title: Split central venous sampling of parathyroid hormone: an adjunct to surgical exploration.
abstract: BACKGROUND
  Minimally invasive parathyroid surgery mandates preoperative localization of the adenoma for a targeted operative approach. This technique uses split internal jugular vein parathyroid hormone (PTH) samples to determine a gradient that then directs the surgical exploration.
  
  
  METHODS
  Blood samples were drawn low in the neck from the jugular veins after the neck was opened. The p values for the difference in PTH between the right and left internal jugular veins were calculated with independent sample t tests.
  
  
  RESULTS
  For left-sided adenomas, the left internal jugular vein mean was significantly higher than the right p = .001). For right-sided adenomas, the right internal jugular vein mean was significantly higher than the left (p = .004). In hyperplasia, there was no significant difference (p = .43).
  
  
  CONCLUSIONS
  This study demonstrates the usefulness of split PTH internal jugular vein samples in patients in whom preoperative localization failed. Eighty percent of these patients with a gradient were treated with site-directed unilateral exploration.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. maceri@usc.edu
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Maceri
authors.forename: Niels
authors.initials: N
authors.lastname: Kokot
authors.forename: Kathrine
authors.initials: K
authors.lastname: Green
authors.forename: Vida
authors.initials: V
authors.lastname: Montgomery
authors.forename: Jahangir
authors.initials: J
authors.lastname: Sharifi
mesh_terms: D006801:Humans; D006965:Hyperplasia; D007601:Jugular Veins; D016343:Monitoring, Intraoperative; D010280:Parathyroid Glands / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000601:surgery*; D016105:Parathyroidectomy
chemical_list: D010281:Parathyroid Hormone