Successful treatment of a patient with renal failure, treated with haemodialysis, and advanced ovarian germ cell tumour using modified cisplatin-based chemotherapy duplet.

There are no reports on chemotherapy treatment in patients with ovarian germ cell tumours and kidney failure. We report the case of a 29-year-old female diagnosed with an advanced right ovarian germ cell tumour and severe kidney damage treated with haemodialysis. The first cycle of chemotherapy was administered with 10 mg/m2 of cisplatin on days 1, 3, and 5, and 35 mg/m2 of etoposide from day 1 through 5, followed by haemodialysis 1 hour after the end of cisplatin infusion on days 1, 3, and 5, with grade 3 haematologic toxicity. After the first cycle, kidney function improved and haemodialysis was suspended. From the second cycle onwards, the dose was increased to 80% cisplatin and 100% etoposide with grade 3 haematologic toxicity; following that, the dose of etoposide was decreased to 80% in cycle 3. In the face of tumour progression, the regimen was changed to a standard dose of ifosfamide on days 1 through 5, and carboplatin on day 1 calculated at the area under the plasma concentration curve of free carboplatin versus time of 5 mg/ml/minute. An 80% dosage of ifosfamide and cisplatin was used from the second to fourth cycle, achieving partial response by imaging. The patient was taken to surgery and there was no histopathological evidence of viable cancer cells. In conclusion, cisplatin-based chemotherapy can be administered to a patient with advanced ovarian germ cell tumour and renal insufficiency at lower doses to prevent side effects while retaining efficacy in a multidisciplinary treatment setting.

[Ileal carcinoid tumor manifesting as gastrointestinal hemorrhage and diagnosed with capsule endoscopy: Case report]. / Tumor carcinoide ileal manifestado por hemorragia gastrointestinal y diagnosticado por cápsula endoscópica: reporte de un caso.

OBJECTIVE: To present a case of carcinoid tumor of the small bowel that produced hemorrhage and was identified by capsule endoscopy before surgery. INTRODUCTION: Carcinoid tumors of the small bowel are difficult to diagnose since most of them are asymptomatic and endoscopic examination by standard methods is not possible. Therefore they are rarely detected before a surgical procedure. METHOD: A review of the literature is done. Emphasis in the importance of early diagnosis due to its invasive tendency is also made. RESULTS: Male patient who had 3 episodes of malena along three years before hospitalisation. During this period three upper gastrointestinal endoscopies (EGD), three colonoscopies, two small bowel scintigraphies, one mesenteric angiography and one CAT scan were done before a capsule endoscopy was performed. This procedure revealed a tumor 0.8 cm diameter in the ileum, which was surgically resected. The pathological examination revealed carcinoid tumor invading the serosa. CONCLUSIONS: The carcinoid tumor is highly infiltrating, therefore early diagnose is mandatory. Since the capsule endoscopy makes possible the complete examination of the small bowel, it should be indicated in patients with gastrointestinal hemorrhage in whom EGD and colonoscopy are negative.

Can UV radiation-blocking soft contact lenses attenuate UV radiation to safe levels during summer months in the southern United States?

PURPOSE: Peak solar UV radiation (UVR) intensities are typically experienced in summer months. People living in the southern states of the United States, where the UVR frequently exceeds the recommended minimum erythema dose (MED), are at particular risk, especially outdoor workers. The present study analyzed summertime MED readings in Houston, TX, to assess the frequency of intensities regarded as unhealthy. The study also sought to assess whether UV-blocking hydrogel contact lenses provide ocular protection from these high doses. METHODS: Readings, taken at midday using a UVR biometer, were analyzed to assess the potential UVR risk. The spectral response of the meter, modified by the spectral transmission curves of the contact lenses, allowed us to mathematically assess the ocular protection provided. In addition, ambient UVR measurements were taken at midday, using a portable UVR radiometer. The detector was adapted so that a standard diameter hydrogel contact lens could be placed over it to quantify the UV-blocking capabilities of the lens. RESULTS: The MED readings showed that the recommended safety standards were exceeded approximately at local midday 90% of the time. Model calculations and empirical data demonstrated that contact lenses attenuated the MED readings by up to 90%, bringing them well within the recommended Environmental Protection Agency safety standards. CONCLUSION: The efficacy of the model used in this study was verified through direct comparison of the modeled and measured data. UV-blocking hydrogel soft contact lenses reduce the MED to the human eye and therefore limit the lifetime ocular dose. These lenses are highly recommended to prevent the development of UVR-related ocular pathologic conditions.