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.
Los quistes hepáticos son una entidad frecuente y, en general, no dan manifestaciones clínicas. Sin embargo, algunos pacientes desarrollan síntomas derivados de la compresión de estructuras vecinas, distensión hepática o complicación de los quistes. Este grupo de enfermos requerirá tratamiento. Existen diversas opciones terapéuticas, siendo la alternativa quirúrgica la que presenta mejores resultados. Con el avance de las técnicas de cirugía mínimamente invasiva, la vía laparoscópica es de elección. Presentamos tres casos clínicos, el primero de un quiste hepático simple y los dos siguientes de enfermedad poliquística hepática, todos sintomáticos, en que la técnica de fenestración por vía laparoscópica se llevó a cabo con éxito.
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