Outcome of emergency abdominal surgery in elderly patients

The outcome of emergency abdominal surgery in elderly patients [above 60 years old] remains unsatisfactory. Factors contributing to this outcome were studied; particularly in those aged 80 years and older. 44 patients aged 80 years or more [group A] and 152 patients aged 60-79 years [group B] who underwent emergency abdominal surgery between 1998 and 2003 in El-Minia University hospital and Al Haram hospital. Complications were significantly higher in group A than in group B. Respiratory failure was the most common postoperative complication. The mortality rate within 30 days after operation was also higher in group A[23%] than in group B [4.5%]. Morbidity and mortality did not differ significantly between those with and without preexisting concomitant disease in group A. Group B showed significant difference in morbidity and mortality among those Patients with or without preexisting concomitant disease Systemic Inflammatory Respouse Syndrome [SIRS]was noted in 26 patients [59%]in group A and in 71 patients [47%]in group B. Severe complications occurred in 22 patients [50%] of group A with Preoperative SIRS. The mortality rate in those with SIRS was significantly higher than that in patients without. So SIRS is considered a predictor of poor outcome in elderly patients who have emergency abdominal surgery. We concluded that Patients with SIRS should initially receive minimal treatment whenever possible, rather' than be over treated, until their condition stabilizes

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