Anesthetic Management in Patient with Suspected Brain Abscess, Atrium Septal Defect, and Eisenmenger Syndrome

Introduction: Patients with congenital heart disease especially with systemic shunting between systemic and pulmonary circulation often develop pulmonary hypertension and left-to-right shunt (Eisenmenger syndrome) if left untreated. These patients are at risk of developing spontaneous brain abscess due to brain infarction caused by polycythemia, impaired immune function, and loss of lung phagocytosis. Such patients were often admitted to the emergency room with signs of increased intracranial pressure (ICP), and needed specific consideration during surgery. Case: a 31-year old female diagnosed with intracranial space occupying lesion (SOL) due to suspected brain abscess with concurrent heart defects (atrial septal defect / ASD and Eisenmenger syndrome) was consulted to the operating theatre for emergency burrhole aspiration. The surgery was performed for an hour and the postoperatively the patient was admitted to the intensive care unit (ICU). Conclusion: perioperative management of patients with brain abscess and concurrent ASD and Eisenmenger syndrome consists of preoperative management, methods of anesthesia, monitoring, and interventions to prevent the worsening of left-to-right shunt and increasing intracranial pressure. These managements consist of optimal pain management, perioperative oxygen therapy, and prevention of precipitating factor that increases left-to-right shunting.

Preoperative Management of Diabetic Patients, an Overview

Glycemic control is critical in the perioperative setting, especially in diabetic patients. The consequences of surgical tension and anesthesia on blood sugar levels are distinct, and should be considered in order to maintain optimal glycemic control. Each stage of surgery presents its own set of challenges in terms of keeping glucose levels within the target range. Furthermore, there are some surgical conditions that necessitate specific glucose management protocols. Authors hope to highlight the most crucial factors to consider when developing a perioperative diabetic regimen, while still allowing for specific adjustments based on sound clinical judgement. Overall, by carefully managing glycemic control in perioperative patients, we may be able to reduce morbidity and mortality while improving surgical outcomes.

Bröstrom Repair Review

Since its introduction in 1966, the Bröstrom repair has been the workhorse for the treatment of chronic ankle instability. The procedure has expanded with the advent of arthroscopy, ultrasound, and other techniques. Because chronic ankle sprains/instability pose a barrier to athletes who perform high-level activities for a living, discussions concerning postoperative recovery and return to play criteria are important. Here we present an update on the Bröstrom-Gould procedure from preoperative management to return to play. Level of Evidence: Level V

Dopamine secreting pheochromocytoma and paraganglioma

Predominantly or exclusively dopamine-secreting pheochromocytoma and paraganglioma are very rare. We report a 64-year-old woman with an adrenal incidentaloma. She was normotensive and had no symptoms of catecholamine excess. The 24-hour urine catecholamine level showed normal norepinephrine (122.9 μg/day), epinephrine (24.3 μg/day), whereas markedly elevated dopamine (148,212.4 μg/day). 123I-metaiodobenzylguanidine (MIBG) scintigraphy revealed tumor uptake. After α-blockade as preoperative management, she successfully underwent laparoscopic left adrenalectomy and was finally diagnosed with an exclusively dopamine-secreting pheochromocytoma. The tumor was histologically comprised of small polygonal cells with high cellularity and was immunohistochemically positive for all three catecholamine synthesizing enzymes: tyrosine hydroxylase (very weak), dopamine β-hydroxylase (heterogeneous), and phenylethanolamine N-methyltransferase (very weak). Electron microscopy revealed very few catecholamine-containing small vesicles with a few organelles, which reflected immature cells. No biochemical or imaging evidence of recurrence or metastasis were evident 1 year after the surgery. We conducted a literature search in the Pubmed database. A total of 33 cases were collected. Our case had the second-highest 24-hour urinary dopamine excretion and was the first in which immunostaining for catecholamine synthase and electron microscopy were performed together. Histological findings in our case give a possible hypothesis that the mechanism underlying a dopamine-secreting pheochromocytoma is associated with immature catecholamine vesicles in which DBH is localized, thus resulting in inhibited conversion from dopamine to norepinephrine. We also discuss the reasons for the lack of catecholamine excess symptoms, whether preoperative management of α-blockade is needed, and the association between the prognosis and genetic mutation with an extensive literature review.

Physiotherapy in a patient with colorectal cancer - preoperative management

During the surgical treatment of colorectal cancer, whether by laparoscopic or classic open method, the tissues in the abdominal cavity are traumatized. The cuts of the muscle fibers are associated with the disturbance of the tone of the postural muscles. A scar within the abdominal cavity also causes movement limitations in the form of restrictions in the mobility of the spine. The implementation of patient rehabilitation in the form of targeted physiotherapy before the procedure should be an indispensable element of the treatment of colorectal cancer. The aim of the study is to propose a therapy that uses the spine mobility test to diagnose deficits. The proposed preoperative therapy focuses mainly on improving the parameters of the spine's mobility. The paper presents examples of activities that can be used in therapy before surgery. A review of the available literature and own experience were used for the work. It can be concluded from the analyzed literature that physiotherapy in oncological patients is not very widespread and is neglected in the treatment process. Patients, by In the literature, before colorectal cancer removal surgery, they are not subjected to physical rehabilitation, which is associated with complications resulting from the course of the procedure. The process of rehabilitating patients after surgical treatment of colorectal cancer should take place in the pre-operative period. Physiotherapy should take into account the weakening of the muscle strength in the trunk and limitations of mobility caused by age. Rehabilitation should be aimed at restoring functionality.