ABSTRACT
Introducción: el síndrome de vena cava superior resulta de la obstrucción del flujo sanguíneo a través de este vaso. Casi la totalidad de los casos en la actualidad se asocian con tumores malignos. Existen controversias acerca del manejo apropiado de este cuadro. Actualmente, las terapias endovasculares son consideradas de elección. Materiales y métodos: se recolectaron y describieron, a partir de datos de la historia clínica electrónica, los casos de pacientes mayores de 18 años internados de forma consecutiva, que desarrollaron el síndrome en el Hospital Italiano de Buenos Aires en 2021. Se constataron las características basales, los tratamientos recibidos y los desenlaces clínicos intrahospitaliarios de cada uno de ellos. Resultados: un total de cinco pacientes fueron incluidos en el presente estudio y seguidos durante su instancia intrahospitalaria. Todos los casos descriptos fueron secundarios a enfermedades oncológicas. La mayoría de los pacientes presentaron un cuadro de moderada gravedad según las escalas utilizadas. En cuatro de cinco pacientes se optó por terapias endovasculares y dos de ellos fallecieron durante la internación. Discusión: existen controversias respecto del tratamiento óptimo del síndrome de vena cava superior, y heterogeneidad en la práctica clínica. Los estudios futuros deberían centrarse en identificar a aquellos pacientes que más probablemente se beneficien de las estrategias terapéuticas endovasculares, anticoagulantes o antiagregantes. (AU)
Introduction: superior vena cava syndrome results from an obstruction of blood flow through this vessel. Currently, almost all cases are associated with malignancies. There are controversies about the optimal management of this syndrome. Endovascular therapies are considered the first-line therapy. Material and methods: we collected clinical, laboratory and pharmacological data from patients admitted at the Hospital Italiano de Buenos Aires, between January 1st and November 1st 2021 with a diagnosis o superior vein cava syndrome. Baseline characteristics, treatment strategies and clinical outcomes were recorded. Results: a total of five patients were included in the present study. All cases were malignancy-related. Most of the patientsdeveloped moderate symptoms. Four out of five patients were treated with endovascular therapies and two patients died during hospitalization. Discussion: controversies regarding optimal management of the superior vena cava syndrome remain. Future research should focus on identifying those patients who are most likely to benefit from endovascular, anticoagulant or antiplatelet therapeutic strategies. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Superior Vena Cava Syndrome/therapy , Endovascular Procedures , Hospitalization , Neoplasms/complications , Superior Vena Cava Syndrome/etiology , Superior Vena Cava Syndrome/mortality , Superior Vena Cava Syndrome/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Stents , Electronic Health Records , Anticoagulants/therapeutic useSubject(s)
Humans , Male , Young Adult , Pulmonary Embolism/diagnostic imaging , Thrombosis/diagnostic imaging , Superior Vena Cava Syndrome/diagnostic imaging , Behcet Syndrome/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Pulmonary Embolism/physiopathology , Pulmonary Embolism/drug therapy , Thrombosis/physiopathology , Thrombosis/drug therapy , Warfarin/therapeutic use , Superior Vena Cava Syndrome/physiopathology , Superior Vena Cava Syndrome/drug therapy , Prednisolone/therapeutic use , Diagnostic Imaging , Colchicine/analogs & derivatives , Colchicine/therapeutic use , Behcet Syndrome/physiopathology , Behcet Syndrome/drug therapy , Treatment Outcome , Tubulin Modulators/therapeutic useABSTRACT
To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer. From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival [OS], Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates [MVA] and analyzed on SPSS software [version 19.0; SPSS, Inc., Chicago, IL]. Thirteen patients [72%] had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 [28%] progressed to SVCO after initiating treatment with chemotherapy. Twelve [68%] patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 [62%], while the median biologically equivalent dose delivered was 28 Gy. Six [33%] patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3 +/- 1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score [p=0.02], and partial response to chemotherapy [p= 0.001] have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients [p = 0.05] have a better OS. RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients
Subject(s)
Humans , Male , Female , Carcinoma, Non-Small-Cell Lung/complications , Superior Vena Cava Syndrome/drug therapy , Lung Neoplasms/complications , Radiotherapy Dosage , Chemotherapy, Adjuvant , Survival Rate , PrognosisABSTRACT
We describe a case of a 15-year-old boy with vincristine-induced simultaneous isolated bilateral facial palsy. The boy presented with superior vena caval syndrome (SVC syndrome), right-sided pleural effusion and anterior mediastinal lymphadenopathy. Histopathological examination of left axillary lymph node was suggestive of lymphoblastic lymphoma. We started chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisolone. SVC syndrome disappeared completely after the 1st cycle, and he achieved remission after the 3rd cycle of chemotherapy. He noticed that he could not close his eyes. Neurological examination revealed bilateral lower motor neuron facial palsy. Findings from examination of other cranial nerves and peripheral nerves were normal. Results of MRI of brain and cerebrospinal fluid examination were normal. He received 6 mg vincristine before developing toxicity.
Subject(s)
Adolescent , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Facial Paralysis/chemically induced , Humans , Male , Pleural Effusion/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Prednisolone/administration & dosage , Superior Vena Cava Syndrome/drug therapy , Vincristine/adverse effectsABSTRACT
Trombose venosa profunda de membros superiores é relativamente incomum, sendo geralmente decorrente de neoplasia ou uso prolongado de cateter venoso. O epônimo Paget-Schroetter se refere à trombose venosa profunda de membros superiores sem fatores aparentes. É descrito o caso de uma mulher de 34 anos que amanheceu com trombose da veia subclávia esquerda. Foram identifi cados os seguintes fatores desencadeantes: apofi somegalia na sétima vértebra cervical, heterozigose do fator V de Leiden e uma provável alteração na percepção de estímulos internos durante o sono. A paciente foi submetida à trombólise e usou cumarínicos por dois meses. Em dez meses de observação, não houve recrudescimento do quadro
Subject(s)
Adult , Humans , Female , Superior Vena Cava Syndrome/diagnosis , Superior Vena Cava Syndrome/drug therapy , Superior Vena Cava Syndrome/therapyABSTRACT
Introducción: Un niño con cáncer puede presentar durante su enfermedad una emergencia, ya sea como manifestación inicial, en la fase de diagnóstico, durante la evolución o en el período terminal. Objetivo: Presentar nuestra experiencia en el manejo del síndrome de vena cava superior en niños con linfoma. Pacientes y Método: Revisión retrospectiva de 44 fichas clínicas de menores de 15 años con linfoma tratados entre enero de 1989 y diciembre de 1999 en la Unidad de Hematología/Oncología Infantil del Hospital Clínico Regional de Valdivia. Resultados: 5 casos presentaron síndrome de vena cava superior: linfoma de Hodgkin 2. Linfoma no Hodgkin 3. El síndrome de vena cava superior fue la manifestación inicial en 4. En la emergencia todos los pacientes recibieron corticoides y radioterapia. Tres pacientes se encuentran vivos y en remisión completa. Conclusiones: El síndrome de vena cava superior, es poco frecuente en niños con patología tumoral, sin embargo, por constituir una emergencia médica requiere tratamiento inmediato, necesitándose claras pautas de manejo.
Subject(s)
Male , Humans , Female , Child, Preschool , Child , Hodgkin Disease/complications , Lymphoma, Non-Hodgkin/complications , Superior Vena Cava Syndrome/etiology , Chile , Adrenal Cortex Hormones/therapeutic use , Emergencies , Retrospective Studies , Superior Vena Cava Syndrome/drug therapy , Time Factors , Treatment OutcomeABSTRACT
The case of a 56 year-old male with acute lymphoid leukemia and no signs of activity for the last four months is reported. He presented with superior vena cava thrombosis caused by a Hickman catheter, and had positive blood cultures for Candida albicans and Staphylococcus epidermidis. Despite adequate antimicrobial therapy, the fever persisted, and the patient was submitted to surgical thrombectomy. One week following the procedure, the fever returned, and thrombosis of the superior vena cava extending to the right atrium was identified by transesophageal echocardiography (TEE). The patient underwent thrombolytic therapy with streptokinase, and no thrombus could be identified in the control TEE. No hemorrhagic or thromboembolic complication occurred. The patient was discharged with oral anticoagulation.
Subject(s)
Humans , Male , Middle Aged , Streptokinase , Fibrinolytic Agents/therapeutic use , Superior Vena Cava Syndrome/drug therapy , Catheters, Indwelling , Thrombectomy , Echocardiography, Transesophageal , Remission Induction , Superior Vena Cava Syndrome/etiology , Superior Vena Cava Syndrome/surgery , Superior Vena Cava SyndromeABSTRACT
La importancia del síndrome de vena cava superior, se debe a que es una urgencia oncológica aguda o subaguda, cuya presentación es frecuente en nuestro medio. La patología maligna, el cáncer pulmonar primario, es su principal causa. El diagnóstico es esencialmente clínico al encontrar la triada clásica: Edema en esclavina, cianosis y circulación colateral venosa que depende del nivel de obstrucción de la vena ácigos. El tratamiento se basa en cuatro modalidades: Radioterapia, quimioterapia, cirugía y manejo médico; la de mejor resultado ha sido la cirugía, seguida de radioterapia. En la actualidad a pesar del progreso en los métodos terapéuticos continua siendo de mal pronóstico