Case report: the thoracoscopic surgery in peritoneal-pleural leakage. A valid therapeutic strategy.

Pleuro-peritoneal leakage is an uncommon complication of peritoneal dialysis (PD). In this study, we report the case of a male patient (age 83), treated with PD (daytime single-exchange). In October 2019, hospitalization was necessary due to dyspnoea and a reduction of peritoneal ultrafiltration. A right pleural leakage resulted at chest x-ray. A regression of the pleural leakage was immediately observed after interrupting PD. It was then performed a pleuro-peritoneal CT scan at baseline, followed by a second scan performed 4 hours after the injection of 2 L of isotonic solution with 100ml of contrast medium, which evidenced a pleuro-peritoneal communication. It was then decided to perform a video-assisted thoracoscopic surgery (VATS), that showed no evidence of diaphragm communication. It was then executed a pleurodesis using sterile talcum. The patient was released on the 3rd day, with a conservative therapy and a low-protein diet. After 2 weeks a new pleuro-peritoneal CT scan with contrast medium was executed. This time the scan evidenced the absence of contrast medium in the thoracic cavity. The patient then resumed PD therapy, with 3 daily exchanges with isotonic solution (volume 1.5 L), showing no complications. Concerning the treatment of pleuro-peritoneal leakage, VATS allows both the patch-repairing of diaphragmatic flaws and the instillation of chemical agents. In our case, VATS allowed the chemical pleurodesis which in turn enabled, in just 2 weeks of conservative treatment, the resuming of PD. In conclusion, this methodology is a valid option in the treatment of pleuro-peritoneal leakage in PD patients.

Magnetic resonance imaging as an early indicator of clinical outcome in patients with metastatic colorectal carcinoma treated with cetuximab or panitumumab.

UNLABELLED: We show that detection, by week-2 magnetic resonance imaging, of tumor shrinkage >10% in response to therapy with cetuximab or panitumumab for metastatic colorectal carcinoma represents an early indicator of clinical outcome because it is predictive of the prolongation of progression-free survival and overall survival. PURPOSE: The early identification of patients with metastatic colorectal carcinoma who are likely to benefit from treatment with panitumumab or cetuximab remains of paramount importance. We evaluated whether the early tumor shrinkage assessed by magnetic resonance imaging (MRI) is predictive of long-term outcome to these epidermal growth factor receptor-targeted therapies. PATIENTS AND METHODS: Thirty-nine patients with chemorefractory metastatic colorectal carcinoma were treated with cetuximab or panitumumab. The patients were evaluated by unenhanced MRI at baseline, week 2, and week 8 after the beginning of the treatment and by contrast-enhanced computed tomography within 3 months. Early response was defined as a tumor shrinkage ≥ 10% at week-2 MRI, whereas response by contrast-enhanced computed tomography was defined according to standard Response Evaluation Criteria in Solid Tumors 1.1. RESULTS: At week-2 MRI, 15 (38.5%) of 39 patients had an early response. Eleven (73.3%) of these 15 early responders then presented a partial response by contrast-enhanced computed tomography, whereas none of the 24 early nonresponders obtained a partial response (P < .0005, Fisher exact test). Median progression-free survival (PFS) was 29.7 and 8 weeks in patients with or without early response, respectively (hazard ratio [HR] 0.156 [95% CI, 0.069-0.355]; P < .0001)]. The median overall survival (OS) was 80 weeks in patients with early response and 23.3 weeks in those without early response, respectively (HR 0.154 [95% CI, 0.057-0.420]; P < .00005]). CONCLUSIONS: Early detection of tumor response by week-2 MRI without contrast medium is associated with a prediction of clinical outcome in patients with metastatic colorectal carcinoma treated with cetuximab or panitumumab.

ADC maps in the prediction of pelvic lymph nodal metastatic regions in endometrial cancer.

OBJECTIVES: To evaluate the usefulness of apparent diffusion coefficient (ADC) in discriminating metastatic from non-metastatic pelvic lymph nodal sites in endometrial cancer. MATERIALS AND METHODS: This retrospective study included 40 patients with endometrial cancer who underwent MRI [T2-weighted, dynamic T1-weighted images and diffusion-weighted images with body background suppression (DWIBS), b-values 0 and 1,000 s/mm(2)], total hysterectomy and pelvic lymphadenectomy. Lymph nodes identifiable on DWIBS were evaluated, classified into six nodal regions, and for each node ADC values, short- and long-axis diameters were measured by two readers. Histopathological findings and follow-up information served as the reference standard. RESULTS: Average (± standard deviation) mean and minimum ADC region value (0.87 ± 0.15 and 0.74 ± 0.07 × 10(-3) mm(2)/s) of metastatic sites (n = 7) were significantly lower than those of non-metastatic ones (n = 89; 1.07 ± 0.20 and 1.02 ± 0.20; p-value = 0.010 and 0.0004). Mean short-axis and short-to-long axis ratios of metastatic nodes were 7.47 mm and 0.68. Using the minimum ADC region value with threshold 0.807 × 10(-3) mm(2)/s, sensitivity, specificity, positive and negative predictive value and accuracy were 100 %, 98.3 %, 63.6 %, 100 % and 98.3 %, respectively (reader 1). CONCLUSION: In endometrial cancer, mean and minimum ADC region values of metastatic nodal sites are significantly lower than those found at normal sites.