title: Autotransplant tissue selection criteria with or without stereomicroscopy in parathyroidectomy for treatment of renal hyperparathyroidism.
abstract: BACKGROUND
  Several methods have been proposed to improve operative success in renal hyperparathyroidism.
  
  
  OBJECTIVE
  To evaluate stereomicroscopy in parathyroid tissue selection for total parathyroidectomy with autotransplantation in secondary (SHPT)/tertiary (THPT) hyperparathyroidism.
  
  
  METHODS
  118 renal patients underwent surgery from April of 2000 to October 2009. They were divided into two groups: G1, 66 patients operated from April of 2000 to May of 2005, with tissue selection based on macroscopic observation; G2, 52 patients operated from March of 2008 to October 2009 with stereomicroscopy for tissue selection searching for the presence of adipose cells. All surgeries were performed by the same surgeon. Patients presented SHPT (dialysis treatment) or THPT (renal-grafted). Follow-up was 12-36 months. Intra-operative parathyroid hormone (PTH) was measured in 100/118 (84.7%) patients.
  
  
  RESULTS
  Data are presented as means. G1 included 66 patients (38 SHPT, 24 females/14 males; 40.0 years of age; 28 THPT, 14 females/14 males; 44 years of age). G2 included 52 patients (29 SHPT, 11 females/18 males; 50.7 years of age; 23 THPT, 13 females/10 males, 44.4 years of age). SHPT patients from G2 presented preoperative serum calcium higher than those of SHPT patients in G1 (p<0.05), suggesting a more severe disease. Definitive hypoparathyroidism was found in seven of 118 patients (5.9%). Graft-dependent recurrence occurred in four patients, two in each group. All occurred in dialysis patients.
  
  
  CONCLUSIONS
  Stereomicroscopy in SHPT/THPT surgical treatment may be a useful tool to standardize parathyroid tissue selection.
authors.affiliation: Department of Endocrinology and Metabology, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil. Electronic address: moniqueohe@uol.com.br.
authors.forename: Monique Nakayama
authors.initials: MN
authors.lastname: Ohe
authors.affiliation: Department of Otorhinolaryngology, Head and Neck, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Rodrigo Oliveira
authors.initials: RO
authors.lastname: Santos
authors.affiliation: Department of Otorhinolaryngology, Head and Neck, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Murilo Catafesta das
authors.initials: MC
authors.lastname: Neves
authors.affiliation: Department of Nephrology, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Aluizio Barbosa
authors.initials: AB
authors.lastname: Carvalho
authors.affiliation: Department of Endocrinology and Metabology, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Ilda Sizue
authors.initials: IS
authors.lastname: Kunii
authors.affiliation: Department of Otorhinolaryngology, Head and Neck, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Márcio
authors.initials: M
authors.lastname: Abrahão
authors.affiliation: Department of Otorhinolaryngology, Head and Neck, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Onivaldo
authors.initials: O
authors.lastname: Cervantes
authors.affiliation: Department of Endocrinology and Metabology, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Marise
authors.initials: M
authors.lastname: Lazaretti-Castro
authors.affiliation: Department of Endocrinology and Metabology, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: José Gilberto Henriques
authors.initials: JG
authors.lastname: Vieira
mesh_terms: D000328:Adult; D064592:Autografts; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Hiperparatireoidismo secundário; Hormônio paratireóideo; Hyperparathyroidism, secondary; Parathyroid hormone; Parathyroidectomy; Paratireoidectomia