| Autor: |
Seehofer, Daniel, Rayes, Nada, Klupp, Jochen, Steinmüller, Thomas, Ulrich, Frank, M&üller, Christian, Schindler, Ralph, Frei, Ulrich, Neuhaus, Peter |
| Předmět: |
|
| Zdroj: |
Langenbeck's Archives of Surgery; Jul2005, Vol. 390 Issue 3, p222-229, 8p |
| Abstrakt: |
Abstract Background and aims: In contrast to that in patients with primary hyperparathyroidism, the value of intra operative intact parathyroid hormone (iPTH) measurement is still unclear in patients with renal hyper- parathyroid ism and was, therefore, evaluated in a large cohort of patients. Patients: Intra operative iPTH mea- surmount was performed in 153 patients with renal hyperparathyroidism (129 with terminal renal failure and 24 with frmnctioning kidney graft). Subtotal and total parathyroidectomy were performed in 123 and 13 patients, respectively, during initial surgery. In patients with recurrent disease (17), the respective hyper- functioning tissue was removed. Intra operative blood samples were obtained by puncture of the internal jugular vein before preparation of the parathyroids (PTH0) and 15 mm after parathyroidectomy (PTH15). iPTH was measured with the Elecsys 2010 system. Postoperative iPTH levels (PTHPOSI) were determined at postoperative days 1 to 3 and at week 2. Patients were arbitrarily divided in four groups according to the po stop ergative iPTH values: 0-25 pg/ml (group 1), 26-65 pg/ml (group 2), 66-150 pg/ml (group 3) and more than 150 pg/ml (group 4). Results: The mean PTH0 value was 869±57 pg/ml, which decreased to 167±15 pg/ml at PTH15. The mean relative PTH15 value was 2 1.6±1.7%. Postoperatively, iPTH decreased to 42±9 pg/ml. The postoperative iPTH value of the 129 patients with terminal renal failure was 25 pg/ml or less in 99 patients, 26-65 pg/ml in 11 patients, 66-150 pg/ml in eight patients and higher than 150 pg/ml in 11 patients. Two successive criteria of iPTH de- crease were used: first, a PTH15 of s150 pg/ml or, second, a relative PTH15 of S30% less was used. Fifteen patients did not fulfil both criteria. In 13 of them (86.7%) iPTHPOSt was higher than 65 pg (true failure to decline). Of 114 patients who fulfilled the criteria, 108 (94.7%) had normal postoperative iPTH values (true de- cline). Absolute PTH15 values of less than 150 pg/ml predicted normal postoperative iPTH levels in 77 of 78 patients. Conclusion: A PTH15 value of 150 pg/ml or less predicts operative success in patients with renal failure in 98.7% of cases, independently of the relative decay. In contrast, if the relative PTH15 is higher than 30%, high postoperative PTH values are predicted with a probability of 8 6.7%. Although there remain some borderline cases, intraoperative iPTH measurement is accurate and also can be useful in patients with renal hyperparathyroidism. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
|
Full text from SpringerLink