ergoline and Postoperative-Complications

Hemodynamic effects of nicergoline injected by intravenous route were studied in 43 patients early after open-heart operations. A serial witnesses has been compared with 5 other groups for which the posologies were increased. Catheterisms of radial artery and pulmonary artery allows the measuring of systolic arterial pressure (SP), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP) and cardiac index (CI). The heart rate (HR) was noticed. The systemic vascular resistance (SVR), the stroke index (SI) and the left ventricular stroke work index (SWI) were calculated. The results were statistically analysed by the Student test. After injection of a bolus of 0,3 mg kg-1 by intravenous route, stable effects are obtained with a maintenance posology of 0,8 mg.kg-1.h-1. The SP diminishes by 20 p. cent (123 to 104 mm Hg; p less than 0,01). There is a loose of 16 p. cent from the RAP (9,5 to 8 mm Hg; p less than 0,05) and of 18 p. cent from the PCWP (16,5 to 13,5 mm Hg; NS). The HR decreases by 13 p. cent (97 to 81 syst. min.-1; p less than 0,05). The CI increases by 25 p. cent (2,2 to 2,75 1.min.-1m-2; p less than 0,01); the SI by 40 p. cent (35 to 35 ml beat-1m-2; p less than 0,01) and the SWI by 32 p. cent (27,5 to 36 g.m.m-2; p less than 0,05). We conclude from this investigation that nicergoline injected through intravenous route with an output of 0,8 mg.kg-1.h-1 mainly leads to afterload reduction. Thanks to its effect on the CI and on the HR as well as to its mild to moderate action, it is a clinical useful agent for primary or adjunctive therapy of postoperative low cardiac output.

Topics: Adult; Aged; Cardiac Output; Cardiac Output, Low; Cardiac Surgical Procedures; Ergolines; Female; Hemodynamics; Humans; Infusions, Parenteral; Male; Middle Aged; Neuroleptanalgesia; Nicergoline; Postoperative Complications

We investigated surgical cure rate and surgical complications of patients with macroprolactinomas who desired pregnancy to evaluate the efficacy of transsphenoidal surgery.. Surgical cure rate was investigated in 138 female patients who were under 40 years old.. We found a significant correlation between serum prolactin levels and adenoma volume (r=0.004; p<0.0001), adenoma volume and age (r=-0.213; p<0.03), and proliferative index of the adenoma and age (r=-0.15; p<0.007). Seventy-seven out of 81 patients with enclosed macroadenoma were considered cured, and therefore the overall surgical cure rate was 95%. However, during long-term follow-up, recurrence of adenomas with hyperprolactinemia was seen in 5 out of 81 patients (6%), and the long-term cure rate in patients with enclosed macroadenomas was 89%. Adenomas that did not invade the cavernous sinus showed a significantly higher surgical curability and lower serum prolactin levels, and a smaller size than those adenomas that invaded the cavernous sinus.. The long-term surgical cure rate was found to be 89% and this success rate far surpasses the complication rate of 39% during pregnancy by dopamine agonist therapy. Thus, transsphenoidal surgery should be considered as a first-line treatment for female patients who desire pregnancy.

Topics: Adult; Cabergoline; Cavernous Sinus; Dopamine Agonists; Endoscopy; Ergolines; Female; Humans; Magnetic Resonance Imaging; Microsurgery; Neoplasm Recurrence, Local; Neurosurgical Procedures; Pituitary Neoplasms; Postoperative Complications; Pregnancy; Prolactin; Prolactinoma; Retrospective Studies; Sphenoid Bone; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Cabergoline; Cesarean Section; Dopamine Agonists; Ergolines; Female; Hallucinations; Humans; Lactation; Postoperative Complications; Pregnancy; Pregnancy Complications; Pregnancy, Twin; Psychomotor Agitation; Psychotic Disorders; Puerperal Disorders; Risperidone; Sleep Initiation and Maintenance Disorders

To evaluate our experience regarding the treatment of pituitary macroadenomas with cavernous sinus invasion in a series of 23 cases of transphenoidal resection.. Twenty two patients, fifteen males and seven females, with ages ranging from 27 to 75 (mean of 48), were operated under protocol by a single surgeon between May of 2002 and December of 2004. Preoperatively all lesions were diagnosed by MRI and staged according to the Knosp classification. All tumors had extension to one or both cavernous sinuses. Four patients were considered to be grade 1, two grade 2, one grade 3 and sixteen grade 4. Twenty three operations were performed on twenty-two patients. Twenty cases were the standard transsphenoidal approach, and three were endoscopic. Postoperatively, the excision was classified as Complete or Total, Subtotal or Partial. Mean follow up was 15 months. The variables considered for analysis include invasion and resection grades. All six patients with graded 1 and 2 lesions and two patients with grade 4 lesions underwent a complete resection. Subtotal (greater than 80%) excision was achieved in one patient with a grade 3 tumor and six patients with grade 4 tumors. The remaining seven patients with grade 4 adenomas had a Partial (less than 80%) excision. We compare de resection grade versus invasion grade with exact Fisher test. And there is not estadistical difference (p=0.12).. The Knosp classification alone cannot predict the behavior of these tumors. In our experience, despite tumor extension to the cavernous sinus, pituitary macroadenomas can be safely resected with low morbidity and mortality.

Topics: Adenoma; Adult; Aged; Antineoplastic Agents; Cabergoline; Cavernous Sinus; Combined Modality Therapy; Cranial Irradiation; Diabetes Insipidus, Neurogenic; Dose Fractionation, Radiation; Endoscopy; Ergolines; Female; Follow-Up Studies; Humans; Hypophysectomy; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Pituitary Neoplasms; Postoperative Complications; Predictive Value of Tests; Prognosis; Prospective Studies; Radiography; Radiotherapy, Adjuvant; Somatostatin; Sphenoid Bone; Treatment Outcome

A 46-year-old woman was referred to the neurosurgery department for treatment of a macroadenoma of the pituitary. She had complained of recurrent galactorrhoea for 7 years; a hysterectomy was performed 4 years ago. The clinical investigation was unremarkable, except for a slight galactorrheoa on both sides.. The endocrinological work-up revealed a moderately elevated prolactin level of 3133 mU/l (147 ng/ml) with intact pituitary functions. She had no visual impairment and the MRI depicted a pituitary tumor with a maximal diameter of 1.9 cm and both intra- and suprasellar extension.. The diagnosis of a nonfunctioning macrodenoma with functional hyperprolactinemia was made and a selective transsphenoidal adenomectomy was performed. The primary histology showed a chromophobe adenoma. However, additional immunohistological investigations revealed distinct staining for prolactin. In the meantime, because of persistent galactorrhea and elevated prolactin levels, treatment with cabergolin 0.5 mg/week was started. This stopped galactorrhea and normalized the prolactin levels. A follow-up MRI after 3 months of treatment showed a significant shrinkage of the residual tumor.. This case demonstrates that the differential diagnosis of macroprolactinoma with low secretory activity and functional hyperprolactinemia is very difficult preoperatively in individual cases. This is relevant because macroprolactinomas with low secretory activity can also be treated successfully with dopamine agonists. We therefore suggest a drug treatment trial with dopamine agonists in all macroadenoms with hyperprolactinemia, particularly in those with prolactin levels above 2000 mU/l (100 ng/ml).

Topics: Cabergoline; Diagnosis, Differential; Ergolines; Female; Follow-Up Studies; Humans; Hyperprolactinemia; Magnetic Resonance Imaging; Middle Aged; Neoplasm, Residual; Pituitary Gland; Pituitary Neoplasms; Postoperative Complications; Prolactinoma

We report a case of hepatolithiasis (intrahepatic stone) complicated by gram-negative sepsis in a 37 year old male with acromegaly being treated with octreotide. As a child, he had suffered a traumatic injury to his liver requiring the surgical repair of a laceration. This is the first reported case of hepatolithiasis during octreotide therapy. Gallstones and bile sludge are common side effects of octreotide therapy but rarely become symptomatic or require treatment. Hepatolithiasis is uncommon in western countries but is quite prevalent in East Asia and is often associated with a predisposing condition that causes intrahepatic bile stasis (eg. bile duct stricture). In addition to its known effect on gallbladder stasis, octreotide alters bile acid composition and may thus hasten intrahepatic sludge and stone formation. Extra caution should be taken in using octreotide or its long-acting analog in patients otherwise predisposed to intrahepatic bile stasis.

Topics: Abdominal Pain; Acromegaly; Adenoma; Adult; Anti-Bacterial Agents; Bile Ducts, Intrahepatic; Bilirubin; Cabergoline; Chemical and Drug Induced Liver Injury; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis; Cholesterol; Ergolines; Gram-Negative Bacterial Infections; Hepatectomy; Humans; Insulin-Like Growth Factor I; Liver; Liver Diseases; Male; Octreotide; Pituitary Neoplasms; Postoperative Complications; Sepsis; Surgical Wound Infection

We investigated the potential value of vasodilating therapy in critically ill patients with inappropriately low cardiac output during acute illness. In seven patients with low flow state during septic or postoperative state, sodium nitroprusside (20-100 micrograms/min) was compared with nicergoline (NIC) (0.5 to 2.5 mg/min), a new selective alpha 1-blocking agent with negative chronotropic action. Sodium nitroprusside (NP) decreased arterial pressure (from 90 +/- 5 to 68 +/- 5 mm Hg, p less than 0.01) and pulmonary artery balloon-occluded pressure from 20.3 +/- 3.1 to 15.4 +/- 2.8 mm Hg, p less than 0.01) and increased heart rate (from 110 +/- 11 to 120 +/- 13 beats/min, p less than 0.05) but failed to increase stroke volume (from 24.7 +/- 4.8 to 23.4 +/- 4.4 ml, NS). During NIC administration, a comparable decrease in systemic vascular resistance was associated with a significant increase in stroke volume (from 21.6 +/- 3.3 to 25.6 +/- 3.2 ml/m2, p less than 0.01) and cardiac output (CO) (from 2.4 +/- 0.3 to 2.7 +/- 0.3 L/min/m2, p less than 0.025), whereas the decrease in arterial pressure was less significant (from 91 +/- 8 to 84 +/- 7 mm Hg, p less than 0.05). Because NIC has no positive inotropic action, the most likely mechanism is that a baroreceptor-mediated increase in heart rate with NP was prevented by the negative chronotropic action of NIC. Both drugs adversely affected arterial blood oxygenation. By its unique property to decrease heart rate, NIC could represent a valuable vasodilating agent, especially in acute conditions.

Topics: Cardiac Output, Low; Critical Care; Ergolines; Ferricyanides; Humans; Infections; Nicergoline; Nitroprusside; Postoperative Complications; Time Factors

Topics: Adrenal Gland Neoplasms; Ergolines; Female; Humans; Hypertension; Injections, Intravenous; Middle Aged; Nicergoline; Pheochromocytoma; Postoperative Complications

Topics: Adult; Akinetic Mutism; Bromocriptine; Carbidopa; Ergolines; Humans; Hypothalamic Neoplasms; Hypothalamus; Levodopa; Male; Methylphenidate; Postoperative Complications

Topics: Adolescent; Adult; Aged; Child; Ergolines; Female; Humans; Male; Middle Aged; Nicergoline; Postoperative Complications; Thrombophlebitis

Topics: Adrenalectomy; Adrenocorticotropic Hormone; Adult; Bromocriptine; Cushing Syndrome; Ergolines; Female; Humans; Male; Postoperative Complications; Prolactin; Syndrome

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Blood Coagulation Disorders; Blood Donors; Blood Platelets; Clot Retraction; Dipyridamole; Drug Interactions; Ergolines; Female; Gastrointestinal Hemorrhage; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Membrane Potentials; Platelet Aggregation; Platelet Factor 3; Postoperative Complications; Pregnancy; Prostaglandins; Serotonin; Thrombocytopenia; Thromboembolism; Vitamin K Deficiency Bleeding

Topics: Aged; Depression, Chemical; Ergolines; Female; Humans; Male; Middle Aged; Nicergoline; Platelet Aggregation; Postoperative Complications; Thrombosis