BACKGROUND Acute pulmonary embolism(APE)is a rare and potentially life-threatening condition,even with early detection and prompt management.Intraoperative APE required specific ways for detecting since classic sympto...BACKGROUND Acute pulmonary embolism(APE)is a rare and potentially life-threatening condition,even with early detection and prompt management.Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.CASE SUMMARY A 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava(IVC)tumor thrombus.APE that occurred during tumor thrombectomy with hypercapnia and desaturation.The capnography combined with the transesophageal echocardiography(TEE)provided a crucial differential diagnosis during the operation.The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability.He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist.There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.CONCLUSION Under general anesthesia for IVC tumor thrombus surgery,a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE,which occurs before hemodynamic changes.When intraoperative APE is suspected,TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram.Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.展开更多
BACKGROUND Recurrent hepatocellular carcinoma(HCC)with inferior vena cava tumor thrombus is a great challenge for oncologists and has a poor prognosis.To date,the safety and efficacy of programmed cell death ligand 1(...BACKGROUND Recurrent hepatocellular carcinoma(HCC)with inferior vena cava tumor thrombus is a great challenge for oncologists and has a poor prognosis.To date,the safety and efficacy of programmed cell death ligand 1(PD-L1)inhibitors are still unknown.CASE SUMMARY A 59-year-old male was identified as having a tumor thrombus in the inferior vena cava 3 years after surgery.The patient underwent a second surgery and adjuvant chemotherapy.However,the level of alpha-fetoprotein was elevated after 2 mo,and lung metastases and mediastinal lymph node metastases were identified.The expression of PD-L1 in HCC and inferior vena cava tumor thrombus tissues was analyzed by immunohistochemistry.Then,the patient received atezolizumab immunotherapy.The level of alpha-fetoprotein dropped to normal,the mediastinal lymph node metastases decreased in size and the lung metastases disappeared after 3 mo of immunotherapy.The patient had no signs of recurrence at 21 mo of follow-up.A 60-year-old male underwent left hepatic tumor resection,inferior vena cava incision and thrombus removal,followed by regular chemotherapy.The patient developed lung and splenic metastases after surgery.Pembrolizumab was used for six courses,and the splenic metastasis shrank,after which splenectomy was performed.The patient continued to receive pembrolizumab for thirteen courses,and the lung metastases showed no progression.A 34-year-old male was diagnosed with liver cancer with inferior vena cava tumor thrombus.The patient underwent right hepatectomy and received tislelizumab for three courses.He is still receiving immunotherapy and in good condition.CONCLUSION Anti-PD-L1 therapy in HCC patients with inferior vena cava tumor thrombus and metastasis is associated with relatively good patient outcomes.展开更多
<strong>Background:</strong> A thrombus of the inferior vena cava and renal vein makes the management of renal cancer more difficult. <strong>Aim:</strong> The aim is to highlight and discuss t...<strong>Background:</strong> A thrombus of the inferior vena cava and renal vein makes the management of renal cancer more difficult. <strong>Aim:</strong> The aim is to highlight and discuss the management of a case of renal cancer with an unusual thrombus in our context. <strong>Case Presentation:</strong> We report the case of a 49-year-old female with left kidney cancer, complicated by a calcified thrombus of the renal vein and inferior vena cava. A calcification of renal vein and vena cava was discovered during surgery, even though the diagnosis prior to surgery was a renal tumor with partial thrombus of the IVC. We performed a thrombectomy and left nephrectomy. The post-operative course was marked by the death of the patient a month later. <strong>Conclusion: </strong>Renal vein and inferior vena cava (IVC) calcifications are uncommon. Preoperative diagnosis is difficult but guided by medical imaging. Renal cancer is one of the causes. A thrombus or calcification of the vena cava worsens the prognosis of cancer.展开更多
文摘BACKGROUND Acute pulmonary embolism(APE)is a rare and potentially life-threatening condition,even with early detection and prompt management.Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.CASE SUMMARY A 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava(IVC)tumor thrombus.APE that occurred during tumor thrombectomy with hypercapnia and desaturation.The capnography combined with the transesophageal echocardiography(TEE)provided a crucial differential diagnosis during the operation.The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability.He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist.There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.CONCLUSION Under general anesthesia for IVC tumor thrombus surgery,a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE,which occurs before hemodynamic changes.When intraoperative APE is suspected,TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram.Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.
基金Supported by The Special Research Foundation of the National Nature Science Foundation of China,No.81972262 and No.81972255The Guangdong Basic and Applied Basic Research Foundation,No.2018A030313645,No.2020A1515010117 and No.2016A030313840+4 种基金Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology,No.[2013]163the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes,No.KLB09001Guangdong Science and Technology Department,No.2015B050501004Guangdong Science and Technology Department,No.2017B030314026Sun Yat-sen University Clinical Research 5010 Program,No.2018008.
文摘BACKGROUND Recurrent hepatocellular carcinoma(HCC)with inferior vena cava tumor thrombus is a great challenge for oncologists and has a poor prognosis.To date,the safety and efficacy of programmed cell death ligand 1(PD-L1)inhibitors are still unknown.CASE SUMMARY A 59-year-old male was identified as having a tumor thrombus in the inferior vena cava 3 years after surgery.The patient underwent a second surgery and adjuvant chemotherapy.However,the level of alpha-fetoprotein was elevated after 2 mo,and lung metastases and mediastinal lymph node metastases were identified.The expression of PD-L1 in HCC and inferior vena cava tumor thrombus tissues was analyzed by immunohistochemistry.Then,the patient received atezolizumab immunotherapy.The level of alpha-fetoprotein dropped to normal,the mediastinal lymph node metastases decreased in size and the lung metastases disappeared after 3 mo of immunotherapy.The patient had no signs of recurrence at 21 mo of follow-up.A 60-year-old male underwent left hepatic tumor resection,inferior vena cava incision and thrombus removal,followed by regular chemotherapy.The patient developed lung and splenic metastases after surgery.Pembrolizumab was used for six courses,and the splenic metastasis shrank,after which splenectomy was performed.The patient continued to receive pembrolizumab for thirteen courses,and the lung metastases showed no progression.A 34-year-old male was diagnosed with liver cancer with inferior vena cava tumor thrombus.The patient underwent right hepatectomy and received tislelizumab for three courses.He is still receiving immunotherapy and in good condition.CONCLUSION Anti-PD-L1 therapy in HCC patients with inferior vena cava tumor thrombus and metastasis is associated with relatively good patient outcomes.
文摘<strong>Background:</strong> A thrombus of the inferior vena cava and renal vein makes the management of renal cancer more difficult. <strong>Aim:</strong> The aim is to highlight and discuss the management of a case of renal cancer with an unusual thrombus in our context. <strong>Case Presentation:</strong> We report the case of a 49-year-old female with left kidney cancer, complicated by a calcified thrombus of the renal vein and inferior vena cava. A calcification of renal vein and vena cava was discovered during surgery, even though the diagnosis prior to surgery was a renal tumor with partial thrombus of the IVC. We performed a thrombectomy and left nephrectomy. The post-operative course was marked by the death of the patient a month later. <strong>Conclusion: </strong>Renal vein and inferior vena cava (IVC) calcifications are uncommon. Preoperative diagnosis is difficult but guided by medical imaging. Renal cancer is one of the causes. A thrombus or calcification of the vena cava worsens the prognosis of cancer.