Complexed prostate specific antigen density is better than the other PSA derivatives for detection of prostate cancer in men with total PSA between 2.5 and 20 ng/ml: results of a prospective multicenter study

PURPOSE: This prospective, multicenter study was initiated to evaluate the diagnostic performance of PSA, free/total PSA (f/tPSA) and complexed PSA (cPSA) with volume-based parameters for early detection of prostate cancer in patients with PSA between 2.5 and 20 ng/ml. MATERIALS AND METHODS: 408 subjects with serum PSA values between 2.5 and 20 ng/ml regardless of digital rectal examination (DRE) were included in to the study. The diagnostic validity, sensitivity, specificity and cut-off values were evaluated by Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Of 408 patients 77 (18.9%) were positive for prostate cancer. Digital rectal examination was non-suspicious in 86% (351/408) of the patients. Area under curve (AUC) values for cPSA were better than PSA and f/tPSA in patients with PSA values of 2.5-10 ng/ml and 4-10 ng/ml, as well as the whole group. Furthermore, on ROC curve analysis cPSAD was the best predictor of prostate cancer for all PSA ranges regardless of the DRE findings except PSA values between 2.5 and 4 ng/ml. The cut-off value of cPSAD at 90% sensitivity was 0.06 ng/ml/cm(3) with a 35.3% specificity saving 126 unnecessary biopsies in the whole group. CONCLUSION: cPSA might be a better initial test than PSA for prostate cancer detection and measurement of cPSA alone and its derivatives obviate the need for additional fPSA testing.     

Effects of water storage of E-glass fiber reinforced denture base polymers on residual methyl methacrylate content

This study investigated the effect of water storage on residual methyl methacrylate (MMA) content of continuous E-glass fiber (Wetrotex International) reinforced denture base polymers. Heat-polymerization (short- and long-term boiling and conventional curing cycle using Meliodent), autopolymerization (processed in air at room temperature and in water at 60 degrees C with the use of Meliodent Rapid Repair), and microwave-polymerization (3 min at 500 W with the use of Acron MC) were employed. The residual MMA contents of 120 specimens were analyzed by high-performance liquid chromatography at deflasking (control) and after water (37 degrees C) storage of 1 day, 1 week, and 1 month. Bonferroni's pairwise comparison test was used for statistical analysis. Significant reduction were determined only in the long-term terminal boiled heat-polymerized test group at the end of 1 day (p < 0.01), 1 week (p < 0.05) and also 1 month of water storage (p < 0.01). Significant reduction in autopolymerized test groups started even after 1 week of water storage (p < 0.05). Microwave-polymerized test groups did not show a significant residual MMA reduction in all time intervals (p > 0.05). The polymerization methods and cycles applied to the glass fiber reinforced denture base polymers influence both the content and the reduction of residual MMA after water storage.     

Geriatric problems in otolaryngology

Overall data in the feld of 'gerontology' are scarce in India. Some major geriatric problems in otolaryngology like presbyacusis, disequilibrium, vertigo, tinnitus, nasal and pharyngeal changes, voice change, dysphagia, arthritis, snoring, falls, have been briefly addressed to in the present article.     

Relationship between complications due to prostate biopsy and the scores of pain and discomfort

INTRODUCTION: Transrectal ultrasound (TRUS)-guided prostate biopsy is routinely performed in the prostate-specific antigen era. In this study, we evaluated morbidity and complications observed in patients undergoing TRUS-guided prostate biopsy following intrarectal lidocaine application and the relation of these complications to pain and discomfort. PATIENTS AND METHODS: Between January 2000 and August 2002, a total of 128 patients underwent TRUS-guided prostate biopsy. The procedure was carried out following an intrarectal application of 10 cm(3) 2% lidocaine gel. Immediately after the biopsy, pain and discomfort scores were determined using a 10-point linear visual analog scale. The patients were seen 10 days later and questioned for complications. RESULTS: At least one complication was observed in 107 patients (84%). Most frequent complications were macroscopic hematuria (90%), hematochezia (36%), and hematospermia (13%). The mean pain and discomfort scores of the patients were found to be correlated to each other (p < 0.01). The complication-negative group had significantly lower pain and discomfort scores (p < 0.01). The scores of the patients with hematochezia were significantly higher than the scores of the patients with other complications (p < 0.01). CONCLUSIONS: Minor complications like hematuria, hematochezia, and hematospermia are frequently seen in patients undergoing TRUS-guided prostate biopsies. The pain and discomfort scores may be predictors of minor complications, particularly of rectal bleeding.     

Obstetric and gynecologic malpractice in Turkey: incidence, impact, causes and prevention

The Forensic Medicine Association was established in Turkey by law number 2659 for the purpose of providing expertise in legal cases. In this study the opinions given by the lawcourts and public defenders in the Forensic Medicine Association's First, Second, Third, and Fifth Specialization Divisions between the years 1990 and 2000 (approximately 680,000 files) were examined retrospectively. It was determined from these that there were 636 cases of medical malpractice. In examining the distribution of cases based on specialty branch, it was established that 16.82% (n=107) were in the area of obstetrics and gynecology, 10.69% (n=68) in general surgery, 10.53% in neurology and neurosurgery, and the remaining areas were found to be at lower percentages. It also showed that in recent years there has been an increase in the number of cases claiming medical malpractice in the area of obstetrics and gynecology, and that 58% of the cases (n=62) from 1998 to 2000 were in this area. 96% of the 107 cases that claimed malpractice in the area of obstetrics and gynecology were found to be related to obstetrics and 3.8% (n=4) to gynecology and surgical procedures. In 31% (n=33) of the 107 cases fault was found; all of the cases where medical malpractice was found were in the area of obstetrics and none of the cases related to gynecology were found to have an element of error. Cases that had an element of error were evaluated from the aspect of profession of the health care personnel at fault, areas of fault, places where fault occurred, situations that resulted in death, cause of death, whether or not an autopsy was done, injury that resulted from fault, intervention that was done, and obstetric and gynecologic risk factors that set the stage for claims. Care standards and breach of standards were examined.     

Analysis of CHEK2 gene for ovarian cancer susceptibility

OBJECTIVES: A deletion variant in the CHEK2 gene (del1100C) has been implicated as a low-penetrance risk factor for breast cancer. We sought to determine contribution of CHEK2 mutations to the etiology of ovarian cancer (OvCa). METHODS: We used cases ascertained from the United States through Gynecologic Oncology Group (GOG) protocols 172, 182, and 144, the University of Hawaii Cancer Research Center, and Creighton University. Control women were recruited from Pittsburgh and Hawaii. Denaturing high-performance liquid chromatography, sequence analysis, and single nucleotide polymorphism genotyping by Pyrosequencing were employed to analyze the CHEK2 gene. RESULTS: Mutation screening of the CHEK2 gene in 48 cases who had a first-degree relative with OvCa uncovered only del1100C and A252G variants. Altogether, the del1100C variant was detected in none of 751 unselected cases, in 1 of 52 (1.9%) cases who had a first-degree relative with OvCa, and in 3 of 521 (0.6%) unselected controls. The frequencies of del1100C and A252G variants did not show statistically significant differences between the cases and the controls. CONCLUSIONS: These results suggest that variations in CHEK2 do not make a significant contribution to the pathogenesis of OvCa in the U.S. population.     

Heat-mediated enzyme-linked immunosorbent assay procedure on a photoactivated surface

The human burden of infectious and allergic disease has necessitated rapid screening and measurement of antibodies in sera. Here, we report an enhancement of speed and sensitivity of an enzyme-linked immunosorbent assay (ELISA) technique by performing it at elevated temperature on an activated surface. The activated polymer was able to bind covalently anti-human IgG at 50 degrees C over 40 min to form a solid phase. The covalently bound solid phase was stable enough to withstand subsequent ELISA steps at elevated temperature. Thus, when blocking, human IgG and antibody-enzyme conjugate binding were performed on this solid phase at 40 degrees C in 40 min, 50 degrees C in 45 min and 50 degrees C in 40 min, respectively. The ELISA readings obtained were 1.5-fold higher than those obtained at 37 degrees C over similar incubation times. Total IgE was also determined by the heat-mediated ELISA (HELISA) technique in less than 3 h and gave similar ELISA values to those obtained by the conventional procedure carried out for 18 h on an untreated surface. A stable covalently bound solid phase is a prerequisite for the HELISA technique and was further verified when a solid phase prepared through adsorption onto an untreated surface showed less than half the ELISA absorbance values obtained with the activated surface at elevated temperatures. As surface activation can be achieved by application of a simple technique, the HELISA procedure could be a powerful alternative to conventional ELISA.     

Synchrotron microangiography with no contrast agent

Coherent x-rays from synchrotron sources are increasingly used in non-conventional radiological techniques ('phase-contrast' radiology). Our experiments demonstrate that by using white (unmonochromatic) radiation and a time-resolving system, it is possible to image microscopic details of moving blood vessels in different live animals without using any contrast agent. The images have excellent contrast plus unprecedented spatial resolution for microangiography (< 10 microm). This result is likely to impact many different areas of biological and medical research and of diagnostic radiology.     

Ameloblastic fibrodentinoma. A case report

A case report of an ameloblastic fibrodentinoma (AFD) in a 21-year-old female patient is presented. This rare, benign tumor was surgically treated. The histological findings and follow-up are presented.