Surgical management of renal cell carcinoma with subhepatic inferior vena cava tumor thrombus: a case report and review of the literature.

BACKGROUND: Renal cell carcinomas are the most common form of kidney cancer in adults. In addition to metastasizing in lungs, soft tissues, bones, and the liver, it also spreads locally. In 2-10% of patients, it causes a thrombus in the renal or inferior vena cava vein; in 1% of patients thrombus reaches the right atrium. Surgery is the only curative option, particularly for locally advanced disease. Despite the advancements in laparoscopic, robotic and endovascular techniques, for this group of patients, open surgery continues to be among the best options. CASE REPORT: Here we present a case of successful tumor thrombectomy from the infrahepatic inferior vena cava combined with renal vein amputation and nephrectomy. Our patient, a 58 year old Albanian woman presented to the doctors office with flank pain, weight loss, fever, high blood pressure, night sweats, and malaise. After a comprehensive assessment, which included urine analysis, complete blood count, electrolytes, renal and hepatic function tests, as well as ultrasonography and computed tomography, she was diagnosed with left kidney renal cell carcinoma involving the left renal vein and subhepatic inferior vena cava. After obtaining informed consent from the patient we scheduled her for surgery, which went well and without complications. She was discharged one week after to continue treatment with radiotherapy, chemotherapy, and immunotherapy. CONCLUSION: Open surgery is a safe and efficient way to treat renal cell carcinoma involving the renal vein and inferior vena cava. It is superior to other therapeutic modalities. When properly done it provides acceptable long time survival and good quality of life to patients.

Surgical management of extracranial internal carotid artery aneurysm-Case report and literature review.

Key Clinical Message: Extracranial internal carotid artery aneurysms (EICAAs) can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture. Although rare, they should be suspected cause in every patient with transitory ischemic attack or stroke, especially in the presence of pain, palpable mass or bruit in the neck. Abstract: Extracranial internal carotid artery aneurysms (EICAAs) are rare arterial aneurysms, with a prevalence of less than 1%. Although they are not common, these aneurysms can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture of the aneurysm. This report presents a case of a successful surgical intervention for EICAA, and an overview of symptoms, risk factors, causes, diagnostic procedures, treatments, and potential postoperative complications. A 70-year-old Albanian lady had been experiencing pain due to a pulsating mass in her neck for many years. Physical examination did not reveal any signs of infection, injury, or previous surgery. A palpable thrill and a carotid bruit were detected over an evident pulsating mass on the left side of her neck. Her past medical history was consistent with three transitory ischemic attacks in recent months and a stroke 5 years earlier. Comorbidities included hypercholesterolemia, hypertension, and long-standing coronary artery disease. Imaging investigation in terms of ultrasound and CT-scan confirmed the presence of an aneurysm of the proximal tract of the internal carotid artery measuring 42 × 31 mm. Surgery was indicated on symptomatic and anatomical grounds. The procedure was carried out under general anesthesia. After proximal and distal clamping, the aneurysm was excised followed by end-to-end anastomosis of the internal carotid artery. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Despite the growing number of reported cases of successful endovascular treatment for internal carotid artery aneurysms, open surgery remains a safe and effective treatment option. However, it is crucial to provide customized treatment plans for each patient based on their individual characteristics and the particularities of their aneurysm.

Pierpont syndrome-Report of a new patient.

We report on a 6-year-old girl with Pierpont Syndrome who was diagnosed using the whole-exome sequencing technique. In addition to commonly recognized traits, our patient had scoliosis, a feature reported only in one other occasion.

Massive hematuria due to an autogenous saphenous vein graft and urinary bladder fistula in an extra-anatomic iliofemoral bypass: a case report.

INTRODUCTION: Gross hematuria caused by rupture of an artery in the urinary tract is a rare but potentially fatal condition. Iliac artery aneurysms, pelvic surgery with radiation, vascular reconstructive surgery, surgery for stenosis of the ureteropelvic junction, and transplantation are reported to be associated with this condition. In the vascular reconstructive surgery group, the most common etiology is rupture of the degenerated artery or synthetic graft in the ureter. CASE PRESENTATION: We present a case of rupture of the small anastomotic pseudoaneurysm at the proximal anastomosis of a right iliofemoral autogenous vein extra-anatomic graft in the urinary bladder. To our knowledge, this is the first report of a rupture of an autogenous vein graft in the urinary bladder. Our patient, a 24-year-old Albanian farmer, was admitted to the emergency department in severe hemorrhagic shock induced by exsanguinating hematuria. He underwent immediate surgery, during which direct sutures to the bladder were placed and the saphenous graft was replaced with a synthetic one. The patient recovered completely, was free of hematuria, and showed no signs of pathological communication between the urinary and arterial tracts on postoperative cystoscopy and computed tomographic angiography during 2 years of follow-up. CONCLUSION: The incidence of artery-to-urinary tract fistulas is growing due to the increasing use of urologic and vascular surgery, pelvic oncologic surgery, and radiation therapy. In addition to fistulas involving a degenerated artery and ureter or synthetic grafts and ureter, they can also involve an autogenous vein graft and the urinary bladder. In our patient, the fistula was a result of erosion of the bladder from a pseudoaneurysm at the proximal anastomosis of an autogenous vein iliofemoral bypass in an extra-anatomic position. Open surgery remains the best treatment option, although there is increasing evidence of successful endovascular treatment.