RESUMO
Persistent or recurrent hyperparathyroidism is a challenging problem for endocrine surgeons. The aim of this study was to review our experience using ultrasound-guided (US-G) methylene blue dye injection for the localization and removal of abnormal parathyroid glands in patients having primary hyperparathyroidism and previous neck surgery. Between January 2012 and May 2013, six consecutive patients with primary hyperparathyroidism (PHPT) and previous neck surgery underwent focused parathyroidectomy with the use of US-G methylene blue dye injections to localize the presumed parathyroid adenoma were included in the study. We analyzed the data of six patients who underwent reoperative parathyroid surgery using US-G methylene blue dye injection retrospectively. The dye injection was performed just prior to surgery. All patients were successfully treated for their hyperparathyroidism which was confirmed by at least 50 % drop in intraoperative parathormone level 10 min after resection. There were no complications related with US-G dye injection or with surgery. US-G methylene blue dye injection is a cheap, safe, and effective method for localization of diseased parathyroid glands and guiding surgery in the reoperative neck.
RESUMO
BACKGROUND/AIMS: Esophageal variceal bleeding is a major complication of portal hypertension and the optimal therapeutic modality for each individual patient differs. We reviewed the results of modified Sugiura procedure in patients with variceal bleeding of esophagus. METHODOLOGY: We retrospectively reviewed the charts of 13 patients who were subjected to modified Sugiura procedure (transabdominal esophagogastric devascularization + esophageal stapled transection + splenectomy) for bleeding esophageal varices between 1996 and 2001. Three patients disappeared from routine follow-up and were excluded from the study. Survival, rebleeding and encephalopathy were evaluated. RESULTS: The mean age was 46 (18-56). The etiology of portal hypertension was cirrhosis of liver in six (60%) and portal vein thrombosis in four (40%). One patient had Child-Pugh's Class A, two had Class B and three had Class C cirrhosis. Previous variceal bleeding were confirmed by endoscopy in all patients who had recurrent variceal bleeding despite treatment with beta-blockers (three patients) or endoscopic sclerotherapy +/- band ligation (seven patients). Two were subjected to emergency surgery while the remaining eight were operated on electively. No postoperative mortality was seen. The bleeders were stopped immediately in the emergent cases. During a mean follow-up of 27 (4-53) months, one (10%) patient suffered from encephalopathy and one (10%) from rebleeding at 20th and 28th months after the operation respectively. Three (30%) patients with Child C cirrhosis died due to bleeding (one) and hepatic failure (two) at 4, 25, and 28 months after the surgery. The prognoses of other patients are well at the present time. CONCLUSIONS: In our small number of patients, modified Sugiura procedure was found to be a safe and effective procedure for urgent and long-term control of bleeding varices in patients with portal hypertension due to cirrhosis and noncirrhotic etiology. The outcomes are encouraging in noncirrhotic patients and cirrhotic patients with good liver functions.
