Major hepatectomy and right hemicolectomy at the time of primary cytoreductive surgery for advanced ovarian cancer: report of a case.

Major liver involvement at the time of diagnosis is a rare event in patients with ovarian cancer, and the issue of major hepatectomy at the time of primary cytoreductive surgery is controversial. A 61-year-old woman was admitted to our hospital with nonspecific abdominal pain of 2-month duration and weight loss of 5 kg during the last semester. A computed tomography scan demonstrated bilateral ovarian masses, extending to the right iliac fossa, pressing the cecum-ascending colon. In the liver parenchyma, three cystic lesions were found of about 6-cm maximum diameter each, along with pelvic lymphadenopathy. There was no ascites. The diagnosis of advanced ovarian cancer was clinically suspected; the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, right hemicolectomy, omentectomy, left lobectomy, deroofing, and draining of the cystic formation of the right liver lobe along with systematic pelvic and para-aortic lymphadenectomy. Systemic chemotherapy (six cycles of paclitaxel/carboplatin) was subsequently administered, and after 15 months of follow-up period, the patient is still in first remission and alive. Ovarian cancer with concomitant extensive right colon infiltration and hematogenous liver metastases can be successfully managed with aggressive surgical resection and postoperative chemotherapy in carefully selected patients.

HRCT in miliary lung disease.

PURPOSE: To analyze high resolution CT (HRCT) features of a miliary pattern in different diseases. MATERIAL AND METHODS: Eight HRCT studies with a miliary lung pattern were retrospectively reviewed with the diagnoses tuberculosis (n=3), Candida albicans (n=1), sarcoidosis (n=3), and metastatic adenocarcinoma (n=1). RESULTS: In all cases, HRCT showed diffusely disseminated nodules up to 3 mm. In 2 cases of tuberculosis and 1 of sarcoidosis, the lesions predominated in the upper/middle lung zones. In the case of metastatic adenocarcinoma the nodules were more sparse in the lung periphery while in 1 case of sarcoidosis, HRCT revealed a predominance of the lesions in the outer third of the lungs. Cyst-like lesions of 12 mm were observed in 2/3 cases of tuberculosis and in metastatic adenocarcinoma. Notably thickened interlobular septa and interlobar fissures were each seen in 2/3 cases of sarcoidosis. In general, a random relationship of miliary nodules to secondary lobular structures and bronchovascular bundles was observed, despite the co-existence of centrilobular, subpleural and paraseptal nodules. CONCLUSION: HRCT features that potentially contribute in making a differential diagnosis are: a) A peripheral distribution of nodules, an increased number of thickened interlobular septae, and a notable thickening of interlobar fissures, all of which are indicative of sarcoidosis; and b) Multiple cyst-like lesions which should direct attention to tuberculous or metastatic origin. The predominance of miliary nodules in relation to cephalocaudal axis, their margin and size are not helpful features to the differential diagnosis of diseases presenting a miliary pattern.

Preincisional single-dose ceftriaxone for the prophylaxis of surgical wound infection.

BACKGROUND: Preincisional intraparietal injection of antibiotics is used for the prophylaxis of postoperative surgical infections. Whether topically injected antibiotics remain primarily in the surgical wound or are systematically absorbed is uncertain, however. PATIENTS AND METHODS: The pharmacokinetics of preincisional injection of 2 g ceftriaxone were studied in 20 patients who have undergone abdominal surgery, with determination of serum, wound tissue, and wound fluid antibiotic concentrations. RESULTS: Preincisional injection of ceftriaxone resulted in high antibiotic concentrations in the wound tissue and wound fluid. The highest plasma concentrations were achieved at 1.50 hours (99.47 +/- 14.67 micrograms/mL). Plasma concentrations exceeded the minimal inhibitory concentrations of most aerobic gram-positive and gram-negative organisms with the exception of Pseudomonas aeruginosa, Acinetobacter species, and Streptococcus faecalis for 24 hours (10.42 +/- 4.12). No local or general complications arose in any of the patients. CONCLUSIONS: Our results suggest that preincisional administration of ceftriaxone for prophylaxis is very effective.

Effect of aprotinin on fibrinopurulent peritonitis in rats.

The effect of aprotinin on the clinical and pathologic course of experimentally induced peritonitis in the rat was studied. Peritonitis was induced in 40 rats by creating a closed ileal loop 4 cm long 5 cm from the ileocecal valve. The rats were divided into two groups of 20 rats each. Group 1 served as a control group, whereas each animal in Group 2 received a bolus dose of aprotinin (10 ml) intraperitoneally immediately after closing the laparotomy. In the aprotinin-treated group, survival was drastically increased (p less than 0.01) and formation of adhesions and abscesses was considerably reduced. The results of peritoneal cultures showed a decreased incidence of Escherichia coli and Clostridia in the aprotinin-treated group. We conclude that the administration of aprotinin significantly prolongs the survival time of animals with peritonitis and reduces the development of adhesions and abscesses in the peritoneal cavity. This beneficial effect can be attributed to decreased fibrinogen deposits within the peritoneal cavity and the stabilization of the organism after bacterial shock. Thus, bacteria were more susceptible to cellular and noncellular clearing mechanisms.

Pentoxifylline in the treatment of experimental peritonitis in rats.

The objective of this study was to determine the effect of pentoxifylline on the clinical and pathologic course of experimentally induced peritonitis in rats. This drug is a methyxanthine derivative that has vasodilating properties and may decrease platelet aggregation. Peritonitis was induced in 40 Wistar rats by creating a closed ileal loop 4 cm long 5 cm from the ileocecal valve. The animals were divided into two groups of 20 animals each. The first group served as controls, while each animal of the second group received 17 mg/kg/day of pentoxifylline intramuscularly from the day of operation until 30 days postoperatively. The survival rate was significantly increased in the group receiving pentoxifylline and adhesion or abscess formation was considerably reduced. We concluded that the administration of pentoxifylline prolongs significantly the survival of animals with experimental peritonitis and reduces the development of adhesions and abscesses in the peritoneal cavity. This beneficial effect may be attributed to decreased fibrinogen deposits and increased fibrinolytic activity within the peritoneal cavity, thus rendering the bacteria more susceptible to cellular and noncellular clearing mechanisms.

[Secretion of gastric acid, gastrin and cyclic nucleotides in relation to the action of the vagus nerve]. / La sécrétion de l'acide gastrique, de la gastrine et des nucléotides cycliques en rapport avec l'action du nerf vague.

Changes on levels gastric acidity, on serum gastrin, cAMP and cGMP levels were studied in 18 healthy volunteers after either stimulation (injection of 0.2 IU of soluble insulin/kg body weight to a group of 9 subjects) or stimulation and inhibition (injection of insulin plus atropine per os to the other group of 9 subjects) of the vagus nerve. After vagus nerve stimulation, gastric acid levels, serum gastrin and cGMP were raised and cAMP reduced. After stimulation and inhibition of vagus nerve, gastrin and cAMP were increased, cGMP reduced and gastric acid levels remained unchanged. These findings suggest that the vagus nerve, and more particularly the acetylcholine released from its metaganglionic fibers, stimulate parietal cells provoking acid secretion, and also stimulate G cells with subsequent gastrin secretion through cGMP.