1/9. diagnosis of acromegaly in orofacial pain: two case reports.acromegaly is an uncommon condition, with an annual incidence in the UK of three per million. The gradual onset of the clinical features mean that often friends and relatives are unaware of the underlying pathology. In view of the morbidity, and indeed mortality, arising from undiagnosed cases, general dental practitioners and other healthcare workers should routinely take note of systemic as well as intra-oral changes occurring in their patients when seen on review. The association of paraesthesia, anaesthesia and pain with acromegaly is well documented. However, there appear to be few reports linking acromegaly with orofacial pain or dysaesthesia. This paper describes two such cases.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/9. Translaryngeal guided intubation in a patient with raised intracranial pressure.A 60-year old man with intracranial space occupying lesion, presented with difficulty in intubation at induction of anaesthesia. Several attempts at direct tracheal intubation were made until the airway was finally secured. Though the brain was slack, the tumour could not be located at this operation. He presented for re-operation with worse signs of raised intracranial pressure which may accompany repeated attempts at intubation, a planned translaryngeal guided intubation was employed to secure the airway. Where fibreoptic laryngoscope is unavailable and difficult tracheal intubation is envisaged, translaryngeal guided intubation may save time and reduce morbidity of prolonged and repeated attempts at tracheal intubation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/9. pituitary apoplexy following cholecystectomy.A case of pituitary apoplexy, which presented with hyperaesthesia in the distribution of the ophthalmic division of the left trigeminal nerve and a left sixth nerve palsy following cholecystectomy, is reported. Computed tomography and magnetic resonance imaging revealed a large intrasellar mass which extended laterally into the left cavernous sinus and showed evidence of old and recent haemorrhage within the tumour. This case demonstrates that patients who present with unusual neurological symptoms involving the cranial nerves after general anaesthesia, should undergo neurological and radiological investigations.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/9. An unusual presentation of a pituitary tumour in the early postpartum period.The case of a parturient, who first presented with a partial oculomotor nerve palsy shortly after caesarean delivery while participating in a clinical trial, is presented. The anaesthesia for the caesarean delivery involved a combined spinal-epidural with intrathecal bupivacaine and postoperative epidural pethidine patient-controlled analgesia. The trial was examining the possible effects of magnesium infusions on acute and chronic pain. The partial oculomotor nerve palsy was an unusual presentation and the signs and symptoms were transient. magnetic resonance imaging confirmed the presence of a presumed pituitary macroadenoma. Possible reasons for the timing of onset and the rapid resolution of symptoms, and the implications and management of pituitary pathology in the peripartum period, are considered. The uncomplicated course of a later caesarean delivery in the same patient, using the same anaesthesia technique, is also noted.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
5/9. Anaesthesia for transsphenoidal surgery in a patient with extreme gigantism.The management of anaesthesia for transsphenoidal removal of a pituitary adenoma in a true pituitary giant with acromegaly is described. Problems which may be anticipated in such a patient and an approach to their management are discussed, with particular emphasis upon the need for thorough preoperative assessment of the upper airway and the provision of adequate pulmonary ventilation during anaesthesia.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/9. Cardiac arrhythmia induced by pneumoencephalography.Cardiovascular collapse associated with pneumoencephalography (PNE) has been reported but there has been no prospective study of its nature and cause. We have recorded prospectively the e.c.g. of 82 unselected patients, with no cardiovascular or metabolic disease, undergoing PNE under general anaesthesia. The frequency of arrhythmia following air injection was 60%; bradycardia 22%; ventricular ectopic beats 26%; nodal rhythm or sinus tachycardia 11%. Cardiovascular collapse occurred in three patients; two with "torsades de pointes" and one with bigeminy and q.r.s. block. Arrhythmia was more frequent in patients with a pituitary tumour and intracranial hypertension (91%). Eight postoperative control PNE examinations were uneventful. Three of four patients with frontal lobe tumours and four of seven with posterior fossa tumours exhibited arrhythmia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/9. Endoscopic management of craniopharyngiomas: a review of 3 cases.The authors describe the endoscopic management of cystic craniopharyngiomas in 3 cases. This method has been attempted in cystic craniopharyngiomas using a rigid endoscope. The instrument has been described earlier (7-9). All these operations were done under general anaesthesia. Criteria for endoscopic extirpation and removal included type D, E, F classification according to Yasargil (17). All 3 cases fitted in the F category. There were one female and two male patients. In the female patient an aspiration of cyst contents was performed as a first attempt to relieve her hydrocephalus. Two months later recurrent symptomology necessitated a larger intervention. All cysts were opened using the laser, drained by a Fogarthy balloon-catheter, and the capsule removed by forceps. This technique is safe and provides a reasonable alternative to open microsurgery, radioactive isotope instillation, or radiotherapy. In our series we achieved total removal in one case after the second intervention and partial removal in two cases. There was no mortality directly associated with this procedure and the female patient developed severe electrolyte disturbances after macroscopic total removal. Our results suggest that endoscopic of management of cystic craniopharyngiomas is a safe and effective procedure which could be considered as the initial management for cystic craniopharyngiomas of the intraventricular type.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
8/9. Cushing's disease treated by trans-sphenoidal selective adenomectomy in mid-pregnancy.The clinical course and diagnosis of a patient with Cushing's disease complicated by pregnancy is described, and the anaesthetic management of trans-sphenoidal selective adenomectomy performed during the second trimester outlined. Problems included obesity, diabetes, hypertension and a suboptimal airway. Fibreoptic awake intubation and intravenous anaesthesia were used. insulin requirements decreased substantially after surgery. Early administration of hydrocortisone after surgery avoided the risk of an addisonian crisis but delayed biochemical confirmation of a metabolic cure.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/9. pituitary apoplexy after spinal anaesthesia.We report the case of a previously healthy 51-yr-old male who underwent an uneventful total hip replacement under spinal anaesthesia. His immediate postoperative course was complicated by the development of a severe frontal headache. Initial conservative treatment included oral analgesics and an epidural blood patch. The headache persisted and was followed by progressive vision loss and a right partial third nerve palsy. The patient was almost blind at the time of transfer to our neurosurgical unit. Relevant investigations revealed marked hyponatraemia (serum sodium concentration 122 mmol litre-1) and second-degree heart block (Mobitz I). A CT scan showed a pituitary tumour and confirmed the clinical diagnosis of pituitary apoplexy. Urgent craniotomy was scheduled and a large necrotic pituitary adenoma was excised. The postoperative course was uneventful with return of near normal vision at the time of discharge. Clinicians should consider this diagnosis when focal neurological deficits occur with post-dural puncture headache.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |