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Query: UMLS:C0221002 (primary hyperparathyroidism)
 4,921 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The traditional approach to primary hyperparathyroidism has been a bilateral neck exploration for evaluation of all four parathyroid glands. With the advent of minimally invasive surgery, minimally invasive parathyroidectomy has become a popular approach for the treatment of parathyroid adenomas. Though exceedingly rare, pneumothorax formation is a potential complication following this procedure. In this paper, we report four cases of pneumothorax following minimally invasive parathyroidectomies. The commonality in all these cases was positioning with extreme neck hyperextension. Additional risks in three patients were dissection in the superior mediastinum, traction on the thyrothymic ligament, and a low-lying inferior parathyroid gland. One patient developed a pneumothorax prior to dissection along the superior mediastinum. This suggests that further risk factors may be heat conduction from the electrocautery and total intravenous anesthesia with spontaneously breathing of the patient.
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PMID:Minimally invasive parathyroidectomy complicated by pneumothoraces: a report of 4 cases. 1746 11

Primary hyperparathyroidism (PHPT) is classically thought of as the somatic manifestation of hypercalcemia in which patients suffer from a variety of complaints including abdominal pain, nephrolithiasis, osteopenia, and mental status changes. Contemporary PHPT patients are generally free of somatic manifestations and are most often diagnosed when routine biochemical testing shows an elevated serum calcium level. The modern day patient may present with much more subtle neurocognitive symptoms including fatigue, lethargy, muscle weakness, depression, and cognitive impairment. Advances in imaging technology, intraoperative parathyroid hormone measurement, and surgical technique now allow parathyroidectomy to be performed using a focused approach without the absolute need of a four-gland exploration. Minimally invasive techniques allow the procedure to be accomplished under local anesthesia on an outpatient basis. This brief review summarizes the presentation, biochemical evaluation, operative intervention, and follow-up care of the modern day PHPT patient.
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PMID:Primary hyperparathyroidism. 1760 56

Minimally invasive parathyroidectomy is performed after preoperative parathyroid localization-usually with high-quality sestamibi scans and/or ultrasonography-often under cervical block anesthesia during which a limited exploration is performed. The rapid intraoperative parathyroid hormone assay is then employed to confirm an adequate resection and cure of primary hyperparathyroidism. This article discusses imaging, anesthesia, results, and the surgical management of patients undergoing minimally invasive parathyroidectomy.
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PMID:Focused approach to parathyroidectomy. 1839 51

The association of high performance techniques and low morbidity has enabled the development of preventive surgery for hyperparathyroidism. Over the last 30 years, 2500 patients have undergone this type of procedure at the Visceral Surgery Unit of the Cochin Hospital in Paris. This experience has enabled us to achieve the current concept of surgical treatment for primary hyperparathyroidism, particularly with the development of minimally invasive techniques performed under local anesthesia. The promotional role played by our institution over the last 30 years in this area has enabled sturdy evidence-based reflection. The report of the work accomplished would not be complete without the story of the rich adventure which began in the 19th century. We propose here a review of the major advance achieved in order to better apprehend the principles currently regulation our approach to surgery of the parathyroid glands.
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PMID:[Treatment of primary hyperparathyroidism at Cochin hospital (Paris). Changes in procedures during the last thirty years]. 1868 87

In recent years the advances in preoperative localization studies, the availability of intraoperative parathyroid hormone (PTH) assay and the introduction of cervicoscopy revolutionized the surgical treatment of primary hyperparathyroidism (PHPT). Several endoscopic and video-assisted techniques for parathyroidectomy have been described. In spite of the enthusiasm manifested by some authors, the role of these techniques with respect to the time-honored conventional surgery have been largely debated. Among them, video-assisted parathyroidectomy (VAP) has emerged as one of the leading and more diffuse techniques. To date many large and comparative studies have shown that VAP is an efficacious and feasible procedure with the same complication rate as conventional surgery. Moreover, VAP seems to have significant advantages in terms of cosmetic results, postoperative pain, recovery, and patient satisfaction. When compared with other minimally invasive techniques, it offers the significant advantages of being more similar to conventional surgery and reproducible in different surgical settings. Moreover, it permits bilateral neck exploration, associated thyroid resections and can be performed under locoregional anesthesia. All these characteristics and the excellent results obtained render VAP a valid and well-validated, and even preferable, alternative to conventional surgery for the surgical treatment of sporadic PHPT, especially in case of suspected single adenoma.
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PMID:Advantages of a video-assisted approach to parathyroidectomy. 1897 96

The brachial plexus block, either deep or superficial, is one of the anesthetic techniques used in parathyroidectomy. The block is easy to perform and has few hemodynamic side effects. Surgery can be carried out in an awake patient. We describe 3 cases of patients with primary hyperparathyroidism (parathyroid adenoma) who underwent unilateral minimally invasive parathyroidectomy under regional anesthesia and sedation with 2 mg of midazolam plus remifentanil at dosages ranging from 0.6 to 0.1 microg kg(-1) min(-1). To provide a deep cervical block, we administered 15 mL of 0.75% ropivacaine. For a superficial block, 15 mL of 0.2% ropivacaine was used. The procedure could be completed in all 3 patients under regional anesthesia. The latency time for the block ranged from 21 to 30 minutes, and remifentanil dosages from 0.05 to 0.09 microg kg(-1) min(-1) were administered for procedures that lasted 30 to 45 minutes. No patient required postoperative opioids or antiemetics, although a local anesthetic had to be used at the moment of incision for 1 patient. All 3 patients were discharged the same day. We wish to underline the utility of the brachial plexus block for parathyroid surgery. The technique is easy to perform, safe, and effective; as a result, surgery can be carried out on an outpatient basis.
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PMID:[Brachial plexus block for minimally invasive parathyroidectomy: report of 3 cases]. 1898 89

Primary hyperparathyroidism (PHPT) is a disease whose form of presentation, diagnosis and treatment recommendations have been substantially modified in the last few years. With the development of autoanalyzers and routine calcemia determination, classical forms of presentation with bone and renal involvement have disappeared and the disease is more frequently detected in patients undergoing investigation for osteoporosis or kidney stones. Moreover, there is a difficult-to-quantify relationship between PHPT and cardiovascular and neurocognitive diseases. Therefore, although surgical treatment is clearly recommended in symptomatic patients, several consensus meetings have been required in the last 18 years to establish the recommendations for surgery in asymptomatic patients (age less than 50 years, calcemia 1 mg/dl above the normal limit, glomerular filtrate less than 60 ml/min, osteoporotic fracture or osteoporosis detected by densitometry in the hip, spinal column or forearm or impossibility of follow-up). If medical follow-up is chosen, annual evaluation of calcemia, glomerular filtrate and bone mass measurement is recommended and the possibility of medical treatment with bisphosphonates, raloxifene or cinacalcet is considered. If surgery is indicated, parathyroid scintigraphy and other localization techniques help to identify patients with a single adenoma who can undergo a minimally invasive approach under local anesthesia, as well as those with parathyroid tissue remnants undergoing reintervention due to persistent or recurrent PHPT. Intraoperative parathyroid hormone determination seems to be valid in these situations.
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PMID:[Consensus and clinical practice guidelines in primary hyperparathyroidism]. 1962 60

Cognitive and affective complaints are common in patients with primary hyperparathyroidism (PHPT), but few studies have used psychometric testing to document these symptoms and their response to parathyroidectomy. The current study sought to clarify the nature of cognitive and affective impairments in PHPT and changes postparathyroidectomy. One hundred eleven patients with PHPT underwent neuropsychological evaluation prior to parathyroidectomy with 68 returning for an early postsurgical evaluation. Changes in cognition were assessed using practice effect corrected reliable change indices. Biochemical and anesthesia variables were compared between groups who improved and declined. In a subset of patients, assessment revealed a significant pattern of cognitive slowing, reductions in psychomotor speed, memory impairment, and depression prior to parathyroidectomy. Postsurgical evaluations revealed a trend for improvements on timed tests and depression but a decline in memory. Older patients responded less well to surgical intervention, as did patients who experienced more dramatic changes in biochemical status following surgery. Cognitive changes early postparathyroidectomy are characterized by improved information processing speed and decline in verbal memory, with younger patients more likely to recover during this acute phase. The need for longer-term follow-up studies and increasing utilization of neuropsychological assessments in this population are discussed.
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PMID:Cognitive and affective sequelae of primary hyperparathyroidism and early response to parathyroidectomy. 1980 40

Primary hyperparathyroidism (HPT1) is a common endocrine disorder, which is asymptomatic in 80% of cases. The diagnosis is ordinarily easily made, based on an inappropriately elevated parathormone level (PTH) in the face of hypercalcemia. In 85% of cases, HPT1 is due to hormone secretion from a single parathyroid gland (uniglandular disease) and the remaining patients have multiglandular disease. The best localization study is MIBI scintigraphy (methoxy isobutyl isonitrile) coupled with the results of a neck ultrasound exam (sensitivity >95%). Other investigations are reserved for patients with persistent or recurrent HPT1 post-surgery. Surgery is the only cure. The surgical approach may include a bilateral cervical exploration, a unilateral approach under local anesthesia, or focused minimally invasive (video-assisted or totally endoscopic) approaches. A decrease in PTH level measured intraoperatively of greater than 50% is predictive of cure in more than 97% of cases. Surgery is recommended even for moderate HPT1 and for very elderly patients because improvement in both the quality of life and bone density have been proven in these situations. The role of medical treatment is limited. Persistent or recurrent HPT1 requires a meticulous diagnostic approach and management in surgical centers with expertise. Persistent elevation of PTH postoperatively without hypercalcemia does not mandate further exploration. The prognosis of normocalcemic patients with elevated postoperative PTH levels remains uncertain.
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PMID:Sporadic primary hyperparathyroidism. 2088 15

Minimally invasive parathyroidectomy (MIP) is an operative approach for the treatment of primary hyperparathyroidism (pHPT). Currently, routine use of improved preoperative localization studies, cervical block anesthesia in the conscious patient, and intraoperative parathyroid hormone analyses aid in guiding surgical therapy. MIP requires less surgical dissection causing decreased trauma to tissues, can be performed safely in the ambulatory setting, and is at least as effective as standard cervical exploration. This paper reviews advances in preoperative localization, anesthetic techniques, and intraoperative management of patients undergoing MIP for the treatment of pHPT.
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PMID:Minimally invasive parathyroidectomy. 2174 51


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