There is significant hypocalcemia within the first 24 hr after thyroidectomy, caused by calcitonin release and hypoalbuminemia. Preservation of maximum number of parathyroids in-situ can counter and normalize this hypocalcemia.
Background: Due to the high mortality rate of established sepsis in patients with burn injuries, it would be beneficial if the onset can be predicted before it is fully established. The objective of the study was to estimate the predictive value of C-reactive protein in thermal burns patients. The secondary objective was to determine how much earlier CRP level allowed the prediction of sepsis in these patients.Methods: This was a case-control study, conducted prospectively on 60 human patients admitted with thermal burns. Cases were those who developed sepsis following burns and the controls were burns patients without sepsis. All patients underwent serial estimation of C-reactive protein values on alternative days, along with other blood parameters. From the data, the predictive value of C-reactive protein in sepsis was analysed.Results: A significant higher value of C-reactive protein was found in septic patients. Rise in serum C-reactive protein level predicted sepsis with an efficacy of 87%, while the sensitivity was found to be 93% and the specificity was 80%, with a significant odds ratio of 56. Also a pre-defined rise in C-reactive protein predicted the onset of sepsis about 2 days before the clinical onset.Conclusions: C-reactive protein is a useful indicator for sepsis in burns patients. In combination with clinical sepsis markers, C-reactive protein can be used to initiate intensive monitoring and appropriate antibiotic therapy.
Background: Surgical dissection is the accepted mode of staging the axilla in breast cancer. However, the associated morbidity has led researchers to look at less invasive options like sentinel lymph node biopsy. Proper prediction of axillary node positivity can help towards stratifying patients for dissection or sentinel biopsy. The primary objective of the study was to assess the factors influencing pathological axillary lymph node positivity in early carcinoma breast. Secondary objective was to assess the reliability of clinical evaluation of axillary lymph nodes in these patients. Methods: This was an Observation study, conducted from January 2012 to December 2014, at Government Medical College Hospital, Trivandrum, Kerala, India. 100 Consecutive cases of early carcinoma breast admitted in the general surgery wards during this period were included in this study. Results: Axillary lymph node positivity was found to be more in younger age group, pre-menopausal patients, lobular pathology, and HER 2 neu positive patients. Premenopausal women and outer quadrants tumours have more axillary lymph node positivity. Clinical palpation for axillary lymph nodes was found to have a sensitivity of 58.18%, specificity of 62.22%, and positive predictive value of 65.31% and negative predictive value of 54.9%. Conclusions: Younger age, HER 2 neu positivity and higher histological grade are associated with more risk of axillary disease. Also, the clinical examination of axillary lymph nodes is associated with significant false negative and false positive rates in early breast carcinoma. Axillary involvement and thus the need for loco-regional treatment can be predicted from the patients' clinico-pathological characteristics.
Background: Deep venous thrombo-embolism is a proven major complication in the postoperative setup among the western population. Hence specific guidelines exist on thrombo-prophylaxis for surgical patients. The limited number of studies available on the Indian patients do not provide conclusive data regarding the incidence of postoperative thrombo-embolism. Also, Indian patients are not routinely given prophylactic anticoagulants in many settings still now. In this research, we studied the incidence of deep venous thrombosis among patients who underwent major abdominal surgeries, over a period of 2 years.Methods: This retrospective descriptive study was done on patients who underwent any sort of major abdominal surgery from the surgical wards of Government Medical College, Thiruvananthapuram, for 2 years. This data was used to analyses the incidence of and factors related to postoperative deep venous thrombo-embolism.Results: We studied a total of 334 patients who fulfilled the inclusion criteria. Among these patients, only 1.19% developed deep venous thrombosis during the post-operative period. Since no guidelines existed regarding the usage of thrombo-prophylaxis during that period, very few patients were found to have used any of the prophylactic measures.Conclusions: The incidence of postoperative deep venous thrombosis is not very high in the Indian population after major abdominal surgeries. This might be due to the relatively low prevalence of hyper-coagulable states in the community itself. As a corollary, routine chemical prophylaxis might be administered only in high risk patients. Other measures like early ambulation and mechanical prophylaxis might be used in patients with lesser risk.
INTRODUCTIONThyroidectomy is a relatively common major surgical procedure all over the world. The proximity of the gland to the recurrent laryngeal nerve and the parathyroids makes it a procedure with potential complications. Unilateral nerve injury produces hoarseness of voice while bilateral injury is a serious problem and may even cause life threatening stridor. Before the late 20 th century, the incidence of recurrent laryngeal nerve injury and permanent hypoparathyroidism were very high after thyroidectomy because the nerve was inadvertently injured during glandular mobilisation. Hence there were a large number of studies which proved that routine nerve dissection and demonstration of the nerve was able to prevent nerve injury. This change in approach has definitely brought down the incidence of permanent injury to the nerve and parathyroids. ABSTRACTBackground: Recurrent laryngeal nerve injury and hypoparathyroidism are two of the much discussed major complications of thyroid surgery. It has been classically described by the majority of textbooks to meticulously dissect out the course of the recurrent laryngeal nerve to avoid its injury. However, the argument remains that this dissection might devascularise the nerve and the parathyroids, leading to recurrent laryngeal neuropraxia and temporary hypocalcemia. Hence some authors have recommended adopting a capsular dissection technique in order to avoid these complications. Methods: This retrospective descriptive study analysed the outcome in a large series of patients who underwent total thyroidectomy by capsular dissection technique, over a 5 year period in a tertiary care center. Results: As per this study, the incidence of permanent nerve damage was zero whereas the incidence of temporary neuropraxia was found to be around 0.5%. The incidence of temporary and permanent hypocalcemia was found to be around 0.7% and 0.2% respectively. These complications were found more in obese patients and those with malignancies. Conclusions: Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.
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