Perirenal fat thickness as a risk factor for postoperative complications in elective colorectal cancer surgery

Visceral obesity is an important factor that increases the risk of complications after colorectal cancer surgery. As calculating visceral fat is difficult and time-consuming, more practical fat measurements that are not time-consuming have been introduced. This study aimed to investigate the effects of perirenal fat thickness on postoperative complications and prognosis in patients undergoing surgery for colorectal cancer. Perirenal fat thickness was measured from the dorsal aspect of the left kidney on preoperative computerized tomography of patients who underwent surgery for colorectal cancer. The effects of perirenal fat thickness on postoperative complications were investigated. Diagnostic test performance was examined using the Roc Curve test to determine the cutoff value for the perirenal fat thickness values according to the complication findings of the patients. The cutoff value of perirenal fat thickness was found to be above 25.1, according to the presence of complications in the patients. Those with a perirenal fat thickness greater than 25.1 mm were considered to have high perirenal fat thickness values, and those with a low perirenal fat thickness value were considered low. Multivariate analysis revealed that increased perirenal fat thickness is an independent risk factor for postoperative complications. We believe that perirenal fat thickness measurement, as an indicator of visceral fat volume, can be used to identify patients at high risk of developing complications after colorectal cancer surgery. This may change the disease management and affect the patient information process.

Are there differences on tooth movement between different sectional canine retractors?

The aim of this study was to compare the effects of two retraction springs, demonstrating differences in reactivation and constancy of force, on tooth movement during canine distalization. Upper and lower canines of 16 patients (9 females, 7 males; mean age 14.6±1.7 years) with Angle Class I or II malocclusion were included in the study. Left upper and lower canines were distalized using Poul Gjessing (PG) retractors, whereas right canines of the same patients were distalized using Hybrid retractors. Angular and linear measurements were performed on lateral cephalometric radiographs and dental models taken prior to and at the end of canine distalization. Paired Samples t-test, Repeated Measures of Analysis of Variance and Greenhouse-Geisser tests were used for statistical analysis. The mean rates of canine distalization in PG retractors were 1.03 and 0.88 mm/months and 1.13 and 0.93 mm/months for Hybrid retractors for upper and lower canines, respectively. No significant differences were detected in the rate of canine distalization, sagittal and vertical movement of canines, and first molars between retractors or arches. Despite the differences in reactivation and constancy of the forces between PG and Hybrid retractors, both revealed similar canine distalization, distal tipping, rotation, and anchorage loss of molars. As a clinical point of view, Hybrid retractors could provide more benefits due to fewer activation requirements.

Coverage of axillary lymph nodes with high tangential fields in breast radiotherapy

The aim of this study is to evaluate the coverage of axillary nodal volumes with high tangent fields (HTF) in breast radiotherapy and to determine the utility of customised blocking. The treatment plans of 30 consecutive patients with early breast cancer were evaluated. The prescription dose was 50 Gy to the whole breast. Axillary level I-II lymph node volumes were delineated and the cranial border of the tangential fields was set just below the humeral head to create HTF. Dose-volume histograms (DVH) were used to calculate the doses received by axillary nodal volumes. In a second planning set, HTF were modified with multileaf collimators (MLC-HTF) to obtain an adequate dose coverage of axillary nodes. The mean doses of the axillary nodes, the ipsilateral lung and heart were compared between the two plans (HTF vs MLC-HTF) using a paired sample t-test. The doses received by 95% of the breast volumes were not significantly different for the two plans. The doses received by 95% of the level I and II axillary volumes were 16.79 Gy and 11.59 Gy, respectively, for HTF, increasing to 47.2 Gy and 45.03 Gy, respectively, for MLC-HTF. Mean lung doses and per cent volume of the ipsilateral lung receiving 20 Gy (V20) were also increased from 6.47 Gy and 10.47%, respectively, for HTF, to 9.56 Gy and 16.77%, respectively, for MLC-HTF. Our results suggest that HTF do not adequately cover the level I and II axillary lymph node regions. Modification of HTF with MLC is necessary to obtain an adequate coverage of axillary levels without compromising healthy tissue in the majority of the patients.

Erectile dysfunction (ED) in successfully treated lymphoma patients

18570

Background: Information on male potency in lymphoma survivors is insufficient. In this study, we assessed male sexual function in successfully treated lymphoma patients (pts). Methods: Fifty-nine pts treated for Hodgkin’s (HL) or non-Hodgkin’s lymphoma (NHL) with chemotherapy ± radiotherapy were recruited. Pts older than 55 years and those with a history of pelvic/inguinal radiotherapy or surgery were excluded. Study pts had to be disease-free and off-treatment for at least 6 months at the time of evaluation. Pts completed a survey questionnaire that consisted of demographic characteristics, risk factors for ED and the International Index of Erectile Function (IIEF) to assess their current level of sexual function. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone levels were also determined. Results: The mean age of the 59 pts was 40.2 ± 11.0 (range, 18–55 years). Thirty-eight (64.4%) had HL and 21 (35.6%) NHL. The mean interval between the end of active treatment and study evaluation was 7.7 years (range: 10 mths to 20 yrs). According to the IIEF score, 61.0% had some degree of ED (IIEF score <26): 33.9% had mild ED (IIEF score 17–25), 15.2% moderate ED (IIEF score 11–16) and 11.9% severe ED (IIEF score 6–10). Mean total scores of sexual desire, sexual satisfaction, orgasm and overall satisfaction domains of IIEF were significantly lower in pts with ED than those with normal ED (26.0 ± 1.8 and 39.0 ± 0.8, respectively; p < 0.001). Nine (18.4%) of 49 pts had an elevated FSH, 7 (14.2%) had elevated LH, and 3 (6.1%) had decreased testosterone levels. These hormonal disturbances did not affect the presence of ED and its severity. Six (10.2%) pts had hypertension and 3 (5.1%) had diabetes mellitus. Forty (57.6%) pts were ever-smokers, 29 (49.2%) were overweight or obese (BMI >25), but none had coronary artery disease. These risk factors did not statistically affect the presence of ED or its severity in our pts. Conclusions: These findings suggest that diagnosis and treatment of lymphoma may be a risk factor per se for the development of ED. Therefore, the underlying pathology, either organic or psychological, remains to be defined. Clinicians should be aware of this problem in lymphoma survivors and offer these pts adequate treatment options.

No significant financial relationships to disclose.

The biomechanical relationship between incisor and condylar guidances in deep bite and normal cases

The purpose of this study was to investigate the biomechanical relationship between the condylar and anterior guidances in deep bite malocclusion and control groups. The subjects consisted of 18 deep bite patients and 14 normal occlusions. A four-bar mechanism was described on the lateral cephalogram films and a computer program, for which the lengths of the links measured on the films were the inputs, was developed. The computer program was used to calculate the angles of rotation of the mandible and the condyle during contact of the mandibular anterior teeth with the lingual surface of the maxillary anterior teeth as the mandible moves forward. Comparison of the mean values of the angles of rotation of the mandible and condyle in the two groups has shown that the change in the angle of rotation of the condyle is statistically significant (P < 0.05). The angles of rotation of condyle in deep bite group were found larger than the angles of normal group. Correlation between the angles of rotation of the condyle and mandible has shown that they were significantly related. The cause of temporomandibular disorders may be attributed to the large angle of rotation of the condyle in deep incisal overbite.

The retraction of upper incisors with the PG retraction system

The aim of this study was to evaluate the effect on the dentoalveolar structures of the application of PG springs for retraction of upper incisors and to compare the outcome with the effect of a closed coil spring retraction system. Thirty-six subjects with Angle Class I or Class II malocclusions were selected for the study. Each subject had the two upper first premolars extracted and presented a symmetrical extraction space of at least 3 mm distal to the lateral incisors after canine retraction. The subjects were divided into two groups, the PG group with 17 subjects and the coil group with 19 patients. One group had the incisors retracted by PG universal retraction springs, whereas in the other a closed coil spring system was used. The average chronological ages were 18 years 4 months for the PG group, and 18 years 7 months for the coil group. In both groups the springs were activated to produce an initial force of 150 g per side. To examine the type of movement of the anterior and posterior teeth, and the time and rate of space closure, 20 parameters were measured and evaluated statistically with Wilcoxon and Mann-Whitney U-tests. In both groups the incisor retraction was accompanied by mesial movement of the buccal segments. Distal movement of the root apex of the incisors was observed in both groups, although more pronounced in the PG group (P < 0.01). A significant incisor intrusion resulting in a decrease in overbite was found in the PG group, whereas the deep bite increased significantly in the coil spring group. The PG spring produced a three-dimensional control in the movement of the upper incisors, so that application of additional intrusive mechanics after completion of the incisor retraction became unnecessary.

Response evaluation of bone metastases in breast cancer: value of magnetic resonance imaging

The clinical utility of magnetic resonance imaging (MRI) in judging therapeutic response of bone metastases was evaluated in 18 patients with advanced breast cancer. Treatment efficacy was assessed by MRI and conventional methods such as plain radiograph, bone scan, pain and analgesic scale, and serum CA15-3. The response by MRI was evaluated mainly on T1-weighted sequences by measuring the volume of the bone lesion and soft tissue component. The patient was assumed to be a conventional responder if a complete or partial response was observed in any of the conventional methods described above. Response was most concordant between plain radiographs and MRI findings (91%, 10/11, 95% confidence interval [CI]: 58.7-99.8). The rate of concordance was 61% (11/18, 95% CI 35.8-82.7) for all conventional methods and MRI. MRI revealed response in four patients in whom progressive disease was observed by bone scan and the marker response was not measurable. This pilot study suggests that posttherapy evaluation with MRI may provide useful clinical information in breast cancer patients with bone metastases and may be a valuable adjunct to conventional methods with conflicting results.

Chlamydial infections and male infertility

Chlamydial infections may be difficult to diagnose due to the silent symptoms and difficulty in culturing. An infectious process may impair fertility by adversely affecting sperm functions, resulting in testicular damage or causing obstruction of the genital tract. In our study, we tried to find Chlamydial antigen by using EIA (Enzyme Immune Assay) and to compare the Ag(+) and Ag(-) groups according to semen parameters. Except for semen volume, we found significant differences in density, morphology, motility and viability (intervolume p > 0.05, interdensity p < 0.01, intermorphology p < 0.001, intermotility p < 0.001 and interviability p < 0.001).

Evaluation of phosphohexose isomerase as a metastasis marker in breast cancer patients

In this study the value of PHI serum measurements in breast cancer as an index of metastases was investigated. Serum CA 15-3 and CEA tumor marker and gamma-glutamyltranspeptidase (gamma-GT) levels were also determined in groups of patients with established distant metastases or in patients on follow-up with no evidence of disease. Fifty-one female breast cancer patients were included in the study. The mean values for each parameter were higher when metastases were present. However, the difference was mostly not meaningful. The only significant difference was observed for CA 15-3. Our data do not support the usefulness of the PHI assay for early detection of the metastases in breast cancer.

Utility of CA 15-3 and CEA in monitoring breast cancer patients with bone metastases: special emphasis on "spiking" phenomena

OBJECTIVES

CA 15-3 and CEA are considered useful tumor markers in monitoring breast cancer patients. This study was undertaken to specifically evaluate the transient elevations in these markers that are observed during systemic treatment for metastatic disease. This phenomenon has been termed "spiking."

DESIGN AND MATERIALS

Serum tumor marker levels were investigated by enzyme immunoassay in 20 breast cancer patients without metastases and in 20 patients with bone metastases receiving systemic treatment.

RESULTS

Both CEA and CA 15-3 levels were significantly elevated in the patients with bone metastases. Serum CEA and CA 15-3 levels in patients with metastases displayed a transient, but significant, elevation days 15 and 30, respectively, after commencing systemic treatment, which returned to pretreatment levels on the 60th day.

CONCLUSIONS

The spiking effect observed in the tumor marker levels should be carefully evaluated, and not be misdiagnosed as disease progression.

Plastic surgery in irradiated areas: analysis of 200 consecutive cases

Reconstructive surgery in previously irradiated areas is more difficult than in non-irradiated cases. A retrospective analysis of the outcome of 200 previously irradiated patients who had skin graft or flap reconstruction performed by the same surgeon is presented, and the most suitable surgical technique in irradiated areas is discussed. One hundred and fifty-six patients had skin and oral cavity cancer, and were operated on after local recurrence. Twenty patients had breast cancer; 15 were operated on for local recurrence and five for breast reconstruction. Twenty-four patients had soft tissue sarcomas. Eighty-five patients had a skin graft (group 1), 35 had a skin flap (group 2), 10 had a fascia/muscle flap plus skin graft and 70 had a myocutaneous flap (group 3). Analysis of complications revealed statistically significant differences in terms of incomplete graft/flap necrosis between group 1 and 2 (P < 0.001) and groups 1 and 3 (P < 0.001), and in terms of infection between groups 1 and 3 (P < 0.01). We conclude that the method of reconstruction is determined by the characteristics of the defect such as size and localization; the quality, fractionation, total dose, and energy of radiation used; skin and subcutaneous tissue changes due to radiation; and operation time. However, it is reasonable to choose fascia/muscle or myocutaneous flaps for reconstruction in previously irradiated areas. These methods are more resistant to bacterial inoculation, more prone to clean residual infection, and provide better vascularized tissue and volume replacement for contour defects.

The effects of cervical headgear on dentofacial structures

A study was made on the effects of cervical headgear on dentofacial structures, especially non-erupted teeth, in the early and late mixed dentition periods. Pretreatment and post-treatment cephalometric evaluation was done on 8 patients in the early mixed dentition period and 10 patients in the late mixed dentition period. The results showed that any reference line passing through Ptm point should not be used to evaluate the efficiency of cervical headgear, and that such headgear is more effective on non-erupted teeth in early mixed dentition.

The effects of different sectional arches in canine retraction

The purpose of the present study was to compare the effects of Gjessing's canine retraction arch with a sectional arch including a reverse closing loop, which are both used for canine retraction in extraction cases. Our study involved both the maxilla and the mandible independently. After upper first premolar extractions and levelling of the teeth with 0.018-inch slot standard Edgewise appliances on 12 subjects, with a mean age of 15 years, the right maxillary canines were retracted by 0.016 x 0.022-inch sectional arches including a reverse closing loop, for a mean period of 7.75 months whereas the left maxillary canines were retracted by 0.016 x 0.022-inch Gjessing retraction arches for a mean period of 6.25 months. Following lower first premolar extractions and levelling of the teeth in eight subjects with a mean age of 13 years 7 months, the right mandibular canines were retracted by 0.016 x 0.022-inch sectional arches with reverse closing loop for a mean period of 7.75 months and the left mandibular canines were retracted by 0.016 x 0.022-inch Gjessing arches for a mean period of 6 months. The present study was carried out on 40 lateral cephalometric films of 20 subjects taken prior to and at the end of canine retraction. The differences between the mean changes of the sectional arch including reverse closing loop and Gjessing retraction arch groups were found to be statistically significant for the amount of upper canine crown retraction, mesial movement of upper first molar crown and duration and rate of upper canine distal movement.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum tumor markers for detection of bone metastasis in breast cancer patients

For the diagnosis of bone metastasis in breast cancer patients during systemic treatment serum tumor markers, including carbohydrate antigens 15-3 (CA 15-3) and 19-9 (CA 19-9), cancer antigen 125 (CA 125), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), beta-2 microglobulin (BMG), ferritin, and tissue polypeptide antigen (determined by the M3 monoclonal antibody, TPS) were measured in 22 patients with known bone metastases and in 30 patients without documented metastases. The most useful single marker was CA 15-3. By stepwise discriminant analysis, it was found that 90% of the patients could be diagnosed truly by using the markers CA 15-3, BMG and ferritin. It is concluded that monitoring with combinations of tumor markers at regular intervals increases the diagnostic efficiency.

[The effect of growth and development on soft tissue profile in boys and girls with normal occlusion]

In this study the effect of the growth and development on soft tissue profile of preadolescent subjects with normal occlusion, skeletal class 1 and mesiodivergent structure was investigated. 10 girls, the mean skeletal age being 9.28 +/- 1.58 years and 10 boys, the mean skeletal age being 9.88 +/- 1.80 years were selected. Two standardized lateral cephalometric roentgenographs were taken from all subjects at one year interval. The angular and linear measurements were performed on tracing films. The mean values of these measurements were calculated and statistically evaluated. According to statistical evaluation, the growth and development of the lips and soft tissue chin in both girls and boys were normal and they were in harmony with each other. However in girls the increase of lower lip thickness and in boys the changes of hard and soft tissue pogonion positions were found to be statistically insignificant. In girls, the correlations between the upper lip position and maxillary growth.

[Study of the structural compensation of the mandible during treatment with cervical headgear]

This study was performed on two cephalometric films of each fourteen subjects with skeletal class 1 facial structure and Angle Class II molar relation treated with cervical headgear for a period 0.777 +/- 0.06 years; and of each thirteen control subjects with skeletal class 1 facial structures and normal occlusion observed for a period of 0.807 +/- 0.03 years. The correlation coefficients for the longitudinal changes of angular and linear measurements during control and treatment periods in both groups were evaluated. The correlation coefficients belonging to each group were compared; and the compensational regions during cervical traction were investigated. It was concluded that; the structural compensations occurred in the mandible according to the inhibition of the mesial migration of lower permanent first molars because of the interdigitation with the upper ones were the increase in the ramus inclination, change in the growth pattern of the mandibular condyle, increases in the gonial angle, lower anterior facial height and the mandibular plane angle.

[Examination of the effect of topical fluoride treatment on the enamel surface in the S.E.M]

The study was undertaken to determine the effect of topical fluoride treatment on the enamel surface in the direct bonding system. In this in vitro study, the enamel surfaces of the sample teeth that were subjected to the acidic phosphate fluoride treatment, the basic phosphate fluoride treatment and the only orthophosphoric acid treatment were examined in the S.E.M. Scanning electron photomicrographs were taken at magnifications x2000 and x5000. The overall etching effect on the enamel surface treated with the basic phosphate fluoride solution was very similar to sample surface etched with orthophosphoric acid. It was concluded that there wasn't any differences about mechanical retention specialty at surface characteristics.

[Treatment of Class 2-high Angle cases using the combined activator-occipital headgear]

In this article, the use of a combined activator-occipital headgear appliances for treatment of 3 class 2, high angle cases at prepubertal period and results of the treatment are discussed. It was benefited from the orthodontic and orthopedic effects of functional and extraoral appliances separately and it was thought that undesirable effects of each appliances for cases could be eliminated by using the appliances together properly.

[Effect of topical fluoride treatment on the tensile bond strength of an orthodontic bonding resin]

A study was undertaken to determine the effect of an acidic phosphate fluoride solution (% 2 NaF in 0.1 M H3 PO4, PH3) and a basic phosphate fluoride solution (10(-2) M Na3 PO4 + 10(3) ppm F-, PH 8) on the tensile bond strength of an orthodontic bonding resin (3 M Consise System) soon after application of the pre-bonding etch. 24 premolars were evenly divided into three groups and % 37 orthophosphoric acid was applied to all enamel surfaces for 3 minute to simulate the pre-bonding etch; on the first group of teeth which served as control, brackets were bonded directly to etched surfaces with a Bis-GMA direct bonding adhesive; second group of teeth were received a 1.5 minute application of acidic phosphate fluoride solution and the brackets were bonded directly; third group of teeth were also received a 2.5 minute application of basic phosphate fluoride solution and brackets were bonded directly too.