55 research outputs found
Post-Thyroidectomy Hypocalcemia: Timing of Discharge Based on Serum Calcium Levels
Purpose: The study concerns about the evaluation of Calcium serum levels in patients who underwent
total thyroidectomy. Our previous experience underlined how patients who had levels
of serum Calcium more than 9 mg/dl at the first day after surgery, did not show Hypocalcemia
in the next days,so that this value could be considered a good cut-off for the decision of an
early discharge. With regards to this experience, the aim of our current study was to confirm
the effective feasibility of an early discharge based on the levels of serum Calcium at the first
post-operative day.
Patients and Methods: Our study included 102 consecutive patients (82 F; 20 M, age with a
range between 14-78 year sold, average 52.6) that were submitted to total thyroidectomy in the
years 2010 to 2014, performed by the same operator and all done with sutureless technique (Ligasure
precise©) We classify hypocalcemia, according to their normal range (8.6 to 10.4 mg/dl),
in mild (not less than 7.6 mg/dL), moderate (between 7.5 mg/dL and 7 mg/dL) and severe (less
than 7 mg/dL) We classified the normal range of serum Calcium between 8.6 mg/dl and 10.4
mg/dl. Patients that showed levels of serum Calcium under this limit (<8.6 mg/dl) were treated
with 6 fials of Gluconate Calcium 40 mEq in 500 ml of saline solution NaCl 0.9% i.v. (one per
day), until the return to the normal range. Patients who had serum Calcium levels more than 9
mg/dl at the first post-operative days, and did not have other complications, were discharged at
the same day and revaluated after 7 days.
Discussion and Conclusion: Moreover our study has been useful to confirm what we observed
in the previous experience, that levels of serum Calcium more than 9 mg/dl at the first postoperative
day can be considered a feasible cut-off to exclude the appearance of hypocalcaemia
in future.
Therefore, according to our results, we assume to propose an early discharge for the patients
who have serum Calcium levels more than 9 mg/dl, asking them to come back for controls one
week after discharge
Hyperfunctioning Parathyroid Giant Adenoma
Purpose: The objective of this paper is to report the management and treatment of a 47-year-old
patient admitted with multiple problems including asthenia, nausea and bradycardia, and was
diagnosed with a giant parathyroid adenoma.
Case report: A 47-year-old man was admitted to the Department of General Surgery for acute
and worsening asthenia, nausea and bradycardia. Blood tests showed hypercalcemia, hypophosporemia,
very high serum parathormone level, so that he was diagnosed with primary
hyperparathyroidism. Cervical ultrasonography and scintigraphy with technetium 99 mTc Methoxyisobutylisonitrile
(99 mTc-MIBI) showed the presence of positive nodule at the isthmus
of the thyroid gland. The patient underwent neck exploration. Intra-operative iPTH essay was
measured. A giant parathyroid adenoma was identified and excised, with no macroscopic signs
of malignancy.
Discussion and conclusion: Hyper functioning parathyroid giant adenoma can present with
typical symptoms of hypercalcemic crisis: ECG alterations, kidney failure, emotional lability,
confusion, delirium, psychosis, asthenia, epilepsy. Elective treatment is the excission. The
surgical technique contemplates neck exploration and to ensure the finding of the adenoma,
previously identified with imaging tests. It is necessary to measure intra-operative iPTH assay
The digital AcuBlade laser system to remove huge vocal fold granulations following subglottic airway stent.
We report a case of granulations that complicated subglottic stent placement and completely destroyed vocal folds with luminal stent obstruction. A microbial aetiology significantly contributed to the occurrence of granulations associated with mechanical irritation. The granulations were successfully resected using a digital AcuBlade laser system, a new generation of CO2 laser used in otorhinolaryngology, particularly in vocal cord disease. It permitted a precise control of the scan line between vocal fold and granulation for several reasons. The scan line was completely electronic and integrated in the scanner. The sweep in speed was constant and the energy distribution was uniform along the entire length of the time. The interpulse pause was of ∼1 ms, allowing the tissue cooling with reduction of thermal spread and quicker healing support. The result was the radical excision of granulations without injuring vocal folds. The respiratory function was restored and no other treatments such as arytenoidectomy or cordectomy associated with the alteration of phonatry function were required. No intraoperativ
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