Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience.

OBJECTIVES: A combination of cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) was performed for the treatment of primary and secondary pleural malignancies. We describe the perioperative management and our clinical experience. METHODS: Between September 2008 and August 2011, eight patients with pleural manifestation of thymoma (Masaoka stage IVa) and eight patients with malignant pleural mesothelioma (MPM) were prospectively enrolled. Postoperative morbidity, recurrence and survival rates were analysed. RESULTS: All the patients received multimodality therapy, including chemotherapy, radiation and surgical resection (pleurectomy/decortication) followed by the HITHOC procedure. Chemotherapy perfusion was performed with cisplatin (100-150 mg/m(2)) at 42°C for 1 h. Severe chemotherapy-related complications were not observed. Reoperation was necessary in two patients. There was no 30-day mortality. The median stay on the intensive care unit was 1 day, and the median duration of hospitalization was 15 days. Pleural recurrence of thymoma was evident in one thymoma patient 6 months after HITHOC. At mean follow-up of 22 months, seven thymoma patients (7/8; 88%) are alive without recurrence. Tumour progression was present in six mesothelioma patients (6/8; 75%). Four patients (50%) with MPM are alive, including two with no evidence of mesothelioma, and the median survival is 18 months. CONCLUSIONS: Cytoreductive surgery in combination with HITHOC can be performed with acceptable morbidity and mortality rates in selected patients. Patients should be evaluated by an interdisciplinary team to determine their eligibility for this therapeutic alternative. Early clinical results may encourage the use of this surgical option to provide better local tumour control in a multimodality treatment setting.

Optic neuritis with visual field defect--possible Ibuprofen-related toxicity.

OBJECTIVE: To report a case of optic neuritis with visual field defect associated with ibuprofen. CASE SUMMARY: A 41-year-old white man developed blurred vision in his right eye and pain with eye and head movements that lasted 2 days after use of ibuprofen 400 mg 3 times daily during the preceding 3 weeks. Medical and family histories were negative for significant related disease. Ophthalmologic examination revealed a marked decrease in visual acuity to 20/200 in the right eye with quadrant visual field loss and absent responses in visual evoked potential (VEP). After discontinuation of the drug and treatment with high-dose intravenous methylprednisolone and subcutaneous low-molecular-weight heparin, the patient's vision improved to 20/70, the visual field defect vanished, and the VEP returned to almost normal values during a 1 year follow-up period. An objective causality assessment revealed that the adverse reaction was possibly related to ibuprofen. DISCUSSION: Ocular toxicity with blurred vision and centrocecal visual field defects have been rarely associated with long-term ibuprofen intake. We report a case of retrobulbar optic neuritis with quadrant visual field defect following short-term but regular ibuprofen intake. Although idiopathic optic neuritis cannot be completely ruled out, the absence of other risk factors and additional findings plus the improvement after discontinuation of the drug speak for isolated toxic optic neuritis of the right eye. CONCLUSIONS: Drug toxicity is an important differential diagnosis in retrobulbar optic neuritis. Clinicians should be aware of the potential optic toxicity, even with short-term use of a drug, and perform a thorough medication history in every patient with visual disturbances without a clear cause.