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1.
Niger J Clin Pract ; 23(1): 54-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929207

RESUMO

Objectives: The first aid implemented just after the traumatic dental injury (TDI) is of vital importance. This study aims to evaluate the attitudes of emergency medical technicians (EMTs) and paramedics toward TDI and their levels of knowledge about the issue. Subjects and Methods: A questionnaire, which comprised 14 questions, was applied to 389 EMTs and paramedics all across Turkey. The questionnaires were sent to the participants through e-mails, and the results were obtained by an online system. Results: 336 out of 389 EMTs and paramedics (86.4%) mentioned that they did not have any training about the TDI issue. On the other hand, among the ones who mentioned that they received this training, 50.9% suggested that the training was not sufficient. It was observed that 63.5% of the participants encountered cases of injuries in oral and dental regions, and in 83% of these cases the only treatment applied was bleeding intervention. About 75.6% of them think that an avulsed tooth cannot be reimplanted. Conclusion: In conclusion, it was determined that the EMTs and paramedics did not have sufficient and accurate information about the TDI. Lack of knowledge about TDI prevents rapid and accurate intervention to the cases.

2.
Niger J Clin Pract ; 22(11): 1546-1552, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719276

RESUMO

Objectives: The aim of this in vitro study was to evaluate the effects of casein phosphopeptides (CPP)-ACPF, NovaMin+ fluoride-containing toothpaste and Xylitol+ fluoride containing cream on demineralized areas on the enamel surface. Materials and Methods: A total of 100 enamel slab samples was prepared to investigate in the laboratory experiments. For this purpose, a total of 50 freshly extracted third molar teeth which completed root formation split into two portions in the mesiodistal direction. Enamel surfaces were immersed in a pH cycling protocol as described in the literature to simulate oral conditions for 9 days in order to evaluate the effect of test materials on the artificial enamel lesions. Then the remineralization agents were applied on the enamel surfaces, and we analyzed their effects. Results: We used Vickers Microhardness with the purpose of calculating the amount of lost or acquisition of minerals on the enamel surface qualitatively; inductively coupled plasma atomic emission spectroscopy (ICP-AES) to define the calcium and phosphorus ions that dissolved in acid. One-way ANOVA and Tukey's T Post-Hoc tests were performed to distinguish significant differences among groups (P < 0.05). Conclusions: Remineralization was provided in all treated groups, according to the data obtained from all tests. NovaMin was more effective in increasing acid resistance. It was also found that all three experimental groups were effective in increasing the surface hardness, but CPP-ACPF and NovaMin are more effective than Xylitol. However, there was no statistically significant difference between the experimental groups.

3.
Niger J Clin Pract ; 22(8): 1063-1069, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417048

RESUMO

Aim: The objective of this study was to determine the prevalence of burnout syndrome and associated factors among family physicians before and after family medicine system (FMS). Materials and Method: The first part of the study was conducted in 2008 (pre-FMS) and the second part in 2012 (post-FMS). Physician's burnout was investigated by using the Maslach Burnout Inventory (MBI). In total, 139 physicians had been participating pre-FMS and 246 physician's post-FMS. Results: The mean pre-FMS emotional exhaustion score was 15.7 ± 5.8, increasing significantly to 17.14 ± 7.5 post-FMS (P = 0.045). Mean pre-FMS and post-FMS depersonalization and reduced personal accomplishment scores were similar (P > 0.05). Age was negatively correlated with depersonalization in this study (P = 0.012) and positively correlated with personal accomplishment (P = 0.001). The primary care physicians in the post-FMS period were older, female physicians had a greater preference for primary care, and the levels of married doctors were higher. In addition, a higher level of physicians also owned their own home and cars compared to the pre-FMS period. A negative correlation has been reported between physicians' burnout levels and home or car ownership in the present study. Conclusion: Our findings suggest that physicians working under the family medicine system, a new primary care model, are at greater risk of emotional exhaustion, but that no change has occurred in terms of personal accomplishment or depersonalization, despite this new system.


Assuntos
Esgotamento Profissional/psicologia , Estresse Ocupacional/psicologia , Médicos de Família/psicologia , Carga de Trabalho , Adulto , Esgotamento Profissional/epidemiologia , Estudos Transversais , Despersonalização , Emoções , Medicina de Família e Comunidade/organização & administração , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/epidemiologia , Prevalência , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Turquia/epidemiologia
4.
Niger J Clin Pract ; 22(5): 626-632, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31089016

RESUMO

Background: Widespread irrational medical prescription adversely affects the outcomes of patient health and medical services. Aim: This study aims to investigate the determinants of medical prescription behavior of family physicians in Erzurum Province. Materials and Methods: This cross-sectional descriptive study was conducted during August-December 2016 on a voluntary sample of 191 out of 234 physicians (81.6%) working at family health centers in the districts of Erzurum. Physicians were visited at their workplaces, and data were collected using a self-administered and structured, 45-item questionnaire. Results: The mean age of the physicians was 34.7 ± 7.9 years, and 70.7% (n = 135) of the participants were males. About 83.8% (n = 160) of physicians responded "yes" or "sometimes" to the question "Do you prescribe medicine on demand of the patients?" The two most important factors that affected the prescribing behavior of the participants were the pharmacology lectures attended during medical education (50.8%) and the prescribing experience acquired during clinical internship (46.0%). Presentations given by the representatives of drug companies, in-service training programs after graduation, and Internet/mobile phone applications had the lowest rate of contribution as behavioral determinants. The participants perceived having sufficient information in the areas of indication for use (77.5%) and daily dose (72.8%). Only 4.2% of participants deemed their knowledge of medication costs sufficient. Pharmacology lessons were found to be more effective in the prescribing behaviors of the physicians who had less than 10 years of professional experience (Chi-square = 12.131; P = 0.002). Conclusion: Rational medical prescription continues to be a trouble among family physicians. The study findings suggest a substantial knowledge gap in participating physicians occurring after graduation and clinical internship training, in the areas of costs of medicine and rational medical prescribing.


Assuntos
Prescrições de Medicamentos , Medicina de Família e Comunidade/educação , Farmacologia/educação , Padrões de Prática Médica , Adulto , Competência Clínica , Estudos Transversais , Custos de Medicamentos , Prescrições de Medicamentos/economia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internato e Residência , Masculino , Preferência do Paciente , Inquéritos e Questionários , Turquia
5.
J Stomatol Oral Maxillofac Surg ; 120(1): 61-66, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30142393

RESUMO

Distraction osteogenesis is usually performed in cleft lip and palate patients with severe maxillary sagittal discrepancies, considering the stability of surgical maxillary advancement and the limited complications of velopharyngeal valve insufficiency. Moreover, interdental distraction osteogenesis is a successful treatment protocol for repairing large clefts. Herein, we report a multidisciplinary approach for the treatment of two patients with cleft lip and palate using an archwise distraction appliance (AWDA). AWDA is a tooth-supported, custom-made appliance for closing the alveolar cleft and providing sagittal correction of the maxilla. Using it, the curve of the dental arch is maintained during distraction, and there is no need for a second operation to activate and remove the appliance. Few cases in which archwise distraction was performed have been reported so far. AWDA is a functional and inexpensive appliance used to reduce the alveolar cleft width and produce maxillary advancements in patients with cleft lip and palate.


Assuntos
Fenda Labial , Fissura Palatina , Osteogênese por Distração , Humanos , Maxila
6.
Cell Mol Biol (Noisy-le-grand) ; 63(9): 53-58, 2017 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-28980934

RESUMO

Past several years have witnessed dramatic leaps in our understanding of rewiring of gene expression at the translation level during cancer developmentthat provides linchpin support to the transformed phenotype. Most recent and ground-breaking developments in the field of molecular oncology aredriven by an explosion in technological advancements and have started to reveal previously unimagined regulatory mechanisms and how they intricately co-ordinate to modulate cancer progression, loss of apoptosis and development of resistance against different therapeutics. However, the insights gained from work in this natural product research have far-reaching impact because of rapidly increasing repertoire of medicinally and biologically efficient phytochemicals. How Tanshinones mediate targeting of JAK-STAT, ER stress associated signaling cascade,PI3K/AKT/mTOR pathway,autophagy, TRAIL pathway and microRNAs are being discovered and will prove to be helpful in getting a step closer to personalized medicine.


Assuntos
/uso terapêutico , Antineoplásicos Fitogênicos/uso terapêutico , Neoplasias/tratamento farmacológico , Transdução de Sinais/efeitos dos fármacos , /farmacologia , Animais , Antineoplásicos Fitogênicos/farmacologia , Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Avaliação Pré-Clínica de Medicamentos , Humanos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Metaloproteinases da Matriz/metabolismo , Neoplasias/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ligante Indutor de Apoptose Relacionado a TNF/metabolismo , Serina-Treonina Quinases TOR/metabolismo
7.
Niger J Clin Pract ; 20(3): 394-396, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28256499

RESUMO

Torsion of a wandering spleen is a rare disease. The symptoms and signs of this condition are only present when the splenic pedicle torts. The etiological factors are the congenital absence of the ligaments that hold the spleen in its normal anatomic position, or the relaxation of these ligaments resulting from conditions like trauma and abdominal surgery. We aimed to present a rare case with torsion of wandering spleen that consequently developed thrombosis of portal vein and its branches, taking into consideration the relevant literature.


Assuntos
Veia Porta , Veia Esplênica , Anormalidade Torcional/complicações , Trombose Venosa/etiologia , Baço Flutuante/complicações , Adulto , Feminino , Humanos , Esplenectomia , Anormalidade Torcional/cirurgia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/cirurgia , Baço Flutuante/cirurgia
8.
Niger J Clin Pract ; 20(11): 1489-1496, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29303137

RESUMO

OBJECTIVE: The purpose of this study was to compare the effects of thymoquinone and icodextrin in rats within the framework of an experimental adhesion model. MATERIALS AND METHODS: Rats were separated into three groups: (1) a control group consisting of rats that had 2 ml of isotonic solution administered intraperitoneally, (2) an ICO group administered with 2 ml of 4% icodextrin, and (3) a TQ group administered thymoquinone (10 mg/kg), all following cecal abrasion. The three groups underwent a reoperation on the 7th postoperative day. Hydroxyproline levels were analyzed in the resected adhesive tissues, and histopathological investigations were conducted. Blood samples were collected for biochemical analyses. RESULTS: Fewer postoperative adhesions were observed in the ICO and TQ groups compared with the control group. A comparison of the TQ and ICO groups revealed lowers levels of postoperative adhesions in the TQ group. Compared with the control group, malondialdehyde, 8-OH-deoxyguanosine/deoxyguanosine (8-OHdG/10dG), Coenzyme Q10 (CoQ10), and CoenzymeQ10/reduced CoenzymeQ10 (CoQ10/CoQ10H) values were found to be lower in the TQ and ICO groups. When the TQ and ICO groups were compared with respect to their biochemical parameters, the results for all of the four parameters were found to be statistically significantly lower in the TQ group (P < 0.000). The levels of hydroxyproline in the control, ICO, and TQ groups were found to be (mean ± standard deviation) 502.25 ± 90.39 µg/g, 342.13 ± 66.61 µg/g, and 287.88 ± 49.59 µg/g, respectively. CONCLUSIONS: A comparison of the antiadhesive effects of thymoquinone and icodextrin revealed thymoquinone to be more effective. These results indicate that thymoquinone is an efficient and strong antiadhesive molecule.


Assuntos
Benzoquinonas/farmacologia , Glucanos/farmacologia , Glucose/farmacologia , Complicações Pós-Operatórias , Aderências Teciduais/prevenção & controle , Animais , Benzoquinonas/administração & dosagem , Modelos Animais de Doenças , Glucanos/administração & dosagem , Glucose/administração & dosagem , Humanos , Icodextrina , Injeções Intraperitoneais , Masculino , Ratos , Ratos Wistar , Aderências Teciduais/etiologia , Aderências Teciduais/patologia , Ubiquinona/análogos & derivados
9.
Scand J Surg ; 106(1): 62-67, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26929288

RESUMO

BACKGROUND: Intraoperative testing of gastrointestinal anastomosis effectively ensures anastomotic integrity. This study investigated whether the routine use of methylene blue intraoperatively identified leaks to reduce the postoperative proportion of clinical leaks. METHODS: This study retrospectively analyzed consecutive total gastrectomies performed from January 2007 to December 2014 in a university hospital setting by a general surgical group that exclusively used the methylene blue test. All surgeries were performed for gastric or junctional cancers (n = 198). All reconstructions (Roux-en Y esophagojejunostomy) were performed using a stapler. The methylene blue test was used in 108 cases (group 1) via a nasojejunal tube. No test was performed for the other 90 cases (group 2). Intraoperative leakage rate, postoperative clinical leakage rate, length of hospitalization, and mortality rate were the outcome measures. RESULTS: The intraoperative leakage rate was 7.4% in group 1. The postoperative clinical leakage rate was 8.6%. The postoperative clinical leakage rate was 3.7% in group 1 and 14.4% in group 2 (p = 0.007). There were no postoperative clinical leaks when an intraoperative leak led to concomitant intraoperative repair. The median length of hospital stay was 6 days in group 1 and 8 days in group 2 (p < 0.001). One death occurred in each group. No test-related complications were observed. CONCLUSION: The methylene blue test for esophagojejunostomy is a safe and reliable method for the assessment of anastomosis integrity, especially in cases with difficult esophagojejunostomic construction.


Assuntos
Fístula Anastomótica/diagnóstico , Corantes , Esôfago/cirurgia , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/diagnóstico , Jejuno/cirurgia , Azul de Metileno , Adulto , Idoso , Anastomose Cirúrgica , Fístula Anastomótica/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Cell Mol Biol (Noisy-le-grand) ; 62(5): 2-8, 2016 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-27188862

RESUMO

Spine injury associated with traumatic spinal cord injury eventuates in oxidative stress, inflammation and neuronal apoptosis. The aim of this study is to find out whether the glycyrrhizic acid treatment protects spinal cord from traumatic injuries in rats. To this end, the rats were divided into three groups: group I; control group (no drug or operation, n=8), group II; traumatic spinal cord injury group (TSCI, n=8) and group III; glycyrrhizic acid group (TSCI-GA, 80 mg/kg, n=8). Total laminectomy was performed at T10 level. A balloon angioplasty catheter was inserted into the T9 level thoracic spinal cord extradurally. The rats were evaluated with the Tarlov Scale. After 24 hours, spinal cord tissues were taken for biochemical and histopathological examinations. TSCI effectuates unwanted results on tissues, antioxidant systems and cell membranes. Antioxidant enzyme level decreased and lipid peroxidation increased. However, TSCI led to inflammation and apoptosis. Glycyrrhizic acid treatment provided a significant decrease in lipid peroxidation in group III in comparison with group II. Moreover, nuclear respiratory factor 1 levels and superoxide dismutase activity of group III were significantly higher than group II (p<0.05). The histopathological and immunohistochemical results revealed that the numbers of apoptotic and necrotic neuron, edema, hemorrhage, inflammatory cells, NF-κB and S100B expressions were significantly lower than group II (p<0.05). Our study showed that the glycyrrhizic acid treatment reduced oxidative stress and inflammation, and promoted the neuronal functions in traumatic spinal cord injury.


Assuntos
Ácido Glicirrízico/uso terapêutico , Traumatismos da Medula Espinal/tratamento farmacológico , Animais , Ácido Glicirrízico/farmacologia , Imuno-Histoquímica , Masculino , Malondialdeído/metabolismo , NF-kappa B/metabolismo , Fator 1 Nuclear Respiratório/metabolismo , Ratos Sprague-Dawley , Proteínas S100/metabolismo , Medula Espinal/efeitos dos fármacos , Medula Espinal/metabolismo , Medula Espinal/patologia , Traumatismos da Medula Espinal/patologia , Coloração e Rotulagem , Superóxido Dismutase/metabolismo
11.
Hernia ; 18(6): 837-43, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24121841

RESUMO

PURPOSE: The aim of this study was to emphasize the importance of differential diagnosis in patients with acutely incarcerated abdominal wall hernia (AWH). METHODS: The medical records of patients who underwent emergency surgery with preoperative diagnosis of acutely incarcerated AWH and in whom acutely incarcerated AWH was the consequence of increased intraabdominal pressure due to other abdominal emergencies were reviewed. The following data were collected: demographics, the duration between the onset of symptoms and admission, clinical findings, biochemical test results that were abnormal, radiological findings, preoperative and intraoperative diagnosis, operative findings, surgical procedure, different diagnosis made in the postoperative period, reoperation, morbidity, mortality, and the length of hospital stay. RESULTS: Ten patients were included to the study. The primary pathology was found to be perforated peptic ulcer disease in three, bowel obstruction due to neoplastic mass in three, complicated appendicitis in two, acute mesenteric ischemia in one, and acute diverticulitis in one. The correct diagnosis was made during emergency surgery for hernia repair, whereas the primary pathology was identified postoperatively in two patients. CONCLUSIONS: Patients who are diagnosed to have acutely incarcerated AWH preoperatively should undergo further diagnostic workup, if any level of clinical suspicion for differential diagnosis is present. Moreover, the surgeon should consider general abdominal exploration if contradictory findings are encountered during the exploration of the hernia sac, even if preoperative diagnostic studies reveal no gross pathology or non-specific findings.


Assuntos
Parede Abdominal , Hérnia Inguinal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Obstrução Intestinal , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Emergências , Feminino , Gastroenteropatias/classificação , Gastroenteropatias/complicações , Gastroenteropatias/diagnóstico , Hérnia Inguinal/fisiopatologia , Hérnia Ventral/fisiopatologia , Humanos , Achados Incidentais , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Obstrução Intestinal/cirurgia , Volvo Intestinal/diagnóstico , Volvo Intestinal/fisiopatologia , Volvo Intestinal/cirurgia , Tempo de Internação , Masculino , Registros Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Turquia
12.
Eur J Gynaecol Oncol ; 33(1): 62-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22439408

RESUMO

PURPOSE: To investigate the clinical features, prognostic factors, and treatment outcome in early-stage cervical carcinoma patients treated with postoperative radiotherapy (RT)/radiochemotherapy (RCT). METHODS: The records of 256 Stage IB and II cervical cancer patients treated with postoperative RT/RCT from 1992-2007 were retrospectively reviewed. Median age of the patients was 47 (range: 25-78). Two hundred one (78.6%) patients had squamous cell carcinoma and 29 (11.3%) had adenocarcinoma. One hundred and eighty-seven (73.0%) had FIGO Stage IB and 69 (27%) had Stage II disease. Concomitant cisplatin-based chemotherapy was administered to 47 (18.4%) patients. Metastatic lymph node ratio (MLNR), defined as number of metastatic lymph nodes divided by the number of dissected lymph nodes, was 0 in 142 (55.5%) patients, from 1% to 10% in 27 (10.5%) and > 10% in 31 (12.1%) patients. RESULTS: Median follow-up duration was 60.5 months (range: 6-202 months). Five-year locoregional control (LRC), disease-free survival (DFS), disease specific survival (DSS) and overall survival (OS) rates were 90.8%, 83.4%, 91.2%, and 85%, respectively. In multivariate analysis; bulky tumor (> 4 cm) was shown as an important prognostic factor for LRC, DFS and DSS. Pretreatment hemoglobin level (< 10 g/dl) was associated with lower OS rate. Endometrial involvement was associated with lower LRC and DFS. Treatment break > 14 days showed significance for DFS and DSS. MLNR was found as a valuable prognostic factor for all endpoints (LRC, DFS, DSS and OS). The rate of grade 3-4 late toxicity was 3.6% and 2%, respectively. CONCLUSION: Postoperative RT/RCT is an effective treatment modality for early-stage cervical cancer patients with unfavorable features and provides satisfactory local control and survival rates with low morbidity.


Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/terapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Braquiterapia , Quimiorradioterapia Adjuvante/efeitos adversos , Cisplatino/uso terapêutico , Intervalo Livre de Doença , Endométrio/patologia , Feminino , Seguimentos , Hemoglobinas/metabolismo , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos
13.
J BUON ; 15(3): 561-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20941828

RESUMO

PURPOSE: To evaluate the necessity and direct cost effectiveness of screening and staging procedures in breast cancer patients having ≥4 positive axillary lymph nodes and to identify further possible biopathological risk factors associated with increased risk of metastasis. METHODS: We reviewed the demographic and clinicopathological data from the medical records of 1897 newly diagnosed breast cancer patients. Patients having ≥4 positive axillary lymph nodes after primary surgery for breast cancer and who had staging examinations for metastasis were eligible. The impact of staging procedures (thoracoabdominal CT, bone scan etc.) for detecting metastasis, decision of adjuvant treatment and direct costs were analyzed in 329 patients with operable breast cancer. RESULTS: Thirty-five (10.6%) patients were found with metastasis at diagnosis. Seven (20.0%) among them had multiple metastases. Eighteen (51.4%) had lung, 17 (48.6%) bone, and 7 (20.0%) liver metastasis. Twenty-one (60.0%) patients needed further radiological investigation for metastasis confirmation. Treatment decision was changed in 27 (77.1%) patients. No statistically significant risk factor was identified among the metastatic patients by means of conventional demographic and biopathological parameters. The cost of screening was lower when compared to the cost of treatment without any screening procedure. CONCLUSION: Since the conventional clinicopathological data seems not sufficient to define the risk of developing metastasis in breast cancer patients with ≥4 axillary lymph node involvement, all of them should undergo full staging examinations until new parameters based on genomic level are defined. Staging procedures need modification for high risk breast cancer patients.


Assuntos
Neoplasias da Mama/patologia , Adulto , Idoso , Axila , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias
14.
Neurochirurgie ; 55(6): 600-2, 2009 Dec.
Artigo em Francês | MEDLINE | ID: mdl-19091358

RESUMO

Pituitary apoplexy is characterized by an abrupt neurological deteriorating condition associated with rapid expansion of the pituitary gland, caused by ischemic necrosis and hemorrhage. Craniopharyngioma may be difficult to distinguish from pituitary apoplexy. In this study, we discuss a case of pituitary apoplexy in a 19-year-old male patient. In our patient, the tumor was confused with a craniopharyngioma because of the suprasellar extension of the tumor on magnetic resonance (MR) images and the hyperintensity in T1-weighted images, the young age of the patient, and the gradually progressive onset of the symptoms. In conclusion, even without a known history of pituitary adenoma or an abrupt onset of the clinical symptoms, the diagnosis of pituitary apoplexy should be considered in a patient with a suprasellar mass hyperintensity in T1-weighted MR images, which may mimic craniopharyngioma.


Assuntos
Craniofaringioma/diagnóstico , Apoplexia Hipofisária/diagnóstico , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Hipófise/patologia , Sela Túrcica/patologia , Adulto Jovem
15.
Eur J Gynaecol Oncol ; 29(5): 505-10, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19051823

RESUMO

PURPOSE: Patients with Stage IA Grade (G) III, Stage IB GII-III and Stage IC GI-II-III endometrial cancer who received postoperative adjuvant radiotherapy were evaluated in terms of local control, disease-free and overall survival rates and prognostic factors. MATERIALS AND METHODS: Four hundred and three patients with Stage I endometrial cancer treated with radiotherapy from January 1990 to December 2003 at Ege University Faculty of Medicine Department of Radiation Oncology were reviewed retrospectively. According to our radiotherapy protocol patients with Stage IB G2 disease (149 patients) received only external radiotherapy and the remaining (254 patients) received both external radiotherapy and intracavitary brachytherapy. RESULTS: Median age of the patients was 58 (range: 37-83). Nine patients (2.2%) had Stage IA, 196 (48.6%) had Stage IB and 198 (49.1%) had Stage IC disease. Histologic grade was 1 in 52 (12.9%) patients, 2 in 268 (66.5%) patients and 3 in 83 (20.6%) patients. Seventy-one (17.7%) patients had lymphovascular space invasion. Five-year locoregional relapse-free, distant-free, disease-free survival (DFS) and overall survival (OS) were 98.2%, 92.8%, 91.8% and 87.7%, respectively. In multivariate analysis, myometrial invasion and lymphovascular invasion were predictive factors for DFS and for OS prognostic factors were histologic type, myometrial invasion, and histologic grade. During radiotherapy 47.9% of the patients developed acute morbidity and 26.3% developed late morbidity, vaginal stenosis being the most frequent late morbidity. CONCLUSION: Postoperative adjuvant radiotherapy provides high locoregional control rates with acceptable toxicity in selected patients with Stage I endometrial carcinoma.


Assuntos
Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Taxa de Sobrevida
16.
Eur J Gynaecol Oncol ; 29(2): 154-7, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18459551

RESUMO

PURPOSE: The purpose of this study was to evaluate acute and late radiation morbidity in patients with gynaecologic malignancy using the RTOG criteria and Franco-Italian glossary, and to compare the usefulness and disadvantages of each system. MATERIALS AND METHODS: Between February 2001 and February 2003, 107 patients with gynaecologic malignancy who received either radical or djuvant external radiotherapy +/- intracavitary brachytherapy or radiochemotherapy were enrolled in this study. The patients were evaluated before radiotherapy and weekly during radiotherapy for acute morbidity using the RTOG grading system and Franco-Italian glossary. Postradiotherapy evaluation was done one month after radiotherapy and at 3-month intervals thereafter. Median follow-up duration was 17 months. Morbidity was graded and recorded according to each scoring system. RESULTS: Median age was 46 years (range 37-82). Sixty-four patients (59.8%) had endometrial cancer. Radical radiotherapy was applied to 26 patients because of inoperability and 81 patients received postoperative radiotherapy. Biologically effective doses for the bladder, rectum and vagina were 98.39, 103.54 and 121.81, respectively, for late morbidity (BED3); 70.88, 72.84 and 80.92, respectively, for acute morbidity (BED10). According to the RTOG grading system acute morbidity rate for the genitourinary and gastrointestinal systems, and skin were 52.3%, 83.2% and 63.5%, respectively. Late morbidity rate for the bladder, colon-rectum, skin and vagina were 16.8%, 20.6%, 47.7% and 51.4%, respectively. The morbidity rate for the bladder, nonspecific abdominal, hematopoietic system, uterus-vulva-vagina, skin and rectum were 35.4%, 29.9%, 5.6%, 60.8%, 40.1% and 32.7%, respectively using the Franco-Italian glossary. In patients with carcinoma of the vulva--whose treatment fields were wider--acute morbidity rate according to RTOG criteria was higher (p = 0.057); photon energy (6 Mv rather than 1.25 MV) (p = 0.01) and treatment interruption of more than eight days (p = 0.019) were correlated with decreased long-term morbidity. According to the Franco-Italian glossary morbidity rates were higher in patients who received chemotherapy (p = 0.047), both external radiotherapy and brachytherapy (p = 0.022) and treatment interruption of less than eight days (p = 0.019). CONCLUSION: There is no common language between the RTOG grading system and Franco-Italian glossary for defining and scoring radiation morbidity. Up to date no standard and well-defined system has been developed for recording and reporting acute and late radiation morbidity in gynaecologic malignancy, but rather it depends on the subjective evaluation and experience of a radiation oncologist and subjective complaints of the patient, and sometimes on clinical findings. A standard and well-defined user friendly objective scoring system is needed to define and predict the morbidity rate more properly.


Assuntos
Braquiterapia/efeitos adversos , Neoplasias dos Genitais Femininos/radioterapia , Lesões por Radiação/classificação , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Radioterapia Adjuvante/efeitos adversos
17.
Eur J Gynaecol Oncol ; 29(1): 46-51, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18386463

RESUMO

PURPOSE: The aim of this study was to evaluate treatment outcome, survival data and prognostic factors in patients with uterine sarcoma treated by postoperative radiotherapy. MATERIALS AND METHODS: The records of 46 patients treated between 1993 and 2003 were reviewed. Median age was 55 (range 31-75). There were 21 mixed mullerian tumors, 12 leiomyosarcomas, 11 endometrial stromal sarcomas and two adenosarcomas. According to FIGO classification 65.2% were Stage I, 17.4% Stage II, 13% Stage III and 4.3% Stage IV. All patients received external radiotherapy with 1.8 Gy daily fractions up to 50.4-64 Gy (median 50.4 Gy). Intracavitary brachytherapy was applied to 39 patients. Twelve patients received adjuvant chemotherapy. RESULTS: Median follow-up time was 48 months (6-144 months). Seventeen patients (37%) developed distant metastases and one patient had local failure. Five-year overall, disease-free and local recurrence-free survival rates were 57.8%, 60.5% and 97.8%, respectively. Univariate analysis demonstrated that stage (p = 0.011), histologic subtype (p = 0.010), tumor size (p = 0.044), positive peritoneal cytology (p = 0.006) and the use of chemotherapy (p = 0.005) had a significant effect on overall survival. Prognostic factors influencing disease-free survival were stage (p = 0.009), positive peritoneal cytology (p = 0.000) and the use of chemotherapy (p = 0.002). The only prognostic factor affecting local control was stage (p = 0.000). CONCLUSION: Postoperative radiotherapy seems to be an effective adjuvant treatment providing high local control rates in uterine sarcomas. However its efficacy should be clarified by randomized trials. The important prognostic factors influencing the treatment results were stage, histologic subtype, tumor size and positive peritoneal cytology.


Assuntos
Radioterapia Adjuvante , Sarcoma/radioterapia , Neoplasias Uterinas/radioterapia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Ovariectomia , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/cirurgia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
18.
Acta Radiol ; 48(10): 1092-1100, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17963087

RESUMO

BACKGROUND: Coronary sinus flow reflects global cardiac perfusion and has been used for the assessment of myocardial flow reserve, which is reduced in chronic heart failure(CHF). Coronary flow reserve (CFR) can be measured by using phase-contrast (PC)velocity-encoded cine (VEC) magnetic resonance imaging (MRI). PURPOSE: To quantify and compare global left ventricular (LV) perfusion and CFR inpatients with CHF and in a healthy control group by measuring coronary sinus flow with PC VEC MRI, and to correlate this with global LV perfusion, segmental first-pass perfusion, and viability in the same patients. MATERIAL AND METHODS: Cardiac MRI was performed in 20 patients with CHF of ischemic origin and in a control group of healthy subjects (n=11) at rest and after pharmacological stress induced by i.v. dipyridamole. The MRI protocol included cine MRI, VEC MRI, first-pass perfusion, and delayed contrast-enhanced MRI for viability.Global LV perfusion was quantified by measuring coronary sinus flow on VEC MRI at rest in all subjects. CFR was determined as the ratio of global LV perfusion before and after pharmacologic stress. RESULTS: At rest, global LV perfusion was not significantly different in patients with CHF and the control group. After administration of dipyridamole, global LV perfusion and CFR were significantly lower in patients with CHF compared to the control group(P<0.001). An inverse correlation was observed between CFR and the number of infarcted and/or ischemic segments (P=0.083, P=0.037). CONCLUSION: A combined cardiac MRI protocol including function and perfusion techniques together with VEC MRI can be used to evaluate global LV perfusion and CFR in patients with CHF. Global LV perfusion and CFR measurements may have potential in the monitoring of CHF. Impaired CFR may contribute to progressive decline in LV function in patients with CHF.


Assuntos
Doença da Artéria Coronariana/complicações , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Circulação Coronária , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão , Disfunção Ventricular Esquerda
19.
Eur J Gynaecol Oncol ; 28(3): 196-200, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17624086

RESUMO

OBJECTIVE: This retrospective trial aims to report the treatment results of patients with locally advanced cervical cancer treated by concomitant radiochemotherapy with weekly cisplatin. METHODS: Between October 1999 and December 2003, 81 patients with FIGO Stages IB-IVA were treated at Ege University Faculty of Medicine Department of Radiation Oncology by radiochemotherapy with weekly cisplatin (40 mg/m2). Intracavitary high-dose rate brachytherapy was applied to 76 patients (93.8%) and five patients (6.2%) were treated with external radiotherapy alone. Early and late side-effects of the treatment were analyzed according to RTOG-EORTC criteria. RESULTS: Median age was 55 years and the most frequent histology was epidermoid carcinoma. Median follow-up time was 42 months. Five-year overall, disease-free and local relapse-free survival rates were 69%, 77%, and 82%, respectively. The presence of low Hgb level (< 12 g/dl), bulky tumor (> 4 cm), poor performance status, pelvic nodal involvement and limited early response to treatment had a significant impact on the local failure rate. Prognostic factors influencing disease-free survival were bulky tumor, performance status, pelvic nodal status, pretreatment Hgb level and limited early response to treatment. A significantly higher 5-year overall survival rate was observed in patients with good performance status, without pelvic nodal involvement, normal pretreatment Hgb level and complete response to treatment. Grade 3-4 side-effects were not observed in any patients. The most frequent acute side-effects were leukopenia, anemia, nausea and vomiting. Long-term side-effects were observed in 54% of patients. CONCLUSION: This series suggests that radiochemotherapy with weekly cisplatin is an effective and a safe treatment in locally advanced cervical cancer.


Assuntos
Antineoplásicos/administração & dosagem , Braquiterapia/métodos , Cisplatino/administração & dosagem , Radioisótopos de Irídio/administração & dosagem , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/radioterapia , Adulto , Idoso , Terapia Combinada , Intervalo Livre de Doença , Relação Dose-Resposta à Radiação , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Estudos Retrospectivos , Resultado do Tratamento , Turquia
20.
Transcult Psychiatry ; 44(1): 5-26, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17379607

RESUMO

To identify child mental health problems in a mid-sized to large city in Iraqi Kurdistan, the Reporting Questionnaire for Children (RQC), followed by the Child Behaviour Checklist (CBCL) and the Post-traumatic Stress Symptom Checklist for Children (PTSS-C), were administered in interview form to the caregivers of 806 school-aged children. To cover different categories of children, four samples were randomly selected from among the general population (n = 201), orphans (n = 241), primary medical care patients (n = 199), and hospital patients (n = 165). The RQC revealed satisfactory validity against a deviant CBCL cut-off. The screening capacity of the RQC was further supported by its similarity to the CBCL in distribution of problem scores among the four samples and its positive correlation with the CBCL, but not with the trauma-related PTSS-C. Although the general population showed lower problem scores than the orphans and the two clinical samples, problem scores in all instruments were considerably higher than those reported from other societies. The RQC seems to be useful as a first-stage screening instrument for child mental health problems in Kurdistan.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Programas de Rastreamento/métodos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etnologia , Inquéritos e Questionários , Criança , Feminino , Humanos , Iraque/epidemiologia , Masculino , Transtornos Mentais/psicologia , Prevalência , Curva ROC
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