{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:07:55Z","timestamp":1764173275143,"version":"3.32.0"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[1992,7,1]],"date-time":"1992-07-01T00:00:00Z","timestamp":709948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[1992,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Hypercalcemia was corrected in 62 (90%) of 69 patients after re\u2010operation for primary hyperparathyroidism during a mean follow\u2010up of 6.3 years. Failed primary exploration was mainly due to inadequate visualization of the pathological parathyroid glands, often in association with misleading or absent peroperative histology. Other causes included seeding of parathyroid adenoma tissue, truly recurrent adenomas, and recurrent hyperplasia, especially in patients with multiple endocrine neoplasia type 1. A considerable number of parathyroid glands missed at the primary operations were subsequently found in essentially normal positions. Ectopic superior glands were most frequently positioned para\u2010esophageally or retro\u2010esophageally, while abnormally placed inferior glands were generally situated within or close to the thymus. Glands in 3 patients were dissected from around the large vessels in the mediastinum. Concomitant thyroid procedures during the primary operation yielded few abnormal parathyroids and made the re\u2010exploration considerably more difficult. We suggest a semilateral approach and caudal identification of the recurrent laryngeal nerve to reduce the hazards of difficult parathyroid re\u2010operations. Mediastinal exploration may require total removal of the thymus and careful dissection of the middle mediastinum.<\/jats:p>","DOI":"10.1007\/bf02067321","type":"journal-article","created":{"date-parts":[[2005,8,13]],"date-time":"2005-08-13T21:45:46Z","timestamp":1123969546000},"page":"562-568","source":"Crossref","is-referenced-by-count":60,"title":["Causes of failed primary exploration and technical aspects of re\u2010operation in primary hyperparathyroidism"],"prefix":"10.1002","volume":"16","author":[{"given":"G.","family":"\u00c5kerstr\u00f6m","sequence":"first","affiliation":[{"name":"Departments of Surgery and Pathology University Hospital Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Rudberg","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Pathology University Hospital Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Grimelius","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Pathology University Hospital Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Johansson","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Pathology University Hospital Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Lundstr\u00f6m","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Pathology University Hospital Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Rastad","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Pathology University Hospital Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[1992,7]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90063-4"},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01655560"},{"key":"e_1_2_1_4_1","first-page":"13","article-title":"Clinical characteristics and surgical treatment of sporadic primary hyperparathyroidism with emphasis on chief cell hyperplasia","volume":"107","author":"Wallfelt C.","year":"1989","journal-title":"Surgery"},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(82)90094-0"},{"key":"e_1_2_1_6_1","first-page":"409","article-title":"Parathyroid surgery in Scandinavia","volume":"154","author":"Malmaeus J.","year":"1988","journal-title":"Acta Chir. 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