Clinical Study on Safety and Efficacy of Microwave Ablation for Primary Hyperparathyroidism.

OBJECTIVE: To evaluate the safety, feasibility, and efficacy of microwave ablation (MWA) for the treatment of primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: This study enrolled 67 PHPT patients (22 men, 45 women; mean age, 56.0 ± 16.3 years; range, 18-83 years) from January 2015 to December 2018. The laboratory data, including the serum intact parathyroid hormone (iPTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels, were evaluated before MWA and again 2 hours, 1 day, 7 days, 1 month, 3 months, 6 months, 12 months, 18 months, and 24 months after. RESULTS: Complete ablation was achieved with all 72 hyperplastic parathyroid glands found on the 67 patients enrolled, 64 of whom were treated in one session and 3 were treated over two sessions. The technical success rate was 100%. The median follow-up time was 13.6 months (range, 10.0-31.1 months). The clinical success rate was 89.4%. The volume reduction rate was 79.4% at 6 months. Compared to pre-MWA, the serum iPTH, calcium, phosphorus, and ALP levels had significantly improved 6 months post-MWA (iPTH, 157.3 pg/mL vs. 39.2 pg/mL; calcium, 2.75 ± 0.25 mmol/L vs. 2.34 ± 0.15 mmol/L; phosphorus, 0.86 ± 0.20 mmol/L vs. 1.12 ± 0.22 mmol/L; ALP, 79 U/L vs. 54 U/L, respectively; all, p < 0.01). Hoarseness was a major complication in 4 patients (6.0%), but it improved spontaneously within 2-3 months. CONCLUSION: MWA is safe, feasible, and effective for the treatment of PHPT.

Complications encountered in the treatment of primary and secondary hyperparathyroidism with microwave ablation - a retrospective study.

Purpose: To evaluate the complications encountered during microwave ablation (MWA) for primary and secondary hyperparathyroidism (HPT).Materials and methods: The retrospective study enrolled 213 secondary hyperparathyroidism (SHPT) and 51 primary hyperparathyroidism (PHPT) patients who received MWA between July 2015 and September 2018. The major and minor treatment-related complications were documented. The baseline data, clinical parameters, laboratory indices and characteristics of the parathyroid glands were analyzed to assess the risk factors associated with these complications.Results: The incidence of post-MWA complications in HPT patients was 12.1% (32/264). In total, five (5/264, 1.9%) patients with SHPT had major complications, including aphonia/hoarseness (n = 4) and Horner syndrome (n = 1). A total of 27 (10.2%, 27/264) HPT patients had minor complications, including neck hematoma (0.8%, 2/264), bucking (4.2%, 11/264) and phonasthenia (5.3%, 14/264). The incidence of severe hypocalcemia (SH) after MWA was 18.2%. Cutaneous necrosis occurred in two SH patients after intravenous calcium supplementation. There were no significant differences in the incidence of overall complications, major complications and minor complications between SHPT and PHPT patients (12.7% vs 9.8%, p = 0.811; 2.3% vs 0, p = 0.587; 10.3% vs 9.8%, p = 1.000). A history of parathyroidectomy (PTX) (p = 0.031) and multiple symptoms (p = 0.000) were risk factors for the occurrence of complications in SHPT patients. One patient sustained a permanent injury to a unilateral recurrent laryngeal nerve (RLN), and the two patients who experienced cutaneous necrosis underwent debridement plus autologous skin transplantation. The remaining patients recovered without sequelae.Conclusion: The incidence of major complications was low which only occurred in SHPT patients. Most of the patients with complications recovered spontaneously. MWA is safe for the treatment of HPT.

[Reproduction of a murine model of hyperthermic treatment].

OBJECTIVE: To find out the most suitable conditions for a whole body hyperthermia (WBH) model and the influence of these conditions on the blood brain barrier (BBB) disruption and brain edema in rats. METHODS: Forty male Sprague-Dawley (SD) rats were randomly assigned to four groups (n=10 in each group): control group, group A, group B and group C. After anesthesia with pentobarbital, rats were subjected to femoral artery and vein cannulation. Rats of control group were housed at a controlled room temperature (25-26 degrees C) for 4 hours. Rats of group A, group B and group C were exposed to WBH in a biological oxygen supply heated container (relative humidity 65%, wind velocity 25 cm/s) maintained at 34, 36 and 38 degrees C for 3 hours, respectively. Then the rats were removed from the heated container and their body temperature was cooled down for 1 hour. During heating, rectal temperature, heart rate (HR), mean arterial pressure (MAP), pH, partial pressure of oxygen in artery (PaO(2)), partial pressure of carbon dioxide in artery (PaCO(2)), the dosage of anesthetic, and the mortality rate in each group were recorded. Evans blue (EB) was administered into the femoral vein and allowed to circulate for 5 minutes. At the end of the experiment, the animals were perfused with 0.9% saline and heparin through the heart, and the brain was harvested for the examination of BBB permeability, water content and morphological alterations in brain tissues and neurons. RESULTS: The total dosage of pentobarbital was not significantly different among all groups. After WBH for 3 hours, the average rectal temperature was higher than rats without WBH, and the mortality rate was 0, 10%, 10% and 40% in groups control, A, B, C, respectively. HR of groups A, B and C were significantly higher than those of control group; MAP, pH of group A, B and C were significantly lower than those of control group (all P<0.05). Compared to that of control group, water content of the brain and permeability of EB in groups A, B and C were significantly increased (P<0.05 or P<0.01), but there was no marked difference on PaO(2), PaCO(2) and haematocrit (HCT) among groups A, B and C. Morphological investigation showed that there were different degrees of structural changes in brain tissue in groups A, B and C under light microscopy. Under transmission election microscopy, the structure of nerve cells and BBB in group B and group C showed moderate to profound alterations, but there were no changes in group A. CONCLUSION: Rats housed in a biological oxygen supply heat container with the temperature maintained at 36 degrees C for 3 hours could establish an ideal WBH model with notable BBB breakdown, moderate brain edema, and histological changes in brain.