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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report two cases of complex renal carcinoma in which retrograde transvenous perfusion cooling (RTPC) of the kidney was used as adjunct to in situ partial nephrectomy. Definite advantages seem to favour this technique of regional renal hypothermia. We are hopeful that RTPC of the kidney will in future allow to reduce the frequency of potentially harmful extracorporeal bench surgery with autotransplantation in the conservative management of renal carcinoma. Renal RTPC is applicable whenever the kidney is approached transperitoneally with preliminary exposure of the renal vascular pedicle. Tumour cell spill has to be discussed as possible complication of this method. Both patients are alive 25 and 19 months, respectively, after surgery without evidence of haematogenous, peritoneal or retroperitoneal tumour disease.
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PMID:Retrograde transvenous perfusion cooling of the kidney, a valuable adjunct to in situ partial nephrectomy in complex renal cell carcinoma. First clinical results. 317 Jan 3

Two patients with renal cell carcinoma invading the inferior vena cava to the level of the right atrium underwent complete excision of their renal tumours. Clearance of the caval extension was accomplished using cardiopulmonary bypass, profound hypothermia and circulatory arrest. The use of these techniques visually improved the operative field without extending operating time. Profound hypothermia and circulatory arrest do not increase postoperative morbidity or mortality and offer the best opportunity for cure.
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PMID:Profound hypothermia and circulatory arrest in excision of renal cell carcinoma invading the vena cava. 336 9

Cardiopulmonary bypass, hypothermia, temporary cardiac arrest and exsanguination represent the next logical step in the evolutionary management of intracaval neoplastic extension with renal cell carcinoma. This method of management provides control of the circulation of the entire body and allows for careful dissection in a bloodless field with less risk of embolization. From 1981 to 1986, 15 patients were treated with intracaval neoplastic extension of renal cell carcinoma above the level of the most inferior hepatic veins. In 6 patients mobilization of the vena cava with division of the hepatic veins to the caudate lobe allowed excision of the tumor and tumor thrombus without cardiopulmonary bypass (group 1). The remaining 9 patients underwent cardiopulmonary bypass and hypothermia (group 2). There was 1 postoperative mortality in the entire group. Most patients had advanced regional disease but the feasibility of this technique has been demonstrated. Survival appeared to be less in the bypass group. Although some of the patients have had metastatic disease, the quality of life and survival have been prolonged in many of these acutely ill patients.
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PMID:Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins. 337 79

The authors report a case of successful extraction of renal cell carcinoma thrombus extending into the inferior vena cava and right atrium in a 36-year-old female patient using extracorporeal circulation, profound hypothermia and cardiac arrest.
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PMID:Successful extraction of renal cell carcinoma thrombus extending into the right atrium using extracorporeal circulation, profound hypothermia and cardiac arrest. 358 41

The authors report a case of right renal carcinoma with a supradiaphragmatic vena cava thrombus. The patient presented to the emergency ward with a severe pulmonary embolus managed by fibrinolytic treatment. After alcohol embolization of the tumor, the patient underwent a right radical nephrectomy with cavectomy. A large tumor extending to the heart was removed by cardiopulmonary bypass combined with hypothermia and cardiac arrest. The immediate postoperative course was satisfactory. Eighteen months later, a CT scan revealed a suprarenal growth. A cytological study was performed on a specimen obtained by percutaneous fine needle aspiration under CT guidance and revealed local a recurrence of the renal cell carcinoma. This was removed without any problems. Two years later, no pulmonary metastases have been noted despite, the fibrinolytic therapy.
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PMID:[Treatment of renal cancer extending supradiaphragmatically with fibrinolytics following surgery under extracorporeal circulation, hypothermia and circulatory arrest]. 370 80

Hemorrhage and poor visualization of the interior of the vena cava frequently occur with the removal of a renal cell carcinoma with a suprahepatic vena caval tumor thrombus. The use of cardiopulmonary bypass, hypothermia, and temporary cardiac arrest facilitates surgical removal of a suprahepatic vena caval tumor thrombus. This technique provides total control of the circulation of the body and creates a disciplined, well-visualized operative field.
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PMID:Technique for removal of renal cell carcinoma with suprahepatic vena caval tumor thrombus. 372 2

Supradiaphragmatic extension of tumor thrombus from a renal cell carcinoma presents a major surgical challenge. The use of cardiopulmonary bypass, hypothermia and cardiac arrest with temporary exsanguination has allowed for successful surgical excision of these tumors. A renal cell carcinoma on the right side with a supradiaphragmatic tumor thrombus still may only partially occlude the vena cava. The collateral venous circulation of the left renal vein may be developed poorly and a pericardial patch can allow successful reconstruction of the inferior vena cava. If the tumor arises on the left side continued venous drainage of the right kidney is mandatory to prevent venous infarction of the right kidney. The entire vena cava also might be reconstructed theoretically with pericardium.
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PMID:Supradiaphragmatic renal cell carcinoma tumor thrombus: indications for vena caval reconstruction with pericardium. 396 47

A 36-year-old man presented with massive edema below the axillae, pleural effusion and renal cell carcinoma with a tumor thrombus extending up the vena cava to the right atrium. A metastatic evaluation was negative otherwise. Hypothermia, cardiac arrest and temporary exsanguination in conjunction with cardiopulmonary bypass were used to create a bloodless field for excision of the renal cell carcinoma and its tumor thrombus. The patient has had total resolution of all symptoms and edema. Hypothermia and cardiac arrest facilitated greatly surgical excision and may be a useful adjunct in the excision of malignancies with massive involvement of the great vessels or heart.
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PMID:A new technique for management of renal cell carcinoma involving the right atrium: hypothermia and cardiac arrest. 669 Jul 24

Surgical management for cavoatrial involvement of malignant tumors and its outcome is reported on for 6 patients; their age ranged from 55 to 79 years and 5 were male and 1 female. The basic disease was renal cell carcinoma in 5 cases and adrenal leiomyosarcoma in 1. Intracaval tumor extension was diagnosed by computed tomography, magnet resonance imaging, digital subtraction angiography, and echocardiography. The tumor was resected together with adherant vena cava and invaded right-atrial wall, using cardiopulmonary bypass and normo- or mild-hypothermia in 5 patients. The caval defect needed to be reconstructed with a slit GORE-TEX vascular prosthesis in 3 patients. In all patients the tumor resections were successful and without major complications. All patients survived and are well from 4 to 52 months after the surgery. It is concluded that such cavoatrial extensions of malignant tumors can be safely and accurately resected with the aid of cardiopulmonary bypass, with favorable early and late outcomes in patients who have no distant metastatic lesions.
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PMID:Surgery for cavoatrial extension of malignant tumors. 757 May 68

The effects of high-energy shock waves (HESW) on the human renal cell carcinoma were examined. The kidneys were available from 32 patients treated by radical nephrectomy due to renal cell carcinoma. Immediately after nephrectomy the kidneys were perfused with cold HTK solution and stored for a maximum of 4 h in hypothermia at 8 degrees C. The tumors were treated with 4,000 shocks (65 mPa = 0.6 mJ/mm2) in an electromagnetic lithotriptor (Siemens Co., Erlangen, Germany). Microscopic and immunohistological examinations of the tumors were performed after treatment, and cell proliferation rates of treated and untreated specimens were analyzed by cell cultures in 10 cases. HESW induce severe microscopic damage in the tumor tissue as complete rupture of the vessel walls and destruction of the tubular-formed tumor masses in the focal area. Immunohistochemistry shows intact immune reactive endothelial cells by factor 8-associated antibodies until the border to histological damage. Around this region a zone of negative antibody reaction against collagen type 4 is found. In cell cultures the proliferation rates of treated specimens were significantly lower compared to untreated. The human renal cell carcinoma seems to be susceptible for treatment with shock waves. HESW induce direct damage of tumor cells and vascular damage in the tumor which may be the primary cause of tumor necrosis.
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PMID:Treatment of human renal cell carcinoma with high-energy shock waves--a new in vivo/in vitro model. 757 Nov 74


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