Aneurysmal bone cyst of the zygoma. A case report and review of the literature

Aneurysmal bone cyst is a cystic vascular osseous tumor. It is rare in the craniofacial area; it is even rarer in the zygoma. A case of aneurysmal bone cyst of the zygoma was presented. Its pathogenesis, clinical and radiological features and treatment options were discussed under the view of the literature.

Positive surgical margins in cancer of the larynx

In order to determine what should be done for laryngeal cancer patients when surgical margins are positive, and to evaluate their prognosis, a retrospective review of 21 laryngeal cancer patients with positive surgical margins out of 714 surgically treated cases (2.9%) was carried out. Nineteen patients were treated with postoperative radiation therapy. Two patients who had had endolaryngeal partial laryngectomy were treated with vertical partial laryngectomy. Two patients were lost to follow-up. Ten patients (10/19; 53%) were recurrence-free. Four patients had local, two had regional, and two had locoregional recurrences. Only one patient with a local recurrence could be salvaged with total laryngectomy and is disease-free. One patient developed liver metastasis. Nineteen patients had a mean and median disease-free survival of 48 and 36 months, respectively. Nine out of fourteen patients (64%) treated curatively were recurrence-free. The patients with positive margins developed significantly more locoregional recurrences than those with free margins (P < 0.05). We conclude that surgical margins must be checked peroperatively with frozen sections to make sure that they are free. The margins of every laryngectomy specimen must be diligently examined. If positive, re-excision, postoperative radiotherapy and chemotherapy are treatment alternatives. They should not just be managed with close follow-up. However, whatever treatment is applied, the prognosis for patients with positive margins is significantly worse than for those with free margins.

Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children

We investigated the clinical value of intranasal budesonide in acute sinusitis in 52 children with acute maxillary sinusitis. We randomly divided them into two groups: group 1 received oral pseudoephedrine (2 x 30 mg) and cefaclor (40 mg/kg) for 10 days, and group 2 received intranasal budesonide (2 x 100 microg) and cefaclor (40 mg/kg) for 10 days. Symptoms of headache, cough, and nasal stuffiness and signs of nasal discharge were graded before and after treatment. The patients whose symptoms and signs completely normalized after treatment were considered to have recovered, and those with persisting symptoms and signs after treatment as having not recovered. The results of the two treatment groups were compared. The recovery rate of the children in group 2 were significantly higher than those in group 1 (P < 0.05). No adverse drug effects were determined during the study period. These findings suggest that topical steroids may be a useful adjunctive agent in the treatment of acute sinusitis of children without apparent side effects and can possibly hasten the resolution of symptoms.

Pulmonary metastasectomy in the treatment of recurrent ameloblastoma of the maxilla and mandible: a case report

Ameloblastoma is an aggressive benign tumor with frequent local recurrences. Although histologically benign, it occasionally metastasizes to many organs, most commonly to the lungs. The metastasis develops after multiple recurrences and many unsuccessful attempts at removal of the tumor. When distant metastasis occurs, the prognosis is poor and there is no effective treatment. A case of metastatic ameloblastoma of the mandible and maxilla is reported which was treated with pulmonary metastasectomy. The treatment options are discussed in relation to the literature.

The value of elective neck dissection in treatment of cancer of the tongue

PURPOSE

The "adequate" therapy of tongue cancer has not yet been determined. The authors report their experience with 58 N(0) patients to elucidate the role of elective neck dissection in surgical treatment of cancer of the tongue.

MATERIALS AND METHODS

The files of 58 N(0) patients with tongue cancer were evaluated retrospectively. In every patient, partial glossectomy continuous with neck dissection was the mainstay of the treatment. TNM staging, intraoperative N staging, pathologically confirmed cervical lymph node metastases and their levels, and clinical outcomes (local and regional recurrences) were recorded. The sensitivity and specificity of intraoperative staging was determined.

RESULTS

Fifty-four percent (31/58) of the patients presented as T(1), and 26% (15/58) as T(2). The overall occult metastasis rate was 29.3% (17/58). The occult metastasis rate for T(1) and T(2) lesions was 19.4% (6/31) and 26.7% (4/15), respectively. The sensitivity of intraoperative staging was 76.5%, and the specificity was 51.2%.

CONCLUSIONS

The rate of occult metastasis to the neck is too high in all tongue cancer cases to take the risk of regional recurrence, and the surgeon can not solely depend on neck palpation for determination of neck metastasis. Radiologic investigations and fine-needle aspiration decrease, but never reduce to zero the rate of false-negative examination. There is an obvious indication for neck dissection, even in early cases.

Assessment of whole saliva flow rate in denture wearing patients

It has been suggested that salivary flow rate decreases with age. As is known, the presence of a thin salivary film layer is essential for the comfort of the mucosa beneath a denture base and for denture retention. The purpose of this study was to determine the flow rates, viscosity and the pH of resting and stimulated whole saliva before and after prosthetic treatment in complete denture wearing patients. Saliva was collected under clinical conditions between 08.00 and 10.00 hours. The flow rates of whole saliva were measured at three stages: (i) resting and stimulated saliva before prosthetic treatment; (ii) immediately after the first wearing of the complete denture; and (iii) resting and stimulated saliva after 2 or 3 months of wearing the complete denture. Saliva production was stimulated by chewing paraffin wax. Flow rate was calculated as collected volume/collection time. It was found that there was a significant difference between resting and stimulated whole salivary flow rates before and after complete denture wearing.

Comparison of Regional Recurrence Rates of Radical and Comprehensive Neck Dissection Type 3 in N0 Laryngeal Cancer

To determine whether comprehensive neck dissection (CND) type 3 could accomplish regional tumor control as well as radical neck dissection (RND) in clinically N0 laryngeal cancer patients, we compared the regional recurrence rates of 316 N0 laryngeal cancer patients. In the 316 N0 patients, 486 neck dissections were performed. For 170 patients the dissection was bilateral, and for 146 patients it was unilateral. Of these, 193 were type 3 CNDs, and 293 were RNDs. In 30 (15.5%) of 193 type 3 CNDs and in 53 (18.1%) of 293 RNDs, metastatic lymph nodes were determined histopathologically in neck dissection specimens. The difference in cervical lymph node metastasis rates was not statistically significant ( P < 0.05). During follow-up, 3 patients who underwent CND type 3 (1.6%) and 12 who underwent RND (4.1%) had regional recurrences. The difference between recurrence rates was not statistically significant (P < 0.05). A conclusion was reached that CND type 3 safely provided regional cancer control in N0 laryngeal cancer and that it might be performed to decrease the morbidity of RND.

Comparison of regional recurrence rates of radical and comprehensive neck dissection type 3 in N0 laryngeal cancer

To determine whether comprehensive neck dissection (CND) type 3 could accomplish regional tumor control as well as radical neck dissection (RND) in clinically N0 laryngeal cancer patients, we compared the regional recurrence rates of 316 N0 laryngeal cancer patients. In the 316 N0 patients, 486 neck dissections were performed. For 170 patients the dissection was bilateral, and for 146 patients it was unilateral. Of these, 193 were type 3 CNDs, and 293 were RNDs. In 30 (15.5%) of 193 type 3 CNDs and in 53 (18.1%) of 293 RNDs, metastatic lymph nodes were determined histopathologically in neck dissection specimens. The difference in cervical lymph node metastasis rates was not statistically significant (P > 0.05). During follow-up, 3 patients who underwent CND type 3 (1.6%) and 12 who underwent RND (4.1%) had regional recurrences. The difference between recurrence rates was not statistically significant (P > 0. 05). A conclusion was reached that CND type 3 safely provided regional cancer control in N0 laryngeal cancer and that it might be performed to decrease the morbidity of RND.

Influence of insulin resistance on total renin level in normotensive women with polycystic ovary syndrome

OBJECTIVE

To evaluate the influence of insulin resistance on the plasma total renin level in normotensive women with polycystic ovary syndrome (PCOS).

DESIGN

Prospective, controlled study.

SETTING

University hospital.

PATIENT(S)

Twenty-five normotensive women with PCOS were compared with 11 normotensive control women with regular cycles and no features of PCOS.

INTERVENTION(S)

Clinical, ultrasonographic, and hormonal findings were used to define PCOS. Insulin resistance was estimated by continuous infusion of glucose with model assessment in the early follicular phase.

MAIN OUTCOME MEASURE(S)

Plasma levels of total renin and angiotensin II and serum levels of gonadotropins, DHEAS, total T, free T, 17 alpha-hydroxyprogesterone, and PRL were determined.

RESULT(S)

Plasma concentrations of angiotensin II were similar in the PCOS group and the control group. The concentration of total renin in plasma was higher in women with PCOS than in healthy women independent of insulin resistance. The sensitivity and specificity of the plasma total renin level to diagnose women with PCOS were calculated as 80% and 71.4%, respectively.

CONCLUSION(S)

The plasma total renin level is higher in normotensive women with PCOS than in healthy women independent of insulin resistance.

Tumor thickness as a predictor of cervical lymph node metastasis in squamous cell carcinoma of the lower lip

Tumor thickness is a relatively new prognostic factor that has been investigated for lower lip cancer. This study was performed in 27 patients, 13 of whom had histopathologically confirmed cervical metastasis, to investigate whether tumor thickness could be used as a predictor of cervical lymph node metastasis. The mean tumor thickness of those cases with neck metastasis was 5.60 mm (SD = 2.24), and the mean thickness of cases without neck metastasis was 3. 79 mm (SD = 1.68). The difference between tumor thicknesses of both groups was found to be statistically significant (P < 0.05). The tumor thickness of 5 mm was determined as a cutoff point, above which the cervical lymph node metastasis rate was significantly increased. As a conclusion, tumor thickness is an objective histopathologic factor that is easily reproducible; it significantly influences cervical lymph node metastasis in lower lip cancer, and it may be used in the assessment of prognosis.

Distant metastases in laryngeal squamous cell carcinoma

Distant metastases (DM) is the point of concern and seems to be on the rise with the improved control of the laryngeal cancer in the primary site and neck regions. Prognostic factors must be evaluated to improve the detection of DM at early stage of the disease. Therefore, we have analyzed our cases of laryngeal squamous cell carcinoma with DM to find out the risk factors in these patients. We analyzed the records of laryngeal squamous cell carcinoma patients with DM. The records were evaluated according to distant metastases site, TNM staging, the metastases at the neck, treatment and survival. The incidence of DM was 7.2% in our series. Lung is the most common site of DM in laryngeal squamous cell carcinoma. Staging grouping has been helpful in predicting DM, most of the cases were in stage III and IV (85%). Supraglottic lesions is the most common site in patients with DM. The recurrence in the locoregional site was observed in 47% of cases. The overall survival with DM is 28 months, without DM 22 months. The patients with DM in laryngeal squamous cell carcinoma were from the group with supraglottic lesions, stage 3, 4a and 4b. Stage grouping seems to be a better indicator of DM rather than T or N stage alone. The most common site of metastasis is the lung.

Plasma thrombomodulin levels in lung cancer patients

BACKGROUND

Thrombomodulin (TM) is a glycoprotein and besides its anticoagulant property it is accepted as an onco developmental antigen. Considering these properties we hypothesised that active TMB might have a role in cancer cell behaviour.

METHODS

We measured serum TMB levels by the enzyme immunoassay method in 40 patients with lung cancer and 20 healthy subjects.

RESULTS

TMB levels were found as 54.6 +/- 11.5 in controls and 60.9 +/- 31.2 ng/ml in lung cancer patients TM levels were 59.4 +/- 24.2 ng/ml in 24 epidermoid carcinoma patients, 65 +/- 50.2 ng/ml in 10 small cell carcinoma patients and 60 +/- 18.4 ng/ml in 6 adenocarcinoma patients. Patients with stage 4 and distant metastasis had a value of 65 +/- 33.9 ng/ml. No significant differences were found between healthy subjects and cancer patients. Also the differences between 3 groups of patients were insignificant.

CONCLUSIONS

It was concluded that serum TMB levels could not be accepted as a tumour marker in lung cancer patients.

Prognostic significance of histopathological parameters in cancer of the larynx

In this study we investigated the prognostic significance of differentiation, the mode of tumor invasion to surrounding tissues, the microscopic appearance of tumor, peritumoral lymphocytic infiltration and cartilage involvement according to disease-free survival, and the recurrence and presence of cervical lymph node metastasis in cancer of the larynx. Only the mode of tumor invasion to surrounding tissues was significantly related to survival (P < 0.05). The patients with "well-defined margin" tumors survive significantly longer than those with "groups of cells, no distinct margin." Patients with supraglottic tumors and a mode of invasion other than "well-defined margin" have a significantly higher risk of recurrence (P < 0.05) and therefore require adjuvant therapy. Patients with poorly differentiated, cartilage invading, ulcerative supraglottic tumors, and patients with glottic tumors having diffusely infiltrating margins, certainly need elective neck dissection (P < 0.05). According to the multivariant analysis, none of the factors significantly affect disease-free survival independently (P > 0.15). According to multiple logistic regression and cox regression analysis, in decreasing order of significance, the mode of invasion, microscopic tumor appearance and lymphocytic infiltration significantly affect the recurrence and time between surgery and the development of recurrence independently (P < 0.15).

Prognostic significance of depth of invasion in cancer of the larynx

To determine the prognostic significance of depth of invasion in laryngeal cancer, the depth of invasion of tumor was measured with an ocular micrometer on the laryngectomy specimens of 94 surgically treated patients with T1, T2, and T3 laryngeal cancer and was expressed in millimeters. There was a significant negative correlation between the depth of invasion and disease-free survival. The tumors with no clinical involvement of regional lymph nodes in neck (NO neck) had significantly less depth of invasion than those with involvement (N+ neck). The tumors with pathologically confirmed cervical lymph node metastasis had significantly more depth of invasion than those without metastasis. For tumors with a depth of invasion equal to or greater than 3.25 mm, the rate of cervical metastasis in this study has always been significantly higher than for those with a depth of invasion less than 3.25 mm (P < .05). The mean depths of invasion for cases with and without recurrence were not significantly different. According to the multivariate analysis, depth of invasion (P = .047) and patient age (P = .113) significantly affected the disease-free survival independently. The depth of invasion did not significantly affect the recurrence and the interval between surgery and the development of recurrence (P > .15). The depth of invasion should be measured in every laryngectomy specimen. The depth of invasion influences the cervical metastasis and disease-free survival significantly but does not affect the recurrence rate. The depth of invasion plays an independent role in determining the disease-free survival.

A comparison of procaine penicillin with sulbactam-ampicillin in the treatment of peritonsillar abscesses

The clinical efficacy of procaine penicillin and sulbactam-ampicillin was compared in patients with peritonsillar abscesses after peroral abscess drainage. Forty-two patients were randomly assigned to receive either procaine penicillin or sulbactam-ampicillin intramuscularly on an outpatient basis. The mean time required for clinical symptoms (throat pain, dysphagia and fever) to resolve was compared. No statistically significant difference was found between the clinical recoveries of patients using either antibiotic (P > 0.05). The authors conclude that intramuscular procaine penicillin can be safely prescribed on an outpatient basis to most patients with peritonsillar abscess after incision and drainage. In contrast, a broader spectrum and more expensive antibiotic, such as sulbactam-ampicillin, should be reserved for non-responders.

Prognostic significance of vascular and perineural invasion in cancer of the larynx

PURPOSE

Perineural and vascular invasion are generally recognized as poor prognostic factors in cancer. The authors report the prognostic significance of perineural and vascular invasion in cancer of the larynx.

MATERIALS AND METHODS

The laryngectomy specimens of 94 patients with squamous cell carcinoma of the larynx were analyzed histopathologically for vascular and perineural invasion. Prognostic significance of vascular and perineural invasion was evaluated related to the cervical lymph node metastasis, recurrence, and disease-free survival.

RESULTS

Vascular invasion significantly influences cervical lymph node metastasis for supraglottic tumors, yet not for glottic and transglottic tumors. Perineural invasion has marginal significance in cases of cervical lymph node metastasis of supraglottic tumors; it has no significance in cases of cervical lymph node metastasis of glottic and transglottic tumors. Vascular invasion significantly increases local and regional recurrence rate, but not distant metastasis rate. Perineural invasion significantly increases local recurrence rate, but not regional recurrence and distant metastasis rate. The disease-free survival is significantly shortened by the presence of vascular and perineural invasion. According to multivariant analysis, neither vascular nor perineural invasion significantly effects the disease-free survival independently (P> .15). The presence of vascular invasion significantly affects the recurrence independently (P=.045). The presence of vascular invasion significantly reduces the interval between surgery and the development of recurrence (P=.013).

CONCLUSION

The presence of vascular and perineural invasion should be checked in every laryngectomy specimen because both have a significant prognostic value; both influence the disease-free survival and recurrence significantly. Vascular invasion significantly increase cervical lymph node metastasis of supraglottic tumors; perineural invasion has only marginally significant effect on cervical lymph node metastasis of supraglottic cancers. Vascular invasion plays an independent role in determining the recurrence.

Glass in the frontal sinus: report of three cases

Patients with paranasal sinus foreign body are not commonly seen in otolaryngological practice; glass in the frontal sinus as a complication of maxillofacial trauma should be very rare, and papers dealing with this issue appear to be rare in the English literature. To elucidate the diagnostic pitfalls and the treatment aspects we present three cases of glass in the frontal sinus which occurred as a result of road traffic accidents.

Effects of methylprednisolone pulse therapy on insulin injections in patients with insulin-dependent diabetes mellitus

In this study we evaluated 31 insulin-dependent diabetes mellitus (IDDM) patients (ages 12.1 +/- 3.4 years, 18 males/13 females) who started on multiple subcutaneous insulin injections (MSII) within six weeks of diagnosis and achieved either complete (CR: no insulin requirement and near-normoglycemia for at least two weeks) or incomplete (ICR: minimum 50% decline in insulin requirement while maintaining near-normoglycemia for two weeks or more) remissions within the first 12 weeks of the MSII trial. Methylprednisolone pulse therapy (MP) was administered four times per day by i.v. bolus at a dose of 30 mg/kg (max. 1000 mg) on alternative days. Eleven patients did not accept "MP-pulse" therapy; therefore, we followed these cases (7 males/4 females) as the control group. During the first year of follow-up, 13 patients from the "MP pulse" group achieved CR (3 males/1 female) or ICR (5 males/4 females) in 3.5 to 14 months. Remission occurred in only two of the control group cases (1 male CR for 17 days and 1 female CR for 7 months). Of those with CR in the "MP-pulse" and control groups, all were greater than 12 years of age, and all but one in the "MP-pulse" group were males. The stimulation capacity of beta cells (as defined by percentage increase in serum C-peptide levels after glucagon injection) among CR cases was found to be higher than that of non-remitted (NR) cases (p < 0.05 at onset, p < 0.001 during MSII-induced remission and p < 0.05 at the end of the first year of follow-up). Although patients with CR or ICR had higher beta cell reserves than NR cases at onset, only CR cases could sustain this capacity during the MSII-induced remission phase and one year after "MP-pulse" therapy. From this preliminary study, we conclude that "MP-pulse" therapy, may lead to prolonged near-normal beta cell function or partly preserved residual beta cell reserve during the MSII-induced remission phase of IDDM, The beneficial effects of MP could be seen clearly in patients diagnosed during the late childhood years.

Ataxia telangiectasia and mucoepidermoid carcinoma of the parotid gland: a case report

Ataxia telangiectasia (AT) is an immunodeficiency disorder with increased incidence of malignancy. Most of the tumors are lymphomas, and salivary gland neoplasms are very uncommon. A case with ataxia telangiectasia and mucoepidermoid carcinoma of the parotid gland, the second case in English literature, was presented. The treatment was discussed under the view of the literature.

The effect of lymphocytic infiltration on clinical survival in cancer of the tongue

Many factors have been claimed to influence the clinical prognosis of cancer of the tongue, one of them being the inflammatory response at the advancing tumor border. In a retrospective study of 60 patients with squamous cell carcinoma of the oral tongue, lymphocytic peritumoral inflammation was not found to be an objective prognostic marker.

Comparison of the sealing efficacies of two obturation techniques in curved root canals instrumented with and without ultrasonic irrigation

Volumetric dye penetration into the canals of 131 teeth was studied spectrophotometrically. The teeth were first divided into three groups according to the degree of curvature. Each group was then subdivided into four groups, in which the Thermafil and lateral condensation techniques were used with or without ultrasonic irrigation. Significant microleakage differences were observed between group I (0-10 degrees) and group III (21-30 degrees) for lateral condensation filling with ultrasound irrigation and Thermafil filling without ultrasound irrigation (p < 0.05).

Primary ovarian pregnancy. A case report

A primary ovarian pregnancy was diagnosed in a patient with intrauterine device. Primary ovarian pregnancy which is a rare form of ectopic pregnancy, was reviewed according to etiology, pathogenesis and improvements in diagnosis and therapy. In this article, our case was multiparous and used intrauterine device for 5 years. Ovarian pregnancy was diagnosed before operation. This diagnosis was verified histologically and she was treated by oopherectomy.

Ketone bodies and islet function: 86Rb handling and metabolic data

The metabolism of ketone bodies was investigated in rat pancreatic islets incubated in the absence or presence of D-glucose. The generation of 14CO2 from 3-14C-labeled ketone bodies, the interconversion of D-(-)-beta-hydroxybutyrate and acetoacetate (AcAc), the reciprocal effects of ketone bodies and D-glucose on their respective catabolism, and the influence of these exogenous nutrients on the output of 14CO2 from islets preincubated with either L-[U-14C]glutamine or [U-14C]palmitate provided an estimation of the nutrient-induced changes in O2 uptake that was in fair agreement with the observed modifications of islet respiration. There was a close correlation between such changes and the corresponding values for insulin output. Because the stimulation of insulin release by ketone bodies also coincided with a decrease in 86Rb outflow from prelabeled islets, these findings suggest that the insulinotropic action of ketone bodies is causally linked to their catabolism through an increase in ATP generation rate and a subsequent decrease in K+ conductance. A complementary participation of changes in mitochondrial redox state to stimulus-secretion coupling is considered, however, in the light of comparisons between the effects of D-(-)-beta-hydroxybutyrate and AcAc, respectively, on mitochondrial NADH generation, 45Ca net uptake, and D-[6-14C]glucose oxidation.