No abstract

In the hands of experienced surgeons, laparoscopic liver resection for malignant lesions is safe and offers some short-term advantages over open resection. Oncologically, similar survival rates have been observed in patients treated with the laparoscopic approach when compared to their open resection counterparts.

Introduction: Postoperative hypocalcemia is frequent after total thyroidectomy. The role of preoperative vitamin D levels in the pathogenesis of this condition has not been studied under the most current guidelines for evaluation of the role of vitamin D in calcium homeostasis. We hypothesized that patients with preoperative vitamin D deficiency are more likely to suffer from postoperative hypocalcemia, thereby requiring prolonged hospitalization. Methods: A retrospective chart review of patients undergoing total thyroidectomy at the University of New Mexico Hospital between 2005 and 2014 was performed. Patients who underwent parathyroidectomy were excluded. The study included 30 patients who had a 25-hydroxyvitamin D levels obtained within 12 months before surgery. Results: 12 patients with vitamin D deficiency (VDD; 25-hydroxyvitamin D ≤ 20 ng/ml) were compared to 18 patients without vitamin D deficiency (Non-VDD; 25-hydroxyvitamin D > 20 ng/ml). The mean nadir postoperative ionized calcium concentration was lower in the VDD group (0.99±0.10 vs. 1.06±0.06 mmol/l, p=0.04) (Ref Range = 1.15–1.27 mmol/l), as was the postoperative concentration of phosphorus (3.48±0.60 vs. 4.17±0.84 mg/dl, p=0.03). VDD patients had a longer length of stay (4.3±4.4 vs. 1.7±1.5 days, p=0.03). Three patients in the VDD group required intravenous calcium for treatment of symptomatic hypocalcemia, but none of the Non-VDD patients required this intervention (p=0.054). Conclusions: Preoperative vitamin D deficiency is associated with an increased risk of postoperative hypocalcemia and a prolonged length of stay in patients undergoing total thyroidectomy. Vitamin D replacement before thyroidectomy may improve postsurgical outcomes in vitamin D deficient patients.

US and MIBI offer little benefit in localizing ectopic glands and rarely change the conduct of a standard four-gland exploration. Although there was a benefit of US in the assessment of thyroid nodules, in only 8.7% of patients was sestamibi of benefit in identifying ectopic glands.

SUMMARYA 92-year-old woman presented to the emergency department with a 2-week history of worsening rightsided abdominal pain. On examination she had right mid-abdominal tenderness. Laboratory studies demonstrated leukocytosis with normal liver function tests. A CT of the abdomen was remarkable for a large fluid collection in the right abdomen and no discernible gallbladder in the gallbladder fossa. An ultrasound confirmed the suspicion of a distended, floating gallbladder. The patient was taken to the operating room for laparoscopic cholecystectomy. The gallbladder was found to have volvulised in a counter -clockwise manner around its pedicle, with gross necrosis of the gallbladder. She underwent laparoscopic cholecystectomy. Pathological examination revealed acute necrotising calculus cholecystitis. BACKGROUND