Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been suggested as an alternative option for treating peritoneal carcinomatosis (PC). Even with its clinical advantages, the current PIPAC system still suffers from limitations regarding drug distribution area and penetration depth. Thus, we evaluated the new PIPAC system using a novel prototype, and compared its performance to the results from previous studies related with the current MIP^® indirectly because the system is currently not available for purchase in the market. The developed prototype includes a syringe pump, a nozzle, and controllers. Drug distribution was conducted using a methylene blue solution for performance test. For penetration depth evaluation, an ex-vivo experiment was performed with porcine tissues in a 3.5 L plastic box. Doxorubicin was sprayed using the novel prototype, and its penetration depth was investigated by confocal laser scanning microscopy. The experiment was repeated with varying nozzle levels from the bottom. The novel prototype sprays approximately 30 μm drug droplets at a flow rate of 30 mL/min with 7 bars of pressure. The average diameter of sprayed region with concentrated dye was 18.5 ± 1.2 cm, which was comparable to that of the current MIP^® (about 10 cm). The depth of concentrated diffusion (DCD) did not differ among varying nozzle levels, whereas the depth of maximal diffusion (DMD) decreased with increasing distance between the prototype and the bottom (mean values, 515.3 μm at 2 cm; 437.6 μm at 4 cm; 363.2 μm at 8 cm), which was comparable to those of the current MIP^® (about 350–500 μm). We developed a novel prototype that generate small droplets for drug aerosolization and that have a comparably wide sprayed area and depth of penetration to the current MIP^® at a lower pressure.

Even though rotational intraperitoneal pressurized aerosol chemotherapy (RIPAC) has been developed to improve the distribution and penetration depth of anti-cancer agents by pressurized intraperitoneal aerosol chemotherapy (PIPAC), the optimal nozzle position and patient’s posture have not been investigated. Thus, we used nine pigs weighing 50–60 kg, and sprayed 150 mL of 1% methylene blue as an aerosol through the nozzle, DreamPen^® (Dreampac Corp., Wonju, Republic of Korea), with a flow rate of 0.6 ml/min under a pressure of 140 to 150 psi for RIPAC in six and three pigs with supine and Trendelenburg positions, respectively. When we evaluated its distribution and penetration depth, even distribution among 13 regions of the abdomen was observed in three pigs with Trendelenburg position regardless of the depth of the nozzle. Regarding penetration depth, the numbers of regions with maximal penetration depth were high in the 2 cm depth of the nozzle with supine position (n = 5) and the 4 cm depth with Trendelenburg position (n = 3). Conclusively, even distribution and maximal penetration of anti-cancer agents can be expected during RIPAC in the medium depth (4 cm) between the nozzle inlet and the visceral peritoneum located on the opposite side of it and the Trendelenburg position.

Traumatic uterine rupture is uncommon but can be fatal and life-threatening for both the mother and infant. In addition to complications caused by trauma itself, such as pelvic fracture, gestational complications such as placental abruption, abortion, premature labor, rupture of membranes, maternal death, and stillbirth can occur. In particular, fetuses have been reported to have a high mortality rate in cases of traumatic uterine rupture. A 36-year-old pregnant female patient fell from the fourth floor and was admitted to our trauma center. We observed large hemoperitoneum, pelvic fractures, and spleen laceration, and the fetus was presumed to be located outside the uterus. The pregnant woman was hemodynamically unstable. Although the fetus was stillborn, angioembolization and surgical treatment were properly performed through collaboration with an interventional radiologist, obstetrician, and trauma surgeons. After two orthopedic operations, the patient was discharged after 34 days. This case report suggests the importance of a multidisciplinary approach in the treatment of pregnant trauma patients.

Background: Abnormal uterine bleeding (AUB) caused by adenomyosis can result in significant iron-deficiency anemia. Given that transvaginal ultrasound (TVUS) is commonly performed during routine examinations, its assessment may facilitate preemptive treatment. Methods: In this study, TVUS images from patients with surgically confirmed adenomyosis were preprocessed to minimize intra- and inter-scan variability. Radiomics features were extracted using PyRadiomics to train automated machine-learning classifiers under k-fold nested cross-validation. Multiple dataset configurations were evaluated, including feature extraction from a custom region-of-interest (ROI) of the uterine corpus, whole-image features adjusted for uterine size, and supplementary variables from complete blood counts (CBC). Results: Radiomics-centered models demonstrated modest discrimination (mean accuracy 0.606–0.618). While incorporating CBC variables with radiomics features substantially improved performance compared to radiomics alone, models trained exclusively on CBC data yielded overall higher results. Conclusions: These findings indicate that quantitative features derived from routine TVUS provide modest complementary information for predicting anemia. While they do not offer clear incremental value when highly discriminatory clinical data (CBC) are available, TVUS radiomics may serve as a supplementary diagnostic tool in settings where blood tests are incomplete or unavailable. Further validation in larger, multi-institutional cohorts with patient-level separation is warranted.

Oh S, et al. J Gynecol Oncol. 2025 Apr;36:e107. https://doi.org/10.3802/jgo.2025.36.e107

Background: Previous studies have reported that loss of muscle mass and quality (sarcopenia) is related to disability, poor quality of life, and decreased survival across various cancer types. This retrospective study aimed to evaluate the influence of preoperative skeletal muscle quantification on prognosis in epithelial ovarian cancer (EOC) patients undergoing primary debulking surgery (PDS). Methods: The medical records of 222 EOC patients treated from June 2002 and December 2017 were reviewed. Preoperative computed tomography (CT) scans at the level of the third lumbar vertebra were used to identify and classify skeletal muscle based on radiodensity. The proportion of low-attenuation muscle within the total skeletal muscle area was calculated. Healthy muscle was defined as containing 23.5% or less low attenuation muscle, determined using a maximal chi-square test. Results: Based on these criteria, 84 patients were classified into the healthy muscle group, while the remaining 138 patients were categorized into the unhealthy muscle group. Patients with healthy muscle demonstrated improved overall survival (OS) and progression-free survival compared with those in the unhealthy muscle group. Multivariate analysis identified unhealthy muscle as a significant predictor of decreased survival, alongside with advanced stage, high-grade histology, and suboptimal surgery. Conclusions: Preoperative skeletal muscle quantification was identified as an independent prognostic factor in EOC patients. EOC patients with healthy muscle demonstrated a better prognosis than patients with unhealthy muscle.