Adrenal gland surgery needs a multidisciplinary team including endocrinologist, radiologist, anesthesiologist, and surgeon. The indications for adrenal gland surgery include hormonal secreting and non-hormonal secreting tumors. Adrenal hormonal secreting tumors present to the anesthesiologist unique challenges requiring good preoperative evaluation, perioperative hemodynamic control, corrections of all electrolytes and metabolic abnormalities, a detailed and careful anesthetic strategy, overall knowledge about the specific diseases, control and maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will focus on the endocrine issues, as well as on the above-mentioned aspects of anesthetic management during hormone secreting adrenal gland tumor resection.
Background; Coronavirus disease-19 (COVID-19) is an infectious respiratory disease. The first confirmed case of 2019-nCoV infection in Albania was reported in Tirana on 08 March 2020, when a patient and his adult son who had come from Florence, Italy tested positive. Patients with COVID-19 can be presented with a series of signs and symptoms. Acute abdomen as a presentation of COVID-19 is rare. The diagnosis of COVID-19 should be suspected and investigated in every case of acute abdomen. Case presentation: We report a case of a 42-year-old male who presented with features of acute appendicitis. SARS-CoV-2 polymerase chain reaction test result was positive for COVID-19. Abdominal ultrasonography and his computed tomography of the chest and abdomen showed a perforated appendix and no infiltrates or abnormalities of COVID-19. The diagnosis of our case was appendicitis with COVID-19 without pneumonia. He was admitted and treated with antibiotic therapy and supportive care. He had an improvement in his health condition which made it possible to leave the hospital on the third day of hospitalization. Conclusion: Based on our clinical case and literature data, we suggest that clinicians should suspect the diagnosis of acute appendicitis in patients with COVID 19. So the case of acute abdomen pain must be completed with a SARS-CoV-2 test. Therefore we recommend additional studies to reinforce the idea of linking SARS COV 2 infection with acute appendicitis.
An abdominal aortic aneurism (AAA) is an enlargement of the lower part of the aorta that extends through the abdominal area.The diameter of the aneurismatic vessel is represented by 3 cm or more in either anterior – posterior , or transverse planes. The developpement of Abdominal aortic aneurysm (AAA) is a complex, multifactorial process involving destructive remodeling of aortic wall connective tissue. Four interrelated factors involved in this process include: (1) chronic inflammation associated with neovascularization and increased proinflammatory cytokine production, (2) increased and dysregulated production of matrix-degrading proteinases, (3) destruction of structural matrix proteins, and (4) decreased medial smooth muscle cell (SMC) presence, resulting in impaired connective tissue repair. This understanding has developed from a characterization of human AAA tissue, as well as the use of different animal models that replicate human disease. The mortality of ruptured AAA is set between 40 – 70% in patients that manage to arrive alive in the emergency room, and that of 90% in overall patients confirmed with rAAA in the autopsy results. A ruptured abdominal aortic aneurysm (rAAA) represents a disruption of a dilated aortic wall that leads to blood outside the aortic wall.
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