RESUMO
To evaluate the clinical significance of dissection parathyroidectomy for secondary hyperparathyroidism (SHPT) in patients with renal disease on maintenance dialysis. We retrospectively reviewed 195 patients with SHPT treated in the Department of Otolaryngology & Head and Neck Surgery of Beijing Civil Aviation General Hospital between September 2009 and September 2017, including 92 males and 103 females, aged from 23 to 77 years old. There were 167 patients by operated firstly and 28 patients by operated secondly for persistent or recurrent SHPT after operation. All patients received dissection parathyroidectomy with parathyroid autograft in the sternocleidomastoid. The easement of symptoms, the levels of serum intact parathyroid hormone (iPTH), serum-ionized calcium, phosphorus, and hemoglobin were compared before and after operation. Data were analyzed by SPSS 22.0 software. Confirmed by postoperative pathology, a total of 804 hyperplastic parathyroid glands were removed in 195 patients with SHPT. Among them, 765 parathyroid glands were clearly identified and located with naked eye. The anatomic distribution of the glands showed 577 (75.4%) in the tracheoesophageal groove. The incidence of ectopic parathyroid glands was 24.6% (188/765). Other 39 (4.9%) hyperplastic parathyroid glands from 22(11.3%) patients, which were not identified and located with naked eye during operation, were pathologically detected in the dissected tissue specimens. Among 195 patients, 28(14.4%) showed supernumerary parathyroid glands. No serious complications occurred after operation. Within 6 months after the operation, the bone pain and skin itch symptoms were completely relieved and, also, the symptoms of muscle weakness, restless leg, anemia and poor sleep quality were significantly alleviated. Following-up at 6 months after surgery showed the serum levels of iPTH [(70.31±60.12) pg/ml], calium [(2.13±0.22) mmol/L], and phosphorus [(1.17±0.27) mmol/L] decreased significantly respectively compared with the preoperative serum levels of iPTH [(1 501.02±167.26) pg/ml], calium [(2.40±0.32) mmol/L], and phosphorus[(2.27±0.50)mmol/L], all with statistically significant differences (0.01); the levels of hemoglobin [(120.32±10.63) g/L] and hematocrit [(39.20±3.21)%] were higher than the preoperative levels of hemoglobin[(104.11±15.17) g/L] and hematocrit [(31.25±5.12)%], both with statistically significant differences ( valve was 12.22,18,37,respectively, all 0.05). Dissection parathyroidectomy is a beneficial and safe surgical procedure for patients with medically refractory SHPT.
RESUMO
<p><b>OBJECTIVE</b>To discuss the treatment of compound betamethasone injection in cases with the intractable low-frequency sensorineural hearing loss (LFSNHL).</p><p><b>METHODS</b>Compound betamethasone injection 1 ml had been injected postaural only once to 23 cases with the unilateral LFSNHL, then observe the effect and follow-up at least 6 months. At the same time, the same therapy used to 4 cases with the binaural LFSNHL. The control group gave Merislon and Sibelium peroral for 2 weeks to 18 cases with the unilateral LFSNHL.</p><p><b>RESULTS</b>In unilateral LFSNHL group, twelve cases recovered, 7 cases had the hearing improved and 4 cases were ineffective in 23 cases. The efficiency was 82.6%. 2 cases (2 ears) showed hearing falling at low-frequency after 2-3 months. Others didn't recur after 6 months. 1 case showed low-grade skin atrophy at the local injection part. No other side-effects showed. In 4 binaural cases, 2 cases in effect and the others had no effect, and the former recurred after 1-2 months. In control group, 1 week after the end of therapy, 3 cases (3 ears) recovered, 1 case (1 ear) recovered 2 weeks later after the end of therapy, and the 4 cases didn't recur after 2 months. The other 14 cases were ineffective.</p><p><b>CONCLUSIONS</b>Compound betamethasone injection postaural treated intractable LFSNHL effectively, but no obvious efficiency to cases with the binaural LFSNHL. May be these cases have some relationship with autoimmune inner ear disease (AIED).</p>
