ContextThe development of diabetes insipidus (DI) following transsphenoidal resection of pituitary adenomas has been associated with higher postsurgical morbidity and longer hospitalizations. Identifying these patients promptly and efficiently can lead to improved health care outcomes.ObjectiveWe evaluated our institution’s incidence of DI following pituitary adenoma resection and assessed for preoperative risk factors that were associated with postoperative DI.DesignA retrospective review of 271 patients who underwent endoscopic endonasal resection of a pituitary adenoma between July 2010 and December 2016 by a single neurosurgical provider was completed.SettingAll cases were from a single-center, academic institution.PatientsPatients with a pituitary adenoma diagnosis confirmed on histology were included in the study. Those with previous surgery by a different provider were excluded.ResultsThe incidence of DI at our institution was 16.6% (45 of 271 patients), with only 4% (11 patients) having permanent DI. The presence of visual abnormalities (CI 1.29 to 4.75), suprasellar extension (CI 1.36 to 6.88), and maximal tumor diameter (1.02 to 1.08) was significantly associated with an increased incidence of postoperative DI (P < 0.05). Hyperprolactinemia, tumor functionality, and cerebrospinal fluid exposure were not associated with higher rates of postoperative DI (P > 0.05).ConclusionPituitary adenoma patients presenting with visual abnormalities, suprasellar extension, or large tumors are at higher risk of developing DI postoperatively. These patients warrant closer postoperative monitoring as well as adequate preoperative counseling to decrease their postsurgical morbidity.
Cerebrospinal fluid (CSF) from 274 cases of subacute to chronic meningitis in age groups from 3 months to 12 years were analysed for the presence of antibody response to mycobacterial and cysticercal antigens by enzyme linked immunosorbent assay (ELISA). Simultaneously other correlative parameters such as CSF cell cytology by cytospin studies, mycobacterial antigens of Lipoarabinomannan (LAM) type (a polysaccharide antigen) by reverse passive haemagglutination assay (RPHA) CSF C-reactive protein (CRP) by latex agglutination and microbial cultures for mycobacterium tuberculosis and fungi were carried out. Antimycobacterial antibody was present in 35.4% of the cases. In 57.66% of the cases there was no demonstrable immune response to either mycobacterial or cysticercal antigens. However, it was interesting to note that 5.47% of the cases revealed the presence of anticysticercal antibody in the CSF. The mycobacterial antigen (LAM polysaccharide antigen) was found in 72.6% of the cases. There was no evidence of carcinomatous or cryptococcal meningitis. This study stresses the role of multimodal diagnostic tests on CSF for investigating cases of chronic and subacute meningitis irrespective of leading clues such as tuberculosis.
F Sbeih, S El Boghdadly, V Palkar, P Nayak, Endoscopic Retrograde Cholangiopancreatography (Ercp) for Symptomatic Choledocholithiasis During Pregnancy. 1997; 17(2): 233-234 Choledocholithiasis, although uncommon during pregnancy, is a challenging condition with serious potential complications for the mother and fetus. As the risk of fetal loss from surgery is high, 1,2 surgeons defer, whenever possible, cholecystectomy and exploration of the common bile duct (CBD) until after delivery.3,4 Fetal exposure to ionizing radiation has been a concern and the reason for not performing endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy in the past. Over the last few years, there were a few small series and case reports 5-8 describing ERCP and endoscopic sphincterotomy (EST) for the management of choledocholithiasis during pregnancy. We describe the safe and effective use of ERCP and EST to remove symptomatic common bile duct stones in two pregnant women. Patients and MethodsTwo pregnant women were admitted to hospital because of repeated episodes of biliary pain, with evidence of obstructive jaundice by liver biochemical tests and abdominal ultrasound. In one patient, there was also evidence of biliary pancreatitis. The decision to perform ERCP was made after discussing the case with the attending surgeon and obstetrician. All possible measures to protect the fetus from radiation had been discussed and arranged with the radiologist. Both patients received prophylactic antibiotics intravenously. Conscious sedation with small doses of demerol and diazepam were administered intravenously. Patients underwent the procedure in the prone position. Measures were taken to protect the fetus from radiation, consisting of shielding the abdomen of the mother with a lead apron and limiting the radiation time to the minimum possible. Selective cannulation of the biliary duct could be achieved in both cases. Case 1A 25-year-old Saudi female, who was 16 weeks pregnant, presented to the emergency room with a two-week history of attacks of biliary pain, which became more severe on the day of presentation and was associated with nausea and vomiting. The urine color became dark one day prior to presentation. The physical examination was remarkable for mild scleral icterus and right upper quadrant (RUQ) abdominal tenderness. The biochemical tests of the liver were reported as follows: total bilirubin 49 μmol (normal <17), direct 42 (normal <7), AST 151 U/L (normal 15-37), ALT 239 U/L (normal 30-65), alkaline phosphatase 262 μmol/L (normal 50-136) and gamma GT 140 U/L (normal 15-85). Serum amylase was normal. The abdominal ultrasound examination showed a distended gallbladder filled with stones, mildly dilated intrahepatic ducts and moderate dilation of the CBD (1.2 cm) with a stone in its distal part. Preparation, as mentioned earlier, was undertaken. ERCP with selective cannulation of the biliary system was performed and revealed a 0.5-cm stone in the distal end of the CBD. Subsequently, EST was performed and the stone...
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