Choice Of Treatment Modality Research Articles

Determinants of outcome and survival following treatment of recurrent hepatocellular carcinoma: a systematic review & meta-analysis

Objective: This review aimed to identify the optimum treatment strategies for hepatocellular carcinoma (HCC) recurrence. Methods: A systematic review, up to July 2015, was conducted in accordance with MOOSE guidelines. The primary outcome was the hazard ratio for overall survival of different treatment modalities. Meta-analysis of differing treatment modalities was carried out using a random effects model with further assessment of additional prognostic factors for survival. Results: 18 cohort studies (2662 patients) were included in final data analysis. The median 5-year survival of repeat hepatectomy (RH; n = 481 pts), ablation (n = 389) and transarterial chemoembolization (TACE; n = 878) were 43.0%, 52.7% and 9.0% respectively. Pooled analysis of 10 studies demonstrated no significant difference between overall survival after RH or ablation (HR = 1.03; p = 0.897). Median tumor size across these studies was 23.0 mm (RH) and 20.5 mm (ablation). Pooled analysis of 7 studies comparing TACE with RH showed a non-significant trend to improved survival from RH (HR = 1.61; p = 0.056). Review of prognostic factors identified those negatively associated with overall survival includes: recurrence of HCC within one year (HR 6.8; p < 0.05), presence of more than 3 recurrent tumors (HR 3.78; p < 0.05) and tumors greater than 3 cm in size (HR 4.01; p < 0.05). Conclusion: There was significant heterogeneity in the reporting of these studies preventing the implementation of formal meta-regression. Despite a paucity of available data, these results suggest a non-significant trend to improved survival following RH compared with TACE and identification of important negative prognostic factors, which may influence choice of treatment modality.

Appropriateness and efficacy of Spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy.

The aim of the study was to identify the main aspects concerning appropriateness and efficacy of Spa therapy for musculoskeletal pathologies. A committee of 8 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Clinicians from Italian medical centers specialized in rheumatology, rehabilitation and thermal medicine took part in a Delphi process aimed at obtaining consensus statements among the participants. Large consensus was obtained for statements grouped under the following main themes: treatment indications; choice of treatment modality and treatment efficacy. The experts developed a number of consensus statements which may be used as a practical reference to guide the choice of physicians to treat musculoskeletal diseases with Spa therapy.

Prognostic Significance of Indicators of Systemic Inflammatory Responses in Glioblastoma Patients

Background:High-grade gliomas, with glioblastomas as the most frequently observed histologic subtype, are the most common primary brain tumours in adults. It is considered that inflammatory responses play a major role in malignancies, including tumour progression. This study aimed to determine the prognostic significance of the neutrophil to lymphocyte ratio (NLR) and the thrombocyte to lymphocyte ratio (PLR) as indicators of systemic inflammatory response (SIR) in glioblastoma patients.Methods:A total of 90 patients treated for glioblastoma were retrospectively evaluated. Absolute counts were used to generate NLR and PLR. A SIR was considered to be present with an NLR ≥5 and/or PLR ≥150.Results:Median follow-up time was 11.3 months (range: 1-70 months). The 1-year and 2-year overall survival rates were 55.2% and 19.5%, respectively. Univariate analysis showed that there was no correlation between overall survival and gender (p=0.184), comorbid disease (p = 0.30), clinical presentation (p = 0.884), or tumour lateralization (p = 0.159). Multivariate analysis showed that overall survival was significantly correlated with SIR based on NLR (HR: 2.41), and ECOG performance status (HR: 1.53). The prognostic factors that affected survival, other than SIR, were Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.003), and tumour localization (p = 0.006).Conclusion:The present findings confirm that NLR based on peripheral blood counts prior to treatment can be used as a prognostic factor in patients with glioblastoma. Since tumour aggression increases and survival decreases as the NLR value rises, choice of treatment modality is facilitated for glioblastoma patients.

Recurrence of temporomandibular joint ankylosis: Fascia lata a good alternative. A case report

Recurrence of temporomandibular joint (TMJ) ankylosis is a known complication. Studies have contributed to the various treatment options in recurrent ankylosis. The causes of reankylosis of TMJ, to our experience is due to inadequate gap arthroplasty, insufficient interpositional material, adhesion and elongation of the coronoid process. It has been reported in the literature that the incidence varies with choice of treatment modality, severity of ankylosis, site (unilateral/bilateral), and the surgeons skill. The patient's compliance to the post-treatment physiotherapy is the main reason for reankylosis. Here, we present a case of left TMJ reankylosis in a 22-year-old female, previously treated by interpositional gap arthroplasty using temporalis muscle, and had developed recurrence after ˜ 1 year of treatment, then it was successfully treated with gap arthroplasty using fascia lata as interpositional material.

Utilization of Radioimmunotherapy (RIT) and Hematopoietic Stem Cell Transplantation (HSCT) in B-cell Non-Hodgkin’s Lymphoma (NHL): 10 Year Experience of a Single Community Cancer Center

After Yttrium (Y90) Ibritumomab tiuxetan (Zevalin) and Iodine (131I) tositumomab (Bexxar) were approved by the FDA, the improved response of B-cell NHL to this novel RIT makes it a promising alternative to more aggressive treatment like HSCT. In this study, we describe the experience of a single community-based cancer with RIT and HSCT in patients with B-cell NHL in terms of response, survival and toxicity. Retrospectively, we reviewed 75 patients with B cell NHL who were treated with either RIT (N=50) or HSCT (N=25) between 2003 and 2013. Choice of treatment modality, i.e. RIT vs. HSCT was based on discretion of treating Oncologist taking into consideration patient’s age, performance status, comorbidity and preferences. RIT-treated patients were older. HSCT was more likely to be used in aggressive lymphoma and as a consolidation of primary therapy. RIT was used mainly in indolent lymphoma and as salvage treatment. Overall response rates were better in HSCT-treated patients (100% vs. 76%). Median overall survival was higher in HSCT-treated patients (221 vs. 79.4 months). Similar results were obtained when we compared OS in patients younger than 60 years (221 vs. 79.4 months) and in patients with aggressive lymphoma (221 vs. 59.7 months). PFS was not met in HSCT, while it was 16.2 months in RIT. Myelodysplastic syndrome (MDS) occurred in both groups (12% HSCT vs. 2% RIT). Thrombocytopenia was more prevalent with RIT. All other toxicities were significantly more common with HSCT. This study shows that, in clinical practice, younger patients with aggressive B-cell NHL and without significant comorbidity are more likely to be offered HSCT. On the other hand, RIT was offered to older patients with indolent histology. Our results show that RIT is a reasonable alternative salvage treatment modality for B-cell NHL patients who are not candidates for HSCT.

Retrospective analysis of 30 cases of pilonidal sinus by various techniques of conservative and surgical management and review of literature

Background:The pilonidal sinus disease may present as chronic cutaneous infection, pilonidal abscess, pilonidal sinus or recurrent pilonidal sinuses. There are several conservative non-surgical and surgical methods of treatment of pilonidal sinus. The wound healing of pilonidal sinus depends upon multiple factors such as the stage at which patient presented to the surgeon, co-existing medical conditions, method of medical/surgical treatment chosen and the expertise of the surgeon. Here we are presenting the retrospective analysis of 30 cases of pilonidal disease, in view of different modalities of treatment, challenges faced, post-operative results and hospital stay.Methods: Over a period of 7 years, 30 patients suffering from various stages of pilonidal sinus disease were treated by conservative and surgical methods. The choice of treatment modality offered to each patient was individualized based on the stage and severity at the time of presentation. The patients were followed up to assess recurrence for 1 year after complete healing of the pilonidal sinus.Results:All patients with pilonidal sinus/ ulcer &lt; 5 mm showed complete healing without recurrence with conservative line of management. There was recurrence of sinus in 80 % patients treated with only Incision and Drainage for pilonidal sinus abscess. The patients with large sinus (&gt; 5 mm ulcer or skin involvement), were treated by excision with healing by secondary intension. This group of patients was associated with recurrence in 80% cases. The remaining patients with large pilonidal sinus disease were treated by the newer technique of semi-closed method with drain. In this group, only 20% patients developed recurrent sinus. All patients with recurrences healed after either conservative method or surgical method involving local skin flap.Conclusions:The conservative method of treatment is suitable for early and superficial pilonidal sinuses. For chronic and extensive pilonidal sinus disease, surgical treatment with the newer technique of semi-closed method with drain was found to reduce the rate of recurrence. The cases with superficial recurrent pilonidal sinuses may heal with conservative approach and extensive recurrent lesions require reconstruction with local skin flap. The results of the newer technique of semi-closed method with drain were found to be comparable with that of surgery by excision with primary closer. These results may be further evaluated at high volume centre for practical statistical significance regarding choice of treatment.

MGMT expression in primary central nervous system diffuse large B cell lymphoma and its relationship with prognosis

Objective: To study the correlation between MGMT expression, clinicopathologic features and post-chemotherapy prognosis in patients with primary central nervous system lymphoma diffuse large B-cell lymphoma (PCNS-DLBCL). Methods: MGMT expression was detected in 76 cases of PCNS-DLBCL by EnVision method with immunohistochemical staining.Follow-up data including treatment response and overall survival time, were analyzed. Results: The rate of MGMT expression in PCNS-DLBCL was 67.1%(51/76). The MGMT expression rate in male patients was higher than that in female(P<0.05). Univariate analysis showed that these clinical pathological characteristics affected the overall survival of PCNS-DLBCL patients, including age and Hans algorithm, although no statistical significance was detected(P value was 0.065 and 0.069 respectively). The overall survival of the patients with positive MGMT and aged over 60 years was shorter after chemotherapy than those without chemotherapy (P=0.022). In the patients aged over 60 years, the prognosis of MGMT-positive patients was significantly better than MGMT-negative patients (P=0.044). Conclusions: The expression of MGMT is more commonly found in male patients. In the patients aged over 60 years with the same therapy, the prognosis is better in the MGMT-negative ones. Detection of MGMT protein expression can provide some guidance in choice of treatment modalities in PCNS-DLBCL patients.

Efficacy and Safety of Treatment of Ruptured Intracranial Aneurysms

To compare the treatment results of ruptured aneurysms treated endovascularly with aneurysms treated with microsurgical clipping. This prospective multicenter study recorded and analyzed 661 cases of ruptured intracranial aneurysms with consecutive subarachnoid hemorrhage treated between 1997 and 2014 at 2 large medical centers. Endovascular treatment was performed in 271 cases, and microsurgical treatment was performed in 390 cases. The treatment modality was chosen by neuroradiologists and vascular neurosurgeons and was classified by predetermined decision criteria. Symptomatic ischemic stroke occurred in 46 patients (17.0%) in the endovascular group versus 26 patients (6.7%) in the microsurgery group (odds ratio [OR]= 2.86; 95% confidence interval [CI], 1.72-4.76; P<0.0001). There was a significantly better occlusion rate (OR= 11.48; 95% CI, 5.10-25.83; P < 0.0001) in the microsurgery group compared with the endovascular group. The rebleeding rate was significantly lower in the microsurgery group (OR= 14.90; 95% CI, 1.90-117.13; P= 0.00085). No patient required retreatment in the microsurgery group, whereas 23 patients required retreatment in the endovascular group (P < 0.0001). There was no significant difference regarding the low direct mortality rate of coil embolization versus microsurgical clipping (P= 0.21). Microsurgical clipping shows a lower rate of treatment-associated complications and a higher occlusion rate of ruptured intracranial aneurysms than coil embolization. The individual evaluation and decision process for choice of treatment modality in this study is very effective.

P.096 A single institution experience with 217 average risk patients undergoing carotid angioplasty and stenting in the post CREST era, a real life experience

Background: The CREST trial remains the most influential study regarding choice of treatment modality for carotid revascularization in the modern era. The effect of the CREST trial on patient outcomes and changes to clinical practice are yet to be fully elucidated. Methods: We report a cohort of 217 consecutive symptomatic average risk patients undergoing CAS at St. Michael’s Hospital, between 2010 and 2016. Outcome measures were stroke, MI and death at 30 days post procedure. Of the 217 patients, 42 were above the age of 75 (19%). Results: The 30-day combined stroke, MI and death outcome for all patients was 4.1%. One death occurred (0.46%) in a patient who suffered an MI. One disabling stroke (0.46%) and 3 mild strokes (1.38%) with full recovery by 6 months occurred. Overall 4 patients suffered an MI (1.84%). Conclusions: As a result of the CREST trial in our single institutional experience there has been a clear migration to treating average risk patients using CAS, a treatment previously reserved for high risk patients. In this average risk cohort we report favourable outcomes when compared to the CREST trial as well as the firmly established benchmarks for CEA complications derived from the NASCET trial.

Selection of Treatment Strategies among Patients with Type 2 Diabetes Mellitus in Malaysia: A Grounded Theory Approach.

BackgroundDiabetes Mellitus is a multifaceted chronic illness and its life-long treatment process requires patients to continuously engage with the healthcare system. The understanding of how patients manoeuvre through the healthcare system for treatment is crucial in assisting them to optimise their disease management. This study aims to explore issues determining patients’ treatment strategies and the process of patients manoeuvring through the current healthcare system in selecting their choice of treatment for T2DM.MethodsThe Grounded Theory methodology was used. Twelve patients with Type 2 Diabetes Mellitus, nine family members and five healthcare providers from the primary care clinics were interviewed using a semi-structured interview guide. Three focus group discussions were conducted among thirteen healthcare providers from public primary care clinics. Both purposive and theoretical samplings were used for data collection. The interviews were audio-taped and transcribed verbatim, followed by line-by-line coding and constant comparison to identify the categories and core category.ResultsThe concept of “experimentation” was observed in patients’ help-seeking behaviour. The “experimentation” process required triggers, followed by information seeking related to treatment characteristics from trusted family members, friends and healthcare providers to enable decisions to be made on the choice of treatment modalities. The whole process was dynamic and iterative through interaction with the healthcare system. The decision-making process in choosing the types of treatment was complex with an element of trial-and-error. The anchor of this process was the desire to fulfil the patient’s expected outcome.ConclusionPatients with Type 2 Diabetes Mellitus continuously used “experimentation” in their treatment strategies and help-seeking process. The “experimentation” process was experiential, with continuous evaluation, information seeking and decision-making tinged with the element of trial-and-error. The theoretical model generated from this study is abstract, is believed to have a broad applicability to other diseases, may be applied at varying stages of disease development and is non-context specific.

Invasive lobular carcinoma of male breast: What we don't know-A report of 5 cases

Male breast carcinoma is a very rare malignancy. It mostly has invasive ductal histology while invasive lobular histology is exceptionally uncommon constituting no more than 1–2% of male breast cancer cases. Here we present five cases of invasive lobular breast carcinoma arising in male breasts which were diagnosed by histological examination. Immunohistochemistry was performed to evaluate the hormonal receptor status. Early diagnosis of breast carcinoma in males have prognostic implication in patients’ survival and show better response to hormonal therapy when it is reactive for estrogen and progesterone receptors. Therefore it is mandatory for the pathologists to keep this rare condition in their minds while evaluating any case of male breast lump and to perform a vigorous search for any small focus of this tumour in circumstances of male breast lump including gynaecomastia. Majority of information regarding treatment of male breast cancer is retrospective in nature and is derived mainly from small single-institution series; thus, the choice of treatment modalities is generally guided by extrapolation of data from female breast cancer. Due to paucity of data and the extreme rarity, male breast carcinoma should be considered and managed as a distinct entity. The invasive lobular carcinoma perhaps with an added advantage for being reactive of hormonal receptors, which could be treated by adjuvant Tamoxifen. It is hoped that a long term multicentric studies will help us to know the prognostic implication of uncommon invasive lobular histology, as well as trials could be strategically designed to optimize the treatment.

The role of phenol application in the management of pilonidal sinus disease

Background: Pilonidal sinus disease (PNSD) is common among young adults. The diagnosis of disease is more often a clinical one, based on the patient's history and physical findings. Numerous treatment options, ranging from simple excision to extensive flap procedures, currently exist. However, hospital stay, missed days of work, recurrence rates, and surgeon's familiarity with the techniques are important factors in the choice of treatment modality. The aim of present study was to study the role of phenol application in the management of PNSD. Patients and Methods: In our study, we aimed to share the results of our patients who underwent treatment with local application of 80% phenol. After shaving from waist to mid-thigh posteriorly, 1 cc phenol was injected via sinus under local anesthesia. Results: In this study, all the 30 outpatients were male. The average age was 23.5 years. Complete cure was obtained in 24 (80%) patients. The mean number of days required for complete healing of sinus were 47.83 days. Four patients had nonhealing of sinus and two patients developed recurrence. Conclusion: This method of treatment is very simple and has acceptable relapse rates. It does not affect productive life of patient and does not need hospitalization. Thus, it could be considered as the first choice in the treatment of noncomplicated pilonidal sinus.

Prognostic impact of salvage treatment on hearing recovery in patients with sudden sensorineural hearing loss refractory to systemic corticosteroids: A retrospective observational study.

To determine the prognostic factors for hearing recovery in patients with sudden sensorineural hearing loss (SSHL) refractory to systemic corticosteroids following salvage treatment. This is a retrospective observational study at nine tertiary referral hospitals. A total of 120 patients with sudden deafness refractory to systemic corticosteroids were enrolled. The patients were randomly assigned to receive topical application of recombinant human IGF-1 or intratympanic injection of dexamethasone as salvage treatment. Multiple regression analysis was performed to identify determinants of hearing recovery using pure tone audiometry results at 8 weeks after treatment. Clinical predictors that were evaluated included age, sex, pretreatment hearing level, presence of vertiginous symptoms, days to study entry from symptom onset and salvage treatment assignment (IGF-1 vs. dexamethasone). The linear regression model identified age (P=0.001), pretreatment hearing level (P<0.001), days to study entry from symptom onset (P=0.011) and treatment assignment (P=0.033) at 8 weeks after treatment as significant variables influencing the recovery of pure tone audiometry average thresholds. Younger age (<60 years), early initiation of salvage treatment and treatment with topical IGF-1 therapy had significant effects on hearing recovery. The results indicate that early initiation and choice of treatment modalities for salvage treatment may be important for the prognosis of patients with refractory SSHL. The positive effect of topical IGF-1 therapy on hearing recovery indicates its utility as salvage treatment.

Therapy of leptomeningeal metastasis in solid tumors.

Leptomeningeal metastasis (LM), i.e. the seeding of tumor cells to the cerebrospinal fluid (CSF) and the leptomeninges, is a devastating and mostly late-stage complication of various solid tumors. Clinical signs and symptoms may include cranial nerve palsies, radicular symptoms, signs of increased intracranial pressure such as headache, nausea and vomiting, and cognitive dysfunction. In cases of suspected LM, the highest diagnostic sensitivity is provided by the combination of CSF cytology and contrast-enhanced MRI (cranial as well as complete spine). The therapeutic spectrum includes radiotherapy of the clinically involved region as well as systemic and intrathecal chemotherapy. The choice of treatment modalities depends on the type of LM (non-adherent tumor cells in the CSF vs. nodular contrast-enhancing tumor growth), additional systemic involvement (uncontrolled vs. controlled systemic disease) and additional involvement of the CNS parenchyma (LM as the only CNS involvement vs. LM+parenchymal CNS metastases). Larger contrast-enhancing nodular LM or symptomatic lesions of the spine may be treated with radiotherapy. In case of uncontrolled systemic disease, the treatment regimen should include systemic chemotherapy. The choice of systemic treatment should take into account the histology of the primary tumor. Intrathecal chemotherapy is most important in cases of LM of the non-adherent type. There are three substances for routine use for intrathecal chemotherapy: methotrexate, cytarabine, and thiotepa. Liposomal cytarabine shows advantages in terms of longer injection intervals, a sufficient distribution in the entire subarachnoid space after lumbar administration and improved quality-of-life. The role of new agents (e.g. rituximab and trastuzumab) for intrathecal therapy is still unclear.

Traitement conservateur, hémodialyse ou dialyse péritonéale chez le sujet âgé : le choix du traitement ne modifie pas la survie

Hemodialysis is the predominant replacement therapy in the 70 year-old French population (18% in peritoneal dialysis, 72% in hemodialysis from the REIN registry). Managing older patients reaching the end stage renal disease poses many ethical questions, since outcomes balanced regarding survival and quality of life. The aim of this study was to compare the survival of patients aged over 70 years according to the ESRD treatment choice: conservative treatment without dialysis (CT), hemodialysis (HD) and peritoneal dialysis (PD). We included all patients over 70 years reaching stade IV CKD integrated in a predialysis information program between 01/01/2005 and 31/12/2010. We compared their survival from the start of their program, in function of their treatment choice: HD, PD or CT. On this period, 148 patients were included, we excluded from analysis 17 patients who had a contraindication to PD, 26 patients who did not make a choice because their kidney function was stabilized, 4 patients lost to follow-up and 12 patients who died before the treatment choice. The average age was 79±6 years, 40% of patients were women, and the mean eGFR was 16±9 mL/min/1.73 m2 at the entry in the program. Among the 89 patients, 21 choose CT (24%), 68 accepted dialysis (76%), including 48 HD (71%) and 20 PD (29%). No significant eGFR difference at the inclusion time between the groups. The time initiation of dialysis was significantly shorter in the PD group (146 days vs 442 in the HD group; P=0.004). Survival between the groups of patients who accepted or refused dialysis was not statistically different (749 days or 2 years in the HD + PD group vs 562 days, or 1 year and 6 months in the CT group; P=0.95) and between the HD group (760 days or 2 years and 2 months) and the PD group (343 days or 11 months; P=0.32). As measured from the time they entered in the predialysis program, the survival of older patients over 70 years does not seem to depend on their choice of treatment modality. Whether they accepted or refused dialysis, whatever their choice concerning hemodialysis or peritoneal dialysis, their survival was close to one year.

Accuracy of Biopsy in Subtyping Periocular Basal Cell Carcinoma.

To determine the accuracy of initial biopsy in the diagnosis of basal cell carcinoma (BCC) histologic subtype. Retrospective histopathologic review of patients with a diagnosis of primary periocular BCC from 2006 to 2013 inclusive. A total of 174 primary BCCs were identified. BCCs were classified as nodular, superficial, or aggressive (including mixed cases with an aggressive component). Punch biopsies were used in 41% of cases, while the remaining patients underwent shave or incision biopsies. The final histologic subtypes at excision were nodular (59%), superficial (7%), nodular and superficial (7%), and aggressive (51%). The overall concordance between the BCC subtype identified in the biopsy specimen and the subsequent excision specimen was 54%. In total, there were 51 cases (29%) of BCC, which included aggressive subtypes, of which 52% of initial biopsies failed to detect an aggressive component. There were 45 cases (26%) of mixed BCC, and an aggressive histologic subtype was present in 73% of these cases. The accuracy of initial biopsy for BCC histologic subtype at excision is highest for nodular BCC. For aggressive BCC, biopsy was able to detect the aggressive component in only 48% of cases. This may have implications for choice of treatment modality.

Tinnitus following treatment for sporadic Acoustic neuroma

To evaluate the impact of treatment modality, tumor size, time from therapy, and demographic features on tinnitus distress, as measured by the Tinnitus Functional Index (TFI) in patients treated for sporadic acoustic neuroma. Cross-sectional observation study. A Web-based 44-question online survey was made available on the Acoustic Neuroma Association Web site for 3 months. Of 154 unique surveys that were completed in entirety, further screening netted 143 study participants. Questions included the TFI, treatment modality, tumor size, time from therapy, demographic features, and hearing status of both ears. Tinnitus distress following treatment for acoustic neuroma is independent of treatment type, tumor size, tumor laterality, time after treatment, age, and gender. Tinnitus Functional Index scores closely mirror severity profile of the study population as reported in the pivotal TFI instrument validation study by Meikle et al.(17) Tinnitus is "not a problem" in 20% of respondents, a "small problem" in 20%, a "moderate problem" in 11%, a "big problem" in 22%, and a "very big problem" in 27%. Subscale analysis suggests that acoustic tumor patients struggle most with tinnitus intrusiveness and loss of control. Whereas tinnitus is a common symptom in acoustic neuroma patients in both the pre- and posttreatment settings, clinicians can provide counsel that choice of treatment modality, tumor size, age, and gender have little to no bearing on severity of posttreatment tinnitus distress. Tinnitus severity does not differ among the treatment choices of open microsurgery, stereotactic radiosurgery, external beam radiation, and observation. NA Laryngoscope, 126:1639-1643, 2016.

Coming Together to Move Apart: Family Therapy for Enhancing Adolescent Development.

An important goal of adolescent development is emotional separation from the family of origin. Differing views on how to accomplish this task exist, and these are reflected in the choice of treatment modality. It has been common practice in the treatment of adolescents for work with parents to be done separately from the adolescent. Since social, cultural, and economic factors have an impact on development, as society changes it is important to think creatively about effective ways to accomplish the process of becoming a functioning adult. It is in this context that authors have focused recently on the need for young adults to have a positive connection with their parents. This paper will address the role of involvement of family in the psychotherapy of adolescents either by inviting them to participate in some of the individual sessions or through conjoint family therapy to facilitate forward development. Clinical illustrations will demonstrate the issues of an adolescent with unresolved early traumatic separation, an adolescent who is fulfilling parental needs, an adolescent with too much power in the family, the importance of beginning treatment after assessing where everyone is emotionally, and the problem of premature disconnection by parents.

Stone component analysis of 1000 patients in yi-lan county

Stone component analysis of 1000 patients in yi-lan county

Keratokistik odontojenik tümör: 64 vakalık retrospektif çalışma

Aim: The purpose of this retrospective study was to evaluate the clinicopathological features of 64 patients with keratocystic odontogenic tumor (KCOT). Materials and Methods: The patients ranged in age at the time of diagnosis from 8 to 74 years (mean: 38.20 ± 16.71). Postoperative follow-up period was 3-8 years (mean time 4.76 ± 1.10). This research was carried out on panoramic radiographs and histopathological samples. Data such as gender, age, treatment methods, location of the tumor, presence of impacted teeth and its histological features were subjected to descriptive statistical analyses with the statistical software program. Results: Of the 64 analyzed cases of KCOT, 68.8% of them were men and 31.2% were females (male-to-female ratio was 2.2:1). It was observed that KCOT peaked in the third and fifth decade of life (23.4%-20.3%). The incidence of KCOT was higher in the mandible than in the maxilla (76.6%-23.4%). There was recurrence in nine out of 64 subjects (14.1%) in the follow-up period. The recurrence was more often found in posterior mandible. It is noteworthy that in 9 recurrent subjects, 7 lesions were parakeratotic and 4 lesions were associated with daughter cysts. Conclusion: Although there are several studies about KCOT in the literature, the choice of treatment modalities remains controversial. In recurrent subjects, more aggressive therapy approaches should be considered. Periodic controls and aggressive treatment approaches may be effective in the prevention of recurrences.