Neoplastic involvement of the inferior vena cava

Inferior caval vein invasion not infrequently complicates advanced neoplastic lesions. Primitive caval neoplasms (leiomyosarcomas) or other tumors such as renal carcinomas, pheochromocytoma, as well as liver, testis, and retroperitoneal tumors most likely cause caval invasion. In the past, caval invasion was a clear index of non operability, while today, a modern multidisciplinary approach allows to treat successfully even so advanced diseases. In the present report the Authors analyze the cases treated at the Dept. of Surgery of the University of Perugia, and review the most important international reports on this subject illustrating the new possibilities offered by IVC substitution with biological or artificial grafts.     

Study of superior vena cava syndrome--aetiopathology, diagnosis and management

Thirty two patients of superior vena cava syndrome (SVCS) were studied. Clinical features noted were diffuse neck swelling, breathlessness, chest pain, engorged neck veins, facial swelling and dilated engorged veins over chest wall. Radiography revealed a superior mediastinal mass in 31.2% of patients and right upper lobe mass in 50% patients. FNAC of lung showed aetiology in 34.5% patients and lymph node biopsy in 31.2% patients. Aetiology of SVCS was benign in 12.5% patients and malignant in 87.5% patients. Squamous cell carcinoma was the commonest cause of SVSC. Radiotherapy proved to be the most beneficial form of treatment. The mean survival period in patients due to malignant etiology was 6 months.     

Left-sided superior vena cava: diagnosis by magnetic resonance imaging

We describe a case of left-sided superior vena cava. The diagnosis was suggested by chest radiograph after central venous catheter placement. This was subsequently confirmed by magnetic resonance imaging.     

Leiomyosarcoma of the inferior vena cava

BACKGROUND: The inferior vena cava is an uncommon location for leiomyosarcoma, a malignant tumor which develops from the smooth muscle tissue of the media. CASE REPORT: A 76-year-old woman was hospitalized for swelling of the lower limbs. Ultrasonography, computed tomography of the abdomen and magnetic resonance imaging showed tumoral invasion of the inferior vena cava extending to the atrium. Histology examination of a tumoral fragment obtained by transjugular catheterism affirmed the diagnosis of leiomyosarcoma. DISCUSSION: Prognosis of leiomyosarcoma of the inferior vena cava is very poor. No medical or surgical treatment has given satisfactory results. Two factors would explain the poor prognosis: the tumoral localization and the low degree of tumoral differentiation. Clinical presentation and imaging findings suggest the diagnosis which must be confirmed by pathology examination of a tumoral biopsy specimen.     

Leiomyosarcoma of the inferior vena cava

1. The effects of graded dietary concentrations of cholestyramine (CSTY, a bile acid binding polymer), which prevents micelle formation and bile acid reabsorption, on the lipid and energy metabolism of chicks given diets containing different dietary concentrations of medium chain triacylglycerol (MCT) and long chain triacylglycerol (LCT) were investigated. 2. MCT- or LCT-supplemented diets containing 100 or 200 g oil/kg diet and 0, 10 or 20 g CSTY kg were fed to 7 d old chicks for 10 d. As dietary CSTY concentration increased, a reduction in the metabolisable energy value was observed for both dietary lipid sources. Consequently, fat and energy retentions were also reduced as the dietary CSTY content increased.     

From venous ligation to vena cava filter. Objectives and hazards of vena cava interruption

Adrenocortical adenomas (ACA) are frequently discovered at autopsy. Nowadays, modern radiologic techniques incidentally uncover the usually silent ACA during lifetime. On the basis of various reports and the results of endocrine tests, i.e. dexamethasone suppression (DST) and CRH response, we characterize 3 major types of functioning ACA. Type I ACA (cortisol < 100 nmol/l after 1 mg dexamethasone (DXM)) comprises the majority of the so-called 'nonfunctioning' adrenocortical adenomas. However, these adenomas may not be 'truly nonfunctioning' ACA, as their mean FMAX/ACTHMAX-ratio after CRH is significantly higher than in controls without ACA. Also, 19-iodocholesterol adrenal scan has shown persistent adrenal uptake despite DXM administration in some patients with normal DST. Type II ACA ('pre-Cushing's') is comparable to the euthyroid autonomous adenoma. The results of function tests suggest the existence of an ACTH-hyperresponsive subtype. Finally, type III ACA are associated with overt hypercortisolism. An ACTH-responsive and an ACTH-unresponsive form can be characterized. A continuous functional spectrum and the transition between the different types of adenomas is discussed.     

Rational diagnosis and surgical therapy of renal cell carcinoma with tumor thrombosis in the vena cava

Cerebral blood flow (CBF) rises when the glucose supply to the brain is limited by hypoglycemia or glucose metabolism is inhibited by pharmacological doses of 2-deoxyglucose (DG). The present studies in unanesthetized rats with insulin-induced hypoglycemia show that the increases in CBF, measured with the [14C]iodoantipyrine method, are relatively small until arterial plasma glucose levels fall to 2.5 to 3.0 mM, at which point CBF rises sharply. A direct effect of insulin on CBF was excluded; insulin administered under euglycemic conditions maintained by glucose injections had no effects on CBF. Insulin administration raised plasma lactate levels and decreased plasma K+ and HCO3- concentrations and arterial pH. These could not, however, be related to the increased CBF because insulin under euglycemic conditions had similar effects without affecting CBF; furthermore, the inhibition of brain glucose metabolism with pharmacological doses (200 mg/kg intravenously) of DG increased CBF, just like insulin hypoglycemia, without altering plasma lactate and K+ levels and arterial blood gas tensions and pH. Nitric oxide also does not appear to mediate the increases in CBF. Chronic blockade of nitric oxide synthase activity by twice daily i.p. injections of NG-nitro-L-arginine methyl ester for 4 days or acutely by a single i.v. injection raised arterial blood pressure and lowered CBF in normoglycemic, hypoglycemic, and DG-treated rats but did not significantly reduce the increases in CBF due to insulin-induced hypoglycemia (arterial plasma glucose levels, 2.5-3 mM) or pharmacological doses of deoxyglucose.     

Postpartum ultrasonographic diagnosis of inferior vena cava thrombus associated with ovarian vein thrombosis

Postoperative ultrasonographic assessment as a result of unremitting fever after cesarean section depicted a large pedunculated thrombus within the inferior vena cava at the level of the right renal vein. Subsequent imaging studies revealed that this thrombus was the distal extension of right ovarian vein thrombosis into the inferior vena cava.     

Thrombosis of the cranial vena cava in a cow

Thrombosis of the cranial vena cava in a cow was followed by the formation of aneurysms in the pulmonary arteries. Embolism, pulmonary hypertension and the development of a collateral venous and lymphatic circulation are the suggested causes of these uncommon arterial lesions.     

Interventional therapy of inferior vena cava thrombosis in pregnancy--use of a new kind of temporary vena cava filter

The most common suicide theories share a widely recognized set of social factors that contribute to suicide and suicide attempts. This paper discusses additional suicide risk factors that affect the gay and lesbian community such as: discrimination, gay adolescence, coming out, establishment of a gay identity, HIV/AIDS, intrapersonal stressors, drugs and alcohol, racial/ethnic factors and limited support structures. Poor awareness of these additional risks, both within mainstream society and within the gay and lesbian community, is also discussed. A review of the literature is conducted that examines the impact of these risk factors and the implications of these issues to mental health nursing.     

Ultrasonic diagnosis of infrahepatic interruption of the inferior vena cava with azygos (hemiazygos) continuation

Two patients with infrahepatic interruption of the inferior vena cava (IVC) with azygos (hemiazygos) continuation were examined ultrasonographically and the findings compared to seven normal studies. Pathognomonic ultrasonographic features of this anomaly are easily demonstrated and include absence of the IVC at the level of the liver and independent drainage of the confluence of hepatic veins into the right atrium. Conventional venography can now be replaced by ultrasonic examination to establish this diagnosis. The embryology, anatomy and clinical implications of this entity are discussed.     

The use of vena cava filters in Denmark

By means of a questionnaire we studied the current indications for and the extent of the use of vena cava filters (VCF) in 325 Danish hospital departments. Two hundred and eighty (86%) responded. Only six clinical and four radiological departments (4%) used VCF. Eighteen percent did not find any indications for the use of VCF, 32% were not familiar with the method, and 46% replied that they did not have the relevant patient population. The reported indications for VCF are consistent with the international guidelines. We discussed the scientific background, indications and limitations for the use of VCF and concluded that the current use of VCF in Denmark probably is less than optimal. VCF should be considered in patients with pulmonary embolism or at high risk of pulmonary embolism when anticoagulant therapy is contraindicated.     

Two-step procedure in Budd-Chiari syndrome with severe intrahepatic vena cava stenosis: vena cava stenting and portocaval shunt

Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction, which often leads to death as a result of portal hypertension and liver failure. Venous decompressive shunt surgery and liver transplantation represent efficient surgical treatments of Budd-Chiari syndrome. In the case presented here, severe intrahepatic compression of the inferior vena cava (IVC) was caused by the hypertrophic caudate lobe. A mere portocaval shunt was not feasible because of a large pressure gradient across the intrahepatic stenosis. A two-step procedure with preoperative radiological dilation and stenting of the intrahepatic IVC followed by a portocaval shunt was successfully performed. Consequently, liver transplantation and its subsequent immunosuppression could be avoided.     

Morphogenesis of the vena cava inferior roots in human embryogenesis

The roots of the vena cava inferior are formed during the 2nd month of human embryogenesis in the course of transformation of posterior caudal veins and their tributaries, including anastomoses with umbilical veins, which is associated with the growth of pelvic kidney and lower extremities. The roots and initial part of vena cava inferior originate from secondary cardinal veins, primarily from sacrocardinal anastomosis and sacrocardinal veins proximal regions.     

Computed tomography-guided central venous catheter placement in a patient with superior vena cava and inferior vena cava occlusion

Erythropoietin (EPO) is a glycoprotein hormone produced principally by the kidney and is the major stimulus for erythropoiesis. Recombinant human EPO has now been biosynthesized and is available for clinical use, particularly in patients with renal failure. EPO has been reported to be effective in treating anaemia due to chronic renal failure. It has been used in pregnancy to correct anaemia following renal transplantation with graft dysfunction. We report here the case of a post-renal transplant patient who became pregnant and developed severe anaemia which was not related to iron, B12, or folate deficiency. Her anaemia was successfully treated with EPO with no evidence of rejection or significant graft dysfunction following therapy. She tolerated EPO very well, and there was a successful outcome of the pregnancy. This case has encouraged us to conclude that EPO has a useful role in the treatment of anaemia in pregnant women following renal transplantation.