Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Malign Peritoneal Mesothelioma: Clinical Aspects and Therapeutic Perspectives

Malignant mesotheliomas develop commonly in the pleural cavity and second mesotheliomas arise in the peritoneal cavity (20–30%). Most frequent symptoms/signs are ascites (77%) and abdominal pain (f69%). Biopsy in these patients should be taken from the peritoneum by invasive method (laparotomy, laparoscopy and core needle biopsy). The couplet of systemic pemetrexed and cisplatin had an overall response rate of approximately 25% and a median overall survival of approximately 1 year. Patients with a good general condition, epithelioid histology, nonabdominal disease, complete or near cytoreduction (CC0/CC1), low Ki67 proliferative index and peritoneal cancer index (PCI) score less than 17 should be administered through cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) rather than palliative systemic chemotherapy. The survival rate with Ki67 ≤ 9% is higher than patients with Ki67 > 9. The basic principles of the CRS are not different from other peritoneal carcinomas. The combination of cisplatin and doxorubicin is the best recommended drug regimen for the hyperthermic intraperitoneal chemotherapy. © 2021, Association of Surgeons of India

Rare cause of weight loss in a kidney transplant recipient: Iron overload

PubMed ID: 24059653Various reasons such as malignancies and chronic infections may cause weight loss in kidney transplant patients. In this report, iron overload as a rare cause of weight loss in a kidney transplant patient is presented. Forty-seven-year-old male patient who transplanted from a deceased donor 5 years ago was hospitalized because of 20kg of weight loss. In medical history, he had history of hemodialysis for 89 months and received 100-300mg of intravenous iron therapy per week before transplantation and transfused eight units of blood. In physical examination, weight and height were 45kg and 185cm, respectively. Respiratory and cardiac auscultation was normal. Laboratory results revealed as follow: glucose 76mg/dL, urea 60mg/dL, creatinine 1.35mg/dL, aspartate aminotransferase 74U/L, alanine aminotransferase 77U/L, C-reactive protein 2.59mg/dL, albumin 3.3g/dL, globulin 3.4g/dL, white blood cells 3200/mm3, hemoglobin 13.1g/dL and platelets 190,000/mm3. Chest and abdominal tomography didn't reveal any pathology. Portal Doppler ultrasound showed signs of early cirrhosis. Viral and autoimmune hepatitis markers were negative. Ferritin was 5300ng/mL and transferrin saturation was 82%. In liver biopsy, hemosiderosis was diagnosed and heterozygous H63D gene mutation was detected. Totally, 19 units of phlebotomy were performed. Liver function tests and serum ferritin decreased gradually. At outpatient follow-up in 6 months, he returned to former weight. In conclusion, there can be several causes of weight loss in kidney transplant patients. Iron overload can come across as a rare cause of weight loss. In these patients, ferritin levels should be checked and diagnosis should be clarified by liver biopsy and gene mutation analysis. © 2014 Informa Healthcare USA, Inc

A feasible technique for intraoperative endoscopy of gastrointestinal bleeding: Clothed endoscopy

PubMed ID: 22964193[No abstract available