BMC Surgery最新文献

Objective: Hypoparathyroidism and hypocalcemia are common complications following total thyroidectomy (TT). This study aimed to evaluate the risk of post-total thyroidectomy transient hypoparathyroidism and hypocalcemia through a large single-center retrospective analysis.

Methods: In this retrospective study, consecutive patients underwent total thyroidectomy from May 2021 to September 2022 were included. Postoperative parathyroid hormone (PTH) level and serum calcium levels were evaluated within 24 h. Univariate and multivariate analysis were performed for assessing risk factors for developing transient hypoparathyroidism and hypocalcemia after total thyroidectomy.

Results: A total of 1065 patients undergoing total thyroidectomy who met the inclusion criteria were enrolled in this study. Among the patients, 460 patients (43.2%) developed hypoparathyroidism after surgery, and a total 325 patients (30.5%) developed hypocalcemia. After multivariate analysis, the independent risk factors related to hypoparathyroidism are female (OR = 1.65, p < 0.001), inadvertent parathyroidectomy (OR = 2.26, p = 0.004), non-papillary thyroid microcarcinoma (OR = 1.55, p = 0.003) and capsule invasion (OR = 1.39, p = 0.034). Meanwhile, the independent risk factors related to hypocalcemia are female (OR = 1.94, p < 0.001) and inadvertent parathyroidectomy (OR = 2.01, p = 0.011).

Conclusion: Transient hypoparathyroidism and hypocalcemia are relatively common complications following total thyroidectomy. Female, inadvertent parathyroid gland excision, papillary thyroid microcarcinoma, and capsular invasion were identified as independent risk factors for hypoparathyroidism and hypocalcemia.

Objectives: This retrospective cross-sectional study aimed to investigate the differences and influencing factors between the headache patients who achieved complete remission or significant reduction in headache frequency postoperatively and those whose frequency remained unchanged.

Methods: The study was conducted on 386 patients who underwent bariatric surgery at the four university hospitals between January 2018 and June 2024. Patients were divided two groups as with or without headache and then patients with headache were divided into migraine and tension-type headache groups.

Results: Headache duration, HIT-6 and VAS scores were also significantly reduced after operation. Bariatric surgery was significantly and negatively correlated with headache duration (r=-0.170; p < 0.05), HIT-6 (r=-0.353; p < 0.01) and VAS (r=-0.408; p < 0.01). Bariatric surgery had significant effect on HIT-6 (OR: 7.120; p < 0.01), headache frequency (OR: 13.634; p < 0.01) and VAS (OR: 2.024; p < 0.01). In migraine group; duration, HIT 6 and VAS levels were significantly decreased after operation (p < 0.05). In tension type group; only VAS level was significantly decreased after operation (p < 0.05).

Conclusion: After bariatric surgery, a statistically significant decrease in headache in terms of impact and severity was observed. This situation reveals that bariatric surgery has a direct and significant effect on headache. In patients with a BMI value on the borderline for bariatric surgery, these values ​​can be lowered slightly in case of severe headache.

This case explored the association among posterior circulation hypoperfusion, cryptogenic vertebral artery dissection (CVAD), and idiopathic intractable otalgia. A 67-year-old male patient, afflicted with recurrent right otalgia for over 50 years and misdiagnosed with otitis and trigeminal neuralgia, demonstrated posterior circulation hypoperfusion on cerebral CT perfusion imaging. Conventional vascular tests turned up nothing, yet dynamic contrast-enhanced CT (DCE-CT) disclosed a long-segment CVAD with endothelial flaps within the intracranial vertebral artery, precisely matching the hypoperfused territory. Post endovascular stent repair of the CVAD, the hypoperfusion normalized and the otalgia vanished. At 29 months, the patient remained pain - free without analgesics.This case highlights that CVAD-related posterior circulation hypoperfusion is a critical contributor to cryptogenic intractable otalgia. The evidence supports the efficacy of endovascular therapy as a promising intervention.

Objective: To identify independent risk factors for radial artery occlusion (RAO) after coronary angiography (CAG) and percutaneous coronary intervention (PCI), and to develop risk prediction models for CAG, PCI, and the overall population.

Methods: This retrospective study included 781 patients undergoing CAG or PCI. RAO occurrence was recorded. Baseline characteristics, intraoperative factors, and laboratory indicators were collected. Variables were screened using univariate logistic regression and LASSO regression. Independent risk factors were identified via multivariate logistic regression to develop nomogram prediction models. Model performance was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis.

Results: The overall RAO incidence was 8.32%, significantly higher in the CAG group than the PCI group (11.26% vs. 5.64%, P=0.007). Independent risk factors for RAO in the CAG group were female, elevated creatine kinase, multiple punctures, radial artery spasm, and puncture site pain, with BMI ≥25 kg/m² as a protective factor; in the PCI group, heart failure, multiple punctures, and puncture site pain, with elevated creatinine as a protective factor; in the overall population, smoking, heart failure, high CHA₂DS₂VASc score, multiple punctures, radial artery spasm, and puncture site pain, with BMI ≥25 kg/m² and elevated creatinine as protective factors. The prediction models demonstrated good discriminatory ability in each group (AUCs: 0.979, 0.921, and 0.951, respectively) and clinical utility.

Conclusion: Risk prediction models for RAO established in patients undergoing CAG, PCI, and the overall population can accurately identify high-risk patients, providing a reference for individualized clinical prevention and treatment. Multiple punctures, radial artery spasm, and puncture site pain are significant, modifiable risk factors.