Uso del valor de la hormona paratiroidea intacta en el primer día postoperatorio tras tiroidectomía total como predictor de hipoparatiroidismo permanente / Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism

Introducción: El hipoparatiroidismo permanente es la complicación a largo plazo más prevalente tras una tiroidectomía total, siendo responsable de una importante morbilidad y de necesidad de tratamiento sustitutivo a largo plazo. El objetivo de este estudio fue determinar si el valor de la hormona paratiroidea intacta (PTHi) en el primer día postoperatorio tras una tiroidectomía total es un buen predictor de hipoparatiroidismo permanente. Material y métodos: Estudio retrospectivo de observación en el que se analizaron todos los pacientes intervenidos de tiroidectomía total entre enero de 2009 y diciembre de 2014. Se recogieron los valores de PTHi y calcio sérico en el primer día postoperatorio, y todos los pacientes tuvieron un seguimiento mínimo de un año. Resultados: Se incluyeron 481 pacientes con una edad media de 53±14 años, el 82% de los cuales eran mujeres. La causa más frecuente de tiroidectomía fue el bocio multinodular (75%), seguido del carcinoma papilar de tiroides (15%). La complicación precoz más frecuente fue la hipocalcemia transitoria (49%), y a largo plazo fue el hipoparatiroidismo permanente (6%). El estudio estadístico mediante curvas ROC mostró que la PTHi en el primer día postoperatorio es un buen predictor de hipoparatiroidismo permanente (área bajo la curva de 0,87; IC 95%: 0,84-0,91). Valores de 5pg/ml presentan una sensibilidad del 95%, una especificidad del 77%, un valor predictivo positivo del 21,6% y un valor predictivo negativo del 99,6%. Conclusiones: La PTHi en el primer día postoperatorio de la tiroidectomía total es un predictor útil de hipoparatiroidismo permanente gracias a su alto valor predictivo negativo. Valores de PTHi>5 pg/ml excluyen prácticamente la presencia de hipoparatiroidismo permanente

Background: Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy, causing significant morbidity and requiring long-term replacement therapy. Our study objective was to assess whether intact parathyroid hormone (iPTH) levels on the first day after total thyroidectomy are a good predictor of permanent hypoparathyroidism. Patients and methods: A retrospective observational study of all patients undergoing total thyroidectomy between January 2009 and December 2014. iPTH and calcium levels were measured the first day after surgery. Patients were followed up for at least one year after surgery. Results: The study group consisted of 481 patients with a mean age of 53±14 years, 82% of them females. The most common reason for thyroidectomy was multinodular goiter (75%), followed by papillary thyroid cancer (15%). Transient hypocalcemia was the most common early complication after total thyroidectomy (49%), and permanent hypoparathyroidism was the most common long-term complication (6%). ROC curve analysis showed that iPTH level on the first postoperative day was a good predictor of permanent hypoparathyroidism (area under the curve 0.87; 95% CI: 0.84-0.91). Cut-off iPTH levels of 5pg/mL had 95% sensitivity, 77% specificity, 21.6% positive predictive value, and 99.6% negative predictive value. Conclusions: iPTH level on the first day after total thyroidectomy is a useful predictor of permanent hypoparathyroidism because of its high negative predictive value. Serum iPTH levels >5pg/mL virtually exclude presence of permanent hypoparathyroidism

Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism. / Uso del valor de la hormona paratiroidea intacta en el primer día postoperatorio tras tiroidectomía total como predictor de hipoparatiroidismo permanente.

BACKGROUND: Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy, causing significant morbidity and requiring long-term replacement therapy. Our study objective was to assess whether intact parathyroid hormone (iPTH) levels on the first day after total thyroidectomy are a good predictor of permanent hypoparathyroidism. PATIENTS AND METHODS: A retrospective observational study of all patients undergoing total thyroidectomy between January 2009 and December 2014. iPTH and calcium levels were measured the first day after surgery. Patients were followed up for at least one year after surgery. RESULTS: The study group consisted of 481 patients with a mean age of 53±14 years, 82% of them females. The most common reason for thyroidectomy was multinodular goiter (75%), followed by papillary thyroid cancer (15%). Transient hypocalcemia was the most common early complication after total thyroidectomy (49%), and permanent hypoparathyroidism was the most common long-term complication (6%). ROC curve analysis showed that iPTH level on the first postoperative day was a good predictor of permanent hypoparathyroidism (area under the curve 0.87; 95% CI: 0.84-0.91). Cut-off iPTH levels of 5pg/mL had 95% sensitivity, 77% specificity, 21.6% positive predictive value, and 99.6% negative predictive value. CONCLUSIONS: iPTH level on the first day after total thyroidectomy is a useful predictor of permanent hypoparathyroidism because of its high negative predictive value. Serum iPTH levels >5pg/mL virtually exclude presence of permanent hypoparathyroidism.

Gastrojejunocolic fistula in a 49 year-old male.

Gastrojejunocolic fistula is an unusual finding in patients with colon neoplams because long evolution time is required for its appearance. The methods of diagnosis have been and continue under discussion, being the barium enema the most accepted nowadays. Gastrocolic fistula is characterized by a declining incidence due to the new methods of diagnosis. An early detection of the tumour is completely necessary to prevent complications like fistulas or malnutrition. We present a case report of gastrojejunocolic fistula in a 49 year-old patient with colon carcinoma.

Small bowel obstruction due to broad ligament hernia successfully treated by laparoscopy.

We present the second case of a broad ligament hernia to be treated by laparoscopy. A 43-year-old gravida 0, para 0 woman presented to our hospital with a chief complaint of right upper quadrant abdominal colicky pain and vomiting. Her clinical history was significant for an "unknown" bowel surgery through a Pfannenstiel incision. Her abdomen was soft, nondistended, and slightly tender to palpation in the right upper quadrant. The laboratory tests showed an elevated white blood cell count of 15.2 [1] 109/L with a left shift, and a normal serum C-reactive protein. Plain abdominal X-rays showed a lightly prominent small bowel loop in the pelvic area. An abdominal ultrasound revealed only a small amount of fluid in the pouch of Douglas. After 24 hours, the pain had migrated to the hypogastrium. There was an increase in the white blood cell count, in the C-reactive protein level, and in her temperature (37.7 degrees C). At this stage, we elected to perform an urgent laparoscopic exploration. We discovered 60-80 cm of ileum strangulated through a 2 x 3 cm defect in the left broad ligament of the uterus. The strangulated bowel was successfully reduced and the defect was closed with a 2-0 silk running suture. No bowel resection was required. The patient was discharged from the hospital on day 4, with no postoperative complications.

Reparación laparoscópica de las úlceras pépticas perforadas. Experiencia en la provincia de Girona durante el año 2002 / Laparoscopic repair of perforated peptic ulcers. Experience in the province of Girona (Spain) in 2002

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[Randomized, prospective and comparative clinical trial of piperacillin/tazobactam versus ceftriaxone plus ornidazole in the treatment of biliary tract infections]. / Estudio comparativo, prospectivo y aleatorizado de piperacilina/tazobactam frente a ceftriaxona y ornidazol en el tratamiento de las infecciones de las vías biliares.

BACKGROUND AND OBJECTIVE: The treatment of biliary tract infections requires antibiotics and an appropriate surgical procedure. The aim of this study was to evaluate the efficacy and safety of piperacillin/tazobactam versus ceftriaxone plus ornidazole in the treatment of biliary tract infections. PATIENTS AND METHOD: This was a randomized, prospective and comparative clinical trial of two antibiotic regimens in the treatment of biliary tract infection. One hundred and fifty three patients were randomly allocated into two groups; three patients were excluded after randomization. One group (n = 75) received piperacillin/tazobactam (4 g/8 h iv) and the other group (n = 75) was administered a combination of ceftriaxone (2 g/24 h iv) plus ornidazole (1 g/24 h iv). In both groups, protocolized surgical or endoscopic procedures were carried out. Clinical efficacy and safety were assessed at the end of treatment. RESULTS: Demographic data and severity of disease were similar in both groups. Three patients were excluded of the study by deviations from the protocol. Sixty-seven patients (89.3%) out of the piperacillin/tazobactam group and sixty-six patients (88%) out of the ceftriaxone plus ornidazole group were clinically cured (OR = 0.87 [95% CI, 0.31-2.4]). Twelve patients died, seven in the piperacillin/tazobactam group and five in the ceftriaxone plus ornidazole group. Adverse events were similar in both groups (OR = 1.18 [95% CI, 0.37-3.7]). CONCLUSIONS: This study suggests that piperacillin/tazobactam is as efficacious and safe as ceftriaxone plus ornidazole in the treatment of biliary tract infections.

Estudio comparativo, prospectivo y aleatorizado de piperacilina/tazobactam frente a ceftriaxona y ornidazol en el tratamiento de las infecciones de las vías biliares / Randomized, prospective and comparative clinical trial of piperacillin/tazobactam versus ceftriaxone plus ornidazole in the treatment of biliary tract infections

FUNDAMENTO Y OBJETIVO: El tratamiento de las infecciones de las vías biliares comprende la administración de antibióticos y un procedimiento quirúrgico adecuado. El objetivo principal del estudio fue evaluar la eficacia y seguridad de piperacilina/tazobactam frente a ceftriaxona y ornidazol en el tratamiento de las infecciones de las vías biliares. PACIENTES Y MÉTODO: Estudio comparativo, prospectivo y aleatorizado de dos regímenes antibióticos en el tratamiento de las infecciones de las vías biliares. Se distribuyó de forma aleatoria a 153 pacientes en dos grupos. Después de la aleatorización se excluyó a tres pacientes, por lo que fueron válidos para el análisis 75 en el grupo piperacilina/tazobactam (4 g/8 h i.v.) y 75 en el grupo de ceftriaxona (2 g/24 h i.v.) y ornidazol (1 g/24 h i.v.). En ambos grupos se realizaron procedimientos quirúrgicos o endoscópicos protocolizados. Se evaluaron la eficacia clínica y la seguridad al final del tratamiento. RESULTADOS: Los datos demográficos y la gravedad de los pacientes fueron similares en ambos grupos. Se excluyó a tres pacientes del estudio por desviaciones del protocolo. Obtuvieron curación clínica 67 pacientes (89,3 por ciento) del grupo piperacilina/tazobactam y 66 (88 por ciento) del grupo ceftriaxona y ornidazol (odds ratio = 0,87 [intervalo de confianza del 95 por ciento, 0,31-2,4]). Fallecieron 12 pacientes, 7 en el grupo piperacilina/tazobactam y 5 en el grupo de ceftriaxona y ornidazol. Los efectos adversos atribuidos a los antibióticos fueron similares en ambos grupos de tratamiento (odds ratio = 1,18 [intervalo de confianza del 95 por ciento, 0,37-3,7]). CONCLUSIONES: Piperacilina/tazobactam fue tan eficaz y seguro como ceftriaxona y ornidazol en el tratamiento de las infecciones de las vías biliares (AU)