Hypocalcemia is a recognized complication following thyroid surgery. Variability in the definition of hypocalcemia and different opinions on its management can lead to unnecessary patient morbidity and longer hospital stays as a result of inappropriate or untimely treatment. Therefore, we developed a management guideline for the recognition and treatment of post-thyroidectomy hypocalcemia, and we conducted a retrospective study to assess its impact on length of stay (LOS). Between April 1, 2007, and March 31, 2009, 29 adults had undergone a total or completion thyroidectomy at our large district general hospital. Of this group, postoperative hypocalcemia (defined as a serum calcium level of <2.00 mmol/L) developed in 13 patients (44.8%) during the first 3 postoperative days. Our guideline went into effect on July 1, 2009, and from that date through June 30, 2010, 18 more adults had undergone a total or completion thyroidectomy. Of that group, hypocalcemia developed in 7 patients (38.9%); the guideline was actually followed in 5 of these 7 cases (71.4%). In the preguideline group, the development of hypocalcemia increased the mean LOS from 2.0 days to 7.0 days (p < 0.001). The management of postoperative hypocalcemia in these cases was highly variable and was dictated by variations in practice rather than patient needs. In the postguideline group, postoperative hypocalcemia increased the mean LOS from 2.7 days to only 3.7 days (p = 0.07). While the difference between LOS in the two hypocalcemic groups did not reach statistical significance, we believe it merely reflects the relatively small number of patients rather than any lack of guideline efficacy. The implementation of a simple flowchart guideline for the management of postoperative hypocalcemia in our hospital has resulted in more uniform management and a reduced LOS.
Nasal myiasis is a rare condition, with only a few reported cases and no treatment consensus. We propose a conservative treatment approach with saline irrigation and debridement. Two patients in the ICU of Norfolk General Hospital, a tertiary academic referral center, presented simultaneously with nasal myiasis. Both patients were negative for necrotic masses or tumors, and neither patient had any contributory medical comorbidities. Both patients were treated conservatively with a single dose of pyrantel pamoate, daily sinus irrigation with saline, and daily bedside endoscopic debridement. After 2 days, the nasal myiasis resolved, and both patients recovered without sequelae. We conclude that this conservative, nonsurgical approach to management is both safe and effective.
Human myiasis is often seen in the tropics and subtropics but is extremely rare in the Northern Hemisphere.1 Myiasis is a parasitic infestation of live human or vertebrate animal tissues by dipterous larvae of nonbiting flies, which feed on host tissues or fluids.1
As the patient was asymptomatic, close observation and only laser excision were recommended if the patient's condition progressed.
The etiology of the disease is based on the primary predisposing factor, which is an obstruction of the ostiomeatal complex that results in hypoventilation of the maxillary sinus gases
A 53-year-old woman presented to our institution with a 2-month history of diplopia, followed by bouts of intermittent vertical diplopia that were more pronounced later in the day. She also reported drooping of her left eyelid, occasional gait instability, and headaches that were possibly indicative of myasthenia gravis.
Cholesteatoma should be differentiated from other conditions with similar otoscopic findings, such as myringosclerosis.