1/13. glycine toxicity and unexpected intra-operative death.A rare complication of the use of glycine irrigation fluid during prostatic surgery in a 69-year-old man is described. Following cystolithopexy and transurethral resection of the prostate for benign prostatomegaly, abdominal distension developed with increasing ventilatory pressures. Despite retroperitoneal fluid evacuation at subsequent urgent laparotomy, cardiac arrest occurred that was not amenable to resuscitation. At autopsy a traumatic defect in the posterior bladder wall filled with calculus debris was confirmed that did not communicate with the peritoneal cavity. hyponatremia with markedly elevated levels of blood, urine, and body fluid glycine were demonstrated. death was, therefore, attributed to glycine toxicity following tracking of glycine through a surgical defect in the posterior bladder wall. Careful dissection of surgical sites is required in such cases to demonstrate any additional trauma that may be associated with the fatal episode. Analysis of body fluids for glycine and electrolytes is also necessary to assist in the determination of possible mechanisms of death.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/13. stroke associated with alpha blocker therapy for benign prostatic hypertrophy.Benign enlargement of the prostate is a malady of older males, reaching an estimated prevalence of 90% in patients aged over 70 years. Many of these patients are treated with alpha blockers, which can lower blood pressure significantly. We report on a 64-year-old man who developed a right hemiparesis after taking one dose of doxazosin 4 mg for prostatic symptoms. A CT scan of the brain and carotid ultrasound studies were normal. He recovered most of his neurological function within a few days. Ambulatory blood pressure monitoring on doxazosin 2 mg revealed a striking sleep blood pressure reduction.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
3/13. Transient circadian hyper-amplitude-tension (CHAT) may be intermittent: case reports illustrating gliding spectral windows.Taking the heart rate (HR) for one cycle, whether to examine behavior in the region of periods of 1 s, 1 day, 1 week, 1.3 or 10.5 years, etc., is hazardous. Replications, when possible are mandatory for examining altered variability, whatever the period(s) involved may be. This replication in the individual, and across individuals when the periods are long, measured in decades, may serve for diagnosis and treatment. This rule applies in particular to a seemingly transient circadian hyper-amplitude-tension (CHAT), an over peer-threshold variability in blood pressure (BP), based on the fit of a 24-h cosine curve to time series of appropriate length, rather than to a mere snapshot covering just a single day or week. Transient CHAT may turn into intermittent CHAT, as determined in two cases presented herein. One case of transient CHAT could be so named after a successful treatment (Rx) change eliminated CHAT as an effect validated by monitoring at 30-min intervals for a 7-day span on a new treatment. CHAT disappeared for over 300 consecutive half-hourly measurements, but thereafter it reappeared. During the ensuing nearly continuously monitored 5 years, CHAT continued to appear and disappear sometimes without a treatment change. In another case, which was responsive to a change in the timing of medication, CHAT also disappeared and thereafter reappeared. In a short-term perspective of weeks or months of monitoring, CHAT seemed to be transient, but further monitoring again revealed it to be intermittent. Cases of intermittent CHAT require follow-up for outcomes by comparison with the population at large. Miniaturized instrumentation for their detection should be a high priority, but it must be realized that the automatic ambulatorily functioning monitors, available at 10% of the regular price through a BIOCOS project ([email protected]), already signify great progress, as compared to previously used manual measurements made around the clock by hypertensive opinion leaders in medicine from diagnosis to death. On automatically collected time series of BP and HR, gliding pergressive spectral windows as such, or such pergressive windows aligned further with global spectral windows, visualize the changing dynamics involved in health and disease, in the steps of Werner Menzel and Paolo Scarpelli.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/13. Bilateral ischemic optic neuropathy after transurethral prostatic resection: a case report.BACKGROUND: Nonarteritic ischemic optic neuropathy affects the anterior portion of the optic nerve and is characterized by sudden, painless visual loss. The affected eye has a relative afferent pupillary defect. The typical funduscopic appearance includes optic disc edema, with associated nerve fiber layer hemorrhage. risk factors include advanced age, systemic hypertension, nocturnal hypotension, diabetes mellitus, and a small cup-to-disc ratio. Bilateral presentation is rare. Postoperative optic neuropathy has been associated with nonocular surgery; risk factors include a combination of prolonged surgical times, acute systemic hypotension, anemia due to blood loss, or prone positioning. We report for the first time a patient with bilateral, simultaneous anterior ischemic optic neuropathy after elective transurethral prostatic resection. CASE PRESENTATION: A 66-year old man underwent surgery for benign prostatic hyperplasia. The preoperative blood pressure was 140/85 mmHg, hemoglobin 15.9 g/dL, and hematocrit 48.6%. Two hours postoperatively, the blood pressure, hemoglobin, and hematocrit dropped dramatically. One day later, transient horizontal diplopia developed. Funduscopy showed a congenitally small cup-to-disc ratio without papillary edema. Other ocular findings were unremarkable. By 4 days postoperatively, sudden and painless amaurosis bilaterally developed when the patient awoke with nausea and vomiting. visual acuity was no light perception bilaterally. The optic discs were swollen with small hemorrhages. Scans of the head and orbits and electrolyte levels were normal. There were no responses on visual evoked potentials bilaterally. The blood pressure was 90/50 mm Hg, the hemoglobin 7.0 g/dL, and the hematocrit 22.9%, necessitating infusion of three units of packed red blood cells. The blood pressure, hematocrit, and hemoglobin increased to normal levels. Three months later the visual acuity remained no light perception. The pupils were unreactive and there was marked optic disc atrophy bilaterally. CONCLUSION: Bilateral and simultaneous acute ischemic optic neuropathy may be a rare but devastating surgical complication. The combination of anemia and hypotension may increase the risk of anterior ischemic optic neuropathy postoperatively after transurethral prostatic resection.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
5/13. Perirenal urinoma secondary to prostatic obstruction.We report a case of perirenal urinoma secondary to benign prostatic hypertrophy. This rare complication of bladder outlet obstruction was due to subsequent hydronephrosis and increased pressure in the renal cavities, leading to rupture of caliceal fornix and allowing perirenal extravasation of urine. Complete resolution of the urinoma was obtained with bladder decompression and conservative management.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/13. Changes in oncotic pressure, osmolality and electrolytes following transurethral resection of the prostate using glycine as irrigating solution.Thirteen patients undergoing resection of benign prostatic hyperplasia were given furosemide 40 mg at the end of the procedure. The changes in body weight, colloid oncotic pressure (COP), osmolality, electrolyte concentrations and several haematological variables were compared with the values of 13 patients treated similarly, but without furosemide. During the operation there was an estimated mean absorption of 300 ml of irrigating fluid (glycine 1.5%). There was a significant peroperative decrease in serum sodium concentration, osmolality, COP, and haemoglobin concentration in both groups. The furosemide group had a more rapid return of COP towards preoperative values, and this group did also approach the preoperative weight more rapidly than the control group. In 10 selected patients variations in the total aminoacid pattern were measured. There was a significant increase in glycine concentration, with the maximum increase ten times the preoperative value. In the absence of uncontrolled bleeding, the resorption of fluid during TUR leads to hypervolemia and reduction in serum sodium and COP. This may lead to the TUR syndrome, as illustrated by one of our patients. Treatment in the symptomatic patient consists of reduction of circulating blood volume and when this is achieved, hypertonic saline may be beneficial if there are neurological symptoms.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
7/13. Submucosal fibromatosis: prostatism in a young boy?A seven-year-old boy was seen with a urodynamically significant, obstructing, posterior urethral mass. It was believed to represent either a fibromuscular prostatic enlargement or a nonpedunculated congenital polyp. The differential diagnosis is discussed. Transurethral resection of the mass resulted in decreased voiding pressure and relief of symptoms.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/13. urodynamics in benign prostatic hypertrophy.Synchronous urinary flow and pressure studies were carried out on 51 male subjects of whom 12 were normal subjects and 39 had benign prostatic hypertrophy with varying degrees of bladder outlet obstruction. A urodynamic scoring system was evolved for accurate and objective diagnosis of bladder outlet obstruction. The minimum urethral resistance was found to be the most valuable single urodynamic parameter for the diagnosis of bladder outlet obstruction. Hitherto this urodynamic parameter was determined through tedious calculations. In the course of the present study a new instrument, the Urethroresistance, was devised for the direct recording of urethral resistance during micturition.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/13. A comparison between intermittent and continuous transurethral resection of the prostate.123 transurethral resections of the prostate were studied. The operations were randomized to either continuous or intermittent technique. The first 64 operations were performed using an irrigating fluid pressure head of 65 cm (measured from the top of the operating table). In the rest of the operations an 80 cm pressure head was used. In this way four groups were obtained comprising 30 to 31 patients, differing from each other in respect of irrigating technique. Isotonic 5% mannitol solution was used as an irrigating fluid. The irrigating fluid absorptions were calculated from the plasma mannitol levels determined immediately postoperatively. The use of a trocar significantly lessened the average absorbed fluid volume, while there was no significant difference between the groups of high and low irrigating fluid pressure head. The intraoperative bleeding, the decrease in serum sodium, the resection time and resection rate did not differ significantly between the four groups.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
10/13. Deep venous thrombosis following transurethral resection of the prostate: diagnosis by phleborheography.Deep venous thrombosis is a potential complication of transurethral resection of the prostate. We evaluated 150 paients undergoing transurethral resection of the prostate for benign and malignant disease to determine the postoperative incidence of deep vein thrombosis, using phleborheography as the instrument of detection. Phleborheography is an accurate, inexpensive, non-invasive method that uses low pressure transducers to detect volumetric changes in the lower extremity through recording cuffs. A 4.6 per cent incidence of deep venous thrombosis was detected by this technique. At the time this complication was discovered no patient exhibited clinical signs of thrombophlebitis, which reinforces the belief that clinical diagnosis alone is not a reliable screening technique for deep venous thrombosis. Anticoagulant therapy appears to be effective and safe in the treatment of this postoperative complication.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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