title: [Efficiency of total parathyroidectomy and autotransplantation in 31 patients with uremic hyperparathyroidism].
abstract: OBJECTIVE
  To analyse the efficacy of total parathyroidectomy with autotransplantation (total PTX + AT) in treating uremic secondary hyperparathyroidism and to discuss the relevant medical treatment used.
  
  
  METHODS
  The clinical data of 31 patients with uremic SHPT admitted into our hospital from 1996-2005 were analysed with respect to total PTX + AT.
  
  
  RESULTS
  The period of hemodialysis were for the patients was on the average 9.2 years. There were 22 male and 9 female with an average age of 42.4 (31 - 67) years. The clinical manifestations consisted of osteoarticular pain in 83.9%, fractures in 35.5%, soft tissue and vascular calcification in 45.2% and pruritus in 80.6%. Laboratory examination yielded the following results: haematocrit 0.25 +/- 0.04, serum Ca (2.61 +/- 0.35) mmol/L, serum P (2.14 +/- 0.31) mmol/L, plasma total alkaline phosphatase (AKP) (885 +/- 335) U/L and parathyroid hormone (iPTH) (1811 +/- 879) ng/L (700 - 2500 ng/L). Cervical ultrasonography and/or emission computed tomography showed 2 - 4 hyperplastic glands. All of the patients showed no response to medical treatment including vitamin D. Total PTX + AT was performed on the 31 cases. Clinical symptoms and signs markedly improved after operation in 1 to 2 weeks. However, fracture and ectopic calcification showed no improvement. Plasma iPTH decreased rapidly (< 200 ng/L) postoperatively in 1 to 2 days. Serum Ca and P returned to normal. AKP was corrected in 1 to 3 months.
  
  
  CONCLUSIONS
  Total parathyroidectomy with autotransplantation is an effective treatment for severe uremic secondary hyperparathyroidism patients.
authors.affiliation: Division of Nephrology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
authors.forename: Jian-ming
authors.initials: JM
authors.lastname: Hu
authors.forename: Hong-fei
authors.initials: HF
authors.lastname: Wu
authors.forename: Xiao-yun
authors.initials: XY
authors.lastname: Wang
authors.forename: Xiang-bao
authors.initials: XB
authors.lastname: Yu
authors.forename: Yi-hua
authors.initials: YH
authors.lastname: Zhao
authors.forename: Xia
authors.initials: X
authors.lastname: Shen
authors.forename: Jia
authors.initials: J
authors.lastname: Liu
authors.forename: Bin
authors.initials: B
authors.lastname: Sun
authors.forename: Chang-ying
authors.initials: CY
authors.lastname: Xing
authors.forename: Jun-wei
authors.initials: JW
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D006435:Renal Dialysis; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014511:Uremia / Q000150:complications