Navegando por Palavras-chave "Parathyroidectomy"

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    Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism
    (Associação Brasileira de Divulgação Científica, 2007-04-01) Oliveira, Ulisses Eliseu Maia de [UNIFESP]; Ohe, Monique Nakayama [UNIFESP]; Santos, Rodrigo Oliveira [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Abrahão, Márcio [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Vieira, Jose Gilberto Henriques [UNIFESP]; Hauache, Omar Magid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Fleury
    Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.
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    Autotransplant tissue selection criteria with or without stereomicroscopy in parathyroidectomy for treatment of renal hyperparathyroidism
    (Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2014-07-01) Ohe, Monique Nakayama [UNIFESP]; Santos, Rodrigo Oliveira [UNIFESP]; Neves, Murilo Catafesta das [UNIFESP]; Carvalho, Aluizio Barbosa de [UNIFESP]; Kunii, Ilda Sizue [UNIFESP]; Abrahão, Marcio [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Vieira, José Gilberto Henriques [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION:Several methods have been proposed to improve operative success in renal hyperparathyroidism.OBJECTIVE:To evaluate stereomicroscopy in parathyroid tissue selection for total parathyroidectomy with autotransplantation in secondary (SHPT)/tertiary (THPT) hyperparathyroidism.METHODS:118 renal patients underwent surgery from April of 2000 to October 2009. They were divided into two groups: G1, 66 patients operated from April of 2000 to May of 2005, with tissue selection based on macroscopic observation; G2, 52 patients operated from March of 2008 to October 2009 with stereomicroscopy for tissue selection searching for the presence of adipose cells. All surgeries were performed by the same surgeon. Patients presented SHPT (dialysis treatment) or THPT (renal-grafted). Follow-up was 12-36 months. Intra-operative parathyroid hormone (PTH) was measured in 100/118 (84.7%) patients.RESULTS:Data are presented as means. G1 included 66 patients (38 SHPT, 24 females/14 males; 40.0 years of age; 28 THPT, 14 females/14 males; 44 years of age). G2 included 52 patients (29 SHPT, 11 females/18 males; 50.7 years of age; 23 THPT, 13 females/10 males, 44.4 years of age). SHPT patients from G2 presented preoperative serum calcium higher than those of SHPT patients in G1 (p < 0.05), suggesting a more severe disease. Definitive hypoparathyroidism was found in seven of 118 patients (5.9%). Graft-dependent recurrence occurred in four patients, two in each group. All occurred in dialysis patients.CONCLUSION:Stereomicroscopy in SHPT/THPT surgical treatment may be a useful tool to standardize parathyroid tissue selection.
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    Localizacao de glandulas paratireoides ectopicas e supranumerarias em pacientes com hiperparatireoidismo secundario e terciario: descricao cirurgica e correlacao com ultrassonografia e cintilografia Tc99m-Sestamibi pre-operatorios
    (Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2014-01-01) Andrade, José Santos Cruz de [UNIFESP]; Mangussi-Gomes, João Paulo [UNIFESP]; Rocha, Lillian Andrade da [UNIFESP]; Ohe, Monique Nakayama [UNIFESP]; Rosano, Marcello [UNIFESP]; Neves, Murilo Catafesta das [UNIFESP]; Santos, Rodrigo Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction:Hyperparathyroidism is an expected metabolic consequence of chronic kidney disease (CKD). Ectopic and/or supernumerary parathyroid glands (PT) may be the cause of surgical failure in patients undergoing total parathyroidectomy (PTX).Aim:To define the locations of ectopic and supernumerary PT in patients with renal hyperparathyroidism and to correlate intraoperative findings with preoperative tests.Materials and methods:A retrospective study was conducted with 166 patients submitted to PTX. The location of PT during surgery was recorded and classified as eutopic or ectopic. The preoperative localizations of PT found by ultrasonography (USG) and Tc99m-Sestamibi scintigraphy (MIBI) were subsequently compared with intraoperative findings.Results:In the 166 patients studied, 664 PT were found. Five-hundred-seventy-seven (86.4%) glands were classified as eutopic and 91(13.6%) as ectopic. Eight supernumerary PT were found. The most common sites of ectopic PT were in the retroesophageal and thymic regions. Taken together, USG and MIBI did not identify 56 (61.5%) ectopic glands. MIBI was positive for 69,7% of all ectopic glands located in the mediastinal and thymic regions.Conclusion:The presence of ectopic and supernumerary PT in patients with renal hyperparathyroidism is significant. Although preoperative imaging tests did not locate most of ectopic glands, MIBI may be important for identifying ectopic PT in the mediastinal and thymic regions.
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    Tratamento cirúrgico do hiperparatireoidismo relacionado a doença renal crônica: adequação à realidade brasileira e avaliação da técnica do autoenxerto.
    (Universidade Federal de São Paulo (UNIFESP), 2018-09-27) Neves, Murilo Catafesta das [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Santos, Rodrigo Oliveira [UNIFESP]; http://lattes.cnpq.br/2752448898797822; http://lattes.cnpq.br/3840689958519232; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Surgical treatment of hyperparathyroidism related to chronic kidney disease is a challenging procedure even for experienced parathyroid surgeons. Over the years adjuvant techniques have been developed to assist medical team to improve surgical outcome. However, in poor countries, medical staff have less access to these techniques creating doubts about the real effectiveness of surgery in this context. Objective: verify the effectiveness of surgery for treatment of hyperparathyroidism related to chronic kidney disease without adjuvant techniques. Methods: Over a 5years period, patients with hyperparathyroidism with clinical therapeutic failure were evaluated for surgical treatment. Total parathyroidectomy with autograft or subtotal resection were the selected procedures. Surgery were performed in a tertiary hospital in Brazil without the assistance of some of the adjuvant techniques that are usually applied. Frozen section, nerve monitoring and gamma probe were not utilized in any procedure. Intraoperative PTH and localization preoperative exams were applied, but with huge restrictions. Results: A total of 518 patients, 128 secondary and 390 tertiary hyperparathyroidism were surgically treated. Total parathyroidectomy was realized in 81,5%, subtotal in 12,4% and 6,1% of patients had a surgical failure. Between all failures only 1,4% needed a second surgery making a 98,6% of successful initial surgical treatment. Neck hematoma and unilateral vocal fold paralysis occurred in 1,9% and 1,5%, respectively. Conclusion: parathyroidectomy is a safe and reproducible surgical procedure even in the absence of adjuvant techniques.
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    Utilidade da medida de PTH intra-operatório no tratamento cirúrgico do hiperparatiroidismo primário e secundário: análise de 109 casos
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2006-10-01) Ohe, Monique Nakayama [UNIFESP]; Santos, Rodrigo Oliveira [UNIFESP]; Kunii, Ilda Shizue [UNIFESP]; Abrahão, Márcio [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Carvalho, Aluizio Barbosa de [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Vieira, José Gilberto H. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: Intraoperative parathyroid hormone measurement (IO-PTH) was first described in 1988 and it's potentially useful in predicting cure after parathyroidectomy. The aim of this study was to evaluate IO-PTH decay profile and the utility of this procedure in predicting cure in primary (PHH) and secondary (SHH) hyperparathyroidism due to renal disease. PATIENTS AND METHODS: 109 patients were evaluated from 06/2000 to 12/2004. 33 had PHH and 76 SHH (52 in dialysis, 24 with renal graft). IO-PTH was measured at times 0 (before resection), 10, 20 minutes after parathyroidectomy using immunometric assay (Elecsys-PTH/Immunoassay-Roche). Time necessary to perform assay: 10 minutes. RESULTS: HPP patients: IO-PTH average decrease 79.2% from basal levels after 10 minutes. HPS: IO-PTH average decrease 85.8% and 87.6% after 10 minutes in dialysis and renal graft patients respectively. All patients were cured, except 2 (1 PHH, 1 SHH), because of a double adenoma and ectopic (mediastinal) parathyroid respectively. Failure in IO-PTH decrease was observed in both. CONCLUSION: IO-PTH measurement is useful in improving surgical success rates in PHH and SHH.