Should sentinel lymph node mapping be performed for colorectal cancer?

BACKGROUND/AIMS: Correct determination of lymphatic nodal statement is essential to stage correctly and to predict survival. As it is vital to make an assessment about the adjacent lymph node(s), this study was designed to compose a sensitive detection on the sentinel lymph nodes (SLN) indicating tumoral lymphatic basin using advanced pathologic examination. MATERIALS AND METHODS: From June 2002 to June 2003, this prospective study was performed in 41 patients undergoing standard resection for colorectal cancer. In this study we employed the ex-vivo SLN mapping technique. RESULTS: At least one SLN in 37 of 41 patients was identified (90.2%). The lymph nodes (LN) from those patients were studied by hematoxylin and eosin dye (H&E) and multisectioning. Twenty of 37 patients with trace of the metastasis were found. The remaining 17 patients without any metastatic LN by H&E underwent clarification of micrometastases (MM) using immunohistochemical (IHC) staining technique. Two patients (11.7%) had MM in the SLN(s). Upstaging was evaluated in those two. The sensitivity of SLNs was obtained as 90%. Two patients with no metastatic SLN had metastasis in the non-sentinel LNs. CONCLUSIONS: In the LNs from the basin of tumor, MM exposed by IHC staining was still not obvious to indicate poor prognosis. The need for treatment adjustment in those patients is clear since the upstaging was evident.     

Colorectal cancers under 45 years of age

BACKGROUND/AIMS: The aim of this study was to evaluate patients with colorectal cancer under the age of 45 and compare with colorectal cancer patients over the age of 45 treated in our surgical clinic. METHODOLOGY: At the Surgical Department of the Medical Faculty of Uludag University between 1986-2000 (15 years), 680 cases with colorectal cancer diagnosis were operated on. One hundred and thirty-six (20%) of these cases who were under the age of 45 were retrospectively evaluated and compared with other patients. RESULTS: The family history of ten of those patients was positive. The most common referring symptoms were rectal bleeding (61.7%), and weight loss (29.4%). Tumor was localized at right colon in 19%, at left colon in 6.6%, at the sigmoid and the rectum in 74%. Nine of those cases (6.6%) were operated emergently, the rest (93.3%) were operated electively. One hundred and eighteen of the cases (86.7%) were resectable and 61 cases (44.8%) were showing distant metastases during the operations. CONCLUSIONS: As a conclusion, in Turkey, young age group colorectal cancers are 4-5 times more common than in Western communities. Because of the high probability of colorectal cancers, considering the possibility of colorectal cancer and taking a careful family history will help to catch the case at an earlier stage and will improve the chance of cure.     

Fibromyalgia Syndrome: Is It Related to Vitamin D Deficiency in Premenopausal Female Patients?

There are a number of studies that have evaluated the relationship between fibromyalgia (FM) and vitamin D deficiency with conflicting results. The aim of this study was to assess vitamin D deficiency in patients with FM and to evaluate the relationship with the common symptoms of FM and levels of serum vitamin D. Forty premenopausal female fibromyalgia patients and 40 age- and sex-matched control subjects were included in the study. The demographic characteristics of all subjects, including age, sex, and body mass index, were recorded. The number of tender points was recorded, and the intensity of the widespread pain of the subjects was measured by the visual analog scale. The activities of daily living component of the Fibromyalgia Impact Questionnaire (FIQ-ADL), was used to assess physical functional capacity. Serum vitamin D was measured in both groups, and vitamin D levels <37.5 nmol/L were accepted as vitamin D deficiency. The vitamin D levels and clinical and laboratory characteristics of the patient and control groups were comparatively analyzed. The relationship between vitamin D levels and clinical findings of the FM patients were also determined. The mean age was 41.23 ± 4.8 and 39.48 ± 4.08 years for the patient and control groups, respectively. The pain intensity, number of tender points, and FIQ-ADL scores were higher in FM patients than in control subjects. The mean levels of vitamin D in the patient and control groups were determined to be 31.97 ± 15.50 and 28.97 ± 13.31 nmol/L, respectively (p > .05). The incidence of vitamin D deficiency was similar between the patient and control groups (67.5% vs. 70%). Vitamin D levels significantly correlated with pain intensity (r = ?0.653; p = .001) and FIQ-ADL scores in the FM group (r = ?0.344; p = .030). In conclusion, the results of this study indicate that deficiency of vitamin D is not more common in premenopausal female patients with FM than in control subjects without FM. However, the association between pain and vitamin D levels in FM patients emphasizes that hypovitaminosis of vitamin D in the FM syndrome may have an augmenting impact on pain intensity and functional status. Future studies are needed to show the effect of vitamin D supplementation in the reduction of pain intensity and disability in patients suffering from this chronic condition.     

Three‐dimensional imaging of the craniofacial complex

Orthodontic treatment requires the rearrangement of craniofacial complex elements in three planes of space, but oddly the diagnosis is done with two‐dimensional images. Here we report on a three‐dimensional (3D) imaging system that employs the stereoimaging method of structured light to capture the facial image. The images can be subsequently integrated with 3D cephalometric tracings derived from lateral and PA films ( http://www.clinorthodres.com/cor‐c‐070 ). The accuracy of the reconstruction obtained with this inexpensive system is about 400 μ.     

The effect of watching live arthroscopic views on postoperative anxiety of patients

Surgery is a stressful experience. Many minor interventions have been shown to cause considerable anxiety in patients, but whether arthroscopy leads to such anxiety is not well-known. Methods for lowering perioperative anxiety have been sought and listening to music or watching a movie have been recommended. The method of permitting patients to watch their own endoscopy has been studied infrequently. Our aim in this study was to find out the effect of watching simultaneous arthroscopic views on postoperative anxiety. A total of 63 patients were randomly divided into two groups: those watching their own arthroscopy formed group W, while patients that were only verbally informed formed group NW. The mean age of patients in both groups were 33 and 34, respectively. Meniscal surgery was the most commonly performed procedure (49/63 patients). The patients filled in state scale of State-trait anxiety inventory (STAI) forms and the study questionnaire (SQ) prepared for this study, just before and after the arthroscopy. Group W had significantly lower postoperative scores of STAI-S, whole questionnaire (Q-score) and all but one of individual statements in SQ. Having a previous operation history did not affect STAI scores. Age and level of education was not correlated with any of the studied parameters either. The ratio of patients that were pleased with the arthroscopy experience in group W and NW were 94 and 63%, respectively. Watching live arthroscopic views has led to a significant decrease in postoperative anxiety and worries about the surgery and the postoperative period, while increasing overall understanding and satisfaction of the patient.