Local versus radical surgery for early rectal cancer with or without neoadjuvant or adjuvant therapy.

BACKGROUND: Total mesorectal excision is the standard of care for stage I rectal cancer. Despite major advances and increasing enthusiasm for modern endoscopic local excision (LE), uncertainty remains regarding its oncologic equivalence and safety relative to radical resection (RR). OBJECTIVES: To assess the oncologic, operative, and functional outcomes of modern endoscopic LE compared to RR surgery in adults with stage I rectal cancer. SEARCH METHODS: We searched CENTRAL, Ovid MEDLINE, Ovid Embase, Web of Science - Science Citation Index Expanded (1900 to present), four trial registers (ClinicalTrials.gov, ISRCTN registry, the WHO International Clinical Trials Registry Platform, and the National Cancer Institute Clinical Trials database), two thesis and proceedings databases, and relevant scientific societies' publications in February 2022. We performed handsearching and reference checking and contacted study authors of ongoing trials to identify additional studies. SELECTION CRITERIA: We searched for randomized controlled trials (RCTs) in people with stage I rectal cancer comparing any modern LE techniques to any RR techniques with or without the use of neo/adjuvant chemoradiotherapy (CRT). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. We calculated hazard ratios (HR) and standard errors for time-to-event data and risk ratios for dichotomous outcomes, using generic inverse variance and random-effects methods. We regrouped surgical complications from the included studies into major and minor according to the standard Clavien-Dindo classification. We assessed the certainty of evidence using the GRADE framework. MAIN RESULTS: Four RCTs were included in data synthesis with a combined total of 266 participants with stage I rectal cancer (T1-2N0M0), if not stated otherwise. Surgery was performed in university hospital settings. The mean age of participants was above 60, and median follow-up ranged from 17.5 months to 9.6 years. Regarding the use of co-interventions, one study used neoadjuvant CRT in all participants (T2 cancers); one study used short-course radiotherapy in the LE group (T1-T2 cancers); one study used adjuvant CRT selectively in high-risk patients undergoing RR (T1-T2 cancers); and the fourth study did not use any CRT (T1 cancers). We assessed the overall risk of bias as high for oncologic and morbidity outcomes across studies. All studies had at least one key domain with a high risk of bias. None of the studies reported separate outcomes for T1 versus T2 or for high-risk features. Low-certainty evidence suggests that RR may result in an improvement in disease-free survival compared to LE (3 trials, 212 participants; HR 1.96, 95% confidence interval (CI) 0.91 to 4.24). This would translate into a three-year disease-recurrence risk of 27% (95% CI 14 to 50%) versus 15% after LE and RR, respectively. Regarding sphincter function, only one study provided objective results and reported short-term deterioration in stool frequency, flatulence, incontinence, abdominal pain, and embarrassment about bowel function in the RR group. At three years, the LE group had superiority in overall stool frequency, embarrassment about bowel function, and diarrhea. Local excision may have little to no effect on cancer-related survival compared to RR (3 trials, 207 participants; HR 1.42, 95% CI 0.60 to 3.33; very low-certainty evidence). We did not pool studies for local recurrence, but the included studies individually reported comparable local recurrence rates for LE and RR (low-certainty evidence). It is unclear if the risk of major postoperative complications may be lower with LE compared with RR (risk ratio 0.53, 95% CI 0.22 to 1.28; low-certainty evidence; corresponding to 5.8% (95% CI 2.4% to 14.1%) risk for LE versus 11% for RR). Moderate-certainty evidence shows that the risk of minor postoperative complications is probably lower after LE (risk ratio 0.48, 95% CI 0.27 to 0.85); corresponding to an absolute risk of 14% (95% CI 8% to 26%) for LE compared to 30.1% for RR. One study reported an 11% rate of temporary stoma after LE versus 82% in the RR group. Another study reported a 46% rate of temporary or permanent stomas after RR and none after LE. The evidence is uncertain about the effect of LE compared with RR on quality of life. Only one study reported standard quality of life function, in favor of LE, with a 90% or greater probability of superiority in overall quality of life, role, social, and emotional functions, body image, and health anxiety. Other studies reported a significantly shorter postoperative period to oral intake, bowel movement, and off-bed activities in the LE group. AUTHORS' CONCLUSIONS: Based on low-certainty evidence, LE may decrease disease-free survival in early rectal cancer. Very low-certainty evidence suggests that LE may have little to no effect on cancer-related survival compared to RR for the treatment of stage I rectal cancer. Based on low-certainty evidence, it is unclear if LE may have a lower major complication rate, but probably causes a large reduction in minor complication rate. Limited data based on one study suggest better sphincter function, quality of life, or genitourinary function after LE. Limitations exist with respect to the applicability of these findings. We identified only four eligible studies with a low number of total participants, subjecting the results to imprecision. Risk of bias had a serious impact on the quality of evidence. More RCTs are needed to answer our review question with greater certainty and to compare local and distant metastasis rates. Data on important patient outcomes such as sphincter function and quality of life are very limited. Results of currently ongoing trials will likely impact the results of this review. Future trials should accurately report and compare outcomes according to the stage and high-risk features of rectal tumors, and evaluate quality of life, sphincter, and genitourinary outcomes. The role of neoadjuvant or adjuvant therapy as an emerging co-intervention for improving oncologic outcomes after LE needs to be further defined.

In vivo optoacoustic temperature imaging for image-guided cryotherapy of prostate cancer.

The objective of this study is to demonstrate in vivo the feasibility of optoacoustic temperature imaging during cryotherapy of prostate cancer. We developed a preclinical prototype optoacoustic temperature imager that included pulsed optical excitation at a wavelength of 805 nm, a modified clinical transrectal ultrasound probe, a parallel data acquisition system, image processing and visualization software. Cryotherapy of a canine prostate was performed in vivo using a commercial clinical system, Cryocare® CS, with an integrated ultrasound imaging. The universal temperature-dependent optoacoustic response of blood was employed to convert reconstructed optoacoustic images to temperature maps. Optoacoustic imaging of temperature during prostate cryotherapy was performed in the longitudinal view over a region of 30 mm (long) × 10 mm (deep) that covered the rectum, the Denonvilliers fascia, and the posterior portion of the treated gland. The transrectal optoacoustic images showed high-contrast vascularized regions, which were used for quantitative estimation of local temperature profiles. The constructed temperature maps and their temporal dynamics were consistent with the arrangement of the cryoprobe and readouts of the thermal needle sensors. The temporal profiles of the readouts from the thermal needle sensors and the temporal profile estimated from the normalized optoacoustic intensity of the selected vascularized region showed significant resemblance, except for the initial overshoot, that may be explained as a result of the physiological thermoregulatory compensation. The temperature was mapped with errors not exceeding ±2 °C (standard deviation) consistent with the clinical requirements for monitoring cryotherapy of the prostate. In vivo results showed that the optoacoustic temperature imaging is a promising non-invasive technique for real-time imaging of tissue temperature during cryotherapy of prostate cancer, which can be combined with transrectal ultrasound-the current standard for guiding clinical cryotherapy procedure.

The Impact of Simultaneously Applying Normal Stress and Vibrotactile Stimulation for Feedback of Exteroceptive Information.

Commercially available prosthetic hands do not convey any tactile information, forcing amputees to rely solely on visual attention. A promising solution to this problem is haptics, which could lead to new prostheses in which tactile information is conveyed between the amputee and the artificial limb. However, the haptic feedback must be optimized so that amputees can use it effectively; and although several studies have examined how specific haptic feedback systems can transmit certain types of tactile information, there has not yet been much research on the effects of superposing two or more types of feedback at the same location, which might prove to be more effective than using a single type of feedback alone. This paper investigates how the simultaneous application of two different types of haptic feedback-vibration and normal stress-impacts the human sensory perception of each separate feedback type. These stimuli were applied to glabrous skin on the forearms of 14 participants. Our experiments tested whether participants experienced more accurate sensory perception, compared to vibration or normal stress alone, when vibration was applied at the same time as the normal stress, at either the same location, or at a different location 6 cm away. Results indicate that although participants' perception of the normal stress diminished when vibration was applied at the same location, the same combination improved their perception of the vibration. Apparently, vibration has a negative impact upon the ability to perceive normal stress, whether applied at the same or a different location; whereas the opposite is true for the effect of normal stress upon the perception of vibration.

The Effect of Locally Administered Pamidronate on Autogenous Bone Graft in Maxillofacial Reconstruction: A Randomized Clinical Trial.

BACKGROUND: Although bone grafts are commonly used in reconstructive surgeries, they are sensitive to local perfusion and are thus prone to severe resorption. Biphosphonates can inactivate osteoclasts and can be used to control the undesirable bone resorption. OBJECTIVE: To assess the effect of administration of biphosphonates on bone resorption. METHODS: 20 patients with bony defects who were candidates for free autogenous grafts were randomized into "pamidronate" and "control" groups. Bone segments were soaked in either pamidronate solution or normal saline and were inserted into the area of the surgery. Bone densities were measured post-surgery and in 6-month follow-up. Data were obtained via Digora software and analyzed. RESULTS: The mean±SD bone density in pamidronate group changed from 93.4±14.6 to 93.6±17.5 (p<0.05); in the control group the density decreased from 89.7±13.2 to 78.9±11.4 (p<0.05). The mean difference of bone density in anterior areas of the jaws showed higher DXA in comparison to posterior regions (p=0.002). CONCLUSION: Locally administered pamidronate affects reduction in bone resorption.

The Use of Vibrotactile Feedback to Restore Texture Recognition Capabilities, and the Effect of Subject Training.

This paper presents a vibrotactile haptic feedback system for use under dynamic conditions, verifies its functionality, and shows how results may be affected by the amount of training that subjects receive. We hope that by using vibrotactile feedback to distinguish between different textures, upper-limb amputees may be able to partially regain the sense of touch. During a previous experiment (Motamedi et al., 2015) we noticed a correlation between how familiar the subjects were with haptic systems, and how well they were able to use the haptic system to accurately identify textures. This observation lead us to conduct a second experiment, the results of which are the main focus of this paper. We began with a group of subjects who were completely unfamiliar with haptic systems, and tracked the improvements in their accuracy over a period of four weeks. Although the subjects showed a 16% improvement in their ability to recognize textures, going from a 64% success rate after the first week to 80% after the fourth, perfect accuracy was not attained. A subsequent experiment, however, shows that this result should not diminish our perception of the haptic system's effectiveness. When we asked the same subjects to identify the textures using only their fingertips, we found that even humans cannot distinguish between near-identical textures with complete accuracy. The subjects' overall success rate when using their own hands was 91%, demonstrating that the proposed haptic system is not far from achieving the same texture recognition capabilities as the human sense of touch.

Molecular characterization of environmental Cladosporium species isolated from Iran.

BACKGROUND AND PURPOSE: Cladosporium species are ubiquitous, saprobic, dematiaceous fungi, only infrequently associated with human and animal opportunistic infections. MATERIALS AND METHODS: Airborne samples were collected using the settle plate method, and soil samples were obtained from a depth of 5-10 cm of the superficial soil layer. Samples were cultured on Sabouraud dextrose agar (SDA) plates, incubated at 25°C, and examined daily for fungal colonies for two to three weeks. Isolates were identified as Cladosporium species according to the macroscopic and microscopic criteria. For species differentiation, DNA from 53 isolates was extracted and subjected to amplification of the internal transcribed spacer (ITS) region followed by sequencing. RESULTS: A total of 270 samples were collected from various environmental sources, of which 79 strains of Cladosporium species were isolated. The most frequent species was C. cladosporioides (50.6%), followed by C. iridis (44.3%), C. elatum (2.5%), C. peranqestum (1.3%), and C. alicinum (1.3%). CONCLUSION: The collected data can serve as baseline information for future research and may be useful in the development of preventive and educational strategies.

Aspergillus tubingensis and Aspergillus niger as the dominant black Aspergillus, use of simple PCR-RFLP for preliminary differentiation.

This work aimed to identify the species distribution of common clinical and environmental isolates of black Aspergilli based on simple restriction fragment length polymorphism (RFLP) analysis of the ß-tubulin gene. A total of 149 clinical and environmental strains of black Aspergilli were collected and subjected to preliminary morphological examination. Total genomic DNAs were extracted, and PCR was performed to amplify part of the ß-tubulin gene. At first, 52 randomly selected samples were species-delineated by sequence analysis. In order to distinguish the most common species, PCR amplicons of 117 black Aspergillus strains were identified by simple PCR-RFLP analysis using the enzyme TasI. Among 52 sequenced isolates, 28 were Aspergillus tubingensis, 21 Aspergillus niger, and the three remaining isolates included Aspergillus uvarum, Aspergillus awamori, and Aspergillus acidus. All 100 environmental and 17 BAL samples subjected to TasI-RFLP analysis of the ß-tubulin gene, fell into two groups, consisting of about 59% (n=69) A. tubingensis and 41% (n=48) A. niger. Therefore, the method successfully and rapidly distinguished A. tubingensis and A. niger as the most common species among the clinical and environmental isolates. Although tardy, the Ehrlich test was also able to differentiate A. tubingensis and A. niger according to the yellow color reaction specific to A. niger. A. tubingensis and A. niger are the most common black Aspergillus in both clinical and environmental isolates in Iran. PCR-RFLP using TasI digestion of ß-tubulin DNA enables rapid screening for these common species.

Anthropomorphic assessment of the retromolar foramen and retromolar nerve: anomaly or variation of normal anatomy?

The retromolar foramen, retromolar canal, and retromolar nerve constitute a variation of the inferior alveolar nerve (IAN) with a prevalence of 12-75%; this represents type 1 bifidity of the IAN. The aim of this study was to assess the prevalence of the retromolar nerve in our population and to obtain related data. One hundred and thirty-six mandibles of fresh cadavers aged 20-75 years were dissected. The buccolingual location, diameter, and distance from the third molar, and their associations with sex, were measured. The area of innervation and demographic data were also documented and analysed statistically. The retromolar foramen and retromolar nerve were observed in 55 cases (40.4%). The mean diameter of the retromolar foramen was 1.7 mm (range 1.1-2.1 mm); the mean diameter was 1.8 mm in males and 1.5mm in females. Histological findings showed that the retromolar nerve extended from the anterior border of the ramus, innervating the retromolar pad and continuing to the buccal gingiva of up to two teeth anteriorly (first molar region). This high percentage of IAN type 1 bifidity (40.4%) suggests it to be a normal anatomical variation of the IAN rather than an anomaly.

Proteolytic activity and cooperative hemolytic effect of dermatophytes with different species of bacteria.

BACKGROUND AND PURPOSE: Globally, dermatophytes are the most common filamentous group of fungi causing cutaneous mycoses. Dermatophytes were shown to secrete a multitude of enzymes that play a role in their pathogenesis. There is limited data on co-hemolytic (CAMP-like) effect of different bacterial species on dermatophyte species. In this study, we sought to the evaluate exoenzyme activity and co-hemolytic effect of four bacteria on clinical dermatophytes isolated from patients in Shiraz, Iran. MATERIALS AND METHODS: A total of 84 clinical dermatophyte species were isolated from patients suffering dermatophytosis and identified by conventional methods. Hemolytic activity was evaluated with Columbia 5% sheep blood agar. Proteolytic activity was determined by plate clearance assay method, using gelatin 8% agar. CAMP-like factor was evaluated with four bacteria, namely, S. areus, S.saprophyticus, S.pyogenes, and S.agalactiae. Fisher's exact test was run for statistical analysis. RESULTS: T. mentagrophytes was the most predominant agent (27 [32.1%]) followed by T. verrucosum(20 [23.8%]), T. tonsurans (10 [11.9%]), Microsporum canis (7 [8.3%]), T. rubrum (6 [7.1%]), E. floccosum (6 [7.1%]), M. gypseum (5 [6%]), and T. violaceum (3[3.6%]). The most common clinical area of dermatophytosis was the skin. All the isolates expressed the zone of incomplete alpha hemolysis. All the isolates had CAMP- positive reaction with S. aureus and the other bacteria were CAMP-negative. All the isolates expressed proteolytic activity and no significant differences were noted among diverse genera of dermatophytes and severities of proteolytic activity. CONCLUSION: This study indicated that hemolysin and proteolytic enzymes potentially play a role in dermatophyte pathogenesis and S. aureus could be considered as a main bacterium for creation of co-hemolytic effect in association with dermatophyte species.

Molecular identification and in-vitro antifungal susceptibility testing of Candida species isolated from patients with onychomycosis.

BACKGROUND AND PURPOSE: Candida species are the most opportunistic fungi affecting the nails and resulting in onychomycosis. In this study, we identified and evaluated in-vitro susceptibility of the recovered isolates against fluconazole (FLC), voriconazole (VRC), and clotrimazole (CLT) using the Clinical and Laboratory Standards Institute (CLSI) M27-A3 document. MATERIALS AND METHODS: From patients with either clinically or mycologically proven onychomycosis, 97 isolates comprising of seven Candida species were isolated, which were identified by both conventional and molecular techniques such as polymerase chain reaction-restriction fragment length polymorphism. In addition, Candida dubliniensis was confirmed by restriction endonuclease analysis. Antifungal susceptibility of each isolate against the three azoles applied in this study was determined using the CLSI microdilution reference method M27-A3. RESULTS: Candida parapsilosis(C. parapsilosis) was the most frequently isolated species (n=44), followed by C. albicans (n=23), C.tropicalis (n=13), C.glabrata (n=7), C.krusei (n=6), C.guilliermondii (n=3), and C. dubliniensis (n=1). All the isolates were susceptible to CLT. VRC had lower minimum inhibitory concentration (MIC) values for the isolates compared to FLC. Geometric mean MIC values of VRC, FLC, and CLT for C. parapsilosis isolates were 0.07 µg/ml, 0.8 µg/ml, and 0.35 µg/ml, respectively. Collectively, all species exhibited greater susceptibility to VRC in comparison to C. albicans (P≤0.001). CONCLUSION: This study showed that non-albicansCandida species were the most common etiologic agents of non-dermatophyte onychomycosis. The major antifungal agents used in clinics to empirically treat yeast onychomycosis are FLC and CLT. Our data suggested that CLT is a better choice for the treatment of Candida onychomycosis, especially in drug resistant cases.

Dental Erosion in Patients with Gastroesophageal Reflux Disease (GERD) in a Sample of Patients Referred to the Motahari Clinic, Shiraz, Iran.

STATEMENT OF PROBLEM: Systematic reviews of the literature show that the dental erosion is associated with the gastroesophageal reflux disease (GERD).The prevalence of the problem may not be exclusively similar in different countries. PURPOSE: The purpose of this study was to investigate the association of gastro-esophageal reflux disease (GERD) with dental erosion in a sample of Iranian population regarding the standing difference in the Iranian oral hygiene and diet. Material s and Method: 140 patients with the average age of 30 to 50 years old comprised the study group. The participants were already eligible for the endoscopic examination, diagnosed by their gastroenterologist. All patients completed a detailed questionnaire regarding the medical and dental situations. After completing the questionnaire and before endoscopy, dental examination was performed by two blinded dentists.The endoscopy was then performed by a gastroenterologist and the patients were divided into three groups of healthy, suspected to GERD, and positive GERD. Data were collected and analyzed by Chi- Square test. The cross tabulation test was performed to compare the qualitative variants and discover the correlations. The statistical significance was adopted as: p < 0.05. RESULTS: The prevalence of dental erosion in GERD patients (22.6%) was found to be higher than the suspected (5.3%) and the healthy (7%) individuals. CONCLUSION: This study declared the GERD patients are at higher risk of developing dental erosion compared to the healthy individuals in a sample of Iranian population.

Tumour regression induced by co-administration of MIP-3α and CpG in an experimental model of colon carcinoma.

CCL20/macrophage inflammatory protein-3α (MIP-3α) represents one of the potent chemoattractive proteins for dendritic cells (DCs). Herein, we investigated whether in vivo genetic modification of tumour cells aimed at intratumoural production of MIP-3α might lead to accumulation of DCs in tumour tissue. Mice injected with CT26, received recombinant adenovirus (Ad) vectors (AdMIP-3α) expressing MIP-3α protein. This was complemented by injections of CpG. Interestingly, MIP-3α gene therapy combined with CpG injections resulted in specific cytotoxicity. This was associated with significant suppression of tumour growth rate. These findings demonstrate the potential of strategies that utilize in vivo overexpression of chemokines.

Subcutaneous forehead island flap for nasal reconstruction.

BACKGROUND: Reconstruction of nasal skin after tumor resection is imperative for full patient rehabilitation; and use of similar skin is necessary to achieve best esthetic and functional results. METHODS: This clinical series study represent management of patients with large nasal defects (up to 4x7 cm) using subcutaneous pedicle island paramedian forehead flap, during a period of 2007-2009, 8 patients with large nasal defects were repaired with this flap, among them 5 patients were male and 3 patients were female with mean age of 53 years, all cases were reconstructed with island pedicle flap in a single stage. RESULTS: Good and satisfying results were achieved in all cases except for one case that was operated again for debulking of flap. CONCLUSION: Island paramedian forehead flap provides esthetic and functional results in a single stage reconstruction of defects with various sizes and locations. This variation of forehead flap is a good choice especially for those patients that have problems with cost or problem with multistage reconstruction of nasal defects.

CPR Training for Nurses: How often Is It Necessary?

BACKGROUND: The ability to respond quickly and effectively to a cardiac arrest situation rests on nurses being competent, prepared and up-to-date in the emergency life-saving procedure of cardiopulmonary resuscitation (CPR). This study aimed to determine the extent to which nurses acquire and retain CPR cognitive knowledge and psychomotor skills following CPR training courses. METHODS: A quasi-experiment was used. CPR knowledge of 112 nurses was assessed via a questionnaire using valid multiple-choice questions. An observatory standard checklist was used and CPR performance on manikins was evaluated to assess psychomotor skills (before the course baseline, after the course, after 10 weeks and then 2 years after the 4 hours CPR training course). Scores were based on a scale of 1 to 20. RESULTS: A mean baseline score of 10.67 (SD=3.06), a mean score of 17.81 (SD=1.41) after the course, 15.26 (SD=3.17) 10 weeks after and 12.86 (SD=2.25), 2 years after the 4 hours CPR training course was noticed. Acquisition of knowledge and psychomotor skills of the nurses following a four-hour training program was significant. However, significant deterioration in both CPR knowledge and psychomotor skills was observed 2 years after the training program among 42 nurses. CONCLUSION: The study findings present strong evidence to support the critical role of repetitive periodic CPR training courses to ensure that nurses were competent, up to date and confident responders in the event of a cardiac arrest.

Assessment and outcome of 496 penetrating gastrointestinal warfare injuries.

AIM: The abdominal viscera are among the most vulnerable organs of the body to penetrating trauma. Proper management of such trauma in war victims at the first-line hospital where these victims are first seen is of paramount importance. We reviewed medical records of war victims suffering small bowel and colorectal injuries treated at first, second and third-line hospitals during the Iraq-Iran War (1980-88) to assess surgical outcomes. METHODS: The medical records of 496 Iranian war victims suffering penetrating gastrointestinal (GI) injuries treated at first, second and third-line (tertiary) hospitals, a total of 19 centres, were reviewed. Laparotomy had been performed at the 1st line hospitals for all patients who had an acute abdomen, whose wounds violated the peritoneum or whose abdominal radiographs showed air or shrapnel in the abdominal cavity. Stable patients were transferred from first-line to second-line or from second line to tertiary hospitals postoperatively. The treatments, complications and patient outcomes were documented and analyzed. RESULTS: There were 496 patients; 145, 220 and 131 victims underwent laparotomy for GI injuries at first, second and third-line hospitals respectively. The small intestine and colon respectively were the most prevalent abdominal organs damaged. Those first treated for GI injuries at front-line hospitals (145 victims) had more serious conditions and could not be transferred prior to surgery and presented a higher prevalence of complications and mortality. Overall mortality from GI surgery was 3.6% (18 patients). Eleven patients (7.5%) whose first GI operation was performed at frontline hospitals and 7 patients (3.2%) who underwent their first surgical operation at second-line hospitals died. The most common reason for these deaths was complications relating to the gastrointestinal operation such as anastomotic leak. Six missed injuries were seen at the frontline and one at second line hospitals. There were no deaths at the 3rd line hospitals. CONCLUSION: Penetrating abdominal injuries were common in Iranian victims of war often causing multiple organ injuries. The colon and small intestine were the more commonly injured organs and carried the most postoperative complications. Mortality at 1st line hospitals was more than double that of 2nd line hospitals; the complication rate was also greater as was the number of missed injuries. Adherence to the standard surgical protocols, prompt evaluation, proper triage and management are factors which may lower patient morbidity and complications.

Gnathic osteosarcomas: a 10-year multi-center demographic study.

BACKGROUND: Osteosarcomas (OS) of the jaws are uncommon lesions representing 6-8% of skeletal OS. We assessed the characteristics, demographics, prevalence clinical and histopathological findings and distribution of gnathic OS relative to non-gnathic OS in four major treatment centers. MATERIALS AND METHODS: This study assessed 13 gnathic OS patients of 98 OS patients from four major referral centers during 1996-2007. The age distribution, gender, involved site, clinical findings, signs, symptoms, grade and sub-types were assessed. Hematoxylin-eosin, Picrosirius red, Ponceau trichrome, Masson trichrome and osteoid staining methods were used. RESULTS: Of the 98 OS lesions, 85 (86.8%) involved the skeleton, the youngest patient was 6 and the oldest 60 years old; 13 lesions (13.2%) involved the jaws (seven mandibular and six maxillary) and the youngest and oldest patients were 15 and 50 years-old, respectively. Non-gnathic OS was more prevalent between the ages of 11 and 20 years (avg. 15 years) and was common in the distal femur and proximal tibia, presenting most frequently with pain and swelling. OS of the jaws, however, presented more than 10 years later than non-gnathic OS, being more prevalent between the ages of 20 and 30 years (avg. 27 years). OS of the jaws most frequently involved the mandibular body and the posterior maxillary alveolar ridge, presenting frequently with pain, swelling and loosening of teeth. Two patients with gnathic OS died during the 10-year follow-up period (15.3%). CONCLUSION: Prevalence of OS of the jaws was about twice as high as that reported in other studies and presented later than non-gnathic cases. Pain and swelling were common signs and symptoms in this disease. The mixed sub-type was the most common sub-type of gnathic OS.

Anaesthetic efficacy of a labial infiltration method on the nasopalatine nerve.

BACKGROUND AND AIM: The conventional nasopalatine nerve block is commonly used to obtain anaesthesia in the anterior portion of the palate. The painful nature of this approach, however, has led investigators to seek alternative methods to obtain anaesthesia. Labial infiltration of the maxillary central incisors can be considered an effective anaesthetic approach for the anterior palate. Our study aimed to assess the anaesthetic effect of a modified labial infiltration method on the nasopalatine nerve. MATERIALS AND METHOD: A case-control clinical trial was done on 60 patients referring for extraction of maxillary incisors (mean age 44 years). The patients were divided into two groups of 30 people. For the first group, a primary conventional infiltration was given to each patient from a point between the maxillary canine and the lateral to obtain preliminary anaesthesia for the maxillary anterior labial area. The second or the control group was anaesthetised by conventional injection into incisive papilla. Two to three minutes afterwards, a labial infiltration approach was done and the amount of pain determined by OPS (objective pain score) was assessed. After five to six minutes the level of anaesthesia in the anterior palate was assessed in both groups by an explorer and recorded as pain-free, mild pain or severe pain. The sign test was used to statistically analyse the data (p <0.001). RESULTS: Total, moderate and no anaesthesia were observed in 76.7%, 13.3%, and 10% of the patients receiving anesthetic injection at the labial side. For the control group, these results were 83%, 17% and 0% respectively. CONCLUSION: This method of labial infiltration may be an effective alternative to the painful conventional palatine nerve block to obtain efficient anaesthesia of the anterior palate (p <0.001).

Trapezoid supracondylar femoral extension osteotomy for knee flexion contractures in patients with haemophilia.

Flexion deformity of the haemophilic knee is a considerable cause of disability and may need to be managed surgically in severe cases. We have used a trapezoid supracondylar femoral extension osteotomy to correct severe knee flexion deformity. Nine severe haemophilic patients with contractures >30 degrees that were unresponsive to conservative measures underwent 11 trapezoid osteotomies. The angle of deformity was measured using anteroposterior and lateral knee X-ray films at maximum extension. Factor levels of 80-100% were achieved before the operation. A trapezoid osteotomy of the distal femur bone was performed using a lateral approach. The frontal plane angular deformity (if any) was corrected at the same time. The osteotomy site was fixed using an Arbeitsgemeinschaft für Osteo synthesefragen (AO) condylar blade plate. Following surgery, the knee was supported by a plaster splint at 20 degrees of flexion. Physiotherapy was started on third postoperative day and continued three times a week. There was no serious complication. The deformities were corrected in all of the patients and the mean range of motion increased form 68.6 degrees to 98.1 degrees . Bleeding episodes decreased in all four knees which had a bleeding score of 3 before surgery. Using the Orthopaedic Advisory Committee of the World Federation of Haemophilia scores, nine good and two fair results were obtained. All patients regained the ability to walk for both short and long distance without any aid, climb the stairs, bath, and use public transportation. Trapezoid supracondylar femoral extension osteotomy should be considered in the surgical management of severe haemophilic flexion deformity of the knee joint.