SODIUM AND WATER IMBALANCE AFTER SELLAR, SUPRASELLAR, AND PARASELLAR SURGERY.

OBJECTIVE: To report the frequency of sodium and water disturbances (SWDs) in patients undergoing sellar, suprasellar, and parasellar surgery (SSPS). METHODS: We conducted a cross-sectional, retrospective study on 115 patients in the Aga Khan University Hospital after ethical approval. Patients were 16 years old or older undergoing pituitary or sellar surgeries. We collected data on basic sociodemographic characteristics and clinical indication for surgery. We noted laboratory values for serum electrolytes, plasma and urine osmolality, urine sodium, and 24-hour fluid balance from the immediate postoperative day until discharge and follow-up. We recorded medical management plans. We also recorded diabetes insipidus (DI), syndrome of inappropriate antidiuretic hormone (SIADH), cerebral salt wasting (CSW), triphasic response, and hyponatremia, according to the diagnostic definitions. Finally, we performed data analysis using Statistical Package for the Social Sciences, version 19.0. RESULTS: Of 115 patients, there were 61.7% males, mean age 42.3 ± 13.86 years, 91.3% had pituitary adenoma (73.0% nonfunctioning), and 86.1% underwent transsphenoidal surgical approach. Transient DI occurred from days 1 to 6, peaking with 57.4% on day 2. Permanent DI and SIADH were rare. We did not note typical triphasic response or CSW in any of the patients. However, isolated hyponatremia occurred in 11%, and 20.9% had DI with hyponatremia. CONCLUSION: Transient DI is the most common postoperative SWD after SSPS. Hyponatremia occurred alone and following DI. This is the first study describing postoperative SWDs after different sellar surgeries in Pakistan. ABBREVIATIONS: ADH = antidiuretic hormone CSW = cerebral salt wasting DI = diabetes insipidus SIADH = syndrome of inappropriate antidiuretic hormone SSPS = sellar, suprasellar, and parasellar surgery SWD = sodium and water disturbance.

Incidence and management of rupture uterus in obstructed labour.

BACKGROUND: Obstructed labour with ruptured uterus is a serious obstetrical complication with a high incidence of maternal and foetal morbidity and mortality. This study was conducted to find out the incidence of uterine rupture particularly in the patients of obstructed labour (OL), foeto-maternal outcome of such patients, and its management. METHODS: This two year descriptive study was conducted in the Department of Obstetrics and Gynaecology Unit-I, at Muhammad Medical College Hospital from 1st January 2007 to 31st December 2008, on 40 diagnosed cases of OL. Patients were admitted through Casualty or were admitted in ward. Patients with previous caesarean section and myomectomy were excluded. RESULTS: Ruptured uterus was found in 8 out of 40 patients of obstructed labour, they were relatively elder and grand-multiparous. Mean age of the patients was 36.5 years, while parity ranged between 5 and 12. Only one (12.5%) patient was primigravida with mean gestational age of 39.15 weeks. Seven (87.5%) patients had abdominal pain and tenderness, 5 (62.5%) vaginal bleeding, and 2 (25%) had shock. All cases were immediately managed with fluid replacement, blood transfusion and surgery. Six (75%) cases were diagnosed as ruptured uterus on clinical features while 2 (25%) with incomplete rupture were diagnosed on caesarean section for obstructed labour. Foetal mortality rate was high (7, 87.5%); 5 (62.5%) were fresh stillbirth and 2 (12.5%) died in nursery. Only 1 (12.5%) baby survived. There was 1 maternal death due to puerperal sepsis. CONCLUSION: The incidence of rupture uterus in obstructed labour was 20%. Immediate intervention is important factor for successful management of uterine rupture.