Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): The First Reported Case in Brazil Using Standardized Technique with the Capnopen® Nebulizer Device.

BACKGROUND Peritoneal metastasis is a common progression of abdominal-pelvic cancers, and it is associated with poorer oncological prognosis when compared to other metastasis sites. Its treatment has limited results, mainly because of poor bioavailability of chemotherapy within the abdominal cavity after systemic administration. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proposed as a novel method to deliver chemotherapy directly into the peritoneal surface; it combines the effectiveness and response of an intraperitoneal therapy with benefits of a minimally invasive approach. The laparoscopic capnoperitoneum is used to instill chemotherapy particles in a more efficient way for distribution and penetration when compared to peritoneal lavage. In the present study, we describe the first PIPAC performed in Brazil, according to the standard technique previously described with the Capnopen® nebulizer device, as well as technique details based on our literature review. CASE REPORT A 67-year-old man with pancreatic adenocarcinoma metastatic to the liver at first diagnosis underwent systemic treatment with the FOLFIRINOX protocol. After a major clinical response due to systemic treatment, pancreaticoduodenectomy was performed with resection and radiofrequency ablation of hepatic nodules. After 7 months of follow-up, the patient's condition evolved with symptomatic relapse in the peritoneum. Aiming at better control of this site, multiple PIPAC procedures were performed, showing excellent control of the peritoneal cavity disease. The patient had a sustained response in the peritoneal cavity and showed systemic disease progression 6 months after the first PIPAC procedure, which deceased at 20 months after the first PIPAC procedure and 42 months after the primary diagnosis. CONCLUSIONS This report shows that the PIPAC procedure is reproducible elsewhere, with safety and good functional results.

Paced auditory serial addition test (PASAT): a very difficult test even for individuals with high intellectual capability.

OBJECTIVE: To assess the difficulty of paced auditory serial addition test (PASAT) in a population of high intellectual level, under ideal cognitive testing circumstances. METHOD: One hundred medical students underwent PASAT testing. They had slept well the night before, they had eaten before the assessment, they were not using any drugs that could affect the central nervous system and they did not have depression, anxiety or any chronic disease. RESULTS: The average result from the three-second version of PASAT was 57.5% and, from the two-second version, it was 44.3%. CONCLUSION: Even under ideal circumstances, PASAT is a very difficult test for the general population. It may not be ideal for neurologists to screen, assess and follow up patients with cognitive function in multiple sclerosis.

Paced auditory serial addition test (PASAT): a very difficult test even for individuals with high intellectual capability / Teste auditivo compassado de adição seriada (PASAT): um teste muito difícil mesmo para indivíduos com alta capacidade intelectual

OBJECTIVE: To assess the difficulty of paced auditory serial addition test (PASAT) in a population of high intellectual level, under ideal cognitive testing circumstances. METHOD: One hundred medical students underwent PASAT testing. They had slept well the night before, they had eaten before the assessment, they were not using any drugs that could affect the central nervous system and they did not have depression, anxiety or any chronic disease. RESULTS: The average result from the three-second version of PASAT was 57.5 percent and, from the two-second version, it was 44.3 percent. CONCLUSION: Even under ideal circumstances, PASAT is a very difficult test for the general population. It may not be ideal for neurologists to screen, assess and follow up patients with cognitive function in multiple sclerosis.

OBJETIVO: Avaliar a dificuldade do teste auditivo compassado de audição seriada (PASAT) em uma população de alto nível intelectual, sob condições ideais para testes cognitivos. MÉTODO: Cem estudantes de medicina se submeteram ao PASAT. Eles haviam dormido bem na noite anterior, tinham comido antes da avaliação, não estavam em uso de qualquer droga que pudesse afetar o sistema nervoso central e não apresentavam depressão, ansiedade ou qualquer doença crônica. RESULTADOS: A média de acertos na versão de três segundos do PASAT foi 57,5 por cento e, para a versão de dois segundos, a média foi 44,3 por cento. CONCLUSÃO: Mesmo sob condições ideais, PASAT é um teste muito difícil para a população geral. Talvez ele não seja ideal para que os neurologistas triem, avaliem e façam seguimento da função cognitiva na esclerose múltipla.