A case is presented of a 72-year old male patient presenting with a massive intestinal blood loss due to a solitary jejunal metastasis of a poorly differentiated adenocarcinoma of the right lung resected two years earlier. After diagnostic workup and stabilization a small bowel resection with end to end anastomosis was performed. Patient is alive and well 5 months after operation. Solitary bleeding intestinal metastasis of a primary bronchogenic tumour are extremely rare but should be included in the differential diagnosis of gastrointestinal blood loss in a patient with a known bronchogenic tumour. Resection with end to end anastomosis is the treatment of choice.

Aged↗

PubMedDate not supplied

[The Denver shunt in malignant ascites].

Malignant ascites is often refractory to therapy and rapidly deteriorating the nutritional and physical state of the cancer patient. Nevertheless, ascites does not always implicate preterminal state of the cancer process (e.g. ovarian carcinoma). A short review is made of the pathophysiology of ascites in cirrhosis and in malignancy, and different modes of treatment are discussed. The results of medical therapy of malignant ascites (salt and water restriction, diuretics, intraperitoneal cytostatics or radiocolloids) are not convincing. The immunotherapy with OK-432, as worked out by Katano (16-46) has to prove its value. The best and most hopeful results in cases of massive previously resistant ascites, are obtained with a peritoneojugular shunt, improving immediately the nutritional status and life condition, providing excellent palliation. The superiority of the Denver shunt versus the Le Veen shunt has been assessed recently, especially for malignant ascites. Some technical and perioperative details merit more attention, to limit the high risk ratio. Control of the intrathoracic position of the catheter tip, the maintenance of the bloodflow in the jugular vein, the intramuscular tunnelisation of the peritoneal catheter, the discard of 3 or 5 liters ascitic fluid and the substitution of part of it by physiological fluid, perioperative prophylactic antibiotics and heparinisation, flow-rate control in the postoperative period by changing patients position, respiratory exercises, daily flushing, all those measures limit the risk of fibrinolysis (DIC), shunt occlusion, fluid overload and infection. The fear of metastasis by shunt is unfounded, since the survival of the primary tumor is mostly too short (41). The postoperative follow up in an intensive care unit is necessary during 24-72 hours.

Abdominal Neoplasms↗

PubMedDate not supplied

Bronchogenic cysts in children.

Three children with symptomatic bronchogenic cysts are presented. Because of the variability in clinical presentation and the shortcomings of diagnostic procedures, bronchogenic cysts present a diagnostical problem. In view of the risk of serious complications an aggressive attitude towards all congenital cystic lung lesions is advised, even when they are asymptomatic. Surgical excision assures an excellent outcome in most cases, and is therefore the treatment of choice.

Bronchogenic Cyst↗

PubMedDate not supplied

Deep venous thrombosis of the upper extremity: case reports and review of the literature.

The development of a thrombosis of the axillary-subclavian vein has long been an uncommon clinical entity. The more routinely use of central venous lines in modern patient management, however, has increased its incidence. Three cases of deep venous thrombosis of the upper extremity are reported. The different possible etiologic factors, the diagnostic tools, complications and different treatments--both conservative and non-conservative--are reviewed and discussed.

Adult↗

PubMedDate not supplied

Surgical excision of pulmonary metastases from primary testicular cancer--case reports.

In disseminated nonseminomatous testicular cancer, chemotherapy is the first choice because this treatment can be curative. To illustrate the particular indications for surgical excision of pulmonary metastases from primary nonseminomatous testicular cancer three patients are presented who were operated on during the past two years. Surgery is recommended to ascertain the histologic nature of remaining metastases after chemotherapy, when there is no further response to chemotherapy or a partial response only. Histologic findings range from necrotic pulmonary lesions to benign transformation or viable tumor. These results should guide further therapy, particularly to decide whether chemotherapy should be continued or changed.

Adult↗

PubMedDate not supplied

Primary intrathoracic goitre.

A right paratracheal mass in a 56-year-old man was found to be a primary intrathoracic goitre. Pathological examination showed nodular hyperplasia with focal lymphocytic thyroiditis. Enlarged mediastinal thyroid tissue may result from extension of a cervical goitre into the chest and is then called secondary or may develop from ectopic thyroid tissue located in the mediastinum and is then called primary. In the latter case blood supply comes from local intrathoracic vessels and no connections with the cervical gland are observed. Differentiation can be made by ultrasonography, CT scanning or radioisotope scanning. Primary goitres are best operated on by way of a thoracotomy as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision.

Goiter, Substernal↗

PubMedDate not supplied

Occlusion of the left common femoral artery after total hip replacement. Report of a case and review of the literature.

Total occlusion of the left common femoral artery occurred after total hip replacement. Presumably the occlusion was caused by polymerization heat produced by the methyl-methacrylate. Only two similar cases have been reported previously. The vascular complications after hip surgery are discussed.

Arterial Occlusive Diseases↗

PubMedDate not supplied

[Current status of fibrinolysis--a literature review of 25 years of fibrinolytic treatment].

Thrombolytic therapy is an effective, rapid method in treatment of massive lung embolism and major deep venous thrombosis extending to the caval vein. Besides resolution of the thrombus and improving hemodynamics, it prevents evolution to chronic pulmonary hypertension or postphlebitic syndrome. To have a beneficial effect in the early course of acute myocardial infarction, thrombolytic therapy should be instored within about three hours after the onset of pain; a real brief time limit. Intracoronary or systemic fibrinolysis later than the three hours period does not improve cardiac wall motion and hemodynamics and cannot assure infarct size reduction in spite of reestablished coronary flow. In peripheral arterial disease, fibrinolytic therapy of thrombosed grafts or vessels facilitates detection and unmasking of the underlying anatomical lesion permitting definite therapy (graft revision, percutaneous transluminal angioplasty). Selective intraarterial infusion has given encouraging results. Thrombolysis is a reasonably safe therapeutic method, on the condition of respecting all contraindications and avoiding unnecessary punctions. Allergy and hyperthermia are mostly benign and responsive to medical treatment. Cost-effectiveness renders streptokinase the most applicated thrombolytic agent.

Fibrinolysis↗

PubMedDate not supplied

[Membranous obstruction of the inferior vena cava].

A case of idiopathic membranous obstruction of the inferior vena cava (MOVC) is reported. Varicose veins of both lower limbs associated with dermatitis and venous ulceration were the presenting symptoms. Diagnosis was made by cavography after phlebography of both legs had revealed a normal deep system. Ultrasonography demonstrated a 4 mm thick membrane in the inferior vena cava just above the level of the hepatic veins. Stripping of the greater saphenous vein and ligation of incompetent perforating veins was performed to partially correct the venous insufficiency of the most affected limb. The patient refused further treatment of the MOVC. Concise review of the literature. Up to date therapeutic possibilities are discussed.

Adult↗

PubMedDate not supplied

The management of bronchopleural fistulas.

Bronchopleural fistulas remain a severe complication of pulmonary surgery and pulmonary disease. Treatment often requires multiple surgical interventions. The etiology, the methods for diagnosis and the different possible therapeutic procedures are discussed.

Aged↗

PubMedDate not supplied

[Sigmoid necrosis: a complication of total hip replacement].

After total hip replacement on the left side, a patient developed sigmoid necrosis, apparently as a major complication. Extensive review of the recent literature related to complications of total hip replacement.

Aged↗