scholarly journals Unusual association between spinal cord tumour and perioperative arrhythmia

2015 ◽  
Vol 02 (02) ◽  
pp. 127-129
Author(s):  
Vikas Chauhan ◽  
Ashish Bindra ◽  
Parmod Bithal
Keyword(s):  
Elective Surgery ◽  
Perioperative Period ◽  
Spinal Cord Tumour ◽  
Anaesthetic Agents ◽  
Catecholamine Excess ◽  
Intraoperative Period ◽  
Systemic Pathology ◽  
Preoperative Work Up ◽  
Work Up ◽  
Ventricular Ectopics

AbstractThere are multiple causes of perioperative arrhythmias. Some have underlying cardiac disease while others accompany systemic pathology. Use of anaesthetic agents in the intraoperative period is also a known cause of rhythm abnormalities. Preoperative benign arrhythmias may progress to serious ones in intraoperative period. The trigger may be a transient insult such as hypoxemia, cardiac ischaemia, catecholamine excess or electrolyte abnormality. Thus, presence of arrthymia in the preoperative period adds to preoperative work-up and especially in the elective surgery settings, they call for additional opinion and patient evaluation. However, not all arryhthmias are amenable to drug treatment and modalities like pacing, some require just careful watch in the perioperative period. We report a patient with thoracic intramedullary space occupying lesion who presented to us with multiple ventricular ectopics on electrocardiography, which eventually disappeared with tumour removal. The case highlights the association of multiple ectopics with spinal tumour and their management.

scholarly journals Concomitant Pheochromocytoma and Primary Aldosteronism: A Case Series and Literature Review

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A80-A80
Author(s):  
Jimmy J Mao ◽  
Jessica Baker ◽  
William E Rainey ◽  
William F Young ◽  
Irina Bancos
Keyword(s):  
Primary Aldosteronism ◽  
Case Series ◽  
Retrospective Case ◽  
Adrenal Vein Sampling ◽  
Catecholamine Excess ◽  
Tertiary Center ◽  
Preoperative Work Up ◽  
Work Up ◽  
Urinary Metanephrines

Abstract Objective: The detection and management of concomitant pheochromocytoma (PHEO) and primary aldosteronism (PA) is not well understood. Our objectives were to investigate varying presentations and outcomes of cases with coexisting PHEO and PA to provide an approach to its diagnosis and management. Design: Retrospective case series from 2000–2020 at a single institution tertiary center; additional review of previously known cases before 2000 and from the medical literature. Patients and Measurements: Adult patients with concomitant PHEO and PA. Clinical, biochemical, radiologic, and histologic parameters were reviewed. Results: Fifteen patients (53% men, median age 53 years) were diagnosed with concomitant PHEO and PA. The majority presented with hypertension (13, 87%) and hypokalemia (13, 87%), but only 6 (40%) presented with symptoms suggestive of catecholamine excess. All patients with preoperative work-up for catecholamine excess (14, 93%) were found to have elevated plasma or urinary metanephrines/catecholamines above the upper limit of normal. Adrenal vein sampling (AVS) was performed in 9 (60%) patients, where 5 (56%) were diagnosed with bilateral PA, and 4 (44%) with unilateral PA. All patients underwent either unilateral (12, 80%) or bilateral (3, 20%) adrenalectomy to treat their PHEO and/or PA. Postoperative catecholamines and/or catecholamine breakdown products normalized or improved in 13 (87%) patients and were not measured in 2. Recurrence of PHEO was not observed. Six (40%) displayed persistent PA postoperatively, where 4 required long-term mineralocorticoid blockade. Conclusions: Concomitant PHEO and PA is a rare but likely under-reported condition. Hypertension with or without hypokalemia should prompt evaluation for PA, while any indeterminate adrenal mass should be worked up for PHEO. Coexisting disease warrants consideration of AVS to determine the laterality of PA to ensure appropriate management.

scholarly journals ASSESSMENT OF CHANGES OF SKIN MOISTURE IN PATIENTS SUBJECT TO GENERAL ANESTHESIA WITH NEUROLOGICAL DISEASES IN AN INTERVIEW

2019 ◽  
Vol 72 (7) ◽  
pp. 1288-1294
Author(s):  
Jolanta Piskorz ◽  
Gustaw Wójcik ◽  
Włodzimierz Bulikowski ◽  
Dorota Kozak-Putowska
Keyword(s):  
General Anaesthesia ◽  
Mild Hypothermia ◽  
Elective Surgery ◽  
Neurological Diseases ◽  
Circulatory System ◽  
Perioperative Period ◽  
Hydration Status ◽  
Control Group ◽  
Anaesthetic Agents ◽  
Skin Moisture

Introduction: General anaesthesia is carried out using anaesthetic agents that among others depress the circulatory system and CNS. Central and peripheral thermoregulation occurs, which is due to mild hypothermia as well as changes in skin moisture. An important element of therapy in the perioperative period is adequate intravenous fluid therapy, which affects the final effects of treatment. The aim: Evaluation of skin moisture as a result of changes in central and peripheral thermoregulation during general anaesthesia and evaluation of the hydration status of patients. Material and methods: The study included 180 patients undergoing general anaesthesia for elective surgery, aged 20-85 years of age. Before general anaesthesia, patients were evaluated for ASA-related risk of anaesthesia (ASA 1 - healthy patients, ASA 2 and 3 - patients with neurological and circulatory disorders). Patients were divided into 2 groups, the study group (90 people) were patients who were given no intravenous fluids before the surgery and the control group (90 patients) were those receiving doses of 500 ml crystalline intravenously one hour before anaesthesia. The research was carried out at the Operational Block of the Provincial Hospital in Tarnobrzeg, from November 2013 to November 2014. Skin moisture was measured using a CM 825 Corneometer: before general anaesthesia, after induction for anaesthesia, 15 min after surgical incision of the skin and after awakening the patient. Results: Both in the test and control groups, statistically significant differences were found in subsequent skin moisture measurements. Pairwise comparisons indicate statistically significant differences between each pair of measurements. In both groups of patients, there is a clear decrease in skin moisture after induction of anaesthesia compared to the measurement performed before general anaesthesia. The skin moisture values are reduced in subsequent measurements, however the difference is much lower. Conclusions: 1 Measurement of skin moisture can be used as one of the parameters to assess perioperative stress and changes in body temperature during general anaesthesia, which indirectly determines the functioning of the hypothalamus. 2 By measuring the skin moisture it is possible to indirectly assess the hydration status of patients as well as the decrease of the metabolism during general anaesthesia. 3 The decrease in skin moisture during general anaesthesia is the effect of changes in central and peripheral thermoregulation.

scholarly journals Concomitant Pheochromocytoma and Primary Aldosteronism: A Case Series and Literature Review

2021 ◽  
Author(s):  
Jimmy J Mao ◽  
Jessica E Baker ◽  
William E Rainey ◽  
William F Young ◽  
Irina Bancos
Keyword(s):  
Primary Aldosteronism ◽  
Case Series ◽  
Single Institution ◽  
Retrospective Case ◽  
Adrenal Vein Sampling ◽  
Catecholamine Excess ◽  
Upper Limits ◽  
Tertiary Center ◽  
Preoperative Work Up ◽  
Work Up

Abstract Context The detection and management of concomitant pheochromocytoma (PHEO) and primary aldosteronism (PA) is not well understood. Objective To investigate varying presentations and outcomes of cases with coexisting PHEO and PA to provide an approach to its diagnosis and management. Design Retrospective case series from 2000-2020; additional review of cases before 2000 and from the medical literature. Setting Single institution tertiary center. Patients Adults with concomitant PHEO and PA. Main Outcome Measures Clinical, biochemical, radiologic, and histologic parameters. Results Fifteen patients (53% men, median age 53 years) were diagnosed with concomitant PHEO and PA. The majority presented with hypertension (13, 87%) and hypokalemia (13, 87%), and 6 (40%) presented with symptoms suggestive of catecholamine excess. All patients who underwent preoperative work-up for catecholamine excess (14, 93%) were found to have biochemical levels above the upper limits of normal. Adrenal vein sampling (AVS) was performed in 9 patients (60%), where 5 (56%) were diagnosed with bilateral PA, and 4 (44%) with unilateral PA. Patients underwent either unilateral (12, 80%) or bilateral (3, 20%) adrenalectomy. Biochemical improvement or resolution of catecholamine excess was confirmed in all cases with documented measurements. Recurrence of PHEO was not observed. Six patients (40%) displayed persistent PA postoperatively. Conclusions Concomitant PHEO and PA is a rare but likely under-reported condition. Hypertension with or without hypokalemia should prompt evaluation for PA, while any indeterminate adrenal mass should be assessed for PHEO. Coexisting disease warrants consideration of AVS to determine the laterality of PA to ensure appropriate management.

Extrinsic Pathway Inhibitor in Elective Surgery: A Comparison with other Coagulation Inhibitors

1989 ◽  
Vol 62 (03) ◽  
pp. 856-860 ◽  
Author(s):  
P M Sandset ◽  
H E Høgevold ◽  
T Lyberg ◽  
T R Andersson ◽  
U Abildgaard
Keyword(s):  
Vascular Surgery ◽  
Protein C ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Acute Phase Reactant ◽  
Hip Surgery ◽  
Albumin Concentration ◽  
Extrinsic Pathway ◽  
Heparin Cofactor Ii ◽  
Coagulation Inhibitors

SummaryExtrinsic coagulation pathway inhibitor may be an important regulator of haemostasis to prevent thrombosis after tissue damage. The functional activity of this inhibitor was determined using a chromogenic substrate assay, and compared to the activities of anti thrombin, heparin cofactor II and protein C during the perioperative period of elective hip replacement (n = 28), cholecystectomy (n = 11), and vascular surgery (n = 5). Peroperatively, all the inhibitors decreased rather similarly and to the same degree as the decrease in albumin concentration. The decreases during hip surgery were about 2-fold the decreases observed during cholecystectomy. A significant peroperative increase in extrinsic pathway inhibitor activity was observed in vascular surgery, probably due to a bolus injection of heparin. Antithrombin, heparin cofactor II and protein C levels normalized on days 3-5 postoperatively in all three patient groups. Sustained low levels of extrinsic pathway inhibitor were observed on postoperative days 1 to 7 in hip surgery patients. Apparently, extrinsic pathway inhibitor is not an acute phase reactant. In uncomplicated surgery, the decreases of the coagulation inhibitor levels are mainly due to hemodilution.

Surgery for Skull Base Malignancies-Preoperative Work-Up to Minimize Complications

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
Andrew King ◽  
Stephen MacNally ◽  
Jarod Homer ◽  
Richard Ramsden ◽  
Shakeel Saeed ◽  
...  
Keyword(s):  
Skull Base ◽  
Preoperative Work Up ◽  
Work Up

Preoperative preparation of alcohol and psychoactive substances-addicted patients

2011 ◽  
Vol 58 (2) ◽  
pp. 151-155
Author(s):  
Ivan Dimitrijevic ◽  
Zoran Zoricic ◽  
Miodrag Milenovic ◽  
Ivan Palibrk ◽  
Draga Dimitrijevic ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Postoperative Care ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Psychoactive Substance ◽  
Preoperative Preparation ◽  
Psychoactive Substances ◽  
Key Issues ◽  
Proper Diagnosis

Proper diagnosis of psychoactive substance abuse and addiction, as well as acute intoxication, withdrawal syndrome and overdosing are of great importance in patients who are preparing for surgical intervention. There are some specific details in their preoperative preparation whether they underwent emergency or elective surgery. Good knowledge of the characteristics of psychoactive substance abuse and addiction, interaction of psychoactive substances and anesthetics and any other drugs that could be used in the perioperative period is important especially for anastesiologist. In this work we present key issues for recognizing theese patients as well as some guidelines for adequate preoperative preparation and postoperative care.

scholarly journals Comparison of MRI and colonoscopy in determining tumor height in rectal cancer

2017 ◽  
Vol 6 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Lotte Jacobs ◽  
David B Meek ◽  
Joost van Heukelom ◽  
Thomas L Bollen ◽  
Peter D Siersema ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Intraclass Correlation ◽  
Rectal Tumor ◽  
Height Measurement ◽  
Treatment Allocation ◽  
Large Variability ◽  
Magnetic Resonance Imaging Mri ◽  
Preoperative Work Up ◽  
Work Up

Background and aim Endoscopy and magnetic resonance imaging (MRI) are used routinely in the diagnostic and preoperative work-up of rectal cancer. We aimed to compare colonoscopy and MRI in determining rectal tumor height. Methods Between 2002 and 2012, all patients with rectal cancer with available MRIs and endoscopy reports were included. All MRIs were reassessed for tumor height by two abdominal radiologists. To obtain insight in techniques used for endoscopic determination of tumor height, a survey among regional endoscopists was conducted. Results A total of 211 patients with rectal cancer were included. Tumor height was significantly lower when assessed by MRI than by endoscopy with a mean difference of 2.5 cm (95% CI: 2.1–2.8). Although the agreement between tumor height as measured by MRI and endoscopy was good (intraclass correlation coefficient (ICC) 0.7 (95% CI: 0.7–0.8)), the 95% limits of agreement varied from –3.0 cm to 8.0 cm. In 45 patients (21.3%), tumors were regarded as low by MRI and middle–high by endoscopy. MRI inter- and intraobserver agreements were excellent with an ICC of 0.8 (95% CI: 0.7–0.9) and 0.9 (95% CI: 0.9–1.0), respectively. The survey showed no consensus among endoscopists as to how to technically measure tumor height. Conclusion This study showed large variability in rectal tumor height as measured by colonoscopy and MRI. Since MRI measurements showed excellent inter- and intraobserver agreement, we suggest using tumor height measurement by MRI for diagnostic purposes and treatment allocation.

SPINAL ANGIOGRAPHY IN THE PREOPERATIVE WORK-UP OF THORACOLUMBAR TRAUMA

1990 ◽  
Vol 83 (Supplement) ◽  
pp. 2S-69
Author(s):  
Jesse Rael ◽  
Lee Kesterson ◽  
Jerry King
Keyword(s):  
Spinal Angiography ◽  
Preoperative Work Up ◽  
Work Up

Reappraisal of left‐sided gallbladder and its accompanying anomalies: a report of two cases and literature review

2005 ◽  
Vol 46 (3) ◽  
pp. 233-236 ◽  
Author(s):  
T. ‐C. Wu ◽  
R. ‐C. Lee ◽  
J. ‐H. Chiang ◽  
C. ‐Y. Chang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Portal Vein ◽  
Three Dimensional ◽  
Ligamentum Teres ◽  
Hepatobiliary Surgery ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Anatomical Information ◽  
Preoperative Work Up ◽  
Work Up

We report two cases of coexistent left‐sided gallbladder and right‐sided ligamentum teres with portal vein anomalies documented by magnetic resonance imaging (MRI) and three‐dimensional (3D) computed tomography during arterial portography (CTAP). Reformatted 3D MR and CTAP images provide an informative illustration of the accompanying portal vein anomalies. This important anatomical information is useful in preoperative work‐up of hepatobiliary surgery.

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