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Amjad W, Ginzberg SP, Passman JE, Heintz J, Kelz RR, Wachtel H. Predictive Risk Score for Postparathyroidectomy Hungry Bone Syndrome in Patients With Secondary Hyperparathyroidism. J Clin Endocrinol Metab 2024; 109:603-610. [PMID: 37897423 DOI: 10.1210/clinem/dgad636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/03/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Secondary hyperparathyroidism (SHPT) frequently affects patients with end-stage renal disease. Hungry bone syndrome (HBS) is a common complication among patients who undergo parathyroidectomy for SHPT and may cause prolonged hospitalization or require intensive care. The objective of this study is to develop a scoring system to stratify patients according to their risk of developing HBS. METHODS A retrospective cohort study was performed using the US Renal Data System (2010-2021). Univariable and multivariable logistic regression models were developed and weighted β-coefficients from the multivariable model were used to construct a risk score for the development of HBS. Positive and negative predictive values were assessed. RESULTS Of 17 074 patients who underwent parathyroidectomy for SHPT, 19.4% developed HBS. Intensive care unit admission was more common in patients who developed HBS (33.5% vs 24.6%, P < .001). On multivariable logistic regression analysis, younger age, renal osteodystrophy, longer duration of dialysis, longer duration of kidney transplant, and higher Elixhauser score were significantly associated with HBS. A risk score based on these clinical factors was developed, with a total of 6 possible points. Rates of HBS ranged from 8% in patients with 0 points to 44% in patients with 6 points. The risk score had a poor positive predictive value (20.3%) but excellent negative predictive value (89.3%) for HBS. CONCLUSION We developed a weighted risk score that effectively stratifies patients by risk for developing HBS after parathyroidectomy. This tool can be used to counsel patients and to identify patients who may not require postoperative hospitalization.
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Affiliation(s)
- Wajid Amjad
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Sara P Ginzberg
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jesse E Passman
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jonathan Heintz
- Biostatistics Analysis Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Rachel R Kelz
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Heather Wachtel
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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2
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Dabaghi E, Berber E. An update on the use of near-infrared autofluorescence imaging in endocrine surgical procedures. J Surg Oncol 2024; 129:40-47. [PMID: 38031992 DOI: 10.1002/jso.27541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
Over the past decade, near-infrared autofluorescence (NIRAF) imaging has been a major breakthrough in endocrine surgery. Although initial focus was directed at the parathyroid glands, subsequent work has also shown that non-parathyroid neuroendocrine tumors also possess autofluorescence properties. The aim of this review is to present an update and synopsis about NIRAF applications in various endocrine surgical procedures. Methodology includes a review of the literature supplemented with expert opinion. Overall, our review reveals that the use of NIRAF may provide the surgeon with adjunctive critical information that has the potential to change the conduct of many various endocrine surgical procedures.
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Affiliation(s)
- Elissa Dabaghi
- Department of Endocrine Surgery, Cleveland Clinic, Ohio, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Ohio, USA
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3
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Sobutay E, Cakit H, Terzioglu T. Assessing Parathyroid Gland Viability and Predicting Postoperative Hypoparathyroidism in Thyroid Surgery: The Utility of Indocyanine Green Angiography. Sisli Etfal Hastan Tip Bul 2023; 57:466-472. [PMID: 38268654 PMCID: PMC10805044 DOI: 10.14744/semb.2023.06691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024]
Abstract
Objectives Postoperative hypoparathyroidism is a common complication following thyroidectomy, with the potential for significant morbidity and cost. While various techniques have been proposed for intraoperative parathyroid gland (PG) identification and preservation, indocyanine green (ICG) angiography has emerged as a promising method. In this retrospective study, patients who underwent total thyroidectomy with or without central neck dissection were evaluated for the utility of ICG angiography in identifying PGs and the correlation of ICG scores with postoperative parathyroid function. Methods ICG angiography was performed using a standardized protocol, and the degree of PG vascularization was assessed visually. A scoring system was employed based on ICG uptake intensity in PGs, as described in the literature. Pearson's correlation test examined the relationship between the total ICG score and percentage parathyroid hormone (PTH) gradient, postoperative calcium, and PTH levels. In addition, patients with at least one well-vascularized PG were also evaluated. Results Twenty-two patients were included in the study. Significant positive correlations were found between the total ICG score and postoperative PTH levels (r=0.549, p=0.008), and a negative correlation with the percentage of PTH gradient (r=-0.504, p=0.01). However, six patients with well-vascularized PGs on ICG angiography still developed postoperative hypoparathyroidism. Conclusion ICG angiography offers a potential tool for evaluating PG vascularization during thyroidectomy and predicting the risk of postoperative hypoparathyroidism. However, its application should be used judiciously, and the technique should be improved for PG preservation. Further studies are warranted to better understand its benefits and limitations in thyroid surgery.
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Affiliation(s)
- Erman Sobutay
- Department of General Surgery, Koc Foundation American Hospital, Istanbul, Türkiye
| | - Hakan Cakit
- Department of General Surgery, Koc Foundation American Hospital, Istanbul, Türkiye
| | - Tarik Terzioglu
- Department of General Surgery, Koc Foundation American Hospital, Istanbul, Türkiye
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Pannu AY, O’Connor-Manson MR, Wyld L, Balasubramanian SP. Near-infrared fluorescent imaging for parathyroid identification and/or preservation in surgery for primary hyperparathyroidism. Front Endocrinol (Lausanne) 2023; 14:1240024. [PMID: 38111703 PMCID: PMC10726132 DOI: 10.3389/fendo.2023.1240024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/03/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Near infrared autofluorescence (NIRAF) is a novel intraoperative technology that has shown promising results in the localisation of parathyroid glands (PGs) over the last decade. This study aimed to assess the potential utility of NIRAF in first time surgery for primary hyperparathyroidism (PHPT). Methods An observational study over a period of 3 years in patients who underwent surgery for PHPT was designed. Data on the use of NIRAF and fluorescent patterns in different organs (thyroid and parathyroid) and parathyroid pathology (single versus multi-gland disease) were explored. In addition, cure rates and operating times were compared between the NIRAF and no-NIRAF groups to determine the potential value of NIRAF in this cohort. Results In 230 patients undergoing first time surgery for PHPT, NIRAF was used in 50 patients. Of these 50 patients, NIRAF was considered to aid parathyroid identification in 9 patients (18%). The overall cure rate at 6 months of follow-up was 96.5% (98% in NIRAF and 96.1% without NIRAF; p=1.0). The median (interquartile range) operating time was longer in the NIRAF arm at 102 minutes (74-120 minutes) compared to the no-NIRAF arm at 75 minutes (75-109 minutes); however, this difference was not statistically significant (p=0.542). Although the median parathyroid to thyroid (P/T) auto-fluorescence (AF) ratio was similar between single gland and multi gland disease (2.5 vs to 2.76; p=1.0), the P/T AF ratio correlated negatively with increasing gland weight (p=0.038). Conclusion The use of NIRAF resulted in some potential "surgeon-perceived" benefit but did not lead to improvements in cure rates. The negative correlation between fluorescent intensity and gland weight suggests loss of fluorescence with pathology, which needs further investigation. Further studies on larger cohorts of patients, in depth analysis of fluorescence patterns between normal, adenomatous, and hyperplastic glands and evaluation of user experience are needed. Primary hyperparathyroidism, hyperparathyroidism, autofluorescence, near-infrared fluorescence, parathyroid glands, endocrine, surgery.
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Affiliation(s)
- Arslan Y. Pannu
- University of Sheffield, Sheffield, United Kingdom
- Chesterfield Royal Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Lynda Wyld
- University of Sheffield, Sheffield, United Kingdom
| | - Saba P. Balasubramanian
- University of Sheffield, Sheffield, United Kingdom
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
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Nomine-Criqui C, Nguyen-Thi PL, Van Slycke S, Makay O, Brunaud L, Bergenfelz A. Role of hospital and patient factors in the outcome of reoperations for primary hyperparathyroidism: a retrospective multicenter cohort study. Int J Surg 2023; 109:3441-3449. [PMID: 37578454 PMCID: PMC10651301 DOI: 10.1097/js9.0000000000000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There are few data on outcomes after reintervention for persistent or recurrent primary hyperparathyroidism (PHPT). The authors hypothesized that the variation in outcomes at the hospital level after reoperation would be significant. After accounting for this variability, some patient-level clinical criteria could be identified to help inform treatment decisions in this patient population. The aim of this study was to determine whether there is significant variation in outcomes after reoperation for PHPT between hospitals (hospital-level analysis) and identify clinical factors (patient-level analysis) that influence postoperative outcomes. MATERIALS AND METHODS This retrospective multicenter cohort study was performed using the Eurocrine registry. Data from 11 countries and 76 hospitals from January 2015 to October 2020 were extracted. A generalized linear mixed model was used to assess the variation in outcomes at the hospital level and to identify risk factors of postoperative outcomes at the patient level. The primary endpoint (textbook outcome) was achieved when all six of the following postoperative conditions were met: no hypocalcemia or persistent hypercalcemia, no laryngeal nerve injury, no negative exploration, no normal parathyroid gland only on histopathology, and no postoperative death. RESULTS Among 13 593 patients who underwent parathyroidectomy for PHPT, 617 (4.5%) underwent reoperative parathyroidectomy. At follow-up, 231 patients (37.4%) were hypocalcemic, 346 (56.1%) were normocalcemic without treatment, and 40 (6.5%) had persistent hypercalcemia. Textbook outcomes were achieved in 321 (52.0%) patients. The hospital-level variation in textbook outcome rates was significant ( P <0.001), and this variation could explain 29.1% of the observed outcomes. The criterion that remained significant after controlling for inter-hospital variation was 'a single lesion on sestamibi scan or positron emission tomography (PET) imaging' (odds ratio 2.08, 95% confidence interval 1.24-3.48; P =0.005). CONCLUSION Outcomes after reoperation are significantly associated with hospital-related factors. A 'single lesion observed on preoperative sestamibi scan or PET' appears relevant to select patients before reoperation.
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Affiliation(s)
- Claire Nomine-Criqui
- Department of Gastrointestinal and Metabolic Surgery (CVMC), University of Lorraine, CHRU Nancy – Hospital Brabois Adultes, and Faculty of Medicine, INSERM NGERE, «Nutrition, Genetics, Environmental Risks», Vandoeuvre-les-Nancy
| | - Phi-Linh Nguyen-Thi
- Department of Medical Informatics and Evaluation, University of Lorraine, CHU Nancy, Nancy, France
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Ozer Makay
- Department of Surgery, Ege University Hospital, Izmir, Turkey
| | - Laurent Brunaud
- Department of Gastrointestinal and Metabolic Surgery (CVMC), University of Lorraine, CHRU Nancy – Hospital Brabois Adultes, and Faculty of Medicine, INSERM NGERE, «Nutrition, Genetics, Environmental Risks», Vandoeuvre-les-Nancy
| | - Anders Bergenfelz
- Department of Clinical Sciences, Lund University, and Department of Surgery and Gastroenterology, Skane University Hospital, Lund, Sweden
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Seo S, Ali KM, Wolfe SA, Nagururu NV, Ding AS, Desai D, Harbison RA, Kim Y, Ning B, Cha RJ, Russell JO. TOETVA parathyroid autofluorescence detection: hANDY-i endoscopy attachment. Front Endocrinol (Lausanne) 2023; 14:1233956. [PMID: 37693365 PMCID: PMC10484600 DOI: 10.3389/fendo.2023.1233956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/12/2023] [Indexed: 09/12/2023] Open
Abstract
Background Treatment options for thyroid pathologies have expanded to include scarless and remote access methods such as the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Currently, no standardized methods exist for locating parathyroid glands (PGs) in patients undergoing TOETVA, which can lead to parathyroid injury and subsequent hypocalcemia. This early feasibility study describes and evaluates the hANDY-i endoscopic attachment for detecting PGs in transoral thyroidectomy. Methods We used a prototype parathyroid autofluorescence imager (hANDY-i) that was mounted to a 10-mm 0-degree endoscope. The device delivers a split screen view of Red-green-blue (RGB) and near-infrared autofluorescence (NIRAF) which allows for simultaneous anatomical localization and fluorescence visualization of PGs during endoscopic thyroid dissection. Results One cadaveric case and two patient cases were included in this study. The endoscopic hANDY-i imaging system successfully visualized PGs during all procedures. Conclusion The ability to leverage parathyroid autofluorescence during TOETVA may lead to improved PG localization and preservation. Further human studies are needed to assess its effect on postoperative hypocalcemia and hypoparathyroidism.
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Affiliation(s)
- Stefanie Seo
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Khalid Mohamed Ali
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Samantha A. Wolfe
- Department of Endocrine Surgery, University Health Network, Toronto, ON, Canada
| | - Nimesh V. Nagururu
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Andy S. Ding
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Dipan Desai
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - R. Alex Harbison
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Yoseph Kim
- Department of Research, Optosurgical, LLC, Columbia, MD, United States
| | - Bo Ning
- Sheikh Zayed Institute, Children’s National Hospital, Washington, DC, United States
| | - Richard Jaepyeong Cha
- Department of Research, Optosurgical, LLC, Columbia, MD, United States
- Sheikh Zayed Institute, Children’s National Hospital, Washington, DC, United States
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Jonathon O. Russell
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Díaz-Flores L, Gutiérrez R, González-Gómez M, García MDP, Carrasco JL, Madrid JF, Díaz-Flores L. Telocytes/CD34+ Stromal Cells in the Normal, Hyperplastic, and Adenomatous Human Parathyroid Glands. Int J Mol Sci 2023; 24:12118. [PMID: 37569493 PMCID: PMC10419317 DOI: 10.3390/ijms241512118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Telocytes/CD34+ stromal cells (TCs/CD34+ SCs) have been studied in numerous organs and tissues, but their presence and characteristics in the parathyroid glands have not been explored. Using immunological and ultrastructural procedures, we assess the location, arrangement, and behavior of TCs/CD34+ SCs in normal human parathyroids, during their development and in their most frequent pathologic conditions. In normal parathyroids, TCs/CD34+ SCs show a small somatic body and long thin processes with a moniliform aspect, form labyrinthine systems, connect other neighboring TCs/CD34+ SCs, vessels, adipocytes, and parenchymal cells directly or by extracellular vesicles, and associate with collagen I. TCs/CD34+ SCs and collagen I are absent around vessels and adipocytes within parenchymal clusters. In developing parathyroids, TCs/CD34+ SC surround small parenchymal nests and adipocytes. In hyperplastic parathyroids, TCs/CD34+ SCs are prominent in some thickened internodular septa and surround small extraglandular parenchymal cell nests. TCs/CD34+ SCs are present in delimiting regions with compressed parathyroids and their capsule in adenomas but absent in most adenomatous tissue. In conclusion, TCs/CD34+ SCs are an important cellular component in the human parathyroid stroma, except around vessels within parenchymal nests. They show typical characteristics, including those of connecting cells, are present in developing parathyroids, and participate in the most frequent parathyroid pathology, including hyperplastic and adenomatous parathyroids.
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Affiliation(s)
- Lucio Díaz-Flores
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, 38071 La Laguna, Spain (J.L.C.)
| | - Ricardo Gutiérrez
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, 38071 La Laguna, Spain (J.L.C.)
| | - Miriam González-Gómez
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, 38071 La Laguna, Spain (J.L.C.)
- Canary Biomedical Technology Institute, University of La Laguna, 38071 La Laguna, Spain
| | - Maria del Pino García
- Department of Pathology, Eurofins Megalab–Hospiten Hospitals, 38100 La Laguna, Spain
| | - Jose Luis Carrasco
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, 38071 La Laguna, Spain (J.L.C.)
| | - Juan Francisco Madrid
- Department of Cell Biology and Histology, School of Medicine, Campus of International Excellence “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, 30100 Murcia, Spain;
| | - Lucio Díaz-Flores
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, 38071 La Laguna, Spain (J.L.C.)
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Moreno-Llorente P, Pascua-Solé M, García-Barrasa A, Muñoz-de-Nova JL. Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique. Front Surg 2023; 10:1217764. [PMID: 37529659 PMCID: PMC10388241 DOI: 10.3389/fsurg.2023.1217764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Background Postoperative hypoparathyroidism is the most common complication after total thyroidectomy and, when becomes permanent, lead to a myriad of clinical symptoms, long-term need of calcium and vitamin D supplementation and negative impact on the patient's health-related quality of life. Any surgical innovation that could reduce complications and improve outcomes of patients undergoing total thyroidectomy deserves to be considered. Angiography-Guided Thyroidectomy has been proposed as a modification of the standard technique of thyroidectomy aimed to identifying the vascular pattern of the parathyroid glands to maximize efforts for preserving functioning glands at the time of operation. Our aim is to provide a technical description of this procedure based on the use of indocyanine green (ICG) angiography to standardize this technique. Methods The surgical steps that are followed during a total thyroidectomy are modified due to previous visualization of the feeding vessels of the parathyroid glands according to fluorescence of the vascular mapping obtained by ICG angiography prior to thyroidectomy. The first step is to perform an ICG angiography to assess anatomical features of the feeding vasculature of the parathyroid glands, which allows precise surgical dissection for preservation of the glands. Once the viability of the parathyroids has been evaluated angiographically, thyroidectomy is performed in a second step. Conclusions ICG angiography-guided thyroidectomy may be effective to preserve the largest number of better perfused parathyroid glands, which would contribute to reduce the risk of postoperative and permanent hypoparathyroidism. It can be successfully and safely implemented in thyroid surgery and standardization of the technique is necessary to homogenize this procedure in the future, allowing a better comparation of the results to be published.
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Affiliation(s)
- Pablo Moreno-Llorente
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Barcelona, Spain
| | - Mireia Pascua-Solé
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Barcelona, Spain
| | - Arantxa García-Barrasa
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Barcelona, Spain
| | - José Luis Muñoz-de-Nova
- Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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9
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Kano M, Mizuno N, Sato H, Kimura T, Hirochika R, Iwasaki Y, Inoshita N, Nagano H, Kasai M, Yamamoto H, Yamaguchi T, Suga H, Masaki H, Mizutani E, Nakauchi H. Functional calcium-responsive parathyroid glands generated using single-step blastocyst complementation. Proc Natl Acad Sci U S A 2023; 120:e2216564120. [PMID: 37379351 PMCID: PMC10334775 DOI: 10.1073/pnas.2216564120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/24/2023] [Indexed: 06/30/2023] Open
Abstract
Patients with permanent hypoparathyroidism require lifelong replacement therapy to avoid life-threatening complications, The benefits of conventional treatment are limited, however. Transplanting a functional parathyroid gland (PTG) would yield better results. Parathyroid gland cells generated from pluripotent stem cells in vitro to date cannot mimic the physiological responses to extracellular calcium that are essential for calcium homeostasis. We thus hypothesized that blastocyst complementation (BC) could be a better strategy for generating functional PTG cells and compensating loss of parathyroid function. We here describe generation of fully functional PTGs from mouse embryonic stem cells (mESCs) with single-step BC. Using CRISPR-Cas9 knockout of Glial cells missing2 (Gcm2), we efficiently produced aparathyroid embryos for BC. In these embryos, mESCs differentiated into endocrinologically mature PTGs that rescued Gcm2-/- mice from neonatal death. The mESC-derived PTGs responded to extracellular calcium, restoring calcium homeostasis on transplantation into mice surgically rendered hypoparathyroid. We also successfully generated functional interspecies PTGs in Gcm2-/- rat neonates, an accomplishment with potential for future human PTG therapy using xenogeneic animal BC. Our results demonstrate that BC can produce functional endocrine organs and constitute a concept in treatment of hypoparathyroidism.
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Affiliation(s)
- Mayuko Kano
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
- Metabolism and Endocrinology, Department of Medicine, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa216-8511, Japan
| | - Naoaki Mizuno
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
| | - Hideyuki Sato
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
| | - Takaharu Kimura
- Laboratory of Stem Cell Therapy, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki305-8577, Japan
| | - Rei Hirochika
- Laboratory of Stem Cell Therapy, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki305-8577, Japan
| | - Yasumasa Iwasaki
- Department of Clinical Nutrition, Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Mie510-0293, Japan
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Oko-cho, Nankoku, Kochi783-8505, Japan
| | - Naoko Inoshita
- Department of Pathology, Moriyama Memorial Hospital, Edogawa-ku, Tokyo134-0081, Japan
| | - Hisato Nagano
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama359-8513, Japan
| | - Mariko Kasai
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
| | - Hiromi Yamamoto
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
| | - Tomoyuki Yamaguchi
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
- Laboratory of Regenerative Medicine, Tokyo University of Pharmacy and Life Science, Hachioji, Tokyo192-0392, Japan
| | - Hidetaka Suga
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya466-8550, Japan
| | - Hideki Masaki
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
| | - Eiji Mizutani
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
- Laboratory of Stem Cell Therapy, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki305-8577, Japan
| | - Hiromitsu Nakauchi
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo113-8510, Japan
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo108-8639, Japan
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA94305
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10
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Moreno-Llorente P, García-González G, Pascua-Solé M, García-Barrasa A, Videla S, Muñoz-de-Nova JL. Indocyanine green angiography-guided thyroidectomy versus conventional thyroidectomy for preserving parathyroid function: study protocol for a randomized single-blind controlled trial. Front Endocrinol (Lausanne) 2023; 14:1193900. [PMID: 37223015 PMCID: PMC10200987 DOI: 10.3389/fendo.2023.1193900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Angiography with indocyanine green (ICG) fluorescence performed before thyroidectomy would allow identification of the vascularization of parathyroid glands, maximizing efforts for preserving functioning glands intraoperatively. The rationale of the study was based on the hypothesis that showing the vascular pattern of the parathyroid glands by means of ICG angiography before performing the thyroidectomy could prevent permanent hypoparathyroidism. Methods and analysis We propose a randomized single-blind controlled and multicenter clinical trial to assess the efficacy and safety of ICG angiography-guided thyroidectomy to identify the vascular pattern of the parathyroid glands versus conventional thyroidectomy in patients scheduled for elective total thyroidectomy. Patients will be randomized 1:1 to ICG angiography-guided thyroidectomy (experimental group) or conventional thyroidectomy (control group). Patients in the experimental group will undergo ICG angiography before thyroidectomy to identify the feeding vessels of the parathyroid glands and then, post-thyroidectomy ICG angiography to predict immediate parathyroid gland function by scoring the degree of fluorescence of the glands. Patients in the control group will undergo post-thyroidectomy ICG angiography only. The primary outcome measure will be the rate of patients with permanent hypoparathyroidism. Secondary outcome measures will be rate of postoperative hypoparathyroidism, the percentage of well vascularized parathyroid glands remaining in situ, the levels of iPTH and serum calcium after surgery and the influence of the type of vascular pattern of the parathyroid glands over these outcomes, as well as the safety profile of ICG angiography. Discussion The results will contribute to adopt a new surgical strategy based on intraoperative ICG angiography before performing total thyroidectomy, according to which the rate of permanent hypoparathyroidism could be substantially reduced. Clinical trial registration ClinicalTrials.gov. identifier NCT05573828.
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Affiliation(s)
- Pablo Moreno-Llorente
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Guillermo García-González
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Mireia Pascua-Solé
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Arantxa García-Barrasa
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastián Videla
- Clinical Research Support Unit (HUB), Institut d’Investigació Biomèdica de Bellvitge (IDIBELL) (HUB-IDIBELL), Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Muñoz-de-Nova
- Department of General and Digestive Surgery, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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11
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Obongo Anga R, Abbaci M, Guerlain J, Breuskin I, Casiraghi O, Marhic A, Benmoussa-Rebibo N, de Kermadec H, Moya-Plana A, Temam S, Gorphe P, Hartl DM. Intraoperative Autofluorescence Imaging for Parathyroid Gland Identification during Total Laryngectomy with Thyroidectomy. Cancers (Basel) 2023; 15:cancers15030875. [PMID: 36765832 PMCID: PMC9913419 DOI: 10.3390/cancers15030875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/08/2022] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Hypoparathyroidism is a known complication of total laryngectomy, although parathyroid preservation and/or reimplantation are not routine. Autofluorescence is a new technique for identifying parathyroid glands intraoperatively. The aim of this study was to evaluate the feasibility of autofluorescence in this context. MATERIALS AND METHODS A retrospective study of patients undergoing total laryngectomy/pharyngectomy with concomitant thyroidectomy using the Fluobeam® (Fluoptics, Grenoble, France) and frozen section of a parathyroid fragment in case of reimplantation. The rates of identification using autofluorescence, reimplantation, and hypoparathyroidism were evaluated. RESULTS Eighteen patients (16 males, median age 67) underwent total laryngectomy/pharyngectomy with total thyroidectomy (n = 12) or hemithyroidectomy (n = 6). A median of 2 parathyroid glands were identified per patient. Ninety-two percent were identified by autofluorescence before visualisation. All parathyroids were reimplanted due to devascularization. Temporary hypoparathyroidism occurred in nine patients, and was permanent in one patient. After 34 months of median follow-up (range 1-49), no tumor recurrence was observed in the reimplantation sites. CONCLUSIONS To our knowledge, this is the largest study to evaluate autofluorescence during total laryngectomy with thyroidectomy. No tumor recurrence occurred in the sites of parathyroid reimplantation.
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Affiliation(s)
- Raïs Obongo Anga
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Department of Head and Neck Cancer and ENT Surgery, Henri Becquerel Cancer Center, 76038 Rouen, France
| | - Muriel Abbaci
- Plateforme d’Imagerie et de Cytométrie, UMS AMMICa, Gustave-Roussy Cancer Campus—Grand Paris, Université Paris-Saclay, 94805 Villejuif, France; Laboratoire d’Imagerie Biomédicale Multimodale Paris Saclay, Université Paris-Saclay, CEA, CNRS, Inserm, 91401 Orsay, France
| | - Joanne Guerlain
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Ingrid Breuskin
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Odile Casiraghi
- Department of Pathology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Alix Marhic
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Nadia Benmoussa-Rebibo
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Héloïse de Kermadec
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Dana M. Hartl
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Correspondence:
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12
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Ramas A, Umihanic S, Kasumovic M, Salkic A, Uscuplic S, Altumbabic H. Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization. Mater Sociomed 2023; 35:130-134. [PMID: 37701350 PMCID: PMC10495146 DOI: 10.5455/msm.2023.35.130-134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 09/14/2023] Open
Abstract
Background The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. Objective To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Methods Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. Results The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. Conclusion The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.
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Affiliation(s)
- Almedina Ramas
- Otorhinolaryngology Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sekib Umihanic
- Otorhinolaryngology Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Merima Kasumovic
- Plastic and Maxillofacial Clinic, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Almir Salkic
- Otorhinolaryngology Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sabrina Uscuplic
- Otorhinolaryngology Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Hasan Altumbabic
- Otorhinolaryngology Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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13
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Podhráský M, Libánský P, Tvrdoň J. Surgical treatment of hyperparathyroidism with a pathologically changed parathyroid gland found in the mediastinum. Rozhl Chir 2023; 102:169-173. [PMID: 37344198 DOI: 10.33699/pis.2023.102.4.169-173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
The most common indication for surgical treatment of parathyroid gland pathology is primary hyperparathyroidism where extirpation of the pathologically changed parathyroid gland is the first-choice treatment. Embryonic development of the lower pair of parathyroid glands is quite complex and is closely related to the tissue of the thymus; for this reason it is not uncommon for a parathyroid adenoma to be located in the mediastinum or directly in the tissue of the thymus. The treatment of primary hyperparathyroidism is becoming a multidisciplinary issue in which radiodiagnostics and nuclear medicine methods play a significant role as they are needed to accurately localize the affected gland and to plan an adequate surgery. In case of intrathoracic localization of parathyroid adenoma, the therapy belongs in the hands of thoracic surgery. At our department, the endocrine surgery program, including parathyroid gland surgery, has a long tradition, and complicated patients are concentrated here, often patients with refractory hyperparathyroidism after a previous procedure. In the last 10 years, almost 2,300 procedures for parathyroid pathology have been performed at the IIIrd Department of Surgery of the 1st Faculty of Medicine, Charles University and University Hospital in Motol, of which some pathologies with mediastinal localization were managed using minimally invasive methods, i.e. videothoracoscopy or robotic-assisted surgery.
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14
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Demarchi MS, Karenovics W, Bédat B, Triponez F. Near-infrared fluorescent imaging techniques for the detection and preservation of parathyroid glands during endocrine surgery. Innov Surg Sci 2022; 7:87-98. [PMID: 36561508 PMCID: PMC9742281 DOI: 10.1515/iss-2021-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives In over 30% of all thyroid surgeries, complications arise from transient and definitive hypoparathyroidism, underscoring the need for real-time identification and preservation of parathyroid glands (PGs). Here, we evaluate the promising intraoperative optical technologies available for the identification, preservation, and functional assessment of PGs to enhance endocrine surgery. Methods We performed a review of the literature to identify published studies on fluorescence imaging in thyroid and parathyroid surgery. Results Fluorescence imaging is a well-demonstrated approach for both in vivo and in vitro localization of specific cells or tissues, and is gaining popularity as a technique to detect PGs during endocrine surgery. Autofluorescence (AF) imaging and indocyanine green (ICG) angiography are two emerging optical techniques to improve outcomes in thyroid and parathyroid surgeries. Near-infrared-guided technology has significantly contributed to the localization of PGs, through the detection of glandular AF. Perfusion through the PGs can be visualized with ICG, which can also reveal the blood supply after dissection. Conclusions Near infrared AF and ICG angiography, providing a valuable spatial and anatomical information, can decrease the incidence of complications in thyroid surgery.
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Affiliation(s)
- Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Benoît Bédat
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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15
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Bijnens J, Van den Bruel A, Vander Poorten V, Goethals I, Van Schandevyl S, Dick C, De Geeter F. Retrospective real-life study on preoperative imaging for minimally invasive parathyroidectomy in primary hyperparathyroidism. Sci Rep 2022; 12:17427. [PMID: 36261462 PMCID: PMC9581917 DOI: 10.1038/s41598-022-18219-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/08/2022] [Indexed: 01/12/2023] Open
Abstract
The objective of this study was to retrospectively evaluate preoperative imaging modalities for localization of parathyroid adenomas with a view to enable minimally invasive parathyroidectomy and in particular, to consider the contribution of 18F-fluorocholine-PET/CT. 104 patients with primary hyperparathyroidism, who underwent parathyroid surgery in a single centre during a 6-year period were included. Of these, 103 underwent ultrasound, 97 99mTc-Pertechnetate/SestaMIBI-SPECT, 20 MRI and 30 18F-fluorocholine-PET/CT. Based on surgical findings, sensitivities and specificities for correct lateralisation in orthotopic locations were: for ultrasound 0.75 (0.65-0.83) and 0.89 (0.81-0.94), for 99mTc-MIBI-SPECT 0.57 (0.46-0.67) and 0.97 (0.91-0.99), for MRI 0.60 (0.36-0.81) and 0.83 (0.59-0.96) and for 18F-fluorocholine-PET/CT 0.90 (0.73-0.98) and 0.90 (0.73-0.98). Correctly lateralized adenomas were significantly larger than those not found with ultrasound (p = 0.03) and SPECT (p = 0.002). Pre-operative PTH-levels were higher in single adenomas detected by scintigraphy than in those not (p = 0.02). 64 patients could be treated with a minimally invasive procedure. Cure after parathyroidectomy was obtained in 94% of patients. 18F-Fluorocholine-PET/CT could be shown to be a highly accurate modality to localize parathyroid adenomas preoperatively, obviating the need for total exploration in the majority of patients in whom ultrasound and scintigraphic results are discordant or both negative.
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Affiliation(s)
- Jacqueline Bijnens
- grid.420036.30000 0004 0626 3792Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
| | - Annick Van den Bruel
- grid.420036.30000 0004 0626 3792Internal Medicine, Endocrinology, AZ Sint-Jan, Bruges, Belgium
| | - Vincent Vander Poorten
- grid.410569.f0000 0004 0626 3338Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Oncology, Section Head and Neck Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Ingeborg Goethals
- grid.410566.00000 0004 0626 3303Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Steven Van Schandevyl
- grid.410566.00000 0004 0626 3303Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Catherine Dick
- grid.420036.30000 0004 0626 3792Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
| | - Frank De Geeter
- grid.420036.30000 0004 0626 3792Nuclear Medicine, AZ Sint-Jan, Bruges, Belgium
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16
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Chen PP, Zhang X, Li JG, Chen G. Predictors of impaired effectiveness of carbon nanoparticle-based central lymph node tracing in patients who underwent surgery for papillary thyroid cancer: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e31257. [PMID: 36253990 PMCID: PMC9575759 DOI: 10.1097/md.0000000000031257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Carbon nanoparticles (CNs) are used in papillary thyroid cancer (PTC) surgery to facilitate central lymph node dissection (CLND) and protect the parathyroid glands (PGs). However, some cases develop hypoparathyroidism after using CNs. This cohort study was undertaken to explore the predictors of the reduced effectiveness of CNs. Data on patients with PTC who underwent surgery wherein CNs were used during CLND were reviewed retrospectively. Patients who did not develop hypoparathyroidism and developed hypoparathyroidism were classified into Group A and B, respectively. Demographic and clinical characteristics were compared between the 2 groups. Univariate and multivariate logistic regression analysis were performed on related variables. The receiver operating characteristic curve was used to evaluate the predictors of the binary logistic model and the cutoff value of each predictor was obtained. A total of 265 patients were included. Compared with Group A, the patients in Group B had a higher body mass index (BMI) (P = .003), were more frequently associated with Hashimoto thyroiditis (HT) (P = .001), and tumors were larger in size (P = .026). Multivariate logistic regression analyses were performed on these variables and showed that HT (P = .001) and tumor size (P = .001) predicted the impaired role of CNs. CNs are not always useful in protecting PG function in patients who undergo CLND for PTC. In patients with coexisting HT (blood thyroid peroxidase antibody [TPOAb] level higher than 44.0 IU/mL or blood anti-thyroglobulin antibody [ATG] level higher than 125.0 IU/mL) or a tumor size exceeding 1.1 cm in diameter, the protective role of CNs may be impaired.
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Affiliation(s)
- Ping-Ping Chen
- Department of Thyroid and Breast Surgery, the Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
- *Correspondence: Ping-Ping Chen, Department of Thyroid and Breast Surgery, the Affiliated People’s Hospital of Ningbo University, Ningbo 315040, Zhejiang, China (e-mail: )
| | - Xing Zhang
- Department of Thyroid and Breast Surgery, the Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Jia-Gen Li
- Department of Thyroid and Breast Surgery, the Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Gun Chen
- Department of Pathology, the Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
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17
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Chen S, Hou X, Hua S, Liu Z, Li B, Li X, Cong L, Liao Q, Fang J, Hou L, Jing S, Zhao Z, Qin J, Zhang S, Li Z, Huang D, Zhang N, Zhao Y, Liu J, Wang S, Chen G, Zhao Y. Mitoxantrone hydrochloride injection for tracing helps to decrease parathyroid gland resection and increase lymph node yield in thyroid cancer surgery: a randomized clinical trial. Am J Cancer Res 2022; 12:4439-4447. [PMID: 36225640 PMCID: PMC9548014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/30/2022] [Indexed: 06/16/2023] Open
Abstract
The identification and preservation of parathyroid glands (PGs) during thyroid surgery can be challenging. Many techniques have been developed to help surgeons find PGs. We have developed a novel mitoxantrone hydrochloride injection that can be used for lymphatic targeting. After local application during surgery, mitoxantrone hydrochloride injection for tracing (MHI) helps surgeons better identify and preserve PGs and helps pathologists find more lymph nodes. We conducted an open-label, multicenter, randomized clinical trial (CTR20171137) in six centers in China from 08/2017 to 12/2018. Patients with thyroid carcinoma were randomized to the MHI group or the control group. All patients received total thyroidectomy and bilateral central compartment lymph node dissection. The primary outcomes were the PG resection rate and lymph node staining rate. The full analysis set (FAS) included 461 patients, of which 228 were assigned to the MHI group, and 233 were assigned to the control group. The PG resection rates of the MHI group and the control group were 6.6% (15/228) and 26.6% (62/233), respectively, with a significant difference (P < 0.001). No PGs were stained blue with MHI. The central lymph nodes were stained blue with MHI, and the staining rate was 90.5%±12.0%. More lymph nodes were detected in the MHI group than in the control group (13.0±7.3 vs. 10.1±6.4 nodes/patient, P < 0.001). No adverse events related to MHI were observed. MHI is a safe and effective tracer that may help to preserve PGs and identify more central lymph nodes in patients with thyroid cancer.
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Affiliation(s)
- Shaobo Chen
- Department of Surgery, Peking Union Medical College HospitalBeijing, China
| | - Xianming Hou
- Department of Thoracic Surgery, Beijing Tsinghua Changgung HospitalBeijing, China
| | - Surong Hua
- Department of General Surgery, Peking Union Medical College HospitalBeijing, China
| | - Ziwen Liu
- Department of General Surgery, Peking Union Medical College HospitalBeijing, China
| | - Binglu Li
- Department of General Surgery, Peking Union Medical College HospitalBeijing, China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College HospitalBeijing, China
| | - Lin Cong
- Department of General Surgery, Peking Union Medical College HospitalBeijing, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College HospitalBeijing, China
| | - Jugao Fang
- Department of Head and Neck Surgery, Beijing Tongren Hospital, CMUBeijing, China
| | - Lizhen Hou
- Department of Head and Neck Surgery, Beijing Tongren Hospital, CMUBeijing, China
| | - Shanghua Jing
- Department of Otorhinolaryngology Head and Neck Surgery, The Fourth Hospital of Hebei Medical University and Hebei Cancer HospitalHebei, China
| | - Zhen Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, The Fourth Hospital of Hebei Medical University and Hebei Cancer HospitalHebei, China
| | - Jianwu Qin
- Department of Thyroid Head and Neck Surgery, Henan Cancer HospitalHenan, China
| | - Songtao Zhang
- Department of Thyroid Head and Neck Surgery, Henan Cancer HospitalHenan, China
| | - Zhendong Li
- Department of Head and Neck Surgery, Liaoning Cancer Hospital & InstituteLiaoning, China
| | - Dongning Huang
- Department of Head and Neck Surgery, Liaoning Cancer Hospital & InstituteLiaoning, China
| | - Ning Zhang
- Department of Hospital Thyroid Surgery, The Second Hospital of Dalian MedicalDalian, China
| | - Yongfu Zhao
- Department of Hospital Thyroid Surgery, The Second Hospital of Dalian MedicalDalian, China
| | - Jun Liu
- Shenyang Pharmaceutical UniversityShenyang, China
| | - Shujun Wang
- Shenyang Pharmaceutical UniversityShenyang, China
| | - Ge Chen
- Department of General Surgery, Peking Union Medical College HospitalBeijing, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College HospitalBeijing, China
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18
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Koimtzis G, Stefanopoulos L, Alexandrou V, Tteralli N, Brooker V, Alawad AA, Carrington-Windo E, Karakasis N, Geropoulos G, Papavramidis T. The Role of Carbon Nanoparticles in Lymph Node Dissection and Parathyroid Gland Preservation during Surgery for Thyroid Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14. [PMID: 36011009 DOI: 10.3390/cancers14164016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 12/07/2022] Open
Abstract
Thyroid cancer is the most common endocrine malignancy with an increasing incidence over the past few years. Surgery is considered the primary therapeutic option, which often involves lymph node dissection. The aim of this study was to assess the role of carbon nanoparticles, a novel agent, in thyroid cancer surgery. For that purpose, we conducted a systematic review of the literature on MEDLINE, EMBASE, Scopus, Cochrane and Google Scholar databases from 1 January 2002 to 31 January 2022. Ultimately, 20 articles with a total number of 2920 patients were included in the analysis. The outcome of the analysis showed that the use of carbon nanoparticles is associated with a higher number of harvested lymph nodes (WMD, 1.47, 95% CI, 1.13 to 1.82, p < 0.001) and a lower rate of accidental parathyroid gland removal (OR 0.34, CI 95% 0.24 to 0.50, p < 0.001). Based on these results, we suggest that carbon nanoparticles are applied in thyroid cancer surgery on a wider scale, so that these findings can be confirmed by future research on the subject.
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19
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Wang X, Liang Y, Zhu Z, Li W, Shi B, Deng Y, Li C, Sha O. Fn1 Regulates the Third Pharyngeal Pouch Patterning and Morphogenesis. J Dent Res 2022; 101:1082-1091. [PMID: 35259939 DOI: 10.1177/00220345221078775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The parathyroid and thymus are derived from the common primordia, the third pharyngeal pouch. During their development, endodermal cells actively interact with surrounding mesenchymal cells, mainly derived from neural crest cells (NCCs). However, the mechanism by which NCCs regulate the development of the third pharyngeal pouch remains largely unknown. In this study, we showed that fibronectin 1 (Fn1), which is synthesized by NCCs, modulates the functions of NCCs in the third pharyngeal pouch patterning and in the morphogenesis of the thymus/parathyroid. Loss of Fn1 in NCCs leads to decreased Foxn1 expression in the presumptive thymus domain at E11.5. In the mutant, we detected upregulation of the Hedgehog signaling activity in the presumptive parathyroid domain and downregulation of Bmp4 in the presumptive thymus domain. Tbx1, a Hedgehog signaling target gene in endoderm development, was ectopically expanded to the presumptive mutant thymus domain at E11.5. Fgf10, an important gene regulating the proliferation of endoderm development, was downregulated in the mutant NCCs. At later organogenesis stages, derivatives of the third pharyngeal pouch endoderm of mutant embryos were abnormal, showing conditions such as hypoparathyroidism, hypoplastic thymus, and ectopic thymus and parathyroid. These data support that Fn1 plays an important role in NCCs by regulating the patterning of the third pharyngeal pouch and morphogenesis of the thymus/parathyroid.
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Affiliation(s)
- X Wang
- Department of Anatomy and Histology, Shenzhen University Health Science Center, Shenzhen, China
| | - Y Liang
- Department of Anatomy and Histology, Shenzhen University Health Science Center, Shenzhen, China
| | - Z Zhu
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, China
| | - W Li
- Department of Anatomy and Histology, Shenzhen University Health Science Center, Shenzhen, China
| | - B Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Deng
- Department of Somatology, Shenzhen University General Hospital, Shenzhen, China
| | - C Li
- Department of Anatomy, Shantou University Medical College, Shantou, China
| | - O Sha
- Department of Anatomy and Histology, Shenzhen University Health Science Center, Shenzhen, China
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, China
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20
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Kim Y, Lee HC, Kim J, Oh E, Yoo J, Ning B, Lee SY, Ali KM, Tufano RP, Russell JO, Cha J. A coaxial excitation, dual-red-green-blue/near-infrared paired imaging system toward computer-aided detection of parathyroid glands in situ and ex vivo. J Biophotonics 2022; 15:e202200008. [PMID: 35340114 PMCID: PMC9357067 DOI: 10.1002/jbio.202200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
Early and precise detection of parathyroid glands (PGs) is a challenging problem in thyroidectomy due to their small size and similar appearance to surrounding tissues. Near-infrared autofluorescence (NIRAF) has stimulated interest as a method to localize PGs. However, high incidence of false positives for PGs has been reported with this technique. We introduce a prototype equipped with a coaxial excitation light (785 nm) and a dual-sensor to address the issue of false positives with the NIRAF technique. We test the clinical feasibility of our prototype in situ and ex vivo using sterile drapes on 10 human subjects. Video data (1287 images) of detected PGs were collected to train, validate and compare the performance for PG detection. We achieved a mean average precision of 94.7% and a 19.5-millisecond processing time/detection. This feasibility study supports the effectiveness of the optical design and may open new doors for a deep learning-based PG detection method.
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Affiliation(s)
- Yoseph Kim
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St. Baltimore, MD 21218, USA
- Optosurgical, LLC, 11076 Birchtree Ln., Laurel, MD 20723, USA
- These authors contributed equally to this work
| | - Hun Chan Lee
- Department of Mechanical Engineering, Boston University, 44 Cummington Mall, Boston, MA 0221571, USA
- These authors contributed equally to this work
| | - Jongchan Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
- These authors contributed equally to this work
| | - Eugene Oh
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St. Baltimore, MD 21218, USA
- Optosurgical, LLC, 11076 Birchtree Ln., Laurel, MD 20723, USA
| | - Jennifer Yoo
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Bo Ning
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Seung Yup Lee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr. NE, Atlanta, GA 30322 USA
- Department of Electrical and Computer Engineering, Kennesaw State University, 840 Polytechnic Lane, Marietta, GA 30060, USA
| | - Khalid Mohamed Ali
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287, USA
| | - Ralph P. Tufano
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287, USA
| | - Jonathon O. Russell
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287, USA
| | - Jaepyeong Cha
- Optosurgical, LLC, 11076 Birchtree Ln., Laurel, MD 20723, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, 2300 Eye St. NW, Washington, DC 20052, USA
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21
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Dimitroukas CP, Metaxas V, Efthymiou F, Zampakis P, Kalogeropoulou C, Panayiotakis G. Organs' absorbed dose and comparison of different methods for effective dose calculation in computed tomography of parathyroid glands. Biomed Phys Eng Express 2022; 8. [PMID: 35593909 DOI: 10.1088/2057-1976/ac7169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022]
Abstract
Objective:To estimate organs' absorbed dose from the two-phase CT of parathyroid glands, effective dose (ED) based on three different methods, and compare the dose values with those reported by other published protocols.Methods:Volumetric-computed-tomography-dose-index (CTDIvol), dose-length-product (DLP), and the corresponding scan length during each phase of a parathyroid protocol were recorded, for seventy-six patients. One k-factor, and two different k-factors for the neck and chest area were used to estimate the ED from DLP. A Monte Carlo software, VirtualDoseCT, was also used for the estimation of organs' absorbed dose and ED.Results:Two-phase parathyroid CT resulted in a mean ED of 3.93 mSv, 4.29 mSv and 4.21 mSv according to the one k-factor, two k-factors, and VirtualDoseCT methods, respectively. The two k-factors method resulted in a slight overestimation of 1.9% in total ED compared to VirtualDoseCT. No statistically significant difference was found in ED values between these methods (Wilcoxon test, p>0.05), except for female patients in the pre-contrast phase. The organs inside the SFOV received the following doses: thymus 23.3 mGy, lungs 11.5 mGy, oesophagus 9.2 mGy, thyroid 6.9 mGy, and breast 6.3 mGy. The ED and organs' dose (OD) values were significantly lower in the pre-contrast than in the arterial phase (Wilcoxon test, p<0.001). A statistically significant difference was observed between male and female patients for the pre-contrast phase (Mann-Whitney test, p<0.05), regarding the ED values obtained with the two k-factors method and VirtualDoseCT software.Conclusions:The two k-factors method could be applied for the ED estimation in clinical practice, if appropriate software is not available. An extensive range of ED values derived from the literature, mainly depending on the acquisition protocol parameters and the estimation method.
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Affiliation(s)
- Christos P Dimitroukas
- Department of Medical Physics, University of Patras, School of Medicine, Patra, 26504, GREECE
| | - Vasileios Metaxas
- University of Patras, Department of Medical Physics, Patra, Periféria Dhitikís Elládh, 26504, GREECE
| | - Fotios Efthymiou
- University of Patras, Department of Medical Physics, Patra, Periféria Dhitikís Elládh, 26504, GREECE
| | - Petros Zampakis
- Department of Radiology, University of Patras, School of Medicine, Patra, Periféria Dhitikís Elládh, 26504, GREECE
| | - Christina Kalogeropoulou
- Department of Radiology, University of Patras, School of Medicine, Patra, Periféria Dhitikís Elládh, 26504, GREECE
| | - George Panayiotakis
- Department of Medical Physics, University of Patras, School of Medicine, Patra, 26504, GREECE
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22
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Mercante G, Costantino A, De Virgilio A, Ferreli F, Spriano G. High-Definition 3D Exoscope in Thyroid Surgery. Surg Innov 2022:15533506221097553. [PMID: 35533236 DOI: 10.1177/15533506221097553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The high-definition 3D exoscope is an innovative and promising tool that was recently introduced in the clinical practice. It may be used during open surgical procedures to enhance the ability to perform precise dissection of fine structures. We describe our preliminary experience with the 3D exoscope in thyroid surgery, discussing potential advantages of this system. METHODS A high-definition 3D exoscope (3D VITOM®) mounted on the VERSACRANETM holding system (Karl Storz, Tuttlingen, Germany) was used to perform open thyroid surgery. RESULTS The 3D exoscope was used in three patients without significant intra-operative delay or complications. Both thyroidectomy and central compartment dissection were performed. The 3D exoscope allows to perform precise dissection in the identification and preservation of the recurrent laryngeal nerve and the parathyroid glands. CONCLUSIONS 3D exoscope-assisted thyroid surgery seems to be feasible and safe. Further studies should be encouraged to analyze potential clinical benefit in the post-operative period.
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Affiliation(s)
- Giuseppe Mercante
- Department of Biomedical Sciences, 437807Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI) Italy.,Otorhinolaryngology Unit, 437807IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, 437807Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI) Italy.,Otorhinolaryngology Unit, 437807IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, 437807Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI) Italy.,Otorhinolaryngology Unit, 437807IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, 437807Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI) Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, 437807Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI) Italy.,Otorhinolaryngology Unit, 437807IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
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23
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郭 飞, 耿 胜, 张 静. [Research progress of autofluorescence imaging of parathyroid glands]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:397-401. [PMID: 35483695 PMCID: PMC10128258 DOI: 10.13201/j.issn.2096-7993.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Indexed: 06/14/2023]
Abstract
The main causes of hypoparathyroidism are unintentional parathyroidectomy and/or impaired blood supply. Therefore, accurate identification and preservation of parathyroid glands in situ during thyroid or parathyroid surgery has become one of the problems that plague endocrine surgeons. In recent years, near-infrared autofluorescence imaging technology has gradually attracted more and more attention from surgeons because of its simplicity, safety, accuracy, real-time, no-contrast agent, and non-invasiveness. This article reviews the development history, clinical application, and application prospects of the parathyroid gland autofluorescence imaging technology in recent years.
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Affiliation(s)
- 飞跃 郭
- 河北省人民医院腺体外科(石家庄,050001)Department of Glandular Surgery, Hebei General Hospital, Shijiazhuang, 050051, China
| | - 胜杰 耿
- 河北医科大学研究生学院Graduate School of Hebei Medical University
| | - 静 张
- 河北省人民医院腺体外科(石家庄,050001)Department of Glandular Surgery, Hebei General Hospital, Shijiazhuang, 050051, China
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24
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Epameinondas Georgakopoulou V, Avramopoulos P, Papalexis P, Bitsani A, Damaskos C, Garmpi A, Venetikou MS, Paramythiotis D, Karlafti E, Sklapani P, Trakas N, Spandidos DA. COVID-19 induced hypoparathyroidism: A case report. Exp Ther Med 2022; 23:346. [PMID: 35401797 PMCID: PMC8988155 DOI: 10.3892/etm.2022.11276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/15/2022] [Indexed: 12/17/2022] Open
Abstract
Low levels of serum calcium, elevated levels of serum phosphorus and absent or abnormally low levels of serum parathyroid hormone characterize hypoparathyroidism, a rare endocrine deficiency illness. Hypoparathyroidism is caused by injury to the parathyroid gland as a result of surgery or autoimmune disease. In addition, hypoparathyroidism may develop due to genetic causes or infiltrative diseases. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterized by multi-organ involvement, including the dysfunction of endocrine glands. Previous studies have demonstrated that SARS-CoV-2 infection induces endocrine tissue damage via various mechanisms, including direct cell damage from viral entry to the glands by binding to the angiotensin converting enzyme 2 receptors and replication, vasculitis, arterial and venous thrombosis, hypoxic cell damage, immune response and the cytokine storm. The effects of the new coronavirus, coronavirus disease 2019 (COVID-19) on the parathyroid glands have received limited attention. Hypoparathyroidism has been observed in a small number of individuals as a result of SARS-CoV-2 infection. The present study describes the case of a patient with primary hypoparathyroidism induced by COVID-19. Clinicians should also keep in mind that, despite the fact that SARS-CoV-2 has no known tropism for the parathyroid glands, it can result in primary hypoparathyroidism and decompensation of old primary hypoparathyroidism.
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Affiliation(s)
| | - Pantelis Avramopoulos
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athen, 11527 Athens, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.,Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Aikaterini Bitsani
- First Department of Propedeutic and Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Anna Garmpi
- First Department of Propedeutic and Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria S Venetikou
- Laboratory of Anatomy-Pathological Anatomy and Physiology Nutrition, Department of Biomedical Sciences, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
| | - Daniel Paramythiotis
- First Propedeutic Department of Surgery, AHEPA University Hospital of Thessaloniki, 54621 Thessaloniki, Greece
| | - Eleni Karlafti
- Emergency Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Pagona Sklapani
- Department of Cytology, Mitera Hospital, 15123 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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25
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Abstract
BACKGROUND Hyperparathyroidism (HPT) is classified into primary HPT (PHPT), secondary HPT (SHPT), tertiary HPT (THPT), and pseudohyperparathyroidism. Parathyroid surgery is generally reserved for patients with symptomatic PHPT and asymptomatic patients who meet the surgical guideline criteria. However, the risk of complications and mortality after parathyroid gland surgery increases with increasing patient age. AIM This study aimed to review existing research on laser ablation, radiofrequency ablation, microwave ablation, and high-intensity focused ultrasound in the treatment of HPT and analyze its application prospects. CONCLUSIONS Thermal ablation is a good alternative treatment for patients with parathyroid hyperplasia who do not meet the criteria or decline surgery. Being a type of minimally invasive treatment, ultrasound-guided thermal ablation has the advantages of easy operation, rapid recovery, and reusability and is used widely.
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Affiliation(s)
- Zhiguang Chen
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggang Cheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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26
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Yin S, Pan B, Yang Z, Tang M, Mo H, Li Y, Yi Z, Yin T, Shao C, Yan C, Mo L, Yuan Y, Sun Y, Zhang F. Combined Use of Autofluorescence and Indocyanine Green Fluorescence Imaging in the Identification and Evaluation of Parathyroid Glands During Total Thyroidectomy: A Randomized Controlled Trial. Front Endocrinol (Lausanne) 2022; 13:897797. [PMID: 35784544 PMCID: PMC9243533 DOI: 10.3389/fendo.2022.897797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/02/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Accurate identification and evaluation of the parathyroid glands (PGs) intraoperatively is critical to reduce the incidence of postoperative hypoparathyroidism after total thyroidectomy. Near-infrared fluorescence imaging (NIFI), including the autofluorescence (AF) and indocyanine green fluorescence (ICGF) imaging, is a promising technique to protect PGs. This study aimed to assess whether the combined use of AF and ICGF could reduce the incidence of postoperative hypoparathyroidism and improve the identification and evaluation of PGs during total thyroidectomy. METHODS This randomized controlled trial enrolled 180 patients who were randomized into two groups and underwent total thyroidectomy with unilateral or bilateral central lymph node dissection. In the control group, the PGs were identified and evaluated by the naked eye. In the NIFI group, AF was used to identify the PGs and ICGF was applied to assess the blood perfusion of the PGs in situ. The primary outcome was the incidence of postoperative hypoparathyroidism. The secondary outcomes included the number of identified PGs, autotransplanted PGs, and known preserved PGs in situ. RESULTS The incidence of postoperative transient hypoparathyroidism was significantly lower in the NIFI group than in the control group (27.8% vs. 43.3%, P = 0.029). More PGs were identified in the NIFI group than in the control group (3.6 ± 0.5 vs. 3.2 ± 0.4, P < 0.001). No significant difference was observed in the number of autotransplanted PGs between the two groups (P = 0.134). Compared with the control group, a greater number of known PGs were preserved in situ in the NIFI group (1.3 ± 0.6 vs. 1.0 ± 0.5, P < 0.001). In the NIFI group, only 4.5% of the patients with at least one well-perfused PG (ICG score of 2) developed postoperative hypoparathyroidism, which was significantly lower than that of the control group (34.6%, P < 0.001). CONCLUSION Combined use of AF and ICGF during total thyroidectomy reduces the risk of transient postoperative hypoparathyroidism, enhances the ability to identify and preserve PGs, and improves the accuracy of evaluating the perfusion of PGs during surgery. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Register (www.chictr.org.cn), identifier ChiCTR2100045320. Registered on April 12, 2021.
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Affiliation(s)
- Supeng Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Bin Pan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Zeyu Yang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Mi Tang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Hongbiao Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Yao Li
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Ziying Yi
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Tingjie Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cong Shao
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cunye Yan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Linlong Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Yuquan Yuan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Yiceng Sun
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- *Correspondence: Fan Zhang, ; Yiceng Sun,
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- *Correspondence: Fan Zhang, ; Yiceng Sun,
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27
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Lu D, Tang E, Yin S, Zhu J, Mo H, Yi Z, Chai F, Sun Y, Li Y, Yin T, Yang Z, Zhang F. Factors in the occurrence and restoration of hypoparathyroidism after total thyroidectomy for thyroid cancer patients with intraoperative parathyroid autotransplantation. Front Endocrinol (Lausanne) 2022; 13:963070. [PMID: 35937810 PMCID: PMC9353036 DOI: 10.3389/fendo.2022.963070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Postoperative hypoparathyroidism (POH) is the most common and important complication for thyroid cancer patients who undergo total thyroidectomy. Intraoperative parathyroid autotransplantation has been demonstrated to be essential in maintaining functional parathyroid tissue, and it has clinical significance in identifying essential factors of serum parathyroid hormone (PTH) levels for patients with parathyroid autotransplantation. This retrospective cohort study aimed to comprehensively investigate influential factors in the occurrence and restoration of POH for patients who underwent total thyroidectomy with intraoperative parathyroid autotransplantation (TTIPA). METHOD This study was conducted in a tertiary referral hospital, with a total of 525 patients who underwent TTIPA. The postoperative serum PTH levels were collected after six months, and demographic characteristics, clinical features and associated operative information were analyzed. RESULTS A total of 66.48% (349/525) of patients who underwent TTIPA were diagnosed with POH. Multivariate logistic regression indicated that Hashimoto's thyroiditis (OR=1.93, 95% CI: 1.09-3.42), P=0.024), the number of transplanted parathyroid glands (OR=2.70, 95% CI: 1.91-3.83, P<0.001) and postoperative blood glucose levels (OR=1.36, 95% CI: 1.06-1.74, P=0.016) were risk factors for POH, and endoscopic surgery (OR=0.39, 95% CI: 0.22-0.68, P=0.001) was a protective factor for POH. Multivariate Cox regression indicated that PTG autotransplantation patients with same-side central lymph node dissection (CLND) (HR=0.50; 95% CI: 0.34-0.73, P<0.001) demonstrated a longer time for increases PTH, and female patients (HR=1.35, 95% CI: 1.00-1.81, P=0.047) were more prone to PTH increases. Additionally, PTG autotransplantation with same-side CLND (HR=0.56, 95% CI: 0.38-0.82, P=0.003) patients had a longer time to PTH restoration, and patients with endoscopic surgery (HR=1.54, 95% CI: 1.04-2.28, P=0.029) were more likely to recover within six months. CONCLUSION High postoperative fasting blood glucose levels, a large number of transplanted PTGs, open surgery and Hashimoto's thyroiditis are risk factors for postoperative POH in TTIPA patients. Elevated PTH levels occur earlier in female patients and patients without CLND on the transplant side. PTH returns to normal earlier in patients without CLND and endoscopic surgery on the transplant side.
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Affiliation(s)
- Dengwei Lu
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
| | - Enjie Tang
- Epidemiology Department, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Supeng Yin
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Junping Zhu
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Hongbiao Mo
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Ziying Yi
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Fan Chai
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Yizeng Sun
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Yao Li
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Tingjie Yin
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Zeyu Yang
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
- *Correspondence: Fan Zhang, ; Zeyu Yang,
| | - Fan Zhang
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
- *Correspondence: Fan Zhang, ; Zeyu Yang,
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Kim DH, Kim SH, Jung J, Kim SW, Hwang SH. Indocyanine green fluorescence for parathyroid gland identification and function prediction: Systematic review and meta-analysis. Head Neck 2021; 44:783-791. [PMID: 34908194 DOI: 10.1002/hed.26950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/21/2021] [Accepted: 12/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To evaluate the diagnostic accuracies of indocyanine green (ICG) fluorescence for identifying parathyroid glands during surgery and predicting the postoperative function. METHODS From six databases, 21 studies were finally included in the study. True-positive, true-negative, false-positive, and false-negative data were extracted for the analysis. The quality of each study was analyzed using the QUADAS-2 tool. RESULTS The sensitivity of ICG-based parathyroid gland identification was 0.9380 (95% CI [0.9003, 0.9621]). The diagnostic odds ratio for ICG-based prediction of parathyroid gland function was 54.5652 [13.2059, 225.4570]. The area under the summary receiver operating characteristic curve was 0.909. Fluorescence intensity-based prediction presented higher diagnostic accuracy than that of score-based prediction. The incidence of postoperative hypoparathyroidism was higher in the group with a zero ICG score compared to the high scored group. CONCLUSIONS Identification of parathyroid gland and prediction of postoperative function using ICG are valuable to patients undergoing thyroidectomy or parathyroidectomy.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology - Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - So-Hyun Kim
- Department of Otolaryngology - Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jaehoon Jung
- Department of Otolaryngology - Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Kim
- Department of Otolaryngology - Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Se Hwan Hwang
- Department of Otolaryngology - Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Aurilia C, Donati S, Palmini G, Miglietta F, Falsetti I, Iantomasi T, Brandi ML. Are Non-Coding RNAs Useful Biomarkers in Parathyroid Tumorigenesis? Int J Mol Sci 2021; 22:ijms221910465. [PMID: 34638805 PMCID: PMC8508841 DOI: 10.3390/ijms221910465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
Tumors of the parathyroid glands are common endocrine diseases almost always characterized by parathyroid hormone hypersecretion that determines the clinical manifestations of primary hyperparathyroidism, such as fatigue, kidney problems, weakness, brittle bones, and other symptoms. Most parathyroid neoplasia are benign adenomas, although rare malignant forms have been described. They are heterogeneous in terms of clinical presentation and the associated signs and symptoms overlap with those of disease and aging. Furthermore, most patients with hypercalcemia are discovered during routine blood tests for other reasons. Surgical removal is considered the main therapeutic option to cure these endocrine tumors and, therefore, innovative therapeutic approaches are actively required. Recently, a growing number of studies have suggested that alterations to the epigenetic mechanisms could play a pivotal role in parathyroid tumorigenesis. Most of the attention has been focused on non-coding RNAs (ncRNAs) (i.e., miRNAs, lncRNAs, and circRNAs) whose expression profile has been found to be deregulated in parathyroid tumors. The aim of the present paper is to give an insight into the ncRNAs involved in parathyroid tumorigenesis, which could be used in the future either as innovative diagnostic biomarkers or as therapeutic targets for the treatment of this endocrine neoplasia.
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Affiliation(s)
- Cinzia Aurilia
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Simone Donati
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Gaia Palmini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Francesca Miglietta
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Irene Falsetti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Teresa Iantomasi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Maria Luisa Brandi
- Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO Onlus), 50141 Florence, Italy
- Correspondence:
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Perigli G, Cianchi F, Giudici F, Russo E, Fiorenza G, Petrone L, Sparano C, Staderini F, Badii B, Morandi A. Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing. J Clin Med 2021; 10:jcm10194323. [PMID: 34640352 PMCID: PMC8509338 DOI: 10.3390/jcm10194323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The diagnosis of thyroid cancer is continuously increasing and consequently the amount of thyroidectomy. Notwithstanding the actual surgical skill, postoperative hypoparathyroidism still represents its most frequent complication. The aims of the present study are to analyze the rate of postoperative hypoparathyroidism after thyroidectomy, performed for cancer by a single first operator, without any technological aid, and to compare the data to those obtained adopting the most recent technological adjuncts developed to reduce the postoperative hypoparathyroidism. METHODS During the period 1997-2020 at the Endocrine Surgery Unit of the Department of Clinical and Experimental Medicine of the University of Florence, 1648 consecutive extracapsular thyroidectomies for cancer (401 with central compartment node dissection) were performed. The percentage of hypoparathyroidism, temporary or permanent, was recorded both in the first period (Group A) and in the second, most recent period (Group B). Total thyroidectomies were compared either with those with central compartment dissection and lobectomies. Minimally invasive procedures (MIT, MIVAT, some transoral) were also compared with conventional. Fisher's exact and Chi-square tests were used for comparison of categorical variables. p < 0.01 was considered statistically significant. Furthermore, a literature research from PubMed® has been performed, considering the most available tools to better identify parathyroid glands during thyroidectomy, in order to reduce the postoperative hypoparathyroidism. We grouped and analyzed them by technological affinity. RESULTS On the 1648 thyroidectomies enrolled for the study, the histotype was differentiated in 93.93 % of cases, medullary in 4% and poorly differentiated in the remaining 2.06%. Total extracapsular thyroidectomy and lobectomy were performed respectively in 95.45% and 4.55%. We recorded a total of 318 (19.29%) cases of hypocalcemia, with permanent hypoparathyroidism in 11 (0.66%). In regard to the literature, four categories of tools to facilitate the identification of the parathyroids were identified: (a) vital dye; (b) optical devices; (c) autofluorescence of parathyroids; and (d) autofluorescence enhanced by contrast media. Postoperative hypoparathyroidism had a variable range in the different groups. CONCLUSIONS Our data confirm that the incidence of post-surgical hypoparathyroidism is extremely low in the high volume centers. Its potential reduction adopting technological adjuncts is difficult to estimate, and their cost, together with complexity of application, do not allow immediate routine use. The trend towards increasingly unilateral surgery in thyroid carcinoma, as confirmed by our results in case of lobectomy, is expected to really contribute to a further reduction of postsurgical hypoparathyroidism.
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Affiliation(s)
- Giuliano Perigli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Fabio Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
- Correspondence:
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Giulia Fiorenza
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Luisa Petrone
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (L.P.); (C.S.)
| | - Clotilde Sparano
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (L.P.); (C.S.)
| | - Fabio Staderini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Benedetta Badii
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Alessio Morandi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
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Aswani Y, Dhume V, Varma R, Saifi S. Enlarged parathyroid glands with variable sonomorphology in a case of tertiary hyperparathyroidism: Sonographic-histopathologic correlation. Indian J Radiol Imaging 2021; 26:513-516. [PMID: 28104949 PMCID: PMC5201085 DOI: 10.4103/0971-3026.195786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The typical sonomorphology of homogeneously hypoechoic texture of an enlarged parathyroid gland (PG) is a reflection of uniform arrangement of the parathormone-producing chief cells. A variable cellular arrangement, hemorrhage, fibrosis, and adipocytes cause heterogeneous appearance. We describe a case of a 32-year-old male, a case of tertiary hyperparathyroidism, with increased serum parathormone levels, hypercalcemia, and enlargement of all four PGs, albeit with differing morphology. The left lower gland had two nodules, namely, superior and inferior. The inferior nodule of the left lower gland had an echogenic core surrounded by a sonolucent rim whereas the superior nodule was homogenously hyoechoic. The left upper gland had an echopattern exactly reverse of the inferior nodule of the left lower PG, i.e., hypoechoic gland surrounded by hyperechoic periphery. The appearance of the right-sided glands was that of the superior nodule of the left lower PG. On histopathology, the hypoechoic areas corresponded to numerous chief cells and congested vessels whereas edema gave rise to an increase in echogenicity. This report exemplifies atypical sonographic appearances of PG and their histopathologic correlation.
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Affiliation(s)
- Yashant Aswani
- Department of Radiology, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Varsha Dhume
- Department of Pathology, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Ravi Varma
- Department of Radiology, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Shenaz Saifi
- Department of Radiology, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
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Abstract
INTRODUCTION The incidence of parathyroid - glandula parathyreoideae (PTG) diseases has been increasing worldwide. Unlike benign tumours, the incidence of malignant PTG tumours is rather a rare diagnosis. The morbidity of parathyroid surgery is associated with surgical removal of one or more pathologically altered parathyroid glands, particularly parathyroid adenoma associated with primary hyperparathyroidism (HPPT), but also hyperplasia associated with secondary or tertiary HPPT, and last but not least, HPPT due to parathyroid cancer. METHODS A retrospective statistical analysis was performed in the set of patients undergoing surgery for a parathyroid disorder at the Department of Otorhinolaryngology and Maxillofacial Surgery, 3rd Faculty of Medicine, Charles University and Military University Hospital in Prague in 2013-2019 (7-year period). In this period, 127 procedures were performed. The incidences of morbidity, mortality, complications and lethality were analysed. RESULTS Parathyroid surgery was performed in 20 male and 107 female patients. The mean age was 54.7 years, and the morbidity expressing recurrent laryngeal nerve (RLN) palsy was 0.7% of the nerves exposed during the procedure. The incidence of permanent normal postoperative calcaemia was 98.43%, demonstrated by a decrease in serum parathyroid hormone (PTH) levels. In 12 cases, this state was achieved only after a surgical revision (primary procedure for primary HPPT in 2 cases; 10 patients came for surgical revision with secondary or tertiary HPPT from other centres). Decreased PTH levels were demonstrated intraoperatively in 12.6% patients using the so-called PTH assay (a rapid serum PTH assay). Surgery for secondary or tertiary hyperparathyroidism was done in 33 patients (26% procedures). PTG surgery lethality (mortality) was divided into perioperative mortality within 24 hours from the procedure and early mortality within 120 hours. Lethality related to PTG surgery was 0.0% including patients undergoing the surgery while being in a dialysis programme and those with kidney transplant. CONCLUSIONS Surgery is always associated with complications, with morbidity and mortality. Experience of endocrinology surgeons of all specialties is reflected in a very low incidence of RLN injuries and in sufficient oncological, or respectively, surgical radicality. This, in connection with other medical fields of endocrinology, nephrology, transplantology, nuclear medicine and oncology, allows a safe and effective treatment of all PTG disorders with a good prognosis for the patients. In those with secondary or tertiary HPPT, it not only improves their quality of life, which was not explored in our study, but in many cases it is an essential step for listing the patient for the transplant surgery. The current level of experience in the field of parathyroid carcinoma does not enable us to formulate any conclusions in terms of prognosis which should be considered as very serious in all cases.
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Xing Z, Qiu Y, Fei Y, Xia B, Abuduwaili M, Zhu J, Su A. Protective strategy of parathyroid glands during thyroid lobectomy: A retrospective cohort and case-control study. Medicine (Baltimore) 2021; 100:e21323. [PMID: 33832057 PMCID: PMC8036091 DOI: 10.1097/md.0000000000021323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
Parathyroid protection during thyroid lobectomy was not illustrated previously. Aim of this study was to find out the influence of parathyroid glands in situ preservation and autotransplantation on postoperative parathyroid function in thyroid lobectomy.Consecutive patients who underwent primary thyroid lobectomy with unilateral central neck dissection for papillary thyroid carcinoma in our center were included retrospectively. Postoperative hypoparathyroidism was defined as low parathyroid hormone (PTH) levels (<1.6 pmol/L) and keeping over 6 months was defined as permanent. Patients were divided into 3 groups: all identified parathyroid glands preserved in situ (preservation group); at least one parathyroid gland autotransplanted without accidental resection (autotransplantation group); at least one parathyroid gland accidental resected (resection group).A total of 425 patients were included. No permanent hypoparathyroidism was reported, and the rates of transient hypoparathyroidism were similar among all groups. Significantly lower serum PTH levels were found in autotransplantation group versus preservation group at postoperative 1-day (3.77 ± 1.61 vs 4.72 ± 2.31, P < .001). Transient hypoparathyroidism was significantly associated with reduced intraoperative carbon nanoparticles utilization (57.1% vs 77.4%, P = .039).Thyroid lobectomy was a safe surgical method for parathyroid protection no matter the practice to ipsilateral parathyroid glands. However, preservation of all parathyroid glands was still recommended considering relatively stable PTH levels.
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Affiliation(s)
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery
- Department of Ultrasound, West China Hospital, Sichuan University, PR China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery
| | | | | | | | - Anping Su
- Center of Thyroid & Parathyroid Surgery
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Sun R, Sheng J, Zhou Y, Zhou Y, Cai Y, Shui C, Zeng D, Jiang J, Li R, Wang X, Zhu J, Li C. Relationship between the extent of central node dissection and parathyroid function preservation in thyroid cancer surgery. Gland Surg 2021; 10:1093-1103. [PMID: 33842253 DOI: 10.21037/gs-21-121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The risk and effect of hypocalcemia following surgery of different magnitudes remains unclear. Thus, we assessed whether different extents of central lymph node dissection (CLND) and status of preserved parathyroid glands can influence parathyroid function in differentiated thyroid carcinoma (DTC) patients with initial surgical resection. Methods Participants were categorized into 6 groups based on the extent of the surgical procedures, number of parathyroid glands preserved in situ, and parathyroid autotransplantation. The frequencies of hypocalcemia, serum calcium (Ca) levels, and parathyroid hormone (PTH) levels among the different groups were analyzed. Results The prevalence of hypocalcemia, number and status of parathyroid glands preserved in situ, and parathyroid autotransplantation were inversely related to extensive CLND (r=-0.18; P<0.05). The decrease of serum Ca and PTH was most severe on postoperative days (POD) 1-7. The incidence of hypocalcemia was higher in Group C than in Group B and A (P<0.05). The average postoperative serum Ca and PTH levels in Group C were significantly lower than group A on POD 1-7 (P<0.05). The incidence of hypocalcemia was obviously increased in Group D compared to Groups E and F (P<0.05). The mean serum Ca and PTH levels in Group D were significantly lower than in Group F (P<0.05), and the same results could be observed between Groups D and E (P<0.05). However, through parathyroid autotransplantation, there was no significant difference that could be found between Groups E and F on POD 1-7 (P>0.05). Conclusions With the expansion of CLND scope, postoperative parathyroid function will be affected, increasing the risk of postoperative hypocalcemia. When at least 1-2 parathyroid glands were reserved in situ plus at least 1 parathyroid gland autotransplantation, there was little effect on postoperative parathyroid function.
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Affiliation(s)
- Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianfeng Sheng
- Department of Otorhinolaryngology Head and Neck Surgery, Mianyang Third People's Hospital, Mianyang, China
| | - Yue Zhou
- Department of Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunyan Shui
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jian Jiang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xu Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Xing Z, Qiu Y, Xia B, Abuduwaili M, Fei Y, Zhu J, Su A. Surgical strategy when identifying less than four parathyroid glands during total thyroidectomy: a retrospective cohort study. Gland Surg 2021; 10:10-22. [PMID: 33633958 DOI: 10.21037/gs-20-486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Parathyroid glands protection is still controversial in patients with less than 4 parathyroid glands during thyroidectomy. The aim of this study was to investigate the strategy of parathyroid autotransplantation or in situ preservation in patients with 3 parathyroid glands. Methods Consecutive patients who underwent primary total thyroidectomy with bilateral central neck dissection for papillary thyroid carcinoma (PTC) in our center were included retrospectively. Serum calcium and parathyroid hormone (PTH) levels (pg/mL), incidence of hypocalcemia and hypoparathyroidism during 24 months follow-up were compared grouping by the number of parathyroid glands both identified intraoperatively and confirmed postoperatively by pathology. Results A total of 1,424 patients were included. Serum PTH and calcium levels were lower and the incidence of hypocalcemia was higher in patients with 3 identified parathyroid glands. When excluding patients with accidental parathyroid resection, the results remained similar. Of the 212 patients with 3 identified parathyroid glands, PTH levels at postoperative 12-month in patients underwent autotransplantation were significantly lower than patients with all parathyroid glands preserved in situ (3.65±1.30 vs. 4.67±1.89, P=0.026). Conclusions The parathyroid function was weaker in patients with 3 parathyroid glands than patients with 4 before and after operation. Parathyroid glands preserved all in situ promoted better recovery of postoperative function in patients with 3 identified parathyroid glands.
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Affiliation(s)
- Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Baoying Xia
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Munire Abuduwaili
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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Maurer E, Vorländer C, Zielke A, Dotzenrath C, von Frankenberg M, Köhler H, Lorenz K, Weber T, Jähne J, Hammer A, Böttcher KA, Schwarz K, Klinger C, Buhr HJ, Bartsch DK. Short-Term Outcomes of Surgery for Graves' Disease in Germany. J Clin Med 2020; 9:jcm9124014. [PMID: 33322553 PMCID: PMC7763951 DOI: 10.3390/jcm9124014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical treatment of Graves' disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. METHODS Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student's t-test or Fisher's exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. RESULTS A total of 1808 patients with GD with a median age of 44 (range 14-85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. CONCLUSION Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.
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Affiliation(s)
- Elisabeth Maurer
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg Baldingerstrasse, 35043 Marburg, Germany;
- Correspondence:
| | - Christian Vorländer
- Department of Endocrine Surgery, Bürgerhospital Frankfurt/Main, 60318 Frankfurt am Main, Germany;
| | - Andreas Zielke
- Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Cornelia Dotzenrath
- Department of Endocrine Surgery, Helios Universityhospital Wuppertal, 42283 Wuppertal, Germany;
| | | | - Hinrich Köhler
- Department of General Surgery, Herzogin Elisabeth Hospital Braunschweig, 38124 Braunschweig, Germany;
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center Halle, 06120 Halle, Germany;
| | - Theresia Weber
- Department of Endocrine Surgery, Katholisches Klinikum Mainz, 55131 Mainz, Germany;
| | - Joachim Jähne
- Department of General and Visceral Surgery, Diakovere Henriettenstift Hannover, 30171 Hannover, Germany;
| | - Antonia Hammer
- Department of Endocrine Surgery, DKD Helios Clinic Wiesbaden, 65191 Wiesbaden, Germany;
| | - Knut A. Böttcher
- Department of General and Visceral Surgery, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany;
| | - Katharina Schwarz
- Department of Endocrine Surgery, Lukas Hospital GmbH Neuss, 41464 Neuss, Germany;
| | - Carsten Klinger
- German Society of General and Visceral Surgery, 10117 Berlin, Germany; (C.K.); (H.J.B.)
| | - Heinz J. Buhr
- German Society of General and Visceral Surgery, 10117 Berlin, Germany; (C.K.); (H.J.B.)
| | - Detlef K. Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg Baldingerstrasse, 35043 Marburg, Germany;
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Donati S, Ciuffi S, Marini F, Palmini G, Miglietta F, Aurilia C, Brandi ML. Multiple Endocrine Neoplasia Type 1: The Potential Role of microRNAs in the Management of the Syndrome. Int J Mol Sci 2020; 21:ijms21207592. [PMID: 33066578 PMCID: PMC7589704 DOI: 10.3390/ijms21207592] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited tumor syndrome, characterized by the development of multiple neuroendocrine tumors (NETs) in a single patient. Major manifestations include primary hyperparathyroidism, gastro-entero-pancreatic neuroendocrine tumors, and pituitary adenomas. In addition to these main NETs, various combinations of more than 20 endocrine and non-endocrine tumors have been described in MEN1 patients. Despite advances in diagnostic techniques and treatment options, which are generally similar to those of sporadic tumors, patients with MEN1 have a poor life expectancy, and the need for targeted therapies is strongly felt. MEN1 is caused by germline heterozygous inactivating mutations of the MEN1 gene, which encodes menin, a tumor suppressor protein. The lack of a direct genotype–phenotype correlation does not permit the determination of the exact clinical course of the syndrome. One of the possible causes of this lack of association could be ascribed to epigenetic factors, including microRNAs (miRNAs), single-stranded non-coding small RNAs that negatively regulate post-transcriptional gene expression. Some miRNAs, and their deregulation, have been associated with MEN1 tumorigenesis. Recently, an extracellular class of miRNAs has also been identified (c-miRNAs); variations in their levels showed association with various human diseases, including tumors. The aim of this review is to provide a general overview on the involvement of miRNAs in MEN1 tumor development, to be used as possible targets for novel molecular therapies. The potential role of c-miRNAs as future non-invasive diagnostic and prognostic biomarkers of MEN1 will be discussed as well.
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Affiliation(s)
- Simone Donati
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Study of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (S.D.); (S.C.); (F.M.); (G.P.); (F.M.); (C.A.)
| | - Simone Ciuffi
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Study of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (S.D.); (S.C.); (F.M.); (G.P.); (F.M.); (C.A.)
| | - Francesca Marini
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Study of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (S.D.); (S.C.); (F.M.); (G.P.); (F.M.); (C.A.)
| | - Gaia Palmini
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Study of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (S.D.); (S.C.); (F.M.); (G.P.); (F.M.); (C.A.)
| | - Francesca Miglietta
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Study of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (S.D.); (S.C.); (F.M.); (G.P.); (F.M.); (C.A.)
| | - Cinzia Aurilia
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Study of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (S.D.); (S.C.); (F.M.); (G.P.); (F.M.); (C.A.)
| | - Maria Luisa Brandi
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Study of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (S.D.); (S.C.); (F.M.); (G.P.); (F.M.); (C.A.)
- Unit of Bone and Mineral Diseases, University Hospital of Florence, Largo Palagi 1, 50139 Florence, Italy
- Fondazione Italiana Ricerca Sulle Malattie Dell’Osso (FIRMO Onlus), 50141 Florence, Italy
- Correspondence: ; Tel.: +39-055-7946304
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Spartalis E, Giannakodimos A, Athanasiadis DI, Chrysikos D, Paschou SA, Schizas D, Patelis N, Papasilekas T, Themistoklis K, Spartalis M, Troupis T, Nikiteas N. The Potential Role of Carbon Nanoparticles in Lymph Node Tracing, Recurrent Laryngeal Nerve Identification and Parathyroid Preservation During Thyroid Surgery: A Systematic Review. Curr Pharm Des 2020; 27:2505-2511. [PMID: 32962609 DOI: 10.2174/1381612826666200922154824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/02/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND/OBJECTIVE Carbon nanoparticles (CNs) are a novel injected suspension used during thyroidectomy in order to black stain the thyroid gland and the lymph nodes while maintaining the anatomic color of the parathyroid glands and the laryngeal nerves. The aim of this systematic review is to investigate the benefits of carbon nanoparticles in thyroid surgical procedures and examine their role in lymph node tracing, parathyroid preservation, and recurrent laryngeal nerve protection. METHODS A systematic review of the literature in the PubMed/Medline database was performed. Articles reporting randomized clinical trials, prospective, and retrospective studies that compared the use of carbon nanoparticles in one group of patients with a control-blank group were included. The article was reported in accordance with PRISMA guidelines (CRD42021243015). RESULTS The search strategy retrieved 22 studies of the literature. Fourteen studies calculated a greater number of lymph nodes detected/dissected in the central neck zone to the patients using CN solution and 1 article noted a higher rate of lymph nodes resected in the lateral neck zone in the same group of patients. A significant increase in the number of metastatic lymph nodes retrieved in the CN group was found in 7 studies. Twenty-one studies suggested that the use of CNs for the protection of the parathyroid glands was beneficial. Transient hypoparathyroidism and transient hypocalcemia were presented with a significantly lower incidence in the CN group in 13 and in 8 studies, respectively. CONCLUSION Carbon nanoparticles may improve both central and lateral neck dissection and enhance parathyroid gland identification and preservation.
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Affiliation(s)
- Eleftherios Spartalis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Alexios Giannakodimos
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Dimosthenis Chrysikos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, Aghia Sophia Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Patelis
- 1st Department of Neurosurgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S Christeas", National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodore Troupis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Li D, Guo B, Liang Q, Liu Y, Zhang L, Hu N, Zhang X, Yang F, Ruan C. Tissue-engineered parathyroid gland and its regulatory secretion of parathyroid hormone. J Tissue Eng Regen Med 2020; 14:1363-1377. [PMID: 32511868 DOI: 10.1002/term.3080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/11/2022]
Abstract
Parathyroid glands (PTGs) are important endocrine organs being mainly responsible for the secretion of parathyroid hormone (PTH) to regulate the balance of calcium (Ca) /phosphorus (P) ions in the body. Once PTGs get injured or removed, their resulting defect or loss of PTH secretion should disturb the level of Ca/P in blood, thus damaging other related organs (bone, kidney, etc.) and even causing death. Recently, tissue-engineered PTGs (TE-PTGs) have attracted lots of attention as a potential treatment for the related diseases of PTGs caused by hypoparathyroidism and hyperparathyroidism, including tetany, muscle cramp, nephrolithiasis, nephrocalcinosis, and osteoporosis. Although great progress has been made in the establishment of TE-PTGs with an effective strategy to integrate the key factors of cells and biomaterials, its regulatory secretion of PTH to mimic its natural rhythms in the body remains a huge challenge. This review comprehensively describes an overview of PTGs from physiology and pathology to cytobiology and tissue engineering. The state of the arts in TE-PTGs and the feasible strategies to regulate PTH secretion behaviors are highlighted to provide an important foundation for further investigation.
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Affiliation(s)
- Duo Li
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China.,University of Chinese Academy of Sciences, Beijing, PR China
| | - Baochun Guo
- Department of Nephrology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, PR China.,Key Laboratory of Shenzhen Renal Diseases, Shenzhen, PR China
| | - Qingfei Liang
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China.,University of Chinese Academy of Sciences, Beijing, PR China
| | - Yunhui Liu
- University of Chinese Academy of Sciences, Beijing, PR China.,The Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China
| | - Lu Zhang
- The Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China
| | - Nan Hu
- Department of Nephrology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, PR China.,Key Laboratory of Shenzhen Renal Diseases, Shenzhen, PR China
| | - Xinzhou Zhang
- Department of Nephrology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, PR China.,Key Laboratory of Shenzhen Renal Diseases, Shenzhen, PR China
| | - Fan Yang
- University of Chinese Academy of Sciences, Beijing, PR China.,The Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China
| | - Changshun Ruan
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China.,University of Chinese Academy of Sciences, Beijing, PR China
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Hassani S, Afkhamizadeh M, Teimouri A, Najaf Najafi M, Vazifeh Mostaan L, Mohebbi M. Evaluation of Serum Level of FGF23 and 1,25(OH) 2D 3 in Primary Hyperparathyroidism Patients Before and After Parathyroidectomy. Int J Gen Med 2020; 13:289-295. [PMID: 32606893 PMCID: PMC7295333 DOI: 10.2147/ijgm.s253246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) play critical roles in phosphate homeostasis. To the best of our knowledge, there are limited data on the impact of FGF23 and PTH on serum calcium, 1,25(OH)2D3, and phosphate in patients with primary hyperparathyroidism (PHPT). We examined these parameters and their correlations in PHPT patients before and after parathyroidectomy (PTX). Patients and Methods In this prospective cohort study, 29 PHPT patients who met the inclusion criteria were selected. The patient’s blood samples were taken three times: before the operation, 24 h after the operation, and 1 week after the operation. The concentrations of serum calcium, FGF23, 1,25(OH)2D3, phosphate, PTH, and alkaline phosphatase were measured in a referral laboratory at each of the three steps. Moreover, 25(OH)D was primarily measured just before the surgery. Results Of 29 patients included in this study with a mean age of 52.37±12.3 years, majority were females (75.8%). Serum FGF23 and 1,25(OH)2D3 levels were high before PTX and decreased after the operation; however, the difference was not statistically significant. FGF23 levels were significantly correlated with 1,25(OH)2D3 at each of the three steps (r=0.964, P <0.01; r=0.985, P <0.0; and r=0.976, P <0.05). The variations in calcium, phosphate, creatinine, and PTH were preoperatively and postoperatively significant. Conclusion Although 1,25(OH)2D3 and FGF23 levels were preoperatively higher in PHPT, their variations were not meaningful. There was a statistically direct significant relationship between 1,25(OH)2D3 and FGF23 preoperatively and postoperatively; however, the correlations between FGF23 and calcium, phosphate, and PTH were not significant.
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Affiliation(s)
- Solmaz Hassani
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mozhgan Afkhamizadeh
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Teimouri
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Najaf Najafi
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Masoud Mohebbi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Spartalis E, Ntokos G, Georgiou K, Zografos G, Tsourouflis G, Dimitroulis D, Nikiteas NI. Intraoperative Indocyanine Green (ICG) Angiography for the Identification of the Parathyroid Glands: Current Evidence and Future Perspectives. In Vivo 2020; 34:23-32. [PMID: 31882459 DOI: 10.21873/invivo.11741] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/16/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Recently, indocyanine green (ICG) fluorescence imaging has been used for the identification of the parathyroid glands (PG) during thyroid and parathyroid surgery. However, an overall consensus on the optimal technique, the dosage, the timing of the ICG administration and finally its interpretation and clinical usefulness is still lacking evidence. The aim of this review is to investigate the use of ICG angiography during thyroidectomy and/or parathyroidectomy for identification as well as for the perfusion integrity of the parathyroid glands. MATERIALS AND METHODS The PubMed database was systematically searched for publications regarding intraoperative ICG imaging in patients that undergo thyroidectomy or parathyroidectomy. RESULTS Eighteen publications reporting on 612 patients, namely 71 parathyroidectomy and 541 thyroidectomy patients met the inclusion criteria. Eleven publications reported the use of ICG angiography for the identification of the parathyroid glands during thyroidectomy and seven during parathyroidectomy for primary and secondary hyperparathyroidism. CONCLUSION ICG fluorescence imaging is a simple, fast and reproducible method capable of intraoperatively visualizing and assessing the function of parathyroid glands, and can, therefore, assist surgeons in their decision-making. Despite all this, ICG fluorescence imaging technique for PG detection still lacks standardization and further studies are needed to establish its clinical utility.
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Affiliation(s)
- Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", National and Kapodistrian University of Athens Medical School, Athens, Greece .,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Georgios Ntokos
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,3rd Surgical Department, "George Gennimatas" General Hospital, Athens, Greece
| | - Konstantinos Georgiou
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Zografos
- 3rd Surgical Department, "George Gennimatas" General Hospital, Athens, Greece
| | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos I Nikiteas
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", National and Kapodistrian University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
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Doulaptsi M, Ierodiakonou D, Prokopakis E, Stanitsa N, Rogdakis A, Karatzanis A. Effect of incidental parathyroidectomy on postoperative calcium levels after to-tal thyroidectomy. Hippokratia 2020; 24:72-76. [PMID: 33488055 PMCID: PMC7811874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Incidental parathyroidectomy during total thyroidectomy may occur even in the most experienced hands. This study aims to assess the incidence, risk factors, and impact of incidental parathyroidectomy on this very targeted group of patients. METHODS Three hundred and four consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively studied. Based on the histopathology report, incidental parathyroidectomy was assessed in relation to postoperative transient/permanent hypocalcemia. Demographic, clinical, and histological data were analyzed. RESULTS The overall incidence of unintentional removal of parathyroid glands during total thyroidectomy was 35.5 %. Indicators were the postoperative hypocalcemia, the percent change of parathormone serum levels, and the presence of lymph nodes in the histopathology report. Patients with incidental parathyroidectomy exhibited a higher incidence of transient hypocalcemia and hypoparathyroidism postoperatively. CONCLUSIONS Incidental parathyroidectomy is associated with transient hypocalcemia after total thyroidectomy. Even single parathyroid in the histopathology specimen may be sufficient for influencing postoperative PTH levels and calcium. Every effort should be made by surgeons to identify and protect all parathyroid glands successfully. HIPPOKRATIA 2020, 24(2): 72-76.
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Affiliation(s)
- M Doulaptsi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece
| | - D Ierodiakonou
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - E Prokopakis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece
| | - N Stanitsa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece
| | - A Rogdakis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece
| | - A Karatzanis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece
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Kamal W, Björnsdottir S, Kämpe O, Trolle Lagerros Y. Concordance Between ICD-10 Codes and Clinical Diagnosis of Hypoparathyroidism in Sweden. Clin Epidemiol 2020; 12:327-331. [PMID: 32273771 PMCID: PMC7102876 DOI: 10.2147/clep.s242528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/22/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction Chronic hypoparathyroidism is a rare disorder. The disease is characterized by low serum calcium, high serum phosphate, and deficient production of parathyroid hormone. The most common etiology is unintentional damage and intentional removal to the parathyroid glands during anterior neck surgery. Other causes include genetic disorders and autoimmune diseases. Knowledge about the epidemiology of chronic hypoparathyroidism is sparse and the prevalence in Sweden is unknown. It is of importance to know the validity of the registers used to study the epidemiology of hypoparathyroidism in Sweden. The purpose of this study was to validate the International Classification of Diseases - 10th revision (ICD-10) diagnosis of hypoparathyroidism in the Swedish National Patient Register. Methods We included patients with the ICD-10 diagnosis of hypoparathyroidism that were found in the Swedish National Patient Register during 2004 to 2016. Through the unique national registration number assigned to all Swedish inhabitants, we could link this information to the Swedish Prescribed Drug Register. We included patients with an ICD-10 diagnosis for hypoparathyroidism and on concurrent conventional treatment for the disease. The validation of the diagnosis was assessed through review of medical records of 120 patients. Results A total of 958 patients, 70% women (n=671) and 30% men (n=287) met the inclusion criteria. In total, 120 randomly chosen medical records were reviewed and 109 cases were confirmed. This corresponds to an overall positive predictive value of 91%. Conclusion The validity of the ICD-10 diagnosis of hypoparathyroidism in the Swedish National Patient Register is high and the register is a reliable source for further research. There is a risk of miscoding when assigning an ICD-code to the medical records. We urge clinicians to be aware of this risk, especially the risk of mix-ups with the more common diagnosis of hyperparathyroidism.
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Affiliation(s)
- Wafa Kamal
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Capio Sankt Görans Hospital, Stockholm, Sweden
| | - Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Olle Kämpe
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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Chang W, Tu CL, Jean-Alphonse FG, Herberger A, Cheng Z, Hwong J, Ho H, Li A, Wang D, Liu H, White AD, Suh I, Shen W, Duh QY, Khanafshar E, Shoback DM, Xiao K, Vilardaga JP. PTH hypersecretion triggered by a GABA B1 and Ca 2+-sensing receptor heterocomplex in hyperparathyroidism. Nat Metab 2020; 2:243-255. [PMID: 32694772 PMCID: PMC7377265 DOI: 10.1038/s42255-020-0175-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
Abstract
Molecular mechanisms mediating tonic secretion of parathyroid hormone (PTH) in response to hypocalcaemia and hyperparathyroidism (HPT) are unclear. Here we demonstrate increased heterocomplex formation between the calcium-sensing receptor (CaSR) and metabotropic γ-aminobutyric acid (GABA) B1 receptor (GABAB1R) in hyperplastic parathyroid glands (PTGs) of patients with primary and secondary HPT. Targeted ablation of GABAB1R or glutamic acid decarboxylase 1 and 2 in PTGs produces hypocalcaemia and hypoparathyroidism, and prevents PTH hypersecretion in PTGs cultured from mouse models of hereditary HPT and dietary calcium-deficiency. Cobinding of the CaSR/GABAB1R complex by baclofen and high extracellular calcium blocks the coupling of heterotrimeric G-proteins to homomeric CaSRs in cultured cells and promotes PTH secretion in cultured mouse PTGs. These results combined with the ability of PTG to synthesize GABA support a critical autocrine action of GABA/GABAB1R in mediating tonic PTH secretion of PTGs and ascribe aberrant activities of CaSR/GABAB1R heteromer to HPT.
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Affiliation(s)
- Wenhan Chang
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA.
| | - Chia-Ling Tu
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Frederic G Jean-Alphonse
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amanda Herberger
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Zhiqiang Cheng
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Jenna Hwong
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Hanson Ho
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Alfred Li
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Dawei Wang
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hongda Liu
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex D White
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Graduate Program in Molecular Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Insoo Suh
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Wen Shen
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Elham Khanafshar
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Dolores M Shoback
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Kunhong Xiao
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean-Pierre Vilardaga
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Wang C, Wang X, Liu L. [Clinical application of carbon nanoparticles suspension in operation of papillary thyroid carcinoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:165-169. [PMID: 32086925 PMCID: PMC10128415 DOI: 10.13201/j.issn.1001-1781.2020.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Indexed: 11/12/2022]
Abstract
Objective:The aim of this study is to evaluate the application of carbon nanoparticle lymphatic tracer in total thyroidectomy and bilateral Central District's thyroidectomy for papillary thyroid carcinoma. Method:Sixty-four patients with cN0 papillary thyroid carcinoma that primary treated were random divided into two groups: Trial group and control group. Carbon nanoparticles suspension was injected into the thyroid gland of trial group patients.After ten minutes, total thyroidectomy plus bilateral central neck dissection was performed in the all patients. The black stained tissue in the dissection specimen of trial group was separated. The control group underwent total thyroidectomy plus bilateral central neck dissection. Total lymph node and parathyroid gland in the black stained tissue,and non-black stained tissue in the central compartment dissection specimen of trial group and central compartment dissection specimen of control group were counted respectively.Total lymph node, the mis-cut parathyroid glands in the adipose tissue of central lymph node,post-operative blood calcium and parathyroid hormone(PTH)of two groups were contrasted and analyzed. Result:There are 235 lymph nodes in the black-stained tissue of central compartment dissection specimen of trial group.No parathyroid gland was found in the black-stained tissue.Five lymph nodes and 2 parathyroid glands were found in the non-black stained tissue of central compartment dissection specimen of trial group. There were 164 lymph nodes and 9 parathyroid glands in central compartment dissection specimen of control group. There is statistic difference between the number of lymph nodes in black stain tissue and that of control group(t=8.291, P=0.000).Rate of staining lymph node were 97.9 percent. No parathyroid glands were found in the black stained tissue. Nine mis-cut parathyroid glands(7.0%) were observed in the control group,while 2(1.6%) in the trial group(P<0.05).None permanent hypocalcemia and PTH decrease were observed in the two groups.There were 10 patients(31.3%) with temporary hypocalcemia and 9 patients(28.1%)with temporary PTH decrease respectively in the control group,and there was 1 patient(3.1%) and 1 patient(3.1%) respectively in the trial group(P<0.05). Conclusion:The effect of nano-carbon is ideal, and the parathyroid gland can not be stained black. It can distinguish the thyroid tissue from the surrounding lymphoid adipose tissue and clearly mark the Central District lymph nodes, reduce the risk of parathyroid gland injury during thyroid cancer. Neck dissection in the central region can improve the efficiency of lymph node dissection, protect the parathyroid gland and reduce the risk of postoperative complications.
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Affiliation(s)
- Chunhui Wang
- Department of Otolaryngology,Liangxiang Hospital,Capital Medical University,Beijing,102401,China
| | - Xiaoqin Wang
- Department of Otolaryngology,Liangxiang Hospital,Capital Medical University,Beijing,102401,China
| | - Liangfa Liu
- Department of Otorhinolaryngology Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical University
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Roztoczyńska D, Wójcik M, Konturek A, Nogieć A, Hubalewska-Dydejczyk A, Starzyk J. Bilateral slipped capital femoral epiphysis as first manifestation of primary hyperparathyroidism in a 15-year-old boy. Pediatr Endocrinol Diabetes Metab 2020; 26:220-4. [PMID: 33554497 DOI: 10.5114/pedm.2020.100805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ABSTRACT Primary hyperparathyroidism (PHP) in children is a rare condition and has a very dynamic course with nonspecific symptoms, what complicates the diagnosis and delays PHP treatment. CASE PRESENTATION A 15-year-old boy was admitted to the Orthopedic Ward with the diagnosis of juvenile bilateral slipped capital femoral epiphysis and valgus deformities. Gait disturbances, limb pains and valgus knee deformities, polyuria, polydipsia and weight loss, have been increasing for 8 months. Despite the hypercalcemia found in laboratory tests and bone destruction demonstrated in computed tomography of the hips, orthopedic correction was performed. In histopathological examination -brown bone tumors. The PTH concentration was determined (PTH - 589.1 pg/ml; (N: 10-60) and the child was referred to the Department of Pediatric Endocrinology, where severe hypercalcemia (Ca - 4.07 mmol/l, N: 2.2-2.84) and hypophosphatemia (P - 0.68 mmol/l; N: 0.95-1.75) and adenoma of the left lower parathyroid gland was diagnosed. Forced diuresis, loop diuretics and pamidronic acid were used to obtain normocalcemia. The complications of hypercalcemia were excluded; diagnostic management excluding multiple endocrine neoplasia type 1 and 2a (MEN 1 and MEN 2A) syndrome were performed. The child was referred to the Department of Endocrinological Surgery, where the adenoma of the left inferior parathyroid gland was resected. CONCLUSIONS 1) Patients with PHP should be diagnosed of the condition based on clinical symptoms. In patients with specific symptoms, it is necessary to determine serum Ca levels, especially prior to the surgical procedures. 2) In each case of PHP, determinations should be made of blood PTH, Ca and P and detection of MEN 1 and MEN 2A syndromes. 3) Patients with hyperparathyroidism require management of multiorgan complications of hypercalcemia. 4) Following surgical treatment of parathyroid adenoma, long-term endocrinological follow-up is necessary.
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Abstract
This review summarizes the results of studies concerning the problem of post-surgical hypoparathyroidism, a common complication of thyroid gland surgery, decreasing the quality of life in patients and, in some cases, leading to disability. A search for publications was carried out in electronic databases Web of Science, Scopus, Academic Search Complete (EBSCO), eLIBRARY, using keywords. The search depth was 7-10 years. Prevalence of post-surgical hypoparathyroidism was evaluated, the pathogenetic causes of the disease development, its clinical forms, methods of diagnosis and treatment were studied. It has been found that there is no single algorithm for analyzing the prognostic factors for the development of this pathological condition. It is emphasized that drug therapy of post-surgical hypoparathyroidism has a number of adverse effects. Therefore, the issues of prevention and surgical correction are of particular relevance. However, controversial opinions of contemporary authors about their clinical effectiveness determine the scientific and practical significance of further research on these issues.
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Affiliation(s)
- A.A. Melikyan
- Surgeon, Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko, 190 Rodionova St., Nizhny Novgorod, 603126, Russia
| | - A.V. Menkov
- Professor, Department of General, Operative Surgery and Topographic Anatomy named after A.I. Kozhevnikov, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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Miller MJ, Agrawal N, Katz G, Ogilvie J, Melamed J. Parathyromatosis with a papillary architecture. Histopathology 2019; 75:598-602. [PMID: 31152597 DOI: 10.1111/his.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Nidhi Agrawal
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
| | - Gillian Katz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
| | - Jennifer Ogilvie
- Department of Surgery, Division of Endocrine Surgery, NYU Langone Health, New York, NY, USA
| | - Jonathan Melamed
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, NY, USA
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Aiti A, Rossi M, Alviano F, Morara B, Burgio L, Cioccoloni E, Cavicchi O, Pasquinelli G, Bonsi L, Buzzi M. Parathyroid Tissue Cryopreservation: Does the Storage Time Affect Viability and Functionality? Biopreserv Biobank 2019; 17:418-424. [PMID: 31025874 DOI: 10.1089/bio.2018.0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Parathyroidectomy is a standard practice to treat recurrent or persistent hyperparathyroidism. However, this can lead to the onset of hypoparathyroidism, treatable with the autotransplantation of parathyroid tissue (PT). Tissue can be transplanted immediately after parathyroidectomy or cryopreserved and transplanted only in case of necessity. Since 2011, the Cord Blood Bank and Cardiovascular Tissue Bank of Emilia-Romagna has been storing PT for potential autologous transplantation. To date, there are highly variable data about the viability and function of PT after thawing. However, it is not clear if the PT quality is affected by different cryopreservation protocols and/or by the storage time. The aim of this study was to assess the ex vivo function and viability of the PTs of ten patients stored in the Bank. Tissue morphology was evaluated before and after cryopreservation through histological investigations. PT function was analyzed by assessing the ability of cryopreserved PT to synthesize and secrete parathyroid hormone (PTH) in response to different calcium concentrations. Moreover, viability and function were also investigated on tissue-isolated cells in culture. These data show that tested tissues appear to be viable and able to produce PTH even after 5 years of storage, and the histological architecture is well preserved.
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Affiliation(s)
- Annalisa Aiti
- Emilia Romagna Cord Blood Bank, Immunohaematology and Transfusion Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Martina Rossi
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Alviano
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Barbara Morara
- Emilia Romagna Cord Blood Bank, Immunohaematology and Transfusion Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luca Burgio
- Otolaringology Unit, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eleonora Cioccoloni
- Otolaringology Unit, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Ottavio Cavicchi
- Otolaringology Unit, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gianandrea Pasquinelli
- Unit of Surgical Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Laura Bonsi
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marina Buzzi
- Emilia Romagna Cord Blood Bank, Immunohaematology and Transfusion Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy
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Chai YJ, Chae H, Kim K, Lee H, Choi S, Lee KE, Kim SW. Comparative Gene Expression Profiles in Parathyroid Adenoma and Normal Parathyroid Tissue. J Clin Med 2019; 8:E297. [PMID: 30832348 DOI: 10.3390/jcm8030297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 12/19/2022] Open
Abstract
Parathyroid adenoma is the main cause of primary hyperparathyroidism, which is characterized by enlarged parathyroid glands and excessive parathyroid hormone secretion. Here, we performed transcriptome analysis, comparing parathyroid adenomas with normal parathyroid gland tissue. RNA extracted from ten parathyroid adenoma and five normal parathyroid samples was sequenced, and differentially expressed genes (DEGs) were identified using strict cut-off criteria. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using DEGs as the input, and protein-protein interaction (PPI) networks were constructed using Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) and visualized in Cytoscape. Among DEGs identified in parathyroid adenomas (n = 247; 45 up-regulated, 202 down-regulated), the top five GO terms for up-regulated genes were nucleoplasm, nucleus, transcription DNA-template, regulation of mRNA processing, and nucleic acid binding, while those for down-regulated genes were extracellular exosome, membrane endoplasmic reticulum (ER), membrane, ER, and melanosome. KEGG enrichment analysis revealed significant enrichment of five pathways: protein processing in ER, protein export, RNA transport, glycosylphosphatidylinositol-anchor biosynthesis, and pyrimidine metabolism. Further, PPI network analysis identified a densely connected sub-module, comprising eight hub molecules: SPCS2, RPL23, RPL26, RPN1, SEC11C, SEC11A, RPS25, and SEC61G. These findings may be helpful in further analysis of the mechanisms underlying parathyroid adenoma development.
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