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Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Unilateral and minimally invasive parathyroidectomies with endoscopic and video-assisted technique have been introduced. Most of these procedures utilize preoperative localization and intraoperative monitoring of parathyroid hormone. There are only a few reports on these procedures. The objective of this study was to evaluate video-assisted parathyroidectomy (MIVAP) for surgery in patients with primary hyperparathyroidism (pHPT). From February 1997 to June 1999 a series of 123 consecutive patients with pHPT at four surgical centers were evaluated. The patients' ages ranged from 18 to 77 years (median 50 years). Preoperatively, sestamibi scintigraphy and ultrasonography for localization were performed for all patients. Selection criteria for a MIVAP procedure excluded patients with negative localization, suspicion of multiglandular disease (MGD) or thyroid malignancy, a large thyroid mass, and prior surgery or irradiation to the neck. MIVAP was performed with a 1.5 cm suprasternal incision; the operation was then done through this incision with a 30 degree 5 mm endoscope and microsurgical instruments with brief CO2 insufflation for adenoma identification. We then proceeded with an open technique through the small incision under video-assistance. Intraoperative monitoring of intact parathyroid hormone (iPTH) assays was used in all patients. Among the 123 patients in whom MIVAP was attempted, the procedure was accomplished in 109 (89%). Conversion to conventional cervicotomy was required in 14 (11%) patients because of failed localization, failure of the iPTH level to fall appropriately, or technical problems. There was no persistent or recurrent HPT during the 3 to 12-month follow-up. Oral calcium replacement for symptomatic hypocalcemia postoperatively was given in 7 (6%) cases. A unilateral transient laryngeal nerve palsy, resolving within 6 months postoperatively, occurred in two (2%) patients. The median hospital stay was 1.5 days (range 0.5-5.0 days). This study showed the feasibility of MIVAP as an alternative surgical treatment for pHPT in a selected group of patients. Further studies are necessary to evaluate the efficacy and rationale of MIVAP compared to other techniques for parathyroidectomy in pHPT patients.
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PMID:Minimally invasive video-assisted parathyroidectomy: multiinstitutional study. 1137 2

We set out to determine the accuracy in predicting the success of biochemical and localizing studies for use in a minimally invasive parathyroidectomy. Preoperative sestamibi scans, intraoperative gamma-probe examinations, and intraoperative PTH (IOPTH) monitoring were performed on a prospective cohort of patients. Seventy-one patients were included in the study. Of the 59 patients (83%) with primary HPT, adenoma localization by sestamibi scanning was correct in 95% with solitary adenomas, but was correct in only 25% of the 14 patients with multiple adenomas. In patients with secondary and tertiary disease, sestamibi scanning incorrectly identified a single hot spot in 64% of cases. In no case of hyperplasia was the probe useful in locating other glands after a single gland was removed. IOPTH was accurate in 78% of patients with primary disease and in only 45% of patients with nonprimary disease. A minimal approach can be considered in a select group of patients that does not have familial primary HPT, secondary or tertiary disease, coexisting thyroid pathology, or an equivocal sestamibi scan. Only patients with a positive single hot spot on sestamibi scan can be considered candidates. Using this criteria only 64% of all patients with hyperparathyroidism are candidates for a minimally invasive approach. The combination of a solitary hot spot on sestamibi scan and a fall in IOPTH allows the surgeon to make the correct decision regarding the need to convert to a bilateral approach in 93% of these selected patients.
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PMID:Parathyroid surgery: separating promise from reality. 1188 56

Secondary hyperparathyroidism (II HPT) is a major complication in chronic dialysis patients, and percutaneous ethanol injection therapy (PEIT) has become a useful alternative treatment for II HPT. However, the existence of ectopic parathyroid glands is a major problem when conducting PEIT. Ectopic parathyroid gland accepts 10-35% of II HPT, and the missing glands cannot be detected consistently by any imaging techniques, including scintigraphy. Intrathyroid parathyroid gland is as rare as about 1% and recurrence of missing glands after parathyroidectomy (PTx) has been reported in some cases. We report here a 52-year-old female in whom an ectopic parathyroid gland was defected successfully and intact-PTH controlled by tentative PEIT. At the first examination, a left parathyroid adenoma and a right thyroid goiter were pointed out by ultrasonography, CT and scintigraphy. PEIT was applied twice to the left parathyroid adenoma, but intact-PTH was not decreased. Ultrasonography, CT, 201Tl-99mTc subtraction scintigraphy and fine needle aspiration biopsy (FNAB) were performed again to search for the existence of ectopic glands. The results suggested that the right intrathyroid tumor was an ectopic parathyroid gland. Consequently, tentative PEIT was applied to the right intrathyroid tumor, and successful control of intact-PTH and serum Ca was eventually achieved. To our knowledge, this is the first reported case of secondary hyperparathyroidism with an ectopic intrathyroid gland that was successfully controlled by PEIT. In this case, it was suggested that tentative PEIT of intrathyroid tumor was a useful method for detecting an ectopic parathyroid gland.
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PMID:[A case of secondary hyperparathyroidism with an ectopic intrathyroid gland successfully diagnosed and controlled by percutaneous ethanol injection therapy (PEIT)]. 1207 27

Mediastinal exploration to resect ectopic parathyroid is required in approximately 2% of all cases of hyperparathyroidism. Traditionally, it has been performed through a midsternotomy or thoracotomy. A few reports about thoracoscopic resection of mediastinal parathyroid were published recently. We report here successful video-assisted thoracoscopic resection (VATS) of a mediastinal parathyroid and present a review of all previously reported cases. A 42-year-old woman presented with spontaneous fracture of the left femur and hypercalcemia. She had previously undergone cervical parathyroidectomy for primary hyperparathyroidism. A computed tomography (CT) scan of the chest and a technetium scan showed ectopic mediastinal parathyroid. The patient underwent successful thoracoscopic resection of ectopic parathyroid. A total of 26 patients were reviewed, 21 in the English literature and 5 in others. Of the 21 patients reported in the English literature, 16 had primary hyperparathyroidism (1 degrees HPT), whereas 5 had secondary hyperparathyroidism (2 degrees HPT). All but 3 patients had undergone previous cervical exploration. Ectopic mediastinal parathyroid was localized preoperatively in all by CT scans of the chest and nuclear scans. All 21 patients had successful thoracoscopic resection. All but 3 had parathyroid adenoma. Postoperatively, serum calcium (Ca ), phosphate (PO4 ), and parathormone (PTH) values returned to normal in all patients. Age and sex of the patient, type of hyperparathyroidism (1 degrees or 2 degrees ), size of the gland, its location within the anterior mediastinum, the approach used to resect it (right or left thoracoscopic), and final histopathology of the resected gland (adenoma or hyperplasia) had no bearing on the success of thoracoscopic resection. The data seem to suggest that thoracoscopic resection of mediastinal parathyroid is a less-invasive, effective, and safe procedure. Accurate preoperative anatomic localization by CT and nuclear scans of the chest is the key to success.
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PMID:Thoracoscopy: the preferred method for excision of mediastinal parathyroids. 1219 31

The typical manifestations of severe hypercalcemia with osteitis fibrosa cystica have become exceedingly rare. We describe the case of a woman hospitalized for a tibial tumor with functional impotence, leading to a diagnosis of primary hyperparathyroidism (HPT I) associated with profound vitamin D deficiency. This 31-year-old woman was admitted, after two pregnancies complicated by the HELLP syndrome. Preoperative laboratory values were as follows: calcemia 4.05 mmol/l (2.2-2.6); urinary calcium 30 mmol/24 h (1.25-7.5); parathormone (PTH) 1 195 pg/ml (10-60); and 25 OH-vitamin D 13 nmol/l (22-120). Specific MIBI uptake by the tibial lesion oriented the diagnosis towards a brown tumor. After surgical excision of a parathyroid adenoma and the brown tumor (associated with tibial fracture), calcemia fell to 1.55 mmol/l and normalized after three months. Urinary calcium fell to 0.1 mmol/24 h and remained low during the 2 years following surgery. Vitamin D levels rapidly normalized on supplementation (87 nmol/l). PTH levels fell markedly after surgery but remained higher than normal till 2 years after surgery despite normalization of calcemia three months after. Bone repair, estimated by means of bone densitometry, improved from preoperative Z-score values of - 6.54, - 5.20 and - 3.50 in the left femoral neck, right femoral neck and lumbar spine, respectively, to - 0.20, - 1.55 and - 0.28, respectively, one year after surgery. In conclusion, this case illustrates: 1) the severe osseous expression of HPT probably related to vitamin D deficiency; 2) specific MIBI uptake by the bone lesion, orientating the diagnosis towards a brown tumor; 3) the consequences of vitamin D deficiency on postoperative outcome, with transient severe initial hypocalcemia related to bone calcium avidity; 4) a possible link between HPT and the HELLP syndrome.
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PMID:Vitamin D deficiency and severe hyperparathyroidism. 1252 57

For a long time, bilateral cervicotomy with a scrupulous exploration of the sites of the parathyroid glands was the technique of choice in the treatment of primary hyperparathyroidism. Recently new less invasive surgical techniques appeared: unilateral approach under local anaesthesia (UA LA) and video endoscopic parathyroidectomy (VEP), which could be used in 50% of patients after elimination of contraindications. Three factors support these new techniques: HPT I is in 85% of the patients related to a solitary adenoma. Ultrasonography or scintigraphy isolated or associated can detect the adenoma. Peroperative monitoring of the PTH can control the success of surgery. In our experience, 95 to 98 per cent of patients are cured of their HPTI.... In our opinion, UALA, technically simpler, with long term good results, is the technique of choice.
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PMID:[New directions in the surgical treatment of primary hyperparathyroidism]. 1455 64

In the last years, with the aim of reducing operative time and having better cosmetic results, minimally-invasive parathyroidectomy (MIP) has become to be extensively performed. Several techniques are available, including video-endoscopic techniques, and radioguided parathyroidectomy. In patients undergoing radio-guided parathyroidectomy receive an intravenous injection of 99mTc-sestamibi 60-90 minutes before the operation was scheduled to start. Four early images are obtained 5 minutes after radiopharmaeutical administration, with the aim of confirming the side and site of the enlarged PT gland. Intraoperative nuclear mapping using a hand-held gamma probe and quantitative gamma camera counting in the four quadrants is obtained. A 2-3 cm incision is made, and the enlarged PT gland excision is guided by the probe, resulting in a decline in radioactivity in the corresponding quadrant. Intraoperative quick PTH is routinely assayed. When the PTH levels at 10 min fail to fall to less than 50% of the preoperative levels, a multiglandular disease should be suspected and a bilateral neck exploration is usually required. MIP is a safe, cost-effective alternative to bilateral exploration, and should be considered the procedure of choice in patients with primary HPT, when preoperative imaging tests have suggested the presence of a PT adenoma. Radioguided MIP may improve the success rate of surgery in patients with primary hyperparathyroidism.
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PMID:Minimally invasive radioguided parathyroidectomy. 1497 Dec 84

This article presents the authors' technique of minimally invasive radio guided parathyroidectomy (MIRP) with intra-operative use of the hand-held gamma probe for primary HPT caused by a solitary adenoma. It points out how this approach varies from that of others who perform MIRP. It also illustrates ways to troubleshoot common problems with the technique in inexperienced hands. The goal is to present an understandable and systematic approach to MIRP for surgeons who do not currently use this technique. This article is not intended to replace formalized training, which is essential to master the technique.
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PMID:Minimally invasive radioguided parathyroidectomy using intraoperative sestamibi localization. 1526 16

Primary hyperparathyroidism (PHPT) is not a rare disease. Renal stones are the most frequent complication of PHPT The authors report the case of a patient with giant parathyroid adenoma responsible for early recurrence of renal stones. Ultrasound examination of the neck, parathyroid MRI and Technetium99m-Sestamibi scintigraphy confirmed the parathyroid adenoma. Surgical exploration allowed resection of a giant adenoma (6.5 x 2.5 x 1.5 cm weighing 17 g). In the light of this case, the authors describe the characteristics of HPT define the place of preoperative imaging and emphasize the need for systematic aetiological work-up looking for HPT in all patients with a first episode of renal stones.
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PMID:[Giant parathyroid adenoma causing early recurrence of renal stones]. 1537 85

Selected patients with primary hyperparathyroidism (pHPT) who have a positive preoperative sestamibi scan can be managed safely and successfully with a focused cervical exploration without either adjuvant intraoperative parathyroid hormone (PTH) monitoring or use of a gamma probe. This article reports a retrospective analysis of a consecutive series of patients surgically treated at a tertiary referral center. From August 1998 to August 2002, 100 patients (68 women, 32 men; mean age 63 years [range: 29-89 years]) underwent a focused cervical approach without intraoperative PTH monitoring or use of the gamma probe after perioperative sestamibi injection. The study group comprised 9% of all patients (n = 1063) undergoing cervical exploration for pHPT during the study period. Ninety patients underwent an initial exploration, and 10 others underwent repeat cervical exploration following prior parathyroid (n = 7) or thyroid (n = 3) operation. Sestamibi scanning correlated with one enlarged parathyroid gland in all patients. Other enlarged glands were, however, not demonstrated in three patients (true positive = 97%; false negative = 3%). The single enlarged glands excised in all patients had a mean weight of 795 mg (range: 90-3640) and were histologically compatible with an adenoma. Postoperatively, 97% of patients were eucalcemic. Three patients remained hypercalcemic (3%). Of the three patients with persistent hypercalcemia, one underwent successful re-exploration with excision of a 500 mg second adenoma, whereas the other two patients (with confirmed familial HPT) remained hypercalcemic. Mean hospitalization was 0.5 days (range: 0-3 days). There was no operative mortality. No patients had permanent hypocalcemia. Postoperative morbidity occurred in three patients: two self-limiting cervical hematomas and one permanent vocal cord paralysis. Selected patients with pHPT due to single-gland disease and an unequivocally positive preoperative sestamibi scan can safely and successfully be managed with a focused unilateral cervical exploration without either intraoperative PTH monitoring or use of the gamma probe. Further experience with this surgical approach seems warranted to determine the overall cure rate, operative morbidity, and the sensitivity and specificity of preoperative localization studies.
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PMID:Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or use of the gamma probe. 1549 69


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