Genetic markers of survival and liver recurrence after resection of liver metastases from colorectal cancer.

A significant number of patients with liver metastases from colorectal cancer (CRC) achieve 5-year survival after liver resection. Increased expression of genetic markers in the primary tumor are known to predict outcome after colonic resection, but the predictive value of such markers after resection of hepatic metastases is unknown. The objective of this study was to evaluate whether DNA content and multiple genetic markers, separately or expressed together, can predict patient outcome (liver recurrence and survival) after resection of hepatic metastases. We studied the paraffin-embedded liver tissue of 71 consecutive patients who had undergone a potentially curative resection of hepatic metastases from CRC. Using DNA flow cytometry and immunohistochemical staining techniques we determined the DNA content and the level of co-expression of seven tumor-associated proteins: proliferating cellular nuclear antigen (PCNA), epidermal growth factor receptor (EGFr), p53, c-erbB-2, H-ras, c-myc, and nm23. Three endpoints (liver recurrence, cancer specific, overall survival) were correlated with these tumor markers. The 5-year overall survival of the group was 31.2%. There was no correlation detected between the DNA aneuploidy and overall or cancer-specific survival. Similarly, expression of the individual tumor-associated proteins did not predict survival. Patients whose tumors co-expressed multiple markers had survivals similar to those whose tumors expressed fewer markers. However, a significant difference in hepatic recurrence was found between the p53-positive and p53-negative patients (p = 0.007), with marker-negative tumors having decreased recurrence. In conclusion, this study demonstrates that the DNA content and genetic markers c-myc, c-erbB-2, EGFr, H-ras, p53, PCNA, and nm23 do not predict survival after potentially curative resection of hepatic metastases from CRC. However, the immunoreactivity of p53 may be an important marker of local recurrence in the liver, which may be useful if re-resection of metastatic liver tumors is considered a viable management option in this disease.

Hypomagnesemia and hypocalcemia after thyroidectomy: prospective study.

Hypomagnesemia after total thyroidectomy has not been studied extensively. Our anecdotal experience suggests that it may be important in some patients after thyroid excision. The hypomagnesemic hypocalcemic syndrome has been described in other disease states in which a state of functional hypoparathyroidism exists. This study was designed to determine the incidence of hypomagnesemia after total thyroidectomy and relate it to hypocalcemia and symptoms during the postoperative period. A prospective study of all patients undergoing total thyroidectomy between September 1994 and July 1996 was performed. Patient data, thyroid function, retrosternal extension, initial versus reoperative surgery, operative details, parathyroid resection, and pathology were recorded. Calcium, magnesium, electrolytes, blood count, liver function tests, and albumin were measured prior to surgery and twice daily during the postoperative period. Fifty patients underwent total thyroidectomy: 68% were hypocalcemic, 72% were hypomagnesemic, and 36% were symptomatic during the postoperative period. Hypomagnesemia and gender were associated with hypocalcemia. Volume of fluid and neck dissection were associated with low magnesium levels. Hypomagnesemia and parathyroid resection were risk factors for symptoms after thyroidectomy. No patients developed permanent hypoparathyroidism. Transient hypocalcemia and hypomagnesemia occur frequently after total thyroidectomy. The etiology of this phenomenon is probably multifactorial. Patients are more likely to be symptomatic when both cations are low, and attempting to correct only hypocalcemia may prolong symptoms. It is important to monitor both calcium and magnesium levels after total thyroidectomy and to correct deficiencies to facilitate prompt resolution of symptoms.

Voice changes and thyroid surgery: is pre-operative indirect laryngoscopy necessary?

BACKGROUND: Indirect laryngoscopy (IDL) is often performed prior to thyroid surgery to detect pre-existing vocal cord pathology. METHODS: A retrospective chart review of 201 patients undergoing thyroid surgery at the Prince of Wales Hospital was undertaken in order to study the patterns of pre-operative and postoperative voice changes and IDL findings. RESULTS: A total of 9% of patients had pre-operative voice symptoms, and 22% of this group had abnormalities detected on pre-operative IDL. Of 160 documented IDL, 4% revealed vocal cord pathology in asymptomatic patients, including an asymptomatic recurrent laryngeal nerve palsy. CONCLUSIONS: Indirect laryngoscopy remains a useful but flawed pre-operative screening tool for patients with voice symptoms, but the literature suggests that more advanced phoniatric tests will provide superior diagnostic sensitivity. The role of routine pre-operative laryngoscopy for asymptomatic patients is of debatable value.

Predicting dentists' career choices using the Myers-Briggs type indicator.

The Myers-Briggs Type Indicator is a psychological measure designed to determine personality preferences, learning styles and management styles and to assist with career choices. The authors surveyed 1,117 practicing dentists to determine if the MBTI was useful in determining which respondents were most likely to be specialists. They found no significant differences between general practitioners and specialists.

Perceived sources of stress in the dental school environment.

The purpose of this study was to identify the perceived stress of dental students across the entire curriculum (D1-D4 years). The dental environmental stress (DES) questionnaire was administered to 244 (90.4 percent) dental students during 1990. Significant differences were found for 12 questionnaire items across four classes. For male-female comparisons, significant differences were found for 17 questionnaire items, all perceived as more stressful by females; and between classes, significant differences were accounted for by three questionnaire items. Comparisons with previous dental students (1980s) on the identical questionnaire were noted.

Personality types of dentists.

The Myers-Briggs Type Indicator (MBTI) was used to determine the personality types of dental graduates, 1964-1984, from Creighton University, School of Dentistry. The MBTI reveals the strength and nature of preferences along four dimensions: extraversion-introversion, sensing-intuition, thinking-feeling, and judging-perceptive. In sample (N = 472), four personality types: ISTJ (108), ESTJ (66), ISFJ (48), and ENTJ (37), accounted for 54.9% (N = 259) of the dentists. The remaining 45.1% (N = 213) were divided among 12 personality types without any type accounting for more than 6.1% (N = 29). Comparisons with a general population (N = 9,320) revealed that the dental sample included more introverts (58.9%), thinkers (65.9%) and judgers (75.0%). The implications of personality characteristics, as applied to dentistry through communication patterns, relationships with co-workers and management styles were discussed.

Personality styles of first-year dental students.

The Myers-Briggs Type Indicator (MBTI) was used to measure the personality styles of dental students in two first-year classes. The MBTI measures the strength and nature of preferences along four dimensions: extroversion-introversion, sensing-intuition, thinking-feeling, and judging-perceptive. In the sample (N = 120), four personality styles--ESTJ (19), ESFJ (19), ENTJ (16), and ISTJ (12)--accounted for 55 percent of the students (N = 66). The remaining 45 percent (N = 54) were divided among 12 personality styles with no style comprising more than 5.8 percent of the students (N = 7). Further comparisons of personality traits emphasized the similarities of the student sample on dimensions of extroversion (68.3 percent), sensing (61.7 percent), and judging (74.2 percent). Comparisons with previous research confirmed the predominance of ST (sensing with thinking) and SF (sensing with feeling) combinations within dentistry. The implications for the organization and curriculum of dental schools considering the personality traits of these dental students are discussed.

An experimental analysis of injuries to the menisci of the knee joint.

Direct methods were used to determine the distribution of injuries to the menisci in formalin fixed knee joints, rotated under physiological pressures when extended and at different degrees of flexion. The position of the joint during rotation rather than the direction of rotation determined the distribution of injury between the menisci, whereas both direction of rotation and joint position determined the position of major types of lesion within the meniscus. Support is given for the view that the incidence of injury to the lateral meniscus is higher than generally accepted.