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

Three new aspects of the operative treatment of renal cell carcinoma can be made out: 1. for the removal of tumor thrombus extending to the right atrium, the surgical technique of choice involves whole-body hypothermia and extra-corporeal circulation. Only in this way can these tumors be removed completely under good vision. 2. Provided the patient's contralateral kidney is healthy, even small peripheral renal tumors should be submitted to radical nephrectomy. The rate of concomitant small tumors is reported to be as high as 20, while the recurrent rate associated with local incision is just on 7%, and the risk of carcinomas developing in the contralateral kidney is only 1.8-3.8%. 3. Radical nephrectomy for tumor should continue to include the ipsilateral adrenal gland. Although in our own patients the incidence of simultaneous adrenal metastasis was only 1.4%, if the adrenal gland is left in situ, part of the renal capsule also has to be left behind, and the upper pole of the kidney dissected free, with the associated risk of disseminating tumor cells.
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PMID:[Concepts in surgical therapy of kidney cancer]. 139 90

Review of our experience in the diagnosis and treatment of 44 patients with inferior vena cava tumoral thrombosis (IVCTT), associated or not to other neoplastic processes: 34 hypernephroma, 2 cava leiomyosarcoma, 1 paratesticular rhabdomyosarcoma and 1 biphasic synovial sarcoma. Twenty-five patients with hypernephroma and tumor thrombi in the ipsilateral renal vein only were excluded from the analysis since this fact did not change the usual therapeutic approach. In the 19 remaining patients, concomitantly to the primary tumour exeresis a thrombectomy was performed, using cavotomy with proximal and distal clamping in 11 patients and cardiopulmonary by-pass, deep hypothermia and cardiocirculatory arrest in 8 patients. The paper analyzes the radiological investigations performed in order to reach a IVCTT diagnosis, and reviews the related literature.
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PMID:[Tumor thrombosis in inferior vena cava: diagnostic imaging and therapeutic approximation]. 150 99

A case of recurrent intravenous leiomyomatosis with cardiac extension and a temporally extended presentation is described. Complete excision was achieved employing simultaneous sternotomy and laparotomy and deep hypothermia with circulatory arrest. Coronary revascularization was performed concomitantly with complete tumor resection. Diagnostic, operative, and pathologic considerations are reviewed and a preferred surgical approach discussed.
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PMID:Recurrent intravenous leiomyomatosis with cardiac extension. 172 22

This study reviews eight patients, 39-63 years old, with tumor-related obstruction of the inferior vena cava (IVC) extending into the right atrium (n = 5) and ventricle (n = 3). Five patients suffered from renal cell carcinoma, 3 from sarcomatous disease. The general approach was a median sternotomy and laparotomy with hypothermic circulatory arrest (17.0-20.5 degrees C; 23-46 min) in six patients, while in two patients, the IVC was clamped sequentially under moderate hypothermia and extracorporeal circulation. Four patients had tumor infiltration of the IVC necessitating partial caval resection. In three, the IVC was reconstructed by fabric patches or tubular prothesis. In one patient, the continuity of the IVC was interrupted permanently. Three patients underwent nephrectomy during the same procedure, two before and one after IVC disobliteration. In one patient each, pulmonary embolectomy and intrahepatic IVC stenting were performed. Two patients died early, one due to uncontrollable hemorrhage the other due to non-cardiogenic pulmonary edema. Six patients were discharged in good physical condition and are still alive at a mean follow-up of 24 months. Five patients have since remained free of recurrence, one patient underwent three further surgical interventions for bone metastases. We feel that IVC desobliteration is feasible in selected cases with extended tumor-related obstruction with an acceptable early risk and late outcome.
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PMID:Tumor-related obstruction of the inferior vena cava extending into the right heart--a plea for surgery in deep hypothermic circulatory arrest. 177 82

The incidence of renal cell carcinoma with a vena caval tumour thrombus has been reported in the literature, form 4% to 19%. Vena caval involvement causes serious diagnostic and therapeutic problems. Surgical treatment is usually conditioned by the tumor thrombus cranial extension and the possible invasion of the vena caval wall. Using Diagnostic Imaging (ECHO, CAT, MRI) we are able to establish the real presence, dimension and extension of the tumor thrombus, but we can not evaluate precisely its nature or the infiltration of the vena caval wall. We report our own experience in 27 patients with renal cell carcinoma extending into the vena cava (22 cases with tumor thrombus extending under the diaphragm and 5 cases over the diaphragm) and describe our favourite approach for thrombus extending into the right atrium using extracorporeal circulation, profound hypothermia and cardiac arrest (3 cases). From our data, we believe that the vena cava involvement doesn't make the prognosis any worse, if it isn't associated with the infiltration of the vena caval wall and nodal disease.
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PMID:[Surgical treatment of caval thrombosis caused by parenchymal renal neoplasms]. 183 Jun 71

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

Six female and 4 male patients (age, 23 to 75 years) underwent operation for difficult intracranial lesions. Preoperative diagnoses included four giant intracranial aneurysms, three base of skull glomus jugulare tumors, two arteriovenous malformations, and one cerebellar hemangioblastoma. All lesions were inoperable or nearly so by standard neurosurgical techniques. All patients were placed on total bypass via groin cannulations. Bypass times ranged from 111 to 269 minutes (mean, 174 minutes) with cooling times of 26 to 83 minutes (mean, 48 minutes) and warming times of 68 to 110 minutes (mean, 83 minutes). Circulatory arrest times ranged from 1.25 to 60 minutes with 1 patient not requiring arrest. The lowest core temperatures recorded varied from 8.4 degrees to 13.7 degrees C. There was one postoperative death and one major complication, both in patients with arteriovenous malformations. Eight patients (80%) have achieved an excellent result. Profound hypothermia with the option of circulatory arrest and exsanguination has been an indispensable adjunct to the safe management of intracranial aneurysm, glomus jugulare tumor, and hemangioblastoma.
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PMID:Cardiopulmonary bypass, profound hypothermia, and circulatory arrest for neurosurgery. 151 May 42

A patient who had a 5-year history of a low-grade nongenital pelvic leiomyosarcoma was evaluated for worsening dyspnea, hypertension, and jugular venous distension. An echocardiogram revealed a large right atrial mass. At surgical exploration, metastatic leiomyosarcoma was found within the inferior vena cava extending from below the renal veins up into the right atrium. Using cardiopulmonary bypass with profound hypothermia and circulatory arrest, the inferior vena cava was opened below the renal veins, and the tumor was transected. That portion of the tumor above this transection was then extracted through a right atriotomy. Resection of the pelvic tumor was not thought to be feasible. The patient remains asymptomatic with stable pelvic tumor 1 year after the procedure.
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PMID:Nongenital pelvic leiomyosarcoma metastatic to the heart. 195 93

In the last 25 years, there have been extraordinary advances and new developments in diagnosis and surgical treatment for cardiac tumors. New diagnostic methods have almost replaced the need for cardiac catheterization and ventriculography. During cardiopulmonary bypass the myocardium can be protected by means of hypothermia and cardioplegia. Various techniques have been developed to excise cardiac tumors. Depending upon the site and the extent of the neoplasm, additional cardiac repair may be required, including bypass grafting or valve replacement. Primary tumors of the heart are usually intracavitary lesions and more than 75% are benign. Myxomas are the most common cardiac tumors. They are usually attached to the intraatrial septum in the left atrium close to the fossa ovalis. Left atrial myxomas must be distinguished from mitral valve disease, since the clinical presentation may suggest rheumatic feaver and acute myocarditis. Since 1957 we have operated upon 71 patients with myxomas with no deaths. Removal of a myxoma should be undertaken more aggressively and thoroughly than formerly was recommended. Rhabdomyomas are usually multiple tumors, and most often they involve the ventricular myocardium. Because these tumors do not grow rapidly, surgical resection can be successful. It the tumor is large, it can be partially resected to release the obstruction. We have operated upon 3 patients with this tumor. Cardiac fibromas are the second most common tumor in infants and children. These are usually solitary tumors which compress the surrounding structures as they grow. Complete excision of fibromas is difficult since the tumors tend to grow large. We have operated upon 11 patients with this tumor.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical treatment of cardiac neoplasms: 32-year experience. 223 99

On rats hypothermia of 22 to 20 degrees C and rewarming to normal body temperature leads to an amplification of the hyperglycemic tumor acidification. Mechanism and significance of this effect are discussed.
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PMID:[Intensification of hyperglycemic tumor hyperacidity by hypothermia]. 224 11


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