Does the presence of an unerupted lower third molar influence the risk of mandibular angle and condylar fractures?

It has been suggested that unerupted lower third molars (M3) increase the fragility of the mandibular angle and simultaneously decrease the risk of condylar fracture. However, it is unknown whether this applies regardless of the direction and point of impact of the traumatic force. The aim of this study was to investigate the impact of an unerupted M3 on the fragility of the angle and condyle in terms of a force acting from different directions and affecting different regions of the mandible. Computed tomography scans of a human mandible and finite element methodology were used to obtain two three-dimensional models: a model with, and the other without an unerupted M3. A force of 2000N was applied to three different regions of the models: the symphysis, ipsilateral body, and contralateral body, respectively. When the force was applied to the mandibular body, the results revealed increased angle fragility in cases with unerupted M3. When the force was applied to the symphysis, the condyle region showed higher fragility, irrespective of the presence of an unerupted M3. In summary, fragility of the angle and condyle regions depends on the presence of an unerupted M3 and on the direction and point of impact of the force.

Paranasal sinus osteoma: is there any association with anatomical variations?

BACKGROUND

Developmental disturbances of the paranasal sinuses are proposed as the cause of osteoma. We examined whether such disturbances may result in the frequent presence of anatomical variations of the paranasal sinuses in patients with osteoma.

METHODOLOGY/PRINCIPAL

The study was performed retrospectively on 2,820 patients subjected to CT examination during 2005 - 2011. Demographic and CT characteristics of osteoma, and associated pathological findings were evaluated for 104 patients with diagnosed osteoma. The presence of anatomical variations was assessed for 51 osteoma patients with a complete medical history, and for 1,233 patients from a control group.

RESULTS

The prevalence of osteomas was found to be 3.69%, with male to female ratio 1.08:1. The frontal sinus was most commonly affected. The presence of anatomical variations was more frequent in patients with osteoma than in controls, with significant differences confirmed for the sphenomaxillary plate, infraorbital cell, and crista galli pneumatization.

CONCLUSIONS

The paranasal sinus osteoma is associated with higher prevalence of anatomical variations. This can be explained either by the stronger influence of genetic and/or environmental factors on the development of the paranasal sinuses in patients with osteoma, or by their higher susceptibility to above mentioned factors.

Incidence of brain metastases in early stage HER2 3+ breast cancer patients; is there a role for brain CT in asymptomatic patients?

PURPOSE

Human epidermal growth factor receptor 2 overexpression (HER2 3+) is reported in retrospective studies as a factor that contributes to higher incidence of brain metastases (BM) in patients with metastatic breast carcinoma. Although there are some reports suggesting higher incidence of BM in adjuvant trastuzumab trials, the true incidence, as well as the time of occurrence of BM in early-stage high risk breast carcinoma patients, has not been widely prospectively explored. The main objective of this study was to prospectively explore the incidence of BM during and after adjuvant trastuzumab administration in HER2 3+ early-breast carcinoma patients.

METHODS

Two hundred and fifty-eight patients with early, HER2 3+ breast carcinoma have been included in this analysis. Brain computed tomography (CT) scan was scheduled once during adjuvant trastuzumab therapy and thereafter only if central nervous system (CNS) symptoms occurred.

RESULTS

Eighty-five patients (33%) underwent brain CT in the absence of CNS symptoms. The median number of trastuzumab cycles at the time of brain CT was 9 (range 4-18). There were no BM detected by brain CT in these 85 asymptomatic patients. However, during a median follow up of 18 months 5/258 patients (1.93%) developed BM, but only 2 (0.77%) while still receiving adjuvant trastuzumab. The median time from breast cancer diagnosis to BM was 24 months (range 14-43).

CONCLUSION

BM are a rare event during adjuvant trastuzumab treatment and brain CT screening is not justified in asymptomatic patients with early HER2 3+ breast carcinoma.

Local control of glomus tumors of the head & neck by radiation therapy and surgery

PURPOSE

Glomus tumors are rare tumors, highly vascular and typically radiosensitive. Therapeutic options include surgery, radiation therapy (RT), embolisation or any combination of them, but the appropriate treatment still remains a challenge. The purpose of this study was to report the results of local control of 7 patients with glomus tumors treated with surgery and external beam RT (EBRT).

METHODS

All of the patients underwent primary surgery and then postoperative EBRT. Follow-up was calculated from the date of initiation of EBRT and ranged from 3 to 15 years (mean 7.14, median 6.2). The likelihood of local control was analysed using the Kaplan-Meier product limit method. We also analysed the average duration of response between two groups of patients with different doses of EBRT as well as the presence of acute and late EBRT complications.

RESULTS

Local control was obtained in 6/7 (85.7%) patients. Moreover, local control was achieved in 3/4 (75%) patients with recurrent glomus tumors, while in patients with postoperative residual disease local control was obtained in 3/3 (100%) of them. Patients who received <50 Gy (n=2) had shorter average duration of response compared to patients who received >50 Gy (n=5; p=0.248). There were no severe treatment complications.

CONCLUSION

Surgery and RT represent an appropriate treatment approach for advanced glomus tumors with acceptable complications.

Invasive inflammatory pseudotumor of the pelvis: a case report with review of the literature

Inflammatory pseudotumor (IPT) is a rare benign lesion of unknown etiology, which mimics malignant neoplasm and may arise from various organs. A 53-year-old woman was submitted to diagnostic evaluation because of bilateral, hydroureteronephrosis and oedema of the left leg after a 3-month history of fever of unknown origin. On bimanual vaginal and rectal examination, a mass was involving the uterus, parametria and mostly left adnexa, while the cervix appeared normal. Computed tomographic (CT) scan revealed a 13x10.5 cm mass in the pelvis, mostly at the place of the left adnexa, uterus and both parametria, also involving the surrounding tissues and producing bilateral hydroureteronephrosis. At laparotomy, a grey solid mass was seen, mainly involving the reproductive system. As no radical operation could be performed, the mass was only biopsied and histology showed an inflammatory pseudotumor. Antibiotic therapy was given for one month. Follow-up CT 4 and 8 months after laparotomy showed local regression of IPT. The last follow-up CT, 20 months after laparotomy, revealed no evidence of tumor.

Surface resistivity estimation by scanning surface potential microscopy

Nickel was sputter deposited on a glass with a thin film thickness of 600 nm under either in an argon atmosphere or under a partial pressure of nitrogen of either 1.3 x 10(-4) or 4 x 10(-4) mbar. Atomic force microscopy and scanning surface potential microscopy (SSPM) were used to study the morphology and to estimate the surface resistivity of the obtained Ni thin films taking into account surface-roughness effects. For the three samples investigated, the surface resistivity values as estimated using SSPM were in good agreement with the results obtained by standard four-point probe measurements.

Patient-physician relationship in the aftermath of war

During the period of conflict that led to the dissolution of the former Yugoslavia, the Serbian healthcare system suffered greatly; as a result, relationships between physicians and their patients reached an all-time low. After cessation of the various wars, a group of medical students attempted to assess the state of the patient-physician relationship in Serbia. Their study showed a relationship characterised by very meek patients and rather arrogant physicians. Empowered by their engagement, the medical students constructed a set of standards for achieving a proper patient-physician relationship; physicians should be capable of hearing and understanding patients, with the result that the ensuing empowerment can enable patients and physicians to create a tool for changing the relationship between both parties.

The role of surface defects in hopg on the electrochemical and physical deposition of Ag

The role of defects on a substrate surface during the initial stages of nucleation and growth ofAg deposited electrochemically and physically on highly oriented pyrolytic graphite (HOPG) has been observed ex situ by scanning tunneling microscopy (STM). The silver was electrodeposited under current controlled electrochemical conditions at 26?A/cm2, which corresponded to a deposition rate of 0.1 monolayers (ML) per second. For comparison, physical deposition of Ag on HOPG was performed by DC Ar + ion sputtering, at the same deposition rate and for the same deposition times. In both cases, Ag grows in an island growth mode, but the distribution of the islands appears to be quite different. In physical deposition, the Ag islands are almost homogeneously distributed over the substrate surface and a slight accumulation of islands on steps does not contribut e significantly to the overallmorphology. This indicates the crucial role of point defects on the substrate in the initial stages of nucleation. In electrochemical deposition, more line d defects are observed after a flow of current, andtheir role in the beginning of the nucleat ion is more pronounced. Lined defects are responsible for the string-like shaped domains of deposited atoms. Also, the existence of string-like shaped nucleation exclusion zones is indicated. The problem of the formation of nucleation exclusion zones,which appear only in electrochemical deposition, has been reconsidered and a new explanaton of their formation is given. A mathematical model for the calculation of the radius of the nucleati on exclusion zone has been developed.