The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Histomorphometric and functional studies of the rat thyroid throughout the estrous cycle Histomorfometria e função tireoidiana no ciclo estral da rata

The influence of the estrous cycle on the thyroid gland was studied. Twenty one five-to-seven-month-old Wistar female rats were divided according to the stage of the estrous cycle in two groups: metaestrus-diestrus and proestrus-estrus. After gross inspection, the thyroids were weighed, sampled, and processed for staining with hematoxilyn-eosin. Seric concentrations of total T4, free T4, total T3, TSH, progesterone, and estradiol were measured. The values of estradiol were significantly higher in the proestrus-estrus stage. However, no significant differences in the plasmatic concentrations of progesterone, free T4, total T4 and TSH throughout the cycle were found. The results of the morphometric study of the thyroid did not indicate any significant differences between the groups. These findings suggest that there is no thyreotrophic effect of estrogen during the estrous cycle in rats

Hipogonadismo e função tireoidiana em ratas hipertireóideas e eutireóideas Hypogonadism and thyroid function in hyper and euthyroid rats

A influência do hipogonadismo sobre a função tireoidiana de ratas hipertireóideas e eutireóideas foi medida com base no perfil sérico dos hormônios tireoidianos, dos esteróides ovarianos e do TSH e na histomorfometria da tireóide. Ratas Wistar, com cinco meses de idade, castradas, foram mantidas em estado eutireóideo ou hipertireóideo por períodos de 30, 60 e 90 dias. Um grupo não castrado foi mantido nas mesmas condições e serviu como controle. O hipertireoidismo foi induzido mediante a administração diária 50µg de L-tiroxina, por sonda gástrica. Ao final de cada período, nove ratas por grupo tiveram suas tireóides inspecionadas, pesadas e processadas para avaliação histomorfométrica e o plasma sangüíneo colhido para dosagem de estradiol, progesterona, T4 total, T4 livre, T3 total e TSH. O hipogonadismo não alterou os valores de T3 total e de TSH, mas aumentou significativamente as concentrações de T4 livre, independente do estado hipertireóideo ou eutireóideo. As concentrações de T4 total sofreram influência da castração apenas no grupo hipertireóideo. O peso das tireóides não sofreu influência do hipogonadismo, mas a altura do epitélio folicular nos animais eutireóideos variou ao longo do experimento, apresentando-se maior aos 30 e 90 dias e menor aos 60 dias. Não se observou correlação entre os níveis de estrógeno e as variáveis estudadas, mas os níveis de progesterona foram inversamente proporcionais à elevação dos níveis de T4 total e T4 livre. Concluiu-se que o hipogonadismo altera a histomorfometria da tireoide em indivíduos eutireóideos, aumenta os valores plasmáticos de T4 livre independentemente do estado funcional da tireóide e potencializa a elevação de T4 total no hipertireoidismo, provavelmente sob influência do hipoprogesteronismo e não do hipoestrogenismo.<br>The effects of hypogonadism on thyroid function of hyper and euthyroid rats were measured based on plasmatic profile of thyroid hormones, ovarian steroids, TSH and thyroid histomorphometry. A group of five-month-old ovariectomized Wistar rats were maintained at hyper or euthyroid state for 30, 60 and 90 days. A group of non castrated was used as control. The hyperthyroidism was induced by gastric infusion of L-tiroxin 50µg daily. At the end of each period nine rats of each group were sacrificed, the blood plasma collected and the thyroid inspected, measured and processed for histomorphometric analyses. In blood plasma the concentrations of estradiol, progesterone, total and free tiroxin, total and free T3 and TSH were determined. The hypogonadism did not alter the values of free T3 and TSH but was able to rise free tiroxin in both hyper and euthyroid states. Total tiroxin levels were affected by castration, but only in the hyperthyroid state. Folicular epithelium height presented variations along the experiment in euthyroid individuals although these did not influence thyroid weight. No correlations between estrogen and any other variables were observed, but the progesterone levels were conversely proportional to the total and free tiroxin levels. It was concluded that hypogonadism alter the histomorphometric patterns of thyroid gland in euthyroid individuals, rise the plasmatic levels of free tiroxin regardless the functional state of thyroid gland and powered the total tyroxin rise in hyperthyroidism, probably due to the influence of hypoprogesteronism but not to the hypoestrogenism