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

Of 29 patients with inferior vena caval tumor thrombus, 14 with supradiaphragmatic extension were deemed suitable for operation. Patients (age, 7.5 to 70 years) had renal cell carcinoma (n = 8), Wilms' tumor (n = 2), transitional cell carcinoma (n = 1), and adrenal carcinoma (n = 3). Seven patients had stage III disease, and 7 patients had stage IV disease. Two patients (group A) had unresectable disease at exploratory celiotomy, 4 patients (group B) underwent tumor thrombectomy without cardiopulmonary bypass, and cardiopulmonary bypass was employed in 8 patients (group C). Three of 8 group C patients had Budd-Chiari syndrome at diagnosis. Cardiopulmonary bypass with moderate hypothermia, and inferior vena caval interruption (clip or filter), was employed in all patients. There were no perioperative deaths. Transient neurological impairment was observed postoperatively in 2 patients. Coagulopathy developed in 1 patient who had hepatic encephalopathy and Budd-Chiari syndrome preoperatively and in another patient in whom protamine could not be administered. No patient had acute renal failure requiring hemodialysis. Median survival is 41 and 17 months in groups B and C, respectively. Some authors have advocated profound hypothermia and circulatory arrest in these patients. We find that satisfactory visualization and excision can be performed with cardiopulmonary bypass and moderate hypothermia, avoiding potential renal, hepatic, neurological, and septic complications associated with circulatory arrest.
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PMID:Cavoatrial tumor thrombectomy using cardiopulmonary bypass without circulatory arrest. 185 Sep 76

A 14-year-old male presented with a one week history of weakness, lightheadedness and vomiting. Bilateral pleural effusions were evident on chest radiography; electrocardiogram revealed decreased voltages. Echocardiogram, abdominal ultrasound and magnetic resonance imaging revealed a mass in an hepatic vein and the inferior vena cava extending up to and filling the right atrium. Under deep hypothermia and extracorporeal circulation the mass was removed en bloc. It originated from the hepatic vein. Pathology revealed a smooth muscle tumour intermediate between benign and malignant (atypical leiomyoma). This is the first reported pediatric primary leiomyoma of the hepatic vein. It caused the Budd-Chiari syndrome, a rare pediatric entity.
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PMID:Atypical hepatic vein leiomyoma extending into the right atrium: an unusual cause of the Budd-Chiari syndrome. 218 75

The case of a 21-year-old patient operated on as an emergency for traumatic rupture of the suprahepatic inferior vena cava (IVC) and hepatic vein (HVs) is presented. Since anatomic reconstruction of the ruptured vessels was considered unfeasible, a direct anastomosis was instituted between the right atrium and the liver capsule around the disrupted IVC and HVs, using extracorporeal circulation, deep hypothermia and circulatory arrest. Hemorrhage was easily controlled and the patient survived. As far as we know, this operation, originally developed for the treatment of the Budd-Chiari syndrome, has never been used before as a life saving procedure under the circumstances described.
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PMID:Hepato-atrial anastomosis as emergency treatment for traumatic rupture of suprahepatic inferior vena cava and hepatic veins. 228 49

A 47-year-old man was seen with Budd-Chiari syndrome caused by a congenital membranous web obstructing the inferior vena cava (IVC) above the hepatic veins. Operative repair was accomplished using cardiopulmonary bypass, profound hypothermia (24 degrees C), and 10 minutes of circulatory arrest. This technique permitted accurate resection of the web, thorough removal of thrombus from the IVC and the hepatic veins, and repair of the atriocaval junction with an autologous pericardial patch. Postoperative angiographic study showed unobstructed flow through the IVC with filling of the hepatic veins. We believe this is the first report of use of this technique to treat Budd-Chiari syndrome resulting from a congenital web obstructing the IVC and hepatic veins.
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PMID:Budd-Chiari syndrome resulting from a membranous web of the inferior vena cava: operative repair using profound hypothermia and circulatory arrest. 381 11

Injuries of the inferior vena cava (IVC) require prompt and definitive action. To evaluate our current management strategy, we reviewed 38 patients with IVC trauma treated from 1983 through 1990. Sixteen were injured by gunshots, eight by stabs, and 14 by blunt mechanisms. Thirty of the 38 survived (79%). All were awake on presentation, although 45% were hypotensive (systolic blood pressure < 90 mmHg). The mean Injury Severity Score was 27. At laparotomy all demonstrated active retroperitoneal bleeding or an expanding hematoma. The caval injury was retrohepatic in 12 (three involving the hepatic veins), suprarenal in seven, pararenal in nine, and infrarenal in ten. Among the eight deaths, five had retrohepatic injuries, two pararenal injuries, and one had an infrarenal injury. Surgical repair was accomplished in 33, 26 (79%) via lateral venorrhaphy and seven via polytetrafluoroethylene patch repair. The right chest was entered with diaphragmatic division in 8 of 12 cases with retrohepatic injuries. Two atrial-caval shunts were used and both patients survived. Twenty follow-up studies (at > or = 3 months) were performed in which three patients demonstrated IVC occlusion, and one had a Budd-Chiari-like syndrome. We conclude that inferior vena caval injury remains a highly lethal injury. Successful outcome depends on prompt volume restoration, a stratified selective management approach, and avoidance of hypothermia. Prosthetic vena caval reconstruction represents an acceptable alternative.
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PMID:Contemporary management strategy for major inferior vena caval injuries. 802 56

A patient with Budd-Chiari syndrome who underwent a new surgical technique; venoplasty of right hepatic vein and liver portion of inferior vena cava using veno-venous bypass, was reported. The patient was 31 year-old man whose weight and height were 55 kg and 157 cm, respectively. During the anesthetic management of this patient, we encountered following problems; continuous massive bleeding, profound hypothermia and hemodynamic derangement. These problems were similar to those of liver surgery using veno-venous bypass such as extracorporeal liver surgery and liver transplantation.
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PMID:[Anesthesia for venoplasty of right hepatic vein and liver portion of inferior vena cava using veno-venous bypass]. 843 63

The authors report their experience of one case of Budd-Chiari syndrome with total thrombosis of the portal vein. The patient was undergoing hepatico-atrial anastomosis with Senning's procedure. The original technique utilised extracorporeal circulation with hypothermia; the authors utilised venovenous bypass from femoral vein to axillary vein. Anastomosis function is proved with nuclear magnetic resonance and echo-Doppler on year after operation. Senning's procedure is feasible in the case of Budd-Chiari syndrome with total portal thrombosis with venovenous bypass without extracorporeal circulation with hypothermia.
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PMID:[The Senning procedure in Budd-Chiari syndrome associated with complete portal vein thrombosis]. 846 58

The authors designed a new operation for the treatment of Budd-Chiari syndrome under deep hypothermia anesthesia with extracorporeal circulation, opening the superhepatic inferior vena cava (IVC) when the circulation was paused. Then the diseased focuses of IVC and HVs were resected under direct bloodless vision. After the incision of IVC was sutured, the normal circulation restored. From September 1993 to November 1995, 11 cases were treated in our hospital. All patients are well postoperatively, and followed up from 5 to 33 months. Ultrasonography revealed patent IVC and hepatic veins in all cases.
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PMID:[Radical operation for Budd-Chiari syndrome under extracorporal circulation with deep hypothermia and circulatory pause]. 959 Jul 55

A retrospective analysis of 131 cases of major vascular surgery, mainly aneurysms of the ascending and descending aorta, was undertaken to determine whether use of different bypass methods chosen according to location of the individual lesions resulted in improved results. For the 93 cases of ascending aortic aneurysm, the method for cardiac protection was improved by the use of continuous retrograde coronary sinus perfusion with cardioplegic blood. In sixteen cases with dissection involving the aortic arch, deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion through the superior vena cava was employed for brain protection. The safe brain circulation arrest time was thus prolonged to the longest record of 81 minutes. Among the group of 93 cases, there were four operative and four hospital deaths, giving a mortality rate of 8.6% (8/93). For the 34 cases of descending aortic aneurysms, left heart bypass was employed to avoid ischemia of the heart, lungs, brain, and the abdominal organs; the operative mortality rate was 8.8% (3/34). In three cases of interrupted aortic arch, separate upper and lower body perfusion under deep hypothermia with low flow rate perfusion for the upper body provided the necessary conditions for radical surgery. In one patient with Budd-Chiari syndrome, a total corrective surgery was achieved under right heart bypass.
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PMID:Extracorporeal circulation for great vessels surgery: a review of 131 cases. 1015 28

Fulminant hepatitis is an emergency because within a few hours, the physician must find the cause of the hepatitis (not identified in 15 to 20% of cases), rule out any contraindication to liver transplantation, verify that it is indicated, and prevent and/or treat the complications associated with liver failure. Viruses (especially hepatitis viruses A and B), drugs, and toxic agents are the most common causes of fulminant hepatitis, with the proportions varying between countries. Hepatitis viruses, the leading cause through 1995-1996, have fallen behind drugs and in particular paracetamol, which is now the leading cause of this disease in Europe and in the United States. There are also other rarer causes: other viruses (e.g., herpes virus HSV1 or 2, hepatitis virus E, parvovirus B19, and chickenpox-herpes zoster), Wilson Disease, acute Budd-Chiari and Reyes syndromes, autoimmune hepatitis, neoplastic infiltration of the liver, hypoxic hepatitis, heatstroke, acute pregnancy-related steatosis, and the HELLP syndrome. Prognosis is essentially determined by neurological status, but is also affected very rapidly by damage to other organs. Liver transplantation has revolutionized the prognosis of fulminant hepatitis, causing survival to increase from 10-20% (all causes combined) to 75-80% at 1 year and 70% at 5 years. These patients can be treated only in specialized centers with access to liver transplantation and to different modern means of liver resuscitation (hypothermia, artificial liver support, albumin dialysis, monitoring intracranial pressure and cerebral perfusion, etc.) -all from the onset of the disease.
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PMID:[Fulminant and subfulminant hepatitis: causes and treatment]. 1957 22


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