SummaryBackgroundThe inappropriate elevation of parathormone (PTH), which regulates the process of angiogenesis in parathyroid tissue, causes the changes of activity of enzymes responsible for the removal of free radicals. Parathyroidectomy (PTX) in patients with primary hyperparathyroidism (PHPT) lowers the level of PTH and leads to the reduction of risk of cardiovascular and all-cause mortality by normalization of the antioxidant status. Therefore, the aims of the study were to assess the activity of antioxidant enzymes and free radical reaction products in patients after parathyroidectomy, and to evaluate the correlation between the systemic oxidative stress and angiogenic parameters.Materials and methodsPatients with PHPT treated surgically were enrolled into the study. Total antioxidant capacity (TAC), total oxidative status (TOS), oxidative stress index (OSI), superoxide dismutase (SOD), ceruloplasmin (CER), lipid hydroperoxides (LHP) and malondialdehyde (MDA) were measured before and after parathyroidectomy. The immunohistological expression of angiogenic factors in parathyroid specimens was assessed by the BrightVision method from ImmunoLogic using murine monoclonal anti-human: anti-VEGF, anti-CD31 and anti-CD106 antibodies.ResultsThe significant increase of TAC, CER, reduction of TOS, MDA, SOD, especially for cytoplasmic form, and significant decrease of OSI, LHP were observed after PTX. There was no significant correlation between changes of oxidative stress markers and angiogenic parameters: VEGF, CD-31, CD-106 in parathyroid tissue. The correlation level was low and medium.ConclusionsParathyroidectomy causes down-regulation of lipid peroxidation processes and leads to reduction of oxidative stress in patients with PHPT. The decrease in the OSI is the results of down-regulation of oxidative stress in the postoperative period. The change of the antioxidant status has no impact on angiogenesis processes in parathyroid tissue.
2Kierownik: dr hab. J. GawrychowskiThe aim of the study was to analyze the gene expression of JUn and ccnd1 in a group of parathyroid tissues obtained from patients with primary hyperparathyroidism in comparison to hyperplastic parathyroid and normal/atrophic parathyroid tissues by real-time quantitative PCR. Our goal was to validate the conclusion of Forsberg et al (2005) who reported overexpression of JUn in parathyroid adenomas by a joint microarray and QPCR study. material and methods. The analysis of JUn, ccnd1 was carried out by QPCR in 14 parathyroid adenomas, 8 hyperplasia cases and 50 normal/atrophic parathyroid samples taken intraoperatively. Expression of the examined genes was normalized to the reference index (geometric mean of reference genes expression: eiF3s10, UBe2d2, atP6V1e). Results. We observed a decrease of JUn expression in parathyroid adenomas in comparison to both normal/atrophic and hyperplastic parathyroids. The fold change value was 0.71 in comparison of adenomas to normal/atrophic samples (p = 0.044) and 0.75 to hyperplastic glands (p = 0.003). For ccnd1 we observed one case of parathyroid adenoma with a very clearly increased expression, while 3 adenomas (21.4% of all adenomas) exhibited the increase over the highest value seen in normal parathyroids (fold change = 3.52). conclusions. In parathyroid adenomas we were not able to confirm any overexpression of JUn gene, as suggested by the previous study. On the contrary, we observed a distinct inhibition of JUn RNA expression in comparison to non-neoplastic parathyroids. For ccnd1 gene overexpression in parathyroid adenomas, we report the frequency of 21.4%.
1. MEN syndrome is a rare cause of primary hyperparathyroidism. 2. Subtotal parathyroidectomy helps to bring back a normal calcium metabolism. 3. Recurrence of hyperparathyroidism in patients with MEN syndrome requires total parathyroidectomy with an autotransplantation into the anterior forearm muscles.
1. The clinical course of purulent thyroiditis leads to a diagnostic challenge. The surgical treatment of purulent thyroiditis allows for a faster recovery for the patient.
The aim of the study was intraoperative assessment of surgical treatment used for primary hyperparathyroidism (PH) basing on immediate histopathological findings and of parathormone (PTH) concentrations in blood serum, the latter being determined before and after removal of the affected parathyroid glands. Material and methods. The study group consisted of 110 patients: 85 women and 25 men aged 16-72 years (mean 49.3), treated surgically for PH or its recurrence. Each patient was operated together with bilateral neck exploration. The identified parathyroid glands were assessed. The operation was considered successful if the cause of PH could be confirmed by intraoperative histopathological examination, and PTH level was found lower than 50% of its preoperative value. Negative results of intraoperative tests were considered an indication for wider exploration of the neck or another full imaging diagnostics in order to decide about reoperation. Results. Parathyroid adenoma was detected in 85 (77.3%) patients, proliferation of the gland in 18 (16.4%) and parathyroid cancer in 7 (6.3%). Basing on intraoperative microscopic and immunochemical examinations, the surgical treatment was found successful in 107 (97.3%) patients. PTH concentration was found normal in 94 patients, and significantly lower in 13. The operation was assessed as unsuccessful in 3 (2.7%) patients (2x recurrence of parathyroid cancer, 1x proliferation of parathyroid glands). A non-significant PTH drop was noted in 1 patient, and PTH increase in 2. One patient died because of disseminated tumor disease, and 2 patients received another imaging diagnostics and reoperation with good result. Conclusions. 1. Positive result of intraoperative histopathological examination together with a significant drop in parathormone concentration in peripheral blood serum are essential for successful surgical treatment of PH. 2. Negative results of microscopic and immunochemical examinations are an indication for wider neck exploration. If further procedure is still unsuccessful, a more profound imaging diagnostics is necessary followed by reoperation.
1. The most frequent causes of acute respiratory failure in postoperative period are a hemorrhage from the operation site and bilateral paralysis of recurrent laryngeal nerves. 2. Acute postoperative respiratory failure is an indication for postoperative wound revision.
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