Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.
【Abstract】ObjectiveTo investigate the effect of xenotransplantation of microencapsulated rabbit parathyroid tissue in different sites in rats for the treatment of hypoparathyroidism. MethodsThe parathyroid glands from Wistar rats were removed to make them aparathyroid. Ultimately, sixteen rats were included because their serum calcium values were continuously below 1.6 mmol/L. We also encapsulated the cultured rabbit parathyroid tissue with alginateBaCl2 microcapsule. According to the transplantation sites, rats were randomly divided into two groups: renal adipose microcapsule group and peritoneal microcapsule group, eight in each group. Encapsulated rabbit parathyroid tissues were then transplanted accordingly to different microcapsule groups. The calcium serum contents were examined on 5，15，25，35，45，55 and 65 d respectively after transplantation and the grafts were observed through electron microscope on the 65 d in particular. ResultsThe calcium contents after transplantation in renal adipose microcapsule group restored to normal and the observation outcomes of grafts showed that they survived well. The calcium contents of posttransplantation in peritoneal group also restored to normal with an exception that it dropped to a level lower than 1.6 mmol/L on the 65 d. Electron microscope also showed that there were necrotic tissues in the center and only a few cells survived on the edge of the grafts. Within peritoneal microcapsule group, the values were significantly lower than others taken at different phases. ConclusionMicroencapsulated rabbit parathyroid tissue that was xenotransplanted into rats can survive and function without administration of immunodepressant. There are significant differences of calcium contents at varying phases between two transplantation sites, which demonstrate that renal adipose may be an optimal site for microcapsule xenotransplantation.
ObjectiveTo summarize the clinical manifestations, pathogenesis, diagnosis and treatment of multiple endocrine neoplasia type 1 (MEN-1) so as to improve the understanding of MEN-1.MethodThe clinical data of 1 case of MEN-1 with new mutated gene in the Yantai Yuhuangding Hospital of Medical College of Qingdao University (our hospital) were analyzed retrospectively.ResultsThe patient was a 73-year-old woman, who was admitted to our hospital because of “abdominal pain, diarrhea” for 4 d. After discussion by a multidisciplinary team, MRI of pancreatic, adrenal and pituitary, and endoscopy examinations were performed to further identify the cause of diarrhea. Meanwhile, MEN-1 gene was detected in the peripheral blood of the patient and her relatives, and the result showed that the proband and his daughter had a cytosine deletion at c.1401 in exon 10 of MEN-1 gene, which resulted in frame shift mutation of p.e468r fs, it was confirmed as MEN-1. After 5 d of conservative treatment of the disease, the patient’s family requested discharge and the patient died half a month after discharge.ConclusionsMEN-1 is a rare autosomal dominant inheritable disease, with diverse clinical manifestations and easy misdiagnosis. Therefore, it is necessary to be alert to abnormal indicators in the glands associated with MEN-1, so as to achieve early diagnosis and treatment.
Secondary and tertiary hyperparathyroidism are common complications in patients with chronic kidney disease, especially in end stage renal disease. Surgery is an important method for the treatment of secondary and tertiary hyperparathyroidism. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism is the first evidence based guideline focus on renal hyperparathyroidism surgical management. Recommendations using the best available evidence by a panel of 10 experts in secondary and tertiary renal hyperparathyroidism constructed this guideline, which provides evidence-based, individual and optimal surgical management of secondary and tertiary renal hyperparathyroidism. This paper made a guideline interpretation on the indications of surgery, imaging examination, preoperative and perioperative management, relevant evaluation and treatment during perioperative period, and intraoperative parathyroid hormone monitoring during operation, and so on.
ObjectiveTo investigate the risk factors of accidental parathyroidectomy following thyroid surgery.MethodsData of patients who accepted at least total thyroidectomy in the Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases between January 2013 and June 2016 was collected retrospectively. According to the appearance or non-appearance of parathyroid gland in the specimens after pathologic examination, the patients were divided into accidental parathyroidectomy group and non-accidental parathyroidectomy group. Clinical data was collected for comparison between the two groups. The risk factors of accidental parathyroidectomy were indentified with univariate analysis and multivariate analysis.ResultsA total of 983 patients, 50 patients in the accidental parathyroidectomy group and 933 patients in the non-accidental parathyroidectomy group, were included in the study. Incidence of temporary hypoparathyroidism was 66.0% (33/50) in the accidental parathyroidectomy group and 36.2% (338/933) in the non-accidental parathyroidectomy group, there was significant difference between the two groups (χ2=19.903, P<0.05). Incidence of permanent hypoparathyroidism was 2.0% (1/50) in the accidental parathyroidectomy group and 0.4% (4/933) in the non-accidental parathyroidectomy group, and there was no significant difference between the two groups (χ2=2.315, P=0.128). Univariate analysis showed that bilateral central lymph nodes dissection (P=0.004) and the number of identified parathyroid glands ≤2 (P=0.002) were risk factors of accidental parathyroidectomy. Multivariate analysis showed that bilateral central lymph nodes dissection [OR=2.553, 95% CI was (1.236, 5.277), P=0.011] and the number of identified parathyroid glands ≤2 [OR=2.819, 95% CI was (1.423, 5.581), P=0.003] were independent risk factors of accidental parathyroidectomy.ConclusionsAfter careful consideration of the possible risks and benefits, bilateral central lymph nodes dissection should be performed rationally. Thyroid surgeons should improve the ability of identification of parathyroid gland to reduce the incidence of accidental parathyroidectomy.
Objective To investigate the reliability of culture method of adult human parathyroid cells. Methods Adult human parathyroid tissue was digested by collagenase, then the original generation of cells were cultured and passaged, and their morphological changes were observed and recorded every other day. Part of the passaged cells were observed through electron microscope and its supernatant parathyroid hormone (PTH) was assayed. Meanwhile, the other part of cells were tested the parathyroid markers, including PTH, calcium-sensing receptor (CaSR) and glial cells missing-2 (GCM-2) by PCR. Results Abundant cytoplasm, mitochondria, endoplasmic reticulum and Golgi apparatus from the seventh day's passaged cells were observed by the electron microscopy, as well as, some secretory granules existing in both cytoplasm and intercellular lacuna. Also, the PTH from supernate was detected, and parathyroid specific markers, such as CaSR, PTH, and GCM2 were positive. Conclusions These trials demonstrated the adult human parathyroid cells could be harvested by collagenase digestion and the cultured. Furthermore, the cells remained good shape and kept functioning, making it a potential source for allogeneic cell transplantation to the treatment of permanent hypoparathyroidism.
Objective To culture primary parathyroid cells by mean of simulated microgravity, observe their basic morphological characteristics, study survival rate and secretory function of parathyroid cells, and explore more excellent culture mean of parathyroid cells. Methods There were 37 male Wistar rats, the body weight was 150–200 g. The rat was intraperitoneally injected with 1% pentobarbital sodium (50 mg/kg). The parathyroid glands were surgically excised and identified pathologically. The parathyroid gland cells were got and digested them with collagenase Ⅱ, which were divided into three groups: conventional culture group (simple parathyroid cells were cultured), polyglycolic acid (PGA) scaffold culture group (the parathyroid cells were cultured on the PGA scaffold), and simulated microgravity culture group (the parathyroid cells and PGA scaffolds were cultured in simulated microgravity environment). The parathyroid cells were cultured for 1, 3, 5 or 7 days in different culture conditions, then the parathyroid hormone (PTH) was measured, morphological characteristics of the parathyroid cell was observed under phase contrast microscope, survival rate of the parathyroid cells was calculated by acridine orange/propidium iodide staining. Results The parathyroid cell morphologies of most cells were well and center of part of cell mass was necrosis on day 7 in the conventional culture group. The most parathyroid cells were spreading toward the poles along the PGA cell scaffold in the longitudinal direction and the adjacent stents were connected by extracellular matrix on day 7 in the PGA scaffold culture group. The parathyroid cells cultured under the simulated microgravity were got round and formed clusters on day 7 in the simulated microgravity culture group. Compared with the other two groups on day 7, the PTH and the survival rate of the parathyroid cells were significantly higher in the simulated microgravity culture group (P<0.05). Conclusions Parathyroid cells cultured in simulated microgravity environment could maintain better morphology, survival rate is higher, and secretory function is better. Therefore, parathyroid cells cultured in simulated microgravity could be used as good donor cell for treatment of hypoparathyroidism. PGA scaffold could be used as a good carrier for culture of parathyroid cell.
ObjectiveTo investigate the effectiveness of probe-based near infrared autofluorescence (AF) technology in the identification and functional protection of parathyroid gland (PG) during endoscopic total thyroidectomy. MethodsWe retrospectively collected the clinical data of 160 patients who underwent total thyroidectomy with bilateral central compartment lymph node dissection due to papillary thyroid carcinoma in Chongqing General Hospital from 1 July 2023 to 31 January 2024. Among them, 80 patients who used probe-based near infrared AF technology to identify the PGs were categorized as the AF group, 80 patients who used naked eye (NE) to identify the PGs were categorized as the NE group. The number of PGs identified, inadvertently removed, preserved in situ and autotransplanted, the incidence of postoperative hypoparathyroidism, and operative time were compared between the two groups. ResultsThe incidence of transient hypoparathyroidism was significantly lower in the AF group than that of the NE group [21.25% (17/80) vs. 43.75% (35/80), χ2=9.231, P=0.002], with no cases of permanent hypoparathyroidism in either group. The AF group had significantly more PGs identified and preserved in situ than the NE group (P<0.05) , but had significantly fewer PGs inadvertently removed and autotransplanted than the NE group (P<0.05). The AF group identified the first PG earlier than the NE group (4 min vs. 5 min, P<0.001). But there was no statistically difference in the operative time between the two groups (90 min vs. 94 min, P=0.052). ConclusionThe probe-based near infrared AF technology can help surgeons better identify and protect PGs during surgery, reducing the incidence of postoperative transient hypoparathyroidism.
Objective To investigate clinical features of accidental parathyroid adenoma (APTA) and to explore diagnosis and treatment strategies of APTA. Methods From February 2009 to December 2016, the patients who would receive the thyroid surgery and were accidentally found the parathyroid adenoma by preoperative examination in the Department of Thyroid & Parathyroid Surgery, West China Hospital of Sichuan University were enrolled in the research. The clinical characteristics, surgical procedure, results of postoperative follow-up were analyzed retrospectively, and which were compared between the patients with APTA and the other patients diagnosed as primary parathyroid adenoma or received thyroid surgery (1 : 4 chosen randomly) in the same period. Results From February 2009 to December 2016, the patients who treated with thyroid surgery and were diagnosed as the primary parathyroid adenoma in our center were 5 881 and 251 respectively. Twenty-six patients with APTA were found in this research. The incidence rate of APTA was 0.44% (26/5 881), accounted for 10.4% (26/251) of the primary parathyroid adenoma. The positive rates of the ultrasound and the parathyroid scintigraphy were 69.2% (18/26) and 72.7% (8/11), respectively. The abnormal rate of the bone mineral density examination was 85.7% (6/7). The preoperative PTH was (38.17±40.69) pmol/L (3.40–181.20 pmol/L), and the serum calcium was (2.73±0.27) mmol/L (2.22–3.23 mmol/L). The number of detected parathyroid adenoma was 29, which were 55.2% (16/29) in the right-lower, 6.9% (2/29) in the right-upper, 27.6% (8/29) in the left-lower, and 10.3% (3/29) in the left-upper location. The rate of single parathyroid adenoma was 88.5% (23/26) and the maximum diameter of parathyroid adenoma was (21.72±9.65) mm. There was 13 cases (44.8%) of the A1 type and 16 cases (55.2%) of the B1 type in these 29 parathyroid adenomas. The rates of the recurrence, postoperative transient hypoparathyroidism, and permanent hypoparathyroidism were 7.7% (2/26), 30.8% (8/26), and 3.8% (1/26), respectively. Additionally, the preoperative PTH and serum calcium levels of the patients with APTA were significantly lower as compared with the primary parathyroid adenoma (P<0.001,P<0.001), which were significantly higher as compared with those of the patients received thyroid surgery without APTA in the same period (P=0.001, P<0.001). Conclusions APTA is a specific type of asymptomatic primary hyperparathyroidism. Examinations for PTH and serum calcium levels before thyroid surgery are important for finding APTA. For the patients with APTA, it is safe and effective to carry out exploratory parathyroidectomy with thyroid surgery at the same time.
Objective To summarize the research progress of the treatment of primary hyperparathyroidism (PHPT) in multiple endocrine neoplasm type 1 (MEN1). Method The literature about the treatment of PHPT in MEN1 in recent years was reviewed. Results When the symptoms of MEN1 related PHPT were obvious, surgery was an effective treatment. In addition to conventional total parathyroidectomy with autotransplantation and subtotal parathyroidectomy, less-than subtotal parathyroidectomy, and single gland excision had also been proved to be effective recently. Conclusions Combining the clinical manifestations with the actual involvement of the parathyroid of MEN1 related PHPT patients, personalized selection of appropriate timing and methods of parathyroidectomy can help MEN1 related PHPT patients obtain ideal parathyroid function and ensure the quality of life to the greatest extent.