Does intraprostatic vasopressin prevent the TURP syndrome? - Poster abstract

OBJECTIVE: To determine whether intraprostatic vasopressin (PVP) prevents the TURP syndrome. PATIENTS AND METHODS: Thirty-three (33) consecutive patients, whose mean age was 68 years (range 54-85 years), with prostates clinically assessed as > 20 g comprised the study group who had vasopressin injected into the prostate transrectally before operation. Blood samples were taken both pre- and post-operatively and serum electrolyte and free Hb levels determined. The TURP irrigant was cooled, bioled water and the head of resecting pressure was kept at 70-80 cm H2O. The patients were breathalysed at 10-minute intervals. Sensorium was monitored continuously. Extreme care was taken to avoid/identify capsular damage during resection. RESULTS: There was no significant change in the clinical features studied - sensorium, pulse and blood pressure. Alcoholometer changes were very small indeed. Free Hb and serum Na+ were very little changed. CONCLUSION: Insignificant volumes of irrigation fluid entered the circulation during the procedure. There was therefore no risk of the patient developing the TURP syndrome. It appears that IPVP does prevent the TURP syndrome.(AU)

A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy

OBJECTIVE: To assess the comparative efficacy of perivascular vasopressin and tourniquet in minimizing bleeding and its sequelae at myomectomy. METHODS:between March 1994 and February 1995, 52 women with symptomatic uterine leiomyomas scheduled for myomectomy were entered into a randomized trial comparing vasopressin (26 patients) and tourniquet (26 patients) for hemostasis. Myomectomy was performed after either the perivascular injection of 20 U of vasopressin diluted to 20 mL with normal saline or with the use of a Foley catheter tourniquet around both uterine vessels. The efficacy of each method was measured by comparing differences in pre-and postoperative hemoglobin levels, intraoperative blood pressure, measured blood loss, need for blood transfusion, evidence of postoperative febrile morbidity, complications, and length of hospital stay. RESULTS: Vasopressin resulted in less blood loss (mean 287.3 mL [standard deviation (SD) 195] verus 512.7 mL [SD 400] for tourniquet [P = .036]. Six of 26 patients in the tourniquet lost more than 1000 mL of blood, whereas all of the vasopressin subjects lost less than this amount (P = .023). However, there were no significant differences between the two groups in the fall in the hemoglobin level, number of blood transfusion given, intraoperative blood pressure, highest postoperative pulse and temperature, or other complications. CONCLUSION: Vasopressin prevents blood loss better than using the tourniquet durIng myomectomy.(AU)

Vasopressin use in myomectomy a community hospital experience

Perivascular vasopressin as a haemostatic agent in myomectomy has recently been shown to be very useful in reducing the amount of bleeding during operation. The published data have, however, come from work done in university or large hospital settings. The aim of this case series was to establish that vasopressin can be used effectively in a small community hospital setting, to reduce the need for blood transfusion, especially in the small countries of the Caribbean where blood banking is not often available. Twenty-two patients were evaluated in this case series. Vasopressin 1 unit/ml solution was injected into the broad ligament posteriorly, inferior to the insertion of the ovarian ligament and anteriorly, inferior to the insertion of the round ligament. The drug was also injected along the line of of the incision in the myometrium. Of the twenty-two patients evaluated three were excluded, two because of degenerating fibroids while the other had adenomyosis. None of the nineteen patients required transfusion. The average blood loss was 240 ml; three patients had losses greater than 500 ml. Intraoperative changes in vital signs in these patients were minimal and no patient required reoperation because of post-operative haemorrhage. As has been reported previously, vasopressin can be used effectively as a haemostatic agent in myomectomy. The reduction in the need for blood transfusion in this community hospital setting is a major clinical advantage (AU)

Intraprostatic vasopressin: an aid to TURP - abstract

Intraprostatic vasopressin (IPVP) reduces the bothersome small vessel bleeding encountered during routine transurethral prostatectomy (TURP). Ten units vasopressin (VP) in 0.5 ml diluted with 4.5 ml normal saline are injected transrectally into the prostate gland. Thirty-eight consecutive patients with prostates assessed as smaller than 40 gm were studied. Nineteen patients were given IPVP and 19 were not. The results in the 19 IPVP study group were compared with those of the controls (no IPVP group). Blood loss was halved by a single intraprostatic injection of 10 units VP in 5 ml saline solution. This difference was statistically significant. The IPVP patients were the normal older age group men with hypertension and other cardiovascular diseases. They all tolerated the IPVP without any morbidity. The injection of IPVP makes TURP easier to do and to teach/learn because bleeding is markedly reduced. Blood transfusion will therefore be less often required. No patient in this series required blood transfusion (AU)

Perivascular vasopressin versus tourniquet as haemostatic agents during myomectomy: a prospective randomised trial - abstract

This study sought to assess the efficacy of perivascular vasopressin compared to tourniquet in minimising bleeding and its sequelae at myomectomy. It was a prospective randomized trial carried out at the University Hospital of the West Indies, Kingston, Jamaica. Thirty-eight women with symptomatic uterine fibroids scheduled for myomectomy were recruited after satisfying eligibility criteria. There were 18 patients in the vasopressin group and 20 in the tourniquet group. Myomectomy was performed after the injection perivascularly of either 10 units vasopressin in 20 ml normal saline or with the use of a Foley catheter tourniquet around the uterine vessels. The efficacy of each method was measured by looking at differences in pre- and post-operative haemoglobin and haematocrit, changes in intraoperative pulse and blood pressure, measured blood loss, need for blood transfusion and evidence of post-operative febrile morbidity. Pre-operative variables were almost identical in both groups. The use of vasopressin resulted in less blood loss with a mean of 254 ml versus 401 ml for tourniquet (p = 0.09) approaching significance. This resulted in a similar fall in the haemoglobin mean, 1.7 versus 2.2 (p = 0.248). Of the 20 patients who received tourniquet 5 had to have blood transfusion compared to one of the 18 receiving vasopressin. There were no significant differences in highest post-operative pulse and temperature. The results suggest that vasopressin is as effective in preventing blood loss as the tourniquet and is probably better, reducing the need for transfusion during myomectomy (AU)

Intramyometrial vasopressin as a haemostatic agent during myomectomy

OBJECTIVE: To assess the efficacy of intramyometrical vasopressin for minimising bleeding and its sequelae at myomectomy. DESIGN: A randomised placebo controlled trial. SETTING: University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS: Twenty women with symptomatic uterine fibroids scheduled for myomectomy who satisfied entry criteria: 10 randomised to the vasopressin group and 10 to the control group. INTERVENTION: Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 ml in normal saline or placebo (20 ml normal saline). MAIN OUTCOME MEASURES: The efficacy of vasopressin was measured by comparing pre- and post-operative haemoglobin levels and haematocrit, changes in intra-operative pulse and blood pressure, measured blood loss, need for blood transfusion post-operative febril morbidity in the treatment and control groups. RESULTS: The use of vasopressin resulted in median blood loss of 225 ml (range150-400ml) compared with 675 ml (range 500-800ml) in the placebo group (p<0.001). The vasopressin group had a correspondingly lower fall in haemoglobin level (median 1.7g/dl vs 5.3g/dl, P<0.001) and haematocrit (median 5 percent vs 13 percent, P<0.001) compared with the controls. Fifty percent of the placebo group had blood transfusions compared with none in the vasopressin group (P=0.03). There were no significant differences between the groups in intra-operative pulse and blood pressure or post-operative white blood cell counts or temperature. CONCLUSION: The results indicate that vasopressin is effective in preventing blood loss and reducing the need for blood transfusion during myomectomy (AU)

Intraprostatic vasopressin before TURP - abstract

Intraprostatic vasopressin reduces the bothersome small vessel prostatic bleeding encountered during routine transurethral prostatectomy. Ten units vasopressin in 0.5 ml diluted with 1.5 ml normal saine are injected transrectally into the prostate gland. A single injection suffices for the procedure. TURP proceeds rapidly and safely. Large amounts of prostate tissue can be removed. Less blood is lost and blood transfusion is therefore less often required (AU)

Inappropriate secretion of antidiuretic hormone induced by chlorpropamide

A patient with diabetes mellitus treated with the sulfonylurea chlorpropamide developed the syndrome of inappropriate secretion of antidiuretic hormone. The mode of clinical presentation was one suggesting a central nervous system disorder. A clinical study of the patient's response to chlorpropamide was carried out. Headache, systolic hypertension, serum hypo-osmality, hyponatremia, urine hyperosmolality, fall in urinary output and continued renal excretion of sodium were demonstrated, confirming the initial diagnosis (AU)

Oxytocin and antidiuresis in pregnancy at term

The urinary output in thirty-eight patients was observed during the intermittent running of an oxytocin drip at or near term. Urinary volumes at half-hourly intervals were significantly lower during an oxytocin infusion than when dextrose only was infused. No differences in blood pressure changes were evident, in comparison with normal patients in labour. It is shown that oxytocin has an antidiuretic effect on the kidney. The sensitivity of this effect increases as pregnancy advances. Oxytocin infusion may need to be used with care in women in whom renal output is already compromised (Summary)