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Case Reports 2012; 33(8): 765-768 PubMed PMID: 23391974 Citation  Keywords:  Adenoma:surgery, Adult, Angiography, Digital Subtraction, Female, Humans, Male, Middle Aged, Neuronavigation:methods, Neurosurgical Procedures:methods, Oculomotor Nerve Diseases:surgery, Pituitary Neoplasms:surgery, Sella Turcica:diagnostic imaging, Sphen.   

: A concha non-pneumatized sphenoid is considered to be a contraindication for the transsphenoidal resection of a pituitary adenoma. Specifically, this anatomical variation makes it difficult to approach the sella turcica. However, in this report, an intra-operative navigational system was used as a guide to access the sella through the sphenoid sinus. This procedure was found to be both reasonable and safe....

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Clinical Trial 2012; 33(7): 722-726 PubMed PMID: 23391885 Citation  Keywords:  Abdomen:surgery, Adult, Analgesics, Opioid:administration & dosage, Biomarkers:blood, Drug Monitoring:methods, Elective Surgical Procedures, Female, Humans, Hysterectomy:methods, Infusions, Subcutaneous:methods, Middle Aged, Morphine:administration & dosa.   

OBJECTIVES: Systemic β-endorphin, an endogenous opioid and stress hormone, has been demonstrated to correlate with the postoperative pain intensity, however its putative role as a postoperative pain biomarker has not been cleared.

METHODS: Thirty patients scheduled for elective hysterectomy were included into the study. Postoperative pain was assessed by a numeric rating scale from 0 to 10. Plasma morphine concentrations were determined using high performance liquid chromatography with UV detection. Plasma β-endorphin concentrations were measured by a radioimmunoassay.

RESULTS: Administration of morphine in intravenous infusion turned out to be a markedly better method of morphine administration up to 4th hour postoperatively regarding both drug concentration and pain rating. A significant correlation between systemic β-endorphin concentration and pain rating at the 4th postoperative hour was found. No association between morphine and β-endorphin concentrations was detected.

CONCLUSION: Systemic β-endorphin is not an appropriate pain marker in postoperative gynaecologic patients....

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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(5): 483-488 PubMed PMID: 23090264 Citation  Keywords:  Adult, Critical Illness, Dopamine Agonists:therapeutic use, Female, Humans, Neurosurgical Procedures:methods, Pituitary Apoplexy:drug therapy, Pituitary Neoplasms:drug therapy, Pregnancy, Pregnancy Complications:drug therapy, Prolactinoma:drug therapy, Sp.   

: Prolactinoma is the most common secreting pituitary adenoma. It is typically diagnosed in women of reproductive age and is common cause of infertility. Currently the treatment of choice is pharmacotherapy with dopamine agonists, whereas surgical treatment is reserved for a selected group of patients. Pituitary-tumor apoplexy is a rare, life-threatening condition associated with significant morbidity and mortality. The authors present the case of a 25-year-old woman with prolactinoma treated with dopamine agonist. In course of such a treatment the patient became pregnant. The bromocriptine was gradually withdrawn. In the 14th week of pregnancy she was admitted for symptoms suggesting pituitary tumor apoplexy. The treatment with bromocriptine was reinitiated. In the 20th week of pregnancy further deterioration of the patient's neurological condition and visual-field abnormalities were observed. The patient was qualified for surgical treatment - selective transsphenoidal adenomectomy. The successful surgery led to improvement of neurological condition. The early postoperative PRL level decreased significantly and hormonal function of the pituitary was preserved. The pregnancy ended in 38th week with a caesarean section. Endocrinological evaluation conducted after the uneventful delivery confirmed normal function of the pituitary. Magnetic resonance imaging (MRI) did not reveal tumor re-growth. The patient is kept under constant medical care. In this case study the authors discussed therapeutic management and reviewed literature regarding gestational pituitary-tumor apoplexy with particular emphasis on surgical treatment....

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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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Case Reports 2011; 32(3): 234-237 PubMed PMID: 21712785 Citation  Keywords:  Adult, Antineoplastic Agents:therapeutic use, Bone Marrow:pathology, Decompression, Surgical, Female, Humans, Immunohistochemistry, Leukemia, Myelogenous, Chronic, BCR-ABL Positive:complications, Leukocyte Count, Low Back Pain:etiology, Magnetic Resonance.   

: Granulocytic sarcoma (GS) may be a presenting sign of myelogenous leukemia. Occasionally, an extramedullary neoplasm composed from myelocytic precursor cells occurs in patients without evidence of leukemia. Rarely, undiagnosed leukemia occurs initially manifesting with paralysis to spinal cord GS. We present a case report of 20-year-old girl with an undiagnosed leukemia, initially manifesting as paralysis. En bloc spondylectomy with chemotherapy postoperatively constituted the treatment of choice for this tumor. After two courses of chemotherapy, the patient made a good postoperative recovery with notable bilateral lower extremity improvement....

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Case Reports 2010; 31(5): 597-601 PubMed PMID: 21173743 Citation  Keywords:  Adult, Anti-Bacterial Agents:therapeutic use, Biopsy, Brain Abscess:drug therapy, Diagnosis, Differential, Female, Headache:etiology, Humans, Magnetic Resonance Imaging, Neurosurgical Procedures, Pituitary Diseases:complications, Sphenoid Bone:surgery, Tr.   

OBJECTIVES: Pituitary abscess is rare disease and the correct diagnosis is difficult because there are non-specific symptoms and it is often radiologically indistinguishable from other pituitary lesions.

CASE PRESENTATION: We present one case of pituitary abscess that constitute 0.15% of all pituitary adenomas operated in our department in the 20 years. A 49-year-old woman presented with a history of 10 months bifrontal headache. The MRI showed cystic intra and suprasellar mass with ring enhancement after contrast injection. During transsphenoidal surgery, copious yellowish pus was found. Antibiotic therapy was performed. Histological study of the cyst wall confirmed the diagnosis of pituitary abscess.

CONCLUSION: Pituitary abscess should be considered in the differential diagnosis of all other cyst mass in patients with diabetes insipidus....

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Journal Article 2009; 30(2): 262-267 PubMed PMID: 19675521 Citation  Keywords:  Adolescent, Adrenal Hyperplasia, Congenital:pathology, Child, Child, Preschool, Disorders of Sex Development:pathology, Female, Genitalia:abnormalities, Genitalia, Female:abnormalities, Humans, Infant, Male, Reconstructive Surgical Procedures, Treatment O.   

INTRODUCTION: Ambiguous genitalia always present diagnostic and therapeutic problem. Long-term results of feminizing operations are unsatisfactory in some cases and reports from follow-up after feminizing genitoplasty are rare in the literature. Systematic studies are needed to evaluate ultimate function of all girls undergoing feminizing surgery. In our opinion, the lack of worldwide-accepted scale for the assessment of long-term effects of feminizing genitoplasty, enabling the possibility of comparing outcomes between institutions and countries, may contribute to this deficit of reliable data.

AIM: The aim of the study was the evaluation of the outcomes of surgical management of masculinization using a novel scale developed by the authors.

MATERIAL AND METHODS: We examined 43 patients aged 3-24 years (mean age 15,4 years) operated due to ambiguous genitalia. Most of the patients were females with congenital adrenal hyperplasia (CAH) diagnosed in 38 of subjects (88.4%).The patients were operated at the age from 10 months - 15 years (mean age 4,5 years). Five patients had to be reoperated. The effects of surgical management in ambiguous genitalia were assessed using our own scale. We evaluated five anatomical and cosmetic parameters (general appearance, size of pudendal labia, symmetry of pudendal labia symmetry, size and position of clitoris, size of introitus and position of urethra opening), each of them was scored 0-2 points.

RESULTS: In 36 of examined patients the result of the surgery was considered good, in 4 patients - satisfactory and in 3 - poor. The most common complication of feminizing genitoplasty in our patients was stenosed vagina (in 10 patients, 23.8%). Location of urinary coil in anterior wall of vagina was found in 6 patients (13.9%) and in 1 patient it was invisible (2.3%). Post-operational clitoral enlargement was found in 3 cases (6.9%).

CONCLUSION: Taking into consideration controversial data about the results of feminizing genitoplasty, a standarized, well-defined and commonly accepted scale enabling comparison between methods and institutions is necessary. In our opinion scoring scale makes the evaluation more precise and the results are more comparable....

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