Aim Severe hypocalcaemia following parathyroidectomy for secondary or tertiary hyperparathyroidism (SHPT/THPT) is scarcely studied. We aimed to describe and identify risk factors for early and persistent hypocalcaemia after parathyroidectomy. Methods Retrospective pair‐matched cohort study. We assessed 87 dialysis patients with SHPT (n = 73) or THPT (n = 14) paired with 146 subjects with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy and were followed for 12 months. Early severe hypocalcaemia was defined as a free Ca ≤0.8 mmol/L [3.2 mg/dl] or corrected Ca ≤1.87 mmol/L [7.5 mg/dl] within 48 h. After parathyroidectomy and persistent hypocalcaemia, as an elemental Ca intake >3.0 g/day to achieve corrected Ca >2 mmol/L [8.0 mg/dl]. Results Early severe hypocalcaemia occurred in 77% (67/87) versus 6.8% (10/146) of subjects with SHPT/THPT and PHPT, respectively (p < .001). In SHPT/THPT cases, persistent hypocalcaemia occurred in 77% (49/64) and 64% (35/54) after 6 and 12 months of parathyroidectomy, respectively. In PHPT cases, persistent hypocalcaemia occurred in 6.8% (10/146) after 4–12 months of parathyroidectomy. Preoperative serum alkaline phosphatase (ALP) was the only risk factor associated to early severe hypocalcaemia (OR 7.3, 95% C.I. 1.7–10.9, p = .006) and persistent hypocalcaemia (OR 7.1, 95% C.I: 2.1–14.2, p = .011). Subjects with persistently low intact parathormone (iPTH) (<5.3 pmol/L [50 ng/ml]), suggestive of adynamic bone disease) showed higher Ca increases and less oral calcium requirements compared to those who progressively increased iPTH after parathyroidectomy. Conclusion Early and persistent hypocalcaemia after parathyroidectomy in severe HPT were a common event associated directly to preoperative ALP levels. Subjects with persistently low postoperative iPTH normalized serum Ca more frequently after 1 year of follow up.

Background and Aims The FGF23-lowering effect of different phosphate-sources (vegetable versus animal) in low-phosphorus diets are scarcely known. In this trial, we assess the effect on intact FGF23 (iFGF23) of two low-phosphorus diets, animal versus mixed (vegetable + animal), in dialysis patients. Method A randomized, two-center, open-label, clinical trial was performed. Subjects on stable dialysis for &gt;6 months with P&gt;4.5 mg/dL were randomized into a mixed-based (3 ounces equivalent of animal protein + 3 ounces equivalent of legumes) vs. animal-based (6 ounce equivalent of animal protein) low phosphorus diet with equivalent nutrients (phosphorus &lt;1000 mg/day; protein=1.3 g/kg/day). The primary outcome was the difference in serum iFGF23 change (ELISA) after 12 wks. We excluded patients who modified their dialysis dose, phosphate binder, or vitamin D prescription during trial. Results 556 subjects were screened, only 57 subjects (37 hemodialysis[HD] and 18 peritoneal dialysis[PD]) were randomized. Age, sex, phosphate-binders use, and other baseline characteristics were similar between groups. Baseline iFGF23 levels were 7394 (IQR 2379-16629) and 6859 (1543-17521) ng/mL in mixed-based and animal-based groups respectively (p=0.62). Both groups had a significant decrease in iFGF23 after 12 weeks of intervention (iFGF23 change: -285 [IQR -3002 to 227] ng/mL, p&lt;0.001, and -182 [IQR -9323 to 228] ng/mL, p&lt;0.001); there were not significant differences in iFGF23-decrease between both diets (Figure, p:0.78). Serum phosphorus in the mixed-based and the animal-based declined by -0.66 (95% confidence interval [95% IC], -1.39 to -0.04] mg/dL and -0.21 (95% IC -0.81 to 0.38) respectively (p=0.14). There was a trend between the decrease in observed phosphorus and iFGF23 (rho = 0.265, p=0.058). There were no differences between groups in the change of serum Ca, albumin, PTH, and other biochemical parameters. Conclusion Dietary phosphorus restriction for 12 weeks with animal-based or mixed-based phosphorus sources similarly decreases iFGF23 concentration in HD or PD patients.

E l hematoma agudo en la cirugía de implantes mamarios se reporta como la tercera complicación más común después de la contractura capsular y ruptura. 1 Su incidencia se informa con una frecuencia del 2 al 10.3% y generalmente ocurre en los primeros tres días. Hasta 2004, sólo se habían notificado 10 casos de hematomas mamarios tardíos. 2 En enero de 2020 encontramos sólo 44 casos relacionados con hematoma espontáneo tardío

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de obstrucción mecánica (80-90%), dolor abdominal (80%), sensibilidad abdominal (62%), náuseas y/o vómitos (60%), estreñimiento (40%) y fiebre (37%) en 400 casos revisados por Vanek en 1986. 2 La pseudoobstrucción aguda del colon da como resultado síntomas compatibles con obstrucción intestinal y se asocia a enfermedades sistémicas como postinfarto de miocardio, hipotiroidismo, intervenciones quirúrgicas o traumatismos no quirúrgicos. 3 INTRODUCCIÓNL a pseudoobstrucción aguda del colon (POAC), conocida como síndrome de Ogilvie, es una condición rara caracterizada por dilatación colónica aguda en ausencia de obstrucción mecánica. Sir Heneage Ogilvie describió por primera vez dos casos en dos pacientes con infiltración maligna de los ganglios prevertebrales en 1948. 1 Se caracteriza por distensión colónica masiva en ausencia