Title alternative:
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Intraoperatieve bepaling van parathormoon bij primaire
hyperparathyreoïdie; vooral waardevol bij vermoeden van solitair
bijschildklieradenoom en bij heroperatie
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Subject:
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EBP 1: Determinants in Health and Disease IGMD 5: Health aging / healthy living IGMD 6: Hormonal regulation NCEBP 14: Cardiovascular diseases NCEBP 1: Molecular epidemiology NCMLS 1: Immunity, infection and tissue repair ONCOL 3: Translational research ONCOL 5: Aetiology, screening and detection UMCN 1.5: Interventional oncology UMCN 5.2: Endocrinology and reproduction |
Organization:
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Endocrinology Health Evidence Internal Medicine Surgery Chemical Endocrinology |
Former Organization:
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Epidemiology, Biostatistics & HTA
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Journal title:
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Nederlands Tijdschrift voor Geneeskunde
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Abstract:
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OBJECTIVE: Analysis of the value of intraoperative parathormone (PTH) measurement in patients with primary hyperparathyroidism. DESIGN: Prospective study. METHOD: Evaluation of the value of intraoperative measurement ofPTH in 75 patients (including 19 patients with multiple endocrine neoplasia(MEN)-1 syndrome) who underwent parathyroidectomy in 2001-2005. RESULTS: The so-called Miami-criterion (PTH concentration 10 min after excision at least 50% below the value measured prior to the first incision) correctly predicted the success of the operation in 91% of the subjects. The success rate was correctly predicted as follows: in subgroups of patients with MEN-1 syndrome, 85%, patients after exclusion of MEN-1, 94%, and patients in whom a solitary adenoma was likely after preoperative localization studies, 97%. In 13% of the total number of operations, PTH-measurements led to further exploration, removal of additional parathyroid tissue and normocalcemia postoperatively. In patients without MEN-1 syndrome, in whom a solitary adenoma was likely on the basis of preoperative investigations, it was possible to limit the operation to a unilateral procedure in 87%. CONCLUSION: In the majority of patients with primary hyperparathyroidism, intraoperative PTH-measurement in combination with preoperative imaging studies leads to patients being cured with a unilateral instead of a bilateral operation.
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