Safety and efficacy of vemurafenib in end stage renal failure.

BACKGROUND: Serine-threonine inhibitors, such as vemurafenib, are being used increasingly in cancer treatment, and the toxicity and therapeutic benefit need to be balanced carefully both before and during treatment. CASE PRESENTATION: A patient with metastatic melanoma and end stage renal failure who was on peritoneal dialysis was treated with the serine-threonine kinase inhibitor, vemurafenib. After 5 months of treatment, a substantial response to vemurafenib was observed using imaging, but when he developed a prolonged QTc interval (common toxicity criteria (CTC) grade 3), treatment was interrupted. Vemurafenib was restarted at a reduced dose when the QTc interval returned to normal. The patient has had a significant response to vemurafenib and continued on treatment for 12 months after beginning the therapy. CONCLUSION: This is the first reported case of end stage renal failure in a patient who is taking vemurafenib. Although the patient developed QTc prolongation, it appears to be asymptomatic, and was managed with dose reduction. This case highlights the need for closer QTc monitoring at the start and during treatment.

Ectopic liver encountered during laparoscopic cholecystectomy.

Ectopic liver is hepatic tissue that histologically resembles the mother tissue but is located at a site away from its usual location. Initially thought to be a rare anatomical anomaly of no clinical significance, it is now increasingly recognised to be capable of causing clinically relevant pathology. More specifically, it has been associated with a higher incidence of hepatocellular carcinoma, cholelithiasis and cholecystitis. Here, we report a case of ectopic liver encountered incidentally during laparoscopic cholecystectomy.

Multiplanar reconstruction in adult intussusception: case report and literature review.

We describe the use of computed tomography (CT) with multiplanar reconstruction (MPR) in positive diagnosis of a case of enteric intussusception in an adult. To our knowledge, there have been no previous reports of the use of MPR in this setting. Intussusception in adults is an uncommon cause of bowel obstruction that usually presents with non-specific symptoms. An underlying lesion is found in most cases. Multiplanar reconstruction should be used to confirm the diagnosis of intussusception when suspected on axial views, and should increase the yield of positive diagnoses when used in the assessment of a complex abdominal mass involving the bowel.