Postoperative transient hypoparathyroidism in graves' disease

Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a deficiency in calcium and Vitamin D concomitant with transient hypoparathyroidism induced by surgery. In this study, we try to predict the risk factors for this observation by referring to serum 25-hydroxyvitamin D and alkaline phosphatase. The serum level of intact parathyroid hormone, calcium, other electrolytes, and 25-hydroxyvitamin D were measured preoperatively in 59 female patients with Graves' disease who underwent Subtotal thyroidectomy. A systematic accurate identification and preservation of parathyroid glands were always performed. Of the 59 female patients, 5 [8.4%] developed tetany. From analysis of different possible risk factors, the results showed that two were statistically significant: serum 25-hydroxyvitamin D [25 [OH] D] and alkaline Phosphatase [ALP] levels. The incidence of tetany according to the serum levels of 25 [OH] D and ALP was 20% [3/15] in patients with 25 [OH] D l55U/L, 9.09% [1/11] in those with 25 [OH] D 10 ngm/ml and ALP> 155u/L, and 0% [0/17] in those with 25 [OH] D> 10 ngm/ml and ALP >/= 155 u/L. Patients with Graves disease who have vitamin D deficiency and high serum alkaline phophatase levels is the highest risk group for postoperative tetany, so, serum 25 [OH] D and ALP should be monitired in patients with Graves' disease and preventive prescription of vitamin D and Calcium is recommended

Repair of large paraesophageal hiatus hernia with polypropylene prosthesis

Posterior Cruroplasty repair of a large paraesophageal hiatus has a higher than desirable rate of recurrence attributable to the inexorable cyclic negative intrathoracic pressure of respiration and positive intrabdominal pressure produced by straining, physical exertion and coughing. To reduce the risk of recurrence, we have used posterior cruroplasty reinforced with an onlay polypropylene mesh prosthesis. Thirty consecutive patients with paraesophageal hiatus hernia had transabdominal posterior cruroplasty and onlay polypropylene mesh prosthesis applied to the crura and adjacent diaphragm to reinforce the hiatal defect with Nissen fundoplication to control associated reflux which was present in 80% of the patients. As regards to pre-and postoperative clinical manifestations, contrast radiography and upper gastrointestinal endoscopy, the results of the operation were excellent in 22 patients [73%], good in 6 patients [7%] Postoperative course was sound in most patients [23 from 30 patients]. After a period of follow up [from 18 to 48 months] there was neither cases of recurrence, nor complications related to the mesh. We conclude that mesh reinforcement of the esophageal hiatus hernia repair is effective, have a low clinical recurrence rate, and devoid of any complications related to the used polypropylene mesh. Concomitant antireflux procedure [we used Nissen fundoplication] is recommended in all operations for paraesophageal hiatus hernia especially if reflux can not be excluded before operation, or retroesophageal dissection is needed

Changes in the serum gastrin levels in patients with colorectal cancer

Gastrin receptors have been demonstrated on the human colon cancer cell line, which may indicate that gastrin has trophic effect on human colon cancer cell. A total of 16 patients [5 men [31.25%] l1 women [68.75%]; mean age 49.3 years] with established diagnosis of colorectal cancer [group1] and 10 patients [5 men [50%], 5 women [50%]; mean age 36.2 year]with different types of hernia [group 2] taken as control, were studied. Blood sample for estimation of serum gastrin were taken both fasting and postprandial before and after resection of the tumor in group I, also blood samples from group 2 [control] were taken once for estimation of fasting and postprandial serum gastrin. The results shows that,the fasting [mean +/- sd 59,63 +/- 18.78 pgm/ml] and postprandial [mean +/- SD 94.65 +/- 33.25 pgm/ml] serum gastrin in group 1 before resection were significantly higher when compared with group 2 [control] fasting [means +/- SD 40.68 +/- 8.15 pgm/ml] and postprandial [means +/- SD 59.02 +/- 16.42 pgm/ml] p=0.006 and p=0.004 respectively. Also serum gastrin concentrations were significantly lower, fasting [means +/- SD 44.89 +/- 9.46 pgm/ml], postprandial [means +/- SD 69.32 +/- 25.39 pgm/ml] p=0.009 and p=0.002 respectively after apparently curative resection when compared to the preoperative level. In conclusion, the presence of colorectal cancer is associated with endogenous hypergastriaemia, which resolved after resection of the tumour. Substances which decrease the level of circulating gastrin will be as useful in regulating tumour growth as gastrin receptor antagonists