Objective To introduce the advanced diagnostic technologies and share the surgical experience of parathyroid adenoma. Methods From November 1986 to August 2000, 9 patients with parathyroid adenoma who underwent operations were analyzed retrospectively. Out of them, there were 3 males and 6 females and their ages ranged from 12 to 55 years with an average of 32 years. The average disease course was 4 years and 9 months. General decreased density of the bone cortex and subperiosteum absorption were found in all 9 cases, while multi bone cyst lesion in 3 cases; obsolete fracture in 5 cases, in\cluding 2 cases of nephrolithiasis. Before operation, one child bore claudication and the other 8 patients suffered from disability. Serum parathyroid hormone (PTH) level increased markedly in 5 patients examined (633.87-1017.40 pmol/L, normal value: 28.50-90.50 pmol/L. Radionuclide scan showed tha imagings of parathyroid adenoma appeared in 4 patients. Results Parathryriod adenoma was resected via neek approach in 7 cases, and by way of sternum in the other 2 of the adnomas located in the chest, Parathyroid adenoma was diagnosed pathologically in 9 cases. All the 9 patients had no relapse during the 2-16 years of follow-up, with apparent relief of ostealgia and the normal serum PTH level, and roentgenogram showed fracture healing, great allevation of the osetopathia. Conclusion PTH examination as an advanced technique plays an important role in the differential diagnosis of hypercalcaemia. Color Dopperler and radionuclide scan can locate the lesion. It is vital to judge the nature of the lesion by naked eyes, while frozen slices serves as a necessity to confrrm. Enough parathyroid tissue should to be remained to assure normal parathyroid function. The variable number and ectopic possibility of parathyroid glands should be consiered. Both the short-term and long-term surgical outcome of parathyroid adenoma are satisfactory.
ObjectiveTo evaluate the value of parathyroid hormone (PTH) in predicting hypocalcemia at different time after thyroidectomy. MethodsThe literatures in CBM, WanFang, CNKI, VIP in Chinese, and OVID, PUBMED, EMBASE, and MEDLINE in English were searched. Hand searches and additional searches were also conducted. The studies of predicting hypocalcemia after thyroidectomy by detecting postoperative PTH at different time were selected, and the quality and tested the heterogeneity of included articles were assessed. Then the proper effect model to calculate pooled weighted sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were selected. The summary receiver operating characteristic (SROC) curve was performed and the area under the curve (AUC) was computed. ResultsTwenty-three articles entered this systematic review, 21 articles were English and 2 articles were Chinese. Fifteen of 23 articles were designed to be prospective cohort study (PC) and 8 of 23 articles were retrospective study (Retro). These articles were divided into two groups. Group 1 was the studies of detecting postoperative PTH in 1 hour, which included 2 012 cases (494 of them occurred hypocalcemia). Group 2 was the studies of detecting postoperative PTH between 4-12 hours, which included 693 cases (266 of them occurred hypocalcemia). The publication bias of 2 groups were smaller that founded through the literature funnel. Meta analysis showed that in addition to merge SEN, between the 2 groups with merge SPE, LR+, LR-, and AUC differences were statistically significant (P < 0.01);the forecast effect of group 1 was better than group 2, and the AUC was the largest area when the PTH value in 1 hour after operation was below 16 ng/L. ConclusionDetection of postoperative PTH value is an effective method for predicting postoperative hypocalcemia. The 1 hour after operation for detecting PTH value below 16 ng/L to predict postoperative hypocalcemia have the best effect.
Objective To investigate the function and survival of parathyroid tissue transplanted into the rectus of rat by different pre-treatment. Methods Male，adult Wistar rats （seventy）as donors and adult SD rats （thirty-five）as receptors. Model rats were established by resection of parathyroid and randomly divided into five groups （digital random method）：direct transplantation group， high-oxygen culture group， ciclosporin A （CsA） group， 60Co irradiated group， and integrated treatment group. Each receptor received four PTG from two donors and the PTG were transplanted into the rectus of the receptors. Changes in concentration of serum calcium and PTH at different time points before and after parathyroid transplantation in each group recipient rats were observed. Results Serum calcium and PTH could reach or remain normal level after thyroid tissue transplantation in all groups in 1 week after operation， which significantly differed from those of pre-transplanted （P＜0.01）. The survival time among the five groups were different： the duration for keeping serum calcium and PTH at normal level（only 3 week and 4 weeks）in direct transplantation group was shortest than that in high-oxygen culture group （5 weeks and 8 weeks）， CsA group （6 weeks and 8 weeks）， 60Co irradiated group （5 weeks and 7 weeks）, and integrated treatment group （5 weeks and 9 weeks）. Compared with direct transplantation group， the levels of serum calcium and PTH in high-oxygen culture group，CsA group，60Co irradiated group, and integrated treatment group were significantly higher in 4-9 weeks point （P＜0.05， except high-oxygen culture group in 9 weeks and 60Co irradiated group in 8 weeks after operation had no significant difference）. Compared with integrated treatment group， the levels of serum calcium and PTH in high-oxygen culture group，CsA group， and 60Co irradiated group were significantly lower in 7-9 weeks point （P＜0.05）. Conclusions PTG tissues transplanted in rectus can maintain serum calcium level at normal range，and measurement on graft or receptors can prolong the survival period of parathyroid graft. Tissue transplantation of parathyroid after culture may provide a potent way to cure hypothyroidism.
Objective To learn the postoperative wound complications of thyroid and parathyroid, respiratory complications, duration of hospital stay and postoperative mortality, so as to further clarify the clinical effectiveness of placing drainage tube after thyroid and parathyroid surgery. Methods The following databases as The Cochrane Library, MEDLINE, EMbase, SCI and CNKI were retrieved orderly from the date of their establishment to March 29th, 2011. The literature was screened strictly according to inclusive criteria, included studies were analyzed using RevMan5.1.2 software, and the evidence levels of all indicators were evaluated using GRADEpro 3.5.1 software. Results A total of 16 studies involving 1 907 participants were included. There was no high-quality literature. No case reports of death and respiratory distress syndrome. Comparing the drainage group with the non-drainage group among the 16 studies, no significant difference was found in the incidence of re-operation, wound hematoma/seroma, wound infection and subcutaneous fluids. Incision pain score was significantly different between the two groups (RR=2.15, 95%CI 1.10 to –4.23, P=0.03); and the duration of hospital stay was significantly prolonged in the drainage group (SMD=0.79, 95%CI 0.38 to –1.20, I2=93%, P=0.000 2). Conclusion The evidence shows that drainage after thyroid and parathyroid surgery can not significantly reduce the incidence of postoperative complications; but increase the duration of hospital stay. Current evidence is based on the circumstance of non-substernal goiter surgery, normal coagulation indexes and non neck lymphadenectomy, which does not apply to the conclusion of this study. It is suggested that this issue should be further studied in the future due to the lack of high-quality, multi-center and large-scale RCTs.
Objective To explore the impact of basic fibroblast growth factor (bFGF) and parathyroid hormone-related protein (PTHrP) on early and late chondrogenic differentiation of rabbit bone marrow mesenchymal stem cells (BMSCs) induced by transforming growth factor β1 (TGF-β1). Methods BMSCs were isolated from 3 healthy Japanese rabbits (2-month-old, weighing 1.6-2.1 kg, male or female), and were clutured to passage 3. The cells were put into pellet culture system and were divided into 5 groups according to different induce conditions: TGF-β1 group (group A), TGF-β1/bFGF group (group B), TGF-β1/21 days bFGF group (group C), TGF-β1/PTHrP group (group D), and TGF-β1/21 days PTHrP group (group E). At the beginning, TGF-β1 (10 ng/mL) was added to all groups, then bFGF and PTHrP (10 ng/mL) were added to groups B and D respectively; bFGF and PTHrP (10 ng/mL) were added to groups C and E at 21 days respectively. The gene expressions of collagen type I (Col I), Col II, Col X, matrix metalloproteinases (MMP)-13, and alkaline phosphatase (ALP) activity were detected once every week for 6 weeks. The 1, 9-dimethylmethylene blue (DMMB) staining was used to observe the extracellular matrix secretion at 6 weeks. Results The expression of Col I in groups C and E showed a significant downward trend after 3 weeks; the expression in group A was significantly higher than that in groups C and E at 4 and 5 weeks (P lt; 0.05), and than that in groups B and D at 3-6 weeks (P lt; 0.05); and significant differences were found between groups B and C at 3 and 4 weeks, and between groups D and E at 3 weeks (P lt; 0.05). After 3 weeks, the expressions of Col II and Col X in groups C and E gradually decreased, and were significantly lower than those in group A at 4-6 weeks (P lt; 0.05). Groups B and D showed no significant difference in the expressions of Col II and Col X at all time points, but there was significant difference when compared with group A (P lt; 0.05). MMP-13 had no obvious expression at all time points in group A; significant differences were found between group B and groups A, C at 3 weeks (P lt; 0.05); and the expression was significantly higher in group D than in groups A and E (P lt; 0.05). ALP activity gradually increased with time in group A; after 4 weeks, ALP activity in groups C and E obviously decreased, and was significantly lower than that in group A (P lt; 0.05); there were significant differences between groups B and C, and between groups D and E at 2 and 3 weeks (P lt; 0.05). DMMB staining showed more cartilage lacuna in group A than in the other groups at 6 weeks. Conclusion bFGF and PTHrP can inhibit early and late chondrogenic differentiation of BMSCs by changing synthesis and decomposition of the cartilage extracellular matrix. The inhibition is not only by suppressing Col X expression, but also possibly by suppressing other chondrogenic protein.
【Abstract】Objective To study the influence of transplantation of cultured parathyroid cells on the survival of the allografts in rats. Methods Parathyroid cells digested with collagenase and trypsin were cultured and transplanted under the left renal capsule. The survival time of the allografts was recorded and the allografts were examined by transmission electron microscopy.Results In fresh parathyroid cells group, the mean survival time was (9.25±3.45) days. While in cultured parathyroid cells group, the survival time was (46.25±7.44) days (P＜0.01). During the 50 days of observation, serum calcium and PTH remained normal in 6 of 8 rats. There were intact parathyroid cells in the allografts which had abundant rough endoplasmic reticula,mitochondria and secretory granules. Conclusion Transplantation of cultured parathyroid cells in rats can prolong the survival time of allografts and is a potent way to cure hypoparathyroidism.
ObjectiveTo investigate the significance of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT in the diagnosis of primary hyperparathyroidism, and its relationship with the level of serum calcium (CA). MethodsThe clinical data of 73 patients with parathyroid dysfunction (serum parathyroid hormone (PTH) > 130 pg/mL) were retrospectively analyzed. The 99Tcm-MIBI SPECT double phase imaging were performed in 73 cases, 63 cases underwent cervical B-ultrasound examination, and 16 cases underwent CT examination. According to the serum calcium (CA) levels, the patients were divided into CA < 2.7 mmol/L group and CA > 2.7 mmol/L group, and the postoperative pathological examination and followed-up results were as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT for diagnosis of PHPT in different serum CA levels were compared. ResultsThe sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.6%, 81.8% and 35.7%, respectively; the specificity was 87.5%, 75.5% and 50.0%, respectively; the positive predictive value was 98.2%, 93.7% and 83.3%, respectively; and the negative predictive value was 46.7%, 33.3% and 10%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT were significantly higher than those of CT examination(P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging for diagnosis of PHPT were higher than those of B-ultrasound examination, but the difference was not statistically significant (P > 0.05). In the CA < 2.7 mmol/L group, the sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 91.1%, 84.7% and 37.9%, respectively; the specificity was 80.2%, 72.9% and 49.7%, respectively; the positive predictive value was 96.8%, 96.0% and 79.4%, respectively; and the negative predictive value was 50.0%, 37.5% and 10.0%. In the CA > 2.7 mmol/L group, The sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.9%, 83.9% and 42.8%, respectively; the specificity was 83.3%, 79.2% and 50.0%, respectively; the positive predictive value was 96.9%, 94.1% and 75.0%, respectively; and the negative predictive value was 50.0%, 40.5% and 20.0%. There were no significant difference in the diagnostic accuracy between the 3 methods and the level of serum CV in different levels. ConclusionsThe diagnostic accuracy of 99Tcm-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT patients with PTH > 130 pg/mL (especially parathyroid adenoma) were higher than that of CT examination, and it is not associated with the serum CA concentration.
To verify the role of mAbCD28 in allograft transplantation. The biological action of mAbCD28 had been tested in mixed-lymphocyte-reaction and parathyroid gland allotranplantation in rats. Results: mAbCD28 could significantly suppress the proliferation of T cells in vitro and prolong the survival time of allograft in vivo. The results showed that mAbCD28 could block the costimulatory signals transmitted by CD28 molecules, and played an immunosuppressive role in parathyroid gland transplantation in rats.
In order to reduce the immunogenicity of parathyroid allografts and induce immunotolerance, we depleted Ⅰa＋ donor cells of rat parathyroid allografts by anti-Ⅰa monoclonal antibody plus complement, transplanted the treated glands underneath the capsule of the recipient kindey,and observed the median survival time (MST) of the allografts. Our results showed that the MST of the treated group were 60 days, compared with control group (MST:14 days), Ｐ＜0.01. This results indicate that rat parathyroid allografts survival can be prolonged dramatically by depletion of Ⅰa＋ donor cells.
ObjectiveTo explore the diagnosis and treatment features of parathyroid carcinoma (PTC). MethodsThe clinical data of 7 cases of parathyroid carcinoma treated from January 1993 to April 2014 were analyzed retrospectively. ResultsAll of the 7 patients had symptoms of hyperparathyroidism. Four patients had palpable neck mass. The average serum calcium level of preoperation was 3.07 mmol/L (2.35-4.98 mmol/L). The average parathyroid hormone (PTH) level was 1 181.5 pg/mL (78.4-2 061.7 pg/mL), which elevated 17 times the upper limit of normal. One case had operation in other hospital and six cases in Jishuitan hospital. The tumors located in the left inferior parathyroid gland in 3 cases, 2 cases of right lower parathyroid, and right superior parathyroid gland in 1 cases. One case underwent parathyroidectomy, parathyroidectomy including ipsilateral thyroid lobe or part of it was performed in 5 cases. Of 5 cases, 1 case was added central compartment lymphadenectomy. Three cases of postoperative tumor recurrence underwent reoperation, of which 1 case recurred 3 times. Two cases died. The remining 5 had survived until now, had survived for 5 years in 3 cases. ConclusionsA comprehensive approach with clinical presentation, serum calcium and PTH levels, B-ultrasonography, 99Tcm-MIBI, intraoperation aberrant findings, and histopathology offers help to accurate diagnosis of parathyroid carcinoma. Surgery is en bloc resection of the primary lesion. Recurrence needs reoperation, and long-term follow-up is advised.