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Kurtom S, Carty SE. Primary Hyperparathyroidism: Part Two: Surgical Management. Surg Clin North Am 2024; 104:799-809. [PMID: 38944500 DOI: 10.1016/j.suc.2024.02.009] [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] [Indexed: 07/01/2024]
Abstract
Primary hyperparathyroidism (PHPT) is caused by the overproduction of parathyroid hormone by 1 or more parathyroid glands resulting in hypercalcemia and its downstream clinical consequences. The definitive management of PHPT is surgery. Approaches to successful surgery include bilateral exploration or focused parathyroidectomy with intraoperative parathyroid hormone monitoring, which in experienced hands are both associated with a low risk of complications.
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Affiliation(s)
- Saba Kurtom
- Department of Surgical Oncology, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Suite 101, Pittsburgh, PA 15213, USA
| | - Sally E Carty
- Department of Surgical Oncology, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Suite 101, Pittsburgh, PA 15213, USA.
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2
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Maheshwari M, Khan IA. Risk Factors for Transient and Permanent Hypoparathyroidism Following Thyroidectomy: A Comprehensive Review. Cureus 2024; 16:e66551. [PMID: 39258042 PMCID: PMC11383864 DOI: 10.7759/cureus.66551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/09/2024] [Indexed: 09/12/2024] Open
Abstract
Hypoparathyroidism is a common complication following thyroidectomy, resulting in significant disturbances in calcium homeostasis due to low parathyroid hormone (PTH) levels. This comprehensive review examines the risk factors associated with transient and permanent hypoparathyroidism post-thyroidectomy, emphasizing surgical, patient-related, and perioperative factors. Transient hypoparathyroidism, characterized by temporary hypocalcemia resolving within weeks to months, is often managed with short-term calcium and vitamin D supplementation. In contrast, permanent hypoparathyroidism persists beyond six months post-surgery, necessitating lifelong supplementation and potentially PTH replacement therapy. The review delves into the anatomy and physiology of the parathyroid glands, mechanisms leading to hypoparathyroidism, and incidence rates. Surgical factors such as the extent of thyroidectomy, surgeon expertise, and intraoperative parathyroid gland preservation are critical in determining the risk of hypoparathyroidism. Patient factors, including age, sex, pre-existing conditions, and perioperative management, influence outcomes. Diagnostic and monitoring strategies, along with management protocols for both transient and permanent hypoparathyroidism, are discussed. Prevention strategies, emerging research, future surgical techniques, and intraoperative monitoring directions are highlighted to improve clinical outcomes. This review aims to enhance understanding, inform surgical practices, and optimize postoperative care to minimize the incidence and impact of hypoparathyroidism in thyroidectomy patients.
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Affiliation(s)
- Maulik Maheshwari
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Imran Ali Khan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Goncu B, Yucesan E, Salepcioglu Kaya H, Kazancioglu R, Ersoy YE, Akcakaya A. The Challenge of Preoperative Panel Reactive Antibody Positivity in Parathyroid Transplantation. EXP CLIN TRANSPLANT 2024; 22:233-242. [PMID: 38385404 DOI: 10.6002/ect.mesot2023.p59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Identifying suitable recipient criteria and matching recipients with appropriate donors are required to increase survival for parathyroid transplant. This study was undertaken to evaluate transplant survival rates while comparing preoperative panel reactive antibody positivity. MATERIALS AND METHODS The study included 14 hypoparathyroidism patients who presented to our clinic for parathyroid transplant. Preoperative ABO compatibility and negative cross-match tests were prioritized for recipient-donor matching, and panel reactive antibody screening tests were performed. During the 24-month follow-up, we evaluated medication use and serum calcium, phosphorus, and parathormone levels of patients. RESULTS Preoperative panel reactive antibody positivity was assessed in 3 groups. The HLA class I-positive group (mean fluorescence intensity range, 179-1770) showed decreased medication use and stability in serum calcium levels. The HLA class IIpositive (mean fluorescence intensity range, 85-3959) showed decreased medication use by 25% to 50% and returned to their former prescription doses after 12 months. An opposite pattern was observed in 2 patients with panel reactive antibody positivity for both HLA classes (mean fluorescence intensity range, 462-2289), with 1 patient requiring medication for continuing symptoms and the other patient occasionally taking additional magnesium supplementation, despite decreased medication doses after 12 months. Serum calcium levels remained normal, and parathormone and phosphorus levels were elevated. CONCLUSIONS Improving patient symptoms and having no requirement for intravenous calcium replacement are priorities, and monitoring serum levels is the next important step. Varied panel reactive antibody positivities and survival rates indicate a requirement, and each HLA class could require a proper limitation for the mean fluorescence intensity. Preoperative mean fluorescence intensity cut-off value should be <900. Higher mean fluorescence intensity values in panel reactive antibody screenings could increase risk of short-term graft survival after parathyroid transplant. Further studies should include immunological risk assessments by individualizing the outcome with donor-specific antibodies.
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Affiliation(s)
- Beyza Goncu
- From the Department of Medical Services and Techniques, Vocational School of Health Services, Bezmialem Vakif University; and the Parathyroid Transplantation Unit, Organ Transplantation Center, Bezmialem Vakif University Hospital, Istanbul, Türkiye
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4
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Jeon S, Lee YS, Oh SR, Jeong J, Lee DH, So KH, Hwang NS. Recent advances in endocrine organoids for therapeutic application. Adv Drug Deliv Rev 2023; 199:114959. [PMID: 37301512 DOI: 10.1016/j.addr.2023.114959] [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: 03/15/2023] [Revised: 05/21/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
The endocrine system, consisting of the hypothalamus, pituitary, endocrine glands, and hormones, plays a critical role in hormone metabolic interactions. The complexity of the endocrine system is a significant obstacle to understanding and treating endocrine disorders. Notably, advances in endocrine organoid generation allow a deeper understanding of the endocrine system by providing better comprehension of molecular mechanisms of pathogenesis. Here, we highlight recent advances in endocrine organoids for a wide range of therapeutic applications, from cell transplantation therapy to drug toxicity screening, combined with development in stem cell differentiation and gene editing technologies. In particular, we provide insights into the transplantation of endocrine organoids to reverse endocrine dysfunctions and progress in developing strategies for better engraftments. We also discuss the gap between preclinical and clinical research. Finally, we provide future perspectives for research on endocrine organoids for the development of more effective treatments for endocrine disorders.
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Affiliation(s)
- Suwan Jeon
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea
| | - Young-Sun Lee
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Seh Ri Oh
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Jinseong Jeong
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dong-Hyun Lee
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyoung-Ha So
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea; Bio-MAX/N-Bio Institute, Institute of Bio-Engineering, Seoul National University, Seoul 08826, Republic of Korea.
| | - Nathaniel S Hwang
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea; Bio-MAX/N-Bio Institute, Institute of Bio-Engineering, Seoul National University, Seoul 08826, Republic of Korea; Institute of Engineering Research, Seoul National University, Seoul, 08826, Republic of Korea.
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5
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Rao SS, Rao H, Moinuddin Z, Rozario AP, Augustine T. Preservation of parathyroid glands during thyroid and neck surgery. Front Endocrinol (Lausanne) 2023; 14:1173950. [PMID: 37324265 PMCID: PMC10266226 DOI: 10.3389/fendo.2023.1173950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/13/2023] [Indexed: 06/17/2023] Open
Abstract
The parathyroid glands are situated in close proximity to the thyroid gland. They have an important endocrine function maintaining calcium and phosphate homeostasis in the body by the secretion of parathormone (PTH), which is responsible for this function. The parathyroid glands are commonly damaged during thyroid surgeries. This could lead to transient or permanent hypoparathyroidism in 30% of cases. Preservation of the parathyroid glands, is an important and integral part of thyroidectomy and other surgical interventions in the neck. The main principle underlying this is a thorough understanding of parathyroid anatomy in relation to the thyroid gland and other important structures in the area. There can also be significant variation in the anatomical location of the glands. Various techniques and methods have been described for parathyroid preservation. They include intraoperative identification utilizing indocyanine green (ICG) fluorescence, carbon nanoparticles, loupes, and microscopes. The techniques of surgery (meticulous capsular dissection), expertise, central compartment neck dissection, preoperative vitamin D deficiency, extent and type of thyroidectomy are the risk factors associated with damaged thyroids, inadvertent parathyroidectomy and subsequent hypoparathyroidism. Parathyroid Autotransplantation is a treatment option for inadvertent parathyroidectomy. Ultimately, the best way to assure normal parathyroid function is to preserve them in situ intraoperatively undamaged.
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Affiliation(s)
- Smitha S. Rao
- Department of Endocrine and Breast Surgery, Oncology, K.S. Hegde Medical Academy, Nitte University, Mangalore, India
| | - Himagirish Rao
- Department of Endocrine and General Surgery, St. John's National Academy of Health Sciences, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Zia Moinuddin
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Anthony P. Rozario
- Department of Endocrine and General Surgery, St. John's National Academy of Health Sciences, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Titus Augustine
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Gadelha DD, Filho WA, Brandão MAJ, Montenegro RM. Is parathyroid allotransplantation a viable option in the treatment of permanent hypoparathyroidism? A review of the literature. Endocrine 2022; 80:253-265. [PMID: 36583826 DOI: 10.1007/s12020-022-03292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The standard clinical treatment for hypoparathyroidism, replacement of calcium and vitamin metabolites (calcitriol), has been used for decades; however, evidence points to its inefficiency in acting on the pathophysiology of the disease, which may precipitate or aggravate conditions already related to hypoparathyroidism. Therapies based on recombinant human parathyroid hormone have emerged in recent years but still have low availability due to their high cost. Parathyroid allotransplantation (Pt-a) has been reported as a strategy for treating more severe cases. METHODS This narrative review highlights relevant aspects of conventional permanent hypoparathyroidism treatment and provides a comprehensive and critical review of the reports of applications of Pt-a, especially those carried out in recent years. Particular focus is placed on the following key points: parathyroid immunogenicity, immunosuppression regimens (short-term or chronic), techniques to reduce the expression of immunogenic molecules, follow-up time, and reductions in calcium and vitamin D supplementation. CONCLUSION Pt-a has been considered a safe and relatively low-cost therapy and is believed to have the potential to cure the disease, in addition to treating symptoms. However, there is considerable heterogeneity in treatment protocols; therefore, more studies are required to improve the standardization of the procedure and thus improve the consistency of outcomes.
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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] [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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Simultaneous Kidney and Parathyroid Transplantation in the Management of Genetic Hypoparathyroidism in a Child. Transplant Direct 2022; 8:e1284. [PMID: 35317006 PMCID: PMC8929518 DOI: 10.1097/txd.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/29/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background. Genetically determined hypoparathyroidism can lead to life-threatening episodes of hypocalcemia and, more rarely, to end-stage kidney disease at a young age. Parathyroid allotransplantation is the only curative treatment, and in patients already receiving immunosuppression for kidney transplantation, there may be little additional risk involved. We report the first such case in a child. Methods. An 11-y-old girl, known to have hypoparathyroidism secondary to an activating pathogenic variant in the calcium-sensing receptor, developed end-stage kidney disease and was started on intermittent hemodialysis. Since the age of 2.5 y, she had been receiving treatment with exogenous synthetic parathyroid hormone (PTH). In June 2019, at the age of 11.8 y, she received a living-donor kidney and simultaneous parathyroid gland transplant from her father. The kidney was implanted into the right iliac fossa, followed by implantation of the parathyroid gland into the exposed rectus muscle. Results. The kidney graft showed immediate function while the intrinsic serum PTH level remained low at 3 ng/L. Exogenous PTH infusion was reduced on day 6 posttransplantation to stimulate PTH production by the new gland, which resulted in improving intrinsic PTH concentrations of 28 ng/L by day 9. Twelve months after transplantation, PTH levels remain in normal range and the kidney graft function is stable with a serum creatinine of 110 μmol/L. Conclusions. Simultaneous living donation and transplantation of a kidney and a parathyroid gland into a child is safe and feasible and has the potential to cure primary hypoparathyroidism as well as kidney failure.
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Goncu B, Yucesan E, Ersoy YE, Aysan ME, Ozten Kandas N. HLA-DR, -DP, -DQ expression status of parathyroid tissue as a potential parathyroid donor selection criteria and review of literature. Hum Immunol 2022; 83:113-118. [PMID: 34955228 DOI: 10.1016/j.humimm.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/21/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Basic and clinical studies about parathyroid allotransplantation have to be utilized with more definitive criteria for longer graft survival. Several reports demonstrated different isolation and cultivation methods for parathyroid cells to minimize their immunogenicity. In this study, we aim to compare and evaluate the clinical characteristics and the status of HLA class II expression changes in parathyroid tissue. METHODS A total of 22 parathyroid hyperplasia tissue donors was included in this study. Clinical characteristics were evaluated and compared with the HLA-DR, -DP, -DQ mRNA, and protein expression levels which were determined by qRT-PCR and Western blot. RESULTS We have compared the clinical characteristics (age, dialysis duration, frequency, recurrency of hyperparathyroidism and, calcimimetic usage) and HLA class II expression. HLA class II mRNA and protein levels showed varied expression patterns between tissues. Only, the HLA-DP has high mRNA expression levels without affecting the protein level when compared with the ages of the tissue donors. In addition, the HLA-DR, HLA-DP, and HLA-DQα1 protein expression levels showed a permanent and varied expression rate between tissues. CONCLUSION Expression of HLA class II molecules in parathyroid cells appears to constitute a decisive factor. Despite the lack of clinical outcomes, present data proposes new insight with a detailed understanding of parathyroid immunogenicity. In the future, randomized controlled clinical trials are needed for the accurate assessment of the effect of the varied HLA class II expression profiles in parathyroid tissue.
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Affiliation(s)
- Beyza Goncu
- Bezmialem Vakif University, Vocational School of Health Services, Department of Medical Services and Techniques, Istanbul, Turkey; Bezmialem Vakif University, Experimental Research Center, Parathyroid Transplantation Unit, Istanbul, Turkey; Bezmialem Vakif University, Health Science Institute, Department of Biotechnology, Istanbul, Turkey.
| | - Emrah Yucesan
- Bezmialem Vakif University, Experimental Research Center, Parathyroid Transplantation Unit, Istanbul, Turkey; Bezmialem Vakif University, Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - Yeliz Emine Ersoy
- Bezmialem Vakif University, Experimental Research Center, Parathyroid Transplantation Unit, Istanbul, Turkey; Bezmialem Vakif University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - Mustafa Erhan Aysan
- Bezmialem Vakif University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - Nur Ozten Kandas
- Bezmialem Vakif University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Istanbul, Turkey
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Yao XY, Zhou Y, Chen SJ, Wu Y, Bian C, Chen H, Liu H. Is There a Regular Pattern in the Recovery of Parathyroid Function After Thyroid Cancer Surgery? Cancer Manag Res 2021; 13:6891-6899. [PMID: 34512028 PMCID: PMC8423411 DOI: 10.2147/cmar.s326705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate whether there is a pattern of recovery of parathyroid function after thyroid cancer surgery. Patients and Methods The study included 183 patients with papillary thyroid cancer (PTC) who underwent “total thyroidectomy (TT)” plus “unilateral central lymph node dissection (UCLND)” or “bilateral central lymph node dissection (BCLND)”. The intact parathyroid hormone (iPTH) and serum calcium (sCa) were analyzed several times within 1 month after surgery to explore the recovery pattern of parathyroid gland function. Then, these 183 cases were divided into group A (97 cases) with UCLND and group B (86 cases) with BCLND to analyze whether the impairment and recovery of parathyroid function were different between the two subgroups. Results Postoperative hypoparathyroidism was seen in 115 out of 183 cases. iPTH values decreased significantly on postoperative day (POD) 1 compared with preoperative values, dropped to the lowest point on POD 3, showed an increasing trend on POD 5 and 14, and increased to 85.0% of preoperative values at POD30, whereas changes in sCa differ from changes in iPTH, which showed the lowest sCa value on POD1, and rebounded on the POD3 with the intervention of calcium supplementation, and continued to rise on the POD5 and POD14, and the sCa value reached 96.6% of the preoperative level at POD30. Subgroup analysis showed that temporary hypoparathyroidism was more pronounced in group B than in group A. SCa and iPTH levels in both subgroups showed the same trend of first decrease and then increase. Conclusion The recovery of hypocalcemia and hypo-iPTHemia in the first month after thyroid cancer surgery shows a trend of decreasing and then increasing, and knowing the recovery of parathyroid function at different time points is of great value to surgeons and patients alike.
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Affiliation(s)
- Xi-Yu Yao
- Department of Head and Neck Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, People's Republic of China
| | - Yan Zhou
- Department of Epidemiology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, People's Republic of China
| | - Shun-Jin Chen
- Department of Head and Neck Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, People's Republic of China
| | - Yu Wu
- Department of Head and Neck Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, People's Republic of China
| | - Cong Bian
- Department of Head and Neck Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, People's Republic of China
| | - Hongbin Chen
- Department of Head and Neck Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, People's Republic of China
| | - Hui Liu
- Department of Head and Neck Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, 350011, People's Republic of China
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Hirokawa M, Suzuki A, Higuchi M, Hayashi T, Kuma S, Miya A, Miyauchi A. Histological alterations following fine-needle aspiration for parathyroid adenoma: Incidence and diagnostic problems. Pathol Int 2021; 71:400-405. [PMID: 33740321 PMCID: PMC8252439 DOI: 10.1111/pin.13091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/24/2021] [Indexed: 01/17/2023]
Abstract
This study aimed to clarify the histological alterations following fine-needle aspiration for parathyroid adenoma and discuss the occurrence of diagnostic problems. Among the 392 patients with parathyroid adenoma who underwent resection, fine-needle aspiration was performed for 21 (5.1%) parathyroid adenoma nodules. Histological findings that were significantly more frequent in cases that underwent fine-needle aspiration were considered histological alterations following fine-needle aspiration for parathyroid adenoma, including the following six findings: thick fibrous capsule (71.4%), multilayered fibrous capsules (14.3%), capsular pseudo-invasion (42.9%), fibrous bands (57.1%), hemosiderin deposition (14.3%), and tumor implantation (14.3%). Eighteen parathyroid adenoma nodules (85.7%) exhibited one or more of the six findings. Tumor cells and adipocytes entrapped within the thick fibrous capsule were occasionally observed. The fibrous bands were frequently connected to the thick fibrous capsule. The number of passes, duration between fine-needle aspiration and resection, tumor size, and purpose of fine-needle aspiration were not related to the incidence of histological findings. Because of the histological alterations following fine-needle aspiration for parathyroid adenoma that can be easily mistaken for signs of atypical adenoma or parathyroid carcinoma, we recommend that the six findings be excluded from pathological findings indicating atypical adenoma or parathyroid carcinoma in patients with preoperative fine-needle aspiration.
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Affiliation(s)
- Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, Japan
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, Japan
| | - Miyoko Higuchi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, Japan
| | - Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, Japan
| | - Seiji Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan
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Zhang H, Zhang Y, Qiu C, Zhu W, Wen M, Lao X. Differentiation of human umbilical cord mesenchymal stem cells into parathyroid cells by editing the PTH gene with the CRISPR/Cas9 system. BIOTECHNOL BIOTEC EQ 2021. [DOI: 10.1080/13102818.2021.1961608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Huiting Zhang
- Department of General Surgery, Zhaoqing First People’s Hospital, Zhaoqing, Guangdong, PR China
| | - Yiting Zhang
- Department of General Surgery, Zhaoqing First People’s Hospital, Zhaoqing, Guangdong, PR China
| | - Changhong Qiu
- Department of General Surgery, Zhaoqing First People’s Hospital, Zhaoqing, Guangdong, PR China
| | - Wentian Zhu
- Department of General Surgery, Zhaoqing First People’s Hospital, Zhaoqing, Guangdong, PR China
| | - Mingbo Wen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China
| | - Xuejun Lao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China
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13
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Goncu B, Salepcioglu Kaya H, Yucesan E, Ersoy YE, Akcakaya A. Graft survival effect of HLA-A allele matching parathyroid allotransplantation. J Investig Med 2020; 69:785-788. [PMID: 33443056 DOI: 10.1136/jim-2020-001648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/04/2022]
Abstract
Permanent hypoparathyroidism is an endocrine disease that is mostly associated with the disruption of the parathyroid glands during surgery. Allotransplantation is the most promising approach for treatment particularly for its cost-effective and exact curative potential. Herein our aim was to evaluate human leukocyte antigen (HLA)-A allele matching effect on clinical improvement and graft survival after parathyroid transplantation. We performed parathyroid transplantation between ABO/Rh compatible recipient and an unrelated donor who has chronic kidney disease. Preoperative immunological tests include panel reactive antibody, T-flow cytometry crossmatch, B-flow cytometry crossmatch, autoflow cytometry crossmatch, and complement-dependent cytotoxicity crossmatch tests were performed. After histopathological evaluation, half of the resected parathyroid gland cells were isolated and transplanted to the omentum surface by laparoscopy. The transplantation outcome was followed up throughout 382 days. The recipient discharged 2 days after transplantation without any complication. During follow-up, calcium and vitamin D supplementation reduced to a one-third dose; even the intact PTH levels remained low. However, clinical improvement was observed by serum calcium levels. The recipient still continues with low-dose supplementation after 382 days of post-transplantation. Parathyroid cell transplantation to the omental tissue is the most promising option even with only one allele matching for patients with using lifelong high-dose supplementation. Clinical improvements and long-term effect of HLA-A allele matching should be evaluated with more studies and in larger cohorts as well.
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Affiliation(s)
- Beyza Goncu
- Experimental Research Center, Bezmialem Vakif University, Istanbul, Turkey .,Parathyroid Transplantation Laboratory, Bezmialem Vakif University, Istanbul, Turkey
| | - Harika Salepcioglu Kaya
- Faculty of Medicine, Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Emrah Yucesan
- Faculty of Medicine, Department of Medical Biology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yeliz Emine Ersoy
- Faculty of Medicine, Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey.,Parathyroid Transplantation Laboratory, Bezmialem Vakif University, Istanbul, Turkey
| | - Adem Akcakaya
- Faculty of Medicine, Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey.,Organ Transplantation Unit, Bezmialem Vakif University, Istanbul, Turkey
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Risk of Permanent Hypoparathyroidism After Total Thyroidectomy for Benign Disease: A Nationwide Population-based Cohort Study From Sweden. Ann Surg 2020; 274:e1202-e1208. [PMID: 32032086 DOI: 10.1097/sla.0000000000003800] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the prevalence and risk factors for permanent hypoparathyroidism after total thyroidectomy for benign disease in a population-based setting with data independent of input of complication data. SUMMARY OF BACKGROUND DATA The reported rate of permanent hypoparathyroidism is highly variable and mostly rely on reported complication data from national or institutional registries. METHODS All patients who underwent total thyroidectomy in Sweden from 2005 to 2015 were identified through Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery and the Swedish National Patient Register. Patients were matched to outcome data from the Swedish Prescribed Drug Register. Permanent hypoparathyroidism was defined as treatment with calcium and/or active vitamin D more than 1 year after surgery. RESULTS Seven thousand eight hundred fifty-two patients were included and 938 (12.5%) developed permanent hypoparathyroidism. The risk was lower in patients registered in the quality register (11.0% vs 16%, P < 0.001). In a multivariable analysis there was a higher risk of permanent hypoparathyroidism in patients with parathyroid autotransplantation [Odds ratio (OR) 1.72; 95% confidence interval 1.47-2.01], center-volume <100 thyroidectomies per year (OR 1.22; 1.03-1.44), age above 60 year (OR 1.64; 1.36-1.98) and female sex (OR 1.27; 1.05-1.54). Reported data from the quality register only identified 178 of all 938 patients with permanent hypoparathyroidism. CONCLUSION The risk of permanent hypoparathyroidism after total thyroidectomy was high and associated with parathyroid autotransplantation, higher age, female sex and surgery at a low volume center. Reported follow-up data might underestimate the rate of permanent hypoparathyroidism.
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Boron A, Dennison JV, Dennison CB, Royall I, Scherer K. Parathyroid Auto-transplantation Mimicking Liposarcoma. Cureus 2019; 11:e5445. [PMID: 31632890 PMCID: PMC6797014 DOI: 10.7759/cureus.5445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Parathyroid autotransplantation is an increasingly common procedure given the increasing rate of hyperparathyroidism. However, post-autotransplantation imaging is not commonly performed and the imaging findings can mimic liposarcoma. Therefore, radiologists should be aware of the imaging characteristics of parathyroid autotransplantation. Here we discuss the CT and Tc99m-Sestamibi 4D-CT findings of parathyroid autotransplantation. We will also discuss the pathophysiology of liposarcoma and present the gross histological findings seen on pathology.
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Affiliation(s)
- Agnieszka Boron
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | | | - Ivey Royall
- Radiology - GME, AdventHealth Orlando, Orlando, USA
| | - Kurt Scherer
- Radiology - GME, AdventHealth Orlando, Orlando, USA
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Aysan E, Yucesan E, Idiz UO, Goncu B. Discharging a Patient Treated With Parathyroid Allotransplantation After Having Been Hospitalized for 3.5 Years With Permanent Hypoparathyroidism: A Case Report. Transplant Proc 2019; 51:3186-3188. [PMID: 31371218 DOI: 10.1016/j.transproceed.2019.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Parathyroid allotransplantation is one of the methods used in the treatment of permanent hypoparathyroidism. We present a patient who underwent continuous intravenous (IV) calcium replacement therapy because of permanent hypoparathyroidism after total thyroidectomy. CASE PRESENTATION A 47-year-old woman who underwent a total thyroidectomy with a multinodular goiter developed hypoparathyroidism and hypocalcemia 1 week after discharge. The patient was started on daily oral calcitriol, magnesium effervescent, vitamin D, and IV calcium gluconate and was unable to be discharged because the IV calcium could not be stopped. After 3.5 years, 50×10⁶ parathyroid cells were transplanted by injecting the cells into the left deltoid muscle of the patient. The immunosuppression of the patient, who used 20-mg methylprednisolone for the first month, was completely discontinued. RESULTS No complications were observed in the patient after transplantation. The parenteral calcium replacement of the patient was progressively interrupted after transplantation. The patient's serum calcium level was 7.8 mg/dL and the PTH level was 6.9 pg/mL without IV calcium replacement at 12 weeks after transplantation, and the patient was discharged using oral ionized calcium. In the 10-week follow-up after discharge, the need for IV calcium was not observed in the patient. CONCLUSION Parathyroid allotransplantation is a simple, fast, and cost-effective method that should be tried in patients with persistent hypoparathyroidism, especially those who have to take IV calcium replacement, because its cost is much cheaper than standard medical care, its morbidity is much more limited, and it increases the patient's quality of life.
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Affiliation(s)
- Erhan Aysan
- Department of General Surgery, Yeditepe University, Istanbul, Turkey
| | - Emrah Yucesan
- Institute of Life Sciences and Biotechnology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ufuk Oguz Idiz
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Beyza Goncu
- Experimental Research Center, Bezmialem Vakif University, Istanbul, Turkey
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17
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Yucesan E, Basoglu H, Goncu B, Akbas F, Ersoy YE, Aysan E. Microencapsulated parathyroid allotransplantation in the omental tissue. Artif Organs 2019; 43:1022-1027. [DOI: 10.1111/aor.13475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/28/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Emrah Yucesan
- Institute of Life Sciences and Biotechnology Bezmialem Vakif University Istanbul Turkey
| | - Harun Basoglu
- Faculty of Medicine, Department of Biophysic Bezmialem Vakif University Istanbul Turkey
| | - Beyza Goncu
- Experimental Research Center Bezmialem Vakif University Istanbul Turkey
| | - Fahri Akbas
- Faculty of Medicine, Department of Medical Biology Bezmialem Vakif University Istanbul Turkey
| | - Yeliz Emine Ersoy
- Faculty of Medicine, Department of General Surgery Bezmialem Vakif University Istanbul Turkey
| | - Erhan Aysan
- Faculty of Medicine, Department of General Surgery Bezmialem Vakif University Istanbul Turkey
- Faculty of Medicine, Department of General Surgery Yeditepe University Istanbul Turkey
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18
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Yucesan E, Goncu B, Ozdemir B, Idiz O, Ersoy YE, Aysan E. Importance of HLA typing, PRA and DSA tests for successful parathyroid allotransplantation. Immunobiology 2019; 224:485-489. [PMID: 31204065 DOI: 10.1016/j.imbio.2019.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/18/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023]
Abstract
Parathyroid allotransplantation is increasingly practiced for patients who have permanent hypoparathyroidsm. Parathyroid allotransplantation success is varied, and no defined criteria about immunologic monitoring for pre-/post-transplantation follow-up. This study sought to evaluate the possible role of immunological tests. Four unrelated recipients and one living donor who have chronic kidney disease were evaluated for HLA-typing, PRA, CXM tests to conduct parathyroid allotransplantation. Parathyroid glands were obtained and resected from the donor, then cells were isolated and cryopreserved. Upon histologic examination, cells were cultivated and injected into muscle of four recipients. Recipient's were followed for parathormone and calcium levels for four years. PRA screening were monitored and de novo DSA was evaluated as well. In two of the recipients, allografts continued to be functional more than four years. In one recipient, allograft remained functional for two years and another recipient lost function after one year. Two out four were negative for de novo DSA and three out of four of the recipients remained negative for PRA. Neither HLA-matching nor de novo DSA positivity and PRA screenings seems significant for successfull parathyroid allotransplantation. This study has considerable potential for immunological monitoring of parathyroid allotransplantation.
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Affiliation(s)
- Emrah Yucesan
- Bezmialem Vakif University, Institute of Life Sciences and Biotechnology, Istanbul, Turkey.
| | - Beyza Goncu
- Bezmialem Vakif University, Experimental Research Center, Istanbul, Turkey
| | - Burcu Ozdemir
- Bezmialem Vakif University, Experimental Research Center, Istanbul, Turkey
| | - Oguz Idiz
- Istanbul Teaching and Research Hospital, General Surgery Clinic, Istanbul, Turkey
| | - Yeliz Emine Ersoy
- Bezmialem Vakif University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - Erhan Aysan
- Bezmialem Vakif University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
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Goncu B, Yucesan E, Aysan E, Kandas NO. HLA Class I Expression Changes in Different Types of Cultured Parathyroid Cells. EXP CLIN TRANSPLANT 2019; 20:854-862. [PMID: 30995898 DOI: 10.6002/ect.2018.0388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Tissue-specific immunogenicity can be characterized by the determination of human leukocyte antigens (HLA). Parathyroid hyperplasia tissue cells are presumed to have the ability to lose HLA class I expression profile during cultivation, whereas healthy parathyroid cells are presumed to already express HLA class I molecules at low levels. However, there are conflicting results about the expression of HLA class I antigens. In this study, our aim was to evaluate different patterns of HLA class I expression in different parathyroid tissue cells. MATERIALS AND METHODS Parathyroid tissue cells were isolated enzymatically and cultured in vitro. Expression of HLA class I (HLA-A, HLA-B, HLA-C) mRNA and protein levels were studied in 7 parathyroid adenomas and 9 parathyroid hyperplasia tissue samples by reverse transcriptase-polymerase chain reaction and Western blot analyses. RESULTS HLA-A protein expression remained stable in parathyroid adenoma and hyperplasia tissue, but HLA-A mRNA expression decreased in adenoma tissue. In parathyroid hyperplasia tissue, HLA-B protein expression remained stable, although mRNA expres-sion levels decreased during cultivation. HLA-C mRNA expression was steady in parathyroid adenoma yet significantly decreased in hyperplasia tissue samples. HLA-C protein expression levels were below 30 pg for both types of parathyroid tissue during cultivation. CONCLUSIONS HLA class I expression levels of para-thyroid hyperplasia and adenoma tissue were not found to be similar. Parathyroid hyperplasia tissue is the donor tissue for the treatment of permanent hypoparathyroidism. Therefore, expression patterns of HLA class I are directly relevant to the transplant process. In particular, the HLA region is highly polymorphic, and, as a consequence of this, heterogeneous correlations among HLA-A, HLA-B, and HLA-C expression patterns of parathyroid tissue should be evaluated in detail before transplant for future studies.
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Affiliation(s)
- Beyza Goncu
- From the Experimental Research Center, Bezmialem Vakif University, Istanbul, Turkey
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20
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Xia C, Zhu Q, Li Z, Hu M, Fang J, Zhong Q, Yue C, Bai Y. Study of the Ultrasound Appearance of the Normal Parathyroid Using an Intraoperative Procedure. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:321-327. [PMID: 29802631 DOI: 10.1002/jum.14691] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/28/2018] [Accepted: 04/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study was designed to confirm the echogenicity of normal parathyroid glands using intraoperative ultrasound (US). METHODS Between October 2015 and January 2016, normal parathyroid glands were examined with an intraoperative US transducer during thyroidectomy procedures in 13 patients with thyroid disease. According to the findings from intraoperative US, routine percutaneous US of normal parathyroid glands was performed in a group of adults. On the basis of previous information on normal parathyroid echogenicity, a series of parathyroid diseases that were proved by surgery and histopathologic analyses were retrospectively reviewed. The presence of residual normal parathyroid in the lesion on US imaging, which was defined as the residual parathyroid sign in this study, was reviewed and correlated with histopathologic results. RESULTS In the intraoperative US group, 23 parathyroid glands were scanned intraoperatively, and 21 (91.3%) were hyperechoic, homogeneous in texture, and oval. In the routine percutaneous US group, 106 parathyroid glands were found in total, and 96 (90.5%) of the glands had hyperechoic and homogeneous echogenicity, with 75 (70.8%) being oval. In the review of parathyroid diseases, 33 parathyroid glands in 30 cases were reviewed, with a positive residual parathyroid sign in 7 (21.2%) parathyroid glands, presenting with a hyperechoic rim in the margin, and 4 of them (12.1%) were confirmed by histopathologic results. CONCLUSIONS The normal parathyroid had hyperechoic echogenicity on both intraoperative and percutaneous US imaging. Residual tissue of parathyroid glands can also be observed in some parathyroid abnormalities with an echogenic appearance on US imaging and confirmed by histopathologic results.
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Affiliation(s)
- Chunxia Xia
- Department of Radiology, Division of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhu
- Department of Radiology, Division of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zheng Li
- Department of Diagnostic Ultrasound, Beijing Aerospace General Hospital, Beijing, China
| | - Minxia Hu
- Department of Radiology, Division of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jugao Fang
- Department of Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Zhong
- Department of Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Changli Yue
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuping Bai
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Abbaci M, De Leeuw F, Breuskin I, Casiraghi O, Lakhdar AB, Ghanem W, Laplace-Builhé C, Hartl D. Parathyroid gland management using optical technologies during thyroidectomy or parathyroidectomy: A systematic review. Oral Oncol 2018; 87:186-196. [PMID: 30527238 DOI: 10.1016/j.oraloncology.2018.11.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023]
Abstract
New optical technologies enhancing localization or assessing viability of parathyroid glands (PG) during endocrine surgery have been reported in clinical studies. These technologies could become complementary to the surgeon's eyes and may improve surgical outcomes in thyroidectomy and parathyroidectomy. Here, we conducted a systematic review focusing on PG identification and functional assessment using optical methods to enhance surgery. A systematic literature review was performed using MEDLINE and Embase database. Two authors selected studies and extracted data; qualitative analysis was performed to summarize the characteristics of reported optical tools for thyroidectomy or parathyroidectomy. Identification and vascularisation of PG during surgery were evaluated. Clinical and biochemical outcomes were appraised when reported. Studies relating to parathyroidectomy or thyroidectomy combined with autofluorescence, fluorescent methylene blue, 5-aminolevulinic acid, indocyanine green (ICG), optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging and Raman spectroscopy were identified with MEDLINE and Embase. We included a total of 47 relevant articles with a total of 1615 patients enrolled. Each optical technique is described and appreciated related to its surgical purpose. Autofluorescence and ICG imaging of PG are the most widely reported optical technologies for identification and assessment of vascularisation of PG. Results are mainly based on observational studies and argue for the feasibility of both techniques in endocrine surgery but prospective randomized studies have not been performed. In vivo applications are still limited for the other methods and further investigations correlating these techniques with post-operative parathormone measurements are still needed before considering these technologies in clinical practice.
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Affiliation(s)
- Muriel Abbaci
- Gustave Roussy, Université Paris-Saclay, Plate-forme Imagerie et Cytométrie, UMS 23/3655, Villejuif F-94805, France; IR4M-UMR 8081, Université Paris-Saclay, Université Paris Sud, CNRS, Orsay F-91401, France.
| | - Frederic De Leeuw
- Gustave Roussy, Université Paris-Saclay, Plate-forme Imagerie et Cytométrie, UMS 23/3655, Villejuif F-94805, France
| | - Ingrid Breuskin
- Gustave Roussy, Université Paris-Saclay, Départements de Cancérologie et de Chirurgie Cervico-Faciale, Villejuif F-94805, France
| | - Odile Casiraghi
- Gustave Roussy, Université Paris-Saclay, Département de Biologie et Pathologie Médicale, Villejuif F-94805, France
| | - Aïcha Ben Lakhdar
- Gustave Roussy, Université Paris-Saclay, Département de Biologie et Pathologie Médicale, Villejuif F-94805, France
| | - Wahib Ghanem
- Gustave Roussy, Université Paris-Saclay, Départements de Cancérologie et de Chirurgie Cervico-Faciale, Villejuif F-94805, France
| | - Corinne Laplace-Builhé
- Gustave Roussy, Université Paris-Saclay, Plate-forme Imagerie et Cytométrie, UMS 23/3655, Villejuif F-94805, France; IR4M-UMR 8081, Université Paris-Saclay, Université Paris Sud, CNRS, Orsay F-91401, France
| | - Dana Hartl
- Gustave Roussy, Université Paris-Saclay, Départements de Cancérologie et de Chirurgie Cervico-Faciale, Villejuif F-94805, France
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Goncu B, Yucesan E, Ozdemir B, Basoglu H, Kandas NO, Akbas F, Aysan E. A New Transport Solution for Parathyroid Allotransplantation: Effects on Cell Viability and Calcium-Sensing Receptors. Biopreserv Biobank 2018; 16:278-284. [PMID: 29963899 DOI: 10.1089/bio.2018.0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Cold ischemia protects organs and tissues by slowing their metabolism, but it also causes ischemic injury. Minimizing cold ischemia has been an important goal in parathyroid auto- and allotransplantation, as well as the transplantation of other major organs. Parathyroid glands are responsible for calcium homeostasis by releasing parathormone (PTH) into the blood circulation. Functionality of a new parathyroid transport solution (NPTS) and effects on cell viability, PTH secretion, and calcium-sensing receptor (CaSR) levels during cold ischemia were evaluated. MATERIALS AND METHODS A NPTS was prepared, and the pH was adjusted to a range of 7.2-7.4 and kept at +4°C until use. Seven patients with parathyroid hyperplasia secondary to chronic renal failure who were scheduled to undergo subtotal parathyroidectomy were enrolled in the study. Glands were cold-preserved in NPTS with different time intervals (0, 6, 12, 18, and 24 hours), and then parathyroid cell viability before and after cryopreservation, PTH secretion, and CaSR levels were determined. RESULTS The mean cell viability before cryopreservation was 92.7% (range 89.2%-97.2%). There were no significant differences in cell viability rates before and after cryopreservation (p = 0.1168 and p = 0.4085, respectively), and CaSR levels (p = 0.5446) were not significant. CONCLUSIONS NPTS is a solution designed specifically for parathyroid tissue transplantation. This patent pending product can support cellular viability and PTH release, as well as protect CaSR functionality for up to 24 hours of cold ischemia.
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Affiliation(s)
- Beyza Goncu
- 1 Experimental Research Center, Bezmialem Vakif University , Istanbul, Turkey
| | - Emrah Yucesan
- 2 Institute of Life Sciences and Biotechnology, Bezmialem Vakif University , Istanbul, Turkey
| | - Burcu Ozdemir
- 1 Experimental Research Center, Bezmialem Vakif University , Istanbul, Turkey
| | - Harun Basoglu
- 3 Department of Biophysics, Faculty of Medicine, Bezmialem Vakif University , Istanbul, Turkey
| | - Nur Ozten Kandas
- 4 Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Bezmialem Vakif University , Istanbul, Turkey
| | - Fahri Akbas
- 5 Department of Medical Biology, Faculty of Medicine, Bezmialem Vakif University , Istanbul, Turkey
| | - Erhan Aysan
- 6 Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University , Istanbul, Turkey
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Yan S, Zhao W, Wang B, Zhang L. Preoperative injection of carbon nanoparticles is beneficial to the patients with thyroid papillary carcinoma: From a prospective study of 102 cases. Medicine (Baltimore) 2018; 97:e11364. [PMID: 29979421 PMCID: PMC6076069 DOI: 10.1097/md.0000000000011364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/06/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND More surgeons had noticed the importance of carbon nanoparticles (CNs) in protection of parathyroid grand in the surgery of thyroidectomy and central lymph lode dissection, but paid less attention to the injection time. The purpose of this study was to investigate whether preoperative injection of CNs can improve the dissection of lymph nodes (LNs) and protect parathyroid grand (PG) for the patients with papillary thyroid carcinoma (TC). METHODS A total of 102 consecutive patients were enrolled into this study from August 2016 to June 2017. All the patients were divided randomly into preoperative group and intraoperative group by the injecting time of the CNs. We compared the patients who had CNs injected into thyroid gland 1 month before surgery with a control group of patients who had CNs injected during the operation. The primary endpoints were operative time, numbers of total LN and metastatic LN, ratio of PG auto-transplantation, parathyroid hormone (PTH) level, and postoperative complications. RESULTS We identify 206 PGs and 162 PGs in the preoperative and intraoperative group, respectively, (P = .000) and there was low ratio of auto-transplantation in the preoperative group compared with the intraoperative group (39.3% vs 50.62%, P = .003). We also found that the PTH level in the preoperative group was higher than that of preoperative group (2.60 ± 1.00 vs 2.19 ± 0.72, P = .021), and the operation time in the preoperative group was less than the intraoperative group (60.17 ± 6.28 vs 80.94 ± 7.12, P = .000). Meanwhile pathological results revealed 3 PGs of accidental removal occurred in the preoperative group, whereas 9 PGs of accidental removal occurred in the intraoperative group (P = .039). Also there was no difference in the numbers of total and metastatic LN in the 2 groups (P > .05). CONCLUSION Preoperative injection of CNs was safe, and can help protect PG and reduce the difficulty of operation.
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Affiliation(s)
- Shouyi Yan
- Department of Thyroid and Vascular Surgery
- Department of General Surgery
- Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Wenxin Zhao
- Department of Thyroid and Vascular Surgery
- Department of General Surgery
- Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Bo Wang
- Department of Thyroid and Vascular Surgery
- Department of General Surgery
- Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Liyong Zhang
- Department of Thyroid and Vascular Surgery
- Department of General Surgery
- Minimal Invasive Center, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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