الفهرس 
ANATOMY OF PARATHYROID GLANDSOnly 14 pages are availabe for public view
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Abstract
Over 2 years, 30 patients were complaining of hyperparathyroidism 14 patients were secondary transferred from renal ward as cases of renal failure on dialysis, 9 patients tertiary (5 cases were post renal transplant and 4 cases had autonomous nodules. and 7 patients were primary hyperparathyroidism. The most common presentation of PHPT is asymptomatic hypercalcemia (this is the main presentation in the developed countries while renal and or bone disease is the main presentation in the developing countries) detected by routine biochemical screening. All patients evaluated by complete clinical evaluation including personal history, drug intake (e.g. lithium), present history, and family History of MEN type I or type II disease.
General examination including neck examination for any palpable neck swelling ,in addition to breast, abdominal and chest examination clinically by symptoms and signs of hyperparathyroidism, laboratory and radiologicaly by PTH, Calcium, ultrasound, sestaMIBI and C-T for 3 cases not localized by ultrasound or sestaMIBI. Therefore, all efforts should be made to handle the parathyroid glands only by their pedicles and not to crush, suture, or violate the capsule.
Summary
184
Needle aspiration of parathyroid cysts could lead to implantation along the needle tract. We followed the technique of total parathyroidectomy for all cases with autotransplantation of 50-60 mg. (half of parathyroid gland) of the parathyroid tissue. 14 cases in the musculature area of the anticubital region and 16 cases in the pectoral region.
Auto transplantation of the parathyroid glands should be performed whenever the parathyroid is devascularized or damaged by retraction or hematoma. It is essential for every thyroid surgeon to be familiar with the technique of parathyroid auto transplantation. Patients were followed up by PTH and serum Calcium level .28 cases were improved as the symptoms and signs resolved and they succeeded to gain calcium homeostsis for either normal calcium or need less calcium supplementation for renal patients but radiologicaly bony changes for hyperparathyroidism were reversed over 6 months. While there were 2 cases not improved clincaly and laboratory. one case was made total parathyroidectomy with autotransplantaion in the pectoral region. Post operative follow up patient was hypocalcimc for 6 monthes on calcium supplementation and continue due to graft failure. Another patient was made autotransplantation in the anticubital region so, post operative fpllow up shows PTH level was not improved, recurance happened and patient reoperated under local anathesia
Summary
185
by removal of part of the implanted gland and postoperatively improved as the level of PTH droped to normal. So, for all types of hyperparathyroidism we recommend in case of failure of medical treatment to do total parathyroidectomy with autotransplantation either in the pectoral or anticubital mascular area. For calcium homeostasis.