Predictors of early postoperative hypocalcemia after total parathyroidectomy in renal hyperparathyroidism

PURPOSE: Patients with secondary hyperparathyroidism are at high risk for developing postoperative hypocalcemia. However, there are limited data regarding predictors of postoperative hypocalcemia in renal failure patient with secondary hyperparathyroidism. This study aimed to determine the clinical presentations of renal hyperparathyroidism and the predictors of early postoperative hypocalcemia after total parathyroidectomy.METHODS: Data of patients with renal hyperparathyroidism who underwent total parathyroidectomy between January 2007 to December 2014 were reviewed retrospectively. Patients were divided into 2 cohort groups according to their serum calcium levels within 24 hours of parathyroidectomy: the hypocalcemia group (calcium levels of 2 mmol/L or less), and the normocalcemia group (calcium levels more than 2 mmol/L). With the use of multivariable logistic regression analyses, the predictors of early postoperative hypocalcemia after total parathyroidectomy in patients with renal hyperparathyroidism were investigated.RESULTS: Among 68 patients, 56 patients (82.4%) were symptomatic preoperatively. Fifty patients (73.5%) presented with bone pain and 14 patients (20.6%) had muscle weakness. Early postoperative hypocalcemia occurred in 25 patients (36.8%). Preoperative alkaline phosphatase level was the predictor of early postoperative hypocalcemia (adjusted odds ratio, 1.004; 95% confidence interval, 1.001–1.006; P = 0.002).CONCLUSION: Results from our study show that most of the patients with renal hyperparathyroidism were symptomatic preoperatively and the most common clinical presentations were bone pain and muscle weakness. The significant predictor of early postoperative hypocalcemia after total parathyroidectomy was the preoperative alkaline phosphatase levels.

Comparison of liver resection combined with microwave ablation and simple liver resection in the treatment of primary liver cancer / 国际外科学杂志

Objective To investigate the curative effect between liver resection combined with microwave ablation during operation and simple liver resection in the treatment of primary liver cancer.Methods From January 2005 to December 2013,a total of 84 patients diagnosed as primary liver cancer in our hospital were collected and divided into combination group(42 cases) and simple group(42 cases) according to the surgical method.Combination group were treated by combining liver resection with microwave ablation during operation,simple group by simple liver resection.Results The intraoperative blood loss for combination group was (323.9 ± 93.1) ml and simple group was (524.5 ± 119.2) ml,P ＜ 0.05.postoperative tumor recurrence rate for combination group was 14.2％ and simple group was 33.3％,P =0.040.1-,3-,and 5-year survival rate for combination group was 96.5％,67％ and 51％,and simple group was 84％,49.5％ and 36.5％,P =0.036.The differences of the above parameters between the two groups were statistically significant.The operation time for combination group was (177.7 ± 30.7) min and simple group was (165.1 ± 29.5) min,P =0.058.The postoperative hospital stay for combination group was (15.5 ± 3.7) d and simple group was (14.0 ± 4.0) d,P =0.068.The changes of ALT,AST,ALB,TBIL on the first postoperative day and the incidence of postoperative complications (including bile leakage,fever,pleural effusion,blooding,abdominal infection and some others) between the two groups had no statistical significances (P ＞ 0.05).Conclusion The curative effects of liver resection combined with microwave ablation during operation are superior to pure liver resection in the treatment of primary liver cancer.

Infratentorial benign cystic meningioma mimicking a hemangioblastoma radiologically and a pilocytic astrocytoma intraoperatively: a case report.

INTRODUCTION: Cystic meningiomas are rare variants of meningiomas; they can pose a radiological diagnostic dilemma. CASE PRESENTATION: We present a rare case of a 30-year-old Chinese woman with a histopathological diagnosis of infratentorial cystic meningioma (World Health Organization Grade 1) in which the features in imaging modalities were suggestive of a hemangioblastoma. Intraoperatively, however, the gross macroscopic features were more in keeping with a pilocytic astrocytoma. CONCLUSION: In benign cystic meningiomas, particularly the infratentorial variety, radiological findings utilizing the various imaging modalities and intraoperative impressions may not be reflective of or in keeping with the final histopathological diagnosis.

Duplex ultrasonography arteriography as first-line investigation for peripheral vascular disease

<p><b>INTRODUCTION</b>The gold standard for evaluation of the lower extremity arterial tree is catheter angiography. Duplex arterial-occlusive imaging or duplex ultrasonography arteriography, a noninvasive technique, is used as the first-line investigation in patients with peripheral vascular disease at our centre. Based on the results of duplex imaging, patients who require angiographic intervention then proceed with simultaneous catheter arteriography and intervention. This study aimed to compare the results of duplex imaging alone as the first-line investigation against the eventual results of catheter angiography, and to assess the impact of the former on patients' clinical outcomes.</p><p><b>METHODS</b>All cases involving patients who underwent duplex imaging followed by angiographic intervention, from May 2008 to February 2009, were discussed at weekly interdisciplinary meetings. Only patients who underwent lower limb imaging were included in the study. Those who were involved in grafts and stent surveillance studies, as well as those with incomplete duplex images were excluded.</p><p><b>RESULTS</b>During the study period, 113 duplex imaging studies of the lower limb followed by percutaneous transluminal angioplasty were performed at our hospital for peripheral vascular disease. The iliac artery was visualised in 40 images, but could not be visualised in 73 images. There was a potential change in management in three cases due to radiological differences between the duplex images and angiography films.</p><p><b>CONCLUSION</b>In our series, duplex imaging was found to be accurate enough to guide initial clinical management of patients with peripheral vascular disease. This modality is the preferred first-line investigation for such patients at our centre.</p>

[Upper eyelid reconstruction with forehead skin flap with base at the supraorbital artery region].

OBJECTIVE: In order to find an ideal method to reconstruct the upper eyelid defect resulted from trauma or inflammation, we explored the possibility of using forehead skin flap with the base at the supraorbital artery region and combined with free mucous membrane transplanting. METHODS: This article was a retrospective case senes analysis. Nine cases of upper eyelid defect have been collected from September 2003 to July 2008 in Tongji Hospital, Huazhong University of Science and Technology. We designed a forehead skin flap with the base at the opposite side supraorbital artery region transferring from the subcutaneous tunnel and combined with free mucous membrane transplanting to reconstruct the defected eyelid. We also made a forehead muscle in auxiliary to achieve upper eyelid elevating function. We followed up 1 to 5 years by Clinical observation and questionnaire survey from fuction, appearance and patient satisfaction. RESULTS: All of these nine forehead skin flaps were survived. These flaps had stable blood supply, similar texture and color as well as fine feeling. The postoperative complications included 1 case of upper eyelid dysraphism, 1 case of skin hypertrophy, 2 cases of pedicle overstaffed, all these complications have been repaired in half a year after the operation. We followed up 1 to 5 years, every patient had got a good repair effect. CONCLUSION: The forehead skin flap with the base at the supraorbital artery region is an ideal flap supply for repairing upper eyelid defect.

Evidence of sibling species in the brown planthopper complex (Nilaparvata lugens) detected from short and long primer random amplified polymorphic DNA fingerprints.

The inheritance of 31 amplicons from short and long primer RAPD was tested for segregating ratios in two families of the brown planthopper, Nilaparvata lugens, and they were found to be inherited in a simple Mendelian fashion. These markers could now be used in population genetics studies of N. lugens. Ten populations of N. lugens were collected from five locations in Malaysia. Each location had two sympatric populations. Cluster and principal coordinate analyses based on genetic distance along with AMOVA revealed that the rice-infesting populations (with high esterase activity) at five localities clustered together as a group, and Leersia-infesting populations (with low esterase activity) at the same localities formed another distinct cluster. Two amplicons from primers OPD03 (0.65 kb) and peh#6 (1.0 kb) could be considered diagnostic bands, which were fixed in the Leersia-infesting populations. These results represent evidence of a sibling species in the N. lugens complex.

Arteriovenous fistula aneurysm--plicate, not ligate

<p><b>INTRODUCTION</b>Arteriovenous fistula (AVF) created for haemodialysis can be complicated by aneurysm formation.</p><p><b>CLINICAL PICTURE</b>Ligation of the fistula is often required to prevent aneurysmal rupture and the life-threatening haemorrhage that ensues. Other methods of treatment involve using foreign bodies like mesh and grafts.</p><p><b>TREATMENT</b>We describe a new method in the treatment of this condition--plication. It involves plicating the excess free wall of the aneurysm with sutures and does not require resection or anastomosis.</p><p><b>OUTCOME</b>Early results show that this method shrinks the aneurysm size and reduces the risk of haemorrhage.</p><p><b>CONCLUSION</b>The AVF can continue to be used and the patient is spared the agony of having to go through the entire cycle of creating a new vascular access site.</p>

A case report of endovascular stenting in Salmonella mycotic aneurysm: a successful procedure in an immunocompromised patient

<p><b>INTRODUCTION</b>Mycotic aneurysms are associated with high mortality rates and are managed in the local setting with extra-anatomical bypass followed by ligation, exclusion and debridement of the aneurysm. This is the first case of successful endovascular stenting in an immunocompromised patient with Salmonella mycotic aneurysm.</p><p><b>CLINICAL PICTURE</b>A middle-aged man who was HIV positive had Salmonella septicaemia. He developed abdominal pain 5 days after admission and a computed tomography (CT) scan of the abdomen revealed infrarenal aortitis. He developed a mycotic aneurysm 3 weeks later.</p><p><b>TREATMENT</b>He opted for endovascular stenting and after prolonged antibiotic therapy and negative blood cultures, he underwent the procedure using a Talent stent, with an iliac extension.</p><p><b>OUTCOME</b>He was discharged 1 week after stenting and maintained on oral bactrim based on sensitivity. At 1-year follow-up, he remains well symptomatically and CT scan showed no endoleak or collection.</p><p><b>CONCLUSION</b>Endovascular stenting, though a fairly new procedure, can be successfully deployed even in a mycotic aneurysm in the right setting.</p>