The Effectiveness of Acupuncture versus Clonazepam in Patients with Burning Mouth Syndrome

Objective

Burning mouth syndrome (BMS) is a chronic oral condition, characterised by burning symptoms, which mainly affects perimenopausal and postmenopausal women. Neuropathy might be the underlying cause of the condition. There are still insufficient data regarding successful therapy. The aim of this study was to compare the effectiveness of acupuncture and clonazepam.

Methods

Forty-two patients with BMS (38 women, 4 men) aged 66.7±12.0 years were randomly divided into two groups. Acupuncture was performed on 20 participants over 4 weeks, 3 times per week, on points ST8, GB2, TE21, SI19, SI18 and LI4 bilaterally as well as GV20 in the midline, each session lasting half an hour. Twenty-two patients took clonazepam once a day (0.5 mg in the morning) for 2 weeks and, after 2 weeks, two tablets (0.5 mg in the morning and in the evening) were taken for the next 2 weeks. Prior to and 1 month after either therapy, participants completed questionnaires: visual analogue scale, Beck Depression Inventory, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale, 36-item Short Form Health Survey (SF-36) and Montreal Cognitive Assessment (MoCA).

Results

There were significant improvements in the scores of all outcome measures after treatment with both acupuncture and clonazepam, except for MoCA. There were no significant differences between the two therapeutic regimens regarding the scores of the performed tests.

Conclusions

Acupuncture and clonazepam are similarly effective for patients with BMS.

[CANCER PATIENTS FOLLOW-UP – CROATIAN SOCIETY FOR MEDICAL ONCOLOGY CLINICAL GUIDELINES Part IV: planocellular head and neck cancer, oesophageal cancer, gastric cancer, colorectal cancer]

Treatment of oncological patients must be based upon multidisciplinary approach, and takes place in specialized oncological centers. By the end of a specific oncological treatment further follow-up is being managed mostly by the oncologists, but the role of the general practitioners becomes more important every day and therefore should be precisely defined. Nowadays, most of the existing follow-up guidelines are not being based on prospective studies, yet on the expert’s opinion of a precise oncological center or specialists. The aim of the Croatian Society of Medical Oncology (CSMO) with these recommendations is to standardize and rationalize the diagnostic procedures’ algorithm in follow–up of oncological patients after primary treatment, in patients with planocellular head and neck cancer, oesophageal cancer, gastric cancer and colorectal cancer.

[CLINICAL GUIDELINES FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH INVASIVE BREAST CANCER--CROATIAN ONCOLOGY SOCIETY]

Breast cancer is the most common cancer in women. It can be diagnosed in early stage through screening, early detection and educational programs, and when diagnosed early it can be efficiently treated. Treatment modalities include surgery, chemotherapy, radiotherapy, hormonal therapy and targeted biologic therapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for diagnosis, management, treatment and monitoring of patients with breast cancer in the Republic of Croatia.

Expression of Ki-67 and p27(Kip1) in fine-needle aspirates from breast carcinoma and benign breast diseases

Cell atypia in breast fine needle aspiration (FNA) can introduce some diagnostic difficulties. Molecules reflecting proliferative cell potential, such as Ki-67 and p27(Kip1) , can help in recognizing the true biological nature of a cell. Thus, the objective of the study was to analyze the difference in Ki-67 and p27(Kip1) cell immunoexpression in breast FNA specimens between fibroadenomas, fibrocystic changes (FCC) with atypia, and breast carcinoma. Microscopic analyses of cell cytomorphology and Ki-67 and p27(Kip1) breast cell immunoexpression were done after standard Pappenheim and immunocytochemical staining (labeled streptavidin-biotin, LSAB) method in autostainer DakoCytomation TechMate™. The study included 50 patients with breast carcinoma, 20 patients with fibroadenoma, and 20 patients with FCC with atypia. High Ki-67 and low or absent p27(Kip1) were found in most patients with breast carcinoma, while majority of FCC with atypia were characterized by low Ki-67 and moderate to high p27(Kip1) cell immunoexpression. Majority of fibroadenomas were associated with low Ki-67 and low to moderate p27(Kip1) cell immunoexpression indicating progressive decrease in cell cycle inhibition, but still not so high proliferative activity as in carcinoma. However, although statistically significant difference for Ki-67 and p27(Kip1) was found between breast lesions in our study, the large ranges observed for each marker make them essentially useless for better cytological diagnosis in a single case. Regarding their opposite role in cell cycle, inverse correlation of Ki-67 and p27(Kip1) was noticed. Poorly differentiated carcinoma cells had mostly high Ki-67 and low p27(Kip1) cell immunoexpression.

Rectal metastasis from lobular carcinoma of the breast: a case report

Rectal metastases from breast carcinomas are very rare. They often occur in lobular invasive breast carcinoma (ILC), usually after a long disease-free period. It is important to be aware of these unusual metastatic patterns of ILC of the breast because of the possibility of systemic therapy. We present a case of 83-year old woman with rectal metastesis from ILC seven years after surgery of primary tumor.

Fine needle aspiration cytology in diagnosing rare breast carcinoma--two case reports

In this paper, we are presenting the two cases of very rare tumors: breast sebaceous carcinoma, which has been described for the first time in Croatian medical literature, and pure breast squamous carcinoma. First case, sebaceous carcinoma, is still quite unknown regarding its morphological characteristics and biological behavior. In the second case, squamous carcinoma, also very rare, was found in a patient who previously had a number of diagnosed head and neck skin carcinomas, and was diagnosed as primary squamous breast carcinoma. As a first case we present a 85-year-old female with a two months history of swelling of the left breast under the mammilla. The second one, a 69-year-old female presented to our hospital in January 2008 with a two months history of a lump in the lower outer region of the left breast and enlarged lymph nodes in left axillary region. Fine needle aspiration cytology (FNAC) of the breast was performed in order to diagnose the exact type of both tumours. This methodology was found important in diagnosis, but in both cases showed certain limitations in diagnosing such rare tumors. The final diagnoses were determined after carefully synthesizing the histological findings and clinical data. Careful and accurate classification of these tumors is necessary. A detailed analysis of their biological behavior and response to the therapy is necessary in order to formulate definite recommendations in managing these patients/diseases.

Histological types of polypoid cutaneous melanoma II

The aim of this study was to ascertain which histological types of melanoma can clinically and morphologically appear as polypoid melanomas. In 645 cases of primary cutaneous melanoma we have analyzed criteria for diagnosis of polypoid cutaneous melanoma and afterwards we have analyzed growth phase in each polypoid melanoma, histological type of atypical melanocytes, the number of epidermal ridges which are occupied by atypical melanocytes, and distribution according to age, sex and location, as well as the disease free survival. According to the criteria for polypoid melanomas we have found 147 (22.8%) polypoid cutaneous melanomas. Analyzing the growth phases, histological types of atypical melanocytes and the number of affected epidermal ridges in the group of polypoid melanomas we have ascertained 2 (1.4%) ALMs, 4 (2.8%) LMMs, 42 (28.6%) SSMs and 99 (67.2%) NMs. Our conclusion is that polypoid cutaneous melanomas are morphological forms of various histological melanoma types (ALM, LMM, SSM and NM) and they can all display polypoid morphological form. Polypoid cutaneous melanomas are most often of nodular histological type.