Navegando por Palavras-chave "paratireoidectomia"

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    Definição de valores de corte para medida de PTH intraoperatório no tratamento cirúrgico do hiperparatiroidismo secundário e terciário
    (Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2013-08-01) Ohe, Monique Nakayama [UNIFESP]; Santos, Rodrigo Oliveira [UNIFESP]; Kunii, Ilda Sizue [UNIFESP]; Carvalho, Aluizio Barbosa de [UNIFESP]; Abrahão, Márcio [UNIFESP]; Neves, Murilo Catafesta das [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Vieira, Jose Gilberto Henriques [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    In order to improve success rates in surgery of renal hyperparathyroidism, we evaluated intraoperative PTH (IOPTH) measurement utility. METHOD: 86 patients underwent total parathyroidectomy with intramuscular presternal autotransplantation from 04/2000 to 10/2009 and were followed for 26.5 months on average (prospective cohort). Patients were divided in secondary (SHPT) and tertiary hyperparathyroidism (THPT). SHPT group was composed by patients under dialysis treatment, THPT group included renal grafted ones. IOPTH (Elecsys-PTH-Immunoassay/Roche) was measured at anesthesia induction (IOPTH-0') and 20 minutes (IOPTH-20') after parathyroidectomy. RESULTS: 80.2% (69/86) presented with 80% decrease or more in the IOPTH-20' and all were cured. In 11/86 patients (12.7%), a lower IOPTH-20' drop (70-79%) was observed, and 2 of them (18.1%) failed to cure. 6/86 (6.9%) patients presented IO-PTH-20' decrease of less than 70%: two were cured, in three a supernumerary/ectopic parathyroid was found and removed, and in one of these six patients, surgery was finished after 4-gland excision and the patient failure to cure. CONCLUSION: IOPTH-20' decrease of 80% or more compared to IOPTH-0' predicts cure in all renal patients throughout follow-up. A decay of less than 70% points to missed or hyperfunctioning supernumerary gland and is predictive of surgical failure in 66.6%. A marginal IOPTH drop of 70-79% leaves the decision whether or not surgery should be continued up to the experienced surgeon.
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    Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2013-08-01) Bandeira, Francisco; Griz, Luiz; Chaves, Narriane; Carvalho, Nara Crispim; Borges, Lívia Maria; Lazaretti-Castro, Marise [UNIFESP]; Borba, Victoria Zeghbi Cochenski [UNIFESP]; Castro, Luiz Cláudio de; Borges, João Lindolfo; Bilezikian, John; University of Pernambuco Medical School Ministry of Health; Universidade Federal de São Paulo (UNIFESP); Federal University of Parana Medical School; University of Brasilia Medical School; Catholic University of Brasilia; Columbia University College of Physicians & Surgeons
    OBJECTIVE: To conduct a literature review on the diagnosis and management of primary hyperparathyroidism including the classical hipercalcemic form as well as the normocalcemic variant. MATERIALS AND METHODS: This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society for Endocrinology as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including D, are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. CONCLUSION: We present a scientific statement on primary hyperparathyroidism providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment.