Endocrine Surgeon In Bangalore India-
Dr Adarsh M Patil mbbs ms FALBS (Belgium ) FILHS (Boston University USA)
Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.
He has experience of treating numerous Parathyroid gland surgery patients in Bangalore .
He believes in that Patient safety comes first and strives to provide exceptional service to patients.
Call Now ! –+91- 9972446882
Email- adarsh1982p@gmail.com
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Parathyroid gland surgery in Bangalore India & Cost
Hyperparathyroidism
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Hyperparathyroidism (HPT) refers to hypercalcemia caused by inappropriate parathyroid hormone (PTH) release from the parathyroid glands. Primary HPT results from autonomous release of PTH from parathyroid adenoma or hyperplastic parathyroid glands. Secondary HPT results from a defect in mineral homeostasis (e.g., renal failure), with a compensatory increase in parathyroid function. Tertiary HPT results from the development of autonomous, calcium- insensitive parathyroids after prolonged secondary stimulation (e.g., prolonged renal failure).
Primary HPT
Incidence-
The more common clinical findings-
Differential diagnosis of hypercalcemia
Endocrine Surgeon In Bangalore-
Dr Adarsh M Patil mbbs ms Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.
He has experience of treating numerous Parathyroid gland surgery patients in Bangalore .
He believes in that Patient safety comes first and strives to provide exceptional service to patients.
Call Now ! –+91- 9972446882
Preoperative localization of parathyroid adenomas
is generally not necessary before a careful neck exploration by an experienced endocrine surgeon, as stated by the 1991 National Institutes of Health consensus conference. However, current practice makes use of several techniques to facilitate limited neck exploration to ensure a high success rate and optimal cosmesis in the outpatient setting. These techniques include radio- and/or image-guided exploration (sestamibi- or ultrasound-guided), videoscopic exploration, and intraoperative intact PTH level monitoring (Surgery 1997;122:1107) for Parathyroid gland surgery in Bangalore. The most frequently applied approach is preoperative sestamibi scanning, followed by direct excision of the scan-identified gland and confirmation of cure by intraoperative PTH measurement. This intraoperative test requires the availability of a rapid assay of intact PTH, which confirms the success of the surgery immediately if the PTH level falls more than 50% 10 minutes after the apparent source of PTH has been removed. If the preoperative localization scan is not informative, then the standard full neck exploration is appropriate.
Parathyroidectomy -Parathyroid gland surgery in Bangalore
Endocrine Surgeon In Bangalore-
Dr Adarsh M Patil mbbs ms Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.
He has experience of treating numerous Parathyroid gland surgery patients in Bangalore .
He believes in that Patient safety comes first and strives to provide exceptional service to patients.
Call Now ! –+91- 9972446882
Hypercalcemia from secondary and tertiary HPT
Operative strategy.
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Parathyroid autotransplantation
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Indications for total parathyroidectomy and heterotopic parathyroid autotransplantation include HPT in patients with renal failure, in patients with four-gland parathyroid hyperplasia, and in patients undergoing neckreexploration in which the adenoma is the only remaining parathyroid tissue. The site of parathyroid autotransplantation may be the sternocleidomastoid muscle or the brachioradialis muscle of the patient’s nondominant forearm. Parathyroid grafting into the patient’s forearm is advantageous if recurrent HPT is possible (e.g., MEN type 1 or 2A). If HPT recurs, the hyperplastic parathyroid tissue may be partially excised from the patient’s forearm under local anesthesia for Parathyroid gland surgery in Bangalore .
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Technique. Freshly removed parathyroid gland tissue is cut into fine pieces approximately 1 mm by 1 mm by 2 mm and placed in sterile iced saline. An incision is made in the patient’s nondominant forearm, and separate intramuscular beds are created by spreading the fibers of the brachioradialis with a fine forceps. Approximately four to five pieces are placed in each site, and a total of approximately 100 mg of parathyroid tissue are transplanted. The beds are closed with a silk suture to mark the site of the transplanted tissue. Transplanted parathyroid tissue begins to function within 14 to 21 days of surgery.
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Cryopreservation of parathyroid glands is performed in MEN patients and all patients who may become aparathyroid after repeat exploration. Cryopreservation may be performed by freezing approximately 200 mg of finely cut parathyroid tissue in vials containing 10% dimethyl sulfoxide, 10% autologous serum, and 80% Waymouth medium. Cryopreserved parathyroid tissue can be used for autotransplantation in patients who become aparathyroid or in patients with failure of the initial grafted parathyroid tissue.
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Postoperative hypocalcemia
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Transient hypocalcemia commonly occurs after total thyroidectomy or parathyroidectomy and requires treatment if it is severe (total serum calcium <7.5 mg/dL) or if the patient is symptomatic. Chvostek sign (twitching of the facial muscles when the examiner percusses over the facial nerve anterior to the patient’s ear) is a sign of relative hypocalcemia but is present in up to 15% of the normal population. This sign is not necessarily an indication for calcium replacement.
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Patients with persistent hypocalcemia after total thyroidectomy or after parathyroid autotransplantation can require continued supplementation for 6 to 8 weeks postoperatively. Usually, patients are given calcium carbonate, 500 to 1,000 mg orally 3 times per day, and 1,25-dihydroxyvitamin D3, 0.25 µg orally per day.
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Hypocalcemic tetany is a medical emergency that is treated with rapid intravenous administration of 10% calcium gluconate or calcium chloride until the patient recovers. Specifically, 1 to 2 ampules (10 to 20 mL) of 10% calcium gluconate are given intravenously over 10 minutes, and the dose may be repeated every 15 to 20 minutes, as required. Subsequently, a continuous infusion of 10% calcium gluconate (90 mg elemental calcium/10 mL), 60 mL in 500 mL D5W (1 mg/mL), is initiated at 0.5 to 2.0 mg/kg per hour to maintain the serum calcium at 8 to 9 mg/dL. Patients with severe hypocalcemia also must have correction of hypomagnesemia for Parathyroid gland surgery in Bangalore.
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Parathyroid carcinoma-
is rare and accounts for less than 1% of patients with HPT. Approximately 50% of these patients have a palpable neck mass, and serum calcium levels may exceed 15 mg/dL.
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Surgical treatment is radical local excision of the tumor, surrounding soft tissue, lymph nodes, and ipsilateral thyroid lobe when the disease is recognized preoperatively or intraoperatively. Reoperation is indicated for local recurrence in an attempt to control malignant hypercalcemia.
Patients with parathyroid carcinoma and some patients with benign HPT may develop hyperparathyroid crisis. Symptoms of this acute, sometimes fatal, illness include profound muscular weakness, nausea and vomiting, drowsiness, and confusion. Hypercalcemia (16 to 20 mg/dL) and azotemia are usually present. Ultimate treatment of “parathyroid crisis†isparathyroidectomy; however, hypercalcemia and volume and electrolyte abnormalities should be addressed first. Treatment is warranted for symptoms or a serum calcium level greater than 12 mg/dL. First-line therapy is infusion of 300 to 500 mL per hour of 0.9% sodium chloride (5 to 10 L per day intravenously) to restore intravascular volume and to promote renal excretion of calcium. After urinary output exceeds 100 mL per hour, furosemide (80 to 100 mg intravenously every 2 to 6 hours) may be given to promote further renal sodium and calcium excretion. Thiazide diuretics impair calcium excretion and should be avoided. Hypokalemia and hypomagnesemia are complications of forced saline diuresis and should be corrected. If diuresis alone is unsuccessful in lowering the serum calcium, other calcium-lowering agents may be used. These include the bisphosphonates pamidronate (60 to 90 mg in 1 L 0.9% saline infused over 24 hours) and etidronate (7.5 mg/kg intravenously over 2 to 4 hours daily for 3 days); mithramycin [25 µg/kg intravenously over 4 to 6 hours daily for 3 to 4 days (malignant hypercalcemia only)]; and salmon calcitonin (initial dose, 4 IU/kg subcutaneously or intramuscularly every 12 hours, increasing as necessary to a maximum dose of 8 IU/kg subcutaneously or intramuscularly every 6 hours). Orthophosphate, gallium nitrate, and glucocorticoids also have calcium-lowering effects.
Parathyroid gland surgery in India.
India is one of the best destinations for quality and cost effective Esophageal cancer treatment .
Parathyroid gland surgery in India.
Approximate cost is 90000 to 350000 INR based on type of hospital and patient condition
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Endocrine Surgeon In Bangalore-
Dr Adarsh M Patil mbbs ms Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.
He has experience of treating numerous Parathyroid gland surgery patients in Bangalore .
He believes in that Patient safety comes first and strives to provide exceptional service to patients.
Call Now ! –+91- 9972446882
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