Leiomyosarcoma of the retrohepatic portion of the inferior vena cava: clinical presentation and surgical management in five patients

BACKGROUND: Leiomyosarcoma (LMS) is a rare primary soft tissue sarcoma arising from the inferior vena cava (IVC). For LMS involving the retrohepatic portion of IVC there are limited published data about tumor features, surgical strategies, and IVC replacement. STUDY DESIGN: Clinical data, surgical procedures, and pathologic features of five consecutive patients referred for IVC-LMS, in 5 years, were reviewed. A complete surgical resection of the tumor was performed in each patient and IVC replacement used expanded polytetrafluoroethylene grafts. RESULTS: Abdominal pain (n = 4) and palpable flank mass (n = 3) were the most frequent signs. To assure a complete tumoral exeresis, adjacent organ resection included hepatectomy (n = 4), extended right nephrectomy (n = 3), and right adrenalectomy (n = 1). Prosthetic IVC reconstruction was performed in four patients, three times associated with arteriovenous fistula. Median postoperative stay was 18 days. No prosthetic-related complication was observed, venous insufficiency sequela did not occur. Tumoral clearance was achieved in all patients, and direct tumoral involvement of the liver was less frequent than for kidney. Three patients died at a median followup of 34 months, two are alive and disease-free at 34 and 44 months. CONCLUSIONS: LMS of the IVC is characterized by locally advanced status at the time of diagnosis. A radical tumoral resection associated with liberal use of venous prosthetic replacement may offer a chance for cure and good quality of life in palliative situations.     

Artefacts in continuous ECG recordings--provoking and preventing manoeuvres

OBJECTIVES: A systematic estimation of the effects of some clinically important artefact provoking and artefact-preventing manoeuvres. DESIGN: A test protocol for the evaluation of technical modifications of continuous ECG recordings was tested in 17 patients. The programme comprised ECG recordings during five artefact-provoking manoeuvres (slight shaking of the ECG cables, rotating shoulders, slight electrode touching, washing, teeth-brushing) and two simple artefact-preventing manoeuvres (taping ECG cables and covering electrodes with paper cups). RESULTS: The artefact-provoking manoeuvres induced a substantial increase in artefactual ECG. The artefact-preventing manoeuvres only incompletely prevented this increase. CONCLUSION: There is a great need of technical improvements to reduce the distortion of ECG by artefacts. The test protocol developed by us exposes a broad spectrum of different categories of ECG qualities and is therefore suitable for evaluating technical improvements concerning artefactual ECG.     

Teaching of microsurgery--in service of research and clinical practice

We analyse the improving role of teaching microsurgery, the advantages of the microsurgical models in research and clinical practice. We summarize our experience in teaching basic microsurgery according to Furka's model in the last 15 years. The main characteristics of the principles are: activity, synchronism, video assistance, self-control, individualization, analysis. We show the curriculum of the courses for researchers and participants in graduate and postgraduate education, which consists dry-training on models followed by surgical interventions on rats. Summarizing of our practices: to learn the basic microsurgical techniques the participants need endurance, patience, and have to work hard. Effectiveness of the education is most successful if we organize small groups, if one teacher deals with a maximum of two or three candidates.     

Monitoring of trace elements in breast milk sampling and measurement procedures

The aims of this study were to test analytical procedures for the determination of Cd, Cu, Mn, Pb, Se and Zn in breast milk and to establish optimum sampling conditions for monitoring purposes. Two population groups were analysed: (1) Seven women from Prague whose breast milk was sampled on days 1,2, 3, 4, 10, 20 and 30 after delivery; (2) 200 women from four (two industrial and two rural) regions whose breast milk was sampled at defined intervals. All samples were mineralised in a microwave oven in the mixture of HNO3 + H2O2 and analysed by atomic absorption spectrometry. Conditions for the measurement of the elements under study (i.e. those for the electrothermal atomisation for Cd, Mn and Pb, flame technique for Cu and Zn, and hydride generation technique for Se) were optimized. Using optimized parameters the analysis was performed and the following conclusion has been made: the concentrations of zinc and manganese decreased very sharply over the first days, that of copper slightly increased within the first two days and then slightly decreased, that of selenium did not change significantly. Partial "stabilisation" was achieved after the second decade. No correlation among the elements was found. A significant difference between whole and skim milk was only found for selenium (26% rel. higher in whole milk). The majority concentrations of cadmium and lead were below the detection limit of the method (0.3 microg x l(-1) and 8.2 microg x l(-1), respectively, as calculated for the original sample). To provide biological monitoring, the maintenance of sampling conditions and especially the time of sampling is crucial.     

A rare involvement of Romberg’s disease: frontal region

Progressive hemifacial atrophy is characterized by slow progressive atrophy of the subcutaneous tissue. Although, in the majority of sufferers, half of the face and the chin are the most severely-affected areas, we present the case of a patient with a 2-year history of local atrophy in the forehead, a very rare involvement. Reconstruction was done using bilateral subcutaneous flaps. There was no recurrence of the atrophy at the 12th-month postoperative check.     

Mitral annular calcification and brown tumor of the rib in a child with chronic renal failure

Mitral annular calcification and liquefaction necrosis of this lesion mimicking intracardiac tumor because of secondary hyperparathyriodism have been described in adult patients with chronic renal failure, but have not been reported in children. Chronic renal failure is one of the predisposing factors of this condition. We report the case of a 13-year-old patient with continuous ambulatory peritoneal dialysis with severe hyperparathyroidism who was found to have intracardiac and rib lesions considered to be brown tumors.     

Postnatal management of infants with antenatally detected hydronephrosis

With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. Because of the lack of consensus regarding treatment of these infants, the postnatal approach toward fetal renal pelvis enlargement remains controversial. The aim of this prospective study is to demonstrate the postnatal investigation, treatment, and outcome of infants with prenatally diagnosed hydronephrosis. Infants whose antenatal ultrasound scan showed a fetal renal pelvis of 5 mm or greater were investigated postnatally using ultrasound (US) and voiding cystourethrography. When indicated, isotope studies and intravenous urograms were also performed. We followed prospectively neonates with antenatally diagnosed hydronephrosis and recommended management guidelines on the basis of our findings. In 156 neonates (193 kidney units) that were found to have hydronephrosis, the average gestational age at which the diagnosis was made was 32.94±5.10 weeks. The mean duration of postnatal follow-up was 26.3±13.56 months (range 3–60 months). The mean APPD of the fetal renal pelvis was 10.35±3.24 mm (5–9 mm in 84 kidneys, 10–14 mm in 96 kidneys and 15 mm in 13 kidneys). Of the 193 kidney units, 145 units were found to be pathological. The most common detected underlying abnormalities were ureteropelvic junction obstruction (in 91 kidneys; 62.7%) and vesicoureteral reflux (in 24 kidneys; 16.6%). Postnatally, 23 (45%) of 51 patients whose first US was normal were diagnosed postnatally as having urinary tract abnormality. There was a negative correlation between APPD and the rate of spontaneous resolution and positive correlation between APPD and the rate of surgery (P<0.01). In conclusion, because it is not possible to determine an upper limit of normal for the antenatal renal pelvis, any baby with AH should not be considered clinically insignificant. Infants with antenatal renal pelvis measurements 5 mm should be investigated postnatally. A normal postnatal ultrasound scan does not preclude the presence of urinary tract abnormality.     

Outcome of Surgery for Lung Cancer in Young and Elderly Patients

Purpose It has been suggested that lung cancer follows a more aggressive course and has a poorer prognosis in young patients than in elderly patients. We conducted this study to determine whether the basal characteristics and survival of young patients undergoing surgical resection of lung cancer differ from those of elderly patients.Methods Eighty patients who underwent surgery for lung cancer at our hospital between 1989 and 2004 were divided into two groups according to age. Group 1 comprised 50 patients aged 45 years or younger and group 2 comprised 30 patients aged 70 years or older. The patients’ medical records were reviewed with respect to age, gender, histological diagnosis, coexisting diseases, smoking history, postoperative staging, type of operation, and postoperative morbidity, mortality, and survival results.Results The average ages were 40.2 ± 3.77 years (range, 29–45 years) in group 1 and 72.2 ± 2.53 years (range, 70–80 years) in group 2. The incidence of postoperative complications was significantly higher in group 2 (P = 0.02). However, the 5-year survival rates for patients who underwent surgery for non-small cell lung cancer did not differ between groups 1 and 2, at 33.3% versus 21.3%, respectively (P = 0.09).Conclusions The incidence of adenocarcinoma was higher in the young patients, whose prognosis was slightly better than that of the elderly patients. Coexisting diseases and postoperative complications were the major factors that adversely affected the prognosis of the elderly patients.