PURPOSE: Hypocalcemia is the most common complication after total thyroidectomy. The purpose of this study was to determine whether measurement of intact parathyroid hormone (i-PTH) level in thyroidectomy patients could predict hypocalcemia. MATERIALS AND METHODS: We performed a prospective study of patients undergoing total thyroidectomy. Serum concentration of i-PTH, total calcium (Ca), ionized calcium (Ca2+), phosphate (P), magnesium (Mg), and albumin were measured preoperatively and at 0 hour, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours postoperatively. RESULTS: 108 patients were recruited to the study. A total of 50 patients (46%) experienced hypocalcemia. The serum i-PTH concentration was linearly related to the time of measurement, while concentrations of P, Mg, albumin, Ca, and Ca2+ were not. We compared odds ratios, and found that the concentration of i-PTH at 6 hours post operation was the most closely related to the occurrence of hypocalcemic symptom. On ROC analysis using i-PTH level at 6 hours, an i-PTH level of 10.6 mg/dL was found to maximize both sensitivity and specificity at the same time point. CONCLUSION: We found that i-PTH was a predictor of hypocalcemia, and that the earliest predictor of hypocalcemic symptoms was an i-PTH concentration lower than 10.6 mg/dL obtained 6 hours after total thyroidectomy.
Calcium/blood ; Humans ; Hypocalcemia/*diagnosis ; Magnesium/blood ; Odds Ratio ; Parathyroid Hormone/*blood ; Phosphates/blood ; Postoperative Complications/blood/*diagnosis ; Prospective Studies ; Serum Albumin ; Thyroidectomy/*adverse effects

OBJECTIVETo evaluate the significance of a serum 1,3-beta-D-glucan (BG) assay for early diagnosis of invasive fungal infection (IFI) and determine its cutoff value in Chinese post-hematopoietic stem cell transplant (HSCT) recipients.

METHODSSerum BG levels were measured twice weekly by Glucatell kit (G-Test) in 36 post-HSCT patients with suspected IFI. The sensitivities and specificities of the assay for clinical proven IFI and non-IFI patients were calculated retrospectively according to different G-Test positive criteria and determined its cutoff.

RESULTSThe sensitivity, specificity, positive and negative predictive values were 81.0%, 81.8%, 89.5% and 69.2% (P=0.002) respectively, as the cutoff value was set at more than 80 ng/L once or 60 ng/L consecutively twice.

CONCLUSIONThe cutoff value of G test in Chinese post HSCT patients basically is the same as specified in the instruction of the kit, and it is a quick and reliable method for early diagnosis of IFI.

Early Diagnosis ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Mycoses ; blood ; diagnosis ; etiology ; Postoperative Complications ; blood ; diagnosis ; Predictive Value of Tests ; Sensitivity and Specificity ; beta-Glucans ; blood

OBJECTIVETo evaluate the value of serum galactomannan (GM) detection for diagnosis of invasive aspergillosis (IA) in hematopoietic stem cell transplant recipients.

METHODSThe serum GM concentration in 167 sera from 46 patients was detected by Platelia Aspergillus double-sandwich enzyme linked immunosorbent assay (PADSELISA). According to the diagnostic criteria of invasive fungal infections in China, the diagnostic changes were evaluated, the sensitivity, specificity and predictive values were calculated.

RESULTSThe sensitivity and specificity of the PADSELISA were 81.8% and 93.3% and the positive and negative predictive values were 90.0% and 87.5% respectively. There were 15 positive cases, and 31 negative cases, and the probable IA cases were increased from 11 to 19 after the GM detection. Moreover, the serous level of galactomannan was correlated with the prognosis of the IA.

CONCLUSIONSThe PADSELISA for GM detection is a reliable method for early diagnosis and treatment of IA in hematopoietic stem cell transplant recipients.

Adult ; Aspergillosis ; blood ; diagnosis ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; methods ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Mannans ; blood ; Postoperative Complications ; blood ; diagnosis ; Sensitivity and Specificity

OBJECTIVETo compare the clinical effects of the circumcision stapler, circumcision cerclage, and traditional circumcision in the treatment of phimosis and redundant prepuce.

METHODSUsing the circumcision stapler (group A), foreskin cerclage (group B), and traditional circumcision (group C), we treated 276 patients with phimosis or redundant prepuce. We made comparisons among the three groups in the operation time, intraoperative blood loss, intraoperative and 24-hour postoperative pain scores, and incidence of postoperative complications. Results: The operation time, intraoperative blood loss, and intraoperative pain score were (6.52 ± 2.45) min, (1.93 ± 0.82) ml, and 1.37 ± 0.68 in group A and (7.24 ± 1.86) min, (1.51 ± 0.72) ml, and 1.20 ± 0.79 in group B, all significantly lower than (28. 36 ± 4.22) min, (9.52 ± 3.29) ml, and 3.06 ± 0.75 in group C (P <0.05). The 24-hour postoperative pain score was remarkably higher in group B than in A and C (3. 18 ± 0. 82 vs 1. 85 ± 0. 63 and 1. 82 ± 0. 75, P <0. 05). The incidence rate of postoperative complications was markedly lower in group A than in B (5. 43% vs 14. 13%, P < 0.05), but with no significant differences between either A and C or B and C (P >0.05).

CONCLUSIONThe circumcision stapler, with its advantages of simple operation, minimal invasiveness, fewer complications, and better cosmetic result, deserves a wider clinical application.

Blood Loss, Surgical ; Circumcision, Male ; adverse effects ; instrumentation ; methods ; Foreskin ; Humans ; Incidence ; Male ; Pain Measurement ; Pain, Postoperative ; diagnosis ; Penis ; abnormalities ; Phimosis ; therapy ; Postoperative Complications ; Postoperative Period

The medical records of six cases of nesidioblastosis were examined to determine the diagnostic approach, treatment, and neurologic sequelae. All six patients were male, and their ages at the onset of the disease ranged from one day to six months (mean 3.36 +/- 2.5 mo.). Initial clinical features were seizure, cyanosis, poor feeding, and apnea. Other subsequent symptoms were developmental delay, hyperactivity, and cold sweating. The Birth weight of the neonatal onset group was heavier than the postneonatal onset group (4.4 +/- 0.3 vs 3.26 +/- 0.04 kg). Before the diagnosis of hyperinsulinism, steroids of ACTH proved effective for seizure control. Initially, hyperinsulinemia (serum insulin greater than 10 microU/ml) was detected in four cases, but another two cases also showed hyperinsulinism by insulin/glucose(I/G) ratio greater than 0.3 during the fasting test. The glucagon response performed in 2 cases, showed normal and partial responses. Euglycemia was obtained by near total pancreatectomy (95% pancreatic resection)without malabsorption or persistent diabetes. In one case, nesidioblastoma coexisted with nesidioblastosis. Developmental delay was noted in three cases. In this group, the mean duration between symptom onset and operation was longer than the group without developmental delay (1.25 +/- 0.47 vs 0.38 +/- 0.19 yr).
Brain Damage, Chronic/*etiology ; Child, Preschool ; Developmental Disabilities/etiology ; Humans ; Hypoglycemia/blood/*etiology ; Infant ; Infant, Newborn ; Insulin/*blood ; Male ; Pancreatic Diseases/complications/*diagnosis/therapy ; Postoperative Complications/epidemiology

Aged ; Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; Endoleak ; diagnosis ; etiology ; Humans ; Male ; Postoperative Complications

BACKGROUNDAcute renal failure (ARF) after liver transplantation is associated with high mortality and morbidity. Early therapeutic or preventive intervention is hampered by the lack of early effective prognostic factors. Recent studies indicated that serum levels of cystatin C and beta2-microglobulin (beta2 MG) as well as urinary beta2 MG and N-acetyl-beta-D-glucosaminidase (NAG) would increase in patients with early and mild renal impairment. In this study, these factors were detected during the different stages in patients who accepted orthotopic liver transplantation (OLT), and their feasibilities to predict early ARF after OLT were also analyzed.

METHODSSixty patients with normal blood urea nitrogen (BUN) and serum creatinine (SCr) who received modified piggyback liver transplantation without veno-venous bypass were prospectively studied. Blood samples were drawn from patients for the determination of serum beta2 MG (n = 60), SCr (n = 60) and serum Cystatin C (n = 39) at following 5 intervals: before operation (T0), 20 minutes before anhepatic phase (T1), 25 minutes in anhepatic (T2), 60 minutes after reperfusion (T3) and at the end of operation (T4). Urinary beta2 MG (n = 60) and NAG (n = 60) were also examined at following 3 intervals: before operation (T0), 60 minutes after reperfusion (T3) and at the end of operation (T4). According to the Rimola A criteria of ARF in 24 hours after operation, all the patients were divided into two groups: ARF group and non-ARF group. The data were statistically analyzed to evaluate the feasibiliy of regarding these factors as prognostic factors for early ARF after liver transplantation in patients with normal SCr and BUN before operation.

RESULTSTen of sixty cases showed ARF (16.7%). The Logistic regression analysis showed that the levels of serum and urinary beta2 MG as well as serum cystatin C before operation were correlated with early ARF after liver transplantation (P < 0.05), while only serum levels of cystatin C and Cr at the end of operation correlated with early ARF (P < 0.05, P < 0.01) after liver transplantation. The serum beta2 MG, Cystatin C, SCr and urinary beta2 MG levels in ARF group were much more higher than that in non-ARF group (P < 0.05, P < 0.01). There were significant differences between the correct and false predictive positive ratios of serum cystatin C, serum and urinary beta2 MG levels before operation (P < 0.05, P < 0.01), while only SCr showed significant difference between these groups at the end of operation (P < 0.01).

CONCLUSIONSThe results revealed that there was potential renal damage among those patients who demonstrated normal SCr and BUN before operation, and that liver transplantation could aggravate this damage and causing ARF. Here we provided the prognostic values of serum Cystatin C, beta2 MG, urinary beta2 MG and NAG in patients with early acute renal failure after liver transplantation.

Acetylglucosaminidase ; urine ; Acute Kidney Injury ; blood ; diagnosis ; urine ; Adult ; Blood Urea Nitrogen ; Cystatin C ; blood ; Female ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Complications ; blood ; diagnosis ; urine ; Predictive Value of Tests ; Prognosis ; beta 2-Microglobulin ; analysis ; blood ; urine

OBJECTIVETo investigate the efficacy and possibly prognositic factors of anterior approach on two-level cervical spondylotic myelopathy.

METHODSA retrospective review was performed on 44 cases of two-level cervical spondylotic mydopathy from Jun. 2007 to Sep. 2009. Among the patients, 24 cases were male and 20 cases female, with an average age of (60.072 +/- 10.77) years (ranged from 39 to 80 years). The affected segments ranged from C(3.4)-C(6.7). Improvements of cervical curvature and segmental height, preoperative sagittal diameter of the spinal cord at the site of maximal compression and signal intensity changes on T2WI were respectively measured. Function of nerves was assessed according to Japanese orthopaedic association system (JOA:17 score) before and after surgery. Operation by anterior approach including: anterior corpectomy and titanium cage fusion with internal fixation, anterior corpectomy body and auto iliac bone fusion with internal fixation. Statistical analysis was made on the correlation between JOA recovery rate and prognostic factors.

RESULTSImprovements of cervical curvature was -9.1 degrees to 16.6 degrees with the mean of (1.30 +/- 5.77) degrees and improvements of segmental height was -0.3 to 12.3 mm with the mean of (4.23 +/- 3.08) mm. Sagittal diameter of the spinal cord at the site of maximal compression was 1.6 to 7.2 mm with the mean of (4.01+/- 1.25) mm. T2WI with high signal changes was in 29 cases, no change in 15 cases. Bleeding amount was 50 to 700 ml with the mean of (242.05 +/- 148.22) ml. Operative time was 90 to 250 min with the mean of (153.75 +/- 34.54) min. All patients were followed up from 6 to 31 months with an average of (17.18 +/- 7.41) months. The mean JOA score preoperatively was (12.73 +/- 2.23); at the final follow-up, the JOA score was(15.09 +/- 1.91); and the recovery rate was (60.01 +/- 26.98)%. According to standard of JOA scoring, 16 cases obtained excellent result, 12 good, 15 fair and 1 poor. The effect of anterior approach had correlations with age, time of course, preoperative JOA score, sagittal diameter of the spinal cord at the site of maximal compression and signal intensity changes on T2WI, but had no correlations with operation time, bleeding amount and improvements of cervical curvature and segmental height.

CONCLUSIONTwo-level cervical spondylotic myelopathy can achieve good effect through anterior approach. The extent of the spinal cord compression may be a reliable and direct factor to judge effect.

Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Spinal Cord Diseases ; complications ; diagnosis ; diagnostic imaging ; surgery ; Spondylosis ; complications ; diagnosis ; diagnostic imaging ; surgery ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

The aim of this study was to compare the clinical outcome and cost-effectiveness of preoperative biliary drainage (BD) methods in periampullary cancer, and to suggest guidelines for selecting the appropriate preoperative BD method. Between October 2004 and August 2010, 211 patients underwent pancreatoduodenectomy after preoperative BD. Clinical outcome and cost-effectiveness of the preoperative BD methods were compared based on the final drainage method used and on intention-to-treat analysis. There was no significant difference in drainage duration between percutaneous transhepatic biliary drainage (PTBD) and endoscopic BD groups (14.2 vs 16.6 days, respectively; P = 0.121) but daily diminution of serum bilirubin level was higher in the PTBD group (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Based on intention-to-treat analysis, drainage duration was shorter (13.2 vs 16.5 days, respectively; P = 0.049), daily diminution of serum bilirubin level was higher (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Medical care cost was lower (14.2 vs 15.7 x 10(3) USD, respectively; P = 0.040) in the PTBD group than in the endoscopic BD group. When selecting the preoperative BD method, practitioners should consider that PTBD is more cost-effective and safer than endoscopic BD.
Aged ; Bilirubin/blood ; Common Bile Duct Neoplasms/complications/economics/*surgery ; Cost-Benefit Analysis ; *Drainage ; Female ; Humans ; Jaundice, Obstructive/complications/*diagnosis ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/economics/*surgery ; Pancreaticoduodenectomy ; Postoperative Complications ; Preoperative Care/*economics ; Retrospective Studies ; Time Factors ; Treatment Outcome

The aim of this study was to compare the clinical outcome and cost-effectiveness of preoperative biliary drainage (BD) methods in periampullary cancer, and to suggest guidelines for selecting the appropriate preoperative BD method. Between October 2004 and August 2010, 211 patients underwent pancreatoduodenectomy after preoperative BD. Clinical outcome and cost-effectiveness of the preoperative BD methods were compared based on the final drainage method used and on intention-to-treat analysis. There was no significant difference in drainage duration between percutaneous transhepatic biliary drainage (PTBD) and endoscopic BD groups (14.2 vs 16.6 days, respectively; P = 0.121) but daily diminution of serum bilirubin level was higher in the PTBD group (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Based on intention-to-treat analysis, drainage duration was shorter (13.2 vs 16.5 days, respectively; P = 0.049), daily diminution of serum bilirubin level was higher (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Medical care cost was lower (14.2 vs 15.7 x 10(3) USD, respectively; P = 0.040) in the PTBD group than in the endoscopic BD group. When selecting the preoperative BD method, practitioners should consider that PTBD is more cost-effective and safer than endoscopic BD.
Aged ; Bilirubin/blood ; Common Bile Duct Neoplasms/complications/economics/*surgery ; Cost-Benefit Analysis ; *Drainage ; Female ; Humans ; Jaundice, Obstructive/complications/*diagnosis ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/economics/*surgery ; Pancreaticoduodenectomy ; Postoperative Complications ; Preoperative Care/*economics ; Retrospective Studies ; Time Factors ; Treatment Outcome