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Although recurrent hyperparathyroidism should not be rare on theoretical grounds, only a few cases of proved recurrence have been reported in the literature. In the present author's series only 4 patients (1 per cent) had true recurrence. Criteria for recurrence were: 1. Histological identification by biopsy and frozen section of all the parathyroid glands at the first operation. 2. Complete removal of the enlarged gland(s). 3. A normocalcaemic period of at least 1 year. 4. The finding of a tumour at the site of a previously normal-sized gland. The low incidence of recurrent hyperparathyroidism might be explained by the long period of time needed for the recurrence to develop. However, since diagnosis of hyperparathyroidism is now more easily made and patients are treated surgically earlier in the course of the disease, the incidence of true recurrence might be expected to rise. A meticulous exploration during operation and careful follow-up of the patients are therefore required.

1. The results of various commercial radio-immune essays for digoxin differ and cannot readily be compared. 2. For each RIA it is therefore necessary to determine one's own therapeutic and toxic levels in relation to the clinical requirements. 3. When quoting data, it is necessary to define the method of RIA with its therapeutic and toxic levels. 4. A cause for the high digoxin estimations of 2 RIA's carried out by the same firm has been identified as being due to the low concentration of the standard preparation. 5. The introduction of a defined and obligatory digoxin standard is recommended.

A review of 51 successful reoperations for persisting hypercalcaemia due to primary hyperparathyroidism shows that inadequate anatomical knowledge, inadequate surgical technique and unusual localizations of the parathyroids are the most frequent causes of failure of the primary operation. The majority of these failures are therefore preventable. There is a frequent need for cervical thymectomy in parathyroid surgery. Sternotomy is only very rarely necessary.

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