Trauma centres and the efficient use of financial resources

✍ Scribed by S. Paterson-Brown

• Publisher: John Wiley and Sons
• Year: 1991
• Tongue: English
• Weight: 158 KB
• Volume: 78
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800780245

✦ Synopsis

original surgery. One patient in our own series became hypercalcaemic 4 years after a successful four gland parathyroidectomy and had a large hyperplastic parathyroid removed from the superior mediastinum.

The presence of an implant complicates the management of the patient who develops hypercalcaemia on follow-up -is the problem due to an overactive implant or recurrent active parathyroid tissue in the neck? The results of venous sampling from the arm can be equivocal and, in our own experience, excision of the muscle segment containing the implant has not universally been followed by restoration of normocalcaemia. Although parathyroid carcinoma is rare we have had one case in a renal patient with tertiary hyperparathyroidism. Carcinoma is difficult to detect on frozen section and it would be extremely unfortunate if an autotransplant of malignant cells was performed.

Medical control of hypocalcaemia is relatively straight forward, especially after kidney translantation. In view of the established late incidence of hypercalcaemia after total parathyroidectomy we feel that the practice of autotransplantation should be abandoned.