Platelet-rich Plasma Gel versus Hyaluronic Acid on Prevention of Peritoneal Abdominal Adhesion Formation in Rats.

Background: Intra-abdominal adhesion formation is still unavoidable and a cause of significant morbidity in abdominal surgery. Platelet-rich plasma gel and hyaluronic acid have been studied for their protective of therapeutic effects on adhesions. The aim of the present study is to compare Platelet-rich plasma and hyaluronic acid in adhesion prevention. Material and method: Twenty-seven Sprague-Dawley rats were randomly allocated into three equal groups(n=9). Surgical trauma was used to induce adhesion formation. After trauma, 1 ml normal saline was instilled in the peritoneal cavity in control group (n=9), 1 ml liquid Hyaluronic acid (25 mg/ml) was instilled in group A (n= 9) and 1 ml of platelet-rich plasma was instilled in group B (n = 9). Four weeks after the laparotomy, a repetitive laparotomy was performed and adhesions were examined microscopically and macroscopically. Results: Platelet-rich plasma gel and hyaluronic acid both reduce the extent and grade of adhesions macroscopically. Interestingly, PRP turns out to be superior in the reduction of tenacity and adhesion area. Moreover, platelet-rich plasma ameliorates abdominal adhesion formation by reducing neutrophils, fibrosis, and inflammation. Conclusion: The results indicate that platelet-rich plasma gel surpasses hyaluronic acid in abdominal adhesion prevention.

Vulvo-Perineal and Perianal Paget Disease. Radical Excision and Reconstruction with Singapore Flap.

Extramammary Paget disease (EMPD) is an uncommon intraepithelial malignancy, affecting the vulvo-perineal and perianal region, occurring in 6.5% of all Paget diseases. Usually, an underlying invasive adenocarcinoma denotes a more aggressive behaviour of the disease. We present the multidisciplinary approach in a 75-year old patient with this rare disease. The patient underwent a radical surgical excision and, subsequently, a Singapore flap was used for primary closure. The final histology confirmed the presence of a non-invasive Paget tumor, but a focus of high-grade invasive adenocarcinoma was noted in a perineal nodule. The histological margins were free of tumor. The patient did not undergo any adjuvant treatment because of severe chronic medical problems, although, eighteen months after treatment, she remains well, with no signs of recurrence. In conclusion, radical surgical excision, often necessitating reconstruction techniques, remains the gold standard of care and further adjuvant treatment should be individualised.

Paraffinoma, siliconoma and Co: Disastrous consequences of failed penile augmentation-A single-centre successful surgical management of a challenging entity.

The purpose of this study was to present our series of patients with disastrous consequences of failed penile self-augmentation and suggested surgical reconstruction. Ten patients with median age of 23 years and a variety of penile and scrotal deformities due to injections of several substances had undergone successful surgical reconstruction of external genitalia. The injections were self-performed in nine cases and the patients reported from 4 to 20 substance injections throughout the penile shaft. Three patients presented with fibrotic scirrhous masses in their scrotum, although they did not report any injections in scrotal area. All patients underwent extended penile-shaft skin excision, while all palpable scrotal lesions were removed in one-by-one fashion, as an attempt to destroy the less possible scrotal tissue. All patients were discharged on first post-operative day and reassessed at 2 months post-operatively. As a result, penile self-augmentation with injected substances may cause severe complications. Our proposed single-staged procedure seems safe and effective.