Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism

Garner, Sanford C.; Leight, George S.

doi:10.1067/msy.2099.101429

Cited by 163 publications

(112 citation statements)

References 13 publications

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“…Therefore, blood concentrations of intact PTH should decrease immediately within a short period of time subsequent to the removal of all hypersecreting parathyroid glands [18]. In the setting of primary hyperparathyroidism, numerous studies have shown that a rapid intraoperative PTH assay was accurate in predicting surgical success and reported cure rates of 96-98 % [7,19]. Meanwhile, studies also revealed the recurrence rate after limited parathyroidectomy to be 1.5 %.…”

Section: Discussionmentioning

confidence: 99%

“…Even Beyer and colleagues [12] agreed that this technique minimises unnecessary costs associated with operating room time, length of hospital stay and related services fees [23]. In addition, this technique significantly decreased the number of reoperations and it allowed the use of local anaesthesia for parathyroidectomy [19]. Udelsman and colleagues [13] reported that when compared with traditional methods of parathyoidectomy, MIP resulted in 50 % cost saving through the avoidance of an overnight hospital stay and use of local anaesthesia instead of general anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

2012

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There is no doubt that the success of minimally invasive parathyroidectomy (MIP) has changed the whole treatment of patients with primary hyperparathyroidism, especially the approach towards traditional bilateral neck exploration. A single adenoma is the most common cause of primary hyperparathyroidism and its removal results in cure. Hence, it is worth the effort to localise and excise the single adenoma using modern technologies such as highquality sestamibi scans and to confirm complete excision using rapid intra operative parathormone (IOPTH) assays. The objective of the study was to evaluate the feasibility of rapid IOPTH assay in successfully facilitating minimally invasive parathyroid excision. This research involved the retrospective study of seven patients, who underwent MIP at Sagar Hospital in Bengaluru, India, for parathyroid adenoma. All patients with evidence of unifocal disease on sestamibi scanning and cervical ultrasonography, underwent MIP via 2-3 cm lateral incision. Blood samples for measurement of IOPTH were taken at the time of induction of anaesthesia and 10 min after the adenoma excision. Reduction of parathormone (PTH) levels of more than 50 % in the postexcision sample was taken as evidence for complete extirpation of parathyroid adenoma. A solitary adenoma was identified in all the seven patients. After MIP, IOPTH levels fell in six of the seven patients.Following the surgery, all the cases were followed up for a period of 1 month. During this time, except for one patient, six patients remained asymptomatic and blood tests revealed normal serum calcium levels. A histopathological examination confirmed the diagnosis of parathyroid adenoma in six of the seven patients. After accurate preoperative localisation of the adenoma in patients with primary hyperparathyroidism, MIP with IOPTH measurement offers a safe and successful outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

2012

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“…Surgical treatment of PHP has undergone some changes in recent years. The standard technique of bilateral neck exploration with identification of parathyroid adenoma together with the three other normal glands is being replaced in selected cases at many medical centers with a less time-consuming procedure of unilateral neck exploration based on preoperative localization by 99m TC-sestamibi scans (26). The utility of a test that can assure the surgeon that multiglandular disease is not present after the excision of a large parathyroid gland, or that can help localize intraoperatively an eluding adenoma, and quantitatively confirm the adequate excision, is clear.…”

Section: Resultsmentioning

confidence: 99%

Usefulness of a rapid immunometric assay for intraoperative parathyroid hormone measurements

Ohe

Santos

Kunii

et al. 2003

Braz J Med Biol Res

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Intraoperative parathyroid hormone (IO-PTH) measurements have been proposed to improve operative success rates in primary, secondary and tertiary hyperparathyroidism (PHP, SHP and THP). Thirty-one patients requiring parathyroidectomy were evaluated retrospectively from June 2000 to January 2002. Sixteen had PHP, 7 SHP and 8 THP. Serum samples were taken at times 0 (before resection), 10, 20 and 30 min after resection of each abnormal parathyroid gland. Samples from 28 patients were frozen at -70ºC for subsequent tests, whereas samples from three patients were tested while surgery was being performed. IO-PTH was measured using the Elecsys immunochemiluminometric assay (Roche, Mannheim, Germany). The time necessary to perform the assay was 9 min. All samples had a second measurement taken by a conventional immunofluorimetric method. We considered as cured patients who presented normocalcemia in PHP and THP, and normal levels of PTH in SHP one month after surgery and who remained in this condition throughout the follow-up of 1 to 20 months. When rapid PTH assay was compared with a routine immunofluorimetric assay, excellent correlation was observed (r = 0.959, P < 0.0001). IO-PTH measurement showed a rapid average decline of 78.8% in PTH 10 min after adenoma resection in PHP and all patients were cured. SHP patients had an average IO-PTH decrease of 89% 30 min after total parathyroidectomy and cure was observed in 85.7%. THP showed an average IO-PTH decrease of 91.9%, and cure was obtained in 87.5% of patients. IO-PTH can be a useful tool that might improve the rate of successful treatment of PHP, SHP and THP.

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“…This advantage does not always mean better patient outcomes, the medical unit that would like to perform POCT should be interested in the real impact of results in clinical practice, besides the accuracy of devices. Kendal et al [1] [13] 2000 Prospective USA 1788 NR Borgard [14] 2006 Prospective France 473 NR Engle [15] 2002 Prospective USA 404 NR Ho [16] 2006 Prospective China 4689 SN, SP, PPV, NPV Kazmierczak [17] 2004 Prospective USA Unclear NR Lam [18] 2008 Prospective China 113 SN, SP Maisels [19] 2004 Prospective USA 849 NR Mielsch [20] 2010 Prospective Germany 240 NR Robertson [21] 2002 Prospective USA 101 NR Rolinski [22] 2001 Prospective Germany 142 NR Rubaltelli [23] 2001 Prospective Italy NR NR Schmidt [24] 2009 Cohort USA 94 SN, SP, NPV Schumacher [25] 1995 Prospective USA NR NR Tan [26] 1996 Prospective Singapore 540 NR Tayaba [27] 1998 Prospective USA 900 NR Wong [28] 2002 Prospective UK 64 PPV Yamanouchi [29] 1980 Prospective Japan NR NR Yamauchi [30] 1988 Prospective Japan 576 NR Procalcitonin Bektas [31] 2011 Prospective Turkey 141 SN, SP, LR+, LRGaletto-Lacour [32] 2003 Prospective Switzerland 99 SN, SP, PPV, NPV Hesselink [33] 2009 Prospective Netherlands 101 NR Meisner [34] 2000 Prospective Germany 237 NR PTH Agarwal [35] 2001 Prospective Australia 88 NR Chou [36] 2002 Case series Taiwan NR NR Garner [37] 1999 Prospective NC 130 NR Johnson [38] 2001 Prospective USA 104 NR Mace [39] 2008 Prospective UK 20 NR Sokoll [40] 2000 Prospective USA 200 NR Troponin Apple [41] 2000 Prospective USA 1550 SN, SP Apple [42] 2006 Observational retrospective USA 545 NR Birkhahn [43] 2010 Prospective USA 151 SN, SP, PPV, NPV Bock [44] 2008 Prospective US...…”

Section: Discussionmentioning

confidence: 99%

Point-of-care testing: where is the evidence? A systematic survey

Pecoraro

Germagnoli

Banfi

2013

Clinical Chemistry and Laboratory Medicine (CCLM)

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Point-of-care testing (POCT) has had rapid techno logical development and their use is widespread in clinical laboratories to assure reduction of turn-aroundtime and rapid patient management in some clinical settings where it is important to make quick decisions. Until now the papers published about the POCT have focused on the reliability of the technology used and their analy tical accuracy. We aim to perform a systematic survey of the evidence of POCT efficacy focused on clinical outcomes, selecting POCT denoted special analytes characterized by possible high clinical impact. We searched in Medline and Embase. Two independent reviewers assessed the eligibility, extracted study details and assessed the methodological quality of studies. We analyzed 84 studies for five POCT instruments: neonatal bilirubin, procalcitonin, intra-operative parathyroid hormone, troponin and blood gas analysis. Studies were at high risk of bias. Most of the papers (50%) were studies of correlation between the results obtained by using POCT instruments and those obtained by using laboratory instruments. These data showed a satisfactory correlation between methods when similar analytical reactions were used. Only 13% of the studies evaluated the impact of POCT on clinical practice. POCT decreases the time elapsed for making decisions on patient management but the clinical outcomes have never been adequately evaluated. Our work shows that, although POCT has the potential to provide beneficial patient outcome, further studies may be required, especially for defining its real utility on clinical decision making.

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Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism

Cited by 163 publications

References 13 publications

Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

Usefulness of a rapid immunometric assay for intraoperative parathyroid hormone measurements

Point-of-care testing: where is the evidence? A systematic survey

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