RESUMO
The management of intravascular metallic foreign bodies (FB) can be difficult and challenging. We report a case of a migrating FB, initially within the femoral vein which subsequently migrated to the intrahepatic vena-cava. Following a change of posture, the metallic FB moved with gravity against the normal venous blood flow to the left renal vein. It was finally fixed in position in a peripheral branch of the renal vein using an intravascular stent. Employing gravity as a therapeutic intervention and the technique used in isolating the FB has not, to our knowledge, been reported before. A case is described, and the literature is reviewed.
Assuntos
Acidentes de Trabalho , Cateterismo Periférico/instrumentação , Migração de Corpo Estranho/terapia , Gravitação , Ferrovias , Stents , Ferimentos Penetrantes/terapia , Adulto , Anticoagulantes/uso terapêutico , Veia Femoral/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Flebografia , Postura , Veias Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veias Cavas/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/etiologiaRESUMO
BACKGROUND: Predicting response to treatment has long been the Holy Grail of clinicians treating patients with upper gastrointestinal malignancy. The widespread use of neoadjuvant therapy for esophageal cancer has provided an added urgency to the issue and at the same time brought success a step closer because accurate response can be determined from analysis of the resected specimen. METHODS: A search was undertaken of the Medline database for text references to neoadjuvant therapy, esophagus, stomach and predicting response. The references of these publications were further scanned for appropriate references in the text and reference lists. RESULTS: Publications describing predictive markers to neoadjuvant therapy for esophageal cancer, which were most likely to be of clinical significance, were selected for inclusion in this report. CONCLUSIONS: The most reliable tissue markers of response based on analysis of pretreatment biopsy specimens include P53, Ki-67, EGFR and the most impressive serum marker for monitoring response are CYFRA 21-1 and CEA. The results, however, are inconsistent, and the markers of relatively low sensitivity and none reliably identifies individual patients who will respond.