RESUMO
A 66 years old male developping an acute lower right limb oedema due to an extended venous thrombosis of the common femoral and iliac veins was diagnosed to have a leiomyosarcoma of the inferior vena cava (IVC) involving both renal veins. The characteristics and management of this level II IVC leiomyosarcoma are discussed with particular attention to the renal vein reconstruction and neo-adjuvant therapy.
Assuntos
Leiomiossarcoma/cirurgia , Veias Renais/cirurgia , Neoplasias Retroperitoneais/cirurgia , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Idoso , Angiografia por Tomografia Computadorizada/métodos , Seguimentos , Humanos , Laparotomia/métodos , Leiomiossarcoma/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Masculino , Doenças Raras , Veias Renais/patologia , Neoplasias Retroperitoneais/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/patologiaRESUMO
A 66 years old male developping an acute lower right limb oedema due to an extended venous thrombosis of the common femoral and iliac veins was diagnosed to have a leiomyosarcoma of the inferior vena cava (IVC) involving both renal veins. The characteristics and management of this level II IVC leiomyosarcoma are discussed with particular attention to the renal vein reconstruction and neo-adjuvant therapy.
Assuntos
Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Veias Renais , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia , Veia Cava Inferior , Idoso , Humanos , Leiomiossarcoma/diagnóstico por imagem , Masculino , Terapia Neoadjuvante , Radiografia , Radioterapia Adjuvante , Neoplasias Vasculares/diagnóstico por imagemRESUMO
The management of portal hypertension complicated by iterative gastro-intestinal bleeding remains challenging, especially in a low-income environment. Interventional radiology and endoscopic treatments are not always accessible, and a definitive surgical option may prove to be lifesaving. We report a new technique of surgical portosystemic shunt that can be performed in all contexts. We describe the surgical technique of a H-shaped splenorenal shunt using autologous rolled up peritoneum as a vascular graft.
Assuntos
Hipertensão Portal , Derivação Esplenorrenal Cirúrgica , Humanos , Derivação Esplenorrenal Cirúrgica/efeitos adversos , Derivação Esplenorrenal Cirúrgica/métodos , Peritônio/cirurgia , Hipertensão Portal/complicações , Hipertensão Portal/cirurgia , Derivação Portossistêmica Cirúrgica/efeitos adversos , Derivação Portossistêmica Cirúrgica/métodos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgiaRESUMO
Unlike simple obesity, Madelung's disease (MD) is a rare disease characterized by symmetric accumulation of massive adipose tissue on the neck, the superior part of the trunk and limbs, leading to a pathognomonic cosmetic deformity. Here, we report an extremely rare case of MD associated with bilateral gynecomastia in a 61-year-old man, with a history of recent liver transplantation for alcoholic liver disease (ALD).
Assuntos
Lipomatose Simétrica Múltipla , Transplante de Fígado , Humanos , Lipomatose Simétrica Múltipla/diagnóstico , Lipomatose Simétrica Múltipla/etiologia , Lipomatose Simétrica Múltipla/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-IdadeRESUMO
Liver transplantation (LT) remains the only curative option for patients suffering from end-stage liver disease, acute liver failure and selected hepatocellular carcinomas and access to the LT-waiting list is limited to certain strict indications. However, LT has shown survival advantages for patients in certain indications such as acute alcoholic hepatitis, hepatocellular carcinoma outside Milan criteria and colorectal cancer metastases. These newer indications increase the pressure in an already difficult context of organ shortage. Strategies to increase the transplantable organ pool are therefore needed. We will discuss here the use of HCV positive grafts as the use of normothermic isolated liver perfusion. Belgian Liver Intestine Advisory Committee (BeLIAC) from the Belgian Transplant Society (BTS) aims to guarantee the balance between the new indications and the available resources.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Transplante de Fígado , Comitês Consultivos , Bélgica , Humanos , IntestinosRESUMO
All patients transplanted for hepatitis C (HCV)- related cirrhosis will experience a recurrence of the viral disease on the liver graft with an accelerated course of the disease and a progression to advanced liver fibrosis in up to 50% of the patients at 5 years post-liver transplantation. HCV infection is a high risk for graft lost. We report here three cases of patients transplanted for hepatocellular carcinoma on HCV-related cirrhosis. All cases experienced an acute cellular rejection after the end of HCV therapy with direct acting antivirals (DAAs). We thus advocate for a close monitoring of tacrolimus and liver tests even a few months after the end of the treatment. Clinicians using DAAs after liver transplantation should be aware of the dynamics of tacrolimus levels during therapy and immunological changes that can occur even several weeks (or months) after the end of DAA treatment.