Document Detail


Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome.
MedLine Citation:
PMID:  15517474     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Intraoperative parathyroid hormone (PTH) assay (QPTH) has made possible less invasive operative approaches in the treatment of primary hyperparathyroidism with stated advantages. When compared to the traditional bilateral neck exploration (BNE), only the targeted, hypersecreting gland is excised, leaving in situ non-visualized but normally functioning parathyroids. The QPTH-guided limited parathyroidectomy (LPX) must be able to identify multiglandular disease (MGD), predict a successful outcome, and have a low recurrence rate. In our series, 421 patients who underwent LPX were compared to 340 undergoing BNE; all operative failures and patients followed for 6 months or longer were included. Operative failure occurred if serum calcium and PTH levels were elevated within 6 months of parathyroidectomy. Multiglandular disease was defined in the LPX group as more than one gland excision guided by QPTH or operative failure after removal of a single abnormal gland; in the BNE group it was defined as excision of more than one enlarged gland. Recurrence was defined as elevated calcium and PTH after 6 months of eucalcemia. Operative failure and MGD rates were compared using chi-squared analysis. The method of Kaplan-Meier and the log-rank test were used to compare recurrence rates. Operative success was seen in 97% of LPX patients and in 94% of the BNE group ( p = 0.02). Multiglandular disease was identified in 3% of LPX patients and 10% of BNE patients ( p < 0.001). There was no statistical difference in the overall recurrence rates ( p = 0.23). The QPTH-guided parathyroidectomy identifies MGD and allows an improved success rate with the same low recurrence rate when compared to the results of BNE.
Authors:
George L Irvin; Carmen C Solorzano; Denise M Carneiro
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Publication Detail:
Type:  Journal Article     Date:  2004-11-11
Journal Detail:
Title:  World journal of surgery     Volume:  28     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-14     Completed Date:  2005-03-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1287-92     Citation Subset:  IM    
Affiliation:
DeWitt Daughtry Family Department of Surgery, University of Miami/Jackson Memorial Hospital, P.O. Box 016310 (M-875), Miami, FL 33101, USA. girvin@miami.edu
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MeSH Terms
Descriptor/Qualifier:
Humans
Hypercalcemia / etiology
Hyperparathyroidism / surgery
Immunoradiometric Assay / methods*
Intraoperative Period
Monitoring, Intraoperative
Parathyroid Hormone / blood*
Parathyroid Neoplasms / surgery
Parathyroidectomy* / methods
Postoperative Period
Radiopharmaceuticals / diagnostic use
Technetium Tc 99m Sestamibi / diagnostic use
Treatment Failure
Chemical
Reg. No./Substance:
0/Parathyroid Hormone; 0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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