PMID- 17973936
OWN - NLM
STAT- MEDLINE
DCOM- 20090831
LR  - 20210503
IS  - 1365-2265 (Electronic)
IS  - 0300-0664 (Linking)
VI  - 68
IP  - 4
DP  - 2008 Apr
TI  - The management of high-risk patients with primary hyperparathyroidism - minimally 
      invasive parathyroidectomy vs. medical treatment.
PG  - 520-8
AB  - OBJECTIVE: Parathyroidectomy (PTx) for high-risk primary hyperparathyroidism 
      (PHPT) patients poses a surgical challenge. We hypothesize that a minimally 
      invasive parathyroidectomy (MIP) under local anaesthesia may minimize the 
      perioperative risks and facilitate easier clinical care than medical treatment 
      for these patients. DESIGN AND PATIENTS: We performed a prospective, 
      nonrandomized, controlled study of 33 PHPT patients evaluated as poor general 
      anaesthesia risks. The outline of the diseased parathyroids and the thyroid were 
      mapped by Tc(99m) sestamibi scan and focused sonogram. MIPs were performed under 
      local anaesthesia (group 1, 19 patients). Medical treatment with bisphosphonates 
      was continued for patients refusing operation (group 2, 14 patients). 
      MEASUREMENTS: Serum Ca, PO(4), and i-PTH were measured the following morning, 
      every 6 months in the first postoperative year and then yearly for group 1 
      patients, or every 3 months for group 2 patients. American Society of 
      Anaesthesiologists (ASA) and New York Heart Association (NYHA) class designations 
      were re-evaluated every 3 months. RESULTS: In group 1, there were no operative 
      complications, mortality or recurrent hypercalcaemia during a mean follow-up of 
      35.5 months. Group 2 patients had a significantly higher incidence of episodes of 
      hypercalcaemic crisis, deteriorating renal function and weight-bearing bone 
      fractures, while group 1 patients had a higher incidence of improved ASA and NYHA 
      class, better 3-year overall survival rate (83.1%vs. 60.8%, P = 0.032), and less 
      medical costs. CONCLUSION: MIP can be safely performed under local anaesthesia 
      and it facilitates clinical care in high-risk PHPT patients. It is recommended 
      for those selected by image localization.
FAU - Fang, Wen-Liang
AU  - Fang WL
AD  - Division of General Surgery, Department of Surgery, Veterans General Hospital, 
      Taipei, Taiwan.
FAU - Tseng, Ling-Ming
AU  - Tseng LM
FAU - Chen, Jui-Yu
AU  - Chen JY
FAU - Chiou, See-Ying
AU  - Chiou SY
FAU - Chou, Yi-Hong
AU  - Chou YH
FAU - Wu, Chew-Wun
AU  - Wu CW
FAU - Lee, Chen-Hsen
AU  - Lee CH
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20071029
PL  - England
TA  - Clin Endocrinol (Oxf)
JT  - Clinical endocrinology
JID - 0346653
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anesthesia, Local
MH  - Female
MH  - Humans
MH  - Hyperparathyroidism/*surgery
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures
MH  - Parathyroidectomy/*methods
MH  - Perioperative Care
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Treatment Outcome
EDAT- 2007/11/02 09:00
MHDA- 2009/09/01 06:00
CRDT- 2007/11/02 09:00
PHST- 2007/11/02 09:00 [pubmed]
PHST- 2009/09/01 06:00 [medline]
PHST- 2007/11/02 09:00 [entrez]
AID - CEN3076 [pii]
AID - 10.1111/j.1365-2265.2007.03076.x [doi]
PST - ppublish
SO  - Clin Endocrinol (Oxf). 2008 Apr;68(4):520-8. doi: 
      10.1111/j.1365-2265.2007.03076.x. Epub 2007 Oct 29.