Transsphenoidal Microneurosurgery : 第2報術後の水・Na代謝の動態とその管理

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Among 150 cases of transsphenoidal pituitary operations performed at the Evanston Hospital, Evanston, Illinois, 84 cases were carefully reviewed prospectively or restrospectively in the light of postoperative patterns of water-sodium metabolism. Postoperative diabetes inspidus was observed more remarkably in hypophysectomized patients. Among these patients with severe postoperative diabetes inspidus, there was a significantly high rate of pituitary metastasis of breast cancer in the pathological findings of the hypophysectomized gland. In grade III diabetes inspidus (continuing over a month), 62.5% of the patients showed this finding. The postoperative pattern of sodium metabolism was complicated. Fifty out of 58 cases had remarkably decreased natriuresis in the first 3 or 4 postoperative days demonstrating a sudden drop of urine osmolarity followed by increased serum osmolarity with or without polyuria. Among these patients, 26 cases returned to normal in the next two weeks. However, eight had continuous diabetes inspidus with or without hypernatremia, three showed possible "essential hypernatremia", nine had S.I.A.D.H. and two were diagnosed as overhydration. Sodium regulation should be considered independently from water metabolism in certain patients. In many examples, hypo- or hyper-natremia is not associated with abnormal water metabolism. It was emphasized that monitoring the daily osmolarity of serum and urine as well as serum sodium level is very important in post transsphenoidal pituitary operative care.
日本脳神経外科学会の論文
1980-11-15

Transsphenoidal Microneurosurgery : 第2報術後の水・Na代謝の動態とその管理

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Transsphenoidal Microneurosurgery : 第2報 術後の水・Na代謝の動態とその管理

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Transsphenoidal Microneurosurgery : 第2報術後の水・Na代謝の動態とその管理