Salvaging a porcelain/metal bridge with a bonded porcelain-fused-to-metal overcasting

Porcelain fractures from ceramo-metal fixed bridges often are troublesome for both dentist and patient, especially when problems occur in the anterior region. Repairing these fractures can be a challenge because the repair must be not only durable but also pleasing esthetically. While repair can be achieved with a composite resin material, matching the color and texture with the surrounding intact porcelain often is difficult and the bonding between the resin and porcelain is susceptible to marginal leakage, which may result in esthetic failure. This article reviews a technique designed to salvage a fractured porcelain-fused-to-metal bridge and return it to form and function by utilizing a porcelain-fused-to-metal overcasting.     

The role of hematopoietic stem cells in the treatment of ovarian cancer

In recent years hematopoietic stem cells (HSC) have been the object of new research efforts and scientific advances. Therapeutic strategies have been set up using HSC for the treatment of solid tumors such as ovarian cancer. In this context different approaches have been proposed and clinically investigated. The "autologous" approach refers to the use of HSC as hematologic support to high-dose chemotherapy regimens, and to the use of HSC as an abundant source of dendritic cells for cancer vaccination protocols. Our institution has developed a long-term experience in high-dose chemotherapy with autologous HSC transplantation as first-line treatment of advanced ovarian cancer, and in the use of cytokines both for the HSC collection and for the post-transplantation hematopoietic recovery. Moreover, the "allogeneic" approach with HSC consists of the allogeneic transplantation with both myeloablative/standard or nonmyeloablative/reduced conditioning regimens, which has been proposed as a new adoptive immunotherapeutic treatment for different nonhematologic malignancies. Perspectives in the use of HSC in oncology comprise the possibility of an HSC ex vivo expansion, the use of umbilical cord blood HSC, and the development of future HSC-based gene-therapy programs.     

Severe hypoglycaemia associated with a giant solitary fibrous tumor of the pleura

Solitary fibrous tumors (SFT) of the pleura are a rare neoplasm, with benign biological behaviour. Recurrences are rare, and no distant metastases are described in the literature. SFT can secrete hormone-like substances, responsible for paraneoplastic syndromes. The authors describe a case of severe hypoglycaemia due to insulin-like growth factor II (IGF-2)'s secretion by a giant SFT of the pleura. Hypoglycaemia was controlled by the resection of the tumor. Diagnosis and surgical management of these neoplasms are also discussed.     

Dietary soy modulation of biochemical parameters in DMBA-induced mammary tumors

The aim of this study was to extend our previous observations on the soy modulation of biochemical parameters in 7,12-dimethylbenz[a]anthracene (DMBA)-induced rat mammary tumors, by simultaneously investigating the expression of estrogen receptor-alpha (ERalpha), estrogen receptor-beta (ERbeta), progesterone receptor (PR), apoptosis, neu, and markers of cell proliferation, such as proliferating cell nuclear antigen (PCNA) by immunohistochemistry. The percentage of ERalpha positive tumors was 65.8% in masses from control animals, and significantly dropped to 36.8% in tumors from soy treated rats (P=0.010). The percentage of ERbeta positive tumors was 70.3% in masses from control animals vs. 50.0% in tumors from soy exposed animals (P=0.066). Moreover, the percentage of cases which were both ERalpha and ERbeta positive was significantly lower (17.6%) in soy treated than in control animals (51.3%) (P=0.006). The percentage of PR positive tumors was 34.2% in control animals vs. 2.6% in tumors from soy treated rats (P=0.0006). There were no statistically significant differences in the percentage of tumors positively stained for neu, apoptosis, or PCNA, in control vs. soy treated rats. However, when analyzing the reciprocal correlation among the different biochemical parameters we showed that, in treated animals, the majority of ERalpha positive tumors (91.7%) were also PCNA positive (P=0.036). The median percentage of PCNA positivity was significantly higher in ERalpha positive than in ERalpha negative tumors (25 vs. 5%) (P=0.0031). Moreover, an association was found between PCNA and neu status since all neu positive tumors were also PCNA positive (P=0.011).     

Phase I study of gemcitabine and liposomal doxorubicin in relapsed ovarian cancer

Twenty-three patients were enrolled in a phase I study conducted to determine the maximum tolerated doses (MTD) of combined liposomal doxorubicin (CAE) and gemcitabine (GEM) in relapsed ovarian cancer patients. A total of 82 courses are evaluable, with a median number of three cycles administered per patient (range 2-8). GEM was administered on days 1 and 8 by 30-min intravenous infusion immediately after CAE given by 60-min intravenous infusion on day 1; cycles were repeated every 21 days. The starting doses were CAE 20 mg/m(2) and GEM 600 mg/m(2). Following dose levels were 20/800; 20/1,000; 30/800; 30/1,000; 35/800, and 35/1,000 for CAE and GEM, respectively. The MTD was reached at dose level 5, with febrile neutropenia and thrombocytopenia as dose-limiting toxicities. After the MTD, granulocyte-colony stimulating factor was administered in 15% of cycles. Non-hematological toxicity was mild and manageable. All patients are so far evaluable for response. Among them, 5 partial responses (21.7%; 95% confidence interval, CI: 4.9-38.5), 5 disease stabilizations (21.7%, 95% CI: 4.9-38.5) and 13 progressions (56.6%, 95% CI: 36.4-76.8) have been registered. These results warrant further research in a phase II study.     

Lymph nodes of patients with regional metastases from head and neck squamous cell carcinoma as a predictor of pathologic outcome: size changes at CT before and after radiation therapy

BACKGROUND AND PURPOSE: Viable tumor in a neck dissection specimen is important in predicting prognosis and directing treatment. Our purpose was to clarify the importance of size changes of regional metastases from head and neck squamous cell carcinoma on CT scans obtained before and after radiation therapy (RT) as a predictor of pathologic outcome. METHODS: Thirty-seven heminecks in 34 patients who underwent pre-RT CT, RT, post-RT CT, and post-RT neck dissection were reviewed. Thirteen hemineck specimens were pathologically positive. Decrease ratios of the largest axial dimension of the lymph nodes between the pre- and post-RT CT studies were calculated. RESULTS: Six of 37 heminecks had a decrease ratio greater than 50%. These yielded negative specimens after planned neck dissection. In two of 37 heminecks, the largest axial dimension of the largest node increased between studies, resulting in negative decrease ratio. One (decrease ratio, -20%) had a positive specimen, and the other (decrease ratio, -3%) had a negative specimen. No interval change in size in the largest node was noted in one of the 37 heminecks; its specimen was positive. Average decrease ratios were 41.2% (range, -3% to 62%) in the negative specimen group (n = 24) and 27.2% (range, -20% to 50%) in the positive specimen group (n = 13). Univariate analysis revealed that the decrease ratio was not a significant predictor of a positive surgical specimen (P =.154). CONCLUSION: Heminecks in which the decrease ratio was greater than 50% tended to have a negative surgical specimen. However, this trend was not statistically significant.     

Carcinoma of the skin of the head and neck with perineural invasion.

BACKGROUND: Perineural invasion is observed in a small subset of patients with carcinomas of the skin of the head and neck. METHODS: Review of the patient literature highlighting the University of Florida experience. RESULTS: Patients with early perineural invasion are asymptomatic, and the phenomenon is discovered only on pathologic examination of the excised lesion. These patients are defined as having "incidental" perineural invasion, and treatment with surgery followed by postoperative irradiation results in a cure rate of approximately 80%. Undiagnosed, the perineural carcinoma slowly progresses and eventually results in symptoms, usually facial weakness or numbness. The disease eventually extends to the skull base and becomes incompletely resectable. Symptomatic patients are defined as having "clinical" perineural invasion, and aggressive treatment results in a cure rate of approximately 45%. CONCLUSIONS: Perineural invasion is an uncommon spread pattern observed in patients with skin cancer and is associated with a relatively poor prognosis. The likelihood of cure is inversely related to the proximal extent of the cancer and is lower for symptomatic compared with asymptomatic patients.     

Postcricoid region and cervical esophagus: normal appearance at CT and MR imaging

PURPOSE: To establish the normal variations of the postcricoid portion of the hypopharynx, esophageal verge, and cervical esophagus, as seen on computed tomographic (CT) and magnetic resonance (MR) images. MATERIALS AND METHODS: One hundred twenty-one CT and 92 MR images were reviewed. Diameter and wall thickness were measured at multiple levels. Depiction of the layers of the musculature and adjacent fat planes was evaluated. The frequency and size of the tracheoesophageal lymph nodes were noted. RESULTS: An esophageal anteroposterior diameter greater than 16 mm and lateral diameter greater than 24 mm were considered abnormal. The average wall thickness was 4.8 mm laterally and 3.8 mm posteriorly. Demonstration of the intramural fat planes of the postcricoid region decreased from the upper to the lower region of the cricoid cartilage. The ability to separate the esophageal wall from the trachea was highest at the esophageal verge and declined markedly more distally. The tracheo-esophageal groove nodes were seen more often on the right (mean size [+/- SD], 4.5 mm +/- 2.2). CONCLUSION: Knowledge of the normal appearance and variations of the post-cricoid region and cervical esophagus is essential in detecting abnormalities in these areas.