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Long term results of total parathyroidectomy/autotransplantation without cryopreservation in secondary hyperparathyroidism

Year 2018, Volume: 43 Number: Supplement 1, 129 - 138, 29.12.2018
https://doi.org/10.17826/cumj.398492

Abstract

Purpose: The aim of this study was to compare the efficacy and early-late results of subtotal parathyroidectomy and total parathyroidectomy/auto transplantation without cryopreservation conducted on cases with secondary hyperparathyroidism (HPT). 

Materials and Methods: 68 patients with secondary HPT who had parathyroidectomy were analysed retrospectively. In group1 (n=47) subtotal parathyroidectomy, in group2 (n=21) total parathyroidectomy/auto transplantation without cryopreservation were performed in our clinic. Patients' demographic characteristics and clinical features were evaluated.  

Results: In group1 8 patients (14.9%), in group2 17 patients (76.2%) had concurrent thymectomies. The rates of persistant HPT in group1 and group2 were 14.9% (n=7), 4.8% (n=1) respectively. In group2 no recurrent HPT was seen, in group2 10.6% (n=5) of the patients had recurrent HPT. The reasons of  persistent and recurrent HPT were ectopic or supernumerary glands in 69.2% (n=9) of the patients.  

Conclusion: In patients with end stage renal failure and secondary HPT, bilateral cervical thymectomy concurrent with total parathyroidectomy/auto transplantation without cryopreservation can be applied as a safe and efficient surgical procedure.


References

  • 1. Walker MD, Silverberg SJ.Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-125.
  • 2. Hörl WH. The clinical consequences of secondary hyperparathyroidism: Focus on clinical outcomes. Nephrol. Dial. Transplant (2004);19 [Suppl 5]: v2–v8.
  • 3. Bellorin-Font E, Ambrosoni P, Carlini RG et al. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults. Nefrologia 2013; 33: 1–28.
  • 4. Palmer SC, Nistor I, Craig JC et al. Cinacalcet in patients with chronic kidney disease: A cumulative meta-analysis of randomized controlled trials. PLoS Med. 2013; 10 e1001436.
  • 5. Neagoe RM, Muresan M, Voidazan S, et al. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplant in secondary hyperparathyroidism: a single-centre prospective cohort of 43 patients. Endokrynol Pol 2016;67:202–9.
  • 6. Komaba H, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Fukagawa M. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int. 2015; 88: 350–9.
  • 7. F. Albuquerque RFC, Carbonara CEM, Martin RCT, Dos Reis LM, do Nascimento CP Júnior, Arap SS, Moysés RMA, Jorgetti V, Montenegro FLM, de Oliveira RB. Parathyroidectomy in patients with chronic kidney disease: Impacts of different techniques on the biochemical and clinical evolution of secondary hyperparathyroidism. Surgery. 2018 Feb;163(2):381-387.
  • 8. Albright F, Bauer W, Ropes M, Aub JC. Studies of calcium and phosphorus metabolism: IV. The Effect of the Parathyroid Hormone. J Clin Invest. 1929 Apr;7(1):139-81.
  • 9. Ivarsson KM, Akaberi S, Isaksson E, et al. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant 2015;30:2027–33.
  • 10. Decker PA, Cohen EP, Doffek KM, Ashley BA, Bienemann ME, Zhu YR, et al. Subtotal parathyroidectomy in renal failure: still needed after all these years. World J Surg 25:708-12, 2001.
  • 11. Tominaga Y, Matsuoka S, Sato T. Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease. Ther Apher Dial. 2005 Feb;9(1):44-7.
  • 12. Stranbury SW, Lumb GA, Niholson WF. Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet 1:793-800, 1960.
  • 13. Alveryd A. Parathyroid glands in thyroid surgery. Acta Chir Scand Suppl 389:1-120, 1968.
  • 14. Spindler A, Paz S, Berman A, Lucero E, Contino N, Penalba A, et al. Muscular strength and bone mineral density in haemodialysis patients. Nephrol Dial Transplant 12:128-32, 1997.
  • 15. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-Year Prospective Study of Primary Hyperparathyroidism with or without Parathyroid Surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55.
  • 16. Meola M, Petrucci I, Cupisti A. Ultrasound in clinical setting of secondary hyperparathyroidism. J Nephrol 2013;26:848–55.
  • 17. Muros MA, Soto JB, Ruiz MJ, Portillo MR, Navarro AR, Guardia MB. Two-phase scintigraphy with technetium 99m–sestamibi in patients with hyperparathyroidism due to chronic renal failure. The American Journal of Surgery 193:438–442, 2007.
  • 18. Yumita S. Intervention for recurrent secondary hyperparathyroidism from a residual parathyroid gland. Nephrol Dial Transplant 18:62-64, 2003.
  • 19. Jorna FH, Jager PL, Lemstra C, Wiggers T, Stegeman CA, Plukker TM. Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism. The American Journal of Surgery 196:13-18, 2008.
  • 20. Profanter C, Wetscher GJ, Gabriel M, Sauper T, Rieger M, Kovacs P, et al. CT-MIBI image fusion: A new preoperative localization technique for primary, recurrent, and persistent hyperparathyroidism. Surgery 135:157-162, 2004.
  • 21. Li JG1, Xiao ZS, Hu XJ, Li Y, Zhang X, Zhang SZ, Shan AQ. Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients. Medicine (Baltimore). 2017 Dec;96(49)
  • 22. Rothmund M, Wagner PK, Schark C. Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: a randomized trial. World J Surg 15:745-750, 1991.
  • 23. Malmaeus J, Akerstrom G, Johansson H, et al. Parathyroid surgery in chronic renal insuficiency. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation in forearm. Actachil-Chant 148:229-238, 1982.
  • 24. Takagi H, Tominaga Y, Uchida K, et al. Subtotal versus total parathyroidectomy with forearm autograft for secondary hyperparathyroidectomy in chronic renal failure. Ann Surg 200:18-23, 1984.
  • 25. Welsh CL, Tylor GW, Cattell WR, Baker LR. Parathyroid surgery in chronic renal failure: Subtotal parathyroidectomy or autotransplantation? Br J Surg 71:591-592, 1984.
  • 26. Chen J, Jia X, Kong X, Wang Z, Cui M, Xu D. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renalhyperparathyroidism: A systematic review and meta-analysis. Nephrology (Carlton). 2017 May;22(5):388-396.
  • 27. Anderson K Jr, Ruel E, Adam MA, Thomas S, Youngwirth L, Stang MT, Scheri RP, Roman SA, Sosa JA. Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes. Am J Surg. 2017 Nov; 214(5):914-919.
  • 28. Li C, Lv L, Wang H, Wang X, Yu B, Xu Y, Zhou X, Zhou Y.Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail. 2017 Nov;39(1):678-687.
  • 29. Schlosser K, Bartsch DK, Diener MK, Seiler CM, Bruckner T, Nies C, Meyer M, Neudecker J, Goretzki PE, Glockzin G, Konopke R, Rothmund M. Total Parathyroidectomy With Routine Thymectomy and Autotransplantation Versus TotalParathyroidectomy Alone for Secondary Hyperparathyroidism: Results of a Nonconfirmatory Multicenter Prospective Randomized Controlled Pilot Trial. Ann Surg. 2016 Nov;264(5):745-753.
  • 30. Konturek A, Barczyński M, Stopa M, Nowak W. Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgicaloutcome study. Langenbecks Arch Surg. 2016 Nov;401(7):965-974.
  • 31. Delmonico FL, Wang CA, Rubin NT, et al. Parathyroid surgery in patients with renal failure. Ann Surg 200:644-647, 1984.
  • 32. Brossard JH, Cloutier M, Roy L, Lepage R, Gascon-Barre M, D’Amour P. Accumulation of a non-(1-84) molecular from of parathyroid hormone (PTH) detected by intact PTH assay in renal failure and importance in the interpretation of PTH values. J Clin Endocrinol Metab 81:3923-3929, 1996.
  • 33. Akerstrom G, Malmaeus J, Bergstrom R Surgical anatomy of human parathyroid glands. Surgery 95:14, 1984.
  • 34. Linch DC, Watson LC,Cowie AG. Ectopic parathyroid adenomas. J R Soc Med 73:638-640, 1980.
  • 35. Tominaga Y, Numano M, Tanaka Y, Uchida K, Takagi H: Surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 13:87-96, 1997.
  • 36. Henry JF, Denizot A, Audiffret J, France G. Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients. World J Surg 14:303-306, 1990.
  • 37. Kinnaert P, Nagy N, coster-Gervy C, De PL, Salmon I, Vereerstraeten P. Persistent hyperparathyroidism requiring surgical treatment after kidney transplantation. World J Surg 24:1391-1395, 2000.
  • 38. Cattan P, Halimi B, Aidan K, et al. Reoperation for secondary uremic hyperparathyroidism: are technical difficulties influenced by initial surgical procedure? Surgery 127:562-565, 2000.
  • 39. Gasparri G, Camandona M, Abbona GC, Papotti M, Jeantet A, Radice E, et al. Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg 233:65-69, 2001.
  • 40. Jorna FH, Jager PL, Lemstra C, Wiggers T, Stegeman CA, Plukker TM. Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism. The American Journal of Surgery 196:13-18, 2008.
  • 41. Daphnis E, Stylianou K, Katsipi I, Stratigis S, Karamitopoulou E, Karkavitsas N, Kyriazis J.Parathyromatosis and the challenge of treatment. Am J Kidney Dis 48:502-505, 2006.
  • 42. Edis AJ, Levitt MD. Supernumerary parathyroid glands: implications for the surgical treatment of secondary hyperparathyroidism. World J Surg 11:398-401, 1987.
  • 43. Wells SA, Grunnels J, Caulie S, Schneider JO, Arthur B, Sherwood L. Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78:34-44, 1975.
  • 44. Carter WB, Crowell SL,Boswell CA, Williams SK. Stimulation of angiogenesis by canine parathyroid tissue. Surgery 120:1089-1094, 1996.

Sekonder hiperparatiroidizm olgularında kriyoprezervasyonsuz total paratiroidektomi/önkol ototransplantasyon tekniğinin uzun dönem sonuçları

Year 2018, Volume: 43 Number: Supplement 1, 129 - 138, 29.12.2018
https://doi.org/10.17826/cumj.398492

Abstract

Amaç: Bu çalışmada, kliniğimizde sekonder hiperparatiroidizm (HPT) olgularına uygulanan subtotal paratiroidektomi ve kriyoprezervasyonsuz total paratiroidektomi ve ototransplantasyon cerrahi yöntemlerinin erken ve geç dönem sonuçları ve etkinliklerinin karşılaştırılması amaçlanmıştır.

Gereç ve Yöntem: Çalışmaya paratiroidektomi yapılan 68 sekonder HPT hastası dahil edildi ve hastalar retrospektif olarak değerlendirildi. Subtotal paratiroidektomi yapılan hastalar grup 1 (n=47) olarak, total paratiroidektomi ve ototransplantasyon yapılan hastalar grup 2 (n=21) olarak sınıflandırıldı. Hastaların demografik ve klinik özellikleri değerlendirildi.

Bulgular: Ameliyatta, grup 1’de 8 hastaya (%14.9), grup 2’de 17 hastaya (%76.2) eş zamanlı timektomi yapıldı. Grup 1’de görülen persistan hiperparatiroidi (HPT) oranı %14.9 (n=7) iken, grup 2’de %4.8 (n=1) idi. Rekürren HPT grup 2’de görülmezken, grup 1’de %10.6 oranında (n=5) görüldü. Tüm hastalar değerlendirildiğinde, persistan veya rekürren HPT gelişen hastaların %69.2’sinde (n=9) neden, ektopik veya süpernumara bez varlığıydı.

Sonuç: Son dönem böbrek yetmezlikli sekonder HPT tanılı hastalara, bilateral servikal timektominin eklendiği, kriyoprezervasyonsuz total paratiroidektomi ve ototransplantasyon tekniği, güvenli ve etkili bir cerrahi seçenek olarak uygulanabilir.


References

  • 1. Walker MD, Silverberg SJ.Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-125.
  • 2. Hörl WH. The clinical consequences of secondary hyperparathyroidism: Focus on clinical outcomes. Nephrol. Dial. Transplant (2004);19 [Suppl 5]: v2–v8.
  • 3. Bellorin-Font E, Ambrosoni P, Carlini RG et al. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults. Nefrologia 2013; 33: 1–28.
  • 4. Palmer SC, Nistor I, Craig JC et al. Cinacalcet in patients with chronic kidney disease: A cumulative meta-analysis of randomized controlled trials. PLoS Med. 2013; 10 e1001436.
  • 5. Neagoe RM, Muresan M, Voidazan S, et al. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplant in secondary hyperparathyroidism: a single-centre prospective cohort of 43 patients. Endokrynol Pol 2016;67:202–9.
  • 6. Komaba H, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Fukagawa M. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int. 2015; 88: 350–9.
  • 7. F. Albuquerque RFC, Carbonara CEM, Martin RCT, Dos Reis LM, do Nascimento CP Júnior, Arap SS, Moysés RMA, Jorgetti V, Montenegro FLM, de Oliveira RB. Parathyroidectomy in patients with chronic kidney disease: Impacts of different techniques on the biochemical and clinical evolution of secondary hyperparathyroidism. Surgery. 2018 Feb;163(2):381-387.
  • 8. Albright F, Bauer W, Ropes M, Aub JC. Studies of calcium and phosphorus metabolism: IV. The Effect of the Parathyroid Hormone. J Clin Invest. 1929 Apr;7(1):139-81.
  • 9. Ivarsson KM, Akaberi S, Isaksson E, et al. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant 2015;30:2027–33.
  • 10. Decker PA, Cohen EP, Doffek KM, Ashley BA, Bienemann ME, Zhu YR, et al. Subtotal parathyroidectomy in renal failure: still needed after all these years. World J Surg 25:708-12, 2001.
  • 11. Tominaga Y, Matsuoka S, Sato T. Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease. Ther Apher Dial. 2005 Feb;9(1):44-7.
  • 12. Stranbury SW, Lumb GA, Niholson WF. Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet 1:793-800, 1960.
  • 13. Alveryd A. Parathyroid glands in thyroid surgery. Acta Chir Scand Suppl 389:1-120, 1968.
  • 14. Spindler A, Paz S, Berman A, Lucero E, Contino N, Penalba A, et al. Muscular strength and bone mineral density in haemodialysis patients. Nephrol Dial Transplant 12:128-32, 1997.
  • 15. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-Year Prospective Study of Primary Hyperparathyroidism with or without Parathyroid Surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55.
  • 16. Meola M, Petrucci I, Cupisti A. Ultrasound in clinical setting of secondary hyperparathyroidism. J Nephrol 2013;26:848–55.
  • 17. Muros MA, Soto JB, Ruiz MJ, Portillo MR, Navarro AR, Guardia MB. Two-phase scintigraphy with technetium 99m–sestamibi in patients with hyperparathyroidism due to chronic renal failure. The American Journal of Surgery 193:438–442, 2007.
  • 18. Yumita S. Intervention for recurrent secondary hyperparathyroidism from a residual parathyroid gland. Nephrol Dial Transplant 18:62-64, 2003.
  • 19. Jorna FH, Jager PL, Lemstra C, Wiggers T, Stegeman CA, Plukker TM. Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism. The American Journal of Surgery 196:13-18, 2008.
  • 20. Profanter C, Wetscher GJ, Gabriel M, Sauper T, Rieger M, Kovacs P, et al. CT-MIBI image fusion: A new preoperative localization technique for primary, recurrent, and persistent hyperparathyroidism. Surgery 135:157-162, 2004.
  • 21. Li JG1, Xiao ZS, Hu XJ, Li Y, Zhang X, Zhang SZ, Shan AQ. Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients. Medicine (Baltimore). 2017 Dec;96(49)
  • 22. Rothmund M, Wagner PK, Schark C. Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: a randomized trial. World J Surg 15:745-750, 1991.
  • 23. Malmaeus J, Akerstrom G, Johansson H, et al. Parathyroid surgery in chronic renal insuficiency. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation in forearm. Actachil-Chant 148:229-238, 1982.
  • 24. Takagi H, Tominaga Y, Uchida K, et al. Subtotal versus total parathyroidectomy with forearm autograft for secondary hyperparathyroidectomy in chronic renal failure. Ann Surg 200:18-23, 1984.
  • 25. Welsh CL, Tylor GW, Cattell WR, Baker LR. Parathyroid surgery in chronic renal failure: Subtotal parathyroidectomy or autotransplantation? Br J Surg 71:591-592, 1984.
  • 26. Chen J, Jia X, Kong X, Wang Z, Cui M, Xu D. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renalhyperparathyroidism: A systematic review and meta-analysis. Nephrology (Carlton). 2017 May;22(5):388-396.
  • 27. Anderson K Jr, Ruel E, Adam MA, Thomas S, Youngwirth L, Stang MT, Scheri RP, Roman SA, Sosa JA. Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes. Am J Surg. 2017 Nov; 214(5):914-919.
  • 28. Li C, Lv L, Wang H, Wang X, Yu B, Xu Y, Zhou X, Zhou Y.Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail. 2017 Nov;39(1):678-687.
  • 29. Schlosser K, Bartsch DK, Diener MK, Seiler CM, Bruckner T, Nies C, Meyer M, Neudecker J, Goretzki PE, Glockzin G, Konopke R, Rothmund M. Total Parathyroidectomy With Routine Thymectomy and Autotransplantation Versus TotalParathyroidectomy Alone for Secondary Hyperparathyroidism: Results of a Nonconfirmatory Multicenter Prospective Randomized Controlled Pilot Trial. Ann Surg. 2016 Nov;264(5):745-753.
  • 30. Konturek A, Barczyński M, Stopa M, Nowak W. Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgicaloutcome study. Langenbecks Arch Surg. 2016 Nov;401(7):965-974.
  • 31. Delmonico FL, Wang CA, Rubin NT, et al. Parathyroid surgery in patients with renal failure. Ann Surg 200:644-647, 1984.
  • 32. Brossard JH, Cloutier M, Roy L, Lepage R, Gascon-Barre M, D’Amour P. Accumulation of a non-(1-84) molecular from of parathyroid hormone (PTH) detected by intact PTH assay in renal failure and importance in the interpretation of PTH values. J Clin Endocrinol Metab 81:3923-3929, 1996.
  • 33. Akerstrom G, Malmaeus J, Bergstrom R Surgical anatomy of human parathyroid glands. Surgery 95:14, 1984.
  • 34. Linch DC, Watson LC,Cowie AG. Ectopic parathyroid adenomas. J R Soc Med 73:638-640, 1980.
  • 35. Tominaga Y, Numano M, Tanaka Y, Uchida K, Takagi H: Surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 13:87-96, 1997.
  • 36. Henry JF, Denizot A, Audiffret J, France G. Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients. World J Surg 14:303-306, 1990.
  • 37. Kinnaert P, Nagy N, coster-Gervy C, De PL, Salmon I, Vereerstraeten P. Persistent hyperparathyroidism requiring surgical treatment after kidney transplantation. World J Surg 24:1391-1395, 2000.
  • 38. Cattan P, Halimi B, Aidan K, et al. Reoperation for secondary uremic hyperparathyroidism: are technical difficulties influenced by initial surgical procedure? Surgery 127:562-565, 2000.
  • 39. Gasparri G, Camandona M, Abbona GC, Papotti M, Jeantet A, Radice E, et al. Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg 233:65-69, 2001.
  • 40. Jorna FH, Jager PL, Lemstra C, Wiggers T, Stegeman CA, Plukker TM. Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism. The American Journal of Surgery 196:13-18, 2008.
  • 41. Daphnis E, Stylianou K, Katsipi I, Stratigis S, Karamitopoulou E, Karkavitsas N, Kyriazis J.Parathyromatosis and the challenge of treatment. Am J Kidney Dis 48:502-505, 2006.
  • 42. Edis AJ, Levitt MD. Supernumerary parathyroid glands: implications for the surgical treatment of secondary hyperparathyroidism. World J Surg 11:398-401, 1987.
  • 43. Wells SA, Grunnels J, Caulie S, Schneider JO, Arthur B, Sherwood L. Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78:34-44, 1975.
  • 44. Carter WB, Crowell SL,Boswell CA, Williams SK. Stimulation of angiogenesis by canine parathyroid tissue. Surgery 120:1089-1094, 1996.
There are 44 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research
Authors

Tevfik Avcı 0000-0001-5225-959X

Feza Yarbuğ Karakayalı This is me 0000-0002-1874-947X

Hakan Yabanoğlu 0000-0002-1161-3369

Gökhan Moray This is me 0000-0003-2498-7287

Publication Date December 29, 2018
Acceptance Date July 5, 2018
Published in Issue Year 2018 Volume: 43 Number: Supplement 1

Cite

MLA Avcı, Tevfik et al. “Sekonder Hiperparatiroidizm olgularında Kriyoprezervasyonsuz Total paratiroidektomi/önkol Ototransplantasyon tekniğinin Uzun dönem sonuçları”. Cukurova Medical Journal, vol. 43, no. Ek 1, 2018, pp. 129-38, doi:10.17826/cumj.398492.