|Discussion in 'All Categories' started by Amjed - Jul 14th, 2014 8:44 am.|
|My dear thank you so much for your cooperation ,
I am the Iraqi doctor who call you this morning about my mother condition,I will present her case to you as following;
She is 64 years old lady,just 7 days ago she complained from frank painless haematuria , preceded by generalized weakness ,loss of appetite,loss of weight,depression,pale skin,
Then she consult a urosurgeon who ask here to do blood ,urine tests and CT scan and the result was;
Blood sugar 92 mg/dl
Blood urea 32 mg/100 ml
S.uric acid 6.3
CT scan of the abdomin ( native and dynamic iv contrast study :
Nearly 5.5 by 5 by 4.4 cm well defined cortical right renal soft tissue mass is seen with exophytic growth,central area of
break down and no calcification.
The mass showed significant enhancement within arterial phase after IV contrast injection with rapid wash out more than
normal renal tissue in delayed phases.
The mass not extend beyond Gerotas fascia with no major vascular or regional organs invasion ,no regional LAP,
but Perinephric evident abnormal vessels and fat stranding are seen with normally functioning kidney.
Abnormal intra-renal vascularity are seen goes with AV fistula with presence of upper pole 5 mm stone.
Left kidney in size and function.
Conclusion :? right renal cell carcinoma
Then the decision of the urosurgeon is to do Radical Nephrectomy ,since the patient is known case of Myocarial infarction for 5 years ago,also she is has bronchial asthma ,then the urosurgeon ask to be evaluated by cardiologist to assess her fitness for surgery under GA;
The report of cardiologist was as following :
Moderate LV systole
Dystolic EF = 36%
She has high risk for the operation .
My questions are;
1-Is the risk will be the same in your hospital ?
2- what type of anasthesia for this specific case your hospital will do?General anasthesia or spinal?
3-what type of surgery ? Anterior approach or laparoscopic operation?
4- what about the estimated cost in your hospital ?
My best regards and wishes
Dr. Amjed Aljabri
re: RenL cell carcinoma by Dr.J S Chowhan - Jul 15th, 2014 4:00 pm
Dr.J S Chowhan
|Dear Dr Amjed Aljabri
Your mother is definitely high risk patient because of the H/O Myocardial Infarction. She will require pre operative Stress Thallium scan to see the viable heart muscle. Ideally the patients with boiopsy proven malignant disease should undergo open surgery because retrieval in minimal accesss surgery can lead to seedling of the cancer cells. The surgery will be done under general anasthesia. The estimated cost of this operation will be around USD 8000/ (Eight Thousand US dollars.)
Dr J S Chowhan
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