Tratamiento quirúrgico del hiperparatiroidismo secundario recidivado

Jimeno, Jaime; Pérez, Marta; Pereira, José António; Sancho, Juan José Alegre; Sitges‐Serra, Antonio

doi:10.1016/s0009-739x(05)70881-2

Cited by 7 publications

(2 citation statements)

References 17 publications

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“…Among the cases in our study, ioPTH changed the management in 2 out of 36 (5.6%) of the patients. Persistent SHPT has been reported to range from 4% to up to 30% even in the hands of experienced surgeons in various references [ 19 , 23 – 26 ]. The recurrence can be due to ectopic or supernumerary glands in the neck or mediastinum.…”

Section: Discussionmentioning

confidence: 99%

Investigating the effectiveness of intraoperative rapid parathyroid hormone assay in parathyroidectomy surgery in patients with secondary hyperparathyroidism

et al. 2023

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Introduction The use of Rapid Intraoperative parathyroid hormone (Io-PTH) assay during surgery in the management of parathyroid tissue in cases of primary hyperparathyroidism has been proven to be effective, while its utilization in secondary hyperparathyroidism (SHPT) has been rarely reported. In the present study, we aim to demonstrate the application of rapid Io-PTH assay in patients with SHPT following chronic kidney disease undergoing parathyroidectomy surgery. Method In this prospective study, five blood samples were taken from patients undergoing parathyroidectomy and upper thymectomy. Among the samples, two were pre-excision, including prior to the first incision, after exploration, and before parathyroids resection. Two additional samples were taken 10 and 20 min after the excision of the parathyroid glands. Another sample was collected twenty-four hours after the operation. Serum Calcium levels and PTH levels were evaluated and analyzed. Results We successfully managed SHPT in all 36 patients in our study. The patients included 24 males (66.7%) with a mean age of 49.97 ± 14.92. The mean PTH decreased significantly at 10 min, 20 min, one day, and six months after surgery (P < 0.001). The highest reduction occurred 10 min after removal of the parathyroid glands so the mean PTH compared to time zero was reduced from 1737 to 439, and in 100% of cases, more than 50% reduction was seen in PTH. Conclusion A 60% or more reduction in PTH Rapid at 10 min after parathyroidectomy has an accuracy of 94.4% and a positive predictive value of 100%. Thus, if the PTH level does not decrease by more than 60% at 10 min or more than 80% at 20 min, tissue exploration is continued with the aim of finding the ectopic parathyroid gland.

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Section: Discussionmentioning

confidence: 99%

Investigating the effectiveness of intraoperative rapid parathyroid hormone assay in parathyroidectomy surgery in patients with secondary hyperparathyroidism

et al. 2023

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“…Es necesaria la cirugía en el 15-20% de los casos. Al asociarse a glándulas ectópicas o supernumerarias y a la menor sensibilidad de los estudios con MIBI-99mTc hacen que la tasa de persistencia o recurrencia sea elevada, pudiendo llegar hasta el 15% [46,47]. La infusión de dobutamina intravenosa a bajas dosis (2 microgramos/kg/min/60 min) previo a la inyección de MIBI, produce una hiperpolarización de las mitocondrias y por lo tanto una mayor acumulación y retención de MIBI, facilitando la visualización gammagráfica y la radiolocalización quirúrgica [48].…”

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Cirugía radioguiada de paratiroides

Rayo-Madrid

Martínez-Esteve

Torre

et al. 2019

ORL

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Conflicto de intereses: Los autores declaran no tener conflictos de intereses Imágenes: Los autores declaran haber obtenido las imágenes con el permiso de los pacientes Política de derechos y autoarchivo: se permite el autoarchivo de la versión post-print (SHERPA/RoMEO) Licencia CC BY-NC-ND. Licencia Creative Commons Atribución-NoComercial-SinDerivar 4.0 Internacional Universidad de Salamanca. Su comercialización está sujeta al permiso del editor RESUMEN El hiperparatiroidismo primario es la principal causa de hipercalcemia en pacientes no hospitalizados, estando causado en el 85-90% de los casos por un adenoma solitario. La cirugía radioguiada (CRG) es una técnica quirúrgica mínimamente invasiva que emplea medicamentos radiofármacos para facilitar la localización y extirpación de lesiones benignas o malignas. La cirugía radioguiada de paratiroides (CRGP), como técnica GOSTT (Guided intraOperative Scintigraphic Tumor Targeting) y mínimamente invasiva, precisa de una prueba de diagnóstico por la imagen que permita localizar anatómicamente la lesión y establecer su comportamiento funcional. El MIBI-99mTc es el trazador de elección, debiendo siempre incluir estudios tomográficos, especialmente la SPECT-CT. Se emplea durante la CRGP junto con sondas intraoperatorias, gammacámaras y dispositivos SPECT portátiles, herramientas de navegación y sistemas robóticos laparoscópicos. La CRGP disminuye el tiempo quirúrgico, los costes hospitalarios y la morbilidad sobre el paciente, con una elevada efectividad y eficiencia. PALABRAS CLAVE Cirugía mínimamente invasiva; cirugía radioguiada; paratiroides; hiperparatiroidismo; MIBI; 99mTc. SUMMARY Primary hyperparathyroidism is the main cause of hypercalcemia in outpatients. It is caused in 85-90% of cases by a solitary adenoma. Radioguided surgery (RGS) is a minimally invasive surgical technique that uses radiopharmaceutical drugs to facilitate the location and removal of benign or malignant lesions. Radioguided parathyroid surgery (RGPS), as a GOSTT (Guided intraOperative Scintigraphic Tumor Targeting) technique and minimally invasive, requires a diagnostic imaging test to anatomically locate the lesion and establish its functional behavior. The MIBI-99mTc is the tracer of choice, and should always include tomographic studies, especially the SPECT-CT. This radiotracer is used during the RGPS together with intraoperative probes, gammacameras and portable SPECT devices, navigation tools and laparoscopic robotic systems. The RGPS reduces surgical time, hospital costs and patient morbidity with high effectiveness and efficiency.

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Reoperative Parathyroid Surgery

Olubowale

Harrison

2009

Endocrine Surgery

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Tratamiento quirúrgico del hiperparatiroidismo secundario recidivado

Cited by 7 publications

References 17 publications

Investigating the effectiveness of intraoperative rapid parathyroid hormone assay in parathyroidectomy surgery in patients with secondary hyperparathyroidism

Investigating the effectiveness of intraoperative rapid parathyroid hormone assay in parathyroidectomy surgery in patients with secondary hyperparathyroidism

Cirugía radioguiada de paratiroides

Reoperative Parathyroid Surgery

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