Medullary carcinoma of the thyroid.
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Calcitonin↗
Biomedical subjects
O I Gamvros
Publications and source records attributed to O I Gamvros.
Subtotal parathyroidectomy for primary chief cell hyperplasia of the multiple endocrine neoplasia type I syndrome.
To evaluate the efficacy of subtotal parathyroidectomy (STP) in the treatment of primary hyperparathyroidism due to multiple gland disease, 12 patients with multiple endocrine neoplasia (MEN) type I syndrome were reviewed out of 132 patients undergoing parathyroidectomy. Each patient had yearly follow-up examinations and calcium determinations for a minimum of four years except for one patient who died one year after S.T.P. Permanent hypoparathyroidism occurred in three patients. Two patients remained persistently hypercalcemic, and two patients developed recurrent hypercalcemia. One patient required oral administration of calcium and vitamin D for ten years following STP before recurrent hypercalcemia developed. Another patient was normocalcemic for three years before recurrent hypercalcemia was noted. Only five of these 12 patients remain normocalcemic without need of calcium and vitamin D therapy. In patients with MEN type I, the long-term results of STP are less than satisfactory. Not only is it difficult to gauge how viable parathyroid tissue must be left to prevent both permanent hypoparathyroidism and persistent hyperparathyroidism but there is also a long-term risk of recurrence.
Calcium↗
Reoperations for hyperparathyroidism.
During a 20 year period, 27 patients have undergone reoperations for primary hyperparathyroidism. Hypercalcemia has been successfully controlled in 21 of the 27 patients after a total of 64 operations. Reasons for failure at initial exploration included surgical error in 12, multiple gland disease in five, unusual parathyroid gland location in five, carcinoma of the parathyroid gland in two and unknown in three. A variety of techniques were used to localize missing parathyroid glands prior to reoperation. Selective venous sampling was the most helpful but gave correct localizing information in only nine of 18 patients. Postoperatively, hypoparathyroidism was temporary in two patients and permanent in four. Recurrent laryngeal nerve injury was temporary in one patient, permanent and unilateral in two and bilateral in one patient. Reoperations for hyperparathyroidism are associated with increased morbidity and decreased success. Most importantly, failure at the initial operation is preventable in most patients.
Adolescent↗