Fluid Absorption In Patients Research Articles

Risk factors of high fluid absorption in patients treated with mini-PCNL: a single-center prospective study.

The factors influencing fluid absorption in mini-percutaneous nephrolithotripsy (mini-PCNL) are still unknown. We aim to investigate the factors that influence irrigation fluid absorption during mini-PCNL. A total of 94 patients who underwent mini-PCNL were included in this prospective study. The endoscopic surgical monitoring system (ESMS) was used to measure the volume of irrigation fluid absorbed during the procedure. Irrigating time, the total volume of irrigation fluid, stone size, S.T.O.N.E. score, hemoglobin, electrolyte levels, and postoperative complications were recorded. A significant correlation was observed between fluid absorption and the presence of postoperative fever, and based on this phenomenon, patients were divided into low and high fluid absorption groups. The serum creatinine level in the high fluid absorption group was significantly high (7 vs. 16.5, p = 0.02). Significant differences were observed between the low and high fluid absorption groups in terms of mean stone size (21.70 mm vs. 26.78 mm), presence of stone burden ≥ 800 mm2 (4% vs. 23%), S.T.O.N.E. score > 8 (4% vs. 38%), the fluid used > 18,596 ml (19% vs. 78%), irrigation time (55.61 min vs. 91.28 min), and perfusion rate (24% vs. 45%) (all p < 0.05). The rates of postoperative fever and SIRS in the high fluid absorption group were significantly high (p < 0.05). Mean stone size, presence of stone burden ≥ 800 mm2, S.T.O.N.E. score > 8, the fluid used > 18596 mL, irrigation time, and perfusion rate are risk factors of intraoperative fluid absorption in mini-PCNL.

The Impact of Spinal Anesthesia and Use of Oxytocin on Fluid Absorption in Patients Undergoing Operative Hysteroscopy: Results from a Prospective Controlled Study.

ObjectiveThe aim of this study was to determine if combining intravenous oxytocin infusion and spinal anesthesia will reduce the amount of glycine absorption in patients undergoing operative hysteroscopy.Patients and MethodsA prospective controlled study was conducted in premenopausal patients who had hysteroscopic surgery including endometrial resection, endometrial polypectomy, myomectomy resection and uterine septal resection. The effect of combined spinal anesthetic with oxytocin infusion on fluid deficit was studied.ResultsA total of 88 patients were studied. Sixty-two cases were done under general anesthesia (control group) and 26 cases were performed with spinal anesthesia and the use of oxytocin infusion (study group). There was a statistically significant less mean fluid deficit in the study group than control group in the endometrial polypectomy patients (220±36 mL vs 392±178 mL, respectively, P value 0.010, 95% C.I.: 163–276) and the myomectomy patients (308±66 mL vs 564±371 mL, respectively, P value 0.003, 95% C.I.: 239–378). In the endometrial resections, there was also a statistically significant less mean fluid deficit in the study than the control group (P value ˂ 0.001). Regarding septal resection, there was no statistically significant difference in the mean fluid deficit between the two groups (P value 0.833).ConclusionSpinal anesthesia combined with intravenous oxytocin infusion in operative hysteroscopy results in a statistically significant reduction in the glycine fluid deficit than the general anesthesia. We also recommend studying the effects of this combination in operative hysteroscopy using bipolar devices with isotonic solutions.

Intravitreous injection of bevacizumab for chronic central serous chorioretinopathy

Background/PurposeTo evaluate the effect of intravitreal bevacizumab on subretinal fluid absorption in patients with chronic central serous chorioretinopathy (CSCR). Materials and methodsThis was a retrospective case series study. Patients with CSCR symptoms for > 3 months and who received intravitreal injection of bevacizumab were included. Ocular examinations were carried out at baseline and every follow-up visit, including visual acuity, fundus examination, and optic coherence tomography. ResultsTwelve eyes in 12 patients were included in this study. One month after injection, three of the 12 patients who had increased central macular thickness were considered nonresponders. Nine of the 12 patients who had decreased central macular thickness were considered to have responded to intravitreal bevacizumab injection. The response rate was 75%. In the response group, the mean central macular thickness significantly decreased, from 306.7 ± 77.8 μm to 204.3 ± 59.3 μm (p = 0.001) at 1 month. The mean Logarithm of the Minimum Angle of Resolution (logMAR) visual acuity was significantly improved from 0.72 ± 0.35 to 0.50 ± 0.28 (p = 0.008). Six of these nine patients had stable conditions lasting > 6 months. Three of them had recurrence. ConclusionIntravitreal bevacizumab injections improved subretinal fluid absorption in some patients with CSCR. It could be an alternative therapy for patients with CSCR, especially when they are not suitable for other treatments.

Changes in Blood Volume and Colloid Osmotic Pressure during Fluid Absorption in Patients Undergoing Endoscopic Urosurgery: An Observational Study

Background and Objective: Anesthesiologists need to be familiar with perioperative changes in blood volume (BV); however, there is no standard method for repeated evaluation of BV over a short interval of time. We evaluated BV in the operation room using repeatable estimation methods. Method: Eighty-five ASA physical status I-II patients scheduled to undergo endoscopic urosurgery using irrigation fluid under general anesthesia at Nippon Medical School Hospital were included in this study. Irrigation with 3% sorbitol in water was commenced after establishment of general anesthesia and volumetric fluid balance, which was defined as control water balance (WB). Hematocrit (Hct), colloid osmotic pressure (COP), total protein (TP) and albumin (Alb) were repeatedly determined before and during anesthesia. BV was calculated using Allen’s formula and the changes in Hct, COP, TP and Alb. Main Outcome Measures: The main outcome was the accuracy of measuring changes in BV (△BV) calculated using the four serum markers. WB and the estimated △BV calculated from Hct, COP, TP and Alb (△BV-Hct, △BV-COP, △BV-TP, and △BV-Alb) were analysed using Pearson’s correlation coefficient test and Bland-Altman analysis. Results: Sixty-five patients were excluded. In the remaining 20 patients, there was a significant correlation between WB and △BV-COP (R2 = 0.72; P △BV-TP (R2 = 0.59; P △BV-Alb (R2 = 0.57; P △BV-Hct (R2 = 0.06). Conclusion: △BV-COP, △BV-TP and △BV-Alb had correlation with WB. However, since COP can be measured repeatedly with simplified instruments under selected clinical circumstances, while TP and Alb cannot. COP is the most useful marker to measure △BV during perioperative period. Hct does not allow precise estimation of △BV.

The degree of fluid absorption during hysteroscopic surgery in patients pretreated with goserelin

To assess the effects of pretreatment with the gonadotropin-releasing hormone analog goserelin on fluid absorption in patients undergoing hysteroscopic endometrial ablation. Prospective, randomized, placebo-controlled study. A university-based clinic. Thirteen women with dysfunctional uterine bleeding who were scheduled for electrosurgical hysteroscopic ablation. Seven women were randomized to receive luteal phase goserelin 3.75 mg and six saline in the menstrual cycle approximately 10 weeks before surgery. Operative hysteroscopy was carried out with glycine 1.5% mixed with 2% alcohol medium under constant pressure as an irrigant. The amount of irrigant used, irrigant deficit, blood levels of albumin and ethanol, hematocrit, hemoglobin, changes in sodium levels, and central venous pressure were compared between the groups. All of the patients had an unsuccessful course of medical therapy for at least 3 months and a normal endometrial biopsy. The age, weight, and uterine size were similar between the groups. The mean volume of irrigant used and operating time were similar in both groups (4.18 +/- 0.2 vs 4.5 +/- 0.5 L, and 33.7 +/- 1.5 vs 37 +/- 2.1 min). Although operating time, volume deficit, decrease in protein level, and hematocrit were less in the goserelin than in the saline group, the differences were not statistically significant (p >0.05). The ethanol levels in blood, decrease in Na+, and irrigant deficit were significantly lower in the goserelin than in the saline group (17.4 +/- 3.8 vs 25.3 +/- 4.2 mg/ml, 6.7 +/- 1.2 vs 9.1 +/- 0.9 mEq/L, and 0.49 +/- 0.08 vs 0.66 +/- 0.05 L, respectively; p <0.05). Based on these results we conclude that in women undergoing hysteroscopic endometrial ablation, pretreatment with goserelin may decrease the absorption of hysteroscopic medium, prevent fluid overload, and improve the outcome possibly by causing hypovascularity and decreased endometrial growth.

Lyphatic absorption in CAPD patients with loss of ultrafiltration capacity.

During continuous ambulatory peritoneal dialysis (CAPD) treatment, loss of ultrafiltration capacity (UFC) is a common complication that can be associated with increased peritoneal fluid absorption rate. The aim of the present study was to investigate the relative importance of lymphatic absorption for total peritoneal fluid absorption in patients with permanent loss of UFC associated with a high peritoneal absorption rate (KE, ml/min; high-KE group, n = 4). Clinically stable CAPD patients (n = 23) as well as patients with loss of UFC associated with increased diffusive mass transport coefficients (KBD, ml/min; high-KBD group, n = 8) served as control groups. The patients were investigated with a 6-hour dwell study with 3.86% glucose solution. The total fluid absorption rate was estimated by the disappearance rate (KE) of 131I-radioiodinated human serum albumin (RISA) from the peritoneal cavity, and the lymphatic absorption rate was estimated by the rate of RISA appearance in plasma (KPP, ml/min). The values of KE and KPP in the high-KE group (4.65 +/- 0.93 and 0.42 +/- 0.31 ml/min, respectively) were markedly higher than in the clinically stable CAPD patients (1.77 +/- 0.60 and 0.15 +/- 0.06 ml/min, respectively; both p < 0.001 vs. the high-KE group). In the high-KBD group, KE was lower (2.19 +/- 0.38 ml/min, p < 0.001) compared to the high-KE group, whereas KPP was similar (0.26 +/- 0.09 ml/min, NS). The fraction of KE which could be accounted for by KPP was on average only 9 +/- 5% in the high-KE group and did not differ from the fractions in the clinically stable patients or in the high-KBD group (9 +/- 5 and 12 +/- 4%, respectively). In 5 patients in whom plasma RISA activity was measured for 24 h from the beginning of the 6-hour dwell study, a continuous increase of the RISA level in plasma was observed during this time period. We conclude that although KPP was increased in patients with UFC loss associated with high KE, it accounted for only a minor part of KE. Furthermore, the relatively slow but prolonged appearance of RISA in plasma indicates that the interstitial compartment may serve as a reservoir of macromolecules which are slowly absorbed by local lymphatics. The present study supports previous findings that direct lymphatic absorption is only of relatively minor importance for the fluid absorption in peritoneal dialysis.

Deficit in Cerebrospinal Fluid Absorption in Patients with Symptoms of Normal Pressure Hydrocephalus

SUMMARYSix patients aged between 51 and 76 years, with signs of normal pressure hydrocephalus, underwent ventriculolumbar perfusions. The average rate of csf formation was 0.313 ± 0.020ml/min, comparable to that reported for non‐hydrocephalic adults and children. However, due to the larger csf compartment, the turnover rate of the csf compartment was approximately one‐third that of non‐hydrocephalic patients. This condition was further aggravated by an absorption deficiency.Normally, csf absorption begins at approximately 68mm csf pressure, and thereafter increases linearly with pressure at a rate of 7.6uL/min/mm csf pressure. In four of the six patients studied, absorption began at 68mm csf, and thereafter increased linearly at a similar rate. However, the rate became drastically reduced to 2.5uL/min/mm csf once a critical mean csf pressure was reached. It is suggested that this deficit in absorption, which is accompanied by elevated pressure plateaus and heightened pulse pressures, leads to ventricular enlargement and secondarily to the symptomatology associated with normal pressure hydrocephalus.RÉSUMÉDéficit dans l'absorption du LCR chez des malades présentant les symptomes d'une hydrocéphalie à pression normaleSix malades, âgés de 51 à 76 ans, avec des signes d'hydrocéphalie à pression normale ont subi des perfusions ventriculo‐lombaires. Le taux moyen de formation de lcr a été de 0,313 ± 0,020ml/min, comparable à ce qui est observé chez les adultes et enfants non hydrocéphales. Cependant en raison de la plus grande capacité de lcr, le taux de renouvellement du compartiment de lcr a été approximativement un tiers de celui d'un malade non hydrocéphale. Cet état était de plus aggravé par une déficience de l'absorption.Normalement, l'absorption du lcr débute pour une pression de 68mm de lcr et ensuite augmente linéairement avec la pression à un taux de 7,6μl/min par mm de pression de lcr. Chez 4 des 6 malades étudiés, l'absorption commençait à 68mm de lcr et ensuite, augmentait linéairement à un taux similaire. Cependant, le taux était brutalement réduit à 2,5μl/min par mm de lcr une fois qu'une pression moyenne critique de lcrétait atteinte. Nous suggérons que ce déficit d'absorption associéà un plateau de pression élevée et à un accroissement de la pression pulsatile conduise à une dilatation des ventricules et secondairement à la symptomatologie associée à une hydrocéphalie à pression normale.ZUSAMMENFASSUNGMangelhafte Liquorabsorption bei Patienten mit Symptomen eines Normaldruck‐HydrocephalusSechs Patienten zwischen 51 und 76 Jahren mit den Zeichen eines Normaldruck‐Hydrocephalus wurden ventriculo‐lumbalen Perfusionen unterzogen. Die durchschnittliche Rate der Liquorproduktion betrug 0.133 ± 0.020ml/min, vergleichbar den Befunden bei nicht‐hydrocephalen Erwachsenen und Kindern. Jedoch betrug abhängig vom größeren csf‐Raum die Umsatzrate des csf‐Raumes annähernd ein Drittel der nicht hydrocephalen Patienten. Diese Bedingung wurde weiter verschlechtert durch eine mangelhafte Absorption.Normalerweise beginnt die csf‐Absorption bei einem csf‐Druck von ungefähr 68mmHg und nimmt dann linear mit dem Druck zu mit einer Rate von 7.5ul/min/mm csf‐Druck. Bei vier der sechs untersuchten Patienten begann die Absorption bei 68mmHg csf und nahm dann mit einer ähnlichen Rate linear zu. Diese Rate wurde jedoch drastisch reduziert auf 2.5ul/min/mm csf, wenn einmal ein kritischer csf‐Mitteldruck erreicht war. Wir vermuten, daß diese mangelhafte Resorption, begleitet von erhöhten Druckplateaus und einer vergrößerten Blutdruckamplitude, zur Ventrikelerweiterung führt und sekundär zur Symptomatik, die mit einem Normaldruck‐Hydrocephalus verbunden ist.RESUMENDéficit de absorción de LCR en pacientes con síntomas de hidrocefalia con presión normalSe practicó una perfusión ventriculo‐lumbar a 6 pacientes de 51 a 76 años, con signos de hidrocefalia con presión normal. La frecuencia promedia de formación de lcr fue del 0,313 ± 0,020ml/min, comparable con lo publicado en niños y adultos no hidrocefálicos. Sin embargo, debido a un compartimiento de lcr más largo, la velocidad de recambio del compartimiento de lcr era aproximadamente un tercio del de los pacientes no hidrocefálicos. Este hecho venía agravado además por una deficiencia en la absorción.Normalmente la absorción de lcr empieza aproximadamente a la presión de lcr de 68mm; a partir de aquí aumenta linealmente con la presión a una velocidad de 7,6uL/min/mm de presión de lcr. En cuatro de los seis pacientes estudiados, la presión empezó con 68mm de lcr para aumentar después linealmente a una velocidad parecida. Sin embargo la velocidad resultó drásticamente reducida a 2,5uL/min/mm de lcr al alcanzar un promedio crítico de presión de lcr. Sugerimos que este déficit en la absorción, que está acompañado de una presión elevada en forma de mesetas de aumentos de pulso de presión, conduce a un aumento ventricular y secundariamente a la sintomatología asociada a la hidrocefalia con presión normal.