Virtual surgical design in accurate mandibular reconstruction with vascularized fibular graft / 中华显微外科杂志

Objective To introduce the application and assess the outcome of ProPlan CMF software in virtual surgery of mandibular resection and reconstruction with vascularized fibular graft.Methods Nineteen patients were performed mandibular resection,and immediate reconstruction with free fibular graft by application of ProPlan CMF software between March 1,2013 and January 31,2014,including 7 cases of osteoradionecrosis,6 cases of adamantoblastoma,4 cases of carcinoma of gingiva,2 cases of intra-osseous carcinoma of mandible.There were 12 males and 7 females,with an age range of 21-73 years (median,54 years).In each case,three-dimensional spiral CT scan of mandible and fibula was obtained before operation.The CT data were imported into the ProPlan CMF software and the virtual surgical planning was performed.After that,the mandibular rapid prototyping and surgical guide plates were made according to customized design.The segmental resection of mandible,titanium plate bending,fibular molding,insetting and fixing were then carried out by using these surgical guide plates.Results Operations were undertaken successfully according to preoperative design in all nineteen patients and negative margin was detected by intraoperative frozen section.The fibula was cut,shaped and fixed accurately.The operations took 4.5-7.0 hours (mean,5.5 hours).Primary healing of incision was obtained without complications except fistula in 2 cases of osteoradionecrosis,which were resolved with local wound care after 4 weeks.19 patients were followed up between 3 months to 1 year and all patients were alive with disease free.All patients were satisfactory with their maxillofacial appearance,occlusion and function.The ranges of mouth opening was 2.0-4.0 cm.The postoperative panoramic radiographs or CT scan showed perfect situation and contour of fibular graft.Healing of the donor site occurred without significant complications.All patients started early postoperative ambulation,and walked normally after 2 or 3 months.Conclusion The application of ProPlan CMF software in virtual surgical design and guide plates creation can simplify the operation,and improve the accuracy of mandibular resection and reconstruction,especially the spatial relationship of the mandible and the fibula graft.It is worth promotion widely in clinical practice.

Actividad antimicótica "in vitro" del aceite esencial Cinnamomun zeylanicum Breyn "canela" frente a Cándida albicans ATCC 6538, Tacna, 2012 / Antimycotic activity "in vitro" of the essential oil Cinnamomun zeylanicum Breyn "cinnamon" against Candida albicans ATCC 6538, Tacna, 2012

Objetivo: Determinar la actividad antimicótica "in vitro" del aceite esencial de Cinnamomum zeylanicum Breyn "canela" frente a Cándida albicans ATCC 6538. Metodología: Se obtuvo el aceite esencial de las cortezas Cinnamomun zeylanicum Breyn "canela" mediante destilación por arrastre de vapor. Utilizando los métodos de: a) Kirby Bauer, se conoció el grado de sensibilidad en función al tamaño de los halos de inhibición, b) Por dilución en medio líquido se determinó la Concentración Mínima Inhibitoria (CMI) y c) Por difusión en agar la Concentración Mínima Fungicida (CMF) del aceite esencial. Resultados: Se demostró que Cándida albicans presenta alta sensibilidad al aceite esencial. La CMI para Cándida albicans fue de 0,01895 mg/ml y la CMF fue de 0,020529166 mg/ml. Conclusión: El aceite esencial de Cinnamomun zeylanicum Breyn presenta actividad antimicótica frente a Cándida albicans.

Toxicity of Concurrent Adjuvant CMF Chemotherapy and Radiotherapy in Patients with Early Breast Cancer / 한국유방암학회지

PURPOSE: Many patients with early stage breast cancer are currently being treated with both adjuvant chemotherapy (CT) and radiotherapy (RT). We performed this study to assess the toxicity of concurrent adjuvant cyclophosphamide, methotrexate, and 5-fluourouracil (CMF) CT and RT for treating early breast cancer patients. METHODS: Between January 2000 and December 2005, 97 patients with stage I or II invasive breast carcinoma were treated with breast-conserving surgery, and they received 6 monthly cycles of classic oral chemotherapy with CMF. Within day 7 of cycle 1, the patients started 3 dimensional conformal RT (3DCRT) with a stadard dose, followed by a boost. We used the Common Terminology Criteria for Adverse Events v 3.0 to score the level of acute toxicity for CT. The adverse effects of RT were graded according to the Radiation Therapy Oncology Group criteria. RESULTS: The mean age of the patients was 45.8 yr (range:30-64). The most common toxicity was nausea and leukopenia. The dose of chemotherapy was reduced to 80% of the planned dose for 6.2% of the patient. CT was disrupted for 4.1% of the patients. RT was not disrupted for any patient. Grade 3 and 4 neutropenia occurred in 41 (42.3%) patients, but only one patient needed hospitalization due to fever. Grade 3 skin lesions developed during or shortly after RT in 10.7% of the patients. Radiation penumonitis was noted in 15.5% of the patients. The median follow-up time was 38 months. There was no local recurrence and 2 (2.08%) distant metastases during follow-up. CONCLUSION: From the results of our study, we conclude that the concurrent administration of adjuvant CMF CT and RT is associated with a low risk of serious toxicity and this is an acceptable adjuvant regimen for patients with early stage breast cancer.

Five-year follow-up in respectable breast cancer patients with “CMF” adjuvant chemotherapy and radiation.

From 1989 to 1991, there were 36 female breast cancer patients came to the Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University. All36 patients had surgical treatment involving either MRM or conservatiove breast surgery. The combination CMF regimen were given as the adjuvant chemotherapy for six cycles. (Cyclophosphamide 100 mg./m2 p.o. day 1-14, Methotrexate 40 mg./m2 i.v. day 1 and 8, 5-Fluorouracil 600 mg./m2 i.v. day 1 and 8; repeated on a 28-day cycle). Conventional radiation treatment was given to the chest wall and regional lymph nodes at 5,000 cGy/25 fractions, while those who had conservative breast surgery received booster doses of 1,000-1.600 cGy/5-8 fractions to the tumour bed. The follow-up period was ranged between 52 and 86 months (mean = 62.25 months). The disease-free survival rate was 66.66 percent (24 patients). Nine of 10 patients who had loco-regional and/or distant failure were premenopausal women. So the authors suggest that CMF chemotherapy is inadequate for controlling the disease because in premenopausal patients there is greater risk of recurrence and metastases than in post-menopausal patients. Anthracyclines-based combination chemotherapy should be considered for premenopausal breast cancer patients.