In 12 patients with secondary hyperparathyroidism, 13 parathyroid tumors detected with the use of sonography and confirmed by fine-needle aspiration biopsy were treated by percutaneous injection of absolute ethanol under ultrasonographic guidance. Indications for this procedure were recurrence of parathyroid tumors after previous subtotal surgery, high surgical risk, or refusal of surgery. Significant volume reductions were recorded for the larger glands; in the smaller ones, structural changes were observed as well. Clinical and biochemical therapeutic effects were obtained in most cases of single hyperplastic glands treated. Percutaneous alcoholic ablation of enlarged parathyroid glands can be used in cases of secondary hyperparathyroidism when surgery is contraindicated or problematic; it can also improve responsiveness to medical therapy, delaying the need for surgery.

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Four hundred and eighty CAPD and 373 HD patients started regular dialysis treatment between 1981 and 1987 in 6 dialysis centers. The CAPD patients were 6 years older, on average, than the HD patients and had more complicating conditions (43.3% with 3 or more coexisting risk factors versus 28.9% with coexisting complications). The 7-year patient survival rate was not significantly different. Cox's proportional hazards regression showed that age, cardiovascular disease, cerebrovasculardisease, peripheral vasculardisease, diabetes, malignancy and multisystem disease had significant adverse effects on patient survival. After correcting for the influence of these factors, no significant differences in patient survival were seen. However, after 53.5 years of age, the increase in the risk of death was significantly higher in HD than in CAPD patients. Technique survival was significantly different in the 6 centers and was better for HD than for CAPD. There was no statistically significant difference between CAPD and HD technique survival when peritonitis was eliminated as a cause of failure. Based on this 7 year analysis, CAPD would appear to be an excellent alternative to HD.

Only primary renal disease and proteinuria were related to renal survival, being baseline plasma creatinine confounding factor. By blocking the possible causal role of proteinuria and hypertension, end-stage renal failure could be prevented in a significant percentage of patients.

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