Local recurrence after curative resection in patients with colon and rectal cancers

BACKGROUND AND AIMS

There are a range of rates and a number of prognostic factors associated with the local recurrence of colorectal cancer after curative resection. The aim of this study was to identify the potential prognostic factors of local recurrence in patients with colon and rectal cancers.

MATERIALS AND METHODS

A retrospective review of 1,838 patients who underwent curative resection of non-metastatic colorectal cancer was conducted. The patients were treated between 1994 and 2004, and had a minimum follow-up of 3 years.

RESULTS

There were 994 patients with colon cancer and 844 patients with rectal cancer. The median duration of follow-up was 60.9 +/- 24.5 months. With respect to colon cancer, the local recurrence rate was 6.1% (61 patients). With respect to rectal cancer, 95 patients had a local recurrence (11.3%), the rate of which was statistically greater than the local recurrence rate for colon cancer (p < 0.001). The overall recurrence rate was 16.4% (301 patients), and the local recurrence rate, with or without systemic metastases, was 8.5% (156 patients). Local recurrences occurred within 2 and 3 years in 59.9% and 82.4% of the patients, respectively. In patients with colon and rectal cancer, the pathologic T stage (p = 0.044 and p = 0.034, respectively), pathologic N stage (p = 0.001 and p < 0.001, respectively), and lymphovascular invasion (p = 0.013 and p = 0.004, respectively) were adverse risk factors for local recurrence. The level of the anastomosis from the anal verge was an additional prognostic factor (p = 0.007) in patients with rectal cancer.

CONCLUSION

Compulsive follow-up care of patients with colon and rectal cancers is needed for 3 years after curative resection, especially in patients who have adverse risk factors for local recurrence.

Antibacterial effect of octylcyanoacrylate against methicillin-resistant Staphylococcus aureus isolates from patients with chronic suppurative otitis media

There has been a steady increase in the number of cases of methicillin-resistant Staphylococcus aureus (MRSA) otorrhea; this is a growing medical concern. For otological surgery in children, octylcyanoacrylate can be an alternative method of closure for surgical incisions. Recent in vitro studies have shown that octylcyanoacrylate is effective as an antimicrobical barrier. To date, there have been only rare reports on the antibacterial effect of octylcyanoacrylate against MRSA. The purpose of this study is to determine the antimicrobial effects of octylcyanoacrylate against the MRSA that was isolated from patients with chronic suppurative otitis media.

MATERIALS AND METHODS

Clinical MRSA (n=20) bacteria and methicillin-sensitive SA (MSSA) (n=20) were obtained from patients. The susceptibilities to various antibiotics were determined by disk diffusion method.

RESULTS

MSSA was sensitive to octylcyanoacrylate. The antibacterial activity of octylcyanoacrylate was weak against MRSA.

CONCLUSION

Our results demonstrated that octylcyanoacrylate has slight antibacterial activity against MRSA.

The effect of Interceed for reducing adhesion as a middle ear packing agent: an experimental study

BACKGROUND AND OBJECTIVE

Interceed (oxidized regenerated cellulose) has been used to prevent postoperative abdominal adhesion. However, the efficacy and safety of using Interceed in middle ear surgery have not been thoroughly studied.

MATERIALS AND METHODS

The animals were divided into two groups: the Interceed group and the Gelfoam (Gelatin sponge) group. In every group, the study was performed on five guinea pigs (ten ears). Under the aseptic condition, the middle ear mucosa was abraded using a pick through a myringotomy incision. Interceed and Gelfoam were then packed into the guinea pigs' middle ear cavities. The auditory brainstem responses (ABRs) were assessed preoperatively and at 3 weeks after the operation with the animals under general anesthesia. Histopathologic study was performed 3 weeks after the operation.

RESULTS

The ABR results on postoperative week 3 showed no statistically significant difference for myringotomy and postpacking. The fibrosis, middle ear mucosa thickening and adhesion formation appeared to be less in the Interceed group compared with the Gelfoam group. Any foreign body reaction was not observed in the Interceed group.

CONCLUSION

Our results show that Interceed is nonototoxic and biocompatible with the guinea pig's middle ear cavity. Therefore, these results suggest that Interceed could be used safely in the middle ear as a middle ear packing agent during otosurgery.

Congenital cholesteatoma extending into the internal auditory canal and cochlea: a case report

We report here on a case of congenital cholesteatoma that extended into the internal auditory meatus and cochlea. A 17-year-old boy underwent surgery for a very large cholesteatoma, which was discovered behind an intact tympanic membrane. Pure tone audiometry revealed an unresponsive ear. High resolution temporal bone computed tomography showed perilabyrinthine extension with its absence in the vestibular area, and destruction of the bony cochlea at the basal turn, the tegmen and the posterior cranial fossa. Magnetic resonance imaging revealed no intracranial extension. Surgical exploration of the middle ear and the mastoid cavity revealed that both the vestibule and the basal turn of the cochlea were filled with a noninfected cholesteatoma. The cholesteatoma extended into the internal auditory meatus through translabyrinthine destruction; it extended into the basal turn of the cochlea through the infralabyrinthine route. The bony segment of the facial nerve canal demonstrated near total dehiscence. The cholesteatoma was removed by the transotic approach. Congenital cholesteatoma is characterized by no specific history. Therefore, early detection of this malady can be challenging, but it is important to prevent such complications as were observed in this reported case.

Geometric calibration of a mobile C-arm for intraoperative cone-beam CT

A geometric calibration method that determines a complete description of source-detector geometry was adapted to a mobile C-arm for cone-beam computed tomography (CBCT). The non-iterative calibration algorithm calculates a unique solution for the positions of the source (X(s), Y(s), Z(s)), detector (X(d), Y(d), Z(d)), piercing point (U(o), V(o)), and detector rotation angles (phi, theta, eta) based on projections of a phantom consisting of two plane-parallel circles of ball bearings encased in a cylindrical acrylic tube. The prototype C-arm system was based on a Siemens PowerMobil modified to provide flat-panel CBCT for image-guided interventions. The magnitude of geometric nonidealities in the source-detector orbit was measured, and the short-term (approximately 4 h) and long-term (approximately 6 months) reproducibility of the calibration was evaluated. The C-arm exhibits large geometric nonidealities due to mechanical flex, with maximum departures from the average semicircular orbit of deltaU(o) = 15.8 mm and deltaV(o) = 9.8 mm (for the piercing point), deltaX and deltaY = 6-8 mm and deltaZ = 1 mm (for the source and detector), and deltaphi approximately 2.9 degrees, deltatheta approximately 1.9 degrees, and delta eta approximately 0.8 degrees (for the detector tilt/rotation). Despite such significant departures from a semicircular orbit, these system parameters were found to be reproducible, and therefore correctable by geometric calibration. Short-term reproducibility was < 0.16 mm (subpixel) for the piercing point coordinates, < 0.25 mm for the source-detector X and Y, < 0.035 mm for the source-detector Z, and < 0.02 degrees for the detector angles. Long-term reproducibility was similarly high, demonstrated by image quality and spatial resolution measurements over a period of 6 months. For example, the full-width at half-maximum (FWHM) in axial images of a thin steel wire increased slightly as a function of the time (delta) between calibration and image acquisition: FWHM=0.62, 0.63, 0.66, 0.71, and 0.72 mm at delta = 0 s, 1 h, 1 day, 1 month, and 6 months, respectively. For ongoing clinical trials in CBCT-guided surgery at our institution, geometric calibration is conducted monthly to provide sufficient three-dimensional (3D) image quality while managing time and workflow considerations of the calibration and quality assurance process. The sensitivity of 3D image quality to each of the system parameters was investigated, as was the tolerance to systematic and random errors in the geometric parameters, showing the most sensitive parameters to be the piercing point coordinates (U(o), V(o)) and in-plane positions of the source (X(s), Y(s)) and detector (X(d), Y(d)). Errors in the out-of-plane position of the source (Z(s)) and detector (Z(d)) and the detector angles (phi, theta, eta) were shown to have subtler effects on 3D image quality.

Antibacterial effect of tea-tree oil on methicillin-resistant Staphylococcus aureus biofilm formation of the tympanostomy tube: an in vitro study

The antibacterial effects of tea-tree oil against the formation of methicillin-resistant Staphylococcus aureus (MRSA) biofilm on the surface of the tympanostomy tubes was evaluated.

MATERIALS AND METHODS

Silicone tympanostomy tubes were pretreated with normal saline for 12 hours, the control group (n=4), with 100% tea-tree oil, experimental group A (n=3), or with 50% tea-tree oil, experimental group B (n=3). All the tubes were incubated in a MRSA solution for 2 days and then processed for evaluation using scanning electron microscopy.

RESULTS

The development of the biofilm mode of growth of MRSA was observed in the saline-treated control group. In contrast, only focal biofilms were present on the tube surface in experimental group A and considerable reduction of biofilm with destruction of the MRSA cells was shown in experimental group B.

CONCLUSION

From these results, the antimicrobial effect of tea-tree oil against biofilm formation on tympanostomy tubes in vitro has been verified.

Effect of topical dexamethasone on sensorineural hearing loss in endotoxin-induced otitis media

Sensorineural hearing loss, which is limited to the cochlear basal turn, due to acute or chronic otitis media has been reported in clinical and experimental studies. In the present study, the effect of intratympanic dexamethasone on endotoxin-induced cochlear damage was investigated by measuring the cochlear blood flow and hearing.

MATERIALS AND METHODS

Ten male Sprague-Dawley rats were inoculated with lipopolysaccharide (LPS), and divided into 2 groups of five rats each. One hour after intratympanic inoculation, the group A received 40 microl of phosphate-buffered saline (PBS) in the right middle ear cavity, group B received 40 microl of dexamethasone. The treated animals were examined 24 h after inoculation using auditory brainstem response (ABR) and cochlear blood flow (CBF).

RESULTS

The elevated threshold decreased significantly after intratympanic dexamethasone administration compared to the PBS-treated group. Intratympanic dexamethasone administration to the round window of rats led to a statistically significant increase in CBF compared to the PBS-treated group (p <0.05). The response to round window application of prostaglandin E1 (PGE1) in the dexamethasone-treated group was better than in the PBS-treated group.

CONCLUSION

Our results showed that intratympanic dexamethasone treatment was effective in protecting the function of the cochlea against endotoxin-induced otitis media.

Cochlear tolerance of Nd:YAG laser myringotomy

AIM

The objective of this study was to assess whether Nd:YAG laser myringotomy has a negative effect on the cochlea.

MATERIALS AND METHODS

Ten adult guinea pigs with a normal Preyer's reflex were treated by myringotomy with an Nd:YAG laser (power output 8-10W) under surgical microscopic guidance. Preoperative and immediately postoperative hearing tests were performed using auditory brainstem response. The cochlear hair cells were investigated by scanning electron microscope (SEM).

RESULTS

The mean postoperative hearing threshold of the auditory brainstem response showed an insignificant elevation. SEM findings revealed normal outer and inner hair cells after laser myringotomy.

CONCLUSION

No negative effect of Nd:YAG laser myringotomy on the cochlea was found. From these results, it can be concluded that the Nd:YAG laser is safe and effective for myringotomy.

Evaluation of bioactive glass for mastoid obliteration: a guinea pig model

BACKGROUND

Mastoid obliteration seeks to replace an open mastoid cavity with material that will become viable and free of infection and cholesteatoma. The purpose of this study was to evaluate the efficacy of bioactive glass ceramic particles for mastoid obliteration using a guinea pig animal model.

MATERIALS AND METHODS

Ten male guinea pigs (weighing 250-300 g) with normal eardrums and Preyer reflexes were used. Bulla obliteration using bioactive glass was performed on the left side in all guinea pigs. The implanted bioactive glass ceramic particles were examined clinically and radiologically by computed tomography (CT) and histologically.

RESULTS

Clinically, there were no signs of inflammation, infection or implant exposure in all guinea pigs. The CT scans showed hyperintense areas that represented new bone formation. Histological evidence of new bone formation was observed in the implant specimens that included: active osteoblasts, osteocytes, chondrocytes and osteoid tissue. There was a definite bond between the implant and the bone interface at the areas of new bone formation. No inflammatory or foreign body reactions, caused by the bioactive glass ceramic particle implantation, were observed in the surrounding tissue.

CONCLUSION

Our results suggest that bioactive glass ceramic particles are an ideal implant material. Further studies on bioactive glass ceramic particles should include a larger animal trial to lay the groundwork for human studies.

Typical carcinoid tumor of the nasal cavity

The nasal cavity is a rare site of origin of neuroendocrine tumors. They can be classified typical carcinoid, atypical carcinoid and small cell carcinoma, neuroendocrine type. The tumor histology and prognosis correlate closely. The typical carcinoid tumors are well differentiated with benign course. The treatment of the typical carcinoid is a conservative surgery and the prognosis is good. But, typical carcinoid tumor of the nasal cavity was extremely rare, so the treatment has not been established. We report a case of typical carcinoid tumor of the nasal cavity in a 76-year-old man who treated by conservative surgery using sinus endoscopy. To the best of our knowledge this is the first report on an typical carcinoid in the nasal cavity.

A case of malignant otitis externa caused by Candida glabrata in a patient receiving haemodialysis

A 74-y-old male receiving haemodialysis presented with right-sided otalgia, otorrhoea and diffuse swelling on the right external auditory canal. Following an initial successful treatment with prolonged intravenous antibiotics, the patient relapsed with a secondary infection in the same site due to Candida glabrata. We report an unusual case of malignant otitis externa caused by the fungus C. glabrata.

Three cases of organized hematoma of the maxillary sinus

Organized hematoma of the maxillary sinus is a rare clinical disease. To our knowledge, only a few cases of organized hematoma of the maxillary sinus have previously been published, most coming without bleeding history and disorders. We report three cases of organized hematoma of the maxillary sinus presenting with an enlarging maxillary sinus mass. In the evaluation of a patient with recurrent nasal bleeding, nasal obstruction, and an enlarging maxillary mass, organized hematoma of the maxillary sinus should be included in the differential diagnosis.

A novel four-dimensional radiotherapy method for lung cancer: imaging, treatment planning and delivery

We present treatment planning methods based on four-dimensional computed tomography (4D-CT) to incorporate tumour motion using (1) a static field and (2) a dynamic field. Static 4D fields are determined to include the target in all breathing phases, whereas dynamic 4D fields are determined to follow the shape of the tumour assessed from 4D-CT images with a dynamic weighting factor. The weighting factor selection depends on the reliability of patient breathing and limitations of the delivery system. The static 4D method is compared with our standard protocol for gross tumour volume (GTV) coverage, mean lung dose and V20. It was found that the GTV delineated on helical CT without incorporating breathing motion does not adequately represent the target compared to the GTV delineated from 4D-CT. Dosimetric analysis indicates that the static 4D-CT based technique results in a reduction of the mean lung dose compared with the standard protocol. Measurements on a moving phantom and simulations indicated that 4D radiotherapy (4D-RT) synchronized with respiration-induced motion further reduces mean lung dose and V20, and may allow safe application of dose escalation and CRT/IMRT. The motions of the chest cavity, tumour and thoracic structures of 24 lung cancer patients are also analysed.

Pneumocephalus secondary to mastoid surgery: a case report

Pneumocephalus secondary to mastoid surgery is uncommon. Serious sequelae and central nervous system infection may result from inadequate management. It is diagnosed by careful history, physical examination and imaging studies. Treatments of pneumocephalus secondary to mastoid surgery are conservative treatment or surgery. The aim of surgery is to detect communication between mastoid cavity and brain, and to correct it. We present a case of pneumocephalus secondary to mastoid surgery in 22-year-old man, which was treated with surgery.

Endoscopy-aided laser therapy for intractable granular myringitis

Objective: We report our technique and results for endoscopy-aided CO2 laser therapy for the treatment of intractable granular myringitis, as an out-patient office procedure.

Materials and methods: A total of 21 patients (14 women and seven men; mean age 32.6 years) were retrospectively reviewed, all of whom suffered from intractable granular myringitis and had undergone endoscopy-aided laser treatment. Granulation tissue was vaporized for one to two seconds with a CO2 laser (spot size 0.5–1 mm with a power setting of 5–10 W in continuous mode). The mean follow-up period was 11 months.

Results: Eighteen of the 21 patients (85 per cent) were cured after a single treatment. Three patients with the diffuse form of the disease required repeat laser treatments coupled with self-irrigation with a diluted vinegar solution. We noted no perforations of patients' tympanic membranes after laser vaporization. We also observed no recurrences over follow-up periods ranging from three months to 2.6 years. Our laser procedure produced no adverse effect on hearing thresholds, nor were any other complications observed.

Conclusion: Our results suggest that endoscopy-aided CO2 laser ablation is a reliable and minimally invasive method associated with low rates of recurrence and a low incidence of complications. It can be conducted as an office procedure.

The effect of postural restrictions in the treatment of benign paroxysmal positional vertigo

The treatment of benign paroxysmal positional vertigo (BPPV) consists of a repositioning maneuver in order to remove otoliths from the posterior semicircular canal and subsequent postural restrictions to prevent debris from reentering the canal. However, the extent to which postural restrictions affect the final outcomes of BPPV is still uncertain. The purpose of this study is to determine the effects of postural restrictions in the treatment of BPPV, which is caused by otoliths in the posterior semicircular canal, and to evaluate its usefulness as a therapy. Seventy cases diagnosed as BPPV of the posterior semicircular canal were studied. All patients were treated utilizing the modified Epley maneuver. They were divided into two groups. The first group (group A, 35 patients) was instructed to sleep in a semi-sitting position and to avoid moving their heads forward or backward, whereas no instructions were given to the second group (group B, 35 patients). The information gathered from the patients was analyzed by age of onset, gender, duration of the disease and cure rates or recurrence rates. In group A, the average age was 54.5 years and the mean duration of symptoms was 116.5 days, whereas in group B, these measurements were 54.8 years and 86.7 days. The cure rates were 91.4 and 94.3%, respectively. Symptoms recurred in 12.5% of group A patients, while in group B, there was a 9.1% recurrence rate. Our study did not show any significant difference between the two groups. Postural restriction therapy, practiced after the modified Epley repositioning maneuver, did not have a significant effect on the final outcomes of BPPV. Based on our results, we do not recommend this therapy since there was no significant benefit for the patients who utilized postural restrictions.

Otoacoustic emissions in an aberrant internal carotid artery: a case report

A 52-year-old Korean woman who complained of impaired hearing and tinnitus of the left ear was diagnosed with an aberrant internal carotid artery (ICA) in the middle ear using a temporal bone high resolution CT (HRCT) scan. Upon otoscopic examination, her left eardrum was found to be in contact with a mass in the middle ear cavity. Upon audiometric evaluation, a mild conductive hearing impairment was documented, and a discrepancy in the results of otoacoustic emissions (OAEs) was found for the left ear. This case report studies the aberrant ICA in the middle ear that revealed abnormal OAE findings.

Excitatory effects of 5-hydroxytryptamine on the medial vestibular nuclear neuron via the 5-HT2 receptor

This study was designed to investigate the mechanisms of action of the 5-HT2 receptor on the spontaneous electrical activity and potassium currents of the rat medial vestibular nuclear neurons using whole-cell patch clamp recordings. The spike width of spontaneous action potential was not affected by 5-alpha-methylhydroxytryptamine. The spike frequency and resting membrane potential was increased by 5-alpha-methylhydroxytryptamine. The amplitude of afterhyperpolarization was decreased by 5-alpha-methylhydroxy-tryptamine. The peak current of the potassium currents of the neuron treated with 5-alpha-methylhydroxytryptamine was decreased. After blockade of calcium-dependent potassium currents, 5-alpha-methylhydroxytryptamine did not inhibit potassium currents. These results suggest 5-alpha-methylhydroxytryptamine increases spontaneous firing of the medial vestibular nuclear neurons by inhibiting calcium dependent potassium currents.

Effect of SKI 306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study

SKI 306X is a purified extract from a mixture of three oriental herbal medicines (Clematis mandshurica, Trichosanthes kirilowii and Prunella vulgaris) that have been widely used for the treatment of inflammatory diseases such as lymphadenitis and arthritis in far East Asia. A double-blind, controlled study was performed to evaluate the efficacy and safety of SKI 306X with placebo in 96 patients with classical osteoarthritis of the knee. Patients were randomized to four treatment groups: placebo, 200 mg, 400 mg and 600 mg of SKI 306X t.i.d.. Clinical efficacy and safety were evaluated for 4 weeks continuous treatment. SKI 306X demonstrated its clinical efficacy, as assessed by 100 mm visual analogue scale (VAS), Lequesne index and patients' and investigators opinion of the therapeutic effect compared with placebo (p<0.01). No significant adverse events were observed in patients treated with SKI 306X. This study demonstrated that SKI 306X, a new herbal anti-arthritic agent provided clinical efficacy in patients with osteoarthritis.

A Phase I study of cis-malonato[(4R,5R)-4,5-bis(aminomethyl)-1,3-dioxolane] platinum(II) in patients with advanced malignancies

BACKGROUND

A Phase I study of cis-malonato[(4R,5R)-4,5-bis(aminomethyl)-1,3-dioxolane] platinum(II) (SKI 2053R), a new platinum derivative, was performed to determine the maximum tolerated dose (MTD), the dose limiting toxicities (DLTs), and the pharmacokinetic profile of SKI 2053R in patients with advanced, refractory malignancies.

METHODS

Twenty-one patients were entered into the study. SKI 2053R was administered with an intravenous infusion over 1 hour every 4 weeks. The SKI 2053R dose was escalated from 40 mg/m(2) up to 480 mg/m(2) using a modified Fibonacci scheme. Pharmacokinetic analysis was done in all patients to determine the total and ultrafiltrable platinum concentrations in both the plasma and the urine.

RESULTS

All patients were evaluable for toxicity and response. There was no significant toxicity with dosages up to 360 mg/m(2). At 480 mg/m(2), two of three patients developed Grade 4 hepatotoxicity, Grade 3 leukopenia and thrombocytopenia, and Grade 2 azotemia and proteinuria. Other toxicity included nausea and emesis, but it was controlled with antiemetics. SKI 2053R did not cause significant neurotoxicity or mucositis. There were 4 patients with stable disease among the 21 patients. Plasma decay of the total and free platinum concentrations was best fitted by using a two-compartment, open model. The terminal plasma half-life of the total platinum after SKI 2053R administration ranged from 63.4 hours to 114.1 hours in dosages ranging from 40 mg/m(2) to 480 mg/m(2) without significant dose dependency. However, the terminal plasma half-life of the free platinum concentration showed a significant dose dependent, incremental pattern. The renal excretion of SKI 2053R measured as platinum ranged from 49% to 75% of the administered dose.

CONCLUSIONS

The MTD of SKI 2053R was 480 mg/m(2). The major DLTs were hepatotoxicity, nephrotoxicity, and myelosuppression. The recommended starting dose for a subsequent Phase II study is 360 mg/m(2) once every 4 weeks.