Osteocalcin and cross-linked C-terminal telopeptide of type I collagen in gingival crevicular fluid during piezocision accelerated orthodontic tooth movement: A randomized split-mouth study.

Background: Piezocision, a minimally invasive surgical procedure, has been used to accelerate tooth movement'' is appropriate as a background to the abstract section. Aim: The aim of this randomized split-mouth study was to evaluate gingival crevicular fluid (GCF) osteocalcin (OC) and type I collagen cross-linked C-terminal telopeptide (ICTP) levels during canine distalization with and without piezocision acceleration. Material and Methods: Fifteen systemically healthy subjects (M:F 7:8, 16.27 ± 1.14 years) requiring extraction of maxillary first premolars before retraction of canines were included in the study. Piezocisions were randomly carried out on one of the maxillary canines while bilateral canines served as controls. Canine distalization was conducted using closed-coil springs applying a force of 150 g/side by using miniscrews as anchorage. GCF sampling was performed from maxillary canine mesial and distal sites at baseline, 1, 7, 14, and 28 days. The GCF levels of OC and ICTP were detected by enzyme-linked immunosorbent assay (ELISA). The rate of tooth movement was evaluated at 2-week intervals. Results: The amounts of canine distalization from baseline to 14 and 28 days in the piezocision group were significantly higher than the control group (P < 0.05). The GCF OC level of the piezocision group on the tension side and the ICTP level of the same group on the compression side were higher than the respective sides of the control group on day 14 (P < 0.05). Conclusions: Piezocision was found to be an effective treatment procedure for accelerating canine distalization accompanied by increased levels of OC and ICTP.

The gingival crevicular fluid levels of growth factors in patients with amlodipine-induced gingival overgrowth: A pilot study.

BACKGROUND: Amlodipine, calcium channel blocker (CCB), is used in the management of cardiovascular diseases which causes gingival overgrowth (GO). The growth factors may have a role in the pathogenesis of amlodipine-induced GO. OBJECTIVES: This pilot study aimed to investigate the growth factors including transforming growth factor-b1 (TGF-b1), platelet-derived growth factor-BB (PDGF-BB), and basic fibroblast growth factor (bFGF) in gingival crevicular fluid (GCF) of patients with amlodipine-induced GO and compare with of healthy subjects. METHODS: GCF samples were collected from 56 sites presenting GO (GO + group) and from 38 sites not presenting GO (GO- group) of 5 patients using amlodipine for more than one year, and from 45 sites (control group) of 5 healthy subjects. The levels of TGF-b1, PDGF-BB, and bFGF were determined by using ELISA kits. RESULTS: The mean concentration of TGF-b1 in GCF samples of GO + group (9.50 ± 7.30 ng/ml) was higher than both GO- group (2.07 ± 0.50 ng/ml) and control group (2.74 ± 1.01 ng/ml) (P = 0.014). No significant difference was found among the groups in the GCF levels of PDGF-BB (P = 0.767). bFGF was detected in only 33% of the sites from patients. CONCLUSION: These preliminary results suggest that TGF-b1 may play a crucial role in the pathogenesis of amlodipine-induced GO.

Effects of 810-nanometer diode laser as an adjunct to mechanical periodontal treatment on clinical periodontal parameters and gingival crevicular fluid volume of residual periodontal pockets.

BACKGROUND: Aim of this randomized controlled parallel-designed study was to evaluate the effects of diode laser as an adjunct to mechanical periodontal treatment on clinical parameters and gingival crevicular fluid (GCF) volume of the residual pockets diagnosed following initial periodontal treatment in chronic periodontitis (CP) patients. MATERIALS AND METHODS: A total of 84 residual pockets on single-rooted teeth in 11 CP patients were included and randomly assigned into three groups. Residual pockets were treated either only by mechanical treatment (Group M) (n = 28) or only by diode laser disinfection (Group L) (n = 28) or by a combination of these techniques (Group M + L) (n = 28). Plaque index, gingival index (GI), bleeding on probing (BoP), probing depth (PD), clinical attachment level and gingival recession were assessed at baseline and 8 weeks after treatment of residual pockets. GCF samples were collected at baseline, 1 and 8 weeks after treatment. RESULTS: All treatment modalities resulted in significant reductions in PD and attachment gain. GI and BoP showed a greater reduction in both Group M and Group M + L than Group L (P < 0.001), but there was no difference between the Groups M and M + L (P > 0.05). No difference was also found among groups for other clinical parameters. GCF volume decreased significantly in the Groups M and M + L (P < 0.05) but there was no difference among the groups (P > 0.05). CONCLUSION: Results demonstrated clinical improvements on residual pockets in CP patients treated with all three modalities. Moreover, our findings suggest that application of diode laser as an adjunct to mechanical periodontal treatment doesn't demonstrate any additional clinical effect on the residual pockets.

Evaluation of gingival crevicular fluid transforming growth factor-ß1 level after treatment of intrabony periodontal defects with enamel matrix derivatives and autogenous bone graft: A randomized controlled clinical trial.

AIM: The present study aimed to evaluate the effects of enamel matrix derivatives (EMD) either alone or combined with autogenous bone graft (ABG) applied to intrabony defects in chronic periodontitis patients on clinical/radiographic parameters and gingival crevicular fluid (GCF) transforming growth factor-ß1 (TGF-ß1) level and to compare with open flap debridement (OFD). MATERIALS AND METHODS: A total of 30 deep intrabony defects in 12 patients were randomly treated with EMD + ABG (combination group), EMD alone (EMD group), or OFD (control group). Clinical parameters, including plaque index, gingival index, bleeding on probing, probing depth, relative attachment level, and recession were recorded at baseline and 6 months postsurgery. Intrabony defect fill percentage was calculated on the standardized radiographs. TGF-ß1 level was evaluated in GCF just before surgery and 7, 14, 30, 90, 180 days after surgery using enzyme-linked immunosorbent assay. RESULTS: All treatment procedures led to significant improvements at 6 months (P < 0.01). Gain in attachment level (P < 0.01) and radiographic defect fill (P < 0.05) of the combination and EMD groups were found to be significantly higher than those of the control group, while the use of EMD either with ABG or alone was observed to produce significantly less recession than the OFD (P < 0.05). CONCLUSION: The findings suggest no clinical and radiographic differences between the combination and EMD groups whereas GCF TGF-ß1 level demonstrates an increase during the healing phase and is positively affected from EMD.

Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category III (AUS/FLUS).

BACKGROUND: Selection of nodules for surgery diagnosed as Bethesda category III [atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category] is very important. We aimed at to define the predictive factors for malignancy and factors associated with triage to surgery. METHODS: The records of all patients with nodules who underwent fine needle aspiration biopsy (FNAB) and classified by Bethesda reporting system as AUS/FLUS between 2011 and 2015 at our institution were reviewed. Univariate and multivariate analysis were performed to select independent factors associated with thyroid cancer and with triage to surgery. Using independent risk factors for malignancy predictive index categories were created. RESULTS: Of the 485 patients who were classified as AUS/FLUS on initial FNAB, 153 underwent surgery with the associated malignancy rate of 22.8%. The malignancy rates for AUS/FLUS patients with and without repeat FNAB were 37.5% and 16.2%, respectively. Multivariate logistic regression analysis revealed that solid structure, microcalcification, hypoechogenicity, increased vascularization, and irregular margin were found to be significant and independent risk factors associated for malignancy, and solid structure, microcalcifications, increased nodule size (≥2 cm) and younger patient age (<65 years) were associated with triage to surgery. CONCLUSIONS: Our findings showed that using predictive factors for malignancy in AUS/FLUS category as risk indices, an important proportion of patients (35%) who had nodules without any risk factors could be spared unnecessary surgery. We suggest that predictive indices should be considered for selection of the patients to triage to surgery.

Radiographic and histologic evaluation of platelet-rich plasma and bovine-derived xenograft combination in bilateral sinus augmentation procedure.

There is currently a great interest regarding the use of platelet-rich plasma (PRP) in combination with various bone graft materials in sinus lift procedures. The purpose of this study was to assess and compare the radiographic and histological results of sinus augmentation procedures following treatment with PRP/bovine-derived xenograft (BDX) vs. BDX/collagen membrane. Using a split mouth design, 10 patients, with ≤5 mm of residual alveolar bone in the vertical direction, were treated with PRP/BDX or BDX/collagen membrane. At 8 months after surgery, both graft materials led to a satisfactory increase in vertical dimensions of bone. Bone biopsies were taken from the augmented sites during the implant placement. Histological analysis demonstrated that majority of the trabecula contained orderly layered lamellar bone in the PRP/BDX group, whereas mainly woven bone with a haphazard arrangement of collagen fibers were noticed in the BDX /collagen membrane group. It can be concluded that both combinations resulted with a satisfactory bone height, but more prominent and mature bone formation was observed at sites treated with PRP/BDX.

Application of sentinel node biopsy in breast cancer patients with clinically negative and positive axilla and role of axillary ultrasound examination to select patients for sentinel node biopsy.

PURPOSE: To evaluate the identification rate and the false-negative (FN) rate of sentinel lymph node biopsy (SLNB) using preoperative axillary ultrasound (AU) in patients with clinically negative and positive axilla and to prove that SLNB could also be performed in clinically axillary positive patients. METHODS: Three hundred and fifty seven consecutive T1-2 invasive breast cancer patients with clinically negative or positive axilla were enrolled in our Institution between 2006 and 2011. All patients had preoperative AU, and underwent SLNB followed by breast conserving surgery or mastectomy with level 1, 2 axillary dissection. SLNB was performed using 5 mL of 1% methylene blue. The identification (ID) rate and the FN rate of SLNB were calculated for patients with clinically negative and positive axilla, and for patients with negative AU. RESULTS: Two hundred thirty two patients (65%) were clinically axillary-negative and 125 (35%) were clinically axillary-positive. The ID rates of SLNB were 91 and 89% and the FN rates were 7 and 9%, respectively, in patients with clinically negative and positive axilla. The ID rate of SLNB increased to 94% and the FN rate decreased to 4% after the exclusion of 85 patients (24%) with metastatic lymph nodes on AU. CONCLUSION: SLNB can be safely applied to T1 tumors regardless of the clinical status of the axilla. Use of AU before SLNB significantly increases the ID rate and decreases the FN rate of SLNB in clinically axillary negative as well as in positive patients.

Prognostic factors for locoregional recurrence and survival in stage IIIC breast carcinoma: impact of adjuvant radiotherapy.

INTRODUCTION: The aims of the present study were to define the prognostic factors for locoregional recurrence (LRR) and survival in stage IIIC breast carcinoma as well as to examine the impact of adjuvant radiotherapy on the outcome of the disease. METHODS: The records of 586 consecutive patients with stage IIIC breast carcinoma who underwent modified radical mastectomy were evaluated, and the prognostic factors for LRR and survival were analysed. Survival curves were generated using the Kaplan-Meier method, and multivariate analysis was performed using the Cox proportional hazard model. RESULTS: Five-year LRR and survival of stage IIIC breast carcinoma were 15 percent and 41.3 percent, respectively. Five-year LRR was significantly lower and five-year survival was significantly higher for all patients as well as for T1-2 patients with one to three apical node involvements who were treated with adjuvant radiotherapy. In multivariate analysis, apical node involvement, age below 35 years, T4 tumour, grade 3, extracapsular extension and lymphovascular invasion decreased survival, whereas adjuvant tamoxifen and adjuvant radiotherapy (risk ratio [RR] 0.51, 95 percent confidence interval [CI] 0.39-0.67) increased survival. Adjuvant radiotherapy was the sole independent factor that was found to be significantly associated with decreased LRR (RR 0.25, 95 percent CI 0.16-0.38). CONCLUSION: Radiotherapy decreased LRR and increased survival significantly in all stage IIIC patients and in the subgroup of T1-2 patients with one to three apical node involvements. Thus, it should be considered in the treatment of stage IIIC breast carcinoma.

Prognostic factors for survival in breast cancer patients who developed distant metastasis subsequent to definitive surgery.

INTRODUCTION: The present study was undertaken to define the prognostic factors for overall survival subsequent to definitive surgery, and for survival after the development of distant metastasis in breast cancer patients who developed distant metastasis subsequent to definitive surgery. METHODS: The records of 470 breast cancer patients with T1-3 tumours and distant metastasis following surgery were reviewed. Prognostic factors were compared to the first metastatic sites as solitary skeletal, multiple skeletal, and visceral metastases, and were analysed for overall survival following surgery and survival after metastasis. Survival curves were generated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. RESULTS: 79 patients (17 percent) had a solitary skeletal metastasis, 105 (22 percent) had multiple skeletal metastases, and 286 (61 percent) had a visceral metastasis. The five-year overall survival was significantly better for patients with a solitary bone metastasis (73 percent) compared to patients who had multiple bone metastases (46 percent), or a visceral metastasis (22 percent) (p-value is less than 0.0001). Pathological lymph node status 3, stage IIIC, grade 3, oestrogen receptor negativity, and visceral metastases were found to have independent detrimental influence on overall survival following surgery and survival after metastasis. A long-term metastasis-free interval affected post-metastatic outcome favourably. Radiotherapy improved overall survival. CONCLUSION: Pathological lymph node status, stage, grade, and oestrogen receptor status predicted survival after surgery as well as after the development of metastasis. Solitary bone metastasis has a more favourable prognosis than multiple bone metastases, and compared to visceral metastasis, skeletal metastasis has a more favourable prognosis.

Platelet-rich plasma in combination with bovine derived xenograft in the treatment of generalized aggressive periodontitis: a case report with re-entry.

Prominence has been given recently to the use of platelet-rich plasma (PRP) in combination with bone graft materials for predictably obtaining periodontal regeneration through bioengineering. The purpose of this report was to present clinical, radiographic and re-entry results of a generalized aggressive periodontitis (GAP) patient with wide intrabony periodontal defects treated with combined PRP and bovine derived xenograft (BDX). A-32 year old GAP patient who received non-surgical therapy and had 12 intrabony defects was treated with PRP and BDX combination. Prior to surgery and at 12 months, probing depth, marginal recession, relative attachment, probing bone and radiographic bone levels were measured. Re-entry was additionally performed at 12 months. Clinical and radiographic measurements together with re-entry results showed marked improvements from baseline with increased stabilization of whole dentition including the hopeless teeth. The surgical technique together with the materials used may be a possible solution for extensive bone loss.

Prognostic significance of total number of nodes removed, negative nodes removed, and ratio of positive nodes to removed nodes in node positive breast carcinoma.

BACKGROUND: This study was undertaken to investigate whether total number of nodes (pNtot) removed, negative nodes removed (pNneg), and ratio of positive nodes to total nodes removed (pNratio) are predictors of survival in node positive patients. STUDY DESIGN: The records of 801 consecutive invasive breast cancer patients with T1-3 tumour and positive axillary lymph node who underwent modified radical mastectomy in our hospital were reviewed. pNtot and pNneg were categorized, and pNratio was computed. The influence of these probable prognostic factors on survival was investigated. Survival curves were generated by Kaplan-Meier method and log-rank test was used for comparisons. Multivariate analyses were performed by Cox proportional hazard model. RESULTS: Median pNtot, and pNneg are 19 (range 5-54), and 13 (range 0-53), respectively. pNtot>15, and pNneg>15 were independently associated with reduced hazard ratios (HRs) of 0.62 (CI 0.48-0.79), and 0.68 (CI 0.52-0.89), respectively. The highest ratio (>0.25) of pNratio is associated with the highest hazard ratio for death (HR 3.8, CI 2.74-5.50) compared to the lowest ratio for death (<0.001). CONCLUSIONS: pNtot, pNneg, and pNratio appear prognostic factors for survival in node positive breast cancers. Axillary lymph node dissection with more number of nodes removed (>15) or negative nodes (>15) are associated with increased survival.

Effects of beta-D-glucan on steroid-induced impairment of colonic anastomotic healing.

BACKGROUNDS/AIMS: Inflammation during the early phase of anastomotic wound healing is an essential cellular response and is suppressed by corticosteroids. The anti-inflammatory effect of corticosteroids is largely responsible for its impairment of wound healing in bowel anastomosis. Beta-D-glucan, a commonly used macrophage activator, has been shown to improve anastomotic wound healing under normal conditions. In the present study, we have investigated the effects of beta-D-glucan on anastomotic wound healing in rats treated with long-term corticosteroid. METHODOLOGY: 92 male Sprague-Dawley rats were randomized into four groups. 1 : control, 2: control + beta-D-glucan, 3 : steroid, 4 : steroid + beta-D-glucan. Methylprednisolone (5mg/kg) was injected IM daily for 14 days in groups 3 and 4. After 14 days, following anaesthesia and laparotomy, colonic anastomosis was performed 3 cm away from the peritoneal reflection of rectum. In groups 2 and 4, 100mg/kg beta-D-glucan was administered orally for 7 days before laparotomy. On postoperative day 3, relaparotomies were performed and bursting pressures, hydroxyproline levels and histopathological specimens were studied. RESULTS: The mean values of bursting pressures groups were 50.8 (95% CI 46.99-56.50), 58.2 (95% CI 54.49-61.90), 32.0 (95% CI 29.21-34.98), 45.9 (95% CI 43.09-48.80) respectively. The differences of the mean values of the groups between group 1 and 2 and also 3 were significant (p = 0.002, p < 0.001). The mean values of hydroxyproline of the groups were 3.8 (95% CI 3.56-4.06), 4.7 (95% CI 4.50-5.04), 2.9 (95% CI 2.73-3.20), 3.9 (95% CI 3.65-4.22) respectively. The differences of the values of the groups between control (group1) and group 2 and also group 3 were significant (p = 0.001, p < 0.001). In histopathological examination, increased macrophages and fibroblast population were observed in specimens from beta-D-glucan-treated animals. CONCLUSION: The results indicate that in rat model, oral administration of beta-D-glucan causes a significant improvement in the healing of anastomotic wound impaired by long-term corticosteroid administration.

A comparison of the outcomes of non-randomised chemotherapy regimens in node positive breast cancer.

Adjuvant chemotherapy increases disease-free survival (DFS) and overall survival (OS) following surgery for breast cancer. However, debates concerning the type of adjuvant chemotherapy continue. The effect of adjuvant chemotherapy on loco-regional recurrence-free survival (LFS) was also reported. The present study was undertaken to compare the results of adjuvant FAC (5-fluorouracil, Doxorubicin, Cyclophosphamide) and CMF (Cyclophosphamide, Methotrexate, 5-fluorouracil) chemotherapy on DFS, OS and LFS for node positive breast carcinoma treated with mastectomy in a non-randomised setting. Data from 688 consecutive lymph node positive breast cancer patients who underwent radical or modified radical mastectomy and received adjuvant FAC (600/60/600 mgr/m2 for 6 cycles every three weeks) or CMF (600/40/600 mgr/m2 for 6 cycles on days land 8 every four weeks) chemotherapy were reviewed. The effect of FAC on DFS, OS and LFS as compared with CMF was analysed. Survival curves were generated by the Kaplan-Meier method, and a multivariate analysis was performed by the Cox proportional hazard model. Adjuvant FAC was found to improve DFS, OS and LFS. 5-year DFS, OS and LFS were longer for patients treated with FAC as compared to CMF (67% versus 53%, p < 0.001; 77% versus 66%, p < 0.001, and 97% versus 91%). Adjusted hazard ratio (HR) for potential risk factors and tamoxifen treatment showed that FAC treated patients much benefitted in terms of survival as compared to CMF treated patients (HR 0.53, CI 0.40-0.69 for DFS; HR 0.48, CI 0.35-0.65 for OS, and HR 0.33, CI 0.16-0.65 for LFS). In conclusion, adjuvant FAC improves DFS, OS and LFS as compared to CMF in node positive breast carcinoma patients treated with mastectomy.

Expression of growth factors in the gingival crevice fluid of patients with phenytoin-induced gingival enlargement.

The mechanism underlying phenytoin (PHT)-induced gingival enlargement (GE) is not yet known. The aim of the present study was to investigate transforming growth factor-beta1 (TGF-beta1), platelet-derived growth factor-BB (PDGF-BB) and basic fibroblast growth factor (bFGF) profiles in the gingival crevice fluid (GCF) of patients with PHT-induced GE and to compare the results with healthy controls. Five PHT-treated patients and five healthy subjects with normal periodontal tissue were included in this study. GCF samples were collected from (i) enlarged gingival sites in patients receiving PHT (GE+); (ii) non-enlarged gingival sites in the same patients (GE-); (iii) normal gingival sites of healthy subjects (control). The levels of TGF-beta1, PDGF-BB and bFGF in the GCF samples were analysed by ELISA. The results showed that the total amounts of TGF-beta1 and PDGF-BB in the GE+ group were higher than in the GE- group and significantly higher than in the control group (P < 0.05). However, no significant differences were found between the groups when the concentrations of these growth factors were compared. bFGF levels were not compared as this growth factor could be detected in only 33, 41 and 44% of the GE+, GE- and control GCF samples, respectively. These results show that TGF-beta1 and PDGF-BB are readily detectable in GCF obtained from enlarged and non-enlarged sites of PHT recipients and suggest that since the amounts were markedly higher at the GE+ than the GE- sites, the systemic administration of PHT has a pronounced localised effect on the levels of these growth factors. Moreover, our findings provide evidence that both TGF-beta1 and PDGF-BB are closely associated with the clinical manifestation of PHT-induced GE.

The effects of locally injected granulocyte macrophage-colony stimulating factor on the healing of intraoperatively irradiated intestinal anastomoses in rats.

Intraoperative irradiation is used to reduce the number of local recurrences and to increase disease free survival in the treatment of intestinal malignancies. Irradiation for the local control of tumours diminishes the wound healing in the intestine as in any other tissues. For many surgeons, it seems too risky to make resection and anastomosis in an irradiated intestine. Granulocyte Macrophage-Colony Stimulating Factor (Gm-csf) had been successfully used in chronic and incisional dermal wounds. In this study, we evaluated the effect of locally applied Gm-csf on intraoperatively irradiated rat small intestinal anastomosis. 160 male Sprague-Dawley rats were randomized into 4 groups. In group 1 (control), ileal resection was made (1 cm. in length) and anastomosis was performed. In group 2, ileal resection and anastomosis were performed and 50 microgr. rHu Gm-csf was injected subserosally in the perianastomotic area. In group 3, intraoperatively 2000 cGy irradiation was applied to the intestine following ileal resection and anastomosis. In group 4, ileal resection and anastomosis were performed, and 50 microgr. rHu Gm-csf was injected subserosally in the perianastomotic area, then intraoperatively 2000 cGy irradiation was applied to the intestine. On the 3rd and 7th days, relaparotomies were made in order to measure the bursting pressures of the anastomotic segments. The measurement of hydroxyproline levels were evaluated to determine the amount of anastomotic collagen. Histopathological evaluations were also performed. The bursting pressure values in gm-csf given groups were significantly higher than their control groups. The hydroxyproline content of group 4 was significantly higher than group 3 on the 3rd day. In conclusion, these data indicate that local injection of Gm-csf improves the wound healing of intraoperatively irradiated bowel anastomosis.

Effect of different enteral nutrients on bacterial translocation in experimental obstructive jaundice.

Obstructive jaundice leads to bacterial translocation (BT) by disruption of the gut barrier, intestinal microecology, and impaired host immune defence. The objective of the present study is to investigate the effects of different enteral nutrients on BT that is induced by obstructive jaundice in rats. Eighty male Wistar-Albino rats were randomly assigned into 4 groups. Group 1: 20 rats underwent laparotomy, common bile duct (CBD) was not actually ligated and transected, but sham ligation of CBD was performed. Groups 2-4: 60 rats underwent laparotomy, CBD ligation and transection. Group 1 and 2 rats were given rat chow, group 3 rats were fed a glutamine and arginine supplemented enteral diet, and group 4 rats were fed an arginine, m-RNA and omega-3 supplemented enteral diet, an immunonutrient. Rats in groups 3 and 4 had significantly less BT to mesenteric lymph nodes compared to rats in group 2 (p = 0.001). These findings suggest that oral administration of an arginine and glutamine supplemented diet and immunonutrition reduce BT in rats with obstructive jaundice.

Effects of locally applied recombinant human granulocyte-macrophage colony-stimulating factor on ischemic bowel anastomoses in rat.

BACKGROUND: Ischemia is one of the most common causes of anastomosis disruption. In the present study we investigated the effect of locally injected recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on ischemic bowel anastomosis in rats. METHODS: 144 male Sprague-Dawley rats were randomized into four groups: in group 1, colon anastomoses were performed; in group 2, anastomoses were performed then 50 microg rhGM-CSF was injected subserosally into the perianastomotic area; in group 3, anastomoses were performed on ischemic colon segments, and in group 4, colon anastomoses were performed on ischemic segments and then 50 microg rhGM-CSF was injected subserosally into the perianastomotic area. On the 3rd and 7th post-operative days, the rats were sacrificed and anastomotic bursting pressures were measured. Hydroxyproline contents were studied on the tissues from the anastomotic line. Three anastomotic segments were saved from each group for histopathological studies before bursting pressure measurement. RESULTS: The bursting pressure in group 3 was significantly weaker than in the other groups. There were no significant differences between the bursting pressures in groups 1 and 4. The levels of hydroxyproline content in group 4 were significantly greater than in group 3. CONCLUSIONS: These data suggest that the local injection of rhGM-CSF improves the healing of ischemic and even normal colon anastomoses.

Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma.

AIM: The objective of this study is to analyze the complication rates after the completion thyroidectomy and compare them with primary total thyroidectomy. METHODS: The outcomes of patients with differentiated thyroid carcinoma who were operated over a period of eight years were evaluated. One hundred and forty-one patients underwent completion thyroidectomy and 92 patients had primary surgery. RESULTS: The two groups were comparable in respect of clinical variables. Residual tumor was found in 66 of 141 patients (46.8%) in completion thyroidectomy group. The rate of the two most important complications, permanent recurrent laryngeal nerve palsy and permanent hypoparathyroidism were 3.5 and 4.2%, in completion thyroidectomy group, and 3.3 and 4.3%, in primary total thyroidectomy group. The complication rates were not significantly different between groups. CONCLUSION: In conclusion, completion thyroidectomy can be done safely in a specialized center with acceptable morbidity.

Prognostic significance of axillary node and infraclavicular lymph node status after mastectomy.

AIMS: The American Joint Committee on Cancer staging system for breast carcinomas has been revised. According to this revised staging system, metastasis to infraclavicular lymph nodes and number of positive axillary nodes have prognostic significance and a new stage, stage IIIC, has been introduced. The aim of this study is to investigate the association of positive axillary nodes by level and number with survival and stage migration between the old and the new stages in a large series of mastectomy patients. METHODS: Data from 1277 consecutive breast cancer patients treated by mastectomy were studied, retrospectively. Prognostic value of number of positive axillary nodes and entirely invasion of apex axillary nodes were analysed. Survival curves were generated by Kaplan-Meier method, and multivariate analysis was performed by Cox proportional hazard model. RESULTS: Five-year survival rates for metastasis to axillary level III and for stage IIIC breast cancer were 35.4 and 38.2%, respectively. Metastases to apex axillary nodes, 4-9 and 10 or more positive lymph nodes were found to be adverse and independent prognostic factors for survival in lymph node positive patients. CONCLUSION: Invasion of infraclavicular nodes and 4-9 and > or =10 positive axillary lymph nodes were independent predictors for survival in node positive breast carcinomas in this series. Patients with the new stage IIIC had the worst survival among breast cancer patients.

Prognostic factors affecting local recurrence and survival for operable rectal cancers.

The aim of this study was to define the local recurrence, survival rates and independent prognostic factors for survival, and local recurrence in patients with rectal carcinoma treated throughout 7 years. Between January 1990 and January 1998, 197 consecutive patients with rectal carcinoma, who underwent resection by conventional technique in Ankara Oncology Hospital, were retrospectively reviewed. Several clinical and pathological characteristics of patients were categorized. Kaplan-Meier method was used to obtain survival curves, and independent prognostic factors affecting survival and local recurrence were obtained by Cox regression analysis. 5-year survival, and local recurrence rates were 59%, and 33%, respectively. Stage, location of the tumour in distal one third, anterior resection, and poor differentiation were found to be independent detrimental influence on local recurrence. The independent prognostic factors for survival were invasion of tumour into serosa and adjacent organs, lymph node metastases and the total number of resected lymph nodes. Adjuvant therapy affected favourably local recurrence in stage II and III patients, and survival in stage III patients. In conclusion our local recurrence is high in stage I patients as well as in stage II and III patients although most of the patients received adjuvant therapy. Conventional technique might be responsible for high local recurrence rates; therefore, total mesorectal excision technique may be the proper choice to achieve a local recurrence rate under 10% and to have a better survival.