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The woman recalls that she did not experience the exceptional symptoms of this rare disease. “I have been active all my life: I walk a lot, I exercise, I love working in the garden, I try to eat healthy. Just a year ago, I noticed that I was starting to breathe, without air. The belly also increased a little, I thought that Once I gained weight, Vida smiles. – I only went to the doctor when I saw a lump in my stomach after more hard physical work. I thought it was a hernia, I would fix it easily and a lot of knowledge. At that time, I still didn’t know how long The treatment route was waiting for me. “
The abdominal surgery doctor at the Kaunas Surgery Clinic, who supervised the patient and performed the operation, doc. Linas Venclauskas remembers that the relationship with Vida began even before the New Year.
“The woman had fluid in her abdomen, so we first examined her for liver cirrhosis, which can cause this health disorder, and gastroenterologist Roland Gedgaud repeated the necessary tests, but they did not show any pathology. Only after the CT scan did we see that there are some changes in the abdominal area. This is how the long search for the real disease began during the quarantine period, ”says Assoc. L. Venclauskas.
During the first laparoscopic surgery, doctors noticed small individual foci in the peritoneum. “Since all of the previous studies showed no change, we suspected Vidai had peritoneal mesothelioma,” says Doc. L. Venclauskas. – However, the research responses are 100%. did not confirm our assumption, and the patient continued to accumulate fluid in the abdominal area and deteriorated his health. The exact cause of a patient’s illness is our eternal puzzle, which eventually becomes the joy of discovery. “
After re-examining the details, the doctors decided to remove all the fat: the Vidai operation was carried out in late March, when the quarantine in Lithuania began. During the surgery, the doctors noticed that the patient’s illness had progressed.
“The work stopped at the hospital during the quarantine, but it did not stop at all. We twice held multidisciplinary team meetings on women’s health and actively discussed with oncologists – doc. Rasa Jančiauskiene, oncologist and chemotherapist Dainora Mačiuliene, both due to the scope of the surgical treatment and the possibility of applying hyperthermic abdominal chemotherapy (HIPEC) to this patient. We decided that the only way to help Vidai was with the HIPEC method. We carried out the operation in April and finally the histological examination of the patient confirmed our initial diagnosis: peritoneal mesothelioma, “says Dr. L. Venclauskas.
After the operation, the woman feels very good, research shows that there are no new outbreaks of cancer, free fluid in the abdominal area was kept very minimal.
“I just had to adjust my diet a little: I stopped drinking milk and eggs, but I still move around a lot and I don’t sit still. I’m glad I trusted the doctors, their professionalism and now I can enjoy my family and my life again I’m just making progress, “says a Kaunas Clinics patient, smiling.
Like the prof. Žilvinas Dambrauskas, during operations together with hyperterminal chemotherapy, doctors try to remove the organ covered by the tumor, the surrounding lymph nodes, in some cases the part of the peritoneum or other organs covered by the advanced tumor.
“Studies have shown that even after the tumor is completely removed, cancer cells remain in the abdominal cavity that are invisible to the eye, but the disease may recur or the tumor may spread to other organs. To protect patients from such scenarios, we performed hyperthermic chemotherapy in the abdominal cavity. At the end of the operation, a fluid heated to 41-43 ° C with a chemotherapeutic preparation is injected into the abdominal cavity, circulates in a special circulation apparatus for 60-90 minutes. This procedure allows higher doses of the drug to be reached in the abdominal cavity and, at higher temperatures, cancer cells are more sensitive to the drug being given. “
Using the HIPEC method, cancer cells die at 40 ° C and healthy cells at approximately 44 ° C, so the effect on healthy cells is minimal. The circulating fluid from the abdominal cavity is filtered into the circulatory system, so some of the tumor cells are removed and removed during the procedure. The HIPEC treatment method is most commonly used to treat gastrointestinal or ovarian tumors that grow on the surface of internal organs or even adjacent organs, as well as when the tumor has spread.
Both physicians argue that without the professionalism and knowledge of a multidisciplinary team of experienced anesthesiologists, preoperative and postoperative patient care would make such complex surgeries impossible.
At Kaunas clinics this year, of 10 radical surgeries along with hyperterminal abdominal chemotherapy, eight were performed during the COVID-19 pandemic.
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