Subtotal parathyroidectomy for secondary hyperparathyroidism in chronic renal failure.

Twenty-seven patients on chronic haemodialysis and with secondary hyperparathyroidism underwent subtotal parathyroidectomy during the period 1985-1989. The operation was indicated by severe clinical symptoms and evidence of radiological abnormalities not responsive to conservative treatment (low phosphorus diet, phosphate binding substances, oral calcium and vitamin D). If despite intensive medical management, inadequate control of parathyroid hyperplasia continues surgical intervention becomes necessary. Ultra-sonography was performed pre-operatively in all 27 cases and detected 42 of 99 glands (42.5 per cent). Also scintigraphy was carried out in every patient but it gave a relatively low detection rate (24.5 per cent). Surgery was followed by improvement in 20 patients and progression of hyperparathyroidism in seven cases. Three of the seven patients failed to improve after subtotal parathyroidectomy, necessitating a re-intervention; the remaining four responded sufficiently to medical therapy. From our experience we conclude that subtotal parathyroidectomy for renal hyperparathyroidism is recommended.

Bone changes in end-stage oxalosis.

Primary hyperoxaluria is a rare metabolic disease characterized by exaggerated production of oxalic acid. Clinically the disease is characterized by recurrent calcium nephrolithiasis, progressive renal failure, and early death in uremia. As the regular dialysis treatment may prolong survival, a new syndrome may develop. This is due to intense and continuous deposition of calcium oxalate crystals in soft and bone tissues. The radiologic aspects of oxalate deposition in four adult patients on chronic renal dialysis with histologic and clinical evidence of massive bone oxalosis are reported.