The diagnosis of primary hyperparathyroidism (PHP) may be difficult, especially in the case of asymptomatic hypercalcemia. Since bone is the major target organ of parathyroid hormone (PTH), the hyperseeretion of PTH in patients with PHP can be assessed by bone biopsy and by measured markers of bone turnover. In a first study, a transiliac bone biopsy was performed in 184 patients with surgically proven parathyroid adenoma (159 cases) or parathyroid hyperplasia (25 cases), and quantitative measurements were compared with age-and sex-matched controis. In patients with parathyroid adenoma, there was a marked and significant increase of the resorption surfaces, the area of the periosteocytic lacunae, and the osteoid surfaces measured on the trabecular bone. Similar results were found in patients with parathyroid hyperplasia. Only 4 patients (2.2% of cases) had a normal bone biopsy, indicating that bone histomorphometry is a sensitive method for detecting an increase of bone turnover in PHP. However, this method is not specific and does not differentiate between primary and secondary hyperparathyroidism.In a second study, we measured serum bone gla-protein (sBGP), also called osteocalcin, which is a new specific marker of bone turnover, in 25 patients with primary hyperparathyroidism: sBGP was increased (14.2 ~-9.6 ng/ml versus 6.2 _+ 2.4 ng/ml in controls, p < 0.001) and was significantly correlated with serum PTH, serum calcium, and adenoma weight. In the patients who had a simultaneous bone biopsy, sBGP was found to be significantly correlated with the parameters reflecting bone formation. In conclusion, bone histomorphometry and mea-

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Eighty-one selected patients with documented gastro-oesophageal reflux were managed with standardized transabdominal Nissen fundoplication from 1973 to 1984 and regularly evaluated. None of the patients had undergone previous repair, or had peptic stenosis, acquired oesophageal shortening, or evidence of motility disorder. Operation resulted in prompt disappearance of reflux in all patients, and in a significant increase of low oesophageal sphincter pressure to four times that of the pre-operative level. Two recurrences of reflux were observed respectively 7 and 18 months post-operatively. By actuarial analysis patients were demonstrated to have a 97% probability of remaining free of reflux 5 years after operation. A post-fundoplication gastric ulcer was observed in 3 patients, leading in 1 of them to a total gastrectomy for severe haemorrhage. During the early post-operative period 40% of the patients experienced post-fundoplication symptoms; these persisted in 27% of the 81 patients, but were always mild, and never disturbing. It is concluded that with proper selection, and respect of technical details, the Nissen fundoplication can remain the operation of choice in the management of documented gastro-oesophageal reflux.