Efficiency of the diamond versus carbide burs on the bond strength of composite to dentin in a self-etch bonding system

Nowadays, with regard to the quantitative and qualitative growth of dental-plastic services and qualitative advances made in tooth-colored restorations, there is a great rise of demands for use of composite resins. The aim of this study was to assess the efficacy of diamond burs in comparison with carbide burs on bond strength of self etch adhesives to dentin. In this in vitro experimental study, sixty sound extracted human third molars were selected and mounted in a self-cure acrylic resin. Then, teeth were randomly assigned to two groups, [n=30 each]: In group A the teeth were ground with high-speed medium grit diamond bur and in group B with high-speed carbide burs. A composite cylinder 3 mm in diameter was bonded to each specimen with a self-etch bonding system and the shear bond test with performed using a universal testing machine. The results were expressed in MPa and were subjected to and Tukey's test. The average shear bonding strength in diamond and carbide burs were 17.67 [SD= +/- 4.41] and 14.51 [SD +/- .18] MPa, respectively. There was a significant difference in dentin bond strength when comparing bonding strength between two groups [P< 0.05]. The use of different burs was considered influential on the shear bond strength of the self-etch adhesives 'to dentin. This adhesive significantly outperformed when a diamond bur was used to prepare dentin surface

Radiation exposure of the surgeons in sentinel lymph node biopsy

Sentinel node biopsy [SLNB] is the standard of care for breast cancer treatment and it is getting wide acceptance in Iran. The radiation safety of the procedure has been investigated under controlled conditions, but the standard dose of radiotracer and techniques are not always observed in the community setting. The aim of this study was to assess the magnitude of the absorbed doses of radiation to the hands of operating surgeons. Twenty consecutive SLNB procedures were studied. Radiation dose to the hands of the surgeons was measured by placing lithium fluoride thermoluminescent dosimeters [TLDs] in the surgeons' glove. The radiation dose to the abdomen and thyroid area was measured by placing TLDs at these areas. The injected dose of radiotracer, the time interval to the surgery and the duration of the surgery were recorded. The injected dose of radiotracer ranged from 0.1 to 5 mCi. The highest absorbed dose was recorded by TLD, placed on the non-dominant hand third finger [189.1 microSv]. Mean recorded doses were higher for non-dominant hand second finger [53.49 +/- 24.60 microSv]. The measured absorbed doses for the abdominal and thyroid area were lower than those for the fingers. This study has confirmed the procedure safety, even with high dose of radiotracer. Nevertheless, it is advisable to use the lowest dose of the radiotracer to avoid the waste of resources

[Safety and efficacy of anticholinergic and alpha-blocker combination therapy in treatment of benign prostatic hyperplasia]

Although voiding symptoms are classically related to BPH, as many as 50% of patients can experience irritative symptoms. We compared safety and efficacy of combination therapy using alpha-blocker with anticholinergic agents with tamsulosin alone. We compared anticholingergic and alpha-blocker combination therapy versus alpha-blocker alone in BPH patients with dominant irritative symptoms in a clinical trial during 2006. Eighty four patients who fulfilled the inclusion/exclusion criteria were randomly divided into two groups of tamsulosin monotherapy versus tamsulosin and an anticholinergic agent combination therapy. Therapeutic efficacy and safety were analyzed using international prostate symptom score [IPSS] and residual urine volume. Total IPSS was significantly improved in both groups. We considered significant improvements in total IPSS were also seen for the combination therapy group [P=0.0008 within group], but not for the monotherapy group. At the end of treatment, median PVR was not significantly higher for the co-therapy group [51.6 mL] than for the monotherapy group [47.0 mL] [P=0.173]. There was no retention in either group. Combination of alpha-blocker and anticholinergics in BPH patients with dominant irritative symptoms is a reasonable and safe therapeutic option without any increase in urinary retention rate

Psychosocial care for breast cancer: physicians' perspective

Many literatures have documented that psychosocial care can improve health outcomes and reduce morbidity in women with breast cancer. The aim of this study was to evaluate the opinion of the breast cancer professional team members on integration of psychosocial care in regular management of breast cancer. A cross sectional sample of 313 physicians involving in diagnosis, treatment and supportive care for breast cancer patients were interviewed using a questionnaire. The majority of participants [52.7%] declared that psychosocial care is necessary for all patients with breast complaints. All except one of the respondents irrespective to their age and job believed that providing the patients with psychosocial supportive care definitively have some positive points for the patients with breast cancer. Of all respondents, 29.6% thought it should be offered as soon as suspicion is raised toward breast cancer, 54.7% preferred to provide such care after the diagnosis of malignancy is confirmed, 11.3% thought it should be prescribed before surgery and 4.4% believed that care should be provided before adjuvant therapy. The necessity of providing psychosocial care for breast cancer patients was mentioned by the majority of respondents; however there are some major differences among the team members of breast cancer care in regard to psychosocial supportive care. The results of this study highlight the insufficient collaboration among medical team members and the necessity of multidisciplinary approach to all aspects of the important disease through programmed sessions and provide the patients with an integrated comprehensive care

Tamsulosin and spontaneous expulsion of ureteral stones

ureteral stones have a high rate of spontaneous expulsion, especially when they are smaller than 6 mm. some medications including corticosteroids, Ca channel blockers and alpha-blocker have been used by some to enhance spontaneous stone passage. In this paper we evaluate the effect of Tamsulosin in spontaneous stone passage in a clinical trial study. We performed clinical trial study of 100 renal colic patients with lower ureteral stones and stone size less than 7 mm determined by CT scan, KUB or ultrasonography of UVJ region who didn't have UTI, intractable pain or any indications of immediate intervention during January 2006 and April 2007.50 of the patients got only standard regime of analgesics and 50 of them got standard regime and Tamsulosin [0.4 mg/d]. The stone expulsion rate was 60% [30/50 patients] for group A and 86% [43/50] for group B [P=0.01] with a mean expulsion time of 8.1 +/- 2.2 [range 3.5-12] and 5.1 +/- 2.7 days [range 1.8-10.5] [P=0.005]. Tamsulosin increase spontaneous stone passage and decrease expulsion time and analgesic use significantly

[Experimental comparison of shear bond strength of a self-etch adhesive system by three dentin conditioning methods]

The aim of this study was to evaluate the bond strength of self- etch adhesive system [AdheSE] with three dentin conditioning methods. Sixty six human intact premolar was divided into 3 group [n=22], a flat dentin surface was made. In group 1: The tooth was etched by phosphoric acid [35%], then bonding material of AdheSE was used. In group 2: only bonding material was used. In group 3: The procedure was as the first group, but after etching, the tooth surface was deproteinized by Naocl [5%]. Then with a cylindrical composite models were made. Thermolcycling was performed using 500 cycle, and subjected to a blade [cross head] with the speed of 0.5 mm / min .Collected data was analyzed using 1 way ANOVA test in addition to a Duncan test. Results revealed that hypochlorite sodium [Naocl] decreased the bond strength. when acid phosphoric and then dentin bonding agent were used, mean bond strength [25.72 MPa] was the most. Excess etching increases the bond strength. When the self etching adhesives are used for repair of teeth, excess etching increases the bond strength

Evaluation of preoperative elevation of serum C-Reactive protein as an indicator for prognosis in Colorectal Cancer

The C-reactive protein [CRP] is a product synthesized in hepatocytes and has been reported to be up-regulated by such proinflammatory cytokines as interleukin-1 [IL-1], interleukin-6 [IL-6], and tumor necrosis factor [TNF]. The significance of a preoperative serum elevation in CRP as a predictive indicator for the malignant potential and prognosis in colorectal cancer has not been elucidated. Forty consecutive patients with colorectal cancer, whose local lesions were resected in our department, plus forty volunteer healthy persons, were selected. Any patient with inflammatory diseases such as infection or collagen disease was excluded from the current study. Then preoperative serum CRP level were measured, and also from the control group. The relationships between the serum elevation of CRP and both the clinicopathologic factors and prognosis of the patients was investigated. The rate of patients with elevated serum CRP level was significantly higher in colorectal cancer patients in comparison with the control group [55% versus 2.5%]. Furthermore the incidence of liver metastasis, peritoneal carcinomatosis, histopathologic lymph nodes metastasis, and tumor invasion in colorectal cancer patients with a preoperatively elevated serum CRP level were significantly more frequent than in those with a negative serum CRP level. The survival rates of colorectal cancer patients without a preoperative elevation of serum CRP proved to be significantly more favourable than what in colorectal cancer patients with such an elevation [94.4% versus 59.1%; P < 0.001]. A preoperative serum elevation of CRP was thus found to be an indicator of malignant potential of the tumor as well as a predictor for the prognosis of patients with colorectal cancer

Non-contrast spiral computed tomography in diagnosis of acute appendicitis

Approach to patients with acute right lower quadrant pain remains a clinical dilemma. Decreasing the risk of negative appendectomies is one of the major goals surgery units intend to achieve. This study has been conducted to determine the accuracy of non-contrast focused appendiceal computed tomography [CT] in preoperative diagnosis of acute appendicitis. During a period of three months, 50 consecutive adult and adolescent patients who were clinically diagnosed as acute appendicitis were included in this study. Focused non-enhanced appendiceal spiral computed tomography [CT] was performed for all patients, preoperatively. Two radiologists who were unaware of the surgical findings assessed the CT scans. After the operation and pathologic assessment, eight patients with negative appendectomy were found. The sensitivity of CT was 0.71 and 0.83 according to the interpretations of the first and second radiologists, respectively. Moreover, its specificity was 0.88 and 0.75 according to the first and second radiologists' reports, respectively. In patients with clinically diagnosed acute appendicitis, relying on abdominal CT is not helpful

[Comparing AVF ligature and transvenous endorrhaphy for AVF closure in hemodialysis patients]

Arteriovenous fistulae are the principal chronic hemodialysis access in patients with end stage renal disease. There is an increasing number of patients who need AVF closure because of serious complications or renal function retrieval by transplantation. Multiple open and endovascular techniques have been proposed for AVF closure. In this study, we are going to compare two surgical methods and select the preferred one as the standard technique for closure. A randomized controlled clinical trial was designed. 140 patients were randomly assigned into two matched groups. 70 patients underwent AVF ligature and the other 70 subjects underwent transvenous endorrhaphy. Each patient was followed for at least 6 months to monitor surgical results. Of 140 patients, 26 [18.6%] AVF closures were failed during 6 months of follow up. Of 26 failed cases, 24 had undergone AVF ligature. Thrill recurrence and closure failure was 37.1% in the ligature group and 2.9% in the endorrhaphy group. Transvenous endorrhaphy is associated with better AVF closure results. Therefore, we recommend this procedure as the standard technique of AVF closure

[Duplication of appendiceals: a case report]

Background: appendiceal duplication is one of the rare appendiceal anomalies with an incidence between 0.004% and 0.009% appendectomy specimens. Herein we present a 34 year old woman with appendiceal duplication, which caused in acute abdomen

Case presentation: a 34-year-old woman was admitted on an emergency basiswith a 10-day abdominal pain, loss of appetite,nausea, and.There was localized tenderness at McBurney'spoint, moderate rebound tenderness, guardingThe blood count showed leukocytosis [WBC :16800/mm3] with a shift to the left.Appendectomy was done and patient discharge after 3 days. Because fecal fistula and limited response to conservative management right hemicolectomy was done and pathology report a second appendix in iliocecal junction

Conclusion: in conclusion, appendiceal duplications are a rare finding. They may be confused with cecal diverticular disease or even colorectal cancer. The classification system of these abnormalities is important as a missed Type B appendix may result in serious clinical and medico-legal consequences. In addition, a double appendix can be associated with other congenital abnormalities. It is therefore important that trainee surgeons are aware of the anatomical anomalies and malpositions of the appendix

[Role of tumor markers in breast cancer recurrence]

Introduction: The value of clinical use of tumor markers for prediction of breast cancer recurrence in follow-up or level of response to treatment is still controversial

Objective: In this study, the role of tumor markers in breast cancer recurrence was evaluated

Materials and Methods: One hundred and forty-one breast cancer patients were entered into the study and followed up for 132 months [mean= 34.0, SD= 28.0]. The mean age of the patients at time of diagnosis was 47.1 [SD= 12.3] ranging from 23 to 81 years. Most patients [51%] were presented with stage II breast cancer. 81% of the patients underwent modified radical mastectomy and the remaining 19% had breast preservation surgery. The association between clinical recurrence with age, tumor size, nodal involvement, stage, type of surgery and pathology, CA15.3, CEA, P53, ER, PR, and HRE-2 status were examined by using the forward conditional logistic regression analysis

Results: Recurrence occurred in 22% of patients during the follow up time. The results indicated that recurrence was significantly predicted by the status of CA15.3 [odds ratio= 6.1, 95% CI= 1.62-23.1, P= 0.007]

Conclusion: The findings showed that independent of age and other known prognostic factors CA 15.3 is an individual factor for prediction of recurrence in breast cancer patients

[Evaluation of general surgeons' practice regarding different types of breast cancer surgery: breast conserving surgery or mastectomy]

Introduction: Nowadays breast-conserving surgery [BCS] where only a part of breast tissue is extracted is a standard and accepted method of treating breast cancer under certain condition. BCS use in Iran is very limited

Objective: This study aims to evaluate general surgeons' practice regarding BCS and its related factors

Materials and Methods: Structured questionnaires were sent by mail to 300 general surgeons whose addresses were extracted from address list of general surgeons in Iranian Medical Council. The questionnaire included general surgeons' characteristics such as age, sex, work experience, practicing in a university hospital, number of breast cancer patients treated per year, preference of surgeons about performing mastectomy versus breast conserving surgery [BCS] and the reasons for avoiding breast conserving surgery

Results: In all, 83 surgeons returned back the completed questionnaires. The response rate was 27%. Results showed that only 19% of surgeons were performing BCS in their routine practice. Of all evaluated factors, only surgeon's experience that was defined as "the number of patients treated annually" had a statistically significant correlation with performing BCS [P= 0.01]. There was no association between other mentioned variables and the use of BCS. The most frequent reasons noted for avoiding BCS were uncertainty about conservative therapy results [46%], uncertainty about quality of available radiotherapy services [32%] and probability of patients' incompliance for radiotherapy [32%]

Conclusion: These findings indicated that BCS is not routinely selected by Iranian surgeons as the first and the best treatment modality. Further research to evaluate patients' outcome treated by BCS in Iran, with regard to available medical facilities and cultural factors [patients' compliance] is recommended

Is bladder cancer more common among opium addicts?

Many environmental and occupational risk factors have been proposed for bladder cancer, among which opium consumption has been considered in few studies. We designed a study to determine the relationship between opium consumption and bladder cancer. In a retrospective, case-control study, male patients with bladder cancer, who had been referred to our hospital in a three-year period, were selected. Data regarding age, gender, smoking, and opium consumption were collected from patients' records and compared with data of a control group, consisting of patients with benign prostatic hyperplasia [BPH]. Fifty-two male patients with bladder tumor [group 1] were compared with 108 patients with BPH [group 2]. Of the patients with bladder cancer, 36 [68%] were smokers, of whom 12 were also opium addicts. In general, 13 [25.5%] patients were opium consumers [one opium consumer was not smoker]. From 108 patients with BPH, 25 [23%] were smokers, of whom, 5 were also opium addicts. Mean duration of cigarette smoking was 31 +/- 13.6 and 20.2 +/- 14.7 years in patients with bladder cancer and BPH, respectively. The duration of opium consumption was 11.9 +/- 1.4 and 6.2 +/- 1.3 years in groups 1 and 2, respectively. The duration of cigarette smoking and opium consumption in group 1 was greater than that in group 2. In addition, smoking increases the risk of bladder cancer 3.8-fold [OR=8.3, 95% CI=1.8-7.8]. Simultaneous cigarette smoking and opium consumption increases the risk of bladder cancer 6.2-fold [OR=6.2, 95% CI=2.04-18.7]. There are few studies regarding the carcinogenic effect of opium on bladder. We demonstrated that, the incidence of bladder cancer in smokers, who are simultaneously opium consumers, was higher than in patients who were only smokers. Simultaneous opium addiction and cigarette smoking may have some roles in the pathogenesis of bladder tumor. However, further studies with large sample sizes are warranted

Molecular analysis of pseudomonas aeruginosa strains isolated from hospitalized patients in Shiraz

Sixty nine Pseudomonas aeruginosa isolates were studied for in vitro activity of eight different anti-pseudomonal compounds. Ciprofloxacin and ceftazidime were most active and inhibitory in all of the isolates. It was followed by imipenem [88.4%], aztreonam [64.1%], piperacillin [58%], and amikacin [48%]. Plasmid profile analysis showed that only three isolates harbored plasmids of identical patterns with approximate molecular sizes of 2.5 and 3 kbp. Restriction endonuclease analysis of extracted plasmids by HincII and Sau3AI revealed no difference in the digestion patterns. Single digestion of chromosomal DNA using EcoRI and PstI revealed an identical pattern in two isolates from one patient and different patterns among the other two. In this study, the Field Inversion Gel Electrophoresis [FIGE] was found more efficient than Contour-clamped Homogeneous Electric Field [CHEF] in separating the restricted fragments of P. aeruginosa chromosomal DNA