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Sebekos K, Guiab K, Stamelos G, Capron G, Brigode W, Poulakidas S, Bokhari F. Comparison of Outcomes in Below-Knee Amputation Between Vascular, General, and Orthopedic Surgeons. J Surg Res 2023; 290:247-256. [PMID: 37302212 DOI: 10.1016/j.jss.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION General surgeons (GS), orthopedic surgeons (OS), and vascular surgeons (VS) can perform below-knee amputation (BKA) operations. We compared the outcomes of BKA patients among the three specialties. METHODS Adult patients who underwent a BKA were identified from the 2016-2018 National Surgical Quality Improvement Project database. Statistical data for orthopedic and vascular BKA cases were then compared with GS cases using logistic regression analysis. Outcomes included mortality, length of hospital stay, and complications. RESULTS There were 9619 BKA cases. VS had the highest volume of BKA with 58.9% of the cases, compared to GS at 22.9% and OS at 18.1%. 4.4% of general surgery patients had severe frailty compared to OS (3.3%) and VS (3.4%, P < 0.001). VS has the lowest rates of emergency cases (11.9% versus 16.1 for GS versus 15.8% versus OS) and the most favorable wound classification (38.3%, versus 48.7% for GS and VS). Peripheral vascular disease was notably highest in VS (34.0% versus. 20.6% for GS and 9.9% for OS, P < 0.001). Compared to GS, VS was more likely to have a prolonged length of stay (odds ratio) (OR)(1.409), 95% CI 1.265-1.570) while OS was less likely (OR 0.650, 95% CI 0.561-0.754). OS had a lower risk of complications (OR 0.781, 95% CI 0.674-0.904). Mortality was not significantly different among the three specialties. CONCLUSIONS The National Surgical Quality Improvement Project retrospective analysis of BKA cases suggested that mortality was not statistically different when performed by VS, GS, and OS. There were fewer overall complications when OS performed a BKA, but this is more likely a result of operating upon a generally healthier patient population with lower incidence of preoperative comorbid conditions.
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Affiliation(s)
- Konstantinos Sebekos
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois.
| | - Keren Guiab
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - George Stamelos
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - Gweniviere Capron
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - William Brigode
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - Stathis Poulakidas
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - Faran Bokhari
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
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Rizk Y, Saad N, Arnaout W, Chalah MA, Farah S. Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management. J Clin Med 2023; 12:6321. [PMID: 37834965 PMCID: PMC10573864 DOI: 10.3390/jcm12196321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a common endocrine disorder among older adults. The aim of this review is to shed light on PHPT, particularly in this age group, in terms of prevalence, clinical manifestations, medical and surgical management, and post-operative complications. METHODS Eligible studies were those considering PHPT exclusively in the older population (main databases: PubMed, Medline, Google Scholar and the University Online database). Articles published in the last 10 years (2013-2023) were considered. Eligibility criteria followed the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. The methodological quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tool. A total of 29 studies (mainly observational) matched the inclusion criteria. RESULTS The prevalence of PHPT is approximately 1 per 100 in the elderly, and it is more common in females. The clinical presentation varies by age and can include osteoporosis, fractures, and neuropsychiatric symptoms. Conservative management can be an option whenever surgery is not indicated or feasible. However, parathyroidectomy (PTX) remains a safe and effective modality in aging populations with improvement to symptoms, bone mineral density, fracture risk, frailty, quality of life, and metabolic derangements. Complication rates are similar in elderly people compared to younger ones, except for mildly longer length of hospital stay and reoperation for those with higher frailty. CONCLUSION PHPT is a common yet overlooked and underdiagnosed condition among the older population. The safety and efficacy of PTX in the older population on different levels is now well demonstrated in the literature.
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Affiliation(s)
- Youssef Rizk
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Nour Saad
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Wassim Arnaout
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Moussa A. Chalah
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), 75116 Paris, France
| | - Stephanie Farah
- Endocrinology, Diabetes and Metabolism, Private Practice, Haddade Street, Batroun P.O. Box 1400, Lebanon
- Division of Research, LAU Medical Center-Rizk Hospital, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon
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Murruste M, Kivilo M, Kase K, Kirsimägi Ü, Tähepõld A, Tammiksaar K. The Utility of 4D-CT Imaging in Primary Hyperparathyroidism Management in a Low-Volume Center. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1415. [PMID: 37629704 PMCID: PMC10456658 DOI: 10.3390/medicina59081415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023]
Abstract
Background: Ultrasonography (US) and the 99mTc-sestamibi parathyroid scan (SPS) may have suboptimal accuracy when detecting the localization of enlarged parathyroid gland(s) (PTG). Therefore, the more accurate four-dimensional computed tomography scan (4D-CT) has been employed for PTG imaging. Currently, there is a paucity of data evaluating the utility of 4D-CT in low caseload settings. Aim and Objectives: To evaluate the impact of PTG imaging, using 4D-CT in conjunction with its intraoperatively displayed results, on the outcomes of surgical PTX. Materials and Methods: A single-center retrospective analysis of surgically treated patients with pHPT from 01/2010 to 01/2021 was conducted. An evaluation of the impact of the preoperative imaging modalities on the results of surgical treatment was carried out. Results: During the study period, 290 PTX were performed; 45 cases were excluded due to surgery for secondary, tertiary or recurrent HPT, or due to the use of alternative imaging techniques. The remaining 245 patients were included in the study. US was carried out for PTG imaging in 236 (96.3%), SPS in 93 (38.0%), and 4D-CT in 52 patients (21.2%). The use of 4D-CT was associated with a significantly higher rate of successful localization of enlarged PTG (49 cases, 94.2%) compared to US and SPS (74 cases, 31.4%, and 54 cases, 58.1%, respectively). We distinguished between three groups of patients based on preoperative imaging: (1) PTG lateralization via US or SPS in 106 (43.3%) cases; (2) precise localization of PTG via 4D-CT in 49 (20.0%) patients; and (3) in 90 cases (36.7%), PTG imaging failed to localize an enlarged gland. The group of 4D-CT localization had significantly shorter operative time, lower rate of simultaneous thyroid resections, as well as lower rate of removal of ≥2 PTG, compared to the other groups. The 4D-CT imaging was also associated with the lowest perioperative morbidity and with the lowest median PTH in the one month follow-up; however, compared to the other groups, these differences were statistically not significant. The implementation of 4D-CT (since 01/2018) was associated with a decrease in the need for redo surgery (from 11.5% to 7.3%) and significantly increased the annual case load of PTX at our institution (from 15.3 to 41.0) compared to the period before 4D-CT diagnostics. Conclusions: 4D-CT imaging enabled to precisely locate almost 95% of enlarged PTG in patients with pHPT. Accurate localization and intraoperatively displayed imaging results are useful guides for surgeons to make PTX a faster and safer procedure in a low-volume center.
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Affiliation(s)
- Marko Murruste
- Surgery Clinic of Tartu University Hospital, 50406 Tartu, Estonia; (K.K.); (Ü.K.)
| | - Martin Kivilo
- Faculty of Medicine, University of Tartu, 50406 Tartu, Estonia;
| | - Karri Kase
- Surgery Clinic of Tartu University Hospital, 50406 Tartu, Estonia; (K.K.); (Ü.K.)
- Faculty of Medicine, University of Tartu, 50406 Tartu, Estonia;
| | - Ülle Kirsimägi
- Surgery Clinic of Tartu University Hospital, 50406 Tartu, Estonia; (K.K.); (Ü.K.)
| | - Annika Tähepõld
- Radiology Clinic of Tartu University Hospital, 50406 Tartu, Estonia;
| | - Kaia Tammiksaar
- Internal Medicine Clinic of Tartu University Hospital, 50406 Tartu, Estonia;
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Harrington CC, Hayden DM. Maximizing Opportunities: Primary Hyperparathyroidism in the Older Adult. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hangge PT, Norain A, Butterfield RJ, Wasif N, Cronin PA, Stucky CCH. Parathyroidectomy in the elderly is beneficial and safe with similar improvements in postoperative bone mineral density. Am J Surg 2022; 224:147-152. [PMID: 35534296 DOI: 10.1016/j.amjsurg.2022.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/20/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND This study evaluated bone health outcomes of parathyroidectomy in elderly primary hyperparathyroidism (pHPT) patients. METHODS A retrospective review was performed of parathyroidectomy patients with pHPT at a single institution from 2010 to 2019. Bone mineral density (BMD) improvements at postoperative dual-energy X-ray absorptiometry (DEXA) scans were analyzed between groups aged ≥75 and < 75 years using 1:1 matching on preoperative BMD. RESULTS Patients ≥75 had BMD improvements through the second postoperative DEXA scans. While mean T-scores slightly improved in the ≥75 group during the study period, T-score improvement was more significant in the <75 group at first and third postoperative DEXA scans with +0.7 < 75 and +0.1 improvements ≥75 by the third DEXA (p = 0.026). Postoperative fragility fracture rates were similar in the ≥75 group, but significantly improved in patients <75 (10.4% preoperatively to 1.4% postoperatively, p = 0.020). Both cohorts had low complication rates with recurrent laryngeal nerve injury and permanent hypocalcemia of <1% (p = 0.316). CONCLUSIONS Postoperative BMD improvement was similar between the two cohorts with no difference in complication rates suggesting parathyroidectomy is safe and effective in the elderly.
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Affiliation(s)
- Patrick T Hangge
- Department of General Surgery, Division of Oncologic and Endocrine Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Abdullah Norain
- Department of General Surgery, Division of Oncologic and Endocrine Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | | | - Nabil Wasif
- Department of General Surgery, Division of Oncologic and Endocrine Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Patricia A Cronin
- Department of General Surgery, Division of Oncologic and Endocrine Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Chee-Chee H Stucky
- Department of General Surgery, Division of Oncologic and Endocrine Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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Sutton W, Canner JK, Shank JB, Fingeret AL, Karzai S, Segev DL, Prescott JD, Mathur A. The impact of patient age on practice patterns and outcomes for primary hyperparathyroidism. Am J Surg 2022; 224:400-407. [DOI: 10.1016/j.amjsurg.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
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Mueller M, Ebrahimi F, Christ E, Nebiker CA, Schuetz P, Mueller B, Kutz A. Safety of parathyroidectomy in older vs. younger patients with primary hyperparathyroidism. Endocr Connect 2021; 10:1273-1282. [PMID: 34519277 PMCID: PMC8558907 DOI: 10.1530/ec-21-0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Primary hyperparathyroidism is a prevalent endocrinopathy for which surgery is the only curative option. Parathyroidectomy is primarily recommended in younger and symptomatic patients, while there are still concerns regarding surgical complications in older patients. We therefore assessed the association of age with surgical outcomes in patients undergoing parathyroidectomy in a large population in Switzerland. METHODS Population-based cohort study of adult patients with primary hyperparathyroidism undergoing parathyroidectomy in Switzerland between 2012 and 2018. The cohort was divided into four age groups (<50 years, 50-64 years, 65-74 years, ≥75 years). The primary outcome was a composite of in-hospital postoperative complications. Secondary outcomes were intensive care unit (ICU) admission, unplanned 30-day-readmission, and prolonged length of hospital stay. RESULTS We studied 2642 patients with a median (IQR) age of 62 (53-71) years. Overall, 111 patients had complications including surgical re-intervention, hypocalcemia, and vocal cord paresis. As compared to <50 year-old patients, older patients had no increased risk for in-hospital complications after surgery (50-64 years: odds ratio (OR): 0.51 (95% CI, 0.28 to 0.92); 65-74 years: OR: 0.72 (95% CI, 0.39 to 1.33); ≥75 years: OR: 1.03 (95% CI, 0.54 to 1.95), respectively. There was also no association of age and rates of ICU-admission and unplanned 30-day-readmission, but oldest patients had longer hospital stays (OR: 2.38 (95% CI, 1.57 to 3.60)). CONCLUSION ≥50 year-old patients undergoing parathyroidectomy had comparable risk of in-hospital complications as compared with younger ones. These data support parathyroidectomy in even older patients with primary hyperparathyroidism as performed in clinical routine.
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Affiliation(s)
- Marlena Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Correspondence should be addressed to M Mueller:
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | | | - Philipp Schuetz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Faculty of Medicine, University Hospital Basel, Basel, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Faculty of Medicine, University Hospital Basel, Basel, Switzerland
- Correspondence should be addressed to M Mueller:
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
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O'Sullivan K, Yen TWF, Doffek K, Dream S, Mazotas I, Evans DB, Wang TS. An Institutional experience with primary hyperparathyroidism in the elderly over two decades. Am J Surg 2021; 222:549-553. [PMID: 33551115 DOI: 10.1016/j.amjsurg.2021.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Parathyroidectomy is the only curative treatment for primary hyperparathyroidism (pHPT) and is associated with low morbidity. This study examined the severity of disease and outcomes of parathyroidectomy based on patient age at a high-volume institution. METHODS This is a retrospective review of sporadic pHPT patients who underwent initial parathyroidectomy. To study disease severity over time, patients were divided into timeframes: 1999-2007, 2007-2012, and 2013-2018. Elderly was defined as age ≥75 years. RESULTS Over time, the elderly had progressively lower preoperative calcium (11.0, 10.7, 10.7; p = 0.05) and PTH (150.4, 111.9, 107.9; p < 0.001) levels. By age, there was no difference in preoperative calcium (10.8, 10.9; p = 0.91) or in rates of recurrent laryngeal nerve injury, hypoparathyroidism, or persistent/recurrent pHPT. CONCLUSIONS Over the 3 time periods of the study, elderly patients had progressively lower calcium and PTH levels. There was no difference in endocrine-specific complications between the age groups, suggesting that parathyroidectomy in the elderly is safe and therefore, age-associated morbidity should not preclude parathyroidectomy.
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Affiliation(s)
- Kayla O'Sullivan
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Tina W F Yen
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Kara Doffek
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Sophie Dream
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Ioanna Mazotas
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Cormier C, Koumakis E. Bones and Primary Hyperparathyroidism. Joint Bone Spine 2021; 89:105129. [PMID: 33484857 DOI: 10.1016/j.jbspin.2021.105129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Primary hyperparathyroidism (PHPT) is a disease caused by excessive and inappropriate secretion of parathyroid hormone resulting in hypercalcemia. It is usually diagnosed incidentally in the face of hypercalcemia, a complication such as osteoporosis or, more rarely, a renal complication with lithiasis. The clinical presentation reflects hypercalcemia and involves several organs, mainly the cardiovascular system, bones, and kidneys. However, most patients with PHPT are asymptomatic. The diagnosis is made based on laboratory tests. It is easy when serum calcium and parathyroid hormone levels are high, but difficult when one of these two values is normal. Normocalcemic PHPT can be diagnosed only after ruling out all causes of secondary hyperparathyroidism. Parathyroid imaging cannot diagnose it but guides the surgeon and rules out an associated thyroid abnormality. The reference treatment is surgery. The surgical indication is based on the presence or risk of complications, and it is the only treatment that prevents fractures. Pharmaceutical treatments have only limited effects on complications and are reserved for cases where surgery is contraindicated. After parathyroid surgery, the use of bisphosphonates must be avoided as they seem to interfere with the parathyroidectomy's fracture-preventing effects. If surgery is not indicated, a plan for monitoring laboratory values, bone density, and renal function will be established.
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Affiliation(s)
- Catherine Cormier
- Service de Rhumatologie Hôpital Cochin, APHP, Université Paris Descartes Centre de Référence des Maladies du Métabolisme du Calcium et du Phosphate 27 Rue du Faubourg St Jacques, 75679 PARIS Cedex 14, France.
| | - Eugénie Koumakis
- Service de Rhumatologie Hôpital Cochin, APHP, Université Paris Descartes Centre de Référence des Maladies du Métabolisme du Calcium et du Phosphate 27 Rue du Faubourg St Jacques, 75679 PARIS Cedex 14, France
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Meyer AM, Wiebe L, Faust M, Chiapponi C, Brinkkötter PT, Polidori MC, Bartram MP. [Cognitive disorder, depression and gait disturbance in an internal medicine patient-geriatric syndromes in an acute care hospital]. Z Gerontol Geriatr 2020; 54:77-80. [PMID: 33185719 DOI: 10.1007/s00391-020-01811-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Anna Maria Meyer
- Klinik II für Innere Medizin und Zentrum für Molekulare Medizin Köln, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Laura Wiebe
- Klinik II für Innere Medizin und Zentrum für Molekulare Medizin Köln, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Michael Faust
- Poliklinik für Endokrinologie, Diabetologie und Präventivmedizin, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Costanza Chiapponi
- Klinik für Allgemein-, Viszeral-, Tumor- und Transplantationschirurgie, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Cologne, Germany.,Endokrine Chirurgie, Evangelisches Klinikum Köln Weyertal (EVK), Köln, Deutschland
| | - Paul Thomas Brinkkötter
- Klinik II für Innere Medizin und Zentrum für Molekulare Medizin Köln, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland.,CECAD, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Maria Cristina Polidori
- Klinik II für Innere Medizin und Zentrum für Molekulare Medizin Köln, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland.,CECAD, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Malte P Bartram
- Klinik II für Innere Medizin und Zentrum für Molekulare Medizin Köln, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland.
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Cipriani C, Bilezikian JP. Non-surgical management of primary hyperparathyroidism in the aging population. Maturitas 2020; 136:49-53. [PMID: 32386666 DOI: 10.1016/j.maturitas.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/24/2023]
Abstract
Primary hyperparathyroidism (PHPT) is commonly observed in the aging population, and the average age at diagnosis has increased in the last 20 years. Parathyroidectomy, the only definitive cure for PHPT, is indicated in symptomatic and asymptomatic older PHPT patients with skeletal and renal disease. It is as effective in older patients as it is in younger patients. Nevertheless, older patients may present with comorbidities and greater frailty, leading to the possibility of more complications, higher morbidity and mortality after surgery. This review focuses on the non-surgical clinical management of PHPT in elderly patients. We also summarize the most recent literature regarding the pharmacological management of PHPT to reduce serum calcium levels, to improve bone mineral density or to do both in the aging population.
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Affiliation(s)
- Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - John P Bilezikian
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA.
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