BACKGROUND/AIMS: To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required. METHODS: We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively. RESULTS: In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Deltaphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX. CONCLUSIONS: Preoperative ALP, preoperative iPTH, and Deltaphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.
Administration, Intravenous ; Administration, Oral ; Adult ; Aged ; Biomarkers/blood ; Calcium/blood ; Calcium Carbonate/*administration & dosage ; Calcium Compounds/*administration & dosage ; Calcium Gluconate/*administration & dosage ; *Decision Support Techniques ; *Dietary Supplements ; Female ; Humans ; Hyperparathyroidism, Secondary/blood/diagnosis/*surgery ; Hypocalcemia/diagnosis/etiology/*prevention & control ; Lactates/*administration & dosage ; Linear Models ; Male ; Middle Aged ; Models, Biological ; Multivariate Analysis ; Parathyroid Hormone/blood ; Parathyroidectomy/*adverse effects ; Phosphorus/blood ; Recurrence ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Young Adult

BACKGROUND/AIMS: The aim of this study is to measure the difference of ionized calcium between heparinized whole blood and serum. METHODS: We recruited 107 maintenance hemodialysis (HD) patients from our hospital HD unit. The clinical and laboratory data included ionized calcium in serum and in whole blood (reference, 4.07 to 5.17 mg/dL). RESULTS: The level of ionized calcium in serum was higher than that in whole blood (p < 0.001). Bland-Altman analysis showed that difference for ionized calcium was 0.5027. For the difference, the nonstandardized beta was -0.4389 (p < 0.001) and the intercept was 2.2418 (p < 0.001). There was a significant difference in the distribution of categories of ionized calcium level between two methods (kappa, 0.279; p < 0.001). CONCLUSIONS: This study demonstrates that whole blood ionized calcium is underestimated compared with serum ionized calcium. Positive difference increases as whole blood ionized calcium decreases. Therefore, significant hypocalcemia in whole blood ionized calcium should be verified by serum ionized calcium.
Aged ; Biological Markers/blood ; Calcium/*blood ; Female ; Humans ; Hypercalcemia/blood/*diagnosis/etiology ; Hypocalcemia/blood/*diagnosis/etiology ; Kidney Diseases/blood/complications/diagnosis/*therapy ; Male ; Middle Aged ; Predictive Value of Tests ; *Renal Dialysis/adverse effects ; Reproducibility of Results ; Specimen Handling/*methods

OBJECTIVE: lo discuss the inmtluence of different thyroidectomy on perioperative blood calcium concentration. METHOD: Total number of patients was 240. These patients of thyroid tumors were recruited. Clinical and follow-up datum were retrospective analyzed. RESULT: Patients were divided into four groups by different operative methods. Group one was patients taken one-side thyroidectomy, group two taken one-side lymph node dissection plus, group three taken two-sides thyroidectomy,and group four taken one or two sides lymph node dissection plus. Group two was easier to become hypocalcemia and their calcium concentration decreased more remarkably, compared with group one. Patients taken two-sides thyroidectomy had the familiar outcome. CONCLUSION Patients taken lymph node dissection were easier to become hypocalcemia, compared with patients only taken thyroidectomy.
Calcium ; blood ; Humans ; Hypocalcemia ; etiology ; Lymph Node Excision ; Neoplasm Recurrence, Local ; Retrospective Studies ; Thyroid Neoplasms ; Thyroidectomy ; adverse effects

Although renal calcium crystal deposits (nephrocalcinosis) may occur in acute phosphate poisoning as well as type 1 renal tubular acidosis (RTA), hyperphosphatemic hypocalcemia is common in the former while normocalcemic hypokalemia is typical in the latter. Here, as a unique coexistence of these two seperated clinical entities, we report a 30-yr-old woman presenting with carpal spasm related to hypocalcemia (ionized calcium of 1.90 mM/L) due to acute phosphate poisoning after oral sodium phosphate bowel preparation, which resolved rapidly after calcium gluconate intravenously. Subsequently, type 1 RTA due to Sjogren's syndrome was unveiled by sustained hypokalemia (3.3 to 3.4 mEq/L), persistent alkaline urine pH (> 6.0) despite metabolic acidosis, and medullary nephrocalcinosis. Through this case report, the differential points of nephrocalcinosis and electrolyte imbalances between them are discussed, and focused more on diagnostic tests and managements of type 1 RTA.
Acidosis, Renal Tubular/*diagnosis/etiology ; Acute Disease ; Adult ; Antibodies, Antinuclear/blood ; Calcium Gluconate/therapeutic use ; Chronic Disease ; Female ; Humans ; Hydrogen-Ion Concentration ; Hypocalcemia/*chemically induced/complications/drug therapy ; Nephrocalcinosis/complications/*diagnosis/ultrasonography ; Parotid Gland/ultrasonography ; Phosphates/*adverse effects ; Salivary Glands/radionuclide imaging ; Sjogren's Syndrome/complications/*diagnosis/metabolism ; Submandibular Gland/ultrasonography

Dilated cardiomyopathy (DCM) is usually an idiopathic disease with a poor prognosis. Hypocalcemia is a rare and reversible cause of DCM. Here, we report a 50-year-old female with DCM, induced by idiopathic hypoparathyroidism, that improved after treatment with calcium.
Calcium/administration & dosage ; Cardiomyopathy, Dilated/diagnosis/*etiology/physiopathology ; Dietary Supplements ; Electrocardiography ; Female ; Humans ; Hypocalcemia/diagnosis/drug therapy/*etiology ; Hypoparathyroidism/*complications/diagnosis/drug therapy ; Middle Aged ; Recovery of Function ; Treatment Outcome ; Vitamin D/administration & dosage

BACKGROUNDHemolytic anemia, elevated liver enzymes and low platelet count (HELLP) syndrome is a severe obstetric complication which usually resolves in most patients after delivery.

METHODSWe report a rare case of aggravation of HELLP syndrome after delivery.

RESULTSThe patient underwent the treatment for HELLP syndrome, including glucocorticoid therapy. The symptoms of HELLP syndrome reappeared and became more severe than before the termination of pregnancy. The patient also had severe and persistent hypoproteinemia, hyponatremia and hypocalcemia.

CONCLUSIONSHELLP syndrome is an acute and critical obstetric syndrome which can have heterogeneous presentations and variable prognosis. We should be fully aware of the diverse clinical characteristics of this condition.

Adult ; Anemia, Hemolytic ; diagnosis ; etiology ; Delivery, Obstetric ; adverse effects ; Female ; HELLP Syndrome ; diagnosis ; etiology ; Humans ; Hypocalcemia ; diagnosis ; etiology ; Hyponatremia ; diagnosis ; etiology ; Hypoproteinemia ; diagnosis ; etiology ; Pregnancy ; Young Adult

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.
Calcium ; blood ; Female ; Humans ; Hypercalcemia ; etiology ; Hyperparathyroidism ; diagnosis ; Hypocalcemia ; drug therapy ; etiology ; Mediastinal Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Middle Aged ; Parathyroid Glands ; pathology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Postoperative Complications ; Technetium Tc 99m Sestamibi ; pharmacology ; Tomography, X-Ray Computed ; Ultrasonography

The metabolic alterations caused by hyperaldosteronism are being increasingly recognized and have generated considerable interest among the medical fraternity. Hyperaldosteronism is suspected to have a pivotal role in the patho-physiology of congestive cardiac failure where it has been studied extensively. But its effects on calcium metabolism, parathyroid metabolism and renal handling of calcium are less well described. Recent experimental models have shed light into the roles played by previously unknown mechanisms in causing these metabolic alterations. We hereby report a case of primary hyperaldosteronism due to adrenal adenoma (Conn's syndrome) who presented with a myriad of clinical features including symptomatic hypocalcemia, significant weight loss along with uncontrolled hypertension for a prolonged period before eventually detected to have primary hyperaldosteronism. Surgical removal of the causative tumor resulted in prompt disappearance of all the symptoms and signs and regain of lost weight.
Adrenal Cortex Neoplasms/*complications/diagnosis/pathology/surgery ; Adrenocortical Adenoma/*complications/diagnosis/pathology/surgery ; Adult ; Female ; Humans ; *Hyperaldosteronism/complications/etiology/physiopathology ; Hypocalcemia/*etiology ; Pregnancy ; Treatment Outcome

OBJECTIVETo explore a cosmetic incision in the neck dissection for differentiated thyroid carcinoma.

METHODSAn extended collar incision was used for neck dissection in 82 consecutive patients with thyroid carcinoma from May 1999 to December 2006. The incision was designed to start as a conventional thyroid collar incision, and then to extend it along the skin crease to the anterior border of trapezium, so to avoid the vertical limb of conventional hockey stick incision. There were 60 females and 22 males in this series, with a median age of 40.5 years (range, 10 to 80 years). Ninety-six procedures of neck dissection were performed in 82 patients, including one radical neck dissection, one type I modified neck dissection, 8 type II modified neck dissections, and 86 type III modified neck dissections.

RESULTSThe average time of anesthesia was 197 minutes. The average dissected lymph nodes were 37.5, with average metastasis in 8.8 nodes. Eight patients (9.8%) developed complications related to neck dissection. The follow-up period in these patients were 1 to 96 months with a median follow-up time of 23 months. Cervical recurrence was found in only one patient (1.2%). Neither death nor distant metastasis was observed in this series.

CONCLUSIONIt is feasible to perform a modified neck dissection for differentiated thyroid cancer through the extended collar incision. The preliminary results show that the above described incision is not only oncologically safe, but also offers a cosmetic benefit for the patient with thyroid carcinoma.

Adenocarcinoma, Follicular ; pathology ; surgery ; Adenocarcinoma, Papillary ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Follow-Up Studies ; Humans ; Hypocalcemia ; etiology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; adverse effects ; methods ; Thyroid Neoplasms ; pathology ; surgery ; Young Adult

Arrhythmias, Cardiac ; etiology ; Birth Weight ; Electrocardiography ; Female ; Humans ; Hypocalcemia ; complications ; Infant, Newborn ; Male