Diagnostic models for predicting malignancy in thyroid nodules classified as Bethesda Category III in an endemic region

BACKGROUND

This study aims to develop a diagnostic model to help physicians determine whether thyroid nodules categorized as atypia of undetermined significance (AUS) in category III of the Bethesda system are benign or malignant preoperatively. To create a diagnostic model for predicting thyroid nodules' benign or malignant with AUS cytology based on clinical, ultrasonographic, and cytopathological findings.

METHODS

This is a retrospective cohort study involving patients (>19) at risk of thyroid cancer who had thyroidectomy after an AUS cytology. The dataset consists of 53 variables 204 nodules from 183 patients. Binary logistic regression and factor analysis methods were used to identify risk factors for malignancy. Finally, four prediction models were developed using different approaches, based on clinical, pathological clinical + pathological, and the factors.

RESULTS

A total of 88 (48.1%) of 183 patients diagnosed with AUS were benign and 95 (51.9%) the malignant. After determining risk factors, four prediction models were developed based on different approaches to assist physicians in deciding to detect AUS nodules early. It was seen that bilaterality was found to be a risk factor for malignancy in the clinical model (pbilaterality  = .03) and it was also seen that the pathological variables pale chromatin and irregular contours in the oncocyte variables were risk factors for malignancy (ppalechromatin  = .02, pirregularcontoursintheoncocyte  = .04). The best model obtained sensitivity and specificity values are 73% and 87% based on clinical and pathological variables.

CONCLUSION

This comprehensive study may provide a more in-depth understanding of AUS and make a notable contribution to healthcare professionals before surgery.

Prediction of gestational diabetes using deep learning and Bayesian optimization and traditional machine learning techniques

The study aimed to develop a clinical diagnosis system to identify patients in the GD risk group and reduce unnecessary oral glucose tolerance test (OGTT) applications for pregnant women who are not in the GD risk group using deep learning algorithms. With this aim, a prospective study was designed and the data was taken from 489 patients between the years 2019 and 2021, and informed consent was obtained. The clinical decision support system for the diagnosis of GD was developed using the generated dataset with deep learning algorithms and Bayesian optimization. As a result, a novel successful decision support model was developed using RNN-LSTM with Bayesian optimization that gave 95% sensitivity and 99% specificity on the dataset for the diagnosis of patients in the GD risk group by obtaining 98% AUC (95% CI (0.95-1.00) and p < 0.001). Thus, with the clinical diagnosis system developed to assist physicians, it is planned to save both cost and time, and reduce possible adverse effects by preventing unnecessary OGTT for patients who are not in the GD risk group.

A novel computer based risk prediction model for vocal cord palsy before thyroidectomy

BACKGROUND

Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts suspicious findings on fine needle aspiration (FNA) biopsy, dyspnea from airway compression or dysphagia from cervical esophageal compression, etc. The incidences of vocal cord palsy (VCP) caused by thyroid surgery were reported to range from 3.4% to 7.2% and 0.2% to 0.9% for temporary and permanent vocal fold palsy respectively which is a serious complication of thyroidectomy that is worrisome for patients.

OBJECTIVE

Therefore, it is aimed to determine the patients who have the risk of developing vocal cord palsy before thyroidectomy by using machine learning methods in the study. In this way, the possibility of developing palsy can be reduced by applying appropriate surgical techniques to individuals in the high-risk group.

METHOD

For this aim, 1039 patients with thyroidectomy, between the years 2015 and 2018, have been used from Karadeniz Technical University Medical Faculty Farabi Hospital at the department of general surgery. The clinical risk prediction model was developed using the proposed sampling and random forest classification method on the dataset.

CONCLUSION

As a result, a novel quite a satisfactory prediction model with 100% accuracy was developed for VCP before thyroidectomy. Using this clinical risk prediction model, physicians can be helped to identify patients at high risk of developing post-operative palsy before the operation.

Young's syndrome, a rare syndrome that can cause infertility and mimics cystic fibrosis and immotile-cilia syndrome: a case report

INTRODUCTION

Young's syndrome (YS) is a rare, inherited syndrome commonly seen in middle-aged men with chronic rhinosinusitis, nasal polyps, decreased fertility due to azoospermia, and bronchiectasis. In this paper, we present a case of YS of unknown cause together with a literature review.

CASE PRESENTATION

A 28-year-old male patient with the complaints of cough, sputum, recurrent nasal congestion, and shortness of breath lasting for more than ten years, was admitted to our clinic after bronchiectasis was observed in the thoracic computed tomography.

CONCLUSIONS

An accurate diagnosis of YS is usually made late, which reduces patients' quality of life and leads to chronic respiratory problems. Failure to diagnose this disease may expose the patient to unnecessary and repeated hospitalizations and examinations, and result in treatment failure.

Investigation of haptoglobin, serum amyloid A, and some biochemical parameters in calves with omphalitis

Aim:

In this study, it was aimed to determine the concentration of some important acute phase proteins (APPs) and some biochemical parameters pre-operative and post-operative in calves with omphalitis.

Materials and Methods:

A total of 20 calves were used in the study and they consist of 10 clinically healthy calves that were used as a control and 10 calves with omphalitis were used as the treatment group. Blood samples were collected from Vena jugularis of animals to tubes with anticoagulant (sodium citrate) and without anticoagulants, pre-operative (day 0), and post-operative (day 7). Samples were used to determine the concentration of haptoglobin (Hp), serum amyloid A (SAA), ceruloplasmin (Cp), fibrinogen, glucose, total protein, albumin, urea, total bilirubin, creatinine, calcium, phosphorus, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) concentrations.

Results:

While the Hp, SAA, Cp, fibrinogen, urea, creatinine, total bilirubin, ALP, and GGT concentrations were statistically and significantly increasing rather than the control group during the pre-operative period for calves with omphalitis, they decreased to the post-operative period. Moreover, an insignificant increase in the glucose, total protein, and AST concentrations and an insignificant decrease in the albumin, calcium, and phosphorus concentrations were statistically determined.

Conclusion:

We have the opinion that the assessment of biochemical parameters and especially APP levels in calves with the omphalitis together with the clinical findings may be important in terms of the treatment and prognosis.

Effects of Plantago lanceolata L. extract on full-thickness excisional wound healing in a mouse model

Wound healing requires cells that increase both collagen production as a result of inflammatory events and regeneration of epithelial tissue. The Plantago species of herbs have been used in traditional treatment of skin disorders and infectious diseases, and digestive, respiratory, reproductive and circulatory conditions. We investigated the efficacy of different concentrations of Plantago lanceolata L. extract (PLE) for wound healing owing to its anti-inflammatory, anti-bacterial, anti-fungal, anti-oxidant, anti-ulcerative, analgesic and immunomodulatory properties. We used 72 mice in four groups of 18. An excisional 1 cm wound was created in the skin on the back of the mice in all groups. An ointment containing 10% PLE was applied to the wound in group 1, an ointment containing 20% PLE was applied in group 2 and vaseline was applied in group 3. In group 4, no treatment was applied to the wound. On days 7, 14, and 21 of the experiment, six animals in each group were sacrificed after the wounds were photographed and specimens from the wound sites were examined. On day 14, epithelialization was more prominent in group 2, while vascularization and collagen deposition was more advanced in groups 1 and 2 compared to the other groups. Immunohistochemical examination revealed that TGF-β1 expression was elevated on day 14 in all groups; however, this elevation was more limited in groups 1 and 2 than in groups 3 and 4. Although ANGPT-2 expression increased in groups 1 and 4 on day 14, it decreased significantly in groups 2 and 3. We found that different concentrations of PLE exhibited positive effects on wound healing. Application of 10% PLE ointment may be a useful strategy for wound healing.

The prevalence of asthma and allergic diseases among adults 30-49 years of age in Bolu, Western Black Sea Region of Turkey

AIMS

To determine the prevalence of asthma, asthma-like symptoms and allergic diseases among adults 30-49 years of age in regions of Bolu.

MATERIALS AND METHODS

A questionnaire was given to families of students in schools in different areas of Bolu, Turkey. The European Community Respiratory Health Survey (ECRHS) and a questionnaire, including questions about the socioeconomic status and demographic characteristics of the participants, were responded to by 1403 people.

RESULTS

The prevalence of symptoms and diseases were as follows: wheezing in the last year 12.0% (n=168), asthma 8.7% (n=121), doctor-diagnosed asthma 3.6% (n=50), currently taking drugs for asthma 1.2% (n=17), allergic rhinitis 16.5% (n=230), and eczema 9.6% (n=134). The risk factors for each symptom or disease were as follows: for wheezing: smoking in the house (odds ratio [OR]=2.43 and 95% Confidence Limits [95%CL]=1.53-3.86), living in a non-concrete building (OR=2.17, 95%CL=1.27-3.69); for asthma: mold in the house (OR=1.70, 95% CL=1.05-2.76), living in a shanty (OR=2.76, 95%CL=1.30-5.85), smoking in the house (OR=1.51, 95%CL=1.02-2.22); for allergic rhinitis: being female (OR=1.55, 95%CL=1.08-2.24), living in a shanty (OR=5.81, 95%CL=2.06-16.39), a monthly income below $300 (OR = 1.74, 95%CL=1.13-2.69).

CONCLUSIONS

A high rate of undiagnosed and untreated people with asthma among adults 30-49 years of age is present in Bolu. Especially, while a low socioeconomic level was observed to increase the risk of asthma and allergic rhinitis, risk of wheeze and asthma was found to be elevated by smoking in house.

Effects of renal denervation on renal pelvic contractions and connexin expression in rats

AIMS

The renal pelvis shows spontaneous rhythmic contractile activity. We assessed to what extent this activity depends on renal innervation and studied the role of connexins in pelvic contractions.

METHODS

Rats underwent unilateral renal denervation or renal transplantation. Renal pelvic pressure and diuresis were measured in vivo. Spontaneous and agonist-induced contractions of isolated renal pelves were investigated by wire myography. Rat and human renal pelvic connexin mRNA abundances and connexin localization were studied by real-time PCR and immunofluorescence respectively.

RESULTS

Renal denervation or transplantation increased renal pelvic pressure in vivo by about 60 and 150%, respectively, but did not significantly affect pelvic contraction frequency. Under in vitro conditions, isolated pelvic preparations from innervated or denervated kidneys showed spontaneous contractions. Pelves from denervated kidneys showed about 50% higher contraction frequencies than pelves from innervated kidneys, whereas contraction force was similar in pelves from denervated and innervated kidneys. There was no denervation-induced supersensitivity to noradrenaline or endothelin-1. Renal denervation did not increase pelvic connexin37, 40, 43 or 45 mRNA abundances. Gap junction blockade had no effect on spontaneous pelvic contractile activity.

CONCLUSIONS

The denervation-induced effect on pelvic pressure may be the consequence of the enhanced diuresis. The mechanisms underlying the denervation-induced effects on pelvic contraction frequency remain unknown. Our data rule out a major role for two important candidates, by showing that renal denervation neither induced supersensitivity to contractile agonists nor increased connexin mRNA abundance in the pelvic wall.

A case of a sinonasal adenocarcinoma with metaplastic ossification

Sinonasal adenocarcinomas are rare tumours, with three subtypes. They are mostly low-grade tumours, although they can also be aggressive. In this case report, we describe a 34-year-old patient with sinonasal adenocarcinomas. Within his nasal cavity was found an irregular mass. Given the intratumoral calcification and bone, the mass was thought to be a bone-producing tumour, such as an osteosarcoma. The pathological diagnosis was a sinonasal adenocarcinoma with extensive metaplastic bone. To the best of our knowledge, this is the first case of a sinonasal adenocarcinoma with metaplastic ossification.

High-dose testosterone and dehydroepiandrosterone induce cardiotoxicity in rats

The aim of this study is to assess cardiotoxic effect of testosterone (TES) and dehydroepiandrosterone (DHEA) in Sprague Dawley rats. We compared the impact of subacute (14 days) and subchronic (90 days) administration of suprapharmacologic doses of TES and DHEA on body weight, locomotor activity, muscle strength, echocardiographic parameters, heart histopathology, and oxidative stress markers with the control group. Testosterone (10, 30, and 100 mg/100 g body weight) and DHEA (10 mg/100 g body weight) administration decreased the body weights and locomotor activity ( p < 0.05), and the combination of both increased muscle strength ( p < 0.05) in rats. In our histopathological evaluation, misshapen cell nuclei, disorganized myocardial fibers, and leukocytic infiltrates were observed in high-dose TES (100 mg/100 g)-treated rats, especially on day 14. On day 90, mild changes such as misshapen cell nuclei, disorganized myocardial fibers, and leukocytic infiltrates were observed in TES and DHEA-treated groups. According to our echocardiographic study on day 14 and day 90, TES, especially at high doses, induced increase in left ventricular posterior wall diameter and ejection fraction ( p < 0.05). In this study, blood oxidative stress marker malondialdehyde was increased slightly but not significantly in TES and DHEA groups. On the other hand, antioxidant enzymes such as SOD and glutathione peroxidase (GSH-Px) levels were slightly but not significantly increased in TES and DHEA groups. These data demonstrate that the potential risk to cardiac health due to exogenous androgen use may be related to oxidative stress in rats.

A novel automatic suspicious mass regions identification using Havrda & Charvat entropy and Otsu's N thresholding

Mass detection is a very important process for breast cancer diagnosis and computer aided systems. It can be very complex when the mass is small or invisible because of dense breast tissue. Therefore, the extraction of suspicious mass region can be very challenging. This paper proposes a novel segmentation algorithm to identify mass candidate regions in mammograms. The proposed system includes three parts: breast region and pectoral muscle segmentation, image enhancement and suspicious mass regions identification. The first two parts have been examined in previous studies. In this study, we focused on suspicious mass regions identification using a combination of Havrda & Charvat entropy method and Otsu's N thresholding method. An open access Mammographic Image Analysis Society (MIAS) database, which contains 59 masses, was used for the study. The proposed system obtained a 93% sensitivity rate for suspicious mass regions identification in 56 abnormal and 40 normal images.

Comparison of enhancement methods for mammograms with performance measures

Mammograms are generally contaminated by noise which assures the need for image enhancement to aid interpretation. The enhancement of mammograms is a very important problem for easy extraction of suspicious regions known as regions of interest (ROIs). This paper introduces comparison of various hybrid enhancement algorithms based on mathematical morphology, contrast stretching, wavelet transform, anisotropic diffusion filter and contrast limited adaptive histogram equalization (CLAHE). The performances of algorithms have been compared by using three global image enhancement evaluation measures; Enhancement Measure (EME), Absolute Mean Brightness Error (AMBE) and Peak Signal-to-Noise Ratio (PSNR). For this study, we have used MIAS database. Experimental results show that the combination of mathematical morphology, anisotropic diffusion filter and CLAHE methods, yields significantly superior image quality and provides more visibility for the suspicious regions.

Effect of proanthocyanidin, arginine and glutamine supplementation on methotrexate-induced gastrointestinal toxicity in rats

Methotrexate is a folate antagonist that is commonly used as an antitumor and antiarthritic drug. The aim of this study was to investigate the possible roles of exogenous glutamine (Glu), arginine (Arg) and proanthocyanidin (PA) on gut protection from methotrexate-induced intestinal damage in rats. Experimental rats were separated into eight groups. The first (sham) group received a 0.9% NaCl solution alone. The second group received intraperitoneal injections of methotrexate (20 mg/kg/day) administered on day 4 of the experiment and continued for 5 days. Rats in the other six groups were administered PA, Glu, Arg, Glu+PA, Arg+PA or Glu+Arg orally by gavage together with methotrexate and animals were sacrificed on day 8 of the experiment. All animals were sacrificed 4 days after methotrexate injection for histopathological analysis, tissue glutathione peroxidase, malondialdehyde and superoxide dismutase assays. Proanthocyanidin and Glu decreased the severity of intestinal injury and oxidant injury as evident by histopathology and changes in malondialdehyde levels. Histological analysis confirmed that PA and to a lesser extent Glu supplementation were more favorable than Arg for the protection of the small intestine from methotrexate-induced injury.

CYP and GST polymorphisms and survival in advanced non-small cell lung cancer patients

Several polymorphisms in cytochrome P-450s (CYP)s and Glutathione S-transferases (GST)s have been reported to be associated with survival rates of patients with non-small cell lung cancer (NSCLC) but the studies in this regard are scarce and the results are contradictory. In this study, CYP1A1 (Ile462Val), CYP1B1(Asn453Ser), GST M1, GSTP1 exon 5 (Ile105Val) and exon 6(Ala114Val) and GSTT1 polymorphisms were determined in 138 patients with advanced NSCLC to evaluate their role in survival. Of the studied CYP and GST polymorphisms only GSTP1 exon 6 variant significantly altered (improved) the survival compared to wild type (p=0.036) with median survival of 22.2 months and 16.1 months, respectively. Multivariate analysis also revealed a significant reduction of adjusted hazard ratio of death associated only with the GSTP1 exon 6 variant genotype of 0.45 (95% confidence interval (95% CI), 0.23-0.89, p=0.022). These results show that the GSTP1 exon 6 variant genotype is associated with improved survival in the patients with advanced NSCLC.

KEYWORDS

Cytochrome P-450, glutathione S-transferase, non small cell lung cancer, polymorphism, survival.

Cyclooxygenase-2 (cox-2) expression and angiogenesis in intracranial ependymomas

AIM

Cyclooxygenase-2 (Cox-2), the inducible key enzyme in the biosynthesis of prostaglandins, appears to play a role in the regulation of progression, invasiveness and angiogenesis of various neoplasms including some glial tumors. Little is known about the role of Cox-2 in angiogenesis and proliferation of ependymomas. We studied Cox-2 expression, Ki-67 labeling index (Ki-67 LI) and microvessel density (MVD) in 30 intracranial ependymomas and analyzed the relationship among these parameters to evaluate their importance in the tumor biology of ependymomas.

RESULTS

The mean Ki-67 LI for all tumors ranged from 1 - 50% (mean 9%). Statistically significant difference was present for Ki-67 LI between ependymomas (grade II, WHO) and anaplastic ependymomas (grade III, WHO) (p < 0.001) (mean Ki-67 LI for ependymoma, 2.8%, for anaplastic ependymomas, 15.6%). Anaplastic ependymomas did not demonstrate a greater vascularization than ependymomas, and the MVD values were 84.5 +/- 39.7 for ependymomas, and 90.6 +/- 61.4 for anaplastic ependymomas. Cox-2 immunohistochemical expression was observed in 19 tumors (63%). Although Cox-2 expression was slightly higher in anaplastic ependymomas, it was not statistically significant. No correlation was found between Cox-2 expression and MVD and Ki-67 LI.

CONCLUSION

Similar to morphologic and prognostic heterogeneity in ependymomas, Cox-2 expression, MVD and Ki-67 LI also show a great variability. Other factors may be more important for the proliferation and angiogenesis of ependymomas.

Relationship between quality of life and characteristics of patients hospitalised with tuberculosis

SETTING

Atatürk Lung Diseases and Chest Surgery Hospital in Ankara, Turkey.

OBJECTIVE

To determine the relationships between differences in socio-demographic and family characteristics and changes that occur within the family and social environment in hospitalised patients with tuberculosis (TB) and levels of quality of life (QOL).

DESIGN

TB in-patients were interviewed using a structured questionnaire and a QOL instrument.

RESULTS

Findings indicated that the patients had a lower QOL level, and that those with low levels of education, no social insurance coverage and insufficient housing conditions had lower QOL scores. Patients who experienced negative changes in family life and social environment had lower QOL levels.

CONCLUSION

Diagnosis, changes in family life and social milieu, the illness process and beliefs about the illness have diverse affects on the QOL of TB patients.

MIB-1 expression in odontogenic epithelial rests, epithelium of healthy oral mucosa and epithelium of selected odontogenic cysts. An immunohistochemical study

The aim of this study is to investigate the proliferative potential of rests of odontogenic epithelium found in follicles of unerupted teeth, epithelium of oral mucosa and epithelial linings of various odontogenic cysts. MIB-1 expression was studied in the rests of odontogenic epithelium (n=10), healthy oral mucosa (n=10), odontogenic keratocysts (n=10) and other odontogenic cysts (n=10) using an avidin-biotin peroxidase technique on paraffin sections. The number of positively stained cells was counted on 10 representative areas of epithelium using a x40 objective. The average number of MIB-1 positive cells in each group was calculated. No MIB-1 positive cells were seen in the rests of odontogenic epithelium. The mean numbers of MIB-1 positive cells detected within the epithelium of oral mucosa, and of radicular and dentigerous cysts were similar. The number of MIB-1 positive cells was found to be increased in the presence of marked inflammatory cell infiltration. The highest number of MIB-1 positive cells was seen in the keratocysts. These findings suggest that removal of an unerupted tooth to prevent the possibility of neoplastic transformation of rests of odontogenic epithelium is not a justifiable rationale.

Diffuse panbronchiolitis observed in a white man in Turkey

Diffuse panbronchiolitis (DPB) is a distinct clinicopathological entity which is characterized by chronic recurrent sinopulmonary infection and inflammation. It is prevalent in the Far East, but extremely rare in western countries. In this report, we described the first Turkish case of DPB and also evaluated demographic and diagnostic characteristics of 18 patients with DPB, previously reported from non-Asian countries. We believe that DPB patients described from these countries may also increase if this disease is taken into consideration in differential diagnosis of sinopulmonary diseases. Another consideration is that, since the treatment and prognosis of DPB are different from other obstructive pulmonary diseases, it should not be mistaken for others.

Root-end cavity preparation after apicoectomy using a new type of sonic and diamond-surfaced retrotip: a 1-year follow-up study

PURPOSE

This study evaluated the outcome of periradicular surgery using a new set of retrotips for root-end cavity preparation.

PATIENTS AND METHODS

Forty-three patients who had 50 consecutively treated teeth with periradicular pathology were enrolled in this prospective study. After apicoectomy, root-end cavity preparation was performed, using diamond-surfaced retrotips driven by a sonic handpiece; EBA-cement was used as the root-end filling material. Healing assessment was based on clinical and radiographic criteria.

RESULTS

At the 1-year follow-up, 82% of the reexamined surgical cases presented with successful healing. Fourteen percent of the treated teeth were deemed as improved (partial healing), and 4% were classified as failures.

CONCLUSION

The new retrotips were found to be ideal for root-end cavity preparation. They simplify the surgical approach to root ends where the working space is limited by restricted access. Root-ends prepared with this new sonoabrasive technique yielded excellent results at the 1-year follow-up examination.

Implant placement and simultaneous ridge augmentation using autogenous bone and a micro titanium mesh: a prospective clinical study with 20 implants

This prospective clinical study evaluated bone regeneration around 20 dental implants placed in 15 patients (mean age 39.7 years). Peri-implant bone defects were augmented with autogenous bone grafts harvested intraorally from the mandible (chin or retromolar area). Augmented sites were covered with an individually trimmed micro titanium mesh which was rigidly affixed with microscrews to the residual jaw bone. Height of implant exposure (mean 6.5 mm), i.e. dehiscencies (80%) or fenestrations (20%), and graft height (mean 6.2 mm) were measured in an apico-coronal direction using a periodontal probe. At re-entry (mean interval 6.6 months) the titanium mesh and microscrews were removed and bone regeneration assessed. The mean height of the integrated bone graft was 5.8 mm corresponding to a mean bone fill of 93.5%. The overall postop healing course was excellent with only one site developing a soft tissue dehiscence with subsequent mesh exposure (complication rate 5%). This study demonstrated that a micro titanium mesh in combination with autogenous bone grafts is effective for treatment of peri-implant bone defects.

Implant placement and simultaneous peri-implant bone grafting using a micro titanium mesh for graft stabilization

This article reports the surgical technique and outcome of simultaneous bone grafting and implant placement. A new treatment philosophy different than the principle of guided bone regeneration is presented. The technique is characterized by grafting autogenous bone into a peri-implant bone defect rather than by regenerating bone in a secluded space. Stabilization of the autogenous bone graft is achieved with a micro titanium mesh. The study sample comprised 10 implant sites in six patients. All sites were successfully treated, and postoperative healing was uneventful. The autogenous bone grafts demonstrated perfect integration upon reevaluation when the implants were recovered. The micro titanium mesh proved to be highly biocompatible, exhibited excellent mechanical properties, and avoided graft displacement and contour collapse.

Preliminary results and analysis of a new set of sonic instruments for root-end cavity preparation

The introduction of microinstruments for root-end cavity preparation has clearly improved the surgical technique in periradicular surgery with apicectomy. The new generation of sonic and ultrasonic root-end preparation devices, usually termed 'retrotips', has simplified the preparation of a sufficiently deep cavity that follows the original path of the root canal. The present paper describes the use of a new set of diamond-surfaced retrotips driven by a sonic handpiece. For clinical evaluation a prospective study was carried out, with assessment of pre-, intra- and postoperative data in 50 teeth (43 patients). This paper analyses: (i) the applicability of the new retrotips; (ii) the quality of the root-end filling assessed radiographically; (iii) the immediate postoperative course. Access with the retrotips to the resected root-end was found to be excellent in 80% of the treated teeth. The postoperative radiographs showed a root-end filling of at least 3 mm in 70% of the resected teeth. Healing was uneventful in all cases and most patients presented without any symptoms after 5 days and 10 days. The long-term treatment outcome will be reported in a future paper.

Treatment of severe peri-implant bone loss using autogenous bone and a resorbable membrane. Case report and literature review

Clinical case reports and animal studies have demonstrated that the principle of guided bone regeneration can be applied for surgical treatment of moderate to profound peri-implant bone loss (peri-implantitis). However, the degree of bone regeneration within the peri-implant osseous defect was reported to be variable depending on different clinical factors and on the postoperative course. Most papers dealing with surgical treatment of peri-implantitis advocate the use of a non-resorbable ePTFE membrane for secluding the peri-implant bone defect enabling bone regeneration. Additionally some surgeons fill the defects with allografts or alloplasts. The present case report demonstrates another surgical approach by using autogenous cancellous bone for grafting into the peri-implant bone defect and placing a bioresorbable polylactide membrane as a matrix barrier. The successful outcome of this modified surgical approach enabled the patient to maintain the implant for prosthetic reconstruction after early but severe bone loss.

Ifosfamide, cisplatin and etoposide (ICE) combined chemotherapy with recombinant human granulocyte colony-stimulating factor support in small cell lung cancer

This study was aimed to evaluate the effect of ifosfamide, cisplatin and etoposide (ICE) combined chemotherapy in small cell lung cancer (SCLC), and to test the feasibility of adding recombinant human granulocyte colony-stimulating factor (rhG-CSF) to aggressive chemotherapy. Thirty consecutive, previously untreated, patients with SCLC (17 with limited disease and 13 with extensive disease) entered this study. The ICE regimen consisted of ifosfamide (I) 4 g/m2 i.v. with same dose mesna i.v. on first day, cisplatin (C) 25 mg/m2 i.v. on days 1 to 3 and etoposide (E) 100 mg/m2 i.v. on days 1 to 3. A total of 30 MU rhG-CSF i.v. were given from day 7 to 14 if WBC were lower than 3000 x 10(6)/L, neutrophils were lower than 1000 x 10(6)/L. Overall response (OR) rate was 93% with a complete response (CR) rate of 23%. Median survival was 12 months [95% confidence interval (CI): 11-14] and median response duration was 10 months [95% CI: 8-10]. Thirty-seven percent of patients had grade 3 neutropenia, 40% had grade 3 anemia, and 1% had grade 2 thrombocytopenia. Nonhematologic toxicity was mild with nausea and vomiting being the most common. RhG-CSF, which reduced leukopenic nadirs and shortened the neutropenic period, was also well tolerated. This chemotherapy protocol seems to be active, well tolerated and is currently being compared with various conventional chemotherapies.

Combination of chemotherapy and recombinant interferon-alpha in advanced non-small cell lung cancer

Some studies have shown that the combination of chemotherapy and interferon in non-small cell lung cancer (NSCLC) and other solid tumors is feasible and possesses antitumor activity. Our study was aimed at verifying whether the addition of recombinant human interferon alpha (rh-IFN alpha) to combined chemotherapy would be able to increase the response rate and survival of patients with NSCLC. Thirty-eight patients with previously untreated advanced NSCLC were evaluated in this study. Median age of patients was 57 years; performance status according to ECOG 0 and 1, 37 pts (97%); stage IIIB, 27 pts (71%); stage IV, 11 pts (29%). Histology was squamous cell carcinoma in 53%, adenocarcinoma 44% and large cell carcinoma 3%. Our schedule consisted of 80 mg/m2 cisplatin I.V., 100 mg/m2 etoposide I.V., 10 million U rh-IFN alpha IM and 10 million U rh-IFN alpha I.V. on first day of treatment, every 3 weeks. None of the patients had complete response. Partial response rate was 34%. Median response duration was 7 months (range 3-19 months), median survival time was 11 months (range 4-41 months). Twenty-nine percent of patients had grade 3 nausea and vomiting, 24% had grade 2 leucopenia, 5% had grade 2 cardiotoxicity, 2.6% had flu-like syndrome. According to these results, in advanced NSCLC, the addition of rh-IFN alpha did not increase the cisplatin-etoposide combined chemotherapy induced response rate and survival time.

Two dose levels of ifosfamide in malignant mesothelioma

Thirty-one consecutive patients with histologically proven and symptomatic malignant mesothelioma were treated with two dose levels of ifosfamide. The first group of 15 patients were given 2.3 g/m2/day for 5 days (group A) and the following 16 patients were treated with 1.2 g/m2/day for 5 days of ifosfamide (group B). Treatment cycles were repeated every 3 weeks. While the partial response rate (PR) in group A was 38.5%, it was only 6.25% in group B (P > 0.05). The 95% confidence interval for the difference in PR rates was 3.3-61.2% > The overall survival (OAS) of groups A and B were similar (8 months and 9 months, respectively). Higher Grade 3-4 myelotoxicity was observed in group A when compared to group B (30.8% vs. 18.7%; P > 0.05). In conclusion, a favourable response rate could be achieved in malignant mesothelioma with high dose ifosfamide at the cost of increased toxicity.