The correlation between tumor markers and Ga-68 DOTA-TATE PET/CT findings in patients with advanced medullary thyroid cancer. / La correlación entre los marcadores tumorales y los hallazgos de Ga-68DOTA-TATE PET/TC en pacientes con cáncer medular de tiroides avanzado.

BACKGROUND: Medullary thyroid cancer is a rare type of neuroendocrine tumor. Calcitonin (Ctn) and carcinoembryonic antigen (CEA) are used as markers for medullary thyroid cancer. The aim of the study was to evaluate the importance of serum Ctn and CEA levels in predicting total tumor volume. MATERIAL AND METHODS: Ga-68 DOTA-TATE PET/CT findings such as whole-body somatostatin receptor-expressing metabolic tumor volume (SSR-E MTV) and total lesion volume (SSR-E TLV) were calculated and correlation analysis was done for tumor markers and whole-body SSR-E MTV and TLV. RESULTS: A total of 28 patients with advanced medullary thyroid cancer were included in this retrospective study. In the correlation analysis, there was a statistically significant positive correlation between Ctn and whole-body SSR-E MTV (rho=0.503 and P=.008). Similarly, significant positive correlation was observed between Ctn and whole-body SSR-E TLV (rho=0.436 and P=.023). There was a significant positive correlation between CEA and whole-body SSR-E MTV (rho=0.584 and P=.007). Also, a positive correlation was observed between CEA and whole-body SSR-E TLV (rho=0.436 and P=.023). These correlations were most marked in patients with Ctn≥152pg/mL and/or both nodal and bone involvement. CONCLUSION: These results could stimulate clinicians to perform Ga-68 PET for treatment decisions, especially in patients with high CEA and Ctn levels at the time of diagnosis.

Comparison of arch width changes following orthodontic treatment with and without extraction using three-dimensional models.

OBJECTIVE: To compare the arch width changes in patients treated fixed orthodontic mechanics without extraction (Group 1), with upper and lower first premolar extractions (Group 2), and with upper first premolar extraction only (Group 3). MATERIALS AND METHODS: The study was conducted with pre- and post-treatment digital models from 240 patients. Anterior, middle, and posterior distances were measured on pre- and post-treatment models. At T1 measurements, the distance among the canine cusp tips, the second premolar buccal cusp tips, and the first molar mesiobuccal cusp tips were measured. In addition, the distance (D) between the intercanine and intermolar lines and the distance (D') between the interpremolar and intermolar lines were defined on the anatomic y-axis, and this distance was maintained in calculating posttreatment measurements (T2). Mandibular and maxillary arch width changes were evaluated within and between groups. RESULTS: Anterior, middle, and posterior arch widths increased significantly in Groups 1 and 3. Maxillary anterior and middle arch widths also increased in Group 2, but the increases were not statistically significant. Changes in maxillary anterior and middle arch widths were higher in Groups 1 and 3 when compared to Group 2. However, there was no statistically significant difference in mandibular arch changes between the groups. CONCLUSION: Extraction treatment mechanics did not cause narrow dental arches, but nonextraction treatment increased arch width in all 3 measurements. Treatments with only upper arch extraction showed similar results with nonextraction treatment.

The diagnostic ability of core needle biopsy in nodular thyroid disease.

INTRODUCTION Non-diagnostic results of fine needle aspiration biopsy (FNAB) remain an important limitation of this technqiue. The aim of our study was to evaluate the results of core needle biopsy (CNB) of thyroid nodules and its effectiveness in non-diagnostic FNAB cases. METHODS CNBs were performed in 1,000 patients (154 male, 846 female; mean age: 50.2 years, range: 18-86 years) with a spring loaded 20G needle. Of these, 143 had initially had FNABs that were insufficient for evaluation. The CNB reports were reviewed. Patients with suspicious or malignant CNB results underwent total thyroidectomy. RESULTS When considering all 1,000 CNBs, the non-diagnostic rate was 1.5% (15/1,000). However, when the first 100 cases were eliminated as a learning curve, this reduced to 0.9% (8/900). Of the 143 cases with initial FNABs that were non-diagnostic, 0.7% (1/143) were also non-diagnostic on CNB. Twelve patients underwent surgery because of malignant CNB reports and all of these cases were confirmed as malignant by the postoperative pathology specimen results (100% accuracy). There were no major complications although three self-limiting minor complications were observed. CONCLUSIONS CNB is a safe and accurate method. It is more diagnostic than FNAB for nodular thyroid disease.

Prevalence of sleep disturbance in chronic pain.

OBJECTIVE: Sleep is a vital function for human beings, which can be affected by several factors. Chronic pain is one of these factors where it is the most frequent cause for seeking medical care in combination with insomnia. The aim of this study is to examine the prevalence and relationship between sleep disturbance and chronic pain. PATIENTS AND METHODS: After approval, a total of 85 Family Medicine Units from over 170 in Tokat were randomly selected using a 50% sampling. A sample of 2635 subjects, over the age of 19 years, who were registered with the selected Family Medicine Units, were assessed due to gender, age group, and the urban/rural population size of Tokat using the stratified sampling method. The sample size distribution was calculated as 1515 urban subjects, 1120 rural subjects; 1345 female subjects, 1290 male subjects; 1123 subjects between 20-39 years of age, 1103 subjects between the ages of 40-64, and 409 subjects over 64 years of age. After sampling, subjects were invited to participate in the study via an invitation letter, and agreeing individuals were taken to the Family Medicine Unit for face-to-face meetings. Written, informed consent was obtained, along with demographic data. The presence of chronic pain was recorded. According to the presence of chronic pain, all subjects were separated into two groups as Group Chronic Pain and Group Non-Chronic Pain. The visual analog scale for pain intensity, and Pittsburgh Sleep Quality Index for sleep quality, were performed with all subjects. A multiple linear regression model was used to assess the predictors of sleep quality. Analyses were conducted using the Statistical Package for Social Sciences program (SPSS Inc., Chicago, IL, USA), version 20.0. The statistical significance for all analyses was set at p < 0.05. RESULTS: The mean global Pittsburgh Sleep Quality Index score of Group Chronic Pain (5.30 ± 4.29) was significantly higher than in Group Non-Chronic Pain (3.22 ± 3.30; p < 0.01). The mean Pittsburgh Sleep Quality Index scores of females (5.69 ± 4.40) were significantly higher than males (4.54 ± 3.96) in Group Chronic Pain (p = 0.000045). A total of 40.7% of patients in Group Chronic Pain, and 21.9% in Group Non-Chronic Pain demonstrated poorer sleep quality according to the Pittsburgh Sleep Quality Index scores, with a cut-off level > 5. A moderate positive correlation was found between the global Pittsburgh Sleep Quality Index and Visual Analog Scale scores (r = 0.310, p < 0.01). A multiple linear regression analysis showed that age, gender, income, Visual Analog Scale, and presence of depression were the significant predictors for Pittsburgh Sleep Quality Index score. CONCLUSIONS: The current study revealed that chronic pain and pain intensity are important predictors of sleep quality.

Central nervous system toxicity after acute oral formaldehyde exposure in rabbits: An experimental study.

Formaldehyde (FA) is one of the most widely used chemical compounds in industrial field. It is described as toxic, particularly to the nervous system, the urogenital system, and the respiratory tracts. In this study, we determined the effects of acute oral exposure to FA in rabbit brain tissue. A total of 16 rabbits were selected and divided into 2 groups: formaldehyde group (group F) and control group (group C). FA was administered to group F at a rate of 40 mg/kg/day via a nasogastric tube for 5 days. Saline was similarly administered to the eight controls. All the animals were euthanized after 5 days of exposure, and brain tissue samples were collected in 10% neutral formalin and embedded in paraffin. To investigate the effects of FA on the apoptotic process, we examined active caspase-3, Bax, and Bcl-2 immunohistochemical expression and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate -biotin nick-end labeling (TUNEL) reactivity in the rabbit brains. In addition, glial fibrillary acidic protein (GFAP) was biochemically assessed in brain tissue samples for neurotoxicity. We found that FA treatment caused a significant decrease in Bcl-2 expression and an increase in active caspase-3 and Bax expressions as well as an increase in the number of TUNEL-positive apoptotic cells. The GFAP level was found to be significantly higher in group F. In conclusion, acute oral exposure to FA caused DNA damage, apoptosis, and neuronal injury in the rabbit brains.

Effects of isoflurane in an intoxication model: experimental study.

BACKGROUND: Isoflurane is a volatile anaesthetic that has been commonly used since 1980. The major metabolites of isoflurane are fluoride ion and trifluoroacetate, both excreted in the urine. AIM: This study manage to show the histopathological findings of ingested isoflurane on liver, kidney and lugs in an animal model. Twenty-one rabbits were selected and divided into three groups: Group Isoflurane-5 (I-5); Group Isoflurane-10 (I-10); and Group Control (C). Each group consisted of seven rabbits. I-5 and I-10 received 5 ml/kg and 10 ml/kg of liquid isoflurane, respectively, via nasogastric tube, while C received 5 ml/kg saline (0.9% NaCI). All animals in I-5 and I-10 were sacrificed without anesthetic drug administration. Tissue samples from livers, kidneys and lungs were collected, preserving tissue unity and avoiding infliction of any trauma. Samples were fixed in 10% formalin solution, embedded in paraffin blocks and sliced into 5 µm sections. To investigate the effects of isoflurane, sections were examined under light microscope and histopathological changes were scored. RESULTS: Mean injury scores and the appearance of portal lymphocyte infiltration in liver samples showed significant increases in I-5 and I-10 compared to C (p = 0.005, p = 0.001 and p = 0.001, respectively). Mean lung injury scores revealed significant increases after isoflurane treatment in I-5 and I-10 compared to C (p = 0.026 and p = 0.017, respectively). CONCLUSIONS: Ingested isoflurane led to mild liver and lung injuries in rabbits.

An electrophysiological study of the sequential water swallowing.

BACKGROUND: Sequential water swallowing (SWS) was mostly investigated by the videofluoroscopic and endoscopic methods. However some physiological features of SWS was rarely evaluated by neurophysiological techniques. Our aim was to investigate some neural and muscular changes on sequences of SWS using electromyography (EMG) methods. METHODS: Fifty-eight normal adults were investigated. SWS was initiated voluntarily with 50ml and 100ml water volumes from a cup. Submental EMG, respiratory signals, heart rate, and sympathetic skin responses (SSR) were measured during SWS. KEY RESULTS: All parameters were increased significantly during the 100ml SWS. During swallowing apnea period, compensatory respiration cycles occurred in 24% and 48% of participants in the 50ml and 100ml SWS, respectively. Heart rate increased during swallowing apnea. SSR were evoked just before and just after the SWS in more than halves of participants. A foreburst EMG in SM muscles at the initiation of SWS was recorded in 86% of normal participants. Older age was associated with a prolonged duration of the apnea period. CONCLUSIONS: All parameters of the SWS could be recorded numerically and objectively using electrphysiological methods. These are similar to those obtained by videofluoroscopic and similar methods. The foreburst activity of the initiation of SWS may represents preparatory activity from the activation of the fast cortical descending motor pathway. Increasing heart rate and the prolonged apnea urged that older people and patients could be carefully tested for respiratory and cardiac rhythm disorders.

Sympathetic skin responses in adult humans during sequential swallowing.

STUDY AIMS: Autonomic changes, especially those of sympathetic skin responses (SSR), during sequential water swallowing (SWS) have not been systematically investigated. This study aims to electrophysiologically examine these autonomic changes (SSR and heart rate) that occur during 50 ml sequential water swallowing from a cup. MATERIALS AND METHODS: Fifty-eight normal healthy adults were included in the study. Their submental muscle activity, respiratory activity, heart rate changes, and sympathetic skin responses were recorded during 50 ml water swallowing. In addition, we requested subjects to imagine drinking water as they did just before. The same recordings were performed during this imagination period. RESULTS: SSR appeared at the beginning and at the end of SWS in 52% of subjects. A first sympathetic skin response was evoked at the onset of SWS, and a second one appeared 8.6±1.7 seconds after the first one and at the end of swallowing. Similar double SSRs were also obtained during imagination in most investigated subjects (33 out of 35 of selected subjects in a total group of 58 subjects). Swallowing tachycardia was observed during the SWS-associated apnea period, but not during the imagination period. Heart rate significantly increased during the SWS-associated apnea period. CONCLUSION: The first SSR that appeared at the onset of swallowing is likely related to arousal. The appearance of a second response is a novel finding, which is probably related to the activity of subtil corticosubcortical networks. While discrete/single swallows can be used to evoke SSRs, SWS is unlikely to be clinically useful in its current form. In contrast, swallowing tachycardia could be a useful tool to examine dysphagic patients.

Prospective, randomized, double-blinded comparison of the effects of caudally administered levobupivacaine 0.25% and bupivacaine 0.25% on pain and motor block in children undergoing circumcision surgery.

BACKGROUND: Caudal anesthesia is widely used as intraoperative and postoperative analgesia in children's subumbilical surgeries such as on the urogenital system, lower extremities and lower abdomen to reduce the stress response to surgery and to facilitate the general anesthesia. AIM: The purpose of this study was to compare the effects of caudally administered bupivacaine and levobupivacaine of equal volume and concentration on motor block and postoperative pain in children undergoing circumcision surgery. PATIENTS AND METHODS: The prospective, randomized, double-blind study included 60 patients with ages ranging from 1-10 years and ASA (American Society of Anesthesiologists) physical status of I-II who underwent elective circumcision surgery. The patients were divided into two groups: group B received 0.5 ml/kg of bupivacaine 0.25% caudally and group L received 0.5 ml/kg of levobupivacaine 0.25% caudally. Postoperative pain was assessed by children's and infant's postoperative pain scale and motor block was assessed by the Bromage scale. RESULTS: The mean children's and infant's postoperative pain scale of group B was significantly lower than that of group L (p < 0.001). Three patients in group B and seven patients in group L needed additional analgesia after the incision. There was no significant difference between groups in terms of Bromage scores and in both groups the residual motor block was found to be zero at the 150th minutes. CONCLUSION: According to these findings, bupivacaine has an adequate quality of analgesia than levobupivacaine. We suggest that bupivacaine for caudal block at the concentration of 0.25% (0.5 ml/kg) provides an adequate level of analgesia for outpatient circumcision surgery.

The retrospective annual surgical incidence of cystic echinococcosis in Sivas, Turkey.

Cystic echinococcosis is an important public health problem in our region. The aim of this study was to assess the surgical incidence of cystic echinococcosis in Sivas, Turkey. A retrospective follow-up study was carried out between 1997 and 2004. The mean age of 124 men (39.2%) and 192 women was 36.4 years. The liver was the primary site of cyst development (76.6%), followed by the lungs (19.9%), the spleen (5.4%), the kidneys (3.5%) and the peritoneal cavity (3.2%). Mean annual surgical incidence was 6.4 per 100,000 inhabitants for a 7-year period. The most common site of recurrence was the liver. Hepatic cysts were more frequently infected than pulmonary cysts (P < 0.05). In those patients with an infected cyst, the mean circulating eosinophil level was significantly lower than in those without. Rupture and infection were more common in men (P < 0.01). In conclusion, serious structural, legislative, surveillance, prevention and control measures for echinooccus should be undertaken in our region.

Expression of claudin-4 and beta-catenin in gastric premalignant lesions.

BACKGROUND AND STUDY AIMS: Abnormal expression of claudin-4 and beta-catenin play a role in carcinogenesis. The purpose of the present study was to examine claudin-4 and beta-catenin expression in normal and precancerous gastric mucosa. PATIENTS AND METHODS: Endoscopic biopsy specimens [normal gastric mucosa (n = 22), intestinal metaplasia (n = 24), dysplasia (n = 18), Helicobacter pylori (H. pylori)-associated chronic gastritis (n = 32) and remnant gastric mucosa (n = 18)] obtained from different 114 patients were examined by immunohistochemistry. RESULTS: Claudin-4 expression was present in 94.4% of dysplasia, 87.5% of intestinal metaplasia, 62.5% H. pylori-associated chronic gastritis, and 88.9% remnant gastric mucosa but only 18.2% of normal gastric mucosa biopsies. Decreased expression of beta-catenin was present in 27.8% of dysplasia, 8.3% of intestinal metaplasia, 15.6% of H. pylori-associated chronic gastritis, and 22.2% of remnant gastric mucosa biopsies, but was not present in normal gastric mucosa. When compared with normal gastric mucosa, there was a significant difference in claudin-4 expression in all groups (P < 0.05), but a significant difference was detected in dysplasia and remnant gastric mucosa for beta-catenin (P < 0.05). CONCLUSIONS: Our results suggest that claudin-4 expression is upregulated in premalignant gastric alterations.

In vitro comparison of biomechanical characteristics of sagittal split osteotomy fixation techniques.

The aim of the present study was to compare the biomechanical stability of 10 different fixation methods used in sagittal split osteotomy. Twenty-five fresh sheep mandibles were stripped of all soft tissues and sectioned at the midline. A sagittal split osteotomy with 5mm advancement was performed on each hemimandible. The hemimandibles were randomly divided into 10 groups of 5, and then fixed with 5 different bicortical screws, 4 different miniplates with or without bicortical screws, and 1 resorbable screw configuration. All specimens were mounted on a specially designed 3-point biomechanical test model and compression loads were applied using the Lloyd LRX testing machine until 3mm displacement was reached. Load/displacement data were gathered and compared using the Mann-Whitney U-test with Bonferroni correction (P<0.01). The 3 bicortical screws in an inverted backward-L pattern provided the most biomechanical stability of the screw patterns tested. The miniplate fixed obliquely with 2 bicortical screws in the proximal segment provided the most biomechanical stability of the miniplate groups.

Effects of sandblasting metal bracket base on the bond strength of a resin-modified glass ionomer cement: an in vitro study.

The introduction of air abrasion (sandblasting) technology to orthodontics may allow reaching optimum bond strength between the metal bracket and resin-modified glass ionomer cement. This study examined the effects of sandblasting metal bracket bases on the in vitro tensile bond strength of a resin-modified glass ionomer cement. Two-hundred foil-mesh based brackets were divided into ten groups and combinations of three sizes of aluminum oxide powder (25, 50 and 110 microm) and three sandblasting times (3, 6 and 9 seconds) were tested. One group was not sandblasted and used as control. Analysis of variance showed that bond strength was significantly affected by the sandblasting time (p < 0.001) and size of the aluminum oxide powder (p < 0.001). Only the group (SO(25)) sandblasted with 25 microm aluminum oxide powder for 3 seconds yielded higher mean bond strength than that of the control group. The bond strength values were also analyzed using a Weibull analysis, which showed the most favorable size (25 microm) and time combination (3 seconds), and the 5% and 90% probabilities of failures. This study suggests that sandblasting time and particle size have and important effect on the bond between the metal bracket and resin-modified glass ionomer cement.

An easy way of intruding an upper central incisor.

Discrepancies of the incisal edges of the anterior teeth, particularly in the upper jaw, could adversely affect dental aesthetics. This paper presents an easy and straight forward treatment of such a case, which was accomplished taking the patient's demands and profession into consideration. In dentistry, the social status of the patient could affect the treatment plan.

A prospective randomised cross-over study of the effect of local haemostasis after third molar surgery on facial swelling: an exploratory trial.

OBJECTIVE: This study was undertaken in order to evaluate the effects of local haemostasis on the facial swelling induced in patients undergoing surgical removal of impacted mandibular third molar teeth. DESIGN: A prospective randomised cross-over study. SETTING: Department of Oral and Maxillofacial Surgery, Samsun, Turkey, 2002. MATERIALS AND METHODS: Twenty-five healthy patients who were having bilaterally symmetric, impacted third molar extraction were studied. The teeth were removed in two separate operations by two surgeons who had equal academic degrees. The patients were assigned to test and control groups by random selection. One side served as control and on the other local haemostasis was achieved by a haemostatic agent (oxidised regenerated cellulose). This was placed into the socket following gauze packing for 3 minutes (test). The operating time therefore significantly increased in the test group. Data was collected regarding the operating time, mouth opening and facial swelling. RESULTS: There were no statistically significant differences between the test and control groups for the mean values of the facial swelling and mouth opening at day 1 and 3 post-operatively (P > 0.05). Operating time was statistically longer for the test group than the control (P < 0.001). CONCLUSION: This study has shown that establishment of local haemostasis after removal of impacted mandibular third molars is not so effective in preventing facial swelling.

Atypical presentation of an unusual lung tumor.

We describe a case of a rare bronchial epithelial- myoepithelial carcinoma of the lung in a 36-year-old man. Tumor enucleation was carried out and the patient was put on long-term follow up. Tumor categorisation was difficult. The patient is disease-free on the 30th postoper- ative month. The clinicopathological uniqueness of this neoplasm is reviewed.

Oral findings in a typical case of achondroplasia.

We report a 16-year-old boy who had all the typical manifestations of achondroplasia but also had a skeletal and dental class III malocclusion, a narrow maxilla, macroglossia and an open bite between the posterior teeth. The narrow maxilla and bilateral cross-bite were treated with rapid palatal expansion. The open bite and irregular teeth were corrected with fixed orthodontic treatment, taking account of the macroglossia. This case is of clinical interest since dental class III malocclusion, posterior open bite, macroglossia and benign migratory glossitis have not previously been reported in achondroplasia.

Prevalence of Helicobacter pylori in patients with primary hyperparathyroidism.

Dyspeptic symptoms are common in patients with primary hyperparathyroidism (PHPT) and have been attributed to hypercalcemia; however, they may also become permanent after parathyroid surgery. We aimed to evaluate the prevalence of Helicobacter pylori in patients with PHPT and to see whether there is a relationship between dyspeptic complaints and H. pylori infection. Of 21 patients with PHPT, 18 patients had dyspeptic complaints. These 18 female patients with PHPT and dyspeptic symptoms were the study population, and 20 female volunteers with dyspeptic symptoms were the controls. An endoscopic examination was performed in all controls and in patients before parathyroid surgery. H. pylori was assessed by serological and histological evaluation. H. pylori was identified upon histological evaluation in 17 patients (94.4%) and serologically in 17 patients (94.4%). Active macroscopic and microscopic gastritis were found in 15 (83.3%) and in 17 (94.4%) of the patients, respectively. In the control group, H. pylori was identified histologically in 13 subjects (65%) and serologically in 17 subjects (85%). The prevalence of H. pylori assessed by histological examination was significantly (P < 0.05) different between patients and controls. There was a significant association between H. pylori infection identified by histology and/or serology and the presence of microscopic (r = 1; P < 0.001), as well as macroscopic (r = 0.54; P < 0.05), gastritis. In conclusion, this study showed that H. pylori infection was found frequently (85.7%) in patients with PHPT. In the management of PHPT with or without surgery, patients, especially those with dyspeptic symptoms, should be evaluated for H. pylori infection, which can be effectively eradicated by appropriate therapy.

First-trimester diagnosis of Robinow syndrome.

We present 2 cases with Robinow syndrome in a nonconsanguineous Turkish couple. The first case, second living child of the family, has all of the cardinal features of this syndrome including short stature, mesomelic shortening of forearms, frontal bossing, hypertelorism, anteverted nares, triangular mouth, hypoplastic genitalia and vertebral and costal anomalies. The second case was diagnosed with first-trimester ultrasonographic findings such as shortening of extremities and increased nuchal translucency thickness at 12 + 4 weeks of gestation, and the family wished to terminate this pregnancy. After abortion, we obtained findings such as typical face features, shortening of forearms, ambiguous genitalia suggesting Robinow syndrome with autopsy examination.