scholarly journals The pre- and postoperative illness trajectory in patients with pituitary tumours

2019 ◽  
Vol 8 (7) ◽  
pp. 878-886 ◽  
Author(s):  
Eva Jakobsson Ung ◽  
Ann-Charlotte Olofsson ◽  
Ida Björkman ◽  
Tobias Hallén ◽  
Daniel S Olsson ◽  
...  
Keyword(s):  
Postoperative Care ◽  
Care Pathway ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Postoperative Recovery ◽  
Endocrine Treatment ◽  
Pituitary Tumours ◽  
Care And Support ◽  
Before And After ◽  
Operative Evaluation

Objective Experiences and need of support during surgery and start of replacement therapy in patients with pituitary tumours are highly unknown. This study aimed at exploring patient experiences during pre- and postoperative care and recovery after pituitary surgery in patients with a pituitary tumour. Methods Within a qualitative study design, 16 consecutive patients who underwent surgery for pituitary tumours were repeatedly interviewed. In total, 42 interviews were performed before and after surgery. Analysis was performed using qualitative interpretation. Results Suffering a pituitary tumour was overwhelming for many patients and struggling with existential issues was common. Patients expressed loneliness and vulnerability before and after surgery. How professionals handled information in connection with diagnosis greatly affected the patients. Other patients with the same diagnosis were experienced as the greatest support. Normalisation of bodily symptoms and relationships with others were reported during postoperative recovery. However, a fear that the tumour would return was present. Conclusions Patients with pituitary tumours need structured support, including peer support, which acknowledges physical, cognitive as well as emotional and existential concerns. Information related to diagnosis and surgery should be adapted in relation to the loneliness and the existential seriousness of the situation. Care and support for patients with pituitary tumours should preferably be organised based on continuity and an unbroken care pathway from the first pre-operative evaluation through to postoperative care and the start of a life-long endocrine treatment and tumour surveillance.

Evaluation of Outcomes Before and After Implementation of a Standardized Postoperative Care Pathway in Pediatric Posterior Spinal Fusion Patients

2020 ◽  
Vol 39 (4) ◽  
pp. 257-263
Author(s):  
Kembral L. Nelson ◽  
Lindsey L. Locke ◽  
Leslie N. Rhodes ◽  
William A. Mabry ◽  
Jeffrey R. Sawyer ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Postoperative Care ◽  
Care Pathway ◽  
Posterior Spinal Fusion ◽  
Before And After

scholarly journals Safety and efficacy of mini doppler in recurrent pituitary tumours

2020 ◽  
pp. 336-342
Author(s):  
Moshiur Rahman ◽  
Ezequiel Garcia-Ballestas ◽  
Luis Rafael Moscote-Salazar
Keyword(s):  
Cavernous Sinus ◽  
Surgical Excision ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Csf Leak ◽  
Surgical Removal ◽  
Pituitary Tumours ◽  
Female Ratio ◽  
Cavernous Sinus Invasion ◽  
Number Of Patients

Background: Pituitary surgery is the most common surgery used to remove pituitary tumours. The use of mini doppler in surgical removal of an endonasal pituitary tumour has shown good short-term clinical outcomes and few complications in patients. Cavernous sinus invasion limits the surgical excision and still a challenge of gross total resection.   Objective: The main objective of this study is to evaluate the outcome of surgical removal of an endonasal pituitary tumour using mini doppler.    Method: A total of 12 patients were studied retrospectively from 2012 to 2018 in a single institution (Private hospital) in Dhaka, Bangladesh. The male and female ratio was 7:5. Results: 92% of cases of the total number of patients had satisfactory removal/ neurological improvement/hormonal improvement. Among 12 cases, 8 cases had transient diabetes insipidus and one patient had CSF leak.    Conclusion: The intraoperative Doppler is a useful tool to localize the carotids, which provides safer resection of endonasal pituitary tumours. Thus, it is very safe and effective for laterosellar resection of recurrent pituitary tumours and for cavernous sinus invasions.

SERUM PROLACTIN IN PATIENTS WITH "FUNCTIONLESS" CHROMOPHOBE ADENOMAS BEFORE AND AFTER THERAPY

1977 ◽  
Vol 84 (3) ◽  
pp. 449-460 ◽  
Author(s):  
N. A. Samaan ◽  
M. E. Leavens ◽  
J. H. Jesse
Keyword(s):  
Hormone Replacement ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Primary Hypothyroidism ◽  
Pituitary Function ◽  
Serum Prolactin ◽  
Before And After

ABSTRACT The immunoreactive serum human prolactin (PRL) level was measured before and after intravenous administration of 500 μg of thyrotrophinreleasing hormone (TRH) in 11 patients with "functionless" chromophobe adenomas before and after surgery and after radiotherapy in 6 of these patients. The results were compared to other pituitary function tests. Two of the patients studied had recurrent disease after previous pituitary surgery and radiotherapy. Five patients had pituitary surgery through the transfrontal route, while 6 had adenoma removal via the transnasal transsphenoidal route. Before surgery, the serum PRL concentration was abnormally high in 4 patients, before and after TRH administration. It was normal in 6 and subnormal in 1 patient who had had previous therapy. Two of the patients studied showed high serum thyroid-stimulating hormone (TSH) levels in the presence of low serum T3 and T4 suggesting primary hypothyroidism with a secondary TSH-producing pituitary tumour. After surgery all patients showed a significant decrease of the serum PRL level. This contrasts with more variable results in the measurements of other pituitary hormones. Post-operative radiotherapy produced no significant additional change in serum PRL levels in 5 of the 6 patients measured 6 months to 4 years after radiotherapy. Five of the 6 patients who had adenoma removed via the transsphenoidal route required no cortisol replacement and 4 remained euthyroid, whereas all 5 patients after transfrontal surgery required both cortisol and thyroid hormone replacement. These results indicate: (1) that measurement of serum PRL levels at basal and after TRH administration in patients with "functionless" chromophobe adenomas before and after treatment may be the best index for evaluating the effect of therapy; (2) that adenoma removal may be followed by preservation of normal pituitary function, but this is more likely to occur if the transsphenoidal approach is used; and (3) that primary thyroid insufficiency may be associated with a pituitary adenoma.

A critical reappraisal of MIB-1 labelling index significance in a large series of pituitary tumours: secreting versus non-secreting adenomas.

2002 ◽  
pp. 103-113 ◽  
Author(s):  
M L Jaffrain-Rea ◽  
D Di Stefano ◽  
G Minniti ◽  
V Esposito ◽  
A Bultrini ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Hormone Secretion ◽  
Tumour Volume ◽  
Pituitary Tumour ◽  
Labelling Index ◽  
Pituitary Tumours ◽  
Life Threatening ◽  
The Mean ◽  
Monoclonal Antibody Mib 1 ◽  
Mib 1

Pituitary tumours are usually benign neoplasia, but may have a locally aggressive or malignant evolution. This study aimed to identify factors which mostly influence their proliferative activity, in order to clarify its value for clinical and research purposes. The proliferative index was determined in a prospective series of 132 pituitary tumours as the percentage of monoclonal antibody MIB-1-immunopositive cells and referred to as the MIB-1 labelling index (LI). Its distribution was analysed according to both univariate and multivariate models. A life-threatening pituitary tumour is presented separately. The mean LI was 1.24+/-1.59%, with significant differences between clinically secreting (CS) and clinically non-secreting (CNS) adenomas. In CS adenomas (n=65), LI was highly variable and markedly influenced by pre-operative pharmacological treatment (0.80+/-1.03 vs 2.06+/-2.39% in treated vs untreated cases, P=0.009); it decreased with patient's age (P=0.025, r=0.28) and increased with tumour volume and invasiveness. The influence of pre-operative treatment and macroscopic features on LI in this group was confirmed by multivariate analysis. In CNS adenomas (n=67), LI distribution was less variable than in CS adenomas (P<0.0001), it was age-independent and correlations with tumour volume, invasiveness or recurrence did not reach significance. In a rapidly growing parasellar tumour, the mean LI was 24% at first surgery and exceeded 50% at second surgery performed 4 months later. LI should be interpreted according to hormone secretion and pre-operative treatment. Unusually high LI values deserve particular attention.

scholarly journals Evaluation of a Brief Intervention to Improve the Nursing Care of Young Children in a High HIV and AIDS Setting

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Linda M. Richter ◽  
Tamsen J. Rochat ◽  
Celia Hsiao ◽  
Thembelihle H. Zuma
Keyword(s):  
Young Children ◽  
Well Being ◽  
Hiv And Aids ◽  
Child Interaction ◽  
Home Based ◽  
Care And Support ◽  
Nurse Burnout ◽  
Before And After ◽  
Infant Pain ◽  
Outcomes For Children

The HIV epidemic in South Africa is putting great strain on health services, including the inpatient care of young children. Caregivers and young children (107 pairs) and 17 nurses participated in an intervention to improve the care of young children in hospital in a high HIV and AIDS setting. The intervention addressed caregiver expectations about admission and treatment, responsive feeding, coping with infant pain and distress, assistance with medical procedures, and preparation for discharge and home care. Following a preparatory and piloting phase, measures of nurse burnout, caregiver physical and emotional well-being, and caregiver-child interaction were made before and after intervention. No changes were found between before and after intervention on assessments of caregiver wellbeing. However, mothers in the postintervention phase rated nurses as more supportive; mother-child interaction during feeding was more relaxed and engaged, and babies were less socially withdrawn. While the intervention proved useful in improving certain outcomes for children and their caregivers, it did not address challenging hospital and ward administration or support needed by caregivers at home following discharge. To address the latter need, the intervention has been extended into the community through home-based palliative care and support.

Recovery and Discharge for Procedures Conducted Outside of the Operating Room

2011 ◽  
pp. 37-41
Author(s):  
Lianfeng Zhang ◽  
Frances F. Chung
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Regional Anesthesia ◽  
Postoperative Care ◽  
Postoperative Recovery ◽  
Therapeutic Interventions ◽  
Postanesthesia Care Unit ◽  
Discharge Process ◽  
Step Down

Continued advances in procedural techniques, anesthetic pharmacology, and regional anesthesia allow more prolonged diagnostic and therapeutic interventions to be conducted at an increasing variety of locations outside of the operating room (OOOR). However, recovery and discharge process may vary according to the patient’s condition and the specifics of the procedure. Generally, most patients are sent to the postanesthesia care unit (PACU) and ambulatory surgery unit (ASU) or a medical post-procedure recovery unit not staffed by an anesthesiologist, while some patients receive special postoperative care in a step-down or intensive care unit. Therefore, ensuring rapid postoperative recovery and safe discharge are important components following these OOOR procedures.

Pituitary and Neuroendocrine Surgery

2019 ◽  
pp. 213-224
Author(s):  
Douglas A. Colquhoun ◽  
Edward C. Nemergut
Keyword(s):  
Brain Tumours ◽  
Disease Process ◽  
Operative Management ◽  
Neuroendocrine System ◽  
Pituitary Tumours ◽  
Anatomy And Physiology ◽  
The Third ◽  
Primary Brain Tumours ◽  
Operative Evaluation ◽  
Multi Disciplinary Team

Surgeries on the pituitary and neuroendocrine system are commonly encountered in neuroanaesthesia practice. Pituitary tumours are the third most common brain tumour, comprising about 10–15% of all primary brain tumours. Patients with pituitary tumours pose unique challenges to the anaesthestist caring for them in the peri-operative period, and they require the care of a multi-disciplinary team to accurately diagnose and manage their disease process as they undergo surgical resection. This chapter on pituitary and neuroendocrine surgery includes sections on anatomy and physiology, systemic changes associated with pituitary tumours, pre-operative evaluation (including intra-operative management), and common complications (for example, diabetes insipidus).

Postoperative Care Pathway

2008 ◽  
pp. 59-66
Author(s):  
Daniel M. Herron ◽  
Murali N. Naidu
Keyword(s):  
Postoperative Care ◽  
Care Pathway

Audit of the use of Seclusion in an Approved Centre following introduction of an Integrated Care Pathway

2018 ◽  
Vol 6 (2) ◽  
pp. 204
Author(s):  
Sorcha McManus ◽  
Patrick McLaughlin ◽  
Olwyn Cranny ◽  
Peter Whitty
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Retrospective Chart Review ◽  
Medical Practitioner ◽  
Next Of Kin ◽  
Codes Of Practice ◽  
Before And After ◽  
Integrated Care Pathway ◽  
Clinical File ◽  
Full Adherence

Introduction: The Mental Health Commission (MHC) has published guidelines on the rules governing the use of seclusion. These must be followed and the use of seclusion recorded in the patient’s clinical file during each seclusion episode. We devised a Seclusion Integrated Care Pathway (ICP) for use in the Approved Centre in Tallaght Hospital, Dublin, Republic of Ireland. This document was developed in conjunction with the MHC guidelines to assist in the recording and monitoring of each seclusion episode.Methods: The MHC has listed 13 rules governing the use of seclusion. These include the responsibility of the registered medical practitioner (RMP), nursing staff and the levels of observations and frequency of reviews that must take place during each seclusion episode. Using the seclusion register we identified a total of 60 seclusion episodes; 30 prior to the introduction of the ICP and 30 following the introduction of the ICP. We conducted a retrospective chart review to assess the documentation of each seclusion episode. The purpose of this audit was to compare adherence to MHC codes of practice on the use of seclusion before and after the introduction of our ICP.Results: There was overall improvement in adherence following the introduction of the ICP. Areas of improvement included consultant notification, informing the patient of the reasons for and likely duration of seclusion, informing the next of kin, 15 minute nursing observations and 2-hourly nursing review. Medical reviews within 4 hours, documentation of whether seclusion could be discontinued and subsequent medical assessment disimproved following introduction of the ICP.Conclusion: While an ICP is a robust document and ensures that many of the rules in relation to seclusion are explicitly stated adjustments to the document and regular staff training are needed to ensure full adherence to MHC guidelines.

A50 Rationalization of the postoperative care in transsphenoidal pituitary surgery

2012 ◽  
Vol 29 ◽  
pp. S15 ◽  
Author(s):  
R. Castillo ◽  
P. Hurtado ◽  
R. Valero ◽  
G. Serna ◽  
I. Gracia ◽  
...  
Keyword(s):  
Postoperative Care ◽  
Pituitary Surgery ◽  
Transsphenoidal Pituitary Surgery
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