Value of C-reactive protein in the assessment of organ-space surgical site infections after elective open and laparoscopic colorectal surgery.

BACKGROUND: Although C-reactive protein (CRP) has proved useful in the assessment of post-operative infections, its value at those time points useful to assess organ-space surgical site infection (OSI) after open and laparoscopic colorectal surgery has not been clarified. METHODS: We compared values of CRP on post-operative days two and five and percentage of change between those days (Δ%D2-5) in patients with and without OSI, after open (OPEN) and laparoscopic (LAP) colo-rectal surgery. Receiver-operating characteristic analysis was performed and indices of test performance of sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and likelihood ratios (LR+ and LR-) were assessed. RESULTS: The best CRP predictive values for OSI were D5 >120 mg/L (area under the curve [AUC] 0.959; 95% confidence interval [CI] 0.890-0.990) and Δ%D2-5 <40% (AUC 0.968; 95% CI 0.901-0.994; p=0.0001) in OPEN and D5 >66 mg/L (AUC 0.921; 95% CI 0.841-0.969) and Δ%D2-5 <48% (AUC 0.894-95% CI 0.806-0.952; p=0.0001) in LAP. The best measure was NPV (100%; CI 93.6%-100% for D5 and Δ%D2-5 in OPEN and 98.4%, CI 91.3%-99.7% for D5 and 100%, CI 93.4%-100% for Δ%D2-5 in LAP). CONCLUSIONS: In patients with CRP <120.66 mg/L on post-operative day 5 or a decay from post-operative day two to five of >40%-48% in OPEN and LAP, respectively, OSI may be ruled out and the patient discharged safely. Careful workup is needed in those patients with higher postoperative CRP concentrations or lower apparent decay values.

Dificultad en el diagnóstico y el tratamiento del carcinoma de paratiroides / Difficulty in the diagnosis and treatment of parathyroid carcinoma: a case report

El carcinoma de paratiroides es una causa poco frecuente de hiperparatiroidismo primario. El principal problema de esta afección es el diagnóstico diferencial inicial entre adenoma y carcinoma de paratiroides, dado que los criterios histológicos en estos casos es difícil que ofrezcan un diagnóstico definitivo, a diferencia de otras neoplasias. No obstante, se encuentran descritas series de signos clínicos y bioquímicos de alta sospecha inicial de malignidad. Asimismo, en los casos de hiperparatiroidismo primario más aparatosos estamos obligados a pensar en esta enfermedad, que se acaba confirmando en la mayor parte de las ocasiones, incluso años después por la aparición de metástasis a distancia. El objetivo de este artículo es la descripción de un caso de hiperparatiroidismo primario severo y persistente en un paciente varón de 40 años, que años después se confirmó como secundario a un carcinoma de paratiroides (AU)

Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism. Tha main difficulty is the initial differential diagnosis between adenoma and carcinoma of the parathyroid gland because, unlike in other neoplasms, histologic criteria do provide a definitive result. However, clinical and biochemical characteristics that are highly suspicious for malignancy have been described. Moreover, parathyroid carcinoma should be suspected when the primary hyperparathyroidism is severe. In some cases the diagnosis is made several years later with detection of distant metastases. We report the case of a 40-year-old man with severe and persistent primary hyperparathyroidism, which was confirmed years later as being secondary to parathyroid carcinoma (AU)