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John I Lew - One of the best experts on this subject based on the ideXlab platform.
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additional 20 minute intraoperative Parathormone measurement can minimize unnecessary bilateral neck exploration
Journal of Surgical Research, 2019Co-Authors: Zahra F Khan, Josefina C Farra, Andrea R Marcadis, Omar Picado, John I LewAbstract:Abstract Background Parathyroidectomy guided by intraoperative Parathormone (ioPTH) monitoring for primary hyperparathyroidism (pHPT) confirms removal of all hyperfunctioning parathyroid glands. This study evaluates the utility of an additional 20-min ioPTH measurement in patients who fail to meet the >50% ioPTH drop criterion. Methods A retrospective review of prospectively collected data of 706 patients with pHPT who underwent parathyroidectomy guided by ioPTH monitoring was performed. When a >50% ioPTH decrease from the highest either preincision or preexcision level was achieved after 10 min, parathyroidectomy was completed. If this criterion was not met, further exploration was performed or an additional 20-min ioPTH measurement was obtained. Results Of 706 patients, 72 (10%) patients did not meet the >50% ioPTH drop criterion at 10 min. Of these patients, 67% (48/72) underwent immediate bilateral neck exploration (BNE). For the other 33% of patients (24/72), a 20-min Parathormone (PTH) measurement was drawn. Of patients with an additional 20-min PTH measurement, 46% (11/24) had a >50% ioPTH decrease at 20 min where BNE was avoided and parathyroidectomy completed, whereas 54% (13/24) did not. Compared to patients with insufficient ioPTH drop at 10 min and subsequent BNE, there was a statistically significant 46% reduction of BNE in patients with a 20-min PTH level (P Conclusions A 20-min ioPTH measurement is useful in preventing unnecessary BNE in some patients who undergo focused parathyroidectomy with a delayed >50% ioPTH drop.
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intraoperative Parathormone spikes during parathyroidectomy may be associated with multiglandular disease
Surgery, 2017Co-Authors: Richard Teo, Josefina C Farra, Zahra F Khan, Andrea R Marcadis, John I LewAbstract:Abstract Background The importance of intraoperative Parathormone “spikes” during parathyroidectomy remains unclear. This study compared patients with and without intraoperative Parathormone spikes during parathyroidectomy using the criterion of a > 50% Parathormone and determined the effect of intraoperative Parathormone spikes on operative outcome. Methods We performed a retrospective review of prospectively collected data on 683 patients who underwent parathyroidectomy guided by intraoperative Parathormone monitoring. An intraoperative Parathormone “spike value” was calculated by subtracting the preincision intraoperative Parathormone value from the pre-excision intraoperative Parathormone value (SV = PE − PI). An intraoperative Parathormone spike was defined as having a positive spike value ≥9 pg/mL (≥10th percentile of all spike values). Results Of 683 patients, 224 (33%) had intraoperative Parathormone spikes and a greater rate of multiglandular disease (8% vs. 3%, P Conclusions Although the presence of intraoperative Parathormone spikes may increase suspicion for multiglandular disease, the ability of intraoperative Parathormone monitoring to predict operative success after parathyroidectomy is not affected by spikes.
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intraoperative Parathormone monitoring mitigates age related variability in targeted parathyroidectomy for patients with primary hyperparathyroidism
Annals of Surgical Oncology, 2015Co-Authors: Brian E Bishop, Bo Wang, Punam P Parikh, John I LewAbstract:Background Preoperative parathyroid localization studies, namely, sestamibi (MIBI) and surgeon-performed ultrasound (SUS), are commonly used for targeted parathyroidectomy (PTX) with intraoperative Parathormone monitoring (IPM) in patients with primary hyperparathyroidism (pHPT). This study examined age-related variability in abnormal parathyroid gland localization for targeted PTX and the value of IPM across age groups.
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long term effectiveness of localization studies and intraoperative Parathormone monitoring in patients undergoing reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism
American Journal of Surgery, 2015Co-Authors: Punam P Parikh, Josefina C Farra, Bassan J Allan, John I LewAbstract:Abstract Background Reoperative parathyroidectomy (RPTX) for persistent or recurrent hyperparathyroidism is associated with a high rate of operative failure. The long-term effectiveness of RPTX using localization studies and intraoperative Parathormone monitoring (IPM) was examined. Methods Retrospective analysis of prospectively collected data from patients undergoing targeted RPTX with IPM for persistent or recurrent hyperparathyroidism was performed. Persistent hyperparathyroidism was defined as elevated calcium and Parathormone (PTH) levels above normal range less than 6 months after parathyroidectomy. Recurrent hyperparathyroidism was defined as elevated calcium and PTH levels greater than 6 months after successful parathyroidectomy. Sensitivity and positive predictive value (PPV) for sestamibi, surgeon-performed ultrasound, intraoperative PTH dynamics, and surgical outcomes were evaluated. Results Of the 1,064 patients, 69 patients underwent 72 RPTXs with localizing studies and IPM. Sestamibi (n = 69) had a sensitivity of 74% and a PPV of 83%, whereas surgeon-performed ultrasound (n = 38) had a sensitivity of 55% and a PPV of 76%. IPM had a sensitivity of 100% and a PPV of 98%. An intraoperative PTH drop greater than or equal to 50% was predictive of operative success (P Conclusion RPTX can be performed in a targeted approach using preoperative localization studies and IPM, leading to a low rate of complications and a high rate of long-term operative success.
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normocalcemic Parathormone elevation after successful parathyroidectomy long term analysis of Parathormone variations over 10 years
Surgery, 2011Co-Authors: Melanie Goldfarb, Stephen Gondek, George L Irvin, John I LewAbstract:Background The long-term significance of normocalcemic Parathormone elevation (NPE) after successful parathyroidectomy for sporadic primary hyperparathyroidism remains unclear. Method Of 239 consecutive patients who underwent targeted parathyroidectomy with intraoperative Parathormone monitoring, 96 were followed for ≥10 years. NPE was defined as a normal serum calcium level and Parathormone (PTH) above the normal reference range ≥6 months after successful parathyroidectomy. Recurrence was defined as elevated serum calcium and PTH levels ≥6 months after parathyroidectomy. Risk factors for NPE, patterns of postoperative PTH variation, and 10-year outcomes were analyzed. Results Of 96 patients followed ≥10 years, 42 had postoperative NPE. Only male gender ( P = .008) was a risk factor for NPE, and NPE did not predict recurrence. Three patterns of postoperative NPE were identified in patients with ≥3 PTH measurements over this 10-year period. Group 1 ( n = 11): 1 to 2 consecutive PTH elevations; none recurred, and most were explained by physiologic variation. Group 2 ( n = 23): multiple PTH fluctuations; 3 recurred, and almost all had physiologic variations. Group 3 ( n = 4): PTH always elevated; 2 recurred. Conclusion Postoperative NPE may be a dynamic, reversible, and transient clinical entity that does not predict recurrence. Nevertheless, patients with postoperative NPE should be monitored and an attempt made to correct any obvious potential causes of PTH elevation.
Jacques Marescaux - One of the best experts on this subject based on the ideXlab platform.
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impact of roux en y gastric bypass versus sleeve gastrectomy on vitamin d metabolism short term results from a prospective randomized clinical trial
Surgical Endoscopy and Other Interventional Techniques, 2014Co-Authors: Michele Diana, Antonio Durso, Didier Mutter, Jacques MarescauxAbstract:Purpose To assess postoperative outcomes of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). Short-term results on vitamin D and Parathormone (PTH) metabolism are reported.
Punam P Parikh - One of the best experts on this subject based on the ideXlab platform.
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intraoperative Parathormone monitoring mitigates age related variability in targeted parathyroidectomy for patients with primary hyperparathyroidism
Annals of Surgical Oncology, 2015Co-Authors: Brian E Bishop, Bo Wang, Punam P Parikh, John I LewAbstract:Background Preoperative parathyroid localization studies, namely, sestamibi (MIBI) and surgeon-performed ultrasound (SUS), are commonly used for targeted parathyroidectomy (PTX) with intraoperative Parathormone monitoring (IPM) in patients with primary hyperparathyroidism (pHPT). This study examined age-related variability in abnormal parathyroid gland localization for targeted PTX and the value of IPM across age groups.
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long term effectiveness of localization studies and intraoperative Parathormone monitoring in patients undergoing reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism
American Journal of Surgery, 2015Co-Authors: Punam P Parikh, Josefina C Farra, Bassan J Allan, John I LewAbstract:Abstract Background Reoperative parathyroidectomy (RPTX) for persistent or recurrent hyperparathyroidism is associated with a high rate of operative failure. The long-term effectiveness of RPTX using localization studies and intraoperative Parathormone monitoring (IPM) was examined. Methods Retrospective analysis of prospectively collected data from patients undergoing targeted RPTX with IPM for persistent or recurrent hyperparathyroidism was performed. Persistent hyperparathyroidism was defined as elevated calcium and Parathormone (PTH) levels above normal range less than 6 months after parathyroidectomy. Recurrent hyperparathyroidism was defined as elevated calcium and PTH levels greater than 6 months after successful parathyroidectomy. Sensitivity and positive predictive value (PPV) for sestamibi, surgeon-performed ultrasound, intraoperative PTH dynamics, and surgical outcomes were evaluated. Results Of the 1,064 patients, 69 patients underwent 72 RPTXs with localizing studies and IPM. Sestamibi (n = 69) had a sensitivity of 74% and a PPV of 83%, whereas surgeon-performed ultrasound (n = 38) had a sensitivity of 55% and a PPV of 76%. IPM had a sensitivity of 100% and a PPV of 98%. An intraoperative PTH drop greater than or equal to 50% was predictive of operative success (P Conclusion RPTX can be performed in a targeted approach using preoperative localization studies and IPM, leading to a low rate of complications and a high rate of long-term operative success.
Stanley Knoll - One of the best experts on this subject based on the ideXlab platform.
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targeted parathyroidectomy effectiveness and intraoperative rapid Parathormone dynamics
Laryngoscope, 2008Co-Authors: Nader Sadeghi, Esma A Akin, Jenny Yi Lee, Jason Roland, Stanley KnollAbstract:Objective: The objective of this study is to assess the effectiveness of selective parathyroid exploration, using preoperative image localization and intraoperative rapid-Parathormone (rPTH) assay. The kinetics of intraoperative rPTH in parathyroid adenoma vs. multiglandular disease is assessed. Design: This is a prospective noncontrolled study of a cohort of 100 patients with primary hyperparathyroidism, at a single academic institution. The patients underwent selective parathyroidectomy after preoperative localization, including sestamibi scan and ultrasonography. Intraoperative rPTH assay was used to determine the extent and success of parathyroidectomy. Frozen sections were used as additional confirmation. Follow-up serum calcium levels were used to assess the effectiveness of selective parathyroidedcomy. Results: Mean preoperative serum calcium (Ca) and baseline intact-Parathormone were 11.6 mg/dL and 136, respectively. Data were available in 96 cases: 87 single-gland adenoma with two in ectopic mediastinal position, two double adenoma and seven cases of hyperplasia. Ten percent of patients with adenoma needed bilateral exploration for nonlocalizing or false negative imaging, or for intraoperative rPTH failure to decay. All of the patients undergoing unilateral targeted exploration were normocalcemic on follow up. There were only one failed exploration and two cases of recurrent mild hypercalcemia, all three in bilateral exploration cases. Intraoperative rPTH reduction by standard curves was predictive of successful excision of all of the abnormal glands, as confirmed by postoperative serum calcium levels. More than one postexcision rPTH measurement was useful by showing failure of a decaying slope in multiglandular disease. Conclusion: Targeted parathyroidectomy, when appropriately selected and carried out, is an effective treatment of primary hyperparathyroidism in most cases. Intraoperative rPTH can correctly guide removal of hyperfunctioning glands. Targeted parathyroidectomy offers the advantage of less invasive surgery with less tissue dissection confined to one side and avoids surgically disturbing the remainder of the neck. This should reduce postoperative complications and allow for easier and safer re-exploration in the few cases with persistent or recurrent disease.
Alexandre Lages Savassi Rocha - One of the best experts on this subject based on the ideXlab platform.
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elevated serum Parathormone after roux en y gastric bypass
Obesity Surgery, 2004Co-Authors: Maria De Fatima Haueisen Sander Diniz, Marco Tulio Costa Diniz, Soraya Rodrigues De Almeida Sanches, Patricia Paz Cabral De Almeida Salgado, Maristane Mendes Andrade Valadao, Flavia Caldeira Araujo, Daniele Siriaco Martins, Alexandre Lages Savassi RochaAbstract:Background: Abnormalities in calcium and vitamin D metabolism are observed early after gastric bypass, whereas clinical or biochemical evidence of metabolic bone disease might not be detected until many years after the procedure. The aim of the present study was to evaluate the impact of bariatric surgery on bone metabolism determined on the basis of postoperative laboratory changes in calcium, phosphorus, magnesium, alkaline phosphatase and Parathormone (PTH) levels. Methods: 110 patients submitted to Roux-en-Y gastric bypass (RYGBP) were followed after surgery, and the following parameters were determined: intact PTH molecule (PTHi; chemiluminescence), alkaline phosphatase (colorimetric method), ionic calcium (selective electrode), phosphorus and magnesium (colorimetric method). Results: Elevated serum PTHi levels were observed in 29% of the patients and hypocalcemia in 0.9% from the 3rd postoperative month and afterwards (3 to 80 months after surgery). Conclusion: There is a need for careful evaluation of bone metabolism and for routine calcium replacement after RYGBP.
