Use of prophylactic oral calcium after total thyroidectomy: a prospective study

ABSTRACT Objective The aim of this study was to evaluate the use of prophylactic oral calcium after total thyroidectomy in the prevention of symptomatic hypocalcemia, and to develop a rational strategy of oral calcium supplementation following this type of surgery. Subjects and methods Prospective study including 47 patients undergoing total thyroidectomy from January 2007 to February 2012. The patients were allocated to one of the following groups: I (no postoperative calcium) or II (oral calcium 3 g per day). Oral calcium was started at the first postoperative day and administered until the sixth postoperative day. The patients were followed up for a minimum of 6 months and evaluated with a minimum of five measurements of ionized calcium: preoperative, 16 hours after surgery, seventh postoperative day, and at postoperative days 90 (PO90) and 180 (PO180). The cohort included three men and 44 women, of whom 24 (51.9%) had benign thyroid disease, and 23 had suspected or confirmed malignant disease. Results When compared with Group II, Group I had significantly higher rates of postoperative biochemical hypocalcemia at PO1 and PO180, and of symptomatic hypocalcemia at PO1, PO7, and PO90. Other data were not significantly different between the groups. Conclusion We conclude that postoperative calcium supplementation effectively prevents symptomatic and biochemical hypocalcemia after total thyroidectomy, and can be safely used after this procedure. The presented strategy of oral calcium supplementation may be implemented in a viable manner.

Schwannomas in the head and neck: retrospective analysis of 21 patients and review of the literature

CONTEXT AND OBJECTIVE: Schwannomas are benign neoplasms of the peripheral nerves originating in the Schwann cells. According to their cellularity, they can be subdivided into Antoni A or Antoni B types. They are rare and usually solitary, with clearly delimited capsules. They occur in the head and neck region in only 25 percent of the cases, and may be associated with Von Recklinghausen's disease. The present study retrospectively analyzed some data on this disease in the head and neck region and reviewed the literature on the subject. DESIGN AND SETTING: Retrospective study at Head and Neck Service, Universidade Estadual de Campinas. METHODS: Data on 21 patients between 1980 and 2003 were reviewed. The sites of cervical schwannomas and the intraoperative, histopathological and postoperative clinical status of these cases were studied. Diagnostic methods, type of surgery and association with neurofibromatosis were evaluated. RESULTS: The patients' ages ranged from 16 to 72 years. Four patients had a positive past history of type I neurofibromatosis or Von Recklinghausen's disease. The nerves affected included the brachial and cervical plexuses, vagus nerve, sympathetic chain and lingual or recurrent laryngeal nerve. The nerve of origin was not identified in six cases. Tumor enucleation was performed in 16 patients; the other five required more extensive surgery. CONCLUSION: Schwannomas and neurofibromas both derive from Schwann cells, but are different entities. They are solitary lesions, except in Von Recklinghausen's disease. They are generally benign, and rarely recur. The recommended surgical treatment is tumor enucleation.

CONTEXTO E OBJETIVO: Schwannomas são neoplasias benignas dos nervos periféricos, originadas nas células de Schwann, podendo, baseado na sua celularidade, ser subdivididas em Antoni A ou B. São de ocorrência infreqüente, geralmente únicas, com cápsula bem delimitada; ocorrendo na região de cabeça em pescoço em apenas de 25 por cento dos casos, podendo estar relacionadas à doença de Von Recklinghausen. Este estudo objetiva analisar retrospectivamente dados concernentes a esta afecção na região de cabeça e pescoço e rever os dados da literatura. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado no Serviço de Cirurgia de Cabeça e Pescoço, Universidade Estadual de Campinas. MÉTODOS: Revisamos dados de 21 pacientes tratados entre 1980 e 2003. Sítio do tumor, status intra e pós-operatório e laudo histopatológico foram estudados nos schwannomas cervicais. Métodos diagnósticos, tipo de cirurgia e associação com neurofibromatose foram avaliados. RESULTADOS: A idade variou entre 16 e 72 anos. Quatro pacientes tinham história positiva para neurofibromatose tipo I ou doença de Von Recklinghausen. Os nervos afetados incluíram os plexos braquial e cervical, os nervos vago, lingual e recorrente e a cadeia simpática. O nervo de origem não foi identificado em seis casos. Enucleação do tumor foi feita em 16 pacientes; os outros cinco requereram cirurgias mais extensas. CONCLUSÃO: Schwannomas e neurofibromas derivam das células de Schwann, mas são tumores diferentes. São lesões solitárias, exceto na doença de Von Recklinghausen, geralmente benignas e raramente recidivam. O tratamento cirúrgico recomendado é a enucleção do tumor.