532 Background: Pseudomyxoma peritonei (PMP) originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The purpose of this study was to evaluate the outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an International Registry study. Methods: A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International (PSOGI). Results: 2298 patients from 16 specialized units underwent CRS for PMP. Treatment related mortality was 2% and major operative complication was 24%. The median survival was 196 months (16.3 years) and the median progression-free survival was 98 months (8.2 years) with a 10- and 15-year survival rate of 63% and 59% respectively. Multivariate analysis identified prior chemotherapy treatment (P<0.001), PMCA histopathological subtype (P<0.001), major postoperative complication (P=0.008), high PCI (P=0.013), debulking surgery (CCR2/3) (P<0.001), not using HIPEC (P=0.030) as independent predictors for a poorer progression-free survival. Older age (P=0.006), major postoperative complication (P<0.001), debulking surgery (CCR2/3) (P<0.001), prior chemotherapy treatment (P=0.001) and PMCA histopathological subtype (P<0.001) were independent predictors of a poorer overall survival. Conclusions: The combined modality strategy for PMP may be performed safely with acceptable morbidity and mortality in a specialized unit setting with 63% of patients surviving beyond 10-years. Minimizing non-definitive operative and systemic chemotherapy treatments prior to definitive cytoreduction may facilitate the feasibility and outcome of this therapy to achieve long-term survival. Optimal cytoreduction achieves the best outcomes.

Background: Pseudomyxoma peritonei (PMP) is a rare disease with excess intraperitoneal mucin secretion. Treatment involves laparotomy, cytoreduction and chemotherapy that is very invasive with patients often acquiring numerous compromises. Hence a mucolytic comprising of bromelain and N-acetyl cystein has been developed to solubilise mucin in situ for removal by catherization. Owing to differences in mucin appearance and hardness, dissolution varies. Therefore the current study investigates the inter-mucin physical and chemical characteristics, in order to reformulate an effective mucolytic for all mucin.Method: PMP mucin, from the three categories (soft, semi hard and hard mucin) was solubilised and then various physical characteristics such as turbidity, density, kinematic viscosity were measured. The water content and the density of solid mucin were also determined. This was followed by the determination of sialic acid, glucose, lipid, Thiol (S-S and S-H) content of the samples. Lastly, the distribution of MUC2, MUC5B and MUC5AC was determined using western blot technique.Results: Both turbidity and kinematic viscosity and sialic acid content increased linearly as the hardness of mucin increased. However, density, hydration, protein, glucose, lipid and sulfhydryl and disulphide content decreased linearly as hardness of mucin increased. The distribution ratio of mucins (MUC2:MUC5B:MUC5AC) in soft mucin is 2.25:1.5:1.0, semi hard mucin is 1:1:1 and hard mucin is 3:2:1.Conclusion: The difference in texture and hardness of mucin may be due to cellular content, hydration, glucose, protein, lipids, thiol and MUC distribution. Soft mucin is solely made of glycoprotein whilst the others contained cellular materials.

SummaryLiver-directed therapies are continuing to evolve in the field of interventional oncology and are gaining increasing use in the treatment of unresectable primary and secondary liver cancers. In this article, we review two liverdirected therapies that are currently used for the palliative treatment of primary and secondary hepatic tumours: transcatheter arterial chemoembolisation (TACE), including a new type of TACE with drug-eluting beads (DEB-TACE), and radioembolisation. The concept of these transcatheter intraarterial therapies is to selectively deliver high doses of anticancer treatment to the tumour. While TACE delivers one or more chemotherapeutic drugs into the hepatic arteries supplying the tumour, radioembolisation uses non-embolic microspheres incorporating the radioactive isotope 90 Y. In this article, we discuss some technical aspects, patient selection, current clinical evidence, and future directions of TACE, TACE with drug-eluting beads (DEB-TACE) and radioembolisation for primary and secondary liver cancer.

Multimodality therapy in selected patients with peritoneal carcinomatosis is gaining acceptance. Treatment-directing decision support tools are needed to individualize care and select patients best suited for cytoreductive surgery ± hyperthermic intraperitoneal chemotherapy (CRS ± HIPEC). The purpose of this study is to develop a predictive model that could support surgical decisions in patients with colon carcinomatosis. Fifty-three patients were enrolled in a prospective study collecting 31 clinical-pathological, treatment-related, and outcome data. The population was characterized by disease presentation, performance status, extent of peritoneal cancer (Peritoneal Cancer Index, PCI), primary tumor histology, and nodal staging. These preoperative parameters were analyzed using step-wise machine-learned Bayesian Belief Networks (BBN) to develop a predictive model for overall survival (OS) in patients considered for CRS ± HIPEC. Area-under-the-curve from receiver-operating-characteristics curves of OS predictions was calculated to determine the model's positive and negative predictive value. Model structure defined three predictors of OS: severity of symptoms (performance status), PCI, and ability to undergo CRS ± HIPEC. Patients with PCI < 10, resectable disease, and excellent performance status who underwent CRS ± HIPEC had 89 per cent probability of survival compared with 4 per cent for those with poor performance status, PCI > 20, who were not considered surgical candidates. Cross validation of the BBN model robustly classified OS (area-under-the-curve = 0.71). The model's positive predictive value and negative predictive value are 63.3 per cent and 68.3 per cent, respectively. This exploratory study supports the utility of Bayesian classification for developing decision support tools, which assess case-specific relative risk for a given patient for oncological outcomes based on clinically relevant classifiers of survival. Further prospective studies to validate the BBN model-derived prognostic assessment tool are warranted.

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The results showed that miR-451 could play a role in development and progression of colorectal cancer and likely by targeting .

Emphysematous pyelonephritis (EPN) is a severe urinary tract infection (UTI) that causes kidney necrosis by gas‐producing bacteria. Escherichia coli is most implicated. Type‐2 diabetes mellitus (T2DM) is a common predisposing factor. Necrotising fasciitis (NF) is an uncommon complication of EPN that has severe consequences. It is easily missed due to rarity. We present the case of an 82‐year‐old female nursing home resident with T2DM that presents with NF of the left flank following EPN of the left kidney that has penetrated through the superior lumbar triangle. This is the first time this anatomical pathway has been implicated in NF secondary to EPN in the English literature.

Introduction: Visceral metastases from melanoma represent the poorest prognosis based according to the revised version of the AJCC staging system that recognises both clinical and pathological features distinctive to melanoma. Given that systemic treatments in metastatic melanoma to date remains inadequate, we evaluated the efficacy of surgical metastasectomy on survival outcomes. Materials and Methods: Between year 2000 and 2009, 23 patients with visceral metastases from melanoma were evaluated for metastasectomy. Retrospective review was undertaken of the specific therapy administered following consensus meeting of a multidisciplinary team. Results: There were 16 males and 7 females. Seventeen patients (74%) had metachronous gastrointestinal/liver metastases following previous treatment of the primary tumour. The median time to development of gastrointestinal/liver metastases, otherwise known as disease-free interval, was 49 (range, 5 to 559) months. Overall median survival period was 9 months, with a 1- and 3-year survival percentages of 39% and 30%, respectively. Survival was influenced by the number of metastases (P = 0.05) and the treatment received (P = 0.03). The disease-free and overall survival periods after metastasectomy were 14 and 21 months, respectively. The 1- and 3-year survival percentages were 60% and 40%, respectively. Patients with single site of metastasis survived longer than patients with more than one site of metastasis (P= 0.005). Conclusion: Patients with visceral metastases from melanoma may derive survival benefit from metastasectomy over systemic therapy. Judicious selection of patients for metastasectomy is paramount for the success of treatment in this group of patients. Key Words: Melanoma, Metastasectomy, Liver metastasis, Surgery, Prognosis