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Hintergrund: Der Hypoparathyreoidismus (Hypopara) ist neben der Recurrensparese eine typische postoperative Komplikation nach Thyreoidektomie. Ziel dieser Arbeit soll die Prozessoptimierung des postoperativen Managements sein, um einen p.o. Hypopara frühzeitig zu erkennen und zu therapieren und somit die klinischen Symptome zu lindern oder zu vermeiden. Methoden: Es wurden alle Patienten mit einer beidseitigen Schilddrüsenresektion eingeschlossen. Ausschlusskriterien waren simultane Nebenschilddrüsen- erkrankungen sowie fortgeschrittene Schilddrüsenmalignome mit geplantem Tumordebulking und/oder langem ITS-Aufenthalt. Postoperativ wurden Parathormon (EDTA) sowie Kalzium (Serum) bestimmt. Bei einem Parathormon (PTH) - Wert unter dem Referenzbereich (15,0-68,3 pg/ml) und/oder einer ausgeprägten Hypokalzämie mit einem Kalziumwert < 1,9 (Ref. 2,20-2,65 mmol/l) und/oder klinischen Zeichen wie Kribbelparästhesien oder Tetanie wurde Kalzium und Vitamin D mittels festem Schema verordnet. Die Symptombesserung wurde klinisch dokumentiert. Ergebnisse: Am AGAPLESION Elisabethenstift gGmbH in Darmstadt wurden im Zeitraum zwischen Januar 2019 und Juni 2022 Schilddrüseneingriffe bei insgesamt 465 Patienten durchgeführt. Nach Berücksichtigung der Ein- und Ausschlusskriterien wurden 193 Patienten mit Thyreoidektomie in die Auswertung einbezogen. Ein p.o. Hypopara wurde bei 51 Patienten (26,4 %) festgestellt. Bei 40 Patienten (20,7 %) traten Symptome auf (39x Kribbelparästhesie, 1xTetanie). Von den 51 Patienten lag bei 26 (51 %) ein nur leicht erniedrigter Kalziumwert am 1. p.o. Tag vor (zwischen 2,00 und 2,20 mmol/l), bei 10 Patienten (19,6 %) war der Kalziumwert im Normbereich (2,20-2,65 mmol/l). Im Vergleich dazu lag bei 6 von 51 Patienten (11,8 %) ein normwertiger PTH-Wert vor. Bei 20 Patienten (10,4 %) erfolgte intraoperativ eine Nebenschilddrüsen-Replantation in den ipsilateralen M. sternocleidomastoideus. Davon trat bei 8 Patienten (40 %) ein Hypopara auf. Bei 29 Patienten (15, Background: Hypoparathyroidism is beside the recurrent laryngeal nerve paralysis a typical postoperative complication after thyroidectomy. The aim of this study is the process optimization of postoperative management to detect and treat postoperative hypoparathyroidism early so clinical symptoms can be allayed or avoided. Methods: All patients who underwent bilateral thyroidectomy were included. Exclusion criteria were simultaneous parathyroid diseases and progressed thyroid malignoma with scheduled tumor debulking and/or long stay in intensive care unit. Parathyroid hormone (PTH) and calcium in serum were measured postoperative. In case of lower PTH under the reference range (15.0-68.3 pg/ml) and/or hypocalcaemia with calcium < 1.9 (reference range 2.20-2.65 mmol/l) and/or clinical signs like paraesthesia or tetany calcium and vitamin D were prescribed as a fixed scheme. Clinical recovery was documented. Results: At AGAPLESION Elisabethenstift gGmbH in Darmstadt 465 thyroid operations were performed between January 2019 and June 2022. Considering inclusion and exclusion criteria 193 patients with bilateral thyroidectomy were included for analysis. Postoperative hypoparathyroidism was detected in 51 patients (26.4 %). Clinical symptoms were noticed in 40 patients (20.7 %), 39 cases of paraesthesia and 1 case of tetany. In 26 of the 51 hypoparathyroidism patients (51 %) calcium was just gently degraded (between 2.00 and 2.20 mmol/l) on postoperative day 1, in 10 patients (19.6 %) calcium was normal (2.20-2.65 mmol/l). Compared to that in 6 of 51 hypoparathyroidism patients (11.8 %) PTH was normal. In 20 of the 51 hypoparathyroidism patients (10.4 %) parathyroid replantation into ipsilateral sternocleidomastoid muscle was performed, thereof in 8 patients (40 %) a hypoparathyroidism was detected. In 29 patients of all included patients (15 %) histological examination showed an accidental removed parathyroid, thereof in 13 patients (44.8 %) a hypoparathyroidism was dete

The »overlap graph«, where vertices represent atomic orbitals and edges, their in-phase or out-of-phase overlaps, suggests that, . in the thermal electrocyclic opening of oxirane, the second oxygen lone pair has little effect on the allowed conrotatory mode but lowers the activation energy of the forbidden disrotatory mode. This effect does not exist in the electrocyclic opening of aziridine, which is one reason why the energy gap between the allowed and forbidden processes should remain substantial. In the course of an aziridine ring opening, the nitrogen's hydrogen may remain in the plane of the heavy atoms or may move out into either of the two half-spaces defined by this plane. Three different disrotatory pathways are thus conceivable. They are compared by a perturbational treatment using simple Hiickel theory. Localization of the transition states on these three reaction paths - i. e. determination of their »early« or »late« character, as measured by the magnitude of the rotation of the two methylene groups, for example - can be made with the help of »natural correlation diagrams«. This provides a simple criterion for predicting the breakdown of the perturbational treatment, when pathways of similar energies are compared: if one transition state is much earlier (later) than the other(s), no safe conclusion can be reached. These qualitative arguments are fully supported by ab initio calculations (ST0-3G + (3 X 3) CI and 4-31G + extensive CI). Substituent effects and possible cases of violation of orbital symmetry requirements are discussed.

The »overlap graph«, where vertices represent atomic orbitals and edges, their in-phase or out-of-phase overlaps, suggests that, . in the thermal electrocyclic opening of oxirane, the second oxygen lone pair has little effect on the allowed conrotatory mode but lowers the activation energy of the forbidden disrotatory mode. This effect does not exist in the electrocyclic opening of aziridine, which is one reason why the energy gap between the allowed and forbidden processes should remain substantial. In the course of an aziridine ring opening, the nitrogen's hydrogen may remain in the plane of the heavy atoms or may move out into either of the two half-spaces defined by this plane. Three different disrotatory pathways are thus conceivable. They are compared by a perturbational treatment using simple Hiickel theory. Localization of the transition states on these three reaction paths - i. e. determination of their »early« or »late« character, as measured by the magnitude of the rotation of the two methylene groups, for example - can be made with the help of »natural correlation diagrams«. This provides a simple criterion for predicting the breakdown of the perturbational treatment, when pathways of similar energies are compared: if one transition state is much earlier (later) than the other(s), no safe conclusion can be reached. These qualitative arguments are fully supported by ab initio calculations (ST0-3G + (3 X 3) CI and 4-31G + extensive CI). Substituent effects and possible cases of violation of orbital symmetry requirements are discussed.