| Near-total parathyroidectomy is beneficial for patients with secondary and tertiary hyperparathyroidism. | |
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MedLine Citation:
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PMID: 15657584 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Despite several options for the extent of parathyroidectomy in secondary and tertiary hyperparathyroidism, <5% of patients are referred for surgical procedures. The purpose of this study was to identify beneficial outcomes of near-total parathyroidectomy (NTPTX) in this population. METHODS: NTPTX (a vascularized parathyroid remnant is left in situ, and cryopreservation is performed) was completed in 142 patients with secondary (n = 93 patients) and tertiary (n = 49 patients) hyperparathyroidism, and was guided by intraoperative intact PTH (IOPTH). RESULTS: One hundred thirty-six of 142 patients (96%) remain cured at a mean follow-up time of 23 +/- 26 months. Six patients had missed mediastinal (n = 4 patients) or cervical (n = 2 patients) parathyroid glands. No patient required re-resection of a cervical parathyroid remnant. One patient had hypoparathyroidism and underwent autografting with cryopreserved tissue. NTPTX reduced parathyroid mass (4526 +/- 4515 mg to 77 +/- 56 mg) and IOPTH (1171 +/- 1252 pg/mL to 101 +/- 127 pg/mL). Fatigue and musculoskeletal pain resolved promptly after operation. Patients with tertiary hyperparathyroidism experienced an improvement in bone density of 3.6% per year. NTPTX achieved full healing of extremity ulcers without amputations or perioperative death in 22 patients with calciphylaxis. CONCLUSIONS: NTPTX effectively treats secondary and tertiary hyperparathyroidism in >95% patients. IOPTH monitoring and cryopreservation are valuable procedural adjuncts. Limb salvage in calciphylaxis, symptomatic relief, and improved bone density are substantial benefits to recommend this procedure to patients with renal hyperparathyroidism. |
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Authors:
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Mira Milas; Collin J Weber |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Surgery Volume: 136 ISSN: 0039-6060 ISO Abbreviation: Surgery Publication Date: 2004 Dec |
Date Detail:
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Created Date: 2005-01-19 Completed Date: 2005-03-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417347 Medline TA: Surgery Country: United States |
Other Details:
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Languages: eng Pagination: 1252-60 Citation Subset: AIM; IM |
Affiliation:
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Departmnt of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue/A80, Cleveland, OH 44195, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Female Humans Hyperparathyroidism / blood, diagnosis, surgery* Male Middle Aged Parathyroid Hormone / blood Parathyroidectomy / methods* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Parathyroid Hormone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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