This study aimed to assess the safety and effectiveness of different dosages of heparin for adhesion prevention by comparing with Seprafilm, in a murine model. Seventy five Balb/c mice were randomized into five groups. Group C were reserved as controls, and 62.5 IU, 125 IU, 250 IU of heparin, and Seprafilm were intraperitoneally applied in studied groups. The severity and locations of adhesions were assessed after the sacrification on day 14. The cause of death was investigated to evaluate the side effects of the drugs. The death of 2 subjects due to peritonitis (1 in Group C, 1 in Group H62.5) left 14 subjects in Group C and Group H62.5 (P ≥ 0.05), and no hemorrhage related death was observed. The use of the products significantly reduced the severity score of adhesion and the number of animals, had adhesions in different locations of the abdominal cavity, when the results were compared with the control group (P < 0.05 for all comparisons). Higher dosages of heparin seemed to be more effective. The results in group S, groups H250 and H125 were quite similar. Relatively high doses (125 IU and 250 IU) of intra-abdominal heparin may be comparable in safety and effectiveness to Seprafilm in adhesion prevention in mice.

The aim of this study was to evaluate the clinical results of a temporary fecal containment device (Flexi-Seal® FMS) in our burn center. All patients in whom temporary fecal containment devices were applied for perineal burns between August 2008 and August 2009 in our institution were reviewed. Demographics, etiology of burns, total body surface area (TBSA) burned, intensive care unit (ICU) need, early mortality, and post-application data were obtained from a prospectively designed database. In addition, some variables were investigated as potential risks factors for fecal leakage. The mean age of patients (n=15) was 43.1±22.1 years, and 66.7% of the patients were male. The mean %TBSA burned was 40.7±16.6. Fecal leakage was seen in 6 patients. Local infection in the perineum was observed in 6 patients, including 4 of the 6 patients with fecal leakage. The mortality rate was 33% (5 deaths). All exitus patients had 50% or more TBSA burned. Electrical burn injury was found as a significant risk factor for fecal leakage in surviving patients (p<0.05). Autologous split-thickness grafting was performed in 8 patients without complication. The mean duration of catheterization was 22.5±5.7 days. Except for superficial mucosal erosion in the distal rectum in 2 cases, no complication was observed. The mean hospitalization time was 46.7±12.7 days. If the safety of these devices is proven in further prospective, high-volume studies, they may reduce the necessity of diverting stoma operation in burn patients.

Background: Axillary lymph nodes (ALNs) are the most important prognostic factor for survival in breast cancer. Pathological evaluation can affect the number of involved lymph nodes. In the current study, we evaluated whether the metastatic lymph node ratio (n ratio) is important in predicting disease-free survival (DFS) for breast cancer patients. Material and Methods: From 802 breast cancer cases, 427 patients with ALN metastasis were analyzed retrospectively. The n ratio was categorized as n ratio 1 (1–10%), n ratio 2 (10.01–50%) and n ratio 3 (>50%). DFS was established according to the Kaplan-Meier method. Predicting risk factors for relapse were analyzed using the Cox proportional hazards model. Results: The n ratio was significantly higher in breast cancer patients with advanced pathologic pT, pN and clinical stage, undifferentiated histology, lymphovascular and extracapsular invasion, more resected ALNs and positive progesterone receptor. In the univariate analysis, multicentricity, necrosis, grade, pN stage, estrogen receptor and progesterone receptor positivity, trastuzumab and neoadjuvant chemotherapy usage, the presence of inflammatory breast cancer and n ratio were found to be important factors in predicting DFS. Multivariate analysis indicated that multicentricity, neoadjuvant chemotherapy, trastuzumab usage and n ratio were significantly associated with prognosis. Conclusions: The n ratio is inexpensive, easily available and a simple prognostic factor for breast cancer patients with positive ALNs.

Background: Incontinence is not rare after rectal cancer surgery. Platelet-rich plasma may promote tissue repair and generation but has never been tested for the treatment of anal incontinence. This study evaluated the impact of platelet-rich plasma injection on the severity of incontinence and quality of life after low rectal cancer surgery. Methods: This is a prospective cohort proof of concept study in a colorectal cancer institution. Patients had undergone low anterior or intersphincteric resection for low rectal cancer and had a Wexner score > 4. Ten milliliters of platelet-rich plasma were injected into the internal and external sphincters under endoanal ultrasound (EAUS) guidance. Primary outcome measure was > 2 point improvement in Wexner score (improved group). The patients were assessed with endo-anal ultrasound examination, manometry, the Wexner Questionnaire and SF-36 Health Surveys, and patients were asked whether they used pads and antidiarrheal medications before and 6 months after PRP injection. Results: Of 20 patients included in the study, 14 (70%) were men, and the average age was 56.8 (SD = 9.5) years. No statistically significant difference was found in Wexner scores before and after PRP injection (p = 0.66). Seven (35%) patients experienced a > 2 point improvement in Wexner score. Rectal manometry demonstrated improved squeezing pressure (p = 0.0096). Furthermore, physical functioning scoring (p = 0.023), role limitation (p = 0.016), emotional well-being (p = 0.0057) and social functioning (p = 0.043) domains on the SF-36 questionnaire improved. One (5%) and three (15%) patients stopped using pads and antidiarrheal medications. Conclusion: Platelet-rich plasma injection does not restore Wexner scores, but more than one-third of patients may benefit from this application with an improvement of > 2 points in their scores. Platelet-rich plasma injection may improve squeezing pressure and certain life quality measures for incontinent patients after rectal cancer surgery.

Background and Objectives: The combined use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is employed for the treatment of peritoneal carcinomatosis (PC). To achieve optimal cytoreduction, there may be a need for extensive resection and subsequent reconstruction of urologic structures. This study was designed to evaluate the outcomes of urinary tract resection or repair performed in CRS/HIPEC in terms of operative and oncological outcomes. Materials and Methods: After institutional review board approval, data from 550 consecutive patients who underwent the CRS/HIPEC procedure from January 2007 to July 2018 at six university hospitals was retrieved from prospectively maintained databases. Data from patients who had a concomitant curative resection and reconstruction of the bladder, ureter, or kidney during the CRS/HIPEC procedure were analyzed retrospectively. Results: A total of 50 out of 550 patients had undergone resection with a repair of the urinary tract due to tumor invasion or iatrogenic injury. Postoperative (within 30 days) urologic complications were observed in 9 of the 50 patients. It was found that having a peritoneal cancer index (PCI) equal to or greater than 20 (p < 0.009) was the sole significant risk factor associated with the occurrence of early urinary complications. Survival time post CRS/HIPEC treatment did not significantly differ between patients with and without urologic complications (median overall survival: 23 vs. 27 months, p = 0.683). Conclusions: Despite urinary tract issues during CRS/HIPEC for PC, including a PCI over 20 and potential complications from resection or repair, the procedure still offers significant survival benefits.