FIRST DAY SERUM CALCIUM AND PARATHYROID HORMONE LEVELS AS PREDICTIVE FACTORS FOR SAFE DISCHARGE AFTER THYROIDECTOMY.

CONTEXT: Permanent hypocalcemia is a rare but significant complication of thyroid surgery. OBJECTIVE: The aim of this study was to identify predictive factors of hypocalcemia and hypoparathyroidism after thyroidectomy. DESIGN: Study included 134 total patients submitted to thyroidectomy from two endocrine units (January 2015 - August 2016). METHODS: We measured total serum calcium (sCa) and intact PTH (iPTH) on postoperative day one and 1 month after surgery. RESULTS: 118 patients were women with F/M ratio of 7.3/1 and a mean age of 51.8 years. 64 patients were included in group A (iPTH <12 pg/mL) and 70 patients in group B (iPTH >12 pg/mL). sCa and hypocalcemia symptoms were correlated with iPTH, measured 24 hours after surgery. The cut-off value was for sCa 8.05 mg/dL with a sensitivity of 85.29% and a specificity of 88.0% and for iPTH 11.2 pg/mL, with a sensitivity of 82.3% and a specificity of 71.0%. SCa (< 8.05 mg/dL) was a predictive factor with a 99 (IC95%:12.86-761.58) and iPTH (<11.2 pg/mL) with a 10.77 higher risk (CI95%: 3.83-30.30) to be associated with symptoms. CONCLUSION: SCa and iPTH represent good predictive factors of early and safe hospital discharge and can predict the risk of prolonged and permanent hypoparathyroidism.

[Colectomy in emergency surgery]. / Colectomia în chirurgia de urgenta.

Unlike the standardised surgery of the right sided colic emergencies there is still a matter of debate on the emergency approach of the left colon and rectum. Between 1998 - 2007 on 32 patients (15 males, 17 females) we performed the single stage radical procedure total or subtotal colectomy. In the same period we performed 372 emergency operations for low intestinal occlusion. The patients had ages between 24 - 86 years, the admittance diagnosis was intestinal occlusion. The postoperative diagnosis was left colic carcinoma (n=23), strangulated hernia (n=2) strangulated incisional hernia (n=2), sigmoid volvulus (n=3) and synchronous colic carcinoma (n=2). All cases were submitted to surgery in the first 24 h of admission. Despite the presence of liver metastasis at the time of surgery in 2 patients, this had not contraindicate the radical procedure. 21 patients (65.62%) had a good evolution. The others 11 (34.38%) had postoperative complications: 2 anastomotic leakage (6.25%), 7 parietal infections (21.87%) and 2 death (6.25%). The total colectomy offers oncological radicality and satisfactory functional results. The disadvantage consists in postoperative diarrhea, gradually decreased with time.