The Effect of Diltiazem on Microcirculation of Transplanted Tissue Flaps: Experimental Study on Rabbits.

BACKGROUND: The aim of the presented study was to investigate the inhibitory effect of diltiazem on the microcirculation of the tissue flaps created in the delay phenomenon applied rabbits. METHODS: The experiment was performed in Central Research Laboratory of Azerbaijan Medical University, Baku, Azerbaijan in 2018. Ischemia model on the flaps were formed in 30 rabbits for experiment. The subjects were divided into three groups: I (control) group - consists of 10 rabbits who underwent ischemia model, but no medication had been used during the duration of the experiment; II (comparative) group - consists of 10 rabbits who underwent ischemia model, and during 14 d, with a daily dose of 60 mсg nitroglycerin had been applied; III (main) group - consists of 10 rabbits who underwent ischemia model, and during 14 d, with a daily dose of 45 mg diltiazem had been applied. RESULTS: There was statistically significant difference between the control and the main groups when comparing the mean values of endothelial hyperplasia (P=0.001). However, we found a statistically significant difference when compared the mean values of the arterial vessel wall thickening in the main and the control groups (P=0.022); and the mean values of thrombosis in the main and the comparative groups (P=0.001). CONCLUSION: With prescription of diltiazem, endothelial hyperplasia on microcirculatory system, the thickening of arterial vessel walls, the thrombosis in vessel's passage was rarely seen by statistical difference. The main achievement of our study was to discover the correlation between diltiazem and endothelial hyperplasia.

Psychometric evaluation of Azeri version of the head and neck cancer specific quality of life questionnaire (EORTC QLQ-H&N43).

BACKGROUND: Oral cancer surgery can have a deep effect on the quality of life in the patient both in terms of functional and psychological aspects. This study aimed to translate and validate the European Organization for Research and Treatment of Cancer head and neck cancer specific quality of life questionnaire (EORTC QLQ-H&N43) in Azerbaijan. METHODS: Forward-backward translation was applied in order to translate the EORTC QLQ-H&N43 from English into Azeri. Then, a sample of patients with oral cancer attending a teaching hospital affiliated to Azerbaijan Medical University completed the EORTC QLQ-C30 (the core cancer specific questionnaire), and the EORTC QLQ-H&N43. To evaluate psychometric properties of the QLQ-H&N43, known groups validity, convergent and divergent validity was performed. Internal consistency reliability was examined by estimating the Crornbach's alpha coefficient. RESULTS: Ninety-six patients with confirmed diagnosis of oral cancer were entered into the study. The mean age of patients was 59.6 (SD = 10.7) years and 36 patients (37.5%) diagnosed as having stage IV and 10 patients (10.5%) were metastatic. The results obtained from comparing quality of life scores among these patients showed that the questionnaire was able to differentiate among patients who differed in stage and metastasis lending support to its validity. In addition convergent and divergent validity showed satisfactory results. The internal consistency of the multi-item scales as assessed by the Cronbach's alpha coefficient showed acceptable results (alpha ranging from 0.66 to 0.78). CONCLUSION: The findings suggest that in general the Azeri version of EORTC QLQ-H&N43 has satisfactory internal consistency reliability and validity, but additional psychometric evaluation is needed to draw firm conclusions.

The Azeri Version of European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30): Translation and Validation.

OBJECTIVE: Quality of life in cancer patients has become an important outcome measure. This study aimed to translate and validate the European Cancer Research and Treatment Core Quality of Life Questionnaire (EORTC QLQ-C30) in Azerbaijan. METHODS: Forward-backward procedure was applied to translate the EORTC QLQ-C30 from English into Azeri. Then a cross sectional study was conducted to validate the questionnaire in Azerbaijan. A sample of patients with confirmed diagnosis of oral cancer completed the Azeri version of the questionnaire from January 2017 to December 2018. Construct validity was assessed by performing know groups comparison and item-scale correlation matrix. Reliability was examined by estimating the Cronbach's alpha coefficient for internal consistency. RESULTS: In all 141 patients with oral cancer participated in the study. Known groups comparison indicated that the Azeri version of EORTC QLQ-C30 well differentiated between patients who differed in the disease stage. Those with higher stage reported lower functioning and higher symptoms. In addition item-scale correlation matrix showed a good correlation between items and its own hypothesized subscales as expected (Pearson correlation coefficient ranging from 0.735-0.978). The Cronbach's alpha coefficient ranged form 0.68 to 0.94 indicating acceptable results for the internal consistency of the questionnaire. CONCLUSION: This preliminary validation study proved that the Azeri version of EORTC QLQ-C30 is a valid measure of quality of life in cancer patients. However, studies with other cancer patients and stronger psychometric evaluations are recommended.

The Use of Pectoralis Major Musculocutaneus and Deltopectoral Flaps in Oromandibular Defects Reconstruction.

The main complication in patients with combined treatment of head, neck, mandibular and maxillary tumors is osteoradionecrosis, which appears after radiation therapy. Radiation therapy is widely used to treat cancer, but growing concern is related to the risk of osteoradionecrosis after treatment. This can occur after radiation therapy. Below, we would like to describe the treatment of osteoradionecrosis, which appeared 5 years after radiation therapy in a 54-year-old male patient. In 2012, a patient in Turkey was diagnosed with adenocystic carcinoma of the tongue base, and surgery was performed to remove the tumor after the patient underwent a course of radiotherapy. In 2016, the patient underwent again a surgery for tumor recurrence. In December 2017, the patient was admitted to our clinic with osteoradionecrosis. We performed segmental resection of the mandible, type I right-sided modified neck dissection, reconstruction of the mandible with a titanium plate and a pectoralis major muscle skin flap. The technique described in this case is the insertion of a well-vascularized tissue into the pre-irradiated and necrotic hypovascular region of the mandible with a skin-muscle flap of the pectoralis major muscle wrapped around the plate for reconstruction. As a result, a pectoralis major flap coverred the mouth floor on internal side and the outside skin defect was covered with a deltopectoral one. The viability of the skin-muscle flap of the pectoralis major muscle was assessed using clinical monitoring, checking the flap every four hours for the first 3 days. This study describes a successful outcome.

Evaluation of quality of life in patients with oral cancer after mandibular resection: Comparing no reconstruction, reconstruction with plate, and reconstruction with flap.

This cross-sectional study aimed to assess and compare quality of life in patients with advanced oral cavity tumors after mandibular resection in 3 groups (no reconstruction, reconstruction with plate, and reconstruction with flap) at the Cancer Institute, affiliated to Tehran University of Medical Sciences. Quality of life was measured using the European Organization for Research and Treatment of Cancer core quality of life questionnaire and European Organization for Research and Treatment of Cancer head and neck cancer-specific quality of life questionnaire-35 items. The comparison was tested using Kurskal-Wallis analysis. All 120 patients were entered into the study. The mean age of patients was 48.5 (standard deviation = 18.1) years. Patients presented with advanced stage of the disease and underwent mandibular resection with no reconstruction (n = 40), reconstruction with plate (n = 41), and reconstruction with flap (n = 39). The findings showed that in general, there were no statistically significant differences in quality of life among 3 groups except for speech problem (P = .4), dry mouth (P = .03), and feeling ill (P = .04). Although there were no significant differences in quality of life among patients in 3 groups, overall patients who received reconstruction with flap reported better functioning and fewer symptoms. Those who did not receive any reconstruction reported the worse conditions.

The Application of Virtual Planning and Navigation Devices for Mandible Reconstruction and Immediate Dental Implantation.

Routine reconstruction of subtotal defects of the mandible and orthopedic rehabilitation supported by dental implants is achieved by means of detailed planning and lasts over a year. This article shows the outcomes of single-stage surgical treatment and immediate orthopedic rehabilitation performed with the help of preoperative virtual computer simulation. 3D investigation of pathological and donor sites, virtual simulation of tumor resection, positioning of the dental implants into fibula, virtual flap bending and transfer, virtual bending of fixing reconstruction plates, and fabrication of navigation templates and bridge prosthesis supported by dental implants were done preoperatively. The surgery included tumor resection, insertion of dental implants into fibula, elevation of fibula osteocutaneous free flap, rigid fixation within recipient site, and immediate loading by bridge orthopedic device. On 10-month follow-up, functional and esthetic results were asses as reasonable. Radiography showed dental implants to be integrated and positioned appropriately. We found that successful rehabilitation of the patients with extensive defects of the jaws could be achieved by ablative tumor resection, dental implants insertion prior to flap elevation guided by navigation templates, further osteotomy, modeling of the flap based on navigation template, flap transfer, and rigid fixation within recipient site by prebended plates, with application of prefabricated prosthesis.