Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients.

BACKGROUND: One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed. The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI. METHODS: A total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values of selected peripheral blood parameters were analysed. RESULTS: PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p < 0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p < 0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002-1.013, p = 0.013). CONCLUSIONS: Although protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models.

The use of ionic liquids based on choline chloride for metal deposition: A green alternative?

Ionic liquids are studied intensively for different applications. They tend to be denoted as "green solvents", largely because of their low vapour pressure. In recent years toxicity and biotoxicity of ionic liquids have also been investigated, which proved that not all of these are "green". In this paper the use of ionic liquids based on choline chloride and ethylene glycol in electrochemistry is discussed in the context of their use as green solvents. Due to their low toxicity and ready biodegradability, these deep eutectic solvents are promising for the electrodeposition of metals. The influence of the use of these liquids as metal deposition baths on the waste water is investigated. Drag-out was found to be the most influencing parameter on the environmental impact of the process, as it is three times higher compared to classical solutions due to the higher viscosity of the ionic liquid. There are no major changes needed in the rinsing configuration of classic electroplating plants, and ion exchange to remove the metal out of the waste water was not hindered by the presence of the ionic liquid. The formation of by-products during the deposition of metals has to be further investigated and evaluated in consideration of the environmental impact.

Application of biosurfactants and non-ionic surfactants for removal of organic matter from metallurgical lead-bearing slime.

The paper presents evaluation of different extracting solutions used for removal of organic matter, especially polycyclic aromatic hydrocarbons (PAHs), from slime produced in copper smelting. A series of extraction experiments was conducted using biosurfactants and non-ionic surfactant solutions of various concentrations. The results showed that the efficiencies of organic matter removal by biosurfactants were at the level of 20-30% and depended on the type of the used biosurfactant. Biolen Biogrease L, and mixture of alkylobenzenesulfonic acid and oxyethylene fatty alcohol were effective for removal of polycyclic aromatic hydrocarbons (above 50%), whereas Zymbiose-enz. was ineffective. Non-ionic surfactants were found to be more effective in removing organic matter than biosurfactants. In the case of non-ionic surfactants the removal efficiencies depended on the concentration. Increase of Tween 80 concentration caused decrease in the efficiency of organic matter removal. The similar results were obtained for Nonoxynol 14. By contrast, the increase of Nonoxynol 10 concentration resulted in increase of organic matter removal efficiency.

Moderately low alpha/beta ratio for rectal cancer may best explain the outcome of three fractionation schedules of preoperative radiotherapy.

PURPOSE: To estimate the alpha/beta ratio for rectal cancer according to the outcome of three fractionation schedules of preoperative radiotherapy. METHODS AND MATERIALS: Between 1996 and 2002, 168 patients with locally advanced rectal cancer were treated as follows: 53 patients received 25 Gy in 5 Gy per fraction, 45 received 30 Gy in 3.0 Gy per fraction, and 70 were treated with accelerated hyperfractionation (42 Gy, 1.5 Gy per fraction, given twice daily). No patients received concurrent chemotherapy. The clinical characteristics of the groups were comparable. Surgery was performed shortly after radiotherapy. Crude data on locoregional tumor control were fitted directly using a linear-quadratic model, and the actuarial data were analyzed using Cox model. RESULTS: A linear-quadratic model provided an alpha estimate of 0.339 (SE 0.115) and beta estimate of 0.067 (SE 0.027), which resulted in an alpha/beta ratio of 5.06 Gy (95% confidence interval -0.1 to 10.3). In all three schemes the overall radiation treatment time was short, which limits the rationales for incorporating time effect into the model. If, however, time was incorporated the alpha/beta ratio was 11.1 Gy and the dose increment required to compensate for repopulation was 0.15 Gy/day. The actuarial analysis provided similar alpha/beta estimates. CONCLUSION: Although because of the retrospective character of the study, nonrandomized selection of fractionation schedule, and uncontrolled quality of surgery the present results can be regarded as hypothesis generating only, the control rates obtained in the pelvis are consistent with a moderately low alpha/beta ratio for rectal cancer.