ABSTRACT
Recently, there has been an increase in the number of cases of superior vena cava (SVC) syndrome associated with chronic indwelling central venous catheters. Fibrinolytic therapy and endovascular treatment are currently achieving good results. We present a case history of a patient with SVC with a catheter used for chemotherapy, which was successfully treated with catheter-directed (intraclot) infusion thrombolytic therapy with urokinase.
Subject(s)
Catheterization, Central Venous/adverse effects , Fibrinolytic Agents/therapeutic use , Superior Vena Cava Syndrome/drug therapy , Thrombolytic Therapy/methods , Urokinase-Type Plasminogen Activator/therapeutic use , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Combined Modality Therapy , Coumarins/administration & dosage , Coumarins/therapeutic use , Drug Therapy, Combination , Female , Fibrinolytic Agents/administration & dosage , Humans , Infusions, Intravenous , Mastectomy, Segmental , Methylprednisolone/therapeutic use , Middle Aged , Radiotherapy, Adjuvant , Subclavian Vein , Superior Vena Cava Syndrome/diagnosis , Superior Vena Cava Syndrome/etiology , Urokinase-Type Plasminogen Activator/administration & dosageABSTRACT
Recently, there has been an increase in the number of cases of superior vena cava (SVC) syndrome associated with chronic indwelling central venous catheters. Fibrinolytic therapy and endovascular treatment are currently achieving good results. We present a case history of a patient with SVC with a catheter used for chemotherapy, which was successfully treated with catheter-directed (intraclot) infusion thrombolytic therapy with urokinase (AU)
Subject(s)
Humans , Female , Middle Aged , Catheterization, Central Venous/adverse effects , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Vena Cava, Superior , Superior Vena Cava Syndrome/diagnosis , Superior Vena Cava Syndrome/drug therapy , Urokinase-Type Plasminogen Activator/administration & dosage , Urokinase-Type Plasminogen Activator/therapeutic use , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Superior Vena Cava Syndrome/etiologyABSTRACT
Introducción. El riñón pélvico (RP) es una entidad rara, con un intervalo de incidencia en las autopsias de 1:2.000-1:3 .000, que puede crear dificultades para los pacientes que precisan cirugía aortoilíaca. Como cada vez es más frecuente encontrar pacientes renales trasplantados con enfermedad vascular oclusiva, al igual que los que portan ectopia renal, es deseable establecer un tratamiento estratégico para afrontar el desafío de dicha situación. Caso clínico. Describimos el caso de un paciente joven, con isquemia crónica grado II b de miembros inferiores, portador de un riñón pélvico congénito (RPC) detectado de forma casual; la urografía intravenosa comprobó la presencia en el promontorio izquierdo de imágenes de cálices y pelvis renal con uréter corto, y la arteriografía, el nacimiento de la arteria renal en la arteria ilíaca interna ipsilateral. El paciente se trató con una derivación aortobifemoral, mediante la técnica del doble pinzamiento, lo que permitió que el RP se perfundiera por la circulación colateral. Discusión. Se hace una revisión de la anatomía y embriología del RP, y de las alternativas para protegerle en la cirugía aortoilíaca. Conclusión. En la enfermedad oclusiva aortoilíaca, consideramos que la derivación aortobifemoral, junto con la técnica adecuada de preservación del RP, es una opción quirúrgica válida, porque es sencilla, segura y fácil de realizar (AU)
Subject(s)
Male , Humans , Ischemia/complications , Ischemia/surgery , Ischemia/diagnosis , Urography/methods , Arteriovenous Shunt, Surgical/methodsABSTRACT
Computed tomography and magnetic resonance imaging play an important role in the diagnosis of cerebrovascular disease, but only in the morphological aspect. To assess changes in cerebral perfusion are necessary functional images techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). By these methods we can evaluate the cerebral hemodynamics to better understand the significance of chronic ischemia as a stroke risk factor for patients with carotid stenosis. A case of improvement of cerebral blood flow demonstrated by SPECT after carotid revascularization in a young woman with Takayasu's disease is described.
