[Acute urinary retention in primary vaginal carcinoma: therapeutic approach]. / Retentie acuta de urina prin cancer de vagin: atitudine terapeutica.

Carcinoma of the vagina is a very rare disease. Primary vaginal carcinoma tends to spread by local invasion of the adjacent pelvic organs (without any kind of metastases) and secondarily through lymphatic channels. The aim of this report is to add observations concerning the surgical treatment of this rare occurrence of carcinoma. The 33-year old patient's history began with an acute urinary retention which imposed bladder catheterization. Local examination revealed a hard 3/3 cm large mass on the middle third of the anterior vaginal wall, invasive in the urinary bladder. Cystoscopic examination confirmed the tumor invasion in the trigone. Biopsy specimens of the tumor and histological examination showed carcinoma. Anterior pelvic exenteration with pelvic lymph nodes dissection and total colpectomy was performed and the patient received a continent urinary diversion to the skin (modified Indiana pouch), ovary transposition, vaginal reconstruction with gracilis myocutaneous flaps. Postoperative evolution was uneventful. Organ reconstruction surgery including continent urinary diversion, vaginal reconstruction will significantly improve the quality of life and don't change the body image of the patients after pelvic major surgical procedures such pelvic exenteration.

[Total pelvic exenteration in the treatment of advanced pelvic cancer]. / Exenteratia pelvina totala in tratamentul cancerului pelvin avansat.

Total pelvic exenteration (TPE) is a radical and aggressive procedure performed in the local advanced pelvic cancer started from any pelvic organ. The experience of 73 TPE performed for local invasive cancer and centro-pelvic recurrences with initial malignancy at the cervix (45 cases), rectum (19 cases), vagina (5 cases), endometrial (3 cases) and urinary bladder (1 case), in 61 females and 12 males with age range 27-78 years, are analysed. The procedures were performed for advanced pelvic cancer in 24 cases and also for invasive centro-pelvic recurrences in 49 cases (67.5%). In 5 cases, TPE was extended laterally. In 42 patients reconstructive procedures were added. All patients survived to surgery but 5 postoperative deaths (6.8%) were recorded. Complications occurred in 52% of cases, 38 from 73 patients had one or more than one complication with an average of 1.5 per patient. 22 among these patients (30%) requiring operative treatment. The average survival was 49.07 months, the median survival of 55 months and the estimated survival at 11 and 78 months was 66%, respectively 50%. The procedure is indicated in the absence of pelvic wall invasion and secondary distant dissemination and lengthens significantly the life span and increase the quality of life.

The effect of low-energy laser on skin-flap survival in the rat and porcine animal models.

Low-energy lasers are currently being used in the therapy of rheumatoid arthritis, chronic pain, muscle strain, and the promotion of wound healing in human and veterinary medicine. This study examined the effects of low-energy laser on skin-flap survival in a controlled interspecies study using the rat and porcine models. Twenty dorsal skin flaps based caudally were performed in 20 rats (10 laser-treated and 10 control flaps). The wounds were closed, and the flaps were sutured over the skin. Forty dorsal pig skin flaps based medially were raised in five pigs. The flaps were treated once per day for 10 days: 4 days preoperatively, the day of surgery, and 5 days postoperatively (30 s/cm3 per day). The average surviving rat flap surface area for the laser-treated flaps was 653 +/- 112 mm (mean +/- SD) and 580 +/- 60 mm in the control flaps, which was not significant (p greater than 0.05). In the porcine model, the average surviving area for the 20 laser-treated flaps was 949 +/- 174 mm, and the control average (n = 20) was 969 +/- 147 mm, also not significant. No beneficial effect was seen with low-energy laser preoperative and postoperative treatment of skin flaps in the rat and porcine models.

A community health center dental program in Boston, U.S.A.

In 1970, a community-based and federally funded dental program was established in Boston. The multiple objectives of this program included the following: provision of dental treatment; education of schoolchildren in dental health; support for community measures of prevention such as water fluoridation; support of job training programs in dental assisting for community residents; employment of community people; and sensitization and training in community health for dental students and auxiliaries. The program provided a number of dental services at a reasonable benefit-cost ratio of 0.87. Other endeavors included the development of a dental health program with community schools and the involvement of dental students in the delivery of care and in screening for children with dental treatment needs.

Double-blind study of prednisolone and papase as inhibitors of complications after oral surgery.

Both prednisolone and papase are effective in reducing the oral surgical sequelae of trismus and pain, although prednisolone apparently is the more potent drug. The countervailing case for the routine use of prednisolone includes the relatively serious complications produced in some patients.

The Klippel-Feil syndrome: implications for Naval service.

The Klippel-Feil anomaly is usually discovered by serendipity on cervical spine X-rays. Although it may encompass many vertebrae, the typical case is an isolated fusion of two vertebrae. Nearly 1% of the general population has this anomaly and its incidence in the Navy is likely similar. Increased susceptibility to spinal cord injury has been reported in individuals with the Klippel-Feil syndrome. Unusual stress on the head and neck inherent to various aspects of naval service place such persons at risk for debilitating or fatal injury. An algorithm for evaluating suspected Klippel-Feil syndrome is provided.

Valuing dental practice.

Because new dentists are finding that initiating dental practices has become more problematic, the issues of practice purchase and valuation have become more salient. The purchase of a practice, although expensive, decreases the amount of time required before the dentist can experience a profit. This article discusses issues related to valuing, reviews some of the strategies related to the purchase of a practice, and recommends an objective approach to establishing fair market value.

Children's sense of pleasure from nitrous oxide therapy during dental visits.

The purpose of the present study was to measure feelings of pleasure by children who were undergoing dental treatment under nitrous oxide therapy during consecutive treatment sessions, and at a six-month follow-up visit. Fifty-two children between the ages of 3 and 5 years (mean age 4.3 +/- 1.06) children, who required two or more operative treatment visits participated in the study. At the conclusion of the initial treatment and after sufficient time for the effects of the nitrous oxide therapy to subside, patients were asked about their feelings from the gas. At subsequent visits, patients were asked the same questions at the beginning of each treatment session. The same was done at the beginning of a six-month follow-up visit. In general, there was a decrease in pleasure among those who experienced three or more visits. Extraction, in addition to operative treatment, did not result in a decrease in the sense of pleasure from nitrous oxide therapy. A similar response was observed in the recall visits when the reactions of the children were compared with the reactions at the last dental appointment. It is concluded that the sense of pleasure is strengthened through the second visit, but that the sense of pleasure and ability to cope is overwhelmed by the inconvenience of the dental treatment at the third visit.

Assessing an active distracting technique for local anesthetic injection in pediatric dental patients: repeated deep breathing and blowing out air.

The aim of the study was to assess the effect of an active distraction technique that included the repeated breathing and blowing out of air on the pain behavior and facial display of children receiving local anesthesia injections prior to dental treatment. Fifty children between the ages of 3 and 7 years and who were undergoing dental treatment in a pediatric dental clinic were selected for this study. The children were randomly assigned to an intervention group or to a control group. The intervention group of 25 children was told to repeatedly breathe deeply before and during the administration of the injection and to blow the air out. The 25 control group children were given the injection in the slow manner without the repeated breathing and air blowing. Children in the intervention group demonstrated significantly less eyelid squeezing (P = 0.04). Also, more children in the intervention group than in the control group significantly expressed their wish to have the same technique used during the second visit (p = 0.033). Children in the intervention group generally demonstrated less hand and torso movements, less eyebrow bulging, and expressed less pain than in the control group. Boys significantly reported less pain after the injection. The results of this study indicate some advantages of distraction techniques (deep breaths and blowing air) prior to and during the administration of a local anesthetic injection in children.

Reframing--reappraising an old behavioral technique.

Successful reframing converts notions of unpleasantness to notions that are acceptable to the parties involved. However, the basic precursor to successful reframing is that the message conveyed must be consistent with the individuals 'meta' way of thinking and consistent with concepts of reality.

Comparative study of conventional urothelial carcinoma, squamous differentiation carcinoma and pure squamous carcinoma in patients with invasive bladder tumors.

PURPOSE: Treatment results evaluation (radical cystectomy and adjuvant chemo/radiotherapy) in patients with urothelial carcinoma, squamous differentiation carcinoma and pure squamous bladder carcinoma. MATERIAL AND METHODS: The study included 361 patients with invasive bladder carcinoma treated between 1990-2013. Histology showed 296 cases of urothelial carcinoma (82% - group A), 52 cases of urothelial divergent differentiation (squamous and urothelial carcinoma 14.4% - group B) and 13 cases of squamous cell carcinoma (3.6% - group C). All patients benefited from radical cystectomy. Adjuvant chemotherapy was undergone in 68 patients. RESULTS: Group A - urothelial carcinoma - had a 44% rate of patients alive with a mean survival period of 73 months. About 56% of the patients died, the mean survival period being 4 years. Group B - urothelial carcinoma with squamous differentiation - had a mean survival period of 36 months (between 1-156 months). 17 patients (33%) are alive at 50 months postoperatively. Group C - squamous carcinoma - had a mean survival period of 9.4 months. DISCUSSIONS: Locally advanced disease was diagnosed in 50% of the patients in group A, while in group B the rate was 84.6% and 70% in group C, respectively. CONCLUSIONS: Squamous pattern detected in the histopathological specimen represents a negative prognostic factor. It seems that the squamous component influences the outcome of the disease due to its biological characteristics in the evolution of squamous carcinoma, with advanced local stage disease at diagnosis - late onset of symptoms and lack of response to adjuvant treatment.

Oral health status and needs of homebound elderly in an urban home-based primary care service.

OBJECTIVES: This study assessed the oral health status, dental utilization and dental needs of the homebound elderly (HBE) care patients within the Mount Sinai Visiting Doctor program. METHODS: Of the 334 eligible patients, 57% agreed to participate and 95.4% completed the clinical examinations, the Dental Utilization and Needs survey and Geriatric Oral Health Assessment Index conducted in each subject's home by a trained research team. RESULTS: Among 75% who were dentate subjects, 40% needed restorative dental care, 45.6% needed dental extractions, and 33% complained of current oral pain. Overall, 92.0% needed some type of dental care and 96% stated that they had not seen a dentist since they became homebound (mean number of years in program = 3.2 ± 2.58). CONCLUSION: Findings show the oral health status of these homebound elderly was poor and their quality of life was significantly affected by the lack of basic dental care.

Prostate cancer with neuroendocrine differentiation--case report.

RATIONALE: About 95% of prostate cancers are adenocarcinoamas. Depending on the detection method used, neuroendocrine cells are found in 10% to 100% of prostate cancer specimens. OBJECTIVE: A 64-year-old patient was diagnosed in 2006 with adenocarcinoma of the prostate, PSA 4.1 ng/ml, Gleason 6, T3b, positive PSA immunohistochemistry. METHODS AND RESULTS: The patient was started on hormone therapy: orchidectomy followed by flutamide 750 mg/day for three years, and underwent radiotherapy 6400 R. The patient was asymptomatic for three years. In 2009, the patient complained of perineal and rectal pain, but the PSA remained normal. In 2010, the patient underwent TUR of the prostate for acute urinary retention. Pathological exam revealed Gleason 8 adenocarcinoma of the prostate (different pathologist suggested Gleason 9) and foci of neuroendocrine cells. Immunohistochemistry detected 15-20% positivity for Cromogranin A and 10% for synaptophysin. The patient developed multiple liver metastases in October 2010 and underwent five cycles of etoposide, carboplatin. The patient died of liver failure in March 2011. DISCUSSION: Regarding prevalence, neuroendocrine differentiation is the second phenotype after prostate adenocarcinoma, but still remains undiagnosed. It is resistant to radiation therapy and chemotherapy. Detection of the neuroendocrine differentiation is recommended during the clinical, biochemical, histopathological and immunohistochemical follow up of prostate cancer patients treated by EBRT and / or androgen deprivation.