Ugradnja filtra u donju šuplju venu prije operacijskog zahvata u žene s tumorom jajnika i simptomima duboke venske tromboze: prikaz slučaja i pregled literature

Venous thromboembolism is a frequent complication of gynecologic cancer, and may be the first symptom of occult malignant disease. Although anticoagulation therapy remains the standard of care in patients presenting with acute venous thromboembolism, inferior vena cava filters are an important alternative when anticoagulants are contraindicated or ineff ective. We report a case of a 69-year-old women who presented with left leg swelling secondary to deep venous thrombosis before the diagnosis of ovarian cancer. Th e aim of this study is to review the respective literature and report our experience with inferior vena cava fi lter placement to prevent pulmonary embolism in gynecologic cancer patients.Venska tromboembolija je česta komplikacija ginekoloških malignih bolesti, a može se javiti i kao prvi simptom skrivene maligne bolesti. Unatoč tome što je antikoagulantna terapija zlatni standard u liječenju bolesnika s akutnom venskom tromboembolijom, postavljanje fi ltra šuplje vene predstavlja značajnu alternativu u bolesnika kod kojih je antikoagulantna tera pija kontraindicirana ili neučinkovita. U radu je prikazan slučaj 69-godišnje bolesnice s edemom lijeve noge zbog duboke venske tromboze koja je nastala kao prvi simptom karcinoma jajnika. Analizirana je medicinska literatura i opisano naše iskustvo s postavljanjem fi ltra šuplje vene u svrhu sprječavanja moguće plućne embolije u bolesnice s karcinomom jajnika

Torakalna epiduralna analgezija za radikalnu cistektomiju pospješuje funkciju crijeva i u tradicionalnoj perioperacijskoj skrbi

Radical cystectomy is associated with significant morbidity and mortality due to complex surgery and comorbidities associated with advanced age of patients. In contrast to the surgery, which is clearly the procedure of choice for patients with invasive bladder cancer, the optimal anesthesiologic method is still under debate. Therefore, we retrospectively analyzed 85 patients having undergone radical cystectomy at our institution, either under combined epidural-general anesthesia (CEG A) or opioid based general anesthesia (GA). The intraoperative blood loss was significantly lower in CEG A group (497.37±354.13) than in GA group (742.31±403.69; p=0.006), due to induced hypotension. Consequently, blood transfusion requirements were lower in CEG A group (107.20±263.92) than in GA group (388.18±321.32; p=0.001). The incidence of postoperative ileus was also lower in CEG A group (p=0.024). There was no difference in analgesic efficacy, but a trend towards lower incidence of venous thrombosis and infection was noticed. The results of our study suggest that epidural anesthesia might have specific advantages in patients undergoing radical cystectomy.Radikalna cistektomija je praćena značajnom smrtnošću i pobolom zbog složenog kirurškog zahvata i komorbiditeta povezanog sa starijom dobi bolesnika. Za razliku od kirurškog zahvata koji je bez dvojbe metoda izbora za invazivni karcinom mokraćnog mjehura, optimalna metoda anestezije još je predmet rasprave. Stoga smo retrospektivno analizirali 85 bolesnika koji su u našoj ustanovi podvrgnuti zahvatu radikalne cistektomije u kombiniranoj torakalnoj epiduralnoj i općoj anesteziji ili u općoj anesteziji baziranoj na opioidima. Intraoperacijski gubitak krvi bio je značajno niži u skupini na kombiniranoj torakalnoj epiduralnoj i općoj anesteziji (497,37±354,13) nego u skupini na općoj anesteziji baziranoj na opioidima (742,31±403,69, p=0,006). Posljedično, količina transfundirane krvi bila je značajno niža u skupini koja je imala torakalnu epiduralnu anesteziju (107,20±263,92) nego u skupini na općoj anesteziji (388,18±321,32, p=0,001). Incidencija poslijeoperacijskog ileusa također je bila niža u skupini na kombiniranoj anesteziji (p=0,024). Nije uočena razlika u analgetskoj učinkovitosti, ali je zabilježen trend prema nižoj incidenciji venske tromboze i poslijeoperacijskih infekcija u skupini na kombiniranoj anesteziji. Rezultati naše studije impliciraju da bi torakalna epiduralna analgezija mogla imati specifične prednosti kod bolesnika podvrgnutih zahvatu radikalne cistektomije

The Use of Inferior Vena Cava Filters before Surgery in Women with Ovarian Cancer with the Initial Symptom of Deep Venous Thrombosis: Case Report and Review of Literature

Venous thromboembolism is a frequent complication of gynecologic cancer, and may be the first symptom of occult malignant disease. Although anticoagulation therapy remains the standard of care in patients presenting with acute venous thromboembolism, inferior vena cava filters are an important alternative when anticoagulants are contraindicated or ineff ective. We report a case of a 69-year-old women who presented with left leg swelling secondary to deep venous thrombosis before the diagnosis of ovarian cancer. Th e aim of this study is to review the respective literature and report our experience with inferior vena cava fi lter placement to prevent pulmonary embolism in gynecologic cancer patients