renal hyperparathyroidism ( rhpt ) is a serious complication of long - term dialysis treatment .
the european dialysis and transplant association ( edta ) report published in 1991 showed that up to 40% of patients undergo surgical treatment for rhpt after 15 years of dialysis .
rhpt is a form of renal osteodystrophy that causes increased bone fragility , and in addition , it has also been reported that hypercalcaemia and hyperphosphataemia associated with rhpt induce ectopic calcification in the vascular walls and heart valves , thereby significantly affecting the patient 's survival prognosis [ 49 ] . in patients with severe rhpt refractory to medical treatment
there are two types of such methods , percutaneous ethanol injection therapy ( peit ) and a parathyroidectomy ( ptx ) . determining which of these methods is the most appropriate intervention for individual cases is therefore a major issue for clinicians .
peit is easy to perform on an outpatient basis ; however , it has been associated with a significant adverse event , namely adhesion formation .
an indistinct margin of the parathyroid gland is often found during surgery following peit due to the firm fibrous membrane .
ptx is considered to be the last treatment option in patients with severe rhpt resistant to medical treatment and peit .
this study was conducted to determine whether similar results can be expected when ptx is performed in patients who underwent peit by investigating the effect of peit on subsequent ptx .
the patients had a diagnosis of rhpt , for which surgery was indicated , from january 2004 to december 2005 .
the subjects were divided according to whether they underwent peit ( peit group ) or not ( non - peit group ) .
an analysis was performed to compare the pre- and postoperative biochemistry results as well as intact pth levels ( preoperative , postoperative and year 1 postoperatively ) , number of the parathyroid glands detected by ultrasonography , operation time , the amount of bleeding , the number of parathyroid glands removed , the total weight of the removed glands and the frequency of the postoperative complication of hoarseness .
informed consent was obtained from all subjects . for comparisons of the peit and non - peit groups , the homogeneity of variance for each group
was confirmed using the f - test , and testing was performed using student 's t - test . if neither group had a normal distribution , then the mann 
in addition , for the analysis using a 2  2 contingency table , such as testing for the frequency of postoperative complications and patients with high postoperative pth levels , fisher 's exact probability test was performed .
the results were shown as mean  sd . a p - value < 0.05 was considered to be statistically significant .
for comparisons of the peit and non - peit groups , the homogeneity of variance for each group was confirmed using the f - test , and testing was performed using student 's t - test . if neither group had a normal distribution , then the mann 
in addition , for the analysis using a 2  2 contingency table , such as testing for the frequency of postoperative complications and patients with high postoperative pth levels , fisher 's exact probability test was performed .
there were 19 patients in the peit group and 61 in the non - peit group , with no significant difference in the background of patients in these groups .
the operation time was significantly longer in the peit group , but no significant differences were noted in the amount of bleeding or the frequency of recurrent nerve paralysis ( table 1 ) .
pre- and postoperative blood test results showed no significant difference to exist in the preoperative biochemistry results and intact pth levels ; however , the intact pth levels immediately following surgery were slightly higher in the peit group .
no difference was noted in the intact pth levels between the peit and non - peit groups at 1 year after the operation .
pg / ml on postoperative day 1 was significantly higher in the peit group ( table 1 ) .
a comparison of patients who underwent one course of peit and those who underwent two or more courses of therapy revealed no difference in the number of the parathyroid glands removed , the total weight of the removed glands and the operation time , although the postoperative intact pth levels were found to be significantly higher in those who underwent two or more courses of peit ( table 2 ) .
there were 19 patients in the peit group and 61 in the non - peit group , with no significant difference in the background of patients in these groups .
the operation time was significantly longer in the peit group , but no significant differences were noted in the amount of bleeding or the frequency of recurrent nerve paralysis ( table 1 ) .
pre- and postoperative blood test results showed no significant difference to exist in the preoperative biochemistry results and intact pth levels ; however , the intact pth levels immediately following surgery were slightly higher in the peit group .
no difference was noted in the intact pth levels between the peit and non - peit groups at 1 year after the operation .
pg / ml on postoperative day 1 was significantly higher in the peit group ( table 1 ) .
a comparison of patients who underwent one course of peit and those who underwent two or more courses of therapy revealed no difference in the number of the parathyroid glands removed , the total weight of the removed glands and the operation time , although the postoperative intact pth levels were found to be significantly higher in those who underwent two or more courses of peit ( table 2 ) .
peit and ptx are both options for the treatment of severe rhpt refractory to medical treatment .
peit can be performed with minimal invasiveness and it is easily performed on an outpatient basis . however , its efficacy is somewhat uncertain in some patients .
a previous study showed that patients in whom these intact pth levels sufficiently decreased to the target levels were those with a lower density of blood flow distribution in the parathyroid glands .
although the therapeutic outcome of ptx has been reported to be reliable and stable , it is difficult to perform ptx following peit due to adhesion , which is a significant adverse event associated with peit .
postoperative data were studied to assess the degree of difficulty of surgery due to adhesions associated with peit .
there was no significant difference in the amount of bleeding , which is an index for the difficulty of surgery ; however , a significant difference was observed regarding the operation time .
in addition , the postoperative intact pth levels were somewhat but not significantly higher in the peit group than in the non - peit group .
these findings suggest that repeated peit damages the capsule of the parathyroid gland , thus causing the dissemination of hyperplastic parathyroid cells . some residual parathyroid tissue caused by adhesions and dissemination might exist during a parathyroidectomy , thus leading to higher postoperative intact pth levels .
peit can be a useful strategy for controlling rhpt if it is performed for patients who are likely to respond to the therapy .
however , based on the surgical outcomes for patients who underwent peit , repeated peit should be avoided and surgical treatment is preferable in patients who demonstrate a poor response to the initial peit . in conclusion , peit prior to a ptx can affect subsequent surgical outcomes due to associated adhesion and dissemination ; therefore , peit should be performed only for those who are likely to respond to the therapy , and repeated peit should be avoided .
peit should be administered with a full understanding of its advantages and disadvantages . for patients with a possibility of either a decreased efficacy or lack of efficacy for peit ,
 background . 
 renal hyperparathyroidism ( rhpt ) is a serious complication of long - term dialysis treatment . 
 two intervention methods can be administered to treat rhpt , namely percutaneous ethanol injection therapy ( peit ) and a parathyroidectomy ( ptx ) . 
 peit is associated with a significant adverse event , adhesion formation . 
 this study was performed to investigate the effect of peit on subsequent ptx.methods . 
 a total of 80 subjects were included in the study . 
 the patients had a diagnosis of rhpt for which surgery was indicated . 
 they were divided according to whether they underwent peit ( peit group ) or not ( non - peit group ) . 
 the outcomes of ptx following peit were evaluated.results . 
 there were 19 patients in the peit group and 61 in the non - peit group . 
 the operation time was significantly longer in the peit group but no significant differences in the amount of bleeding or frequency of recurrent nerve paralysis were observed . 
 the intact pth levels immediately following surgery were slightly higher in the peit group . 
 the postoperative intact pth levels were found to be significantly higher in those who received two or more courses of peit . 
 the number of patients with an intact pth level > 60 pg / ml on postoperative day 1 was significantly higher in the peit group.conclusions . 
 these findings suggested that peit prior to ptx can affect the subsequent surgical outcome due to associated adhesions and dissemination . for patients with a possibility of either a decreased efficacy or a lack of efficacy for peit 
 , it is therefore important to consider ptx from the very beginning of the treatment . 
Introduction
Subjects and methods
Statistical analysis
Results
Comparison according to the history of PEIT
Discussion