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There is controversy about the effect of the influence of hyperthermia and chemotherapeutic agents on the healing of intestinal anastomosis. The effects of hyperthermic intraperitoneal chemoperfusion (HIPEC) of wound healing after colonic anastomosis were investigated in a rat model.Thirty-six Wag/Rija rats were randomized into three groups of 12 animals each: group I: control (only colonic anastomosis was performed) (n = 12); group II: HIPEC (mitomycin C in a concentration of 20 mg/m(2) (n = 12) colonic anastomosis was performed before HIPEC; group III: HIPEC (mitomycin C in a concentration of 20 mg/m(2) (n = 12) colonic anastomosis was performed after HIPEC. Bursting pressure and bursting sites were recorded 4 and 10 days after intervention. Collagen deposits, inflammation and foreign body reactions were evaluated.Lower bursting pressure and lost of collagen were found in both HIPEC groups and compared with the control group. There was almost no difference between both HIPEC groups. They were noted overwhelmingly at the anastomosis in the HIPEC group. The degree of collagen accumulation was well-correlated with bursting pressure.These results have shown that hyperthermic intraperitoneal chemoperfusion (HIPEC) impairs wound healing in colonic anastomosis in rats.

The Model: For their model the authors used the six core competencies: (a) patient care, (b) medical knowledge, (c) practice based learning and improvement, (d) system based practice, (e) interpersonal and communication skills, (f) professionalism, as outlined by the Accreditation Council for Graduate Medical Education (ACGME) and some specific ‘skills sets’.2 With a Venn diagram of three sets they illustrated how the core competencies and the skills of their model are interrelated. A Venn diagram represents all possible logical relations between a finite collection of setseven a ‘metaphorical Venn diagram’ should follow this rule. The challenge to represent six core competencies with three sets is partly solved by combining competencies (a) and (b) in one set: these competencies characterize what a medical practitioner does. It fails for competencies (e) and (f) since these are no subsets of the other core competencies, but core competencies of their own. We would highly recommend to utilize a higher order Venn diagram.3