[Intraoperative parathormone assay. The value of assessment of primary hyperparathyroidism in surgery]. 1995

A Denizot, and C De Boissezon, and J F Henry
Service de Chirurgie Endocrinienne, CHU Timone, Marseille.

Peroperative assay of intact parathormone has been proposed to improve the surgical results, either by confirming cure peroperatively or to indicate the need for further search in case of persistent pathological secretion. Between October 1992 and July 1994 parathormone was assay peroperatively during 136 operations for primary hyperparathyroidism in 135 patients. Seven samples were made for each patient in the operating theatre: at intubation, at skin incision (ti), at ablation of the pathological gland, then 15 (t15), 30 (t30) and 60 (t60) minutes later. All samples were assayed with the rapid technique and controlled the next day with the standard method. The correlation coefficient between the two methods was 0.97. Comparing the drop in intact parathormone levels between cured patients and those with persistent hyperparathyroidism after surgery showed statistically significant differences. We retained a dramatic drop in hormone level by 80% between t1 and t15 with persistent low levels between t15 and t30 (ratio t30 over t15 < 1) as the criteria of cure: the drop off between t1 and t15 is not sufficient to confirm cure. Peroperative assay of intact parathormone can be used to demonstrate the presence of remaining pathological parathyroid tissue, especially important in case of highly ectopic localizations. This assay technique is not particularly well adapted to routine parathyroid surgery for primary hyperthyroidism but has been reserved for cases planned for limited dissection (operations conducted under local anaesthesia and reoperations).

UI MeSH Term Description Entries
D006961 Hyperparathyroidism A condition of abnormally elevated output of PARATHYROID HORMONE (or PTH) triggering responses that increase blood CALCIUM. It is characterized by HYPERCALCEMIA and BONE RESORPTION, eventually leading to bone diseases. PRIMARY HYPERPARATHYROIDISM is caused by parathyroid HYPERPLASIA or PARATHYROID NEOPLASMS. SECONDARY HYPERPARATHYROIDISM is increased PTH secretion in response to HYPOCALCEMIA, usually caused by chronic KIDNEY DISEASES.
D007430 Intraoperative Care Patient care procedures performed during the operation that are ancillary to the actual surgery. It includes monitoring, fluid therapy, medication, transfusion, anesthesia, radiography, and laboratory tests. Care, Intraoperative
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010281 Parathyroid Hormone A polypeptide hormone (84 amino acid residues) secreted by the PARATHYROID GLANDS which performs the essential role of maintaining intracellular CALCIUM levels in the body. Parathyroid hormone increases intracellular calcium by promoting the release of CALCIUM from BONE, increases the intestinal absorption of calcium, increases the renal tubular reabsorption of calcium, and increases the renal excretion of phosphates. Natpara,PTH (1-84),PTH(1-34),Parathormone,Parathyrin,Parathyroid Hormone (1-34),Parathyroid Hormone (1-84),Parathyroid Hormone Peptide (1-34),Hormone, Parathyroid
D011182 Postoperative Care The period of care beginning when the patient is removed from surgery and aimed at meeting the patient's psychological and physical needs directly after surgery. (From Dictionary of Health Services Management, 2d ed) Care, Postoperative,Postoperative Procedures,Procedures, Postoperative,Postoperative Procedure,Procedure, Postoperative
D011300 Preoperative Care Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed) Care, Preoperative,Preoperative Procedure,Preoperative Procedures,Procedure, Preoperative,Procedures, Preoperative
D002118 Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Coagulation Factor IV,Factor IV,Blood Coagulation Factor IV,Calcium-40,Calcium 40,Factor IV, Coagulation
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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