Abstract | BACKGROUND: METHODS: NTPTX (a vascularized parathyroid remnant is left in situ, and cryopreservation is performed) was completed in 142 patients with secondary (n = 93 patients) and tertiary (n = 49 patients) hyperparathyroidism, and was guided by intraoperative intact PTH (IOPTH). RESULTS: One hundred thirty-six of 142 patients (96%) remain cured at a mean follow-up time of 23 +/- 26 months. Six patients had missed mediastinal (n = 4 patients) or cervical (n = 2 patients) parathyroid glands. No patient required re-resection of a cervical parathyroid remnant. One patient had hypoparathyroidism and underwent autografting with cryopreserved tissue. NTPTX reduced parathyroid mass (4526 +/- 4515 mg to 77 +/- 56 mg) and IOPTH (1171 +/- 1252 pg/mL to 101 +/- 127 pg/mL). Fatigue and musculoskeletal pain resolved promptly after operation. Patients with tertiary hyperparathyroidism experienced an improvement in bone density of 3.6% per year. NTPTX achieved full healing of extremity ulcers without amputations or perioperative death in 22 patients with calciphylaxis. CONCLUSIONS: NTPTX effectively treats secondary and tertiary hyperparathyroidism in >95% patients. IOPTH monitoring and cryopreservation are valuable procedural adjuncts. Limb salvage in calciphylaxis, symptomatic relief, and improved bone density are substantial benefits to recommend this procedure to patients with renal hyperparathyroidism.
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Authors | Mira Milas, Collin J Weber |
Journal | Surgery
(Surgery)
Vol. 136
Issue 6
Pg. 1252-60
(Dec 2004)
ISSN: 0039-6060 [Print] United States |
PMID | 15657584
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adult
- Female
- Humans
- Hyperparathyroidism
(blood, diagnosis, surgery)
- Male
- Middle Aged
- Parathyroid Hormone
(blood)
- Parathyroidectomy
(methods)
- Treatment Outcome
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