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Point-of-Care Ultrasound
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
The purpose is to identify volume status of the patient using ultrasound.Look for the status in subcostal view. If the walls of the left ventricles (LV) are approximating or “kissing” (gap between walls ≤ 2.5 cm), then hypovolaemia is likely. If the gap between the LV walls is approximately > 6 cm, then hypervolaemia/poor systolic function is likely.One can also look for the inferior vena cava (IVC) diameter.Correlation of IVC diameter with central venous pressure (CVP):IVC diameter < 1.5 cm with 100% collapsibility: Approximate CVP is 0–5 mmHg.IVC diameter 1.5–2.5 with > 50% collapsibility: CVP approximates 5–10 mmHg.IVC diameter 1.5–2.5 with < 50% collapsibility: CVP is 10–15 mmHg.IVC diameter > 2.5 with no collapsibility: CVP approximates > 20 mmHg.
Pediatric and Fetal Autopsies
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Stefano D’Errico, Angelo Montana, Giulio Di Mizio, Monica Salerno
By retracting the apex of the heart toward the right, it will be possible to examine the connections of the pulmonary veins to the left lung and the left atria. Retracting the heart to the left, the right pulmonary veins can be observed in the opening between the superior vena cava and the heart. The great vessels must be observed, in particular for arteries branching from the aortic arch and from the ductus arteriosus. Aortic arch and descending aorta could be easily observable, moving the left lung outside the pleural cavity. The inferior vena cava is present in the middle of the inferior (diaphragmatic) surface (Figure 3.42).
Cardiac Ultrasound
Published in John McCafferty, James M Forsyth, Point of Care Ultrasound Made Easy, 2020
Nick B Spath, Anoop SV Shah, Shirjel R Alam
Using the subcostal window as described previously, the inferior vena cava can be seen within the liver and where it connects with the right atrium. With respiration its diameter varies, decreasing in calibre with inspiration in normal physiology, remaining persistently increased throughout respiration in right heart pressure and volume overloaded states, and paradoxically increasing with inspiration in restrictive physiology, the Kussmaul effect. As a general rule, an inferior vena cava diameter of 1.5–2.5 cm can be considered normal and collapses up to 50% with inspiration. Less than 1.5 cm diameter indicates underfilling, >2.5 cm with and without collapse indicates increasing degrees of overfilling with raised right-sided pressures.
Orthotopic kidney transplantation survival and complications: systematic review and meta-analysis
Published in Arab Journal of Urology, 2022
Carlos Alfredo Castillo-Delgado, Herney Andrés García-Perdomo, Mireia Musquera, Antonio Alcaraz
Although case reports were not included, we also wanted to describe a few characteristics from them. Three manuscripts reported cases from young people with specific conditions indicating the orthotopic transplant, such as multiple pelvic arteriovenous malformations, congenital abnormalities, multiple pelvic and abdominal surgeries, and twin pregnancy [18,21,22]. In addition, two papers described people older than 60 years with multiple comorbidities and severe aortoiliac atherosclerosis [23,24]. Rodrigues et al. described four cases (two young people and two older than 60 years old) with severe atherosclerosis [25]. Furthermore, Chan et al. showed three patients (two young and one older than 60 years old) with inferior vena cava (IVC) thrombosis or stenosis [26]. On the other side, Novotny et al. described a patient with a papillary renal cell carcinoma recurrence who underwent radical nephrectomy, along with an OKT [27]. Unfortunately, all those case reports did not show any overall or kidney survival information and associated complications.
A case of a borderline adrenal oncocytoma in a 62-year old female
Published in Acta Chirurgica Belgica, 2022
Olivia Behaeghe, Bernard Geurde, Jean-Luc Jourdan, Céline Bodson, Benoît Seydel, Daniel Lacremans
The patient undergoes surgery for the resection of the tumor. Given the size and the uncertainty of the aspect, we opt for an open surgery under general anaesthesia. She is placed in dorsal decubitus with a 30° left tilt. A right subcostal incision is made to access the abdominal cavity. The superior and inferior right hepatic triangular ligaments are divided and the surrenal mass is visualized. The aspect of the mass is inflammatory, fixed and adherent to the adjacent structures. The liver is reclined up to the inferior vena cava. The dissection is carried out in a circular manner around the tumor. We free the superior part of the kidney while controlling the diaphragmatic vessels. The median adrenal vein is visualized and sutured on the lateral margin of the vena cava for haemostatic control. The arterial vascularization is controlled with a clip. The mass is mobilized anteriorly and is progressively detached from the kidney and the right renal vein. There is a small rim of normal surrenal tissue at the lateral right border of the vena cava that needs a separate resection. A small retrocaval cellulo-fatty blade is also resected in a second time. A drain is placed in the tumorectomy cavity.
An expert spotlight on inferior vena cava filters
Published in Expert Review of Hematology, 2021
Anil Pillai, Manoj Kathuria, Maria del Pilar Bayona Molano, Patrick Sutphin, Sanjeeva P Kalva
Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). The incidence of VTE is on the rise with an estimated incidence of over 900,000 people annually (1–2 per 1000) [1,2]. Anticoagulation is the standard of care for patients with VTE with a low risk of recurrent VTE and a good safety profile [3]. Inferior vena cava (IVC) filters were introduced as a minimally invasive alternative to surgical ligation of the IVC to prevent embolization of lower extremity DVT to the lungs, especially for those unable to receive standard anticoagulation therapy. The IVC filter spans the diameter of the IVC and acts as a mechanical trap for large emboli while preserving venous return. The design and role of the IVC filter have evolved over time resulting in a variety of IVC filter types and expanded indications. This review is based on manuscripts/abstracts published from 1960 to 2021 on venous thromboembolism and IVC filters. The list of the manuscripts/abstracts was generated through a literature search on PubMed. The search terminology included ‘inferior vena cava filters,’ ‘venous thromboembolism,’ ‘deep venous thrombosis’, and ‘pulmonary embolism.’ Relevant studies were reviewed.