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Content available remote Prediction for a planned relaparotomy in secondary peritonitis
Aims. To devise a scoring system for clinical variables related to positive findings at relaparotomy in secondary peritonitis. Methods. We have retrospectively studied 195 cases of patients after relaparotomy. According to the operation’s findings, the patients were divided into two groups: ‘relaparatomy unnecessary’ group A, ‘relaparotomy necessary’ group B. 6 factors (age, sex, leukocyte count, C reactive protein, time of symptoms to index operation, Mannheim Peritonitis Index) were evaluated in respect to their significance in decision making for relaparotomy. The predictive value for positive operation`s findings of these factors was evaluated by logistic multivariate regression analysis. According to this model a risk scoring system was created to support the decision whether to perform a relaparotomy. Results. Relaparotomy was unnecessary (Group A) for 154 (79,0%) patients, for 41 (21,0%) it was necessary (Group B). Comparing the groups A and B, we found a significant difference in patients’ mean age (54 v. 63 years, p=0,002), mean CRP level (133,2 v. 182,8 mg/L, p=0,025), mean time of symptoms to index operation (38,1 v. 67,1 hours, p=0,006) and mean MPI value (22,4 v. 29,4, p<0,0001). According to the above-mentioned predictors, a scoring system was devised: −0,17-(0,003×patient’s age years)+(0.153×time of symptoms to index operation hours)-(0,297×MPI)+(0,192×CRP mg/l). The score was 24,798±25,593 in group A and 36,572±32,543 in group B(p=0,028). Conclusions: Scoring system was devised to assist in creating treatment strategy after secondary peritonitis. If the score is ≥37, a planned relaparotomy should be performed. If the score is ≤24, other diagnostic and therapeutic tactics should be applied.
Content available remote Prognosis of thyroid function after hemithyroidectomy
Identify criteria and create a risk scoring system to predict hypothyroidism after hemithyroidectomy. We have retrospectively studied 216 cases of patients with goiter who had undergone hemithyroidectomy from January 2002 to December 2007 at Vilnius University Hospital Santariškių Klinikos. Patients were divided into two groups according to their thyroid function after hemithyroidectomy: 168 (77.8%) patients’ thyroid function was normal (group A), 48 (22.2%) patients had symptoms of hypothyroidism (group B). The relationship between groups and parameters such as patients’ sex, age, patient’s weight, preoperative serum thyroid-stimulating hormone (TSH) level, weight of the remnant gland, ratio of the remaining thyroid gland weight to patient’s weight was statistically analysed. The patients’ mean age was 41.6 ± 14.1 years in group A and 52.9 ± 13.9 years in group B (p=0.0002). The mean preoperative TSH level was 0.79 ± 0.5 mU/L in group A, compared with 1.42 ± 1.00 mU/L in group B (p= 0.005). The mean ratio of the remaining thyroid gland weight to patient’s weight was 0.102 ± 0.053 g/kg in group A and 0.063 ± 0.027 g/kg in group B (p=0.04). The groups did not establish a significant difference between patients’ sex, patient’s weight or weight of the remaining gland. Patient’s age, preoperative serum TSH level, ratio of the remaining thyroid gland weight to patient’s weight is the main factors of hypothyroidism after hemithyroidectomy. A risk scoring system was created to predict hypothyroidism after hemithyroidectomy before the operation.
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