Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience.

PURPOSE: Hypoparathyroidism is one of the most common and most feared complications of total thyroidectomy (TT). The aim of this study is to detect possible markers that may facilitate early tracing of hypocalcaemia-prone patients in order to reduce clinical cost by optimizing patient discharge and to avoid unnecessary treatment. METHODS: Over an 18-month period, 995 patients, 23 % male and 77 % female, aged 52.9 ± 13.4 years, underwent TT in ten Lombardy hospitals. The following parameters were analyzed: calcaemia before and 12-24 and 48 h after surgery, pre- and post-operative parathyroid hormone (PTH) at 24 h and pre-operative 25OH vitamin D. RESULTS: Mortality was nil and morbidity was 22.4 %. Mean 24-h calcaemia and PTH were 2.17 ± 0.15 mmol/l and 31.81 ± 20.35 pg/ml, respectively; mean 24-h PTH decay was 36.7 ± 34.12 %. Four hundred seventy-three (47.5 %) patients were hypocalcaemic at discharge; 142 of whom had transient hypoparathyroidism that became permanent in 27. Patients developing hypocalcaemia had significantly higher values of PTH and calcium decay. At multiple logistic regression, only 24-h calcium decay, PTH drop and the presence of symptoms and parathyroid auto-grafting were significantly related to hypoparathyroidism. The association of these factors had a 99.2 % negative predictive value (NPV) for the development of hypoparathyroidism. A 70 % PTH drop had a 93.75 NPV for transient hypoparathyroidism. A 12 % calcaemia decay had a 95.7 NPV for hypoparathyroidism. CONCLUSIONS: Hypocalcaemic asymptomatic patients with less than 70 % PTH and 12 % calcaemia decay may be safely discharged without treatment. Symptomatic patients and those with parathyroid grafting should receive calcium and vitamin D.

[Screening and follow-up of patients with arteriopathies of the lower limbs using the test proposed by Laing]. / Screening e follow-up dei pazienti con arteriopatia agli arti inferiori con l'impiego del test proposto da Laing.

The Authors tested a standard exercise suggested by Laing in 1980 for the screening and the follow-up of patients with atherosclerotic lesions of the arteries of the lower limbs. Were included in this study 44 patients with monolateral symptoms and was studied the asymptomatic limb. The results were compared with the ones obtained by the traditional exercise proposed by Strandness and with the ones of a control group studied with the two tests. The excellent correlation of the data gives us the opportunity to reaffirm the utility of the Laing's standard exercise in the clinical investigation of potentially arteriopathic patients.

[Peritoneal reactions caused by starch used regularly for lubricating surgical gloves. Review of the literature]. / Reazioni peritoneali provocate dall'amido correntemente impiegato per la lubrificazione dei guanti chirurgici. Revisione della letteratura.

The contamination of the operating field by a number of substances including the starch used to lubricate surgical gloves is one of the causes of foreign body granuloma formation. The role of starch is particularly clearly documented in the peritoneal cavity where it may provide the basis of a well defined nosological phenomenon, "starch peritonitis", but it has also been reported in most other anatomical districts. The most logical solution to this problem is to use starch-free surgical gloves prepared using another type of lubricant without the aforesaid drawbacks. This paper analyses international clinical and experimental literature focusing on the damaging effects resulting from the introduction of starch into the peritoneal cavity.

[Heterotopia of the gastric fundus wall in bilobate gallbladder associated with dilatation of the main bile duct. Description of a case]. / Eterotopia di parete gastrica fundica in colecisti bilobata associata a dilatazione della via biliare principale. Descrizione di un caso.

On the basis of a recent case of fundic gastric heterotopia in the gallbladder, the principal, possible embryogenetic hypotheses of the malformation are described and discussed. The possibility that acid secretion of the gastric glands contained in the ectopic fundic mucosa determined part of the symptomatological and clinical picture accompanying signs of lithiasic cholecystopathy is also evaluated.

[Problems of diagnostic origin in tumors of the small intestine developing in the smooth muscle. Report on 7 cases]. / Problemi di origine diagnostica nei tumori dell'intestino tenue ad origine dalla muscolatura liscia. Osservazioni su 7 casi.

The smooth muscle tumors of the small intestine are particularly interesting for the difficulty and the delay of their diagnosis. This usually happened for the poor and indefinite symptomatology and the problematic exploration of the organ. Starting up from the observation of 7 patients between 1986 and 1989 the Authors critically examined the literature about this problem to value the diagnostic opportunities of the principal clinical exams, suggesting as resolutive investigation, if indicated, the angiographic selective study of the visceral abdominal arteries.

[Personal experience in the treatment of intestinal carcinoids]. / Nostra esperienza nel trattamento dei carcinoidi intestinali.

The authors report 7 cases of intestinal carcinoids. They examine the clinical aspects and describe and discuss both surgical and medical treatment strategies. They also critically evaluate the value of monitoring some oncological markers and their prognostic significance. Each patient underwent an in-depth evaluation of tumour evolution (CAT, ultrasonography, NMR, angiography) and urinary 5HIAA and platelet 5HT were monitored. Surgery took the form of ileal or ileocolic resection, gastric resection, exeresis of the tumour using a transanal route, ligature of the right branch of the hepatic artery afferent to the metastasised lobe of the liver. Five patients were treated using chemotherapy and three, also suffering from carcinoid syndrome, with octreotide. On the basis of their personal experience the authors underline the limited value of the study of 5HT and 5HIAA tumour markers in the diagnosis of small carcinoid tumours. This is compensated by the outstanding role of these markers in the diagnosis of the hepatic and/or lymphoglandular diffusion of the tumour. These markers were not influenced by octreotide treatment in cases in which longastatin was successfully used to combat carcinoid syndrome. Their behaviour allowed useful information to be acquired regarding the tumour evolution following surgery.

Syphilitic aneurysm of the abdominal aorta: report of two cases.

We have described two histologically confirmed syphilitic abdominal aortic aneurysms arising below the renal arteries. Serological tests were negative and the patients had in the past been treated with penicillin and bismuth. We consider that there may be a correlation between atherosclerosis and syphilis in the natural history of some abdominal aortic aneurysms and the hazard of indiscriminate use of antibiotics for the treatment of other inflammatory vessel disease may allow syphilis to develop insidiously.