ABSTRACT
Introduction: Multiple endocrine neoplasia type 1 (MEN1) is a genetic syndrome manifested initially as primary hyperparathyroidism (HPT/MEN 1). The treatment is classically surgical with total parathyroidectomy with autograft or subtotal parathyroidectomy. In order to maintain normal postoperative function, less than subtotal parathyroidectomy (LTSPTx) has been suggested as an alternative technique. Objective: Analyse critically LTSPTx as a treatment option for patients with HPT/MEN 1. Methods: A retrospective cohort study of patients submitted to LTSPTx from january 2011 to december 2018. Data from demographics, laboratory tests, 6 months postoperative clinical outcomes, intraoperative PTH values and localization studies were analized. Results: LTSPTx was performed non-intentionally in 13 patients and intentionally in 13 other cases; 17 females and 9 males. The mean age was 44 years, but in patients with identified mutation it was 37 years. Seventeen patients (65.4%) had normal parathyroid function, 5 (19.2%) had hypoparathyroidism, in all of them LTSPTx was performed non intentionally. Four patients (15.4%) had persistence, all submitted intentionally to LTSPTx. The mean intraoperative PTH drop was 85.5% (±10.4%), without difference intergroup. A patient with persistence had PTH intraoperative drop > 80%, which also occurred in another patient with postoperative hypoparathyroidism. No persistence was found in patients with concordant image exams, what happened in three cases with non-concordant studies. Conclusion: LTSPTx may be intentionally performed as treatment for HPT/MEN 1, however social aspects, technical expertise, image exams and patient expectations must be taken into account.
ABSTRACT
Objetivo: A lesão renal aguda é uma complicação comum em pacientes gravemente enfermos, sendo os critérios RIFLE, AKIN e KDIGO utilizados para sua classificação. Esse trabalho teve como objetivo a comparação dos critérios citados quanto à capacidade de predição de mortalidade em pacientes gravemente enfermos. Métodos: Estudo de coorte prospectiva, utilizando como fonte de dados prontuários médicos. Foram incluídos todos os pacientes admitidos na unidade de terapia intensiva. Os critérios de exclusão foram tempo de internamento menor que 24 horas e doença renal crônica dialítica. Os pacientes foram acompanhados até a alta ou óbito Para análise dos dados, foram utilizados os testes t de Student, qui-quadrado, regressão logística multivariada e curva ROC. Resultados: A média de idade foi de 64 anos, com mulheres e afrodescendentes representando maioria. Segundo o RIFLE, a taxa de mortalidade foi de 17,74%, 22,58%, 24,19% e 35,48% para pacientes sem lesão renal aguda e em estágios Risk, Injury e Failure, respectivamente. Quanto ao AKIN, a taxa de mortalidade foi de 17,74%, 29,03%, 12,90% e 40,32% para pacientes sem lesão renal aguda, estágio I, estágio II e estágio III, respectivamente. Considerando o KDIGO 2012, a taxa de mortalidade foi de 17,74%, 29,03%, 11,29% e 41,94% para pacientes sem lesão renal aguda, estágio I, estágio II e estágio III, respectivamente. As três classificações apresentaram resultados de curvas ROC para mortalidade semelhantes. Conclusão: Os critérios RIFLE, AKIN e KDIGO apresentaram-se como boas ferramentas para predição de mortalidade em pacientes graves, não havendo diferença relevante entre os mesmos. .
Objective: Acute kidney injury is a common complication in critically ill patients, and the RIFLE, AKIN and KDIGO criteria are used to classify these patients. The present study's aim was to compare these criteria as predictors of mortality in critically ill patients. Methods: Prospective cohort study using medical records as the source of data. All patients admitted to the intensive care unit were included. The exclusion criteria were hospitalization for less than 24 hours and death. Patients were followed until discharge or death. Student's t test, chi-squared analysis, a multivariate logistic regression and ROC curves were used for the data analysis. Results: The mean patient age was 64 years old, and the majority of patients were women of African descent. According to RIFLE, the mortality rates were 17.74%, 22.58%, 24.19% and 35.48% for patients without acute kidney injury (AKI) in stages of Risk, Injury and Failure, respectively. For AKIN, the mortality rates were 17.74%, 29.03%, 12.90% and 40.32% for patients without AKI and at stage I, stage II and stage III, respectively. For KDIGO 2012, the mortality rates were 17.74%, 29.03%, 11.29% and 41.94% for patients without AKI and at stage I, stage II and stage III, respectively. All three classification systems showed similar ROC curves for mortality. Conclusion: The RIFLE, AKIN and KDIGO criteria were good tools for predicting mortality in critically ill patients with no significant difference between them. .