Controlling and Stabilising Mandible During Reconstruction: Significance and Techniques

Objective

Stable and accurate positioning of condyle in the glenoid fossa is necessary for maintaining occlusion, facial symmetry and normal function of the temporomandibular joint following segmental resection of mandible. In non-reconstructed mandibular segments or those with fractured reconstruction plates the bony defect gets altered due to contraction or inadvertent muscular pull. This paper describes various techniques used to control dentate and edentate segments of the mandible during reconstruction following an ablative procedure.

Discussion

Secondary mandibular reconstruction has always been a tedious task for the surgeons. Several techniques have been described in literature ranging the use of external fixators, gunning splints and dentures for stabilising mandibular segments. Use of a pre-bent and adapted reconstruction plate is a common practice but may not be feasible in malignancies, benign tumours causing expansion and secondary reconstruction. The current advances in virtual surgical planning allows mandibular reconstruction to be performed in a simpler yet predictable manner.

Conclusion

The paper describes techniques ranging from twin K-wire placement to occlusal wafers, 3D printed splints and patient specific implants to enable accurate positioning of the segments and achieve pre-operative form. Advances in virtual surgical planning will continue to allow this field to evolve and to improve the quality of life of the patients.

Prosthetic Rehabilitation Options in Post-Ablative Maxillomandibular Microvascular Reconstructions

Objective

Surgery remains the mainstay for managing most neoplasms arising in the head and neck area. Removable or fixed prostheses are commonly used for prosthetic rehabilitation of head and neck defects following surgical resection. Some major challenges in prosthetic rehabilitation after maxillomandibular microvascular reconstruction include excessive prosthetic space, soft tissue bulk, and occlusal disharmony in the remaining dentition. This review focuses on the challenges we have experienced in the real clinical scenario while rehabilitating reconstructed maxillomandibular defects and the effective prosthetic treatment options that could be considered in each situation.

Discussion

Digital revolution has changed all arenas of life, and it has created a significant impact on cancer treatment planning and the delivery of quality treatment to the needy. Creating adequate retention while ensuring stability and support for the prosthesis can be challenging with temporary acrylic and cast partial removable dentures. Endosseous dental implants are considered a stable, reliable, and esthetic option for reconstruction with advantages such as increased chewing efficiency, preservation of the remaining bone height and width, and improved quality of life. The FP3 to RP5 (Misch's classification) are some commonly followed prosthetic rehabilitation options after microvascular reconstruction. The prosthetic design should permit the usage of interdental aids that ensure the longevity of prostheses.

Conclusion

Occlusion-driven/prosthetic-driven implant-assisted prostheses are considered a reliable option that ensures stable and functional oral rehabilitation among patients with free fibula flap reconstruction. Multidisciplinary teamwork is mandatory for an optimal outcome that improves patients' quality of life.

Patient Specific Alloplastic Implant Reconstruction of Mandibular Defects-Safe Practice Recommendations and Guidelines

Mandibular continuity defects are commonly seen after tumor resection, osteomyelitis or maxillofacial trauma. Three-dimensional reconstruction of these mandibular segmental defects is critical for proper mandibular functioning and esthetics. Various methods used to reconstruct such defects include bridging reconstruction plates, modular endoprosthesis, non-vascularized and vascularized bone grafting with stock reconstruction plate or patient specific implants (PSI) and tissue engineering bone transfer. But in the recent years, literature documents use of PSI only alloplastic reconstruction as an alternate to microvascular bone flap reconstruction. Representative cases enumerate current practice of 'patient specific implant only' mandibular reconstruction and its pitfalls. This article discusses current status of literature on PSI's, choice of indications for 'PSI only' mandibular reconstruction and also proposes guidelines for safe practice of patient specific implant reconstruction of mandible.

Bite Force Evaluation in Implant-Assisted Prosthetic Rehabilitation of Reconstructed Jaws Utilizing Vascularized Free Fibula Flap: A Retro-Prospective Cohort Study

Introduction

Maxillary and mandibular defects due to tumor ablation pose considerable challenges to the reconstructive surgeon and in prosthetic management. Dental implants placed in vascularized fibula free flaps are considered to be a dependable technique for prosthetic rehabilitation in head and neck cancer patients. Although, there is evidence of survival of dental implants in the reconstructed jaw bones, there is lack of information regarding the masticatory performance and prosthetic success. The maximum bite force achieved through the prosthetic appliance is a measure of the therapeutic outcome. The purpose of this study was to determine the maximum bite force achieved through implant-assisted prosthetic rehabilitation in reconstructed jaw bones utilizing vascularized free fibula flap.

Methods

The study included a total of 65 implants, from 16 patients who underwent surgical resection of jaw bones due to benign tumors followed by rehabilitation with implant-assisted fixed or removable prosthesis. The maximum bite force was determined with a transducer. Occlusal interferences were analyzed with mounted casts. The parameters were reviewed every 3 months have T 0 marked the baseline assessment, and T 3, T 6, T 9, T 12, and T 15 were subsequent review periods.

Results

The mean occlusal force was increased in most of the patients through 15 months (P < 0.01). The maximum bite force measured in the reconstructed mandible and maxilla were 225.63 N and 176.51 N, respectively. Occlusal interferences were absent in 68.8% of the study population.

Conclusion

The bite force measured in reconstructed maxilla and mandible is comparable to the masticatory force measured with conventional implant supported prosthesis in native mandible and maxilla.

NANOTEX BONE Graft along with Fibula Flap in the Reconstruction of Segmental Mandibular Defect: Protocol for Pilot Clinical Trial

Introduction and objectives

Mandible reconstruction with vascularized fibula flap is the standard treatment for segmental mandibulectomy in patients with tumor or trauma. But the height of the fibula graft is insufficient for dental implant placement and prosthetic rehabilitation to replace the missing teeth, which in turn will compromise the functional efficiency and aesthetics of the patient. Although the bone height can be augmented through onlay grafting with iliac crest, it is associated with limitations like donor site morbidity and fast resorbability. This suggests the need for a synthetic biomaterial for vertical bone augmentation in implant dentistry.We have developed a biomimetic, porous, mechanically stable, and biodegradable nanocomposite named "NANOTEX BONE Graft" and its bone regeneration potential was evaluated in pre-clinical animal models. In this clinical trial, the safety as well as the efficacy of NANOTEX to augment new bone over fibula and further its ability to integrate with dental implants will be studied. The study has received the approval of the Ethics Committee of Amrita Institute of Medical Sciences and Central Drugs Standard Control Organization (CDSCO), India.

Methods

We have designed a prospective, single-center, non-randomized pilot clinical study. Patients with benign tumor or trauma indicated for mandibular reconstruction followed by implant rehabilitation will be included in the study. Eligible patients will be enrolled after obtaining informed consent. The study will be initiated and followed up as per defined timelines.

Highlights

Resection of benign mandibular tumours necessitates surgical removal of jaw bone and adjacent affected areas.The segmental mandibulectomy leaves the patient with functional impairments and aesthetic defects which in turn affect the quality of life.The standard treatment of reconstruction with vascularized fibula flap has challenge in achieving sufficient vertical bone height for implant placement and prosthetic rehabilitation.Alternate surgical techniques cause donor site morbidity and surgical complications.There is need for a synthetic biomaterial to be grafted over fibula for vertical bone augmentation.NANOTEX BONE Graft, a nanofibrous composite scaffold that mimics native bone, promote cell infiltration, neo-angiogenesis and new bone formation.Preclinical studies of NANOTEX in animal models showed bone tissue regeneration, better biodegradation in critical sized defects and efficient integration with dental implants.This clinical study propose to evaluate the safety and efficacy of NANOTEX bone graft augmented over fibula in bone regeneration and Titanium dental implant integration.

Relevance of RED (Recurring Esthetic Dental) proportion and golden proportion among patients attending a tertiary care centre at Kochi, Kerala

Background

Smile plays an essential part in facial esthetics. There have been some mathematical and geometric theories regarding smile designing in literature. The purpose of the study was to assess RED proportion and golden proportion among patients attending a tertiary care centre at Kochi, Kerala.

Methods

Standardised frontal images of 106 subjects, 50 male and 56 females, were captured in the age bracket of 18–25 years. Pictures of the patients were obtained using a DSLR camera (CANON EOS-60D) and then digitally analysed. Measurements of each maxillary anterior tooth was recorded and then the theories of RED and golden proportion were employed and the figures recorded were statistically analysed.

Results

The RED proportion was observed to be inconsistent, while progressing distally, Golden proportion was observed to be in 6–29% of the existing subject population.

Conclusion

Within the limited sample size of the study, RED (Recurring Esthetic Dental) proportion and golden proportion failed to exist in Keralites.

Comparison of Attachment Types in Maxillary Implant-assisted Obturators using Digital Image Correlation Analysis

AIM

The purpose of the study was to evaluate the stress on the implant and to assess the denture displacement for locator and bar and clip attachment types in implant-assisted obturators.

MATERIALS AND METHODS

A maxillary edentulous experimental model with a maxillectomy defect was made along with an opposing edentulous mandibular model with self-cure acrylic. Two endosseous implants were placed in the maxillary model. Corresponding obturator complete denture was fabricated for the maxillary model and a complete denture for the mandibular. The attachments were positioned on the implants in maxillary model, and their sleeve/clip was placed on intaglio surface of the dentures. The mounted articulator was placed on a loading apparatus, and force was incrementally applied to it. The strain and displacement for both the attachment types were measured and compared using Digital Image Correlation (DIC).

RESULTS

Locator attachment showed the least stress and minimal displacement as compared to bar and clip attachment.

CONCLUSION

The stresses around the implants and displacement of the obturator are affected by the attachment type used. It was found that bar and clip (splinted) showed the maximum stresses around the implant and maximum denture displacement. Locator attachment is the better choice over bar and clip because of its additional retentive features.

CLINICAL SIGNIFICANCE

The advantage of using DIC over the conventional strain gauge analysis is that a full-field data of displacement and strain can be obtained instead of getting a mean value on the small surface where the strain gauge is positioned.

Nanocomposite fibrous scaffold mediated mandible reconstruction and dental rehabilitation: An experimental study in pig model

Mandible reconstruction and dental rehabilitation after trauma or tumor resection represent a serious challenge for maxillofacial surgeons. This study aimed to investigate the bone formation potential of nanocomposite fibrous scaffold (silica-nanohydroxyapatite-gelatin reinforced with poly L-lactic acid yarns - CSF) for delayed Titanium (Ti) implantation, which was compared to autograft (AG) taken from the iliac crest. The grafts were placed in critical-sized mandibular defects in an adult pig model for 6 months followed by dental implant placement for another 3 months. There was complete union and vascularised lamellar bone formation within 6 months. Moreover, the biological processes associated with angiogenesis, bone maturation and remodelling were seen in CSF, which was comparable to AG. Later, when Ti dental implant was placed on newly formed bone, CSF group demonstrated better osseointegration. In short, nanocomposite fibrous scaffold promoted quality bone formation in mandible defect that leads to successful osseointegration, suggesting as a potential candidate for implant-based rehabilitation in clinics in future.

Analysis of factors determining thermal changes at osteotomy site in dental implant placement - An in-vitro study

Background

Heat generation during osteotomy site preparation is a crucial factor that determines the success of dental implant placement. Among the factors that affect the heat generation, drilling speed, hand pressure and coolant temperature are independent variables. However, a relation between these three parameters and their optimal values required for the maximum outcome has not been studied so far. This study aims at finding out a relation between these factors in order to derive the optimum balance required, using an in vitro study.

Material and Methods

This in vitro experiment was performed on bovine femur. A total of 72 drillings were undertaken with the aid of a physiodispenser mounted on the test apparatus. Drill diameters of 2 mm and 2.8 mm, rotated at 1500, 2000 and 2500 rpm were included for the analysis. Hand pressures included for the comparison were 1.2 kgf and 2.4 kgf. Normal saline at room temperature, and that chilled to 00C were used for external irrigation. The temperature generated during drilling was recorded by infrared thermography using a Forward-Looking Infrared (FLIR) camera.

Results

The highest temperature during osteotomy was observed at 2000 rpm rotational speed, 1.2 kgf operator hand pressure and saline irrigant solution at room temperature. In contrast, the lowest temperature generated was using 2500 rpm rotational speed, 2.4 kgf operator hand pressure and chilled irrigant solution.

Conclusions

The results indicate that none of the three experimented parameters generated heat above the critical temperature for bone necrosis (47°C). Thus, a high drilling speed with high hand pressure and continuous irrigation with copious amounts of cooled saline may be the ideal combination for implant osteotomy site preparation.

Key words:Heat generation, dental implant drills, drilling speed, drilling pressure, irrigation, infrared thermography, thermal necrosis, osteotomy preparation.

Nanofibrous yarn reinforced HA-gelatin composite scaffolds promote bone formation in critical sized alveolar defects in rabbit model

Alveolar ridge resorption and crestal bone loss necessitate the use of bone graft substitutes for dental rehabilitation. The aim of this study was to compare the bone regenerative property of nanofibre incorporated two composite matrices (nanofibrous sheet layered matrix (CS-S) and nanofibrous yarn reinforced matrix (CS-Y)) in critical sized mandibular defect in a rabbit model (under load bearing scenario). Histological evaluation revealed continuous bone formation in the defect implanted with fibre reinforced scaffolds than those without fibres as well as commercial nanoHA-collagen graft. Interestingly, the mineralisation and the mineral density were significantly higher with nanoyarn reinforced scaffolds. Moreover, the compressive strength of new bone formed from CS-Y scaffolds was almost similar to that of native rabbit mandible. It can be concluded that the mechanical strength provided by three-dimensionally reinforced nanoyarns in the matrix could promote bone formation in load bearing mandibular region, and these can be proposed as a scaffold of choice for alveolar bone augmentation and dental rehabilitation.

Effect of chemical disinfectants and accelerated aging on maxillofacial silicone elastomers: An In vitro Study

Context

Maxillofacial prostheses need frequent refabrication due to degradation of color and deterioration of physical properties of the elastomer.

Aims

This study attempted to evaluate the change in color stability, Shore A hardness, and surface roughness of two maxillofacial silicones, A-2186 and Cosmesil M511, when submitted to chemical disinfection and accelerated aging.

Settings and Design

This was a comparative in vitro study.

Subjects and Methods

The materials included two silicone elastomers - A-2186 and Cosmesil M511 (Factor II Incorporated) - functional intrinsic red pigment and three disinfectants - Fittydent tablet, chlorhexidine gluconate 4%, and neutral soap. The specimens in each group of elastomer were evaluated initially for color, hardness, and surface roughness, which were further divided into subgroups and subjected to disinfection and accelerated aging. The evaluation of color was performed with the help of an ultraviolet reflectance spectrophotometer. Shore A hardness was evaluated using a durometer and surface roughness, with a digital roughness tester followed by scanning electron microscopy analysis.

Statistical Analysis Used:

Analysis of variance and Tukey's multiple comparison test were used for statistical analysis.

Results

Accelerated aging caused a significant decrease in color, increase in Shore A hardness, and variation in surface roughness in both silicone elastomer groups. Chemical disinfection presented significant changes in color and surface roughness whereas no significant effect on Shore hardness, irrespective of the disinfectant used.

Conclusions

The maxillofacial silicone elastomers presented deterioration in color, hardening, and significant variations in surface roughness when subjected to chemical disinfection and accelerated aging, which provides a valid baseline for future research.

Effect of eriodictyol on preneoplastic lesions, oxidative stress and bacterial enzymes in 1,2-dimethyl hydrazine-induced colon carcinogenesis

Eriodictyol, one of the strong flavonoids extracted from Eriodictyon californicum, is known for its antioxidant and anticarcinogenic properties. We estimated the chemopreventive effect of eriodictyol on 1,2 dimethylhydrazine (DMH)-induced experimental colon carcinogenesis in male albino Wistar rats. The rats were randomized into six groups. Our results evaluated the effect of eriodictyol supplementation (200 μg per kg b.w.) on DMH (20 mg per kg b.w)-induced rats (Groups 4-6). The incidence of polyps, aberrant crypt foci (ACF) and the lipid peroxidation levels were significantly decreased as compared to those in the DMH-alone treated rats (Group 2). In eriodictyol-supplemented DMH-treated rats, we observed increased activity of enzymatic and non-enzymatic antioxidants in the circulatory system, liver, and colon. The bacterial enzymes activities of mucosa and faecal were significantly decreased in the group with treatment of eriodictyol on DMH-induced rats. Moreover, in the eriodictyol-supplemented DMH-exposed rats, we observed reduced malignant glands of a histopathological appearance in both liver and colon tissue. Furthermore, we also observed reduced AgNORs counts of eriodictyol supplemented to the DMH-exposed rats. Therefore, we can conclude that eriodictyol can be used as an effective chemopreventive agent against DMH-induced colon carcinogenesis in experimental animal models.

Prosthetic rehabilitation of surgically treated orbital defects - evisceration, enucleation, and exenteration: A case series

The rehabilitation of a patient who has suffered the psychological trauma due to loss of an eye requires a prosthesis that will provide the optimum cosmetic and functional result. The mode of rehabilitation varies based on the type of defect and surgical approach being adopted. A case series of prosthetic rehabilitation of three types of orbital defects - evisceration, enucleation and exenteration have been reported in this article. The clinical relevance of surgical approaches highlights the preservation of remaining anatomic structures creating a negative space or concavity to aid in future prosthetic rehabilitation. A multidisciplinary management and team approach is essential in providing esthetics and to regain the confidence. Follow-up care for the patient is mandatory.

Pelargonidin induces apoptosis and cell cycle arrest via a mitochondria mediated intrinsic apoptotic pathway in HT29 cells

Pelargonidin (PE) is an anticancer anthocyanidin that is abundant in berries.

Tunable release of clavam from clavam stabilized gold nanoparticles--design, characterization and antimicrobial study

A facile one-step approach is developed to synthesize highly stable (up to 6months) gold nanoparticles (GNPs) using Clavam, pharmaceutical form of amoxicillin which contains a mixture of amoxicillin and potassium salt of clavulanic acid, at room temperature (25-30°C). The clavam stabilized GNPs are characterized using various techniques including UV-Visible, FT-IR spectrophotometry and transmission electron microscopy (TEM). Tunable release of clavam from clavam stabilized GNPs is demonstrated using intracellular concentrations of glutathione (GSH). The process is monitored using an UV-Vis spectroscopy and the amount of clavam released in terms of amoxicillin concentration is quantitatively estimated using reverse phase high performance liquid chromatographic (RP-HPLC) technique. In vitro study reveals that the clavam released from GNPs' surface was found to show a significant enhancement in antibacterial activity against Escherichia coli and the cause of enhancement is addressed.

Hypolipidemic effect of ginger in 1,2-dimethyl hydrazine-induced experimental colon carcinogenesis

Colorectal cancer is increasingly common nowadays in Asian countries and still remains the second leading cause of cancer death in the United States. In our laboratory, we studied the chemopreventive and hypolipidemic effect of ginger, a dietary spice, in 1,2-dimethylhydrazine (DMH)-induced colon cancer. Rats were given a weekly subcutaneous injection of DMH (20 mg/kg body weight), a known colon carcinogen, in the groin for 15 weeks. Ginger (50 mg/kg body weight P.O.) was given at the initiation and also at the postinitiation stages of carcinogenesis. The animals were sacrificed at the end of the experimental period of 30 weeks. The fecal bile acids, neutral sterols, and tissue lipid profile were evaluated using various biochemical estimations. The levels of fecal bile acids, neutral sterols, cholesterol, HMG CoA reductase, free fatty acids, triglycerides, phospholipase A, and phospholipase C were significantly increased, whereas the levels of tissue phospholipids was decreased in DMH-treated rats as compared to control rats. On administering ginger at the initiation and also at the postinitiation stages of colon carcinogenesis, the levels of fecal bile acids, neutral sterols, tissue cholesterol, HMG CoA reductase, free fatty acids, triglycerides, phospholipase A, and phospholipase C were significantly decreased, whereas the levels of phospholipids were increased as compared to unsupplemented DMH treated rats. Thus, ginger supplementation was found to reduce the risk of colon cancer markedly by virtue of its hypolipidemic and antioxidative effects.

Mandibular implant-supported overdenture: an in vitro comparison of ball, bar, and magnetic attachments

In an implant-supported overdenture, the optimal stress distribution on the implants and least denture displacement is desirable. This study compares the load transfer characteristics to the implant and the movement of overdenture among 3 different types of attachments (ball-ring, bar-clip, and magnetic). Stress on the implant surface was measured using the strain-gauge technique and denture displacement by dial gauge. The ball/O-ring produces the optimal stress on the implant body and promotes denture stability.

Protective role of luteolin in 1,2-dimethylhydrazine induced experimental colon carcinogenesis

The aim of the present study was to unravel the chemopreventive effect of luteolin on bacterial enzymes such as beta-glucuronidase and mucinase in a colon carcinogenesis model induced by 1, 2-dimethyl hydrazine (DMH). Twenty mg/kg body weight of DMH were administered subcutaneously once a week for the first 15 weeks and then discontinued. Luteolin (0.1, 0.2, or 0.3 mg/kg body weight/everyday (p.o.) was administered in a dose dependent manner at the initiation and also at the post-initiation stages of carcinogenesis to DMH treated rats. The animals were sacrificed at the end of 30 weeks. Colon cancer incidence and the activities of bacterial enzymes beta-glucuronidase (in the proximal colon, distal colon, intestines, liver and colon contents) and mucinase (colon and fecal contents) were significantly increased in DMH -treated rats compared to the control rats. On luteolin administration, colon cancer incidence, number of tumors per rat and the activities of beta-glucuronidase and mucinase, were significantly decreased both in the initiation and post-initiation stages of colon carcinogenesis dependent on the three different doses given. The increase in beta-glucuronidase activity may augment the hydrolysis of glucuronide conjugates, liberating toxins, while the increase in the mucinase activity may enhance the hydrolysis of the protective mucins in the colon. Thus our results demonstrate for the first time that luteolin, a dietary flavonoid, exerts chemopreventive and anticarcinogenic effects against DMH induced colon cancer.

Effect of spices on lipid metabolism in 1,2-dimethylhydrazine-induced rat colon carcinogenesis

Colon cancer is the second most common cancer among men and women worldwide. We investigated the effect of red chilli (Capsicum annum L.), cumin (Cuminum cyminum L.), and black pepper (Piper nigrum L.) on colon cancer induced in rats by a colon-specific carcinogen, 1,2-dimethylhydrazine (DMH). Colon cancer was induced by subcutaneous injection of DMH at a dosage of 20 mg/kg of body weight (15 doses, at 1-week intervals). The rats were continued with the standard pellet diet and supplemented red chilli [C. annum L., 0.015% (wt/wt) mixed with the diet], cumin seeds [C. cyminum L., 1.25% (wt/wt) mixed with the diet], and black pepper (P. nigrum L., 0.5% (wt/wt) mixed with the diet] throughout the experimental period. After the total experimental period of 32 weeks (including 2 weeks of acclimatization) the incidence and number of tumors in the colon were observed to be significantly higher in the rats administered DMH and/or red chillis, as compared with the cumin + DMH and black pepper + DMH groups. No tumors were observed in the control, cumin + DMH, or black pepper + DMH groups. The levels of fecal bile acids and neutral sterols in 24-hour fecal samples were significantly decreased in DMH + chilli-administered rats, while the excretion of fecal bile acids and neutral sterols was significantly increased in cumin + DMH- and black pepper + DMH-administered rats. In DMH-, chilli-, and chilli + DMH-administered rats the levels of cholesterol, cholesterol/phospholipid ratio, and 3-hydroxy-3-methylglutaryl-CoA reductase activity were decreased in cumin + DMH- and black pepper + DMH-treated rats. The phospholipid levels were reduced in the DMH, chilli, and chilli + DMH groups as compared with the cumin + DMH and black pepper + DMH groups. Our results show that chilli supplementation promotes colon carcinogenesis, whereas cumin or black pepper suppresses colon carcinogensis in the presence of the procarcinogen DMH.

Effect of leptin administration on plasma and tissue lipids in alcohol induced liver injury

Previous studies suggest a possible link between leptin and hepatic inflammation; however the role of leptin in liver diseases remains unclear. The purpose of the present study was to evaluate the effect of leptin on plasma and tissue lipids in experimental hepatotoxicity. Administering ethanol (6.32 g/kg body weight) to 4-week-old healthy mice for 45 days resulted in significantly elevated levels of plasma and tissue phospholipids, triglycerides and free fatty acids as compared with those of the control animals. Subsequent to the experimental induction of hepatotoxicity (i.e., the initial period of 30 days) exogenous leptin was simultaneously administered (230 microg/kg body weight) every alternate day for 15 days along with the daily dose of alcohol. Leptin administration to control and alcohol-treated mice reduced the weight gain and significantly lowered the levels of plasma and tissue lipids as compared with the untreated control and alcohol supplemented mice. It is postulated that the increase in systemic leptin levels lower the plasma and tissue lipids of alcohol-treated mice, which operates independently of changes in food intake, body weight and the size of the fat stores.

Oxidative Stress and Tumor Markers in Cervical Cancer Patients

Cervical carcinoma is the second most common cancer worldwide. The extent of free radical induced oxidative stress can be exacerbated by the decreased efficiency of antioxidant defense mechanisms. Low levels of essential antioxidants in the circulation have been found to be associated with an increased risk of cancer. The aim of our study was to assess the extent of oxidative stress, the levels of antioxidants like superoxide dismutase (SOD), catalase (CAT), ceruloplasmin and to evaluate tumor markers such as aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and total sialic acid (TSA) levels in circulation of women with cervical carcinoma and to compare our findings with age matched controls. Low levels of SOD and CAT observed in the circulation of cervical cancer patients may be due to their increased utilization to scavenge lipid peroxides as well as sequestration by tumor cells. Higher levels of TSA, AST, ALT and ALP, in the circulation of cervical cancer patients may be used in the diagnosis and treatment monitoring of patients with cervical carcinoma.

Circulating lipid peroxidation and antioxidant status in cervical cancer patients: a case-control study

OBJECTIVES

The present case-control study was conducted to investigate the status of circulating lipid peroxidation and the enzymic and nonenzymic antioxidants of cervical cancer patients.

DESIGN AND METHODS

Plasma thiobarbituric acid reactive substances (TBARS), conjugated dienes (CD) and the levels of antioxidants such as reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione-S-transferase (GST), superoxide dismutase (SOD), vitamin C and vitamin E were estimated in circulation of thirty patients and an equal number of age matched normal subjects as control.

RESULTS

Significantly elevated levels of plasma TBARS and CD and significantly lowered levels of GSH, GPx, GST, SOD vitamin C and vitamin E were observed in cervical cancer patients as compared to controls. Our study reveals increased lipid peroxidation and possible breakdown of antioxidant status in patients with cervical carcinoma.

CONCLUSION

These results indicate that low levels of GSH, GPx, GST, SOD, vitamin E and vitamin C in the circulation of cervical cancer patients may be due to their increased utilization to scavenge lipid peroxides as well as their sequestration by tumor cells. Malnutrition may also be a significant cause for the increased prevalence of cervical cancer in women with a low socioeconomic status.