RESUMEN
Hepatocellular carcinoma (HCC) has a tendency of rupturing, which can lead to massive hemorrhage. Although the majority of HCC ruptures occur in the liver, some reports have shown that HCC ruptures developed at various metastatic sites including the lung, pleura, rib, sternum, spleen, kidney, adrenal gland, mediastinal lymph node, peritoneum, ileum, and peripancreatic lymph node. Here, we reported a case of HBV-related HCC rupture that was treated by operation and recurred in the form of ruptured omental metastasis. A 55- year-old man, who complained of diffuse abdominal pain, was admitted to our hospital in a state of shock. Abdominal CT showed massive hemoperitoneum with a HCC of 6 cm size in diameter in the left lobe of the liver. The alphafetoprotein level was above 300 ng/ml. After transarterial chemoembolization for hemostasis, left lateral segmentectomy was performed. Resected tumor showed complete tumor necrosis. Four months later, the follow-up CT revealed an extrahepatic abdominal tumor near the transverse colon. With surgery, a ruptured tumor implanted on the great omentum near the transverse colon was found and removed along with the segmental transverse colon. The pathologic result reported that the omental tumor was a poorly differentiated hepatocellular carcinoma.
Asunto(s)
Dolor Abdominal , Glándulas Suprarrenales , Carcinoma Hepatocelular , Colon Transverso , Estudios de Seguimiento , Hemoperitoneo , Hemorragia , Hemostasis , Íleon , Riñón , Hígado , Pulmón , Ganglios Linfáticos , Mastectomía Segmentaria , Necrosis , Metástasis de la Neoplasia , Epiplón , Peritoneo , Pleura , Costillas , Rotura , Choque , Bazo , Esternón , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The studies related to induced hypotention using propofol were rare. So we studied the effectiveness of propofol as induced hypotensive agent in brain aneurysmal surgery. METHODS: The hemodynamic changes during induced hypotension with propofol (propofol-group) and isoflurane(isoflurane group) were observed in patients undergoing aneurysmal surgery. Twenty patients were allocated randomly to receive propofol induction and maintenance, or thiopental sodium induction and isoflurane maintenance for anesthesia. Both groups also received fentanyl, vecuronium, nitrous oxide and oxygen. These hypotensive effects were evaluated before, during and after induced hypotension. Hemodynamic changes were evaluated by measuring systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, systemic vascular resistance and pulmonary vascular resistance. We also compared the ventilatory effect of hypotensive anesthesia by blood gas analysis. RESULTS: There were no significant changes of heart rate, cardiac output, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure and pulmonary vascular resistance before, during and after induced hypotension in both group. Mean arterial pressure and systemic vascular resistance were significantly decresed during induced hypotension (p<0.05). There were no significant changes of PO2, PCO2, HCO3 , base excess before, during and after induced hypotension in both group. CONCLUSION: Propofol is also an effective hypotensive agent comparable to isoflurane.
Asunto(s)
Humanos , Anestesia , Anestésicos , Aneurisma , Presión Arterial , Análisis de los Gases de la Sangre , Gasto Cardíaco , Presión Venosa Central , Fentanilo , Frecuencia Cardíaca , Hemodinámica , Hipotensión , Aneurisma Intracraneal , Isoflurano , Óxido Nitroso , Oxígeno , Propofol , Presión Esfenoidal Pulmonar , Tiopental , Resistencia Vascular , Bromuro de VecuronioRESUMEN
Hydrothorax is a known complication of central venaus catheterization. We observed mediastinal hydrothorax following intrapleural effusion secondary to central venous catheter malposition in a 3 month child who was treated with respiratory support and chest drainage sucessfully. The position of central venous catheter should be evaluated routinely by chest X-ray or aspiration of blood through the central venous catheter to avoid complication.