Immediate and long-term results of parathyroid autotransplantation in primary hyperparathyroidism.

The authors review the experience of total parathyroidectomy with microsurgical autotransplantation with reference to the long-term results. This method--after further control investigations--may be envisaged for making a definitive evaluation of the results.

Acute hyperparathyroidism successfully treated by total parathyroidectomy and parathyroid autotransplantation.

Acute hyperparathyroidism occurs infrequently and sometimes represents a diagnostic problem in urological patients. We report a case of acute hyperparathyroidism successfully treated by total parathyroidectomy and parathyroid autotransplantation.

Treatment of priapism by transcatheter embolization of internal pudendal arteries.

Priapism can be successfully treated by unilateral or bilateral percutaneous transcatheter occlusion of the internal pudendal arteries. Occlusion should be reversible in order to avoid impotence. Embolization with autologous clot satisfies this requirement because of the clot lysis and consequent vessel recanalization. Three cases are extensively described which demonstrate the feasibility of the method and the ability to preserve sexual potency. The rationale for using interventional angiography in priapism is also discussed.

[Parathyroid gland autotransplantation: long-term results and direct test of the function of the implant by selective parathyroid hormone determination and stress test]. / Epithelkörperchenautotransplantation: Langzeitergebnisse und direkte Uberprüfung der Funktion des Implantates durch selektive Parathormonbestimmung und Belastungstests.

The precision of PTH measurement and the location of the implant allow the functioning of the transplanted tissue to be easily checked by separately measuring the PTH concentration in the arm bearing the transplant in comparison with the other side. In 10 of the 13 patients operated on by us it was observed that the transplant had grown and was functioning satisfactorily. In 2 further patients, in whom the PTH concentration alone gave no clear information on the functioning of the transplanted tissue, the tolerance test was for this purpose decisive. In fact the transplanted parathyroid tissue showed a rapid and clear response to pharmacodynamic stimulus, which demonstrated the viability of the transplant. We therefore venture to say that pharmacodynamic investigation is of a certain use in postoperative examinations of these patients, especially in doubtful cases. Unfortunately we have had no opportunity to perform a histological investigation of the implanted endocrine tissue, but this has already been reported on in print.

Temporary embolization in urological practice: myth or reality?

Clot embolization through percutaneous transcatheter technique has proved to be a highly effective and reliable method for stopping bleeding from renal or pelvic areas. The recanalization of the embolized vessels is constant and the recovery of the renal function quite satisfactory. In case of priapism temporary embolization may be very useful in selected cases.

PTH radioimmunoassay and loading tests in the diagnosis of patients with primary hyperparathyroidism.

PTH radioimmunoassay today represents an unreplaceable tool in the diagnosis of primary hyperparathyroidism. However, the diagnostic importance of its dosage on selective venous samples is still discussed. Herein, we report our experience of 47 patients operated on for primary hyperparathyroidism. The catheterization of neck veins was performed according to Doppman and co-workers. The PTH assay was carried out with COOH- and NH2-specific antisera. (In 5 cases an inhibition test with CaCl2 infusion was practiced during selective catheterization to preoperatively discriminate between adenoma and hyperplasia.) In 8 cases loading tests with EDTA and in 6 cases with CaCl2 were also performed in association with peripheral venous sampling, in an attempt to improve its sensibility. The 47 cases operated upon showed the following results: the peripheral PTH values were significantly raised in 60% of the cases; the selective PTH dosage with COOH-specific antiserum showed a parathyroid hyperfunction in 100% of the surgically confirmed cases, whereas with the NH2-specific antiserum an increased PTH rate was found only in 84%. A right preoperative localization was obtained in 73%. The value of loading tests is more difficult to evaluate and is discussed in detail.

Parathyroid autotransplantation.

7 patients with diffuse parathyroid hyperplasia underwent total parathyroidectomy and microsurgical autotransplantation for diffuse parathyroid hyperplasia. 5 of 7 patients showed good function of the grafted parathyroid tissue, as checked by the separate PTH assay from the grafted versus not grafted forearm. In 1 patient parathyroid stimulation test with EDTA infusion and suppression test with calcium infusion were also performed.

Surgical hyperparathyroidism in calcium stone formers. A retrospective study of 20 cases.

Urinary lithiasis, hypercalciuria and hyperparathyroidism are strictly related diseases, and the urologist diagnoses primary hyperparathyroidism (PHP) in the majority of cases. Herein we retrospectively analyze our experience of 20 cases of surgically proved PHP, operated on in the last 4 years. Hypercalcemia was the keystone for the diagnosis of all our cases PTH radioimmunoassay on selectivity sampled blood revealed a fundamental tool in the management of patients with suspicious or certain hyperparathyroidism. It confirmed the diagnosis in all the cases and gave the preoperative localization of parathyroid adenomas in 70% of the cases. Besides, it made it possible to discriminate between parathyroid adenomas and diffuse hyperplasia preoperatively, so offering a considerable aid to the surgeon in deciding between the conservative and liberal approach to parathyroid surgery. At follow-up, 3 out of 14 cases revealed renal hypercalciuria, which could have been the cause of hyperparathyroidism, as proposed by Reiss and associates previously. The relationship between hypercalciuria and hyperparathyroidism and the problem of a new classification of parathyroid hyperfunction are discussed.