Citations

AbstractReoperation for persistent or recurrent hyperparathyroidism is more hazardous than is primary cervical exploration and is also much less likely to result in cure of the disease. Only 21 of 34 reoperations (62%) were successful during the period 1970 through 1972 at the Mayo Clinic, compared with success in 312 of 327 primary operations (95%). In 9 patients who had their initial exploration at this institution, the most common cause of failure at the first operation was inadequate treatment of multiglandular disease; in 25 patients who were first operated on elsewhere, missed adenomas were far more common.Parathyroid arteriography and selective venous sampling with parathyroid hormone assays should improve the results of reoperation by providing preoperative localization of hyperfunctioning parathyroid glands in difficult cases. These procedures, however, are expensive and technically difficult, and they are not always successful. They are also associated with a definite morbidity, which must be weighed against any anticipated benefits. The systematic evaluation and treatment of patients facing reoperation for hyperparathyroidism should be undertaken in special centers accustomed to dealing with these difficult problems.

ABSTRACT Human immunodeficiency virus type 1 (HIV-1), feline immunodeficiency virus (FIV), and Moloney murine leukemia virus (MoMLV) integrases were stably expressed to determine their intracellular trafficking. Each lentiviral integrase localized to cell nuclei in close association with chromatin while the murine oncoretroviral integrase was cytoplasmic. Fusions of pyruvate kinase to the lentiviral integrases did not reveal transferable nuclear localization signals. The intracellular trafficking of each was determined instead by the transcriptional coactivator LEDGF/p75, which was required for nuclear localization. Stable small interfering RNA expression eliminated detectable LEDGF/p75 expression and caused dramatic, stable redistribution of each lentiviral integrase from nucleus to cytoplasm while the distribution of MoMLV integrase was unaffected. In addition, endogenous LEDGF/p75 coimmunoprecipitated specifically with each lentiviral integrase. In vitro integration assays with preintegration complexes (PICs) showed that endogenous LEDGF/p75 is a component of functional HIV-1 and FIV PICs. However, HIV-1 and FIV infection and replication in LEDGF/p75-deficient cells was equivalent to that in control cells, whether cells were dividing or growth arrested. Two-long terminal repeat circle accumulation in nondividing cell nuclei was also equivalent to that of LEDGF/p75 wild-type cells. Virions produced in LEDGF/p75-deficient cells had normal infectivity. We conclude that LEDGF/p75 fully accounts for cellular trafficking of diverse lentiviral, but not oncoretroviral, integrases and is the main lentiviral integrase-to-chromatin tethering factor. While lentiviral PIC nuclear import is unaffected by LEDGF/p75 knockdown, this protein is a component of functional lentiviral PICs. A role in HIV-1 integration site distribution merits investigation.