scholarly journals Postoperative Management in Patients with Pheochromocytoma and Paraganglioma

Cancers ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 936 ◽  
Author(s):  
Divya Mamilla ◽  
Katherine Araque ◽  
Alessandra Brofferio ◽  
Melissa Gonzales ◽  
James Sullivan ◽  
...  
Keyword(s):  
Ganglion Cells ◽  
Tumor Resection ◽  
Clinical Manifestations ◽  
Perioperative Period ◽  
Cardiovascular Complications ◽  
Postoperative Management ◽  
Sudden Increase ◽  
Safe Patient Care ◽  
Precise Diagnosis ◽  
Catecholamine Levels

Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-secreting neuroendocrine tumors of the adrenal medulla and sympathetic/parasympathetic ganglion cells, respectively. Excessive release of catecholamines leads to episodic symptoms and signs of PPGL, which include hypertension, headache, palpitations, and diaphoresis. Intraoperatively, large amounts of catecholamines are released into the bloodstream through handling and manipulation of the tumor(s). In contrast, there could also be an abrupt decline in catecholamine levels after tumor resection. Because of such binary manifestations of PPGL, patients may develop perplexing and substantially devastating cardiovascular complications during the perioperative period. These complications include hypertension, hypotension, arrhythmias, myocardial infarction, heart failure, and cerebrovascular accident. Other complications seen in the postoperative period include fever, hypoglycemia, cortisol deficiency, urinary retention, etc. In the interest of safe patient care, such emergencies require precise diagnosis and treatment. Surgeons, anesthesiologists, and intensivists must be aware of the clinical manifestations and complications associated with a sudden increase or decrease in catecholamine levels and should work closely together to be able to provide appropriate management to minimize morbidity and mortality associated with PPGLs.

scholarly journals The Therapeutic Effect of Endoscopic Tumor Resection on Acromegalic Cardiomegaly in Patients With Pituitary Adenoma

2019 ◽  
Vol 7 (1) ◽  
pp. 31-34
Author(s):  
Kaveh Ebrahimzadeh ◽  
Kurosh Mojtabavi ◽  
Sasan Mohammadi ◽  
Mehrdad Farahani ◽  
Zohreh Gholizadeh Ghozloujeh ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Soft Tissues ◽  
Tumor Resection ◽  
Clinical Manifestations ◽  
Potential Effect ◽  
Tolerance Test ◽  
Cardiovascular Complications ◽  
Oral Glucose ◽  
Cardiovascular Comorbidity ◽  
Plasma Gh

Background: Acromegaly defines as chronic elevations of insulin-like growth factor-1 (IGF-1) and growth hormone (GH), which results in enlargement of organs and soft tissues. Cardiovascular complications of acromegaly such as cardiomegaly, hypertension contributing to a high risk of cardiovascular events. This study aimed to identify the determinants of the prevalence of cardiomegaly as cardiovascular comorbidity of acromegaly and the potential effect of the curative intervention. Methods: A total of 160 patients with acromegaly due to pituitary adenoma participated in this study. Acromegaly diagnosed was based on clinical manifestations, age-adjusted plasma IGF-I, and elevated plasma GH levels, not suppressible during an oral glucose tolerance test (75 g). Electrocardiogram and chest X-ray obtained in all patients. Treatment approaches included transsphenoidal surgery and hormonal evaluation performed before and six months after surgery. Results: The GH serum level was elevated in all patients before surgery, with a mean of 33.7 ng/ mL that reached 5.7 ng/mL after surgery. Mean IGF-1 was 794.1 ng/mL that reached 395.6 ng/mL postoperatively. The prevalence of cardiomegaly was 15% that improved in 5% of patients after trans sphenoidal surgery. Conclusion: Appropriate surgical intervention in acromegaly that complicated by cardiomegaly may result in significant improvement of the cardiac structure.

MULTIPLE ENDOCRINE NEOPLASIA IN PRACTICE OF PRIMARY CARE AND FAMILY PHYISICIANS

2020 ◽  
pp. 11-15
Author(s):  
V. I Pozhar ◽  
O. V. Doroshenko ◽  
M. I. Shevchuk
Keyword(s):  
Family History ◽  
Genetic Analysis ◽  
Multiple Endocrine Neoplasia ◽  
Ganglion Cells ◽  
Family Members ◽  
Clinical Manifestations ◽  
Neurofibromatosis Type ◽  
Endocrine Tumors ◽  
Endocrine Neoplasia ◽  
Cutaneous Lichen Amyloidosis

Multiple endocrine neoplasia is characterized with a predisposition to tumors involving two or more endocrine glands. The four main forms of the disease are inherited as an autosomal dominant syndrome or may occur sporadically. In addition to these four forms, six other syndromes are associated with the presence of multiple endocrine and other neoplasms of the organs: hyperparathyroidism − jaw tumors, Carney complex, von Hippel−Lindau disease, neurofibromatosis type 1, Cowden syndrome and McCune − Albright syndrome. The diagnosis of multiple endocrine neoplasia syndrome can be established in humans by one of the three available criteria: clinical features, family history, genetic analysis. Mutation analysis during these syndromes is useful in clinical practice to confirm the clinical diagnosis; identifying family members who tolerate the mutation and need to be screened, and identifying family members who do not tolerate the mutation. Syndrome of multiple endocrine neoplasia (Wermer syndrome) is characterized by the presence of a triad of tumors, including tumors of the parathyroid glands, pheochromocytoma and tumors of the parathyroid gland. It occurs less frequently in combination with Hirschsprung's disease, caused by the absence of vegetative ganglion cells in the intestine terminal parts, that leads to colonic enlargement, severe constipation and obstruction. This syndrome may be associated with cutaneous lichen amyloidosis, the clinical manifestations of which are pruritus and lichenoid lesions, usually located in the upper back. A clinical case of MEN2 syndrome in a 52−year−old patient is presented. It is noted that for such patients, in addition to timely syndromic rather than component diagnosis of this endocrine multipathology, the spread of neoplastic process in medullary thyroid cancer to its capsule and surrounding tissues, as well as the presence of metastases in peripheral lymph nodes are important. As a rule, such patients cannot be timely cured. Key words: multiple endocrine neoplasia, endocrine tumors, genetic analysis, family history.

scholarly journals Modulation of Autophagy by SARS-CoV-2: A Potential Threat for Cardiovascular System

2020 ◽  
Vol 11 ◽  
Author(s):  
Puneet Kaur Randhawa ◽  
Kaylyn Scanlon ◽  
Jay Rappaport ◽  
Manish K. Gupta
Keyword(s):  
Host Cell ◽  
Rna Virus ◽  
Clinical Manifestations ◽  
Cardiovascular Complications ◽  
Extracellular Proteases ◽  
Potential Threat ◽  
Surface Receptors ◽  
Drug Candidates ◽  
A Genome ◽  
Number Of Patients

Recently, we have witnessed an unprecedented increase in the number of patients suffering from respiratory tract illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 virus is a single-stranded positive-sense RNA virus with a genome size of ~29.9 kb. It is believed that the viral spike (S) protein attaches to angiotensin converting enzyme 2 cell surface receptors and, eventually, the virus gains access into the host cell with the help of intracellular/extracellular proteases or by the endosomal pathway. Once, the virus enters the host cell, it can either be degraded via autophagy or evade autophagic degradation and replicate using the virus encoded RNA dependent RNA polymerase. The virus is highly contagious and can impair the respiratory system of the host causing dyspnea, cough, fever, and tightness in the chest. This disease is also characterized by an abrupt upsurge in the levels of proinflammatory/inflammatory cytokines and chemotactic factors in a process known as cytokine storm. Certain reports have suggested that COVID-19 infection can aggravate cardiovascular complications, in fact, the individuals with underlying co-morbidities are more prone to the disease. In this review, we shall discuss the pathogenesis, clinical manifestations, potential drug candidates, the interaction between virus and autophagy, and the role of coronavirus in exaggerating cardiovascular complications.

scholarly journals A solitary giant neurofibroma of inguinal region: A case report

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042110042
Author(s):  
Haiying Zhou ◽  
Hui Lu
Keyword(s):  
Tumor Resection ◽  
Clinical Manifestations ◽  
Inguinal Region ◽  
Nerve Sheath Tumor ◽  
Neurogenic Tumors ◽  
Long Time ◽  
Giant Neurofibroma ◽  
History Of ◽  
Neuroectodermal Origin ◽  
Recurrence Tendency

Neurofibroma is a rare nerve sheath tumor of neuroectodermal origin, especially the huge and isolated neurofibroma located in the inguinal region. To our knowledge, no such case has previously been reported. We report a case of 34-year-old male patient with a 4-year history of progressive enlargement of the medial root mass in his left thigh with sitting and standing disorders along with pain. The tumor was completely removed by operation, and pathological diagnosis showed neurofibroma. There was no obvious neurologic defect after surgery, and no recurrence tendency was found in the follow-up of 2 years. For a large solitary mass with slow growth and no malignant clinical manifestations for a long time, clinicians cannot rule out the hypothetical diagnosis of neurofibroma, even though its growth site is very rare, such as this case of a huge tumor located in the groin. For neurogenic tumors, early operation should be performed, and the prognosis of patients after tumor resection is excellent.

scholarly journals AB0163 ELECTROCARDIOGRAPHIC MANIFESTATIONS IN PATIENTS WITH SEROPOSITIVE RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1108.2-1108
Author(s):  
S. Spitsina ◽  
E. Mozgovaya ◽  
A. Trofimenko ◽  
S. Bedina ◽  
M. Mamus
Keyword(s):  
Rheumatoid Arthritis ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Heart Defects ◽  
Clinical Manifestations ◽  
Blood Chemistry ◽  
Cardiovascular Complications ◽  
Silent Myocardial Ischemia ◽  
Conduction Disorders ◽  
Artery Disease

Background:Cardiovascular disease in rheumatoid arthritis (RA) is more common than in general population. Particular attention should be paid to cardiac dysfunction, as their timely diagnosis strongly affects the general outcome.Objectives:To assess the prevalence of arrhythmias and conduction disorders in patients with seropositive RA without clinical manifestations of coronary artery disease, as well as to determine their relationship with activity and duration of RA.Methods:The research was carried out in agreement with the WMA Declaration of Helsinki principles. 48 patients with seropositive RA were included in the study. The exclusion criteria were: age over 60 years; obesity; congenital heart defects; coronary artery disease; peripheral atherosclerosis; thyroid disease; diabetes mellitus. All patients were assessed using general physical, laboratory and instrumental survey including CBC, blood chemistry panel, as well as ECG. RA diagnosis was verified using the 2010 ACR / EULAR classification criteria. Central tendencies were expressed as mean ±SD.Results:All the included persons were women. Their average age was 50.50 ± 7.22 years, and average duration of the disease was 8.13 ± 2.34 years. All patients had articular form (without systemic manifestations) of moderate and high activity. The patients were treated with basic and NSAIDs therapy; no glucocorticoids were applied at the time of the examination. Using 12-lead ECG arrhythmias and conduction disorders were revealed in 27 (56.25%) of RA patients. Sinus rhythm deviations had the highest (31.25%) prevalence for all arrhythmias, comprising sinus tachycardias (18.75%), sinus bradycardias (6.25%), and sinus arrhythmias (6.25%). Premature beats were registered in 12.5% cases, being supraventricular and ventricular ones in equal proportions. We have found left anterior bundle branch block in 6 (12.5%) of patients. Despite absence of any angina symptoms, 9 (18.75%) of patients had myocardial repolarization disturbances, either as ST depression deeper than 0.1 mV or as negative T wave appearance, which were quite similar to silent myocardial ischemia manifestations. All the patients with these two features had RA history of more than 10 years. There was no relationship between the prevalence of the manifestations and radiographic stage of RA.Conclusion:Arrhythmias and conduction disorders are quite frequent finding in seropositive RA (56.25% and 18.75%, respectively). Their incidence and severity do not coincide exactly with the radiographic progression in joints, while their prevalence generally increases with disease duration.These data highlight the importance of additional Holter ECG monitoring in RA for revelation and treatment of silent life-threatening cardiovascular complications.Disclosure of Interests:None declared

The Diabetic Surgical Patient

2020 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

The Diabetic Surgical Patient

2020 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

Liver Transplantation in Patients With Cardiac Disease

2017 ◽  
Vol 22 (2) ◽  
pp. 111-121 ◽  
Author(s):  
Christopher L. Wray
Keyword(s):  
Cardiovascular Disease ◽  
Liver Transplantation ◽  
Perioperative Period ◽  
Cardiovascular Complications ◽  
Adverse Outcomes ◽  
Treatment Modalities ◽  
Cardiac Complications ◽  
Major Step ◽  
Cardiac Evaluation ◽  
The Impact

Liver transplantation (LT) is a unique surgical procedure that has major hemodynamic and cardiovascular implications. Recently, there has been significant interest focused on cardiovascular issues that affect LT patients in all phases of the perioperative period. The preoperative cardiac evaluation is a major step in the selection of LT candidates. LT candidates are aging in concordance with the general population; cardiovascular disease and their risk factors are highly associated with older age. Underlying cardiovascular disease has the potential to affect outcomes in LT patients and has a major impact on candidate selection. The prolonged hemodynamic and metabolic instability during LT may contribute to adverse outcomes, especially in patients with underlying cardiovascular disease. Cardiovascular events are not unusual during LT; transplant anesthesiologists must be prepared for these events. Advanced cardiovascular monitoring techniques and treatment modalities are now routinely used during LT. Postoperative cardiovascular complications are common in both the early and late posttransplant periods. The impact of cardiac complications on posttransplant mortality is well recognized. Emerging knowledge regarding cardiovascular disease in LT patients and its impact on posttransplant outcomes will have an important role in guiding the future perioperative management of LT patients.

scholarly journals Composite Mandibulectomy

2012 ◽  
Vol 146 (6) ◽  
pp. 932-937 ◽  
Author(s):  
Douglas R. Sidell ◽  
Tara Aghaloo ◽  
Sotirios Tetradis ◽  
Min Lee ◽  
Olga Bezouglaia ◽  
...  
Keyword(s):  
Animal Model ◽  
Medical Center ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Small Animal ◽  
Postoperative Management ◽  
Single Individual ◽  
En Bloc ◽  
Fracture Nonunion ◽  
Anesthetic Complications

Objectives. Segmental mandibular defects can result after the treatment of various pathologic processes, including osteoradionecrosis, tumor resection, or fracture nonunion with sequestration. The variety of etiologies and the frequency of occurrence make the reconstruction of segmental mandibular defects a topic of significant interest. Despite these incentives, a well-established small-animal model of the segmental mandibulectomy, including composite resection, does not exist. The objective of this study is the creation of a reliable animal model that can be used to study the reconstruction of en bloc mandibular defects. Surgical techniques and an array of reconstructive options are described. Study design. Description of an animal model. Setting. Animal laboratory at a quaternary care university medical center. Methods. We present an Animal Research Oversight Committee–approved prospective analysis of survival operations in the rat model. A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented. Postoperative management, early pitfalls, surgical complications, and future applications are discussed. Results. A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and 9 postoperative complications were recognized. There were 6 orocutaneous fistulas, 2 abscesses, and 1 seroma. There were 4 fatalities, which were attributed to anesthetic complications (2, intraoperative), hematoma formation (1, postoperative), and foreign-body aspiration (1, postoperative). Conclusion. This novel animal model reliably replicates the en bloc segmental mandibular defects seen in our patient population and can be manipulated to achieve a wide variety of research objectives.

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