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1.
J Med Case Rep ; 9: 3, 2015 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-25645320

RESUMO

INTRODUCTION: Vascular malformations of the thyroid gland represent a very rare, often accidentally diagnosed, disease that in the case of eufunctional goitre may be the cause of mechanical neck syndrome. The authors present here the complex differential-diagnosis and treatment approach and stress the importance of histopathology for determining the final diagnosis. CASE PRESENTATION: Using various imaging methods (ultrasound, multidetector computed tomography of the neck), the cause of breathing difficulties in a 64-year-old old man from the Czech Republic with normal thyroid gland function was found to be an arteriovenous malformation of the left lobe of his thyroid gland, 80 × 70 × 55 mm in size, reaching retrosternally between the major arteries branching from his aortic arch and displacing his trachea 10mm to the right. In preparation for surgery, he underwent a radio-interventional procedure with embolisation of the arteries supplying the left lobe. This was followed by a lobectomy on the left via a partial sternotomy. The definitive histology result confirmed that the arteriovenous malformation was the benign cause of the mechanical neck syndrome. CONCLUSIONS: The case report presented here extends the differential diagnostic options in cases of mechanical neck syndrome. It describes a very rare disease of the thyroid gland, which prior to surgery may arouse suspicion of malignancy. It stresses the importance of close team cooperation between the endocrinologist, interventional radiologist and surgeon within the framework of preoperative diagnosis as well as preparation for surgery. Determination of the definitive histopathological diagnosis requires a pathologist experienced in such issues.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Malformações Arteriovenosas/complicações , Glândula Tireoide/irrigação sanguínea , Obstrução das Vias Respiratórias/diagnóstico por imagem , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Diagnóstico Diferencial , Embolização Terapêutica , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Síndrome , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X
2.
Artigo em Inglês | MEDLINE | ID: mdl-22660223

RESUMO

AIM: In this case report, the authors aim to demonstrate the success of recent methods in the radical treatment of a patient with primary inoperable liver and subsequent colorectal cancer pulmonary metastases. METHODS: A 75 year old patient with inoperable bulky metastasis in the right hepatic lobe and insufficient future remnant liver volume was indicated for a stage procedure in the liver parenchyma. Embolization of the right branch of the portal vein was first performed with subsequent administration of stem cells into the contralateral liver lobe. Following compensatory growth of the left liver lobe, right-sided hepatectomy was performed with subsequent adjuvant oncological treatment. Six months after the surgery, a metastasis developed in the right pulmonary lobe which was solved by metastasectomy. RESULTS: The patient, one year after the diagnosis of inoperable liver metastasis, is completely healthy and free of signs of disease recurrence. CONCLUSION: A comprehensive oncosurgical approach using up-to-date diagnostic and treatment options may offer patients with metastatic colorectal cancer, radical treatment with the hope of long-term quality survival.


Assuntos
Adenocarcinoma/terapia , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/cirurgia , Adenocarcinoma/secundário , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/cirurgia , Embolização Terapêutica , Fluoruracila/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Hepatectomia , Humanos , Leucovorina/uso terapêutico , Neoplasias Hepáticas/secundário , Regeneração Hepática , Neoplasias Pulmonares/secundário , Masculino , Compostos Organoplatínicos/uso terapêutico , Pneumonectomia
3.
Hepatogastroenterology ; 59(114): 448-52, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22353514

RESUMO

BACKGROUND/AIMS: Portal vein embolization (PVE) extends the resecability of liver tumours.The issue of PVE is an insufficient growth of the liver parenchyma or a tumour progression in some patients. We evaluated the effect of the volume and the number of liver tumours on the effect of PVE. METHODOLOGY: PVE was performed in 40 patients with liver tumours due to an insufficient future remnant liver volume. The number and the volume of the tumours were evaluated and compared with the final PVE effect. RESULTS: In patients without any increase of the liver volume after PVE (n=3) the number and the volume of the tumours before PVE were 2.7±2.1 and 2205.1±2432.7mm3, respectively. In patients with sufficient growth of the liver (n=22) it was 3.8±2.2 (NS) and 1164.9±1392.1mm3 (NS), respectively. In patients with tumour progression (n=11) it was 5.6±2.2 and 6971.4±5189.5mm3, respectively (p<0.04 and p<0.005, respectively). Four patients were treated by radiofrequency ablation only due to worsening of their health state. Patients with >4 foci (OR 4.7) and a tumour volume >400mm3 (OR=13.0) had a higher probability of cancer progression or insufficient growth of the liver tissue. Patients with <6 foci and a tumour volume <3100mm3 had an 87.5% probability of a successful liver hypertrophy after PVE. CONCLUSIONS: The tumour number and volume were crucial for progression of a malignant disease and growth of the liver parenchyma after PVE.


Assuntos
Embolização Terapêutica , Neoplasias Hepáticas/terapia , Regeneração Hepática , Terapia Neoadjuvante , Neoplasias Primárias Múltiplas/terapia , Veia Porta , Adulto , Idoso , Tomografia Computadorizada de Feixe Cônico , Progressão da Doença , Embolização Terapêutica/efeitos adversos , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Neoplasias Primárias Múltiplas/irrigação sanguínea , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Razão de Chances , Valor Preditivo dos Testes , Curva ROC , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
4.
World J Surg Oncol ; 7: 80, 2009 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-19886993

RESUMO

BACKGROUND: Following failure of standard systemic chemotherapy, the role of hepatic transarterial therapy for colorectal hepatic metastasis continues to evolve as the experience with this technique matures. The aim of this study to gain a better understanding of the value of drug eluting bead therapy when administered to patients with unresectable colorectal hepatic metastasis. METHODS: This was an open-label, multi-center, single arm study, of unresectable colorectal hepatic metastasis patients who had failed standard therapy from 10/2006-10/2008. Patients received repeat embolizations with Irinotecan loaded beads(max 100 mg per embolization) per treating physician's discretion. RESULTS: Fifty-five patients underwent 99 treatments using Irinotecan drug eluting beads. The median number of total treatments per patient was 2(range of 1-5). Median length of hospital stay was 23 hours(range 23 hours - 10 days). There were 30(30%) sessions associated with adverse reactions during or after the treatment. The median disease free and overall survival from the time of first treatment was 247 days and 343 days. Six patients(10%) were downstaged from their original disease status. Of these, four were treated with surgery and two with RFA.Neither number of liver lesions, size of liver lesions or extent of liver replacement(25%) were predictors of overall survival. Only the presence of extrahepatic disease(p = 0,001), extent of prior chemotherapy (failed 1st and 2nd line vs > 2 line failure)(p = 0,007) were predictors of overall survival in multivariate analysis. CONCLUSION: Chemoembolization using Irinotecan loaded beads was safe and effective in the treatment of patients as demonstrated by a minimal complication rate and acceptable tumor response.


Assuntos
Antineoplásicos Fitogênicos/administração & dosagem , Camptotecina/análogos & derivados , Quimioembolização Terapêutica/métodos , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Camptotecina/administração & dosagem , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Sistemas de Liberação de Medicamentos , Feminino , Humanos , Irinotecano , Neoplasias Hepáticas/secundário , Masculino , Microesferas , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento
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