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Background and Aims: The existence of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as a multidisciplinary approach for peritoneal cancer gains acceptance in many countries including Saudi Arabia. The aim of our study is to describe the perioperative management of patients who received CRS/HIPEC and to report their outcomes and complications at our tertiary centre. Methods: The preoperative characteristics, surgical variables, perioperative management, postoperative course and outcomes of 38 CRS/HIPEC patients were prospectively collected and analysed. Results: The mean age of our patients was 52 years, and 23 (60.5%) of them were females. The overall postoperative mortality was 42.1%. Univariate analyses of risk factors for deaths after HIPEC demonstrated that low preoperative (haemoglobin, potassium, calcium and albumin), high (tumour marker (CA19.9), intraoperative transfusion of human plasma protein (HPP), colloids, postoperative activated partial thromboplastin time and bacterial infections were potential risk factors for patient's mortality. Multivariate analysis of those variables demonstrated that low preoperative calcium [hazard ratio (HR) = 0.116; 95% confidence interval (CI) = 0.033–0.407; P = 0.001], high intraoperative HPP transfusion (HR = 1.004; 95% CI = 1.001–1.003; P = 0.012) and presence of postoperative bacterial infection (HR = 5.987; 95% CI = 1.009–35.54; P = 0.049) were independent predictors of patient's death. Seventy morbidities happened after HIPEC; only bacterial infection independently predicted postoperative mortality. Conclusion: To improve postoperative outcome of CRS/HIPEC, optimisation of transfusion, temperature, electrolytes and using broader-spectrum prophylaxis to manage postoperative infections should be warranted.

To develop an alternative medicine, propolis, in emulgel formulation for burn and wound treatment.The effect of two independent variables: emulsifying agent concentration and oil concentration on the cumulative amount of propolis release (dependent variable) from liquid paraffin and isopropyl palmitate emulgels was investigated. Eight formulations were prepared and evaluated for physical appearance, pH, propolis content, viscosity, and in vitro propolis release. The release results were fitted into different kinetic equations and analyzed using contour plot, interaction surface plot and one-way ANOVA. The selected emulgel formulation was investigated for its wound and burn healing activity in rats.All the prepared emulgels showed acceptable physical properties concerning color, homogeneity, consistency, and pH value. The concentration of emulsifying agent had more pronounced effect on propolis release than oil concentration. Formulations F1-F6 showed "anomalous" drug release, while Formulations F7 and F8 showed zero-order kinetic.The formulation F7 with 5% isopropyl palmitate, 5% emulsifier mixture, 1% hydroxyl propyl methyl cellulose, 1% oleic acid, and 10% propylene glycol is a promising formula for better management of wound and burn.

Malignant myoepithelial tumors are a type of recently recognized tumor that occur primarily in soft tissue characterized by myoepithelial elements without ductal differentiation. It appears that this type of tumor may be related to parachordoma or mixed tumor. However, only a small number of cases have been described in the submandibular, parotid and accessory glands, and bone is an extremely rare site for myoepithelial tumor presentation. We herein report a rare case of a 56-year-old woman diagnosed with primary malignant myoepithelial tumor originating in the tibia. Histologically, the tumor was composed of a nodular spindled and epithelioid neoplasm with mild to moderate nuclear pleomorphism embedded within variably collagenous, myxoid and chondromyxoid stroma. Immunohistochemistry staining showed tumor cells that were strongly positive for S100 protein, epithelial membrane antigen, vimentin and focally positive for p63 and cytokeratins (AE1/AE3); they were negative for desmin, smooth muscle actin, HMB45, Melan-A, CD99 and bcl2. This is all consistent with the phenomenon of myoepithelial differentiation. Additionally, Fluorescence in Situ Hybridization (FISH) was shown to be positive for EWSR1 translocation. Ultimately, the final diagnosis was primary myoepithelial carcinoma of bone. The patient was free of disease after three years of follow-up. In this article, we have shared our experience in documenting this rare medical entity, to clarify the crucial need for distinguishing myoepithelial carcinoma from primary benign and malignant bone and cartilage forming tumors. Keywords: Myoepithelial carcinoma, Rare bone tumors

Introduction. While hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreduction surgery (CRS) has been shown to improve patient survival and disease-free progression in peritoneal carcinoma (PC) patients, the procedure relates to a high postoperative infection rate. Herein, we report the bacterial and fungal infections after CRS and HIPEC from a single institution in Saudi Arabia. Patients and Methods. A prospective observational study was conducted on 38 patients with PC selected for CRS/HIPEC procedure between 2012 and 2015 in our centre. Results. Postoperative bacterial and fungal infection within 100 days was 42.2%, bacterial infection was reported always, and fungal infection was reported in 5 (13.2%) cases. Infections from the surgical site were considered the most common infection site. Multidrug-resistant extended-spectrum beta-lactamase (ESBL) Escherichia coli was the most frequent isolate, followed by multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Lower preoperative albumin and a prolonged preoperative activated partial thromboplastin time (APTT) are associated with postoperative infections, while a prolonged preoperative hospital stay (hazard ratio (HR) = 1.064; confidence interval (CI) = 1.002–1.112; P=0.042) and more intraoperative blood loss (>10%) (HR = 3.919; 95% CI = 1.024–14.995; P=0.046) were independent risk factors for postoperative infections. Three cases died during the follow-up period; all were due to infection. Discussion. The infection rate in our centre compared to previous studies of comparable patients was matching. Effective management of postoperative infections should be considered, and identified risk factors in this study can help to focus on effective prevention and treatment strategies.