avaliados em grupos de implantes em 20 lojas (A), cinco lojas (B) e loja única (C), em relação ao Estado Funcional (EF) do implante e ao tempo cirúrgico deste. Foram determinados quatro Estados Funcionais de acordo com o nível sistêmico de PTH: 1-abaixo do normal; 2-normal; 3- elevado não mais que três vezes; 4- elevado mais que três vezes. RESULTADOS: Foram submetidos a Ptx-AI 349 pacientes, por hiperparatireoidismo renal, entre 1994 a 2009. Para o estudo funcional foram elegíveis 101 pacientes com as seguintes observações: grupo A (n=30) - EF1 16,6 por cento, EF2 50 por cento, EF3 23,3 por cento e EF4 10 por cento; grupo B (n=41) - EF1 14,6 por cento, EF2 58,5 por cento, EF3 22 por cento e EF4 4,9 por cento; Grupo C (n=30) - EF1 17 por cento, EF2 57 por cento, EF3 20 por cento e EF4 6 por cento (p=0,9, x²). Porém no grupo C, o tempo cirúrgico médio do implante foi estatisticamente mais rápida (7,9 minutos) em relação à média em cinco lojas (18,6 minutos) e 20 lojas (44 minutos), em 66 pacientes avaliados (p<0,0001, ANOVA). CONCLUSÃO: O auto-implante em loja única diminui o tempo cirúrgico sem alterar a funcionalidade do mesmo.

OBJECTIVE: To evaluate the operation and surgical time of autotransplanted parathyroid in a single site comparing it to the implant performed in five and twenty locations. METHODS: Patients who underwent total parotidectomy with auto implant (Ptx-AI) for secondary and tertiary hyperparathyroidism were evaluated in groups of 20 implant sites (A), 5 sites (B) and single site (C), compared as for Functional Status (FE) of the implant and the surgical time of the procedure. Four functional states were determined according to the systemic level of PTH: 1-below normal, 2-normal, 3-high, no more than three times and 4 - more than three times higher. RESULTS: There were 349 patients subjected to Ptx-AI for renal hyperparathyroidism from 1994 to 2009. For the functional study, 101 patients were eligible for the following observations: group A (n = 30) - 16.6 percent EF1, 50 percent EF2, 23.3 percent EF3 and 10 percentEF4; group B (n = 41) - 14.6 percent EF1, 58.5 percent EF2, 22 percent EF3 and 4.9 percent EF4; Group C (n = 30) - 17 percent EF1, 57 percent EF2, 20 percentEF3 and 6 percent EF4 (p = 0.9, x²). But in group C the mean operative time of implant was statistically lower (7.9 minutes) compared to the average of 5 site (18.6 minutes) and 20-site (44 minutes) implants in 66 evaluated patients (p<0,0001, ANOVA). CONCLUSION: The self-implantation in a single site decreases the operative time without changing its functionality.

incidence of transient and permanent hypocalcaemia after total thyroidectomy for thyroid cancer

Hypocalcaemia is one of the more acute complications of total thyroidectomy and occurs after parathyroid injury during surgery. The aim of this study is to assess the incidence rate and risk factors of transient and permanent hypocalcaemia in patients who had undergone total thyroidectomy, due to malignant thyroid diseases and to determine the value of parathyroid gland autotranplantation in thyroid cancer surgeries. Sixty-five patients, diagnosed with thyroid malignancy, who were treated by total thyroidectomy with or without radical neck dissection between 2002 and 2006, were studied retrospectively. Of patients 60% were female [mean age 39.59 +/- 10.24 years] and 40% were male [mean age 42.11 +/- 11.93 years]. Complications of total thyroidectomy, permanent and transient hypocalcaemia in particular, were studied. In eleven patients, parathyroids were transplanted within fibers of sternocleidomastoid and deltoid muscles. Transient hypocalcaemia occurred in 18 patients and was treated by intravenous and oral calcium supplements. None of patients progressed to permanent hypocalcaemia. Temporary recurrent laryngeal nerve paresis occurred in 2% of patients but there was no case of paralysis. There was a significant difference in hypocalcaemia occurrence between patients, who had just total thyroidectomy and those who underwent thyroidectomyt with neck dissection [p=0.01]. Hypocalcaemia after total thyroidectomy is a serious and dangerous complication, requiring prompt diagnosis and proper treatment. Parathyroid gland transplantation for an injured or incidentally removed parathyroid, between fibers of sternocleidomastoid or deltoid muscles, can prevent the occurrence of permanent hypocalcaemia

Hiperparatireoidismo secundário: fatores prognósticos de recidiva atribuída ao implante após paratireoidectomia total e auto-implante / Secondary hyperparathyroidism: prognostic factors of graft-dependent recurrence after total parathyroidectomy and parathyroid autotransplantation

Nos casos de hiperparatireoidismo secundário onde não é possível o tratamento clínico, é indicada a paratireoidectomia. No Serviço de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, o tipo de cirurgia utilizada é a paratireoidectomia total com auto-implante de paratireóide em membro superior. Nesses casos, ao contrário da paratireoidectomia total, pode haver recidiva do hiperparatireoidismo no sítio do implante, com sintomas sistêmicos e com necessidade de intervenção para retirada do tecido hiperplásico. Já na paratireoidectomia total, há hipoparatireoidismo definitivo e risco de doença óssea adinâmica. O presente estudo tem como escopo avaliar os pacientes submetidos a paratireoidectomia com implante e esclarecer se há fatores clínicos e de imunohistoquímica que possam indicar antes da cirurgia algum risco de recidiva no implante.

When clinical treatment of secondary hyperparathyroidism fails, parathyroidectomy is mandatory. Total parathyroidectomy and immediate parathyroid autotransplantation in the forearm is the treatment of choice at Head and Neck Surgery of Hospital das Clínicas of University of São Paulo Medical School. In this cases, recurrent hyperparathyroidism may be caused by hyperplastic graft tissue. Without autotransplantation, adinamic bone disease may occur. The present study seek to evaluate patients submitted to total parathyroidectomy and autotransplantation and try to clarify clinical or immunohistochemical.

Resultados iniciales con criopreservación de glándulas paratiroides y potenciales aplicaciones / Histological integrity and functional viability results of previously cryopreserved human para thyroid tissue

Objetivo: Analizar la integridad histológica y viabilidad funcional de tejido paratiroideo criopreservado, con miras a un potencial trasplante futuro. Material y método: Se criopreservaron muestras de tejido paratiroideo proveniente de 14 pacientes operados por HPT (8 secundarios, 3 terciarios , 1 primario recidivado y dos hiperplasias primarias). Fraccionado en porciones de 2 x 3 mm, el material fue preservado en suero + solución de Hanks + DMSO y congelados hasta -90°C, conservándolo en nitrógeno líquido. Luego de seis meses, el material de 4 pacientes fue parcialmente descongelado y estimulado con solución de Cloruro de Ca++, midiéndose la secreción de PTH y estudiando la histología con H y E y con el método de Tunnel para apoptosis. Resultados: Se observó en las cuatro muestras un patrón similar de respuesta, con un pico inicial de secreción, un descenso a la hora, y un nuevo ascenso a las dos horas del estímulo. El estudio histológico de las piezas mostró integridad histológica luego de seis meses de criopreservación, pero importante depauperización celular luego del estímulo. Conclusiones: En la muestra analizada, la criopreservación del tejido paratiroideo ha permitido conservar su integridad histológica, así como sus capacidades secretorias básicas. El fenómeno apoptótico que invariablemente acompaña a la estimulación prolongada in vitro, requiere nuevas investigaciones que permitan controlarlo

Paratireoidectomia total com ou sem autotransplante no tratamento do hiperparatireoidismo secundário / Total parathyroidectomy with or without autotransplantation in the treatment of secondary hyperparathyroidism

A progressão do hiperparatireoidismo secundário no doente com insuficiência renal crônica é acompanhada de complicações. Após tentativa de tratamento clínico, pode ser necessária paratireoidectomia. O tipo de operação é assunto controverso. A paratireoidectomia total sem autotransplante poderia representar uma opção com menor risco de recidiva.

Cáncer de tiroides / Thyroid cancer

Ochenta y seis pacientes con cáncer de tiroides, no operados previamente, fueron intervenidos en Antofagasta, por el autor, entre marzo 1980 y agosto 1993. El grupo lo componen 70 mujeres y 16 hombres, cuyas edades fluctúan entre 4 y 81 años de edad. En 49 pacientes el cáncer se presenta clínicamente localizado a la glándula tiroides, en 33 con metástasis ganglionares palpables y 4 pacientes con metástasis óseas o pulmonares. De acuerdo a un protocolo conservador para los enfermos de bajo riesgo se practicaron: 18 lobectomías, más istmectomía, más parte del lóbulo opuesto, 5 tiroidectomías sub-totales, y 63 tiroidectomías totales, 35 de ellas con vaciamiento de cuello. Se trasplantó 37 glándulas paratiroides en 27 pacientes. Un paciente fallece en el postoperatorio. La mitad de la serie cumple ya más de 6 años de seguimiento. Se ha constatado recurrencia en 5 pacientes, ninguno de ellos en tejido tiroideo remanente después de cirugía conservadora, menor que TT, 23 casos. Estos resultados aún siendo preliminares, apoyan la formulación de protocolos de tratamiento conservadores para pacientes con cánceres diferenciados de bajo riesgo y cirugía más agresiva TT, para los pacientes de alto riesgo, agregando vaciamientos en caso de adenopatías palpables y resección de tejidos vecinos si hay invasión

Transplante homólogo de paratiroides en pacientes con hiperparatiroidismo secundario / Homologous transplant of parathyroid glands in patients with secundary hiperparthyroidism

Cinco pacientes portadores de hiperparatiroidismo secundario a insuficiencia renal crónica y sometidos a hemodiálisis por largo tiempo fueron panparatiroidectomizados, y el tejido paratiroideo de la más pequeña de sus glándulas fue transplantado a la cara anterior de uno de sus antebrazos. El diagnóstico previo de hiperparatiroidismo fue establecido con base en niveles persitentemente elevados de paratohormona, hipercalcemia elevada sobre 10.5 mg y no explicada por otra razón y fosfatasa alcalina también elevada. El procedimiento quirúrgico realizado fue el descrito por Samuel Wells en los Estados Unidos y todos los pacientes tuvieron excelente evolución en el trans y postoperatorio. En uno de los casos 18 meses después de la paratiroidectomía y transplante de varios segmentos a la cara anterior de uno de sus antebrazos los síntomas de hiperparatiroidismo recurrieron por lo que fue necesario la remoción de parte del tejido implantado con lo que se corrigió el problema. Este representa el primer reporte a nivel centroamericano de trasplante homólogo de tejido paratiroideo en pacientes con hiperparatiroidismo secundario

Alotransplante de glándula paratiroide / Alotransplantation of the parathyroid glands

Los autores presentan 7 casos de pacientes con hipoparatiroidismo iatrogénico de larga data tratados mediante la técnica de alotransplante de paratiroides en forma exitosa. No hubo necesidad de inmunosupresión ya que los estudios de histocompatibilidad en todos los casos fue negativo. La viabilidad del injerto se demostró clínica y bioquímicamente, manteniéndose asintomáticos les pacientes con niveles de calcio, fósforo y PTH normales. No ha habido rechazo del injerto en más de 20 meses de iniciado el procedimiento, sin tener una explicación de certeza hasta el momento de este fenómeno. Ninguno de los casos presentó complicaciones mayores inherentes a la técnica, y sólo hubo un pequeño hematoma de la herida de una paciente. Se concluye que el alotransplante de paratiroides es un procedimineto exitoso