Locoregional treatment of peritoneal carcinomatosis from gastric cancer

The authors reviewed the natural history and the main features of the peritoneal carcinomatosis from gastric cancer briefly and analyzed the pertinent literature concerning the locoregional modalities for prevention and for treatment. Results of the web based voting by experts were also summarized. As regards the peritoneal perfusion with cytotoxic drugs with or without hyperthermia for preventing peritoneal carcinomatosis in high risk patients, there are some randomized clinical trials and one meta-analysis supporting a benefit of the procedure. However, disparity in methodology (drugs, dosage, duration of the treatment, addition of hyperthermia, etc.) precludes the adoption of a shared protocol to be used in the clinical practice in high risk patients. Once the peritoneal carcinomatosis is established, the approach reported in literature is the peritonectomy associated with hyperthermic perfusion. However, data supporting benefits are scanty, and limited to few centers with a specific experience in this field. With regard to the main questions addressed to the experts' panel and concerning the indications for treatment and methodology, there was a general consistency among the experts and agreement with the findings of the literature. The need for a large multicenter trial to confirm the benefit and risk of intraperitoneal chemotherapy was recognized by both the experts and the authors.     

Hyperthermic intraperitoneal chemotherapy with and without cytoreductive surgery for epithelial ovarian cancer

Women with epithelial ovarian cancer (EOC) usually present with advanced disease and overall only just over half survive 5 years. Even following a complete response to front-line treatment two-thirds will recur, with a resultant dismal prognosis. We review and discuss the role of surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in EOC and present the results of the ovary consensus panel (OCP) convened for the 5th International Workshop on Peritoneal Surface Malignancy.     

Renal-splenic shunt for infrahepatic caval occlusion after piggy-back liver transplantation

Inferior vena cava thrombosis after liver transplantation is uncommon. We describe a case of this unusual complication occurring after piggy-back (end-to-side) graft implantation. Renal failure, lower limb edema, and hemodynamic instability were the presenting symptoms requiring immediate surgical correction with a left renal-to-splenic vein shunt over a ringed 2.5-cm prosthesis. The decision to go ahead with the shunt was preceded by an intraoperative confirmation of a 10-cm H₂O pressure gradient between the caval and portal circulations. This gradient, unlike that observed in liver cirrhosis, ultimately turned a splenorenal shunt into a renal-splenic one. Six months after the procedure, the patient is alive and well with normal liver and renal function. The technique described may be useful in the management of other clinical conditions of acute infrahepatic caval hypertension. Received: 17 January 1997 Received after revision: 2 May 1997 Accepted: 13 May 1997     

Fluctuation of arterial blood pressure during end-of-dose akinesia in Parkinson''s disease.

The supine and erect arterial blood pressure and pulse rate were measured in 13 patients with Parkinson's disease, chronically treated with levodopa and peripheral decarboxilase inhibitors presenting with or without On-Off phenomenon (end-of-dose akinesia). In the patients with dose-related response fluctuations the mean systo-diastolic blood pressure, both supine and erect, was found significantly higher during the Off phase as compared to the On phase and to that of the control group (patients with stable clinical response). The mean diurnal "excursion" of systo-diastolic supine and erect blood pressure in patients with On-Off phenomenon was significantly larger than in the control group. Although the clinical implications of such findings remain to be established, the results of this study indicate that arterial blood pressure fluctuations are a definite autonomic component of end-of-dose akinesia.     

Survivin is highly expressed and promotes cell survival in malignant peritoneal mesothelioma.

BACKGROUND: The biology of malignant peritoneal mesothelioma (MPM) is largely unknown. In the present study, we assessed the expression of survivin and other members of the inhibitors of apoptosis proteins (IAP) family (IAP-1, IAP-2 and X-IAP) in a series of 32 MPM surgical specimens and investigated the effects of survivin knockdown in an established MPM cell line. METHODS: Expression of different IAPs was measured by immunohistochemistry. MPM cells were transfected with a small-interfering RNA (siRNA) targeting survivin mRNA and analyzed for survivin expression, growth rate, and ability to undergo spontaneous and drug (cisplatin, doxorubicin)-induced apoptosis. RESULTS: Survivin expression was observed in 29 (91%) surgical MPM specimens, whereas the positivity rate for the other IAPs ranged from 69% to 100%. Transfection of MPM cells with the survivin siRNA induced a marked inhibition of survivin protein expression, a time-dependent decline in cell growth and an enhanced rate of spontaneous and drug-induced apoptosis, with a concomitant increase in the catalytic activity of caspase-9. CONCLUSION: Our results show for the first time that survivin, as well as other IAPs, is largely expressed in clinical MPMs and suggest that strategies aimed at down-regulating survivin may provide a novel approach for the treatment of the malignancy.     

ASO Visual Abstract: Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Annals of Surgical Oncology -