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1/3. Pitfalls after total parathyroidectomy and parathyroid autotransplantation in chronic renal failure.

    We have described 4 patients with chronic renal failure receiving regular haemodialysis treatment who underwent total parathyroidectomy with autotransplantation of parathyroid fragments into the forearm musculature for hypercalcaemic hyperparathyroidism. In all, there was an immediate and profound fall in plasma calcium levels. Hypercalcaemia recurred 1-5 years post-operatively and was resistant to resection of the autograft. In 3 cases, thallium-technetium subtraction scanning and multiple venous sampling for estimation of parathyroid hormone levels suggested multiple sites of hypersecretion of parathyroid hormone in the neck. In 1 case, these investigations revealed a mediastinal adenoma which was successfully removed. These cases reinforce previous suggestions that total parathyroidectomy is frequently incomplete and undermine the procedure of total parathyroidectomy with autotransplantation in patients with persisting uraemia.
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ranking = 1
keywords = uraemia
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2/3. Tendon disease and adjacent bone erosion in dialysis patients.

    Six out of 169 patients on maintenance haemodialysis showed spontaneous tendon rupture. In all six, bone erosion had previously been observed at the site of tendon insertion. In a further 13 patients whose tendons had never ruptured, marked bone erosions at the sites of tendon insertions were also observed. Both groups of patients, with tendon rupture and with bone erosion only, showed significantly greater blood alkaline phosphatase and parathyroid hormone levels than all the others. Moreover, osseous radiological findings of hyperparathyroidism were more marked in all these 19 patients than in the others. Bone erosion at the site of tendon insertion may be a true and specific sign of tendon disease in patients with uraemia. Our series shows that it bears a close relationship to hyperparathyroidism, and suggests that tendon disease is a specific sign of severe secondary hyperparathyroidism in patients with uraemia.
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ranking = 2
keywords = uraemia
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3/3. Brown tumour as a complication of secondary hyperparathyroidism in uraemia: a case report.

    A 15-year-old girl who developed "brown tumour" as a complication of secondary hyperparathyroidism while on maintenance haemodialysis therapy is described. parathyroidectomy with implantation of a portion of one parathyroid gland was performed. Recovery of the lesion was noted 6 months after surgery and a ratio of about 1/12 was found when the systemic parathormone level was compared to that obtained from the vein draining the implanted parathyroid tissue. We would like to emphasize that signs and symptoms of secondary hyperparathyroidism should be sought for before complications develop; and if medical therapy is unsuccessful, this type of surgery is a justified option.
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ranking = 4
keywords = uraemia
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