Anterior perineal hernia - A case report of a rare complication after pelvic exenteration.

INTRODUCTION AND IMPORTANCE: Perineal hernias are protrusions of intra-abdominal contents resulting from weakness of the pelvic floor muscles. They are an uncommon complication after ultraradical pelvic surgeries, with no established gold standard for surgical treatment. This case describes a rare anterior perineal hernia that developed after radical surgery for bladder carcinoma. CASE PRESENTATION: A 77-year-old Caucasian woman presented with a painful 10 cm bulge in the perineal region. The hernial sac involved the entire left labia majora and developed 4 years after radical surgery for bladder carcinoma. She had been misdiagnosed twice in the past with vaginal prolapse, leading to two unsuccessful vaginoplasty procedures due to recurrence. She underwent hernia repair with perineal approach and polypropylene mesh placement. The postoperative period was uncomplicated, and the patient was discharged after five days, with histology showing no malignancy. CLINICAL DISCUSSION: Perineal hernias are protrusions of intra- or extraperitoneal contents into the perineum due to a defect in the pelvic musculature. Various surgical modalities exist for perineal hernia repair, which adhere to the fundamental principles of hernia surgery: sac mobilization, precise incision, sac debridement and excision, and defect repair. Here, we successfully applied the perineal approach in a complicated case of a misdiagnosed perineal hernia after radical surgery. CONCLUSION: The perineal approach for hernia repair, involving an implantation of a polypropylene mesh and tissue flap was successfully applied, confirming its main place in the surgical treatment of perineal hernias. During the two-year follow-up no postoperative complications or recurrence hernia were registered.

Improving quality of life in pancreatic cancer patients following high-intensity focused ultrasound (HIFU) in two European centers.

OBJECTIVES: Pancreatic cancer patients often have a high symptom burden, significantly impairing patients' quality of life (QOL). Nevertheless, there are hardly any reports on the impact of high-intensity focused ultrasound (HIFU) on the QOL of treated patients. For the first time, this study evaluated the effect of HIFU on QOL and compared these results in two European centers. METHODS: Eighty patients with advanced pancreatic cancer underwent HIFU (50 in Germany, 30 in Bulgaria). Clinical assessment included evaluation of QOL and symptoms using the EORTC QLQ-C30 questionnaire at baseline and 1, 3, and 6 months after HIFU. Pain intensity was additionally evaluated with the numerical rating score (NRS). RESULTS: Compared to baseline, global health significantly improved 3 and 6 months after HIFU treatment (p = 0.02). Functional subscales including physical, emotional, and social functioning were considerably improved at 6 months (p = 0.02, p = 0.01, and p = 0.01, respectively) as were leading symptom pain (p = 0.04 at 6 months), fatigue (p = 0.03 at 3 and p = 0.01 at 6 months), and appetite loss (p = 0.01 at 6 months). Moreover, pain intensity measured by NRS revealed effective and strong pain relief at all time points (p < 0.001). Reported effects were independent of tumor stage, metastatic status, and country of treatment. CONCLUSIONS: This study showed that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL by increasing global health and mitigation of physical complaints with a low rate of side effects, independent of the examiner. Therefore, HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease. KEY POINTS: • In a prospective two-center study, it was shown that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL. • HIFU in pancreatic cancer patients is associated with a low rate of side effects, independent of the performer. • HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease.

Dietary Carbohydrate Promotes Cell Survival in Cancer Via the Up-Regulation of Fat Mass and Obesity-Associated Gene Expression Level.

Cancer cells are mainly dependent on glycolysis for their growth and survival. Dietary carbohydrates play a critical role in the growth and proliferation of cancer and a low-carbohydrate diet may help slow down the growth of tumours. However, the exact mechanisms behind this effect are unclear. This review study aimed to investigate the effect of fat mass and obesity-associated (FTO) gene in the association between dietary carbohydrates and cancer. This study was carried out using keywords such as polymorphism and/or cancer and/or dietary carbohydrate and/or FTO gene. PubMed and Science Direct databases were used to collect all related articles published from 1990 to 2018. Recent studies showed that the level of FTO gene expression in cancer cells is dramatically increased and may play a role in the growth of these cells through the regulation of the cellular metabolic pathways, including the phosphoinositide 3-kinases/protein kinaseB (PI3K/AKT) signaling pathway. Dietary carbohydrate may influence the FTO gene expression by eliminating the inhibitory effect of adenosine monophosphate-activated protein kinase (AMPK) on the FTO gene expression. This review summarised what has been recently discovered about the effects of dietary carbohydrate on cancer cells and tried to determine the mediating role of the FTO gene in these effects.

Multimodality treatment by FOLFOX plus HIFU in a case of advanced pancreatic carcinoma. A case report.

CONTEXT: Pancreatic cancer is one of the most aggressive malignant diseases in which the survival rate has not improved in the past 40 years. CASE REPORT: A fifty-one-year-old male patient with inoperable metastatic pancreatic cancer and low response to chemotherapy with gemcitabine as single therapy underwent palliative high intensity focused ultrasound (HIFU) ablation. Continuing chemotherapy with folinic acid, oxaliplatin and 5-fluorouracil (FOLFOX) was made. Tools, provided by the European Organization for Research and Treatment of Cancer (EORTC) were used to evaluate his quality of life. The Global Health Status improved from 25 to 42 out of 100 and the body mass index (BMI) increased from 14.9 to 18.1 kg/m(2). Measured by the visual analog scale, the pain was reduced from 7 to 2 out of 10. Twelve months after the HIFU ablation, CT revealed decreased size of the tumor and liver lesions. CONCLUSION: FOLFOX plus interventional, physical destruction of the primary tumor by HIFU sufficiently improved the quality of life, reduced pancreatic pain and provided better survival in this case.