Arcuri Mf

The utility of serum PTH assessment 24 hours after total thyroidectomy.

BACKGROUND: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 24 hours after surgery. MATERIAL AND METHODS: A total of 1006 consecutive patients (mean age, 54.8 years; female/male ratio, 4/1) underwent total thyroidectomy for benign or malignant thyroid from January 1995 to November 2003. Serum calcium, phosphorus, and PTH were measured preoperatively and at 24 hours after surgery. All patients underwent preoperative examination to assess cord motility. RESULTS: A total of 253 (25.1%) patients presented with hypocalcemia demonstrated by clinical and laboratory findings. In 101 cases the hypocalcemic syndrome manifested after 24 to 36 hours whereas in 5 of 101 cases, symptom onset was between 48 and 72 hours. Serum calcium levels lower than 7.5 mg/dL were recorded in all the 101 cases. In 239 of 253 cases serum calcium returned to normal values within 7 days following surgery. PTH at 24 hours was below normal levels in 49 of the 101 patients but was within normal limits in 52 cases. The incidence of hypocalcemia was higher in patients undergoing surgery for malignant thyroid (P < 0.05). CONCLUSIONS: We do not consider PTH levels at 24 hours postoperatively as predictive of hypocalcemia.

Minimally Invasive Video-Assisted Thyroidectomy: The Learning Curve

Background: MIVAT (minimally invasive video-assisted thyroidectomy) is a recent technique that requires a learning curve. Materials and Methods: From July 2005 to December 2006, we treated 100 from a total of 467 thyroidectomy patients with MIVAT. We divided the patients into 3 groups. The first 2 groups consisted of 25 patients each: group A (cases 1–25) and group B (26–50). We also divided patients into 2 groups based on our surgical experience: group A + B (cases 1–50) and group C (cases 51–100). Results: The operative times for groups A and B were 101.7 and 84.6 min, respectively (p < 0.03); those for groups A + B and C were 91.07 and 63.06 min, respectively (p < 0.004). Complications of hypocalcemia were observed in 6 cases (4 in the first 50 cases and 2 in the second 50), and complications of nerve palsy were observed in 2 cases from group A. Conclusions: After 25 cases, we observed that the MIVAT procedure allows for a lower mean operative time and a reduction of complications.

Hyperparathyroidism associated with thyroid pathology

BACKGROUND The pathological association between thyroid and parathyroid gland disease is here discussed. The multiphase analyzer has revealed a new type of subclinical primary hyperparathyroidism (HPP) and the role of surgery in these cases is not clear. METHODS This is a prospective study of all cases of thyroid disease in association with parathyroid disease treated surgically in our Institute from July 1999 to June 2001. RESULTS Of the 221 thyroidectomies carried out, 29 patients had an elevated preoperative serum level of parathyroid hormone (PTH). An ultrasonography examination was performed on all patients and a preoperative scanning with 99Tc-MIBI on 11 of 29 patients. We examined intraoperatively 19 cases of HPP (14 parathyroid adenoma, 5 hyperplasia). In 10 cases we observed a normal size of the parathyroid gland and we did not perform a parathyroidectomy. CONCLUSIONS All patients with elevated serum parathyroid hormone and serum calcium levels before thyroidectomy should be considered candidates also for surgery to the parathyroid glands. The pathological association between thyroid and parathyroid gland diseases is not rare. We must conduct an accurate neck exploration in all these cases.

Dunbar's syndrome and superior mesenteric artery's syndrome: a rare association.

Celiac artery compression syndrome (CACS) and superior mesenteric artery syndrome (SMAS) are 2 rare diseases, widely described in literature. Their association has not been specifically investigated; in fact, few cases have been reported. For this reason we reviewed our experience from January 1974 to June 2004. We report 59 patients affected by CACS and 28 by SMAS. Coexistence of both syndromes in 8 patients was observed. These 8 patients were successfully treated with duodenojejunal bypass and decompression of the celiac trunk. In this paper, we analyze the pathogenesis, clinical presentation, diagnosis, and treatment of these syndromes, emphasizing their common aspects. The misdiagnosis of this association may justify in some cases the controversial results reported regarding the surgical treatment of these syndrome.

Self-Expanding Metal Stents in the Treatment of Colonic Obstruction

Background: The use of self-expanding metal stents in the treatment of obstruction of esophageal tract, biliary tract, major vessel diseases and colonic obstruction has found favor in the last years. Patients and Methods: 13 patients (7 women and 6 men) with a mean age of 74.7 years were treated for an obstruction located at the descending colon-sigmoid tract in 9 cases, at the rectosigmoid tract in 2 cases, and at the transverse colon in 2 cases. Two cases had an obstruction post ischemic colitis. Results: The stents were conducted successfully in all patients. The mean hospital stay was 3.7 days versus 7.8 days for a colostomy (p < 0.001). Conclusions: The self-expanding stent for the treatment of colonic obstruction is a procedure that can be used not only in neoplastic and inoperable stenoses but also in all colonic stenoses where the surgical risk is bigger than that of the endoscopic procedure.

Perkutane endoskopische Gastrostomie zur Magenfixierung bei einer kongenitalen Zwerchfellhernie

Percutaneous Endoscopic Gastrostomy for the Fixation of the Stomach in a Patient with Congenital Diaphragmatic Hernia Congenital diaphragmatic hernias at advanced age are rare and found mostly by accident. We present here the case old a 76-year-old female patient with a Morgagni hernia suffering from acute abdominal disturbances. Because of the high anesthesiological risk (ASA IV), a fixation of the stomach was carried out by means of percutaneous endoscopic gastrostomy.