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2.
Medicine (Baltimore) ; 100(1): e24216, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429815

RESUMO

INTRODUCTION: Hyperparathyroid crisis is a rare and potentially life-threatening complication of severe calcium intoxication. Parathyroidectomy is the only curative method for hyperparathyroid crisis. Several case reports and case series have been published on the medical and surgical treatments for hyperparathyroid crisis, however, few reports have focused on the associated perioperative anesthetic management. PATIENT CONCERNS: A 48-year-old Chinese woman presented with a 2-week history of nausea and vomiting and complained of mental status alteration including confusion and agitation in the 24 hours prior to her admission. She denied any history of past illness. Laboratory tests showed severe hypercalcemia crisis with a serum calcium level of 5.21 mmol/L and a serum intact parathyroid hormone level of > 5000 pg/mL. DIAGNOSIS: The diagnosis was hyperparathyroid crisis, acute kidney injury, acute liver injury, rhabdomyolysis, infection, and shock. INTERVENTIONS: She underwent initial management with aggressive intravenous fluid resuscitation, loop diuretic treatment, vitamin D supplement, intravenous bisphosphonates, and calcitonin therapy. However, her condition worsened, and she was transferred to the operating theater for a parathyroidectomy under general anesthesia. She was under general anesthesia and monitored with electrocardiogram, pulse oxygen saturation, continuous arterial blood pressure, central venous pressure and nasopharyngeal temperature. Cardiac output and stroke volume variation were monitored from the FloTrac system. After liberal fluid rehydration, circulatory support, cooling treatment and calcium supplement after tumor removal, her unstable vital signs gradually improved. OUTCOMES: After meticulous anesthetic management by the anesthesiologist and complete tumor resection by the surgeon, she survived this fatal disease. The patients was discharged on postoperative day 37 without any sequelae. LESSONS: Patients with hyperparathyroid crisis should undergo a thorough preoperative evaluation. Difficult airway, fluid depletion, multiple organ dysfunction, hypercoagulability, and concomitant diseases are the primary challenges in anesthetic management. After tumor removal, the serum calcium level should be monitored closely and calcium should be supplemented in a timely manner to prevent serious complications.


Assuntos
Anestesia Geral , Hipercalcemia/sangue , Hiperparatireoidismo/diagnóstico , Paratireoidectomia , Diagnóstico Diferencial , Feminino , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/complicações , Hiperparatireoidismo/cirurgia , Pessoa de Meia-Idade , Náusea/etiologia
4.
Khirurgiia (Mosk) ; (10): 112-115, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047594

RESUMO

According to the modern literature, mediastinal parathyroid glands are diagnosed in 2-20% of cases. In the available Russian-language literature, there are few reports on successful resection of mediastinal parathyroid glands in impossible surgery through cervical approach. Despite the development of minimally invasive surgical approaches and their advantages, traumatic sternotomy was used in these cases. We report a successful thoracoscopic resection of mediastinal parathyroid gland in a patient with persistent hyperparathyroidism. Preoperative topical diagnosis was essential for successful surgery. Favorable postoperative outcome was confirmed by regression of symptoms and vascular calcification, as well as improved densitometric parameters in one year after surgery.


Assuntos
Hiperparatireoidismo/cirurgia , Glândulas Paratireoides/cirurgia , Toracoscopia , Humanos , Hiperparatireoidismo/diagnóstico , Mediastino/cirurgia , Cuidados Pré-Operatórios
6.
Endocrine ; 68(3): 485-488, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32500518

RESUMO

The ongoing spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the coronavirus outbreak began spreading, hospitals were forced to relocate resources to treat the growing number of COVID-19 patients. As a consequence, doctors across the country canceled tens of thousands of nonurgent surgeries. However, recognizing that the COVID-19 situation may be highly variable and fluid in different communities across the country, elective surgery could be still allowed in some centers for patients included in the high-priority class. The majority of endocrine disorders requiring surgical treatment in patients identifiable as first-priority class, or needing hospitalization within 30 days, are generally represented by malignant thyroid tumors, hyperthyroidism, hyperparathyroidism, and some adrenal disorders. The need for urgent intervention is evaluated on a case-by-case basis according to the severity of the symptoms, the likelihood of progression, and global clinical judgment. On the basis of the above indications, during the last 4 weeks, we performed 18 planned surgical treatments in patients with thyroid cancer (total thyroidectomies, plus lymph node dissection if needed) or multinodular toxic goiter. In no case, postoperative ventilatory support was needed, and the average hospital stay was 3 days. The negative COVID-19 status for all the treated patients was appropriately evaluated beforehand. Nobody knows how long the current COVID-19 pandemic will be lasting. Certainly, we will be requested in the next future to incrementally offer surgical services for endocrine disorders that have been deferred for the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Procedimentos Cirúrgicos Endócrinos , Doenças do Sistema Endócrino/cirurgia , Pandemias , Pneumonia Viral , Doenças das Glândulas Suprarrenais/cirurgia , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos , Tratamento de Emergência , Humanos , Hiperparatireoidismo/cirurgia , Hipertireoidismo/cirurgia , Itália/epidemiologia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Prognóstico , Índice de Gravidade de Doença , Neoplasias da Glândula Tireoide/cirurgia
7.
Medicine (Baltimore) ; 99(20): e20313, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443382

RESUMO

Carpal tunnel syndrome (CTS) is the most common mononeuropathy in clinical practice. Some patients with end-stage renal disease (ESRD) often associate with tertiary hyperparathyroidism, and ultimately need parathyroidectomy (PTX). However, no studies have definitively demonstrated an effect of PTX on ESRD patients' quality of life. We selected 1686 patients who underwent PTX and 1686 patients who did not receive PTX between 2000 and 2010. These patients were propensity-matched with others by age, sex, and comorbidities at a ratio of 1:1. We used single and multivariable cox proportional hazard models to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). In this study, 116 ESRD patients developed CTS, and the CTS incidences were 7.33 and 12.5 per 1000 person-years for the non-PTX and PTX group. The results reveal that the incidence curve for the PTX group was significantly higher than that for the non-PTX group (log-rank test, P = .004). After adjustments were made for sex, age, and baseline comorbidities, the PTX group had a 1.70-fold higher risk of CTS (hazard ratio (HR) = 1.70, 95% confidence intervals (CI) = 1.17-2.47) than the non-PTX group. The results also demonstrated that female patients (HR = 1.60, 95% CI = 1.06-2.42) and patients with one or more comorbidities (HR = 1.79, 95% CI = 1.23-2.60) might have an increased risk of CTS. The subhazard ratio for CTS risk was 1.62 (95% CI = 1.12-2.36) for the PTX group compared with the non-PTX group in the competing risk of death. In conclusion, we revealed that ESRD patients who had undergone PTX may have an increased risk of CTS.


Assuntos
Síndrome do Túnel Carpal/epidemiologia , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/cirurgia , Falência Renal Crônica/complicações , Paratireoidectomia/estatística & dados numéricos , Fatores Etários , Comorbidade , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Qualidade de Vida , Fatores de Risco , Fatores Sexuais , Taiwan/epidemiologia
9.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(5): 310-316, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191306

RESUMO

INTRODUCCIÓN: El síndrome del hueso hambriento (SHH) es una complicación tras la cirugía paratiroidea que puede causar una hipocalcemia grave y prolongada. El objetivo fue conocer los factores de riesgo de SHH después de la cirugía por hiperparatiroidismo primario y su relación con los niveles de calcio sérico y de hormona paratiroidea (PTH). MATERIALES Y MÉTODOS: Se realizó un estudio analítico observacional de casos y controles en pacientes operados por hiperparatiroidismo primario en los últimos 10 años (2008-2017). Se estudió la evolución analítica del calcio, la PTH y las características generales de los pacientes. RESULTADOS: La incidencia de SHH en nuestra serie fue del 12,2%. Se encontró una asociación significativa de SHH con la cirugía tiroidea en el mismo acto quirúrgico (odds ratio ajustada [ORa] = 17,241), con la edad mayor de 68 años (Ora = 6,666) y con el tamaño de la lesión mayor a 1,7cm (Ora = 7.165). Observamos una relación estadísticamente significativa entre presentar SHH con un valor mayor a la media de calcio sérico corregido el día después de la cirugía, a la semana y a los 3 meses, así como con un valor mayor de la media de PTH preoperatoria, en la cirugía y un día después de la cirugía. CONCLUSIÓN: Los factores de riesgo independientes para el desarrollo de SHH en nuestra serie fueron la edad del paciente, el tamaño de la lesión y si la intervención se acompaña de cirugía tiroidea, lo que obliga a una monitorización más estrecha del metabolismo mineral durante el perioperatorio


INTRODUCTION: Hungry bone syndrome (HBS) is a complication occurring after parathyroid surgery that can cause severe and prolonged hypocalcemia. The study objective was to know the risk factors for HBS after surgery for primary hyperparathyroidism and its relationship with serum calcium and parathyroid hormone levels. MATERIAL AND METHODS: A case-control, observational, analytical study was conducted in patients who had undergone surgery for primary hyperparathyroidism in the past 10 years (2007-2016). Changes over time in serum calcium and PTH levels and the general characteristics of patients were analyzed. RESULTS: The incidence rate of HBS in our series was 12.2%. HBS was found to be significantly associated to thyroid surgery during the surgical procedure itself (adjusted odds ratio [aOR] = 17.241), to age older than 68 years (aOR = 6.666), and to lesions greater than 1.7cm (aOR = 7.165). A statistically significant relationship was seen between presence of HBS and corrected serum calcium levels higher than the mean the day after surgery and one week and 3 months later, and also with PTH levels higher than the mean before, during, and one day after surgery. CONCLUSIÓN: In our series, independent risk factors for development of HBS included patient age, lesion size, and whether or not the procedure was accompanied by thyroid surgery, which requires closer monitoring of mineral metabolism during the perioperative period


Assuntos
Humanos , Masculino , Feminino , Idoso , Hormônio Paratireóideo/metabolismo , Paratireoidectomia , Hiperparatireoidismo/cirurgia , Hiperparatireoidismo Primário , Doenças Ósseas Metabólicas/diagnóstico , Complicações Pós-Operatórias/terapia , Cálcio/sangue , Fatores de Risco , Hiperparatireoidismo Primário/etiologia , Complicações Pós-Operatórias/diagnóstico , Estudos de Casos e Controles , Cálcio/administração & dosagem , Cálcio/metabolismo , Modelos Logísticos
10.
Einstein (Sao Paulo) ; 18: eRC4819, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31994611

RESUMO

We describe a patient with tertiary hyperparathyroidism with history of three episodes of deep vein thrombosis and on rivaroxaban. The patient underwent a subtotal parathyroidectomy, developing cervical hematoma with airway compression. Therefore, emergency surgical decompression was necessary. Later, on the ninth postoperative day, the serum ionized calcium levels were low. Medical team knowledge about preexisting diseases and their implication in the coagulation state are essential conditions to reduce morbidity and mortality of surgeries. However, no reports were found in literature about the association of hypocalcemia with the use of the new class of anticoagulants, which act as factor X inhibitors (Stuart-Prower factor), predisposing to increased bleeding in the immediate postoperative period.


Assuntos
Transtornos da Coagulação Sanguínea/tratamento farmacológico , Inibidores do Fator Xa/efeitos adversos , Hipocalcemia/induzido quimicamente , Rivaroxabana/efeitos adversos , Cálcio/sangue , Humanos , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/cirurgia , Hipocalcemia/cirurgia , Masculino , Pessoa de Meia-Idade , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Insuficiência Renal Crônica/complicações , Fatores de Risco
11.
Korean J Radiol ; 21(2): 236-247, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31997599

RESUMO

OBJECTIVE: Our aim was to assess the diagnostic performance of F-18 fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) in detecting hyperfunctioning parathyroid tissue (HPT) in patients with elevated parathyroid hormone levels with negative or inconclusive conventional imaging results and to compare the findings with those obtained using technetium-99m sestamibi (MIBI) scintigraphy and neck ultrasonography (US). MATERIALS AND METHODS: Images of 105 patients with hyperparathyroidism who underwent FCH PET/CT, dual-phase MIBI parathyroid scintigraphy (median interval: 42 days), and neck US were retrospectively analyzed. The gold standard was histopathological findings for 81 patients who underwent parathyroidectomy and clinical follow-up findings in the remaining 24 patients. Sensitivities, positive predictive values (PPVs), and accuracies were calculated for all imaging modalities. RESULTS: Among the 81 patients who underwent parathyroidectomy, either parathyroid adenoma (n = 64), hyperplasia (n = 9), neoplasia (n = 4), or both parathyroid adenoma and hyperplasia (n = 1) were detected, except 3 patients who did not show HPT. Of the 24 (23%) patients who were followed-up without operation, 22 (92%) showed persistent hyperparathyroidism. FCH PET/CT showed significantly higher sensitivity than MIBI scintigraphy and US in detection of HPT (p < 0.01). Sensitivity, PPV, and accuracy of FCH PET/CT were 94.1% (95/101), 97.9% (95/97), and 92.4% (97/105), respectively. The corresponding values for MIBI scintigraphy and US were 45.1% (46/102), 97.9% (46/47), and 45.7% (48/105) and 44.1% (45/102), 93.8% (45/48), and 42.9% (45/105), respectively. Among the 35 patients showing negative MIBI scintigraphy and neck US findings, 30 (86%) showed positive results on FCH PET/CT. FCH PET/CT could demonstrate ectopic locations of HPT in 11 patients whereas MIBI and US showed positive findings in only 6 and 3 patients, respectively. CONCLUSION: FCH PET/CT is an effective imaging modality for detection of HPT with the highest sensitivity among the available imaging techniques. Therefore, FCH PET/CT can be recommended especially for patients who show negative or inconclusive results on conventional imaging.


Assuntos
Colina/análogos & derivados , Hiperparatireoidismo/diagnóstico por imagem , Hormônio Paratireóideo/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/química , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colina/química , Feminino , Humanos , Hiperparatireoidismo/patologia , Hiperparatireoidismo/cirurgia , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/patologia , Paratireoidectomia , Estudos Retrospectivos , Tecnécio Tc 99m Sestamibi/química , Adulto Jovem
12.
Cir. Esp. (Ed. impr.) ; 98(1): 18-25, ene. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187950

RESUMO

Introducción: Una correcta localización preoperatoria del adenoma es clave en el tratamiento del hiperparatiroidismo primario (HPTP) mediante paratiroidectomía selectiva. Aunque existen múltiples técnicas de imagen, no siempre consiguen localizar correctamente la/s glándula/s patológica/s. El objetivo es estudiar los factores que puedan influir en la sensibilidad y la concordancia de la ecografía y la gammagrafía 99 mTc-metoxi-isobutil-isonitrilo (MIBI). Métodos: Población a estudio: pacientes intervenidos con HPTP por adenoma con estudio preoperatorio de localización con ecografía y gammagrafía 99 mTc-MIBI. Los pacientes fueron tratados en nuestro centro entre 2004 y 2018. Se han excluido a los que no tuvieran ambas pruebas, las hiperplasias, las neoplasias endocrinas múltiples (MEN) y los adenomas ectópicos no abordables por vía transcervical. Se han estimado la sensibilidad, la concordancia y el valor predictivo positivo (VPP) de las técnicas de imagen con respecto a la localización intraoperatoria, analizando los potenciales factores que pueden influir en ello. Resultados: Se ha analizado a 139 pacientes (82% mujeres, 18% varones). La ecografía ha tenido una sensibilidad del 56,7%, una concordancia (índice kappa) de 0,387 y un VPP del 96,3%. En el caso de la gammagrafía, la sensibilidad ha sido del 81,6%, la concordancia (índice kappa) del 0,669 y su VPP del 97,4%. En el análisis de regresión logística, el factor que ha influido en la localización mediante ecografía ha sido la ausencia de enfermedad tiroidea asociada. En el caso de la gammagrafía, el factor ha sido el peso glandular mayor de 600 mg. Conclusiones: La sensibilidad de la ecografía mejora en ausencia de enfermedad tiroidea y la de la gammagrafía con el peso glandular mayor de 600 mg


Introduction: The treatment of choice for primary hyperparathyroidism (PHPT) when there is proper preoperative localization of the adenoma is minimally invasive parathyroidectomy. However, imaging techniques are not always able to provide the exact location. The objective is to identify potential factors that might influence the sensitivity and concordance of ultrasound (US) and 99mTc-methoxy-isonitrile parathyroid scintigraphy (MIBI-PS) and the actual location of the adenoma. Methods: We reviewed the data of patients who underwent parathyroidectomies for PHPT. All patients had undergone ultrasound and 99mTc-MIBI scintigraphy as a preoperative location study. Multiple endocrine neoplasms, other hyperplasias and non-cervical ectopic adenomas were excluded. The sensitivity, PPV and concordance have been estimated for the location of the gland in both tests compared with the intraoperative location, using a multivariable analysis of the factors that might influence their localization capacity. Results: 139 patients (82% women) have been analysed. The US sensitivity was 56.7%, concordance (Kappa index) 0.387 and PPV 96.3%. The MIBI-PS sensitivity was 81.6%, the concordance (Kappa index) 0.669 and the PPV 97.4%. The factor that improved localization of the glands by US in the multivariable analysis was the absence of a concomitant thyroid pathology. The factor that improved the MIBI-PS results was a gland weight greater than 600 mg. Conclusions: US sensitivity improves when there is no concomitant thyroid pathology. MIBI-PS sensitivity improves when the gland weight is greater than 600 mg


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/diagnóstico por imagem , Ultrassonografia , Cintilografia , Hiperparatireoidismo/diagnóstico por imagem , Sensibilidade e Especificidade , Adenoma/diagnóstico por imagem , Hiperparatireoidismo/cirurgia , Valor Preditivo dos Testes , Curva ROC , Modelos Logísticos
13.
Equine Vet J ; 52(1): 83-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30980730

RESUMO

BACKGROUND: Primary hyperparathyroidism is uncommon in equids. OBJECTIVES: To describe the diagnostic findings and efficacy of treatment in equids with primary hyperparathyroidism. STUDY DESIGN: Retrospective case series describing 16 horses and one mule. METHODS: Cases were identified by retrospective review of records at Cornell University and via an ACVIM listserv query. Inclusion criteria were an equid with hypercalcemia, normal renal function and high parathyroid hormone (PTH) or histopathological diagnosis of a parathyroid adenoma. Equids with normal PTH and PTH-related protein (PTHrP) in the face of hypercalcemia were included as suspect cases. RESULTS: The most common presenting complaints were weight loss (12/17) and hypercalcemia (10/17). PTH was above reference range in 12/17 cases. Suspected parathyroid tumours were localised in 12/14 equids imaged using ultrasonography alone (2/3), technetium 99m Tc sestamibi scintigraphy alone (1/1) or both modalities (9/10). Three horses did not have imaging performed. Surgical exploration successfully excised tumours in six of 10 cases. Five were located at the thoracic inlet, and surgery resulted in complete cure. One tumour was excised from the thyroid lobe, and the horse remained hypercalcemic. Four other cases explored surgically, four treated medically and three that were not treated also remained hypercalcemic. MAIN LIMITATIONS: The small study size prohibited statistical analysis. CONCLUSIONS: Parathyroid adenomas in equids can be successfully localised with ultrasonography and scintigraphy. Surgical excision appears more likely to be successful for single gland disease at the thoracic inlet.


Assuntos
Adenoma/veterinária , Equidae , Hiperparatireoidismo/veterinária , Neoplasias das Paratireoides/veterinária , Adenoma/diagnóstico , Adenoma/cirurgia , Animais , Cálcio/sangue , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/cirurgia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Estudos Retrospectivos
14.
Surg Today ; 50(7): 650-656, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31165923

RESUMO

PURPOSE: To establish if parathyroidectomy is beneficial for patient-reported outcomes (PROs), including quality of life (QoL), of patients with mild hypercalcemia ( < 1.0 mg/dl above the upper limit of reference ranges) caused by primary hyperparathyroidism without classic symptoms (mild PHPT). METHODS: We conducted a systematic review of the literature. Prospective studies were selected if PROs were measured before and after surgery and if the subpopulation of mild PHPT was clearly defined. Selected studies were appraised for their designs, PRO measures, and potential biases, as well as findings. Effect sizes were estimated to evaluate the extent of the benefits, if possible. RESULTS: Four randomized controlled trials and six observational studies were included in this analysis. Seven studies used the SF-36 to measure QoL and the other three used different scales. Quantitative data on outcomes were provided in the four observational studies, but effect sizes could not be estimated. A placebo effect of surgery was discussed in five studies. Statistically significant improvements in PROs were observed in all studies, but the clinical importance of the changes was not discussed in detail. CONCLUSIONS: The surgical treatment of mild PHPT may be associated with improved PROs, but the clinical significance of the changes is not yet confirmed.


Assuntos
Hipercalcemia/etiologia , Hiperparatireoidismo/complicações , Hiperparatireoidismo/cirurgia , Medidas de Resultados Relatados pelo Paciente , Doenças Assintomáticas , Humanos , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
J Surg Res ; 246: 139-144, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31569035

RESUMO

BACKGROUND: Ex vivo aspiration of parathyroid glands for the measurement of intraoperative parathyroid hormone (IOPTH) levels is a rapid point-of-care method to confirm parathyroid tissue during parathyroidectomy and an alternative to frozen section (FS). This study sought to determine the awareness and utilization of this technique among endocrine surgeons. MATERIALS AND METHODS: A de-identified 12-question survey regarding techniques for intraoperative identification/confirmation of parathyroid tissue and the use of IOPTH monitoring was distributed to all 608 members of the American Association of Endocrine Surgeons. RESULTS: Among the 182 (30%) respondents, FS was the most common primary technique utilized by 115 (63%) respondents to confirm parathyroid tissue; only 12 (7%) utilized ex vivo aspiration, although 78 (42%) were familiar with the technique. Availability and familiarity were the principal reasons for use of the primary technique; the most common barrier was time. Serum IOPTH monitoring was routinely used by 124 (74%). Of respondents who utilized FS, serum IOPTH monitoring was routinely used by 75% (86/115), including 71% (45/63) who reported time as a barrier to FS. Of these 45, only 15 (33%) were familiar with ex vivo parathyroid aspiration. Only 48% of surgeons knew how PTH samples were charged. CONCLUSIONS: FS was the most common method of identification/confirmation of parathyroid tissue. Although most respondents routinely performed IOPTH monitoring, relatively few utilized ex vivo aspiration as a technique for parathyroid identification and less than 50% were familiar with this technique. Broader dissemination about novel techniques such as ex vivo aspiration and cost awareness are recommended.


Assuntos
Hiperparatireoidismo/cirurgia , Cuidados Intraoperatórios/métodos , Monitorização Intraoperatória/métodos , Glândulas Paratireoides/patologia , Paratireoidectomia/métodos , Biópsia por Agulha/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Secções Congeladas/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios/estatística & dados numéricos , Monitorização Intraoperatória/estatística & dados numéricos , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/sangue , Paratireoidectomia/estatística & dados numéricos , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo
16.
Rev. ORL (Salamanca) ; 11(2): 1-17, 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193769

RESUMO

Nuestro objetivo es lograr un relato de los detalles anatómicos que ayude al cirujano a conseguir intervenciones seguras, se elude el estilo de las anatomías descriptivas o topográficas tratando de producir una anatomía verdaderamente quirúrgica. Para ello se mencionan las fascias, estructuras capsulares y ligamentos que envuelven a la tiroides. Se hace hincapié en la vascularización, principalmente en lo referente a la arteria tiroidea inferior, fundamental para la localización del nervio recurrente. También en lo relacionado con el conjunto del drenaje venoso, que con su complicada distribución dificulta notablemente la disección. Relatamos minuciosamente las variantes anatómicas y las anomalías que afectan a la estructura de la región, su conocimiento es fundamental ante la posibilidad de que el cirujano encuentre en sus operaciones alguna de ellas. Describimos el aspecto, las relaciones y lo referente a la localización de las glándulas paratiroides, detalles necesarios para evitar su resección inopinada en las tiroidectomías y para el reconocimiento de la glándula patológica en el hiperparatiroidismo


The aim of this article is describe the anatomical details that helps the surgeon to achieve safe surgeries, the style of descriptive or topographic anatomies is avoided trying to produce a truly surgical anatomy. For this, fascias, capsular structures and ligaments that surround the thyroid gland are mentioned. Emphasis is placed on vascularization, mainly in relation to the inferior thyroid artery, essential for the location of the recurrent nerve. Also in relation to the whole of the venous drainage, which with its complicated distribution makes dissection remarkably difficult. We carefully describe the anatomical variants and the anomalies that affect the structures of the region, their knowledge is fundamental to the possibility that the surgeons finds in their surgeries. We describe the appearance, the relationships and the reference to the location of the parathyroid glans. Neccesary details to avoid their inopinate resection in thyroidectomies and for the recognition of the pathological gland in the hyperparathyroidism


Assuntos
Humanos , Glândula Tireoide/anatomia & histologia , Glândula Tireoide/cirurgia , Glândulas Paratireoides/anatomia & histologia , Glândulas Paratireoides/cirurgia , Fáscia/anatomia & histologia , Nervo Laríngeo Recorrente/anatomia & histologia , Nervos Laríngeos/anatomia & histologia , Nervos Laríngeos/cirurgia , Tireoidectomia , Hiperparatireoidismo/cirurgia , Dissecação/métodos , Músculos Laríngeos/anatomia & histologia , Músculos Laríngeos/cirurgia , Tireoide Lingual/cirurgia , Nervo Laríngeo Recorrente/cirurgia
17.
Med Arch ; 73(4): 249-252, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31762559

RESUMO

Introduction: Hyperparathyroidism is a common endocrine disorder with potential complications of bone, renal, neurocognitive and cardiovascular system. Aim: To determine the correlation between the size of parathyroid glands and parathormone values in the patients with hyperparathyroidism. Methods: We analyzed a retrospective-prospective database of 79 consecutive patients who underwent parathyroidectomy for hyperparathyroidism at our institution between January 2011 and February 2018. The values of parathormone, calcium and phosphorus were determined in all patients before and after surgery. Ultrasonography were performed before surgery. Imaging results were confirmed by pathology. We analyzed the correlation between the sizes parathyroid glands obtained trough ultrasonography and pathology with parathormone values. Results: The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. Our study demonstrated that between actual glands sizes (volumes), expresses in millimeters, measured on pathohistological analysis and ultrasound examination and size value of parathormone its increased value does not affect the size of the gland. We investigate the correlation between the size of glands measured according to the pathohistological finding and the value of parathormone we obtained the correlation results close to the statistical features. The correlation value of parathormone and glands sizes according to the pathohistological finding measured trough the determined assessment scale we determined the statistically important of medium value. Conclusion: One of the important factors for parathyroidectomy is the value of parathormone. Serum parathormone level might be predictable by a total size of parathyroid glands and could be an effective the predictor of gland localisation.


Assuntos
Hiperparatireoidismo/patologia , Glândulas Paratireoides/patologia , Hormônio Paratireóideo/sangue , Adulto , Idoso , Cálcio/sangue , Feminino , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo/cirurgia , Pessoa de Meia-Idade , Tamanho do Órgão , Glândulas Paratireoides/diagnóstico por imagem , Paratireoidectomia , Fósforo/sangue , Gravidez , Estudos Retrospectivos , Ultrassonografia , Adulto Jovem
18.
In Vivo ; 33(5): 1691-1696, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471425

RESUMO

BACKGROUND/AIM: Parathyroidectomy has beneficial effects on all-cause and cardiovascular mortality in patients with uncontrolled hyperparathyroidism. B-Type natriuretic peptide (BNP) correlates with the severity of heart failure. We aimed to investigate whether parathyroidectomy modulates the BNP levels in dialysis patients. PATIENTS AND METHODS: Patients who underwent surgical intervention for hyperparathyroidism were included. The serum BNP levels were determined before parathyroidectomy and during follow-up. RESULTS: The preoperative and postoperative BNP levels were 499±561 and 453±442 pg/ml, respectively (p=0.82). The baseline BNP level was positively correlated with weakness and headache, but not biochemical parameters. In multivariate analysis, age (odds ratio=0.837) and preoperative symptom score (odds ratio=0.935) were independent predictors for the postoperative decline in BNP levels Conclusion: The serum BNP levels may increase or decrease after parathyroidectomy. Younger age and lower symptom burden are associated with decline in BNP levels.


Assuntos
Biomarcadores , Peptídeo Natriurético Encefálico/sangue , Paratireoidectomia , Diálise Renal , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/cirurgia , Masculino , Pessoa de Meia-Idade , Paratireoidectomia/efeitos adversos
19.
J Musculoskelet Neuronal Interact ; 19(3): 379-384, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31475947

RESUMO

Hungry Bone Syndrome (HBS) refers to rapid, profound, and prolonged hypocalcemia associated with hypophosphatemia and hypomagnesemia occurring in patients with increased bone turnover after successful management of the underlying disorder. We describe a male patient with primary hyperparathyroidism (PHPT), in whom HBS was diagnosed 6 months after parathyroidectomy. Histopathologic examination revealed an atypical parathyroid adenoma (APA), while immunohistochemistry showed cell proliferation index Ki-67 10% and overexpression of cyclin D1 (>90%). Preoperative treatment with vitamin D3 had normalized 25OHD and alkaline phosphatase levels, reflected in an improvement in bone turnover prior to surgery. Postoperative treatment for HBS with alfacalcidol, calcium, vitamin D3 and magnesium was administered for a long period. This treatment prevented severe postoperative hypocalcemia and he was discharged two days later. Preoperative cinacalcet treatment did not reduce hypercalcemia implying that the tumor had lack of calciumsensing receptors (CaSR). In conclusion, preoperative restoration of low 25OHD levels is essential for prevention of HBS. Postoperative treatment with active metabolites of vitamin D must be initiated as early as possible, in order to prevent or minimize the development of HBS, and to reduce the duration of hospitalization.


Assuntos
Hipocalcemia/etiologia , Hipofosfatemia/etiologia , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adenoma/complicações , Adenoma/cirurgia , Adulto , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/uso terapêutico , Hormônios e Agentes Reguladores de Cálcio/uso terapêutico , Colecalciferol/uso terapêutico , Cinacalcete/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Hiperparatireoidismo/tratamento farmacológico , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/cirurgia , Hipocalcemia/tratamento farmacológico , Hipofosfatemia/tratamento farmacológico , Magnésio/uso terapêutico , Masculino , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Síndrome
20.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(6): 501-503, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31378705

RESUMO

INTRODUCTION: Primary hyperparathyroidism (PHPT) during pregnancy can be responsible for serious maternal and foetal complications and should be treated by elective low-risk, minimally invasive surgery. Preoperative assessment of hyperfunctioning parathyroid glands is classically based on high-resolution neck ultrasound (US) and 99mTc-sestamibi/123I scintigraphy. However, administration of any radiopharmaceutical during pregnancy must be limited and justified and US alone may be sufficient to localize an abnormal parathyroid gland. CASE REPORT: We report the case of a 4-month pregnant woman with severe primary hyperparathyroidism, in whom US failed to localize the abnormal parathyroid gland. 99mTc-sestamibi scintigraphy was performed in preference to 18-fluorocholine (FCH)-PET/CT on the basis of a multidisciplinary decision. As 99mTc-MIBI demonstrated an hyperfunctioning right inferior parathyroid, 123I was not administered. A large right paravertebral parathyroid adenoma was successfully removed, as confirmed by decreased postoperative serum parathyroid hormone and calcium levels. The eutrophic newborn infant was delivered at term, with normal serum calcium and TSH levels. DISCUSSION: In pregnant women with primary hyperparathyroidism, US alone may be sufficient when it localizes the abnormal parathyroid gland, allowing elective low-risk minimally invasive surgery. Otherwise, a multidisciplinary approach is mandatory to select the radiopharmaceutical that can be safely used to identify the hyperfunctioning parathyroid gland with minimal risks for the foetus.


Assuntos
Adenoma/diagnóstico por imagem , Hiperparatireoidismo/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico por imagem , Cintilografia , Tecnécio Tc 99m Sestamibi , Adenoma/patologia , Adenoma/cirurgia , Adulto , Feminino , Humanos , Hiperparatireoidismo/patologia , Hiperparatireoidismo/cirurgia , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Gravidez
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