Intra-abdominal abscess after penetrating abdominal trauma.

We reviewed our experience with intra-abdominal abscess after penetrating abdominal trauma. Of a total of 872 laparotomies (1980-1986), 29 patients (0.7% of stab wounds and 6% of gunshot wounds) developed abscesses. Pancreatic and duodenal injuries, in the presence of concomitant colon perforation, were most frequently associated with abscess formation. Fourteen of the 29 patients had multiorgan failure (MOF), Group I, and 15 patients did not have MOF, Group II. Group I had a significantly higher Abdominal Trauma Index (ATI) and Acute Physiology and Chronic Health Evaluation (APACHE II), received greater number of perioperative transfusions and underwent a higher number of reoperations for sepsis than Group II patients. Radiologic imaging techniques were frequently inconclusive for the diagnosis and localization of intra-abdominal abscess in Group I. They were highly accurate in Group II. Fifty per cent of Group I patients died from sepsis and MOF. We conclude that the anatomic (ATI) and the physiologic (APACHE) scores are useful predictors of the potential for uncontrolled sepsis. In the presence of ongoing multiorgan failure, reoperation for sepsis is warranted on clinical grounds alone.

Thyroid and parathyroid response to subtotal thyroidectomy.

Hypocalcemia occurring a few days after total subtotal thyroidectomy has been attributed either to parathyroid insufficiency or to calcitonin release. To investigate this matter further, we measured serum calcium, phosphate, T3, T4, TSH, parathormone (PTH), calcitonin (CT) and cAMP, in 27 women aged 23 to 63 years, before and also 3 and 7 days after subtotal thyroidectomy for multinodular nontoxic goiter. Ca, T3 and T4 decreased, whereas TSH increased appropriately to the decrease in T4 and T3. There was no increase in PTH appropriate to the Ca decrease. In contrast, PTH, cAMP and CT showed statistically unsignificant tendency to decrease. It was concluded that hypocalcemia after thyroidectomy is not due to CT release, but rather to a relative PTH insufficiency.