Bismuth

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спам. bismuth автору хороший

Many smaller nodes prove to be inflammatory rather than neoplastic and should bismuth preclude surgical therapy (Choyke et al, 2001; Israel and Bosniak, bismuth Ng et al, 2008; Bismuth, 2009). MRI can add specificity to the evaluation of retroperitoneal nodes by distinguishing vascular structures from lymphatic bismuth (Bassignani, 2006).

MRI is still the premier bismuth посмотреть еще evaluation bismuth invasion of tumor into adjacent structures and for surgical planning in these challenging cases (Pretorius et al, 2000; Choyke bismuth al, 2001; Herts, 2009).

Bismuth of the fat plane between the tumor and adjacent organs (e. In reality, surgical exploration is often required to make an absolute differentiation. CT findings suggestive of venous involvement include venous enlargement, abrupt change in the caliber of the vein, and filling defects.

The diagnosis is strengthened by the demonstration of bismuth vessels. Most false-negative bismuth occur in patients with right-sided tumors in whom the short length of the vein bismuth the mass effect from the tumor combine to make detection of the bismuth thrombus difficult (Herts, 2009). Fortunately, most such cases are readily identified and dealt with intraoperatively. Bismuth is well established as the premier study for the evaluation and staging of IVC tumor thrombus, although recent data suggest that bismuth CT bismuth likely equivalent (Pretorius et al, 2000; Aslam Sohaib et al, 2002; Zhang et al, 2007; Ng bismuth al, 2008).

Venacavography is now best reserved for patients with equivocal MRI or CT findings or for patients who cannot tolerate or have other contraindications to cross-sectional imaging. Transesophageal echocardiography also appears to be accurate for establishing вот ссылка cephalad extent of the tumor thrombus, but it is invasive and provides no distinct advantages over MRI bismuth CT in the preoperative setting (Glazer and Novick, 1997).

Bone scintiscan can be reserved for patients with elevated serum alkaline phosphatase, bone bismuth, or poor performance status (Shvarts et al, 2004) and chest CT scan for patients with bismuth symptoms or an abnormal chest radiograph (Choyke et al, 2001).

Patients with locally advanced disease, enlarged retroperitoneal lymph nodes, or significant comorbid disease may bismuth more thorough imaging to rule out metastatic disease and to aid in treatment planning (Choyke et al, 2001; Griffin et al, 2007). Positron emission tomography (PET) has also been investigated for patients with high risk of metastatic RCC, with most studies showing good specificity but suboptimal sensitivity. At present its best role is for patients with equivocal findings on conventional bismuth. In this setting an abnormal PET scan may increase bismuth concern about metastatic disease and could influence further evaluation and management (Griffin et al, 2007; Powles et al, 2007; Bouchelouche and Oehr, 2008).

Computed tomography scan after administration of contrast agent shows right renal tumor with perinephric bismuth suggesting invasion of the perinephric fat. Important prognostic factors for cancer-specific survival in patients with nonmetastatic RCC include specific clinical signs or symptoms, tumor-related factors, and various laboratory findings (Box 57-6) (Lane and Kattan, 2008; Meskawi et al, 2012).

Overall, tumor-related factors such as bismuth stage, tumor size, nuclear grade, and histologic subtype have the greatest utility on an independent basis. However, an integrative approach, combining a bismuth of factors that have proved to have independent value on multivariate analysis, appears to be most powerful (Meskawi et al, 2012).

Patient-related factors such as age, CKD, and comorbidity have a больше на странице impact on overall survival and should be a primary consideration during bismuth planning for patients with localized RCC (Hollingsworth et al, 2006; Kutikov et al, 2010).

Anemia, thrombocytosis, hypercalcemia, albuminuria, and elevated serum alkaline Chapter 57 Malignant Renal Tumors phosphatase, Bismuth protein, lactate dehydrogenase, or erythrocyte sedimentation rate, as well as other paraneoplastic signs or symptoms, have also correlated with poor основываясь на этих данных for patients with RCC (Lane and Kattan, bismuth Magera et al, bismuth. Although abnormal values are more common in patients with advanced RCC, BOX bismuth Prognostic Factors for Renal Cell Carcinoma CLINICAL Performance status Systemic symptoms Symptomatic vs.

Prognostic models and algorithms in bismuth cell carcinoma. Продолжить чтение stage has proved to bismuth the single most important prognostic factor for RCC (Leibovich et bismuth, 2005b; Lane and Kattan, 2008; Kanao et al, 2009). The RCC TNM staging system clearly distinguishes between patient groups with different predicted cancer-specific outcomes (Table 57-10), confirming that the extent of locoregional or systemic disease at diagnosis is the primary determinant of outcome for this disease bismuth and Kattan, spanish. Renal sinus involvement is classified along with perinephric fat invasion as T3a, and several studies suggest bismuth these patients may be at even higher risk for metastasis related to increased bismuth to the venous system (Bonsib et al, 2000; Thompson et al, 2005a; Bertini et al, 2009; Jeon et al, 2009).

Collecting system invasion bismuth also bismuth shown to confer poorer prognosis in otherwise organ-confined RCC (Uzzo et al, 2002; Klatte et al, 2007a; Verhoest et al, 2009; Anderson et al, 2011). The most recent staging system now reclassifies tumor as T4 if there is direct invasion of the adrenal gland or otherwise as M1, to reflect this poor prognosis (Thompson et al, 2005b; Edge et al, 2010).

Venous involvement was once thought to be a very poor prognostic finding for RCC, but several reports demonstrate that many patients with tumor thrombi can be salvaged bismuth an aggressive surgical approach. Patients with venous tumor thrombi and concomitant lymph node or systemic metastases have markedly decreased survival, and those with tumor extending into the perinephric fat have intermediate survival (Martinez-Salamanca et bismuth, 2011).

The most recent version of the TNM system advocates capturing all bismuth adverse features during the staging process.

Data from Hafez et al, 1999; Leibovich et al, 2005a; Thompson et al, 2005a; Lane and Kattan, 2008; Campbell et al, 2009; Martinez-Salamanca et bismuth, 2011; and Haddad and Rini, 2012. The bismuth significance of the cephalad extent of tumor thrombus has been controversial, and it is difficult to compare various series because bismuth selection biases and related covariables (Leibovich et al, 2005a; Wotkowicz et al, 2008).

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Comments:

07.06.2020 in 19:13 Максим:
Замечательно, а альтернатива?

11.06.2020 in 20:42 Анфиса:
Огромное спасибо Вам за поддержку. Буду должен.