The management and outcome of hyponatraemia following transsphenoidal surgery: a retrospective observational study

PURPOSE: Hyponatraemia is a common complication following transsphenoidal surgery. However, there is sparse data on its optimal management and impact on clinical outcomes. The aim of this study was to evaluate the management and outcome of hyponatraemia following transsphenoidal surgery. METHODS: A prospectively maintained database was searched over a 4-year period between January 2016 and December 2019, to identify all patients undergoing transsphenoidal surgery. A retrospective case-note review was performed to extract data on hyponatraemia management and outcome. RESULTS: Hyponatraemia occurred in 162 patients (162/670; 24.2%) with a median age of 56 years. Female gender and younger age were associated with hyponatraemia, with mean nadir sodium being 128.6 mmol/L on postoperative day 7. Hyponatraemic patients had longer hospital stay than normonatraemic group with nadir sodium being inversely associated with length of stay (p < 0.001). In patients with serum sodium ≤ 132 mmol/L, syndrome of inappropriate antidiuretic hormone secretion (SIADH) was the commonest cause (80/111; 72%). Among 76 patients treated with fluid restriction as a monotherapy, 25 patients (25/76; 32.9%) did not achieve a rise in sodium after 3 days of treatment. Readmission with hyponatraemia occurred in 11 cases (11/162; 6.8%) at a median interval of 9 days after operation. CONCLUSIONS: Hyponatraemia is a relatively common occurrence following transsphenoidal surgery, is associated with longer hospital stay and risk of readmission and the effectiveness of fluid restriction is limited. These findings highlight the need for further studies to better identify and treat high-risk patients, including the use of arginine vasopressin receptor antagonists

On the presence of mid-gap states in CaV4O9

Using exact diagonalizations of finite clusters with up to 32 sites, we study the $J_1-J_2$ model on the 1/5 depleted square lattice. Spin-spin correlation functions are consistent with plaquette order in the spin gap phase which exists for intermediate values of $J_2/J_1$. Besides, we show that singlet states will be present in the singlet-triplet gap if $J_2/J_1$ is not too small ($J_2/J_1 \gtrsim 0.47$). We argue that this property should play a central role in determining the exchange integrals in ${\rm CaV}_4{\rm O}_9$Comment: 4 pages, 5 postscript figure

Magnetic properties of NaV2O5, a one-dimensional spin 1/2 antiferromagnet with finite chains

We have performed measurements of the magnetic susceptibility of NaV$_2$O$_5$ between 2 and 400 K. The high temperature part is typical of spin 1/2 chains with a nearest--neighbour antiferromagnetic exchange integral $J$ of 529 K. We develop a model for the susceptibility of a system with finite chains to account for the low temperature part of the data, which cannot be fitted by a standard Curie-Weiss term. These results suggest that the next nearest--neighbour exchange integral $J_2$ in CaV$_4$O$_9$ should be of the order of 500 K because, like $J$ in NaV$_2$O$_5$, it corresponds to corner sharing VO$_5$ square pyramids.Comment: An early version of the manuscript was mistakenly submitted. Although relatively minor, the changes concern the list of authors, the main text, the references and the figure captions. 10 pages of latex, 2 figure

Spin Gap of Two-Dimensional Antiferromagnet Representing CaV4_4O9_9

We examined a two-dimensional Heisenberg model with two kinds of exchange energies, $J_e$ and $J_c$. This model describes localized spins at vanadium ions in a layer of CaV$_4$O$_9$, for which a spin gap is found by a recent experiment. Comparing the high temperature expansion of the magnetic susceptibility to experimental data, we determined the exchange energies as $J_e \simeq$ 610 K and $J_c \simeq$ 150 K. By the numerical diagonalization we estimated the spin gap as $\Delta \sim 0.2J_e \simeq$ 120 K, which consists with the experimental value 107 K. Frustration by finite $J_c$ enhances the spin gap.Comment: 12 pages of LaTex, 4 figures availavule upon reques

Magnetic Susceptibility for CaV4O9CaV_4O_9

We examine experimental magnetic susceptibility $\chi^{tot}(T)$ for CaV$_4$O$_9$ by fitting with fitting function $\alpha \chi^{mag}(T) + c$. The function $\chi^{mag}(T)$ is a power series of 1/T and the lowest order term is fixed as $C/T$, where $C$ is the Curie constant as determined by the experimental $g$-value (g=1.96). Fitting parameters are $\alpha$, $c$ and expansion coefficients except for the first one in $\chi^{mag}(T)$. We determine $\alpha$ and $c$ as $\alpha \simeq$ 0.73 and $c\simeq$ 0 for an experimental sample. We interpret $\alpha$ as the volume fraction of CaV$_4$O$_9$ in the sample and $\chi^{mag}(T)$ as the susceptibility for the pure CaV$_4$O$_9$. The result of $\alpha \ne 1$ means that the sample includes nonmagnetic components. This interpretation consists with the result of a perturbation theory and a neutron scattering experiment.Comment: 4pages, 4figure

Pituitary function at presentation and following therapy in patients with non-functional pituitary macroadenomas: a single centre retrospective cohort study

Background: Non-functioning pituitary macroadenomas (NFPMs) may present with hypopituitarism. Pituitary surgery and radiotherapy pose an additional risk to pituitary function. Objectives: To assess the incidence of hypopituitarism at presentation, the impact of treatment, and the likelihood of endocrine recovery during follow-up. Methods: All patients treated surgically with and without radiotherapy for NFPMs between 1987 and 2018 who had longer than six months follow-up were identified. Demographics, presentation, investigation, treatment, and outcomes were collected. Results: In total, 383 patients were identified. The median age was 57 years, with a median follow-up of 8 years. Preoperatively, 227 patients (227/375; 61%) had evidence of at least one pituitary deficiency. Anterior panhypopituitarism was more common in men (p = 0.001) and older patients (p = 0.005). Multiple hormone deficiencies were associated with large tumours (p = 0.03). Patients treated with surgery and radiotherapy had a higher incidence of all individual pituitary hormone deficiency, anterior panhypopituitarism, and significantly lower GH, ACTH, and TSH deficiencies free survival probability than those treated with surgery alone. Recovery of central hypogonadism, hypothyroidism, and anterior panhypopituitarism was also less likely to be reported in those treated with surgery and radiotherapy. Those with preoperative hypopituitarism had a higher risk of pituitary impairment at latest review than those presented with normal pituitary function (p = 0.001). Conclusion: NFPMs are associated with a significant degree of hypopituitarism at time of diagnosis and post-therapy. The combination of surgery and radiotherapy is associated with a higher risk of pituitary dysfunction. Recovery of pituitary hormone deficit may occur after treatment. Patients should have regular ongoing endocrine evaluation post-treatment to assess changes in pituitary function and the need for long-term replacement therapy

Phase Diagram of the S = 1/2 Frustrated Coupled Ladder System

We present a theoretical study of the magnetic phase diagram of the frustrated coupled ladder structure realized recently in several materials. This system displays a nondegenerate spin-gap state in the dimer limit and an infinitely degenerate spin-gap state in the regime of weakly-coupled zig-zag chains. Between these we demonstrate the existence of gapless, magnetically ordered regions whose order is antiferromagnetic close to the honeycomb lattice limit, and incommensurate along the chains when all three magnetic interactions compete.Comment: 5 pages, RevTeX; 5 .eps figure

An open-label clinical trial to investigate the efficacy and safety of corifollitropin alfa combined with hCG in adult men with hypogonadotropic hypogonadism

Subject disposition. (EPS 1138 kb