Large solitary scalp metastasis of renal cell carcinoma: A case report.

Renal cell carcinoma (RCC) can metastasize to various organs of the body. The skin is an uncommon site for metastasis. However, if metastasis to skin occurs, scalp is a common area. We present a 77-year-old male patient, with a 12-year history of RCC. In the current presentation, he was hospitalized due to hematuria, fatigue, electrolyte imbalance, and deteriorating kidney functions. After the patient was stabilized, he was referred to the plastic surgery clinic due to an unusual, extremely large, hemorrhagic, ulcerative, and vegetative mass on his scalp. Total excision of the scalp mass was performed and, it was noted that the calvarium was intact and the defect was grafted. Histology report of the specimen confirmed to metastatic RCC. Clinicians need to keep in mind that large cutaneous lesion can be a metastasis from an internal malignancy.

Comparison of warm vertical compaction and cold lateral condensation of α, ß gutta-percha and resilon on apically extruded debris during retreatment.

BACKGROUND: This study was performed to evaluate the amount of apically extruded debris removed from a root canal filled with cold lateral condensation (CLC), and warm vertical compaction (WVC) techniques, using b or a phase gutta-percha with AH-Plus (Dentsply DeTrey, Konstanz, Germany) or Resilon (Resilon Research LLC, Madison, WI) with RealSeal SE (SybronEndo, Amersfoort, The Netherlands). MATERIALS AND METHODS: About 100 human incisor teeth were prepared with a #25.06 NiTi rotary system and divided into five groups according to the filling material used: Group 1: CLC (gutta-percha, AH-Plus); Group 2: WVC (b phase gutta-percha, AH-Plus); Group 3: WVC (a phase gutta-percha, AH-Plus); Group 4: CLC (Resilon, RealSeal SE); and Group 5: WVC (Resilon, RealSeal SE). Extruded debris during the retreatment procedure was collected in preweighed Eppendorf tubes. The times required for retreatment were recorded. RESULTS: The amount of debris extrusion was significantly greater with WVC than CLC in the gutta-percha and Resilon groups (P < 0.001). Using a phase gutta-percha resulted in significantly more debris extrusion than b phase gutta-percha (P < 0.001). In the WVC groups, Resilon caused significantly more debris extrusion than gutta-percha (P < 0.05). Retreatment was faster for CLC than WVC (P < 0.05). CONCLUSIONS: In the retreatment procedure, the amount of apically extruded debris and retreatment duration were dependent on the type of obturation material and technique used.

Do separated instruments affect pH levels when using calcium hydroxide as intracanal dressing?

BACKGROUND: The aim of this study was to evaluate the effect of intracanal separated instruments with different lenghts on periapical pH levels using calcium hydroxide (CH) as an intracanal medicament. MATERIALS AND METHODS: In total, 60 teeth were used. Following root canal preparation, teeth were divided into four groups (n = 15). In Group 1, 2 mm and in Group 2, 4 mm weakened from the tip of Revo-S NiTi SC2 (Micro-Mega, Besancon, France) instruments were separated in the apical portion of root canals. In Group 3, there was no separated instrument. CH paste was placed in the first three groups. In Group 4, there was no separated instrument or CH paste. Teeth were placed in containers with deionized distilled water. After 1 h and 1, 2, 7, 15, and 30 days, the pH of the solution was measured. RESULTS: At 1 h, Group 3 showed a significantly higher pH than Groups 1 (2 mm) and 2 (4 mm; P < 0.05). At the same time point, Group 1 (2 mm) showed a higher pH than Group 2 (4 mm) without significance. At 1, 2, 7, 15, and 30 days, Group 2 (4 mm) showed a significantly lower pH than Groups 1 (2 mm) and 3 (P < 0.05). At the same time points, Group 1 (2 mm) showed a lower pH than Group 3 without significance. CONCLUSIONS: Separated instrument may affect the rise in periapical pH level when using CH as the intracanal dressing. Therefore, 4 mm of separated instrument in the apical third showed a significant effect.

Evaluation of fracture resistance in root canal-treated teeth restored using different techniques.

OBJECTIVE: This study aimed to evaluate the effects of different coronal restoration techniques on fracture resistance of root canal-treated mandibular premolars with mesio-occluso-distal (MOD) cavities. MATERIALS AND METHODS: A total of 105 mandibular premolars were selected and randomly distributed into seven groups (n = 15). MOD cavities were prepared except the control group. Root canal treatments were performed. Each tooth was embedded in acrylic resin. Groups were classified as follows; G1: intact teeth (control), G2: unfilled MOD cavity, G3: MOD + composite resin, G4: 10-mm-long fiber post + composite resin, G5: 5-mm-long fiber post + composite resin, G6: Ribbond in the occlusal surface + composite resin, and G7: horizontal fiber post + composite resin. Specimens were loaded using a universal testing machine until fracture occurs. Fracture loads were recorded and statistical interpretations were made (α = 0.05). RESULTS: In Groups 1, 6, and 7, the greatest fracture resistance was shown and there were no significant differences among these groups (P > 0.05). No significant differences were detected among the Groups 3, 4, and 5 (P > 0.05), whereas the fracture resistances of Groups 1, 6, and 7 were significantly greater than these three groups (P < 0.05). Group 2 had the lowest fracture resistance of all groups (P < 0.05). CONCLUSION: Usage of horizontal post or occlusal Ribbond usage increased the fracture resistance of root canal-treated premolars with MOD cavities.

Evaluation of apically extruded debris during root canal retreatment with several NiTi systems.

AIM: To compare the amount of debris extruded apically during root canal retreatment using ProTaper, Mtwo and Reciproc instruments with hand H-files. METHODOLOGY: In total, 60 freshly extracted human mandibular incisor teeth were used. All root canals were prepared with a Reciproc R25 file than filled with Gutta-percha and AH Plus sealer using cold lateral condensation before being assigned randomly to four groups (n = 15 each). In group 1, root fillings were removed with the Protaper Universal retreatment system; ProTaper Universal F3 and F4 instruments were used for the final preparation. In group 2, root fillings were removed with the Mtwo retreatment system; Mtwo size 30, .06 taper, size 35, .06 taper and size 40, .06 taper files were used for the final preparation. In group 3, root fillings were removed with Reciproc R25 instruments; Reciproc R40 instruments were used for the final preparation. In group 4, the root fillings were removed with Gates Glidden burs and sizes 35, 30 and 25 H-files; for final preparation, a size 40 H-file was used. Glass vials were used for debris collection. The vials were weighed before and after Gutta-percha removal. Additionally, the times required for the retreatment procedures were recorded. Data were analysed statistically using one-way analysis of variance. RESULTS: The Reciproc system produced significantly smaller amounts of apical extruded debris than the other groups (P < 0.05). There was no significant difference between the Mtwo, H-file and ProTaper groups. The ProTaper and Reciproc groups required significantly less time than the Mtwo and H-file groups (P < 0.001). CONCLUSIONS: Use of the reciprocating single file system resulted in the extrusion of significantly less debris compared with the full-sequence rotary NiTi instruments and hand filing. Use of the ProTaper and Reciproc instruments required less time for retreatment procedures than use of the Mtwo or H-file.

Evaluation of apically extruded debris associated with several Ni-Ti systems.

AIM: To evaluate the apical extrusion of debris associated with several root canal preparation systems in vitro. METHODOLOGY: Forty-five extracted human mandibular premolars with single canals and similar lengths were used. The root canals were instrumented using ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland), Twisted File (SybronEndo, Orange, CA, USA) or WaveOne (Dentsply Maillefer, Ballaigues, Switzerland). Debris extruded apically during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70 °C for 5 days. The Eppendorf tubes were weighed to obtain the final weight of the Eppendorf tubes plus extruded debris. Three consecutive weights were obtained for each tube. The groups were compared using the Kruskal-Wallis one-way analysis of variance on Ranks and Tukey's test. RESULTS: The ProTaper Next group produced the highest mean extrusion value whilst WaveOne produced less debris compared with all the other instruments (P > 0.05). There was a significant difference between the ProTaper Next and WaveOne group (P < 0.05). CONCLUSIONS: Apically extruded debris was associated with all instrumentation techniques. The WaveOne system extruded less debris compared with the Twisted File and ProTaper Next.

Effects of ozone and photo-activated disinfection against Enterococcus faecalis biofilms in vitro.

OBJECTIVES: The purpose of this study was to compare the antibacterial effects of gaseous ozone (O3) and photo-activated disinfection (PAD) methods against Enterococcus faecalis (E. faecalis) biofilms. MATERIALS AND METHODS: Sixty-five human mandibular premolars with straight root canals were selected. After root canal preparation, the samples were sterilized and placed into eppendorf tubes with 1 mL brain heart infusion broth containing 1.5×10(8) colony-forming units (CFUs)/mL of E. faecalis. The contaminated samples were then divided into four groups (n=15) according to the disinfection method used: Group 1, Saline (positive control); Group 2, NaOCl (negative control); Group 3, Gaseous O3; and Group 4, PAD. Three non-contaminated teeth were used to control the infection and sterilization process. The CFUs were counted and the data were analyzed statistically. RESULTS: There was a statistically significant difference between the experimental and control groups (P<0.05). The saline group had the highest number of remaining microorganisms. Complete sterilization was achieved in the 2.5% NaOCl group. There were no statistically differences between PAD and gaseous O3 (P>0.05). CONCLUSION: Both PAD and gaseous O3 have a significant antibacterial effect on infected root canals. However, 2.5% NaOCl was superior in terms of its antimicrobial abilities compared with the other disinfection procedures.

Effect of solvents on the accuracy of the Mini Root ZX apex locator.

AIM: To evaluate ex vivo, the effects of three solvents on the accuracy of a contemporary electronic root canal length measurement device (ERCLMD), the Mini Root ZX. METHODOLOGY: The actual working length (AWL) of 56 extracted maxillary incisor teeth were measured with an ERCLMD. All root canals were prepared with the ProTaper system to AWL. Of them, 20 were filled with gutta-percha and a resin-based sealer (Group A), 20 with gutta-percha and a zinc oxide/eugenol-based sealer (Group B), and 16 roots were used as the control group (Group C). Removal of the root filling and repreparation processes were performed using the ProTaper system. Guttasolv and Resosolv were used as the solvents in Group A and Guttasolv and Endosolv E in Group B. After the removal of the root fillings had been achieved, the same ERCLMD was used to measure the working length (WL). Differences between AWL and WL measurements were analysed by paired t-test, and the accuracy of ERCLMD was assessed using chi-squared tests. RESULTS: There were significant differences between AWL and WL measurements in subgroups A2 (Resosolv group) and B2 (Endosolv E group). In these subgroups, WL was shorter than AWL (P < 0.05). Also, the accuracy of the Resosolv group was significantly lower than the others (P < 0.05) at a ±0.5 mm margin of error. CONCLUSIONS: Removing root fillings may require use of a solvent. In these cases, ERCLMDs may exhibit a lower accuracy, thus operators must exercise additional care when measuring the working length using ERCLMDs.

Radiographic assessment of the technical quality and periapical health of root-filled teeth performed by general practitioners in a Turkish subpopulation.

AIM: The aim of this study was to evaluate by means of radiographs the technical quality of root fillings performed by dental practitioners. METHODS AND MATERIAL: Standardized periapical radiographs were made on 484 patients who received endodontic treatment in private practice. A total of 831 endodontically treated teeth with 1448 roots were evaluated for technical quality of the root canal filling and the periapical status of the teeth. Also, the apical status of each root-filled tooth was assessed according to the length, density, and taper of root fillings, and the presence of apical transportation, broken root instruments, and overfilled sealer or gutta-percha material was recorded for each root canal. RESULTS: Of the endodontically treated teeth 26.6% had healthy periapical tissues, while technically good endodontic treatment constituted 12.8%. Based on the treatment success, there was no significant difference between the tooth groups. Statistical analysis of the data did not demonstrate statistically significant differences between the various parameters that were evaluated (P < 0.05). CONCLUSIONS: Technical quality of root fillings in a population who received treatment in private practice was poor and was consistent with a low prevalence of apical health. The probable reasons for this failure are multifactorial and may be improved if the operators improve their skills with continuing postgraduate education programs.

D-dimer is a marker of response to chemotherapy in patients with metastatic colorectal cancer.

PURPOSE: D-dimer, LDH and tumor markers are usually overexpressed in colorectal carcinomas (CRC). Our purpose was to assess the prognostic role of D-dimer, lactate dehydrogenase (LDH), CEA, CA19-9 and CA72-4 in patients with metastatic CRC treated with XELOX chemotherapy. METHODS: Thirty-eight CRC patients who had evidence of distant metastasis were enrolled in the study and blood samples were taken before chemotherapy for estimation of the tumor markers CEA, CA19-9 and CA72-4, and for D-dimer and LDH. Patients were randomized into 3 groups: those with partial response (PR), stable disease (SD), and progressive disease (PD) according to their clinical and radiologic evaluation after 3 cycles of XELOX chemotherapy. All parameters were reevaluated after the 3rd cycle of chemotherapy. RESULTS: Eighteen patients (47.3%) achieved PR, 10 (26.3%) SD, and 10 (26.3%) showed PD. After 3 cycles of XELOX CEA (20.55 vs 11.97 ng7sol;ml; p=0.002), LDH (357.50 vs 214.0 U7sol; lt; p=0.001) and D-dimer (1.56 vs 1.17 µgFEU/ml; p=0.022) levels were significantly decreased in the PR group. D-dimer levels were also notably decreased (1.36 vs 0.77 µgFEU/ml; p=0.021) in the SD group. In the PD group a considerable increase was seen in CA 19-9 (119.5 vs 243.09 U/ml; p=0.025), CA 72-4 (5.18 vs 25.8 U/ml; p=0.036) and D-dimer levels (1.77 vs 1.88 µgFEU/ml; p=0.012). CONCLUSION: This study demonstrated that D-dimer, LDH and tumor markers can be helpful in determining CRC prognosis in patients with metastatic disease. D-dimer, LDH and tumor markers provided unique prognostic information in advanced CRC patients.

Energy saving potential analysis applying factory scale energy audit - A case study of food production.

An energy audit (EA) is a crucial step in boosting factory energy efficiency and obtaining certification for cleaner manufacturing. The results of a preliminary energy audit carried out at a sizable industrial facility in Jordan that creates some of the most well-known foods in the Middle East are presented in this study. The monthly demand of the factory for diesel ranged from 75,251.545 to 166,666.67 L. The factory energy model which is used to examine the impact of various energy-saving practices on the factory's primary energy consumption, was developed with the help of the energy audit. It has been established that optimizing the factory's energy use and the boiler systems' performance with regards to diesel consumption can withstand an expected monthly financial savings of 14205.85 Jordanian Dinar (JD). This has allowed a reduction in energy use of up to 18%. The CO2 harmful emissions were also decreased. Additionally, it is estimated that switching from the proposed motors to energy-efficient motors will cost less overall over time, saving around 3472.314 JD/month or 0.33576/year on average. Moreover, it was discovered that a total of 772.82021 Ton CO2/year emissions may be avoided each year.

Corrigendum to "Energy saving potential analysis applying factory scale energy audit - A case study of food production" [Heliyon 9 (3), (March 2023) Article e14216].

[This corrects the article DOI: 10.1016/j.heliyon.2023.e14216.].

Evaluation of residual antimicrobial effects and surface changes of gutta-percha disinfected with different solutions.

AIM: To determine the possible residual antibacterial effects and possible surface changes caused by 5.25% NaOCl, 2.5% NaOCl, 2% CHX and 0.05% Octenisept on in vitro gutta-percha points after different disinfection protocols. MATERIALS AND METHODS: A total of 121 standard # 40, 0.2% gutta-percha cones were cut 10 mm from the tip, sterilized with ethylene oxide. The samples were divided into five groups, and each group was divided into three subgroups according to immersion periods of gutta-percha cones into solutions. One gutta-percha cone from each group was selected for SEM evaluation. RESULTS: All of the tested solutions were effective on the selected microorganisms when compared with the control solution. No surface alterations were detected on the gutta-percha cones. CONCLUSION: In the limits of this study, immersion of gutta-percha into 2% CHX for one minute was found the most effective method to eliminate the selected microorganisms. CLINICAL SIGNIFICANCE: Although gutta-percha points are aseptic in their package, once opened and used, gutta-percha cones may be contaminated. In order to eliminate bacteria and not to cause surface changes on gutta-percha cones, disinfection solution must be selected carefully.

ERCC1 is not expressed in hepatocellular cancer: A turkish oncology group, gastrointestinal oncology subgroup study.

PURPOSE: hepatocellular cancer (HCC) is a common malignancy with a high mortality rate. Existence of excisional repair cross complementation1 (ERCC1) is implicated in resistance to cisplatin treatment. Expression of ERCC1 in HCC is not known. In this study we aimed to find out whether a subset of HCC patients can be identified to benefit from cisplatin. METHODS: sixty-one patients with HCC who had enough tissue to do immunohistochemistry were identified in 3 institutions. Immunohistochemical staining was performed manually using the standard streptavidin-biotin-peroxidase method. Monoclonal anti-ERCC 1 (D-10) antibody from Santa Cruz Biotechnology (Santa Cruz, CA) was used. RESULTS: only one out of 61 patients (1.6%) had ERCC1 expression. CONCLUSION: although around 10% of HCC patients respond to cisplatin, this is unlikely to be due to ERCC1 negativity. Pathways other than ERCC1 should be searched to find ways to help these patients' treatment strategies.

Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes.

PURPOSE: In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients. METHODS: This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers. RESULTS: Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure. CONCLUSIONS: Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.

Xelox (capecitabine plus oxaliplatin) as neoadjuvant chemotherapy of unresectable liver metastases in colorectal cancer patients.

Complete resection of liver metastasis may provide long term survival in patients with colorectal cancer. Increased number of studies on successful resection after neoadjuvant chemotherapy with initially unresectable liver metastasis has been reported. We evaluated retrospectively the results of 35 patients with unresectable liver only metastases from colorectal cancer treated with capecitabine plus oxaliplatin combination (XELOX). Treatment consisted of IV oxaliplatin 130 mg/m2 day 1 and oral capecitabine 1000 mg/m2 day twice daily on days 1 to 14 followed by 7 days of rest repeated every 3 weeks. After chemotherapy, 13 (37, 2 %) patients showed partial clinical response. Among them, 7 patients were considered suitable for surgery but 2 patients refused the surgery. While one of 5 patients had unresectable disease at surgery, the remaining 4 patients (11, 4 %) had a complete resection. There was one postoperative mortality due to sepsis within 2 months after surgery. Our data suggests that XELOX regimen seems to be useful in unresectable liver only metastases from colorectal cancer because of its activity, feasibility and tolerability. Further studies of XELOX in combination with bevacizumab and/ or cetuximab are warranted in this setting.

Solitary plasmacytoma: experiences from Central Anatolia.

BACKGROUND: Solitary plasmacytoma localised to bone or soft tissue without myeloma. AIM: Clinical features and survival was analysed in patients from Central Anatolia. METHODS: Twenty-three solitary plasmacytoma (18 male, 5 female) were evaluated retrospectively. Median age was 58 years (46-72). The major localisation was vertebral column. RESULTS: All patients but one (larynx) had surgical resection and 21 patients received radiotherapy postoperatively. Multiple myeloma developed in eight patients (35%) and local relapse was detected in one patient. Eight patients died, causes of death were multiple myeloma progression in six patients, local relapse of intracranial plasmacytoma in one patient and cranial trauma in one patient who was in complete remission. Three and 5 years progression free survival were 45.6% and 22.8% respectively and overall survivals were 54.4% and 27.2% respectively. CONCLUSION: Solitary plasmacytoma cases should be followed carefully regarding local relapse and progression to myeloma.

A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer.

BACKGROUND: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression. SCLC is associated with alterations in the coagulation system. The present randomized clinical trial (RCT) was designed to determine whether addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) would improve SCLC outcome compared with CT alone. METHODS: Combination CT consisted of cyclophosphamide, epirubicine and vincristine (CEV) given at 3-weekly intervals for six cycles. Eighty-four patients were randomized to receive either CT alone (n = 42) or CT plus LMWH (n = 42). LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT. Results Overall tumor response rates were 42.5% with CT alone and 69.2% with CT plus LMWH (P = 0.07). Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH (P = 0.01). Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH (P = 0.01). Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages. The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 (95% confidence interval 0.30, 0.86) (P = 0.012 by log rank test). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths. CONCLUSIONS: These results support the concept that anticoagulants, and particularly LMWH, may improve clinical outcomes in SCLC. Further clinical trials of this relatively non-toxic treatment approach are indicated.

Effects of DMSO on platelet functions and P-selectin expression during storage.

Recent studies suggested that the expression of P-Selectin on stored platelets is related to in vitro activation and loss of viability. We examined the effects of dimethylsulfoxide (DMSO) on in vitro function and P-Selectin expression of platelet concentrates. Fresh random-donor platelet units (n = 60) were divided into four equal groups. A DMSO-free group was chosen as a control. DMSO (0.5%, 1.0%, and 3.0%) was added to the other three groups. The samples were stored on a horizontal shaker at room temperature. Biochemical, morphological and platelet function tests and P-Selectin expression were monitored during storage. In all groups, P-Selectin expression, lactate and LDH levels, mean platelet volumes and PO2 increased but the aggregation response to agonist, the recovery response to hypotonic shock, platelet count, glucose level, pCO2, and HCO3 decreased during storage. In DMSO-containing groups, the P-Selectin expression which is a predictor of in vitro activation, was found significantly less often than in the DMSO-free group.

Meropenem +/- granulocyte colony stimulating factor in the treatment of febrile neutropenic patients with cancer: prospective randomized study.

The purpose of this study was to evaluate the impact of granulocyte-colony stimulating factor (G-CSF) on the therapy for febrile neutropenia (FN). Our patient population differed significantly from those of previous studies as no patients received antimicrobial or CSF prophylaxis before randomization and all were solid tumor patients. When the diagnosis of FN was established, patients were started on intravenous meropenem 1 g every 8 hours and randomly assigned to receive G-CSF (5 microg/kg body weight per day subcutaneously) or not. Twenty-eight patients with 30 FN episodes received G-CSF and 25 patients with 30 FN episodes did not receive G-CSF according to randomization. The time to resolution of fever, recovery of neutrophil count over 1000/mm3, duration of hospitalization, need for erythrocyte and platelet transfusion and mortality rate were similar in both study groups. Side effects of therapy were mild. These results provide preliminary evidence that G-CSF administration, in addition to effective antibiotic therapy as treatment of febrile neutropenic patients with solid tumor, does not help improve infection-related morbidity and mortality.