| 1. |
- Westerdahl, Christina, et al.
(author)
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High frequency of primary hyperaldosteronism among hypertensive patients from a primary care area in Sweden
- 2006
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:3, s. 154-159
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Journal article (peer-reviewed)abstract
- Objective. To search for primary hyperaldosteronism (PHA) among previously known hypertensive patients in primary care, using the aldosterone/renin ratio (ARR), and to evaluate clinical and biochemical characteristics in patients with high or normal ratio. Design. Patient survey study. Setting and subjects. The study population was recruited by written invitation among hypertensive patients in two primary care areas in Sweden. A total of 200 patients met the criteria and were included in the study. Main outcome measures. The ARR was calculated from serum aldosterone and plasma renin concentrations. The cut-off level for ARR was set to 100, as confirmed in 28 healthy subjects. Patients with increased ARR were considered for a confirmatory test, using the fludrocortisone suppression test. Results. Of 200 patients, 50 patients had ARR >100; 26 patients were further evaluated by fludrocortisone suppression test. Seventeen of these patients had an incomplete aldosterone inhibition. Conclusion. In total 17 of 200 evaluated patients (8.5%) had an incomplete suppression with fludrocortisone. This confirms previous reports on a high frequency of PHA. No significant biochemical or clinical differences were found among hypertensive patients with PHA compared with the whole sample.
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| 2. |
- Westerdahl, Christina, et al.
(author)
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Re-evaluation of the fludrocortisone test: duration, NaCl supplementation and cut-off limits for aldosterone
- 2009
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In: Scandinavian Journal of Clinical & Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 69:2, s. 234-241
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Journal article (peer-reviewed)abstract
- Objective. Primary aldosteronism (PA) is the most common form of secondary hypertension. Thus, the aims of this study were: (1) to clarify whether the fludrocortisone suppression test (FST), which confirms autonomous aldosterone secretion, is reliable when carried out during a shorter period of time and (2) to confirm the importance of NaCl supplementation. The cut-off limits already obtained for aldosterone in healthy subjects during the FST were applied in hypertensive patients with a high aldosterone to renin ratio (ARR). Material and methods. The healthy subjects were allocated to three groups. Fludrocortisone was administered 4 times daily over 4 days and sodium chloride was supplemented in 3 different doses. The result was applied in 24 hypertensive patients, in 24 healthy subjects (10 women (23-38 years old) and 14 men (23-58 years old)) and in 24 patients with hypertension and high ARR (16 women (45-74 years old) and 8 men (56-73 years old)). Blood pressure, aldosterone, renin, potassium and sodium were measured. Results. After three days of FST, there was a significant decrease in the serum level of aldosterone in the healthy subjects, regardless of high or low sodium chloride supplementation (p0.001). The decrease in serum aldosterone was significantly less pronounced in patients with PA than in healthy subjects and hypertensive patients without PA (p0.001). The 95th percentile of plasma aldosterone at the end of the test was 225 pmol/L. Conclusions. The FST can be shortened to 3 days and a daily 500 mg NaCl supplementation is sufficient. A cut-off value for aldosterone of 225 pmol/L after 4 days with FST is appropriate.
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| 3. |
- Bergenfelz, Anders, et al.
(author)
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Complications to thyroid surgery : results as reported in a database from a multicenter audit comprising 3,660 patients
- 2008
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In: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 393:5, s. 667-673
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIM: During recent years, more radical surgery for thyroid disease, i.e., total instead of subtotal resection, has been evident. Results following this strategy on national levels are scarce.MATERIALS AND METHODS: From 2004 to 2006, 26 Scandinavian Departments registered 3,660 thyroid operations in a database. Risk factors for complications were analyzed with multiple logistic regression.RESULTS: After thyroidectomy, re-bleeding occurred in 2.1% and was associated with older age (OR 1.04; p < 0.0001) and male gender (OR 1.90; p = 0.014). Postoperative infection occurred in 1.6% and associated with lymph node operation (OR 8.18; p < 0.0001). Postoperative unilateral paresis of the recurrent laryngeal nerve was diagnosed 3.9% and bilateral paresis in 0.2%. Unilateral paresis was associated with older age, intrathoracic goiter, thyreotoxicosis, and if routine laryngoscopy was practiced (OR 1.92; p = 0.0002). After 6 months, the incidence of nerve paresis was 0.97%. After bilateral thyroid surgery (n = 1,648), hypocalcaemia treated with vitamin D analogue occurred in 9.9% of the patients at the first follow-up and in 4.4% after 6 months.CONCLUSION: Complications to thyroid surgery are not uncommon. The high frequency of hypocalcaemia treated with vitamin D after 6 months is a cause of concern.
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| 4. |
- Hagelsteen, Kristine, et al.
(author)
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Faster acquisition of laparoscopic skills in virtual reality with haptic feedback and 3D vision
- 2017
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In: Minimally Invasive Therapy and Allied Technologies. - : Informa UK Limited. - 1364-5706 .- 1365-2931. ; 26:5, s. 269-277
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Journal article (peer-reviewed)abstract
- BACKGROUND: The study investigated whether 3D vision and haptic feedback in combination in a virtual reality environment leads to more efficient learning of laparoscopic skills in novices.MATERIAL AND METHODS: Twenty novices were allocated to two groups. All completed a training course in the LapSim(®) virtual reality trainer consisting of four tasks: 'instrument navigation', 'grasping', 'fine dissection' and 'suturing'. The study group performed with haptic feedback and 3D vision and the control group without. Before and after the LapSim(®) course, the participants' metrics were recorded when tying a laparoscopic knot in the 2D video box trainer Simball(®) Box.RESULTS: The study group completed the training course in 146 (100-291) minutes compared to 215 (175-489) minutes in the control group (p = .002). The number of attempts to reach proficiency was significantly lower. The study group had significantly faster learning of skills in three out of four individual tasks; instrument navigation, grasping and suturing. Using the Simball(®) Box, no difference in laparoscopic knot tying after the LapSim(®) course was noted when comparing the groups.CONCLUSIONS: Laparoscopic training in virtual reality with 3D vision and haptic feedback made training more time efficient and did not negatively affect later video box-performance in 2D. [Formula: see text].
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| 5. |
- Lindblom, Pia, et al.
(author)
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Peripheral effects of PTH are not altered after thyroid surgery in euthyroid patients
- 2001
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In: Hormone Research. - : S. Karger AG. - 0301-0163. ; 56:3-4, s. 105-109
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Journal article (peer-reviewed)abstract
- Background. We have previously found decreased serum levels of both ionized calcium and 1,25(OH)(2)D and an increase in serum phosphate levels at 1 year after hemithyroidectomy. However, basal and stimulated parathyroid hormone (PTH) secretions were not altered. To investigate whether the observed biochemical changes after unilateral thyroid surgery may be due to a relative end-organ resistance to PTH, we studied the peripheral effects of infused hPTH-(1-34) in 6 patients preoperatively and 3 months after hemithyroidectomy. Methods: Serum levels of TSH, FT4 and FT3 were measured pre- and postoperatively. hPTH-(1-34) was infused at 0.9 IU/kg/h during 6 h. Blood samples for analysis of ionized calcium, intact PTH, phosphate, 25(OH)D, 1,25(OH)(2)D and urinary samples for calcium, phosphate and nephrogenous(n)-cAMP analysis were taken at baseline, when the infusion was discontinued after 6 h and at 24 h. Results: Three months after hemithyroidectomy, serum levels of FT3 were decreased and TSH levels increased. Pre- and postoperative hPTH-(1-34) infusions induced increased serum levels of ionized calcium, 1,25(OH)2D, increased urinary excretion of phosphate and elevated n-cAMP levels. The changes in the studied biochemical variables during the hPTH-(1-34) infusions did not differ between the two study occasions. Conclusion: By using a 6-hour hPTH-(1-34) infusion protocol, we have shown that the peripheral PTH effect is not altered by a slight reduction in thyroid hormone levels at 3 months after hemithyroidectomy.
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| 6. |
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| 7. |
- Westerdahl, Christina, et al.
(author)
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Captopril suppression: Limitations for confirmation of primary aldosteronism.
- 2011
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In: Journal of the Renin-Angiotensin-Aldosterone System. - : Hindawi Limited. - 1752-8976 .- 1470-3203. ; 12, s. 326-332
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Journal article (peer-reviewed)abstract
- INTRODUCTION: : The aldosterone/renin ratio (ARR) is the first line screening test for primary aldosteronism (PA). However, in hypertensive patients with an increased ARR, PA needs to be confirmed by other means. METHODS: : A 25 mg oral captopril test was performed in 16 healthy subjects to obtain reference values for aldosterone and ARR at 120 minutes after the test. Subsequently these data were applied to 46 hypertensive patients screened for PA with an increased ARR. RESULTS: : At 120 minutes after the captopril test ARR decreased in healthy subjects within a narrow range, but remained high in patients with PA and in patients with primary hypertension, especially for those with low renin characteristics. At 120 minutes after captopril, the range of ARR in primary hypertensive patients overlapped in 88% of the cases with the range of the ARR in the PA patients. Sensitivity and specificity of basal ARR and ARR after the captopril test to diagnose PA, calculated as receiver operator characteristics, showed an area under the curve of 0.595 for basal ARR and 0.664 for ARR at 120 minutes after the test. CONCLUSION: : The ARR at 120 minutes after the captopril test is only marginally better than basal ARR in diagnosing PA in hypertensive patients screened with an increased ARR. Owing to an overall limited capacity to clearly discriminate PA from primary hypertension, the test could not therefore be recommended for the confirmatory diagnosis of PA.
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| 8. |
- Westerdahl, Christina, et al.
(author)
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Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area.
- 2011
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In: Scandinavian Journal of Primary Health Care. - 0281-3432. ; 29:1, s. 57-62
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Journal article (peer-reviewed)abstract
- Abstract Objective. To evaluate the prevalence of primary aldosteronism (PA) in newly diagnosed and untreated hypertensive patients in primary care using the aldosterone/renin ratio (ARR), and to assess clinical and biochemical characteristics in patients with high and normal ARR. Design. Patient survey study. Setting and subjects. A total of 200 consecutive patients with newly diagnosed and untreated hypertension from six primary health care centres in Sweden were included. Main outcome measures. ARR was calculated from serum aldosterone and plasma renin concentrations. The cut-off level for ARR was 65. Patients with an increased ARR were considered for confirmatory testing with the fludrocortisone suppression test (FST), followed by adrenal computed tomographic radiology (CT) and adrenal venous sampling (AVS). Results. Of 200 patients, 36 patients had an ARR > 65. Of these 36 patients, 11 patients had an incomplete aldosterone inhibition during FST. Three patients were diagnosed with an aldosterone producing adenoma (APA) and eight with bilateral adrenal hyperplasia (BHA). Except for moderately lower level of P-K in patients with an ARR > 65 and in patients with PA, there were no biochemical or clinical differences found among hypertensive patients with PA compared with patients without PA. Conclusion. Eleven of 200 evaluated patients (5.5%) were considered to have PA. The diagnosis of PA should therefore be considered in newly diagnosed hypertensive subjects and screening for the diagnosis is warranted.
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| 9. |
- Albers, Max B., et al.
(author)
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Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias
- 2020
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In: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2443 .- 1435-2451. ; 405:2, s. 137-143
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Journal article (peer-reviewed)abstract
- Purpose: Surgery is recommended for most patients with gastro-entero-pancreatic neuroendocrine neoplasias (GEP-NENs). Rates of complications and perioperative mortality have been reported in few mostly retrospective single-center series, but there has been no detailed analysis on risk factors for perioperative complications and mortality to date. Methods: Data of patients with GEP-NENs operated between January 2015 and September 2018 were retrieved from EUROCRINE©, a European online endocrine surgical quality registry, and analyzed regarding rate and risk factors of surgical complications. Risk factors were assessed by logistic regression. Results: Some 376 patients (211 female, 167 male; age median 63, range 15–89 years) were included. Most NENs were located in the small intestine (SI) (n = 132) or pancreas (n = 111), the rest in the stomach (n = 34), duodenum (n = 30), appendix (n = 30), colon, and rectum (n = 22), or with unknown primary (n = 15). Of the tumors, 320 (85.1%) were well or moderately differentiated, and 147 (39.1%) of the patients had distant metastases at the time of operation. Severe complications (Dindo-Clavien ≥ 3) occurred in 56 (14.9%) patients, and 4 (1.1%) patients died perioperatively. Severe complications were more frequent in surgery for duodenopancreatic NENs (n = 31; 22.0%) compared with SI-NENs (n = 15; 11.4%) (p = 0.014), in patients with lymph node metastases operated with curative aim of surgery (n = 24; 21.4%) versus non-metastasized tumors or palliative surgery (n = 32; 12.1%) (p = 0.020), and in functioning tumors (n = 20; 23.0%) versus non-functioning tumors (n = 30; 13.5%) (p = 0.042). Complication rates were not significantly associated with tumor stage or grade. Conclusions: Severe complications are frequent in GEP-NEN surgery. Besides duodenopancreatic tumor location, curative resection of nodal metastases and functioning tumors are risk factors for complications.
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| 10. |
- Albers, Max B., et al.
(author)
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Sentinel Lymph Node Biopsy in Thyroid Cancer
- 2020
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 44, s. 142-147
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Journal article (peer-reviewed)abstract
- Background: Prophylactic central neck dissection in patients with papillary thyroid carcinoma is controversial. Sentinel node biopsy might be an adjunct to optimize surgical treatment for these patients. Earlier studies reported inconsistent detection rates and diagnostic value of this technique, and the role of sentinel lymph node biopsy in thyroid cancer needs to be established. Patients and methods: During a single-center prospective interventional study between 2010 and 2017, sentinel lymph node biopsy using 99mTc-nanocolloidal albumin tracer was performed on patients undergoing thyroid surgery for suspected thyroid cancer by fine needle aspiration cytology. All eligible patients without clinical lymph node involvement were invited to participate. Central neck dissection was performed on all patients after the detection of sentinel lymph nodes. Results: Ninety-six patients participated in the study. The detection rates of the sentinel node were 67% and 45% by scintigraphy and intraoperative gamma probe, respectively. The detection rate was not associated with Bethesda score, malignancy, or presence of lymph node metastases. Sensitivity, negative predictive value, and accuracy were 80%, 97%, and 98%, respectively, for the sentinel node to represent the status of lymph node metastasis in the central neck compartment. The false negative rate was 20%. Conclusion: Sentinel lymph node biopsy had a low detection rate and only moderate sensitivity in patients with suspected thyroid carcinoma and is not a useful adjunct to surgery in the context of current treatment concepts.
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| 11. |
- Almquist, Martin, et al.
(author)
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Changing biochemical presentation of primary hyperparathyroidism.
- 2010
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In: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2451 .- 1435-2443. ; 395, s. 925-928
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Journal article (peer-reviewed)abstract
- PURPOSE: Patients with primary hyperparathyroidism, pHPT, present with milder symptoms than previously. Some, but not all studies, suggest that this change in clinical pattern also implies lower preoperative parathyroid hormone (PTH) and/or calcium levels and smaller adenomas. This is important since reports indicate that smaller adenomas are more difficult to detect on preoperative imaging, possibly increasing the risk of surgical failure. METHODS: There were 640 patients with histologically confirmed single-gland pHPT identified in a prospectively collected database. Median values of preoperative calcium, PTH, as well as adenoma weight were compared in three different time periods: 1990-1995, 1996-2000, and 2000-2007. Correlation between the preoperative levels of calcium and PTH and adenoma weight was calculated. RESULTS: Preoperative ionized calcium decreased significantly over time (p < 0.001). There was a positive correlation between preoperative PTH and adenoma weight (r = 0.32, p < 0.001). The magnitude of this correlation decreased over time. In women, adenoma weight decreased significantly over time (p = 0.03). Median (25th-75th percentile) adenoma weight in women was 750 (400-1,380) mg, 650 (350-1,205) mg, and 520 (305-1,065) mg in the first, second, and third period, respectively. CONCLUSION: From 1990 to 2007, there was a significant trend to operate pHPT patients with lower preoperative serum ionized calcium levels. In women, the adenoma weight decreased. This trend could potentially lead to decreased sensitivity in preoperative localization procedures.
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| 12. |
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| 13. |
- Almquist, Martin, et al.
(author)
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Prediction of Permanent Hypoparathyroidism after Total Thyroidectomy.
- 2014
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 38:10, s. 2613-2620
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Journal article (peer-reviewed)abstract
- Hypoparathyroidism is a common complication with thyroid surgery. The ability to predict a high risk of permanent hypoparathyroidism is important for individual prognosis and follow-up.
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| 14. |
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| 15. |
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| 16. |
- Bergenfelz, Anders, et al.
(author)
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Impact of autofluorescence for detection of parathyroid glands during thyroidectomy on postoperative parathyroid hormone levels: parallel multicentre randomized clinical trial
- 2023
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In: The British journal of surgery. - 1365-2168 .- 0007-1323. ; 110:12, s. 1824-1833
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Journal article (peer-reviewed)abstract
- BACKGROUND: Techniques for autofluorescence have been introduced to visualize the parathyroid glands during surgery and to reduce hypoparathyroidism after thyroidectomy. METHODS: This parallel multicentre RCT investigated the use of Fluobeam® LX to visualize the parathyroid glands by autofluorescence during total thyroidectomy compared with no use. There was no restriction on the indication for surgery. Patients were randomized 1 : 1 and were blinded to the group allocation. The hypothesis was that autofluorescence enables identification and protection of the parathyroid glands during thyroidectomy. The primary endpoint was the rate of low parathyroid hormone (PTH) levels the day after surgery. RESULTS: Some 535 patients were randomized, and 486 patients received an intervention according to the study protocol, 246 in the Fluobeam® LX group and 240 in the control group. Some 64 patients (26.0 per cent) in the Fluobeam® LX group and 77 (32.1 per cent) in the control group had low levels of PTH after thyroidectomy (P = 0.141; relative risk (RR) 0.81, 95 per cent c.i. 0.61 to 1.07). Subanalysis of 174 patients undergoing central lymph node clearance showed that 15 of 82 (18 per cent) in the Fluobeam® LX group and 31 of 92 (33 per cent) in the control group had low levels of PTH on postoperative day 1 (P = 0.021; RR 0.54, 0.31 to 0.93). More parathyroid glands were identified during operation in patients who had surgery with Fluobeam® LX, and fewer parathyroid glands in the surgical specimen on definitive histopathology. No specific harm related to the use of Fluobeam® LX was reported. CONCLUSION: The use of autofluorescence during thyroidectomy did not reduce the rate of low PTH levels on postoperative day 1 in the whole group of patients. It did, however, reduce the rate in a subgroup of patients.
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| 17. |
- Bergenfelz, Anders, et al.
(author)
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Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients.
- 2009
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In: Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie. - : Springer Science and Business Media LLC. - 1435-2451 .- 1435-2443. ; 394:5, s. 851-60
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Journal article (peer-reviewed)abstract
- Preoperative localization procedures and the use of intraoperative parathyroidism (iOPTH) have led to a shift of paradigm from bilateral neck exploration to focused parathyroidectomy in primary hyperparathyroidism (pHPT). However, only a small number of randomized trials from specialized centers have been published. The main purpose of the study was to analyze the impact of localization procedures and iOPTH on short-term outcome after pHPT surgery in a multi-institutional setting.
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| 18. |
- Bergenfelz, Anders, et al.
(author)
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Improving outcomes in emergency surgery.
- 2014
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 101:1, s. 1-2
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Journal article (peer-reviewed)abstract
- Merits much greater attention by the surgical community
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| 19. |
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| 20. |
- Bergenfelz, Anders, et al.
(author)
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Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy
- 2020
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In: Surgery (United States). - : Elsevier BV. - 0039-6060. ; 167:1, s. 124-128
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Journal article (peer-reviewed)abstract
- Background: Permanent hypoparathyroidism is common after thyroidectomy. The present study evaluated the risk for morbidity in patients operated with total thyroidectomy with and without permanent hypoparathyroidism. Methods: Data was retrieved from the Scandinavian Quality Register for Thyroid, Parathyroid, and Adrenal Surgery and cross-linked with the Swedish National Prescription Registry for Pharmaceuticals, the National Data Inpatient Registry, and Causes of Death Registry. Patients with benign thyroid disease were included. Permanent hypoparathyroidism was defined as treatment with active vitamin D for more than 6 months after thyroidectomy. Analyzed morbidity was evaluated by multivariable Cox's regression analysis and presented as hazard ratio and 95% confidence interval. Results: There were 4,828 patients. The mean (standard deviation) follow-up was 4.5 (2.4) years. Some 239 (5.0 %) patients were medicated for permanent hypoparathyroidism. Patients with permanent hypoparathyroidism had an increased risk for renal insufficiency, hazard ratio 4.88 (2.00–11.95), and an increased risk for any malignancy, hazard ratio 2.15 (1.08–4.27). Patients with permanent hypoparathyroidism and known cardiovascular disease at the time of thyroidectomy had an increased risk for cardiovascular events during follow-up, hazard ratio 1.88 (1.02–3.47). Conclusion: Patients with permanent hypoparathyroidism after total thyroidectomy have an increased risk of long-term morbidity. These results are a cause of great concern.
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| 21. |
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| 22. |
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| 23. |
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| 24. |
- Bergenfelz, Anders, et al.
(author)
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Scandinavian quality register for thyroid and parathyroid surgery: audit of surgery for primary hyperparathyroidism
- 2007
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In: Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie. - : Springer Science and Business Media LLC. - 1435-2443 .- 1435-2451. ; 392:4, s. 445-51
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIM: Scandinavian Quality Register for Thyroid and Parathyroid Surgery is an on-line web-based database with the aim to improve the quality of thyroid and parathyroid surgery. Preliminary data from surgery for primary hyperparathyroidism are reported here. MATERIALS AND METHODS: Fifteen departments registered 806 operations, with 639 women (79.7%) and 167 men. The median age of the patients was 62 years. RESULTS: Approximately 95.4% of the patients had sporadic disease and first time operation was performed in 93.8% of the patients. Localization examinations were performed in 524 patients (65%); sestamibi scintigraphy in 413 patients, with a true positive adenoma localization in 64.4% and ultrasound in 293 patients with adenoma localization in 61.1%. Bilateral neck exploration was performed in 66.8%, unilateral exploration in 16.1%, and focused minimal invasive surgery in 17.1%. In 301 patients planned for limited parathyroid exploration, conversion to bilateral neck surgery occurred in 11%. The cure rate, based on short follow-up, was 91.9%. Postoperative hypocalcemia occurred in 11.4% of the patients, and was associated with reoperation, concomitant thyroid operation, and the weight of excised parathyroid tissue. CONCLUSION: Localization examinations are performed in 2/3 of the patients, but limited neck exploration was performed in only approximately 1/3 of the operations. The cure rate was lower and postoperative hypocalcemia was more frequent than expected.
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| 25. |
- Bergenfelz, Anders, et al.
(author)
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Serum levels of uric acid and diabetes mellitus influence survival after surgery for primary hyperparathyroidism: A prospective cohort study
- 2007
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 31:7, s. 1393-1402
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Journal article (peer-reviewed)abstract
- Background Primary hyperparathyroidism (pHPT) is associated with an increased mortality attributable to cardiovascular disease (CVD), suggested to be alleviated by surgery. The exact mechanism of the beneficial influence of parathyroidectomy on survival is unknown. Furthermore, studies suggest that there is no increased mortality compared to the mortality rate in the general population during recent years. This study therefore investigated relative survival (RS), as well overall mortality associated with the clinical and biochemical variables in patients undergoing operation for sporadic pHPT. Furthermore, the influence of surgery on biochemical variables associated with pHPT was analyzed. Methods A group of 323 patients with sporadic pHPT operated between September 1989 and July 2003 were followed from surgery over a 10-year period. The median and mean follow-up time was 69 and 70 months, respectively (range: 1-120 months). Relative survival (RS) was calculated, and the impact of clinical and biochemical variables on overall death were evaluated. Results Postoperatively, serum levels of triglycerides and uric acid decreased. Glucose levels and glomerular filtration rate remained unchanged. A decreased RS was evident during the latter part of the 10 year follow-up period. In the multivariate Cox-analysis, diabetes mellitus (hazard ratio [HR] = 2.8, 95%; confidence interval [CI] 1.2-6.7), and the combination of an increased level of serum uric acid and cardiovascular disease (CVD) (HR = 8.6, 95%; CI 1.5-49.7) was associated with a higher mortality. The increased risk of death was evident for patients with persistently increased levels of uric acid postoperatively (HR = 4.8, 95%; CI = 1.4-16.01) Conclusions Patients undergoing operation for pHPT had a decreased RS during a 10-year follow-up compared to the general population. This decrease in RS is associated with diabetes mellitus and increased levels of uric acid pre-and postoperatively.
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