scholarly journals Management of Pediatric Tumors With Vascular Extension

2022 ◽  
Vol 9 ◽  
Author(s):  
Mayara Caroline Amorim Fanelli ◽  
José Cícero Stocco Guilhen ◽  
Alexandre Alberto Barros Duarte ◽  
Fernanda Kelly Marques de Souza ◽  
Monica dos Santos Cypriano ◽  
...  

Background: Pediatric tumors can present with vascular extension to the inferior vena cava and right atrium, which impacts the surgical strategy and can be challenging during surgical treatment. Wilms tumor (WT) is the most common retroperitoneal tumor that can present with vascular extension, but also adrenal tumors, clear cell tumors from the kidney, and hepatoblastomas can present with this situation. Surgical aims include obtaining complete tumor resection without risk for patients, to avoid severe bleeding, cardiac arrest, and embolization, and to avoid cardiac bypass if possible.Objective: To describe and discuss the surgical strategies to deal with pediatric tumors with vascular extension and propose a protocol.Method: Retrospectivly review the experience of treating patients with vascular extension in a single institution, describing different scenarios and a decision making fluxogram based on the preoperative evaluation regarding the surgical techniques and the need for cardiac bypass that are adequate for each situation. Image studies are important to guide the surgical strategy. Depending on the quality of image available, computerized tomography (CT) or magnetic resonance imaging (MRI) can be enough to give the information needed for surgical decisions. Ultrasonography (US) with Doppler is helpful to confirm diagnosis and describes factors to guide the adequate surgical strategy, like the upper level extension and presence or absence of blood flow around the thrombus. Neoadjuvant chemotherapy is indicated in most cases, in order to reduce the upper level of extension (and avoid the need for cardiac bypass) and to lower the risk of embolization. The approach is based on the upper level of the thrombus and can include cavotomy or cavectomy, sometimes with cardiac bypass and cardiac arrest with hypothermia, when the thrombus reaches the diaphragmatic level or above. Pathology analysis of the thrombus can guide staging and the need for radiotherapy postoperatively.Results: A decision making fluxogram protocol is presented focusing on the surgical treatment of such condition.Conclusion: Surgery strategy is highly impacted by the presence of vascular extension in pediatric tumors. Surgeons should be aware of potential complications and how to prevent them. Such cases should be treated in reference centers.

2020 ◽  

Background: Superior vena cava (SVC) aneurysm is a rare clinical disease. Only around 50 cases have been reported in the medical literature. Case presentation: We report a 22-year-old man with SVC aneurysm with cardiac arrest as the first symptom accompanied by typical superior vena cava syndrome. Conclusion: We suggest that patients with giant SVC aneurysm should avoid sudden changes in posture, and that surgical treatment should be implemented urgently.


2019 ◽  
Vol 8 (3) ◽  
pp. 227-252
Author(s):  
Bradley C. Thompson

This research involved a study exploring the changes in an academic institution expressed through decision-making in a shifting leadership culture. Prior to the study, the school was heavily entrenched in authoritarian and centralized decision-making, but as upper-level administrators were exposed to the concept of collaborative action research, they began making decisions through a reflection and action process. Changing assumptions and attitudes were observed and recorded through interviews at the end of the research period. The research team engaged in sixteen weekly cycles of reflection and action based on an agenda they mutually agreed to and through an analysis of post-research interviews, weekly planning meetings, discussions, and reflection and action cycles. Findings revealed experiences centering around the issues of:  The nature of collaboration- it created discomfort, it created a sense of teamwork, it created difficulty.  The change of environment in the process- team members began to respect each other more, and the process became more enjoyable.  The freedom and change in the process- freedom to voice opinions and to actively listen, the use of experience to lead elsewhere in the school.  How issues of power are better understood by working together- the former process was less collaborative, politics will always be part of the process. As a result of this study, members have started using this decision-making methodology in other areas of administration.


BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030430
Author(s):  
Thomas Ott ◽  
Jascha Stracke ◽  
Susanna Sellin ◽  
Marc Kriege ◽  
Gerrit Toenges ◽  
...  

ObjectivesDuring a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a ‘cannot intubate, cannot oxygenate’ situation.DesignDue to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study.SettingWe collected data in our institutional simulation centre between November 2016 and November 2017.ParticipantsWe included 40 experienced staff anaesthesiologists at our tertiary university hospital centre.InterventionThe participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records.Primary outcome measuresThe difference in ‘time to ventilation through cricothyrotomy’ between the two situations was the primary outcome measure.ResultsThe results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3–40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time.ConclusionCricothyrotomy, which is the most crucial treatment for cardiac arrest in a ‘cannot intubate, cannot oxygenate’ situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.


1998 ◽  
Vol 28 (4) ◽  
pp. 645
Author(s):  
Si Eun Song ◽  
Seung Won Li ◽  
Kyoo Sung Cho ◽  
Jung Kiu Chai ◽  
Chong Kwan Kim

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