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    Rapid intraoperative parathyroid hormone assay--more than just a comfort measure.

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    Authors
    Hanif, F
    Coffey, J C
    Romics, L Jr
    O'Sullivan, K
    Aftab, F
    Redmond, H P
    Affiliation
    Department of Surgery, National University of Ireland, Cork, and Cork University , Hospital, Cork, Ireland.
    Issue Date
    2012-02-03T15:06:04Z
    MeSH
    Adult
    Aged
    Cohort Studies
    Female
    Follow-Up Studies
    Humans
    Hyperparathyroidism/blood/radionuclide imaging/*surgery
    Male
    Middle Aged
    Monitoring, Intraoperative/*methods
    Parathyroid Hormone/*analogs & derivatives/blood
    Parathyroidectomy/*methods
    Preoperative Care
    Probability
    Prospective Studies
    Risk Assessment
    Sensitivity and Specificity
    Statistics, Nonparametric
    Surgical Procedures, Minimally Invasive/methods
    Technetium Tc 99m Sestamibi/diagnostic use
    Treatment Outcome
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    Citation
    World J Surg. 2006 Feb;30(2):156-61.
    Journal
    World journal of surgery
    URI
    http://hdl.handle.net/10147/208872
    DOI
    10.1007/s00268-005-0293-5
    PubMed ID
    16425080
    Abstract
    BACKGROUND: Minimally invasive radio-guided parathyroidectomy (MIRP) has been embraced as an acceptable therapeutic approach to primary hyperparathyroidism. Preoperative sestamibi scanning has facilitated this technique. Here we evaluate the addition of a rapid intraoperative parathyroid hormone (iPTH) assay for patients undergoing MIRP. METHODS: A series of 51 patients underwent sestamibi localization of parathyroid glands followed by MIRP for primary hyperparathyroidism. Using peripheral venous samples, iPTH levels were measured prior to gland excision, as well as post-excision at 5, 10, and 15 minutes, taking a 50% reduction in iPTH level as indicative of complete excision. Next, changes in serum iPTH were compared with preoperative and postoperative changes in serum calcium, as well as levels of intraoperative ex-vivo radiation counts taken by hand-held gamma probe. RESULTS: In this series, a drop of greater than 50% in iPTH levels was observed in 94% of patients (n=48). Moreover, a significant drop in iPTH occurred within 10 minutes of excision in the majority (n=42) of cases (P<0.004). Changes in iPTH were comparable with the therapeutic reduction in calcium levels, as well as with the change in intraoperative ex-vivo gamma counts. CONCLUSIONS: This study demonstrates that the addition of an iPTH assay to MIRP provides a quick and reliable intraoperative diagnostic modality in confirming correct adenoma removal. Moreover, it precludes the requirement of frozen section.
    Language
    eng
    ISSN
    0364-2313 (Print)
    0364-2313 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00268-005-0293-5
    Scopus Count
    Collections
    Cork University Hospital

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