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Chirurgia 1999 August;12(4):267-70

language: Italian

Causes of recurrence evaluated in 466 patients operated on for secondary hyperparathyroidism

Gasparri G., Camandona M., Abbona G. C., Papotti M., Jeantet A., Radice E., Mullineris B., Dei Poli M.


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Methods. The purpose of this study is the critical evaluation of the causes of failure in the surgical treatment of the secondary and tertiary HPT due to surgical strategy or histological patterns.
The retrospective investigation was performed on 446 patients operated on for secondary HPT from 1975 until July 1998. They were studied in relationship to the type of intervention and to the possibility of a renal transplantation. In this population two homogeneous groups were subsequently identified, one of 23 patients with clear signs of recurrence and a second one of 27 patients apparently cured; they were studied particularly from the histological and immunohistochemical point of view using Ki-67 antigen.
Results. The results were similar as to regression of osteodistrophy, of itch, of ectopic calcifications, for Subtotal Ptx, Total Ptx with AT and the Total. The last intervention, as predictable, has presented a higher incidence of hypoparathyroidism. The percentage of recurrence was between 5 and 8%; only after incomplete Ptx this percentage climbed reached 34.7%.
In the group of recurrence the nodular aspect was more frequently present and the proliferative fraction detected by Ki-67 was 1.9%, while it was 0.81% in the controls, a statistically meaningful difference (p= 0.001).
Conclusions. In conclusion one could observe that histological patterns and proliferative fraction could be real indexes of a recurrence and these patients should be checked with more accuracy in the postoperative period.

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