Claudia Villanueva

Treatment of Intravenous Leiomyomatosis with Cardiac Extension following Incomplete Resection.

Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.

Cytoreductive surgery and heated intrathoracic chemotherapy for thoracic extension of Pseudomyxoma peritonei

Background: Thoracic extension of Pseudomyxoma peritonei can occur via trans-diaphragmatic spread of abdominal disease. Cytoreductive surgery with intraoperative intrapleural chemotherapy may prolong survival in an otherwise terminal condition. We evaluate the long-term outcomes of patients undergoing thoracic cytoreductive surgery and intrathoracic intraoperative chemotherapy for pleural extension of Pseudomyxoma peritonei. Methods: All patients who underwent thoracic cytoreductive surgery and heated intrathoracic chemotherapy for thoracic spread of PMP were identified from our prospectively compiled registry. Peri operative outcomes were reviewed and long term results were obtained from follow up and correspondence from other specialists. Long-term mortality was calculated from follow-up data. Results: There were three men and three women. The median age at thoracic surgery was 49.7 years. All patients had undergone previous abdominal surgery for pseudomyxoma. Time from initial cytoreductive surgery to thoracic recurrence ranged from 12.1 to 135 months. There was no perioperative mortality. Follow up range was 8 – 132 months. There were no cases of thoracic disease recurrence following complete thoracic cytoreduction. 5 and 10-year survival was 80% and 40% respectively. Conclusions: Complete cytoreduction and heated intrathoracic intraoperative chemotherapy can provide long-term disease free and overall survival for patients with thoracic recurrence of pseudomyxoma peritonei.

Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection

A 63 year-old female was diagnosed with an adenoid cystic carcinoma causing near total tracheal lumen obstruction. The tumour was successfully resected using cardiopulmonary bypass via femoral vessels under local anaesthetic before induction to secure the airway and facilitate the operation.

Ruptured Left Ventricular False Aneurysm Following Acute Myocardial Infarction: Case Report and Review of the Literature

False aneurysms of the left ventricle complicating acute myocardial infarction are rare. Given they are only contained by pericardial adhesions, they are prone to rupture and hence surgical repair is mandatory. We report a successful repair of a ruptured false aneurysm and then briefly review the current literature.

Patient Safety During Chest Drain Insertion—A Survey of Current Practice

OBJECTIVES The aim of this study was to identify the degree of awareness of the current guidelines and common practices for pleural drain insertion. METHODS A 10-item questionnaire was sent electronically to junior physicians from 4 different hospitals in the South Eastern Sydney and Illawarra Shoalhaven Local Health District. Participants were asked to give their level of experience and management practices for chest drain insertion. RESULTS A total of 94 junior medical officers from 4 hospitals in the district completed the survey. More than 20% had never inserted a chest drain at the time; 72% had primarily learned from bedside teaching and peer learning, but 11% had no training at all. More than 50% of physicians felt that the biggest threat to the procedure was their own lack of confidence for drain insertion. Despite current guidelines, 25% insert chest drains routinely without the aid of ultrasound. A third of interviewees were aware of local guidelines but had not read them. Most physicians (86%) believe that formal standardized training should be available for junior physicians. CONCLUSIONS Our findings demonstrate the ongoing need for improved procedural training in chest drain insertion, with emphasis on mandatory thoracic ultrasound. We consider it important to continue to raise concern and awareness that chest drain insertion is not a harmless procedure, and further physician procedural competence is required.