{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T02:21:00Z","timestamp":1793845260043,"version":"4.6.1"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2007,9,17]],"date-time":"2007-09-17T00:00:00Z","timestamp":1189987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2008,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Objective\u2003<\/jats:bold> Parathyroidectomy (PTx) for high\u2010risk primary hyperparathyroidism (PHPT) patients poses a surgical challenge. We hypothesize that a minimally invasive parathyroidectomy (MIP) under local anaesthesia may minimize the perioperative risks and facilitate easier clinical care than medical treatment for these patients.<\/jats:p><jats:p><jats:bold>Design and patients\u2003<\/jats:bold> We performed a prospective, nonrandomized, controlled study of 33 PHPT patients evaluated as poor general anaesthesia risks. The outline of the diseased parathyroids and the thyroid were mapped by Tc<jats:sup>99m<\/jats:sup> sestamibi scan and focused sonogram. MIPs were performed under local anaesthesia (group 1, 19 patients). Medical treatment with bisphosphonates was continued for patients refusing operation (group 2, 14 patients).<\/jats:p><jats:p><jats:bold>Measurements\u2003<\/jats:bold> Serum Ca, PO<jats:sub>4<\/jats:sub>, and i\u2010PTH were measured the following morning, every 6\u00a0months in the first postoperative year and then yearly for group 1 patients, or every 3\u00a0months for group 2 patients. American Society of Anaesthesiologists (ASA) and New York Heart Association (NYHA) class designations were re\u2010evaluated every 3\u00a0months.<\/jats:p><jats:p><jats:bold>Results\u2003<\/jats:bold> In group 1, there were no operative complications, mortality or recurrent hypercalcaemia during a mean follow\u2010up of 35\u00b75\u00a0months. Group 2 patients had a significantly higher incidence of episodes of hypercalcaemic crisis, deteriorating renal function and weight\u2010bearing bone fractures, while group 1 patients had a higher incidence of improved ASA and NYHA class, better 3\u2010year overall survival rate (83\u00b71%<jats:italic>vs.<\/jats:italic> 60\u00b78%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b7032), and less medical costs.<\/jats:p><jats:p><jats:bold>Conclusion\u2003<\/jats:bold> MIP can be safely performed under local anaesthesia and it facilitates clinical care in high\u2010risk PHPT patients. It is recommended for those selected by image localization.<\/jats:p>","DOI":"10.1111\/j.1365-2265.2007.03076.x","type":"journal-article","created":{"date-parts":[[2007,10,31]],"date-time":"2007-10-31T09:42:15Z","timestamp":1193823735000},"page":"520-528","source":"Crossref","is-referenced-by-count":18,"title":["The management of high\u2010risk patients with primary hyperparathyroidism \u2013 minimally invasive parathyroidectomy <i>vs.<\/i> medical treatment"],"prefix":"10.1111","volume":"68","author":[{"given":"Wen\u2010Liang","family":"Fang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling\u2010Ming","family":"Tseng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jui\u2010Yu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"See\u2010Ying","family":"Chiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Hong","family":"Chou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chew\u2010Wun","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen\u2010Hsen","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,9,17]]},"reference":[{"key":"e_1_2_5_2_2","first-page":"1014","article-title":"Multiple parathyroid adenomas: report of thirty\u2010three cases","volume":"108","author":"Attie J.N.","year":"1990","journal-title":"Surgery"},{"key":"e_1_2_5_3_2","first-page":"511","article-title":"Primary hyperparathyroidism due to solitary adenoma. 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