BACKGROUNDDrug treatment for secondary hyperparathyroidism caused by chronic renal failure may be available at the early stage of the disease, but it is not as effective for serious patients. The aim of the study was to evaluate the effect of total parathyroidectomy combined with forearm autotransplantation in the uremic patients with secondary hyperparathyroidism.

METHODSFrom September 1999 through September 2006, parathroidectomy and autotransplantation was performed in 20 patients. The coherence between the results of preoperative parathyroid ultrasonography and surgical exploration were compared. The serum calcium concentration and intact parathyroid hormone (iPTH) were monitored preoperatively, intraoperatively, and postoperatively.

RESULTSA total of 71 hyperplastic parathyroid glands were resected in the 20 patients. The accordance rate of parathyroid localization between B-ultrasonography and intraoperative exploration was 94.4%. The average iPTH value was (110.90 +/- 67.42) ng/L, (433.80 +/- 243.72) ng/L, (48.80 +/- 42.69) ng/L, (229.04 +/- 172.68) ng/L and (232.39 +/- 224.05) ng/L at day 1, 2, 3, 7, 30 after operation respectively. The clinical symptoms were ameliorated and the levels of serum calcium concentration were controlled within the normal range after operation. Recurrent secondary hyperparathyroidism had happened in 1 case, 4 years postoperatively because of the development of autograft hyperplasia, and in another case 2 years postoperatively due to remnant of neck parathyroid glands. The clinical symptoms were all alleviated after re-operation. No surgical complication had occurred in any of the patients.

CONCLUSIONSThe total parathyroidectomy with forearm autotransplantation is feasible, safe, and effective for patients with secondary hyperparathyroidism in the short term. The long-term effects should be further investigated.

Adult ; Aged ; Calcium ; blood ; Female ; Follow-Up Studies ; Forearm ; Humans ; Hyperparathyroidism, Secondary ; blood ; surgery ; Male ; Middle Aged ; Parathyroid Glands ; diagnostic imaging ; transplantation ; Parathyroid Hormone ; blood ; Parathyroidectomy ; methods ; Transplantation, Autologous ; Ultrasonography

Objective To evaluate the difference in Syk expression in different breast lesions, and to study the correlation of expression of Syk in breast cancer with other clinicopathologic markers. Methods Immunohistochemistry was used to detect Syk protein expression in cases of different breast lesions, consisting of 20 cases of fibrocystic disease of the breast 16 cases of ductal intraepithelial neoplasia 2 (DIN2) and 168 cases of breast cancer and 95 specimens of peri-cancer tissue obtained at a distance of 5 cm from the cancer tissue. Concomittantly, ER, PR, p53, HER2/neu were detected in 168 breast cancer tissue with immunohistochemical staining. Results The positive rates of Syk expression were 90.00% (18/20), 50.00%(8/16), 34.52%(58/168) and 78.95%(75/95) respectively in fibrocystic breast disease tissue, DIN2 tissue, breast cancer tissue and peri-cancer tissue. The positive expression rates of Syk were significantly lower in the breast cancer tissue than those in the fibrocystic breast disease tissue (P<0.05) and the peri-cancer tissue (P<0.05); and significantly lower in the DIN2 tissue than those in the fibrocystic breast disease tissue (P<0.05) and the peri-cancer tissue (P<0.05). The correlation between reduction of Syk expression in breast cancer tissue and the other clinicopathologic factors or prognostic markers was not found in our study. Conclusions The positive rates of Syk expression progressively decrease from the fibrocystic disease tissue, peri-cancer tissue, pre-cancer lesion to the cancerous tissue in the breast.