RESUMO
El paciente oncológico de cuidados paliativos puede presentar una variedad importante de condiciones clínicas que producen sufrimiento y disminución en la calidad de vida; esto se presenta como un reto para el clínico en la identificación y correcto abordaje de los pacientes. El dolor se ha considerado por años como el síntoma cardinal a tratar en el paciente oncológico, donde se deben considerar sus condicionantes fisiopatológicos, la farmacología de las intervenciones, los posibles efectos secundarios y los condicionantes familiares, sociales y personales del dolor, pero a pesar de su relevancia, no es el único síntoma, estando acompañado de un abanico de patologías, como las afectaciones gastrointestinales, pulmonares, vasculares, hematológicas y neurológicas, que favorecen la pérdida de capacidad del paciente y, en muchas ocasiones, la muerte. Se realizó una revisión actualizada en bases de datos como EMBASE, PUBMED, SCIELO, además de la revisión de guías de asociaciones internacionales con el objetivo de acercar a todos los médicos, sin distinguir su especialidad o área de trabajo, al abordaje y manejo del paciente oncológico en cuidado paliativo, favoreciendo la sensibilización con estas patologías y la importancia en el curso de vida de los pacientes.
The palliative care cancer patient can present a significant variety of clinical conditions that produce suffering and a decrease in the quality of life. This is a challenge for the clinician in the identification and correct approach of patients. Pain has been considered for years as the cardinal symptom to be treated in cancer patients, where its pathophysiological factors, the pharmacology of the interventions, possible side effects and the family, social and personal conditions of pain must be considered, but despite its relevance is not the onset of symptoms and is accompanied by a range of pathologies such as gastrointestinal, pulmonary, vascular, hematological and neurological affectations that favor the loss of capacity of the patient and in many cases death. An updated review was carried out in databases such as EMBASE, PUBMED, SCIELO in addition to the revision of guides from international associations with the aim of bringing all doctors without distinguishing their specialty or area of work to the approach and management of cancer patients in palliative care favoring awareness of these pathologies and their importance in the life course of patients.
Assuntos
Humanos , Cuidados Paliativos/métodos , Dor do Câncer/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Síndrome da Veia Cava Superior/diagnóstico , Síndrome de Lise Tumoral/diagnóstico , Emergências , Tromboembolia Venosa/diagnóstico , Obstrução Intestinal/diagnóstico , Morfina/uso terapêutico , Neoplasias/complicaçõesRESUMO
RATIONALE: Total absence of superior vena cava (ASVC) is a very rare anomaly, and the patient usually suffers from superior vena cava syndrome (SVCS) or conduction disturbances. PATIENT CONCERNS: We report a 36-year-old white male, born and living in Brazil, without comorbidities presented to hematologist thrombotic episodes even under anticoagulant therapy. On his first hematologic appointment, he had no active complaints except by the fullness after meals, and his physical examination presented remarkable collateral circulation in the chest. DIAGNOSES: Congenital ASVC associated with factor V Leiden mutation. OUTCOMES: In his magnetic resonance angiography of the thorax, a great amount of collateral circulation and communication of the azygos and hemiazygos veins with inferior vena cava were evident, as well as the absence of the upper cava vein. Furthermore, heterozygous genetic mutation was found for Leiden factor V. LESSONS: This case gives us the lesson that we need to include ASVC in the differential diagnosis of SVCS. The importance of the V-Leiden factor as a joint risk with this congenital defect for venous thromboembolism episodes was also highlighted.
Assuntos
Fator V/genética , Mutação , Malformações Vasculares/patologia , Veia Cava Superior/anormalidades , Trombose Venosa/diagnóstico , Adulto , Anticoagulantes/uso terapêutico , Veia Ázigos/anormalidades , Veia Ázigos/diagnóstico por imagem , Brasil , Circulação Colateral , Diagnóstico Diferencial , Evolução Fatal , Heterozigoto , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Síndrome da Veia Cava Superior/diagnóstico , Síndrome da Veia Cava Superior/etiologia , Tórax/irrigação sanguínea , Tórax/diagnóstico por imagem , Tórax/patologia , Tomografia Computadorizada por Raios X/métodos , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem , Veia Cava Superior/patologia , Trombose Venosa/etiologiaRESUMO
Resumen: Se presentan dos casos clínicos de obstrucción de vena cava superior derecha en el postoperatorio alejado de cardiopatía congénita (comunicación interauricular tipo seno venoso asociada a drenaje venoso pulmonar anómalo parcial). Se analizan formas de presentación clínica, procedimiento diagnostico, resolución terapéutica y evolución.
Summary: The study presents the case of two patients who underwent the surgical repair of a congenital heart disease (atrial septal defect and partial anomalous venous drainage), developed in the long term postoperative course, obstruction of the superior vena cava. Clinical features, diagnosis and treatment and long-term follow up are included in this report.
Assuntos
Humanos , Masculino , Período Pós-Operatório , Síndrome da Veia Cava Superior/terapia , Angioplastia Coronária com Balão , Síndrome da Veia Cava Superior/diagnóstico , Cardiopatias Congênitas/cirurgiaRESUMO
Se presentan dos casos clínicos de obstrucción de vena cava superior derecha en el postoperatorio alejado de cardiopatía congénita (comunicación interauricular tipo seno venoso asociada a drenaje venoso pulmonar anómalo parcial). Se analizan formas de presentación clínica, procedimiento diagnostico, resolución terapéutica y evolución.
Assuntos
Humanos , Masculino , Pré-Escolar , Síndrome da Veia Cava Superior/terapia , Período Pós-Operatório , Angioplastia Coronária com Balão , Síndrome da Veia Cava Superior/diagnóstico , Cardiopatias Congênitas/cirurgiaRESUMO
Objetivos: Mostrar la conducta realizada en este síndrome. Material y Métodos: Serie retrospectiva de 5 casos tratados entre el 1 de abril de 1995 y el 31 de marzo de 2013. Diagnóstico por imágenes y toma de biopsia con tratamiento específico posterior. Resultados: Todos se debieron a causas tumorales: 2 timomas (uno irresecable), 1 linfoma Hodgkin, 1 leiomiosarcoma de vena cava y 1 caso de cáncer pulmonar a pequeñas células. Fallecieron por progresión de enfermedad 2 casos, 2 están libres de enfermedad a 12 y 11 meses de tratamiento y 1 enfermo se perdió en el seguimiento. Conclusiones: Se define la necesidad de seguir un algoritmo que determine los pasos a seguir ante la presencia de este síndrome.
Objectives: Management in this syndrome. Material and Methods: Retrospective series of 5 cases treated between April 1, 1995 to March 31, 2013. Diagnostic imaging and taking biopsy with subsequent specific treatment. Results: All patients were due to tumor causes: 2 thymomas (one unresectable), 1 lymphoma Hodgkin, 1 Leiomyosarcoma of vena cava and 1 case of small cell lung cancer. Died of disease progression 2 cases, 2 are free of disease to 12 and 11 months of treatment and 1 patient was lost to follow-up. Conclusions: The need to follow an algorithm which determines the steps to follow in the presence of this syndrome is defined.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Neoplasias do Mediastino/complicações , Síndrome da Veia Cava Superior/cirurgia , Síndrome da Veia Cava Superior/diagnóstico , Síndrome da Veia Cava Superior/etiologia , Biópsia , Neoplasias do Mediastino/cirurgia , Neoplasias do Mediastino/patologia , Estudos Retrospectivos , Síndrome da Veia Cava Superior/patologiaRESUMO
Superior Cava Venous Syndrome (SVCS) encompasses a constellation of signs and symptoms resulting from partial or complete obstruction of blood flow through the superior vena cava (SVC) to the right atrium. Thrombosis can be caused by intrinsic (primary) or extrinsic compression (with or without secondary thrombosis). The causes of SVCS can be grouped according to their etiology in non-neoplastic and neoplastic. The causes malignant correspond to 65-90% of them, thrombosis and nonmalignant conditions are another causes. The presentation may be acute, clinically characterized by dyspnea and a characteristic triad (facial, neck and arms edema, cyanosis and collateral circulation). Early detection improves prognosis and is based on clinical data and imaging studies. We describe 8 cases where the SVCS was the first manifestation of neoplastic diseases. Patients were predominantly of middle-aged, male, without association with consumption of tobacco and lymphoma was most frequent diagnosis.
Se denomina Síndrome de Vena Cava Superior (SVCS) al conjunto de signos y síntomas derivados de la obstrucción parcial o completa del flujo sanguíneo a través de la vena cava superior (VCS) hacia la aurícula derecha. Puede ser causada por trombosis intrínseca (primaria) o a compresión extrínseca (asociada o no a trombosis secundaria) Las causas de SVCS pueden ser agrupadas según su etiología en no neoplásicas y neoplásicas. Las causas malignas corresponden a un 65-90% del total de las causas, la trombosis y las condiciones no malignas son las causantes del resto de los casos. La forma de presentación puede ser aguda, caracterizándose clínicamente por disnea y la triada característica (edema en esclavina, cianosis facial y presencia de circulación colateral). La detección precoz mejora el pronóstico y se asienta sobre los datos clínicos y estudios por imágenes. Presentamos 8 casos registrados en nuestro hospital, donde el SVCS fue la manifestación inicial de enfermedades neoplásicas. En esta serie hubo predominancia de varones de edad media, sin asociación con consumo de tabaco y el diagnóstico más frecuente fue linfoma.
Assuntos
Doença de Hodgkin/complicações , Linfoma não Hodgkin/complicações , Síndrome da Veia Cava Superior/etiologia , Adolescente , Adulto , Diagnóstico Precoce , Feminino , Doença de Hodgkin/diagnóstico , Humanos , Linfoma não Hodgkin/diagnóstico , Masculino , Mediastinoscopia , Pessoa de Meia-Idade , Síndrome da Veia Cava Superior/diagnóstico , Adulto JovemRESUMO
Superior Cava Venous Syndrome (SVCS) encompasses a constellation of signs and symptoms resulting from partial or complete obstruction of blood flow through the superior vena cava (SVC) to the right atrium. Thrombosis can be caused by intrinsic (primary) or extrinsic compression (with or without secondary thrombosis). The causes of SVCS can be grouped according to their etiology in non-neoplastic and neoplastic. The causes malignant correspond to 65-90
of them, thrombosis and nonmalignant conditions are another causes. The presentation may be acute, clinically characterized by dyspnea and a characteristic triad (facial, neck and arms edema, cyanosis and collateral circulation). Early detection improves prognosis and is based on clinical data and imaging studies. We describe 8 cases where the SVCS was the first manifestation of neoplastic diseases. Patients were predominantly of middle-aged, male, without association with consumption of tobacco and lymphoma was most frequent diagnosis.
Assuntos
Doença de Hodgkin/complicações , Linfoma não Hodgkin/complicações , Síndrome da Veia Cava Superior/etiologia , Adolescente , Adulto , Adulto Jovem , Diagnóstico Precoce , Doença de Hodgkin/diagnóstico , Feminino , Humanos , Linfoma não Hodgkin/diagnóstico , Masculino , Mediastinoscopia , Pessoa de Meia-Idade , Síndrome da Veia Cava Superior/diagnósticoRESUMO
Superior Cava Venous Syndrome (SVCS) encompasses a constellation of signs and symptoms resulting from partial or complete obstruction of blood flow through the superior vena cava (SVC) to the right atrium. Thrombosis can be caused by intrinsic (primary) or extrinsic compression (with or without secondary thrombosis). The causes of SVCS can be grouped according to their etiology in non-neoplastic and neoplastic. The causes malignant correspond to 65-90
of them, thrombosis and nonmalignant conditions are another causes. The presentation may be acute, clinically characterized by dyspnea and a characteristic triad (facial, neck and arms edema, cyanosis and collateral circulation). Early detection improves prognosis and is based on clinical data and imaging studies. We describe 8 cases where the SVCS was the first manifestation of neoplastic diseases. Patients were predominantly of middle-aged, male, without association with consumption of tobacco and lymphoma was most frequent diagnosis.