Fukagawa M, Kitaoka M, Kurokawa K
A new intensive and safer protocol for percutaneous ethanol
injection therapy for severe parathyroid hyperplasia
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1813 1996
The authors previously described ethanol ablation of parathyroid glands in
patients with renal failure. Their aim in the present study was to
minimize the amount of ethanol and to prevent the recurrence of
hyperparathyroidism by destroying all glands larger than 1 cm in diameter
by no more than 3 injections in a week. The first injection was done with
70% of calculated gland volume of ethanol and the "minimal volume of
ethanol" was used for the 2nd and 3rd injections in 10 dialysis patients
refractory to pulse calcitriol therapy. PTH levels decreased to less than
200 pg/ml in 8 patients following percutaneous ethanol injection therapy
(PEIT). In the long term, 9 patients maintained PTH levels between 150-200
pg/ml 5 of whom received pulse calcitriol treament. There were no side
effects of neck pain or recurrent laryngeal nerve palsy. The authors state
that PEIT is a safe and effective adjunct therapy in secondary
hyperparathyroidism.
Comment: The previous study described neck pain and transient
recurrent nerve palsy in some patients treated with ethanol injection.
Whether the new protocol is truly superior or the authors are more skilled
in injecting the parathyroid glands by more experience is unclear. The
role of ethanol injection ablations in the management of the general
dialysis population is not known. At the present time it should probably
be reserved for those with refractory hyperparathyroidism who are poor
surgical candidates treated at major medical centers. There may well be
major complications when employed by inexperienced personnel. (James A.
Delmez, M.D., Washington University, St. Louis)
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