Intraperitoneal administration of bevacizumab intraoperatively does not affect abdominal wound healing in rats.

BACKGROUND: Bevacizumab is a monoclonal antibody targeted at vascular endothelial growth factor (VEGF) to treat advanced colorectal cancer as well as other malignancies, but the ideal time point for its administration in patients scheduled for surgery is not well defined due to serious concerns regarding possible side effects on wound healing. Therefore, we conducted an experimental study in rats to clarify this issue. METHODS: Four groups of 10 Wistar rats each underwent a 4-cm midline laparotomy and closure of the wound in 2 layers. In the treatment groups (A and B), bevacizumab (Avastin(®)) received a single dose of 5 mg/kg i.p., and an equal amount of saline was given to the control groups (C and D). Groups A and C were sacrificed on the 7th postoperative day, and groups B and D on the 14th postoperative day. Wounds were inspected by two independent observers upon sacrifice and results were recorded; wound tissues were sent for histology to assess the degree of fibrosis and measurement of tissue hydroxyproline levels. Serum levels of endothelin-1, C-reactive protein, pro-oxidant/antioxidant balance and carbonylated proteins were also determined. For statistical analysis, the Mann-Whitney U test was used. RESULTS: Wound healing did not differ among groups both on the 7th and the 14th postoperative days, and there was also no significant difference regarding the degree of inflammation, fibroblast proliferation and collagen synthesis, as well as hydroxyproline and biochemical marker levels among the groups. CONCLUSIONS: Intraperitoneal bevacizumab administered intraoperatively does not significantly affect abdominal wound healing in rats.

Tension-free by mesh-plug technique for inguinal hernia repair in elderly patients.

BACKGROUND: elderly patients are steadily becoming a growing part of the population. The aim of this study is to evaluate the outcome of open inguinal hernia repair in patients aged over 65 years. METHODS: from January 1999 to December 2008, a total of 719 patients underwent open tension-free inguinal hernia repair with mesh-plug; 301 among them were ≥ 65 years old. RESULTS: elderly patients had a mean age of 72.4 years (women 3.3%), while the mean age of younger patients was 48.7 years (women 5.7%). According to the ASA score, patients aged ≥ 65 years were at significantly higher risk than the younger patients. Spinal anesthesia was used most frequently in both groups. No significant differences were found in postoperative pain, mortality and recurrence. Morbidity and hospital stay were significantly higher in patients aged ≥ 65 years. CONCLUSIONS: open hernia repair in the elderly is safe and well tolerated, but it is associated with higher morbidity and longer hospitalization.

Pelvic malakoplakia simulating recurrence of rectal adenocarcinoma: report of a case.

Malakoplakia represents a chronic inflammatory disease associated with a broad spectrum of bacterial infections. On histopathology, Michaelis-Gutmann bodies are considered as pathognomonic histopathological findings. Rarity of the disease and wide variety of clinical presentation makes its diagnosis very challenging. We report herein the case of a 66-year-old woman who, having undergone lower anterior resection for rectal adenocarcinoma 3 and a half years ago, presented with urinary frequency and dull abdominal pain. CT scan revealed a soft tissue tumour infiltrating the preperitoneal fat over the urinary bladder, which was considered as recurrence of the rectal carcinoma. On laparotomy, a tumour invading the bladder, small intestine and the anterior abdominal wall was resected and the patient recovered uneventfully. On histopathology, malakoplakia of urinary bladder was revealed. Overstaging of patients' malignancy due to malakoplakia is not uncommon, so its early identification can help avoid incorrect treatment.

Epidermoid splenic cyst presented as huge splenic abscess: a case report.

Epidermoid splenic cysts are very rare. Symptoms emerge because of enlargement, infection, haemorrhage or rupture. Although splenectomy is indicated for large cysts, minimally invasive and preservation procedures, such as partial splenectomy or total cystectomy with splenorrhaphy, have been increasingly used during the last decade. We report herein the case of a 16-year old female presented with left upper abdominal quadrant pain, fever and abdominal distention treated in our department.

Intraperitoneal ePTFE mesh repair of parastomal hernias.

Parastomal hernia represents a common complication of colostomy formation. Surgical techniques such as facial repair and stoma relocation have almost been abandoned because of high recurrence rates. Extraperitoneal prosthetic mesh repair had better results but was accompanied by high rates of mesh contamination. A new technique, with intraperitoneal onlay position of expanded polytetrafluoroethylene (ePTFE) was therefore established. We report herein two cases of symptomatic large parastomal hernias treated in our department.