cholecalciferol and Postoperative-Complications

This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy.. This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy.. Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13-59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11-40 per cent) following pre-operative supplementation.. Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

Topics: Calcitriol; Calcium; Calcium Carbonate; Calcium-Regulating Hormones and Agents; Cholecalciferol; Humans; Hydroxycholecalciferols; Hypocalcemia; Postoperative Complications; Preoperative Care; Thyroidectomy; Vitamin D; Vitamins

The aim was to assess the effectiveness of routine administration of calcium +/- vitamin D3 compared with a serum calcium level-based strategy to prevent symptomatic hypocalcaemia after thyroidectomy.. RCTs comparing routine supplementation of calcium +/- vitamin D3 with treatment based on serum calcium levels measured after total thyroidectomy, published between 1980 and 2017, were identified in MEDLINE, Embase, LILACS and Google Scholar databases. Risk of bias was evaluated using the Cochrane Collaboration tool. Risk differences were calculated by random-effects meta-analysis. Meta-regression and cumulative meta-analysis were used to explore the best therapeutic approach.. Fifteen studies with 3037 patients were included, and seven treatment comparisons were made. Routine supplementation with calcium + vitamin D3 offered a lower risk of symptomatic (risk difference (RD) -0·25, 95 per cent c.i. -0·32 to -0·18) and biochemical (RD -0·24, -0·31 to -0·17) hypocalcaemia than treatment based on measurement of calcium levels. The number needed to treat was 4 (95 per cent c.i. 3 to 6) for symptomatic hypocalcaemia. No publication bias was found; although heterogeneity was high for some comparisons, sensitivity analysis did not change the main results.. Routine postoperative administration of calcium + vitamin D3 is effective in decreasing the rate of symptomatic and biochemical hypocalcaemia.

Topics: Calcium; Cholecalciferol; Dietary Supplements; Humans; Hypocalcemia; Postoperative Complications; Thyroidectomy

Topics: Biological Transport, Active; Bone and Bones; Calcium; Cell Membrane Permeability; Cholecalciferol; Endoplasmic Reticulum; Homeostasis; Humans; Hyperparathyroidism, Secondary; Intestinal Absorption; Intestinal Mucosa; Kidney; Kidney Failure, Chronic; Kidney Transplantation; Kidney Tubules; Liver; Magnesium; Muscle Contraction; Phosphates; Postoperative Complications; Sodium

Transient hypocalcemia due to parathyroid gland or vessel manipulation is a common complication following thyroidectomy. Considering the role of 25-hydroxyvitamin D (25(OH)D) in calcium hemostasis, this study aimed to evaluate the effect of preoperative vitamin D supplementation on hypocalcemia incidence in thyroidectomy patients.. In this randomized clinical trial, 100 patients scheduled for total thyroidectomy and suffering from preoperative moderate or severe vitamin D deficiency were enrolled. Patients were randomly allocated to either study or control groups using the sealed envelope method. Patients in the study group received vitamin D3 50,000-unit pearl weekly for 4 weeks prior to the operation. The control group received placebo. Total and ionized serum calcium levels were checked before surgery, the day after surgery, and 2 weeks postoperatively.. No significant difference was observed in terms of demographic data. During serial total calcium checks (5 episodes), total calcium levels changed significantly in patients who had received vitamin D supplements compared to the control group (P = 0.043). Symptomatic hypocalcemia incidence was significantly lower in patients supplemented with 25-hydroxyvitamin D (25(OH)D) (P = 0.04). Also, the requirement for intravenous calcium administration in order to treat the hypocalcemia symptoms was significantly lower in the study in comparison to the control group (P = 0.03).. Vitamin D supplementation in patients with vitamin D deficiency might lead to a lower incidence of early-onset symptomatic hypocalcemia; hence, requiring less calcium supplementation for the management of hypocalcemia.

Topics: Adenocarcinoma, Follicular; Adult; Calcium; Cholecalciferol; Female; Goiter, Nodular; Humans; Hypocalcemia; Male; Postoperative Complications; Preoperative Care; Thyroid Cancer, Papillary; Thyroid Diseases; Thyroid Neoplasms; Thyroidectomy; Vitamin D; Vitamin D Deficiency; Vitamins

The introduction of early rehabilitation exercise is the foundation of treatment post-Posterior lumbar interbody fusion (PLIF) surgery, and the search for additional sources of reinforcement physiotherapy seems to be very important.. The patients were randomly divided into the vitamin D3 (. The limits of stability (LOS) were significantly improved in the D3 group after 5 and 14 weeks (. Vitamin D supplementation seems to ameliorate the effects of an early postoperative rehabilitation program implemented four weeks after posterior lumbar interbody fusion. Early physiotherapy treatment after PLIF surgery combined with vitamin D supplementation appears to be a very important combination with regard to the patients' recovery process.

Topics: Accidental Falls; Adult; Aged; Cholecalciferol; Dietary Supplements; Exercise Therapy; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Postoperative Complications; Postoperative Period; Postural Balance; Recovery of Function; Spinal Fusion; Treatment Outcome; Young Adult

Vitamin D deficiency has been linked to poor outcomes after total hip replacement (THR) or total knee replacement (TKR), including lower patient-reported outcome measures (PROMs), peri-prosthetic infection and longer hospital stay. We present a randomised feasibility trial protocol designed to prospectively investigate the influence of vitamin D testing, and subsequent supplementation for deficiency, prior to THR/TKR.. One hundred adult patients undergoing primary THR/TKR for osteoarthritis at two NHS hospital trusts in North East England will be recruited. Exclusion criteria include lack of mental capacity, revision surgery, participants already taking vitamin D/calcium supplements, or a known contraindication to vitamin D treatment. Participants will be ineligible for the trial if they have an estimated glomerular filtration rate < 30 ml/minute. We will measure patients' vitamin D levels at baseline, and those identified as deficient (vitamin D < 50 nmol/L) will be randomised to receive either vitamin D supplementation or no supplementation prior to, and for 6 months following, surgery. Patients with a normal vitamin D level (≥50 nmol/L) will receive no supplementation. Vitamin D levels will be rechecked on the day of surgery and again at 6 months. Patients will also complete a lifestyle questionnaire, as well as the Oxford hip or knee and EQ-5D-3 L PROM questionnaires, at baseline and at 6 months following surgery. The aims are to determine the feasibility of the methodology and to gather data to inform the conduct of a future, larger trial to investigate if supplementation with vitamin D, in those who are deficient, prior to THR/TKR improves outcomes as measured by PROM scores.. Previous reports have measured vitamin D levels and correlated this to outcome, but we can find no randomised trial in which researchers investigated the effect of supplementation. The aim of this trial is to determine if vitamin D deficiency is a modifiable risk factor for poor outcome after THR/TKR.. ISRCTN Registry, ISRCTN14533082 . Registered on 3 April 2017.

Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cholecalciferol; Clinical Protocols; Dietary Supplements; England; Feasibility Studies; Humans; Osteoarthritis, Hip; Osteoarthritis, Knee; Patient Reported Outcome Measures; Postoperative Complications; Prospective Studies; Research Design; Risk Factors; Time Factors; Treatment Outcome; Vitamin D; Vitamin D Deficiency

In addition to their effects on bone health, high doses of cholecalciferol may have beneficial non-classic effects including the reduction of incidence of type 2 diabetes mellitus, cardiovascular disease, and cancer. These pleiotropic effects have been documented in observational and experimental studies or in small intervention trials. Vitamin D insufficiency is a frequent finding in renal transplant recipients (RTRs), and this population is at risk of the previously cited complications.. The VITALE study is a prospective, multicentre, double-blind, randomized, controlled trial with two parallel groups that will include a total of 640 RTRs. RTRs with vitamin D insufficiency, defined as circulating 25-hydroxyvitamin D levels of less than 30 ng/ml (or 75 nmol/l), will be randomized between 12 and 48 months after transplantation to blinded groups to receive vitamin D3 (cholecalciferol) either at high or low dose (respectively, 100,000 UI or 12,000 UI every 2 weeks for 2 months then monthly for 22 months) with a follow-up of 2 years. The primary objective of the study is to evaluate the benefit/risk ratio of high-dose versus low-dose cholecalciferol on a composite endpoint consisting of de novo diabetes mellitus; major cardiovascular events; de novo cancer; and patient death. Secondary endpoints will include blood pressure (BP) control; echocardiography findings; the incidences of infection and acute rejection episodes; renal allograft function using estimated glomerular filtration rate; proteinuria; graft survival; bone mineral density; the incidence of fractures; and biological relevant parameters of mineral metabolism.. We previously reported that the intensive cholecalciferol treatment (100 000 IU every 2 weeks for 2 months) was safe in RTR. Using a pharmacokinetic approach, we showed that cholecalciferol 100,000 IU monthly should maintain serum 25-hydroxyvitamin D at above 30 ng/ml but below 80 ng/ml after renal transplantation. Taken together, these results are reassuring regarding the safety of the cholecalciferol doses that will be used in the VITALE study. Analysis of data collected during the VITALE study will demonstrate whether high or low-dose cholecalciferol is beneficial in RTRs with vitamin D insufficiency.. ClinicalTrials.gov Identifier: NCT01431430.

Topics: Biomarkers; Cholecalciferol; Clinical Protocols; Dietary Supplements; Double-Blind Method; Drug Administration Schedule; Humans; Kidney Transplantation; Paris; Postoperative Complications; Prospective Studies; Research Design; Time Factors; Treatment Outcome; Vitamin D; Vitamin D Deficiency

Although there have been some case reports suggesting that bone in patients with pseudohypoparathyroidism (PHP) might respond to parathyroid hormone (PTH), no information is available as to whether serum PTH concentration is related to bone metabolic markers or to bone mineral density (BMD) in PHP.. To address these relationships, by comparing intact serum PTH, bone metabolic markers and BMD in patients with PHP with those in patients with idiopathic hypoparathyroidism (IHP) and postoperative hypoparathyroidism (OHP).. Intact serum PTH, bone metabolic markers (osteocalcin, tartrate-resistant acid phosphatase, pyridinoline, deoxypyridinoline) and BMD by dual-energy X-ray absorptiometry or single-photon absorptiometry were measured in patients with PHP Ia (n=2) and PHP Ib (n=8). The results were compared with those in patients with IHP (n=5) and OHP (n=14).. All bone metabolic markers measured were present in significantly greater amounts in patients with PHP Ib than in those with IHP+OHP. The Z score (standard deviation of average BMD at each age) of the BMD of femoral neck was significantly lower in patients with PHP Ib than in those with IHP+OHP. The Z scores of BMD of lumbar spine and radius were also lower in patients with PHP Ib than in those with IHP+OHP, but the difference was not significant. Moreover, the intact serum PTH concentrations were significantly and positively related to bone metabolic marker levels in all patients, and the intact serum PTH concentrations were significantly and negatively related to BMD of lumbar spine in PHP patients.. These results suggest that PTH stimulates bone turnover in PHP Ib patients, resulting in a relatively lower BMD in PHP Ib patients than in IHP+OHP patients. The present study indicates that bones of most cases of PHP could respond to PTH.

Topics: Acid Phosphatase; Adult; Aged; Amino Acids; Biomarkers; Bone Density; Cholecalciferol; Creatinine; Cyclic AMP; Erythrocyte Membrane; Female; GTP-Binding Protein alpha Subunits, Gs; Humans; Hypoparathyroidism; Isoenzymes; Kidney; Male; Middle Aged; Osteocalcin; Parathyroid Hormone; Phosphates; Postoperative Complications; Pseudohypoparathyroidism; Tartrate-Resistant Acid Phosphatase

Accelerated transplant rejection mediated by donor reactive memory T cells is another barrier to the induction of graft tolerance. The aim of this study was to investigate the immunosuppressing effects of vitamin D (1,25(OH)2D3), administered alone or in combination with a costimulatory blockade treatment, on rejection of secondary heart allografts in a mouse model.. Circular full-thickness skin grafts from BALB/c mice were cut and grafted onto the lumbar regions of C57BL/6 mice as allo-primed recipients. Four weeks after skin grafting, the vascularized hearts from the BALB/c mice were transplanted heterotopically into the allo-primed recipients using a non-suture cuff technique. The recipients were then randomly divided into four groups and given either intraperitoneal injection of isotype, Ab, 1,25(OH)2D3, or a combination of Ab and 1,25(OH)2D3. Allograft incidence was determined by hematoxylin-eosin staining, and cytokine expression was assessed by the quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assays, and cytometric bead arrays. Spleen cells from the recipient were used to assess mixed lymphocyte reactions. Memory T cells and regulatory T cells (Tregs) in spleen cells were measured by flow cytometry.. The median allograft survival time was longer with the combined treatment with Ab and 1,25(OH)2D3 than with no treatment or with treatment with Ab or 1,25(OH)2D3 alone. The grafts were protected from infiltration by inflammatory cells and by inhibition of interleukin 2 and interferon gamma expression. Rejection was initially suppressed in the early postoperative period by a reduction in the number of memory T cells and induction of Foxp3. Vitamin D3 administered as an immunosuppressive agent, when combined with monoclonal antibody treatment, may protect heart grafts from memory T cell responses in a secondary heart transplant model.

Topics: Animals; Antibodies, Monoclonal; Cholecalciferol; Drug Therapy, Combination; Female; Forkhead Transcription Factors; Graft Rejection; Graft Survival; Heart Transplantation; Humans; Immunologic Memory; Immunosuppression Therapy; Intercellular Adhesion Molecule-1; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Postoperative Complications; T-Lymphocytes, Regulatory

Hungry Bone Syndrome (HBS) refers to rapid, profound, and prolonged hypocalcemia associated with hypophosphatemia and hypomagnesemia occurring in patients with increased bone turnover after successful management of the underlying disorder. We describe a male patient with primary hyperparathyroidism (PHPT), in whom HBS was diagnosed 6 months after parathyroidectomy. Histopathologic examination revealed an atypical parathyroid adenoma (APA), while immunohistochemistry showed cell proliferation index Ki-67 10% and overexpression of cyclin D1 (>90%). Preoperative treatment with vitamin D3 had normalized 25OHD and alkaline phosphatase levels, reflected in an improvement in bone turnover prior to surgery. Postoperative treatment for HBS with alfacalcidol, calcium, vitamin D3 and magnesium was administered for a long period. This treatment prevented severe postoperative hypocalcemia and he was discharged two days later. Preoperative cinacalcet treatment did not reduce hypercalcemia implying that the tumor had lack of calciumsensing receptors (CaSR). In conclusion, preoperative restoration of low 25OHD levels is essential for prevention of HBS. Postoperative treatment with active metabolites of vitamin D must be initiated as early as possible, in order to prevent or minimize the development of HBS, and to reduce the duration of hospitalization.

Topics: Adenoma; Adult; Bone Density Conservation Agents; Calcium; Calcium-Regulating Hormones and Agents; Cholecalciferol; Cinacalcet; Humans; Hydroxycholecalciferols; Hyperparathyroidism; Hypocalcemia; Hypophosphatemia; Magnesium; Male; Parathyroid Neoplasms; Parathyroidectomy; Postoperative Complications; Syndrome

Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present.. A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946-2017), Cochrane SR (2005-2017), CT databases (1997-2017), and Web of Science (1945-2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness.. Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed.. Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.

Topics: Bone Density; Calcium; Cholecalciferol; Clinical Competence; Diagnosis, Differential; Hospitals, High-Volume; Humans; Hyperparathyroidism, Primary; Intraoperative Neurophysiological Monitoring; Medical History Taking; Parathyroid Glands; Parathyroidectomy; Patient Selection; Postoperative Complications; Preoperative Care; Recurrence; Reoperation; Societies, Medical; Vitamin D Deficiency; Vitamins

Topics: Body Mass Index; Calcium; Calcium Citrate; Cholecalciferol; Follow-Up Studies; Gastric Bypass; Humans; Hyperparathyroidism, Secondary; Postoperative Care; Postoperative Complications; Risk Factors

Long-term management of patients with differentiated thyroid cancer (DTC) commonly includes TSH-suppressive therapy with L-T4 and, in case of postsurgical hypoparathyroidism, Calcium-D3 supplementation, both of which may affect skeletal health. Experience with female patients treated for DTC at a young age and who were then receiving long-term therapy with L-T4 and Calcium-D3 medication is very limited to date. This cross-sectional study set out to investigate effects of Calcium-D3 supplementation and TSH-suppressive therapy on bone mineral density (BMD) in 124 young female patients treated for DTC at a mean age of 14 years and followed-up for an average of 10 years. BMD was found to be significantly higher in patients receiving Calcium-D3 medication than in patients not taking supplements. The level of ionized calcium was the strongest factor determining lumbar spine BMD in patients not receiving Calcium-D3 supplementation. Pregnancy ending in childbirth and HDL-cholesterol were associated with a weak adverse effect on spine and femoral BMD. No evidence of adverse effects of L-T4 and of radioiodine therapies on BMD was found. We conclude that Calcium-D3 medication has a beneficial effect on BMD, and that TSH-suppressive therapy does not affect BMD in women treated for DTC at young age, at least after 10 years of follow-up.

Topics: Adolescent; Bone Density; Bone Density Conservation Agents; Bone Resorption; Calcium, Dietary; Chernobyl Nuclear Accident; Cholecalciferol; Combined Modality Therapy; Cross-Sectional Studies; Dietary Supplements; Female; Follow-Up Studies; Hormone Replacement Therapy; Humans; Hypoparathyroidism; Incidence; Iodine Radioisotopes; Neoplasms, Radiation-Induced; Postoperative Complications; Radiopharmaceuticals; Republic of Belarus; Risk Factors; Thyroid Neoplasms; Thyroidectomy; Thyroxine

Vitamin D has pleiotropic effects on cardiac, renal, and endocrine diseases like diabetes mellitus and deficiency has been correlated with increased Intensive Care Unit (ICU) morbidity and mortality. We studied the relationship between preoperative Vitamin D levels and several short-term endpoints including cardiovascular events, glucose levels, ICU, and hospital length of stay.. Standard demographic data were obtained. Blood samples were drawn for 25-hydroxy-vitamin D3 (Vit D) levels at baseline (just before induction of anesthesia) and on postoperative day (POD #1). The number of inotropes used on POD # 0, 1, and 2 was recorded as well as the Cardiac Index (CI). Baseline glucose, Blood Urea Nitrogen and Creatinine (Cr) levels were obtained and repeated on POD # 1 & 2. Other variables studied are number of days of ICU and hospital stay.. Of the 64 patients included in the cohort, 3 were excluded because of inadequate data. 69% had Vit D levels <20 ng/mL and 31% had levels ≥20 ng/mL. More than 90% of the cohort had a significant decrease in POD # 1 Vit D levels (P < 0.001). Age, sex, race, and body mass index did not predict the preoperative Vit D levels; however, the timing of surgery was associated with preoperative Vit D levels, lowest in subjects who had surgery performed during winter. Preoperative Vit D levels had no effect on postoperative glycemic control, cardiac index, or composite outcome-arrhythmias, respiratory failure, or prolonged inotropic support. On regression analysis, preoperative Vit D levels did show a significant effect on ICU and hospital length of stay in this cohort.. The low levels in this study truly represent the Vit D status as they were obtained before any intervention, including surgery or fluid administration. Vit D levels decreased rapidly after surgery and hence future studies on Vit D may need to focus on premorbid levels obtained at the time of initial presentation and not those obtained after resuscitation or ICU admission. In contrast to epidemiologic reports, we found no association between low Vit D levels and postoperative cardiovascular events. However, low Vit D levels did affect the ICU and hospital length of stay in patients who were undergoing cardiac surgery. This is an important finding especially when many institutions and regulatory agencies are investigating novel therapies and processes to reduce the length of hospitalization. More studies are required to investigate the effect on hospital length of stay of early preadmission or preoperative Vit D supplementation before elective surgery.

Topics: Aged; Blood Glucose; Blood Urea Nitrogen; Cardiac Surgical Procedures; Cholecalciferol; Cohort Studies; Elective Surgical Procedures; Female; Heart; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Patient Readmission; Postoperative Complications; Seasons

Postoperative peritoneal adhesions are major complications of abdomino-pelvic surgeries. We aim to investigate the preventive and therapeutic effects of cholecalciferol (vitamin D3) supplementation on postoperative peritoneal adhesion (PPA) in a rat model.. This randomized, controlled, single blinded animal study was performed in university laboratory. Thirty-two female Wistar albino rats were randomly separated into four equal groups as, group 1: (21-d vitamin-D treatment group), group 2: (21-d corn oil group), group 3: (14-d vitamin-D treatment group), and group 4: (control group). Uterine horns were traumatized with bipolar cautery for adhesion formation process. On postoperative day 14, all the animals were sacrificed and evaluated for adhesions. Adhesion extent, severity, degree, and total adhesion scores were evaluated macroscopically. Histopathologically, adhesions were evaluated for inflammation, fibrosis, and NFκB (nuclear factor kappa b) staining.. On postoperative day 14, we found lesser peritoneal adhesion severity, degree, extent, and total adhesion scores with vitamin-D administration compared with control and corn oil-treated groups; the difference was statistically significant (P < 0.001). Histopathologic adhesion scores of inflammation and fibrosis were statistically different among the four groups (P < 0.001). NFκB staining was markedly increased in control and vehicle groups. The NFκB staining scores were statistically different between the groups (P < 0.001). The intensity of NFκB staining was lower in both vitamin 14 and 21-d vitamin-D groups.. Vitamin D as a supplement and as a therapeutic medicine decreases the formation of PPA in an animal model. In future studies, the association of vitamin D deficiency and PPA should be studied. In addition, vitamin D should be investigated in future clinical studies for the prevention of PPAs.

Topics: Animals; Cholecalciferol; Female; NF-kappa B; Postoperative Complications; Random Allocation; Rats; Rats, Wistar; Single-Blind Method; Tissue Adhesions

Tumor-induced osteomalacia is a rare paraneoplastic syndrome characterized by hypophosphatemia and inappropriately normal or low 1,25-dihydroxyvitamin D.. Here, we report a 6-year postoperative follow-up of a patient with oncogenic osteomalacia with a distinctive skeletal manifestation. The latter was characterized by an almost linear lytic lesion of a few millimeters with irregular borders, mainly involving the trabecular compartment but extending into cortical shell, located in the middle third of the right fibula. Six years after tumor resection, a sclerotic repair with a complete recovery was observed. Furthermore, we monitored a striking increase in bone mineral density throughout the observation period, reaching a peak of 73% over basal values at lumbar spine after 2 years; at total femur and radius, the peak was 47.5 and 4.6% respectively, after 4 years from tumor resection.. We report for the first time that an osteolytic lesion may be part of the skeletal involvement in tumor-induced osteomalacia.

Topics: Bone Density; Bone Density Conservation Agents; Calcium, Dietary; Cholecalciferol; Combined Modality Therapy; Dietary Supplements; Female; Fibula; Fractures, Stress; Humans; Middle Aged; Nasopharyngeal Neoplasms; Neoplasms, Connective Tissue; Osteomalacia; Paraneoplastic Syndromes; Postoperative Complications; Radiography; Treatment Outcome; Up-Regulation

A 55 years old man was extubated on first postoperative day following coronary artery bypass grafting at 7:30 am. The same day at 5 pm, he became drowsy but arousable only on painful stimuli with severe generalized hypertonia and bilateral upgoing plantars. He was reventilated and a provisional diagnosis of cerebrovascular accident was made. CT scan of brain was normal except for bilateral basal ganglia calcification. On further investigations, he was found to be severely hypocalcaemic due to hypoparathyroidism. All symptoms resolved on the treatment of his hypocalcaemia. There was no history of neck surgery in this patient and the case additionally highlights important interaction between parathyroid hormone (PTH) in calcium metabolism.

Topics: Cholecalciferol; Coronary Angiography; Coronary Artery Bypass; Humans; Hypocalcemia; Hypoparathyroidism; Male; Middle Aged; Parathyroid Hormone; Postoperative Complications; Severity of Illness Index; Treatment Outcome

Postoperative parathyroid function was evaluated in 24 total thyroidectomy and 8 subtotal thyroidectomy patients seen by our department between January 1995 and July 1997. Parathyroid function was assessed by measuring the level of serum intact parathyroid hormon (intact-PTH). Hypoparathyroidism was avoided in 23 patients (95.8%) who received a total thyroidectomy and in 7 patients (87.5%) who received a subtotal thyroidectomy. Supplementary therapy for hypoparathyroidism was not required as long as the blood supply to more than two parathyroid glands was preserved. Half of the patients in this study did not require any postoperative supplementary therapy. Thus, the preservation of more than two parathyroid glands is essential for the prevention of hypoparathyroidism. In cases where the parathyroid glands had been resected, parathyroid gland transplantation were performed. In all cases, supplementary therapy was eventually no longer required. In two cases requiring supplementary therapy, a normal range of parathyroid activity was observed 30 months after surgery. The administration of vitamin D3 may suppress the recovery of parathyroid function in patients recieving parathyroid transplantations.

Topics: Biomarkers; Cholecalciferol; Humans; Hyperparathyroidism; Hypoparathyroidism; Parathyroid Glands; Parathyroid Hormone; Postoperative Care; Postoperative Complications; Thyroid Neoplasms; Thyroidectomy

Topics: Adult; Aged; Calcifediol; Calcium; Cholecalciferol; Female; Humans; Hypoparathyroidism; Male; Middle Aged; Phosphates; Postoperative Complications

The generic term "Renal Osteodystrophy" is used to denote a complex of skeletal and metabolic impairments found in nephropathic patients. Neither dialytic treatment nor transplant is always capable of limiting the worsening evolution; transplantation, on the contrary, while it does not in many cases bring the phospho-calcic metabolism back to full normality, introduces new elements of imbalance arising as a result of the inevitable immunosuppressive therapy. After outlining the main post-transplant metabolic problems, the Authors discuss the manifestations of orthopaedic interest, in particular the most severe complication, i.e. aseptic necrosis.

Topics: Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Femur Head Necrosis; Hip Prosthesis; Humans; Kidney Transplantation; Metabolic Diseases; Nephrotic Syndrome; Osteonecrosis; Osteosclerosis; Parathyroid Hormone; Postoperative Complications; Radiography

Topics: Cholecalciferol; Humans; Hyperparathyroidism, Secondary; Ileum; Jejunum; Obesity; Postoperative Complications

Topics: Aged; Calcium; Cholecalciferol; Ergocalciferols; Esophagus; Female; Humans; Hypercalcemia; Hypoparathyroidism; Laryngectomy; Male; Middle Aged; Parathyroid Hormone; Pharyngectomy; Postoperative Complications; Vitamin D

Topics: Adult; Biotransformation; Calcium; Calcium Radioisotopes; Cholecalciferol; Female; Humans; Intestinal Absorption; Kidney; Male; Middle Aged; Nephrectomy; Phosphates; Postoperative Complications; Renal Dialysis; Time Factors; Uremia

Topics: Adult; Aged; Alkaline Phosphatase; Bone and Bones; Bone Development; Calcification, Physiologic; Calcium; Cholecalciferol; Female; Gastrectomy; Humans; Middle Aged; Osteomalacia; Phosphates; Postoperative Complications; Vitamin D Deficiency

Topics: Cholecalciferol; Gastrointestinal Diseases; Humans; Injections, Intravenous; Phosphates; Postoperative Complications; Vitamin D Deficiency