TREATMENT RESULTS OF OSTEOSARCOMA OF THE EXTREMITY IN CHILDREN AND ADOLESCENTS AT EGE UNIVERSITY HOSPITAL

Twenty-five patients were treated for osteosarcoma of the extremity at Ege University Hospital. Eight of them were metastatic. All patients received cisplatin, doxorubicin, ifosfamide, and methotrexate preoperatively. Twenty-three patients underwent surgery at around week 15 (11-18 weeks). All but one underwent limb-sparing surgery. While good responders continued to receive the same drugs, poor responders were given the same regimen before 1996, but high-dose ifosfamide alone after 1996. For all patients the projected event-free survival (EFS) rates were 63.5% at 2 years and 53% at 5 years. The projected overall survival (OS) rates were 72% at 2 years and 62% at 5 years. For nonmetastatic patients, 5-year EFS and OS rates were 67% as compared with metastatic patients (25 and 50%)( p = .01 for EFS; p > .05 for OS). The results show that nonmetastatic patients with osteosarcoma of the extremity have favorable prognosis on this therapy regimen, allowing a high rate of limb-sparing surgery.     

Deep sclerectomy with a nonabsorbable implant (T-Flux): preliminary results

BACKGROUND: Deep sclerectomy is one of the two main types of nonpenetrating surgical methods of treating open-angle glaucoma. We aimed to determine, in a prospective study, the efficacy, success rate and complications of deep sclerectomy with implantation of a nonabsorbable drain made of highly hydrophilic acrylic (T-Flux). METHODS: Twenty-five patients (25 eyes) with medically uncontrolled open-angle glaucoma were treated by deep sclerectomy with implantation of the T-Flux drain. We determined the rates of intraocular pressure (IOP) reduction, surgical success (four categories) and complications. To evaluate the efficacy of this new implant in detail, we compared the success rates with those in a group of patients matched for age, sex, diagnosis, preoperative IOP, number of preoperative antiglaucoma medications and previous ocular surgery who underwent successful viscocanalostomy. RESULTS: For two eyes in the deep-sclerectomy group, surgery was converted to standard trabeculectomy owing to perforation of the trabeculo-Descemet's membrane during dissection of the corneal stroma. The following results apply to the remaining 23 eyes. After a mean follow-up period of 16.21 (standard deviation [SD] 3.93) months, the mean IOP had fallen from 26.26 (SD 4.3) mm Hg preoperatively to 17.60 (SD 4.35) mm Hg at the last postoperative visit (p = 0.000). The rate of complete success (IOP < 21 mm Hg without medication) was 86.9% at 1 month, 56.5% at 12 months and 39.1% at the last visit. The rates of qualified success (IOP < 21 mm Hg with or without medication) were 95.6%, 91.3% and 82.6%, respectively. No postoperative complications of the type that might occur after trabeculectomy were observed. Three eyes with an insufficient reduction in IOP underwent goniopuncture with a neodymium:YAG laser. Statistical analysis of the success rates revealed that deep sclerectomy with T-Flux implantation was comparable to viscocanalostomy at all postoperative visits (p > 0.05). INTERPRETATION: A statistically significant drop of IOP with few postoperative complications over the short term was achieved with deep sclerectomy and T-Flux implantation. The success rates were comparable to, and not significantly better than, those of viscocanalostomy.     

Using theatre in education in a traditional lecture oriented medical curriculum

Background  

Lectures supported by theatrical performance may enhance learning and be an attractive alternative to traditional lectures. This study describes our experience with using theatre in education for medical students since 2001.     

Office hysteroscopy improves pregnancy rates following IVF

The aim of the study was to evaluate the effect of office hysteroscopy (OH) on pregnancy rate in patients undergoing IVF. A total of 1258 patients attending an IVF clinic with normal hysteroscopic findings were enrolled. The impact of timing of OH before embryo transfer on pregnancy rate was investigated. The women were evaluated in three groups: group 1, OH performed 50 days or less before embryo transfer (n = 407), group 2, OH between 51 days to 6 months, (n = 280) and group 3, OH more than 6 months before embryo transfer (n = 571). The implantation rates were 22.1%, 16.1% and 11.1% in groups 1, 2 and 3, respectively. Overall pregnancy rates were 48.2%, 38.9% and 29.9% in groups 1, 2 and 3, respectively. The clinical pregnancy rates were 45.2%, 34.3% and 27.1% and the live birth rates were 36.9%, 27.9% and 22.6%, respectively. Implantation, pregnancy, clinical pregnancy and live birth rates were significantly higher in group 1 compared with groups 2 and 3 (all P < 0.05). OH may improve pregnancy rates, but timing of the procedure is important. The endometrial effect is highest when hysteroscopy is performed 50 days or less before embryo transfer.Office hysteroscopy (OH), which helps the clinician for the evaluation of the uterine cavity before IVF treatment, may affect the pregnancy rates depending on when the procedure is performed. A total of 1258 patients attending an outpatient IVF clinic were enrolled in the study. The women were evaluated in three groups: group 1, OH performed 50 days or less before embryo transfer (n = 407), group 2, OH between 51 days to 6 months, (n = 280) and group 3, OH more than 6 months before embryo transfer (n = 571). The implantation, pregnancy and clinical pregnancy rates were significantly higher in group 1 compared with groups 2 and 3. OH may improve pregnancy rates when performed 50 days or less before embryo transfer.     

The influence of epidermal growth factor on progesterone production by human granulosa--luteal cells in culture

Epidermal growth factor (EGF) stimulates progesterone productionby human granulosa—luteal cells in culture. The presentstudy investigated some of the parameters that affect the magnitudeof human granulosa—luteal cells' response to EGF. Cellsfrom pre-ovulatory follicles obtained 36 h post-human chorionicgonadotrophin (HCG) were cultured for 12 days with or withoutEGF (20 ng/ml). Medium was changed every 48 h and assayed forprogesterone by radio-immunoassay. DNA content of the culturedcells was determined fluorometrically. EGF was added every otherday to the culture medium, starting on either day 4, 6 or 8of culture, up to day 10, and compared with controls. When EGFwas initiated on day 4, the medium had significantly higherprogesterone concentration than control samples on days 6, 8,10 and 12 of culture (P < 0.01). When EGF was withheld untilday 6 or 8, progesterone concentrations were not significantlyhigher than control values. When EGF was added on day 4 anddiscontinued on day 8 or 10, progesterone concentrations werereduced significantly (P < 0.001) compared with the groupwhere EGF was added continuously from day 4 to 10. These datasuggest that: (i) human granulosa—luteal cells requirethe early exposure and continuous presence of EGF for the stimulatoryeffect on progesterone secretion, (ii) cells not exposed initiallyto EGF do not respond in a similar way, (iii) EGF is capableof maintaining progesterone production for a period > 12days. Therefore, normal luteal function may require the earlyand continuous presence of EGF.