1/59. Anesthetic management for pheochromocytoma resection using spinal cord stimulation and intravenous nicardipine--a case report.We have used spinal cord stimulation (SCS), diazepam and nitrous oxide for maintenance of general anesthesia. blood pressure was maintained by bolus administration of nicardipine for the removal of pheochromocytoma. Both SCS and nicardipine reduced systemic vascular resistance and SCS increased cardiac output. However, neither SCS nor nicardipine could inhibit the release of norepinephrine. SCS proved to be useful as one of anesthetic technique during the removal of pheochromocytoma, and also in the management of postoperative pain and the prevention of complications.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/59. Difficult anesthetic management during pheochromocytoma surgery.The anesthetic management of two middle-aged patients having surgical removal of large pheochromocytomas is described. The same team of physicians was involved in the care of the patients, including an endocrinologist, who supervised their preoperative care. Although the preoperative care included pharmacologic adrenergic receptor blockade and fluid administration, guidelines for surgical readiness did not follow those recommended in our literature. Both patients experienced severe intraoperative hypotension after complete interruption of the tumors' venous drainage, and one patient suffered a cardiac arrest. Explanations for the occurrence of these problems are discussed, including factors relating to the complexity of the disease process. However, it is conceivable that appropriate input from the anesthesiologist during the preoperative preparation of these patients may have ameliorated, if not prevented, the encountered difficulties.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/59. pheochromocytoma of the urinary bladder: a case report.We present a 66-year old female patient with pheochromocytoma of the urinary bladder. We performed transabdominal needle biopsy of the tumor without suspicion of pheochromocytoma because of her well-controlled blood pressure and no characteristic symptoms following administration of antihypertensive medication. Hypertensive crisis (260/130 mmHg) occurred just after the needle insertion. The diagnosis was pheochromocytoma. The norepinephrine level in the serum and her blood pressure normalized without antihypertensive medication after partial cystectomy. pheochromocytoma should be suspected in cases of intramural bladder tumors, especially in a normotensive patients receiving antihypertensive medication.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/59. interleukin-6 (IL-6) producing phaeochromocytoma: direct IL-6 suppression by non-steroidal anti-inflammatory drugs.A 35-year-old Japanese woman presented with a phaeochromocytoma and demonstrated marked inflammatory reactions and pyrexia as a result of excessive production of interleukin-6 (IL-6) by the tumour. serum IL-6 level was 262 ng/l (normal; < 4.0 ng/l). fever and inflammatory markers were largely overcome by the administration of the nonsteroidal anti-inflammatory drug, naproxen, and all symptoms disappeared soon after the tumour was excised. Immunohistochemical study revealed positive staining using an antihuman IL-6 antibody and Northern analysis showed increased IL-6 mRNA levels in the tumour. Cultured tumour cells showed IL-6 protein synthesis, and nonsteroidal anti-inflammatory drugs such as naproxen and indomethacin directly inhibited IL-6 release. These results indicate that the effects of naproxen in vivo were due, at least in part, to direct suppression of IL-6 secretion from the tumour.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/59. Elevated vascular resistance after labetalol during resection of a pheochromocytoma (brief report).PURPOSE: To report a case of pheochromocytoma exhibiting an increase in systemic vascular resistance index (SVRI) and decreased cardiac index (CI) after use of labetalol. CLINICAL FEATURES: A 36-yr-old male underwent adrenectomy for pheochromocytoma. midazolam 5 mg, fentanyl 100 microg and labetalol 20 mg were administrated intravenously for premedication upon arrival in the operating theatre. After induction of anesthesia with fentanyl, thiopental and atracurium, 30 mg iv labetalol was administered. The blood pressure gradually rose to 178/101 mmHg with mildly increased SVRI (1958 dn-sec(-1).m(2).cm(5)) and stable CI (3.8 L.min(-1).m(2) ). The blood pressure reached 247/150 mmHg after intubation with an increase in SVRI (3458 dn-sec(-1).m(2).cm(5)) and a decrease in CI (3.6 L.min(-1).m(2)). The SVRI increased further to 4986 dn-sec(-1).m(2).cm(5) and CI declined to 2.4 L.min(-1).m(2) after the administration of additional labetalol 20 mg. sodium nitroprusside was administered and the blood pressure declined immediately to 108/72 mmHg, with a decreased SVRI (2526 dn-sec(-1).m(2).cm(5)) and stable CI (2.3 L.min(-1).m(2)). CONCLUSIONS: The elevated SVRI with low CI was considered to result from increased alpha-adrenergic activity secondary to ss-adrenergic blockade with labetalol. Clinicians should be aware of the possibility of a hypertensive crisis after iv labetalol. We suggest that labetalol should be replaced promptly with alpha-adrenergic blockers or other vasodilators when such a condition arises.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
6/59. A painful pulsatile abdominal mass in a young man with elevated blood pressures: an unusual presentation of phaeochromocytoma.We report an unusual presentation of phaeochromocytoma in a young man with a painful, pulsatile abdominal mass and elevated blood pressures. This led to a delay in diagnosis and resulted in the administration of triggers of catecholamine release, possibly causing a catecholamine surge. This caused the development of catecholamine-induced cardiomyopathy and multiple organ failure, requiring inotropic and ventilatory support, intra-aortic balloon pump and dialysis. Fortunately, his condition reversed with supportive treatment and alpha-adrenergic blockade. This illustrates the importance of having a high index of suspicion of phaeochromocytoma, especially in young patients with elevated blood pressures.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/59. Cardiac failure and multiple organ dysfunction syndrome in a patient with endocrine adenomatosis.In this case report, we present the successful therapy of severe cardiac failure in pituitary adrenal insufficiency. A previously healthy 56-year-old-man in pituitary coma due to an atypical variant of multiple endocrine adenomatosis (pituitary adenoma and pheochromocytoma) suffered from cardiac failure resistant to catecholamine and standard hydrocortisone therapy. After two bolus injections of dexamethasone (2 x 24 mg) mean arterial pressure and cardiac function dramatically improved, probably due to restoration of permissive effects on catecholamine action and reversal of pathophysiological mechanisms of cardiac failure. We conclude that in patients with severe cardiovascular failure in pituitary coma the administration of potent glucocorticoids may be more effective in reversing cardiovascular failure than standard dosages of hydrocortisone.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
8/59. Cushing's syndrome associated with ectopic production of corticotrophin-releasing hormone, corticotrophin and vasopressin by a phaeochromocytoma.We describe a case of Cushing's syndrome caused by a phaeochromocytoma secreting corticotrophin-releasing hormone (CRH) and corticotrophin (ACTH). A 49-year-old white woman presented with a 1-month history of lower limb oedema, polydipsia and polyuria. physical examination revealed a patient with plethoric facies, lanugo-type facial hair, central obesity, red abdominal striae, lower limb oedema, and blood pressure of 210/115 mmHg. Laboratory studies showed high plasma ACTH and markedly elevated urinary cortisol excretion that suppressed more than 50% with high-dose dexamethasone administration. Computed tomographic scan of the abdomen showed a 4-cm left adrenal tumour. catecholamines and metabolites were markedly increased in a 24-hour urine collection. Results of venous catheterization studies showed that CRH and ACTH were secreted by the tumour. In addition, with ovine CRH administration, inferior petrosal sinus sampling showed pituitary secretion of ACTH. Left adrenalectomy resulted in complete remission of Cushing's syndrome. light microscopic and immunohistochemical studies revealed a phaeochromocytoma that produced CRH, ACTH and vasopressin. rna studies showed that this tumour, in contrast to normal adrenal and other reported phaeochromocytomas, transcribed a lone pituitary-sized (1200 nucleotide) pro-opiomelanocortin mRNA. This is the second reported case of a CRH-secreting phaeochromocytoma.- - - - - - - - - - ranking = 2keywords = administration (Clic here for more details about this article) |
9/59. Effects of repeated doses of pseudoephedrine on blood pressure and plasma catecholamines in normal subjects and in patients with phaeochromocytoma.1. Increases in blood pressure (BP) and in plasma noradrenaline concentration (NA) were observed after two doses of a non-prescription decongestant containing pseudoephedrine (PE) in two of three patients with phaeochromocytoma, before but not after removal of the tumour. The pressor response was terminated by oral phenoxybenzamine, and modified by prior exposure to this drug. 2. In eight normal subjects administration of the same two doses prevented falls in BP and in NA usually seen with prolonged recumbency, but neither BP nor NA increased. However, a pressor response was observed in a normal subject with a strong family history of hypertension. 3. Exposure to PE in non-prescription decongestants is not without risk in hypertension.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
10/59. Spontaneous rupture of adrenal pheochromocytoma with capsular invasion.A 67-year-old Japanese man developed a sudden onset of severe right-side upper abdominal pain, nausea and vomiting. On hospitalization, physical examination revealed sweating, tachycardia, hypertension and the appearance of peripheral vasoconstriction. An urgent computed tomography scan with contrast demonstrated a large hematoma in the right retroperitoneal space. A phentolamine test and an 131iodine metaiodobenzylguanidine scan suggested pheochromocytoma. An elective right adrenalectomy was successfully performed after pretreatment for sufficient volume replacement with continuous administration of alpha- and beta-adrenergic blocking agents. Pathological diagnosis was an adrenal pheochromocytoma 9.0 x 6.5 cm in diameter with evidence of capsular invasion, which could be associated with a tear in the capsule.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
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