Key words：cinacalcet hydrochloride, activity of gastric acid secretion, gastric emptying, gastrointestinal motility, medicine releasing acetylcholine 〈Abstract〉 After taking cinacalcet hydrochloride, hemodialysis patients with secondary hyperparathyroidism often complain of upper gastrointestinal symptoms. In order to evaluate gastrointestinal function, the activity of gastric acid secretion was examined by measuring intragastric pH, serum gastrin and serum pepsinogen concentration and gastric emptying test was examined by measuring serum acetoaminophen concentration. Cinacalcet elevated serum gastrin concentration, but was independent of gastric acid secretion. Meanwhile cinacalcet delayed gastrointestinal motility. In cases showing delayed gastrointestinal motility and gastric atrophic mucosa, gastrointestinal complication often occurred. Because cinacalcet operates on gastrointestinal tract as calcimetics, it is supposed that gastrointestinal complication is due to suppression of the parasympathetic nervous system. In order to reduce this complication, it is useful to take cinacalcet during gastric emptying time or post hemodialysis and to take digestive medicine together such as medication releasing acetylcholine or prostaglandin to advance gastrointestinal motility. Before using cinacalcet, it is preferable to check for gastric disease, intragastric acid, intragastric mucosal condition, and gastric motility by endoscopic examination. If the mechanism of upper

IntroductionAn accurate differential diagnosis between single adenoma (SA) and multiglandular disease (MGD) remains difficult in Technetium-99m sestamibi scintigraphy (MIBI)-negative patients with primary hyperparathyroidism (PHPT). The aim of the present study was to evaluate the minimally invasive parathyroidectomy (MIP) in patients with PHPT.MethodsClinical records of 48 patients who underwent neck exploration between November 2002 and June 2012 in Kochi Medical School Hospital were reviewed retrospectively to identify candidates that underwent for MIP which was defined as the selective removal of a SA using less invasive surgery.ResultsThe preoperative detection rate of lesions using ultrasonography, MIBI, computed tomography, and magnetic resonance imaging was 90%, 83%, 76%, and 55%, respectively. Although all 39 patients in the MIBI-positive group were diagnosed with an SA and subsequently underwent curative MIP, 3 patients in MIBI-negative group (n = 6) were MGD, who underwent neck exploration. Preoperative mean intact parathyroid hormone (419 pg/ml vs. 149 pg/ml; P < 0.01) and alkaline phosphatase levels (746 U/l vs. 277 U/l; P < 0.01) were significantly higher in the SA than MGD group.ConclusionsIn MIBI-negative patients with indications for surgery, MIP should not be carried out without a clear localization of SA, or in MGD.