Effective Use of Bromelain and Acetylcysteine (BromAc®) for Treatment of Perigastric Pseudomyxoma Peritonei: A Case Report.

BACKGROUND/AIM: Pseudomyxoma peritonei (PMP) is a rare clinical condition of progressive peritoneal mucin accumulation. PMP has a reasonable survivability but with a notable risk of tumour recurrence. Standard treatment, including for tumour relapse, aims for a cure with complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. In the case of tumour recurrence, surgery becomes progressively complex, and some patients are not suitable for surgery either due to patient preference or morbidity and mortality risk. BromAc® is an emerging, novel mucolytic combination therapy composed of bromelain and acetylcysteine which can be administered intratumorally via radiologically guided drains. It represents a minimally invasive treatment for patients who have symptomatic tumour deposits but are not surgical candidates. CASE REPORT: We report the case of a 64-year-old male with a background of appendiceal PMP who presented with a gastric outlet obstruction from a perigastric tumour deposit. This was managed with BromAc® administration, following which the patient's symptoms resolved. This corresponded with an 80% reduction in the tumour volume radiologically. CONCLUSION: BromAc® is an emerging minimally invasive treatment for PMP tumour deposits that may be considered as adjunctive or alternative treatment in patients who are not surgical candidates to reduce tumour burden and improve symptomatology and quality of life.

Appendiceal Abscess Within a Giant Amyand's Hernia: A Case Report.

Amyand's hernia is a rare clinical entity, defined as an inguinal hernia containing the appendix. Giant inguinoscrotal hernia is also a rare clinical finding that presents major operative dilemmas due to the loss of abdominal domain. Here, we report a case of a 57-year-old male who presented with a giant irreducible right inguinoscrotal hernia and obstructive symptoms. The patient underwent an emergency open right inguinal hernia repair, where an Amyand's hernia was identified. The hernia contained an inflamed appendix and associated abscess, caecum, terminal ileum, and descending colon. Using the giant sac to isolate the contamination, an appendicectomy was performed, the hernial contents reduced and the hernia repair reinforced with partially absorbable mesh. The patient recovered post-operatively and was discharged home with no recurrence on four-week follow-up. This case provides learning points on decision-making and surgical management of a giant inguinoscrotal hernia containing an appendiceal abscess, also known as Amyand's.

Rapid Formation and Rupture of Multiple Abdominal Pseudoaneurysms: A Life Threatening Case of Segmental Arterial Mediolysis.

We present a 62-year-old gentleman with rapidly forming abdominal pseudoaneurysms due to segmental arterial mediolysis (SAM). With rupture of his pseudoaneurysms, he underwent angiography and successful coil embolisation. In this case, we demonstrate the potential for rapid progression of pseudoaneurysms in SAM, with the need for prompt diagnosis and urgent endovascular intervention.

Single stage repair of a giant inguinoscrotal hernia by a combined laparotomy and inguinal approach.

Giant inguinoscrotal hernias are an uncommon but challenging surgical entity. We report on how to repair a giant inguinoscrotal hernia using a single-stage approach suitable for emergency surgery. This involves a combined laparotomy and inguinal approach, with posterior component separation and transversus abdominis release.

Acute Kidney Injury Following Hyperthermic Intraperitoneal Chemotherapy With Cisplatin.

BACKGROUND/AIM: Cisplatin increases the risk of acute kidney injury (AKI) during systemic chemotherapy. However, little is known about its risk of inducing AKI when used during intraperitoneal chemotherapy. This study aimed to determine the incidence of AKI in patients undergoing cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) with cisplatin. PATIENTS AND METHODS: A retrospective analysis of patients who received cisplatin-based HIPEC from November 2008 to March 2018 was undertaken to determine the incidence of AKI. RESULTS: A total of 111 patients were identified. The incidence of AKI was 15.3% (17/111). Univariate analysis showed increased peritoneal cancer index (PCI), low intraoperative and post-operative urine output were significantly associated with the development of AKI. Multivariate analyses did not identify any significant predictors factors for AKI. CONCLUSION: Cisplatin-based HIPEC is associated with AKI. At our centre, the incidence of AKI was 15.3%. Risk factors that may influence its development include high PCI and low perioperative diuresis.

Magnetic noninvasive acupuncture for infant comfort (MAGNIFIC) - a single-blinded randomised controlled pilot trial.

AIM: To determine the safety and feasibility of auricular noninvasive magnetic acupuncture (MA) to decrease infant pain during heel pricks. METHODS: Infants requiring heel pricks for blood collection were randomised to either MA (n = 21) or placebo (P) (n = 19) after parental informed consent. MA or placebo stickers were placed on both ears according to the Battlefield Protocol by an unblinded investigator and left on for 3 days. Pain was assessed with the Premature Infant Pain Profile (PIPP) by blinded clinicians. RESULTS: Mean gestation (MA:34.1, P:34.4 weeks) and age of infants (MA:5.3, P:4.5 days) were similar as were mean (SD) pre (MA:1.7(1.4), P:2.1(1.9)) and post (MA:1.6(1.4), P: 2.1(1.7)) heel prick PIPP scores. PIPP scores were significantly lower in MA infants during heel pricks (MA:5.9(3.7), P: 8.3(4.7), p = 0.04). One-way ANCOVA modelling showed that MA was significantly associated with lower PIPP scores after controlling for analgesic use (p = 0.043). No differences in heart rate, oxygen saturation, analgesic use or adverse effects (e.g. local skin reactions) noted. CONCLUSION: This pilot study shows that auricular MA is feasible in neonates and may reduce PIPP scores during heel pricks. Further study is required to determine the impact of MA on other painful or stressful conditions and on neurodevelopment.