PTH como predictor de hipocalcemia postiroidectomía total / PTH as a predictor of hypocalcemia after total thyroidectomy

Resumen Objetivo: Evaluar la asociación entre el valor de PTH medido a las 6 h posoperatorias de los pacientes sometidos a una tiroidectomía total, y la presentación de hipocalcemia en las primeras 24 h posoperatorias. Materiales y Método: Estudio analítico retrospectivo que utiliza una base de datos de 173 pacientes operados de tiroidectomía total entre enero de 2016 a diciembre de 2018 en el Hospital Militar de Santiago (HMS). Se revisaron datos demográficos y perioperatorios. Se utilizó curva ROC para evaluar la asociación entre PTH e hipocalcemia en nuestros pacientes. Resultados: 106 pacientes que cumplen criterios de inclusión. Promedio de PTH 30,5 (1,4-169), 58% presentó hipocalcemia, solo 17 pacientes fueron sintomáticos. PTH promedio en pacientes sintomáticos fue de 7,8 pg/ml. Curva ROC con área bajo la curva de 0,83 (0,75-0,92). Considerando valores útiles para la práctica clínica, una PTH menor a 6,3 (valor más bajo en nuestro laboratorio), tiene sensibilidad de 97%. El valor 18 de PTH (límite inferior del rango de normalidad del laboratorio) se obtiene 88,89% de sensibilidad con 66,07% de especificidad. Y con un valor de 47 pg/ml, se obtiene con un 91% de especificidad para predecir pacientes que no tendrían hipocalcemia. Conclusión: Con un valor de PTH disminuido bajo su valor normal, se puede decir que el riesgo de tener hipocalcemia es sobre el 80%, por lo que se debería iniciar tratamiento profiláctico y desistir del alta. En cambio, para definir un valor superior sobre el cual dar de alta precoz con seguridad, faltan más estudios.

Aim: To evaluate the association between PTH (parathormone) value measured at 6 hours postoperatively of patients submitted to total thyroidectomy, and the presentation of hypocalcemia in the first 24 hours. Materials and Method: Retrospective study of 173 patients with total thyroidectomy between January 2016 to December 2018 in HMS. Demographic and perioperative data were reviewed. The ROC curve was used to evaluate the association between PTH and hypocalcemia in our patients. Results: 106 patients meet inclusion criteria. Average of PTH 30.5 (1.4-169), 58% presented hypocalcemia, 17 patients were symptomatic. ROC curve with area under the curve of 0.83 (0.75-0.92) was obtained considering useful values for clinical practice, a PTH less than 6.3 (lowest value in our laboratory), has 97% sensitivity to predict hypocalcemia. If we use the value 18 we obtain 88.89% sensitivity with 66.07% specificity. And with a value of 47, it is obtained with 91% specificity to predict patients who would not have hypocalcemia Conclusion: With a PTH value decreased below its normal value, it can be said that the risk of having hypocalcemia is over 80%, so that prophylactic treatment should be initiated. To define a value on which to register early with security, more study is needed.

Hipoparatiroidismo y calcificaciones cerebrales: reporte de caso / Hypoparathyroidism and brain calcifications: a case report

Introducción. El hipoparatiroidismo es una enfermedad caracterizada por la ausencia o concentraciones inadecuadamente bajas de hormona paratiroidea (PTH), que conduce a hipocalcemia, hiperfosfatemia y excreción fraccional elevada de calcio en la orina. Las calcificaciones del sistema nervioso central son un hallazgo frecuente en estos pacientes. Caso clínico. Mujer de 56 años con antecedente de hipotiroidismo, que ingresó por un cuadro de 6 días de evolución caracterizado por astenia, parestesias periorales y movimientos anormales de manos y pies. Las pruebas de laboratorio demostraron hipocalcemia, hiperfosfatemia y niveles bajos de hormona paratiroidea. Se realizó una tomografía computarizada de cráneo que mostró áreas bilaterales y simétricas de calcificaciones en hemisferios cerebelosos, ganglios basales y corona radiata. No se evidenciaron trastornos en el metabolismo del cobre y hierro. Se estableció el diagnóstico del síndrome de Fahr secundario a hipoparatiroidismo y se inició tratamiento con suplementos de calcio y vitamina D con evolución satisfactoria. Discusión. El síndrome de Fahr es un trastorno neurológico caracterizado por el depósito anormal de calcio en áreas del cerebro que controlan la actividad motora. Se asocia a varias enfermedades, especialmente, hipoparatiroidismo. La suplementación con calcio y vitamina D con el objetivo de normalizar los niveles plasmáticos de estos cationes es el tratamiento convencional. (AU)

Introduction. Hypoparathyroidism is a disease characterized by absence or inappropriately low concentrations of circulating parathyroid hormone, leading to hypocalcaemia, hyperphosphataemia and elevated fractional excretion of calcium in the urine. Central nervous system calcifications are a common finding in these patients. Case report. 56-year-old woman with a history of hypothyroidism who was admitted for a 6-day course of illness characterized by asthenia, perioral paresthesias, and abnormal movements of the hands and feet. Laboratory tests showed hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels. A cranial computed tomography was performed. It showed bilateral and symmetrical areas of calcifications in the cerebellar hemispheres, basal ganglia, and radiata crown. No disorders of copper or iron metabolism were evident. The diagnosis of Fahr syndrome secondary to hypoparathyroidism was established and treatment with calcium and vitamin D supplements was started with satisfactory evolution. Discussion. Fahr's syndrome is a neurological disorder associated with abnormal calcium deposition in areas of the brain that control motor activity. It is associated with various diseases, especially hypoparathyroidism. The conventional treatment is supplementation with calcium and vitamin D, with the aim of normalizing their plasma levels. (AU)

Prediction of post total thyroidectomy hypocalcemia using perioperative parathyroid hormone

Background: hypocalcaemia, which is a major contributing factor for delayed hospital discharge, occurs in many patients following total thyroidectomy. Parathyroid hormone [PTH] measurement has been proposed as a marker of this condition

Aim: the aim of this study was to evaluate the reliability of perioperative parathyroid hormone measurement to predict post-total thyroidectomy hypocalcaemia

Patients and methods: a prospective randomized study was conducted in the period between July 2015 and September 2017 in Ain Shams University, General Surgery Department, Endocrine Surgery Unit, Cairo, Egypt. The study was conducted on sixty patients for whom total thyroidectomy was done. Parathyroid hormone was measured pre-operative and 6 hours postoperative, and serum Ca was measured daily to predict hypocalcaemia. Patients were evaluated for symptoms of hypocalcaemia and treated with calcium and vitamin D supplementation as necessary

Results: the study included 60 patients, 12 males and 48 females with mean age 39.1+ 16.52 [20-65]. Co morbid conditions included HTN, DM, ISHD and COPD. Most patients had nodular goiter [48 patients] whether unilateral or bilateral. 63.3% of patients had follicular lesion by FNABC. All patients underwent total thyroidectomy. Hypocalcemia developed in 16.7% [10 of 60] of the patients. Best cut off was 66% reduction giving 77% Sensitivity and 91.4% Specificity. Positive predictive value was 85% and negative predictive value was 94%

Conclusion: the evaluation of PTH and corrected calcium levels 6 hours after thyroidectomy allows for an accurate prediction of the trend of hypocalcemia. This study enables us to discharge most patients safely within 24 hours after total thyroidectomy

Hipocalcemia no deslocamento de abomaso de bovinos: estudo de 39 casos / Hypocalcemia in displacement the abomasum in cattle: study of 39 cases

Este estudo avaliou o status do cálcio sérico em 39 vacas com deslocamento de abomaso (DA), provenientes de 30 propriedades leiteiras selecionadas, na região de Campos Gerais no Paraná. O diagnóstico do deslocamento de abomaso foi realizado por percussão auscultatória, além dos sinais clínicos e informações da anamnese. Previamente ao procedimento cirúrgico, amostras de sangue foram coletadas para a mensuração dos níveis sanguíneos de cálcio, albumina, proteína e glicose. Como grupo controle, amostras de sangue foram coletadas de vacas hígidas que se encontravam em semelhante período de lactação. Das 39 vacas com deslocamento de abomaso, 35 apresentaram hipocalcemia e no grupo controle, apenas um animal. Concentrações sanguíneas de glicose e proteína foram inferiores nos animais com DA, quando comparados com animais do grupo controle.(AU)

This study evaluated the status of serum calcium in 39 Holstein cows with displacement of the abomasum (DA), from 30 dairy farms selected in the region of Campos Gerais, Paraná state, Brazil.. The diagnosis of abomasal displacement was performed by auscultation and percussion, besides the clinical signs and history information. Before surgery, blood samples were collected to measure blood levels of calcium, albumin, protein and glucose. As a control group, blood samples were collected from healthy cows that were in similar period of lactation. Of the 39 cows with abomasal displacement, 35 had hypocalcemia and in the control group only one cow. Blood glucose and protein concentrations were lower in the animals with DA when compared with the control group.(AU)

Medición de niveles de parathormona como predictor de hipocalcemia sintomática en el post-operatorio precoz de tiroidectomía total / Parathormone levels measurement as predictor of symptomatic hypocalcemia after total thyroidectomy

Introduction: The most frequent complication after total thyroidectomy is hypocalcemia. It is difficult to predict it. The objective of this paper is determinate if measurement of parathormone 6 hours after total thyroidectomy can predict symptomatic hypocalcemia, and determinate associated factors in the development of this complication. Material and Method: Prospective case series. Patients that underwent total thyroidectomy between 2006 and 2008 in our Hospital. We registered epidemiological data, related surgery factors and measurement of parathormone 6 hours after surgery. Hypocalcemia symptoms were registered. We used statistical analysis considering significant p < 0.05. Results: We included 82 patients. Median age was 53.2 years. 79.3 percent were female. The average of parathormone 6 hours after surgery was 28.7 pg/dL. Sensibility was 100 percent, specificity 79.4 percent, positive predictive value 59.4 percent, negative predictive value 100 percent and accuracy 84.1 percent to predict symptomatic hypocalcaemia. A statistical association among levels under the normal base line of parathormone and symptomatic hypocalcemia was detected (p < 0.0001). Relative risk was 4.84. Univariated analysis showed association between hypocalcemia and pre-operative thyroid cancer diagnosis (p = 0.01), cervical dissection (p = 0.03) and level of parathormone (p = 0.002). Multivariated analysis showed that only the level of parathormone associates with hypocalcemia (p = 0.002). Conclusion: The measurement of parathormone allows identifying which patients are at risk of presenting symptomatic hypocalcemia after total thyroidectomy.

Introducción: La complicación más frecuente de la tiroidectomía total es la hipocalcemia. Su predicción es difícil. El objetivo de este trabajo es determinar si la medición de parathormona a las 6 h posterior a una tiroidectomía total es un factor que pueda predecir la aparición de hipocalcemia sintomática y determinar los factores asociados al desarrollo de esta complicación. Material y Método: Serie de casos prospectiva. Pacientes intervenidos de tiroidectomía total entre 2006 y 2008 en el Hospital FACH. Se registraron datos epidemiológicos, factores relacionados a la cirugía y la medición de parathormona a las 6 h. Se registraron los síntomas de hipocalcemia. Se utilizó estadística analítica considerando significativo p < 0,05. Resultados: Se enrolaron 82 pacientes. La edad media fue 53,2 años. El 79,3 por ciento fue de sexo femenino. El promedio de parathormona a las 6 h fue 28,7 pg/dL. Se obtuvo sensibilidad 100 por ciento, especificidad 79,4 por ciento, valor predictivo positivo 59,4 por ciento, negativo 100 por ciento y precisión 84,1 por ciento para predecir hipocalcemia. Cuando los valores de PTH estaban bajo el margen normal, el riesgo relativo de hipocalcemia sintomática fue 4,84 (p < 0,0001). El análisis univariado mostró asociación entre hipocalcemia y el diagnóstico pre operatorio de cáncer (p = 0,01), la disección cervical (p = 0,03) y el nivel de parathormona a las 6 h (p = 0,002). El análisis multivariado demostró que sólo el nivel de parathormona se asocia con hipocalcemia (p = 0,002). Conclusión: La medición de parathormona es un elemento que permite estimar de manera adecuada qué pacientes están en riesgo de presentar hipocalcemia sintomática en el post-operatorio precoz de tiroidectomía total.

Whole blood versus serum ionized calcium concentrations in dialysis patients

BACKGROUND/AIMS: The aim of this study is to measure the difference of ionized calcium between heparinized whole blood and serum. METHODS: We recruited 107 maintenance hemodialysis (HD) patients from our hospital HD unit. The clinical and laboratory data included ionized calcium in serum and in whole blood (reference, 4.07 to 5.17 mg/dL). RESULTS: The level of ionized calcium in serum was higher than that in whole blood (p < 0.001). Bland-Altman analysis showed that difference for ionized calcium was 0.5027. For the difference, the nonstandardized beta was -0.4389 (p < 0.001) and the intercept was 2.2418 (p < 0.001). There was a significant difference in the distribution of categories of ionized calcium level between two methods (kappa, 0.279; p < 0.001). CONCLUSIONS: This study demonstrates that whole blood ionized calcium is underestimated compared with serum ionized calcium. Positive difference increases as whole blood ionized calcium decreases. Therefore, significant hypocalcemia in whole blood ionized calcium should be verified by serum ionized calcium.

Evolution of blood magnesium and phosphorus ion levels following thyroidectomy and correlation with total calcium values / Evolução dos níveis dos íons fósforo e magnésio séricos e sua correlação com valores de cálcio total após tireoidectomia

CONTEXT AND OBJECTIVE: Magnesium ion concentration is directly related and phosphorus ion concentration is inversely related to calcemia. The aim of this study was to evaluate the evolution of magnesium and phosphorus ion levels in patients undergoing thyroidectomy and correlate these with changes to calcium concentration. DESIGN AND SETTING: Prospective study at the Alpha Institute of Gastroenterology, Hospital das Clínicas, Universidade Federal de Minas Gerais. METHODS: The study included 333 patients, of both genders and mean age 45 ± 15 years, who underwent thyroidectomy between 2000 and 2005. Total calcium, phosphorus and magnesium were measured in the blood preoperatively and 24 and 48 hours postoperatively. Ionic changes were evaluated according to the presence or absence of postoperative hypocalcemia. RESULTS: There were statistically significant drops in blood phosphorus levels 24 and 48 hours after thyroidectomy, compared with preoperative values, in the patients without hypocalcemia. In the patients who developed hypocalcemia, there was a significant drop in plasma phosphorus on the first postoperative day and an increase (also statistically significant) on the second day, in relation to preoperative phosphorus levels. A significant drop in postoperative magnesium was also observed on the first and second days after thyroidectomy in the patients with hypocalcemia, in relation to preoperative levels. In the patients without hypocalcemia, the drop in magnesium was significant on the first day, but there was no difference on the second day. CONCLUSION: Despite the postoperative changes, neither magnesium nor phosphorus ion levels had any role in post-thyroidectomy calcemia.

CONTEXTO E OBJETIVO: A concentração do íon magnésio está diretamente e a do íon fósforo inversamente relacionada à calcemia. O objetivo foi avaliar a evolução das concentrações dos íons magnésio e fósforo nos pacientes submetidos a tireoidectomia, e relacioná-los com as alterações da concentração do cálcio. TIPO DE ESTUDO E LOCAL: Estudo prospectivo realizado no Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais. MÉTODOS: O estudo incluiu 333 pacientes de ambos os sexos, com média de idade de 45 ± 15 anos, submetidos a tireoidectomia no período de 2000 a 2005. Cálcio total, fósforo e magnésio foram dosados no pré-operatório e com 24 e 48 horas de pós-operatório. As alterações dos íons foram avaliadas de acordo com a presença ou ausência de hipocalcemia pós-operatória. RESULTADOS: Houve queda estatisticamente significativa dos níveis sanguíneos de fósforo 24 horas e 48 horas após a tireoidectomia em relação ao pré-operatório nos pacientes que não tiveram hipocalcemia. Quanto aos pacientes que evoluíram com hipocalcemia, houve queda significativa do fósforo plasmático no primeiro dia de pós-operatório e elevação, também estatisticamente significativa, no segundo dia em relação ao fósforo pré-operatório. Foi também observada queda significativa do magnésio pós-operatório em relação ao pré-operatório no primeiro e no segundo dia após a tireoidectomia nos pacientes com hipocalcemia. Naqueles sem hipocalcemia, a queda do magnésio foi significativa no primeiro dia, mas não houve diferença no segundo dia. CONCLUSÃO: Embora alterados no pós-operatório, as concentrações dos íons magnésio e fósforo não apresentaram papel na calcemia pós-tireoidectomia.

Assessment of risk factors of incidental parathyroidectomy during thyroid surgery: a prospective study

To determine the incidence, risk factors and clinical relevance of incidental parathyroidectomy during thyroidectomy. A total of 207 consecutive patients with benign and malignant thyroid disorders undergoing unilateral or bilateral thyroidectomy were included prospectively in the present study. Patients were divided into two groups according to incidental parathyroidectomy. 210 thyroidectomies were performed. Group A included 26 patients with incidental parathyroidectomy and group B included 181 patients without incidental parathyroidectomy. The parathyroid tissue in the resected specimens was found in intrathyroid [57.7%], extrathyroid [23.1%] and central node compartment [19.2%] sites. On multivariate analysis, two factors sustained their significance independently; reoperation for recurrent goitre [p=0.001] and concomitant central neck dissection [p=0.001]. There was no statistically significant difference regarding the occurrence of postoperative hypocalcemia between the two groups [p = 0.55]. Reoperation for recurrent goitre and concomitant central neck dissection for cancer thyroid may increase the risk of incidental parathyroidectomy. Incidental parathyroidectomy is not usually associated with symptomatic postoperative hypocalcemia. Most of removed parathyroid glands are intrathyroid, so incidental parathyroidectomy may be unavoidable

Functional reversal of duodenal switch with maximum lengthening of gommon channel in a child's C cirrhotic patient: case report and review of the literature

Functional Reversal of Douodenal Switch is avariant of biliopancreatic bypass and is a rare procedure which involves sleeve gastrectomy and pylorus preservation with aduodenal transaction. Many complications results from the procedure specially liver frtilure so consulation for reversal of duodenal switch should be entertained prior to the onset of the complications

Serum calcium, magnesium and uric acid in preeclampsia and normal pregnancy.

OBJECTIVE: To compare serum calcium, magnesium and uric acid in mild, severe preeclamptic women and normal pregnant women. STUDY DESIGN: Cross-sectional study. Setting: Section of Obstetrics and Gynecology, Taksin Hospital. MATERIAL AND METHOD: The data was collected from 36 normal pregnant women, 35 mild preeclamptic women and 33 severe preeclamptic women who were admitted in the Section of Obstetrics and Gynecology at Taksin Hospital between April 2006 and June 2007. The blood samples were collected and analyzed for calcium, magnesium and uric acid The data was analyzed using Analysis of Variances (ANOVA). RESULTS: The serum calcium in severe preeclamptic women was significantly lower (8.7 +/- 0.59 mg/dl vs. 8.99 +/- 0.31 mg/dl, p = 0.045; and 9.05 +/- 0.52 mg/dl, p = 0 014) and serum uric acid was significantly higher (7.01 +/- 1.93 mg/dl vs. 5.33 +/- 1.23 mg/dl, p < 0.001 and 5.95 +/- 1.9 mg/dl, p = 0.044) than in normal pregnant women and mild preeclamptic women respectively, but there was no difference between normal and mild preeclamptic women. There was no difference in serum magnesium among normal pregnancy and both groups of preeclampsia. CONCLUSION: Hypocalcemia and hyperuricemia correlated to severe preeclampsia.

Hypocalcemia in the newborn.

Healthy term babies undergo a physiological nadir in serum calcium levels by 24-48 hours of age. The nadir may be related to the delayed response of parathyroid and calcitonin hormones in a newborn. This nadir may drop to hypocalcemic levels in high-risk neonates including infants of diabetic mothers, preterm infants and infants with perinatal asphyxia. The early onset hypocalcemia which presents within 72 hours, requires treatment with calcium supplementation for at least 72 hours. In contrast, late onset hypocalcemia usually presents after 7 days and requires long term therapy. Ionized calcium is crucial for many biochemical processes and total serum calcium is a poor substitute for the diagnosis of hypocalcemia.

Post thyroidectomy hypocalcaemia

To evaluate the incidence and assess the risk factors of hypocalcaemia and permanent hypoparathyroidism following thyroidectomy. 150 patients operated for thyroidectomy from January 2003 to March 2006 were included in this study the fasting serum calcium and phosphorus levels were measured daily before and after surgery until the day of discharge; parathrome measurement was performed for all hypocalcaemic patients. 12 out of 150 patients [8%] developed postoperative hypocalcaemia, 2 of them [16.6%] were considered permanent. Total thyroidectomy was the procedure in 38 patients, 6 from them [15.8%] devoloped hypocalcaemia and the other 6 out of 112 cases[5.4%] were after subtotal thyroidectomy. The hypocalcaemia was 11.4% in toxic goitre [5 out of 44 patients], 12% were malignant goitre[3 out of 12 patients] and 3.6% were simple multinodular goitre [3 out of 84 patients]. When preservation of parathyroid glands and their blood supply is enforced during thyroidectomy, the incidence of postoperative hypocalcaemia and permanent hypoparathyroidism can be consistently deceased

Hypoparathyroidism and pseudohypoparathyroidism / Hipoparatiroidismo e pseudohipoparatiroidismo

The principal function of the parathyroid hormone (PTH) is maintenance of calcium plasmatic levels, withdrawing the calcium from bone tissue, reabsorbing it from the glomerular filtrate, and indirectly increasing its intestinal absorption by stimulating active vitamin D (calcitriol) production. Additionally, the PTH prompts an increase in urinary excretion of phosphorus and bicarbonate, seeking a larger quantity of free calcium available in circulation. Two mechanisms may alter its function, limiting its control on calcium: insufficient PTH production by the parathyroids (hypoparathyroidism), or a resistance against its action in target tissues (pseudohypoparathyroidism). In both cases, there are significantly reduced levels of plasmatic calcium associated with hyperphosphatemia. Clinical cases are characterized by nervous hyperexcitability, with paresthesia, cramps, tetany, hyperreflexia, convulsions, and tetanic crisis. Abnormalities such as cataracts and basal ganglia calcification are also typical of these diseases. Treatment consists of oral calcium supplementation associated with increased doses of vitamin D derivatives.

A principal função do paratormônio (PTH) é a manutenção dos níveis plasmáticos de cálcio, retirando-o do tecido ósseo, reabsorvendo-o do filtrado glomerular e, indiretamente, aumentando sua absorção intestinal através do estímulo para a produção de vitamina D ativa (calcitriol). Além disso, o PTH promove um aumento na excreção urinária de fósforo e bicarbonato, objetivando uma maior quantidade de cálcio livre disponível na circulação. Dois mecanismos podem alterar sua função, limitando seu controle sobre o cálcio: produção insuficiente de PTH pelas paratiróides (hipoparatiroidismo), ou uma resistência à sua ação nos órgãos-alvo (pseudohipoparatiroidismo). Em ambos os casos, ocorre uma redução significativa dos níveis plasmáticos de cálcio em associação com hiperfosfatemia. Manifestações clínicas características são: hiperexcitabilidade nervosa, com parestesia, cãimbras, tetania, hiperreflexia, convulsões e crise tetânica. Catarata e calcificação dos gânglios basais são anormalidades típicas dessas doenças. O tratamento consiste da suplementação oral de cálcio, associada com doses elevadas de derivados da vitamina D.

Pulmonary dysfunctions in end stage chronic renal failure children on regular hemodialysis; possible risk factors

Lung and kidney functions are intimately related in both health and disease. In renal failure respiratory changes help to mitigate the systemic effects of renal acid-base disturbances. Changes in the function of the respiratory system are among the frequent complications of renal impairment. Alteration in the respiratory drive, mechanics, muscle function, lung volumes, gas exchange and hemodynamics are frequent and could occur in the lungs without obvious pulmonary symptoms. Their effects could be the way to pulmonary functional disorders. Patients with chronic renal failure treated with hemodialysis may exhibit various changes in ventilation and gas exchange. Moreover, hemodialysis and peritoneal dialysis may have their own impact on the respiratory functions. The main objectives of this work were to assess the pulmonary functions and arterial blood gases as well as assessment of echocardiographic changes in a group of children with chronic renal failure undergoing regular hemodialysis. We also aimed to explore possible risk factors that make these children more liable to disturbed pulmonary function. The study included 19 patients with CRF on regular hemodialysis during the period from January to March 2005. Their ages ranged from 8-17 years [mean 13.63 +/- 2.65]. They were 12 males and 7 females. These patients were attending the pediatric nephrology unit in Assiut University Hospital. The duration of dialysis varied from 1-5 years. Patients with known or recent cardiac, infectious, inflammatory or pulmonary diseases were excluded from the study, They were classified according to the duration of dialysis into two groups. Group [1]: 8 CRF children with duration of dialysis<3 years and Group [2]: 11 CRF children with duration of dialysis >/= 3 years, Fifteen apparently healthy children of matchable age, and sex were included as control group. All subjects had full clinical assessment including body weight, height, wt/ht ratio and full examination including: pulse, blood pressure measurement, chest and cardiac examination. The following investigations were also done: complete blood picture, total serum protein, albumin, urea, creatinine, calcium, phosphorus, and arterial blood gases [before and after a hemodialysis session]. Posteroanterior and lateral chest X-ray and echocardiographic examination. Spirometry was performed at the chest department of Assiut University hospital using sensor Medics [IBM] apparatus. The following parameters were obtained: Forced vital capacity [FVC]; Forced expiratory volume in one second [FEV1]; FEVI/FVC ratio; and Peak expiratory flow rate [PEFR]. Out of the studied patients, 15.79%had pulmonary venous congestion while 10.52%had pleural effusions. On the other hand 15.79%had pericardial effusion and a similar percent had cardiomegaly. Cases as a whole and also both subgroups [A and B] showed significantly lower mean levels of wt/ht ratio, Hb, albumin, Ca, and FS but significantly higher mean levels of systolic blood pressure, blood urea, creatinine, P, LVESD, LVEDD, and indexed LVM than controls. Cases as a whole showed significantly lower mean levels of FVC, FEV1 and PEFR than controls. Cases in group B showed significantly lower mean level of FVC and FEVI and PEFR than controls. Analysis of blood gases showed that cases as a whole and also both groups [A and B] had significantly lower mean levels of pH and HCO3 and base excess than controls. Furthermore both groups showed significantly lower PCO2 before and after a HD session. FVC, FEV1 and PEFR correlated positively with each of wt/ratio ratio, Hb, albumin, Ca and FS and negatively with the duration of the dialysis, creatinine, P, and indexed LVM. Restrictive pattern of pulmonary dysfunctions is frequent in ESCRF patients. Structural and functional cardiac abnormalities are very important among the many predisposing factors for pulmonary function disturbances. Other factors such as malnutrition, hypocalcemia, hyperphosphatemia and anemia may also affect the pulmonary functions indirectly through cardiac affection. Uremic toxins are important factors for both system dysfunctions and the longer the duration of the disease, the more are the disturbances of the pulmonary functions. Low PCO[2] in uremic patients may be a trial by the respiratory system to compensate for acidosis by CO[2] wash in order to elevate the pH to near normal. This is very important since the possible noxious effect of overcorrection of acidosis may lead to alkalosis in such patients who are liable to be alkalosis after dialysis. Although standard treatment of malnutrition in CRF, include measures such as early and adequate dialysis, nutritional counseling, oral protein and amino acid supplements, these interventions cannot restore the nutritional status in all malnourished uremic patients. Adequate management of anemia is critically needed for breaking the cycle connecting renal failure, anemia and cardiac disease [all are predisposing factors for pulmonary dysfunctions]. Adequate management of the cardiac problems as well as appropriate monitoring and follow up is necessary to ameliorate the effects on the lungs and may prevent or delay the occurrence of pulmonary dysfunctions. Hemodialysis itself has its own impact on various organs. This points to the importance of renal transplantation as a better therapeutic alternative particularly in children

Permanent hypoparathyroidism following radioiodine treatment for hyperthyroidism.

Persistent hypoparathyroidism following 131I treatment is a rare but recognized complication. A case is presented, where a relatively small dose of 131I produced persistent hypocalcaemia.

Alterations in the systemic acid-base status and blood gas dynamics during progressive hypocalcaemia in cow calves.

Hypocalcaemia, induced in cow calves by slow infusion of Na2EDTA for 6 hr, led to biphasic changes in acid-base status. Decrease in ionized plasma Ca2+ concentration upto 0.82 +/- 0.06 mmole 1(-1) was associated with metabolic alkalosis. Further decrease in ionized plasma Ca2+ concentration (0.61 +/- 0.09 mmole 1(-1)) led to metabolic acidosis, superimposed by a respiratory component. There was significant decrease in oxygen tension and saturation of arterial blood as well as impaired uptake of oxygen by peripheral tissues and pulmonary blood.

Calcium supplementation for preterm and low birth-weight neonates.

Early neonatal hypocalcemia is a common problem in prematurely born infants. To prevent it, therapy with intravenous calcium is often advised. We compared the efficacy and side-effects of intravenous and oral calcium supplementation in preterm and low birth-weight babies. Both the groups were comparable for birth weight, gestational age and cord blood calcium level. Oral calcium administration was as efficacious as intravenous administration in babies of all gestational age groups and birth-weight groups. Side effects associated with therapy were less common and of lesser severity in oral supplementation group. Lower cost and ease of administration were additional benefits.