Re-operation treatment in uremic patients complicated with persistent secondary hyperparathyroidism after parathyroidectomy with autotransplantation / 临床耳鼻咽喉头颈外科杂志

To analyze the clinical profile and therapeutic effect of re-operation treatment in uremic patients complicated with persistent secondary hyperparathyroidism(SHPT)after parathyroidectomy with autotransplantation.Twelve persistent SHPT patients who were treated with reoperation of paramyroidectomy(PTX)were enrolled in this study during the period from Jan 2014 to Jul 2017 in our hospital.We evaluated the location of the remaining parathyroid glands by ultrasonography,dual-phase 99 Tcm-sestamibi scintigraphy,CT and MR imaging of the neck before the operation.We resected the parathyroid gland tissue in situ,and the ectopic parathyroid glands hiding in thymus,mediastinal,tracheal esophageal groove,thyroid gland and other locations in the neck.During the surgery,nanocarbon imaging was used to help identify the parathyroid gland and parathyroid hormone assay(IOPTH)was measured at the end of the surgery.We observed the changes of clinical symptoms after the surgery and collected blood parameters including serum intact aramyroidhomone(i-PTH),calcium(Ca),phosphoms(P),calcium and phosphorus product before and after surgery.Complications and failure were also analyzed.All the 12 patients underwented successful operation.The postoperative pathological results were hyperplastic parathyroid glands tissue.22 parathyroid glands were resected,among which 14 were located at the neck in situ,8 were ectopic,i.e.,located at thymus in 4 cases,superior mediastinum in 2 cases and thyroid parenchyma in 2 cases.The clinical symptoms were significantly improved including osteoarthritis,skin itching and limb weakness.The levels of serum iPTH,calcium,phosphorus and calcium and phosphorus product were significantly lower than those before operation(<0.05).Ten patients presented hypocalcemia after surgery and the level of calcium returned to normal after supplement of calcium.Temporary injury of laryngeal nerve was found in4 cases,but there was no patient with transient bucking,dyspnea or death.No recurrence was found during 1 year follow-up.It was very important to locate the residual parathyroid gland accurately with a variety of imaging methods in uremic patients complicated with persistent or recurrent SHPT when they needed re-operation.Surgeons should explorate ectopic parathyroid gland according to the concept of the superior mediastinum dissection and the central compartment neck dissection.Meanwhile,the use of nanocarbon assisted parathyroid gland negative imaging and rapid IOPTH can significantly improve the success rate of surgery and reduce surgical complications.

[Distribution, sources and risk assessment of polycyclic aromatic hydrocarbons (PAHs) in surface sediments of Yangtze estuary and Zhejiang coastal areas].

PAHs contents of surface sediments were tested from 62 sampling sites of the Yangtze River estuary and Zhejiang coastal zone in 2013. The results showed that: 16 kinds of PAHs, which are listed as priority pollutants by EPA, were found in all the samples. The total PAHs level (dry weight) reached 31. 8-384 µg x kg(-1) and the average amount was 131.1 µg x kg(-1). The distribution of PAHs was affected by terrigenous input and point source pollution, the high-value zones were found at 2# sampling site of the Yangtze River estuary and 21# sampling site of Ningbo. Compared with other sea areas, the survey sea area was at a low PAHs pollution level. PAHs were primarily tetracyclic or tricyclic, and source analysis showed that most of PAHs were originated from combustion of wood and coal. Based on the Sediment Quality Guidelines (SQGs), the assessment result showed that the PAHs content of surface sediments from survey sea area was at a relatively low level of ecological risk; While according to the assessment result of the Sediment Quality Standards (SQSs), PAHs pollution of surface sediments from survey sea area displayed an "Obviously negative ecological effect" to some extent, and some countermeasures are required to control and eliminate pollutions.