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

An assessment of free and total calcium measurements was made in 691 patients with suspected hypercalcemia or disorders often associated with hypercalcemia. In 18.9% of the 1049 specimens analyzed from nine different patient groups, a different impression of hypercalcemia was obtained depending on whether the free or total calcium was considered. Analysis of the ratio of free to total calcium indicated that there are two main factors which influence the distribution of calcium in the serum of hypercalcemic patients: the concentrations of albumin and parathyroid hormone. A lowered albumin concentration accounted for the altered distribution of calcium in patients with malignancies and partially accounted for the altered distribution in patients postrenal transplantation. In patients with confirmed primary hyperparathyroidism a higher ratio of free to total calcium was found, which could not be explained by alterations in protein, albumin, pH, or CO2 content but was related to parathyroid hormone concentration. Free calcium appears to be a slightly better indicator of elevated calcium states than total calcium. Measurements of free calcium should be particularly useful in patients with altered albumin concentration, with multiple myeloma in whom a calcium-binding protein could be present, after renal transplantation, and with suspected hyperparathyroidism and normal or slightly elevated total calcium values.
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PMID:Relationship of free and total calcium in hypercalcemic conditions. 42 92

Parathyroid hormone is mainly regulated by the serum calcium concentration and not by another hormone which is usually the case for other hormones. We examined whether the parathyroid hormone could also be regulated by a hormone such as adrenocorticotropic hormone (ACTH). Experiment I: A two-hour urine sample was collected from 6 AM to 8 AM. At 8 AM one mg of synthetic ACTH was injected intramuscularly. Blood and urine was collected two hours after the injection for determination of the concentration of serum calcium, phosphate, parathyroid hormone and cortisol. Experiment II: Adenoma tissue was obtained during operation from patients with primary hyperparathyroidism. The adenoma was digested with trypsin. Eagle MEM containing 100 ml fetal calf serum per 500 ml medium was used as the culture medium. The specimens were incubated in an atmosphere of 95% air and 5% CO2. Several days later, 25 micrograms of ACTH was added to the medium which was then incubated for 2 hours. The parathyroid hormone in the medium was measured by radioimmunoassay. Experiment III:ACTH was injected intraperitoneally into control male rats and parathyroidectomized rats. Two hours later, serum calcium and parathyroid hormone levels were measured. After ACTH injection, a remarkable increase in serum calcium level was seen in the patients with primary hyperparathyroidism, but in the other groups, no increase in the serum calcium was observed. Parathyroid hormone was increased after ACTH injection in most subjects in all groups. Serum cortisol levels increased markedly after ACTH injection in all groups. The parathyroid concentration in the culture medium was slightly increased after ACTH addition.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Endocrinological characteristic of primary hyperparathyroidism]. 609 27

Endoscopic approach for the treatment of primary hyperparathyroidism is one of the new fields of interest for minimally invasive surgery. The removal of the parathyroid gland can be achieved either by a gas or gasless technique. Massive carbon dioxide (CO2) diffusion and absorption has been reported to occur during the gas procedure. Endoscopic techniques that do not rely on CO2 insufflation have still to be set. We have developed a new procedure that was offered to 20 selected patients with a localized parathyroid adenoma. A 3-minute CO2 insufflation (12 mm Hg) through a conventional trocar inserted under the strap muscles is used just to anatomically dissect the virtual thyrotracheal groove. Actually, the working space is maintained by means of skin retractors so as to allow needlescopic instruments to perform a parathyroid adenomectomy with the gasless procedure. In all cases the parathyroid adenoma was removed through a 1.5-cm skin incision. Quick parathyroid hormone assays always confirmed the removal of all pathologic glands and permitted unilateral cervical exploration. Mean operative time was 71.7 +/- 35.5 minutes. No complication was registered. At follow-up, all patients were normocalcemic. This new endoscopic approach to the neck seems to be safe, effective, and cosmetically satisfactory.
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PMID:Endoscopic parathyroidectomy by a gasless approach. 975 9

Since the advent of extraperitoneal approaches for laparoscopic surgery, the creation of extraperitoneal virtual spaces has spread rapidly. We describe our preliminary experience with selective neck exploration and endoscopic parathyroidectomy in 4 women, aged 57-74, with primary hyperparathyroidism. Preoperative localization of parathyroid adenoma was assessed by technetium-sestamibi scanning and cervical ultrasonography. A cervical work space was created by the introduction of a trocar with an inflatable balloon-tip and maintained with low-pressure CO2 insufflation. All procedures were completed endoscopically. There were no intraoperative complications. Mean operative time was 40 minutes and cosmetic results were very satisfactory. We found endoscopic parathyroidectomy a feasible and safe option and particularly appropriate for the surgical treatment of primary hyperparathyroidism. Further refinements in technique will enhance its practicability in exploring the mediastinum for ectopic parathyroid glands and in those with secondary hyperparathyroidism.
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PMID:[Preliminary experiences with endoscopic parathyroidectomy]. 1088 66

We report our experience and technique of endoscopic removal of parathyroid adenomas in case of primary hyperparathyroidism. Scintigraphy, MRI scan and cervical ultrasound enable exact diagnosis and therefore exact localisation and placement of the three 5 mm trocars for endoscopic operation. The placement of the optic and the function trocars depends on the localisation of the adenoma. The free room to work in is created between thyroid and neck muscles and supported by insufflated CO2 with a pressure of 12 mm Hg. After the adenoma is taken out through an incision above the jugulum. With this technique we operated upon 3 patients successfully. Benefits for the patients seem to be a less painful postoperative course with minimal blood loss because of the exact exploration of the adenoma with minimal invasion of the surrounding tissue.
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PMID:[Endoscopic parathyroidectomy. Surgical technique in primary hyperparathyroidism]. 1114 18

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

More than 95% of patients with primary hyperparathyroidism have been treated with bilateral neck exploration by experienced surgeons. This procedure has been performed without employing preoperative localization tests or specialized techniques of intraoperative measurement. A renewed interest in unilateral neck exploration for primary hyperparathyroidism emerged (in three developments), in an attempt to maintain the excellent cure rate and to minimize the invasiveness of the procedure. The first development was the introduction of sestamibi scintigrams as a new preoperative localization technique and intraoperative nuclear mapping with a hand-held gamma probe. The localization of adenomas using this technique was much more accurate than that of previous localization studies, allowing unilateral procedures to become feasible. Sestamibi guidance enables parathyroidectomies to be performed much more rapidly through a significantly less invasive dissection. Secondly, the intraoperative quick parathyroid hormone assay allows the confirmation of removal of the parathyroid mass. The third development was endoscopic parathyroidectomy. Various approaches have been shown to be technically feasible, including endoscopic procedures that rely on CO2 insufflation to create a working space or video-assisted procedures in which the working space is maintained through conventional external retraction. Given the safety and high success rate of the standard exploration, the potential advantages of these new strategies include decreased operating time, local or regional anaesthesia rather then general anaesthesia, and smaller incisions.
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PMID:New operative strategies in primary hyperparathyroidism. 1237 44

During the last 3 years, 59 patients underwent endoscopic neck surgery. We started the video-assisted neck surgery with the gasless skin-lifting method for benign thyroid and parathyroid diseases to avoid complications of carbon dioxide (CO2) insufflation. Hemithyroidectomy was performed for benign thyroid tumors and subtotal thyroidectomy was selected for Graves' disease. Parathyroid adenomas were extirpated for primary hyperparathyroidism with precise preoperative localization by imaging modalities. In order to obtain a better visual field and to improve the cosmetic results, we have adopted the complete endoscopic method via breast approach with low CO2 insufflation pressure since August 2001. An intraoperative parathormone assay was introduced recently to confirm the complete removal of parathyroid adenomas. Both gasless and insufflation methods are feasible for endoscopic neck surgery with excellent cosmetic results.
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PMID:Endoscopic neck surgery: current status for thyroid and parathyroid diseases. 1248 51