Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0221002 (primary hyperparathyroidism)
 4,921 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to assess the feasibility of a minimally invasive parathyroidectomy performed by videocervicoscopy. 19 patients were operated. Preoperative localization by ultrasonography and/or technetium 99 m sestamibi scan was performed in 17 patients. The technique was first attempted in two pigs, using three 2.5 mm trocars and a 2.5 mm endoscope. However, this technique failed in the first two human cases because of the lack of optical clarity of the 2.5 mm endoscope. A 5 mm endoscope was subsequently used. Carbon dioxide insufflation was maintained at 10 mmHg with a low 3 L/min flow. Three trocars were inserted in to the cervical space: one 5 mm trocar for the endoscope, two 3 mm trocars for the instruments. A unilateral neck exploration was carried out in 5 cases and a bilateral neck exploration in 14 cases. Enlarged glands were discovered in 13 patients (12 adenomas, 1 hyperplasia of the 4 glands). 8 adenomas were removed via a short midline incision, 4 others via a short lateral incision. Horizontal cervicotomy was required in 7 cases (4 failures to identify the abnormal gland, 1 thyroid cancer discovered incidentally, 1 hyperplasia of 4 glands and 1 anterior jugular vein bleeding). Except for the case of bleeding, no other complication occurred. Subcutaneous emphysema resorbed in 3 hours. 17 patients were discharged within 48 hours and 2 patients were discharged within 24 hours. 18 patients had normal serum calcium two months postoperatively. This study demonstrates that videocervicoscopy is safe and feasible in primary hyperparathyroidism.
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PMID:[Videocervicoscopy in surgery of primary hyperparathyroidism. Preliminary study of 19 patients]. 988 77

The gold standard for the surgical treatment of primary hyperparathyroidism has traditionally been bilateral neck exploration with identification of all four parathyroid glands. However, because of the increasing sensitivity and accuracy of preoperative imaging techniques, including ultrasound and sestamibi scanning, and the introduction of intraoperative parathyroid hormone monitoring, unilateral neck exploration has become more widely used. We describe two cases of pneumothorax following minimally invasive parathyroidectomy. The pneumothorax in the first case was thought to be due to the position of the parathyroid adenoma in the mediastinum and thus its close proximity to the lung pleura. In the second case, the patient had a history of emphysema, and the pneumothorax was most likely due to a rupture of a bleb. With prompt diagnosis and early treatment of this potential complication, morbidity can be decreased.
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PMID:Pneumothorax: an uncommon complication of minimally invasive parathyroidectomy. 1571 57