scholarly journals Intraoperative Anesthetic Management in an Asymptomatic and Biochemically Silent Pheochromocytoma

2021 ◽  
Vol 6 (10) ◽  
pp. 716-719
Author(s):  
Omar N. ◽  
Shahid M. ◽  
M. Bashir ◽  
Imran S. ◽  
Vipin K. ◽  
...  
Keyword(s):  
Adrenal Mass ◽  
Intraoperative Complications ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Hypertensive Crisis ◽  
Surgical Techniques ◽  
Surgical Removal ◽  
Asymptomatic Patients ◽  
Laparoscopic Techniques ◽  
Chromaffin Tissue

Pheochromocytomas are tumors that originate from the chromaffin tissue of the adrenal medulla and commonly produce catecholamines. The diagnosis is typically established by the measurement of catecholamines or their metabolites in urine or plasma and tumors are localized with the use of radiographic and scintigraphic studies. Pheochromocytomas can occur in asymptomatic patients and the preferred treatment is surgical removal of the tumor. These chromaffin tissue tumors are not uncommon in anesthetic practice and have varied manifestations. The perioperative management of these tumors has improved remarkably over the yearsin conjunction with the evolution of surgical techniques (laparotomy to laparoscopic techniques and now to robotic approaches.). Majority of the patients present with normal clinical and biochemical parameters in the preoperative period, the incidence of hypertension being only 50 %. Even though patients may be clinically asymptomatic, surveillance and proper preoperative evaluation is important, as surgery for associated tumors may precipitate a hypertensive crisis and result in severe complications. We report an intraoperative anesthetic management of 32-year-old female with a left adrenal mass (pheochromocytoma) and left ovarian cyst. Throughout her entire course of treatment she was asymptomatic with normal blood pressure readings. Her biochemical screening was unremarkable. She underwent open surgical resection of the adrenal mass with confirmation of pheochromocytoma on histology. Pheochromocytoma represents very significant challenges to the anesthesiologist’s especially when undiagnosed. This case illustrates how paucity of literature on perioperative preparation of clinically and biochemically silent Pheochromocytomas led to serious intraoperative complications even in an asymptomatic, biochemically negative patient.

Acute hypertensive crisis due to newly diagnosed pheochromocytoma in the ninth decade of life: an unusual presentation

2021 ◽  
Vol 14 (2) ◽  
pp. e239433
Author(s):  
Carmen Cartwright ◽  
Peter Ucciferro ◽  
Catherine Anastasopoulou
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Adrenal Mass ◽  
Hypertensive Crisis ◽  
Surgical Removal ◽  
Newly Diagnosed ◽  
Alpha Blockade ◽  
Artery Disease ◽  
Biochemical Testing ◽  
High Index Of Suspicion

The patient is an 85-year-old man with multiple comorbidities, including hypertension and coronary artery disease with recent myocardial infarction who underwent cardiac catheterisation. During the procedure, the patient developed profound hypertensive crisis with flash pulmonary oedema, requiring significant intervention for blood pressure (BP) control. His crisis was also marked by wide excursions in his BP. The patient was found to have a large left adrenal mass measuring 9.4×8.7×8.1 cm, with biochemical testing confirming the suspicion of pheochromocytoma. Alpha-blockade was started prior to availability of lab results due to high index of suspicion. Surgical removal, the mainstay of treatment, has yet to transpire as he has no family, and due to his underlying dementia, he was not felt to have capacity for decision-making at the time of diagnosis. The case elucidates the vast presentations of this tumour, the means of diagnosis and the difficulties of treatment.

scholarly journals Ascending Aortic Aneurysm, Wandering towards Old Problem with New Insight

2014 ◽  
Vol 2 (2) ◽  
pp. 49-59
Author(s):  
KK Tiwari ◽  
S Bevilacqua ◽  
A Salvati ◽  
E Varone ◽  
M Solinas ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Early Stage ◽  
Anesthetic Management ◽  
Surgical Techniques ◽  
Aortic Diameter ◽  
Ascending Aortic Aneurysm ◽  
Mortality And Morbidity ◽  
Asymptomatic Patients ◽  
Complex Process ◽  
Patients At Risk

Ascending aortic aneurysm is a silent and highly lethal disease. Generally, ascending aorta grows asymptomatically until it dissect or rupture. In case of acute complication mortality is as high as 90%, whereas if treated on time mortality and morbidity decreases significantly. Pathophysiology of the Ascending aortic aneurysm is a complex process. Aorta itself is an organ and it should not be considered merely as a tube transporting blood from heart to the organs. Several non-invasive and invasive imaging methods are available at disposition to diagnose this indolent killer at early stage. However, discrepancies exists about when to operate these patients. Several other methods has been reported to identify these patients at risk of dissection or rupture. Conservative treatment could be used in patients with small aortic diameter, but effectiveness of such approach is under scrutiny. Emerging endovascular treatment using stents should be advocated with caution. Surgical treatment, the gold standard, is recommended for asymptomatic patients with aortic diameter of 5.5cm, whereas 4-4.5cm for patients with Marfan's disease. Postoperative morbidity and mortality has significantly decreased due to better anesthetic management, improved surgical techniques and progress in preoperative and postoperative care. DOI: http://dx.doi.org/10.3126/jucms.v2i2.11175 Journal of Universal College of Medical Sciences (2014) Vol.2(2): 49-59

Laparoscopic resections in the treatment of children with liver tumors: the first experience

2021 ◽  
Vol 61 (3) ◽  
pp. 27-30
Author(s):  
A. B. Riabov ◽  
M. S. Kubirov ◽  
A. V. Khizhnikov ◽  
M. Yu. Rykov
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Laparoscopic Resection ◽  
Liver Tumors ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Minimally Invasive Surgical ◽  
Laparoscopic Techniques ◽  
Resection Volume ◽  
Selection Of

Relevance: Surgery is one of the main methods of treating patients with liver neoplasms. At that, minimally invasive surgical techniques facilitate the course of the postoperative period and rehabilitation. The purpose of the study was the selection of optimal surgical treatment for children with liver tumors. Results: In 2014-2020, five patients aged 3-9 years with liver tumors underwent laparoscopic resection at the Morozovskaya Children’s City Clinical Hospital (Moscow, Russia). Out of 3 patients with hepatoblastomas, two patients had stage PRETEXT I, one – stage II. All patients underwent radical surgical treatment (R0); in one child (4%), the resection volume was R1. The duration of operations did not exceed 60 minutes; intraoperative blood loss was within 10 ml/kg; no intraoperative complications were registered. Conclusion: Laparoscopic techniques reduce surgery time and blood loss, prevent intraoperative and postoperative complications, shorten the hospital stay, decrease enteral and drug burden, and the need for chemotherapy. They also facilitate radical surgery and early patient mobilization.

scholarly journals Senile eye cataract: medical and social aspects and the risk to public health

2020 ◽  
Vol 22 (1) ◽  
pp. 191-195
Author(s):  
G Ch Javadova ◽  
I E Ioshin ◽  
S T Guliyeva
Keyword(s):  
Growth Rate ◽  
Visual Acuity ◽  
Intraoperative Complications ◽  
Treatment Options ◽  
Medical Science ◽  
Surgical Techniques ◽  
Surgical Removal ◽  
Industrialized Countries ◽  
Severity Of Injury ◽  
Working Age

A review of literature data on issues related to the prevalence of cataract among the population and the possibilities of its treatment is provided. In 2010, there were more than 10,8 million people worldwide who completely lost their vision due to cataracts, and partially lost more than 35,1 million people. Currently, the growth rate of senile cataract is two times faster than the growth rate of the total population, and in industrialized countries - five times. The problem of the wide spread and severity of injury in cataracts, along with the medical one, also has a medical and social character, which is why worldwide attention is paid to the study of etiopathogenesis and treatment options for cataracts among people of working age. To date, cataract treatment involves only surgical removal of a clouded lens with implantation of an intraocular lens. More than 20 million such operations are carried out annually in the world. With the development of medical science and technological progress, new, more advanced surgical techniques are being developed, such as ultrasound and femtolaser phacoemulsification, which allow performing operations in the early stages of the disease and achieving better results in terms of visual acuity, avoiding the development of induced astigmatism, and reducing the likelihood of complications, including macular edema. However, despite the improvement of surgical techniques for cataract phacoemulsification, cases of postoperative complications are not uncommon. Thus, despite the study of the etiopathogenesis of cataracts and the development of advanced modern methods for its surgical treatment, the risk of complications remains. At the same time, the problem of preventing the development of macular postoperative edema is one of the main reasons for the decrease in visual acuity in operated patients. To reduce intraoperative complications, it is necessary to take into account risk factors, their combination, as well as improve the methods of their drug prophylaxis and treatment.

Surgical Pain Management

2016 ◽  
Keyword(s):  
Pain Management ◽  
Intraoperative Complications ◽  
Anesthetic Management ◽  
Surgical Techniques ◽  
Postoperative Management ◽  
X Rays ◽  
Resource Guide ◽  
Surgical Pain ◽  
Chronic Pain Patients ◽  
Pain Patients

Surgical Pain Management is a guide of surgical techniques and the perioperative management of the unique needs of chronic pain patients who are potential candidates for implantable and unique invasive therapies. This book provides the pain practitioner and the staff needed to support a implant program essential step-by-step information and resources to assist with surgical and anesthetic management, patient selection, considerations for device selection, pre-incision management, patient education, incision-onward surgical techniques, wound closure, common intraoperative complications and their management, and postoperative management including potential complications and systematic approaches to trouble shoot stimulator and pump malfunction, technology guide comparing capabilities of the leading stimulator manufacturers and a resource guide to the acquisition of intrathecal medications and admixtures. This book also provides the needed resources to develop a dedicated interdisciplinary implant team capable of managing a implant program, suggestions for surgical instrument kits, considerations for antibiotic prophlaxis, and ensuring quality improvement via FDA reporting mechanisms. X-rays, photographs and case studies are used throughout the book to facilate understanding of discussion points.

scholarly journals Asymptomatic and Biochemically Silent Pheochromocytoma with Characteristic Findings on Imaging

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Andrew Spiro ◽  
Aqueel Usman ◽  
Asif Ajmal ◽  
Thanh D. Hoang ◽  
Mohamed K. M. Shakir
Keyword(s):  
Laparoscopic Resection ◽  
Adrenal Incidentaloma ◽  
Surgical Removal ◽  
Laboratory Studies ◽  
Mri Findings ◽  
Tumor Surveillance ◽  
Asymptomatic Patients ◽  
Ct And Mri ◽  
Chromaffin Tissue

Pheochromocytomas are tumors that originate from the chromaffin tissue of the adrenal medulla and commonly produce catecholamines. The diagnosis is typically established by the measurement of catecholamines or their metabolites in urine or plasma, and tumors are localized with the use of radiographic and scintigraphic studies. Pheochromocytomas can occur in asymptomatic patients, and the preferred treatment is surgical removal of the tumor. We report a 48-year-old male with a left adrenal incidentaloma, which progressively increased in size from 1.1 cm to 2.6 cm over a 4-year period, as measured by an adrenal computed tomography (CT) scan. Throughout his entire course of treatment, he was asymptomatic with normal blood pressure readings. His biochemical screening was unremarkable for the first three years of tumor surveillance. Follow-up imaging, including CT and MRI, showed findings suspicious for pheochromocytoma, and the diagnosis was ultimately made with the combination of imaging and laboratory studies. He underwent laparoscopic resection of the adrenal mass with confirmation of pheochromocytoma on histology. This case illustrates how CT and MRI findings can alert providers to the presence of a pheochromocytoma, even in an asymptomatic, biochemically negative patient.

scholarly journals Laparoscopic resections in the treatment of children with liver tumors: the first experience

2021 ◽  
Vol 61 (3) ◽  
pp. 27-30
Author(s):  
A. B. Riabov ◽  
M. S. Kubirov ◽  
A. V. Khizhnikov ◽  
M. Yu. Rykov
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Laparoscopic Resection ◽  
Liver Tumors ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Minimally Invasive Surgical ◽  
Laparoscopic Techniques ◽  
Resection Volume ◽  
Selection Of

Relevance: Surgery is one of the main methods of treating patients with liver neoplasms. At that, minimally invasive surgical techniques facilitate the course of the postoperative period and rehabilitation. The purpose of the study was the selection of optimal surgical treatment for children with liver tumors. Results: In 2014-2020, five patients aged 3-9 years with liver tumors underwent laparoscopic resection at the Morozovskaya Children’s City Clinical Hospital (Moscow, Russia). Out of 3 patients with hepatoblastomas, two patients had stage PRETEXT I, one – stage II. All patients underwent radical surgical treatment (R0); in one child(4%), the resection volume was R1. The duration of operations did not exceed 60 minutes; intraoperative blood loss was within 10 ml/kg; no intraoperative complications were registered. Conclusion: Laparoscopic techniques reduce surgery time and blood loss, prevent intraoperative and postoperative complications, shorten the hospital stay, decrease enteral and drug burden, and the need for chemotherapy. They also facilitate radical surgery and early patient mobilization.

scholarly journals Excision of Lower Lip Mucocele Using Injection of Hydrocolloid Dental Impression Material in a Pediatric Patient: A Case Report

2021 ◽  
Vol 11 (13) ◽  
pp. 5819
Author(s):  
Gianluca Botticelli ◽  
Marco Severino ◽  
Gianmaria Fabrizio Ferrazzano ◽  
Pedro Vittorini Velasquez ◽  
Carlo Franceschini ◽  
...  
Keyword(s):  
Minor Salivary Gland ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Complete Healing ◽  
Surgical Removal ◽  
Clinical Approach ◽  
Lower Lip ◽  
Impression Material ◽  
Dental Impression

Oral mucocele is a benign cystic exophytic lesion affecting the minor salivary gland and is especially present in pediatric patients (3% under 14 years). It is characterized by an extravasation or retention of fluid or mucus in the submucosal tissue of the minor salivary glands. Several surgical techniques have been proposed over the years, including the excision of the mucocele by using the injection of a hydrocolloid impression material in the light of the cyst to prevent the collapse of the cystic wall and solidify the lesion, resulting in a better cleavage plan. The combined clinical approach between the combination of Shira’s technique and the surgical excision of the cystic lesion results in a conservative surgical removal of the lesion. Here, we reported the removal of a labial mucocele in a 14-year-old male patient, using the injection of a hydrocolloid impression material. At a 12 months follow up, the patient showed complete healing of the surgical site, showing a pinkish lip lining mucosa without scarring or recurrence of the primary lesion. The combined therapeutic approach between Shira’s technique and surgical excision allows a safe and predictable excision of the labial mucocele, minimizing the risk of recurrence.

scholarly journals Evaluation of surgical outcome of giant intracranial meningiomas

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Ramy Teama ◽  
Mohamed Adawy ◽  
Mohamed Emara
Keyword(s):  
Surgical Outcome ◽  
Intraoperative Complications ◽  
Intracranial Meningioma ◽  
Surgical Removal ◽  
Study Group ◽  
Main Body ◽  
Total Removal ◽  
Large Size ◽  
Intracranial Meningiomas

Abstract Background The surgery of giant intracranial meningiomas (GIM) is difficult due to its large size, prominent vascularity, including and limiting visualization of various neurovascular structures, and severe cerebral edema. In this study, we will evaluate the surgical outcome of giant meningiomas according to our experience at our hospital in management of giant intracranial meningioma. Main body A retrospective analysis of 48 patients with histologically proven meningioma (≥ 6-cm diameter) who underwent surgical treatment at Benha University hospitals over a period of 5 years (June 2014/June 2019) is presented. Details regarding clinical presentation, imaging findings, surgical results and complications, and follow-up status were collected. The study group was composed of 41 females and 7 males. The age of the study group ranged from 38 to 69 years with an average of 49 years. The mean follow-up period was 36 months. Different approaches were used according to tumor location with the aim of gross total removal. Gross total removal was achieved in 90% of cases (43 cases). There were 2 cases with intraoperative complications not related to surgery. Recurrence was present in 4 cases. Mortality in this series was 4% (2 cases) with no reported intraoperative mortality. Conclusion Management of giant intracranial meningioma is a relatively common practice in neurosurgical centers in developing countries with the aim of radical total surgical removal being the first and most optimum option. Large size makes surgery difficult, but young age, meticulous surgical techniques, proper localization, trying to minimize operative time, and Simpson grade are of special value. Interdisciplinary cooperation is essential to avoid the common complications like pulmonary embolism (PE), postoperative hematoma in tumor bed that leads to bad surgical outcome.

scholarly journals Video-assisted thoracoscopic extended thymectomy in myasthenic children

2013 ◽  
Vol 5 (1) ◽  
pp. 4 ◽  
Author(s):  
Rita Sonzogni ◽  
Lorenzo Novellino ◽  
Alberto Benigni ◽  
Ilaria Busi ◽  
Magda Khotcholava ◽  
...  
Keyword(s):  
Case Reports ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Ventilator Weaning ◽  
New Drugs ◽  
Extended Thymectomy ◽  
Myasthenic Patient ◽  
Surgical Department ◽  
Video Assisted

Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Ruesch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.

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