Uticaj hirurške traume na koncentraciju paratiroidnog hormona i kalcijuma u pacijenata podvrgnutih totalnoj tiroidektomiji kod benignih oboljenja štitaste žlezde

The aim of this work is the determination of the most important clinicaly, pathological and biochemical risk factors for postoperative clinically relevant hypocalcemia. This clinical study is prospective and controlled. The study included one hundred patients at the Departement of General Surgery, Clinical Center of Nis, who underwent a total thyroidectomy for benign thyroid disease in general endotracheal anesthesia. The study assessed the intraoperative and postoperative PTH, calcium and phosphorus in patients who underwent a total thyroidectomy. It was performed risk assessments for the occurrence of postoperative hypocalcemia therapy and prognosis for these patients. The results showed that there are significant biochemical and clinical parameters that influence the occurrence of postoperative hypocalcemia. Characteristics associated with a hypocalcemia were: preoperatively measured values of calcium, vitamin D and calcitonin, PTH and weight gland. Reduction in PTH by 1% increases the risk of intraoperative hypocalcemia 4.9%. Increasing calcium levels preoperatively to 1 mmol/L reduces the risk of intraoperative hypocalcemia by 100%, while any increase in the value of preoperative vitamin D reduces the risk of intraoperative hypocalcemia by 11.9% Increased preoperative calcitonin measured level of 1 pg/ml reduces the risk of hypocalcemia 12 hours after surgery by 66.1%, increasing the level of preoperative calcitonin for 1 pg/ml reduce the risk of hypocalcemia registered 24 hours after surgery by 97%, whereas any increase in weight removed the thyroid gland to 1g increase the risk of intraoperative hypocalcemia by 9,8%. Calcium levels postoperatively reached the lowest level after 12 hours (total of 78 patients have lowered calcium), and then begins to rise, and the number of patients with reduced calcium begins to decrease. Surgical trauma has increased the number of patients with hypocalcemia. There were a maximum of 64% 12 hours after total thyroidectomy. After that, the presence of hypocalcemia among respondents reduced and calcium normalizes within two months postoperatively

ESTIMATION OF RISK FACTORS OF EARLY POSTOPERATIVE MORTALITY IN ELDERLY PATIENTS WHO ARE SUBJECTED TO GASTRIC SURGICAL PROCEDURES

The use of screening programms in elderly population (age ≥65 years) comprises an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The aim was to determine the intra-hospital mortality rate in elderly patients undergoing gastric surgical procedures. 108 elderly patients (≥65 years old) were examined, divided into two groups: deceased and surviving surgical patients, treated for diseases (benign and malignant) of the stomach. The patients were divided into four age groups and five ASA groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administered transfusion and the occurrence of surgical complications during hospitalization. The mortality rate among elderly patients was 28.7%. The significant risk factors for mortality were: emergency surgery (p < 0.001), bleeding gastric ulcer operations (p = 0.042), lung (p = 0.003), kidney (p < 0.001), heart (p = 0.025) diseases, ASA score of 4 or higher (p < 0.001), serum levels (higher after two times measurement) of creatinine, haemoglobin, CRP, PCT and glycemia (p < 0.001). In order to improve medical treatment, the determination of independent validated risk indicators for mortality in elderly patients might lead to developing a dedicated scoring system

Uticaj hirurške traume na koncentraciju paratiroidnog hormona i kalcijuma u pacijenata podvrgnutih totalnoj tiroidektomiji kod benignih oboljenja štitaste žlezde

The aim of this work is the determination of the most important clinicaly, pathological and biochemical risk factors for postoperative clinically relevant hypocalcemia. This clinical study is prospective and controlled. The study included one hundred patients at the Departement of General Surgery, Clinical Center of Nis, who underwent a total thyroidectomy for benign thyroid disease in general endotracheal anesthesia. The study assessed the intraoperative and postoperative PTH, calcium and phosphorus in patients who underwent a total thyroidectomy. It was performed risk assessments for the occurrence of postoperative hypocalcemia therapy and prognosis for these patients. The results showed that there are significant biochemical and clinical parameters that influence the occurrence of postoperative hypocalcemia. Characteristics associated with a hypocalcemia were: preoperatively measured values of calcium, vitamin D and calcitonin, PTH and weight gland. Reduction in PTH by 1% increases the risk of intraoperative hypocalcemia 4.9%. Increasing calcium levels preoperatively to 1 mmol/L reduces the risk of intraoperative hypocalcemia by 100%, while any increase in the value of preoperative vitamin D reduces the risk of intraoperative hypocalcemia by 11.9% Increased preoperative calcitonin measured level of 1 pg/ml reduces the risk of hypocalcemia 12 hours after surgery by 66.1%, increasing the level of preoperative calcitonin for 1 pg/ml reduce the risk of hypocalcemia registered 24 hours after surgery by 97%, whereas any increase in weight removed the thyroid gland to 1g increase the risk of intraoperative hypocalcemia by 9,8%. Calcium levels postoperatively reached the lowest level after 12 hours (total of 78 patients have lowered calcium), and then begins to rise, and the number of patients with reduced calcium begins to decrease. Surgical trauma has increased the number of patients with hypocalcemia. There were a maximum of 64% 12 hours after total thyroidectomy. After that, the presence of hypocalcemia among respondents reduced and calcium normalizes within two months postoperatively

THE ROLE OF MULTISLICE COMPUTED TOMOGRAPHY IN THE EMERGENCY DIAGNOSIS OF THE TRACHEOBRONCHIAL INJURY AFTER ENDOTRACHEAL INTUBATION - CASE REPORT

Tracheobronchial injury (TBI) is a rare complication occurring after endotracheal intubation. Treatment can be conservative for small lesions and when the patient’s condition is stable, or surgical for bigger lesions and when pneumomediastinum and/or subcutaneous emphysema threaten the patient’s life. Total thyroidectomy was performed in a 60-year-old woman with multinodular goiter. Ten hours after surgery, subcutaneous emphysema of the face and neck developed. A cervical and thoracic multislice computed tomography (MSCT) confirmed subcutaneous emphysema, pneumomediastinum, and posterior wall tracheal rupture 2cm in size. The patient was treated conservatively. The MSCT imaging can be a useful method for diagnosing the location and form of tracheal injury in hemodynamically stable patients

Assessment of axillary lymph nodes involvement in patients with breast cancer depending on the tumor size and its histological and nuclear grades

Background/Aim. There are a lot of studies aiding to the opinion that the involvement degree of axilla lymph nodes grows depending on increase of breast tumor size, and its histological and nuclear grades. The aim of this study was to assess the risk of axillary lymph nodes involvement, as well as the relation between the tumor size, histological and nuclear grades in a group of female patients who underwent breast cancer surgery, including levels 1-3 axillary dissection. Methods. Investigation covered 900 patients operated on during 2005-2008 who underwent modified radical mastectomy including axillar dissection. We assessed a number of involved lymph nodes, depending on tumor macroscopic size (T), histological grade (HG) and nuclear grade (NG). Results. A total number of examined lymph nodes was 9977. The incidence of involved lymph nodes was from 18.6% with T1 tumor size up to 60.2% with T4 tumor size. Concerning histological grade, the number of involved lymph nodes ranged from 14.2% (HGI) to 45.1% (HGIII); while in terms of nuclear grade, the number of involved lymph nodes ranged from 17.4% (NGI) to 54.5% (NGIV). By using χ2-test for trend and odds ratio (OR), the results showed that the axillary lymph nodes involvement degree was increased with the increase of the tumor size and its histological and nuclear grades. The risk of axillary lymphatic nodes involvement was 1.43 times higher in the group of T2 tumors size compared to the smaller tumors T1 size, and even up to 6.62 times higher in case of T4 tumor size. It was also increasied from 1.79 times for HGII to even 4.98 times for HGIII, and from 1.44 times for NGII to 5.71 times for NGIV. Conclusion. In breast cancer patients, there is a strong correlation between tumor size, its histological and nuclear grades and the risk of axillary lymph nodes involvement