scholarly journals Electrolyte disorders after endoscopic transnasal neurosurgical interventions

2019 ◽  
Vol 13 (1) ◽  
pp. 42-55
Author(s):  
Ekaterina A. Pigarova ◽  
Larisa K. Dzeranova ◽  
Artem Yu. Zhukov ◽  
Andrey Yu. Grigoriev ◽  
Vilen N. Azizyan ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Postoperative Period ◽  
Study Groups ◽  
Underlying Disease ◽  
Pathological Examination ◽  
Benign Tumors ◽  
Electrolyte Balance ◽  
Main Diagnosis ◽  
Electrolyte Disorders ◽  
Postoperative Hyponatremia

Background: Disorders of water and electrolyte balance, hyper- and hyponatremia, are common postoperative complications of transsphenoidal neurosurgical interventions and are found in up to 30–40% of cases. At the same time, delayed hyponatremia is the main cause of repeated hospitalizations of patients, and the risk factors/pathogenetic mechanisms responsible for the development of postoperative hyponatremia have not been fully investigated. Aim: To determine the frequency of water-electrolyte disturbances and to identify predictors of dysnatriemia states in patients after transnasal adenomectomy. Materials and methods: A retrospective single-site study included an analysis of electronic medical records of patients who underwent transnasal neurosurgical interventions for benign tumors of the pituitary gland (n = 416). The diagnostic and prognostic factors for the development of postoperative water-electrolyte disorders were evaluated. Results: The prevalence of hyponatremia in the total group of patients was 7.2%, and for hypernatremia it was 3 times higher – 24.3%, with these indicators being kept stable through the years of surgery (p > 0.05; χ2 with the Yeats correction). 66 (16%) of the operated patients, the sodium level in the early (0–5 day) and 157 (38%) patients in the later (6+ day) postoperative period was not determined, which may underestimate the identification of the most dangerous delayed postoperative hyponatremia. When analyzing the main clinical and laboratory characteristics of patients with hypo-, normo- and hypernatremia, no statistically significant differences were found between the parameters characterizing natremia, the osmolality of blood and urine, the frequency of determining blood sodium in different time intervals of the postoperative period. Complications of the main diagnosis (diabetes mellitus, coronary heart disease and arterial hypertension), selected parameters of pathological examination (identification of neurohypophysis cells, adenohypophysis, oxyphilic, basophilic or chromophobic cells, as well as other structures that are not part of the pituitary gland) and the operation protocol (bleeding, coagulation of sellar structures, liquorrhea, excision of the pituitary gland), did not differ between groups. In the hypernatremia group, the tumor volume in quantitative representation was lower than in the normo- and hyponatremia groups (1.0 ml vs. 1.5 and 1.5 ml, respectively). The number of neurosurgical interventions performed in a patient did not differ between the study groups. Conclusions: After transnasal adenomectomy, hypo- and hypernatremia occur in 7.2% and 24.3%, respectively, and do not depend on the presence of complications of the underlying disease, the parameters of the pathomorphological protocol, the appearance of postoperative hypopituitarism or the course of the operation itself. For the timely detection of disorders of water and electrolyte metabolism, the implementation of blood sodium testing in the early and late (6+ day) postoperative period is necessary in management of patients after transnasal adenomectomy.

Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

2019 ◽  
pp. 40-45
Author(s):  
A. Ya. Kosonogov ◽  
S. V. Nemirova ◽  
V. I. Pozdishev ◽  
A. B. Nikolskiy ◽  
K. A. Kosonogov ◽  
...  
Keyword(s):  
Cardiac Tamponade ◽  
Postoperative Period ◽  
Underlying Disease ◽  
Electrolyte Balance ◽  
Symptomatic Therapy ◽  
Electrolyte Disorders ◽  
Results Of Treatment ◽  
Cardiac Compression ◽  
Pericardial Diseases ◽  
Life Threatening

Purpose of the study: to analyze the etiology, diagnostic criteria and results of treatment of life-threatening conditions in pericarditis of different etiologies (based on our clinic materials).Materials and methods. The study included cases of hospitalization of patients with a diagnosis of «Pericarditis» and ICD-10 codes for pericardial diseases for the period from 2009 to 2018. In the course of the work, the history and clinical picture of the disease, laboratory and radiation research methods were analyzed. All patients started treatment of the underlying disease and performed symptomatic therapy, including those aimed at restoring hemodynamics and normalizing water and electrolyte disorders, stopping inflammation and auto-aggression of the immune system. When signs of compression/cardiac tamponade were detected, pericardiocentesis was performed, according to indications, drainage/fenestration of the cardiac sac, pericardiotomy were performed. In the postoperative period was carried out antibacterial and symptomatic therapy.Results. Life-threatening diseases of the pericardium accounted for 32,03% of all patients treated in the hospital for pericarditis. The most frequently detected signs of a hemodynamically significant compression and cardiac tamponade, less often purulent and constrictive P. Isolated 25 patients underwent closed drainage with pericardiocentesis, in 1 case the drainage was supplemented with f ibrinolytic therapy. Sanitation of the cavity and fenestration of the pericardium were carried out in 11 patients, pericardiotomy with notched drainage in 2 patients, thoracotomy with pericardiectomy – 4. In the postoperative period, the symptoms of inflammation were reduced, the level of cardiac enzymes decreased, the electrolyte balance stabilized. Most patients noted a distinct regression of the symptoms of pericarditis and cardiac compression. Recurrent P was noted in 5 cases, deaths occurred in 4 cases (8,16%).Conclusion. Early verification of the diagnosis and timely decompression of the heart with fractional evacuation of the exudate or pericardectomy with respect to the sequence of release of the heart chambers from adhesions and adhesions against the background of complex therapy allows to achieve positive dynamics, and fenestration of the cardiac bag with the formation of a sufficiently sized opening during recurrent fluid accumulation or intrapericardial fibrin. development of severe complications of pericarditis even in patients with multiple concomitant diseases evanii and oncopathology.

Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

2019 ◽  
pp. 40-45
Author(s):  
A. Ya. Kosonogov ◽  
S. V. Nemirova ◽  
V. I. Pozdishev ◽  
A. B. Nikolskiy ◽  
K. A. Kosonogov ◽  
...  
Keyword(s):  
Cardiac Tamponade ◽  
Postoperative Period ◽  
Underlying Disease ◽  
Electrolyte Balance ◽  
Symptomatic Therapy ◽  
Electrolyte Disorders ◽  
Results Of Treatment ◽  
Cardiac Compression ◽  
Pericardial Diseases ◽  
Life Threatening

Purpose of the study: to analyze the etiology, diagnostic criteria and results of treatment of life-threatening conditions in pericarditis of different etiologies (based on our clinic materials).Materials and methods. The study included cases of hospitalization of patients with a diagnosis of «Pericarditis» and ICD-10 codes for pericardial diseases for the period from 2009 to 2018. In the course of the work, the history and clinical picture of the disease, laboratory and radiation research methods were analyzed. All patients started treatment of the underlying disease and performed symptomatic therapy, including those aimed at restoring hemodynamics and normalizing water and electrolyte disorders, stopping inflammation and auto-aggression of the immune system. When signs of compression/cardiac tamponade were detected, pericardiocentesis was performed, according to indications, drainage/fenestration of the cardiac sac, pericardiotomy were performed. In the postoperative period was carried out antibacterial and symptomatic therapy.Results. Life-threatening diseases of the pericardium accounted for 32,03% of all patients treated in the hospital for pericarditis. The most frequently detected signs of a hemodynamically significant compression and cardiac tamponade, less often purulent and constrictive P. Isolated 25 patients underwent closed drainage with pericardiocentesis, in 1 case the drainage was supplemented with f ibrinolytic therapy. Sanitation of the cavity and fenestration of the pericardium were carried out in 11 patients, pericardiotomy with notched drainage in 2 patients, thoracotomy with pericardiectomy – 4. In the postoperative period, the symptoms of inflammation were reduced, the level of cardiac enzymes decreased, the electrolyte balance stabilized. Most patients noted a distinct regression of the symptoms of pericarditis and cardiac compression. Recurrent P was noted in 5 cases, deaths occurred in 4 cases (8,16%).Conclusion. Early verification of the diagnosis and timely decompression of the heart with fractional evacuation of the exudate or pericardectomy with respect to the sequence of release of the heart chambers from adhesions and adhesions against the background of complex therapy allows to achieve positive dynamics, and fenestration of the cardiac bag with the formation of a sufficiently sized opening during recurrent fluid accumulation or intrapericardial fibrin. development of severe complications of pericarditis even in patients with multiple concomitant diseases evanii and oncopathology.

scholarly journals Paraurethral Leiomyoma in a Postmenopausal Woman: First European Case

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Susy Shim ◽  
Camilla Skovvang Borg ◽  
Huda Galib Majeed ◽  
Peter Humaidan
Keyword(s):  
Smooth Muscle ◽  
Postmenopausal Woman ◽  
Smooth Muscle Cells ◽  
Postoperative Period ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Gynecological Examination ◽  
Urethral Pain ◽  
Paraurethral Leiomyoma

Leiomyomas are benign tumors extending from smooth muscle cells and only few cases of paraurethral leiomyomas have been described in the literature. They are often seen in the reproductive age and around 50% of the cases are asymptomatic. We describe a 59-year-old woman with a solid mobile tumor below the symphysis revealed at a gynecological examination. Transvaginal ultrasound and MRI confirmed the tumor and excision of the paraurethral tumor was carried out. The histological examination showed a benign paraurethral leiomyoma. The postoperative period was characterized by urethral pain as well as vaginal leakage of urine.

Mental disorders that occur against the background of water-electrolyte disorders in patients with neoplasms of chiasmal-sellar region

2020 ◽  
pp. 38-56
Author(s):  
K. V. Koval ◽  
G. E. Chmutin ◽  
P. L. Kalinin ◽  
M. A. Kutin ◽  
V. V. Ivanov
Keyword(s):  
Mental Disorders ◽  
Postoperative Period ◽  
World Literature ◽  
Sellar Region ◽  
Electrolyte Disorders ◽  
Appropriate Treatment ◽  
Specific Category ◽  
Neurosurgical Patients ◽  
Before And After ◽  
Shed Light

The work is devoted to assessing the results of the analysis of world literature for a period of more than 50 years: it reflects the data on the nature of the occurrence of mental disorders developing in patients with tumors of the chiasmal-sellar region against the background of water-electrolyte disorders both before and after surgery. The presented data shed light on the occurrence of the variants of mental disorders in such a specific category of neurosurgical patients, which may allow the clinician to timely determine the appropriate treatment tactics and reduce the severity of complications in the postoperative period.

Optimization of pregravidare training of women with hysteromyoma

2017 ◽  
pp. 59-60
Author(s):  
A.A. Dovgan ◽  
Keyword(s):  
Key Words ◽  
Postoperative Period ◽  
Main Diagnosis ◽  
Advanced Technique ◽  
Late Postoperative Period

The objective: to improve tactics of pregravidare training of women with hysteromyoma. Patients and methods. Under observation there were 100 patients of active and late genesial age (from 22 to 44 years), with the main diagnosis hysteromyoma established on the basis of complex inspection. To all patients the conservative myomectomy by laparotomny that laparoscopic accesses out of pregnancy was made, a course of complex rehabilitational therapy in the early and late postoperative period is conducted, the next and remote results are tracked. Results. Efficiency of pregravidarny training of patients with a hysteromyoma made 67.0%, thus authentically larger frequency of offensive of pregnancy is noted in group of the patients receiving in the postoperative period therapy by agonists of GNRG (73.0%), including at women with genesial problems (52.0%). Besides, purpose of agonists of GNRG after operation allows to reduce number of recurrence of a disease in the remote period. Conclusions. The advanced technique of pregravidarny preparation allows to improve the genesial forecast of women with hysteromyoma. Key words: hysteromyoma, pregravidarny preparation, optimization.

scholarly journals Rare presentation of a testicular angiofibroma treated with testis sparing surgery

2016 ◽  
Vol 88 (4) ◽  
pp. 330 ◽  
Author(s):  
Luca Leone ◽  
Paola Fulvi ◽  
Giulia Sbrollini ◽  
Alessandra Filosa ◽  
Enrico Caraceni ◽  
...  
Keyword(s):  
Case Report ◽  
Malignant Tumor ◽  
Gold Standard ◽  
Conservative Surgery ◽  
Pathological Examination ◽  
Benign Tumors ◽  
Frozen Sections ◽  
Rare Presentation ◽  
Final Histology

Introduction: Testicular benign tumors are very rare (< 5%). Testicular Angiofibroma (AF) is one of those, however the gold standard of treatment and follow-up is still unclear. Case report: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. Conclusion: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

scholarly journals SOME ASPECTS OF CT ASSESSMENT OF SUPRAVESICAL URINARY TRACT IN PATIENTS AFTER CYSTILEOPLASTICS

2011 ◽  
Vol 2 (1) ◽  
pp. 54-56
Author(s):  
O P Sukhanova ◽  
T S Borondzhiyan ◽  
E V Minasyan
Keyword(s):  
Urinary Tract ◽  
Radical Cystectomy ◽  
Postoperative Period ◽  
Inflammatory Process ◽  
Underlying Disease ◽  
The State ◽  
Malignant Lesions ◽  
Degrees Of Severity ◽  
Late Postoperative Period ◽  
Ct Studies

The purpose of the research was to determine morphological and urodynamic changes of supravesical urinary tract in patients after cystileoplastics. Methods. CT studies in the late postoperative period in 19 patients after radical cystectomy, combined with vesiculoprostatectomy and cystoileoplastics and malignant lesions of the bladder were performed. Results. None of cases revealed signs of continued growth. In 57% of the cases it was evidence of lymphadenopathy in the absence of negative dynamics of the underlying disease. No dependence of the state of anastomoses of the volume formed by the reservoir and the degree of shortening of the ureter was found. In assessing the state of supravesical urinary tract 11 from 19 (57,8%) patients were registered varying degrees of severity gidroureteronephrosis, and in 4 patients, pelvic ureteric reflux. All patients with urodynamic disorders identified "new bladder" had less volume than patients who did not have these disorders. Conclusion. CT study is the method of choice in the evaluation of supravesical urinary tract after cystoileoplastics for timely prevention of complications of an inflammatory process. It was revealed that the degree of changes in the urinary tract depending of the volume of the reservoir formed, requires further analysis.

scholarly journals Syndrome of inappropriate secretion of antidiuretic hormone in the practice of endocrinologist

2021 ◽  
Vol 14 (3) ◽  
pp. 4-12
Author(s):  
Agunda V. Dzagaxova ◽  
Nino N. Katamadze ◽  
Ekaterina A. Pigarova
Keyword(s):  
Clinical Practice ◽  
Antidiuretic Hormone ◽  
Clinical Guidelines ◽  
Length Of Hospital Stay ◽  
Interdisciplinary Approach ◽  
Electrolyte Balance ◽  
Electrolyte Disorders ◽  
Inappropriate Secretion ◽  
Wide Range ◽  
Water And Electrolyte Balance

Hyponatremia is the most common disorder of water and electrolyte balance encountered in clinical practice. Conditions associated with hyponatremia require hospitalization in 15–20% of cases. Hyponatremia is a predictor of poor outcome in a wide range of diseases and therefore requires an interdisciplinary approach. This problem leads to an increase in complications and the length of hospital stay and mortality. The review focuses on the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), which accounts for approximately one third of all cases of hyponatremia and is more common in endocrinology than other fluid and electrolyte disorders along with central diabetes insipidus. The article presents modern approaches to the treatment of SIADH based on international clinical guidelines.

Ultrasound-guided vascular access in intensive/acute cardiac care

2021 ◽  
pp. 314-322
Author(s):  
Richard Paul
Keyword(s):  
Ph Value ◽  
Fluid Management ◽  
Disease Process ◽  
Blood Gas Analysis ◽  
Underlying Disease ◽  
Gas Analysis ◽  
Cardiac Care ◽  
Acid Base ◽  
Electrolyte Disorders ◽  
Arterial Blood Gas

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects on the human body. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, an approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.

scholarly journals Predictive factors for time to full enteral feeding after pyloromyotomy for infantile hypertrophic pyloric stenosis

2020 ◽  
Vol 3 (1) ◽  
pp. e000081
Author(s):  
David Eriksson ◽  
Martin Salö
Keyword(s):  
Pyloric Stenosis ◽  
Enteral Feeding ◽  
Postoperative Period ◽  
Hypertrophic Pyloric Stenosis ◽  
Underlying Disease ◽  
Symptom Duration ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Linear Regression Models ◽  
Severe Underlying Disease ◽  
Full Enteral Feeding

BackgroundThe aim of the study was to evaluate how different parameters in the preoperative, perioperative, and postoperative period affect time to full enteral feeding (TFEF) in children undergoing pyloromyotomy.MethodsA retrospective study of all children operated for infantile hypertrophic pyloric stenosis between 2001 and 2017 was conducted. Parameters in demographics and in the preoperative and postoperative period were evaluated against TFEF (hours) using linear regression models.ResultsIn the whole cohort of 175 children, mean TFEF was 47 hours with Standard Deviation (SD) of ±35. In the multivariate model, TFEF decreased with age [beta (B): −0.62; 95% confidence interval (95% CI) −1.05 to −0.19; p=0.005) and increased with the presence of severe underlying disease (congenital heart defect or syndrome) (B: 26.5; 95% CI 3.3 to 49.7; p=0.026). Hence, for every day of age, the time to fully fed decreased by 0.6 hour, and the presence of an underlying disease increased the time to fully fed with over one day. TFEF did not seem to be affected by prematurity, weight loss, symptom duration, preoperative acid/base balance or electrolyte values, surgical method, or method of postoperative feeding.ConclusionsTFEF decreased with higher age and increased in children with a severe underlying disease. These results may be useful in providing adequate parental information regarding what affects TFEF and the length of hospital stay.

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