scholarly journals An Undiagnosed Paraganglioma in a 58-Year-Old Female Who Underwent Tumor Resection

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
William C. Fox ◽  
Matthew Read ◽  
Richard E. Moon ◽  
Eugene W. Moretti ◽  
Brian J. Colin
Keyword(s):  
Blood Pressure ◽  
Perioperative Management ◽  
Clinical Presentation ◽  
Tumor Resection ◽  
Healthcare Providers ◽  
Surgical Intensive Care Unit ◽  
High Morbidity ◽  
Tumor Removal ◽  
Surgical Intensive Care ◽  
Acute Complications

Paragangliomas and pheochromocytomas are rare neuroendocrine tumors that can have high morbidity and mortality if undiagnosed. Here we report a case of an undiagnosed paraganglioma in a 58-year-old female who underwent tumor resection. The patient became severely hypertensive intraoperatively with paroxysmal swings in blood pressure and then later became acutely hypotensive after tumor removal. She was managed in the surgical intensive care unit (SICU) postoperatively and discharged from the hospital without acute complications. We briefly discuss the epidemiology, clinical presentation, perioperative management, and possible complications of these tumors to assist healthcare providers if one were to encounter them.

Successful Management of Post-Tumor Resection Middle Cerebral Artery Thrombosis With Stent-Assisted Angioplasty and Thrombolytic Therapy: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. E732-E737 ◽  
Author(s):  
Elad Levy ◽  
Michael Horowitz ◽  
Tudor Jovin ◽  
Amin Kassam
Keyword(s):  
Intracranial Hemorrhage ◽  
Low Dose ◽  
Clinical Presentation ◽  
Tumor Resection ◽  
Antiplatelet Agents ◽  
Cerebral Peduncle ◽  
Artery Thrombosis ◽  
Acute Complications ◽  
History Of ◽  
Postoperative Setting

Abstract OBJECTIVE AND IMPORTANCE: To describe successful endoluminal revascularization of an acute M1 occlusion 4 days after craniotomy and tumor resection. CLINICAL PRESENTATION: A 16-year-old right-handed girl presented with a 1-month history of daily headaches. The neurological examination was normal. Magnetic resonance imaging and computed tomography demonstrated a mass consistent with an epidermoid tumor compressing the left upper pons, left cerebral peduncle, and mesial left temporal lobe. INTERVENTION: A combination of low-dose antiplatelet agents administered intra-arterially and stent-assisted angioplasty was used. Successful endoluminal revascularization was achieved. Acute complications such as intracranial stent-thrombosis and/or intracranial hemorrhage were successfully avoided. CONCLUSION: In the acute postoperative period, most current chemical thrombolytic protocols are contraindicated because of the prohibitive risk of iatrogenic intracranial hemorrhage. With an understanding of the pharmacokinetics of the currently available antiplatelet drugs, combined chemical and mechanical thrombolysis may be used in the acute postoperative setting for endoluminal recanalization.

Labetalol: Response and Safety in Critically Ill Hemorrhagic Stroke Patients

1993 ◽  
Vol 27 (2) ◽  
pp. 180-181 ◽  
Author(s):  
Rakesh V. Patel ◽  
Heather R. Kertland ◽  
Brian E. Jahns ◽  
Barbara J. Zarowitz ◽  
Mark E. Mlynarek ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mental Status ◽  
Hemorrhagic Stroke ◽  
Surgical Intensive Care Unit ◽  
Intravenous Bolus ◽  
Peak Reduction ◽  
Stroke Patients ◽  
Surgical Intensive Care ◽  
Pilot Survey ◽  
Time To Peak

Objective To observe and characterize the blood pressure (BP)-lowering and adverse hemodynamic and/or central nervous system effects of intravenous bolus doses of labetalol in hemorrhagic stroke patients. Design Observational, prospective, pilot survey conducted over an eight-week period. Setting Surgical intensive care unit. Participants Patients admitted with an intracerebral or subarachnoid hemorrhage. Main Outcome Parameters Absolute decline in systolic BP (SBP) and diastolic BP (DBP), time to peak reduction in SBP and DBP, and adverse hemodynamic and mental status changes. Results Labetalol at doses between 5 and 25 mg lowered SBP by 6–19 percent (baseline 152–184 mm Hg) and DBP by 3–26 percent (baseline 50–99 mm Hg). Adverse hemodynamic or mental status changes were not detected following labetalol administration. Conclusions Small (≤25 mg) intravenous bolus doses of labetalol produce mild decreases in BP in hemorrhagic stroke patients.

scholarly journals Risk Factors For Development Of Acute Necrotizing Pancreatitis

2015 ◽  
Vol 16 (2) ◽  
pp. 121-127
Author(s):  
Bojan Stojanovic ◽  
Marko Spasic ◽  
Ivan Radosavljevic ◽  
Dragan Canovic ◽  
Dragce Radovanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Initial Treatment ◽  
Positive Impact ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Surgical Intensive Care Unit ◽  
High Morbidity ◽  
Surgical Intensive Care ◽  
Acute Necrotizing

Abstract Acute necrotizing pancreatitis (ANP) is a severe form of acute pancreatitis that is associated with high morbidity and mortality. Thus, an adequate initial treatment of patients who present with acute pancreatitis (AP) based on correct interpretation of early detected laboratory and clinical abnormalities may have a significant positive impact on the disease course. The aim of the study was to determine patient- and initial treatment-related risk factors for the development of acute necrotizing pancreatitis. For the purpose of this study a case-control design was chosen, including adult patients treated for AP in the surgical Intensive Care Unit (sICU) of Clinical Center of Kragujevac, from January 2006 to January 2011. The cases (n=63) were patients who developed ANP, while the controls (n=63) were patients with AP without the presence of pancreatic necrosis. The controls were randomly selected from a study sample after matching with the cases by age and sex. Significant association with the development of ANP was found for the presence of comorbidity (adjusted OR 6.614 95%CI 1.185-36.963), and the use of somatostatin (adjusted OR 7.460, 95%CI 1.162-47.833) and furosemide (adjusted OR 2710.57, 95%CI 1.996-56.035) started immediately upon admission to the sICU. This study suggests that comorbidities, particularly the presence of serious cardio-vascular disease, can increase the risk for development of acute necrotizing pancreatitis. The probability for the development of ANP could be reduced by the avoidance of the initial use of loop diuretics and somatostatin.

scholarly journals Postoperative Management of Patients with Cervicofacial Free Flap in Surgical Intensive Care Unit: An Updated Clinical Protocol

2020 ◽  
pp. 1-4
Author(s):  
Cyrus Motamed ◽  
Cyrus Motamed ◽  
Lauriane Bordenave ◽  
Stéphanie Suria
Keyword(s):  
Free Flap ◽  
Recent Literature ◽  
Postoperative Management ◽  
Favorable Outcome ◽  
Surgical Intensive Care Unit ◽  
Free Flap Reconstruction ◽  
Tumor Removal ◽  
Surgical Intensive Care ◽  
Management Protocol ◽  
Cancer Tumor

Postoperative management of complex cervico-facial cancer tumor removal followed by free flap reconstruction is evolving since its early beginning 20 years ago. Flap surveillance is a major goal in this period, however the management of comorbidities to predict a favorable outcome cannot be neglected. Based on our experience in this field and recent literature we updated our postoperative management protocol which focus on management of different comorbidities to maintain favorable outcome for the graft and the patient.

Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries

2019 ◽  
Vol 17 (4) ◽  
pp. 388-395 ◽  
Author(s):  
Abdulla Shehab ◽  
Khalid F. AlHabib ◽  
Akshaya S. Bhagavathula ◽  
Ahmad Hersi ◽  
Hussam Alfaleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Quality Of Care ◽  
Middle East ◽  
Clinical Presentation ◽  
Middle Eastern ◽  
High Morbidity ◽  
Inhospital Mortality ◽  
Acute Stemi

Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. Aims: To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.

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