scholarly journals Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease

1999 ◽  
Vol 6 (6) ◽  
pp. E1 ◽  
Author(s):  
Patrick L. Semple ◽  
Edward R. Laws
Keyword(s):  
Deep Vein Thrombosis ◽  
Cushing’S Disease ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Perioperative Period ◽  
Cushing's Disease ◽  
Medical Complications ◽  
Vein Thrombosis ◽  
The University ◽  
Deep Vein

Object Transsphenoidal surgery is the usual treatment of choice for adrenocorticotropic hormone-secreting pituitary adenomas associated with Cushing's disease. In this paper the authors investigate the complications of transsphenoidal surgery in the treatment of a contemporary series of patients with Cushing's disease. Methods Between January 1992 and December 1997, 105 patients with Cushing's disease underwent transsphenoidal surgery at the University of Virginia Health Sciences Center. A retrospective analysis of the complications was conducted, and the mortality rate was found to be 0.9% and permanent morbidity was 1.8%. The overall number of complications was 14 (13.3%), which included seven complications directly related to surgery; one instance of permanent diabetes insipidus; one syndrome of inappropriate secretion of antidiuretic hormone; and five medical complications (four patients developed deep vein thrombosis and one developed pneumonia). Conclusions Transsphenoidal surgery for Cushing's disease has a higher complication rate than that for pituitary adenomas in general. This is primarily related to a greater number of medical complications, most notably deep vein thrombosis, resulting from the generally debilitated state of most patients with Cushing's disease. In view of the high incidence of deep vein thrombosis in these patients, prophylaxis for thromboembolism during the perioperative period is recommended.

Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease

1999 ◽  
Vol 91 (2) ◽  
pp. 175-179 ◽  
Author(s):  
Patrick L. Semple ◽  
Edward R. Laws
Keyword(s):  
Deep Vein Thrombosis ◽  
Cushing’S Disease ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Cushing's Disease ◽  
Medical Complications ◽  
Content Type ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Fine Print

Object. Transsphenoidal surgery is the usual treatment of choice for adrenocorticotropic hormone—secreting pituitary adenomas associated with Cushing's disease. In this paper the authors investigate the complications of transsphenoidal surgery in the treatment of a contemporary series of patients with Cushing's disease.Methods. Between January 1992 and December 1997, 105 patients with Cushing's disease underwent transsphenoidal surgery at the University of Virginia Health Sciences Center. A retrospective analysis of the complications was conducted, and the mortality rate was found to be 0.9% and permanent morbidity was 1.8%. The overall number of complications was 14 (13.3%), which included seven complications directly related to surgery; one instance of permanent diabetes insipidus; one syndrome of inappropriate secretion of antidiuretic hormone; and five medical complications (four patients developed deep vein thrombosis and one developed pneumonia).Conclusions. Transsphenoidal surgery for Cushing's disease has a higher complication rate than that for pituitary adenomas in general. This is primarily related to a greater number of medical complications, most notably deep vein thrombosis, resulting from the generally debilitated state of most patients with Cushing's disease. In view of the high incidence of deep vein thrombosis in these patients, prophylaxis for thromboembolism during the perioperative period is recommended.

High Incidence of Deep Vein Thrombosis in the Perioperative Period of Neurosurgical Patients

2018 ◽  
Vol 112 ◽  
pp. e103-e112 ◽  
Author(s):  
Manabu Natsumeda ◽  
Takeo Uzuka ◽  
Jun Watanabe ◽  
Masafumi Fukuda ◽  
Yasuhisa Akaiwa ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Perioperative Period ◽  
Vein Thrombosis ◽  
Neurosurgical Patients ◽  
High Incidence ◽  
Deep Vein

Tinzaparin in Outpatients with Pulmonary Embolism or Deep Vein Thrombosis

2005 ◽  
Vol 39 (7-8) ◽  
pp. 1182-1187 ◽  
Author(s):  
William E Dager ◽  
Jeff H King ◽  
Jennifer M Branch ◽  
Stacey L Chow ◽  
Ruby E Ferrer ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Warfarin Therapy ◽  
Outpatient Setting ◽  
Minor Bleeding ◽  
Low Molecular Weight Heparins ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
The University ◽  
Deep Vein

BACKGROUND The low-molecular-weight heparins (LMWHs) have been shown to be effective in the outpatient treatment of deep vein thrombosis (DVT). Data regarding outpatient use of any LMWH in pulmonary embolism (PE) or tinzaparin in DVT while transitioning therapy to a vitamin K antagonist are limited. OBJECTIVE To determine the safety and efficacy of tinzaparin in patients with either DVT or PE being transitioned to warfarin during LMWH therapy in the outpatient setting. METHODS All patients who were treated with at least one outpatient dose of tinzaparin for venous thromboembolism (VTE) were identified. Charts of all patients followed within the University of California Davis healthcare system were reviewed. The incidence of bleeding and recurrent thromboembolism over a minimum of the first 4 weeks to a maximum of 12 weeks after initiating anticoagulation was assessed. RESULTS A total of 178 patients with acute VTE were treated with tinzaparin, and outcomes could be determined in 140 cases. Forty-seven percent of these patients had objectively documented PE. Only one (0.7%) case of recurrent VTE was observed. Major bleeding was documented in 5 (3.6%) and minor bleeding in 8 (5.8%) patients. Two bleeding events, both major, occurred during tinzaparin therapy. CONCLUSIONS Outpatient use of tinzaparin during transition to warfarin therapy in the treatment of VTE, including PE, appears to be feasible in patients who are judged candidates for home therapy.

scholarly journals Analysis of Perioperative Risk Factors for Deep Vein Thrombosis in Patients With Femoral and Pelvic Fractures

2020 ◽  
Author(s):  
Linqin Wu ◽  
Bo Cheng
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Blood Transfusion ◽  
Perioperative Period ◽  
Pelvic Fractures ◽  
C Reactive Protein ◽  
Vein Thrombosis ◽  
Reactive Protein ◽  
Independent Risk Factors ◽  
Deep Vein

Abstract Objective: Clinical characteristics, anticoagulant protocols and risk factors of deep Vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors.Methods: This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included. The Clinical data including general conditions,trauma, surgery,anticoagulant protocols and laboratory indexes were collected.According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT.Results: The incidence of DVT was 40.25%, PE was 1.93%, and preoperative DVT was 26.71%,which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%).The average time of DVT formation was 6.55±0.47 days after trauma and 6.67±0.48 days after surgery. Chronic obstructive pulmonary disease(COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT.The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7d, operative time > 2h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture.Conclusions: At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.

Coagulation Alteration and Deep Vein Thrombosis in Brain Tumor Patients During the Perioperative Period

2018 ◽  
Vol 114 ◽  
pp. e982-e991 ◽  
Author(s):  
Xiaopeng Guo ◽  
Fa Zhang ◽  
Yue Wu ◽  
Lu Gao ◽  
Qiang Wang ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Brain Tumor ◽  
Perioperative Period ◽  
Tumor Patients ◽  
Vein Thrombosis ◽  
Deep Vein

Medical complications in acute rehabilitation units: deep vein thrombosis

1989 ◽  
Vol 3 (4) ◽  
pp. 341-345
Author(s):  
Catherine N Miller ◽  
Elliott L Semble ◽  
Debra C Dalgleish
Keyword(s):  
Deep Vein Thrombosis ◽  
Medical Complications ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Acute Rehabilitation

Endoscopic endonasal transsphenoidal surgery: experience with 50 patients

1997 ◽  
Vol 87 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Hae-Dong Jho ◽  
Ricardo L. Carrau
Keyword(s):  
Cavernous Sinus ◽  
Cushing’S Disease ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Elevated Serum ◽  
Cushing's Disease ◽  
Serum Prolactin ◽  
Subtotal Resection ◽  
Operating Microscope ◽  
Endoscopic Endonasal

✓ An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as the tool for visualization. This study focuses on 50 patients (28 females and 22 males) with a median age of 38 years (range 14–88 years). Initially, four patients underwent operation via a sublabial—transseptal approach using a rigid endoscope in conjunction with an operating microscope. The 48 subsequent operations were performed through a nostril using only rigid endoscopes. Forty-four patients had pituitary adenomas and six had various other lesions. Thirteen patients had microadenomas, 16 had intrasellar macroadenomas, nine had macroadenomas with suprasellar extension, and six had invasive macroadenomas involving the cavernous sinus. Seven patients had recurrent pituitary adenomas and 25 had hormonesecreting adenomas (eight patients with Cushing's disease and 17 patients with prolactinomas). Among the eight patients with Cushing's disease, seven had resolution of hypercortisolism clinically and chemically. Of the 17 patients with prolactinomas, 10 improved clinically with normal serum prolactin levels, four improved clinically with elevated serum prolactin levels, and three had residual tumors in the cavernous sinus. Among the 19 patients with nonsecreting adenomas, 16 underwent total resection and three subtotal resection leaving residual tumor in the cavernous sinus. Postoperatively, all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.

scholarly journals D-dimer is Valuable for Predicting the Extension of Isolated Distal Deep Vein Thrombosis of the Lower Limb in Neurocritical Patients: A Retrospective Observational Study

2021 ◽  
Author(s):  
Rui Tang ◽  
Zhi Gao ◽  
Min Du ◽  
Haiyan Liu ◽  
Yanyan Yang ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Brain Injury ◽  
Lower Limb ◽  
Perioperative Period ◽  
Stroke Patients ◽  
Vein Thrombosis ◽  
Coagulation Function ◽  
Deep Vein ◽  
D Dimer ◽  
Valuable Predictor

Abstract Background: Isolated distal deep vein thrombosis (IDDVT) of the lower limb and its extension to the proximal deep veins have high incidence rates in patients with acute brain injury (ABI). The objective of the study was to determine the value of dynamic changes in coagulation function in predicting the occurrence and extension of IDDVT.Methods: In this retrospective cohort study, ABI patients during the perioperative period in a neurocritical care unit (NICU) of a university hospital were identified from September 2019 to September 2020. Complete compression ultrasound was used by a senior sonographer to diagnose the occurrence and extension of IDDVT. Coagulation function was recorded at a series of time points during the perioperative period.Results: A total of 245 ABI patients were identified, including 46 acute traumatic brain injury patients, 117 acute hemorrhagic stroke patients, 36 acute ischemic stroke patients and 46 acute aneurysmal subarachnoid hemorrhage patients. Most of the patients were elderly and male, and most had severe cases. The rates of IDDVT occurrence and extension were 62% and 21%, respectively. Age, GCS score at admission, NICU length of stay were risk factors for IDDVT occurrence. None of coagulation indices was a sensitive predictor of IDDVT occurrence. The elevation of D-dimer on days 5-7 was the most valuable predictor of IDDVT extension (the area under the ROC was 0.89, with a 95% CI of 0.82-0.95, and the sensitivity and specificity were 0.86 and 0.81, respectively with the cutoff of 8.9 mg/L).Conclusions: The occurrence and extension of IDDVT are common in ABI patients during the perioperative period, particularly in elderly patients with severe cases. D-dimer level on days 5-7 is the most valuable predictor of IDDVT extension in ABI patients.

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