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% were female. The average of parathormone 6 hours after surgery was 28.7 pg/dL. Sensibility was 100%, specificity 79.4%, positive predictive value 59.4%, negative predictive value 100% and accuracy 84.1% 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.
Thymic epithelial tumors. Retrospective review of 54 patientsBackground: Thymic epithelial tumors are uncommon and can be associated with myasthenia gravis. Aim: To describe variables associated with survival and treatment of thymic epithelial tumors. Material and Methods: Retrospective review of surgical databases of a respiratory diseases hospital, identifying patients operated for a thymic epithelial tumor between 2000 and 2010. Follow up lasted from 12 to 156 months and information was obtained from medical records and death certificates of the Chilean national identification service. Results: Data from 54 patients aged 52.5 ± 16.4 years (33 women) was retrieved. Forty two patients were symptomatic and 47 were subjected to resective surgery. The pathological diagnosis was thymoma in 46 cases and thymic carcinoma in eight. Fourteen patients had postoperative complications and one died. Mean survival time was 101.8 ± 10.2 months. One, three and five years survival was 90.7 ± 3.9, 81.4 ± 5.7 and 71.8 ± 8.2%, respectively. Preoperative performance status of patients, histological type of the tumor and associated myasthenia gravis were predictors of survival. Conclusions: More commonly, thymic epithelial tumors appear in women, their histological type corresponds to thymomas and their resection is feasible
Pleural empyema. Retrospective review of 343 patientsBackground: Pleural empyema still has a dismal prognosis. Aim: To describe features and prognostic factors of patients with pleural empyema subjected to surgical procedures. Material and Methods: Retrospective review of 343 patients with pleural empyema (mean age 52 years, 71% males), that were subjected to any type of surgical procedure. Criteria for diagnosis of empyema were a positive culture, a fluid pH of less than 7.2 or a compatible macroscopic appearance of the fluid. Results: Empyema was secondary to pneumonia in 243 patients (71%), secondary to surgical procedures in 41 patients (12%), secondary to trauma in 19 patients (5.5%), secondary to a lung abscess in 10 patients (3%), tuberculous in 10 patients (3%), neoplastic in two cases (0.6%), secondary to pneumothorax in 2 cases (0.6%) and of unknown origin in 13 patients (4%). A microorganism was isolated from pleural fluid in 89 patients (26%). The surgical procedures performed were 251 decortications by thoracotomy (73%), 70 pleurotomies (20%), 11 video assisted surgeries (3%), seven decortications with lung resections and four fenestrations. Complications were recorded in 104 patients (30%), 29 patients were re-operated (8.5%) and 31 died (10%), all due to sepsis. Conclusions: The main cause of pleural empyema is pneumonia. In most patients, microorganisms are not isolated from pleural fluid, thoracotomy with decortication is the most frequent surgical procedure. There is a high rate of complications and mortality.
Radiological anatomy of the thorax This article is composed of two parts: I. A radiologic description of the thoracic anatomy and some concepts about lung structure, and II. A computed tomographic atlas of the thorax.
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