Chapters authored
Peritoneal Mesothelioma: Clinical and Therapeutic Aspects
Mesothelioma is a very rare malignant disease that originates from mesothelial cells that line the serosa: pleura, peritoneum, pericardium, or testicular vaginal tunic. Peritoneal mesothelioma accounts for 7–10% of all mesotheliomas diagnosed, and ranks second after pleural localization of mesothelioma. The incidence of peritoneal mesothelioma is 0.5–3 cases per million in men and 0.2–2 cases per million in women. Diagnosis of peritoneal mesothelioma is difficult due to nonspecific symptoms and because of this patients present in advanced stages of the disease. Histologically there are three major categories of malignant peritoneal mesothelioma: epithelioid, sarcomatoid, and biphasic. The differential diagnosis of peritoneal mesothelioma is made with peritoneal pseudomyxoma, ovarian tumors, and peritoneal metastases from colorectal cancer. An important role in differential diagnosis, in addition to immunohistochemistry, is played by various tumor markers and genetic tests. The treatment of peritoneal mesothelioma is performed by cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), with good results for patients in the early stages of the disease. For patients with advanced disease, a new treatment has been proposed: pressurized intraperitoneal aerosol chemotherapy (PIPAC). For patients who cannot use CRS and HIPEC, the only therapeutic option remains chemotherapy (systemic + intraperitoneal).
Part of the book: Mesothelioma
Complicated Colonic Diverticular Disease – Diagnostic and Therapeutic Difficulties
Diverticular disease is one of the most common problems encountered by general surgeons and gastroenterologists. The term refers to complications that occur from colonic diverticulosis. In diverticular colonic disease the sigmoid colon is usually the most commonly involved, while right acute colonic diverticulitis is rarer. In establishing the diagnosis of ALCD, objective clinical examination plays an important role in addition to biological paraclinical examinations (C-reactive protein - CRP and increased leukocyte count) and radiological paraclinical examinations: CT abdomen. CRP is a useful tool in predicting the clinical severity of acute diverticulitis. The treatment applied to patients with uncomplicated colonic diverticular disease can be represented by antibiotic therapy, water regime, hydro-electrolytic rebalancing. In patients with multiple comorbidities, hemodynamic instability, the Hartmann procedure is recommended for the treatment of acute peritonitis caused by perforated colonic diverticulitis and in hemodynamically stable patients without comorbidities, colonic resection with primary anastomosis with or without stoma is suggested.
Part of the book: Diverticular Disease of the Colon