scholarly journals Metabolic Effects of Prostatectomy

1989 ◽  
Vol 82 (12) ◽  
pp. 725-728 ◽  
Author(s):  
P A Hamilton Stewart ◽  
I M Barlow
Keyword(s):  
Serum Sodium ◽  
Transurethral Resection ◽  
Operation Time ◽  
High Plasma ◽  
Significant Rise ◽  
Metabolic Effects ◽  
Prospective Data ◽  
Plasma Ammonia ◽  
Severe Hyponatraemia ◽  
Glycine Level

Transurethral resection syndrome (TURS), complicating transurethral resection of the prostate (TURP) has been ascribed to hyponatraemia but reports have indicated that hyperammonaemia following metabolism of glycine can be the main cause. Prospective data has been collected on 96 prostatectomy patients (82 TURP and 14 retropubic). The retropubic group showed no significant postoperative change in the serum sodium or plasma ammonia. Of the TURP group, no TURS occurred although hyponatraemia was noted in 32 patients. The weight of prostate resected, the volume of glycine used, the time taken and the plasma ammonia levels were not significantly different in the normonatraemic or hyponatraemic groups. In severely hyponatraemic patients (13 out of 32 with a 10mmol/l, or greater, decrease in serum sodium) there was a significant rise (P≤0.05) in plasma ammonia, 1 or 4 h post TURP, which had decreased by 24 h. There was a highly significant increase in serum glycine level in the hyponatraemic compared with the normonatraemic group (P≤0.001). There was no correlation between serum glycine and plasma ammonia levels in the normonatraemic or hyponatraemic group. There were nine patients with post TURP plasma ammonia levels ≥ 100 μmol/l (mean 254) who experienced no mental confusion: six of these patients were hyponatraemic. The weight of prostrate resected (mean 26 g), volume of glycine used (mean 181) and operation time (mean 39 min) were all relatively low. Subsequently, TURS has occurred in a patient, with severe hyponatraemia and hyperglycinaemia but no hyperammonaemia. This study shows that hyperammonaemia does not always correlate with hyponatraemia or hyperglycinaemia, and high plasma ammonia levels can occur in the absence of TURS.

Single Instillation of Hypertonic Saline Immediately Following Transurethral Resection of Bladder Tumor for Recurrence Prevention –A Phase I Study

2021 ◽  
pp. 1-6
Author(s):  
Jonathan Modai ◽  
Alexey Kovalyonok ◽  
Avigdor Scherz ◽  
Dina Preise ◽  
Yuval Avda ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hypertonic Saline ◽  
Serum Sodium ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Osmotic Dehydration ◽  
Control Group ◽  
Plasma Sodium ◽  
Pelvic Cavity ◽  
Blue Discoloration

BACKGROUND: Urologic guidelines recommend perioperative instillation of chemotherapy after transurethral resection of bladder tumor (TURBT) to decrease tumor recurrence, yet implementation of this recommendation is partial due to associated morbidity. Hypertonic saline destroys cells by osmotic dehydration and might present a safer alternative. OBJECTIVE: To evaluate the safety of 3% hypertonic saline (Hypersal) intravesical instillation following TURBT in rats and in humans. METHODS: In 8 rats whose bladders were electrically injured, intravesical blue-dyed Hypersal was administered. We measured serum sodium levels before and after instillation and pathologically evaluated their pelvic cavity for signs of inflammation or blue discoloration. Twenty-four patients were recruited to the human trial (NIH-NCT04147182), 15 comprised the interventional and 10 the control group (one patient crossed over). Hypersal was given postoperatively. Serum sodium was measured before, 1 hour and 12–24 hours after instillation. Adverse effects were documented and compared between the groups. RESULTS: In rats, average sodium levels were 140.0 mEq/L and 140.3 mEq/L before and following instillation, respectively. Necropsy revealed no signs of inflammation or blue discoloration. In humans the average plasma sodium levels were 138.6 mEq∖L, 138.8 mEq∖L and 137.7 mEq∖L before, 1 hour and 12–24 hours after instillation, respectively. During the postoperative follow-up there was one case of fever. A month after the surgery, dysuria was reported by 5 patients while urgency and hematuria were reported by one patient each. The most severe adverse events were grade 2 on the Clavien-Dindo scale. Adverse events were similar in the control group. CONCLUSIONS: Hypersal instillation is safe and tolerable immediately after TURBT.

Aldosterone and ADH response to heat and dehydration in cattle

1980 ◽  
Vol 48 (2) ◽  
pp. 249-255 ◽  
Author(s):  
F. D. El-Nouty ◽  
I. M. Elbanna ◽  
T. P. Davis ◽  
H. D. Johnson
Keyword(s):  
Plasma Protein ◽  
Serum Sodium ◽  
Urine Output ◽  
Heat Exposure ◽  
Urinary Sodium Excretion ◽  
Inhibitory Effect ◽  
Significant Rise ◽  
Plasma Aldosterone ◽  
Total Plasma Protein ◽  
Urinary Potassium

The effect of heat (35 degrees C) and dehydration under heat (30 h) on plasma levels of antidiuretic hormone (ADH) and aldosterone was studied on four nonpregnant dry Holstein cows. Heat exposure caused a rapid significant rise in plasma ADH without significant changes in hematocrit (Hct), small but significant increase in urine output and a significant reduction in total plasma protein. Dehydration under heat caused a sharp increase in ADH levels associated with a significant decrease in urine output and a significant increase in plasma protein, blood Hct, and serum osmolality. A significant reduction in plasma aldosterone level was observed after 24 h of heat exposure. This was associated with a slight rise in urinary sodium excretion and a significant reduction in serum sodium. Both serum and urinary potassium concentrations were significantly lower under heat. Dehydration resulted in a slow rise in aldosterone but did not reach thermoneutral level. This is probably due to the inhibitory effect of higher serum sodium observed during dehydration on plasma aldosterone secretion. The rise in ADH and decrease in aldosterone during heat exposure may explain why cattle are one of the few species that do not concentrate urine during heat exposure.

scholarly journals Effect of Cryoprecipitate Infusion on Factor VIII Response to Venous Congestion in Patients with von Willebrand’s Disease

1977 ◽  
Author(s):  
M. Morfini ◽  
G. Longo ◽  
Rossi P. Ferrini ◽  
A. Seri
Keyword(s):  
Plasma Level ◽  
Normal Subjects ◽  
High Plasma ◽  
Significant Rise ◽  
Venous Congestion ◽  
Single Infusion ◽  
F Test ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Bleeding Episodes

In patients with Von Willebrand’s disease(VWD) venous congestion(v.c.) is un able to increase the VIIIAHF and VIIIAGN level as in normal subjects. To evaluate the effect of rise in VIIIAHF and VIIIAGN levels, 5 patients with VWD received single infusion of lyophilised cryoprecipitate(15 U./Kg) for treatment of bleeding episodes. Two v.c, at 15min and at 300min after the completion of infusion, one on each arm, was performed. VIIIAHF plasma level, raised by infusion, did not show further increase after v.c. at 15min. This finding may suggest that increased levels after v.c. in normal subjects is not achieved by activation of plasma VIIIAHF. In contrast at 300min a significant increase of VIIIAHF was obtained(F test p<0.05). On the other hand VIIIAGN high plasma level immediately after infusion showed a significant rise(F test p<0.05) after v.c. at 15min but much less at 300min when VIIIAGN is reduced. The divergence on response of VIIIAGN and VIIIAHF to v.c. at different times after infusion may support the mechanism of VIIIAGN conversion to VIIIAHF in VWD. As the plasma VIIIAHF activation appears to be unlikely, the endothelial cells may be responsable for release of AGN and AHF i.e. for conversion of AGN to AHF.

Effective Use of Amino Acid Dialysate over four Weeks in CAPD Patients

1983 ◽  
Vol 3 (2) ◽  
pp. 66-72 ◽  
Author(s):  
Arie Oren ◽  
George Wu ◽  
G. Harvey Anderson ◽  
Errol Marliss ◽  
Ramesh Khanna ◽  
...  
Keyword(s):  
Amino Acids ◽  
Amino Acid ◽  
Acid Solution ◽  
Serum Albumin ◽  
Hdl Cholesterol ◽  
Significant Rise ◽  
Protein Malnutrition ◽  
Metabolic Effects ◽  
Amino Acid Solution ◽  
Total Body

We studied the effectiveness, tolerance to, and beneficial metabolic effects of amino acid dialysate over an intermediate period in six CAPD patients. Two liters of 1% amino acid solution (Amino-Dianeal) were alternated with dialysate containing glucose. After four weeks there were significant increases in BUN (from 64 to 102 mg%), total body nitrogen (from 1333 to 1380 g), serum transferrin (from 175 to 222 mg%) and anion gap (from 15.1 to 17.3). Initially, there was a significant rise in HDL cholesterol, however, this was not sustained. No significant change was detected in total-body potassium, fasting serum albumin, triglyceride, insulin, glucagon, electrolytes, anthropometric measurements and daily ingestion of calories and proteins. During the study individual fasting, plasma amino acid levels showed significant increments in respect to histidine, tryptophan and glycine but alanine decreased. Several essential amino acids continued to show values below normal. Two hours after consumption of breakfast and concurrent infusion of the amino acid solution, the plasma levels of the amino acids in the dialysate peaked at emia, which develops in almost onehalf of the CAPD patients (7), and the significant weight gain observed in some of them. Furthermore, the daily losses of albumin and amino acids in the dialysate may induce protein malnutrition, especially if these losses are not replaced by an adequate daily protein intake. The presence of protein malnutrition in CAPD patients is indicated by the low serum albumin and total protein, and by the decrease in total body nitrogen over one year of CAPD (8).

Somatotrophic and thyroid hormones around the onset of lay in broiler breeders under different conditions

2002 ◽  
Vol 50 (4) ◽  
pp. 425-434
Author(s):  
R. D. Malheiros ◽  
Vera Maria Barbosa Moraes ◽  
R. L. Furlan ◽  
Keyword(s):  
Thyroid Hormones ◽  
Cell Function ◽  
High Plasma ◽  
Significant Rise ◽  
Broiler Breeders ◽  
Housing Systems ◽  
Gh Secretion ◽  
Age Related ◽  
Group A ◽  
Plasma Gh

Somatotrophic and thyroid hormones were determined around the onset of reproduction in broiler breeders reared in two different housing systems [dark, close-sided house (CH) and conventional, open-sided house (OH)]. In both groups age-related changes were obvious for thyroxine (T4), growth hormone (GH) and insulin-like growth factor (IGF-1); levels of T4 decreased, especially between 24 and 28 weeks in both groups; concomitantly GH sharply increased over the same period. A transient peak in triiodothyronine (T3) occurred between 25 and 27 weeks. The effect of housing was only present after the onset of lay. Between weeks 27-28 and the end of the period studied, the CH group showed higher levels of GH and T3 but lower T4 levels as compared to the OH group. A significant increase in GH after onset of lay, without any significant rise in T3 or in IGF-I, could point to a relative insensitivity to high plasma GH levels. Changes at GH receptor level, together with an increased pituitary GH secretion and/or decreased GH turnover may be expected. This may indicate that hypothalamo-pituitary changes at the onset of lay not only imply changes of gonadotrophic cell function, but also other hormonal axes. The relatively decrease in T4 without changes in T3, may point to a decrease in the activity of the thyrotropic axis.

scholarly journals Role of preoperative assessment of serum sodium in transurethral resection of prostate to avoid transurethral resection of prostate syndrome: a comparative study

2020 ◽  
Vol 7 (8) ◽  
pp. 2630
Author(s):  
Bhavesh Gamit ◽  
Nimesh Bharatkumar Thakkar
Keyword(s):  
Serum Sodium ◽  
Transurethral Resection ◽  
Tertiary Care ◽  
Prostate Gland ◽  
Preoperative Assessment ◽  
Transurethral Resection Of Prostate ◽  
Age Group ◽  
Tertiary Care Centre ◽  
Group 13 ◽  
Prostate Size

Background: Transurethral resection of prostate syndrome (TURP) syndrome is an iatrogenic complication caused by absorption of the irrigating fluid which is used to distend the bladder during surgery.Methods: A total of 100 patients with benign prostatic hyperplasia (BPH) were taken for study. Study was done in tertiary care centre in Gujarat from January 2016 to December 2017. They were evaluated pre-operative and post-operative for sodium concentration.Results: In this study most of the patients i.e. 32 were seen in age group 61- 65 years.31% cases have developed hyponatremia out of 6% were having serum sodium level <125 mEq/l. 56% of cases were having prostate gland <40 cc. In 70% cases, TURP was completed within 60 minutes, while 30% cases required more than 60 minutes time. 13 were seen in age group 51 to 60 years, means 40.62% patients of this age group (13/32) and 12 patients were seen in age group 71-80 years, means 52.17% patients of this age group (12/23) were having post-operative hyponatremia. Out of 31 patients, 20 patients (64.52%) were having prostate size more than 60 cc and 11 patients (35.48%) were having prostate size between 46 to 60 cc.Conclusions: From present study, it is concluded that electrolyte derangement occurs in older patients, with larger amount of tissue and longer time of resection and higher volume of irrigation fluid. It was also noticed that chances of electrolyte derangement are higher in patients with co-morbid conditions.

scholarly journals Lactate Accumulation during Moderate Hypoxic Hypoxia in Neocortical Rat Brain

1996 ◽  
Vol 16 (6) ◽  
pp. 1345-1352 ◽  
Author(s):  
Jean-François Payen ◽  
Emmanuelle LeBars ◽  
Bernard Wuyam ◽  
Bernard Tropini ◽  
Jean-Louis Pépin ◽  
...  
Keyword(s):  
Control Period ◽  
Relaxation Times ◽  
Significant Rise ◽  
Hypoxic Hypoxia ◽  
Metabolic Effects ◽  
Marked Rise ◽  
Arterial Lactate ◽  
Apparent Decrease ◽  
Lactate Infusion ◽  
Lactate Peak

Neocortical metabolism was studied during moderate hypoxic hypoxia, reoxygenation, and postmortem periods in anesthetized normocapnic rats using 1H nuclear magnetic resonance (NMR) spectroscopic imaging. Rats were prepared with unilateral common carotid occlusion to determine the ipsilateral metabolic effects of inadequate cerebral blood flow (CBF) response to hypoxia. No difference in brain metabolism between the two hemispheres was found during the control period. Hypoxic hypoxia (Pao2 = 54.1 ± 5.8 mm Hg) resulted in a significant rise in neocortical lactate peak in both hemispheres, with an additional marked rise in the clamped side compared to the unclamped side (53 ± 27 vs. 22 ± 13% of postmortem value, p < 0.001). These lactate changes were not reversible within 30 min of reoxygenation in the clamped hemisphere. No changes in neocortical lactate peak were observed while elevating arterial lactate via intravenous lactate infusion without hypoxia. In addition, hypoxic hypoxia resulted in an apparent decrease in neocortical water and N-acetyl aspartate (NAA) signals, which were related to a shortening in T2 relaxation times. It is concluded that neocortical lactate is an early metabolic indicator during moderate hypoxic hypoxia in normocapnic conditions.

scholarly journals Sodium variability is associated with increased mortality in severe burn injury

2017 ◽  
Vol 5 ◽  
Author(s):  
Soman Sen ◽  
Nam Tran ◽  
Brian Chan ◽  
Tina L. Palmieri ◽  
David G. Greenhalgh ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Multivariate Logistic Regression Analysis ◽  
Median Number ◽  
High Plasma ◽  
Plasma Sodium ◽  
Burn Patients ◽  
Severe Burn ◽  
Severe Burn Injury

Abstract Background Dysnatremias are associated with increased mortality in critically ill patients. Hypernatremia in burn patients is also associated with poor survival. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients. Methods We performed a retrospective review of adult burn patients with a burn injury of 15% total body surface area (TBSA) or greater from 2010 to 2014. All patients included in the study had at least three serum sodium levels checked during admission. We used multivariate logistic regression analysis to determine if hypernatremia, hyponatremia, or sodium variability independently increased the odds ratio (OR) for death. Results Two hundred twelve patients met entry criteria. Mean age and %TBSA for the study was 45 ± 18 years and 32 ± 19%. Twenty-nine patients died for a mortality rate of 14%. Serum sodium was measured 10,310 times overall. The median number of serum sodium measurements per patient was 22. Non-survivors were older (59 ± 19 vs. 42 ± 16 years) and suffered from a more severe burn injury (50 ± 25% vs. 29 ± 16%TBSA). While mean sodium was significantly higher for non-survivors (138 ± 3 milliequivalents/liter (meq/l)) than for survivors (135 ± 2 meq/l), mean sodium levels remained within the laboratory reference range (135 to 145 meq/l) for both groups. Non-survivors had a significantly higher median number of hypernatremic (&gt; 145 meq/l) measurements (2 vs. 0). Coefficient of variation (CV) was significantly higher in non-survivors (2.85 ± 1.1) than survivors (2.0 ± 0.7). Adjusting for TBSA, age, ventilator days, and intensive care unit (ICU) stay, a higher CV of sodium measurements was associated with mortality (OR 5.8 (95% confidence interval (CI) 1.5 to 22)). Additionally, large variation in sodium ranges in the first 10 days of admission may be associated with increased mortality (OR 1.35 (95% CI 1.06 to1.7)). Conclusions Increased variability in plasma sodium may be associated with death in severely burned patients.

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