With advanced technology, physicians at The University of Texas Health Science Center at Houston are now able to offer a minimally invasive technique for removing adenomas that develop in parathyroid glands.
Surgery to correct hyperparathyroidism used to require a six- to nine-inch incision along the neck so that surgeons could expose all four parathyroid glands in order to find the culprit that is interfering with the body's ability to regulate calcium.
Nuclear mapping now enables physicians to identify the exact location of the affected gland that needs to be removed. This allows for a much smaller incision and cuts down on operating time.
Richard Andrassy, M.D., chairman of the Department of Surgery at The University of Texas Medical School at Houston, and endocrinologist Carlos Hamilton Jr., M.D., have been offering the minimally invasive surgery for more than a year.
Hamilton, executive vice president for external affairs at the university and president of the American Association of Clinical Endocrinologists, said patients who have high calcium levels in their blood are first thoroughly evaluated to rule out other medical conditions.
Once hyperparathyroidism is diagnosed, patients are scheduled for a Sestamibi nuclear medicine scan. Sestamibi is a small protein that is labeled with a safe, radioactive agent that, when injected into the patient, becomes absorbed by the overactive parathyroid gland.
"The radioactive material lights up the tumor, and we use a probe on the neck to detect it," Andrassy said.
In 90 percent of cases, only one gland is affected. "If you take out the one abnormal gland, the other three start working," Andrassy said.
The outpatient surgery takes about 20 minutes, as opposed to 2-3 hours for the traditional parathyroid operation. There are no side effects from the Sestamibi, Andrassy said, and because the neck isn't being fully exposed, the procedure is much safer, with fewer complications.
Hamilton recommends that surgical patients follow up with an endocrinologist one or two days after the procedure for a blood test to analyze calcium levels.
"If you remove the adenoma, the calcium level usually comes down within hours," Hamilton said. "The parathyroid disease is cured."
If left untreated, patients can develop brittle bones, kidney stones, pancreatitis and/or peptic ulcer disease, as well as non-specific symptoms such as muscle weakness and memory impairment, Hamilton said.
For information or to refer a patient, call UT Physicians at 1-888-4-UT-DOCS.
UPDATED: 11-15-2004
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Dr. Richard Andrassy is chairman of the Department of Surgery at the UT Medical School.
See Dr. Andrassy also at:
Dr. Carlos Hamilton is an endocrinologist and professor in the Department of Internal Medicine at UT Medical School.
See Dr. Hamilton also at:
Microwaves and 'Erupted Hot Water Phenomena'
Hot-water eruption can occur if you use a microwave oven to super-heat water in a clean cup. ("Super-heated" means the water is hot beyond boiling temperature, although it shows no signs of boiling.)
A slight disturbance or movement may cause the water to violently explode out of the cup. There have been reports of serious skin burns or scalding injuries around people's hands and faces as a result of this phenomenon.
Adding materials such as instant coffee or sugar to the water before heating greatly reduces the risk of hot-water eruption. Also, follow the precautions and recommendations found in microwave oven instruction manuals; specifically the heating time.
