ABSTRACT
A 29-year-old pregnant woman with Graves' disease presented with severe persistent hypocalcaemia after thyroidectomy. Six months prior to presentation she was diagnosed with Graves' disease and remained uncontrolled with methimazole. She was confirmed pregnant prior to radioactive iodine ablation (RAI), and underwent total thyroidectomy during her second trimester. After surgery, continuous intravenous calcium infusion was required until delivery of the fetus allowed discontinuation at postoperative day 18, despite oral calcium and calcitriol administration. A total of 38â g of oral and 7.5â g of intravenous elemental calcium was administered. We report an unusual case of recalcitrant hypocalcaemia thought to be due to a combination of postoperative hypoparathyroidism, combined with thyrotoxic osteodystrophy and pregnancy, after surgical correction of Graves' disease. Increased vigilance and early calcium supplementation should be a priority in the management of these patients.
Subject(s)
Calcium/administration & dosage , Graves Disease/surgery , Hypocalcemia/etiology , Hypoparathyroidism/complications , Methimazole/therapeutic use , Pregnancy Complications/diagnosis , Thyroidectomy/adverse effects , Thyrotoxicosis/therapy , Administration, Oral , Adult , Antithyroid Agents/therapeutic use , Drug Administration Schedule , Female , Graves Disease/blood , Graves Disease/complications , Humans , Hypocalcemia/blood , Hypoparathyroidism/etiology , Infusions, Intravenous , Pregnancy , Pregnancy Complications/therapy , Pregnancy Trimester, Second , Time Factors , Treatment OutcomeABSTRACT
This study evaluated whether using a web-linked accelerometer, plus mandatory physical training, is associated with various weight- and fitness-related outcomes in overweight/obese active duty soldiers. Soldiers who failed the height/weight standards of the Army Physical Fitness Test (APFT) were randomized to use a Polar FA20 accelerometer device (polar accelerometer group [PA], n = 15) or usual care (UC, n = 13) for 6 months. Both groups received 1.5 hours of lifestyle instruction. We collected data at baseline, 2, 4, and 6 months, and evaluated group differences in temporal changes in study outcomes. At 6 months, 1/28 subjects (UC) passed the APFT height/weight standards. There were no group differences in changes in weight (PA: -0.1 kg vs. UC: +0.3 kg; p = 0.9), body fat (PA: -0.9% vs. UC: -1.1%; p = 0.9), systolic blood pressure (PA: +1.3 mm Hg vs. UC: -2.1 mm Hg; p = 0.2), diastolic blood pressure (PA: +3.8 mm Hg vs. UC: -2.4 mm Hg; p = 0.3), or resting heart rate in beats per minute (bpm) (PA: +7.8 bpm vs. UC: +0.1 bpm; p = 0.2). These results suggest that using an accelerometer with web-based feedback capabilities plus mandatory physical training does not assist in significant weight loss or ability to pass the APFT height/weight standards among overweight/obese soldiers.
Subject(s)
Accelerometry/instrumentation , Feedback , Military Personnel , Obesity/therapy , Overweight/therapy , Adult , Female , Humans , Male , Physical Education and Training , Prospective Studies , United StatesSubject(s)
3-Iodobenzylguanidine , Iodine Radioisotopes/therapeutic use , Potassium Iodide/adverse effects , Radionuclide Imaging/methods , Skin Ulcer/chemically induced , Adult , Crohn Disease/complications , Crohn Disease/drug therapy , Humans , Male , Medication Errors , Skin Ulcer/pathology , Treatment OutcomeABSTRACT
Recent civilian data obtained in those sustaining head injuries, has found a high prevalence of pituitary dysfunction. Currently, there is no data available in the military population. We reviewed the literature for traumatic brain injury (TBI)-related hypopituitarism and found that the prevalence of anterior hypopituitarism may be as high as 30-80% after 24-36 months. Since many of the symptoms of hypopituitarism are similar to those of TBI, it is important to make clinicians caring for combat veterans aware of its occurrence. Herein, we provide an overview of the literature and recommendations for hormonal testing when TBI-related hypopituitarism is suspected.
Subject(s)
Brain Injuries/complications , Hypopituitarism/diagnosis , Hypopituitarism/etiology , Military Personnel , Brain Injuries/physiopathology , Humans , Hypopituitarism/epidemiology , Hypopituitarism/physiopathology , Pituitary Hormones/blood , Prevalence , United States/epidemiologyABSTRACT
OBJECTIVE: To determine whether implementation of an alphanumeric-paging system would improve physician work environment. DESIGN: Surveys were distributed to all internal medicine residents, faculty, and nurses before and after implementation of an alphanumeric-paging system. MEASUREMENTS: User satisfaction with the paging system was measured using a Likert format survey. RESULTS: Physician preintervention (before deployment of the alphanumeric pager system) perceptions were inflated with regard to the impact of the implementation of the new pager system on delivery of care (average survey score of 1.65 vs. 2.07, p=0.031) and its ability to minimize interruptions (1.62 vs. 2.36, p=0.013), but both pre- and postintervention (after deployment of the alphanumeric pager system) perceptions were positive. Physician perceptions were significantly more positive with respect to time to locate the pager number (average survey score of 1.77 vs. 1.07, p=0.001), and the percentage of pages requiring a callback (average percentage of 71-80% vs. 50-60%, p=0.016). For nursing staff, preintervention perceptions were significantly more positive with regard to time saved (3.33 vs. 2.11, p=0.025) and in improving delivery of patient care (3.44 vs. 2.39, p = 0.034). CONCLUSIONS: Study participants rated the alphanumeric paging system highly. Such systems have the potential to improve delivery of patient care, minimize interruptions in learning, improve physician efficiency, and improve time management of both physicians and nursing staff.
