Selected immuno-histochemical markers in curettage specimens and their correlation with final pathologic findings in endometrial cancer patients

To assess the immuno-histochemical expression of various markers in, endometrial biopsies of patients with endometrial cancer, and to correlate their expression with the final pathologic findings. Sixty-two patients with primary endometrial cancer who underwent surgical treatment were included in this study. Immuno-histochemical expression of estrogen receptor (ER), progesterone receptor (PR), p53, bcl-2, Her-2/neu and Ki-67 were assessed in curettage specimens, and review of the final pathology report from hysterectomy specimens was carried out. The expression of these markers in curettage was correlated with the final tumor characteristics obtained on hysterectomy specimens. Both ER and PR were significantly more expressed in endometrioid type (EC) than non- endometrioid type (NEC) (P value of 0.004 and 0.012). On the contrary, P53, Her-2 and Ki-67 showed higher positivity in NEC than EC (P value of 0.005, 0.025 and 0.002). Positive expression of ER and PR was significantly associated with low grade tumors and superficial myometrial invasion, whereas positive expression of Her-2 and Ki-67 was significantly associated with higher grade lesions, and deep myometrial invasion. Moreover, a statistically significant inverse relationship was observed between the positivity of P53, Her-2 and Ki-67 and the positivity of ER, PR. We found that determination of immuno-histochemical markers in curettage specimens might be helpful in predicting the final pathologic findings in patients with endometrial cancer. This might be helpful in planning the extensivity of the surgery.

[Ectopic pregnancy as a presenting symptom for lung cancer]

This article describes a rare presentation of squamous cell carcinoma of the lung, mimicking an ectopic pregnancy secreting beta-hCG protein in a 47 year old female smoker, who was treated with Methotrexate and subsequently curettage, tubectomy and right ovariectomy, because of suspected hydatidiform mole. This document presents a rare and chaotic case of lung cancer and reviews the differential diagnosis of an increased level of the beta-hCG marker and the therapeutic approach to these cases.

[The effect of adenoidectomy in different operative methods on the function of eustachian tube]

OBJECTIVE

To compare the effect of two different approaches in curettage of adenoid hypertrophy on eustachian tube function: the endoscopic assisted transoral adenoidectomy, and the traditional transoral curette adenoidectomy.

METHOD

Clinical data of adenoid hypertrophy patients who underwent surgery therapy were prospectively analyzed; Eustachian tube function were compared among them.

RESULT

Both traditional curettage of adenoids through mouth(group TCA) and endoscopic assisted transoral adenoidectomy (group ETA) significantly improved eustachian tube function (P < 0.01), while group ETA seemed to have a better outcomes (P < 0.01).

CONCLUSION

Both traditional curettage of adenoids through mouth and the endoscopic assisted transoral adenoidectomy can significantly improve eustachian tube function, and the endoscopic assisted transoral adenoidectomy produces a better outcome.

Diode laser offers minimal benefit for periodontal therapy

Current evidence indicates that use of diode lasers in the treatment of periodontitis--either as a monotherapy or adjunctive to traditional therapy--offers minimal benefit. Further, subgingival application of the diode laser during nonsurgical periodontal therapy can result in undesired outcomes, even when using manufacturer-recommended parameters.

Porous titanium granules in the surgical treatment of peri-implant osseous defects: a randomized clinical trial

PURPOSE

Porous titanium granules (PTG) may have potential as an osteoconductive bone graft substitute to treat peri-implant osseous defects. The aim of this study was to analyze clinical and radiographic outcomes of peri-implant osseous defects after treatment with PTG.

MATERIALS AND METHODS

This prospective, randomized, case-control, clinical 12-month study compared open-flap debridement and surface decontamination with titanium curettes and 24% ethylenediaminetetraacetic acid gel (n = 16) to the same protocol but with the addition of PTG (n = 16). One-, two-, and three-wall infrabony defects were included. Patients were given amoxicillin and metronidazole 3 days before surgery and for 7 days afterwards. Implants were submerged and allowed to heal for 6 months. Probing pocket depths, bleeding on probing, implant stability using resonance frequency analysis, and radiographic evaluation were performed at baseline and at 12 months. The threshold for significance was set at .05.

RESULTS

Change in radiographic defect height and percent fill of the peri-implant osseous defect significantly favored patients treated with PTG. Both treatment modalities demonstrated significant improvements in probing pocket depth, but significant differences between groups were not observed. The PTG-treated implants showed an increase in implant stability quotient (ISQ) of 1.6 units, compared with a decrease of 0.7 ISQ for the control group. No adverse effects were associated with PTG treatment.

CONCLUSIONS

Reconstruction with PTG resulted in significantly better radiographic peri-implant defect fill compared with controls; however, the results do not necessarily imply reosseointegration or osseointegration of PTG particles. Improvements in clinical parameters were seen in both groups, but no differences between groups were demonstrated.

Secondary healing after removal of large keratocystic odontogenic tumor in the mandible: enucleation followed by open packing of iodoform gauze

PURPOSE

The aim of this retrospective study was to present the findings of an open packing method after enucleation of large keratocystic odontogenic tumors (KCOTs) in the mandible.

PATIENTS AND METHODS

We performed a retrospective case series study of 27 patients with KCOTs larger than 5 cm treated at our institution between September 2003 and September 2008. A conservative surgical treatment was applied, which involved enucleation of the primary lesion and open packing of the residual osseous defect with iodoform gauze for secondary healing. Bone regeneration, tumor recurrence, and surgical complications were observed and analyzed. We used the χ(2) test and Pearson correlation coefficient for statistical analysis.

RESULTS

The postoperative follow-up time was 52.3 months on average (range, 24 to 84 months). The packing gauze was changed every 2 weeks after enucleation, and the total duration for packing was 10.2 months on average (range, 7-15 months). Bone regeneration and satisfactory secondary healing were observed clinically and radiographically after treatment. Only 1 case had a recurrence 6 months after initial treatment, which was attributed to insufficient bony unroofing during enucleation. The recurrent lesion was re-treated by the same method, and no recurrence occurred in the following 6 years. No serious complications from this method of treatment were observed. No significant variables were found to be related to the recurrence.

CONCLUSIONS

Enucleation with subsequent open packing was shown to be a conservative and comfortable treatment for patients and appears to be an effective choice for the management of large KCOTs in the mandible.

Morphological features of the maxillary incisors roots and relationship with neighbouring anatomical structures: possible implications in endodontic surgery

The purpose of this study was to investigate the relationship between the root apex of the upper incisors and neighbouring anatomical structures as well as the morphology of the root-end foramen after apicoectomy. Fifty-seven patients requiring endodontic surgical treatment for a maxillary anterior root were enrolled. A preoperative diagnostic computed tomography (CT) scan was analysed to determine: the distance between the anterior wall of the nasopalatine duct and the central (CI-ND) incisor root 4mm from the apex; and the distance between the floor of the nasal cavity and the tip of either the central (CI-NF) or the lateral (LI-NF) incisor root. After apicoectomy, root-end foramen endoscopic pictures were taken in order to characterize their morphology. Fifty-nine central and 26 lateral incisors were evaluated. The average CI-ND was 4.71 ± 1.26 (SD) mm. The average CI-NF was 10.62 ± 2.25 mm. The average LI-NF was 13.05 ± 2.43 mm. The foramen shape after apicoectomy was ovoid to circular in about 90% of cases in both central and lateral incisors. A sound knowledge of the anatomical relationships at the surgical site is essential for the clinician to perform a safe endodontic surgical procedure.

Interdisciplinary treatment of cervical lesions

Soft tissue grafting is an integral part of treatment of cervical lesions due to the common lack of adequate attached gingiva and root exposure associated with these lesions. Complete root coverage is a predictable outcome for Miller Class I and II recession defects, and partial root coverage can be achieved in Miller Class III defects. In the esthetic zone, it is desirable to cover as much of the root as possible, and all sites require an adequate zone of attached gingiva, especially adjacent to a restoration. Restorations are required for cervical lesions with excessive depth and significant involvement of the enamel, but they should be avoided where the lesion is shallow and the enamel involvement is minimal. Of course, some sites will require both soft-tissue grafting and placement of a restoration. An interdisciplinary approach to treating cervical lesions will create the most biologically appropriate, stable, and esthetic outcome. Establishing the appropriate tooth form first in treatment planning and sequencing will determine the gingival level and extent of periodontal procedures necessary to achieve the desired outcome.

Endoscopic transnasal drainage of frontal epidural abscesses

BACKGROUND

Although rare, sinogenic intracranial epidural frontal abscesses remain a serious and potentially life-threatening complication of sinusitis. Traditional therapy involves a combination of intravenous antibiotics, sinus surgery, and neurosurgical drainage through an external approach.

OBJECTIVE

In this report, we present a technique in which a purely endoscopic transnasal approach was used to treat both the sinusitis and the intracranial abscess. Four cases are discussed illustrating the technique and its outcomes.

METHODS

In all cases, endoscopic sinus surgery was performed to treat underlying sinus disease. Next, under image guidance, an endoscopic, intranasal opening through the skull base was performed for intracranial access and abscess drainage.

RESULTS

Our patients tolerated this procedure well and fully recovered with resolution of all presenting neurologic features.

CONCLUSION

This approach may offer a safe and effective alternative to frontal craniotomy for selected cases and can result in lower postoperative morbidity than traditional approaches.

Treatment of Brodie's abscess: excellent results from curettage, bone grafting and antibiotics

INTRODUCTION

Brodie's abscess is not a common variant of subacute osteomyelitis; however, when it does occur, the presentation is atypical and usually late. This study aimed to describe the mode of presentation of Brodie's abscess and evaluate the results of surgical treatment in a resource-poor setting.

METHOD

Over a five-year period, we retrospectively reviewed 20 patients who presented to two tertiary health institutions in south western Nigeria with clinical and radiological features of Brodie's abscess.

RESULTS

Brodie's abscess accounted for just 2 percent of all patients with osteomyelitis. Most patients were adults (mean age 21.5 +/- 7.8 years) and males (75 percent). In the series, the tibia was involved in 50 percent of the cases, the femur in 30 percent, and the radius and fibula each in 10 percent. The diaphyseal part of the long bones was affected in 65 percent of the patients and the metaphysis, in the remaining patients. The average size of the cavities was 3.0 +/- 0.8 cm. 65 percent of the isolates yielded Staphylococcus aureus. All patients were treated by curettage of the abscess cavities, cancellous bone grafting and antibiotics. All patients had satisfactory outcomes, with complete incorporation of the grafts and new bone formation in the cavities. No patient reported any recurrence.

CONCLUSION

Patients with Brodie's abscess respond well to surgical curettage of the abscess, cancellous bone grafting and antibiotic therapy.

Videoendoscopic assisted curettage of central giant cell granuloma of the maxilla in pediatric age

Giant cell granuloma is an uncommon bony benign lesion that generally involves the mandible and maxilla. It may be locally aggressive and result in extensive tissue destruction in advanced cases. Surgery is the traditional and still the most accepted treatment for giant cell granuloma. We report a pediatric case of central giant cell granuloma of the maxilla treated with videoendoscopic assisted surgical excision.

Comparing visual inspection with acetic acid plus random cervical biopsy plus endocervical curettage to colposcopic directed biopsy plus endocervical curettage in detecting cervical lesions in low-resource settings

OBJECTIVE

To compare the sensitivity, specificity, positive and negative predictive values of visual inspection with acetic acid directed cervical biopsy (VDB) in combination with random cervical biopsy (VRB) and endocervical curettage (ECC) to colposcopic directed biopsy (CDB) plus ECC in detecting cervical lesions (HSIL or more) in Thailand.

MATERIALS AND METHODS

A diagnostic-test study was carried out on 164 women with abnormal Pap smear at a tertiary care teaching hospital from March 2011 to June 2011. The women with abnormal Pap smears had further investigations such as; VDB and/or VRB, and CDB plus ECC, and/or loop electrosurgical excision procedure (LEEP). Either VDB plus VRB plus ECC or CDB plus ECC, sometimes LEEP, were used to diagnose cervical lesions. Severest histopathology from any means was taken as the gold standard.

RESULTS

There were 164 patients included in analyses. The sensitivity of VDB plus VRB plus ECC to detect cervical lesions was 95.9% (95%CI, 91.4%-98.1%) compared to the sensitivity of CDB plus ECC of 97.3% (95%CI, 93.2%-98.9%). The two were very similar (mean difference -1.4%, 95%CI, -5.4%-2.6%, by Z-test).

CONCLUSIONS

Thus VDB plus VRB plus ECC can substitute for CDB plus ECC in detecting cervical lesions in low-resource settings.

[Comparison study on the efficacy of three methods for the treatment of osmidrosis]

OBJECTIVE

To compare the efficacy of decollement, combined tumescent liposuction and curettage, Botox injection in the treatment of osmidrosis.

METHODS

From September 2006 to April 2009, 350 patients with osmidrosis were treated by decollement method in 180 cases, curettage in 120 cases,and Botox injection in 50 cases. The therapeutic effect and complications were retrospectively analyzed.

RESULTS

The patients were followed up for 3-24 months. The cure rate was 90.6%, 84.8% and 84.2% in decollement, curettage and Botox groups, respectively. The effective rate was 100% in all groups.

CONCLUSIONS

All the three methods are effective for the treatment of osmidrosis. The odor symptom can be improved a lot with decollement method. Considering the complication, downtime and cosmetic results, Botox injection is suitable for patients with minor or median odor, while combined liposuction and curettage is selected for patients with median to severe odor.

Procedures of endoscopic periradicular surgery

When a tooth with an apical lesion is identified, an apicoectomy is frequently performed when nonsurgical treatment is considered unfeasible or has previously failed. However, the treatment is usually difficult in molars. This article describes a minimally invasive procedure for removing a gutta-percha point under the maxillary sinus mucosa using an ultrathin arthroscope and a visualization approach in apicoectomy using an intranasal endoscope. These surgical techniques using endoscopes are minimally invasive and reliable procedures that provide limited incision and bone removal and respect the integrity of the maxillary sinus.

Controversies in skin surgery: electrodessication and curettage versus excision for low-risk, small, well-differentiated squamous cell carcinomas

BACKGROUND

Electrodesiccation and curettage (ED&C) of low-risk, cutaneous squamous cell carcinoma (SCC) generally consumes less time and resources than excision. Review of the literature reveals few recent studies examining cure rates for ED&C in the treatment of low risk cutaneous SCC.

OBJECTIVE

To evaluate via two retrospective studies the efficacy of ED&C in the treatment of low risk cutaneous SCC.

METHODS

A small controlled study in a Veterans Administration teaching hospital dermatology clinic compared cure rates of low risk SCC at one year by ED&C to those of surgical excision. A second study examined the cure rate of low risk lesions treated by curettage and electrodesiccation in a private practice.

RESULTS

The first study found no significant difference in cure rates between ED&C (14 of 14 cases successfully treated) and excision (15 of 16 successfully treated and one recurrence) (P = 0.1711). The second study found the ED&C cure rate (106 of 106 successfully treated) to be significantly greater than an arbitrary cure rate of 95 percent (P = 0.0091).

CONCLUSION

These findings support the efficacy of ED&C as a treatment modality for low-risk cutaneous SCC.

[Structure of the sweat glands in essential axillar hyperhidrosis and after its surgical treatment]

The structure of sweat glands in their skin portions in axillar regions was investigated in essential hyperhydrosis and after its treatment using mechanical curettage, performed solely or in combination with ultrasonic destruction. There was shown, that hyperhydrosis is accompanied by the sweat glands canaliculus secretory portion enlargement and their diameter as well. Additionally, the secretory epithelium area is practically enhanced twice as in a control and its thickness - in 1.5 times. Curettage is accompanied with removal, along with hypoderma, of majority of the sweat glands terminal portions and, due to evolvement of a dense connective tissue regenerate, prophylaxes their regeneration with a staged hypotrophy of residual secretory portions. The combined application of curettage with ultrasonic destruction, during treatment of hyperhydrosis, secures more prominent, alike while only curettage performance, reduction of terminal parts of sweat glands. It takes place on background of the inflammatory reaction reduction and the connective tissue subtle regenerate formation. Surgical methods of treatment, alike botulotoxin injections, secures more pronounced and persistent reduction of sweat glands in hyperhydrosis.

Accuracy of tumor grade by preoperative curettage and associated clinicopathologic factors in clinical stage I endometriod adenocarcinoma

BACKGROUND

Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage I endometriod adenocarcinoma. However, there is an inconsistency of tumor grade between preoperative curettage and final hysterectomy specimens, and its associated factors are poorly understood. This study aimed to evaluate the accuracy of tumor grade by preoperative curettage so as to achieve a better stratified management for clinical stage I endometriod adenocarcinoma.

METHODS

Clinical data of totally 687 patients with clinical stage I endometriod adenocarcinoma who underwent preoperative curettage and primary surgery were retrospectively collected. Compared with final hysterectomy specimens, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of tumor grade by preoperative curettage were calculated and their associations with clinicopathologic parameters, including age, status of menopause, position of uterus, location and size of lesion, histological grade, depth of myometrial invasion, cervical invasion, extrauterine spread, peritoneal cytology, metastasis to retroperitoneal lymph node, serum CA125 level, and hormone receptor status, were analyzed.

RESULTS

In final hysterectomy specimens, 139 of 259 grade 1 patients by curettage were upgraded to grade 1 or 2; 31 of 296 grade 2 were upgraded to grade 3, with a significantly discrepant rate of 40.9% (281/687) and an upgraded rate of 24.7% (170/687). The specificity and negative predictive value for grade 3 were 90.7% and 89.9%, while the sensitivity and positive predictive value for grade 1 were 67.1% and 40.9%, respectively.

CONCLUSIONS

Preoperative tumor grade by curettage does not accurately predict final histological results, especially in those classified as grade 1. Complete surgical staging seems to be necessary for clinical stage I endometriod adenocarcinoma.

[Accuracy of preoperative tumor grading and intraoperative gross examination of myometrial invasion in clinical stage I endometriod adenocarcinoma]

OBJECTIVE

To evaluate accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion in patients with clinical stage I endometriod adenocarcinoma for lymphadenectomy.

METHODS

Clinic-pathological data were retrospectively collected from 687 patients with clinical stage I endometriod adenocarcinoma who underwent operation in Women's Hospital, Zhejiang University School of Medicine from January 1999 to December 2008. According to postoperative histology diagnosis, accuracy of preoperative tumor grade by curettage and depth of myometrial invasion by intraoperative gross examination was evaluated, and clinic-pathological factors associated with accuracy were analyzed.

RESULTS

Sensitivity, specificity, accuracy, false negative rate, false positive rate, and positive and negative predictive value for the prediction of needing for intraoperative lymphadenectomy in patients with clinical stage I endometriod adenocarcinoma were 70.4%, 80.2%, 77.6%, 12.0%, 43.0%, 57.0% and 88.0%, respectively. Analysis of muti-factors shown that patient age, tumor size, lymph node metastasis and extrauterine spread lesions were independent factors affected the accuracy of prediction (P < 0.05).

CONCLUSION

Prediction of needing for lymphadenectomy by preoperative tumor grade and intraoperative gross examination of myometrial invasion is reliable in clinical stage I endometriod adenocarcinoma patients, while there is a highly false negative rate in prediction of not needing for lymphadenectomy, while other prognostic factors such as patient age, tumor size, lymph node metastasis and extrauterine spread lesion should be together considered.

Management of chalazia in general practice

BACKGROUND

Chalazia, or meibomian cysts, are often seen in general practice. While most can be resolved with a minor operation in a designated procedure room, there is a lack of published literature on the details of the incision and curettage used to treat this condition.

OBJECTIVE

This article outlines the management and treatment of chalazia in the general practice setting.

DISCUSSION

Chalazia are a common cause of morbidity in people of all ages. Treatment, which is based on clinical diagnosis, can involve conservative management, intralesional steroid injection, or incision and curettage.

Treatment of axillary hyperhidrosis/bromidrosis using VASER ultrasound

BACKGROUND

Current methods of treatment for axillary hyperhidrosis and/or bromidrosis are palliative (use of topical aluminum chloride or injections of botulinum toxin type A) or surgically based for more permanence (excisional surgery, endoscopic transthoracic sympathectomy, liposuction/curettage). The surgical approaches have mixed effectiveness and incur the risk of significant side effects and complications.

METHODS

Thirteen patients (3 males, 10 females) with significant axillary hyperhidrosis and/or bromidrosis were recruited, treated with the VASER ultrasound, and followed for 6 months. Preoperative assessment of the impact of hyperhidrosis and/or bromidrosis on lifestyle and the degree of sweat/odor were completed. Postoperative assessment of changes relative to lifestyle and degree of sweat/odor reduction and patient and surgeon satisfaction were completed.

RESULTS

Eleven of 13 patients had significant reduction in sweat/odor and had no recurrence of significant symptoms at 6 months. Two patients had a reduction in sweat/odor but not to the degree desired by the patients. No significant complications were noted. A simple amplitude and time protocol was established that provides consistent and predictable therapy. The complete procedure takes less than 1 h to treat two axillae using local anesthetic.

CONCLUSION

The VASER is safe and effective for treatment of axillary hyperhidrosis/bromidrosis. The method is minimally invasive with immediate return to basic activities and only temporary minor restriction of arm movement. At 6 months the treatment appears to be long-lasting, but further follow-up is required for verification of permanence. This method has become the standard of care for the treatment of axillary hyperhidrosis/bromidrosis in the authors' practice.