Udar przysadki po operacji serca u chorego z podklinicznym gruczolakiem przysadki: opis przypadku i przegląd piśmiennictwa

Abstract Pituitary adenoma infarction associated with cardiac surgery occurs rarely but it is a serious, life-threatening acute clinical event. Several mechanisms have been proposed but no direct cause has been clearly identified. We report a case of pituitary apoplexy occurring in a 74-year-old patient 6 hours after cardiac surgery. The patient presented with confusion, unilateral ptosis and ophthalmoplegia. Neurological examination revealed right oculomotor nerve palsy and decreased level of consciousness. Magnetic resonance imaging showed a hemorrhagic and necrotic pituitary macroadenoma. After prompt endocrinological replacement therapy with hydrocortisone and levothyroxine, the confusion of the patient resolved. Removal of a non-functional macroadenoma with large necrotic areas resulted in full recovery. The physician should be aware of pituitary adenoma infarction after open cardiac surgery and should remember that it can be fatal or cause permanent neurological or endocrine damage without proper treatment. Surgical and endocrine treatment can be life-saving procedures.Streszczenie Zawał w obrębie gruczolaka przysadki związany z operacją serca występuje rzadko, ale jest stanem zagrożenia życia. Wskazywano na kilka mechanizmów wystąpienia tego powikłania, ale dotąd nie określono jednoznacznej przyczyny. Przedstawiono przypadek udaru przysadki, który wystąpił u 74-letniego mężczyzny po 6 godz. od operacji serca. U chorego zaobserwowano zmącenie, jednostronne opadnięcie powieki i zaburzenia gałkoruchowe. W badaniu neurologicznym stwierdzono porażenie prawego nerwu okoruchowego i zaburzenia przytomności. W badaniu za pomocą rezonansu magnetycznego uwidoczniono gruczolaka przysadki ze zmianami krwotocznymi i martwiczymi. Zaburzenia świadomości ustąpiły po niezwłocznym leczeniu hydrokortyzonem i lewotyroksyną. Usunięcie nieczynnego wydzielniczo gruczolaka z dużymi obszarami martwicy spowodowało powrót do zdrowia. Należy pamiętać o zawale w obrębie gruczolaka przysadki jako powikłaniu operacji na otwartym sercu. Nieleczona, choroba ta może doprowadzić do zgonu lub trwałych następstw neurologicznych bądx endokrynologicznych. Leczenie chirurgiczne i endokrynologiczne może być w tej sytuacji działaniem ratującym życie

Endovascular Stent Grafting for Aortic Arch Aneurysm in Aortoiliac Occlusive Disease following Aortic Arch Debranching and Aortobifemoral Reconstruction

Treatment of thoracic aortic aneurysms constitutes high mortality and morbidity rates despite improvements in surgery, anesthesia, and technology. Endovascular stent grafting may be an alternative therapy with lower risks when compared with conventional techniques. However, sometimes the branches of the aortic arch may require transport to the proximal segments prior to successful thoracic aortic endovascular stent grafting. Atherosclerosis is accounted among the etiology of both aneurysms and occlusive diseases that can coexist in the same patient. In these situations stent grafting may even be more complicated. In this report, we present the treatment of a 92-year-old patient with aortic arch aneurysm and proximal descending aortic aneurysm. For successful thoracic endovascular stent grafting, the patient needed an alternative route other than the native femoral and iliac arteries for the deployment of the stent graft. In addition, debranching of left carotid and subclavian arteries from the aortic arch was also required for successful exclusion of the thoracic aneurysm

Rationale for the use of anticholinergic agents in overactive bladder with regard to central nervous system and cardiovascular system side effects

Purpose: Central nervous system (CNS) and cardiovascular system (CVS) side effects of anticholinergic agents used to treat overactive bladder (OAB) are underreported. Hence, this review aimed to focus on the mechanisms of CNS and CVS side effects of anticholinergic drugs used in OAB treatment, which may help urologists in planning the rationale for OAB treatment. Materials and Methods: PubMed/MEDLINE was searched for the key words "OAB," "anticholinergics," "muscarinic receptor selectivity," "blood-brain barrier," "CNS," and "CVS side effects." Additional relevant literature was determined by examining the reference lists of articles identified through the search. Results: CNS and CVS side effects, pharmacodynamic and pharmacokinetic properties, the metabolism of these drugs, and the clinical implications for their use in OAB are presented and discussed in this review. Conclusions: Trospium, 5-hydroxymethyl tolterodine, darifenacin, and solifenacin seem to have favorable pharmacodynamic and pharmacokinetic properties with regard to CNS side effects, whereas the pharmacodynamic features of darifenacin, solifenacin, and oxybutynin appear to have an advantage over the other anticholinergic agents (tolterodine, fesoterodine, propiverine, and trospium) with regard to CVS side effects. To determine the real-life situation, head-to-head studies focusing especially on CNS and CVS side effects of OAB anticholinergic agents are urgently needed

Does vaginal anti-incontinence surgery affect sexual satisfaction? A comparison of TVT and Burch-colposuspension

OBJECTIVE: To evaluate the sexual satisfaction rates of women who underwent tension-free vaginal tape (TVT) procedure for stress urinary incontinence and compare it with the results of Burch-colposuspension. MATERIALS AND METHODS: A self-administered questionnaire was given to 81 patients who had undergone TVT or Burch-colposuspension at our institution to determine sexual satisfaction rates and reasons for dissatisfaction. Forty-seven patients in TVT group and 22 patients in Burch-colposuspension group were considered eligible for the study. The mean follow-up period and age of patients in TVT and Burch-colposuspension groups were 34 months, 51.5 years and 89 months, 52.9 years, respectively. The difference between the ages in the two groups was not statistically significant, while the difference between mean follow-up periods was significant (p = 0.000). RESULTS: When evaluating sexual satisfaction, 73% in the TVT group and 86% in the Burch-colposuspension group did not report any difference in sexual satisfaction following surgery, while in the TVT group, 23% expressed negative and 4% positive changes, and in the Burch-colposuspension group 9% expressed negative and 5% positive post surgical changes. The differences in sexual satisfaction rates between the two groups were not considered significant. The majority (54%) of those who expressed a negative change suffered from dyspareunia. CONCLUSIONS: Although sexual satisfaction seems to be more adversely affected by TVT compared to Burch-colposuspension, the difference was not statistically significant. Further studies are required concerning different anti-incontinence techniques in order to arrive at more precise conclusions

Does Vaginal Anti-Incontinence Surgery Affect Sexual Satisfaction? A Comparison of TVT and Burch-Colposuspension

Objective: To evaluate the sexual satisfaction rates of women who underwent tension-free vaginal tape (TVT) procedure for stress urinary incontinence and compare it with the results of Burch-colposuspension

Is It Possible to Predict Urodynamic Stress Urinary Incontinence in Women with Minimal Diagnostic Evaluation?

Objectives: To determine whether it is possible to predict urodynamic stress urinary incontinence (uSUI) in women with minimal diagnostic evaluation. Materials and Methods: Medical records of 2,643 female incontinent patients were reviewed and 301 women were eligible for this study. The positive predictive values (PPV), sensitivity, specificity and negative predictive values (NPV) for uSUI and uSUI with or without detrusor overactivity (DO), and DO patients of pure SUI symptom (group 1), combination of pure SUI symptom and positive provocative stress test (+PST; group 2) and combination of pure SUI symptom, +PST and absence of overactive bladder symptoms (group 3) were calculated for each group. Results: Mean age was 51.03 years (22-88). PPV, sensitivity and specificity values for uSUI with or without DO of group 3 were 100, 7.4, and 100%, while these values for pure uSUI were 93.3, 9.3, and 99.3%, respectively. Interestingly, none of the patients in groups 2 and 3 had DO. Conclusions: Our results show that it was possible to predict uSUI with high accuracy using minimal diagnostic evaluation in a group of female patients with pure stress incontinence symptoms +PST while it was also possible to eliminate DO accurately in this group of patients. (C) 2014 S. Karger AG, Base

Hidrosefali ile Komplike Olan Bir İntraventriküler Hipotansiyon Vakası

AIM: Intracranial hypotension may have variable clinical presentation. The imaging characteristics of intracranial hypotension are especially well depicted on magnetic resonance imaging studies. Although the clinical and radiological manifestations of spontaneous intracranial hypotension are increasingly recognized in many reports, many other abnormalities in this disorder and complicating cases still exist. MATERIAL and METHODS: A 16-year-old patient suffering from nausea, vomiting and blurred consciousness was admitted to the hospital. MRI showed diffuse pachymeningeal thickening resembling intracranial hypotension and ventricular enlargement like compensated hydrocephalus. The patient was investigated and treated using endoscopic third ventriculostomy. CONCLUSION: The authors presented a case of intracranial hypotension complicated with hydrocephalus. Specific causes for intracranial hypotension as well as additional new treatment options will also be discussed.Wo