Intravital methylene blue staining of parathyroid glands and tumours

Previous intravital staining techniques for parathyroid localisation have met with variable success and complications. Modification of these techniques, employing a more consistent dose, combined with a prolonged infusion time has provided more uniform staining of normal and abnormal parathyroid tissue, other tissues showing little or no colour change. Locally induced oedema, not previously described, was found to be a great asset in the dissection of glands. In 38 of 40 patients (95%), 4 glands were demonstrated and in the remaining 2 cases, only 3 glands appeared to be present. One case alone has required reoperation, due to the presence of a fifth gland. Intra-thyroid and intra-thymic tumours were found easily, as was glandular tissue split accidentally. Apart from slight nausea in one patient, there were no complications attributable to the dye, in the series which included 12 patients with chronic renal failure. Uniformly normal postoperative serum calcium levels indicated the accuracy of the method. The technique is safe, inexpensive and easily reproducible, and would seem to have many advantages over other methods of tumour localisation.