Arch Surg Chicago
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We hypothesized that hypothyroidism and adrenal insufficiency frequently occur together in critically ill patients. ⋯ There is a 12% incidence of simultaneous hypothyroidism and adrenal insufficiency in our study and the routine testing for both may be indicated in this population of critically ill patients.
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The kinetics of technetium Tc 99m sestamibi (MIBI) in primary hyperparathyroidism are variable and affected by the cellular size of the abnormal glands, the parathyroid hormone levels, and the functional expression of P-glycoprotein (Pgp). The success of gamma probe-guided parathyroidectomy is closely related to the parathyroid-to-thyroid activity ratio at the time of surgery. Preoperative determination of maximum uptake ratio may improve the surgical outcome. ⋯ A strong relationship between volume of the parathyroid gland, serum parathyroid hormone levels, and MIBI uptake exists in primary hyperparathyroidism. Gamma probe-guided localization of abnormal gland(s) can be more successful if surgery is undertaken at maximum uptake ratio. High Pgp expression increases MIBI parathyroid clearance rate, decreases gamma probe counts, and may significantly alter the optimal time to surgery.
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To identify significant risk factors associated with mortality in patients with a Glasgow Coma Scale score of 3. ⋯ Patients with head injury with an admission Glasgow Coma Scale score of 3 have a poor prognosis. Mechanism of injury, head AIS, hypotension on admission, and age play a critical role in outcome. These patients are an important source of organ donation and should be evaluated and resuscitated aggressively.
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Transient postoperative anemia is partially a physiologic phenomenon, and variations in blood transfusion rates after liver resection in different series in part are due to different interpretations of postoperative anemia. Based on the hypothesis that transient postoperative anemia is partially a physiologic phenomenon, we analyzed serum hemoglobin and hematocrit values in patients who underwent liver resection without blood transfusion to check fluctuations. ⋯ The fluctuations of hemoglobin and hematocrit levels after liver resection showed a steady and significant decrease until the third postoperative day and then an increase. Therefore, a decrease in the hemoglobin and hematocrit levels between first and fifth postoperative days without evidence of active bleeding from drain discharge or any other possible source of bleeding does not justify blood administration.