TOTAL PARATHYROIDECTOMY WITH AUTOTRANSPLANTATION OF PARATHYROID TISSUE IN FOREARM MUSCLE IN UREAMIC PATIENTS
Abstract
Between 1989 and 1003, 7 pts underwent total parathyroidectomy - as therapy for secondary hyperparathyroidism with autotransplantation of parathyroid tissue in forearm muscle. All patients failed to respond to prior medical treatment with vitamin D and phosphate binding antacids. Criteria for surgery included one or more of the following: 1) radiographic evidence or clinical signs of hyperparathyroidism, 2) severe pruritus, 3) hypercalcemia, 4) high (> 10) levels of 1PTH. All patients tolerated the operation extremely well. There were no operative death. Postoperatively the majority of our pts showed significant clinical improvement. None of the patients showed recurrence of secondary hyperparathyroidism during the time of the study. Histology showed diffuse hyperplasia of the parathyroid gland especially among the chief cells. We conclude that total parathyroidectomy with autotransplantation of parathyroid tissue is an effective method for surgical treatement of secondary hyperparatyroidism.References
Moriniere Ρ, Fournier Α, Ledlon Α. Comparison of 1a OH vitamin D and Highdoses of calcium carbonate for the control of hyperparatyroidism in pts on maintenace hemodialysis. Nephron 1985, 39: 309 - 315
Adler Α, Berlyne Μ. Pnosphate retention and the genesis of secondary hyperparathyroidism. Am. I Nephr 1986, 6: 414 - 421
Fassbinder W, Brunner F, Bryqher Η et al. Combined report on regural dialysis and transplantation in Europe. Nephr Dial Trans 1991, 1:5 - 35
Memmos D, Williams G, Eastwood J, et al. The role of parathyroidectomy in maintenace haemodialysis and after transplantation. Nephron 1982, 30: 143-148
Stanbury SW, Lumb Α, Nicholson W. Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet 1960, 1: 793-799
Oqq GS. Total parathyroidectomy in treatment of secondary (renal)
hyperparathyroidism. Β. Med j. 1967, 4: 331-334
Kaye Μ, D' Amour Ρ, Henderson J. Elective total parathyroidectomy
without autotransplant in end-stage renal disease. Kindn Int 1989, 35: 1390-1399.
Wells S, Poss Α, Dale J, Gran R. Transplantation of the parathyroid
qlands. Current status. Surg Clin North Am 1979, 59: 167-177
Saxe Α. Parathyroid transplantation. Α. reviw. Surgery 1984, 95: 507-526
Frei V, Klempa I, Schneider Μ. Tumor like growth of parathyroid autografts in Uremic pts. Proc Eur Dial transplantation Assoc 1981, 18: 548 - 555
Brand L. Danqaard Η, Tredeqaard Ε, et al. Long - Term Suppression
of Sec Hyperparathyroidism by intrarenous la - OH D in pts on chronic hemodialysis. Am j. Mephr 1992, 12: 311 - 318
Mells Α, Gaulie J, Shellburne j. et al. Transplantation of the parathyroid glands in man. Clinical indications and results. Surgery 1975, 78: 34
Shpitz B, Korzets Ζ, Jebeikin R, et al. Immediate postoperative management of parathyroidectomised patients. Dialys transplant 1986, 15: 507
Μέμμος Δ. Πρόοδοι στην αντιμετώπιση της νεφρικής οστεοδυστροφίας στην δεκαετία του '80. Έλλην Νεφρολογία 1990, 2: 144-145
Tagaki Η, Tominaga Υ, Uchida Κ. Subtotal vetsus total parathyroidectomy with forearm autograft for secondary parathyrpoidectomy in chronic renal failure. Ann Sutg 1984, 200: 18-23
Mozes Μ, Tang G. Total parathyroidectomy and autotransplantation in secondary hyperparathyroidism. Arch Surg 1980, 115LL 378-385
Rorhmunt Μ,. Surgical treatment of secondary hyparparathyroidism:
Indication operative management and results. Prog Dutg 1986, 18: 186-205
White j, Logeflo Ρ, Feind C. Autologus parathyroid transplantation.
Lancet 1983, ii: 461 Autologus parathyroid transplantation. Lancet 1983, iiLL 461 (latter)
Jansson Τ, Tisell Ε. Autotransplantation of diseased parathyroid glands into subcutaneous abdominal adipose tissue. Surgery 1987, 101: 549-556.
