Intensive calcium monitoring improves outcomes on hungry bone syndrome in hyperparathyroidism.

Objectives. Hungry bone syndrome (HBS) is a severe and underdiagnosed complication of parathyroidectomy in the treatment of primary hyperparathyroidism (PHP) and secondary hyper-parathyroidism to chronic kidney disease (SHP-CKD).Methods. A longitudinal study was conducted to compare the postoperative outcomes of patients who developed HBS in two different time frames: before and after implementing a protocol with an intensive electrolytic monitoring and an algorithm regarding electrolytic supplementation.Results. Overall, 77 parathyroidectomies were included. In PHP, a protocol implementation led to an increased admission of patients in the Intermediate Care Unit for intensive electrolytic monitoring (p<0.001) and an increased rate of oral calcium replacement during hospital stay (p=0.013) compared to pre-protocol era. In SHP-CKD, duration of intravenous calcium replacement was reduced (p=0.010). The prevalence of HBS (9.8% in PHP and 58.3% in SHP-CKD) was similar between the two periods, although its diagnosis had an increased trend in PHP since the protocol implementation. None of the diagnosis of HBS was established due to hypocalcemic symptoms in the post-protocol era (contrary to pre-protocol period, p=0.021). Both hypocalcemia length and duration of surgical ward hospitalization were reduced (p=0.047 and p=0.042, respectively).Conclusions. An improved assessment of hyperparathyroidism and a decrease in HBS severity were noted in the post-protocol era. We strongly recommend the implementation of a standardized protocol with an intensive phosphocalcium monitoring in the high-risk patients who undergo parathyroidectomy due to hyperparathyroidism as it improves the health care and management of HBS.

A Rare Complication of Actinomyces Abdominal Infection: A Case Report.

Intraabdominal infection by Actinomyces species, although a rare condition, usually occurs after a disruption of the mucosal barrier in a peritoneal organ. This infection is characterized by the development of an extended and persistent inflammatory and fibrotic reaction that can be mistaken for other pathogens or different etiologies, like tumors or inflammatory diseases. It can present as an abscess, a stricturing tissue with multiple adhesions, and/or a fistulization. Early diagnosis, targeted and prolonged antimicrobial therapy, and optimal drainage when indicated, are the key to success. The authors present a case where laparotomic hysterectomy was complicated by a superficial and an organ/space surgical site infection due to Actinomyces with a posterior developing of a colo-vaginal fistula that was treated surgically.

[Differences between Patients Undergoing Laparoscopic Cholecystectomy with Discharge at the End of the Day Versus Overnight Stay: A Retrospective Study]. / Diferenças entre os Doentes Submetidos a Colecistectomia Laparoscópica com Alta ao Final do Dia Versus Pernoita: Um Estudo Retrospectivo.

INTRODUCTION: Although laparoscopic cholecystectomy is an increasingly performed technique in the outpatient setting, it is not done in some Units due to lack of overnight stay. The objectives of this study are to identify the differences between patients with discharge at the end of the day versus overnight stay and the factors predicting overnight stay. MATERIAL AND METHODS: A retrospective analysis of the pre, peri and postoperative data of patients operated between January/2014 and December/2017 was performed, and a statistical analysis of the variables. RESULTS: A total of 311 patients were included, 33.4% of whom stayed overnight. Of these, 81.7% were operated after 2pm. As predictors factors of overnight stay, the age (p = 0.001) was identified in the morning group, with a greater possibility of overnight stay (15.3%) from 61.50 years (Younden index = 0.396) and the surgery start time (p < 0.0001) in the afternoon group, with a greater possibility of overnight stay (77.1%) from 4:30 pm (Younden index = 0.492). DISCUSSION: Most patients stayed overnight due to the time at which recovery was completed, since no cause was identified (84.7%). If our unit would not have an overnight stay we would have an overall hospitalization rate of 8.4%, which corresponds to patients with an identified cause for overnight stay, and to admitted patients. CONCLUSION: Ambulatory cholecystectomy can be performed in units that cannot cater for an overnight stay, provided that surgeries are performed during the morning period, patients are carefully selected and there is the possibility of admission.

Introdução: Apesar da colecistectomia laparoscópica ser uma técnica cada vez mais realizada em regime de ambulatório, não é praticada em algumas unidades por ausência de pernoita. São objetivos deste estudo identificar as diferenças entre os doentes com alta ao final do dia versus pernoita e os fatores preditores de pernoita.Material e Métodos: Realizámos uma análise retrospetiva dos dados pré, peri e pós-operatório dos doentes operados entre janeiro de 2014 e dezembro de 2017, tendo-se procedido à análise estatística das variáveis.Resultados: Foram incluídos 311 doentes, sendo que apenas 33,4% pernoitaram. Destes, 81,7% foram operados depois das 14 horas. Como fatores preditores de pernoita foram identificados a idade (p = 0,001) no grupo da manhã, havendo a partir dos 61,50 anos (Younden index = 0,396) uma maior possibilidade de pernoita (15,3%) e a hora de início da cirurgia (p < 0,0001) no grupo da tarde, sendo que os doentes operados após as 16 horas e trinta minutos (Younden index = 0,492) têm maior possibilidade de pernoita (77,1%).Discussão: Grande parte dos doentes pernoitou devido à hora em que completou o recobro, uma vez que não se identificou uma causa para tal (84,7%). Caso a nossa Unidade não dispusesse de pernoita teríamos uma taxa global de internamento de 8,4%, que corresponde aos doentes com causa identificada para a pernoita e os doentes internados.Conclusão: A colecistectomia em ambulatório pode ser realizada em unidades que não disponham de pernoita, desde que as cirurgias decorram no período da manhã, os doentes sejam selecionados de forma criteriosa e exista a possibilidade de internamento.