Filter by keywords:



Filtering documents. Please wait...

1/146. anesthesia for cesarean section in two patients with brain tumours.

    PURPOSE: To describe two patients with brain tumours where general anesthesia was used for cesarean sections under emergency and urgent conditions. CLINICAL FEATURES (CASE #1): The first patient presented at 38 wk gestation with an acute intracranial tumour herniation, requiring emergency craniotomy and simultaneous cesarean section. General anesthesia was induced with thiopental and vecuronium, maintained with enflurane 1% in O2 100%. Maternal P(ET)CO2 was maintained at 25 mmHg. After delivering a healthy infant, she was given syntocinon, mannitol and dexamethasone i.v. anesthesia was maintained with fentanyl, nitrous oxide 50% in O2 and isoflurane 1% during frontal-lobe tumour resection. CLINICAL FEATURES (CASE #2): The second patient presented at 37 wk gestation for urgent cesarean section because of placental insufficiency. She had had a brain tumour resection four years earlier. An increase in intracranial pressure necessitated craniotomy for decompression at 20 wk gestation. She was further treated with dexamethasone, carbamazepine and radiation for control of cerebral oedema at 34 wk. cesarean section was performed under general anesthesia; rapid-sequence-induction with thiopental and succinylcholine, followed by isoflurane 1% in O2 100%. Syntocinon, fentanyl and atracurium i.v. were administered after delivery of a healthy infant. Although neurosurgeons stood by, their intervention was unnecessary. CONCLUSION: General anesthesia remains safe and dependable for operative delivery in parturients with intracranial tumour. Tracheal intubation allows maternal hyperventilation thereby controlling raised intracranial pressure. Hemodynamic stability is readily achieved to maintain cerebral perfusion. However, a multidisciplinary-team approach is critical for successful patient management.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

2/146. Borderline ovarian tumors complicating pregnancy: a case report.

    Although the majority of ovarian tumors complicating pregnancy are benign, they still pose a challenge because of the difficulty in differentiating between benign and malignant tumors during pregnancy. To our knowledge, the value of color Doppler ultrasound in the diagnosis of borderline malignant tumors complicating pregnancy remains unclear. We present the case of a 29-year-old pregnant woman with an ovarian tumor of low malignant potential. Preoperative ultrasound revealed a well-encapsulated cystic complex on the left ovary measuring 16 x 18 x 12 cm with an internally smooth surface, multiple septa ranging from 2 to 4 mm in thickness and a small solid component 2 cm in diameter, with a resistance index of 0.42. The differential diagnosis preoperatively was a borderline tumor. The patient underwent a left oophorectomy at 18 weeks of gestation. Frozen pathology indicated a mucinous cystadenocarcinoma of low malignant potential. A thorough surgical staging was completed. The final pathology confirmed mucinous cystadenocarcinoma of low malignant potential, stage IA. Postoperatively, the patient had an uneventful course and did not receive any adjuvant therapy. She delivered a normal male fetus weighing 3,450 g at 38 weeks of gestation. We conclude that color Doppler ultrasound is helpful for the preoperative diagnosis of borderline tumors of the ovaries but its usefulness for making an accurate diagnosis may require further evaluation.
- - - - - - - - - -
ranking = 4
keywords = operative
(Clic here for more details about this article)

3/146. Anesthetic management for pheochromocytoma resection using spinal cord stimulation and intravenous nicardipine--a case report.

    We have used spinal cord stimulation (SCS), diazepam and nitrous oxide for maintenance of general anesthesia. blood pressure was maintained by bolus administration of nicardipine for the removal of pheochromocytoma. Both SCS and nicardipine reduced systemic vascular resistance and SCS increased cardiac output. However, neither SCS nor nicardipine could inhibit the release of norepinephrine. SCS proved to be useful as one of anesthetic technique during the removal of pheochromocytoma, and also in the management of postoperative pain and the prevention of complications.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

4/146. pheochromocytoma and sub-clinical Cushing's syndrome during pregnancy: diagnosis, medical pre-treatment and cure by laparoscopic unilateral adrenalectomy.

    The coexistence of pheochromocytoma and primary adrenal Cushing's syndrome of the same adrenal gland has rarely been reported. We describe here the case of a female patient presenting with mild Cushing's stigmata, hypertension and diabetes mellitus in whom we diagnosed a pheochromocytoma of the left adrenal gland with coexisting non-ACTH-dependent cortisol hypersecretion. While hormonal work-up was still in progress, the patient became pregnant and wanted to carry her pregnancy to full-term. A laparoscopic adrenalectomy in the 17th week of gestation was decided upon and the patient accordingly prepared for surgery by pre-treatment with phenoxybenzamine. Successful surgery--the first ever reported laparoscopic resection of a pheochromocytoma in pregnancy--without perioperative complications was performed under general anesthesia, with the patient receiving peri- and post-operative hydrocortisone substitution. Pathohistological examination revealed a pheochromocytoma with positive immunostaining for interleukin-6 (IL-6) and negative immunostaining for ACTH, vasoactive intestinal polypeptide (VIP) and cytochrome P450, and with no signs of malignancy. A paracrine stimulation of the ipsilateral adrenal cortex by IL-6 produced by the pheochromocytoma, leading to cortical hyperplasia and subclinical Cushing's syndrome, is suggested by the positive immunostaining for IL-6 and the MRI findings. Post-operatively, secondary adrenal insufficiency ensued, necessitating continuing hydrocortisone replacement over 12 months. hypertension resolved after surgery, and diabetes after the uncomplicated vaginal delivery at term.
- - - - - - - - - -
ranking = 3
keywords = operative
(Clic here for more details about this article)

5/146. Colon cancer in pregnancy. A case report.

    BACKGROUND: Carcinoma of the colon diagnosed during pregnancy is very rare. delayed diagnosis is common because of the similarity between early signs and symptoms of colon cancer and gastrointestinal complaints often experienced by pregnant women. We report a case of early-stage colon cancer in pregnancy with a good outcome. CASE: A 35-year-old woman presented with rectal bleeding at 26 weeks of gestation. Initial assessment with digital examination and proctoscopy revealed only a mild degree of hemorrhoids. colonoscopy and biopsy at 30 weeks of gestation showed sigmoid colon cancer. cesarean section was performed after steroid therapy. Subtotal colectomy and ileosigmoid anastomosis were then performed at the same setting. Postoperative adjuvant chemotherapy was given. There was no evidence of recurrence at this writing, 28 months after surgery. CONCLUSION: Colon cancer is a rare complication of pregnancy. The associated poor prognosis is usually due to delay in diagnosis. A high index of suspicion is essential, and it is important not to underestimate the patient's symptoms. early diagnosis is the key to longer survival.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

6/146. An abdominal desmoid tumor involving the xyphoid and costal chondrium associated with pregnancy: report of a case.

    We report herein the case of a 27-year-old woman found to have an abdominal desmoid tumor involving the xyphoid and costal chondrium associated with pregnancy. The patient was referred to our department on the third day after delivery for investigation of a fist-sized, firm tumor in the infrasternal angle, first noticed during the eighth month of gestation. Computed tomography and magnetic resonance imaging revealed a well-defined mass, 9 x 7.5 cm in size, invading the xyphoid. The tumor could be radically excised with the xyphoid, a lower part of sternum, and the chondrium of the bilateral sixth and seventh ribs, including 1.5 cm of free margin. The resected specimen measured 10 x 11.5 x 11.5 cm and weighed 395 g. Histological examination revealed the lesion to be a desmoid tumor consisting of spindle cells with small, elongated nuclei infiltrating dense collagenous fibers. The patient had an uneventful postoperative course and was discharged on the 11th postoperative day. There has been no evidence of recurrence in the 6 months since her operation. This case is of interest with regard to the possible contribution of sex hormones, especially estrogen, to desmoid tumor development.
- - - - - - - - - -
ranking = 2
keywords = operative
(Clic here for more details about this article)

7/146. Primary cardiac sarcoma in pregnancy: a case report and review of the literature.

    Primary cardiac sarcoma (PCS) is a rare disease with a poor prognosis, because of diagnostic delay, therapeutic difficulties, and high metastatic potential. Surgery is the standard treatment. A case of PCS in pregnancy is reported, with a review of published surgical series of PCSs, focusing on the role of surgery and adjuvant therapy. Prompt surgery improved cardiac function and patients' outcome in comparison with untreated cases. The role of adjuvant treatment was analyzed only in a few series, mainly without distinction between postoperative chemotherapy and radiotherapy; adjuvant therapy improved survival in the larger series of resected PCSs. Only three other cases of PCS in pregnancy were reported. In the present case, resection was performed with no major complication for the mother and the infant. Even if the patient's survival was short, cardiac surgery allowed prolonging of pregnancy until an acceptable possibility of fetal survival was reached. Although resection is not curative in most cases, surgery remains the treatment of choice for PCS and has a definite palliative significance. The role of postoperative chemotherapy and radiotherapy is difficult to ascertain; however, adjuvant chemotherapy seems advisable in high-grade tumors.
- - - - - - - - - -
ranking = 2
keywords = operative
(Clic here for more details about this article)

8/146. Posterior fossa surgery in the sitting position in a pregnant patient with cerebellopontine angle meningioma.

    Primary brain tumours and pregnancy rarely occur together; meningioma and pregnancy is rarer still. We describe a 30-yr-old woman in the 25th week of pregnancy who underwent surgery in the sitting position for a large cerebellopontine angle meningioma that was compressing and displacing the pons and medulla. The surgical procedure and postoperative period were uneventful. This case demonstrates that when absolutely necessary, anaesthesia and neurosurgery for posterior fossa lesions can be successful during the second trimester of pregnancy. Furthermore, if indicated and if the operating team is experienced, the operation can be performed safely with the patient in the classical sitting position. It is emphasized that continuous and attentive monitoring of the mother and fetus are essential.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

9/146. Unusual recurrence of cervical adenosquamous carcinoma after conservative surgery.

    The use of less radical procedures for the treatment of early cervical cancers is gaining interest among physicians and young patients. Some authors have described surgical procedures aimed at reducing the surgical aggressiveness but the safety of such procedures remains debated. After a polypectomy, a young patient had a diagnosis of stage Ia(2) cervical adenosquamous carcinoma in 1995. As she wished to preserve her fertility, she underwent a cone biopsy and pelvic lymphadenectomy, without evidence of tumor spread. In 1998, at the 13th week of gestation, she had a diagnosis of a pelvic mass. The mass was a recurrence of carcinoma involving the myometrium, just underneath the peritoneum. She underwent a radical hysterectomy with bilateral oophorectomy. An ovarian metastasis was also detected at pathological exam. She received chemotherapy postoperatively and remains alive without evidence of disease. The recurrence of cervical cancer is traditionally regarded as an issue concerning the cervix, the parametria, or the lymph nodes. When the uterus is preserved we must also consider the possibility of a recurrence involving the corpus. With wider acceptance of limited therapeutic approaches we must be prepared for the detection of previously unknown patterns of recurrence and the follow-up modalities must be consequently adapted.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

10/146. Myomectomy during early pregnancy.

    abdominal pain during early pregnancy may be caused by leiomyoma of the uterus. Inconsistency of uterine size and gestational dates in a pregnant patient with acute abdominal pain may be the first sign of leiomyoma. This 31-year-old primigravida presented with progressively worsening lower abdominal pain at 12 weeks gestational age. ultrasonography and magnetic resonance imaging demonstrated a large fundal heterogeneous mass and an intrauterine gestation compatible with her menstrual dates. Exploratory surgery and myomectomy confirmed a large leiomyoma showing benign degenerative changes. The operative procedure was successful, and the pregnancy progressed normally. An elective cesarean section was performed at 37 weeks gestation after confirming fetal maturity by amniocentesis and serial ultrasonography. abdominal pain in a pregnant patient with leiomyoma uteri may be attributable to degenerative changes in the myoma. Surgical intervention during pregnancy is occasionally necessary in uncommon cases of intractable pain.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)
| Next ->


Leave a message about 'Pregnancy Complications, Neoplastic'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.