Surgical treatment offers a definite cure of patients with primary hyperparathyroidism. When making the diagnosis of primary hyperparathyroidism the success of a surgical solution depends on the experience and judgment of the surgeon. Our experience with 222 operations and re-operations convinced us on the preference of a bilateral approach, i.e. exploration of both sides of the neck. The ectopic localization of the parathyroid glands, the limited possibilities of an unequivocal interpretation of the histological examinations but also the frequent incidence of thyropathies leads the surgeon, in our opinion, to the complete exploration of both sides of the neck within the framework of the primary operation for primary hyperparathyroidism. This approach leads most probably to the best results. We use an aimed unilateral approach only in old patients who are in a very bad condition where we anticipate a benefit from a short operation.

• MeSH
• dítě MeSH
• dospělí MeSH
• hyperparatyreóza diagnóza   etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• paratyreoidektomie metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Surgical- anatomical studies improve experience of a surgeon and technique of the parathyroids preparation. The authors conducted a study aimed at standardization of the parathyroidectomy procedure and collection of the parathyroids from cadaverous donors for allotransplantation. The total of 101 cadavers (51 females, 50 males) were sectioned. Parathyroid regions were closely preparated, the glands were collected and histologically verified. Anatomical differences of this region were recorded. The parathyroid tissue was confirmed microscopically in 75%. Mostly, the parathyroids were mistaken for lymphonodes, a thyroid or thymus tissue. Location of inferior parathyroids was more variable (28% of inferior parathyroids is located within the thymus tissue), compared to the superior ones. Based on the study, systematic anatomical preparation in the cervical region, including a. thyroidea inferior and n. laryngeus recurrens and around the thymus cervical procesi is recommended in parathyroid procedures, where preoperative location examinations were inconclusive. Complete thymectomy with exenteration of the anterior mediastinal adipose tissue is fundamental for preparations in the mediastinum.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• paratyreoidea anatomie a histologie   patologie   MeSH
• paratyreoidektomie MeSH
• primární hyperparatyreóza patologie   chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Surgical management of primary hyperparathyroidism is a very effective method. The target is to cure primary hyperparathyroidism and to reach normal calcium levels. This results in an improvement of health condition and resolution or at least moderation of symptoms. Complications are infrequent and mortality is very low. Surgical management is definite, safe and effective. Authors of this article address the diagnosis of primary hyperparathyroidism, clarify bone, metabolic and biochemical syndromes and present series of 151 patients that have been operated on at the 3rd Department of Surgery of the Motol University Hospital, Prague, with the diagnosis of primary hyperparathyroidism. The survey is focused on the primary hyperparathyroidism concomitant diseases and on the possible sequelae in the postoperative period.

• MeSH
• dítě MeSH
• dospělí MeSH
• hyperparatyreóza diagnóza   etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• paratyreoidektomie škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: Primary hyperparathyroidism is an endocrine disorder affecting calcium and phosphate metabolism. It is surgically treated by removing hyperfunctional parathyroid tissue. The aim of the study was to show, based on surgical results, that the introduction of serum calcium screening in orthopaedic therapy is effective. The detection of hypercalcemia and diagnosis of primary hyperparathyroidism allow for a good timing of endocrine surgery in relation to an orthopaedic procedure. MATERIAL AND METHODS: This retrospective study included 441 patients in the age range of 18 to 83 years who underwent parathyroidectomy between 2004 and 2007. Skeletal disorders were diagnosed by clinical, radiographic and densitometric examination; calcium levels were measured after surgery. Bone repair after parathyroidectomy was followed up by the endocrinologist for 1 year. RESULTS: Before surgery, 48 % of the patients had skeletal disorders. Adenoma was found in 87 %, double adenoma in 2 %, hyperplasia in 10 % and parathyroid carcinoma in 0.5 % of the patients. Complications involved transient paresthesia of the recurrent laryngeal nerve (1 %), transient hypocalcemia (0.5 %), transient post-operative arrhythmias (0.5 %), temporary psychological problems (0.7 %) and post-operative bleeding (0.5 %). None of the patients died. Serum calcium levels were as follows: 2.90 ± 0.01 mmol/L pre-operatively; 2.44 ± 0.01 mmol/L on the evening of surgery; 2.30 ±0.01 mmol/L on the 1st day; 2.19 ± 0.01 mmol/L on the 2nd day; and 2.18 ± 0.01 mmol/L on the 3rd post-operative day. On the 3rd post-operative day most of the patients were discharged from the hospital. Normal calcium levels were achieved in 98 % of the surgically treated patients. DISCUSSION AND CONCLUSIONS: The study provides evidence for the efficiency of calcium screening in primary hyperparathyroidism and shows the feasibility of involving endocrine surgery in the course of orthopaedic treatment.

• MeSH
• dospělí MeSH
• hyperkalcemie etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metabolické nemoci kostí diagnóza   etiologie   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• paratyreoidektomie * MeSH
• primární hyperparatyreóza komplikace   diagnóza   chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Elevated serum parathyroid hormone (PTH) level together with hypocalcemia in chronic kidney disease usually suggests secondary hyperparathyroidism. However, primary hyperparathyroidism should also be considered, especially if concomitant vitamin D deficiency is suspected. We report a case of parathyroid adenoma associated with hypocalcemia and metabolic bone disease in a patient presenting with kidney disorder. The patient was successfully treated by parathyroidectomy that was preceded and followed by intensive calcium and vitamin D supplementation.

• MeSH
• adenom komplikace   chirurgie   MeSH
• hypokalcemie komplikace   MeSH
• lidé MeSH
• nádory příštítného tělíska komplikace   chirurgie   MeSH
• nedostatek vitaminu D komplikace   MeSH
• nemoci ledvin komplikace   MeSH
• paratyreoidektomie MeSH
• primární hyperparatyreóza komplikace   MeSH
• senioři nad 80 let MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

• MeSH
• akutní nemoc MeSH
• dítě MeSH
• dospělí MeSH
• hyperparatyreóza komplikace   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• pankreatitida komplikace   MeSH
• peptický vřed komplikace   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Patients with renal failure frequently have their calcium and phosphate metabolism seriously disrupted. It may result in a skeletal malady--the renal osteopathy. Late forms of this syndrome are difficult to cure. The aim of this comparative study is to follow the relation between parameters of the bone metabolism (calcitriol, calcidiol, parathormone, calcitonin, osteocalcin, Pi, Ca--total or ionised, and others) and the degree of deterioration of the kidney function. METHODS AND RESULTS: Three groups of patients were included into the study: A-hemodialyzed patients with chronic renal failure (Ccreat = 0.07 +/- 0.02 ml/s, n = 21, age 71.0 +/- 10.6 years); B--not dialyzed patients with decreased renal function (Ccreat = 0.33 +/- 0.05 ml/s, n = 19, age 65.0 +/- 9.6 years); C--patients with normal renal function (Ccreat = 1.45 +/- 0.12 ml/s, n = 16, age 85.2 +/- 4.7 years). Calcidiol concentration [microgram/l] did not differ in individual groups (A: 11.3 +/- 4.7, B: 10.7 +/- 8.2, C: 11.7 +/- 5.7, reference limits RM: 8.9-46.7). In contrast, calcitriol concentration [ng/l] was statistically different in all studied groups (A: 1.7 +/- 2.8, B: 17.6 +/- 12.4, C: 30.6 +/- 9.1, p < 0.001, RM: 19.9-67.0) and it correlated with the degree of renal function deterioration (calcitriol vs. creatinine, r = -0.76, p < 0.001). In PTH levels (pmol/l) the group C differed significantly from groups A and B (A: 27.4 +/- 32.0, B: 23.7 +/- 16.5, C: 6.2 +/- 2.4, C vs. A, p < 0.01, C vs. B, p < 0.001, RM: 1.0-6.8). PTH concentrations correlated with osteocalcine and HCO3 (r = 0.74, r = -0.56, p < 0.001). CONCLUSIONS: Results of the tested parameters have shown that abnormalities in the bone metabolism significantly correlate with the degree of renal deterioration. It demonstrates the requirements for vitamin D metabolites supplementation for patients is needed already in the pre-dialysis stage.

• MeSH
• chronické selhání ledvin patofyziologie   terapie   MeSH
• dialýza ledvin MeSH
• kosti a kostní tkáň metabolismus   MeSH
• ledviny patofyziologie   MeSH
• lidé MeSH
• minerálová a kostní nemoc při chronickém onemocnění ledvin metabolismus   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND/AIMS: Small attention is paid to other types of bone diseases then chronic kidney disease-mineral and bone disorder in dialysis patients. The aim of our study was to assess the occurrence of osteoporosis and bone microarchitecture by trabecular bone score in this population. METHODS: 59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafIltration underwent densitometry (Lunar Prodigy, TBS software 2.1.2) and laboratory assessment. RESULTS: Osteoporosis was observed in 34% patients, high bone turnover was found in 80% of them, with SHPT (PTH > 300 ng/l) present in 69%. TBS was significantly decreased in 47.5% of the patients. TBS correlated with T- and Z-scores of the lumbar spine and proximal femur in the total population (P < 0.0001) and in men (P < 0.00001) and there were significant differences between TBS in groups with normal densitometry, osteopenia, and osteoporosis, both in total population (P < 0.0001; P < 0.01) and in men (P < 0.001; P < 0.001). CONCLUSIONS: Osteoporosis was found in about 1/3 of patients treated with hemodiafiltration. Normal TBS was found in only 1/4 of the dialysis population. TBS correlated with densitometric parameters and was significantly different relative to T-scores.

• MeSH
• denzitometrie MeSH
• dialýza ledvin * MeSH
• kostní denzita MeSH
• lidé středního věku MeSH
• lidé MeSH
• minerálová a kostní nemoc při chronickém onemocnění ledvin MeSH
• nemoci ledvin komplikace   patologie   terapie   MeSH
• osteoporóza epidemiologie   etiologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trabekulární kostní tkáň patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Medical management of primary hyperparathyroidism (PHPT) is important in patients for whom surgery is inappropriate. We aimed to describe clinical profiles of adults with PHPT receiving cinacalcet. DESIGN: A descriptive, prospective, observational study in hospital and specialist care centres. METHODS: For patients with PHPT, aged 23-92 years, starting cinacalcet treatment for the first time, information was collected on dosing pattern, biochemistry and adverse drug reactions (ADRs). Initial cinacalcet dosage and subsequent dose changes were at the investigator's discretion. RESULTS: Of 303 evaluable patients with PHPT, 134 (44%) had symptoms at diagnosis (mostly bone pain (58) or renal stones (50)). Mean albumin-corrected serum calcium (ACSC) at baseline was 11.4 mg/dl (2.9 mmol/l). The reasons for prescribing cinacalcet included: surgery deemed inappropriate (35%), patient declined surgery (28%) and surgery failed or contraindicated (22%). Mean cinacalcet dose was 43.9 mg/day (s.d., 15.8) at treatment start and 51.3 mg/day (31.8) at month 12; 219 (72%) patients completed 12 months treatment. The main reason for cinacalcet discontinuation was parathyroidectomy (40; 13%). At 3, 6 and 12 months from the start of treatment, 63, 69 and 71% of patients, respectively, had an ACSC of ≤10.3 mg/dl vs 9.9% at baseline. Reductions from baseline in ACSC of ≥1 mg/dl were seen in 56, 63 and 60% of patients respectively. ADRs were reported in 81 patients (27%), most commonly nausea. A total of 7.6% of patients discontinued cinacalcet due to ADRs. CONCLUSIONS: Reductions in calcium levels of ≥1 mg/dl was observed in 60% of patients 12 months after initiation of cinacalcet, without notable safety concerns.

• MeSH
• cinakalcet MeSH
• dospělí MeSH
• lékařská praxe - způsoby provádění statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• naftaleny terapeutické užití   MeSH
• primární hyperparatyreóza farmakoterapie   epidemiologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Názvy látek
• cinakalcet MeSH
• naftaleny MeSH

The purpose of the study was to bring a contribution to the knowledge of physiology and pathophysiology of the bone mineral heteroionic exchange with respect to sodium ions and metabolic diseases, particularly bone diseases. The instrumental neutron activation analysis was employed to follow the ratio of contents Na/Ca in bone samples from dialyzed patients. A formerly elaborated method for the determination of the Na/Ca ratio in undecalcified bone tissue sections obtained from material embedded in polymethylmethacrylate was used. In the reference group the Na/Ca ratio was of 0.021 +/- 0.003, that in patients with the renal osteopathy was of 0.030 +/- 0.007. Results obtained in patients with different types of the renal osteopathy depending on the intensity of the impairment were discussed.

• MeSH
• dialýza ledvin škodlivé účinky   MeSH
• dospělí MeSH
• kosti a kostní tkáň chemie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• minerálová a kostní nemoc při chronickém onemocnění ledvin metabolismus   MeSH
• minerály analýza   MeSH
• mladiství MeSH
• neutronová aktivační analýza MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• minerály MeSH