Successful Conservative Treatment of Pediatric Renal Trauma and Inferior Vena Caval Thrombosis
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Abstract:
Post traumatic inferior vena cava thrombosis (IVCT) is rare, with only a few cases reported in the literature. Most cases are treated with either thrombectomy, insertion of an IVC filter or anticoagulant therapy. This is the first report of conservative treatment for IVCT.Keywords:
Conservative Treatment
Anticoagulant Therapy
Objectives : We defined that the ruptured disc is extruded trans ligamentous through the posterior longitudinal ligament or sequestrated. The authors have experienced 12 cases of ruptured disc that underwent the conservative treatment. We studied the effect and possibility of the conservative treatment for the ruptured disc. Methods : The patients with ruptured disc have underwent the conservative treatment. After the treatment, we compare pre-treatment with post treatment in the view of state of patients` ambulation and physical conditions. Results : In this study, 12 cases of ruptured disc have underwent the conservative oriental treatment. After the treatment, 75% of the cases were improved above good state Conclusion : The ruptured disc has been operated universally. Except the emergency state, the conservative treatment is helpful to improve the symptoms of the patients with ruptured disc.
Conservative Treatment
Conservative Management
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The inferior vena cava (IVC) is an uncommon site for primary pathologies and secondary involvement is also infrequent, but involvement of the IVC can often drastically change management. It is therefore important to be cognizant of IVC pathologies. This review discussed common and rare neoplastic and non-neoplastic pathologies of the IVC as well as pathology mimics. Primary and secondary neoplasms can lead to tumour extension or bland thrombus formation and it is often important to distinguish between these two entities. It is also important to be aware of pseudo-lesions for accurate diagnosis. Inferior vena cava filter placement and endovascular treatment of the aorta are commonly performed procedures that can be associated with devastating complications, which are luckily infrequent. The calibre of the IVC also has its own clinical significance. Inferior vena cava pathologies, although rare, have a dramatic impact on the patient's outcome and knowledge of these pathologies is prudent.Understand the principles of IVC imaging, the common as well as the rare primary and secondary IVC tumours, differentiate between tumour thrombus and bland thrombus, and recognise IVC lesion mimics and life-threatening pathologies involving the IVC.
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Objective: To study the indications and feasibility of traumatic spleen rupture by conservative treatment.Methods:The data of 28 patients with traumatic spleen rupture were retrospectively analyzed.Results:28 cases were taken conservative treatment,26 cases were cured,the cure rate was 92.9%.Conclusions:If the indications of conservative treatment were mastered strictly,traumatic spleen rupture by conservative treatment is a safe effective method also.
Conservative Treatment
Conservative Management
Cure rate
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Conflicting results have been found regarding correlations between right atrial pressure (RAP) and inferior vena cava (IVC) diameter in mechanically ventilated patients. This finding could be related to an increase in intra-abdominal pressure (IAP). This study was designed to clarify whether variations in IVC flow rate caused by positive pressure ventilation are associated with changes in the retrohepatic IVC cross-section (ΔIVC) during major changes in volume status and IAP. Nine pigs were anesthetized, mechanically ventilated and equipped. IAP was set at 0, 15 and 30 mmHg during two conditions, i.e. normovolemia and hypovolemia, generated by blood removal to obtain a mean arterial pressure value lower than 60 mmHg. At each IAP increment, cardiac output, IVC flow and surface area were respectively assessed by flowmeters and transesophageal echocardiography. At normal IAP, even in presence of respiratory changes in IVC flows, no ΔIVC were observed during the two conditions. At high IAP, neither ΔIVC nor modulations of IVC flow were observed whatever the volemic status. The majority of animals with an IVC area of less than 0.65 cm2 showed evidence of IAP greater than RAP values. Negative RAP–IAP pressure gradients were found to occur with an IVC area of less than 0.65 cm2, suggesting that IVC dimensions determined using standard ultrasound techniques may indicate the direction of the RAP–IAP gradient. The clinical relevance of the present findings is that volume status should not be estimated from retrohepatic IVC dimensions in cases of high IAP.
Hypovolemia
Intravascular volume status
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Introduction Change in inferior cava diameter (IVC) during respiration is a potentially non invasive measure of blood volume in haemodialysis (HD) and heart failure (HF) patients. We tested its sensitivity to acute volume loading in normal volunteers (NV). Methods 30 NV (16 male; 48.7 ± 8.6 years, range 48–63) received intravenous 0.9% saline (IVS; 1.5 L over 20 minutes). IVC was measured by M‐mode echocardiography in long‐(LAX) and short‐axis (SAX) views during expiration (IVCe), inspiration (IVCi) and maximal inspiration (IVCmi) at 0, 1, 2 and 4 h. IVC was corrected for body surface area (IVCD) and IVC collapsibility index (IVCCI) was defined as IVCCIi=[(IVCe‐IVCi)/IVCe] × 100. Results There was good linear correlation between LAX and SAX IVC [IVCe: r=0.809; p<0.0001 , IVCi: r=0.660; p<0.0001 and IVCmi: r=0.498; p=0.005 ]. Parameters increased following IVS, with greater change from baseline in SAX. Only IVCe and IVCDe in SAX increased significantly following IVS (Table 1). Conclusions Despite good correlation between LAX and SAX, SAX inferior vena cava indices are more responsive to IVS in NV. Further studies to assess the utility of these indices in the routine care of HF and HD patients are indicated. Funding Haemostasis Thrombosis and Vascular Biology Unit charitable funds.
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Intravascular volume status
Body surface area
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Objectives: To systematically review the diagnostic utility of the respiratory variation of the inferior vena cava diameter measured using ultrasonography for predicting fluid responsiveness in adult patients and compare the three commonly used equations, inferior vena cava distensibility, inferior vena cava collapsibility and inferior vena cava variability. Methods: We searched PubMed, Scopus, Web of Science and Cochrane library, and included studies investigating the diagnostic accuracy of the respiratory variation of the inferior vena cava measured using ultrasonography compared to a reference standard for measuring cardiac output after a fluid challenge for fluid responsiveness, and stratified participants as fluid responsive or not. We included studies conducted in the emergency department or intensive care unit. We excluded studies on paediatric, prehospital, cancer, pregnant, dialysis patients or healthy volunteers. Results: We retrieved 270 records and excluded 171 because of irrelevance, patient population or publication type. We screened the abstracts of 99 studies and then the full texts of 42 studies. Overall, 21 studies with 1321 patients were included, of whom 689 (52%) were fluid responsive. The mean threshold value for positive inferior vena cava distensibility, inferior vena cava collapsibility and inferior vena cava variability was 17%, 35% and 12%, respectively. The heterogeneity between studies was high. Bivariate diagnostic random-effects meta-analysis was used to calculate the summary receiver operating characteristics curves. The overall accuracy, sensitivity and specificity of respiratory variation of the inferior vena cava diameter were 0.85, 0.72 and 0.81, respectively. The accuracy of inferior vena cava distensibility and inferior vena cava collapsibility was similar. The diagnostic utility of respiratory variation of the inferior vena cava diameter was lower but not statistically significant in mechanically ventilated patients compared with spontaneous breathing for predicting fluid responsiveness. Conclusion: The respiratory variation of the inferior vena cava diameter has moderate diagnostic utility for predicting fluid responsiveness independent of the equation used.
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Inferior vena cava (IVC) thrombosis is a rare but significant complication in hospitalized patients. However, relevant information regarding IVC thrombosis, especially on its morphology, remains scarce. We present three cases of IVC thrombosis, with each showing a different morphology: mural, floating, and small polyp-like thrombus.
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下大静脈（inferior vena cava;以下，IVC）へ浸潤または腫瘍栓を合併した腎・副腎癌は一般的に予後不良であるが，腫瘍栓による肺梗塞や心不全による突然死の回避目的や根治的切除による長期生存例の報告が散見される．今回われわれは，肝臓およびIVC浸潤またはIVC腫瘍栓を呈した腎細胞癌3例・副腎皮質癌2例の計5症例に対し，肝臓外科手技を応用した手術手技とその成績について検討した．結果，全肝血流遮断法を3例に行い，うち1例に大腿動静脈バイパスによる体外循環を併用した．肝直接浸潤の1症例に，後区域切除を行った．全症例で肉眼的根治術が可能であった．5例の平均生存期間は30.6カ月で，遠隔死亡は2例あった．従来手術困難とされた肝臓やIVCへの浸潤あるいはIVC腫瘍栓を合併した腎・副腎癌であっても，肝臓外科手技を応用し，心臓血管外科・泌尿器科共同による根治的切除で長期生存も期待しうると考えた．
Hepatic veins
Vena cava
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背景为 Budd-Chiari 症候群(英国计算机学会) 的治疗的几种激进的外科被设计了。我们描述了初步的努力用一种新奇激进的切除术技术对待英国计算机学会暴露肝的 segment.Methods 的全部劣等的静脉 cava (IVC ) 有英国计算机学会的六十个病人被激进的切除术对待，包括 46 个男人和 14 个女人。英国计算机学会病人从 11 ～ 62 年在年龄，与到自从 BCS 诊断的 11 年的 3 个月。损害在 16 个病人，包括了 IVC 的膜吸藏在在 2 个病人，的 IVC 以内的两倍膜在 3 个病人，在 IVC 和肝的静脉( HV )以内加倍膜有在 10 个病人的远侧的血栓的 IVC 膜，在 5 个病人的 IVC 的长片断血栓(在 2 个病人，的组织血栓在 3 个病人的新鲜血栓)， HV 的插头的吸藏由于在 2 个病人，的墙壁的血栓在 3 个病人，的 IVC 的部分吸藏在有 IVC 的 HV 以内的膜三个过程与血的汽车检索在身体外的循环，有正确中庭的 catheterization 的 52 个病人，有一个房间保护器的 4 个病人，和一个病人下面被执行。检索的血从 300 ml 到 4000 ml。存的血的输送从 400 ml 到为 14 个病人的 2000 ml。为另外的病人，存的血的输送都没被要求。一个病人 peri-operatively 死于肾的失败。最新形成的 IVC 膜被作出对有利的裁决血栓是其 IVC 的一个周期性的病人移开一个年优先。没有症状， IVC 的狭窄在一个病人 post-operatively 被观察。在另外的病人，没有周期性的症状在过程和收益期间在这个新奇手术提供的后续 periods.Conclusion 期间被发现清楚的视觉域令人满意的短、长期的结果。
Budd–Chiari syndrome
Hepatic veins
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症例は52歳の女性. 腹痛を主訴として前医受診, 手術にてIVC原発腫瘍と判明したため当院紹介された. IVC造影ではIVCの閉塞, 側副血行路の形成は見られなかった. 開腹すると腫瘍は中部IVCより壁外性に発育しており, 右腎静脈への浸潤を認めた. 右腎静脈を大伏在静脈にて再建した後, IVCの単純遮断下に腫瘍をIVCとともに切除し, IVCは人工血管にて再建した. 病理組織診断は平滑筋肉腫であった. 術後6か月のMRI検査ではIVCのpatencyは保たれていた. 術後17か月経過した現在, 再発の兆候なく外来通院中である. 下大静脈原発平滑筋肉腫は本邦での報告は自験例を含めて53例で, IVC切除後人工血管にて再建された症例は12例である. IVC切除にあたっては血流遮断時の体外循環の必要性, 腎静脈の処理方法などをIVC造影, 術中所見から判断することが重要である.
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