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Background: Hyponatremia is a common complication following endoscopic endonasal resection (EER) of pituitary adenomas. We report a single-center, multisurgeon study detailing baseline clinical data, outcomes, and factors associated with postoperative hyponatremia., Methods: This was a retrospective cohort study of patients undergoing EER for pituitary adenoma at Tufts Medical Center. Most procedures were performed by the senior author (C.B.H.). Cases were included if at least 1 postoperative sodium value was available and pathology confirmed pituitary adenoma. Hyponatremia was defined as a postoperative sodium level <135 mEq/L., Results: A total of 272 patients underwent 310 EER procedures that met the study inclusion criteria. The mean patient age was 53.3 years, and mean tumor size was 18.8 mm. Postoperative hyponatremia occurred in 12.6% of cases, with 3.6% developing hyponatremia prior to discharge. Lower preoperative sodium level was associated with an increased risk of developing any postoperative hyponatremia. Older age, prolactinoma pathology, and use of selective serotonin reuptake inhibitors were associated with moderate to severe hyponatremia (≤129 mEq/L), and lower preoperative sodium was associated with mild hyponatremia (130-134 mEq/L). Hyponatremia-related readmissions within 30 days occurred in 3.9% of patients. Both African-American race and postoperative hyponatremia were associated with an increased risk of 30-day readmission. The mean nadir sodium for hyponatremic patients was 129.9 mEq/L. Growth hormone-secreting pathology was associated with lower postoperative nadir sodium, whereas higher preoperative sodium was associated with higher postoperative nadir sodium., Conclusions: Hyponatremia is a common postoperative complication of EER for pituitary lesions that can cause significant morbidity, increased readmissions, and increased healthcare costs., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Spinal anesthesia (SA) is used in lumbar surgery, but initial adequate analgesia fails in some patients. In these cases, spinal redosing or conversion to general endotracheal anesthesia is required, both of which are detrimental to the patient experience and surgical workflow., Methods: We reviewed cases of lumbar surgery performed under SA from 2017-2021. We identified 12 cases of inadequate first dose and then selected 36 random patients as controls. We used a measurement tool to approximate the volume of the dural sac for each patient using T2-weighted sagittal magnetic resonance imaging sequences., Results: Patients who had an inadequate first dose of anesthesia had a significantly larger dural sac volume, 22.8 ± 7.9 cm 3 in the inadequate dose group and 17.4 ± 4.7 cm 3 in controls (P = 0.043). The inadequate dose group was significantly younger, 54.2 ± 8.8 years in failed first dose and 66.4 ± 11.9 years in controls (P = 0.001). The groups did not differ by surgical procedure (P = 0.238), level (P = 0.353), American Society of Anesthesia score (P = 0.546), or comorbidities., Conclusions: We found that age, larger height, and dural sac volume are risk factors for an inadequate first dose of SA. The availability of spinal magnetic resonance imaging in patients undergoing spine surgery allows the preoperative measurement of their thecal sac size. In the future, these data may be used to personalize spinal anesthesia dosing on the basis of individual anatomic variables and potentially reduce the incidence of failed spinal anesthesia in spine surgery., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The erector spinae plane block (ESPB) is a novel regional analgesic technique which improves postoperative outcomes in lumbar surgery patients including length of hospitalization, days to ambulation, and postoperative opioid use. Traditionally, the block is administered by anesthesiologists trained in the ultrasound guidance technique. The use of fluoroscopic guidance may improve the efficiency and accessibility of the ESPB for spine surgeons. We aim to measure the time to administer an ESPB using fluoroscopic guidance and localize the anesthetic using intraoperative three-dimensional (3D) imaging., Methods: Two neurosurgeons administered an ESPB to patients undergoing lumbar surgery. Time from insertion of the spinal needle to localize the erector spinae plane using C-arm guidance to time of complete injection and removal of the needle from the skin was recorded. One patient underwent O-arm imaging following injection of an Isovue-Exparel solution at the L3 level to visualize spread of the anesthetic., Results: A total of 21 patients were enrolled in this study. The average duration to perform an ESPB under fluoroscopic guidance was 1.2 minutes. The Isovue-Exparel solution was injected at the L3 level and was well distributed along the ESP on intraoperative O-arm imaging. The anesthetic dissected the erector spinae muscle from the transverse process at L2, L3, and L4., Conclusions: Fluoroscopic guidance allows efficient and appropriate delivery of the anesthetic to the erector spinae plane. Performing an ESPB with fluoroscopic guidance improves efficiency and accessibility of the analgesic technique for spine surgeons, reducing dependence on anesthesiology personnel trained in administering the block., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Polypharmacy and opioid administration are thought to increase the risk of postoperative cognitive dysfunction and delirium in elderly patients. Spinal anesthesia (SA) holds potential to reduce perioperative polypharmacy in spine surgery. As more geriatric patients undergo spine surgery, understanding how SA can reduce polypharmacy and opioid administration is warranted. We aim to compare the perioperative polypharmacy and dose of administered opioids in patients ≥65 years who undergo transforaminal lumbar interbody fusion (TLIF) under SA versus general anesthesia (GA)., Methods: A retrospective analysis of 200 patients receiving a single-surgeon TLIF procedure at a single academic center (2014-2021) was performed. Patients underwent the procedure with SA (n = 120) or GA (n = 80). Demographic, procedural, and medication data were extracted from the medical record. Opioid consumption was quantified as morphine milligram equivalents (MME). Statistical analyses included χ 2 or Student's t-test., Results: Patients receiving SA were administered 7.45 medications on average versus 12.7 for GA patients (P < 0.001). Average perioperative opioid consumption was 5.17 MME and 20.2 MME in SA and GA patients, respectively (P < 0.001). The number of patients receiving antiemetics and opioids remained comparable postoperatively, with a mean of 32.2 MME in the GA group versus 27.5 MME in the SA group (P = 0.14). Antiemetics were administered less often as a prophylactic in the SA group (32%) versus 86% in the GA group (P < 0.001)., Conclusions: SA reduces perioperative polypharmacy in patients ≥65 years undergoing TLIF procedures. Further research is necessary to determine if this reduction correlates to a decrease the incidence of postoperative cognitive dysfunction and delirium., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Spinal stenosis is one of the most common neurosurgical diseases and a leading cause of pain and disability. Wild-type transthyretin amyloid (ATTRwt) has been found in the ligamentum flavum (LF) of a significant subset of patients with spinal stenosis who undergo decompression surgery. Histologic and biochemical analyses of LF specimens from spinal stenosis patients, normally discarded as waste, have the potential to help elucidate the underlying pathophysiology of spinal stenosis and possibly allow for medical treatment of stenosis and screening for other systemic diseases. In the present review, we discuss the utility of analyzing LF specimens after spinal stenosis surgery for ATTRwt deposits. Screening for ATTRwt amyloidosis cardiomyopathy through LF specimens has led to the early diagnosis and treatment of cardiac amyloidosis in several patients, with more expected to benefit from this process. Emerging evidence in the literature also point to ATTRwt as a contributor to a previously unrecognized subtype of spinal stenosis in patients who might, in the future, benefit from medical therapy. In the present report, we review the current literature regarding the early detection of ATTRwt cardiomyopathy via LF screening and the possible contribution of ATTRwt deposits in the LF to spinal stenosis development., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Postoperative urinary retention (POUR) is a common and vexing complication in elective spine surgery. Efficacious prevention strategies are still lacking, and existing studies focus primarily on identifying risk factors. Spinal anesthesia has become an attractive alternative to general anesthesia in elective lumbar surgery, with the potential of having a differential impact on POUR., Methods: 422 spinal anesthesia procedures were prospectively collected between 2017 and 2021 and compared to 416 general anesthesia procedures retrospectively collected between 2014 and 2017, at a single academic center by the same senior neurosurgeon. The main outcome was POUR, defined as the need for straight bladder catheterization or indwelling bladder catheter placement after surgery due to failure to void. A power calculation was performed prior to data collection., Results: The general anesthesia group had a higher rate of POUR (9.1 %) compared with the spinal anesthesia group (4.3 %), p = 0.005. At baseline, the spinal anesthesia cohort had an older average age and fewer patients with a history of previous spine surgery. Other comorbid conditions were comparable between the groups. For perioperative characteristics, spinal anesthesia patients had higher ASA scores, shorter operative times, shorter lengths of hospital stay, less operative levels, and zero use of intraoperative bladder catheterization. Acute pain service consult was similar between the groups. A multivariable logistic regression revealed that spinal anesthesia was associated with a significantly lower rate of urinary retention in the spinal anesthesia group (p = 0.0130), after adjusting for potentially confounding factors. Other statistically significant risk factors for POUR included diabetes, (p = 0.003), BPH (p = 0.014), operative time (p = 4.94e-06), and ASA score (p = 0.005)., Conclusions: We collect and analyze one of the largest available cohorts of patients undergoing simple and complex surgeries under spinal and general anesthesia, finding that spinal anesthesia is independently associated with a lower incidence of POUR compared to general anesthesia, even when adjusted for potentially confounding risk factors. Further prospective trials are needed to explore this finding., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Metabolic acidosis has been proposed as the gold standard to define shock in trauma patients. Other studies determine the presence of shock by use of serum lactate. However, not all medical centers have the ability to utilize point-of-care lactate at bedside., Objective: This study seeks to determine the relationship between serum lactate and metabolic acidemia in trauma patients, and if metabolic acidemia can be used to guide therapy. We hypothesized that acidemia would be strongly correlated with lactate levels and would be associated with activation of massive transfusion (MT) in the presence of shock in trauma., Methods: This was a prospective observational cohort study, level II evidence; this study aids in decision-making. Setting was a Level I academic, urban trauma center. The study took place from July 1, 2012 to March 1, 2013 and included patients who were ≥18 years old and required trauma team activation. Observations included baseline demographics (age, gender, type of injury), vital signs, point-of-care arterial blood gas, lactate, and need for MT., Results: One hundred patients were enrolled over the study period. The average age was 34 years, and 82% were male. Forty patients were acidemic (pH < 7.35), and there was a significant difference in lactate levels between the acidemic and non-acidemic groups (p < 0.002). We found a strong correlation between pH and lactate: rs = -0.38, t = -4.03, p < 0.001. In addition, using a logistic regression, we show that pH was associated with activation of MT (p = 0.002)., Conclusion: This is a prospective observational cohort study with level II evidence. This study demonstrates that acidemia was strongly correlated to serum lactate, lactate levels were higher in the acidemic group, and metabolic acidemia was associated with the activation of MT for trauma patients at our institution., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The aim of this study was to investigate the protective effect of Ginkgo biloba (EGb 761) on testicular torsion/detorsion induced ischemia-reperfusion (I/R) injury. A total of 24 male Wistar albino rats were divided into three groups: control, I/R and I/R treated with EGb 761; each group contains 8 animals. Testicular torsion was created by rotating the left testis 720° in a clockwise direction. The ischemia period was 5 h and orchiectomy was performed after 5 h of detorsion. EGb 761 (50 mg/kg, orally) was administrated only once, 40 min prior to detorsion. To date, no more histopathological changes on testicular torsion/detorsion induced ischemia-reperfusion (I/R) injury in rats by EGb 761 treatment have been reported. Spermatogenesis and mean seminiferous tubule diameter (MSTD) were significantly decreased in I/R groups were compared to the control group. Furthermore, EGb 761 treated animals showed an improved histological appearance in I/R group. Our data indicate a significant reduction in the activity of TUNEL and endothelial nitric oxide synthase (eNOS) in testes tissue of I/R treated with EGb 761 therapy. Electron microscopy of the testes of rats demonstrated that EGb 761 pretreatment was particularly effective in preventing the mitochondrial degeneration, dilatation of SER and enlarged intercellular spaces in both Sertoli and spermatid cells in I/R treated animals. We believe that further preclinical research into the utility of EGb 761 may indicate its usefulness as a potential treatment on testes injury after I/R in rats., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Testicular torsion causes an enhanced formation of reactive oxygen species, which contributes to the pathophysiology of tissue damage. The aim of this study was to investigate the protective effect of melatonin on testicular torsion/detorsion-induced ischemia-reperfusion (I/R) injury. A total of 24 male Wistar albino rats were divided into three groups of 8 animals each: control, I/R, and I/R treated with melatonin. The ischemia period was 5 h and orchiectomy was performed after 5 h of detorsion. Melatonin (10 mg/kg, intraperitoneally [i.p.]) was administrated only once, 40 min prior to detorsion. Spermatogenesis and mean seminiferous tubule diameter (MSTD) were significantly decreased in the I/R groups were compared to the control group. Furthermore, the melatonin treated animals showed an improved histological appearance in the I/R group. Our data indicate a significant reduction in the activity of TUNEL; there was a rise in the expression of proliferating cell nuclear antigen (PCNA) and testosterone in testes tissue of the I/R group treated with melatonin therapy. Electron microscopy of the testes of the rats demonstrated that pretreatment with melatonin was particularly effective in preventing mitochondrial degeneration, dilatation of SER, and enlarged intercellular spaces in both Sertoli and spermatid cells in the I/R treated animals. We believe that further preclinical research into the utility of melatonin may indicate its usefulness as a potential treatment on testes injury after I/R in rats., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The aims of the study were to investigate the effects of immunization against GnRH using OL protein (Ovalbumin-LHRH-7) on feedlot performance, carcass, meat quality and some reproductive traits in Kıvırcık ram lambs. Ram lambs in the immunization (I, n=7) group were immunized against GnRH using OL protein and boosted 2 weeks later. Control (C, n=7) group was not treated. The animals were kept at pasture for 6 weeks after the first immunization, subjected to a 70 day fattening program, and then slaughtered. Growth performance, various carcass and meat quality characteristics were not affected from the immunization. GnRH immunization induced GnRH antibody production, suppressed testosterone production and testicular growth (P<0.01). Testicular structure was negatively affected from the immunization, but not pituitary. These results suggest that immunization against GnRH with OL could be an alternative castration technique in ram lambs without negatively affecting carcass and meat quality characteristics., (Copyright © 2010 The American Meat Science Association. Published by Elsevier Ltd. All rights reserved.)

The aim of the present study was the evaluation of possible protective effects of quercetin (QE) against beta-cell damage in experimental streptozotocin (STZ)-induced diabetes in rats. STZ was injected intraperitoneally at a single dose of 50 mg kg(-1) for diabetes induction. QE (15 mg kg(-1) day, intraperitoneal (i.p.) injection) was injected for 3 days prior to STZ administration; these injections were continued to the end of the study (for 4 weeks). It has been believed that oxidative stress plays a role in the pathogenesis of diabetes mellitus (DM). In order to determine the changes of cellular antioxidant defense system, antioxidant enzymes such as glutathione peroxidase (GSHPx), superoxide dismutase (SOD) and catalase (CAT) activities were measured in pancreatic homogenates. Moreover we also measured serum nitric oxide (NO) and erythrocyte and pancreatic tissue malondialdehyde (MDA) levels, a marker of lipid peroxidation, if there is an imbalance between oxidant and antioxidant status. Pancreatic beta-cells were examined by immunohistochemical methods. STZ induced a significant increase lipid peroxidation, serum NO concentrations and decreased the antioxidant enzyme activity. Erythrocyte MDA, serum NO and pancreatic tissue MDA significantly increased (P < 0.05) and also the antioxidant levels significantly decreased (P < 0.05) in diabetic group. QE treatment significantly decreased the elevated MDA and NO (P < 0.05), and also increased the antioxidant enzyme activities (P < 0.05). QE treatment has shown protective effect possibly through decreasing lipid peroxidation, NO production and increasing antioxidant enzyme activity. Islet cells degeneration and weak insulin immunohistochemical staining was observed in STZ induced diabetic rats. Increased staining of insulin and preservation of islet cells were apparent in the QE-treated diabetic rats. These findings suggest that QE treatment has protective effect in diabetes by decreasing oxidative stress and preservation of pancreatic beta-cell integrity.

The objective was to investigate the effects of a gonadotropin-releasing hormone agonist (GnRH) on ovulation rate and the number and maturation of oocytes in mice superovulated with equine chorionic gonadotropin (eCG) and human chorionic gonadotropin (hCG). Thirty 3-month-old BALB/C female mice (weight: 25-30 g) were assigned to three experimental groups: control, superovulated, and superovulated with GnRH pretreatment (n=10 per group). Control mice received an i.p. injection of 0.1 ml physiological saline solution. Superovulation was induced with 5 IU eCG (i.p.) and 5 IU hCG 48 h later. Mice in the superovulated with GnRH pretreatment group were given GnRH (20 mg/kg Fertirelin, i.m.), 24 h before superovulation. Thirteen hours after hCG administration, mice were sacrificed by cervical dislocation and blood samples were collected to determine serum progesterone concentration (by radioimmunoassay). Ovaries and oviducts were also harvested to enumerate corpora lutea and cumulus-enclosed oocytes. Progesterone concentrations were not significantly different among groups. The oocyte number and the maturation, ovulation rate, and the number of corpora lutea were higher in GnRH-treated mice than both controls and superovulated mice. In conclusion, GnRH given 24 h before superovulation with eCG-hCG increased the number and maturation of oocytes and the rate of ovulation in mice.

Objectives: This article derives new mathematic formulas to calculate the probability that the husband of a D-negative woman is heterozygous for the D antigen., Study Design: Current published formulas and tables that estimate this probability are biased in that they incorrectly assume that the father is randomly selected from the general population. With Bayes' theorem, new formulas were derived to eliminate this bias., Results: The probability of the husband being homozygous or heterozygous for the D antigen can be expressed as a function of the number of previous D-positive children. If he has any D-negative children, he is an obligate heterozygote., Conclusion: Previously published formulas and tables that estimate the likelihood of the father being heterozygous or homozygous at the D locus should no longer be used in the obstetric setting.