CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

2020 ◽  
Vol 30 (3) ◽  
pp. 56-59
Author(s):  
Jūratė Gudaitytė ◽  
Justina Jermolajevaitė ◽  
Martynas Judickas
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
General Population ◽  
Metabolic Disorders ◽  
Upper Airway ◽  
Cardiovascular Complications ◽  
Case Presentation ◽  
Increased Risk ◽  
Fluid Regulation ◽  
Class Iv

Background and objectives: Acromegaly is endocri­nal disorder which results in changes involving ge­neral appearance as well as upper airway abnorma­lities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to compli­cations. We aim to discuss the challenges for anesthe­siologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presen­ted the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallam­pati score IV and ASA class IV. The complemen­tary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for furt­her monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthe­sia compared to general population due to difficult intubation, cardiovascular complications , OSA , alte­ration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and as­sessment are necessary to predict and prepare for possible difficulties in the surgery room.

A narrative review of chronic alcohol-induced atrial fibrillation

2021 ◽  
Author(s):  
Rea Mittal ◽  
Lilly Su ◽  
Devyani Ramgobin ◽  
Ashwani Garg ◽  
Rahul Jain ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Alcohol Use ◽  
Alcohol Intake ◽  
Cardiovascular Complications ◽  
Chronic Alcohol ◽  
Higher Alcohol ◽  
Dependent Relationship ◽  
Increased Risk ◽  
Low Levels ◽  
Dose Dependent

Alcohol use disorder (AUD) is highly prevalent and can lead to many cardiovascular complications, including arrhythmias. Chronic alcohol use has a dose-dependent relationship with incidence of atrial fibrillation (AF), where higher alcohol intake (>3 drinks a day) is associated with higher risk of AF. Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the structural, functional and electrical integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of incident or recurrent AF in AUD populations is abstinence.

scholarly journals Giant Intrapericardial Bronchogenic Cyst Associated with Congestive Heart Failure and Atrial Fibrillation:  A Case Report

2020 ◽  
Author(s):  
Javier Maldonado ◽  
German Molina ◽  
Francisco M- Rincón T ◽  
Lina M. Acosta Buitrago ◽  
Carlos J- Perez Rivera
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Differential Diagnosis ◽  
Case Report ◽  
Bronchogenic Cyst ◽  
De Novo ◽  
Pathological Findings ◽  
Case Presentation ◽  
Bronchogenic Cysts

Abstract Background: Large intracardiac bronchogenic cysts are rare mediastinal masses, however they must always be considered in the differential diagnosis of heart failure. Case Presentation: We present a 60-year-old female patient with de novo atrial fibrillation and heart failure, resulting from an incidental large intrapericardial mass. The patient underwent successful surgical resection, with pathological findings confirming a bronchogenic cyst.Conclusions: Large bronchogenic cysts located intrapericardially are very rare, however they should be included in the differential diagnosis of patients presenting with atrial fibrillation and heart failure.

scholarly journals Aldosterone- and cortisol-co-secreting adrenal tumors: an uneasy sum of well-known parts (review)

2019 ◽  
Vol 65 (2) ◽  
pp. 113-123
Author(s):  
Boris M. Shifman ◽  
Nadezhda M. Platonova ◽  
Natalya V. Molashenko ◽  
Ekaterina A. Troshina ◽  
Natalia Yu. Romanova ◽  
...  
Keyword(s):  
Metabolic Disorders ◽  
Cardiovascular Complications ◽  
Adrenal Tumors ◽  
Venous Sampling ◽  
Symptoms Of Depression ◽  
Peripheral Plasma ◽  
Increased Risk ◽  
High Prevalence ◽  
Potential Risks ◽  
Alternative Test

Primary aldosteronism (PA) is the most common form of secondary arterial hypertension. In patients with PA, more so than in the general population, there is a prevalence of insulin resistance, diabetes mellitus, metabolic syndrome, osteoporosis, and symptoms of depression; these conditions are more likely to manifest a gluco- rather than mineralocorticoid excess. This fact is of particular importance in light of recent studies that have shown that PA is often associated with glucocorticoid excess. Since the first reports of cases of combined secretion of aldosterone and cortisol in 1979, the number of cases of so-called Connshing syndrome has increased. An analysis of data from recent studies suggests that hypercortisolism in PA is closely associated with an increased risk of cardiovascular complications, metabolic disorders and post-surgical adrenal insufficiency. The most important diagnostic problem in adenomas with combined secretion is the risk of false interpretation of the results of adrenal venous sampling (AVS). The indications that suggest aldosterone-and-cortisol-co-producing adenoma are the lack of suppression of cortisol levels following a night test with 1mg of dexamethasone, and an adrenal tumo of over 2.5cm. As an alternative test capable of differentiating this type of tumor, a number of researchers have proposed measuring the level of so-called hybrid steroids in the peripheral plasma and urine. Taking into account the high prevalence and potential risks, ruling out of excess corisol secretion is obligatory in all cases of PA before AVS and when planning surgery.

scholarly journals Tuberculous meningoencephalomyelitis and coinfection with HTLV-I + HTLV-II: case report

2006 ◽  
Vol 64 (1) ◽  
pp. 125-127 ◽  
Author(s):  
Marcio Menna-Barreto ◽  
Denise C. Machado
Keyword(s):  
Cerebrospinal Fluid ◽  
Mycobacterium Tuberculosis ◽  
Case Report ◽  
General Population ◽  
Spastic Paraparesis ◽  
Tropical Spastic Paraparesis ◽  
Normal Blood ◽  
Antituberculous Drugs ◽  
Increased Risk

HTLV-I and HTLV-II are endemic in some areas of Brazil, where an associated disease, HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) have been diagnosed in significant number of infected individuals. Tuberculosis has been demonstrated among those individuals, with higher prevalence than in the general population, suggesting that there is an increased risk for this comorbidity. We report the case of an individual coinfected with HTLV-I and HTLV-II, suffering from an insidious meningoencephalomyelitis caused by Mycobacterium tuberculosis. The patient was a 44 years old man successfully treated with steroids and antituberculous drugs, improving clinically and turning to a negative PCR and to a normal blood-cerebrospinal fluid barrier.

The usefulness of copeptin for the diagnosis of nephrogenic diabetes insipidus in infancy: a case report

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Letícia Bitencourt ◽  
Bruna Luisa Fischer ◽  
Juliana Lacerda de Oliveira Campos ◽  
Pedro Alves Soares Vaz de Castro ◽  
Stephanie Bruna Camilo Soares de Brito ◽  
...  
Keyword(s):  
Case Report ◽  
Diabetes Insipidus ◽  
Pediatric Patient ◽  
Gold Standard ◽  
Nephrogenic Diabetes Insipidus ◽  
Water Deprivation ◽  
Water Restriction ◽  
Case Presentation ◽  
Plasma Measurement ◽  
Increased Risk

Abstract Objectives We report a case of an infant with nephrogenic diabetes insipidus (NDI) diagnosed by the measurement of serum copeptin. There is only one study that previously evaluated the use of copeptin measurement in a pediatric patient. Case presentation We present a 10-month-old child with polyuria–polydipsia syndrome (PPS) and hypernatremia that could not support water restriction due to increased risk of dehydration and worsening of his condition. Therefore, plasma measurement of copeptin allowed the diagnosis of NDI. Conclusions The water deprivation test (WDT) is considered the gold standard for diagnosis in PPS. However, WDT has serious limitations regarding its interpretation. Furthermore, the WDT can cause dehydration and hypernatremia, especially in young children. Therefore, the measurement of plasma copeptin seems to be a promising method to perform an earlier, safer, and accurate investigation of PPS. Up to now, our study is the second to report the usefulness of copeptin in children.

Abstract 17741: Atrial Fibrillation and Incident End-Stage Renal Disease: the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Wesley T O’Neal ◽  
Rikki Tanner ◽  
Jimmy T Efird ◽  
Usman Baber ◽  
Alvaro Alonso ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Renal Disease ◽  
Racial Differences ◽  
End Stage Renal Disease ◽  
Increased Risk ◽  
Regards Study ◽  
Stage Renal Disease ◽  
End Stage ◽  
Study Participants

Background: Recently, it has been shown that atrial fibrillation (AF) is an independent risk factor for end-stage renal disease (ESRD) among persons with chronic kidney disease (CKD). However, the association between AF and incident ESRD has not been examined in the general population. Methods: A total of 25,315 study participants (mean age 65 ± 9.0 years; 54% women; 40% blacks) from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study were included in this analysis. AF was identified in study participants at baseline (2003- 2007) by the study electrocardiogram and self-reported history of a physician diagnosis. Incident cases of ESRD were identified through linkage of REGARDS participants with the United States Renal Data System. Cox proportional-hazards regression was used to generate hazard ratios (HR) and 95% confidence intervals (95%CI) for the association between ESRD and AF. Results: A total of 2,190 (8.7%) participants had AF at baseline. Over a median follow-up of 7.7 years, 295 (1.2%) participants developed ESRD. In multivariable adjusted models, AF was associated with an increased risk of incident ESRD (Table 1). However, the association between AF and ESRD became non-significant after adjustment for baseline markers of CKD. Similar results were obtained when albumin-to-creatinine ratio was included in the model as a continuous variable (log-transformed). An interaction between AF and CKD was not detected. Conclusion: AF is associated with an increased risk of ESRD in the general population. However, this association potentially is explained by underlying CKD.

scholarly journals Ischemic stroke in a patient with interatrial block: Is it only a coincidence or a clear relationship?

2021 ◽  
Vol 91 (2) ◽  
Author(s):  
Athanassios Antonopoulos ◽  
Laila Fiorani
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Case Report ◽  
Early Identification ◽  
Conduction Block ◽  
Embolic Stroke ◽  
P Wave ◽  
Wave Analysis ◽  
Increased Risk ◽  
Interatrial Block

Atrial fibrillation (AF) can be detected in nearly 25% of all patients with stroke by sequentially combining different electrocardiographic methods. Prediction of early cardio-embolic stroke remain a permanent challenge in everyday practice. The early identification of an increased risk for atrial fibrillation episodes (which are frequently asymptomatic) is essential for the prevention of cardioembolic events. One of the noninvasive modalities of atrial fibrillation prediction is represented by the electrocardiographic P-wave analysis. This includes study and diagnosis of interatrial conduction block. Our short case report presents a case with ischemic cortico-sottocortical stroke involving capsulo and caudo regions in a woman patient with interatrial block as realized by electrocardiographic P analysis.  

Porphyria and dementia: a case report

2003 ◽  
Vol 20 (3) ◽  
pp. 96-99
Author(s):  
Dympna Gibbons ◽  
Anne Cullen ◽  
Malcom Garland
Keyword(s):  
Case Report ◽  
General Population ◽  
Cognitive Decline ◽  
Metabolic Disorders ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Acute Intermittent Porphyria ◽  
Cognitive State ◽  
Advanced Stage ◽  
History Of

AbstractThe porphyrias are a group of rare hereditary metabolic disorders where there is an excess formation and excretion of porphyrins or their precursors. Type IIA, acute intermittent porphyria (AIP), has an estimated prevalence of one to eight per 100,000 in the general population but is thought to have a higher prevalence in psychiatric patients. AIP can present with a variety of psychiatric symptoms, often misdiagnosed. Associated neuropathological changes including focal cerebral ischaemic lesions have been found. However, to our knowledge, no case of dementia and AIP has been described. We present the case of a 56 year old man with a five-year history of progressive cognitive decline, diagnosed with AIP at an advanced stage of dementia. Whether AIP contributed to the dementia or is a coincidental finding is unknown. However treatment of AIP in this case resulted in some improvement in the patient's cognitive state.

Multifactorial Analysis of a Group of Prediabetes Patients in Terms of Cardiovascular Risk

2013 ◽  
Vol 20 (1) ◽  
pp. 29-36
Author(s):  
Eduard Adamescu ◽  
Cătălina Niculescu ◽  
Carmen Dobjanschi
Keyword(s):  
General Population ◽  
Risk Score ◽  
Metabolic Disorders ◽  
Population Group ◽  
Control Group ◽  
Average Weight ◽  
Anthropometric Parameters ◽  
Increased Risk ◽  
Ambulatory Patients ◽  
Risk Parameters

Abstract Background and Aims: “Prediabetes” is defined by Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT), both states associated with increased risk for diabetes and high cardiovascular (CV) risk. The aim of our study was to investigate a population with prediabetes compared to a group from the general population in respect with the risk for progression to diabetes and CV risk parameters. Materials and Methods: We investigated 124 ambulatory patients with prediabetes and 98 persons without any known metabolic disorders (control group), for CV risk parameters and risk of developing diabetes. Results: We found statistically significant differences (p <0.05) for average weight, waist, BMI and lipids between the two groups. We also found a double risk score of developing diabetes in prediabetes patients compared to the control group. No significant differences were found in terms of anthropometric parameters, lipid values, cardiovascular disease and diabetes risk score for the IFG, IGT and IFG + IGT subgroups. Conclusions: People with prediabetes have features that differentiate them from the general population, both in terms of the history, anthropometric and biochemical characteristics. Increased risk for progression to diabetes, but also highly increased CV risk makes very useful the prevention efforts focused on this population group.

Longitudinal changes in anthropometric measures and new-onset atrial fibrillation among men and women from general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Lu ◽  
S Geurts ◽  
M.J Tilly ◽  
M.A Ikram ◽  
B Arshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
General Population ◽  
Community Dwelling ◽  
Anthropometric Measures ◽  
Men And Women ◽  
Longitudinal Changes ◽  
Increased Risk ◽  
Over Time ◽  
New Onset

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia of clinical significance. Recent evidence suggests differences in epidemiology and risk factors of AF between women and men. Obesity and body size are established risk factors for AF. However, anthropometric measures tend to change over time. Few studies have investigated the impact of longitudinal changes in anthropometric measures on incident AF among men and women. Purpose To assess the association between longitudinal changes in different anthropometric measures and new-onset AF among community-dwelling men and women. Methods Among 12,848 participants free of AF at baseline were included in this large prospective population-based cohort study, each anthropometric measure was measured at least once and up to five times. Anthropometric measures included weight, height, waist circumference (WC), hip circumference (HC), waist to hip ratio (WHR), and body mass index (BMI). Anthropometric measures were standardized for direct comparisons. Joint models were used to assess the association of each anthropometric factor and their longitudinal changes with incident AF. Models were adjusted for age and traditional cardiovascular risk factors. Results A total of 5,266 men and 7,218 women (mean age 63.87 years for men and 64.94 years for women) were followed up for a median of 10.5 years. AF occurred in 630 (12.0%) men and 692 (8.7%) women. Longitudinal increases in weight, height, WC, HC and BMI increased the risk for new-onset AF in a linear manner. The age-adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) were 1.38 (1.26–1.51) for weight, 1.41 (1.26–1.59) for height, 1.26 (1.13–1.41) for WC, 1.36 (1.19–1.55) for HC and 1.22 (1.11–1.35) for BMI among men. Among women, the age-adjusted HRs (95% CI) were 1.41 (1.30–1.52) for weight, 1.21 (1.07–1.38) for height, 1.39 (1.27–1.52) for WC, 1.29 (1.19–1.40) for HC and 1.28 (1.19–1.37) for BMI. Further, longitudinal increase in WHR was significantly associated with increased risk of AF in women [HR (95% CI): 1.42 (1.21–1.66)] but not in men [HR (95% CI): 1.11 (0.96–1.30)]. Conclusions Longitudinal changes in anthropometric measures were associated with the increased risk for new-onset AF among men and women in the general population. An increase in measures of central obesity over time showed a stronger association with incident AF among women, compared to men. Our findings underscore the importance of a sex-specific approach for screening and monitoring of anthropometric measures for AF prevention. Main results among men and women Funding Acknowledgement Type of funding source: None

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