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ascites and palliative care

Lucia Macken, Deepak Joshi, Jenny Messenger, Mark Austin, Jeremy Tibble, Louise Mason, Sumita Verma
BACKGROUND: Ascites, the commonest complication of cirrhosis, leads to frequent hospitalisations. Refractory ascites confers a median survival of 6 months without liver transplantation. In many, the management remains palliative (large-volume paracentesis). Despite calls for improvement, palliative and end-of-life care is not yet integrated into end-stage liver disease. Long-term abdominal drains are a palliative strategy in malignant ascites, but not end-stage liver disease. CASE PRESENTATION: A retrospective, single centre, case series review was performed of patients undergoing long-term abdominal drain placement for refractory ascites secondary to end-stage liver disease at a large teaching hospital between August 2011 and March 2013...
October 5, 2016: Palliative Medicine
Luigina Graziosi, Elisabetta Marino, Verena De Angelis, Alberto Rebonato, Annibale Donini
: Malignant ascites is an abnormal accumulation of fluid in the peritoneal cavity of patients with intraperitoneal cancer dissemination. This clinical condition could represent the terminal evolution of a lethal disease and could influence the prognosis, severely impairing the patients' quality of life. Treatment options include a multitude of different procedures with limited efficacy and some degree of risk; diuretics, paracentesis, peritoneo-venous shunts and intraperitoneal biologic agents like anti-VEGF molecules, metalloproteinase inhibitors and immunomodulators are included...
2016: Annali Italiani di Chirurgia
Martha M Kirstein, Nora Schweitzer, Nazli Ay, Christina Boeck, Katerina Lappas, Jan B Hinrichs, Torsten Voigtländer, Frank Wacker, Michael P Manns, Thomas Rodt, Arndt Vogel
BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most lethal cancers. Transarterial chemoembolization (TACE) has been accepted as the standard of care for intermediate stage disease. METHODS: In this study, we characterized 606 HCC patients from Hannover Medical School treated with TACE. RESULTS: 606 HCC patients treated with TACE were identified between 2000 and 2015. Most patients (59.8%) were at intermediate stage. Following TACE, most patients subsequently received systemic therapy or best supportive care (BSC), whereas 227 (37...
September 6, 2016: Scandinavian Journal of Gastroenterology
T Burnik Papler, S Frković Grazio, B Kobal
BACKGROUND: Sertoli - Leydig cell tumors (SLCTs) are sex-cord stromal tumors that account less than 0.5 % of primary ovarian neoplasms. They are mostly benign and occur in reproductive age women. Variants with heterologous mesenchymal elements are exceptionaly rare. The usual presentation of SLCTs is with signs of androgen excess as majority of them produce androgens. CASE PRESENTATION: We present a case of a SLCT occurring in a 70 year old woman. Her presenting complaint was abdominal distension and pain...
2016: Journal of Ovarian Research
Ramakrishnan Ayloor Seshadri, Olivier Glehen
Peritoneal metastasis, either synchronous or metachronous, is commonly seen in gastric cancer. It is associated with a poor prognosis, with a median survival of less than one year. The outcomes are not significantly improved by the use of systemic chemotherapy. We review the relevant literature on the role of HIPEC in gastric cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been used in three situations in gastric cancer. Besides its role as a definitive treatment in patients with established peritoneal metastasis (PM), it has been used as a prophylaxis against peritoneal recurrence after curative surgery and also as a palliative treatment in advanced peritoneal metastasis with intractable ascites...
June 2016: Indian Journal of Surgical Oncology
Ramakrishnan Ayloor Seshadri, Olivier Glehen
Gastric cancer associated peritoneal carcinomatosis (GCPC) has a poor prognosis with a median survival of less than one year. Systemic chemotherapy including targeted agents has not been found to significantly increase the survival in GCPC. Since recurrent gastric cancer remains confined to the abdominal cavity in many patients, regional therapies like aggressive cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been investigated for GCPC. HIPEC has been used for three indications in GC- as an adjuvant therapy after a curative surgery, HIPEC has been shown to improve survival and reduce peritoneal recurrences in many randomised trials in Asian countries; as a definitive treatment in established PC, HIPEC along with CRS is the only therapeutic modality that has resulted in long-term survival in select groups of patients; as a palliative treatment in advanced PC with intractable ascites, HIPEC has been shown to control ascites and reduce the need for frequent paracentesis...
January 21, 2016: World Journal of Gastroenterology: WJG
Youhei Miyauchi, Tsukasa Takayashiki, Hiroaki Shimizu, Masayuki Ohtsuka, Atsushi Kato, Hideyuki Yoshitomi, Katsunori Furukawa, Shigetsugu Takano, Satoshi Kuboki, Daisuke Suzuki, Nozomu Sakai, Shingo Kagawa, Hiroyuki Nojima, Masaru Miyazaki
The quality of life of patients with recurrence of biliary cancer is remarkably diminished by the occurrence of refractory ascites caused by peritoneal dissemination or portal vein obstruction. In this study, we examined the effectiveness of peritoneovenous shunting (PVS) in patients with refractory ascites after recurrence of biliary cancer. PVS was performed 7 times in 5 patients, with 6 shunts (85.7%) placed from the left-side abdomen to the left subclavian vein. During the median observation period of 136 days, the ascites and symptoms of abdominal distension disappeared in 4 patients...
November 2015: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Beyhan Ataseven, Christoph Grimm, Philipp Harter, Florian Heitz, Alexander Traut, Sonia Prader, Andreas du Bois
OBJECTIVE: To determine the impact of debulking surgery (DS) and residual disease (RD) on outcome in patients with FIGO stage IV epithelial ovarian cancer (EOC). PATIENTS AND METHODS: This exploratory study included 326 consecutive patients with FIGO IV EOC treated in our centers from 2000 to 2014. Data were extracted from our prospectively maintained registry. RESULTS: In patients, who underwent DS (n=286; 87.7%), complete macroscopic resection was achieved in 54...
February 2016: Gynecologic Oncology
Takafumi Yachi, Shinsuke Nishikawa, Tomohisa Tokura, Masahiro Iwama, Takanobu Akaishi, Minoru Umehara, Yutaka Umehara, Akihiko Murata, Kenichi Takahashi, Takayuki Morita
We experienced a case of pseudo-Meigs syndrome associated with metachronous metastasis to the ovary from ascending colon cancer. A 65-year-old woman underwent curative surgery for ascending colon cancer at another hospital. A follow-up CT carried out 3 months after the surgery revealed a right ovarian tumor and a large amount of ascites. The patient was diagnosed with ovarian metastasis from ascending colon cancer with carcinomatous peritonitis. Palliative care was recommended, and she presented at our department for a second opinion...
October 2015: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Vincent Gamblin, Arlette Da Silva, Stéphanie Villet, Farid El Hajbi
Malignant ascites, occurring in advanced stages of cancer, is linked with poor prognosis and can cause invalidating symptoms. Physiopathological mechanisms of ascites formation are complex and have yet to be fully elucidated. In most cases, ascites is due to peritoneal carcinomatosis in which vascular permeability is enhanced by VEGF production while lymphatic drainage decreases. Ascites can also be secondary to portal hypertension, for example in case of multiple liver metastases, or due to lymphatic obstruction...
November 2015: Bulletin du Cancer
S J Valle, N A Alzahrani, S E Alzahrani, W Liauw, D L Morris
INTRODUCTION: Malignant ascites (MA) is the abnormal accumulation of fluid in the peritoneal cavity of patients with intraperitoneal dissemination of their disease and is associated with a short life expectancy. The most common clinical feature is a progressive increase of abdominal distention resulting in pain, discomfort, anorexia and dyspnoea. Currently, no treatment is established standard of care due to limited efficacy or considerable toxicity. The objective was to examine the efficacy of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliation of refractory MA in patients who were unsuitable for cytoreductive surgery...
November 2015: International Journal of Surgery
Kenichi Harano, Kan Yonemori, Akihiro Hirakawa, Chikako Shimizu, Noriyuki Katsumata, Akihiko Gemma, Yasuhiro Fujiwara, Kenji Tamura
BACKGROUND: The social or familial factors influencing the location chosen for end-of-life (EOL) care for terminally ill breast cancer patients are unknown. METHODS: We retrospectively analyzed 195 patients with recurrent or progressive breast cancer who received anticancer treatment at the National Cancer Center Hospital between January 2008 and May 2012. Detailed data concerning the patients' demographic, familial, and clinical characteristics were collected, and multivariate and Cox logistic regression analyses were performed to evaluate the impact of these characteristics on the place of EOL care and on survival, respectively...
September 2016: Breast Cancer: the Journal of the Japanese Breast Cancer Society
Sayako Maeda, Junko Yabuuchi, Hiroshi Nobuta, Tetsuya Makiishi, Kunihiko Hirose
Novel cell-free and concentrated ascites reinfusion therapy (KM-CART) is easy to use, safe and applicable for refractory ascites. We can get the full amount of ascites, filtrate, and concentrate in a short time. KM-CART can be applied as palliative care for dying patients including patients with massive malignant ascites. Some patients who underwent repeated KM-CART survived longer than those who did not repeat the therapy. The aim of this study was to identify the type of patients with ascites for whom KM-CART would be effective and candidates for repeated KM-CART...
August 2015: Therapeutic Apheresis and Dialysis
Christy E Cauley, Maria T Panizales, Gally Reznor, Alex B Haynes, Joaquim M Havens, Edward Kelley, Anne C Mosenthal, Zara Cooper
BACKGROUND: There is increasing emphasis on the appropriateness and quality of acute surgical care for patients with serious illness and at the end of life. However, there is a lack of evidence regarding outcomes after emergent major abdominal surgery among patients with advanced cancer to guide treatment decisions. This analysis sought to characterize adverse outcomes (mortality, complications, institutional discharge) and to identify factors independently associated with 30-day mortality among patients with disseminated cancer who undergo emergent abdominal surgery for intestinal obstruction or perforation...
September 2015: Journal of Trauma and Acute Care Surgery
R J Stephens, C Whiting, K Cowan
BACKGROUND: In the UK, despite the import and use of all forms of asbestos being banned more than 15 years ago, the incidence of mesothelioma continues to rise. Mesothelioma is almost invariably fatal, and more research is required, not only to find more effective treatments, but also to achieve an earlier diagnosis and improve palliative care. Following a debate in the House of Lords in July 2013, a package of measures was agreed, which included a James Lind Alliance Priority Setting Partnership, funded by the National Institute for Health Research...
August 2015: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Ekta Dhamija, Sanjay Thulkar, Sushma Bhatnagar
Bedside ultrasound is an important tool in modern palliative care practice. It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures. With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards. Major applications of bedside ultrasound include drainage of malignant pleural effusions and ascites, nerve blocks, venous access, evaluation of urinary obstruction, deep vein thrombosis and abscesses...
May 2015: Indian Journal of Palliative Care
Anne M Larson
Liver disease results in over four million physician visits and over 750,000 hospitalizations per year in the USA. Those with chronic liver disease frequently progress to cirrhosis, end-stage liver disease (ESLD), and death. Patients with ESLD experience numerous complications, including muscle cramps, confusion (hepatic encephalopathy), protein calorie malnutrition, muscle wasting, fluid overload (ascites, edema), bleeding (esophagogastric variceal hemorrhage), infection (spontaneous bacterial peritonitis), fatigue, anxiety, and depression...
May 2015: Current Gastroenterology Reports
Yasuhiko Midorikawa, Seiko Suzushino, Kiyokazu Tamotsu
We conducted home care and home palliative care from the department of home care. We provided home care services to 190 patients(105 men, 85 women)in October 2013. Their average age was 78.7(range: 32-102)years old, and home care had been underway from 1 day to 8 years, 10 months. Among all participants, 168(88.4%)suffered from malignant diseases, 168 patients had died, and over half of deceased patients(88 out of 168)had died at home. We used opioids for control of cancer pain, carried out home parenteral nutrition(HPN), home enteral nutrition(HEN), percutaneous endoscopic gastrostomy( PEG), and removed pleural effusion and ascites during home care...
December 2014: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Viral M Bhanvadia, Jignesh K Parmar, Yogendra G Madan, Shamim S Sheikh
Primary peritoneal serous carcinoma (PPSC) is a rare primary malignancy that diffusely involves the peritoneum, indistinguishable clinically and histopathologically from primary serous ovarian carcinoma. The origin of PPSC has not been well characterized. Here we present a case of PPSC diagnosed in ultrasonography-guided fine needle aspiration cytology (FNAC) in a 76- old female presenting with ascites, abdominal pain, distension and constipation. PPSC is an unusual tumour but cytomorphology is distinctive enough to diagnose preoperatively...
May 2014: Indian Journal of Palliative Care
Chan Hyuk Park, Jun Chul Park, Eun Hye Kim, Hyunsoo Chung, Ji Yeong An, Hyoung-Il Kim, Sung Kwan Shin, Sang Kil Lee, Jae-Ho Cheong, Woo Jin Hyung, Yong Chan Lee, Sung Hoon Noh, Choong Bae Kim
BACKGROUND: Self-expandable metal stent (SEMS) placement and palliative gastrojejunostomy (GJJ) are palliative treatment options for malignant gastric outlet obstruction. OBJECTIVE: To compare clinical outcomes of palliative treatments for gastric outlet obstruction caused by unresectable gastric cancer. DESIGN: Retrospective study. SETTING: University-affiliated tertiary-care hospital in the Republic of Korea. PATIENTS: Two hundred fifty-six patients with gastric outlet obstruction caused by unresectable gastric cancer...
February 2015: Gastrointestinal Endoscopy
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