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Journal Article 2016; 37(4): 308-312 PubMed PMID: 27857048 Citation  Keywords:  Cardiac Surgical Procedures, Child, Child, Preschool, Cicatrix:diagnostic imaging, Coronary Vessel Anomalies:surgery, Echocardiography, Female, Fibrosis, Humans, Infant, Magnetic Resonance Imaging, Male, Myocardium:pathology, Postoperative Complications:d.   

OBJECTIVES: Prognosis of patients with anomalous origin of the left coronary artery from pulmonary artery has dramatically improved as a result of both, early diagnosis and improvements in surgical techniques. Post surgical complications are rare and most patients show quick improvement of the left ventricular performance after repair with complete functional recovery within one year after surgery. Exercise-induced electrocardiographic changes have been found in patients postoperatively and scars and perfusion deficits of the left ventricle may not be detected by standard echocardiographic evaluation.

METHODS: Authors present 6 cases of anomalous origin of the left coronary artery from pulmonary artery observed at Martin Univesity Hospital and Pediatric Cardiology Clinic over the last eight-year period. In order to assess the presence of myocardial injury, cardiovascular magnetic resonance imaging with late gadolinium enhancement technique was performed in all 6 cases one year after surgical correction.

RESULTS: One patient died 1.5 year after surgical treatment. One year after surgery, the heart size and myocardial functions returned to normal in all patients. Cardiovascular magnetic resonance imaging demonstrated subendocardial late gadolinium enhancement in varios segments of the left ventricle, representing myocardial fibrosis in all patients one year after surgical correction.

CONCLUSION: Because of the presence of scarr tissue, the long term prognosis of these patients remains unclear. The damaged tissue may have arrhythmogenic potential, therefore close follow-up, excercise testing and avoidance of high-level sport activities may be needed....

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Journal Article 2016; 37(3): 233-238 PubMed PMID: 27618608 Citation  Keywords:  Adolescent, Adult, Aged, Child, Endoscopy, Female, Follow-Up Studies, Humans, Hydrocortisone:blood, Male, Middle Aged, Monitoring, Physiologic, Neurosurgical Procedures:methods, Pituitary ACTH Hypersecretion:blood, Pituitary Gland:surgery, Postoperative C.   

INTRODUCTION: To increase radicality and avoid surgical complications new treatment options are under investigation. One of the promising possibilities is to assess early morning cortisol levels on the first and second postoperative day.

MATERIAL AND METHODS: We enrolled 34 patients (9 males, 25 females) diagnosed with Cushing's disease. Blood samples to determine cortisol level were taken always at 06:00 and sent to the lab. The samples were taken on the first and second postoperative day. For all patients, standard four-handed, a bi-nostril endoscopic endonasal technique was used. Endocrinological follow-up (6-34 months) was performed using morning cortisol sampling.

RESULTS: In total, 36 patients (88%) were disease-free post-surgery. In the group with early postoperative levels of morning cortisol of less than 463 nmol/L, only 2 of 29 patients (7%) exceeded the final morning level of cortisol at follow-up. In patients with early postoperative cortisol levels between 17 nmol/l and 234 nmol/l all subjects showed normal postoperative cortisol levels.

DISCUSSION: In 30 of 34 patients (88%), the level of cortisol was within normal limits. The prediction importance of early measurement of cortisol is 93% for patients with early postoperative cortisol levels of less than 463 nmol/L. The prediction importance of early measurement of cortisol is 100% for patients with early postoperative cortisol levels from 17 to 234 nmol/L.

CONCLUSION: The monitoring of early morning cortisol levels seems to be an important tool in the management of central Cushing's disease....

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Case Reports 2014; 35(4): 252-256 PubMed PMID: 25038596 Citation  Keywords:  Adult, Cerebrum:metabolism, Diabetes Insipidus:blood, Diagnosis, Differential, Humans, Hyponatremia:blood, Intraoperative Complications, Postoperative Complications:blood, Postoperative Period, Sodium:blood, Syndrome, Ventriculoperitoneal Shunt:adverse ef.   

: Cerebral salt wasting syndrome (CSW-cerebral salt wasting) was first described in 1950 by Peters. This syndrome can occur in patients who have sustained damage to the central nervous system (e.g. patients with subarachnoid bleeding, bacterial meningitis or after neurosurgery). Patients present with excessive natriuresis and hyponatremic dehydration. Differentiating this syndrome with the syndrome of inappropriate antidiuretic hormone secretion (SIADH-syndrome of inappropriate antidiuretic hormone secretion), which may occur in the same group of patients, is necessary in order to administer the correct treatment which consists of fluid restriction and sodium replacement in SIADH and fluid and sodium replacement as well as occasional mineralocorticoid therapy in CSW....

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Case Reports 2012; 33(6): 590-596 PubMed PMID: 23160226 Citation  Keywords:  Aged, Brain Neoplasms:diagnosis, Fatal Outcome, Female, Humans, Hydrocephalus:diagnosis, Hypothalamic Diseases:diagnosis, Hypothalamus:surgery, Male, Middle Aged, Neurosurgical Procedures:adverse effects, Postoperative Complications:diagnosis, Subdural Ef.   

BACKGROUND: Opening of the lamina terminalis is often used in surgery of the optico-chiasmatic region. Consequently, alteration of cerebral-spinal fluid (CSF) dynamics can occur after this manoeuvre, thus potentially translating into clinical complications. Herein, we describe 2 cases in which clinically relevant hypothalamic dysfunctions developed after few days opening of the lamina terminalis both patients showed mild to moderate preoperative hydrocephalus which improved postoperatively.

CASES DESCRIPTION: In a patient with ruptured aneurysm of the basilar bifurcation, opening of the lamina terminalis was performed prior to acute-stage clipping. On postoperative day 7th, the patient developed significant subdural hygroma, mild disturbances of consciousness and increase of ADH concentration. These clinical features resolved only following subdural hygroma drainage and ventricular-peritoneal shunting. One previously operated patient in whom the lamina terminalis had been opened to remove a sizeable parasellar tumour showed a similar post-operative course. In this patient, sole subdural hygroma drainage was not an effective treatment, and the patient died subsequently for complications related to long-standing, though mild, hypothalamic dysfunction.

CONCLUSIONS: Our experience may suggest that hypothalamic dysfunctions should be reminded as a possible, although rare, complication following the opening of the lamina terminalis. This clinical condition, if not properly managed, may contribute to trigger severe life-threatening complications....

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Case Reports 2012; 33(2): 107-112 PubMed PMID: 22592189 Citation  Keywords:  Adult, Deamino Arginine Vasopressin:therapeutic use, Diabetes Insipidus:complications, Female, Humans, Pituitary Apoplexy:complications, Pituitary Neoplasms:complications, Postoperative Complications:drug therapy, Pregnancy, Pregnancy Complications, Neopl.   

BACKGROUND: Pituitary apoplexy during pregnancy is so rare that only 15 cases (12 pituitary adenomas, 2 lymphocytic neurohypophysitis, and 1 normal pituitary gland) have been published to date. Here, we report the case of a pregnant woman presenting with pituitary apoplexy from a nonfunctioning pituitary adenoma and provide a possible mechanism and management option for postoperative diabetes insipidus (DI).

CASE PRESENTATION: A 26-year-old woman presented with sudden onset of headache and bitemporal hemianopsia in the 26th week of her first pregnancy. Magnetic resonance imaging clearly revealed an 18 mm pituitary mass with a fluid-fluid level component displacing the optic chiasma upward. Endonasal endoscopic transsphenoidal surgery was successfully carried out 7 days after the onset of symptoms. DI became apparent immediately after the operation and was not controllable by arginine vasopressin (AVP) but by 1-desamino-8-D-arginine vasopressin (DDAVP) instead. This finding suggests an association between DI and vasopressinase secretion from the placenta, because vasopressinase can degrade AVP but not DDAVP. DI had diminished by the time the patient delivered a healthy girl at the 40th week of gestation.

CONCLUSION: Postoperative DI associated with pituitary apoplexy during pregnancy should be treated by DDAVP, which is not affected by placental vasopressinase secretion....

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Journal Article 2011; 32(6): 874-878 PubMed PMID: 22286795 Citation  Keywords:  Adult, Biomarkers:blood, Cardiovascular Diseases:blood, Cervical Vertebrae:surgery, Female, Humans, Male, Middle Aged, Natriuretic Peptide, Brain:blood, Peptide Fragments:blood, Postoperative Complications:blood, Prospective Studies, Sodium:metabolism,.   

OBJECTIVES: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is increasingly being used as a biomarker of cardiovascular risk. To date neither its cut-off for postoperative period in noncardiac surgery nor whether the cardiovascular risk has any relation to natriuresis has been assessed.

DESIGN: The prospective observational study evaluated postoperative serum levels of NT-proBNP with fractional excretion of sodium (FENa+) and sodium clearance (CNa+) in relation to the occurrence of cardiovascular events in patients after elective cervical spine surgery.

METHODS: In 27 otherwise healthy patients after elective cervical spine surgery we prospectively measured serum NT-proBNP and serum sodium immediately after the operation (day 1) and on day two. We correlated both NT-proBNP with FENa+, CNa+, diuresis and intake of fluids and sodium, which were assessed from the beginning of the operation until day two. We followed the incidence of myocardial infarction, heart failure and cardiac death postoperatively to 1 year.

RESULTS: Immediate postoperative NT-proBNP values were within the reference range (mean 4.53 ± 2.48 pmol/l), but they increased significantly on the second day (mean 23.57 ± 12.27 pmol/l, p<0.001). Significantly elevated CNa+ (0.033 ± 0.014 ml/s, p<0.001), FENa+ (0.018 ± 0.008, p<0.001) and fUNa+ (mean 326.9 ± 125.2 mmol, p<0.01) were found. There was a significant positive correlation between the two values of NT-proBNP (r=0.47, p=0.014), but we did not find any correlation between NT-proBNP and the further measured parameters. None of the patients had any cardiovascular events from operation until 1 year.

CONCLUSIONS: The significant postoperative elevation of NT-proBNP had no relationship with the rise in FENa+, CNa+ or fUNa+ and was not connected with any occurrence of cardiovascular events in patients after elective cervical spine surgery....

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Case Reports 2011; 32(5): 627-630 PubMed PMID: 22167133 Citation  Keywords:  Craniopharyngioma:complications, Diabetes Mellitus, Type 2:drug therapy, Female, Humans, Hypoglycemic Agents:therapeutic use, Pituitary Neoplasms:complications, Postoperative Complications:drug therapy, Young Adult,.   

: A 23-year-old non-diabetic woman presented to our emergency room with progressive headache. She was diagnosed with craniopharyngioma and received tumor resection. Her blood glucose level was within the normal limit before surgery, and she had no family history of diabetes. Three months after the surgery, acute hyperosmolar hyperglycemic state developed. After 4 months of follow-up, her diabetes persisted but improved with oral antidiabetic drugs. This is the third case report of diabetes developing several months after craniopharyngioma tumor resection. The possible mechanisms of cranipharyngioma or its surgery inducing diabetes mellitus are hypothalamic obesity or hypothalamic damage. The degree of hypothalamic damage before the operation is predictive of diabetes development, and blood glucose level monitoring is important for these patients....

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Case Reports 2011; 32(Suppl 2): 9-12 PubMed PMID: 22101874 Citation  Keywords:  Aged, Anti-Bacterial Agents:therapeutic use, Aortic Valve:pathology, Cardiac Surgical Procedures, Endocarditis, Bacterial:etiology, Fever:etiology, Heart Valve Prosthesis:adverse effects, Heart Valve Prosthesis Implantation, Humans, Male, Postoperative Co.   

: In this report, we present a case of a 68-year-old male who developed extensive, devastating prosthetic valve endocarditis (PVE) several months following aortic valve replacement with a tissue valve St. Jude Epic Supra. He was successfully treated with a complex surgical procedure. In the discussion, we focus on the issues of prosthetic aortic valve endocarditis and various modes of treatment....

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