Mandibular Flexure and Crestal Bone Stress Distribution on an Implant-Supported Fixed Full Arch Mandibular Prosthesis: Finite Element Analysis in Three Dimensions

Aim This study's objective was to assess and analyze, using 3D Finite Element Analysis, the impact of four mandibular complete arch superstructures on the distribution of stress in the crestal bone during mandibular flexure. Materials and methods Four Finite element models of the mandible with different implant-retained framework designs have been developed. Three of these models had six axial implants placed at intervals of 11.8 mm, 18.8 mm and 25.8 mm from the midline, respectively. One model had two tilted implants and four axial implants splinted with a single piece of framework at intervals of 8.4 mm, 13.4 mm and 18.4 mm from the midline. For analyzing the stress distribution, the finished product was transferred to ANSYS R 18.1 software (Sirsa, Haryana, India) for finite element simulation, the models were constructed, the ends were restrained, and bilateral vertical loads of 50N, 100N and 150N were applied to the distal part of the framework. Results Bilateral loads were applied to each of the four 3D FEM and after assessment of Von Mises Stress and Total Deformation, a finding was made that the model with six axial implants supported by a single piece of framework underwent the highest total deformation and the model with four axial implants and two implants with distal tilts displayed most significant Von Mises stress. Conclusion Within the constraints of this 3D FEA, it was determined that mandibular flexure and peri-implant bone stress were affected by the way the framework is divided and the nature of mandibular movement. The three types of frames with the least bone stress are demonstrated by the mandibular deformation that results from two-piece frameworks on axial implants. Regardless of the number of implants, the single framework splinted with six implants shows a flexure in mandible with the highest bone stress around the implant irrespective of the angulation of the implant. Clinical significance When it comes to edentulous jaws, reducing stress in implant-supported restorative systems at varying degrees of the bone and implant interfaces and superstructures of prosthetics is one of the fundamental goals of implant treatment. A framework with proper design and a low modulus of elasticity reduces mechanical risk. Additionally, a larger number of implants helps to prevent cantilevers and spacing between the implants.

A Prospective Randomized Comparison of Concurrent Chemoradiation with Neoadjuvant and Adjuvant Chemotherapy with Concurrent Chemoradiation Alone for Locally Advanced Carcinoma Cervix

Aims: The aim of this study was to compare concurrent chemoradiation along with neoadjuvant and adjuvant chemotherapy versus concurrent chemoradiation alone in locally advanced cervical cancer regarding treatment response and toxicities. Subjects and Methods: A randomized control study was done on 116 patients with locally advanced carcinoma cervix (Stage IIB to IIIB) registered between January 2014 and February 2015. Patients were randomly divided to receive either one cycle of cisplatin/5-fluorouracil neoadjuvant chemotherapy and two cycles of the same adjuvant chemotherapy with concurrent chemoradiation with weekly cisplatin (Arm A) or only concurrent chemoradiation (Arm B). All patients received three fractions of high-dose-rate intracavitary brachytherapy after completion of the external radiation. Results: A higher proportion of the patients of chemotherapy arm achieved complete response (94%) as compared to the nonchemotherapy arm (56%), and this was statistically significant. There was a trend toward more treatment-related acute toxicity with chemotherapy. Conclusions: These results have corroborated the view that if neoadjuvant and adjuvant chemotherapies are added to concurrent chemoradiation, it could further the effects of concurrent chemoradiation for patients with locally advanced cancer of the uterine cervix.

Cedecea lapagei in a patient with malignancy: Report of a rare case

Cedecea lapagei is a member of the family Enterobacteriaceae and is an uncommon pathogen. There are very few reports of isolation of this organism from biological samples; mostly it is found to be a pathogen in elderly or otherwise medically compromised. We present a rare case of a patient with underlying malignancy of buccal mucosa, who developed an oral ulcer superinfected with C. lapagei. According to the available literature, this is the first case of C. lapagei from India detected in a cancer patient.

Non-pigmented strain of serratia marcescens: an unusual pathogen causing pulmonary infection in a patient with malignancy

Serratia marcescens is a member of the family Enterobacteriaceae. It has emerged in recent years as an opportunistic pathogen of nosocomial infections. Some biotypes of Serratia marcescens produce the non-diffusible red pigment prodigiosin. Though both pigmented and non-pigmented biotypes may be pathogenic for humans, the non-pigmented biotypes are more virulent due to cytotoxin production and presence of plasmids mediating antibiotic resistance. However in India only one study done 31 years back has reported on infections caused by non-pigmented strains of Serratia marcescens. We present a case of a patient with squamous cell carcinoma of the left retromolar trigone, soft palate and buccal mucosa, who developed pulmonary infection with non-pigmented strain of Serratia marcescens. According to the available literature, this is the second report on infection with non-pigmented strain of Serratia marcescens from India. It is imperative to accurately detect the non-pigmented biotypes due to their tendency to cause serious and difficult to treat infections.

Neuroblastoma with concomitant giardiasis: report of a case with diagnosis by fine needle aspiration cytology

BACKGROUND

Diagnosis of two pathologies, including a neoplasm and infectious condition, by fine needle aspiration (FNA) cytology in the same patient is rare.

CASE

A 2-year-old, male child presented with fever, abdominal pain and abdominal mass. Imaging findings were strongly in favor of a neuroblastoma. FNA smears from the mass revealed fecal material containing numerous trophozoites of Giardia lamblia. FNA was repeated in view of the imaging findings. Repeat smears showed a small round cell tumor with rosettes and background filamentous/fibrillar material consistent with a neuroblastoma. Chemotherapy reduced the mass considerably. Histopathology of the resected residual mass revealed a ganglioneuroma in addition to remnants of neuroblastoma. The patient was free of disease two years after the initiation of chemotherapy.

CONCLUSION

When FNA cytology shows an infectious pathology in the clinical and imaging setting of a tumor, FNA should be repeated so that an important component of the diagnosis is not missed.

Oncoprotein c-erbB-2 in squamous cell carcinoma of the uterine cervix and evaluation of its significance in response of disease to treatment

Tissues from 50 cases of squamous cell carcinoma of the uterine cervix were analysed for immunohistochemical expression of c-erbB-2 oncoprotein and the patients were followed-up for 2 years. Immunopositivity of c-erbB-2 was studied with reference to clinical stage, histopathological differentiation and response to the cancer therapy. Expression of c-erbB-2 protein was found to be higher (37.5%) in cases with stage II disease, whereas more expressions were noticed in poorly differentiated squamous cell carcinoma (33.3%). Among cases who showed complete response to the treatment, 20.8% were positive for c-erbB-2 oncoprotein. On the contrary, 36.8% of prognostically unfavourable cases revealed positivity for c-erbB-2 immunostaining. However, the difference between c-erbB-2 expressions of these two said groups of patients, which were divided in accordance with the response to treatment, did not attain to statistical significance. Study on c-erbB-2 among larger number of patients with cervical carcinoma may prove to be an important factor in response to cancer therapy.

Oral leiomyosarcoma in childhood. Report of a case with fine needle aspiration cytology

BACKGROUND

Leiomyosarcomas are rare tumors in the pediatric age group, and occurrence of this neoplasm in the oral cavity is exceedingly rare. This article highlights the fine needle aspiration (FNA) cytology diagnosis of a case of recurrent oral leiomyosarcoma in childhood.

CASE

An 11-year-old male noticed a swelling in the oral cavity near the left lower jaw. It was excised and diagnosed as leiomyosarcoma on histopathology. Four months later the patient presented with a progressive swelling in the oral cavity that extended to the lower jaw. The recurrent swelling was subjected to FNA, and its cytologic features were consistent with leiomyosarcoma. There was a very good initial response to chemotherapy and radiation therapy. However, because of noncompliance with advice for further therapy, the patient had a second local recurrence and dissemination of the disease to the skeletal system, abdomen and thorax. FNA cytology diagnosis of the second locally recurrent lesion and abdominal mass were consistent with leiomyosarcoma. Immunocytochemical staining revealed a positive reaction in the cytoplasm of tumor cells for vimentin and desmin in the FNA smear and paraffin section, respectively.

CONCLUSION

Fine needle aspiration cytology is a useful technique for detection of recurrence and metastasis during follow-up of childhood oral leiomyosarcoma.

Clinical, haematological and radiological evaluation of fragmented autogenous cortical bone grafting of radius in dogs

In eight clinically healthy dogs, a midshaft diaphyseal defect of 2 cm was created in the right radius ulna. This gap was maintained by fixing a four hole sherman bone plate on the radius. In four dogs, the gap was filled with autogenous cancellous bone grafts (2-5 mm in diameter) harvested from the proximal end of the tibia (group 1). In the remaining 4 dogs, the fracture gap was filled with autogenous cortical bone fragments (ACBF) of 2-5 mm diameter made from the same 2 cm piece of bone removed from the radius. While comparing various clinical observations, it appeared that healing of the wounds and bearing of the weight on the grafted limb in dogs subjected to ACBF graft were similar to those given autogenous cancellous bone graft. In radiographs, taken on the 30th day in group 1, a fairly good amount of callus was found emerging from fracture ends but the whole of the bone graft area was not covered by bony density even on the 60th day. In group 2 (ACBF), 45th day radiograph revealed that the callus from the fracture end was mixing up with the cortical bone fragments, and at the 60th day, the callus was clearly found invading the cortical bone fragments grafted in the fracture gap.

Fine needle aspiration cytology diagnosis of a fungal lesion of the Verticillium species. A case report

BACKGROUND

Fine needle aspiration (FNA) cytology has great potential for the diagnosis of fungal lesions and other opportunistic infections, the frequency of which is rising due to immunosuppression, travel and environmental exposure. However, reports on FNA diagnosis of fungal lesions are rare.

CASE

A 40-year-old male juvenile diabetic presented with a 5 x 4-cm swelling over the upper part of the left arm. He had a recent history of a left nephrectomy for renal cell carcinoma followed by radiotherapy. At the time of presentation, he was also receiving chemotherapy and interferon alpha-2a for a suspected pulmonary metastasis. FNA smears from the swelling showed an inflammatory exudate rich in neutrophils and a few septate fungal hyphae that branched at acute angle. Gomori's silver methenamine stain and periodic acid-Schiff stain revealed numerous fungal hyphae. The provisional diagnosis based on the cytomorphologic features was aspergillosis. However, culture of the aspirate confirmed the fungus to be of the Verticillium species. The lesion on the left arm responded to antifungal therapy, and the swelling disappeared gradually.

CONCLUSION

FNA cytology was very useful in the diagnosis of a rare fungal lesion that was not clinically suspected in spite of the fact that the patient was a highly susceptible candidate for it.

Primary pure choriocarcinoma of the ovary

The authors report a case of pure primary choriocarcinoma of the ovary (FIGO stage III A) in a young patient with 24-month follow-up. The patient, an advanced case of choriocarcinoma, was treated with combination chemotherapy comprising vincristine, bleomycin and cisplatinum. It is stressed that at that stage of the disease it is of prime importance to initiate combination chemotherapy for improvement in survival and prognosis of such cases rather than to distinguish the gestational or nongestational origin of the tumor.

Malignant mixed mesodermal tumor of ovary

A case of primary malignant mixed mesodermal tumor (MMMT) of the ovary arising de novo in a post-menopausal multiparous female is reported. The tumor contained heterologous elements in the form of cartilage and fat in addition to carcinosarcomatous areas. Post-operatively, single-agent chemotherapy was administered and up to the time of reporting the patient has been alive and well. Because of the rarity of these tumors the proper treatment remains a dilemma. The differential diagnosis of MMMT of ovary and teratocarcinoma is considered, as the two are confused frequently.

Testicular germ cell tumors. A review of 10 years' experience

Experience with 200 cases of testicular tumors seen over a period of 10 years has been presented. Modes of presentation, response to treatment, and patterns of failure have been analyzed in 186 cases of germ cell tumors. The role of radiation in the overall management of seminomas is reaffirmed, and the need for adjuvant radiation to the supraclavicular region and mediastinum is demonstrated in Stage II cases of seminoma. Results of treatment with radiation alone or combined with chemotherapy were not encouraging in nonseminomas in the current series. The advantages of an aggressive multimodal approach with judicious combination of surgery, radiation treatment, and combination chemotherapy have been discussed, with review of relevant literature.

Effect of fungicides on growth and on DNA, RNA and protein anabolism of a Rhizobium sp

Eleven fungicides were examined for their effect on the growth and anabolism of Rhizobium sp. in pure culture. Of these, only 4 were found to inhibit growth of rhizobia at a concentration as low as 10 micrograms/ml. Growth inhibition by these fungicides appeared to be primarily due to inhibition of respiration, although thiophanate and anilazine also affected DNA and RNA synthesis, respectively. Inhibition is, however, transitory and the bacterium has the ability to overcome this initial inhibition without mutation.

Effect of anilazine on growth, respiration and enzyme activity of Escherichia coli

The effect of anilazine on growth, respiration and enzyme activity of E. coli has been studied. Anilazine delays the growth of E. coli by prolonging the lag period. It inhibits glucose oxidation by 60% and succinate oxidation by 100%. It also inhibits in vitro succinic dehydrogenase activity. It seems that the inhibition of E. coli by anilazine is because of inhibition of respiratory enzymes.

Effect of benomyl and thiophanate-methyl on metabolic activities of Rhizoctonia solani Kühn

Effect of benomyl and thiophanate-methyl on various metabolic activities of Rhizoctonia solani was investigated. Both fungitoxicants strongly reduced endogenous whole cell and mitochondrial respiration by inhibiting one or the other key enzymes of electron transport chain; the activity of cytochrome oxidase being most markedly inhibited. Incorporation of 3II-thymidine was reduced by both while there was little or no inhibition in the rate of incorporation of 14C-uracil and 14C-leucine. Cell permeability was not affected to any appreciable extent and there was a little release of cellular components from the treated cells only at prolonged incubation. It is concluded that benomyl and thiophanate-methyl have a similar mode of action which primarily involves inhibition of respiratory activities, and as a consequence the biosynthesis of DNA is reduced.