Prevention of Anastomotic Leakage in Ovarian Cancer Debulking Surgery and Its Impact on Overall Survival.

AIM: The aim of this retrospective study was to investigate the impact of anastomotic leakage on survival rate and to define potential factors of risk and protection from bowel anastomotic leakage in patients with bowel segment resection treated for epithelial ovarian cancer in an accredited high-volume center. PATIENTS AND METHODS: Data of 136 patients treated with bowel resection between 2010 and 2017 were collected. All operations were performed by three accredited gynecological oncologists and by two specialized colorectal surgeons. Survival and anastomotic leakage rates were analyzed as per preoperative treatment, number and localization of anastomoses, grading of ovarian cancer, and protective loop ileostomy. RESULTS: In total, anastomotic leakage was observed in 23 out of 165 anastomoses (13.9%), representing 23 anastomotic leakages in 136 patients (16.9%). The 30-day mortality rate was 0.73%. There was no statistically significant difference in anastomotic leakage rate depending on localization and number of anastomoses (p=0.634). Patients with a protective loop ileostomy (n=22/136 patients) had no anastomotic leakage (0.0%, p=0.021). The anastomotic leakage rate was significantly different in patients without protective loop ileostomy depending on bevacizumab administration [no bevacizumab: 15/111 (13.5%) vs. bevacizumab administration: 4/8 (50.0%), p=0.007]. Tumor-positive resection margins in bowel segments were an independent prognostic factor (relative risk=6.3; 95% confidence intervaI=3.1-12.9). CONCLUSION: In this data set, protective loop ileostomy likely reduced the anastomotic leakage rate after bowel resection in selected cases of ovarian cancer treated with debulking surgery. Especially in patients treated with bevacizumab, protective loop ileostomy should be considered. There was no significant impact of leakage rate on overall survival.

Hypersensitivity myocarditis confirmed by cardiac magnetic resonance imaging and endomyocardial biopsy.

Myocarditis often occurs due to viral infections and postviral immune-mediated responses. Hypersensitivity myocarditis is a rare form of myocarditis. Numerous drugs can induce myocarditis, which is typically reversible after withdrawal of the causative agent. Here, we report a case of hypersensitivity myocarditis that was probably triggered by amoxicillin and that resolved completely with heart failure management as well as discontinuation of the drug. A 68-year-old woman presented with acute chest pain mimicking acute coronary syndromes, but the coronary angiography was normal. A recent history of taking medications, skin rash, and peripheral eosinophilia suggested a diagnosis of hypersensitivity myocarditis, which was confirmed by cardiac magnetic resonance imaging and endomyocardial biopsy.

Do different arterial stiffness parameters provide similar information in high-risk patients for coronary artery disease?

BACKGROUND AND OBJECTIVES: The aim of our study was to compare the values of brachial-ankle pulse wave velocity (baPWV) measured with two different non-invasive methods as predictors of coronary artery disease (CAD) in patients who had undergone coronary angiography. SUBJECTS AND METHODS: From 6373 patients who visited our laboratory for non-invasive procedures, we enrolled 965 consecutive patients undergoing coronary angiography. Data for baPWV and peripheral augmentation index (pAI) were recorded. CAD was defined as greater than 50% stenosis of a major epicardial artery in a coronary angiogram. In addition, the severity of CAD was classified as: none/minimal or 1-, 2-, or 3-vessel disease, based on previous or current angiographic findings. RESULTS: Among 965 subjects, the mean age was 63.7±11.6 years, and 58.2% were male. Compared with subjects without CAD disease, those with CAD showed higher values of baPWV (16.6±3.5 m/sec vs. 15.9±3.4 m/sec, p<0.001), and lower values of pAI (73.5±15.9% vs. 76.0±15.7%, p=0.01). When the severity of CAD was expressed as none/minimal or 1-, 2-, or 3-vessel disease, there was a significant association between the extent of CAD and baPWV (p<0.001). In univariate analysis, high PWV and low pAI were associated with an increased prevalence of CAD (p<0.001). CONCLUSION: Increased baPWV and decreased pAI were associated with the presence of CAD in the elderly.