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D M Carneiro

Publications and source records attributed to D M Carneiro.

7 recordsLinked to original sources
PubMed2001

"Limited" parathyroidectomy in geriatric patients.

OBJECTIVE: Elderly patients with primary hyperparathyroidism accompanied by other diseases are often denied referral for parathyroidectomy because of the associated risks of general anesthesia and bilateral neck exploration. However, marked symptomatic improvement is recognized after successful parathyroidectomy. The purpose of this report is to examine the postoperative outcome of geriatric patients undergoing "limited" parathyroidectomy. METHODS: Since 1993, 291 consecutive patients with primary hyperparathyroidism were treated with "limited" parathyroidectomy guided by preoperative localization and intraoperative parathyroid hormone assay. In 34 of the procedures (29 initial, 5 reoperations), the patient was 75 years or older; these patients are the subject of this report. Patients were followed up for serum calcium, parathyroid hormone levels, and symptomatology. RESULTS: Twenty-seven patients were followed up for 31 (range 6-84) months: all remained normocalcemic after single gland excision guided by intraoperative parathyroid hormone assay. Another six patients in the immediate postoperative period had normocalcemia. One patient had persistent hypercalcemia. Unilateral neck exploration was possible in 29 patients. The average operating time for initial parathyroidectomy was 50 (range 20-130) minutes. Nineteen patients were eligible for ambulatory surgery. Seven were discharged without an overnight stay, 11 had a 23-hour "social" admission, and one was kept overnight after a prolonged surgical procedure. Permanent hypoparathyroidism and laryngeal nerve injury were not observed. The mortality rate related to the procedure was 0%; there was one postoperative (do not resuscitate) death caused by colonic hemorrhage. With an average follow-up of 2 years, 64% of the patients had marked improvement of symptoms. CONCLUSION: Adjunctive use of preoperative localization and intraoperative parathyroid hormone assay has made "limited" parathyroidectomy a safe, effective treatment option in geriatric patients with primary hyperparathyroidism.

Adenoma↗
PubMed2000

Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration.

BACKGROUND: Controversy continues between bilateral neck exploration and limited parathyroidectomy. One approach depends on gland size and histopathologic factors; the other approach limits excision to only hypersecreting glands. Both have excellent early operative success, but late recurrence rates with limited exploration are unknown. METHODS: Three hundred twenty consecutive patients with primary hyperparathyroidism were followed 6 to 313 months after successful parathyroidectomy. One hundred seventy-six patients had bilateral neck exploration with excision of enlarged glands (group I); 144 patients had glands excised based on hyper-secretion (group II). Calcium and intact parathyroid hormone (iPTH) levels were measured yearly. Parathyroid gland hypersecretion was determined by elevated iPTH levels. RESULTS: In group I, 1 gland was excised in 160 patients (91%); 19 of 176 patients (11%) had elevated iPTH levels. In group II, 139 patients (97%) had 1 gland excised; 19 of 144 patients (13%) had high iPTH levels. The number of patients with more than 1 gland excised in group I (9%) is 3 times higher than in group II (3%) (P <.05). There was no significant difference in the incidence of recurrent hyperfunctioning glands between the 2 different operative approaches (chi-squared test). CONCLUSIONS: Late parathyroid gland function was comparable with both approaches. Multiple gland excision based on size alone may lead to excision of normal functioning glands.

Calcium↗
PubMed1999

Improved success rate in reoperative parathyroidectomy with intraoperative PTH assay.

OBJECTIVE: The clinical usefulness of preoperative localization and intraoperative PTH assay (QPTH) in primary hyperparathyroidism have been established. However, without the use of QPTH, the parathyroidectomy failure rate remains 5% to 10% in large reported series and is probably much higher in the hands of less experienced parathyroid surgeons. Persistent hypercalcemia requires another surgical procedure. The authors compared the outcomes in 50 consecutive patients undergoing more difficult secondary parathyroidectomy with and without the adjunctive support of QPTH. METHODS: Two groups of similar patients underwent reoperative parathyroidectomy for failed surgery or recurrent disease. The successful return to normocalcemia in group I, with QPTH used to localize and confirm complete excision of all hyperfunctioning glands, was compared with group II, who did not have this intraoperative adjunct. RESULTS: In 31/33 patients in group I, calcium levels returned to normal. With good preoperative localization studies, 17 patients underwent successful straightforward parathyroidectomies as predicted by QPTH. In the other 14 patients, QPTH assay proved extremely beneficial by facilitating localization with differential venous sampling; measuring the increase in hormone secretion after massage of specific areas; recognizing suspicious nonparathyroid tissue excised without a decrease in hormone levels, avoiding frozen-section delay; and correctly identifying the excision of abnormal tissue despite false-positive/false-negative sestamibi scans. In group II, who underwent surgery before QPTH was available, 4 of 17 patients (24%) remained hypercalcemic after extensive reexploration. CONCLUSION: With the intraoperative hormone assay used to facilitate localization and confirm excision of all hyperfunctioning tissue, the success rate of reoperative parathyroidectomy has improved from 76% to 94%.

Adult↗
PubMed1999

Parathyroidectomy: new criteria for evaluating outcome.

Following successful parathyroidectomy, subjective improvement in recognized symptoms and in the overall "well being" of asymptomatic primary hyperparathyroid patients has been well documented. Because quantitative methods for measuring parathyroid hormone (PTH) and normal reference ranges of serum calcium have changed in recent years, a revised biochemical criteria for evaluating postoperative outcome has become necessary. Two hundred seventy-one selected patients were followed for an average of 6.3 years after parathyroidectomy. Although 257 patients had serum calcium levels <10.6 mg/dL during the entire follow-up period, 15 per cent of them had elevated intact PTH (iPTH) levels. Fourteen patients had calcium levels > or =10.6 mg/dL at some point during follow-up, with nine patients (64%) showing high iPTH levels and eight (57%) of them developing recurrent hyperparathyroidism (calcium > or =11 mg/dL and iPTH > or =68 pg/mL). Of the 14 remaining patients, 5 had hypercalcemia with normal iPTH levels. In patients with successfully treated primary hyperparathyroidism, the recommended annual follow-up is: 1) monitor total serum calcium only if serum calcium level is <10.6 mg/dL, or if serum calcium level is > or =10.6 mg/dL; and 2) monitor serum calcium and PTH levels, because these patients have an increased incidence of hyperfunctioning parathyroid glands, which may point to late recurrence.

Calcium↗
PubMed1999

The evolution of parathyroidectomy failures.

BACKGROUND: Reported operative failure rates for primary hyperparathyroidism range from 5% to 10%. Failure has been due to multiglandular disease, ectopic parathyroid glands, errors in frozen section, and missed diagnoses. Recently, our operative approach has changed from bilateral cervical exploration to direction by preoperative localization and intraoperative quick parathyroid hormone assay. The purpose of this study is to examine the causes and rates of failure in this evolving approach to parathyroidectomy. METHODS: Among 447 consecutive cases of primary hyperparathyroidectomy, 20 operative failures were examined. Three different operative approaches were compared with respect to causes and rates of failure. RESULTS: From 1969 to 1989, with bilateral neck exploration, failure was due to missed diagnoses, ectopic glands, multiglandular disease, and unknown causes, with a failure rate of 5%. From 1990 to 1993, with bilateral neck exploration and quick parathyroid hormone assay, failure was due to ectopic mediastinal glands, misinterpretation of frozen section, and operative judgment, with a failure rate of 10%. From 1993 to 1998, with preoperative localization and quick parathyroid hormone assay, the two operative failures (1.5%) were due to operative judgment and misinterpretation of the quick parathyroid hormone assay. CONCLUSIONS: The new surgical approach combining preoperative localization studies and intraoperative parathyroid hormone monitoring has eliminated the most common causes of parathyroidectomy failure and has significantly decreased the operative failure rate.

Humans↗