Evaluation of occurrence, fate and removal of priority phthalate esters (PAEs) in wastewater and sewage sludge by advanced biological treatment, waste stabilization pond and constructed wetland.

Phthalate Esters (PAEs), detected in high concentrations generally in treated wastewater discharged from wastewater treatment plants (WWTPs), are important pollutants that restrict the reuse of wastewater. Investigating the fate of these endocrine-disrupting chemicals in WWTPs is crucial in order to protect both receiving environments and ecosystems. For this purpose, di(2-ethylhexyl) phthalate (DEHP), di-n-octyl phthalate (DNOP) and benzyl butyl phthalate (BBP) in the group of PAEs were monitored in simultaneously both in wastewater and sludge lines of selected two nature-based WWTPs and one advanced biological WWTP. Although it was frequently stated that phthalates were significantly removed in WWTPs in many studies found in literature, negative removal efficiencies of selected phthalates in investigated WWTPs during the sampling period were observed generally in this study. One of the reasons for this concentration increase could be releasing of phthalates from microplastics in wastewater during the treatment process or the desorption of PAEs from treatment sludge. DNOP was the compound with the highest concentration increase at almost each treatment unit of the three WWTPs. On the other hand, total PAEs load was 1997 g d-1 in advanced biological WWTP and adsorption onto sludge of PAEs were determined as 90%. The side-stream total load returned from the decanter supernatant was 0.02% of the total PAEs load coming to advanced biological WWTP from the sewer system. As a result of detailed statistical analysis, the correlation between raw wastewater and primary clarifier (PC) effluent was determined as an increasing linear relation for DEHP and DNOP. On the other hand, moderate and strong correlations were observed both between septic tank and constructed wetland (CW) processes with raw wastewater. In the waste stabilization pond (WSP), while a significant correlation was not found between the sludge line data, homogeneous variance, strong and moderate correlations were obtained in the wastewater line data. However, while mean differences for all investigated PAEs were not significant (p > 0.05) in the wastewater line, mean differences of DEHP (p < 0.05) were significant in the sludge line according to ANOVA analysis.

Occurrence, loadings and removal of EU-priority polycyclic aromatic hydrocarbons (PAHs) in wastewater and sludge by advanced biological treatment, stabilization pond and constructed wetland.

Eight polycyclic aromatic hydrocarbon (PAH) compounds which have been accepted as priority micropollutants by European Union (EU) were analyzed both in wastewater and sludge lines throughout three full scale (located in city, sub-province and village) WWTPs during 12-month sampling period. Investigated WWTPs have different treatment types including advanced biological treatment, stabilization pond (SP) and constructed wetland (CW). Removal efficiencies for total PAH compounds varied from 48% in CW to 85% in advanced biological treatment plant. The maximum concentrations of 360-2282 ng/L observed for naphthalene in raw wastewater were decreased to 103-370 ng/L by treatment processes. Minimum concentration were detected for benzo(k)fluoranthene (B[k]F) and benzo(g,h,i)perylene (B[g,h,i]P) ranged between 8 and 12 ng/L and 19-33 ng/L, respectively. While minimum removal efficiencies were obtained for B[k]F and B[g,h,i]P maximum removal efficiencies were obtained for naphthalene in all WWTPs. PAHs present in minimum and maximum levels in the sludge samples were detected as 54 and 6826 ng/g for the B[g,h,I]P and naphthalene, respectively. Considering the removal mechanisms, PAHs have been determined to be removed by biodegradation or vaporization up to 84% and by settling (adsorption onto sludge) up to 2%. The greatest portion (99%) of naphthalene and anthracene were determined to be biodegraded or vaporized in biological treatment due to their low molecular weights. On the other hand, mechanism of adsorption onto sludge was determined as negligible for these two compounds. In addition, approximately 14% of PAHs were discharged to the receiving environment. Among the different WWTP types investigated, advanced biological treatment was found to be the most efficient plant for the removal of PAH compounds.

Evaluation of incidental thyroid cancer in patients with thyroidectomy / Evaluación incidental del cáncer de tiroides en pacientes con tiroidectomía

OBJECTIVE: The present study aimed to emphasize the necessity and significance of thyroidectomy by determining the prevalence of incidental thyroid cancer in the cases that underwent surgical intervention for the treatment of benign thyroid disease. SUBJECTS AND METHOD: Thyroidectomy was performed in 443 cases including those with benign multinodular goitre (BMNG) or toxic adenoma or toxic multinodular goitre. Diagnosis was made based on routine physical examination, laboratory analyses, imaging methods and postoperative histopathological findings of the cases. RESULTS: The mean age of the cases was 45.5 (19-68) years and 72.5% (n = 321) were female. The most common clinical diagnosis prior to the surgery was BMNG (n = 428, 96.6%). While BMNG was determined to be the most common histopathological diagnosis after thyroidectomy at a rate of 81.7% (n = 362), the rate of thyroid cancer was found to be 14% (n = 81). The prevalence ofpapillary cancer was 84% (n = 56), whereas it was 4% (n = 4), 1% (n = 1) and 0.0% (n = 0) for medullary, follicular and anaplastic cancers, respectively. Papillary cancer was also the most common type of thyroid cancer between genders. As compared to gender, there was no statistically significant difference in terms of distribution of age among general, benign and malignant types of thyroid cancer (p > 0.05). CONCLUSION: It is appropriate to prefer thyroidectomy for the treatment of benign thyroid diseases due to the high prevalence ofincidental thyroid cancer after thyroidectomy in such cases.

OBJETIVO: El presente estudio tiene por objeto destacar la necesidad e importancia de la tiroidectomía mediante la determinación de la prevalencia del cáncer de tiroides incidental en los casos sometidos a intervención quirúrgica para el tratamiento de enfermedades tiroideas benignas. SUJETOS Y MÉTODO: Se practicó la tiroidectomía en 443 casos incluyendo aquellos con bocio multinodular benigno (BMNG) o adenoma tóxico o bocio multinodular tóxico. El diagnóstico se realizó a partir de un examen físico de rutina, análisis de laboratorio, métodos de imaginología, y resultados histopatológicos postoperatorios de los casos. RESULTADOS: La edad promedio de los casos fue 45.5 años (19-68) y 73% (n = 321) eran mujeres. El diagnóstico clínico más común antes de la cirugía fue BMNG (n = 428, 96,6%). Si bien se determinó que BMNG era el diagnóstico histopatológico más frecuente después de la tiroidectomía con una tasa de 81.7% (n = 362), se halló que la tasa de cáncer de tiroides era 14% (n = 81). La prevalencia de cáncer papilar fue de 84% (n = 56), mientras que para el cáncer medular, folicular y anaplásico, fue de 4% (n = 4), 1% (n = 1) y 0.0% (n = 0) respectivamente. El cáncer papilar también fue el tipo más común de cáncer de tiroides entre los géneros. En comparación con el género, no hubo ninguna diferencia estadísticamente significativa en cuanto a la distribución por edad entre los tipos generales, benignos y malignos de cáncer de tiroides (p > 0.05). CONCLUSIÓN: Es apropiado preferir la tiroidectomía para el tratamiento de las enfermedades tiroideas benignas debido a la alta prevalencia de cáncer tiroideo incidental después de la tiroidectomía en tales casos.

Evaluation of incidental thyroid cancer in patients with thyroidectomy.

OBJECTIVES: Variations such as communications between median nerve and musculocutaneous nerve or in their abnormal branching pattern constitute a major concern in clinical and surgical field. Knowledge of these variations not only provides the clinician with a proper interpretation of the case, but also minimizes the complication in surgical approaches in this region. METHOD: We examined 50 isolated upper limbs to investigate the possible incidences of various types of communications between these two neighbouring peripheral nerves. RESULT: Twenty-eight per cent of limbs were found to have communication between these two nerves. When categorized according to Venieratos and Anagnostopoulou's classification method, 11 out of 14 cases (79%) showed type I communications, two out of 14 (14%) showed type II and the remaining one (7%) showed type III communication pattern. CONCLUSION: Prior knowledge of communications between these two neighbouring nerves, both in terms of their incidences and pattern of communications, may be of considerable significance to neurologists and orthopaedicians in dealing with nerve entrapment syndromes in the upper limb of patients.

Gallstone ileus with a giant stone and associated multiple stones.

Gallstone ileus is an uncommon cause of small bowel obstruction. Gallstone ileus accounts for only about 1-3 % of cases of mechanical obstructions of the small bowel. It usually occurs in the elderly with a female predominance and may result in high mortality rates. The diagnosis is difficult and early diagnosis reduces the mortality. Terminal ileum is the most common site of gallstone impaction. We report a case of gallstone ileus in an 81-year-old female patient who was admitted to our clinic for abdominal pain, vomiting and constipation. The ultrasonography of abdomen revealed a decrease in bowel motion, and dilated bowel segments. Intraoperatively, a giant gallstone and associated multiple stones were found in the ileum 80 cm from the ileocecal valve and extracted from a longitudinal enterotomy (Fig. 4, Ref. 24).

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.

Diosmin ameliorates intestinal injury induced by hepatic ischemia reperfusion in rats.

BACKGROUND: Hepatic ischemia-reperfusion causes histologic injury to the intestinal mucosa. We investigated the effects of diosmin, a phelobotrophic drug with antioxidant and antiinflammatory effects, on intestinal injury in the experimental liver ischemia-reperfusion model. MATERIALS AND METHODS: Fourty rats were divided into four groups: sham group (Group 1), control group (Group 2), perop diosmin group (50 mg/kg) treatment group (Group 3) and preop 10-day diosmin (50 mg/kg) treatment group (Group 4). Ischemia-reperfusion model was carried out by clamping the hepatic pedicle for 60 min and then reperfusing the liver for 90 min. At the end of procedures, blood and ileum tissue samples were obtained for biochemical and histopathological assessments. RESULTS: According to the results of liver function tests (AST, ALT and LDH) there was a significant difference between the control and other groups (p < 0.001 for all). According to the plasma and ileum oxidative stress parameters (MDA, GSH-Px and XO), there was a significant difference between the control and other groups (p < 0.05 for all). Histopathologically; the specimens in Group 2 showed specific morphological abnormalities (the epithelial lining of the apical surface of villi was degenerated and desquamated to the lumen). Group 3 and 4 showed ileal histomorphology similar to the sham group. Pathological scores were significantly different between Group 2 and other groups. CONCLUSIONS: Diosmin can be administered for protection from destructive effects of hepatic ischemia-reperfusion injury on intestine in both emergent and elective hepatic surgical operations in which the possible ischemic periods are expected (Tab. 4, Fig. 1, Ref. 39).

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.

Psychological profile of Turkish rock climbers: an examination of climbing experience and route difficulty.

The purpose of this study was to examine sensation seeking, physical self-perception, and intrinsic and extrinsic motives of rock climbers and to compare these psychological constructs with respect to their years of climbing experience and the difficulty of their climbing routes. 64 climbers (M age=29.1 yr., SD=6.4) voluntarily participated in this study. The Arnett Inventory of Sensation Seeking (AISS), Physical Self-Description Questionnaire (PSDQ), and Sport Motivation Scale (SMS) were administered to the rock climbers. Analysis indicated that the mean score of rock climbers on the Novelty subscale of the Sensation Seeking Scale was 33.9 (SD= 3.6) and mean value on the Intensity subscale was 29.2 (SD=5.2). The mean scores of rock climbers on the PSDQ ranged between 3.9 (SD= 1.0, Physical Activity) and 5.1 (SD= 1.1, Body Fat). Descriptive analysis indicated that the highest mean score of rock climbers on the SMS was obtained in Intrinsic motivation to Experience Stimulation (5.7, SD= 0.9). The independent sample t test showed no significant differences in sensation seeking, physical self-perception, and sport motivation with regard to years of climbing experience and route difficulty (p>.05). It may be concluded that sensation seeking in climbers is high, and they have internal motivational orientation and positive physical self-perception; their competence in climbing has no obvious relationship to these variables.

Precompetitive anxiety and affective state of climbers in indoor climbing competition.

The purpose of this study was to measure the precompetitive anxiety and affective states of climbers, particularly with regard to sex and types of competition. 37 men (M=25.9, SD=3.8 yr.) and 10 women (M=25.9, SD=4.2 yr.), climbers who enrolled in Indoor Sport Climbing Competition, voluntarily participated in two different types of competition-speed and difficulty indoor climbing. The Competitive State Anxiety Inventory-2 and the Positive and Negative Affect Schedule were administered to all climbers just before the competition. The Sport Competition Anxiety Test was also administered to control competitive trait anxiety. Multivariate analysis of covariance yielded a significant interaction of sex and type of competition for affective state (Hotelling T2=0.21; F2,33=3.43, p<.05). Follow-up univariate analysis indicated that the mean Negative Affect score of women climbers before the difficulty competition was higher than mean Negative Affect scores of men before both speed and difficulty competitions and also the mean for women climbers before the speed competition (F1,34 = 6.15, p <.05). The results partially supported the hypothesis of differences in negative affect by sex and types of competition.

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.

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.

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.

Decreased osteocalcin levels in patients with chronic obstructive pulmonary disease using long-term inhaled beclomethasone dipropionate.

Inhaled corticosteroids have been used in the treatment of chronic obstructive pulmonary disease (COPD) for many years. However the adverse effects of corticosteroids on bone formation may require special consideration in these patients. This study was undertaken to investigate the effects of long-term inhaled beclomethasone dipropionate treatment on the biochemical markers of bone formation. For this purpose, serum osteocalcin, alkaline phosphatase, free calcium, and inorganic phosphate levels were measured in 65 male COPD patients. Patients in the control group (n = 30) had not taken oral or inhaled corticosteroids for at least 1 year. Only those patients using beclomethasone with metered-dose inhalers were included in the treatment group (n = 35). The mean age of the control group was 61.63 +/- 1.84 (mean +/- SEM). In the treatment group, the mean age was 59.10 +/- 2.29 and patients in this group had taken beclomethasone for an average time of 23.94 +/- 2.72 months (for at least 12 months) at an average concentration of 1,142.0 +/- 79.64 microg/d. The mean serum osteocalcin levels in the control group and treatment group were 7.03 +/- 0.19 ng/mL and 3.74 +/- 0.12 ng/mL, respectively. Comparison of values between groups indicates that serum osteocalcin levels in patients using beclomethasone were significantly lower than that of patients in the control group. Serum alkaline phosphatase levels were 167.96 +/- 1.49 U/L and 168.17 +/- 1.60 U/L for the control and treatment groups, respectively. There was no statistically significant difference among these values (Student's t test; P >.05). The mean values of total serum calcium and inorganic phosphate were not statistically different between the groups (P >.05). These results indicate that long-term inhaled beclomethasone treatment in COPD patients may induce significant changes in osteocalcin levels and require close monitoring for osteoporotic changes.

Periodontal pathogens in the shallow pockets of immigrants from developing countries.

The aim of this study was to examine the distribution of typical periodontitis-associated microorganisms in refugees arriving from non-industrialized countries, and to relate the presence of these organisms to the periodontal condition of the subjects. Thirty males between 35-44 years of age were surveyed. Dental plaque, calculus, gingivitis, loss of attachment, and probing depths were recorded for all surfaces. A total of 90 microbiological samples were taken with paper points from mesial sites of teeth 16, 36 and 41. Microbiological test sites were grouped by probing depths and loss of attachment. Only 16.8% of all surfaces had probing depths > 3 mm, although 90.7% of surfaces had loss of attachment > 1 mm. Twenty-one sites with obvious periodontal destruction (PD > 3 mm, LA > 2 mm) showed the greatest recovery of Porphyromonas gingivalis (66.7%). However, 51 sites with minimal periodontal disease (PD < or = 3 mm, LA < 2 mm) and with no gingival recession also showed a relatively high detection frequency of P. gingivalis (34.1%). Twenty-four of these samples came from 12 patients with no pockets > 5 mm and with less than 10% of all sites yielding pockets > 3 mm. The detection frequencies of Prevotella intermedia (91.6%), Bacteroides forsythus (25.0%), Wolinella spp. (33.3%) and Actinobacillus actinomycetemcomitans (50.0%) were similar in these sites compared with periodontitis sites. Morphologically distinct isolates, from 19 individuals positive for A. actinomycetemcomitans, were serotyped by indirect immunofluorescence.(ABSTRACT TRUNCATED AT 250 WORDS)