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1.
Vasc Endovascular Surg ; 55(1): 69-72, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32862786

RESUMO

Venous stent placement of symptomatic occlusion of the superior and inferior vena cava is considered the treatment of choice in malignant disease because this technique can restore patency and achieve a relief of symptoms. However, tumor thrombus extension into the right atrium harbors the potential risk of stent migration and perforation. One strategy to avoid this potential life-threatening complication could be the placement of a bridging stent from the superior vena cava-to-inferior vena cava. This case reports describes the superior vena cava-to-inferior vena cava bridging stent technique in 2 patients with malignant occlusion of the superior and inferior vena cava. Special considerations such as technical details of the devices and potential complications are discussed.


Assuntos
Procedimentos Endovasculares/instrumentação , Átrios do Coração , Neoplasias/complicações , Stents , Síndrome da Veia Cava Superior/terapia , Veia Cava Inferior , Veia Cava Superior , Trombose Venosa/terapia , Idoso , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/patologia , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/patologia
2.
Anticancer Res ; 40(10): 5837-5844, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988913

RESUMO

BACKGROUND/AIM: Renal cell carcinoma (RCC) is one of the most common malignancies of the urinary tract. Venous migration, tumor thrombus and metastases are often seen in patients with RCC and are adverse prognostic factors. Intravascular tumor growth along the renal vein into the inferior vena cava occurs in up to 10% of all patients with RCC. Furthermore, extension of the tumor reaching the right atrium is detected in approximately 1% of all patients. Synchronous involvement of pulmonary arteries with tumor emboli is very rare and challenging. Management of metastatic RCC includes surgical resection of renal and metastatic lesions. We present 3 cases of patients with RCC tumor thrombus extending into the inferior vena cava (IVC) and with pulmonary emboli of the tumor thrombus into one of the branches of the main pulmonary artery. All the cases had simultaneous resection of the kidney tumor with the tumor thrombus and pulmonary lobectomy that included the tumor emboli with satisfactory outcome. CASE REPORT: We present a series of cases of RCC with tumor extension into the inferior vena cava (IVC) and with tumor emboli to the pulmonary arteries. Surgical procedure in all cases consisted of radical nephrectomy with IVC tumor thrombus resection, along with a thoracotomy with lung resection including the tumor emboli to one of the branches of the main pulmonary artery. Synchronous metastatic lesions were found on the liver in one case and contiguous extension of renal tumor to the pancreas in another. CONCLUSION: In patients with IVC thrombus with synchronous pulmonary artery tumor embolus, such as the cases presented in this series, a careful multidisciplinary management approach is preferable. Transplant technique used in our open approach minimizes complications, blood loss, and provides excellent visualization for abdominal vascular manipulation of IVC. This provides a potentially curable treatment option with acceptable survival rates.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Pulmonares/cirurgia , Artéria Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Adulto , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Metástase Neoplásica , Células Neoplásicas Circulantes/metabolismo , Células Neoplásicas Circulantes/patologia , Nefrectomia/métodos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Veias Renais/cirurgia , Trombose/diagnóstico por imagem , Trombose/patologia , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia , Trombose Venosa/cirurgia
6.
Surg Today ; 50(11): 1496-1506, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32613270

RESUMO

PURPOSE: We investigated whether functional future remnant liver volume (fFRLV), assessed using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), could evaluate regional liver function in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and help establish the indication for hepatectomy. METHODS: The subjects of this study were 12 patients with PVTT [PVTT(+) group] and 58 patients without PVTT [PVTT(-) group], from among 191 patients who underwent hepatectomy of more than one segment for HCC. We calculated the liver-to-muscle ratio (LMR) in the remnant liver, using EOB-MRI and fFRLV. Preoperative factors and surgical outcome were compared between the groups. The LMR of the area occluded by PVTT was compared with that of the non-occluded area. RESULTS: The indocyanine green retention rate at 15 min (ICG-R15) and liver fibrosis indices were increased in the PVTT(+) group, but the surgical outcomes of patients in this group were acceptable, with no liver failure, no mortality, and no differences from those in the PVTT(-) group. The fFRLV in the PVTT(+) group was not significantly different from that in the PVTT(-) group (p = 0.663). The LMR was significantly lower in the occluded area than in the non-occluded area (p = 0.004), indicating decreased liver function. CONCLUSION: Assessing fFRLV using EOB-MRI could be useful for evaluating regional liver function and establishing operative indications for HCC with PVTT.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Meios de Contraste , Imagem de Difusão por Ressonância Magnética , Gadolínio DTPA , Neoplasias Hepáticas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Fígado/patologia , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Trombose Venosa/patologia
7.
BMC Surg ; 20(1): 120, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503500

RESUMO

BACKGROUND: To explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombus. METHOD: We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released. RESULT: There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 min, with an average of (6.8 ± 3.2) minutes. The mean time of IVC occlusion was (19.4 ± 4.9) min. Preoperative creatinine was 66 to 130 µmol/L, with an average of (96.6 ± 21.2) µmol/L. One week after operation, serum creatinine was 64 to 632 µmol/L, with an average of (132.4 ± 144.9) µmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4-29 months). The 5 (35.7%) of the 14 cases were died of disease. CONCLUSION: This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Trombose/patologia , Idoso , Feminino , Humanos , Isquemia/etiologia , Rim/patologia , Neoplasias Renais/patologia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Veias Renais , Estudos Retrospectivos , Trombectomia/métodos , Veia Cava Inferior/cirurgia , Trombose Venosa/patologia
8.
Aliment Pharmacol Ther ; 52(2): 329-339, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32506456

RESUMO

BACKGROUND: To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non-cirrhotic, non-malignant portal vein thrombosis (PVT). METHODS: This prospective, observational study enrolled 65 patients with acute (<28 days since begin of symptoms, no cavernoma) PVT in nine centres. Thirty patients received medical treatment and 35 patients received interventional treatment. PVT was graded into grade 1: short thrombosis and incomplete occlusion of the vessel lumen and grade 2: extended thrombosis or complete occlusion. Treatment response was classified as partial or complete, if thrombosis was reduced by one grade or to <25% of the vessel diameter respectively. RESULTS: Partial and complete response rates were 7% and 30% in the medical compared to 17% and 54% (P < 0.001) in the interventional treatment group. In the multivariate analysis, interventional treatment showed a strong positive (OR 4.32, P < 0.016) and a myeloproliferative aetiology a negative (OR 0.09, P = 0.006) prediction of complete response. Complications were rare in the medical group and consisted of septicaemia and upper gastrointestinal bleeding of unknown origin in one patient each. Interventional treatment was accompanied by mild and self-limiting bleeding complications in nine patients, moderate intra-abdominal bleeding requiring transfusions (2 units) in one patient and peritoneal bleeding requiring surgical rescue in one patient. Four patients in each group developed intestinal gangrene requiring surgery. One patient died 52 days after unsuccessful interventional treatment. CONCLUSIONS: Compared to medical treatment alone, interventional treatment doubled response rates at the cost of increased bleeding complications.


Assuntos
Veia Porta/patologia , Derivação Portossistêmica Transjugular Intra-Hepática , Terapia Trombolítica , Trombose Venosa/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hepatopatias , Masculino , Pessoa de Meia-Idade , Femprocumona/uso terapêutico , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Estudos Prospectivos , Trombose Venosa/patologia , Adulto Jovem
9.
Int J Legal Med ; 134(4): 1275-1284, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32500199

RESUMO

Autopsies of deceased with a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide important insights into the novel disease and its course. Furthermore, autopsies are essential for the correct statistical recording of the coronavirus disease 2019 (COVID-19) deaths. In the northern German Federal State of Hamburg, all deaths of Hamburg citizens with ante- or postmortem PCR-confirmed SARS-CoV-2 infection have been autopsied since the outbreak of the pandemic in Germany. Our evaluation provides a systematic overview of the first 80 consecutive full autopsies. A proposal for the categorisation of deaths with SARS-CoV-2 infection is presented (category 1: definite COVID-19 death; category 2: probable COVID-19 death; category 3: possible COVID-19 death with an equal alternative cause of death; category 4: SARS-CoV-2 detection with cause of death not associated to COVID-19). In six cases, SARS-CoV-2 infection was diagnosed postmortem by a positive PCR test in a nasopharyngeal or lung tissue swab. In the other 74 cases, SARS-CoV-2 infection had already been known antemortem. The deceased were aged between 52 and 96 years (average 79.2 years, median 82.4 years). In the study cohort, 34 deceased were female (38%) and 46 male (62%). Overall, 38% of the deceased were overweight or obese. All deceased, except for two women, in whom no significant pre-existing conditions were found autoptically, had relevant comorbidities (in descending order of frequency): (1) diseases of the cardiovascular system, (2) lung diseases, (3) central nervous system diseases, (4) kidney diseases, and (5) diabetes mellitus. A total of 76 cases (95%) were classified as COVID-19 deaths, corresponding to categories 1-3. Four deaths (5%) were defined as non-COVID-19 deaths with virus-independent causes of death. In eight cases, pneumonia was combined with a fulminant pulmonary artery embolism. Peripheral pulmonary artery embolisms were found in nine other cases. Overall, deep vein thrombosis has been found in 40% of the cases. This study provides the largest overview of autopsies of SARS-CoV-2-infected patients presented so far.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/patologia , Pulmão/patologia , Pneumonia Viral/mortalidade , Pneumonia Viral/patologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Células Epiteliais Alveolares/patologia , Autopsia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Comorbidade , Infecção Hospitalar/mortalidade , Exsudatos e Transudatos , Feminino , Fibroblastos/patologia , Fibrose/patologia , Alemanha/epidemiologia , Células Gigantes/patologia , Humanos , Masculino , Megacariócitos/patologia , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Tamanho do Órgão , Sobrepeso/epidemiologia , Pandemias , Reação em Cadeia da Polimerase , Embolia Pulmonar/patologia , Instituições Residenciais/estatística & dados numéricos , Distribuição por Sexo , Doença Relacionada a Viagens , Trombose Venosa/patologia
10.
Ann R Coll Surg Engl ; 102(9): e1-e4, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32538100

RESUMO

The risk of venous thromboembolism increases during pregnancy and postpartum. The incidence in the first six weeks following delivery is approximately 0.15%. Deep vein thrombosis may present with acute appendicitis-like symptoms such as right iliac fossa pain, nausea and vomiting. A 22-year-old woman was admitted with complaints of abdominal pain and vomiting 20 days after spontaneous vaginal delivery. Physical examination and radiological findings were compatible with acute appendicitis. Preoperative re-examination and re-evaluation of computed tomography revealed concomitant deep vein thrombosis on the right side. The patient underwent laparotomy and a normal appendix and ovaries were found. She had an uneventful recovery. Anticoagulant treatment was administered for six months. Early and correct diagnosis should be established to avoid complications of deep vein thrombosis and prevent unnecessary surgical interventions. Physicians should be aware of deep vein thrombosis in women who present acute appendicitis-like symptoms, especially during pregnancy and in the postpartum period.


Assuntos
Apendicite/diagnóstico , Veia Femoral , Veia Ilíaca , Período Pós-Parto , Trombose Venosa/diagnóstico , Doença Aguda , Apendicite/patologia , Diagnóstico Diferencial , Feminino , Humanos , Trombose Venosa/patologia , Adulto Jovem
11.
Platelets ; 31(5): 627-632, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32397915

RESUMO

Coronavirus disease 2019 (COVID-19) is a new infectious disease that currently lacks standardized and established laboratory markers to evaluate its severity. In COVID-19 patients, the number of platelets (PLTs) and dynamic changes of PLT-related parameters are currently a concern. The present paper discusses the potential link between PLT parameters and COVID-19. Several studies have identified a link between severe COVID-19 patients and specific coagulation index, in particular, high D-dimer level, prolonged prothrombin time, and low PLT count. These alterations reflect the hypercoagulable state present in severe COVID-19 patients, which could promote microthrombosis in the lungs, as well as in other organs. Further information and more advanced hematological parameters related to PLTs are needed to better estimate this link, also considering COVID-19 patients at different disease stages and stratified in different cohorts based on preexisting co-morbidity, age, and gender. Increasing the understanding of PLT functions in COVID-19 will undoubtedly improve our knowledge on disease pathogenesis, clinical management, and therapeutic options, but could also lead to the development of more precise therapeutic strategies for COVID-19 patients.


Assuntos
Betacoronavirus , Plaquetas/fisiologia , Infecções por Coronavirus/sangue , Pandemias , Pneumonia Viral/sangue , Trombofilia/etiologia , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Plaquetas/ultraestrutura , Moléculas de Adesão Celular/metabolismo , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Citocinas/metabolismo , Coagulação Intravascular Disseminada/etiologia , Interações Medicamentosas , Células Endoteliais/patologia , Endotélio Vascular/patologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Inflamação , Pulmão/patologia , Peptidil Dipeptidase A/fisiologia , Contagem de Plaquetas , Testes de Função Plaquetária , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Tempo de Protrombina , Receptores Virais/fisiologia , /prevenção & controle , Síndrome Respiratória Aguda Grave/sangue , Síndrome Respiratória Aguda Grave/patologia , Trombofilia/sangue , Trombofilia/tratamento farmacológico , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Trombose Venosa/patologia , Trombose Venosa/prevenção & controle
12.
J Card Surg ; 35(6): 1380-1382, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353896

RESUMO

Intravascular tumor extension in the inferior vena cava (IVC) is known to occur with abdominal tumors, such as renal cell, hepatocellular, adrenal cell carcinoma, and Wilm's tumor. We encountered a 53-year-old male patient presenting with pulmonary embolism and a right atrial mass with imaging evidence of an adrenal tumor extending into the IVC, up to the right atrium. The patient underwent surgery for the resection of the tumor using cardiopulmonary bypass by a team of cardiothoracic surgeons and urologists. Histology identified the tumor as hepatocellular carcinoma, which developed as ectopic hepatic tissue in the right adrenal gland.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Hepatocelular/cirurgia , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/cirurgia , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Carcinoma Hepatocelular/patologia , Ponte Cardiopulmonar , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Veia Cava Inferior/patologia , Trombose Venosa/etiologia , Trombose Venosa/patologia
14.
Eur J Vasc Endovasc Surg ; 60(2): 243-252, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32359973

RESUMO

OBJECTIVE: To review the existing literature on large animal models of central venous thrombosis (CVT) and to evaluate its relevance in regard to the development and testing of dedicated therapeutics applicable to humans. METHODS: A systematic literature search was conducted in PubMed and Embase. Articles describing an in vivo experimental protocol of CVT in large animals, involving the iliac vein and/or the vena cava and/or the brachiocephalic vein, were included. The primary aim of the study, animal characteristics, experimental protocol, and thrombus evaluation were recorded. RESULTS: Thirty-eight papers describing more than 30 different protocols were included. Animals used were pigs (53%), dogs (21%), monkeys (24%), and cattle (3%). The median number of animals per study was 12. Animal sex, strain, and weight were missing in 18 studies (47%), seven studies (18%), and eight studies (21%), respectively. CVT was always induced by venous stasis: solely (55%), or in addition to hypercoagulability (37%) or endothelial damage (10%). The size of the vessel used for thrombus creation was measured in four studies (10%). Unexpected animal death occurred in nine studies (24%), ranging from 3% to 37% of the animals. Twenty-two studies (58%) in the acute phase and 31 studies in the chronic phase (82%) evaluated the presence or absence of the thrombus created, and its occlusive characteristic was reported, respectively, in five and 17 studies. Histological examination was performed in 24 studies (63%) with comparison to human thrombus in one study. CONCLUSION: This review showed advantages and weaknesses of the existing large animal models of CVT. Future models should insist on more rigour and consistency in reporting animal characteristics, as well as evaluating and comparing the thrombus created to human thrombus.


Assuntos
Veias Braquiocefálicas , Veia Ilíaca , Veias Cavas , Trombose Venosa , Animais , Coagulação Sanguínea , Veias Braquiocefálicas/patologia , Modelos Animais de Doenças , Cães , Haplorrinos , Humanos , Veia Ilíaca/patologia , Especificidade da Espécie , Sus scrofa , Veias Cavas/patologia , Trombose Venosa/sangue , Trombose Venosa/etiologia , Trombose Venosa/patologia , Trombose Venosa/terapia
15.
Ann Vasc Surg ; 68: 567.e11-567.e15, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32428643

RESUMO

Leiomyosarcomas are an uncommon malignant subset of tumors accounting for approximately 20% of soft tissue sarcomas. Primary vascular leiomyosarcomas (PVLs) are a rare subset of leiomyosarcomas that may originate in the arterial or venous circulation but most commonly affect the inferior vena cava (IVC). PVLs more commonly affect women to men in a 2:1 ratio and most frequently occur in the fourth to sixth decades of life. Few reports have described this infrequent pathologic state in the setting of advanced pregnancy. Presented is a case of a 44-year-old 30-week pregnant woman who presented with a PVL of the retrohepatic IVC, which was complicated by occlusion of the IVC and tumor thrombus extension into the hepatic veins and right atrium. Herein, we describe our multidisciplinary management of this rare problem with successful surgical resection of her tumor and IVC reconstruction.


Assuntos
Implante de Prótese Vascular , Átrios do Coração/cirurgia , Leiomiossarcoma/cirurgia , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Adulto , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/patologia , Gravidez , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia
16.
Surg Today ; 50(10): 1282-1289, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32346760

RESUMO

PURPOSES: The aim of this study was to explore predictive factors for portal or splenic vein thrombosis (VT) that might cause serious problems after distal pancreatectomy (DP). METHODS: A total of 230 patients who underwent DP between 2008 and 2017 were retrospectively reviewed to identify predictive factors for portal or splenic VT. RESULTS: Ultimately, 164 patients were analyzed. Portal or splenic VT was significantly correlated with age < 65 years old, benign tumor, laparoscopic surgery, preservation of the inferior mesenteric vein (IMV) and left gastric vein (LGV), preservation of the IMV only, no drainage vein, length of the residual splenic vein (RSV) ≥ 26 mm, vessel dissection with a linear stapler, and intra-abdominal abscess (all P < 0.05). Furthermore, a multivariate analysis indicated that the length of the RSV (odds ratio [OR]: 9.15, P = 0.03) was an independent predictive factor for portal VT and that the length of the RSV (OR: 37.9, P < 0.01), vessel dissection with a linear stapler (OR: 6.49, P = 0.03), and intra-abdominal abscess (OR: 23.0, P = 0.02) were independent predictive factors for splenic VT. CONCLUSION: As the length of the RSV was significantly associated with portal or splenic VT, a follow-up imaging diagnosis might be recommended for such cases.


Assuntos
Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Complicações Pós-Operatórias/etiologia , Veia Esplênica/patologia , Trombose Venosa/etiologia , Trombose Venosa/patologia , Abscesso Abdominal , Fatores Etários , Feminino , Previsões , Humanos , Laparoscopia/métodos , Masculino , Veias Mesentéricas , Tratamentos com Preservação do Órgão/métodos , Veia Porta , Estudos Retrospectivos , Fatores de Risco , Grampeadores Cirúrgicos , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem
17.
BMC Cardiovasc Disord ; 20(1): 150, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228467

RESUMO

BACKGROUND: miR-92a-3p and oxidative stress are reportedly associated with venous thrombosis. However, the role of miR-92a-3p and oxidative stress in catheter-related thrombosis (CRT) remains ambiguous. Herein, we studied the roles of miR-92a-3p, oxidative stress, and p38-mitogen-activated protein kinase/nuclear factor kappa-B (MAPK/NF-κB) pathway in CRT. METHODS: Forty-five male rats were randomly and equally divided into control, sham operation, and CRT groups. The rats were sacrificed after 10 days. Reactive oxygen species (ROS), superoxide dismutase (SOD), and malondialdehyde (MDA) levels in the serum were determined by enzyme-linked immunosorbent assay (ELISA). The expression levels of miR-92a-3p, heme oxygenase-1 (HO-1), NF-κB p65, and p38 MAPK in the venous tissues were detected with quantitative polymerase chain reaction (qPCR) and Western blot. RESULTS: Thrombosis was observed only in the CRT group. Compared with the levels in the control and sham operation groups, ROS and MDA significantly increased in the CRT group, but SOD significantly decreased. qPCR and Western blot results showed that miR-92a-3p, HO-1, p38 MAPK, and NF-κB p65 expression was significantly upregulated in the venous tissues of the CRT group. Moreover, miR-92a-3p was positively correlated with HO-1, which was positively correlated with p38 MAPK and NF-κB p65. CONCLUSION: miR-92a-3p was correlated with oxidative stress in CRT. miR-92a-3p and oxidative stress contributed to endothelial dysfunction and simultaneously was associated with CRT.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Veias Jugulares/enzimologia , MicroRNAs/metabolismo , NF-kappa B , Estresse Oxidativo , Trombose Venosa/enzimologia , Proteínas Quinases p38 Ativadas por Mitógeno , Animais , Modelos Animais de Doenças , Heme Oxigenase (Desciclizante)/metabolismo , Veias Jugulares/patologia , Masculino , MicroRNAs/genética , Ratos Sprague-Dawley , Transdução de Sinais , Trombose Venosa/etiologia , Trombose Venosa/genética , Trombose Venosa/patologia
18.
Int J Clin Oncol ; 25(7): 1425-1431, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32249334

RESUMO

BACKGROUND: Wilms tumor (WT) with an inferior Vena cava (IVC) malignant thrombus comprises 4-10% of all WT cases. METHODS: This retrospective analysis included 51 pediatric patients presenting at Children Cancer Hospital Egypt-57357 from July 2007 to December 2016 with the diagnosis of WT with malignant IVC thrombus. RESULTS: Median age at presentation = 4.4 years and 28 cases (55%) were females. Twenty-five patients (49%) were metastatic and 4 patients (7.8%) had bilateral disease. Forty-seven cases (92.2%) had favorable histology with no evidence of anaplasia. Level of thrombus extension at presentation was classified as infra-hepatic, retro-hepatic, supra-hepatic and intra-cardiac in 33, 9, 6 and 3 patients, respectively. Fifty patients started neoadjuvant chemotherapy (CTH) with 16 patients showing complete resolution of thrombus after 6 weeks of CTH. None of the patients developed thrombus progression after neoadjuvant CTH; one patient had stationary intra-cardiac thrombus, while remaining patients showed partial regression of their thrombus and had nephrectomy with en-bloc thrombectomy. The mean cranio-caudal dimension of IVC thrombi at initial presentation was 6.5 cm, and 3.6 cm post 6th week of CTH. The 5-year OS and EFS were 75.9% and 71.1%, respectively. There was no significant correlation of initial levels of thrombus extension with survival. CONCLUSION: Neoadjuvant chemotherapy followed by radical nephrectomy with en-bloc thrombectomy and radiotherapy seems a successful approach for management of patients with WT and IVC tumor thrombus. Measurement of the cranio-caudal dimension of thrombus and its response to treatment should be considered in the surgical planning.


Assuntos
Neoplasias Renais/terapia , Trombose Venosa/patologia , Tumor de Wilms/terapia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Terapia Neoadjuvante , Nefrectomia/métodos , Estudos Retrospectivos , Trombectomia/métodos , Trombose/patologia , Resultado do Tratamento , Veia Cava Inferior/patologia , Tumor de Wilms/patologia , Tumor de Wilms/cirurgia
19.
An Bras Dermatol ; 95(3): 347-350, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32303432

RESUMO

Intravascular histiocytosis is a rare condition characterized by the aggregate of histiocytes within dilated dermal vessels. The diagnosis is mainly histophatological and immunohistochemical. We describe a case of a 55 year-old female patient presenting erythematous/purple patches on the breasts, back and limbs. She previously presented ductal carcinoma in the right breast in 2006 which was treated with mastectomy and proceeded to silicone breast implant in 2009. Clinical hypothesis was telangiectatic metastatic carcinoma. Histopathology showed vascular ectasia, thrombosis and recanalization of upper dermis small vessels. On immunohistochemistry, intravascular cells were CD 68+ and negative for estrogen and progesterone receptors, CK7, EMA and AE1/AE3 and endothelial cells were CD64+, leading to the diagnosis of intravascular histiocytosis.


Assuntos
Implante Mamário/efeitos adversos , Histiocitose/etiologia , Histiocitose/patologia , Silicones/efeitos adversos , Dermatopatias Vasculares/etiologia , Dermatopatias Vasculares/patologia , Dilatação Patológica , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Trombose Venosa/etiologia , Trombose Venosa/patologia
20.
Am J Hematol ; 95(8): 918-926, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32311162

RESUMO

Venous thromboembolic events (VTE) are a frequent complication of lymphoma. We conducted a retrospective analysis to compare VTE risk in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). Subjects were randomly assigned to training and validation sets to identify risk factors of VTE and evaluate risk model performance, including the Khorana score. A group of 790 patients were diagnosed from 2002 to 2014 (DLBCL = 542, FL = 248). Median follow- up was 49 months. We observed 106 VTE, with higher incidence in DLBCL (5-year cumulative incidence = 16.3% vs 3.8% in FL patients). Five-year OS for patients with VTE was 51.4% vs 73.1% in patients without VTE (P < .001). Baseline VTE risk factors identified in the training cohort included lymphoma subtype, previous VTE, ECOG performance status ≥2, decreased albumin, increased calcium, elevated WBC, absolute lymphocyte count or monocyte count, and presence of bulky disease. Addition of new variables to the Khorana score improved its performance measured by Akaike information criterion and Concordance index. A new risk model including lymphoma subtype, albumin, WBC count, and bulky disease was validated in time-based ROC analyses. These findings were confirmed in the validation cohort. Lymphoma subtypes have different VTE risk. The effect of lymphoma subtype was independent from disease burden and the use of systemic therapy. The Khorana risk-score was validated in time to event analyses, and a more robust lymphoma-specific VTE risk score is proposed. These findings suggest lymphoma patients with highest VTE risk can be identified with baseline parameters.


Assuntos
Linfoma Difuso de Grandes Células B/complicações , Trombose Venosa/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombose Venosa/patologia , Adulto Jovem
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