Resection of pulmonary metastases following chemotherapy for high stage testicular tumors

BACKGROUND: Our objective was to analyze retrospectively our experience with 19 patients who had metastatic germ cell testicular tumor and had undergone resection of pulmonary metastases following chemotherapy. We wished to determine the necessity of thoracic surgery on these patients. METHODS: Of 103 patients in need of postchemotherapeutic surgery for metastatic germ cell testicular tumors, 19 patients (mean age 31) underwent surgery for thoracic masses following cis-platin based chemotherapy. Resection of pulmonary metastases was performed on patients with normal tumor markers after chemotherapy, who did not achieve complete radiological remission. Histopathological findings, correlation with the pathology of abdominal surgery and probable prognostic factors for disease-free and overall survivals were evaluated. RESULTS: Disease-free and overall survival rates were 14/19 (73%) and 16/19 (84%), respectively, within a median follow-up time of 30 months (15-212 months). Patients with and without viable tumor cells in their thoracic histopathological specimen had 40% and 85% disease-free survival rates, respectively (P < 0.05). Eight patients had both abdominal and thoracic postchemotherapy surgery. Only two (25%) of these patients had the same histopathological features at both sites. CONCLUSIONS: All patients with residual thoracic masses must be considered candidates for surgery, because there are no predictive factors to determine the thoracic pathology without surgery. With the resection of the pulmonary metastases only, surgery can be performed without significant morbidity and is essential to select patients for further chemotherapy, to remove all visible masses and to provide histopathological confirmation. Patients with viable tumor cells in the thoracic surgical specimen have a poor prognosis.     

Randomized, Evaluator-Blind, Split-Face Comparison Study of Single Cross-linked versus Double Cross-linked Hyaluronic Acid in the Treatment of Glabellar Lines

BACKGROUND At present, various hyaluronic acids are being used to rejuvenate facial skin. There is no comparative study of single cross-linked hyaluronic acid (SCHA) versus double cross-linked hyaluronic acid (DCHA). The objective of our study is to compare the effectiveness and complications of SCHA versus DCHA in the treatment of glabellar lines.
METHODS Ten female patients were enrolled in this randomized, evaluator-blind study. One side (left vs. right) of each patient's glabellar lines was treated with SCHA and the other side was treated with DCHA. Two independent blinded observers reviewed the clinical photographs at 3, 6, 9, and 12 months after the treatment and assessed for degree of improvement as well as complications.
RESULTS The two products were equally effective in producing an optimal cosmetic result, although at 6, 9, and 12 months posttreatment, a higher proportion of patients showed over 50% improvement with DCHA than with SCHA. At 12 months posttreatment, DCHA was considered superior in 70% of patients, whereas SCHA was superior in 10% of patients.
CONCLUSIONS Both SCHA and DCHA are equally effective in producing an optimal cosmetic result. DCHA provides a more durable esthetic improvement when compared to SCHA in the treatment of glabellar lines.     

Two daytime icodextrin exchanges decrease brain natriuretic peptide levels and improve cardiac functions in continuous ambulatory peritoneal dialysis patients

Aim: Peritoneal dialysis patients with ultrafiltration failure frequently have fluid overload. It is known that the increase in the ultrafiltration is associated with decrease in the left ventricle (LV) dysfunction. This study was designed to examine the potential effects of serum brain natriuretic peptide (BNP) on cardiac functions and to determine the relationship between BNP and cardiac parameters in continuous ambulatory peritoneal dialysis (CAPD) patients with ultrafiltration failure. Methods: Twenty‐eight patients with high or high‐average membrane permeability as indicated by the peritoneal equilibration test were enrolled and randomized to receive either once or twice daily icodextrin. Serum BNP levels and echocardiographic measurements were evaluated at baseline and at the end of the eighth week. The correlations between the percentage changes of parameters from baseline were also studied. Results: In both groups there was a significant decrease in serum BNP, LV mass, heart rate (HR) and cardiothoracic index (CTI) and an improvement in ejection fraction (all P < 0.05). However, the percentage of change in all these parameters was significantly better in the twice daily compared with once daily group (all P < 0.05). Furthermore, the percentage decrease in BNP was positively correlated with the percentage decrease in HR, LV mass and BP. Conclusion: Twice daily icodextrin treatment might be useful in hypervolaemic CAPD patients for the improvement of cardiac functions. BNP monitoring may be useful to follow up these patients.     

Langerhans' cell histiocytosis mimicking metastatic carcinoma of the lung

Langerhans' cell histiocytosis (LCH), previously known as Histiocytosis X, is characterized by abnormal accumulations of large mononuclear cells forming granulomas in various organs, mainly bone, skin and lung. This case report describes a 50-year-old man with a history of left pneumonectomy due to squamous cell carcinoma (SCC). During routine follow up, a CXR showed new parenchymal nodules in the right lung 57 months post treatment. Chest CT scan confirmed the presence of multiple parenchymal nodules. Open lung biopsy from the right upper lobe was performed and LCH was diagnosed. Re-analysis of the initial pneumonectomy specimen revealed no evidence of LCH in the surrounding lung tissue. On diagnosis, the patient stopped smoking and was treated with vinblastine and prednisolone for LCH. The nodules disappeared and have not returned in a further 18 months of follow up. In this patient LCH was diagnosed after SCC, which highlights that smoking-related diseases can be seen concomitantly or sequentially in the same patient.     

The effects of physical exercises to mental state and quality of life in patients with schizophrenia

The purpose of this study was to examine the effects of 10 weeks of physical exercises programme on mental states and quality of life (QOL) of individuals with schizophrenia. The study involved 30 inpatients or outpatients with schizophrenia who were assigned randomly into aerobic exercise (n = 15) group and control (n = 15) group, participated to the study voluntarily. There were no personal differences such as age, gender, disorder duration, medication use between the both groups. An aerobic exercise programme was applied to the subject group, the periods of 10 weeks as 3 days in a week. Data were collected by using the Brief Symptom Inventory, the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and to the both group before and after the exercise programme. After the 10‐week aerobic exercise programmes the subjects in the exercise programme showed significantly decreases in the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and the Brief Symptom Inventory points and their World Health Organization Quality of Life Scale‐Turkish Version points were increased than controls. These results suggest that mild to moderate aerobic exercise is an effective programme for decreasing psychiatric symptoms and for increasing QOL in patients with schizophrenia.     

Interventional Versus Surgical Closure of Atrial and Ventricular Septal Defects: Advantages and Limitations of the Catheter-Based Approach

New techniques and devices have revolutionized the transcatheter techniques used to close congenital intracardiac shunts. The advantages, compared to surgery, are the avoidance of a thoracotomy, postoperative pain and morbidity, a long hospital stay, and most often general anesthesia. Atrial septal defect closure has become a routine procedure in many centers. It is amenable in about 80% of the patients with a secundum-type defect. The success rate today is dx > 99% and the rate of any complication is < 0.5%. Ventricular septal defect closure, however, is still in its infancy. Apical, mid-muscular, and selected perimembraneous VSDs with a significant septal rim between the defect and the aortic valve can be closed with the devices currently available. Analysis is still needed to prove the long-term safety and efficacy of ASD or VSD closure.