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Radioguided parathyroidectomy for reexploration of primary hyperparathyroidism - a case report.
Med. Sci. Monitor 2002: 8 (3) s.CS21-CS25, il., bibliogr. 10 poz.
Hasła klasyfikacyjne GBL:
dorośli = 65 r.ż.
Background: We reprot a case of radioguided parathyroidectomy using a hadn-held gamma probe for the reexploration of primary hyperparathyroidism. Case report: The patient was a 66-year-old Japanese woman. She had previously undergone surgical exploration for primary hyperparathyroidism due to a left inferior parathyroid tumor detected by 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy. However, the pathological diagnosis of the resected tumor was adenomatous goiter. 99mTc-MIBi scintirgraphy was performed again and revealed an abnormal uptake close to the right lower lobe of the tyroid. However, venous sampling for PTH measurements did not support this finding. Sestamibi was injected and the radioactivity was measured pre- and intraoperatively with a hand-held gamma probe. With the patient under general anesthesia, the tumor, which was adjacent to the right recurrent laryngeal nerve, was resected, but it contained only a low level of radioactivity ex vivo, indicating that it was not a parathyroid tumor. A hand-held gamma probe accurately located the radioactive parathyroid tumor in the right lower neck. The resected tumor measured 15x6 mm and weighed 331 mg. The pathological diagnosis was parathyroid adenoma. Conclusions: Radioguided parathyroidectomy is useful to localize parathyroid tumors not only in primary hyperparathyroidism at the initial neck exploration but also for reexploration.
Evaluation of an alternative, subclavicular approach to thyroidectomy.
Med. Sci. Monitor 2002: 8 (11) s.CS80-CS82, il., tab., bibliogr. 4 poz.
Hasła klasyfikacyjne GBL:
Background: After presenting with the common finding of a nodular goiter, many patients refuse surgery because of the potential for a conspicuous anterior neck scar. Despite the development of endoscopic approaches to neck dissections, it can be difficult to remove a large thyroid tumor using such approaches. Material/methods: We attempted thyroid lobectomies via a subclavicular approach in three cases - three women whose ages ranged from 36-45 years old. Each patient was diagnosed with a cyytologicallybenign nodular goiter with a diameter greater than 60 mm. Subclavicular incisions were made with the length being determined by the size of teh tumor and with the thyroid bering approached laterally for resection. Results: Despite a maximum tumor diameter of greater than 70 mm, our operative technique was comparable to conventional methods with respect to surgical exposure, safety and operation time. Cosmetically, each patient was satisfied with the post-operative results. Conclusion: We believe that the subclavicular approach to thyroidectomy is a safe and cosmetically-superior alternative to conventional surgery, even in cases that are too large to approach endoscopically.
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