Assessment of Thyroid Lobe Dose in Breast Cancer Intraoperative Radiotherapy.

BACKGROUND: Breast cancer is the most common cancer among women. Considering the fact that a high dose is delivered in a single fraction of IORT, the evaluation of the dose at sensitive organs like thyroid is necessary. OBJECTIVE: The current study has aimed to evaluate the received dose to thyroid lobes in the breast IORT technique. MATERIAL AND METHODS: A total of 49 women with breast cancer undergoing IORT were enrolled in this cross-sectional study with census sampling. Immediately after tumor resection, a single dose of 20 Gray at the applicator surface was delivered using 50KV X-ray by an Intrabeam machine. The thyroid dose was detected using thermoluminescent detectors (TLD) 100 at the mid-thyroid line, left and right lobes. RESULTS: The dose at the right and left lobes of the thyroid gland as well as the mid-thyroid line was found to be 40.18±35.44 mGy, 35.50±27.32 mGy, and 40.61±32.47 mGy, respectively. The right lobe received a significantly higher absorbed dose compared to the left lobe when the right breast was under IORT treatment. The same trend was seen with the left lobe and left breast under IORT treatment (P=0.0001 and P=0.018, respectively). The applicator size showed non-significant effects on the absorbed dose at the thyroid gland. Also, the applicator depth had a non-significant inverse effect on thyroid dose. CONCLUSION: According to our findings, the absorbed dose at each thyroid lobe depends on the under-treatment side as well as the applicator size and depth (applicator upper surface distance from the skin).

Influence of red mud on mechanical and durability performance of self-compacting concrete.

Red mud is a hazardous waste material produced during alkaline leaching of bauxite in the Bayer process. This study proposed the use of red mud to replace fly ash in self-compacting concrete (SCC) and the influences of red mud on fresh and hardened properties, and durability performances of SCC were studied. The fresh concrete results show that red mud had a slight negative impact on the fresh properties of SCC. The hardened concrete results show that the mechanical strength of concrete increased with increasing of red mud content. The half-cell potential test results indicated that red mud had a significant effect on restraining the corrosion process in SCC. Compared to the control sample, the red mud samples suffered less corrosion. Cracks associated with corrosion of reinforcement were observed in RMC0 and RMC100 samples after 28 day accelerated corrosion test. The ICP-MS results showed that there's no significant difference in metal elements among the solutions regardless the red mud content in concrete.The relative corrosion rate test results suggested that red mud can suppress the corrosion current. The SCC samples consisting 75% red mud performed the best resistance to corrosion according to the results of half-cell potentials and mass loss of rebar.

Accessory tongue: Classification and report of a case.

BACKGROUND: Accessory tongue (AT) is a rare congenital anomaly. Due to rarity of AT, various terminologies are applied, including accessory tongue, bifid tongue, double tongue, cleft tongue, and supernumerary tongue. It seems that the anomaly has geographic distribution and most reported cases are from India and Middle East. No comprehensive classification has been introduced yet. So, we present a classification for AT according to review of all papers and documents that we found, and report a 2-month-old male infant with this anomaly.

The clinical effectiveness of various adhesive systems: an 18-month evaluation.

The aim of this clinical trial was to compare the clinical performance of three different adhesive systems over 18 months in noncarious cervical lesions (NCCLs). Thirty patients, with at least three noncarious cervical lesions, were enrolled in the study. One operator randomly restored a total of 90 lesions with resin composite (Herculite XRV). The restorations were bonded with either Optibond FL (OF), three-step total-etch; Optibond Solo Plus (OS), two-step total-etch; or Optibond All-In-One (OA), one step self-etch. The restorations were clinically evaluated at baseline and after six, 12, and 18 months using the eight United States Public Health Services criteria. Data were analyzed using Friedman and Wilcoxon signed ranks tests (p<0.05). After 18 months, the retention rate was (OF) 96.5%, (OS) 93.1%, and (OA) 89.7%. Differences among the three adhesive systems for evaluated criteria were not observed in comparison of the mean Alfa score percentages. There was a significant increase in marginal discoloration for (OA) adhesive after 18 months compared with baseline (p=0.011). Other restoration criteria had no statistically significant differences among the three adhesives (p>0.05). With the exception of marginal discoloration, the clinical effectiveness of three types of adhesive systems in NCCLs was acceptable after 18 months. However, using the one-step self-etch adhesive may lead to some marginal discolorations.

Comparison of the anaesthetic efficacy of and heart rate changes after periodontal ligament or intraosseous X-Tip injection in mandibular molars: a randomized controlled clinical trial.

AIM: To compare the efficacy of supplemental anaesthesia using periodontal ligament injections (PDL) and intraosseous injections with the X-Tip system in terms of the measured heart rate and patient reported pain level. METHODOLOGY: In this single-blind randomized clinical trial, 40 patients (22 women, 18 men) with irreversible pulpitis who had experienced unsuccessful pain management by inferior alveolar nerve block with 2% lidocaine and 1 : 100 000 epinephrine were selected. Patients were divided equally and randomly into two groups. Supplementary anaesthesia was provided through intraosseous injection with the X-Tip system (X-Tip group) or by PDL injection (PDL group). After each step of injection, pain severity was assessed using a visual analogue scale. Patient heart rate was recorded with a pulse oximeter. Data were coded and analysed using Mann-Whitney U-test with SPSS (version 16) software. RESULTS: Anaesthetic success was obtained in 100% of X-Tip and 70% of PDL group patients after the first supplemental injection. Compared with the first PDL injection, the first intraosseous injection resulted in a significant increase in heart rate (P = 0.001); however, this increase was short-lived (mean increase: 9-10 beats per min). No significant difference in heart rate or anaesthesia success was observed between men and women. CONCLUSION: Intraosseous injection using the X-Tip system was more effective than PDL injection as a supplementary anaesthetic for pulpectomy in mandibular molars or second premolars. However, the former resulted in a transient increase in heart rate.

Prosthetic incisional hernioplasty: clinical experience with 354 cases.

BACKGROUND: The use of prosthetic materials has become the standard of care in the management of incisional hernias because of its association with a low rate of recurrence. In this paper, the results of the treatment of incisional hernias is reported. METHODS: Over a 15-year period, 354 open abdominal wall incisional hernia repairs were performed using the Rives-Stoppa, onlay and inlay techniques. The prosthetic materials used were polypropylene and Mersilene mesh. Using a questionnaire, the individual characteristics, type of operation (technique), type of prosthesis, complications and surgical outcome were recorded and analysed by SPSS software. RESULTS: A total of 354 patients underwent prosthetic incisional hernioplasty, comprising 265 women and 89 men, with a mean age of 52.1 years, using three techniques that included Rives-Stoppa (312), onlay (33) and underlay (9). The majority of complications included seroma (10), infection (8), intestinal fistula (2), mesh removal (2) and respiratory complication (4). Eighty percent of the patients used abdominal belts after the surgical procedure. Recurrent hernias were observed in four patients with a mean of 98 months follow up. All patients received pre-operative intravenous antibiotics and were discharged with oral antibiotics. CONCLUSION: In this series, the prosthetic incisional hernioplasty approaches, especially the Rives-Stoppa method, yielded excellent long-term results, with minimal morbidity in patients and large primary or recurrent incisional repair.

Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer

ObjetivoLa biopsia selectiva del ganglio centinela es el método estándar para la estadificación axilar del cáncer de mama. En algunas pacientes el ganglio centinela no es identificado durante la cirugía y tiene que realizarse una linfadenectomía axilar estándar. En este estudio hemos evaluado los factores predictores del fallo en la localización del ganglio centinela utilizando la administración intradérmica del radiotrazador combinada con la inyección de colorante azul de metileno.Material y métodosSe evaluaron retrospectivamente 202 pacientes consecutivas con cáncer de mama, clínicamente estadios I o II. Se analizan y comparan diferentes variables entre las pacientes cuyo ganglio centinela se localizó durante la cirugía y aquellas que no fue posible la detección del ganglio centinela.ResultadosEl ganglio centinela fue identificado en la linfogammagrafía previa en 180 pacientes (89%). El análisis uni y multivariable mostró que la no visualización del ganglio centinela en la linfogammagrafía, la experiencia del cirujano y la existencia de metástasis en los ganglios axilares se asocian con fallo de localización del ganglio centinela durante la cirugíaConclusionesEste estudio muestra la importancia de la linfogammagrafía previa a la cirugía para predecir aquellos pacientes con posible fallo en la localización quirúrgica del ganglio centinela. Recomendamos la necesidad de una fase de aprendizaje de la técnica antes de su aplicación clínica rutinaria(AU)

ObjectiveThe standard method for axillary lymph node staging in early breast cancer is sentinel lymph node biopsy. In some patients the sentinel lymph node can not be localized during surgery and these patients have to undergo standard axillary lymph node dissection. In this study we have evaluated the predictors of sentinel lymph node localization failure using 99mTc-antimony sulfide colloid and intradermal injection combined with blue dye technique.Material and methods202 consecutive patients with early stage breast cancer (clinically stage I or II) were retrospectively evaluated. Patients whose sentinel lymph node was localized during surgery were compared to those with localization failure considering several variables.ResultsSentinel lymph node was successfully located on the pre-operative lymphoscintigraphy images in 180 patients (89%). Both univariate and multivariate analyses showed that only sentinel lymph node non-visualization by pre-operative lymphoscintigraphy, experience of the surgeon, and axillary lymph node involvement are associated with sentinel node localization failure during surgery.ConclusionsThis study shows the importance of pre-operative lymphoscintigraphy in order to identify the group of patients with possible localization failure during surgery and warning the surgeon beforehand. We also recommend that all surgeons pass the learning curve of sentinel lymph node biopsy before routinely performing this procedure(AU)

Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer.

OBJECTIVE: The standard method for axillary lymph node staging in early breast cancer is sentinel lymph node biopsy. In some patients the sentinel lymph node can not be localized during surgery and these patients have to undergo standard axillary lymph node dissection. In this study we have evaluated the predictors of sentinel lymph node localization failure using (99m)Tc-antimony sulfide colloid and intradermal injection combined with blue dye technique. MATERIAL AND METHODS: 202 consecutive patients with early stage breast cancer (clinically stage I or II) were retrospectively evaluated. Patients whose sentinel lymph node was localized during surgery were compared to those with localization failure considering several variables. RESULTS: Sentinel lymph node was successfully located on the pre-operative lymphoscintigraphy images in 180 patients (89%). Both univariate and multivariate analyses showed that only sentinel lymph node non-visualization by pre-operative lymphoscintigraphy, experience of the surgeon, and axillary lymph node involvement are associated with sentinel node localization failure during surgery. CONCLUSIONS: This study shows the importance of pre-operative lymphoscintigraphy in order to identify the group of patients with possible localization failure during surgery and warning the surgeon beforehand. We also recommend that all surgeons pass the learning curve of sentinel lymph node biopsy before routinely performing this procedure.