{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:30:48Z","timestamp":1790184648740,"version":"4.1.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"954","license":[{"start":{"date-parts":[[2005,4,1]],"date-time":"2005-04-01T00:00:00Z","timestamp":1112313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The optimal surgical management of patients in end stage chronic renal failure with secondary hyperparathyroidism is controversial. One approach advocated is four gland parathyroidectomy without reimplantation. The aim of this study was to review the medium term results of this procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Fifty four consecutive patients with end stage chronic renal failure and secondary hyperparathyroidism who had a four gland parathyroidectomy without reimplantation were studied. The procedure was performed by a single surgeon with a median (range) follow up of 29 (0\u201370) months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Most patients (76%) developed postoperative hypocalcaemia but this was easily treated and doses of long term drugs necessary to prevent this were low. Pre-operative bone symptoms, hypercalcaemia, hyperphosphataemia, and an increased alkaline phosphatase were improved or resolved in most patients. Thirteen (24%) patients had an undetectable postoperative parathyroid hormone (PTH), (6 of 12 (50%) with a functioning renal transplant and 7 of 42 (17%) who required dialysis, p\u200a=\u200a0.02). Median (range) postoperative PTH values in these groups were 0.1 (0.1\u201331) compared with 1.0 (0.1\u201324) pmol\/l (p\u200a=\u200a0.085) respectively. The remaining 41 of 54 (76%) patients had residual PTH secretion and postoperative hyperparathyroidism was identified in eight (15%) patients with only two requiring neck re-exploration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Four gland parathyroidectomy without reimplantation produced good medium term biochemical and clinical results. Most patients had minor residual PTH secretion that may contribute to this and mitigate concerns regarding adynamic bone disease. Endogenous PTH secretion is only completely lost in a few patients but occurs more often in those with a functioning renal transplant. Bone densitometry is required to investigate the long term impact of this procedure.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/pgmj.2004.026450","type":"journal-article","created":{"date-parts":[[2005,4,5]],"date-time":"2005-04-05T18:14:14Z","timestamp":1112724854000},"page":"255-258","source":"Crossref","is-referenced-by-count":40,"title":["Four gland parathyroidectomy without reimplantation in patients with chronic renal failure"],"prefix":"10.1093","volume":"81","author":[{"given":"R N","family":"Saunders","sequence":"first","affiliation":[{"name":"Department of Surgery, Leicester General Hospital , Leicester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Karoo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leicester General Hospital , Leicester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M S","family":"Metcalfe","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leicester General Hospital , Leicester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M L","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leicester General Hospital , Leicester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2005,4,5]]},"reference":[{"key":"2023042408261001100_R1","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1159\/000046084","volume":"89","author":"Cohen","year":"2001","journal-title":"Nephron"},{"key":"2023042408261001100_R2","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1056\/NEJM200003023420901","article-title":"Improved graft survival after renal transplantation in the United States, 1988 to 1996","volume":"342","author":"Hariharan","year":"2000","journal-title":"N Engl J Med"},{"key":"2023042408261001100_R3","first-page":"97","article-title":"Parathyroidectomy for hyperparathyroidism associated with renal disease","volume":"77","author":"O\u2019Leary","year":"1995","journal-title":"Ann R Coll Surg Engl"},{"key":"2023042408261001100_R4","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1681\/ASN.V341008","article-title":"Short and long term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in haemodialysis patients","volume":"3","author":"Gagne","year":"1992","journal-title":"J Am Soc Nephrol"},{"key":"2023042408261001100_R5","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/00000658-198603000-00011","article-title":"Vocal cord paralysis and reoperative parathyroidectomy","volume":"203","author":"Patow","year":"1986","journal-title":"Ann Surg"},{"key":"2023042408261001100_R6","first-page":"548","article-title":"Tumour like growth of parathyroid autografts in uraemic patients","volume":"18","author":"Freid","year":"1981","journal-title":"Proc Eur Dialy Transplant Assoc"},{"key":"2023042408261001100_R7","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.1365-2559.1988.tb02040.x","article-title":"Fate of long term parathyroid autografts in patients with chronic renal failure treated by parathyroidectomy: a histopathological study of autografts, parathyroid glands and bone","volume":"13","author":"Ellis","year":"1988","journal-title":"Histopathology"},{"key":"2023042408261001100_R8","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1136\/bmj.4.5575.331","article-title":"Total parathyroidectomy in treatment of secondary (renal) hyperparathyroidism","volume":"ii","author":"Ogg","year":"1967","journal-title":"BMJ"},{"key":"2023042408261001100_R9","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/00000658-197603000-00010","article-title":"The anatomic basis of parathyroid surgery","volume":"183","author":"Wang","year":"1976","journal-title":"Ann Surg"},{"key":"2023042408261001100_R10","doi-asserted-by":"crossref","first-page":"34","DOI":"10.7326\/0003-4819-96-1-34","article-title":"Osteomalacia after parathyroidectomy in patients with uraemia","volume":"96","author":"Felsenfeld","year":"1992","journal-title":"Ann Intern Med"},{"key":"2023042408261001100_R11","first-page":"137","article-title":"The role of the lack of parathyroid hormone in the pathogenesis of uraemic low turnover osteomalacia","volume":"21","author":"Malluche","year":"1982","journal-title":"Kid Int"},{"key":"2023042408261001100_R12","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1038\/ki.1993.323","article-title":"Aplastic osteodystrophy without aluminium. 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