Cases with fewer than four parathyroid glands in XXXX with renal hyperparathyroidism at initial parathyroidectomy.

@entity1 @entity5507 @entity3528 @entity86 @entity3243 @entity461
In the surgical treatment of @entity3528 (2HPT) due to @entity5507 , it is considered necessary to remove all parathyroid glands from the neck to prevent persistent and recurrent @entity3243 . However, in some cases fewer than four parathyroid glands can be recognized at initial operation; in the present study, we evaluated the long-term prognosis and estimated surgical strategy in such cases. Between March 1981 and January 1999, 822 @entity1 underwent total parathyroidectomy (PTx) with forearm autograft for advanced 2HPT at the Department of Transplant Surgery of Nagoya Second Red Cross Hospital. In 21 cases (2.6%) fewer than four parathyroid glands were macroscopically found at the initial operation. These cases were followed up and their parathyroid function was evaluated by measurement of intact @entity461 ( @entity461 ). In 20 of the 21 cases three glands were found, in 1 @entity1 only two glands. In 5 of these cases the fourth gland was identified first after postoperative histopathologic evaluation. In all these cases the intact @entity461 level was normalized. In 8 of the remaining 16 cases high @entity461 levels persisted after the initial operation, including 3 @entity1 who underwent neck reexploration. However, in the other 7 @entity1 @entity461 levels dropped within normal range immediately after PTx and a fourth gland has never been recognized. One @entity1 was lost to follow-up. Thus, using our operative strategy, 12 of 822 cases (0.85%) did not develop persistent or recurrent HPT even though only three glands were identified at the operation. To avoid @entity86 , autotransplantation should be performed when fewer than four parathyroid glands are found at the initial operation.
