Quiste paratiroideo e hiperparatiroidismo / Parathhyroid cyst and hyperparathyroidism

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[Evaluation of parathyroid function in presternal subcutaneous grafting after total parathyroidectomy for renal hyperparathyroidism]. / Evaluación de la función paratiroidea en el injerto subcutáneo preesternal tras paratiroidectomía total en el hiperparatiroidismo renal.

INTRODUCTION: In the setting of total parathyroidectomy (TPT) and parathyroid transplantation (PTx) for renal hyperparathyroidism (RHP), we evaluated long-term parathyroid graft function after subcutaneous presternal transplantation (SCPTx). HYPOTHESIS: Parathyroid glands are surrounded by fatty tissue. Therefore, we postulated that subcutaneous implantation of parathyroid tissue after TPT for RHP could be at least as effective as intramuscular grafting and would avoid the complications of the latter technique. MATERIAL AND METHOD: We performed a study in a university hospital and its dialysis unit. DESIGN: Prospective open efficacy study of a postoperative diagnostic monitoring method of intact parathyroid hormone (iPTH) in a cohort of surgical patients without loss to follow-up. PATIENTS AND INTERVENTIONS: Thirty-five patients (19 women and 16 men) underwent TPT and SCPTx for RHP at the Department of General Surgery and Department of Nephrology, Donostia Hospital, San Sebastián, Gipuzkoa, Spain, from January 2002 to December 2005. Follow-up ranged from 6 to 42 months (mean, 15.4 months). Graft function was evaluated by measurement of plasma iPTH levels before surgery and 24 hours and 1, 3, 5, 15, 30, 60, 100 and 150 weeks after surgery. Reference values for PTH in our laboratory were 20-65 pg/mL. RESULTS: The mean preoperative iPTH values were 1245 +/- 367.9 pg/mL (mean +/- SD) (range, 493-2160). After TPT and SCPTx, iPTH levels became undetectable in all patients at 24 hours. A value of 50 pg/mL was established as the criterion for adequate parathyroid graft function. The following values were obtained: 15.54 +/- 10.61 pg/mL (mean +/- SD) (range, 6-44) after 1 week, 57.2 +/- 1.9 pg/mL (mean +/- SD) (range, 43-74) after 5 weeks, 64.21 +/- 9.73 pg/mL (mean +/- SD) (range, 11.3-89) after 15 weeks, 75.12 +/- 9.05 pg/mL (mean +/- SD) (range, 24.6-104.2) after 30 weeks, 101.63 +/- 19.85 pg/mL (mean +/- SD) (range, 65-143) after 60 weeks, 121.63 +/- 27.85 pg/mL (mean +/- SD) (range, 62-179) after 100 weeks, 63 +/- 19.85 pg/mL (mean +/- SD) (range, 68-723) after 150 weeks and 102 +/- 18.65 pg/mL (mean +/- SD) (range, 68-113) after 200 weeks. The prevalence of hypoparathyroidism (serum iPTH level of < 20 pg/mL with a normal or low serum calcium concentration) was 2 out of 35 patients (5.71%) by week 60, with recovery of normal values by week 100. Graft-related recurrence occurred in one out of 35 patients (2.85%). CONCLUSIONS: SCPTx after TPT and PTx for secondary RHP is an adequate method to replace muscular forearm parathyroid transplantation and avoid its complications. The functional results of TPT and SCPTx compare favorably with published data on other surgical techniques proposed for the treatment of RHP. Long-term follow-up of this series is currently being performed.

Evaluación de la función paratiroidea en el injerto subcutáneo preesternal tras paratiroidectomía total en el hiperparatiroidismo renal / Evaluation of parathyroid function in presternal subcutaneous grafting after total parathyroidectomy for renal hyperparathyroidism

Introducción. En el contexto de la paratiroidectomía total (TPT) y trasplante paratiroideo (PTx) para el hiperparatiroidismo renal (RHP) evaluamos la función a largo plazo de injerto paratiroideo después de trasplante subcutáneo preesternal (SCPTx). Hipótesis: las glándulas paratiroideas están rodeadas por tejido adiposo. Por lo tanto, postulamos que la implantación subcutánea después de paratiroidectomía en el hiperparatiroidismo renal puede ser al menos tan eficaz como el implante muscular y sin sus complicaciones evolutivas. Material y método. Estudio realizado en un hospital universitario y su unidad de diálisis. Diseño: estudio prospectivo sobre la eficacia del procedimiento mediante determinación de paratirina intacta (iPTH) en una cohorte de pacientes quirúrgicos sin pérdida en el seguimiento. Pacientes e intervenciones: 35 (19 mujeres y 16 varones) fueron sometidos a TPT y SCPTx por RHP en el Departamento de Cirugía y Servicio de Nefrología, Hospital de Donostia (San Sebastián, Gipuzkoa, España), entre enero de 2002 y diciembre de 2005. El seguimiento ha variado entre 6 y 42 (media, 15,4) meses. Se evaluó la función del injerto mediante la determinación de las concentraciones plasmáticas de iPTH antes de la operación y 24 horas y 1, 3, 5, 15, 30, 60, 100, 150 y 200 semanas después. Los valores de referencia para la PTH en nuestro laboratorio fueron de 20-65 pg/ml. Resultados. Los valores medios preoperatorios ± desviación estándar de iPTH fueron de 1.245 ± 367,9 (rango, 493-2.160) pg/ml. Después de la TPT y el SCPTx, las concentraciones de iPTH llegaron a ser indetectables en todos los casos a las 24 horas. Se estableció 50 pg/ml como criterio de función adecuada de injerto paratiroideo. Los valores obtenidos fueron: 15,54 ± 10,61 (rango, 6-44) pg/ml a la semana, 57,2 ± 1,9 (rango, 43-74) pg/ml a las 5 semanas, 64,21 ± 9,73 (rango, 11,3-89) pg/ml a las 15 semanas, 75,12 ± 9,05 (rango, 24,6-104,2) pg/ml a las 30 semanas, 101,63 ± 19,85 (rango, 65-143) pg/ml a las 60 semanas, 121,63 ± 27,85 (rango, 62-179) pg/ml a las 100 semanas, 63 ± 19,85 (rango, 68-723) pg/ml a las 150 semanas y 102 ± 18,65 (rango, 68-113) pg/ml a las 200 semanas. La frecuencia de hipoparatiroidismo (concentración de iPTH en suero < 20 pg/ml con una concentración normal o baja de calcio en suero) fue 2/35 (5,71%) a la semana 60, y se recuperó para la semana 100. La recidiva relacionada con el injerto fue del 2,85% (1/35). Conclusiones. El trasplante subcutáneo preesternal tras paratiroidectomía total y trasplante paratiroideo para el hiperparatiroidismo renal secundario parece un método adecuado como alternativa al trasplante muscular antebraquial y para evitar sus complicaciones. Los resultados funcionales del injerto se comparan favorablemente con los datos publicados sobre otras técnicas quirúrgicas utilizadas para el tratamiento del hiperparatiroidismo renal. El seguimiento a largo plazo de la serie está en curso (AU)

Introduction. In the setting total of parathyroidectomy (TPT) and parathyroid transplantation (PTx) for renal hyperparathyroidism (RHP), we evaluated long-term parathyroid graft function after subcutaneous presternal transplantation (SCPTx). Hypothesis: Parathyroid glands are surrounded by fatty tissue. Therefore, we postulated that subcutaneous implantation of parathyroid tissue after TPT for RHP could be at least as effective as intramuscular grafting and would avoid the complications of the latter technique. Material and method. We performed a study in a university hospital and its dialysis unit. Design: Prospective open efficacy study of a postoperative diagnostic monitoring method of intact parathyroid hormone (iPTH) in a cohort of surgical patients without loss to follow-up. Patients and interventions: Thirty-five patients (19 women and 16 men) underwent TPT and SCPTx for RHP at the Department of General Surgery and Department of Nephrology, Donostia Hospital, San Sebastián, Gipuzkoa, Spain, from January 2002 to December 2005. Follow-up ranged from 6 to 42 months (mean, 15.4 months). Graft function was evaluated by measurement of plasma iPTH levels before surgery and 24 hours and 1, 3, 5, 15, 30, 60, 100 and 150 weeks after surgery. Reference values for PTH in our laboratory were 20-65 pg/mL. Results. The mean preoperative iPTH values were 1245 ± 367.9 pg/mL (mean ± SD) (range, 493-2160). After TPT and SCPTx, iPTH levels became undetectable in all patients at 24 hours. A value of 50 pg/mL was established as the criterion for adequate parathyroid graft function. The following values were obtained: 15.54 ± 10.61 pg/mL (mean ± SD) (range, 6-44) after 1 week, 57.2 ± 1.9 pg/mL (mean ± SD) (range, 43-74) after 5 weeks, 64.21 ± 9.73 pg/mL (mean ± SD) (range, 11.3-89) after 15 weeks, 75.12 ± 9.05 pg/mL (mean ± SD) (range, 24.6-104.2) after 30 weeks, 101.63 ± 19.85 pg/mL (mean ± SD) (range, 65-143) after 60 weeks, 121.63 ± 27.85 pg/mL (mean ± SD) (range, 62-179) after 100 weeks, 63 ± 19.85 pg/mL (mean ± SD) (range, 68-723) after 150 weeks and 102 ± 18.65 pg/mL (mean ± SD) (range, 68-113) after 200 weeks. The prevalence of hypoparathyroidism (serum iPTH level of < 20 pg/mL with a normal or low serum calcium concentration) was 2 out of 35 patients (5.71%) by week 60, with recovery of normal values by week 100. Graft-related recurrence occurred in one out of 35 patients (2.85%). Conclusions. SCPTx after TPT and PTx for secondary RHP is an adequate method to replace muscular forearm parathyroid transplantation and avoid its complications. The functional results of TPT and SCPTx compare favorably with published data on other surgical techniques proposed for the treatment of RHP. Long-term follow-up of this series is currently being performed (AU)

Parathyroid subcutaneous pre-sternal transplantation after parathyroidectomy for renal hyperparathyroidism. Long-term graft function.

BACKGROUND: In the setting of total parathyroidectomy (TPT) and parathyroid transplantation (PTx) for renal hyperparathyroidism (RHP), we evaluated long-term parathyroid graft function after subcutaneous pre-sternal transplantation (SCPTx). Because parathyroid glands are surrounded by fatty tissue, we postulated that results of subcutaneous implantation of parathyroid tissue after total parathyroidectomy for renal hyperparathyroidism could be at least as successful as intramuscular grafting, but without its complications. PATIENTS AND METHODS: The study, a prospective open efficacy study of postoperative (po) diagnostic monitoring of intact parathyroid hormone (iPTH) on a cohort of surgical patients, was conducted within a university hospital with a dialysis unit. Thirty five patients (19 women and 16 men) operated on for renal hyperparathyroidism underwent TPT and SCPTx for RHP at the Department of General Surgery and the Department of Nephrology. Donostia Hospital. San Sebastián. Gipuzkoa. Spain, from January 2002 to December 2005. Follow-up ranges from 6 months to 42 months (median: 15.4 months). The main outcome measure was evaluation of graft function by measurement of iPTH plasma level, based on serum levels of iPTH before operation and 24 h and 1, 3, 5, 15, 30, 60, 100, and 150 weeks after surgery. RESULTS: Average preoperative iPTH values were 1,341.52 + 367.78 pg/ml (mean +/- SD) (range: 493-2,180). After TPT and PSCTx, iPTH levels became undetectable in all patients at 24 h. A level of 50 pg/ml was established as the criterion of adequate parathyroid graft function. Values obtained at the various time intervals were as follows: 14.14 + 7.73 1 pg/ml (mean +/- SD) (range: 6-36) after 1 week, 53 + 77.33 pg/ml (mean +/- SD) (range: 35-74) after 5 weeks, 62.95 + 20.93 pg/ml (mean +/- SD) (range: 11-89) after 15 weeks, 77.54 + 18.84 pg/ml (mean +/- SD) (range: 24.6-104.2) after 30 weeks, 109.29 + 50.22 pg/ml (mean +/- SD) (range: 54-327) after 60 weeks, 134.21 + 128.64 pg/ml (mean +/- SD) (range: 43-712) after 100 weeks, and 122.84 + 117.54 pg/ml (mean +/- SD) (range: 68-723) after 150 weeks. Prevalence of hypoparathyroidism (intact parathyroid hormone serum level < 20 pg/ml with a normal or low serum calcium concentration) was 2/35 (5.71%) by week 60 and recovered by week 100. Graft-related recurrence was 2.85% (1/35). CONCLUSIONS: Subcutaneous pre-sternal transplantation (SCPTx) after TPT and PTx for secondary (RHP) is an adequate method to replace muscular forearm parathyroid transplantation and avoid its complications. Functioning results of total parathyroidectomy and presternal subcutaneous grafting compare favorably with the published data on other surgical techniques proposed for the treatment of renal hyperparathyroidism. Results of long-term follow-up exceed previously reported results.

Tiroiditis supurativa aguda / Acute suppurative thyroiditis

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