deamino-arginine-vasopressin and Postoperative-Complications

Diabetes insipidus (DI) is a common complication following pituitary surgery and can be transient or permanent. Neurogenic DI occurs following injury to the magnocellular neurons in the hypothalamus that produce and transport arginine vasopressin (AVP) and form the hypothalamo-hypophyseal tract. DI is defined by a constellation of signs and symptoms resulting in dilute high-volume urine output and increasing serum osmolality. The body's inability to concentrate urine leaves the patient dehydrated and leads to metabolic abnormalities that can be life threatening if not recognized and treated in a timely manner with an exogenous AVP analog. The reported incidence of postsurgical central DI varies from 1 to 67%. This wide range likely reflects inconsistencies in the working definition of DI across the literature. Factors affecting the rate of DI include pituitary tumor size, adherence to surrounding structures, surgical approach, and histopathology of pituitary lesion. The likelihood of postoperative DI can be reduced by careful preservation of the neurovascular structures of the hypothalamus, infundibulum, and neurohypophysis. Vigilance and meticulous surgical technique are essential to minimize injury to these critical regions that can lead to postsurgical DI.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Endoscopy; Humans; Microsurgery; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Postoperative Complications; Vasopressins

Factor XI (FXI) deficiency is a rare inherited coagulation disorder characterized by infrequent spontaneous bleeding, but increased risk of hemorrhagic complications especially after trauma or surgery. Treatment options for FXI-deficient patients include virus-inactivated fresh frozen plasma, plasma-derived FXI concentrates, and activated recombinant FVII. Inhibitors of fibrinolysis, such as tranexamic acid, and desmopressin (DDAVP) have also been used in these patients, especially in mild cases. The current knowledge on the use of the latter agent in this congenital bleeding condition is systematically reviewed here. Although limited, the available literature data suggest the potential role of DDAVP for either treatment of bleeding episodes or the prevention of postoperative bleeding in patients with milder FXI defects. However, these findings need to be supported by further trials on large population of patients.

Topics: Deamino Arginine Vasopressin; Factor XI Deficiency; Hemorrhage; Hemostatics; Humans; Postoperative Complications

Von Willebrand disease (VWD) is the most common genetic bleeding disorder with a prevalence of approximately 1-2 percent confirmed in different population studies. The severity of the bleeding tendency is usually proportional to the degree of the VWF defect, although the large majority of cases diagnosed appear to have a mild disease. Patients with VWD may require short- or long-term prophylaxis treatment. Short-term prophylaxis is usually performed to prevent excessive bleeding following surgery or invasive procedures, while long-term prophylaxis may be needed to control recurrent mucosal and joint bleeding complicating the more severe forms of VWD. This review is focused on the current knowledge on replacement treatment for patients with VWD disease undergoing surgical or invasive procedures. On the whole, the published studies document the safety and efficacy of VWF/FVIII concentrates as surgical prophylaxis in VWD patients, in particular of Haemate P, the most widely used VWF/FVIII concentrate due to its high VWF:FVIII ratio. The recent literature data also show that the best management of VWD patients undergoing surgery is that to perform a pharmacokinetic study in order to strictly tailor for each VWD patient loading and maintenance doses of VWF/FVIII concentrates. Furthermore, the same studies underscore that, along with VWF levels, FVIII levels should be monitored in the peri-operative period in order to prevent exposures to high FVII levels, associated with an increased risk of venous thrombosis.

Topics: Blood Loss, Surgical; Clinical Trials as Topic; Cross-Over Studies; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Combinations; Factor VIII; Half-Life; Humans; Infusions, Intravenous; Multicenter Studies as Topic; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Thromboembolism; Virus Inactivation; von Willebrand Diseases; von Willebrand Factor

After cardiac surgery with extracorporeal circulation, approximately 20% of patients show significant bleeding tendencies and 5% require re-intervention. In 50% of patients undergoing re-operation, no surgical cause can be determined, suggesting coagulopathy after cardiopulmonary bypass (CPB). For perioperative management of transfusion of blood products and coagulation factor concentrates, a clinical algorithm for the perioperative hemostatic therapy in patients undergoing cardiac surgery with CPB has been developed. The currently available evidence and the point of care methods routinely accessible in our institution (blood gas analysis, ACT, point of care Quick value, aPTT and platelet count) were used. The intervention with plasma products, coagulation factor concentrates and hemostatic drugs after extracorporeal circulation are described. Extensive bleeding history as well as the efficacy and side effects of antifibrinolytic treatment are discussed.

Topics: Algorithms; Antifibrinolytic Agents; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Gas Analysis; Blood Transfusion; Deamino Arginine Vasopressin; Extracorporeal Circulation; Fibrinogen; Heparin; Heparin Antagonists; Humans; Partial Thromboplastin Time; Plasma; Platelet Count; Point-of-Care Systems; Postoperative Complications

We report an uncommon case of an intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma as the first manifestation of multiple myeloma. A 57 year old woman was referred to our department with a presumed diagnosis of a non-functioning pituitary macro-adenoma. She reported a 3 month history of headaches and a 2 week history of sudden onset of right facial numbness. Preoperative endocrine evaluation was remarkable only for a modestly elevated serum prolactin. A magnetic resonance imaging (MRI) scan revealed 3.6 x 5 x 4 cm enhancing homogeneous intrasellar mass with extension into the sphenoid and cavernous sinuses bilaterally; the optic chiasm was not displaced. She underwent transphenoidal surgery of the sellar lesion. The surgical specimen was heavily infiltrated with abnormal plasma cells, which stained almost exclusively for Kappa light chain immunoglobulins. An extensive investigation was undertaken to look for occult myelomatous disease. A diagnosis of multiple myeloma was made 1 month later based on a combination of clinical, pathological and radiologic features. She underwent radiation therapy directed towards the residual sellar tumor, followed by chemotherapy and autologous stem cell transplantation. Review of the world literature revealed only 22 previous reports of patients in whom a solitary plasmacytoma or multiple myeloma first presented as a sellar mass; in all cases mimicking clinically and radiologically a non-functioning invasive pituitary adenoma however with additional cranial nerve involvement. Intrasellar plasma cell tumors are rare tumors which may mimic non-functioning invasive pituitary tumors. The diagnosis should be suspected in patients with well preserved anterior pituitary function and cranial nerve neuropathies in the presence of significant sellar destruction.

Topics: Adenoma; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Middle Aged; Pituitary Neoplasms; Plasmacytoma; Postoperative Complications; Treatment Outcome

Hypothermia has been demonstrated to induce pancytopenia in animals, but whether this association exists in humans is unknown. The authors report the case of an 8-year-old girl in whom hypothermia (temperature 33 degrees C-35 degrees C) is the cause of pancytopenia. The patient developed thermoregulatory dysfunction subsequent to surgical resection of a craniopharyngioma. Her recurrent cytopenias could not be explained by any etiology except chronic hypothermia. The pancytopenia improved upon rewarming the patient to a temperature of 36 degrees C. This association between hypothermia and pancytopenia has rarely been reported in humans and may be underdiagnosed especially in cases of transient or milder presentations. The authors recommend careful hematologic monitoring of patients with thermoregulatory dysfunction.

Topics: Adrenal Insufficiency; Blood Cell Count; Cerebral Infarction; Child; Chronic Disease; Consciousness Disorders; Craniopharyngioma; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Female; Frontal Lobe; Humans; Hyponatremia; Hypophysectomy; Hypopituitarism; Hypothalamus; Hypothermia; Hypothyroidism; Pancreatitis; Pancytopenia; Pituitary Neoplasms; Postoperative Complications; Seizures; Sleep Stages

The development of transsphenoidal microsurgery and the refinement of endocrinological and radiological diagnostic procedures have afforded therapeutic options appropriate for each individual case in patients with pituitary-dependent hypercortisolism. Compared with other secreting pituitary tumors, the corticotroph adenoma seems to be the most biologically active tumor. Clinical evidence of hypercortisolism mainly occurs at an early stage of tumor growth when the tumor is very small, below the detection threshold of modern imaging techniques. While the treatment of large tumors remains difficult due to the non-discrete boundary lines of the tumor and extension or invasion, surgical removal of very tiny tumors requires reliable preoperative or peroperative identification in order to achieve total tumor resection for clinical remission and pituitary preservation to prevent hypopituitarism. We reviewed all the current surgical techniques or clever surgical procedures used to achieve both goals with the lowest complication rate. We report here the state-of-the-art of surgical management of corticotroph pituitary adenoma focusing on preoperative radiological and biological data required for performing guided intrasellar surgical exploration and reliable tumor identification. Different technical aspects of the nasosphenoidal approaches are reported as well as the modified transdiaphragmatic or transtubercular transcisternal approaches to tumors in a suprasellar localization or lying along the pituitary stalk. The advantages of minimally invasive surgical techniques such as intrasellar endoscopic surgery are discussed. Adapted surgical techniques for second transnasal surgery indicated for recurrent tumors are described. Guidelines are given for peroperative tumor identification with macroscopic assessment or histological control with frozen section biopsies. Different techniques for tumor removal are discussed from selective microadenomectomy to enlarged pituitary resection and total hypophysectomy. Methods for preoperative guidance of total tumor removal are proposed including histological or biological assessment of normal adjacent pituitary tissue. the strategy of surgical intrasellar exploration and tumor resection is outlined using a set of algorithms. The first is devoted to positive preoperative documentation of the tumor. The second is proposed for the surgical scenario where there is no preoperative MRI evidence of the tumor. Special strategies are dis

Topics: ACTH Syndrome, Ectopic; Adenoma; Adrenocorticotropic Hormone; Anti-Bacterial Agents; Cortisone; Cushing Syndrome; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnostic Imaging; Endoscopy; Humans; Hypophysectomy; Magnetic Resonance Imaging; Petrosal Sinus Sampling; Pituitary Neoplasms; Postoperative Complications; Premedication; Reoperation

Hyponatraemia is a common finding in patients with acute cerebral insults. The main differential diagnosis is between syndrome of inappropriate ADH secretion and cerebral salt wasting. Our aim is to review the topic of hyponatraemia in patients with acute cerebral insults and suggest a clinical approach to diagnosis and management.

Topics: Acute Disease; Algorithms; Brain Diseases; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Fluid Therapy; Humans; Hyponatremia; Hypothalamic Neoplasms; Inappropriate ADH Syndrome; Postoperative Complications; Renal Agents; Sodium

Hyponatremia following acute or chronic central nervous system injury which is due to excessive Na+ loss in the urine without an increase in the body fluid, has been described as Cerebral Salt Wasting Syndrome (CSWS). This syndrome is often confused with dilutional hyponatremia secondary to inappropriate ADH secretion. Accurate diagnosis and management are mandatory for to improve the course of the disease. In this study a patient with CSW Syndrome is presented and the treatment and diagnosis of this syndrome are discussed in view of the literature.

Topics: Adenoma; Adult; Deamino Arginine Vasopressin; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Pituitary Neoplasms; Postoperative Complications; Saline Solution, Hypertonic; Sodium

Prophylactic drug treatment is one of several strategies to reduce postoperative blood loss and potentially limit homologous blood use in open heart surgery. A computerized MEDLINE search supplemented with manual bibliography reviews was performed for randomized clinical trials published in peer-reviewed English-language journals from January 1980 to June 1993. A metaanalysis was conducted of trials evaluating desmopressin (group DD, n = 13), epsilon-aminocaproic acid or tranexamic acid (group EA, n = 4), and aprotinin (group AP, n = 16). Eligible studies used placebo controls and administered the drug in a prophylactic manner. The primary study end point was postoperative chest tube loss (mL, mean +/- standard deviation). There was a significant reduction in postoperative chest tube loss detected for each of the active treatments versus the placebo (DD versus controls: percent reduction 0.11, p = 0.0021; EA versus controls: percent reduction 0.30, p < 0.0001; and AP versus controls: percent reduction 0.36, p < 0.0001). Therapy with EA or AP was associated with a greater reduction in chest tube loss than DD (EA versus DD, p = 0.0033, and AP versus DD, p < 0.0001). Secondary study end points were transfusion requirements, chest reexploration, and perioperative mortality. The volume of postoperative red cell transfusion (mean +/- standard deviation) was reduced with EA (p < 0.0001) or AP treatment (p < 0.0001) compared with a placebo or DD, whereas the proportion of patients given transfusions was limited only in the AP-treated patients (odds ratio 0.23; 95% confidence interval, 0.16 to 0.33; p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aminocaproic Acid; Aprotinin; Blood Loss, Surgical; Cardiac Surgical Procedures; Coronary Artery Bypass; Deamino Arginine Vasopressin; Hemostatics; Humans; Postoperative Complications; Premedication; Tranexamic Acid

We describe a case of spontaneous muscle necrosis of the anterior tibial compartment occurring in a patient who had a hypophysectomy for a craniopharyngioma five years previously. We know of no other reported cases of spontaneous muscle necrosis in association with diabetes insipidus and feel that there should be increased awareness of the association between the two.

Topics: Adult; Biopsy; Compartment Syndromes; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypophysectomy; Leg; Male; Pituitary Neoplasms; Postoperative Complications

Topics: Aged; Blood Coagulation Disorders; Blood Coagulation Factors; Cardiopulmonary Bypass; Deamino Arginine Vasopressin; Hemorrhagic Disorders; Hemostasis; Humans; Male; Platelet Adhesiveness; Postoperative Complications; Signal Transduction; Thrombosis

Topics: Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Drug Evaluation; Hemorrhage; Humans; Middle Aged; Myocardial Infarction; Postoperative Complications; Prevalence; Risk; Thromboembolism

Postoperative bleeding is caused by alterations in the normal process of hemostasis or by a surgical problem. The role of platelets, coagulation proteins, and fibrinolysis in the control of postoperative bleeding is reviewed, as are preoperative and intraoperative factors that interfere with these normal processes. Current treatment of postoperative bleeding is discussed, including the use of positive end-expiratory pressure, control of hypertension, medication, and blood products.

Topics: Blood Coagulation; Blood Transfusion; Cardiac Surgical Procedures; Deamino Arginine Vasopressin; Fibrinolysis; Hemorrhage; Hemostasis; Hemostatic Techniques; Humans; Intraoperative Care; Postoperative Complications; Preoperative Care

A 20-year-old woman with a history of pituitary resection complicated by diabetes insipidus was able to fully breastfeed for three months despite apparent hyposecretion of pituitary hormones. This case report adds to the growing body of evidence that control of milk production shifts from endocrine to autocrine control shortly after delivery. Autocrine control allows efficient regulation of milk supply to match the needs of the infant. A recently discovered factor in human milk that inhibits lactose and casein synthesis in vitro is believed to be responsible for local, short term control of milk production. This study suggests that practices which result in infrequent or incomplete removal of milk from the breast lead to decreased milk production and should be abandoned.

Topics: Abscess; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Lactation; Oxytocin; Patient Education as Topic; Pituitary Diseases; Postoperative Complications; Pregnancy; Prolactin

Topics: Cardiopulmonary Bypass; Deamino Arginine Vasopressin; Hemorrhage; Humans; Postoperative Complications

A 32 year old I P II G with preexisting diabetes insipidus was treated with 1-(3-mercaptopropionic acid)-8-d-arginine vasopressin (DDAVP) during pregnancy. An otherwise normal pregnancy was marked only with an excessive weight increase. A healthy girl was delivered by secondary cesarean section at term. Postoperative the mother developed a water intoxication accompanying oxytocin-infusion. During nursing the diabetes insipidus improved significantly whereby DDAVP doses could be reduced to 20-10 percent. We suppose an overreaction to endogene oxytocin with an antidiuretic effect.

Topics: Administration, Intranasal; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Oxytocin; Postoperative Complications; Pregnancy; Pregnancy Complications; Water Intoxication; Water-Electrolyte Balance

Topics: Benzothiadiazines; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Humans; Hypothalamo-Hypophyseal System; Pituitary Diseases; Postoperative Complications; Prognosis; Prostaglandin Antagonists; Sodium Chloride Symporter Inhibitors; Vasopressins

Topics: Blood Volume; Child; Craniocerebral Trauma; Deamino Arginine Vasopressin; Dehydration; Diabetes Mellitus, Type 1; Diuresis; Female; Humans; Kinetics; Male; Models, Biological; Neurophysins; Osmolar Concentration; Oxytocin; Pituitary Gland, Posterior; Postoperative Complications; Pregnancy; Pregnancy in Diabetics; Thirst; Urine; Vasopressins

Topics: Anesthesia; Brain Neoplasms; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Humans; Hypothalamus; Postoperative Complications; Tomography, X-Ray Computed

The authors present a brief review of the problem of diabetes insipidus in neurosurgical patients, with particular emphasis on the differential diagnosis of postoperative and posttraumatic polyuria and the management of diabetes insipidus in these periods. A listing of drugs currently used in its treatment is given.

Topics: Administration, Intranasal; Benzothiadiazines; Brain Injuries; Carbamazepine; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Diagnosis, Differential; Diuretics; Humans; Hypothalamo-Hypophyseal System; Lypressin; Methods; Polyuria; Postoperative Complications; Sodium Chloride Symporter Inhibitors; Vasopressins; Water-Electrolyte Balance

Topics: Adrenocorticotropic Hormone; Anabolic Agents; Androgens; Clofibrate; Coronary Disease; Deamino Arginine Vasopressin; Drug Therapy, Combination; Female; Fibrinolysis; Fibrinolytic Agents; Glucocorticoids; Humans; Inflammation; Male; Metformin; Phenformin; Plasminogen Activators; Postoperative Complications; Sulfonylurea Compounds; Thromboembolism; Thrombophlebitis; Vascular Diseases

Blood loss is an important issue for patients with rheumatoid arthritis undergoing hip surgery. We hypothesised that intraoperative desmopressin treatment would result in a reduction in blood loss in rheumatoid patients undergoing total hip arthroplasty.. Seventy-five patients scheduled for elective total hip arthroplasty were randomised to three groups to receive 0.4 microg/kg desmopressin (D 0.4), 0.2 microg/kg desmopressin (D 0.2) or placebo intraoperatively in a double-blind fashion. Blood transfusions were based on calculated safe allowable blood loss and haemoglobin measurements (trigger 90 g/l, 5.59 mmol/l). The primary endpoint was the total blood loss measured till the end of the fourth post-operative day. Secondary endpoints included red cell transfusion requirements and haemoglobin.. Total blood loss during the study period was not significantly different between the groups (D 0.4 1829 +/- 1068; D 0.2 2240 +/- 843 and placebo 2254 +/- 1040 ml; P= 0.50). The total amount of red cell transfusions was fewer in group D 0.4 (3.6 +/- 1.6 U) when compared with D 0.2 (4.4 +/- 1.7 U; P=0.009) and placebo (4.5 +/- 2.0 U; P= 0.011) groups. Haemoglobin concentration was lower in the placebo group in the first (5.42 +/- 1.16 vs. 5.98 +/- 0.47 mmol/l; P=0.033) and the second (6.28 +/- 0.66 vs. 6.69 +/- 0.47 mmol/l; P=0.033) post-operative mornings compared with group D 0.4.. Despite a lack of difference in the primary outcome, total blood loss, intraoperative administration of 0.4 microg/kg desmopressin resulted in fewer total red cell transfusion requirements in rheumatoid patients undergoing total hip arthroplasty when compared with 0.2 microg/kg treatment and placebo.

Topics: Aged; Arthritis, Rheumatoid; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Deamino Arginine Vasopressin; Double-Blind Method; Endpoint Determination; Erythrocyte Transfusion; Female; Hemoglobins; Humans; Male; Middle Aged; Partial Thromboplastin Time; Platelet Count; Postoperative Complications; Venous Thrombosis

Recurrence of Cushing's disease (CD) after transsphenoidal surgery (TSS) occurs in about 25% of cases. Twenty percent of patients with immediate postsurgical corticotroph deficiency will present late recurrence.. The aim of the study was to evaluate a coupled dexamethasone desmopressin test (CDDT) as a predictor of recurrence of CD.. We conducted a prospective bicenter study (Marseille and Grenoble, France).. We studied 38 patients treated by TSS for CD with a mean follow-up of 60 months.. We evaluated 24-h urinary free cortisol, ACTH, and cortisol plasmatic levels and performed low-dose dexamethasone suppression test and CDDT 3 to 6 months after surgery and then yearly.. After CDDT, ACTH ratio (ACTHr) was defined as (PeakACTH - BaseACTH)/BaseACTH. Cortisol ratio (Cortisolr) was defined as (PeakCortisol - BaseCortisol)/BaseCortisol. Basal values were observed after low-dose dexamethasone suppression test. Receiver operator characteristics curve defined ACTHr and Cortisolr giving the best sensitivity and specificity associated with recurrence.. Ten patients presented recurrence. ACTHr and Cortisolr were superior or equal to 0.5 in all patients with recurrence and in three of 28 patients in remission (100% sensitivity, 89% specificity). The test became positive in eight of 10 patients with recurrence 6-60 months before classical markers of hypercortisolism. Six patients with immediate postsurgical corticotroph deficiency presented recurrence. All of them presented CDDT positivity during the 3 yr after surgery, and recurrence 6 to 60 months after CDDT positivity.. CDDT is an early predictor of recurrence of CD and could be of particular interest in the first 3 yr after surgery, by selecting patients at high risk of recurrence despite falsely reassuring classical hormonal markers.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Biomarkers; Deamino Arginine Vasopressin; Dexamethasone; Diagnostic Techniques, Endocrine; Early Diagnosis; Female; Follow-Up Studies; Humans; Hydrocortisone; Male; Middle Aged; Pituitary ACTH Hypersecretion; Postoperative Complications; Prognosis; Recurrence; Sensitivity and Specificity; Young Adult

The authors began to use 1-desamino-8-D-arginine vasopressin (DDAVP) Desmopressin Acetate routinely in their facelift patients who had a relatively high risk of bleeding, either from Von Willebrand factor deficiency, platelet dysfunction, aspirin intake, or ease of ecchymosis. Based on their observations that these patients had enhanced clotting and recovery times, they decided to undertake a prospective evaluation of the effects of Desmopressin Acetate when administered as a preoperative intravenous supplement during cosmetic facioplasty. A series of 200 consecutive patients undergoing surgery was divided into control and treatment groups. A total of 100 patients did not receive medication perioperatively, and 100 subsequent patients received preoperative DDAVP. All patients were observed for ecchymosis and swelling postoperatively and were graded by our postsurgical management team. Postsurgical ecchymosis was graded as mild (grade 1), moderate (grade 2), or severe (grade 3). Grade 4 indicated an expanding hematoma that required immediate surgical intervention. Grades 1 and 2 ecchymosis resolved within 3 weeks. Grade 3 ecchymosis or microhematomas required intervention such as needle aspiration or massage therapy. These small collections of blood generally required substantially longer to resolve and generated notable anxiety in the patients involved. Patients were excluded from the trial if there was a previous history of hypercoagulability or because treatment with DDAVP was medically contraindicated. A total of 23% of untreated patients required intervention for grade 3 ecchymosis compared with 3% of DDAVP-treated patients. No patients experienced any complications associated with DDAVP--namely, deep vein thrombosis, pulmonary embolus, electrolyte imbalance, or renal insufficiency. The authors undertook this study to determine whether DDAVP would help to decrease the incidence of microhematomas after facelift. Based on the results of their grading system and study, they think that the use of DDAVP is safe and efficacious in the prevention of troublesome microhematomas after facelift. Interestingly, although their male facelift patients challenged their efforts to obtain satisfactory hemostasis during and after surgery, the DDAVP-treated male patients responded with marked improvement in postoperative grading after treatment. Obtaining hemostasis intraoperatively was facilitated as well in these patients. This gender phenomenon was even more dramatic

Topics: Deamino Arginine Vasopressin; Ecchymosis; Female; Hematoma; Hemostatics; Humans; Male; Postoperative Complications; Prospective Studies; Rhytidoplasty

Platelet dysfunction is a major cause of excessive microvascular bleeding after cardiac surgery. A new point-of-care test (hemoSTATUS) can identify patients at risk of excessive bleeding. We aimed to find out whether patients who can benefit from desmopressin during cardiac surgery can be identified by this test.. We enrolled 203 patients scheduled for elective cardiac surgery in a prospective, double-blind, placebo-controlled trial. Patients with abnormal hemoSTATUS clot-ratio results (<60% of maximum in channel 5) after discontinuation of cardiopulmonary bypass were randomly assigned desmopressin (n=50) or placebo (n=51). Patients with normal clot ratios were included in an untreated control group (n=72).. Intraoperative platelet counts and clot ratios were significantly higher in the untreated control group than in the study-drug groups. In intensive care, clot ratios in patients who received desmopressin were similar to those in the untreated control group, despite significantly lower platelet counts, but were lower in the placebo group than in the other two groups (p=0.0001). Compared with the placebo group, patients who received desmopressin had less blood loss in 24 h (mean 624 [SD 209] vs 1028 mL [682] p=0.0004) and required less transfusion of red blood cells (1.1 [022] vs 2.2 U [0.32] p=0.009), platelets (0.1 [0.04] vs 1.9 U [4.5] p=0.0001), and fresh-frozen plasma (0.1 [0.07] vs 0.75 U [0.21] p=0.0008), and had less total blood-donor exposures (1.56 [0.31] vs 5.2 [0.8] p=0.0001). Placebo patients also had substantially higher blood loss and transfusion requirements than untreated control patients.. Patients identified with hemoSTATUS as being at increased risk of excessive bleeding after cardiac surgery can benefit from administration of desmopressin. Further studies are, however, needed to confirm these findings as well as to identify the mechanism of action and safety of desmopressin in the clinical setting.

Topics: Aged; Blood Coagulation Disorders; Blood Component Transfusion; Coronary Artery Bypass; Deamino Arginine Vasopressin; Double-Blind Method; Female; Hemostatics; Humans; Male; Middle Aged; Platelet Count; Point-of-Care Systems; Postoperative Complications; Postoperative Hemorrhage; Prospective Studies; Whole Blood Coagulation Time

The purpose of this study was to determine the effect of desmopressin acetate (DDAVP) on blood loss, transfusion requirements, and thromboembolic complications in patients undergoing elective aortic operations.. A randomized, double-blind trial was carried out during a 3-year period with patients receiving 20 micrograms DDAVP or identical-appearing placebo at the time of aortic cross-clamp placement. In addition to major bleeding and thromboembolic end points, bleeding times and platelet counts were monitored serially.. Forty-three patients were randomized to receive DDAVP, and 48 were assigned to a placebo. An equivalent proportion of patients with aneurysm and patients with occlusive disease was in each group. In spite of mild prolongation in the postoperative bleeding times and moderate thrombocytopenia, DDAVP had no beneficial effect on blood loss or transfusion requirements. Total blood transfusion amount (mean +/- standard deviation) for patients receiving DDAVP was 3.1 +/- 3.0 U compared with 2.7 +/- 3.0 U for those receiving placebo. For all patients the period associated with the greatest blood loss was the time between heparin administration with cross-clamp application and reversal of heparin with protamine sulfate. The incidence of major thromboembolic complications was similar in both groups.. Thrombocytopenia and mild platelet dysfunction are common after aortic operation, but DDAVP does not improve hemostasis or lessen transfusion requirements. This study does not rule out a beneficial effect of DDAVP in patients who are undergoing more complex aortic operations or who have major hemostatic aberrations.

Topics: Aged; Aorta; Bleeding Time; Blood Loss, Surgical; Blood Transfusion; Deamino Arginine Vasopressin; Double-Blind Method; Female; Hemostasis; Humans; Male; Middle Aged; Platelet Count; Postoperative Complications; Thromboembolism

Patients on cardiopulmonary bypass (CPB) have an increased susceptibility to postoperative bleeding. Previous reports using desmopressin acetate (DDAVP) for the prevention of postoperative bleeding have given contradictory results, whereas the protease inhibitor aprotinin has been shown to reduce blood loss after this type of surgery. This randomized study was performed to assess the efficacy of DDAVP versus aprotinin in the prevention of bleeding after CPB.. One hundred nine of 122 eligible patients were randomized to four different groups: Group A (n = 28) received aprotinin starting with a bolus of 2 x 10(6) KIU followed by a continuous infusion of 0.5 x 10(6) KIU/h until the end of surgery; group B (n = 25) received of DDAVP 0.3 micrograms/kg i.v. on completion of CPB; group C (n = 28) received two doses of DDAVP, the first as in group B and an additional dose 6 hours after surgery; group D (n = 28) received no treatment. There was a marked reduction of postoperative blood loss either at 12 hours (P < .01) or 72 hours (P < .02) in the aprotinin group compared with all other groups, whereas no significant effect was observed in either of the two DDAVP regimens. A significant reduction in the amount of blood used was observed only in the aprotinin group (P < .01). Of the plasma fibrinolytic components assayed, there was a significant reduction of the fibrin degradation product generation in the aprotinin group (P < .001), whereas a significant systemic hyperfibrinolysis was observed in both DDAVP-treated groups and the control group. No side effects related to the study drugs were observed in any patient.. Aprotinin inhibited fibrinolysis; this correlated with a significant reduction of postoperative blood loss and need for blood replacement after CPB. Neither one nor two doses of DDAVP had a beneficial effect. Aprotinin offers a better alternative than DDAVP in the prevention of bleeding after CPB.

Topics: Aprotinin; Blood Loss, Surgical; Blood Transfusion; Cardiopulmonary Bypass; Deamino Arginine Vasopressin; Female; Fibrinolysis; Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies

Aspirin induces a haemorrhagic diathesis that persists for at least 1 week after discontinuation of the drug. The effect of the vasopressin analogue desmopressin was studied in 12 patients treated with aspirin who were undergoing cholecystectomy. Desmopressin was given to six of these patients. There were five postoperative bleeding complications; all occurred in patients who had not received desmopressin (P < 0.05). The bleeding time was prolonged in aspirin-treated patients and normalized by desmopressin (P < 0.05). Desmopressin can be used safely to prevent bleeding induced by aspirin.

Topics: Adult; Aged; Aspirin; Bleeding Time; Cholecystectomy; Deamino Arginine Vasopressin; Female; Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications

Topics: Aged; Antithrombin III; Deamino Arginine Vasopressin; Female; Hip Joint; Hip Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Thromboembolism

Cardiopulmonary bypass during open-heart surgery is sometimes associated with excessive perioperative bleeding. Following a non-randomized study suggesting that desmopressin acetate (desmopressin) reduced blood product requirements in these patients, we conducted a double-blind, placebo-controlled randomized trial of desmopressin (0.3 micrograms/kg, i. v.) in 92 patients with overt bleeding and a prolonged bleeding time. Mean blood loss during the first 24 h post-treatment was similar in the desmopressin and placebo groups (582 vs 465 ml, respectively; p = 0.15). Red-cell (p = 0.76), fresh frozen plasma (r = 0.66) and platelet unit (p = 0.74) requirements were also similar. The haemostatic effect of desmopressin has been attributed to the release of von Willebrand factor (vWF) and a reduced bleeding time. In our study, vWF and factor VIII:C levels increased while the bleeding time decreased significantly at 90 min and 24 h in both groups and, although vWF and factor VIII:C levels were slightly higher in desmopressin-treated patients at 90 min, the difference was not significant. Thrombin-antithrombin III complex, fibrinogen degradation product and tissue plasminogen activator levels, reflecting activation of the coagulation and fibrinolytic systems, respectively, decreased uniformly in both groups. We conclude that desmopressin is not useful in reducing blood loss or blood product requirements in patients with excessive immediate postoperative bleeding.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blood Transfusion; Cardiopulmonary Bypass; Deamino Arginine Vasopressin; Double-Blind Method; Female; Hemorrhage; Hemostasis; Humans; Male; Middle Aged; Postoperative Complications

It has been suggested that desmopressin acetate has been effective in reducing hemorrhage after coronary artery bypass grafting in patients receiving aspirin before operation. We conducted a prospective, randomized, placebo-controlled, double-blind trial to determine the effectiveness and safety of desmopressin in these patients. Sixty-five patients pretreated with aspirin within 7 days before their scheduled elective coronary artery bypass grafting were randomized to receive desmopressin (0.3 micrograms/kg) or placebo after cessation of bypass and reversal of heparin with protamine. The demographic characteristics and last dose of aspirin were similar in both groups. There was a significant reduction in postoperative blood loss noted between groups for both chest tube blood loss (833 +/- 311 ml for the 1-desamino-8-D-arginine vasopressin [desmopressin] group versus 1176 +/- 674 ml for the placebo group; p = 0.016) and total blood loss (1215 +/- 381 ml for the desmopressin group versus 1637 +/- 761 ml for the placebo group; p = 0.0097). Despite the differences in blood loss between the two groups, the red cell transfusions were not significantly different, but the use of platelets was less in the desmopressin group and almost achieved statistical significance (p = 0.053). Neither was there a difference in the occurrence of thrombotic complications between groups. It appears that desmopressin in this specific subgroup of patients receiving preoperative aspirin is effective as a prophylactic agent for reduction of postsurgical hemorrhage.

Topics: Aged; Aspirin; Blood Coagulation Factors; Cardiopulmonary Bypass; Coronary Artery Bypass; Deamino Arginine Vasopressin; Double-Blind Method; Female; Hemorrhage; Humans; Male; Middle Aged; Platelet Function Tests; Postoperative Complications; Prospective Studies; Treatment Outcome

The role of desmopressin acetate in attenuating blood loss and reducing homologous blood component therapy after cardiopulmonary bypass is unclear. The purpose of this investigation was to identify a subgroup of patients that may benefit from desmopressin acetate therapy. One hundred fifteen patients completed a prospective randomized double-blind, placebo-controlled trial designed to evaluate the effect of desmopressin acetate (0.3 microgram.kg-1) on mediastinal chest tube drainage after elective coronary artery bypass grafting surgery in patients with normal and abnormal platelet-fibrinogen function as diagnosed by the maximal amplitude (MA) on thromboelastographic (TEG) evaluation. The 115 patients evaluated were divided into two groups based on the MA of the post-cardiopulmonary bypass TEG tracing. Group 1 (TEG:MA greater than 50 mm) consisted of 86 patients, of whom 44 received desmopressin and 42 received placebo. Twenty-nine patients had abnormal platelet function (TEG:MA less than 50 mm) and were designated as group 2. In group 2, 13 received desmopressin and 16 placebo. During the first 24 h after cardiopulmonary bypass, the placebo-treated patients in group 2 had significantly greater mediastinal chest tube drainage when compared to placebo patients in group 1 (1,352.6 +/- 773.1 ml vs. 865.3 +/- 384.4 ml, P = 0.002). In addition to increases in blood loss, group 2 placebo patients also were administered an increased number of blood products (P less than 0.05). The desmopressin-treated patients in group 2 neither experienced increased mediastinal chest tube drainage nor received increased amounts of homologous blood products when compared to those in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Blood Component Transfusion; Blood Loss, Surgical; Chest Tubes; Coronary Artery Bypass; Deamino Arginine Vasopressin; Double-Blind Method; Drainage; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Risk; Thrombelastography

Bleeding in coronary artery bypass procedures increases morbidity and exposes patients to the risks associated with blood transfusion. Desmopressin acetate (DDAVP), a synthetic vasopressin analogue, may limit bleeding during cardiac surgery. In a prospective randomized trial, the authors evaluated the ability of DDAVP to reduce perioperative bleeding during uncomplicated coronary bypass operations. Sixty-two patients who underwent coronary artery bypass grafting were randomized to receive intraoperatively either a placebo or DDAVP. Both groups were similar with respect to operative characteristics and preoperative hematologic profiles, von Willebrand factor levels increased postoperatively in both placebo (2.77 +/- 1.06 versus 2.17 +/- 1.51 U) and DDAVP groups (2.75 +/- 0.94 versus 1.80 +/- 0.88 U). Only the increase in the DDAVP groups was significant (p less than 0.001). There was no difference in total blood loss between the placebo (1826 +/- 849 ml) and DDAVP groups (1716 +/- 688 ml). Total red cell transfusions were similar in placebo (3.4 +/- 1.3 units of blood) and DDAVP groups (3.6 +/- 0.8 units). These results do not support the intraoperative use of DDAVP to reduce perioperative bleeding in routine coronary artery bypass surgery.

Topics: Blood Transfusion; Coronary Artery Bypass; Deamino Arginine Vasopressin; Female; Hemorrhage; Humans; Male; Middle Aged; Platelet Count; Postoperative Complications; Prospective Studies; Randomized Controlled Trials as Topic; von Willebrand Factor

The vasopressin analog desmopressin (DDAVP) is known to enhance memory in animals and man but its precise mechanism of action is uncertain. We report the case of a patient who experienced chronic memory dysfunction with impaired job performance following transsphenoidal resection of a pituitary adenoma. A prospective double-blind, placebo-controlled trial of the effects of DDAVP was performed. Memory storage and recall improved with DDAVP treatment and declined within 1 week after drug withdrawal both by subjective and objective criteria. The Buschke Selective Reminding Test was clearly the most responsive out of a battery of standard memory testing paradigms employed to track the presence or absence of DDAVP treatment.

Topics: Adenoma; Adult; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Memory Disorders; Pituitary Neoplasms; Postoperative Complications; Prospective Studies

We investigated the effect of an intraoperative desmopressin acetate infusion on blood loss after cardiac operation in 60 children, by using a prospective, randomized, double-blind trial. Thirty patients received a desmopressin dose of 0.3 microgram/kg intravenously over 15 minutes at the conclusion of cardiac bypass, and 30 received a saline placebo. The two groups were comparable with respect to age, sex, cardiac lesion, presence of cyanosis, and prevalence of Down's syndrome. Results showed no significant difference in postoperative blood loss between the two groups (30.5 +/- 37.9 ml/kg in the placebo group versus 40.0 +/- 33.1 ml/kg in the desmopressin group). Postoperative bleeding time, total urine output, postinfusion hemodynamics, and postoperative coagulation studies did not differ significantly between the two groups. We conclude that postbypass desmopressin infusion does not reduce blood loss in children undergoing cardiac operations.

Topics: Cardiac Surgical Procedures; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Female; Hemorrhage; Hemostasis, Surgical; Humans; Infusions, Intravenous; Intraoperative Period; Male; Postoperative Complications; Prospective Studies; Random Allocation; Urine

Previous studies have suggested that desmopressin may reduce the bleeding diathesis that often complicates open-heart surgery. To pursue this question further, we performed a double-blind, randomized, placebo-controlled trial to determine whether the previously reported beneficial effect of desmopressin on hemostasis during complex cardiac surgery was applicable to all elective cardiac surgical procedures involving cardiopulmonary bypass. In 150 consecutive patients, most of whom underwent primary coronary-artery bypass grafting, we compared the effects of intravenous desmopressin (0.3 microgram per kilogram of body weight) with those of saline placebo on postoperative blood loss and the need to replace blood products. The median amount of blood lost within the first 24 hours after operation was similar in the desmopressin and placebo groups (865 vs. 738 ml; P = 0.26). The postoperative use of blood replacement products did not differ significantly between the groups (1025 ml [95 percent confidence interval, 300 to 4140 ml] in the desmopressin group and 860 ml [247 to 5346 ml] in the placebo group). Desmopressin is believed to exert its hemostatic effect by releasing von Willebrand factor. The level of ristocetin cofactor, a functional index of the level of von Willebrand factor, was increased approximately twofold from base line in both treatment groups 90 minutes and 24 hours after the administration of medication. Similarly, the levels of von Willebrand factor multimers increased uniformly in both groups. These findings may be consistent with a normal stress response of von Willebrand factor to major surgery and could explain our failure to detect a therapeutic effect of desmopressin. We conclude that the majority of patients who undergo elective cardiac surgery receive no hemostatic benefit from the use of desmopressin.

Topics: Adult; Aged; Blood Transfusion; Blood Volume; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Hemorrhage; Hemostatics; Humans; Middle Aged; Postoperative Complications; Random Allocation; Time Factors; von Willebrand Factor

It has been suggested that desmopressin acetate (DDAVP) administration reduces blood loss after cardiac surgery. We have investigated the effect of DDAVP administration in a double-blind, randomized, prospective trial including 100 patients placed on cardiopulmonary bypass during surgery. Fifty patients received 0.3 micrograms/kg DDAVP and 50 patients received a placebo administered in a 50 ml saline solution over 15 min when cardiopulmonary bypass had been concluded. Results showed no significant differences either in total blood loss per square meter (458 +/- 206 ml in the DDAVP group vs 536 +/- 304 ml in the placebo group) or in necessity for red cell transfusions (1642 +/- 705 ml in the DDAVP group vs 1574 +/- 645 ml in the placebo group) in the first 72 hr after surgery. Only intraoperative blood loss per square meter was significantly lower (p less than .02) in the DDAVP group (131 +/- 106 ml) as compared with the placebo group (193 +/- 137 ml). The prolongation of bleeding time and the decrease of factor VIII:C and factor VIII:von Willebrand factor 90 min after treatment were significantly lower (p less than .001) in the DDAVP group as compared with the placebo group. We conclude that the administration of DDAVP in patients placed on cardiopulmonary bypass during surgery does not reduce total blood loss and is only effective in reducing intraoperative bleeding.

Topics: Blood Transfusion; Cardiopulmonary Bypass; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Erythrocyte Transfusion; Hemorrhage; Humans; Intraoperative Complications; Postoperative Complications; Prospective Studies; Random Allocation; Time Factors

Management of early postneurosurgical diabetes insipidus (DI) requires parenteral vasopressin before intranasal administration of desmopressin-1 desamino-8 D arginine vasopressin (dDAVP) can be initiated. We have evaluated in 15 neurosurgical patients the effect and the tolerance of a 3-day regimen of dDAVP administered im every 12 h. Patients were randomly ascribed to one of 3 treatment groups: 1 microgram (N = 6), 2 micrograms (N = 5) or 4 micrograms (N = 4) were administered twice daily. dDAVP was effective whatever the dose, and DI was corrected by the 6th h of treatment. Effects were maximal on diuresis and urinary osmolality from the 18th h onwards. The effects were sustained throughout the treatment period. Reversal to pretreatment status occurred 24 h after the last injection. Moreover, 72 h after the last injection, natremia and osmolality reached values significantly below pretherapeutic values. The tolerance was excellent: hyponatremia which occurred in 11 patients, either occasionally or throughout the treatment period, remained mild and never had clinical consequences. In conclusion, before initiation of intranasal dDAVP, a 3-day treatment by 1, 2 or 4 micrograms of dDAVP injected im twice daily in neurosurgical patients corrected DI. Mild overhydration owing to a positive fluid balance was a side-effect which is also encountered in other therapeutic methods necessitating meticulous control of water intake.

Topics: Adolescent; Adult; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Injections, Intravenous; Male; Middle Aged; Osmolar Concentration; Postoperative Complications

Bleeding after cardiopulmonary bypass remains a cause for concern, requiring reexploration of the chest in approximately 3 percent of patients who have had operations on the heart. We examined the possibility that this problem might be alleviated by desmopressin acetate (DDAVP), which increases the plasma level of von Willebrand factor and improves hemostasis in mild hemophilia and other conditions associated with defective platelet function. In a double-blind, prospective, randomized trial, we studied the effect of intraoperative desmopressin acetate in 70 patients undergoing various cardiac operations requiring cardiopulmonary bypass. Patients undergoing uncomplicated primary coronary-artery bypass grafting were not included. The drug significantly reduced mean operative and early postoperative blood loss (1317 +/- 486 ml in the treated group vs. 2210 +/- 1415 ml in the placebo group); of the 14 patients whose 24-hour blood loss exceeded 2000 ml, 11 had received the placebo. Plasma levels of von Willebrand factor were higher after desmopressin acetate than after placebo. Patients with the most bleeding had relatively low levels of von Willebrand factor before operation, suggesting a role for this factor in the hemorrhagic tendency induced by extracorporeal circulation. There were no untoward side effects of desmopressin acetate. We conclude that the administration of desmopressin acetate can be recommended to reduce blood loss in patients undergoing complex cardiac operations. The beneficial effect of the drug on hemostasis after cardiopulmonary bypass may be related to its effect on von Willebrand factor.

Topics: Adult; Aged; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Female; Hemorrhage; Hemostasis; Humans; Intraoperative Care; Male; Middle Aged; Postoperative Complications; Prospective Studies; Random Allocation; von Willebrand Factor

In a randomized double-blind cross-over trial we gave either 1-deamino-8-D-arginine vasopressin or placebo to 12 patients with uremia, hemorrhagic tendencies, and prolonged bleeding times. After vasopressin infusion, all patients had shortened bleeding times, with the effect lasting for at least four hours in most cases. Platelet count, platelet cyclic AMP levels, platelet retention on glass beads, plasma fibronectin, serum thromboxane B2 and residual prothrombin, hematocrit, and plasma osmolarity were unchanged after vasopressin. A consistent post-infusion increase in factor VIII coagulant activity and, to a lesser extent, in factor VIII-related antigen and ristocetin cofactor accompanied the shortening of bleeding time. In addition, vasopressin induced the appearance in plasma of larger von Willebrand-factor multimers than those present in the resting state. The compound was given to nine additional patients with acute or chronic renal failure and prolonged bleeding times, before major surgery or renal biopsy. In these patients, shortening of the bleeding time was associated with normal hemostasis. Our findings indicate that 1-deamino-8-D-arginine vasopressin can be used for temporary correction of bleeding time and may prevent surgical bleeding in patients with uremia.

Topics: Adult; Antigens; Arginine Vasopressin; Bleeding Time; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Factor VIII; Female; Fibrinogen; Hemorrhage; Humans; Male; Middle Aged; Platelet Function Tests; Postoperative Complications; Random Allocation; Uremia; von Willebrand Factor

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypernatremia; Male; Postoperative Complications; Saline Solution, Hypertonic; Sodium

Water and electrolyte disturbances are common after pituitary surgery and can generally be classified into transient hypotonic polyuria and transient or permanent diabetes insipidus (DI). The prevalence varies in the literature between 31-51% for transient hypotonic polyuria, 5.1-25.2% for transient DI, and 1-8.8% for permanent DI.. The aim of this study was to identify the prevalence of water and electrolyte disturbances with polyuria and the preoperative and postoperative predictive factors in patients undergoing surgery with an extended endoscopic endonasal approach.. The overall prevalence of water and electrolyte disorders was 30.5% (62), and the prevalence of postoperative polyuria was 23.6% (48). The median number of desmopressin doses administered to patients with postoperative polyuria was one dose (interquartile range [IQR] 1-2), and thus the median duration of treatment was 0 days. The median initiation of desmopressin was the second day after surgery (IQR 1-2). The overall prevalence of DI was 6.89%. Among the patients with transient DI, the duration was less than 3 months in three patients (1.47%), and between 3 and 6 months in two (0.98%). Nine patients had permanent DI (4.43%). (4.43%).. The prevalence of electrolyte disturbances in our study was high, although similar to that found in the literature. Most of the cases were transient hypotonic polyuria that resolved within one day. The prevalence of transient DI in our cohort was lower than that described in the literature, while permanent DI was similar.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Pituitary Neoplasms; Polyuria; Postoperative Complications; Retrospective Studies; Water-Electrolyte Imbalance

Presented case demonstrates a rare diencephalic pathology - adipsic diabetes insipidus (ADI) with severe hypernatremia in a 58-year-old woman after ttranssphenoidal removal of stalk intraventricular craniopharyngioma. ADI was diagnosed because of hypernatremia (150-155 mmol/L), polyuria (up to 4 liters per day) and absence of thirst. Normalization of water-electrolyte balance occurred on the background of desmopressin therapy and sufficient hydration in postoperative period. After release from the hospital, the patient independently stopped desmopressin therapy and did not consume an adequate amount of fluid of the background of polyuria. This led to severe hypernatremia (155-160 mmol/L) and rough mental disorders.Patients with ADI need closely monitoring of medical condition and water-electrolyte parameters, appointment of fixed doses of desmopressin and adequate hydration.

Topics: Central Nervous System Cysts; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Female; Humans; Hypernatremia; Middle Aged; Neurosurgical Procedures; Polyuria; Postoperative Complications

Diabetes insipidus (DI) develops commonly after endoscopic transsphenoidal surgery (ETS). We retrospectively investigated the incidence, onset, duration and predictors of DI after ETS in patients with non-functioning pituitary adenoma (NFPA).. A total of 168 patients who underwent ETS to remove NFPAs were included. Various perioperative data on demographics, comorbidities, previous treatments, perioperative hormone deficiencies, tumor characteristics, surgery, anesthesia, intraoperative fluid balance, perioperative laboratory findings, postoperative complications, readmission and hospital length of stay were collected and analyzed. Patients were diagnosed with DI and treated with desmopressin when they showed urine output > 5 mL/kg/hr with a serum sodium concentration > 145 mmol/L or an increase ≥ 3 mmol/L in serum sodium concentration between two consecutive tests after surgery. DI was considered permanent when desmopressin was prescribed for > 6 months after surgery.. Seventy-seven (45.8%) patients experienced postoperative DI and 10 (6.0%) patients suffered from permanent DI. The median onset of DI and the median duration of transient DI were postoperative day 1 and 5 days, respectively. In multivariable logistic regression analysis, cephalocaudal tumor diameter (odds ratio [95% confidence interval] 2.59 [1.05-6.36], P = 0.038) was related to postoperative DI. In receiver operating characteristic analysis, its area under the curve was 0.68 (95% confidence interval 0.59-0.76, P < 0.001). Its optimal cutoff value that maximized the sum of sensitivity and specificity for postoperative DI was 2.7 cm.. Postoperative DI was observed in 45.8% of patients undergoing ETS to remove NFPAs. A large cephalocaudal tumor diameter was predictive of postoperative DI in such patients.

Topics: Adenoma; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Humans; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Sodium

Cushing's disease (CD) may recur despite corticotropic insufficiency (COI) following pituitary surgery. The predictive value of the desmopressin test (DT) for recurrence in this setting remains controversial. We have evaluated whether the disappearance of the response to DT predicts a low probability recurrence in a large cohort of patients with post-operative COI.. Multicentre retrospective study.. Ninety-five patients with CD (women 82%, age 41 ± 14 years), responding preoperatively to DT and with early post-operative COI (08 00 am cortisol: <138 nmol/L), underwent a DT within 3 months post-surgery. Association between DT findings and the prediction of recurrence was tested using regression and ROC analyses.. Recurrence occurred in 17/95 patients within 29 to 91 months. The cortisol peak (327, 95% CI (237-417) vs 121 (79-164) nmol/L, P = 0.0001) and absolute increment during DT (208 (136-280) vs 56 (22-90) nmol/L, P = 0.005) were greater in the recurrence vs remission group. Cortisol peak (AUC: 0.786 (0.670-0.902)) and increment (0.793 (0.672-0.914)) yielded a higher prognostic performance for recurrence than did the early post-operative 08 00 am cortisol (0.655 (0.505-0.804)). In the context of COI, cortisol peak >100 nmol/L and increment >30 nmol/L had a high negative predictive value (94, 95% CI (88-100) and 94, (88-100), respectively). Patients with a cortisol peak ≤100 nmol/L (vs >100) or an increment ≤30 nmol/L (vs >30) were less likely to have CD recurrence (odds ratios: 0.12, 95% CI (0.03-0.41) and 0.11 (0.02-0.36), respectively).. The disappearance of the response to the post-operative DT was independently associated with a lower odds of CD recurrence and offers an incremental prognostic value, which may help to stratify patients with COI and refine their follow-up according to the risk of recurrence.

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Humans; Hydrocortisone; Male; Middle Aged; Pituitary ACTH Hypersecretion; Postoperative Complications; Predictive Value of Tests; Recurrence; Retrospective Studies

Topics: Adult; Craniopharyngioma; Deamino Arginine Vasopressin; Drug Administration Schedule; Female; Humans; Hypernatremia; Hypopituitarism; Neurologic Examination; Pituitary Neoplasms; Postoperative Complications; Sodium; Substance Withdrawal Syndrome

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.

Topics: Antidiuretic Agents; Brain Injuries; Coronavirus Infections; COVID-19; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Disease Management; Fluid Therapy; Humans; Hypernatremia; Hyponatremia; Hypotonic Solutions; Inappropriate ADH Syndrome; Neurosurgical Procedures; Pandemics; Pneumonia, Viral; Postoperative Complications; Practice Guidelines as Topic; Saline Solution; Shock

Pituitary stalk sectioning is only essential in cases of craniopharyngioma originating from the stalk or metastatic tumor to the stalk. Some patients can discontinue postoperative antidiuretic hormone (ADH) supplementation with special conditions.. Sixty-three patients with craniopharyngiomas who were treated by surgery with pituitary stalk sectioning were included in this study. Great care was taken to preserve the fine arteries running along the lateral walls of the third ventricle. Removal rates, change of endocrinologic status, and magnetic resonance imaging (MRI) findings were investigated.. Total removal was achieved in 52 of 54 patients in initial surgery (96.3%), and in 5 of 9 patients in retreatment (55.6%). ADH supplementation was required in all patients from the day of surgery, but was discontinued in 29 of 54 patients among the initial surgery group (53.7%) and in 2 of 9 patients among the retreatment group (22.2%). Preservation of thyroid hormone secretion was observed in 24 of 31 patients who could discontinue ADH (77.4%), but only in 12 of 32 patients who could not discontinue ADH (37.5%). Recovery from diabetes insipidus (DI) was significantly associated with preservation of thyroid function (P < 0.01). Postoperative MRI showed that part of the hypothalamus was enhanced in patients with recovery from DI.. Total removal was achieved in 91% of all cases. Half of the patients could discontinue ADH supplementation, which was associated with preservation of thyroid function. The findings of hypothalamic enhancement on postoperative MRI may be associated with recovery from DI.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antidiuretic Agents; Child; Child, Preschool; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Glucocorticoids; Hormone Replacement Therapy; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Hypothyroidism; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Postoperative Complications; Prognosis; Recovery of Function; Thyroid Hormones; Young Adult

To describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD).. The radiology department's electronic database was searched to identify all BIPSS procedures (1990-2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings.. A total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7-81) years. The overall technical success rate was 88% for bilateral cannulation, though nearly two-thirds of the technical failures had unilateral sampling that diagnosed CD. Of the 331 BIPSS procedures, 40 were performed without, and 291 with stimulation by Acthrel or desmopressin. Sensitivity was 89-94% for unstimulated BIPSS, 96% for stimulated BIPSS, and 77% for MRI. BIPSS lateralization was accurate in about half of patients, compared with 75% accuracy for MRI. Mean inferior petrosal sinus (IPS):peripheral adrenocorticotropic hormone ratio was 17.3 (SE 1.8) at baseline, and 99.2 (SE 14.8) at 3 min, with decreasing values over time. All patients with follow-up after surgical resection for centralizing BIPSS were reported to be cured, with cortisol levels significantly decreased from 19 to 4 μg/dL (p<0.0001). Complications from BIPSS were rare, including groin hematoma (2.5%), but no thromboembolic complications were seen.. BIPSS remains the 'gold standard' for diagnosing CD. Stimulation with Acthrel or desmopressin is key to increasing specificity. When only one IPS can be successfully cannulated, results may still be diagnostic. BIPSS findings cannot be used to accurately lateralize lesions within the pituitary.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Cerebral Angiography; Child; Deamino Arginine Vasopressin; Female; Humans; Hydrocortisone; Magnetic Resonance Imaging; Male; Middle Aged; Petrosal Sinus Sampling; Pituitary ACTH Hypersecretion; Postoperative Complications; Reproducibility of Results; Treatment Outcome; Young Adult

To explore the utilization pattern and hemostatic effectiveness of desmopressin acetate (DDAVP) supplemented with point-of-care (POC) hemostatic testing in contemporary cardiac surgery.. Retrospective, observational study.. Single quaternary care university hospital.. The study comprised 2,468 consecutive patients undergoing cardiac surgery-1,237 before and 1,231 after the introduction of POC testing.. The incidence of DDAVP administration during the year before (2012) and after (2013) the initiation of POC-based viscoelastic (ROTEM; Tem International GmBH, Munich, Germany) and platelet function (Plateletworks; Helena Laboratories, Beaumont, TX) testing was determined. Propensity-score matching was used to examine the association between DDAVP administration and major bleeding during each time period.. DDAVP was administered more than twice as often after POC implementation (41% v 20%, p<0.001). Major bleeding was defined based on the universal definition of perioperative bleeding in adult cardiac surgery. Propensity matching identified 224 well-balanced pairs of DDAVP recipients and control patients before and 298 such pairs after the implementation of POC testing. After adjusting for matched data, DDAVP administration was associated with 1.70 (95% confidence interval 1.25-2.32, p<0.001) and 1.51 (95% confidence interval 1.15-1.98, p = 0.003) increases in the odds of major bleeding before and after the initiation of POC testing, respectively.. Clinicians should be cognizant of the potential for increased use of DDAVP despite limited evidence of benefit in contemporary cardiac anesthesia practice supplemented with POC-based hemostatic testing.

Topics: Aged; Cardiac Surgical Procedures; Deamino Arginine Vasopressin; Female; Hemostasis; Hemostatics; Humans; Male; Matched-Pair Analysis; Middle Aged; Point-of-Care Testing; Postoperative Complications; Propensity Score; Prospective Studies; Retrospective Studies; Treatment Outcome

Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

Topics: Antidiuretic Agents; Cardiopulmonary Bypass; Coronary Artery Bypass; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Middle Aged; Polyuria; Postoperative Complications; Time Factors; Treatment Outcome

Topics: Aged; Deamino Arginine Vasopressin; Diuresis; Dose-Response Relationship, Drug; Drinking; Elective Surgical Procedures; Female; Health Personnel; Humans; Hyperparathyroidism, Primary; Hyponatremia; Parathyroidectomy; Postoperative Complications; Seizures; von Willebrand Diseases

Desmopressin (DDAVP) 1-deamino-8-D-arginine vasopressin is used in patients with bleeding disorders, including mild factor VIII deficiency, types 1 and 2 von Willebrand disease, and platelet function defects, undergoing surgeries to help control bleeding. We conducted a retrospective chart review of bleeding disorder patients undergoing inpatient surgery at Toledo Children's Hospital, OH, from 2005 to 2009. Our study population included 107 patients aged 2 to 19 years with platelet function defects and von Willebrand disease. Our study aimed to evaluate the extent of hyponatremia caused by DDAVP and to propose a safe and effective treatment regimen for these patients. The mean change in sodium level before and after DDAVP was statistically significant within each age group. Thirteen patients had second dose of DDAVP withheld, and 11 patients had postoperative sodium levels ≤ 130 mEq/L. There were 2 patients with significant complications: a 6-year-old with postoperative bleeding and a 2-year-old with post-DDAVP tonic-clonic seizures. We conclude that DDAVP causes significant hyponatremia, despite appropriate fluid restrictions. On the basis of our analysis, we recommend monitoring sodium levels before each dose of DDAVP and fluid restriction. These patients should be observed in the hospital setting after DDAVP administration for complications such as seizures and postoperative bleeding.

Topics: Adolescent; Blood Coagulation Disorders; Blood Loss, Surgical; Blood Platelet Disorders; Child; Child, Preschool; Deamino Arginine Vasopressin; Hemophilia A; Hemostatics; Humans; Hyponatremia; Intraoperative Period; Postoperative Complications; Postoperative Period; Retrospective Studies; Sodium; von Willebrand Diseases; Water-Electrolyte Imbalance; Young Adult

Diabetes insipidus (DI) is common following surgery for a pituitary/sellar lesion. Postoperative DI persisting beyond a few weeks is usually regarded as permanent, requiring lifelong desmopressin therapy.. A 16-year-old girl underwent pituitary decompression following a pituitary tumour apoplexy. She developed DI with thirst and hypotonic polyuria in the immediate post-operative period, which was controlled with parenteral DDAVP. Her symptoms persisted and she was discharged on oral desmopressin. Subsequently, she commenced growth hormone replacement. A water deprivation test 6 weeks postoperatively confirmed persistent DI with failure to concentrate urine after 8 hours of dehydration. She was maintained on desmopressin and reported intense thirst and polyuria every time she delayed taking the medication up until 1 year postoperatively. After 1 year, she complained of bloating and stopped taking desmopressin but her symptoms did not recur. A repeat water deprivation test confirmed very late resolution of DI with normal urinary concentration. She has remained asymptomatic ever since.. Delayed recovery of normal posterior pituitary function is exceptionally rare. We hypothesise that the underlying mechanism may be the revascularisation and regeneration of the posterior pituitary tissues or of the axons terminating in the posterior pituitary.

Topics: Adolescent; Antidiuretic Agents; Deamino Arginine Vasopressin; Decompressive Craniectomy; Diabetes Insipidus, Neurogenic; Female; Humans; Pituitary Apoplexy; Pituitary Neoplasms; Postoperative Complications; Recovery of Function; Time Factors

Topics: Aged; Antidiuretic Agents; Deamino Arginine Vasopressin; Female; Free Tissue Flaps; Humans; Injections, Intravenous; Postoperative Complications; Venous Thrombosis

There is no consensus on the remission criteria for Cushing's disease or on the definition of disease recurrence after transsphenoidal surgery, and comparison of the different published series is therefore difficult. A long-term recurrence rate of Cushing's disease ranging from 2%-25% has been reported. Predictors of long-term remission reported include: 1) adenoma-related factors (aggressiveness, size, preoperative identification in MRI), 2) surgery-related factors, mainly neurosurgeon experience, 3) clinical factors, of which dependence on and duration of glucocorticoid treatment are most important, and 4) biochemical factors. Among the latter, low postoperative cortisol levels, less than 2 mcg/dL predict for disease remission. However, even when undetectable plasma cortisol levels are present, long-term recurrence may still occur and lifetime follow-up is required. We report the preliminary results of the first 20 patients with Cushing's disease operated on at our hospital using nadir cortisol levels less than 2 mcg/dl as remission criterion.

Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; Adolescent; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Circadian Rhythm; Combined Modality Therapy; Deamino Arginine Vasopressin; Dexamethasone; Female; Follow-Up Studies; Glucocorticoids; Hormone Replacement Therapy; Humans; Hydrocortisone; Hypophysectomy; Male; Metyrapone; Middle Aged; Neoplasm Recurrence, Local; Pituitary ACTH Hypersecretion; Pituitary Neoplasms; Postoperative Complications; Remission Induction; Retrospective Studies; Saliva; Secretory Rate; Young Adult

Pituitary apoplexy during pregnancy is so rare that only 15 cases (12 pituitary adenomas, 2 lymphocytic neurohypophysitis, and 1 normal pituitary gland) have been published to date. Here, we report the case of a pregnant woman presenting with pituitary apoplexy from a nonfunctioning pituitary adenoma and provide a possible mechanism and management option for postoperative diabetes insipidus (DI).. A 26-year-old woman presented with sudden onset of headache and bitemporal hemianopsia in the 26th week of her first pregnancy. Magnetic resonance imaging clearly revealed an 18 mm pituitary mass with a fluid-fluid level component displacing the optic chiasma upward. Endonasal endoscopic transsphenoidal surgery was successfully carried out 7 days after the onset of symptoms. DI became apparent immediately after the operation and was not controllable by arginine vasopressin (AVP) but by 1-desamino-8-D-arginine vasopressin (DDAVP) instead. This finding suggests an association between DI and vasopressinase secretion from the placenta, because vasopressinase can degrade AVP but not DDAVP. DI had diminished by the time the patient delivered a healthy girl at the 40th week of gestation.. Postoperative DI associated with pituitary apoplexy during pregnancy should be treated by DDAVP, which is not affected by placental vasopressinase secretion.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pituitary Apoplexy; Pituitary Neoplasms; Postoperative Complications; Pregnancy; Pregnancy Complications, Neoplastic

Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.

Topics: Adult; Antidiuretic Agents; Coronary Artery Bypass; Coronary Vessels; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Humans; Hypothalamus; Magnetic Resonance Imaging; Male; Pituitary Gland; Polyuria; Postoperative Complications; Radionuclide Imaging

Topics: Adolescent; Child, Preschool; Craniopharyngioma; Deamino Arginine Vasopressin; Estrogens; Female; Hemostatics; Hormone Replacement Therapy; Humans; Hypopituitarism; Monitoring, Physiologic; Postoperative Complications; Progesterone; Risk Factors; Thrombophilia; Venous Thrombosis; von Willebrand Factor

  The incidence, severity, and risk factors for the development of hyponatremia in patients undergoing craniosynostosis surgery are not well known..   To determine the incidence and severity of hyponatremia as a complication in surgical correction of craniosynostosis and to identify risk factors for postoperative hyponatremia..   A retrospective medical record review for 2003-2008 of the Cleft and Craniofacial Database was made. Specific data collected included sodium values, age, weight, type of surgery, duration of surgery, administration of DDAVP, composition and volume of pre-operative, intra-operative, postoperative parenteral fluids, volume of blood, colloid, and crystalloid transfused, estimated blood loss (EBL), medications, comorbidities, pre-operative signs of elevated intracranial pressure (ICP), syndromic vs nonsyndromic craniosynostosis, and the complications associated with hyponatremia..   A total of 72 records were reviewed. The incidence of postoperative hyponatremia was 30.6%. There was no intra-operative hyponatremia. While hospital stay was not prolonged, ICU stay was significantly longer (1.9 vs 2.9 days, P = 0.001). Elevated ICP was significantly associated with hyponatremia (P < 0.002). A greater volume of blood loss (EBL) was associated with postoperative hyponatremia (P = 0.019). Patients with normal pre-operative ICP were more likely to become hyponatremic if they were female (relative risk = 2.43; P < 0.05). The average decrease in sodium was greater in patients receiving hyponatremic (hypotonic) vs normonatremic (isotonic) postoperative IVF's (5.5 vs 3.2 mEq·l(-1), P = 0.039). There were no postoperative complications related to hyponatremia..   The incidence of postoperative hyponatremia after calvarial vault remodeling was determined to be 30.6%. Hyponatremia was significantly associated with increased pre-operative ICP, blood loss, and female gender (normal pre-operative ICP). The average decrease in sodium was greater in patients receiving hyponatremic postoperative IVF's.

Topics: Anesthesia; Blood Loss, Surgical; Blood Substitutes; Blood Volume; Child; Child, Preschool; Comorbidity; Craniosynostoses; Deamino Arginine Vasopressin; Female; Fluid Therapy; Humans; Hyponatremia; Infant; Intracranial Pressure; Logistic Models; Male; Monitoring, Intraoperative; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Risk Factors; Skull; Sodium

To analyze the incidence and severity of hyponatremia in patients receiving synthetic desmopressin (DDAVP) in the perioperative setting of oropharyngeal surgery in the treatment of von Willebrand disease and to propose a standardized protocol for perioperative fluid resuscitation and postoperative sodium monitoring after DDAVP administration.. Retrospective medical record review.. A retrospective medical record review in an academic pediatric medical center was conducted. From October 1, 2002, to February 1, 2009, all patients undergoing adenotonsillectomy and receiving DDAVP preoperatively for the treatment of von Willebrand disease were identified. A total of 76 patients were identified by initial database review; 63 patients were included in the study, and 13 patients were excluded secondary to incomplete data. DDAVP dose and timing, perioperative fluid volume and composition, and postoperative sodium levels were collected. Extreme adverse events related to hyponatremia were recorded.. Forty-seven of 63 (74.6%) patients developed some degree of hyponatremia after DDAVP administration, and six of 63 (9.5%) patients developed extreme hyponatremia, with the degree of hyponatremia related to the volume of perioperative fluid resuscitation. The sodium nadir occurred within 9 to 20 hours after DDAVP administration. No serious adverse events related to hyponatremia were recorded during the study period.. The incidence of hyponatremia in children receiving DDAVP for prophylaxis of intraoperative bleeding following oropharyngeal surgery is high. The degree of hyponatremia is related to the perioperative fluid volume administered. A protocol for DDAVP administration, perioperative fluid resuscitation, and postoperative sodium monitoring that aims to reduce the incidence of hyponatremia in this population is proposed.

Topics: Academic Medical Centers; Adenoidectomy; Adolescent; Blood Loss, Surgical; Child; Child, Preschool; Cohort Studies; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Humans; Hyponatremia; Incidence; Male; Perioperative Care; Postoperative Complications; Postoperative Hemorrhage; Preoperative Care; Retrospective Studies; Risk Assessment; Severity of Illness Index; Tonsillectomy; Treatment Outcome; von Willebrand Diseases

Cauterization, nasal packing, and topical and/or injection of intranasal vasoconstrictors have been the mainstay of treatment for epistaxis following outpatient nasal surgery. In this study, the authors report the clinical outcomes in a cohort of patients with postoperative epistaxis managed with a single dose of intravenous desmopressin.. A retrospective chart review of 268 consecutive nasal operations (rhinoplasty, septoplasty, and/or turbinectomy for cosmetic and/or functional purposes) was conducted. Information on demographics, perioperative blood pressure, postoperative management, and effectiveness of the measures used was assessed. The primary outcome variable was cessation of bleeding.. Nine patients were identified who experienced excessive postoperative bleeding following discharge from the surgical facility. Each patient received 0.3 μg/kg of intravenous desmopressin over 30 minutes under the supervision of the local emergency room physician with verbal instructions from the treating plastic surgeon. After administration of desmopressin, bleeding either stopped completely (eight patients) or slowed down significantly to allow discharge (one patient). No significant adverse side effects of desmopressin were observed. No patient was known to be taking medication negatively affecting coagulation perioperatively. Preoperatively, two patients were documented to have von Willebrand disease and thus received desmopressin preoperatively. Average blood pressure was 116/71 mmHg intraoperatively (range, 109 to 126/66 to 83 mmHg) and 118/74 mmHg postoperatively (range, 105 to 129/65 to 85 mmHg).. Unremitting postoperative epistaxis following outpatient nasal surgery can be successfully controlled by a protocol using intravenous desmopressin without the need for alternative maneuvers.

Topics: Adolescent; Adult; Cohort Studies; Deamino Arginine Vasopressin; Epistaxis; Female; Follow-Up Studies; Hemostatics; Humans; Infusions, Intravenous; Intraoperative Complications; Male; Middle Aged; Nasal Septum; Postoperative Complications; Postoperative Hemorrhage; Rhinoplasty; Treatment Outcome; Turbinates; von Willebrand Diseases; Young Adult

Patients requiring CSF shunts frequently have comorbidities that can influence water and electrolyte balances. The authors report on a case involving a ventriculoperitoneal shunt in a patient who underwent intravenous hyperhydration and withdrawal of vasopressin substitution prior to scheduled high-dose chemotherapy regimen for a metastatic suprasellar germinoma. After acute neurological deterioration, the patient underwent CT scanning that demonstrated ventriculomegaly. A shunt tap revealed no flow and negative opening pressure. Due to suspicion of proximal shunt malfunction, the comatose patient underwent immediate surgical exploration of the ventricle catheter, which was found to be patent. However, acute severe hypernatremia was diagnosed during the procedure. After correction of the electrolyte disturbances, the patient regained consciousness and made a good recovery. Although rare, the effects of acute severe hypernatremia on brain volume and ventricular size should be considered in the differential diagnosis of ventriculoperitoneal shunt failure.

Topics: Acute Disease; Adult; Antidiuretic Agents; Antineoplastic Agents; Astrocytoma; Brain Stem Neoplasms; Cerebral Ventricles; Chemotherapy, Adjuvant; Cranial Irradiation; Deamino Arginine Vasopressin; Diagnosis, Differential; Diagnostic Errors; Equipment Failure Analysis; Fluid Therapy; Humans; Hydrocephalus; Hypernatremia; Hypertrophy; Male; Neoplasms, Multiple Primary; Pituitary Neoplasms; Postoperative Complications; Substance Withdrawal Syndrome; Tectum Mesencephali; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt

1) Compare rates of post-tonsillectomy bleeding in pediatric patients with and without von Willebrand disease (vWD). 2) Identify factors that may increase the risk for post-tonsillectomy bleeding in children with and without vWD.. Historical cohort study.. Tertiary care, university-based pediatric hospital.. Medical records were examined for 99 patients with vWD and 99 patients without vWD younger than 18 years who underwent tonsillectomy with or without adenoidectomy from August 1997 to October 2005. Subjects were matched for age, year of surgery, type of surgery, and indication for surgery.. Post-tonsillectomy hemorrhage occurred in eight of 99 (8%) vWD patients and in six of 99 (6%) non-vWD patients (P = 0.58, odds ratio 1.36, 95% CI 0.45-4.08). A two-sample test of proportions demonstrated lower and upper limits of -0.051 and 0.092. Four of eight children with vWD and two of six non-vWD patients required surgical intervention for control of bleeding. Ninety-three of 99 vWD patients received desmopressin acetate (DDAVP) preoperatively. In patients with vWD who responded to DDAVP challenge, there was no increased likelihood of post-tonsillectomy bleeding compared with non-vWD patients. No significant difference in the number of bleeding events was noted on the basis of demographics, preoperative laboratories, or use of aminocaproic acid.. Children with vWD undergoing tonsillectomy have a postoperative bleeding rate similar to that of a matched group. However, the sample size was not sufficient to eliminate the possibility of a clinically important difference between the two groups.

Topics: Adolescent; Child; Child, Preschool; Cohort Studies; Deamino Arginine Vasopressin; Female; Hemorrhage; Humans; Male; Postoperative Complications; Tonsillectomy; von Willebrand Diseases

Topics: Deamino Arginine Vasopressin; Female; Humans; Kidney Neoplasms; Male; Nephrectomy; Postoperative Complications; Prognosis; Risk Assessment; Treatment Outcome; Urinary Incontinence

Persistent urine leakage is common following iatrogenic urinary collecting system injuries. Management of a urine leak usually includes manipulations such as catheter drainage, ureteral stenting, and percutaneous nephrostomy placement. The aim of this study was investigation the potential beneficial effect of desmopressin in reduction of urinary leakage duration.. Fifteen patients with incisional urinary leakage were enrolled in this study. They had undergone pyeloplasty (n = 9), pyelolithotomy (n = 4), and ureterocaliceal anastomosis (n = 1). All of them had ureteral stenting or nephrostomy catheters, and urinary leakage had lasted for at least 15 days. Seven patients received desmopressin spray, 1 puff, twice a day, from the 16th days of urinary leakage, and 8 patients (control group) did not receive any medical treatment. The duration of urinary leakage was compared between the two groups.. The patients were 5 women and 10 men with the median age of 37 years (range, 26 to 58 years). None of the patients had urinary obstruction. There were no significant differences in age and sex distribution between the two groups. The mean urinary leakage duration was 28.7 +/- 7.2 days in the patients of desmopressin group and 47.7 +/- 8.8 days in those of the control group (P = .04).. Our study showed that desmopressin can reduce the duration of incisional urinary leakage. We conclude that patients with prolonged urinary leakage after pyelocaliceal surgery who does not respond to surgical urinary drainage may benefit from desmopressin.

Topics: Adult; Anastomosis, Surgical; Case-Control Studies; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Hemostatics; Humans; Kidney Calculi; Male; Middle Aged; Nephrostomy, Percutaneous; Postoperative Complications; Prospective Studies; Risk Assessment; Treatment Outcome; Ureteral Calculi; Urinary Catheterization; Urinary Fistula

A 31-year-old man was sent to hospital for urgent treatment. He was in the terminal state of chronic renal failure, and was placed under hemodialysis immediately. Proteinuria and hypertension had been notified since adolescence, had been left untreated, and there was no record of his conditions, was. Living kidney transplantation was conducted 8 months later. The donor was his father. After the operation, rejection was not recognized, but urine volume per day was not reduced and maintained the level around 10.000 ml. At the same time, the decrease of body weight and the rise in the serum creatinine concentration were noted. The results of magnetic resonance imaging and the hypertonic saline test (Hickey Hare Test) have formed diagnosis of incomplete diabetes insipidus. Immediately after the administration of desmopressin (rhinenchysis), the decrease of urine volume was recognized, and the body weight and serum creatinine concentration became stable.

Topics: Administration, Intranasal; Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Humans; Kidney Transplantation; Living Donors; Magnetic Resonance Imaging; Male; Postoperative Complications; Saline Solution, Hypertonic; Treatment Outcome

In the early postoperative period of Cushing's disease patients, desmopressin may stimulate ACTH secretion in the remnant corticotrophic tumour, but not in nontumour suppressed cells.. The aim of this study is to evaluate the serum cortisol responses to desmopressin after pituitary surgery, establishing an optimal cut-off for absolute increment (Delta) of serum cortisol (F) suitable to predict recurrence risk.. Retrospective case record study.. Fifty-seven Cushing's disease patients submitted to pituitary surgery and desmopressin stimulation in the early postoperative with a long-term follow-up (20-161 months) were studied.. Serum cortisol levels after desmopressin test (10 microg i.v.) 15-30 days after adenomectomy were used to determine DeltaF (absolute increment of F: F peak - F baseline). Sensitivity and specificity of DeltaF were calculated and a ROC curve was performed to establish an optimal cut-off for DeltaF to predict recurrence risk.. Fifteen patients had immediate postoperative failure (basal F > 165 nmol/l; 6 microg/dl) and one patient was lost during the follow-up. Forty-one patients achieved initial remission and were followed-up. Five of 11 patients who recurred had DeltaF > 193 nmol/l (7 microg/dl), but none of 30 patients who remained in prolonged remission showed DeltaF > 193 nmol/l after postoperative desmopressin stimulation.. Persistence of cortisol response (DeltaF > 193 nmol/l) to desmopressin in the early postoperative period can help to identify Cushing's disease patients with initial remission who present risk for later recurrence.

Topics: Adolescent; Adult; Aged; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Diagnostic Techniques, Endocrine; Female; Humans; Hydrocortisone; Male; Middle Aged; Pituitary ACTH Hypersecretion; Postoperative Complications; Postoperative Period; Prognosis; Recurrence; Retrospective Studies; Risk Factors; Young Adult

We present a case of nephrogenic diabetes insipidus that occurred after on-pump coronary artery bypass grafting in a patient taking long-term lithium carbonate. Lithium toxicity (2.79 mmol/L) was identified on postoperative day 9. Serum sodium peaked at 175 mmol/L on postoperative day 21. Serum osmolality peaked at 384 mOsm/kg H2O, with a urinary osmolality of 403 mOsm/kg H2O. The patient was ultimately managed with hemofiltration and high-dose 1-desamino-8-D-arginine-vasopressin. Recommendations are made based on our experience of this case. In patients on long-term lithium therapy, the potentially life-threatening complication of lithium-induced nephrogenic diabetes insipidus should be specifically anticipated and managed.

Topics: Bipolar Disorder; Coronary Artery Bypass; Coronary Disease; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemofiltration; Humans; Lithium Carbonate; Male; Middle Aged; Postoperative Complications; Treatment Outcome

Topics: Adenoma; Deamino Arginine Vasopressin; Electroencephalography; Female; Humans; Hypertensive Encephalopathy; Hypoglycemic Agents; Magnetic Resonance Imaging; Middle Aged; Pituitary Neoplasms; Postoperative Complications

Disorders of fluid and sodium regulation, often termed "diabetes insipidus," are a frequent occurrence following surgery for pituitary adenomas. The present study was undertaken to identify the incidence of diabetes insipidus after pituitary surgery and its associated factors.. A retrospective review of the medical records 300 patients who underwent transsphenoidal surgery for pituitary adenoma was undertaken. Information regarding patient gender, perioperative serum sodium levels and urinary output volumes, tumor size, previous pituitary surgery, tumor subtype, and the use of DDAVP was gathered. A multivariate statistical analysis was performed.. Follow-up data were available on 288 patients. During the inpatient postoperative hospital stay, DDAVP was administered to 19% of all patients and 16% of patients not taking DDAVP preoperatively. Of patients with normal fluid/sodium regulation preoperatively, DDAVP was prescribed for 9% at discharge and 4% at 6 weeks postoperatively. Only 1.4% of patients were taking vasopressing replacement at the time of last follow-up. Significant correlations were found between gender, previous surgery, serum sodium levels, and urine volumes at various time points. Immunohistochemical type of tumor and tumor size were not related to DDAVP requirement.. Transient hypotonic polyuria is frequently encountered after pituitary surgery. However, only a small number of patients will develop a long-term requiring for ongoing medical treatment. Previous surgery, female gender, and elevated serum sodium and urine volumes in perioperative period were associated with DDAVP requirement.

Topics: Adenoma; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Kidney Concentrating Ability; Male; Neoplasm Recurrence, Local; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Polyuria; Postoperative Complications; Reoperation; Retrospective Studies; Sex Factors; Sodium; Sphenoid Bone; Treatment Outcome; Water-Electrolyte Balance

Adipsic diabetes insipidus (ADI) is a rare condition in which thirst, an essential clinical feature for the prevention of hypernatraemic dehydration, is absent. We report the first case of adipsic diabetes insipidus to occur following surgery for a pituitary macroprolactinoma, with loss of both osmoregulated and baroregulated vasopressin release. Following extensive surgery for a vision threatening macroprolactinoma a 14-year-old boy developed profound hypernatraemia with absent thirst sensation. Detailed investigation, with hypertonic saline infusion and trimetaphan infusion, revealed absence of both osmoregulatory and baroregulatory release of vasopressin. We discuss the investigation and management of such patients and the physiology of hypothalamic-neurohypophyseal dysfunction in such patients.

Topics: Adolescent; Deamino Arginine Vasopressin; Diabetes Insipidus; Fluid Therapy; Humans; Magnetic Resonance Imaging; Male; Pituitary Neoplasms; Postoperative Complications; Prolactinoma; Treatment Outcome

Topics: Adenocarcinoma; Anesthesia, Intravenous; Anesthetics, Intravenous; Anticoagulants; Aprotinin; Bernard-Soulier Syndrome; Colectomy; Colonic Neoplasms; Coronary Artery Bypass; Deamino Arginine Vasopressin; Drainage; Erythrocyte Transfusion; Extracorporeal Circulation; Genes, Dominant; Hemorrhagic Disorders; Hemostatics; Heparin; Humans; Leukopenia; Male; Middle Aged; Molecular Motor Proteins; Myosin Heavy Chains; Peptic Ulcer Hemorrhage; Plasma; Platelet Count; Platelet Transfusion; Pleural Effusion; Postoperative Complications; Postoperative Hemorrhage; Propofol; Sclerotherapy; Syndrome

Lymphocytic infundibuloneurohypophysitis is a rare disorder in which neurohypophyseal function is impaired by an autoimmune process. Although several etiologies for this rare entity have been suggested, its occurrence following transsphenoidal adenomectomy has not been reported. A 20-year-old man presented with diabetes insipidus - seven years after successful transsphenoidal microadenomectomy for Cushing's disease, first diagnosed at the age of 13. Seven years later, he developed fairly rapid onset of polydipsia and polyuria. Magnetic resonance imaging demonstrated swelling of the posterior pituitary gland with thickening of the pituitary stalk. Endocrinological evaluation revealed neurohypophyseal dysfunction without the adenohypophysis being affected. On the basis of these findings, a diagnosis of lymphocytic infundibuloneurohypophysitis was made. The mass lesion of the posterior pituitary resolved after the administration of corticosteroids for two months and no operation was required. Lymphocytic infundibuloneurohypophysitis should be considered in the differential diagnosis of pituitary mass lesions following transsphenoidal surgery, especially when the mass is confined to the posterior pituitary gland with neurohypophyseal function being compromised.

Topics: Adenoma; Adult; Anti-Inflammatory Agents; Cushing Syndrome; Deamino Arginine Vasopressin; Humans; Magnetic Resonance Imaging; Male; Neurosurgical Procedures; Pituitary Diseases; Pituitary Gland, Posterior; Pituitary Hormones, Posterior; Pituitary Neoplasms; Postoperative Complications; Prednisolone

Topics: Adenoidectomy; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Fluid Therapy; Hemophilia A; Humans; Hyponatremia; Postoperative Care; Postoperative Complications; Renal Agents; Seizures; Tonsillectomy; Water Intoxication

Topics: 3' Untranslated Regions; Activated Protein C Resistance; Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Contraindications; Coronary Disease; Deamino Arginine Vasopressin; Factor V; Factor VIII; Female; Genetic Predisposition to Disease; Genotype; Heparin; Humans; Hypertension; Postoperative Complications; Prothrombin; Pulmonary Embolism; Thrombophilia; von Willebrand Diseases; von Willebrand Factor

Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

Topics: Adolescent; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Male; Neurosurgical Procedures; Perioperative Care; Postoperative Complications; Prospective Studies; Renal Agents; Seizures; Sodium; Vasopressins; Water-Electrolyte Balance

Desmopressin (DDAVP) is commonly used in cadaveric organ donors to treat diabetes insipidus. The thrombogenic potential of DDAVP is well known. Recent animal data have demonstrated that DDAVP impairs pancreas graft (PG) microcirculation and perfusion. The aim of this study was too evaluate the effect of DDAVP on the incidence of PG thrombosis in clinical pancreas transplantation. A retrospective review of simultaneous kidney-pancreas transplant (SKPT) entered in the Scientific Registry of Transplant Recipients (SRTR) between 10/5/87 and 9/27/02 was performed. Patients were included for analysis if there was definitive documentation as to whether DDAVP was (DDAVP-Y) or was not (DDAVP-N) administered to the donor. Both dose and duration of DDAVP treatment were not recorded by SRTR. A total of 2804 SKPTs were available for analysis. Mean follow-up was 1.75 years (range, 1 month to 8.4 years). A total of 1287 SKPT patients (46%) received a PG from a DDAVP-Y donor. Graft ischemia times, donor and recipient ages, recipient gender distribution, surgical techniques, and immunosuppressive regimens were similar in both groups. The overall incidence of PG thrombosis was 4.3%. The incidence of PG thrombosis in recipients of grafts from DDAVP-Y donors was 5.1% compared to 3.5% in recipients of grafts from DDAVP-N donors (P =.04). Fifty-eight percent of thrombosed PG came from DDAVP-Y donors compared to 42% from DDAVP-N donors (P =.04). We conclude that there appears to be a relationship between donor treatment with DDAVP and PG thrombosis. A prospective study is needed to verify these findings and to determine their clinical significance.

Topics: Cadaver; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Humans; Male; Pancreas; Pancreas Transplantation; Postoperative Complications; Retrospective Studies; Thrombosis; Time Factors; Tissue Donors

Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

Topics: Adolescent; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Male; Neurosurgical Procedures; Perioperative Care; Postoperative Complications; Prospective Studies; Renal Agents; Seizures; Sodium; Vasopressins; Water-Electrolyte Balance

Acquired spontaneous hemophilia is a rare but potentially life-threatening disease, which poses a major challenge to intensive care medicine. We report a case in which the disease occurred postoperatively in a patient following uncomplicated lumbal discectomy. The clinical sequelae involved hemorrhagic shock (cHb 4.1 g/dl; hct 17 %; systolic BP 60 mmHg; HR 130/min; saO2 73 %) due to retroperitoneal hematoma eight days after neurosurgical intervention. While lesions of the retroperitoneal vessels were not found during emergent angiography and laparotomy, the laboratory results showed a slightly prolonged activated prothrombin time (aPTT; 47 s). However, application of fresh frozen plasma (FFP) even prolonged the aPTT (53 s). Analysis of clotting factors proved a deficiency of factor VIII with a reduced activity of about 20 %, which was resistant against therapy with desmopressin (DDAVP) and substitution of factor VIII. Thus, the plasma-mix-test was performed, showing complete inactivation of the factor VIII-activity of the pooled plasma. This evidenced the presence of acquired inhibitors against factor VIII. Hemostasis was successfully and immediately restored with the application of recombinant factor VIIa (rFVIIa), including boluses of 60 - 80 microg/kg every 6th - 8th hour (supplemented with tranexamic acid, 3 x 1 g/d), leading to a continuous infusion of 12 microg/kg per hour. With prednisolone (1 mg/kgBW/d) over the ensuing 8 weeks, the antibodies were sufficiently suppressed and no additional substitution of factor VIII was necessary to maintain normal hemostasis.

Topics: Blood Coagulation Tests; Critical Care; Deamino Arginine Vasopressin; Diskectomy; Factor VIIa; Factor VIII; Hematoma; Hemophilia A; Humans; Laparotomy; Male; Middle Aged; Plasma; Postoperative Complications; Prothrombin Time; Recombinant Proteins; Shock, Hemorrhagic

Transient diabetes insipidus is an uncommon complication of pregnancy, usually manifesting with polydipsia and polyuria. This condition is considered to result from excess placental vasopressinase activity and is managed with deamino D arginine vasopressin.. While on restricted oral intake after cesarean delivery, the patient gradually became disoriented and agitated in conjunction with markedly increased urine output disproportional to her intravenous crystalloid fluid intake. Marked hypernatremia of 178 mEq/dL was noted. Urine osmolality was low at 248 mOsm/L. The clinical presentation and electrolyte abnormalities were considered consistent with transient diabetes insipidus of pregnancy. The patient responded well to nasal-spray-administered deamino D arginine vasopressin and increased intravenous fluid intake, with resolution of symptoms and gradual normalization of serum sodium levels.. Transient diabetes insipidus of pregnancy should be considered in the differential diagnosis of severe hypernatremia in obstetric patients with restricted oral intake after operative delivery.

Topics: Adult; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fluid Therapy; Humans; Hypernatremia; Postoperative Care; Postoperative Complications; Pregnancy; Pregnancy Complications

Topics: Carcinoma, Papillary; Carcinoma, Renal Cell; Deamino Arginine Vasopressin; Female; Hemorrhagic Disorders; Humans; Hyponatremia; Kidney Neoplasms; Laparoscopy; Middle Aged; Neoplasms, Multiple Primary; Nephrectomy; Postoperative Complications; Seizures; Thyroid Neoplasms; Thyroidectomy; von Willebrand Diseases

Topics: Animals; Deamino Arginine Vasopressin; Hemostatics; Humans; Microcirculation; Pancreas; Pancreas Transplantation; Postoperative Complications; Thrombosis; Tissue Donors; Treatment Failure

Hypodipsic hypernatremia (HH) represents a pathological increase in serum sodium due to a lack of thirst and defect in hypothalamic osmoreceptors. While 15% of patients with HH have a vascular aetiology, few cases have been described. Moreover, the presence of such abnormalities in the amnestic patient can have particularly threatening implications, as HH tends to recur unless the patient complies with a regimen of water intake. This study reports the case of a 46-year-old male admitted for rehabilitation of functional deficits following subarachnoid haemorrhage (SAH), with clipping of an anterior communicating artery (ACoA) aneurysm. Clinical examination was remarkable for profound short-term memory loss and inability to retain new information. Blood chemistry on admission showed a serum sodium level of 160 mEq/L, increasing to 167 mEq/L the following day. The patient denied thirst, and showed no clinical signs of dehydration. Neuroendocrine evaluation revealed diabetes insipidus (DI) and HH. Treatment initially included DDAVP and intravenous hydration, later supplemented with chlorpropramide. Stabilization of serum sodium and osmolality did not ensue until the treatment regimen included hydrochlorothiazide and supervision of enforced fluid intake. Endocrine abnormalities may be encountered among patients with vascular lesions adjacent to the hypothalamus. Rehabilitation interventions include establishing a structured medication regimen with fluid administration in the amnestic patient with hypothalamic dysfunction.

Topics: Amnesia, Anterograde; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Drinking Behavior; Drug Administration Schedule; Fluid Therapy; Humans; Hydrochlorothiazide; Hypernatremia; Hypoglycemic Agents; Intracranial Aneurysm; Male; Middle Aged; Postoperative Complications; Renal Agents; Subarachnoid Hemorrhage; Thirst

Hyponatremia is a common complication of intracranial disease or surgery. An evaluation should be undertaken to determine whether cerebral salt wasting (CSW) or inappropriate secretion of antidiuretic hormone is present as a cause. Since the treatment principles are completely different in the two pathological states, differential diagnosis is very important. CSW is defined as the renal loss of sodium leading to hyponatremia and decreased extracellular fluid volume. In the literature, it has been noted that mineralocorticoid administration can be useful in CSW cases. We herein present an 11-year-old boy who developed hyponatremic seizures after intracranial tumor resection. He was diagnosed with CSW on the basis of high urinary sodium excretion and increased urine output, together with signs and symptoms of dehydration. Despite intensive fluid and salt therapy, we were unable to decrease the urinary output. Therefore, fludrocortisone therapy was administered and his urinary output and sodium excretion were decreased and his serum sodium level was normalized. In conclusion, in addition to fluid and salt replacement, mineralocorticoid supplementation also seems to be a safe and effective treatment for CSW.

Topics: Astrocytoma; Brain Neoplasms; Child; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Administration Schedule; Fludrocortisone; Follow-Up Studies; Humans; Hyponatremia; Male; Natriuresis; Postoperative Complications

Disturbances of osmoregulation, leading to diabetes insipidus and hyponatraemia are well known complications after surgery in the sella region. This study was performed to examine the prevalence and predictors of polyuria and hyponatraemia after a complete and selective removal of pituitary adenomas was attempted via the transnasal-transsphenoidal approach.. 1571 patients with pituitary adenomas (238 Cushing's disease, 405 acromegaly, 534 hormonally inactive adenomas, 358 prolactinoma, 23 Nelson's syndrome, and 13 thyrotropinoma) were daily examined within a 10-day postoperative inpatient observation period. Prevalence of patterns of polyuria (> 2500 ml) and oliguria/hyponatraemia (< 132 mmol/l) were surveyed as well as predictors of postoperative morbidity.. 487 patients (31%) developed immediate postoperative hypotonic polyuria, 161 patients (10%) showed prolonged polyuria and 37 patients (2.4%) delayed hyponatraemia. A biphasic (polyuria-hyponatraemia) and triphasic (polyuria-hyponatraemia-polyuria) pattern was seen in 53 (3.4%) and 18 (1.1%) patients, respectively. Forty-one patients (2.6%) displayed immediate postoperative (day 1) hyponatraemia. Altogether, 8.4% of patients developed hyponatraemia at some time up to the 10th day postoperative, with symptomatic hyponatraemia in 32 patients (2.1%). Risk analysis showed that patients with Cushing's disease had a fourfold higher risk of polyuria than patients with acromegaly and a 2.8-fold higher risk for postoperative hyponatraemia. Younger age, male sex, and intrasellar expansion were associated with a higher risk of hypotonic polyuria, but this was not considered clinically relevant.. The analysis illustrates that disturbances in osmoregulation resulting in polyuria and pertubations of serum sodium concentration are of very high prevalence and need observation even after selective transsphenoidal surgery for pituitary adenomas, especially in patients with Cushing's disease.

Topics: Acromegaly; Adenoma; Adult; Cushing Syndrome; Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Male; Middle Aged; Pituitary Neoplasms; Polyuria; Postoperative Complications; Prevalence; Prolactinoma; Renal Agents; Risk Factors; Water-Electrolyte Imbalance

Topics: Blood Coagulation Disorders; Blood Component Transfusion; Cardiopulmonary Bypass; Cryoprotective Agents; Deamino Arginine Vasopressin; Hemostatics; Humans; Plasma; Point-of-Care Systems; Postoperative Complications

Topics: Cerebral Hemorrhage; Deamino Arginine Vasopressin; Fatal Outcome; Female; Humans; Middle Aged; Postoperative Complications; Renal Agents; Subdural Space; Thrombocytopenia; Uremia

In a retrospective study, the intra- and early postoperative data of 39 children with 46 operations for craniopharyngioma were analyzed. Diabetes insipidus (DI) occurred in 30 out of 32 cases without preoperative evidence of DI. We observed that all children who did not have a pituitary stalk preserved and 5 out of 7 patients with preserved pituitary stalk developed DI within 18 h of surgery. Short-term inappropriate secretion of antidiuretic hormone (SIADH) occurred in 2 children, but was quickly followed by DI. The time of onset of DI and SIADH did not correlate with sex, age, body weight, location of tumor, or duration or extent of surgery. Parenteral desmopressin was an effective treatment for intra- and postoperative DI. The duration of the clinical effect of desmopressin administration varied in different patients between 4 and 23 h. An approach to the immediate intra- and postoperative management of children with craniopharyngioma is presented.

Topics: Administration, Intranasal; Adolescent; Child; Child, Preschool; Combined Modality Therapy; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fluid Therapy; Humans; Inappropriate ADH Syndrome; Infant; Infant, Newborn; Male; Perioperative Care; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Water-Electrolyte Imbalance

To evaluate the effectiveness and mode of action of the osmotic diuretic mannitol to prevent the development of acute hyponatremia in a setting designed to mimic the acute hyponatremia observed on the day of surgery.. Hyponatremia (129+/-1 mM, fall of 10+/-1 mM, p <0.01) was induced by the intraperitoneal administration of half-isotonic saline plus DDAVP to rats (n = 8); hyponatremia was due to a positive balance of electrolyte-free water (EFW). Rats given mannitol (10 mmol/kg body wt) in addition to the hypotonic saline plus DDAVP had only a minor degree of hyponatremia (plasma [Na+] 136+/-1 mM, fall 3+/-2 mM, p >0.05). All the mannitol given was excreted over the 16 h of observation, but the urine volume was not higher in these rats. The higher rate of excretion of EFW was due to a marked reduction in the rate excretion of Na+ with mannitol. This antinatriuresis was also present when mannitol was given intravenously.. Although mannitol increased the excretion of EFW, the mechanism required an enhanced renal reabsorption of Na+ rather than an increase in the urine flow rate.

Topics: Animals; Deamino Arginine Vasopressin; Diuretics, Osmotic; Hyponatremia; Male; Mannitol; Natriuresis; Postoperative Complications; Rats; Rats, Wistar; Renal Agents

A prospective observational study of the pathophysiology of sodium and water disorders in patients with pituitary region tumours after surgical excision was carried out in 20 patients. Serial pre-operative and post-operative fluid and sodium balance, plasma and urine elctrolyte biochemistry and their derived parameters, and circulating hormones associated with fluid balance, atrial natriureic peptide (ANP) and antidiuretic hormone (ADH) were documented to correlate with the patients' clinical conditions. Ten out of these twenty cases developed diabetes insipidus (DI) requiring ADH replacement therapy, although in the majority (6 cases), this way only a transient event. Of the nine patients who developed hyponatraemia, six had symptoms such as impaired consciousness and convulsions. Four patients developed alternating hypoatraemia and hypernatraemia, which constituted a difficult group, where appropriate sodium and fluid management, and ADH replacement therapy were based upon twice daily plasma and urine biochemistry and their derived parameters. Whilst DI in this group of patients was the result of a low circulating ADH level, hyponatraemia was not associated with an exaggerated ADH activity (6.0 +/- 2.3 vs 7.4 +/- 2.3 pmol/ml, mean +/- SEM). Rather, hyponatraemia was strongly associated with an elevated circulating ANP concentration (82.4 +/- 10.5 vs 30.0 +/- 3.1 pmol/ml, mean +/- SEM, p < 0.001), resulting in salt wasting and hypovolaemia.

Topics: Adolescent; Adult; Aged; Atrial Natriuretic Factor; Child; Creatinine; Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Prospective Studies; Sodium; Urea; Vasopressins; Water; Water-Electrolyte Balance

This study was designed to evaluate a new point-of-care test (HemoSTATUS) that assesses acceleration of kaolin-activated clotting time (ACT) by platelet activating factor (PAF) in patients undergoing cardiac surgery. Our specific objectives were to determine whether HemoSTATUS-derived measurements correlate with postoperative blood loss and identify patients at risk for excessive blood loss and to characterize the effect of desmopressin acetate (DDAVP) and/or platelet transfusion on these measurements.. Demographic, operative, blood loss and hematologic data were recorded in 150 patients. Two Hepcon instruments were used to analyze ACT values in the absence (channels 1 and 2: Ch1 and Ch2) and in the presence of increasing doses of PAF (1.25, 6.25, 12.5, and 150 nM) in channels 3-6 (Ch3-Ch6). Clot ratio (CR) values were calculated with the following formula for each respective PAF concentration: clot ratio = 1-(ACT/control ACT). These values also were expressed as percent of maximal (%M = clot ratio/0.51 x 100) using the mean CRCh6 (0.51) obtained in a reference population.. When compared with baseline clot ratios before anesthetic induction, a marked reduction in clot ratios was observed in both Ch5 and Ch6 after protamine administration, despite average platelet counts greater than 100 K/microliter. There was a high degree of correlation between clot ratio values and postoperative blood loss (cumulative chest tube drainage in the first 4 postoperative hours) with higher concentrations of PAF: CRCh6 (r = -0.80), %M of CRCh6 (r = -0.82), CRCh5 (r = -0.70), and %M of CRCh5 (r = -0.85). A significant (P < 0.01) improvement in clot ratios was observed with time after arrival in the intensive care unit in both Ch5 and Ch6, particularly in patients receiving DDAVP and/or platelets.. Activated clotting time-based clot ratio values correlate significantly with postoperative blood loss and detect recovery of PAF-accelerated coagulation after administration of DDAVP or platelet therapy. The HemoSTATUS assay may be useful in the identification of patients at risk for excessive blood loss and who could benefit from administration of DDAVP and/or platelet transfusion.

Topics: Aged; Blood Loss, Surgical; Cardiac Surgical Procedures; Deamino Arginine Vasopressin; Evaluation Studies as Topic; Female; Hemostasis; Humans; Male; Middle Aged; Platelet Activating Factor; Platelet Transfusion; Postoperative Complications; Preoperative Care; Renal Agents; Whole Blood Coagulation Time

Both central diabetes insipidus (DI) and a high rate of excretion of sodium (Na) and chloride (Cl) contributed to the development of polyuria and dysnatremia in two patients during the acute postoperative period after neurosurgery. To minimize difficulties in diagnosis and projections for therapy, two available (but not often used) clinical tools were helpful. First, the osmole excretion rate early on revealed the co-existence of central DI and an osmotic diuresis. The osmoles excreted were largely Na salts; after antidiuretic hormone acted, this electrolyte diuresis caused the urine flow rate to be much higher than otherwise anticipated. Interestingly, part of this saline diuresis occurred when the extracellular fluid volume was contracted. The tool to explain the basis for the dysnatremias was a tonicity balance. Hypernatremia, which developed before treatment of central DI, was primarily a result of a positive balance for Na rather than a large negative balance for water. Moreover, hyponatremia that developed once antidiuretic hormone acted was primarily a result of a negative balance for Na; the urine volume was large and its Na concentration was hypertonic. To prevent a further decline in the plasma Na concentration, either the Na concentration in the urine should be decreased by provision of urea or a loop diuretic while replacing all unwanted water and electrolyte losses; alternatively, the fluid infused should have a similar Na concentration and volume as the urine (infuse hypertonic saline).

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Hypernatremia; Hyponatremia; Male; Natriuresis; Osmosis; Postoperative Complications; Sodium; Vasopressins

Topics: Adult; Blood Glucose; Brain Edema; Brain Neoplasms; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus, Type 1; Diabetic Coma; Diabetic Ketoacidosis; Diagnosis, Differential; Fatal Outcome; Female; Fluid Therapy; Headache; Humans; Hypernatremia; Insulin; Polyuria; Postoperative Complications; Radiography

The postoperative course of children undergoing surgery for craniopharyngioma was reviewed. Typically they were below height at presentation. All had an attempt at radical surgical resection of the tumor. Most developed diabetes insipidus in the postoperative period, which was permanent in all but 1 child. 94% required thyroid replacement therapy, and sex steroids were administered in 100% when they reached the age of puberty. 91% required maintenance corticosteroids. 54% required growth hormone replacement, but some children showed continued growth despite apparent growth hormone deficiency. Postoperative obesity develops in one half of patients, and may be improved with administration of growth hormone; a controlled trial is underway.

Topics: Adolescent; Body Height; Body Weight; Child; Child, Preschool; Combined Modality Therapy; Craniopharyngioma; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Growth Hormone; Humans; Hypophysectomy; Hypopituitarism; Infant; Male; Pituitary Function Tests; Pituitary Hormones; Pituitary Neoplasms; Postoperative Complications; Thyroxine

We conducted a retrospective analysis of the cases of 122 children operated on for various brain tumors, to determine the incidence and natural history of postoperative diabetes insipidus (DI), and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Abnormalities of water homeostasis were observed in 15 patients (12%). DI, with or without SIADH, was observed in 10 patients (8%), while SIADH alone was seen in five (4%). DI was permanent in five subjects (50%), whereas SIADH resolved completely in all affected individuals. Parenteral desmopressin (dDAVP) was an effective mode of therapy in the postoperative period. The effect did not correlate with a dosage strictly based on body weight.

Topics: Adolescent; Age Distribution; Brain Neoplasms; Child; Child, Preschool; Craniotomy; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Inappropriate ADH Syndrome; Infant; Male; Postoperative Complications; Sex Distribution; Treatment Outcome; Water

Of 150 consecutive patients who underwent dacryocystorhinostomy, postoperative hemorrhage requiring treatment occurred in 2 patients, both of whom had endogenous platelet dysfunction without thrombocytopenia. The first patient had macroglobulinemia, and the second patient had congenital platelet hypofunction. Prophylactic 1-deamino-8-D-arginine vasopressin (desmopressin; DDAVP) was used successfully to decrease intraoperative bleeding in the second patient. Of the 15 patients with exogenous platelet dysfunction secondary to the use of aspirin or nonsteroidal anti-inflammatory agents within 1 week of operation, none had hemorrhaging. Dacryocystorhinostomy should be undertaken cautiously and with hematologic consultation in patients with blood dyscrasias.

Topics: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Blood Platelet Disorders; Dacryocystitis; Dacryocystorhinostomy; Deamino Arginine Vasopressin; Epistaxis; Female; Hemorrhage; Humans; Lacrimal Apparatus Diseases; Male; Nasolacrimal Duct; Postoperative Complications; Waldenstrom Macroglobulinemia

Patients with ileostomies show an early diuresis when sodium restricted; this, together with an obligatory ileal sodium loss, predisposes them to severe salt and water depletion. The role of arginine vasopressin in this circumstance and whether it is natriuretic, or antinatriuretic, is unclear. There is also controversy over its likely effect on small bowel fluid reabsorption. We have examined the effect of the non-pressor (V2) synthetic vasopressin analogue 1-deamino-8-D-arginine (desmopressin) on renal and ileal sodium and water excretion in ileostomy patients during acute adaptation to a low sodium diet. Patients were studied on two separate occasions (nonrandomised) with and without the administration of desmopressin (0.75 micrograms intramuscular, three times a day). In eight subjects without desmopressin there was pronounced diuresis on the first low sodium day, associated with a fall in renal sodium excretion and no change in ileal output or composition. In five (of the original) subjects with desmopressin there was pronounced antidiuresis, no change in renal sodium excretion, and no change in ileal output or composition. In both studies rises in plasma renin activity and salivary aldosterone concentration lagged behind the early decline in renal sodium excretion. We have confirmed the phenomenon of 'low sodium' diuresis after sodium restriction in ileostomy patients and shown that it can be prevented by desmopressin. Desmopressin has no direct or indirect effect on renal sodium excretion or ileal fluid and electrolyte loss in humans.

Topics: Aged; Aldosterone; Deamino Arginine Vasopressin; Diet, Sodium-Restricted; Diuresis; Female; Humans; Ileostomy; Ileum; Male; Middle Aged; Postoperative Complications; Renin; Sodium; Water

Topics: Adult; Cardiopulmonary Bypass; Deamino Arginine Vasopressin; Estrogens, Conjugated (USP); Hemorrhage; Humans; Male; Postoperative Complications

Topics: Deamino Arginine Vasopressin; Hemorrhage; Humans; Hypotension; Postoperative Complications

Topics: Cardiac Surgical Procedures; Deamino Arginine Vasopressin; Hemorrhage; Humans; Platelet Aggregation; Postoperative Complications; von Willebrand Factor

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Postoperative Complications

Topics: Cardiac Surgical Procedures; Deamino Arginine Vasopressin; Hemorrhage; Humans; Postoperative Complications

Topics: Cardiac Surgical Procedures; Deamino Arginine Vasopressin; Hemorrhage; Humans; Postoperative Complications

A 63-year-old male had major postoperative bleeding complications following the excision of a basal cell carcinoma. The patient denied a prior history of bleeding complications and had normal coagulation screening studies. After coagulation evaluation, he was found to have mild hemophilia A with 23% of normal Factor VIII C. We discuss an approach to the evaluation of coagulation in patients with perioperative and postoperative bleeding. Also, we outline treatment alternatives for patients with hemophilia A who need cutaneous surgery.

Topics: Blood Coagulation; Carcinoma, Basal Cell; Deamino Arginine Vasopressin; Dermatologic Surgical Procedures; Factor VIII; Hemophilia A; Hemorrhage; Hemostasis, Surgical; Humans; Male; Middle Aged; Platelet Count; Postoperative Complications; Skin Neoplasms

Topics: Aged; Cardiopulmonary Bypass; Deamino Arginine Vasopressin; Female; Humans; Hypotension; Male; Middle Aged; Postoperative Complications; Vasodilation

Desmopressin has been used as a hemostatic agent in numerous hematological and nonhematological diseases. We report a case of surgical hemorrhage secondary to prolonged bleeding time of unexplained origin controlled with desmopressin.

Topics: Aged; Aged, 80 and over; Bleeding Time; Deamino Arginine Vasopressin; Hemorrhage; Hemostasis, Surgical; Humans; Male; Nephrectomy; Platelet Function Tests; Postoperative Complications

We have presented a case of pregnancy complicated by diabetes insipidus. Treatment with desmopressin acetate (DDAVP) appropriately managed the DI, and was not associated with a worsening of the condition as pregnancy progressed.

Topics: Adolescent; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Postoperative Complications; Pregnancy; Pregnancy Complications; Pulmonary Edema

The response of components of the coagulation and fibrinolysis systems to infusion of DDAVP has been examined in patients undergoing elective surgery. In the DDAVP treated group there was a significant increase, compared to control, in plasminogen activator (by fibrin plates p less than 0.005, ECLT p less than 0.0125, by Student's t test) before operation. No difference between groups was seen by either methods in the activator levels in samples 24 h postoperation, whereas a significant drop (p less than 0.002) in protein C concentration was observed at this stage in the treated group. Levels of factor VIII components were significantly higher (p less than 0.005) than control at all stages of operation and a significant shortening (5 sec p less than 0.05) of the APTT was seen at all stages (apart from 24 h samples). DDAVP infusion therefore may exacerbate the hypercoagulable state observed in surgical patients without preventing the (post-operatively) fibrinolytic shutdown. Instead, infusion tends to produce fibrinolytic depletion at the key mid-operative stage.

Topics: Adult; Aged; Blood Coagulation; Deamino Arginine Vasopressin; Factor VIII; Fibrinolysis; Humans; Infusions, Parenteral; Middle Aged; Plasminogen Activators; Postoperative Complications; Thrombophlebitis

Topics: Adenoma, Chromophobe; Deamino Arginine Vasopressin; Drug Administration Schedule; Humans; Hyponatremia; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Water Intoxication

Topics: Cardiopulmonary Bypass; Deamino Arginine Vasopressin; Hemorrhage; Humans; Postoperative Complications

Topics: Arginine Vasopressin; Cadaver; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Kidney Transplantation; Postoperative Complications

In nine patients with non-malignant diseases undergoing major upper abdominal surgery, the mechanism of the postoperative fibrinolytic shut-down was investigated because of its potential significance for postoperative deep vein thrombosis by employing new and specific methods for assessing and stimulating the fibrinolytic system. The shut-down was found to result from an impairment of the balance between tissue-type plasminogen activator, t-PA, and its recently discovered fast-acting inhibitor. In this balance, the t-PA antigen concentrations both in resting conditions and after stimulation evoked by desamino-D-arginine vasopressin (DDAVP) were found to be unchanged by surgery. However, there was a significant postoperative increase in t-PA inhibitor levels. The release of t-PA under the stimulus of DDAVP infusion overcame the postoperative shut-down of t-PA activity. However, DDAVP infusion was associated with potentially unfavourable increases in the Factor VIII/von Willebrand factor complex. The discovery of increased t-PA inhibitor in the postoperative period opens new possibilities for a rational approach to reduce or abolish the postoperative fibrinolytic shut-down.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Factor VIII; Female; Fibrinolysis; Glycoproteins; Humans; Male; Middle Aged; Plasminogen Inactivators; Postoperative Complications; Tissue Plasminogen Activator; von Willebrand Factor

An acquired hemorrhagic disorder developed in two patients in association with postsplenectomy thrombocytosis and leukocytosis during the course of the myeloproliferative syndrome. The presence of acquired von Willebrand's disease in these individuals was demonstrated by a decrease or absence of the larger von Willebrand factor (vWF) multimers, alteration of the repeating vWF multimeric "triplet," decreased ristocetin cofactor activity (vWF:RCo), and prolonged bleeding time. The bleeding stopped in both patients after treatment with either 1-deamino-[8-D-arginine]-vasopressin (DDAVP) or Cohn fraction I. Treatment with thrombocytapheresis and azathioprine or busulfan resulted in reduction of the elevated platelet and white cell counts and was associated with partial correction of the vWF abnormalities and remission of the hemostatic abnormalities. In five additional patients with the myeloproliferative syndrome, but without bleeding symptoms, large multimers of plasma vWF were diminished also. These findings suggest that acquired von Willebrand's disease should be considered when a bleeding diathesis develops during the course of the myeloproliferative syndrome.

Topics: Adult; Bleeding Time; Blood Proteins; Deamino Arginine Vasopressin; Female; Humans; Male; Myeloproliferative Disorders; Postoperative Complications; Splenectomy; von Willebrand Diseases; von Willebrand Factor

Of 120 patients presenting with mild bleeding disorders, 63 were found to have a definite coagulopathy. The commonest disorders were haemophilia, Christmas disease and von Willebrand's disease (vWd), the latter being predominant. Diagnosis led to prophylactic treatment prior to surgery in 18 patients with prevention of excessive haemorrhage. Three patients who had received blood products developed hepatitis. DDAVP (desamino-cys-1-8-D-arginine vasopressin) is the treatment of choice in suitable mildly affected patients with haemophilia A and vWd. Examination of blood group distribution suggests an excess of group O among patients with bleeding disorders, especially those with vWd.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Female; Hemophilia A; Hemophilia B; Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications; Tooth Extraction; von Willebrand Diseases

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Female; Hemorrhage; Humans; Ovarian Diseases; Ovarian Neoplasms; Postoperative Complications; von Willebrand Diseases

Topics: Child; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Headache; Humans; Male; Pituitary Neoplasms; Postoperative Complications; Vision Disorders

The effect of DDAVP (1-deamino-8-D-arginine vasopressin), a synthetic analogue of vasopressin, was studied in twelve patients with acute postoperative cranial diabetes insipidus (D.I.). The most severe D.I. occurred in four cases following total removal of tumor (3 pituitary microadenoma, 1 dermoid cyst). The urinary volume over 1000 ml per hour in these four cases could not be controlled by DDAVP but could be controlled by drip infusion of aqueous pitressin (AP) and pitressin tannate in oil (PTO). DDAVP was effective when the urinary volume was decreased in under 500 ml per hour. The mild D.I. occurred in four cases after partial removal of tumor (3 craniopharyngioma, 1 pituitary microadenoma). These four cases could be controlled by drinking water only during one or two postoperative weeks. DDAVP was administered in doses of 10 to 30 microgram two times daily after 2 or 3 postoperative weeks and the urinary production was normalized. The four patients developed D.I. after removal of functioning pituitary microadenoma operated by transsphenoidal route. These four cases were treated with drip infusion of AP and PTO during one or two weeks after the operation and were effectively treated with 5 to 15 microgram of DDAVP intranasally every 8 to 12 hours one or two weeks after the operation. Nine cases in 12 cases with postoperative D.I. became chronic D.I. The maintenance dose of DDAVP gradually lessened in accordance with decreasing urinary volume except the two cases of craniopharyngioma. No side effect was experienced for 19 months of treatment.

Topics: Adenoma; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Craniotomy; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Postoperative Complications; Specific Gravity

1-Deamino-8-d-arginine vasopressin (D.D.A.V.P.) infusion causes a marked increase in factor-VIII (antihaemophilic-factor)-related properties in patients with moderate and mild haemophilia and von Willebrand's disease (vWd). The possibility was therefore evaluated that such an autologous factor-VII response might be haemostatically effective, allowing patients to undergo surgery without plasma concentrates. 0.3 microng/kg of D.D.A.V.P. given before dental surgery and repeated in the early postoperative period was followed by a two to three fold rise in factor-VIII coagulant activity (VII C.A.) in four patients with moderate and mild haemophilia. In two, there was no abnormal bleeding after dental extraction, whereas plasma concentrates were necessary to control oozing from the sockets in the remaining two patients. A higher D.D.A.V.P. dosage (0.4-0.5 microng/kg) in patients with higherstarting VII C.A. (9% or more) was followed by a more marked response (four to six fold). VII C.A. levels up to 100% of average normal were achieved and dental extraction and major surgery (such as cholecystectomy, thoracotomy, and two tonsillectomies) were carried out successfullly in six patients with mild haemophilis and in two with vWd. The mean half-life of autologous VII C.A. was 9.4 h (range 7.5-11.6). Plasma and urine osmolality showed no consistent variation after drug administration. Thus D.D.A.V.P. appears a promision pharmacological alternative to plasma concentrates in the management of some patients with haemophilis and vWd.

Topics: Adolescent; Adult; Biopsy; Blood Coagulation Tests; Cholecystectomy; Deamino Arginine Vasopressin; Drug Evaluation; Factor VIII; Female; Hemophilia A; Hemorrhage; Hemostasis, Surgical; Humans; Infusions, Parenteral; Male; Middle Aged; Postoperative Care; Postoperative Complications; Preoperative Care; Thoracic Surgery; Thorax; Tonsillectomy; Tooth Extraction; Vasopressins; von Willebrand Diseases