Serum Sodium In Group Research Articles

Monopolar Transurethral Resection of the Prostate Versus Holmium Laser Enucleation in Men with Prostate Volume Greater than 100 mL

Purpose: The surgical treatment for severe benign prostatic hyperplasia is challenging. The aim of our study was to compare the safety and efficacy of monopolar transurethral resection of the prostate (M-TURP) and holmium laser enucleation of the prostate (HOLEP) for prostate size >100 ml. Materials and Methods: We retrospectively evaluated our database of two groups of patients. Thirteen patients underwent M-TURP (group 1), and 27 underwent HOLEP (group 2). Results: The mean prostate size was 163.1 ± 49.0 ml in group 1 and 143.4 ± 40.9 ml in group 2 (P = 0.19). There was no significant difference in resected tissue volume, days of catheter removal, admission days, and postoperative serum hemoglobin between treatment groups. However, in group 1, mean postoperative serum sodium dropped from 137.1 mmol/L to 131.4 mmol/L, which was significantly lower than postoperative serum sodium in group 2 (P < 0.0001). There were more complications in group 1 than group 2, especially for patients undergoing transfusion (76.9% in group 1 and 22.2% in group 2) and with hyponatremia (15.4% in group 1 and 0% in group 2). At 3-month follow-up, the international prostate symptom score, quality of life score, and residual urine volume revealed no significant differences between groups. Conclusion: M-TURP and HOLEP in men with prostate volume greater 100 ml had similar operative time, admission days and postoperative functional outcomes. However, higher transfusion rates and postoperative hyponatremia were noted in the M-TURP group comparing to the HOLEP group.

Prophylaxis versus Treatment against Transurethral Resection of Prostate Syndrome: The Role of Hypertonic Saline.

Background:This study aimed at investigating the usage and effects of prophylactic hypertonic saline (HS) to prevent the occurrence of transurethral resection of the prostate (TURP) syndrome.Materials and Methods:Sixty American Society of Anesthesiologists physical status classes I–III candidates for TURP using the monopolar resectoscope were randomized into three groups 20 patients each. Group A received 4 mL.kg-1.h-1 HS 3%; Group B received 2 mL.kg-1.h-1 HS 3%; and Group C received 6 mL.kg-1.h-1 normal saline. Hemodynamics, vasopressors need, electrolytes (sodium, potassium, and chloride), osmolality, and arterial-blood gas (ABG) were recorded. The incidence of transurethral resection syndrome, intensive care unit (ICU) admission, postoperative ventilation, hospital stay as well as any adverse events were noted.Results:Hypernatremia was detected in six patients (P = 0.002) of Group A only, while hyponatremia occurred in five patients (P = 0.009) of Group C alone. Serum sodium in Group C showed a significant decrease starting from T2 (1 h postresection) till Tp3 (48 h postoperative). In Group C, five patients experienced hypotension and bradycardia; hypertensive episodes also occurred in five patients and a hypervolemic state was noted in seven patients. TURP syndrome was confirmed in only five patients, all in Group C (P = 0.009). Postoperative ICU admission was needed for seven patients of C Group, five of which required assisted ventilation. The overall hospital stay was longer for Group C patients.Conclusion:Prophylactic administration of HS during TURP is superior to conventional treatment of an occurred TURP syndrome. Low dose (2 mL.kg-1.h-1 HS 3%) is effective without adverse effects or risk of contrary hypernatremia.

Prevention of hepatorenal syndrome in patients with cirrhosis and ascites

Pentoxifylline is effective in prevention of hepatorenal syndrome (HRS) in alcoholic hepatitis. The aim of this study was to assess the efficacy of pentoxifylline for prophylaxis of HRS in patients with cirrhosis and ascites. One hundred and seventy-six consecutive patients with cirrhosis and ascites were screened. Patients with creatinine clearance (Ccl) between 41 and 80 ml/min and serum creatinine of less than 1.5 mg/dl in absence of renal disease were randomized to receive either pentoxifylline (group A, 1200 mg/day) or placebo (group B) for 6 months. Patients were followed monthly for 6 months, and kidney function tests were carried out at baseline, 1, 3, and 6 months. Primary endpoint was the development of HRS within 6-month follow-up. Thirty-five patients each were randomized to group A and group B. Of the 70 patients, 61 completed follow-up (group A, n = 30 and group B, n = 31). In group A, serum creatinine remained stable at 1 month (0.94±0.2 vs. 0.90±0.4 mg/dl, P = 0.43), at 3 months (0.94±0.2 vs. 0.80±0.3 mg/dl, P = 0.10), and at 6 months (0.94±0.2 vs. 0.8±0.2 mg/dl, P = 0.06). Improvement occurred in Ccl at 1 month (61.7±16.0 vs. 82.0±30.0 ml/min, P = 0.001) and at 3 months (61.7±16.0 vs. 86.2±30.7 ml/min, P = 0.001). Serum sodium in group A showed progressive improvement at 1 month (134.7±4.4 vs. 137.0±5.3 mmol/l, P = 0.006), at 3 months (134.7±4.4 vs. 138.4±5.4 mmol/l, P = 0.004), and at 6 months (134.7±4.4 vs. 137.6±4.9 mmol/l, P = 0.009). Similarly, mean arterial pressure (MAP) also showed progressive improvement at 1 month (76.7±6.7 vs. 81.8±6.9 mmHg, P = 0.001), at 3 months (76.7±6.7 vs.82.3±6.2 mmHg, P = 0.001), and at 6 months (76.7±6.7 vs. 82.6±6.1 mmHg, P = 0.01). Tumor necrosis factor (TNF) level measured at baseline and at 3 months (14.4±4.8 vs. 13.1±3.7 pg/ml, P = 0.28) showed no difference in group A patients. In group B, serum creatinine increased gradually at 1 month (0.80±0.2 vs. 1.0±0.2 mg/dl, P = 0.007), at 3 months (0.80±0.2 vs. 1.1±0.3 mg/dl, P = 0.001), and at 6 months (0.80±0.2 vs.1.1±0.2 mg/dl, P = 0.001). Ccl at 1 month (63.1±14.5 vs. 66.8±28.2 ml/min, P = 0.37) decreased at 3 months (63.1±14.5 vs. 54.4±18.3 ml/min, P = 0.008). Serum sodium, in group B, showed progressive decline at 1 month (136.2±5.0 vs. 132.7±3.2 mmol/l, P = 0.02) and at 6 months (136.2±5.0 vs. 132.7±3.4 mmol/l, P = 0.002). MAP remained stable at 1 month (75.1±7.5 vs. 75.3.8±5.1 mmHg, P = 0.86), at 3 months (75.1±7.5 vs. 73.2±4.6 mmHg, P = 0.19), and at 6 months (75.1±7.5 vs. 74.1±6.1 mmHg, P = 0.06). TNF level also did not show any change at baseline and at 3 months (14.5±6.8 vs. 13.4±5.1 pg/ml, P = 0.31). Of the 12 patients who developed HRS, 10 patients were in group B (type 1 HRS, n = 9 and type 2 HRS, n = 1) and two patients (type-1 HRS, n = 2) were in group A (P = 0.01). Patients with HRS had higher baseline TNF-α (15.3±5.8 vs. 10.9±4.8 pg/ml, P = 0.01), lower MAP (68.0±3.8 vs. 77.8±6.5 mmHg, P = 0.01), and sodium level (131.2±3.0 vs. 135.6±4.7 mmol/l, P = 0.003) than those who did not develop HRS. Pentoxifylline is effective in preventing HRS in patients with cirrhosis and ascites at risk of HRS.

Pathophysiology in malignant hypertension: with special reference to the renin-angiotensin system.

Pathophysiology of malignant hypertension, of which underlying disease was essential hypertension (EHT) in 33 cases and chronic glomerulonephritis (CGN) in 26 cases, was studied with reference to the renin-angiotensin system. Plasma renin activity (PRA) was significantly higher in the EHT than in the CGN group, and angiotensin II antagonist [Sar1, Ile8]angiotensin II (AIIA) induced a significant lowering of blood pressure only in the former group. PRA was linearly correlated with both pretreatment mean blood pressure (MBP, r = 0.474, n = 29, p less than 0.01) and serum creatinine (r = 0.540, n = 29, p less than 0.01) in the EHT group but not in CGN patients, although there was an inverse correlation between PRA and serum sodium in both groups. Multiple regression analysis revealed that PRA was independently related to MBP, serum creatinine, and serum sodium in the EHT group, but not in the CGN group. These results suggest that the renin-angiotensin system plays a significant role in elevating blood pressure and deteriorating renal function in malignant hypertension derived from EHT, but it is less important in CGN related hypertension.