Abstract：
BACKGROUND:Recurrent renal hyperparathyroidism (HPT) is a serious problem after parathyroidectomy (PTx). We evaluated the frequency of graft-dependent recurrent HPT and the clinical outcomes after removal of the autograft. METHODS:Between March 1980 and January 2009, 2660 patients underwent total PTx with forearm autograft. After resection of all parathyroid glands, 30 pieces of 1 x 1 x 3 mm parathyroid tissue from diffuse hyperplasia, if possible, were autografted into brachioradial muscle. Graft-dependent recurrence of HPT was diagnosed by a high PTH gradient and detection of swollen autografts by palpation and/or MRI or US. RESULTS:In 248/2660 (9.3%) patients, removal of the graft was required a total of 327 times (53 patients required removal of the autograft several times). The cumulative frequency of graft-dependent recurrent HPT was 17.4% ten years after the initial PTx. Thirty-two patients underwent both resection of missed glands located in the neck or mediastinum and removal of the graft. En-bloc resection of autograft with surrounding muscle was required to avoid reoperation. When the intact PTH level dropped under 300 pg/ml, in the majority of patients renal HPT could be medically managed after the operation. The mean weight of the resected parathyroid tissue was 1583.7 mg. No specimen had histopathologically malignant features. Three patients suffered from hematoma in the wound. CONCLUSIONS:Graft-dependent recurrent renal HPT is not negligible. However, in the majority of patients, renal HPT can be controlled by removal of the autograft noninvasively. Total PTx with forearm autograft is preferable for hemodialysis patients, especially when long-term survival is expected.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Tominaga Y,Matsuoka S,Uno N,Tsuzuki T,Hiramitsu T,Goto N,Nagasaka T,Watarai Y,Uchida Kdoi
10.1007/s00268-010-0412-9subject
Has Abstractpub_date
2010-06-01 00:00:00pages
1312-7issue
6eissn
0364-2313issn
1432-2323journal_volume
34pub_type
杂志文章abstract：PURPOSE:Restorative surgery for rectal cancer is usually criticized by its functional outcomes. The aim of this study is to assess the efficacy "taeniectomy" pouch in comparison with transverse coloplasty pouch. STUDY DESIGN:This was a prospective controlled study. Most patients who were candidate for low rectal resec...
journal_title：World journal of surgery
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journal_title：World journal of surgery
pub_type： 杂志文章,评审
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pub_type： 杂志文章
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pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期：1997-01-01 00:00:00
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pub_type： 杂志文章
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更新日期：2021-03-01 00:00:00
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pub_type： 杂志文章,meta分析,评审
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journal_title：World journal of surgery
pub_type： 杂志文章
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journal_title：World journal of surgery
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更新日期：2007-06-01 00:00:00
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journal_title：World journal of surgery
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journal_title：World journal of surgery
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journal_title：World journal of surgery
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