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[PMID]:29390544
[Au] Autor:Zeng H; Li Z; Zhang X; Wang N; Tian Y; Wang J
[Ad] Endereço:Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
[Ti] Título:Anesthetic management of primary hyperparathyroidism during pregnancy: A case report.
[So] Source:Medicine (Baltimore);96(51):e9390, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Primary hyperparathyroidism (PHPT) during pregnancy is rare. Nevertheless, hypercalcemia secondary to gestational PHPT may be masked by physiological changes in calcium homeostasis during pregnancy. Gestational PHPT constitutes a serious danger to mother and fetus. Surgery is the only curative treatment when conservative treatment could not control the condition. Due to the lack of guidelines concerning PHPT during pregnancy, the optimal anesthetic management of PHPT during pregnancy needs to be individualized. Patient concerns: We report a case of PHPT with successful surgical treatment under combined cervical plexus block and general anesthesia. DIAGNOSIS: She was diagnosed with hypercalcemia, PHPT, a possible parathyroid adenoma, and a 19-week intrauterine pregnancy. INTERVENTIONS: The patient underwent heparin-free hemodialysis before the surgery in the nephrology department in the presence of a cardiologist. She then received a successful parathyroidectomy under combined bilateral superficial cervical plexus block and general anesthesia in her 19th week of pregnancy. OUTCOMES: She was released from the hospital with no maternal or fetal complications on postoperative day 9. A healthy baby boy was uneventfully born at 37 weeks of gestation. LESSONS: We suggest that surgical removal of the lesion after lowering the blood calcium concentration in mid-pregnancy is currently the optimal treatment option for pregnant patients with PHPT. Furthermore, multidisciplinary perioperative management is particularly important.
[Mh] Termos MeSH primário: Adenoma/cirurgia
Anestesia Geral/métodos
Hiperparatireoidismo Primário/cirurgia
Neoplasias das Paratireoides/cirurgia
Paratireoidectomia
Complicações Neoplásicas na Gravidez/cirurgia
[Mh] Termos MeSH secundário: Adenoma/complicações
Adulto
Feminino
Seres Humanos
Hiperparatireoidismo Primário/etiologia
Neoplasias das Paratireoides/complicações
Gravidez
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009390


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[PMID]:29254595
[Au] Autor:Shi Y; Azimzadeh P; Jamingal S; Wentworth S; Ferlitch J; Koh J; Balenga N; Olson JA
[Ad] Endereço:Division of General and Oncologic Surgery, Department of Surgery, University of Maryland, School of Medicine, Baltimore, MD.
[Ti] Título:Polyclonal origin of parathyroid tumors is common and is associated with multiple gland disease in primary hyperparathyroidism.
[So] Source:Surgery;163(1):9-14, 2018 Jan.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Parathyroid tumors are mostly considered monoclonal neoplasms, the rationale for focused parathyroidectomy in primary hyperparathyroidism. We reported that flow sorting parathyroid tumor cells and methylation-sensitive polymerase chain reaction (me-PCR) of polymorphic human androgen receptor gene and phosphoglycerate kinase gene alleles in deoxyribonucleic acid reveals that ≤35% of parathyroid tumors are polyclonal. We sought to confirm these findings and assess for clinical relevance. METHODS: Parathyroid tumors from 286 female primary hyperparathyroidism patients were analyzed for clonal status. Tumor clonal status was compared with clinical variables and operative findings. Statistical analysis was performed and significance was established at P < .05. RESULTS: In the study, 176 (62%) patients were informative for human androgen receptor gene and/or phosphoglycerate kinase gene. Assignment of clonal status was made in 119 (68%) tumors, of which 64 (54%) were monoclonal and 55 (46%) were polyclonal. Comparison of tumor clonal status to clinical variables in patients with complete operative data (N = 82) showed that while clinical features were the same between tumor types, patients with polyclonal tumors more often had multiple gland disease (risk ratio 4.066, confidence interval, 1.016-16.26; P = .039) potentially missed at unilateral neck exploration. CONCLUSION: This work confirms that primary hyperparathyroidism is often the result of polyclonal tumors and that parathyroid tumor clonal status may be associated with multiple gland disease.
[Mh] Termos MeSH primário: Adenoma/etiologia
Hiperparatireoidismo Primário/etiologia
Neoplasias das Paratireoides/etiologia
[Mh] Termos MeSH secundário: Adenoma/patologia
Adenoma/cirurgia
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Meia-Idade
Glândulas Paratireoides/patologia
Neoplasias das Paratireoides/patologia
Neoplasias das Paratireoides/cirurgia
Paratireoidectomia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


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[PMID]:29245309
[Au] Autor:Li W; Zhu Q; Lai X; Sun J; Jiang Y; Ren X; Zhang Q; Meng Z; Li J; Dai Q
[Ad] Endereço:aDepartment of UltrasoundbDepartment of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
[Ti] Título:Value of preoperative ultrasound-guided fine-needle aspiration for localization in Tc-99m MIBI-negative primary hyperparathyroidism patients.
[So] Source:Medicine (Baltimore);96(49):e9051, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To evaluate the value of preoperative ultrasound-guided fine-needle aspiration (UG-FNA) of ultrasound-detected suspicious parathyroid nodules for localization in Tc-99m MIBI-negative primary hyperparathyroidism patients.From May 2008 to December 2016, Tc-99m MIBI-negative primary hyperparathyroidism patients with ultrasound-detected suspicious cervical nodules underwent UG-FNA. The sample obtained from the solid component of the nodule was subjected to cytological evaluation and immunohistochemical staining. The sample obtained from the cystic component of the nodule or solid nodules was subjected to parathyroid hormone determination. After aspiration, the nodules underwent surgical resection or follow-up.Fifteen nodules (5 cystic, 5 cystic and solid, and 5 solid) from 15 patients were subjected to UG-FNA. Aspirate samples were obtained from 12 of the nodules, and the parathyroid hormone (PTH) levels of these samples were markedly elevated (range: 302- >2500 pg/mL). The samples obtained from the solid components of the 4 cystic and solid and 4 solid nodules were subjected to cytological evaluation, and parathyroid cells were identified in 5 of them. Of these 5 cases, 4 were subjected to immunohistochemical staining, which revealed PTH positivity in the cell block. The UG-FNA results suggested that the suspicious nodules were all parathyroid lesions. The surgical pathology results of 13 cases confirmed the UG-FNA results; the follow-up of 2 cases did not reveal any significant change.The cytological evaluation, immunohistochemical staining, and aspirate fluid PTH determination of UG-FNA were helpful for preoperative localization in Tc-99m MIBI-negative primary hyperparathyroidism patients with ultrasound-detected suspicious parathyroid nodules and can be applied selectively or in combination. Aspirate sample PTH determination should be preferred for nodules with cystic components. Further prospective study with large population is needed to confirm our conclusions.
[Mh] Termos MeSH primário: Biópsia por Agulha Fina/métodos
Hiperparatireoidismo Primário/cirurgia
Paratireoidectomia/métodos
Cuidados Pré-Operatórios/métodos
Ultrassonografia de Intervenção/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Hiperparatireoidismo Primário/diagnóstico por imagem
Masculino
Meia-Idade
Glândulas Paratireoides/diagnóstico por imagem
Glândulas Paratireoides/patologia
Glândulas Paratireoides/cirurgia
Hormônio Paratireóideo/análise
Cintilografia/métodos
Compostos Radiofarmacêuticos
Tecnécio Tc 99m Sestamibi
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Parathyroid Hormone); 0 (Radiopharmaceuticals); 971Z4W1S09 (Technetium Tc 99m Sestamibi)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009051


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[PMID]:29245308
[Au] Autor:Li JG; Xiao ZS; Hu XJ; Li Y; Zhang X; Zhang SZ; Shan AQ
[Ad] Endereço:aDepartment of Thyroid Breast SurgerybDepartment of Nephrology, Yinzhou Hospital of Ningbo University Medical College, Ningbo, China.
[Ti] Título:Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients.
[So] Source:Medicine (Baltimore);96(49):e9050, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Our study aims to explore the effect of total parathyroidectomy (PTX) with forearm autotransplantation (FAT) on the quality of life and recurrence of secondary hyperparathyroidism (SHPT) in chronic kidney disease patients. METHODS: A total of 104 chronic kidney disease patients with SHPT were enrolled and divided into the PTX (n = 62) and PTX + FAT (n = 42) groups. The operation efficacy was evaluated by analyzing preoperative and postoperative values, including levels of intact parathyroid hormone (iPTH), serum phosphorus, serum calcium, alkaline phosphatase (ALP), calcium-phosphorus product, signs and symptoms, and MOS 36-item short-form health survey (SF-36) scores. Moreover, complications and recurrences were followed up for 12 months after the operation. Binary logistic regression was to present the risk factors for the recurrence of chronic kidney disease patients with SHPT. RESULTS: Compared with the preoperative values, the PTX and PTX + FAT groups showed decrease postoperative levels of iPTH, serum phosphorus, serum calcium, calcium-phosphorus product, bone pain, and skin pruritus at all time periods. The PTX and PTX + FAT groups demonstrated decreased ALP, fracture or deformity, and coronary artery calcification at 1 month, decreased short stature at 3 months after the operation but increased SF-36 score after operation. Compared with the PTX group, the level of iPTH decreased and the levels of serum calcium, calcium-phosphorus product increased at 3, 6, and 12 months after the operation in the PTX + FAT group. The levels of ALP, fracture or deformity, short stature, and SF-36 decreased separately at 1 week and 6 and 12 months after the operation, along with the decrease of coronary artery calcification and the recurrence rate, respectively, at 6 and 12 months after the operation in the PTX + FAT group when compared with those in the PTX group. Logistic regression analysis evidenced that the preoperative iPTH level, SF-36 score, and operation type were the risk factors for the recurrence of chronic kidney disease with SHPT. CONCLUSION: Total PTX combined with FAT is more effective in improving the quality of life and reducing the recurrence of chronic kidney disease with SHPT than PTX alone.
[Mh] Termos MeSH primário: Antebraço/cirurgia
Hiperparatireoidismo Secundário/cirurgia
Glândulas Paratireoides/transplante
Paratireoidectomia/métodos
Insuficiência Renal Crônica/complicações
[Mh] Termos MeSH secundário: Adulto
Idoso
Fosfatase Alcalina/sangue
Cálcio/sangue
Terapia Combinada
Feminino
Seguimentos
Seres Humanos
Hiperparatireoidismo Secundário/sangue
Hiperparatireoidismo Secundário/etiologia
Masculino
Meia-Idade
Hormônio Paratireóideo/sangue
Fósforo/sangue
Qualidade de Vida
Recidiva
Transplante Autólogo/métodos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Parathyroid Hormone); 27YLU75U4W (Phosphorus); EC 3.1.3.1 (Alkaline Phosphatase); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009050


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[PMID]:29229131
[Au] Autor:Jang S; Mandabach M; Aburjania Z; Balentine CJ; Chen H
[Ad] Endereço:Howard Hughes Medical Institute, Birmingham, Alabama; Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
[Ti] Título:Racial disparities in the cost of surgical care for parathyroidectomy.
[So] Source:J Surg Res;221:216-221, 2018 Jan.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Parathyroidectomy is the only curative therapy for hyperparathyroidism, but its cost and variation in use among different racial and ethnic groups are largely unexamined. The purpose of this study was to examine the association between race and ethnicity and the total hospital cost of parathyroidectomy. METHODS: This retrospective study included 899 consecutive complete parathyroidectomies in our institution between September 2011 and July 2016. Total length of stay and cost were primary outcomes. Nonparametric and chi-square tests were used for analysis. RESULTS: The study population was 66.4% Caucasian, 31.4% African American, 0.7% Hispanic, and 0.3% Asian. Total hospital costs were greater for African-American patients ($6154.87 ± 389.18) compared to Caucasian patients ($5253.28 ± $91.74). Mean length of stay was 0.99 ± 0.18 for African-American patients and 0.44 ± 0.05 for Caucasian patients. African-American patients were more likely than Caucasian patients to be readmitted (4.6% versus 1.2%). Among African Americans, males had a more expensive hospital cost, higher incidence of cases that cost greater than $10,000, and longer length of stay compared to females. CONCLUSIONS: African-American race was associated with higher hospital costs for parathyroidectomy compared to Caucasian patients, especially male patients. The increased cost could be explained in part by longer length of stay. More detailed efforts are needed to reduce racial disparity in the management of parathyroidectomy patients.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde
Paratireoidectomia/economia
[Mh] Termos MeSH secundário: Idoso
Feminino
Custos Hospitalares
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Racismo
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


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[PMID]:28457397
[Au] Autor:Meng C; Martins P; Frazão J; Pestana M
[Ad] Endereço:Nephrology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: catarinameng@gmail.com.
[Ti] Título:Parathyroidectomy in Persistent Post-transplantation Hyperparathyroidism - Single-center Experience.
[So] Source:Transplant Proc;49(4):795-798, 2017 May.
[Is] ISSN:1873-2623
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Hyperparathyroidism is a common complication in chronic kidney disease and might persist in up to 25% of patients after transplantation. In this setting, vitamin D analogues further aggravate persistent hypercalcemia and cinacalcet has not been approved for these patients, some of whom will require parathyroidectomy to correct post-transplantation hyperparathyroidism. OBJECTIVES: In this single-center, retrospective study we aimed to analyze the long-term effect of parathyroidectomy on calcium, phosphorus, and parathyroid hormone (PTH) levels and its effect on allograft function in kidney transplantation patients submitted to parathyroidectomy. PATIENTS AND METHODS: Fifteen patients underwent parathyroidectomy between January 2005 and January 2015; median age 54 years old; 8 (53.3%) were receiving cinacalcet at the time of surgery. Pre-parathyroidectomy median values of intact PTH, calcium, and phosphorus were, respectively, 262 pg/mL, 10.8 mg/dL, and 2.4 mg/dL. Surgery consisted of uniglandular parathyroidectomy in 5 (33.3%) patients, biglandular in 4 (26.7%), and subtotal in 6 (40%). There was no surgery-related mortality. RESULTS: Compared with baseline, there was a decrease of PTH (262 pg/mL vs. 106 pg/mL, P = .001), calcium, and phosphorus levels (10.8 mg/dL vs. 10.4 mg/dL, P = .3; 2.4 vs. 2.9 mg/dL, P = .05) 1 year after surgery; with normalization of serum calcium at the end of follow-up (10.8 mg/dL vs. 9.4 mg/dL, P = .04). A decrease in estimated glomerular filtration rate occurred 1 month post-surgery (62.7 mL/m vs. 49.7 mL/m, P = .006) but returned to baseline 1 year after surgery (62.7 mL/m vs. 60.8 mL/m, P = .73). CONCLUSION: Parathyroidectomy appears to be a safe procedure and should be considered in kidney transplantation patients with persistent post-transplantation hyperparathyroidism. Although there was an acute estimated glomerular filtration rate decrease, we observed no long-term deterioration in allograft function.
[Mh] Termos MeSH primário: Aloenxertos/fisiopatologia
Hiperparatireoidismo/cirurgia
Transplante de Rim/efeitos adversos
Paratireoidectomia/métodos
Complicações Pós-Operatórias/cirurgia
[Mh] Termos MeSH secundário: Adulto
Cálcio/sangue
Feminino
Sobrevivência de Enxerto
Seres Humanos
Hiperparatireoidismo/sangue
Hiperparatireoidismo/etiologia
Masculino
Meia-Idade
Hormônio Paratireóideo/sangue
Fósforo/sangue
Complicações Pós-Operatórias/sangue
Complicações Pós-Operatórias/etiologia
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Parathyroid Hormone); 27YLU75U4W (Phosphorus); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:29180202
[Au] Autor:Feeney T; Price LL; Chen L; Graham R; Chatterjee A
[Ad] Endereço:Department of Surgery, Tufts Medical Center, Boston, Massachusetts. Electronic address: tpfeeney@gmail.com.
[Ti] Título:Resident and fellow participation in Thyroid and Parathyroid surgery: an ACS-NSQIP clinical outcomes analysis.
[So] Source:J Surg Res;220:346-352, 2017 Dec.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The effect of decreased overall hours of training in surgical specialties is still being examined. Of particular interest is the safety of patients undergoing surgeries with trainee surgeons. The aim of this study was to identify if there were significant differences in outcomes of patients undergoing commonly performed thyroid and parathyroid surgeries when trainees were involved. MATERIALS AND METHODS: Postoperative complication rates, length of stay (LOS), and total operation time (OT) data were gathered from the American College of Surgeons National Surgical Quality Improvement Project database. The cases were identified by CPT code and were divided based on the training level of the participating resident surgeon: Junior (postgraduate year [PGY] 1-2), senior (PGY 3-5), fellow (PGY >5), as well as an attending-only group where no resident was present. We compared the clinical outcomes, LOS, and OT in each trainee group to the attending-only group as the reference. RESULTS: A total of 84,711 cases were identified of which 45.33% involved trainee participation. Odds ratios (ORs) and 95% confidence interval for overall, neurologic, and bleeding complications were calculated. No difference in the odds of overall patient complications or neurologic complications was observed. A decrease in the odds of bleedings complications when a junior or senior trainee was present was observed. Overall complications in operations including a junior trainee (PGY 1-2) had an OR of 1.04 (0.85, 1.29), a senior trainee (PGY 3-5) had an OR of 1.00 (0.89, 1.13), and a fellow had an OR of 0.98 (0.74, 1.31). Mean OT was found to be significantly different between attending only and junior and senior trainees. There was no significant difference in OT between fellows and attending only. LOS did not meaningfully differ across groups. CONCLUSIONS: In three commonly performed thyroid and parathyroid operations, there is not an increased overall or neurologic complication odds when a surgical trainee is involved; there are decreased odds of a bleeding complication.
[Mh] Termos MeSH primário: Competência Clínica/estatística & dados numéricos
Internato e Residência/estatística & dados numéricos
Paratireoidectomia/estatística & dados numéricos
Complicações Pós-Operatórias/epidemiologia
Tireoidectomia/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Seres Humanos
Tempo de Internação
Duração da Cirurgia
Paratireoidectomia/educação
Paratireoidectomia/normas
Estudos Retrospectivos
Tireoidectomia/educação
Tireoidectomia/normas
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:28745704
[Au] Autor:Kurganov IA; Emel'yanov SI; Bogdanov DY; Matveyev NL; Lukyanchenko DV; Mamistvalov MS; Agafonov OA; Rutenburg GM; Guslev AB
[Ad] Endereço:Department of Endoscopic Surgery, Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia.
[Ti] Título:[The minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism].
[Ti] Título:Miniinvazivnaia videoassistirovannaia paratireoidéktomiia pri pervichnom giperparatireoze..
[So] Source:Khirurgiia (Mosk);(7):33-39, 2017.
[Is] ISSN:0023-1207
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To study feasibility, effectiveness and safety of minimally invasive video-assisted parathyroidectomy in patients with primary hyperparathyroidism; to define the advantages and disadvantages of this technique compared with conventional open surgery. MATERIAL AND METHODS: The study includes the results of 33 minimally invasive video-assisted parathyroidectomies performed in patients with primary hyperparathyroidism. The control group included 36 patients who underwent conventional open surgery. RESULTS: There were significantly increased time of surgery in the main group (41.2±12.7 min vs. 28.4±10.9 min, p<0.05), decreased need for postoperative analgesia (1,2±0.3 vs. 1.9±0.5 days, p<0.05) and significantly longer postoperative scar (1.8±0.2 vs. 6.2±0.5 cm, p<0.01). Incidence of complications was similar in both groups (6.1% vs. 8.3%, p>0.05). CONCLUSION: Minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism is feasible, safe and effective intervention that improves early postoperative course and cosmetic outcomes.
[Mh] Termos MeSH primário: Hiperparatireoidismo Primário/cirurgia
Procedimentos Cirúrgicos Minimamente Invasivos
Glândulas Paratireoides/cirurgia
Paratireoidectomia
Cirurgia Vídeoassistida
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Hiperparatireoidismo Primário/diagnóstico
Masculino
Meia-Idade
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
Duração da Cirurgia
Avaliação de Processos e Resultados (Cuidados de Saúde)
Glândulas Paratireoides/patologia
Paratireoidectomia/efeitos adversos
Paratireoidectomia/métodos
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/etiologia
Federação Russa
Cirurgia Vídeoassistida/efeitos adversos
Cirurgia Vídeoassistida/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171130
[Lr] Data última revisão:
171130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.17116/hirurgia2017733-39


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[PMID]:29068975
[Au] Autor:Best CAE; Krishnan R; Malvankar-Mehta MS; MacNeil SD
[Ad] Endereço:aNorthern Ontario School of Medicine, Sudbury bDepartment of Epidemiology and Biostatistics, Western University, London cDepartment of Ophthalmology, Department of Epidemiology and Biostatistics, Western University, London dLondon Health Sciences Center, Western University, London, ON, Canada.
[Ti] Título:Echocardiogram changes following parathyroidectomy for primary hyperparathyroidism: A systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);96(43):e7255, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of the study is to systematically review the evidence on post parathyroidectomy (PTX) changes as measured by echocardiogram (ECHO) in patients with primary hyperparathyroidism (PHPT).PHPT may increase risk of cardiovascular morbidity/mortality. Conclusions of studies assessing ECHO changes, pre versus post PTX, are inconsistent.A systematic literature search was conducted to locate published and unpublished studies. Randomized control trials, nonrandomized control trials, and observational studies were included. Variables were reported as means and standard deviations. An inverse variance statistical method, with random-effects analysis model, was applied to continuous data. The effect measure was standardized mean difference, confidence interval of 95%. Primary outcome measure was left ventricular ejection fraction (LVEF). Secondary outcome measures were left ventricular mass index (LVMI), peak early over peak late diastolic velocity ratio (E/A ratio), isovolumetric relaxation time (IVRT), intraventricular septal thickness (IVST), and posterior wall thickness (PWT).Fourteen studies were included. Follow-up time ranged 3 to 67 months. No significant differences (P > .05) in primary outcome measure LVEF (SMD = -0.03, CI = -0.24, 0.19), or secondary outcome measures E/A Ratio (SMD = -0.05, CI = -0.24, 0.14), IVST (SMD = 0, CI = 0.31, 0.32), PWT (SMD = 0.01, CI = -0.38, 0.39), LVMI (SMD = -0.18, CI = -0.74, 0.38), and IVRT (SMD = -0.84, CI = -1.83, 0.14) were observed.There was no significant difference in LVEF pre to post PTX. Due to heterogeneity of current literature, we were unable to determine if other outcome measures of cardiac function are affected after PTX in patients with PHPT. We recommend a randomized control trial be conducted to make concrete conclusions.
[Mh] Termos MeSH primário: Ecocardiografia
Hiperparatireoidismo Primário/diagnóstico por imagem
Hiperparatireoidismo Primário/cirurgia
Paratireoidectomia
Função Ventricular Esquerda/fisiologia
[Mh] Termos MeSH secundário: Seres Humanos
Hiperparatireoidismo Primário/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171123
[Lr] Data última revisão:
171123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007255


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[PMID]:29040300
[Au] Autor:Jäger MD; Serttas M; Beneke J; Müller JA; Schrem H; Kaltenborn A; Ramackers W; Ringe BP; Gwiasda J; Tränkenschuh W; Klempnauer J; Scheumann GFW
[Ad] Endereço:Klinik für Allgemein-, Viszeral- und Minimal-Invasive Chirurgie, Städtisches Klinikum Wolfenbüttel gGmbH, Wolfenbüttel, Germany.
[Ti] Título:Risk-factors for nodular hyperplasia of parathyroid glands in sHPT patients.
[So] Source:PLoS One;12(10):e0186093, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Nodular hyperplasia of parathyroid glands (PG) is the most probable cause of medical treatment failure in secondary hyperparathyroidism (sHPT). This prospective cohort study is located at the interface of medical and surgical consideration of sHPT treatment options and identifies risk-factors for nodular hyperplasia of PG. MATERIAL AND METHODS: One-hundred-eight resected PG of 27 patients with a broad spectrum of sHPT severity were classified according to the degree of hyperplasia by histopathology. Twenty routinely gathered parameters from medical history, ultrasound findings of PG and laboratory results were analyzed for their influence on nodular hyperplasia of PG by risk-adjusted multivariable binary regression. A prognostic model for non-invasive assessment of PG was developed and used to weight the individual impact of identified risk-factors on the probability of nodular hyperplasia of single PG. RESULTS: Independent risk-factors for nodular hyperplasia of single PG were duration of dialysis in years, PG volume in mm3 determined by ultrasound and serum level of parathyroid hormone in pg/mL. Multivariable analyses computed a model with an Area Under the Receiver Operative Curve of 0.857 (95%-CI:0.773-0.941) when predicting nodular hyperplasia of PG. Theoretical assessment of risk-factor interaction revealed that the duration of dialysis had the strongest influence on the probability of nodular hyperplasia of single PG. CONCLUSIONS: The three identified risk-factors (duration of dialysis, PG volume determined by ultrasound and serum level of parathyroid hormone) can be easily gathered in daily routine and could be used to non-invasively assess the probability of nodular hyperplasia of PG. This assessment would benefit from periodically collected data sets of PG changes during the course of sHPT, so that the choice of medical or surgical sHPT treatment could be adjusted more to the naturally changing type of histological PG lesion on an individually adopted basis in the future.
[Mh] Termos MeSH primário: Hiperparatireoidismo Secundário/patologia
Glândulas Paratireoides/patologia
Hormônio Paratireóideo/sangue
Paratireoidectomia
Diálise Renal
[Mh] Termos MeSH secundário: Adulto
Idoso
Biomarcadores/análise
Feminino
Seres Humanos
Hiperparatireoidismo Secundário/sangue
Hiperparatireoidismo Secundário/diagnóstico por imagem
Hiperparatireoidismo Secundário/cirurgia
Hiperplasia
Meia-Idade
Tamanho do Órgão
Glândulas Paratireoides/diagnóstico por imagem
Glândulas Paratireoides/cirurgia
Prognóstico
Estudos Prospectivos
Curva ROC
Fatores de Risco
Fatores de Tempo
Ultrassonografia Doppler
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Parathyroid Hormone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171018
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186093



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