Surgery for primary hyperparathyroidism 1962-1996: indications and outcomes.
ABSTRACT To examine changes over the past three decades in the indications for, and outcomes of, surgery for primary hyperparathyroidism.
Survey of a prospective hospital database.
Royal North Shore Hospital (a tertiary referral and university teaching hospital), Sydney, New South Wales, January 1962 to December 1996.
All 733 patients who underwent neck exploration for primary hyperparathyroidism.
The annual number of parathyroidectomies increased virtually exponentially, from a mean of two in 1962-1969 to 73 in 1996. In the 1960s and 1970s, the most common indication for surgery was the presence of renal calculi (58% and 43%, respectively), but in the 1980s there was a marked increase in presentation of asymptomatic disease after biochemical screening (19%). In the 1990s, low bone mineral density detected by osteodensitometry has become the most common indication for surgery (31%). After initial operation, 11 patients (2%) had persistent hypercalcaemia, with five of these cured by reoperation--an overall failure rate of 1%.
Surgery for primary hyperparathyroidism has become increasingly common, with low bone mineral density replacing renal calculi as the most common indication for surgery. Neck exploration in experienced hands results in an overall cure rate of 99%.
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ABSTRACT: Störungen der Nebenschilddrüsenfunktion mit klinisch und radiologisch ausgeprägten Symptomen und Befunden sind heutzutage seltener als früher, da anlässlich von Routine-Blutchemieuntersuchungen abnorme Kalziumspiegel früh erkannt, ursächlich weiter abgeklärt und entsprechend therapiert werden. Der Hyperparathyreoidismus manifestiert sich am häufigsten als Osteoporose mit pathologischen Frakturen. Zur Abklärung einer sekundären Osteoporose gehört deshalb die Bestimmung von Kalzium und Phosphat sowie ggf. des intakten Parathormons. Die Osteitis fibrosa cystica sowie braune Tumoren sind seltener. Bei Arthritiden und Knochenschmerzen, speziell im Bereich der Fingergelenke, muss differenzialdiagnostisch an einen Hyperparathyreoidismus gedacht werden. Weitere Manifestationen des Hyperparathyreoidismus umfassen Myopathien und Sehnenrupturen sowie unspezifische muskuloskelettale Symptome. Gicht und Chondrokalzinose sind oft mit einem Hyperparathyreoidismus assoziiert. Der Hypoparathyreoidismus kann zu Beschwerden des Muskel-Skelett-Systems führen, die eine ankylosierende Spondylitis imitieren oder radiologisch einer diffusen idiopathischen skelettalen Hyperostose ähnlich sehen. Auch Myopathien kann ein Hypoparathyreoidismus zugrunde liegen. Eine Assoziation von systemischem Lupus erythematosus und Hypoparathyreoidismus wird beschrieben.Zeitschrift für Rheumatologie 11/2011; 70(9). DOI:10.1007/s00393-011-0796-4 · 0.46 Impact Factor
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ABSTRACT: Objective: To compare operative details and postoperative outcomes in patients undergoing LigaSure thyroidectomy (LT) or conventional thyroidectomy (CT). Experimental: Ninety-four patients requiring thyroidectomy at Ahmadi Hospital, Kuwait, were randomly allocated to undergo LT (n=48) or CT (n=46). Patients' demographics, operative details, hospital stay, time off-work, and postoperative pain and complications were all recorded. Results and Discussion: There were 83 women and 11 men, with a mean age of 37.58.9 years. There were no statistically significant differences in age, gender, indication for surgery, and length of incision between both groups. LT resulted in significantly shorter operative time, reduced blood loss, lesspost-operative pain and parenteral analgesia, shorter hospital stay, and more rapid return to work. There were no significant differences in post-operative complications between both groups. Conclusions: LT is as safe as CT, with the additional benefit of reduced operative time,less post-operative pain, shorter hospital stay and more rapid return to work.
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ABSTRACT: Introduction The development of techniques for preoperative localization, such as Tc-99m-sestamibi scanning, has simplified surgical technique in patients with primary hyperparathyroidism and has allowed the use of a unilateral approach in selected cases. The aim of this study was to prospectively evaluate patients with hyperparathyroidism who underwent ambulatory unilateral surgery. Patients and method We studied 50 patients (43 women and 7 men) with a biochemical diagnosis of hyperthyroidism and single scintigraphic uptake suggestive of solitary adenoma of the cervix. All patients underwent unilateral exploration with resection of the adenoma. The homolateral gland was normal. We excluded patients with secondary or tertiary hyperparathyroidism, familial antecedents of hyperparathyroidism or multiple endocrine neoplasia associated thyroid disease, previous thyroid or parathyroid surgery, alkaline phosphate concentrations greater than 300 U/l and classical reasons for exclusion from major ambulatory surgery. Operating time, number of admissions, complications, histological study of surgical samples and the results of surgery were analyzed. Calcium and parathyroid hormone concentra- tions were determined at 48 hours, 1 month and 3 months after surgery. Results Mean operating time was 34.7 ± 17.53 minutes. Only one patient from the series was admitted. Mortality was nil. Concerning complications, no cases of bleeding/hematoma or recurrent paralysis were found. None of the patients presented permanent hypoparathyroidism and only five presented slight paresthesias that resolved without treatment. In the 50 patients, histological diagnosis was parathyroid adenoma. In all patients, calcium and parathyroid hormone concentrations returned to normal 1 and 3 months after surgery. Conclusions Ambulatory unilateral neck exploration is safe and effective in the surgical treatment of patients with primary hyperparathyroidism due to solitary adenoma. This procedure produces low morbidity and excellent results. Nevertheless, patients should be carefully selected and high-quality scanning should be performed for preoperative localization.Cirugía Española 01/2001; 70(5):222–226. DOI:10.1016/S0009-739X(01)71886-6 · 0.89 Impact Factor