尿毒症患者甲状旁腺全切除加前臂移植术后钙的补充

目的研究尿毒症患者甲状旁腺全切除加前臂移植术后的补钙方法。方法 15例接受甲状旁腺全切除加前臂移植术的尿毒症患者,根据其术后血钙浓度调整补钙剂量,使血钙浓度维持在1.8～2.5mmol/L之间。结果术后2周内平均血钙浓度是(2.235±0.082)mmol/L。术后2周内累计元素钙补充量(CaSUM)为(48.2±17.9)g。术后两周内平均每天、每千克体质量、每维持1mmol/L血钙所需元素钙的量(CaAVG)为(29.1±14.9)mg。CaSUM与甲状旁腺的质量显著相关(r=0.910,P=0.038),但是与甲状旁腺功能亢进持续时间、体质量、碱性磷酸酶(alkaline phosphatase,AKP)水平、标准蛋白分解率(normalized protein catabolic rate,nPCR)、术后第一日血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平不相关。CaAVG与甲状旁腺功能亢进持续时间正相关(r=1.000,P=0.041),与术后第1日iPTH水平负相关(r=-1.000,P=0.002)。结论甲状旁腺全切除加前臂移植术后的补钙量大小与甲状旁腺的质量、甲状旁腺功能亢进持续时间、术后第1日iPTH水平有关。     

Surgical treatment of secondary hyperparathyroidism

Secondary hyperparathyroidism is one of the most serious complications for long-term hemodialysis patients. In our department, we performed parathyroidectomies on 215 patients between July 1973 and June 1990. We found that parathyroidectomies on 215 patients between July 1973 and June 1990. We found that parathyroidectomy was an effective treatment for advanced renal hyperparathyroidism and that after total parathyroidectomy with forearm autograft, renal hyperparathyroidism was controllable, even when hyperparathyroidism was progressive. However, the timing of this operation was important, because skeletal deformity and vessel calcification did not improve after parathyroidectomy. There were two problems after parathyroidectomy for secondary hyperparathyroidism. One was persistent hyperparathyroidism due to supernumerary parathyroid glands, particularly those located in the mediastinum, and the other was recurrent hyperparathyroidism. From our clinical and pathohistological investigations, we suspected that the proliferation of parathyroid cells changed with the progress of renal hyperparathyroidism and we found that it was difficult to prevent enlargement of parathyroid glands and recurrence of this problem.     

Long-term Effects of Parathyroidectomy on Cardiac and Autonomic Nervous System Functions in Haemodialysis Patients

Ten patients receiving regular haemodialysis therapy who underwentparathyroidectomy for secondary hyperparathyroidism were investigatedto evaluate the effects of parathyroid hormone on left ventricularand autonomic nervous system functions. The study which includedM-mode echocardiography and autonomic nervous system tests (hormonaland cardiovascular response to the postural test, cold pressortest, handgrip test, diving reflex test and Valsalva manoeuvre)were performed prior to parathyroidectomy, and 5–8 monthsafter, on a non-dialysis day. The cardiovascular response and plasma noradrenaline changesto postural test remained unchanged following parathyroidectomy.The resting heart rate decreased from 73.1±2.4 to 66.4±2.3beats/min (P<0.05) but mean blood pressure did not changepost-parathyroidectomy. Mean blood pressure and heart rate changesduring the cold pressor test, handgrip test, diving test andValsalva manoeuvre were unaffected by parathyroidectomy. End-diastolicand end-systolic dimensions, fractional fibre shortening, meanvelocity of fibre shortening and the ratio of the pre-ejectionperiod to the left ventricular ejection time were normal priorto parathyroidectomy and remained unchanged following it. This study suggests that the reduction in parathyroid hormoneconcentrations obtained by parathyroidectomy does not significantlymodify heart function and autonomic nervous system activityin the long term.     

Short- and Long-Term Changes in Bone Mineral Density of the Lumbar Spine After Parathyroidectomy in Patients with Primary Hyperparathyroidism

The aims of this study were (1) to analyze whether correlations exist between lumbar spine (LS) bone mineral density (BMD) and the main preoperative biochemical parameters in a large population of patients with primary hyperparathyroidism (HPT); and (2) to evaluate the LS-BMD changes after parathyroidectomy (PTx) at long-term follow-up. Sixty-two patients (median age 57 years, range 23–82 years) with confirmed primary HPT underwent LS osteodensitometry by dual-energy X-ray absorptiometry with BMD measurements at the L2–L4 region before surgery and at 1 year and 2 years after successful PTx. Three groups of patients were considered: Group A (men, n = 14, 22.6%), Group B (premenopausal women, n = 12, 19.3%), and Group C (postmenopausal women, n = 36, 58.1%). There were no linear correlations (P = NS) among the main biochemical parameters, the age of the patients, and their baseline LS-BMD values that were significantly (P < 0.01) lower in Group C patients. At 2-year follow-up the LS-BMD improved by 13.0%, 11.5%, and 11.7% in Groups A, B, and C, respectively (P = NS). In order to compare groups with the same linear relationship between age and LS-BMD, a subgroup of postmenopausal patients aged 60 years (Group C2) was considered. ANOVA showed that the improvement of the LS-BMD at l- and 2-year follow-up was higher (P = 0.002) in Group B than in Group C2 patients. The result was confirmed by using the Mann-Whitney U-test (P = 0.0078). Improvement of LS-BMD after successful PTx was significantly (P < 0.01) higher in premenopausal women, suggesting a possible role of estrogen hormone in complete bone remodeling. This study was presented at the XXVII European Symposium on Calcified Tissue, Tampere, Finland, 6–19 May, 2000     

甲状旁腺切除术对牙齿发育和矿化的影响

甲状旁腺切除术是治疗甲状旁腺机能亢进症的首选方法，但手术后可能造成身体机能各方面的改变，本文主要对实施甲状旁腺切除术后牙齿发育和矿化的改变作一综述。     

Effects of parathyroid hormone on the osteoclastic pool,bone resorption and formation in rat alveolar bone

Summary The osteoclast number and its relation to parathyroid hormone have been studied in rat alveolar bone by quantitative histology and fluorescent labeling. The osteoclast number decreases 60 h after parathyroidectomy and remains constant for the next 132 h. Parathyroid hormone administration to parathyroidectomized animals 96 h after the operation induces an increase in osteoclast number within 12 h to some-what above those of control animals. The elevated osteoclast counts remain constant for 60 h then rapidly fall over the next 24 h to the level seen in untreated parathyroidectomized animals. As determined by fluorescent labeling, normal alveolar bone resorption and formation were disturbed by parathyroidectomy, such that significant bone formation occurred for only 6 days after surgery, after which a quiescent state followed.     

Comparison of effects of parathyroidectomy and ethane-1-hydroxy-1,1-diphosphonate (EHDP) administration upon bone synthesis of hydroxyproline and urinary excretion of hydroxyproline in rats

Summary Disodium ethane-1-hydroxy-1,1-diphosphonate (EHDP) may impair mineralization and reduce turnover of bone. However, its administration has been shown to lead to an accumulation of osteoid in both man and the rat. Using rats, the effects of surgical parathyroidectomy and administration of EHDP (30 mg EHDP/kg body weight by subcutaneous injection daily for 5 days) upon bone composition, uptake of³H-proline into hydroxyproline in bone and the subsequent urinary excretion of labelled and unlabelled hydroxyproline have been compared. Both parathyroidectomized (PTX) rats and EHDP-treated animals accumulated more hydroxyproline in bone and excreted less total urinary hydroxyproline than sham-PTX control animals, the changes induced by EHDP being of greater magnitude than those induced by surgical parathyroidectomy. Skeletal buildup of hydroxyproline was associated with decreased catabolism of mature collagen rather than enhanced synthesis of hydroxyproline in bone. EHDP administration, although decreasing urinary excretion of newly synthesised hydroxyproline, did not alter the skeletal synthesis of hydroxyproline as measured by uptake of³H-proline. In all parameters measured, responses to EHDP were similar in PTX and sham-PTX rats. It is concluded that depression of parathyroid hormone mediated bone turnover may have contributed to, but did not fully account for, the lowering of bone turnover and changes in bone composition induced by EHDP in sham-PTX rats in the present experiment.     

Intraoperative thermal regulation in patients undergoing laparoscopic vs open surgical procedures

BACKGROUND: Although perioperative hypothermia is a well-known consequence of general anesthesia, it has been hypothesized that laparoscopic surgery exacerbates hypothermia to a greater extent than open surgery. The aim of this study was to demonstrate that laparoscopic surgery does not represent an increased risk for hypothermia. METHODS: A case-controlled retrospective study was conducted on 45 patients, 25 undergoing laparoscopic cholecystectomy and 20 undergoing parathyroid surgery under endotracheal general anesthesia. Data were collected regarding age, sex, weight, height, American Society of Anesthesiologists (ASA) status, length of surgery, and anesthesia. In addition, we analyzed the type of intraoperative intravenous fluids, anesthetics and perioperative drugs, and temperature, blood pressure, and heart rate recordings during anesthesia. RESULTS: There was no significant difference between the two groups with respect to age, sex, body mass index (BMI), ASA status, type or amount of intravenous fluids infused, length of anesthesia or surgery, changes in mean blood pressure, or heart rate. Core body temperatures in both groups decreased significantly over time (p 0.05). There was no difference between the groups in terms of maximum drop in temperature (lowest temperature recorded vs baseline temperature) (1.1 +/- 0.7 vs 1.0 +/- 0.7 degrees C, p > 0.05). CONCLUSION: This study demonstrates that patients who undergo laparoscopic and open procedures of similar duration under endotracheal general anesthesia have similar profiles in terms of perioperative hypothermia.     

甲状旁腺占位性病变的临床分析

目的 探讨甲状旁腺占位性病变的临床表现、诊断及治疗方法.方法 回顾性分析42例甲状旁腺占位性病变患者的临床资料,包括临床症状、体征、实验室检查、病理和影像学结果及治疗方法.结果 42例患者中男8例,女34例,男女比例为1:5.25;年龄12～77岁,中位年龄39岁;甲状旁腺癌2例,甲状旁腺腺瘤29例,甲状旁腺囊肿11例.临床表现有颈部肿物40例次、骨质疏松或骨纤维囊性变34例次、泌尿系统症状29例次、声音嘶哑7例次、消化性溃疡4例次、呼吸困难及吞咽受阻症状3例次、胸腔内肿物3例次、淀粉酶升高2例次等.术前定性检查采用血清钙离子及血清甲状旁腺激素检测.术前定位检查分别采用B超、99mTc.甲氧基异丁基异腈、CT、MRI.甲状旁腺腺瘤29例经手术治疗,28例症状缓解,1例手术后23个月复发;甲状旁腺囊肿11例均经手术治疗,随访未见复发.甲状旁腺癌2例均经手术治疗,分别随诊28个月和50个月均无瘤生存.结论 血清钙离子及甲状旁腺激素检测结合B超99mTc-甲氧基异丁基异腈、CT、MRI有助于甲状旁腺占位性病变的诊断.手术为首选治疗方式,甲状旁腺囊肿行单纯肿物切除术,甲状旁腺腺瘤的主要手术方式为双侧颈部探查术,甲状旁腺癌的首次手术应为根治性手术.