Initial robotic assistance in the surgical management of renal cell carcinoma with level 4 cavoatrial thrombus
We report a case of left-sided renal cell carcinoma (RCC) with level 4 cavoatrial tumor thrombus where robotic assistance was used to achieve hemostasis around the kidney in order to minimize coagulopathic hemorrhage from the nephrectomy bed during subsequent open completion nephrectomy and cavoatrial thrombectomy under extracorporeal circulation and hypothermic circulatory arrest. Robotic assistance allowed for meticulous dissection and ligation of parasitic and arterial vessels to the kidney, release of renal attachments, and exposure of the inferior vena cava. The kidney was mobilized while leaving the renal vein attached and tumor thrombus undisturbed using a “minimal touch” technique. Open completion nephrectomy and cavoatrial thrombectomy was then performed. An experienced cardiac anesthesia team performed intraoperative cardiac monitoring, including trans-esophageal echocardiography. A cardiothoracic surgeon was immediately available throughout th e case. Cardiopulmonary bypass was initiated within 60 min of open incision with a total duration a circulatory arrest time of 25 min. There was no bleeding from the nephrectomy bed during bypass despite heparinization and hypothermia. A left RCC with level 4 thrombus may be approached with initia l robotic assistance to achieve hemostasis of the nephrectomy bed for subsequent open completion nephrectomy and cavoatrial thrombectomy under extracorporeal circulation and hypothermic circulatory arrest.
Publication date: May 2020Source: Clinica Chimica Acta, Volume 504Author(s): Damian Jacenik, Jakub FichnaAbstractChemerin is a multifunctional protein involved among others in adipogenesis, angiogenesis and lipid as well as glucose metabolism. Chemerin is an essential factor in promotion of chemotaxis of numerous immune cell types and plays an important role in several pathophysiologic conditions. Chemerin receptors are present on monocytes/macrophages, T cells, natural killer and dendritic cells as well as neutrophils. However, the role of chemerin and chemerin receptors in immune response and gastrointestinal diseases is...
ConclusionUA leads to disruption of Rac1 and Pak1 activity with subsequent actin depolymerization and migration. Thus, use of dietary UA in cancer prevention or as adjuvant therapy is promising.
CONCLUSIONS Sevoflurane-based anesthesia did not increase the incidence of POCD compared to propofol-based anesthesia at 7 days or 3 months post-operation or impact short-term post-operative prognosis. PMID: 32060257 [PubMed - in process]
We describe the successful resuscitation of a 23-year-old previously healthy man who had drowned. After prolonged submersion, hypothermia, severe hypernatraemia, a prolonged time to return of spontaneous circulation was possible using a combination of extr...
Patient comes in for induction of labor for pre-eclampsia without severe features. They get a CBC on arrival. Platelets are 300. How long is that number valid for you for neuraxial placement? What’s your cut off time for needing a repeat draw? What if pre-E with severe features? There’s no institutional policy at my place, just provider discretion. Just trying to get a feel for what others are doing.
Conditions: Advanced Solid Tumors; MSI-H/dMMR Tumors; Cutaneous Squamous Cell Carcinoma; Urothelial Carcinoma, HCC; Cervical Cancer; Esophageal Squamous Cell Carcinoma; Merkel Cell Carcinoma, Small-cell Lung Cancer; Mesothelioma; PD-L1 Amplified Tumor (9p24.1); Nasopharyngeal Carcinoma; Cyclin-dependent Kinase 12 Mutated Tumors; Basal Cell Carcinoma (Unresectable or Metastatic); Sarcoma...
Condition: General Anesthesia Interventions: Procedure: Pressure controlled ventilation with PEEP; Procedure: Manual ventilation without PEEP Sponsor: Region Västmanland Not yet recruiting
Condition: CO2 Absorbers Intervention: Other: Comparing two CO2 absorbers in the ventilator circuit Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) Recruiting
Conditions: Survey; Venous Thromboembolism; Deep Vein Thrombosis; Pulmonary Embolism; Anticoagulant Intervention: Sponsor: Centre Hospitalier Universitaire, Amiens Not yet recruiting
Condition: Adverse Effect Interventions: Drug: Norepinephrine; Drug: Normal saline Sponsor: General Hospital of Ningxia Medical University Not yet recruiting