Carcinoma of the jejunum with multideposit peritoneal seeding, resection and intraperitoneal chemotherapy / Carcinoma del yeyuno con siembra peritoneal – depósito múltiple resección y quimioterapia intraperitoneal

Jejunal adenocarcinoma is rare, often presenting late with widespread intraperitoneal disease. Intraperitoneal chemotherapy (IPC) has been shown in non-randomized studies to improve the survival of patients presenting with intraperitoneal metastases from carcinoma of the colon, appendix and stomach and in primary peritoneal malignancies including mesothelioma and pseudomyxoma peritonei, providing that adequate operative cytoreduction can be performed. A case is presented of obstructive jejunal adenocarcinoma in which 19 intraperitoneal deposits were excised. The patient was treated successfully with immediate postoperative IPC followed by systemic chemotherapy. This condition is reviewed along with the rationale for IPC.

El adenocarcinoma del yeyuno es raro, presentándose a menudo de forma tardía con enfermedad intraperitoneal extensa. Estudios no randomizados han demostrado que la quimioterapia intraperitoneal (QIP) mejora la supervivencia de pacientes que presentan metástasis intraperitoneal del carcinoma de colon, apéndice y estómago, así como en malignidades peritoneales primarias, incluyendo el mesotelioma y el pseudomixoma peritoneal, siempre que se realice una adecuada citoreducción quirúrgica. Se presenta un caso de adenocarcinoma yeyunal obstructivo en el que se extirparon 19 depósitos del intraperitoneal, tratándose inmediatamente al paciente exitosamente con quimioterapia intraperitoneal postoperatoria, seguida de quimioterapia sistémica. Se examina esta condición junto con las razones para practicar la QIP.

Leiomyosarcoma of the rectum. A report of two cases and review of the literature

Rectal leiomyosarcoma is rare. It is frequently treated by abdominoperineal resection. The role of adjuvant therapy is unclear. Two cases of rectal leiomyosarcoma are presented. Pre-operative endorectal ultrasound predicted submucosal invasion in one case treated by low restorative resection and muscularis propria infiltration in the other managed with abdominoperineal resection. In both cases, ultrasound suggested malignant characteristics as evident by heterogeneous cystic spaces, irregular outline, large size and echogenic foci. Histology was CD34 negative and desmin, alpha-smooth muscle actin and HHF-35 positive, distinguishing these tumours from gastrointestinal stromal tumours. Rectal leiomyosarcoma may be successfully treated by restorative resection and pre-operative ultrasound is useful in assisting this surgical decision by defining malignant features of the tumour. Histopathological characteristics predictive of poor prognosis include high mitotic activity, intratumoural necrosis and tumour size

Hormone replacement therapy. Knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad

A questionnaire was used to assess the knowledge, attitudes, and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaecology Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate principally because they regarded the menopause as a natural process (p = 0.023). Only 24 of postmenopausal women were practicing some form of HRT. A minority (7) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.