Cytoreductive surgery and modified heated intraoperative intraperitoneal chemotherapy (HIPEC) for advanced and recurrent ovarian cancer -- 12-year single center experience.

BACKGROUND: The present study reviews our 12-year results with cytoreductive surgery and HIPEC in patients with advanced primary and recurrent ovarian cancer. METHODS: During the period from January 1995 to December 2007, 56 patients (31 with primary and 25 with recurrent epithelial ovarian cancer) underwent cytoreductive surgery and HIPEC (Doxorubicin intra-operatively, and cisplatin next 1-5 postoperative days) at our department. RESULTS: 52 (92.8%) patients had no gross residual disease after the complete surgical procedure (Sugarbaker completeness of cytoreduction CC, score 0-1), and 4 patients had macroscopic residual disease (CC-2 or CC-3) Average PCI (peritoneal cancer index) was 13.4 (4-28). Mean follow-up was 56 months (range, 1-135). The median operation time was 279min (range 190 + or - 500min). Median total blood loss was 850mL (range 250 + or - 1550mL). The median survival time was 34.1 months for primary, 40.1 for recurrent ovarian cancer without statistically significance difference (p>0.05) and median disease-free survival was 26.2 months. The PCI was equal or less than 12 in 31 patients and their median survival time was statistically significant longer than median survival time of months for the 25 patients with PCI greater then 12 (p<0.01). Morbidity and mortality rate were 17.8% (10/56) and 1.8% (1/56). CONCLUSION: This series indicates that in the majority of patients with primary and recurrent advanced ovarian cancer, cytoreductive surgery combined with HIPEC can lead to a substantial increase in subsequent rates of disease-free and overall survival.

[Plantago ovata].

Plantago ovata is a high fibre bulk forming laxative. It absorbs water and expands to provide increased bulk and moisture content to the stool. The increased bulk encourages normal peristalsis and bowel motility. Clinical Indications: Constipation, Fecal Incontinence, Hemorrhoids, Ulcerative Colitis, Appetite, Hyperlipidemia, Diabetes mellitus.

[Assessment of the degree of maturity in the wall of pancreatic pseudocysts in relation to choice of surgical procedure].

The aim of this study is to present our experience in the diagnosis and treatment of pancreatic pseudocysts. A pancreatic pseudocyst is an incapsulated collection of pancreatic juice, enclosed by nonepithelial elements, containing a high concentration of pancreatic enzymes, bicarbonates and necrotic detritus. It is a common complication of acute pancreatitis and trauma of the pancreas. In the period between 1996 and 2001, 53 surgical procedures were performed for pancreatic pseudocyst at the Institute for Digestive Diseases (First Surgical University Hospital), 35 male patients (67%) and 17 female patients (33%) underwent surgery. In 39 (75%) patients the method of choice was cystojejunostomy by Roux. In 4 cases distal pancreatectomy for pseudocysts localized within the pancreatic tail was performed, complete pseudocyst excision only was performed in one case and complete pseudocyst excision combined with cystojejunostomy was also performed in one case. Cystogastrostomy and drainage in one case and partial cystectomy and drainage also in one case. Surgical internal drainage is the method of choice for the treatment of pancreatic pseudocysts, involving low morbidity and mortality rates.

[PHLEBODIA (diosmine): a role in the management of bleeding nonprolapsed hemorrhoids].

The aim of this study is to describe a role of diosmine in the management of bleeding nonprolapsed hemorrhoids. From November 2003 to January 2004, 60 patients were treated with Phlebodia (diosmine). Total colonoscopy was performed at the discretion of the authors according to the age, symptoms and genetic factors of the patient. Patients were treated with Phlebodia (diosmine, 3x1, 5 days) and in addition a bulk agent (3,26 g plantago ovata sachet, twice daily, for the period of next three months). Hemorrhoidal bleeding stopped after 3,2 days. Diosmine, used with fiber supplements, rapidly and safely stops bleeding from nonprolapsed hemorrhoids.

Treatment of peritoneal carcinomatosis from colorectal cancer by cytoreductive surgery and hyperthermic perioperative intraperitoneal chemotherapy.

PURPOSE: Peritoneal carcinomatosis from colorectal cancer is resistant to standard treatments and median survival time for patients ranges between 6 and 8 months. Aggressive cytoreductive surgery with hyperthermic intraperitoneal perioperative chemotherapy may increase median survival. METHOD: Patients undergoing cytoreductive surgery and perioperative hyperthermic chemotherapy (mitomycin C, intraoperatively; 5-fluorouracil early post-operatively) for peritoneal carcinomatosis from colorectal cancer from 1996 to 2003 were evaluated retrospectively. RESULTS: From 1996 to 2003, 18 cytoreductive procedures were performed. The post-operative morbidity rate was 44.4% with no treatment related mortality. The median total operation time was 5 h 28 min (range: 3 h 20 min to 7 h 10 min). The median follow-up was 21 months. The median survival was 15 months. CONCLUSION: Surgical debulking and perioperative intraperitoneal chemotherapy improved survival with acceptable morbidity and mortality. Completeness of the resection was the most important prognostic indicator.

[Plantago ovata (Laxomucil) after hemorrhoidectomy]. / Plantago ovata (Laxomucil) posle hemoroidektomije.

The aim of this prospective randomized study is to describe the effects of laxative plantago ovata after open hemorrhoidectomy (Milligan-Morgan). Sixty patients divided into 2 equal groups were included in this study. The first group was treated postoperatively with 2 sachets of bulk agent Laxomucil (3.26 g plantago ovata), twice daily, for a period of twenty days, while the control group was treated with glycerin oil. The p.ovata group patients had a statistically significant shorter postoperative length of hospital stay (2.9 v.s. 4.1 days). Pain after stool was statistically significant more tolerable in the p.ovata group. In conclusion, the application of bulk agent plantago ovata after hemorrhoidectomy shortens the mean postoperative hospital stay, expedites digestive function recovery and lessens the pain after stool.

Management of advanced pelvic cancer by exenteration.

AIM: To describe our results in managing locally advanced primary or recurrent pelvic malignancies. METHOD: Investigations included: clinical, laboratory, endoscopic (rectoscopy and colonoscopy) examinations, ultrasound scan, and CT scan or MRI of the abdomen and pelvis, to determine the extent of the pelvic malignancy. A careful explorative laparatomy of abdomen and pelvis was performed, followed by anterior, posterior or total pelvic exenteration. RESULTS: In the period June 1995-Jan 2002, 7 anterior, 2 posterior and 51 total pelvic exenterations were performed in 60 patients, distributed as follows: 28 for rectal cancer (12 primary, 16 recurrent), 20 for cervical cancer (9 primary, 11 recurrent) and 12 for other pelvic malignancies. The median survival time and overall 5-year survival rates were as follows: primary rectal cancer--50 months and 32%; recurrent rectal cancer--31 months and 17%; primary cervical cancer--46.4 months and 41% and recurrent cervical cancer--23.4 months and 16%. During the same period, 559 of our patients were treated for primary or recurrent rectal cancer by different types of straightforward resection. CONCLUSION: Pelvic exenteration is justifiable in cases of locally advanced primary and recurrent malignancies of rectum, cervical cancer and possibly in cases of other pelvic malignancies.

Cytoreductive surgery for ovarian cancer.

AIM: The aim of this study is to describe the technique of managing peritoneal dissemination in patients with ovarian cancer, based on radical surgical excision and, later, perioperative chemotherapy. METHOD: Treatments included complete surgical resection of the peritoneal disease, and intraperitoneal intraoperative and postoperative chemotherapy, using Adriamycin intraoperatively, and Cis-platinol next 1-5 postoperative days. RESULTS: Eleven cytoreductive procedures were performed between 1996 and 2002. Eight patients with primary ovarian cancer underwent total hysterectomy with bilateral adnexectomy, omentectomy and peritonectomy of the pelvic cavity. In 3 cases with recurrent ovarian cancer, peritonectomy alone was performed. Bowel resection was performed in all patients. The median operation time was 279 min (range 190-500min). Median total blood loss was 919 mL (range 450-1330 mL). The median survival time was 22 months. CONCLUSION: Cytoreductive procedure offers satisfactory results in peritoneal carcinomatosis in patients with advanced primary ovarian cancer.

[Lateral lymphadenectomy in the treatment of rectal carcinoma]. / Lateralna limfadenektomija u lecenju karcinoma rektuma.

The aim of this work is to present existence of the lateral lymphatic spread of metastases in patients with Dukes C low rectal carcinoma (60% of all patients), located at or bellow peritoneal reflexion. Prospective clinical investigation analyzed the group of 64 patients (32 underwent lateral lymphadenectomy and 32 didn't), all treated at Ist Surgical Clinic, Clinical Center of Serbia. Lateral lymphatic spread of metastases was proven by frozen section in 8 cases, so extensive lateral lymphadenectomy was performed. In the group of patients who underwent lateral lymphadenectomy, positive lymph nodes were registered in 18 patients (56.2%); in group of patients operated without lateral lymphadenectomy, metastatic lymph nodes were registered in 12 patients (37.5%). According to results of this investigation, method of lateral lymphadenectomy, as well as extensive lateral lymphadenectomy, is significant for exact determination of postoperative stage of the disease. Also, there is a significant increase in number of patients with Dukes C stage of the disease. In those patients, mesorectectomy alone is not sufficient.

[Acquired immunodeficiency syndrome, chronic coccidiosis and Salmonella typhimurium septicemia in a couple from Zaire. Immunological functions and attempt at immunostimulation by thymopentin]. / Syndrome de déficit immunitaire acquis, coccidiose chronique, et septicémie à Salmonella typhi murium chez un couple de zaïrois. Fonctions immunitaires et essai d'immunostimulation par la thymopentine.

A clinical review of a young couple from Zaïre with acquired immunodeficiency syndrome (AIDS) is reported. Both had opportunistic infections such as Salmonella typhimurium septicemia, genital herpes and digestive candidiasis. The husband was hospitalized for diarrhea from Isospora belli infection and for hemoptysis from an aspergilloma. His wife was admitted for a thoracic herpes zoster infection and left hemiplegia preceding subacute encephalitis. In both patients the biological immune functions were compatible with AIDS: presence of antibody against lymphadenopathy virus, decreased in OKT4+/OKT8+ ratio, and lack of lymphocyte response to mitogens which was partially restored in vitro after addition of interleukin 2 and thymopentin (TP-5) in the husband. In vitro monocyte cultures showed increased production of prostaglandins E2 (PGE2) and a slight decrease in interleukin 1 production. The symptomatic treatments and an attempt at immunostimulation with TP-5 in the husband are described.