Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.597
Filtrar
1.
Medicine (Baltimore) ; 98(51): e18149, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860962

RESUMO

RATIONALE: Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels. PATIENT CONCERNS: A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year. DIAGNOSES: Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis. INTERVENTIONS: A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification. OUTCOMES: The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic. LESSONS: Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.


Assuntos
Laparoscopia/métodos , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/patologia , Idoso , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Comunicação Interdisciplinar , Extremidade Inferior , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neurilemoma/diagnóstico por imagem , Doenças Raras , Neoplasias Retroperitoneais/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento
2.
Hinyokika Kiyo ; 65(10): 397-402, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31697884

RESUMO

A 36-year-old female was referred to our hospital for a giant abdominal mass found by ultrasound examination. A computed tomographic scan showed a large retroperitoneal mass measuring 11 cm in diameter suspected to be liver invasion,a right atrial and inferior vena cava (IVC) tumor thrombus with obstruction of hepatic vein junction of IVC,and small lung metastases. She was diagnosed with cT4N0M1 adrenocortical carcinoma (ACC) by a needle biopsy and radiographic examination. Right adrenalectomy and thrombectomy were successfully performed without cardiac arrest and without liver dissection. The operative time was 485 minutes,and the estimated blood loss was 7,533 ml. No major peri- or postoperative complications were observed. For the residual lung mass,a first line combination chemotherapy with etoposide,doxorubicin,cisplatin and mitotane followed by a second line chemotherapy with gemcitabine and capecitabine were administered. She has been alive with disease for 45 months under mitotane treatment against residual lung metastases. In conclusion,extended surgery could be successfully performed for advanced ACC with right atrium and IVC tumor thrombus. Although careful planning is needed for successful surgery,combination therapy with extended surgery and subsequent systematic chemotherapy may provide a substantial benefit in patients with advanced ACC.


Assuntos
Neoplasias do Córtex Suprarrenal , Carcinoma Adrenocortical , Trombose , Neoplasias do Córtex Suprarrenal/complicações , Adrenalectomia , Carcinoma Adrenocortical/complicações , Adulto , Feminino , Humanos , Trombectomia , Trombose/etiologia , Veia Cava Inferior
3.
Zhonghua Yi Xue Za Zhi ; 99(43): 3403-3407, 2019 Nov 19.
Artigo em Chinês | MEDLINE | ID: mdl-31752467

RESUMO

Objective: To assess the technical success rate, stent patency, clinical efficacy and complications of stent placement for filter-related chronic occlusion of the inferior vena cava. Methods: A retrospective analysis was carried out for 12 patients with filter-related chronic occlusion of the inferior vena cava associated with severe post-thrombotic syndrome, who underwent stent placement after ineffective conservative therapy at Nanjing First Hospital from March 2016 to December 2018,9 males and 3 females, aged from 48 to 77 years, mean age 60 years, six had bilateral lower extremity symptoms and six had unilateral lower extremity symptoms.Technical success rate, stent patency, clinical efficacy and complications of stent placement were recorded. Clinical success was defined as relief of symptoms and a decrease in clinical, etiology, anatomy, and pathophysiology (CEAP) score for at least grade 1. Results: Stent placement in the unilateral or bilateral iliocaval occlusion was successful in 11 patients. The cause of technical failure in the single patient with failed stent placement was an inability to cross the occluded left iliacvein and the patient was treated with stent placement in the right iliocaval vein.There were 7 patients with inferior vena cava and unilateral iliocaval stent placement; 5 patients with inferior vena cava and bilateral iliocaval stent placement. Acute stent thrombosis occlusion occurred in 1 case after the operation, the blood flow recanalized after catheter-directed thrombolysis and re-stenting. All patients were followed up for 6 to 24 months, with an average of (13±6) months. During the follow-up period, CTV or venography of lower limbs showed that the blood flow in the stent was unobstructed. At the last follow-up, 12 patients were evaluated as clinically effective. Three patients had transient treatment of lateral lumbar pain during operation, which alleviated by themselves.No significant abdominal pain, severe hemorrhage, symptomatic pulmonary embolism and other complications related to treatment occurred in all patients during perioperative period and follow-up. Conclusion: Stent placement is safe and feasible in the treatment of filter-related chronic occlusion of the inferior vena cava, which can alleviate the clinical symptoms of severe post-thrombotic syndrome.


Assuntos
Veia Cava Inferior , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular , Filtros de Veia Cava , Trombose Venosa
7.
Can Assoc Radiol J ; 70(4): 367-382, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31570169

RESUMO

Inferior vena cava filters are commonly encountered devices on diagnostic imaging that were highlighted in a 2010 Food and Drug Administration safety advisory regarding their complications from long-term implantation. The Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) trial is an ongoing after-market study investigating the safety and utility of commonly utilized filters in practice today. While most of these filters are safe, prompt recognition and management of any filter-associated complication is imperative to prevent or reduce the morbidity and mortality associated with them. This review is aimed at discussing the appropriate utilization and placement of inferior vena cava filters in addition to the recognition of filter-associated complications on cross-sectional imaging. An overview of the PRESRVE trial filters is also provided to understand each filter's propensity for specific complications.


Assuntos
Diagnóstico por Imagem , Hemorragia/etiologia , Filtros de Veia Cava , Veia Cava Inferior , Remoção de Dispositivo , Humanos , Vigilância de Produtos Comercializados , Desenho de Prótese , Filtros de Veia Cava/efeitos adversos
9.
Arch Esp Urol ; 72(8): 744-749, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31579032

RESUMO

OBJECTIVE: To perform a literature review on the use of cavoscopy during surgery for renal cell carcinoma with vena cava thrombus (RCCVCT), according to the criteria of Evidence-Based Medicine. MATERIAL AND METHODS: We performed a Pubmed search for studies published with the following keywords: "renal tumor thrombus", "renal tumor cavoscopy" and "cystoscopy thrombus", without time limit and in English. With these criteria, 5 articles were identified with a total of 41 patients. All studies found are case series and expert opinions, so the degree of evidence in the use of cavoscopy in RCCVCT is low. RESULTS: RCCVCT surgery is a complex technique, which can reach over 50% 5-year survival, when a complete oncological resection is achieved. One of the keys for surgical success is complete resection of tumor thrombus, having used different techniques for its verification. One of them is cavoscopy, which consists on the introduction of a flexible cystoscope through the cavotomy incision after thrombectomy, checking the lumen of the vena cava with saline serum irrigation. In two series of clinical cases, cavoscopy detected thrombus persistence in 22% and 43% of patients respectively, allowing resection. The entire resected thrombus showed malignancy in several cases. CONCLUSION: Cavoscopy is a technique that improves detection of tumor remnants after thrombectomy in comparison to indirect review methods. Although oncological impact of caval thrombus is controversial, the use of cavoscopy allows a more complete resection of the thrombus, and it may offer a possible increase in the recurrence-free survival of these patients.


Assuntos
Carcinoma de Células Renais , Cistoscopia , Neoplasias Renais , Células Neoplásicas Circulantes , Nefrectomia , Trombose , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Cistoscópios , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Trombose/complicações , Trombose/cirurgia , Veia Cava Inferior
10.
ABC., imagem cardiovasc ; 32(4): 318-30, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1024061

RESUMO

A doença pulmonar hipertensiva pode ser definida como um conjunto de alterações fisiopatológicas pulmonares que resultam em uma patologia grave, progressiva e com alta morbimortalidade. O ecocardiograma transtorácico é um método de imagem de fácil acesso e essencial para avaliação desta doença, principalmente na faixa pediátrica, na qual há limitações para realização frequente e de rotina do cateterismo direito. Nesta revisão, abordaremos as principais técnicas ecocardiográficas para o diagnóstico e a avaliação hemodinâmica da hipertensão pulmonar na população pediátrica. O diagnóstico precoce e o adequado estadiamento no acompanhamento das intervenções clínicas são fundamentais para escolha assertiva da abordagem terapêutica e, consequentemente, melhora do desfecho clínico


Assuntos
Humanos , Masculino , Feminino , Pediatria , Ecocardiografia/métodos , Criança , Hipertensão Pulmonar/mortalidade , Artéria Pulmonar , Valva Tricúspide , Veia Cava Inferior , Cateterismo Cardíaco , Ecocardiografia Doppler/métodos , Disfunção Ventricular Direita , Disfunção Ventricular Esquerda , Átrios do Coração , Ventrículos do Coração
11.
Braz J Med Biol Res ; 52(10): e8122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531523

RESUMO

Ultrasound-measured inferior vena cava (IVC) and abdominal aorta (Ao)-associated parameters have been used to predict volume status for decades, yet research focusing on the impact of individual physical characteristics, including gender, height/weight, body surface area (BSA), and age, assessed simultaneously on those parameters in Chinese children is lacking. The aim of the present study was to explore the impact of individual characteristics on maximum IVC diameter (IVCmax), Ao, and IVCmax/Ao in healthy Chinese children. From September to December 2015, 200 healthy children from 1 to 13 years of age were enrolled. IVCmax and Ao diameters were measured by 2D ultrasound. We found that age (years), height (cm), weight (kg), waist circumference (cm), and BSA (m2) were positively correlated with IVCmax and Ao. Multivariate linear regression showed that age was the only independent variable for IVCmax (mm) in female children, height was the only independent variable for IVCmax in male children, and age was the only independent variable for Ao in both females and males. IVCmax/Ao was not significantly influenced by the subjects' characteristics. In conclusion, IVCmax and Ao were more susceptible to subjects' characteristics than IVCmax/Ao. IVCmax/Ao could be a reliable and practical parameter in Chinese children as it was independent of age, height, and weight.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Ultrassonografia/métodos , Veia Cava Inferior/diagnóstico por imagem , Adolescente , Aorta Abdominal/fisiologia , Grupo com Ancestrais do Continente Asiático , Composição Corporal/fisiologia , Criança , Pré-Escolar , China , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Veia Cava Inferior/fisiologia
13.
Braz J Med Biol Res ; 52(9): e8827, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482978

RESUMO

This study investigated the effects of tidal volume (TV) on the diagnostic value of pulse pressure variation (PPV) and the inferior vena cava dispensability index (IVC-DI) for volume responsiveness during mechanical ventilation. In patients undergoing elective surgery with mechanical ventilation, different TVs of 6, 9, and 12 mL/kg were given for two min. The left ventricular outflow tract velocity-time integral (VTI) was measured by transthoracic echocardiography. The IVC-DI was measured at sub-xyphoid transabdominal long axis. The PPV was measured via the radial artery and served as baseline. Index measurements were repeated after fluid challenge. VTI increased by more than 15% after fluid challenge, which was considered as volume responsive. Seventy-nine patients were enrolled, 38 of whom were considered positive volume responsive. Baseline data between the response group and the non-response group were similar. Receiver operating characteristic curve confirmed PPV accuracy in diagnosing an increase in volume responsiveness with increased TV. When TV was 12 mL/kg, the PPV area under the curve (AUC) was 0.93 and the threshold value was 15.5%. IVC-DI had the highest diagnostic accuracy at a TV of 9 mL/kg and an AUC of 0.79, with a threshold value of 15.3%. When TV increased to 12 mL/kg, the IVC-DI value decreased. When the TV was 9 and 12 mL/kg, PPV showed improved performance in diagnosing volume responsiveness than did IVC-DI. PPV diagnostic accuracy in mechanically ventilated patients was higher than IVC-DI. PPV accuracy in predicting volume responsiveness was increased by increasing TV.


Assuntos
Pressão Sanguínea/fisiologia , Respiração Artificial , Volume Sistólico/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Veia Cava Inferior/fisiologia , Adolescente , Adulto , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Veia Cava Inferior/diagnóstico por imagem , Adulto Jovem
14.
J Assoc Physicians India ; 67(9): 89-90, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561699

RESUMO

Temporary transvenous pacing is a simple and routinely performed invasive procedure for treatment of life threatening bradyarrhythmias. We present a novel technique for transfemoral venous pacing in a patient with rare co-occurrence of inferior vena cava stenosis, rheumatic mitral stenosis, left ventricular dysfunction and digitoxicity.


Assuntos
Estenose da Valva Mitral/diagnóstico , Veia Cava Inferior , Constrição Patológica , Humanos , Doenças Vasculares
16.
BMC Surg ; 19(1): 122, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455319

RESUMO

BACKGROUND: Presence of inferior vena cava tumor thrombosis (IVCTT) is an unfavorable factor to prognosis for patients with hepatocellular carcinoma (HCC). CASE PRESENTATION: Herein we report a case of HCC with IVC tumor thrombosis extending from the right hepatic vein (RHV) to the IVC, but it had not infiltrated the right atrium. Anterior approach right hepatectomy combined with IVC thrombectomy using trans-diaphragmatic IVC occlusion was performed for this patient. The patient is alive with disease-free at 32 months after treatment. A literature review was also performed. This case was demonstrated with the details and concepts of surgery. CONCLUSION: This case suggested that surgical resection of HCC involving the IVC, but still outside the right atrium (RA), could offer satisfactory surgical outcomes in selected patients.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Trombectomia/métodos , Veias Hepáticas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Veia Cava Inferior/cirurgia , Trombose Venosa/patologia
17.
Methodist Debakey Cardiovasc J ; 15(2): 152-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384380

RESUMO

Iatrogenic aortocaval fistula is an extremely rare pathologic condition that often results in clinically significant left-to-right extracardiac shunt. In slow-progressing cases, chronic right-sided heart failure can occur and, in some patients, may persist for years. We present a patient with a long-standing aortocaval fistula that was causing high-flow left-to-right shunting, tricuspid regurgitation, severe pulmonary hypertension, and right-side heart failure. After undergoing complete endoscopic isolation of the aortocaval fistula, the patient experienced dramatic clinical improvement and continued to have excellent imaging and clinical resolution after 2 years of follow-up.


Assuntos
Aorta/fisiopatologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Doença Iatrogênica , Veia Cava Inferior/fisiopatologia , Aorta/diagnóstico por imagem , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Fluxo Sanguíneo Regional , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
18.
Rozhl Chir ; 98(8): 335-338, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31462057

RESUMO

The authors describe a rare complication of ureteral stenting is the case study of a patient admitted to the hospital for congestion in the outlet system of both kidneys due to external ureteral compression by tumorous mass in the retroperitoneum. Histology confirmed the B-lymphoma of the retroperitoneum as a cause of the patients problems. The ureteral stent was perforated in the course of inserting the stent into the ureter and the end of the splint was introduced into the inferior vena cava. The patient was asymptomatic, and this complication was detected as late as on day 12 on the follow-up CT scan. Stent extraction was without complications and without bleeding.


Assuntos
Contenções , Ureter , Veia Cava Inferior , Remoção de Dispositivo , Humanos , Linfoma de Células B , Neoplasias Retroperitoneais , Contenções/efeitos adversos , Stents , Veia Cava Inferior/lesões
19.
Medicine (Baltimore) ; 98(35): e16913, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464926

RESUMO

RATIONALE: Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can develop from the pelvic or uterine veins and spread into the central veins and heart. Here, we report a case of recurrent IVL in a 48-year-old woman. To the best of our knowledge, this is the first case report of IVL that describes the characteristic ultrasound features of the tumor, including the rainbow sign. PATIENT CONCERNS: A 48-year-old woman developed a solid-cystic lesion in the inferior vena cava (IVC) 3 years after undergoing a right heart tumor resection and 5 years after undergoing hysterectomy. DIAGNOSES: Physical examination was unremarkable. However, ultrasonography showed a solid-cystic lesion in the IVC, and a diagnosis of IVL was made. INTERVENTIONS: The patient underwent complete surgical removal of the tumor by a multidisciplinary team. The tumor was resected successfully. OUTCOMES: Pathological examination confirmed that the IVC tumor thrombus was consistent with IVL. During follow-up, there were no signs of local or distant recurrence. LESSONS: The preoperative diagnosis of IVL is difficult, and the tumor is usually misdiagnosed as a thrombus or right atrial myxoma. A thorough understanding of the characteristic imaging features of IVL is essential for an accurate preoperative diagnosis. The lesion in our patient showed multiple tracts, a honeycomb appearance, and vividly colorful blood flow that resembled a rainbow, which we termed the rainbow sign.


Assuntos
Leiomiomatose/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Feminino , Neoplasias Cardíacas/cirurgia , Humanos , Histerectomia , Leiomiomatose/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Resultado do Tratamento , Ultrassonografia , Neoplasias Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia
20.
Orv Hetil ; 160(33): 1304-1310, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31401861

RESUMO

Introduction: Despite all new promising agents of oncotherapy, it is still liver resection that gives potential curative solution for primary and secondary liver tumors. The size of tumorous liver section for resection means no question any more but major vessel infiltration of tumor proposes challenge in liver surgery. Patients and method: Retrospective analysis was carried out covering 33 patients who underwent liver resection in St. Janos Hospital Surgery Department between 1st May 2017 and 1st May 2019. Demographic, surgical, histological data and postoperative course were taken into consideration and comparison with two of our patients who needed vena cava excision simultaneously with liver resection. Results: Patients with liver resection only (LR) had a mean operation time of 91.7 minutes, while operation time for patients with cava resection (CR) was 250 minutes. The average amount of blood transfusion was 1.2 units (200 ml) in group LR and 5 units in group CR. Among LR patients, resection was rated R0 in 23 and R1 in 8 cases, R2 resection could be performed in 2 cases, in group CR in both cases R1 resection was registered. 5 patients with colorectal liver metastasis were operated after previous chemotherapy. Two patients underwent laparoscopic liver resection and two had synchronous colorectal and liver resection, one of these was treated via laparoscopic approach. Conclusion: Liver resections in case of large vessel (vena cava, hepatic vein) infiltrating by liver tumors are indicated the most challenging procedures of liver surgery. The relating literature refers to oncological liver resections with vena cava excision and reconstruction to be safe and applicable. Orv Hetil. 2019; 160(33): 1304-1310.


Assuntos
Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/cirurgia , Perda Sanguínea Cirúrgica , Transfusão de Sangue/métodos , Hepatectomia/efeitos adversos , Veias Hepáticas/cirurgia , Humanos , Fígado/patologia , Neoplasias Hepáticas/patologia , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA