Near-Total Parathyroidectomy

Paloyan, Edward; Lawrence, A. M.; Baker, William H.; Straus, Francis H.

doi:10.1016/s0039-6109(16)38733-3

Cited by 62 publications

(19 citation statements)

References 10 publications

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“…Similar good results after predominantly conservative parathyroidectomy have been reported by others (Block et al, 1974;Myers, 1974), although after a shorter average follow-up. These results are at variance with the suggestion that conservative parathyroidectomy is likely to be followed by further hypercalcaemia in 15-30 per cent of patients (Paloyan et al, 1969(Paloyan et al, , 1973.…”

Section: Discussionmentioning

confidence: 57%

“…Hyperplasia is the term applying to more than one gland in the same patient which show microscopic hypercellularity, nodular or diffuse; hyperplastic glands may be either grossly enlarged or normal in size (Block et al, 1967;Paloyan et al, 1969;Roth, 1971).…”

Section: Classification Of Parathyroid Pathologymentioning

confidence: 99%

“…Hypercalcaemia after parathyroidectomy is usually noted in the postoperative period or within the first year (Paloyan et al, 1969(Paloyan et al, , 1973Haff and Ballinger, 1971), and represents persistent rather than recurrent disease. Our experience suggests that such failures arise when parathyroid hyperplasia is not diagnosed or is inadequately resected, or when an adenoma is not found.…”

Section: Persistent Hypercalcaemiamentioning

confidence: 99%

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Parathyroidectomy: Extent of resection and late results

Cooke

Boey

Sweeney

et al. 1977

Journal of British Surgery

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Opinion is divided as to the necessary extent of parathyroid resection in primary hyperparathyroidism. Some surgeons urge that subtotal parathyroidectomy be performed routinely, while others reserve subtotal resections for patients with parathyroid hyperplasia. In a review of 102 patients treated by parathyroidectomy for primary hyperparathyroidism and subsequently followed up for an average of 6 years, there were 73 patients with parathyroid adenoma, 26 with hyperplasia and 3 with carcinoma. The adenoma was not found at the first operation in only 3 cases; in the other 70 after removal of the adenoma no further hypercalcaemia was observed during the follow-up period. Persistent or recurrent hypercalcaemia was a problem in 9 out of the 26 patients with primary hyperplasia who had inadequate resection at the first operation, and also in the 3 patients with carcinoma. Experience shows that peroperative biopsy with frozen section of all the parathyroids is useful in confirming their identity and can be a guide to the type of disease present and the appropriate extent of resection.

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Section: Discussionmentioning

confidence: 57%

Section: Classification Of Parathyroid Pathologymentioning

confidence: 99%

Section: Persistent Hypercalcaemiamentioning

confidence: 99%

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Parathyroidectomy: Extent of resection and late results

Cooke

Boey

Sweeney

et al. 1977

Journal of British Surgery

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“…Subtotal (3% gland) parathyroidectomy has been the most commonly employed procedure for the treatment of patients with primary and secondary parathyroid hyperplasia. The result of this approach has been favorable, although recurrent or persistent hyperparathyroidism has been reported in 3-15% of patients [7,8]. Since fourgland enlargement is the rule in some forms of primary hyperparathyroidism as well as in secondary hyperparathyroidism, partial excision of a significantly enlarged parathyroid gland, in an attempt to leave sufficient functioning parathyroid tissue to maintain eucalcemia, can be difficult and could lead to devascularization of the remnant and permanent hypoparathyroidism.…”

Section: Clinical Applications For Parathyroid Autotransplantationmentioning

confidence: 99%

Current status of parathyroid autotransplantation

Brunt

Sicard

1990

Seminars in Surgical Oncology

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Autotransplantation of the parathyroid glands is a clinically useful modality for the management of patients with certain forms of hyperparathyroidism. In conjunction with total parathyroidectomy, this procedure has been used to treat patients with primary and secondary hyperparathyroidism who have generalized parathyroid hyperplasia. Parathyroid autotransplantation is also an important adjunct to the management of patients undergoing radical thyroid or laryngeal surgery to prevent permanent hypoparathyroidism from devascularization of all in situ parathyroid tissue. The technique of parathyroid cryopreservation has been well established and provides surgeons with greater flexibility in the approach to patients undergoing reoperative parathyroid surgery in whom there is uncertainty about the functional status of the remaining parathyroid tissue. Parathyroid allotransplantation has been successfully performed in immunosuppressed patients but is rarely indicated. Parathyroid autografts can be placed heterotopically in a forearm muscle or in the sternocleidomastoid, but the former site is preferred in patients with hyperplastic or adenomatous tissue. This technique results in a low incidence of permanent hypoparathyroidism after radical parathyroidectomy, and recurrent hypercalcemia can be easily managed by local excision of a portion of the grafted tissue.

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“…When the glands show distinct pathological changes, differentiation with respect to multiple adenomata is often impossible (Block et al 1967). Nodular hyperplasia probably represents a transitional form between diffuse chief cell hyperplasia and parathyroid adenoma Utley 1968, Straus andPaloyan 1969).…”

Section: Chapter IV -Histology Of the Parathyroid Tumorsmentioning

confidence: 99%

Surgical Treatment of Hyperparathyroidism. With an Analysis of 267 Cases.

1972

Ann Intern Med

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Near-Total Parathyroidectomy

Cited by 62 publications

References 10 publications

Parathyroidectomy: Extent of resection and late results

Parathyroidectomy: Extent of resection and late results

Current status of parathyroid autotransplantation

Surgical Treatment of Hyperparathyroidism. With an Analysis of 267 Cases.

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