Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center.

Background: Postoperative cerebrospinal fluid (CSF) fistula is the most serious complication after transsphenoidal surgery.

Objective: To analyze the incidence of CSF fistula after endoscopic transsphenoidal surgery for tumor removal in sellar region; to discuss associated factors and methods used for sellar closure.

Method: Retrospective study of 67 patients (73 surgeries) operated via transsphenoidal endoscopy at Hospital Vall D'Hebron and Hospital Clinic of the Universidad de Barcelona, Spain.

Post-ictal analgesia: involvement of opioid, serotoninergic and cholinergic mechanisms.

The neural mechanisms involved in post-ictal analgesia remain to be elucidated. Pentylenetetrazol (PTZ) is used experimentally to induce seizure in animal subjects. This non-competitive antagonist blocks GABA-mediated Cl(-) flux.

Pyrogenic reactions in patients undergoing cardiac catheterization associated with contaminated glass medicine cups.

Pyrogenic reactions are potentially life-threatening complications caused by bacterial endotoxin. After two cardiac catheterization patients developed rigors the same day, the procedures were halted and a case control study was conducted. To identify case patients (persons with rigors < or = 3 hr after catheterization during September 25-November 9, 1995), we reviewed medical records of all cardiac catheterization patients who had a blood culture or received intravenous meperidine.

Perinatal cocaine use: maternal, fetal, and neonatal effects.

The implications of cocaine use during pregnancy include an increased incidence of stillbirths, abruptio placentae, and an increased risk of other delivery complications. The neonate born to a woman using cocaine may show a lack of definite physical stigmata, absence of consistent withdrawal patterns, and high incidence of irritability during the neonatal period. Nursing implications for promoting optimal pregnancy and neonatal outcome primarily involve early pregnancy intervention, consistent care, education, and delivery management.

Concomitant abdominal aortic aneurysm and colorectal carcinoma: priority of resection.

Seventeen patients (15 men and two women) underwent operation for concomitant abdominal aortic aneurysm (AAA) and colorectal carcinoma (Ca) during a recent 12-year period. Ages ranged from 59 to 89 years (median 75.2 years).

Surgical resection of carotid body tumors: long-term survival, recurrence, and metastasis.

We retrospectively reviewed a 20-year experience with 59 carotid body tumors in 55 patients examined at our institution in order to determine the long-term results of surgical resection, including the rates of distant metastasis, local recurrence, and long-term survival. Complete surgical excision was possible in 52 of the 55 patients (95%). Perioperative mortality was only 2% (1 of 59 procedures), and no operative deaths occurred during the last 10 years of the study.

Trends in neurovascular complications of surgical management for carotid body and cervical paragangliomas: a fifty-year experience with 153 tumors.

Almost 75% of carotid body and cervical paragangliomas are adherent to or surround adjacent arteries and cranial nerves. Their resection can result in neurovascular injury, stroke, and excessive blood loss. To assess trends in neurovascular complications, we reviewed 153 carotid body and cervical paragangliomas that were surgically managed between 1935 and 1985.

Update on counseling the family with a first-degree relative with a congenital heart defect.

Updated recurrence risks figures are presented for genetic counseling of families with a congenital heart defect (CHD) in a first-degree relative. Substantial changes are recommended for counseling the family in which a parent has CHD. The risk is much greater if it is the mother rather than the father who has the heart defect.

Contained rupture of the suprarenal aorta.

A contained rupture of the aorta is a rare event; however, this has been recognized with increased frequency in the abdominal aorta. There have previously been two reports of the containment of rupture of the suprarenal aorta. We report two additional cases of contained rupture of the suprarenal aorta, one caused by a penetrating atherosclerotic ulcer, the other from a ruptured aneurysm.

Maternal transmission of congenital heart diseases: new recurrence risk figures and the questions of cytoplasmic inheritance and vulnerability to teratogens.

A review of 8 studies involving 3,996 offspring of parents who have congenital heart disease revealed that the risk for all defects was substantially higher if the affected parent was the mother rather than the father. The risk ratio ranged from a high of 6.39 for aortic stenosis to a low of 1.

Clinical studies in a kindred with a kinetic LDL receptor mutation causing familial hypercholesterolemia.

We have studied a family carrying a variant of the class 2 mutation of familial hypercholesterolemia (FH) in which there is unusual longevity and in which obligate heterozygotes did not express constant or statistically significant hypercholesterolemia. The heterozygotes have the same kinetic defect in the processing of low density lipoprotein (LDL) receptors in their fibroblasts and the reduced fractional catabolic rate for apoLDL that is characteristic of other patients with heterozygous FH. However, their plasma lipid and lipoprotein levels are not as strikingly abnormal because they have normal or near normal rates of apoLDL synthesis.

Familial hypercholesterolemia with "normal" cholesterol in obligate heterozygotes.

We have investigated the family of a 15-year-old proposita with a homozygous, receptor-defective, familial hypercholesterolemia and found that her consanguineous, obligate heterozygous parents have "normal" cholesterol levels and a family history of unusual longevity. Documentation of paternity and the presence of the heterozygous biochemical disorder in the parents is firm. The implications are that, at least in this family, relatively low serum cholesterol and high levels of HDL cholesterol are protective against the risks associated with having a mutant allele for heterozygous familial hypercholesterolemia.

Cardiac and renal responses to cross-clamping of the descending thoracic aorta.

The present study was performed to document the relative efficacy of commonly applied techniques used adjunctively during 1 hour of descending thoracic aortic cross-clamping. Renal and cardiac responses were determined by standard laboratory methods. There were four experimental groups: (1) heparin-bonded shunt; (2) partial femoral-femoral bypass; (3) sodium nitroprusside; (4) control.