More than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism
Section snippets
Patients
Between March 1981 and December 2000, 1,053 patients underwent initial total parathyroidectomy with forearm autograft for advanced renal HPT in our institutions. In 9 patients, parathyroidectomy was performed after successful renal transplantation, whereas all other patients were treated by hemodialysis or peritoneal dialysis. There were 467 women and 586 men. Mean ± SD age at parathyroidectomy was 50.4 ± 29.8 years (range, 19 to 87 years). Mean ± SD duration of hemodialysis before
Number of removed glands and weight
At the initial operation, more than four glands could be identified in 97.5% of all explorations. In 12.2% of patients, supernumerary glands were resected at the initial parathyroidectomy. Supernumerary glands were located most commonly in the thymic tongue (46.2%), and 66.7% of them were recognized microscopically by histopathologic examination.3 The mean ± SD of total glandular weight was 3,486.7 ± 2,267.3 mg, and glands weighing 200 to 500 mg were most common.
Clinical effect
Parathyroid surgery usually had
Discussion
Several issues were crucial in our decision regarding surgical indications for renal HPT. The first was the size of the parathyroid glands. Parathyroid hyperplasia induced by uremia may be divided into diffuse and nodular hyperplasia. The latter exhibits at least one well-circumscribed, encapsulated nodule, and each nodule usually consists of a single cell type with fat-free accumulation.7 It was confirmed that nodular hyperplastic parathyroid tissue had a higher growth potential than diffuse
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Cited by (131)
Surgical Management of Secondary and Tertiary Hyperparathyroidism
2024, Surgical Clinics of North AmericaEctopic and supernumerary parathyroid glands in patients with refractory renal hyperparathyroidism
2021, Surgery (United States)Citation Excerpt :This is based on reported higher adverse outcomes in patients on chronic dialysis whose PTH levels cannot be maintained within a target range of 2–9 times the upper limit of the normal as recommended by the Kidney Disease Improving Global Outcomes clinical practice guidelines.20,22,23 In our cohort of patients with refractory renal HPT, parathyroidectomy was associated with a 30-day mortality of 1.5%, which is comparable to rates of 0.8% to 3.1% reported in other larger studies.4,5,24,25 The single most important correctable cause for perioperative mortality is hyperkalemia, as was true in the 1 patient in our series who died from a dysrhythmia secondary to hyperkalemia.
Alternative transplantation sites for islet transplantation
2019, Transplantation, Bioengineering, and Regeneration of the Endocrine Pancreas: Volume 1The Patterns of Persistence and Recurrence Following Parathyroidectomy for Renal Hyperparathyroidism: A 10-year Review
2024, Journal of Medical Sciences (Taiwan)Neck Reoperation for Recurrent or Persistent Renal Hyperparathyroidism
2023, World Journal of Surgery