RESUMEN
INTRODUCTION: This case report illustrates the significant role that 3D technology can play in major hepatic surgery, aiding in the determination of the optimal surgical approach. CASE PRESENTATION: We present the case of a patient with metachronous liver metastasis from rectal cancer involving segments 6 and 7, extending to retroperitoneal structures such as the inferior vena cava (IVC) and the right renal vein (RRV). DISCUSSION: After confirming the feasibility of a right hepatectomy, we opted for a traditional posterior approach, avoiding the hanging maneuver. The 3D rendering was instrumental in this decision, revealing that the mass was in close proximity to the IVC at the 11 o'clock position, a critical area for surgical instruments during the hanging maneuver. CONCLUSION: When 2D imaging fails to provide sufficient information, 3D rendering can substantially aid the decision-making process.
RESUMEN
Gastric metastasis by solid tumor cancer is a rare event. Concomitant metastases to other organs are frequent, so that this condition is often associated to a poor prognosis. Upper gastrointestinal bleeding and anemia are the most common presenting symptoms. We present the case of a 81 years old women previously treated for cervix carcinoma showing later a stomach metastasis. The patient is alive and disease free 39 months after salvage gastrectomy. A radical surgery in selected patients could be useful for symptom palliation and prolonged survival.
Asunto(s)
Neoplasias Gástricas/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Anciano de 80 o más Años , Cuello del Útero/patología , Supervivencia sin Enfermedad , Femenino , Gastrectomía , Humanos , Metástasis de la Neoplasia , Estómago/patología , Neoplasias Gástricas/secundario , Neoplasias del Cuello Uterino/patologíaRESUMEN
Chronic pain is a common and disabling disorder with major consequences for patient quality of life and it is also a major economic burden to society. The management of chronic pain comprises a large range of different intervention strategies including pharmacological therapy, non-medicinal and invasive therapeutic options. While non-pharmacological and multimodal options are underused, monomodal options, especially pharmacotherapy and invasive therapies are overused. The effectiveness of multidisciplinary and multimodal treatment programs including physical and rehabilitation interventions and psychological treatment has been extensively studied in the last two decades. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy alone, there is some evidence for the effectiveness of behavioral therapy and there is at least moderate evidence for the effectiveness of multidisciplinary and multimodal treatment and other active treatment reducing pain and increasing functional capacity at short and intermediate term. Therefore, blanket coverage with provision of adequate treatment programs for chronic pain as well as studies evaluating the best composition of treatment elements are needed. The characteristics of chronic pain, the necessary assessment procedures and treatment types are described.