The management of non-small-cell lung cancer: a case history.
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Accurate assessment and treatment of the patient with lung cancer requires a team approach involving respiratory physicians, cardiothoracic surgeons, oncologists and the palliative care team. Adequate staging and assessment of prognostic factors are essential before deciding what treatment is appropriate for an individual patient. Surgery is the mainstay of treatment for early disease. Patients with medically inoperable stage 1 (T1, T2, N0) tumours should be considered for radical radiotherapy; additional chemotherapy in early stage disease may offer an additional survival advantage, but its overall role can only be assessed by further clinical trials. In more locally advanced tumours radical radiotherapy has never been formally tested. It is however, often used in patients where the tumour can be encompassed safely within a radiation field. This will depend on total dose and fractionation schedule as well as the volume of tissue irradiated. Neo-adjuvant chemotherapy prolongs survival in these patients. As only a few patients are cured, symptom control and quality of life are usually the most important goals of management and can be achieved by a variety of interventions. It is disappointing that in such a common disease less than 5% of patients are entered into clinical trials. Without such evidence the therapeutic outcomes in NSCLC cannot be improved. (+info)
Mediastinal fibromatosis presenting with superior vena cava syndrome.
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We encountered a fatal case of mediastinal fibromatosis in a 67-year-old female in whom there was aggressive infiltration into the large vessels, nerves and pericardium. She presented with the superior vena cava syndrome, Horner's syndrome, paralysis of bilateral vocal cords and diaphragm and heart failure. Mediastinoscopical examination revealed an extremely firm tumor adhering to the sternum, trachea and brachiocephalic artery. She died of severe heart failure due to the disturbed dilatation of the heart and ventilatory insufficiency. Although mediastinal fibromatosis is very uncommon and sometimes difficult to diagnose at an early stage, physicians should be aware of this disease for the differential diagnosis of mediastinal tumors. (+info)
Superior vena cava syndrome as a complication of transvenous permanent pacemaker implantation.
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Venous thrombosis induced by a transvenous permanent pacemaker is a common complication. However, superior vena cava (SVC) syndrome caused by pacemaker leads is only occasionally seen and its prevalence has been estimated to be less than 1 in 1000 pacemaker patients. Herein, we report a Taiwanese patient of high grade AV block, who presented with SVC syndrome 2 years after transvenous permanent pacemaker implantation. This case features fibrotic stenosis of the junction of right brachiocephalic trunk and SVC, and an extensive thrombus formation resulting in complete obliteration of the left brachiocephalic vein. The collateral circulation was so delicate that he still could lead a rather normal life, even if anticoagulant therapy proved to be ineffective from an angiographic point of view. (+info)
Coronary artery bypass and superior vena cava syndrome.
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Superior vena cava syndrome is the obstruction of the superior vena cava or its main tributaries by benign or malignant lesions. The syndrome causes edema and engorgement of the vessels on the face, neck, and arms, nonproductive cough, and dyspnea. We discuss the case of a 48-year-old obese diabetic woman who was admitted with unstable angina. She had previously been diagnosed with superior vena cava syndrome. Urgent coronary artery bypass grafting was necessary Although thousands of coronary artery bypasses are performed every year, there are not many reports on patients with superior vena cava syndrome who successfully undergo cardiopulmonary bypass and coronary artery grafting with an internal mammary artery as the conduit. The results of the case and alternative recommended methods are discussed. (+info)
Superior vena cava obstruction caused by radiation induced venous fibrosis.
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Superior vena cava syndrome is most often caused by lung carcinoma. Two cases are described in whom venous obstruction in the superior mediastinum was caused by local vascular fibrosis due to radiotherapy five and seven years earlier. The development of radiation injury to greater vessels is discussed, together with the possibilities for treatment of superior vena cava syndrome. (+info)
Successful resection of intracardiac invasive thymoma with right ventricular inflow tract occlusion.
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A 72-year-old man presenting with the superior vena cava syndrome and intracardiac mass was admitted to our hospital. The mass was resected and confirmed to be invasive thymoma. Three years later, he was re-admitted with recurrence into the intracardiac space without any changes in the anterior mediastinum mass. The mass occupied the right atrial cavity and protruded into the right ventricle, causing right ventricular inflow tract obstruction. He underwent re-operation and irradiation. His postoperative course was uneventful, and he has remained alive. Invasive thymoma with intracardiac extension is extremely rare. (+info)
Reconstruction of the superior vena cava with the aid of an extraluminal venovenous jugulo-atrial shunt.
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A 57-year-old woman had chronic benign superior vena cava syndrome related to the long-term use of multiple central venous catheters for chemotherapy. Treatment included resection of the obstructed segment and repair of the superior vena cava with an autologous pericardial patch. Intraoperatively, return venous flow was maintained with an extraluminal venovenous jugulo-atrial shunt. The shunt relieved upper-body hypertension and congestion, resulting in early extubation and a short, smooth postoperative course. (+info)
Lymphocutaneous fistula as a long-term complication of multiple central venous catheter placement.
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We report a case of a lymphocutaneous fistula in a 19-month-old boy who had been a premature neonate, born in the 23rd week of gestation. The fistula, an apparent complication of central venous line placement during the patient's first 5 months of life, was composed of a distinct lymphatic vessel bundle in the right supraclavicular region, with its exit point at the posterior aspect of the right shoulder. The drainage ceased immediately after resection and repair of a 1-cm obstruction in the superior vena cava. (+info)