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S139 – Intact Parathyroid Hormone as a Predictor of Hypocalcaemia
anism propels tumorigenesis in diploid ITAC without gross chromosomal aberrations. In SSCNC, however, it cannot be excluded that MSI is involved in (a subset of) cases. Interestingly, only 1 of the 2 positive cases had the characterizing absence of chromosomal changes; the other carried multiple abnormalities. S138 – Treatment Controversy Incidental MicroMedullary Carcinoma Jamie M. Swartz, DO (presenter); Thomas Peyton Nowlin, IV, MD OBJECTIVES: 1) Investigate the controversial management dilemma of microscopic foci of medullary thyroid carcinoma found incidentally. 2) Describe appropriate treatment strategies for this rare scenario after critically reviewing the literature. METHODS: This case is a 33-year-old Caucasian female with a history of a multinodular goiter seen as a referral from an endocrinologist. She had no previous history of parathyroid disease, pheochromocytoma or MEN syndrome. She also had no family history of medullary thyroid carcinoma. The patient underwent total thyroidectomy for multiple nodules with an uneventful operative course and recovery. RESULTS: The thyroid was sent for permanent section and evaluated microscopically with an H&E stain. Final microscopic evaluation revealed multiple adenomatous nodules, a 2mm focus of papillary thyroid carcinoma, and a 2 mm focus of medullary thyroid carcinoma. The patient underwent no further surgical treatment. She has undergone chromosomal analysis, evaluation for possible multiple endocrine neoplasia, and serial calcitonin measurements. She is currently diseasefree. CONCLUSIONS: Medullary thyroid carcinoma is a welldescribed form of thyroid malignancy that typically mandates aggressive surgical treatment; however, there is a paucity of information in the literature concerning sporadic, microscopic foci of medullary thyroid carcinoma. We review the literature and describe appropriate treatment strategies for this rare scenario. S139 – Intact Parathyroid Hormone as a Predictor of Hypocalcaemia Yuk Hui Ng (presenter); Dawn Tw Teo, MBBS; Mark Li-Chung Khoo, MD OBJECTIVES: 1) To investigate intact Parathyroid Hormone (ipth) as a predictor of hypocalcaemia in post-total thyroidectomy patients. 2) To determine the sensitivity and specificity of ipth as a predictor of hypocalcaemia. METHODS: Prospective study involving 65 patients in a single institution accrued over 2 years. All patients scheduled for total thyroidectomy were empirically started on calcium and vitamin D replacement on the day of surgery. Intact Para-
P123 thyroid Hormone (ipth) levels were taken 4-6 hours after completion of operation. Corrected calcium levels were also obtained 4-6 hours after completion of operation and 24 hours later. All patients were subsequently monitored for development of hypocalcaemia. Hypocalcaemia is defined as corrected serum calcium of ⬍ 1.9 mmol/L or clinical symptoms of cramps or peri-oral numbness. RESULTS: 18 of 65 patients developed hypocalcaemia. All patients who developed hypocalcaemia had a ipth level of ⬍ 0.6 pmol/L. Using 0.6 as a cut-off value, ipth has a sensitivity of 100% and specificity of 76% in our study. CONCLUSIONS: Using a cut-off value of 0.6pmmol/L, early postoperative intact parathyroid hormone has a high sensitivity and good specificity in identifying patients who subsequently develop hypocalcaemia post-total or completion thyroidectomy and can be used identify patients who need close calcium monitoring in the postoperative period. S140 –The Fibula Flap for Through and Through Oral Cavity Defects Kristin Jones (presenter); Thomas J Gal, Jr, MD, MPH; Joseph Valentino, MD OBJECTIVES: 1) Understand the complexity of through and through osteocutaneous defects of the oral cavity and face. 2) Appreciate that extensive bone requirements preclude the use of other single flap reconstructive options such as scapula or iliac crest. 3) Understand the use of the fibula osteocutaneous flap in these circumstances. METHODS: A retrospective review was performed of patients undergoing fibula osteocutaneous flap reconstruction of through and through oral cavity defects between August 2006 and December 2007 at a tertiary care referral center. Size and type of defects as well as success rates were examined. RESULTS: 7 patients underwent reconstruction of composite through and through mandibular defects of the oral cavity. There were 4 patients with complications of prior reconstructions, 2 with primary oral cancer, and 1 gunshot wound to the face. All patients had successful restoration of mandibular continuity. Soft tissue defects were successfully closed using the perforator-based skin paddle with a de-epithelialized segment to create a double skin paddle. 1 skin paddle from an otherwise viable flap was found to be unusable and was replaced with a pectoralis major(PM) flap. A second flap succumbed to delayed venous congestion but had healed uneventfully prior to postop day 8, and was closed post-debridement with a PM flap. CONCLUSIONS: While the usual foibles of the fibula osteocutaneous flap still apply, its versatility in the setting of through and through defects of the oral cavity is underestimated. In the setting of extensive bony defects, it is appropriate to reserve second flaps for salvage reconstruction.
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Scientific Posters
P123 thyroid Hormone (ipth) levels were taken 4-6 hours after completion of operation. Corrected calcium levels were also obtained 4-6 hours after completion of operation and 24 hours later. All patients were subsequently monitored for development of hypocalcaemia. Hypocalcaemia is defined as corrected serum calcium of ⬍ 1.9 mmol/L or clinical symptoms of cramps or peri-oral numbness. RESULTS: 18 of 65 patients developed hypocalcaemia. All patients who developed hypocalcaemia had a ipth level of ⬍ 0.6 pmol/L. Using 0.6 as a cut-off value, ipth has a sensitivity of 100% and specificity of 76% in our study. CONCLUSIONS: Using a cut-off value of 0.6pmmol/L, early postoperative intact parathyroid hormone has a high sensitivity and good specificity in identifying patients who subsequently develop hypocalcaemia post-total or completion thyroidectomy and can be used identify patients who need close calcium monitoring in the postoperative period. S140 –The Fibula Flap for Through and Through Oral Cavity Defects Kristin Jones (presenter); Thomas J Gal, Jr, MD, MPH; Joseph Valentino, MD OBJECTIVES: 1) Understand the complexity of through and through osteocutaneous defects of the oral cavity and face. 2) Appreciate that extensive bone requirements preclude the use of other single flap reconstructive options such as scapula or iliac crest. 3) Understand the use of the fibula osteocutaneous flap in these circumstances. METHODS: A retrospective review was performed of patients undergoing fibula osteocutaneous flap reconstruction of through and through oral cavity defects between August 2006 and December 2007 at a tertiary care referral center. Size and type of defects as well as success rates were examined. RESULTS: 7 patients underwent reconstruction of composite through and through mandibular defects of the oral cavity. There were 4 patients with complications of prior reconstructions, 2 with primary oral cancer, and 1 gunshot wound to the face. All patients had successful restoration of mandibular continuity. Soft tissue defects were successfully closed using the perforator-based skin paddle with a de-epithelialized segment to create a double skin paddle. 1 skin paddle from an otherwise viable flap was found to be unusable and was replaced with a pectoralis major(PM) flap. A second flap succumbed to delayed venous congestion but had healed uneventfully prior to postop day 8, and was closed post-debridement with a PM flap. CONCLUSIONS: While the usual foibles of the fibula osteocutaneous flap still apply, its versatility in the setting of through and through defects of the oral cavity is underestimated. In the setting of extensive bony defects, it is appropriate to reserve second flaps for salvage reconstruction.
SCI. POSTERS
Scientific Posters