Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-300 From Set 98): ----------------------------------------------------------------------------- 1 ("99351665" or "98132732" or "97321740" or "93139336").ui. 4 2 Reproducibility of results/ 53323 3 exp risk/ 227197 4 Models, statistical/ 9724 5 Prevalence/ 44755 6 Discriminant analysis/ 2577 7 Forecasting/ 28594 8 exp Cohort studies/ 367539 9 Evaluation studies/ 99787 10 Risk-taking/ 3751 11 exp Health behavior/ 26393 12 reproducib:.mp. 87122 13 risk:.mp. 414044 14 forecast:.mp. 30078 15 False negative reactions/ or False positive reactions/ 19370 16 (sensitivity or specificity).ti,ab. 279532 17 (predictive adj value$1).mp. 20072 18 (predictive adj validit:).mp. 880 19 (likelihood adj ratio:).mp. 1434 20 (false adj (negative$1 or positive$1)).ti,ab. 23142 21 (randomized controlled trial or controlled clinical 183793 trial).pt. 22 double blind method/ or single blind method/ 65359 23 practice guideline.pt. 4699 24 consensus development conference$.pt. 2783 25 random$.ti,ab. 193352 26 random allocation/ 40827 27 (single blind$3 or double blind$3 or triple blind$3).ti,ab. 56757 28 exp "sensitivity and specificity"/ 89544 29 or/15-28 670432 30 or/2-14 959966 31 exp Tooth demineralization/ 22628 32 demineralization.mp. 1620 33 caries.mp. 15295 34 caires.mp. 1 35 craies.mp. 0 36 careis.mp. 4 37 carise.mp. 0 38 (teeth adj3 cavit:).mp. 422 39 (tooth adj3 cavit:).mp. 217 40 (dental adj3 cavit:).mp. 276 41 (dentin adj3 cavit:).mp. 254 42 (enamel adj3 cavit:).mp. 182 43 (teeth adj3 decay:).mp. 374 44 (tooth adj3 decay:).mp. 321 45 (dental adj3 decay:).mp. 250 46 (dentin adj3 decay:).mp. 12 47 (enamel adj3 decay:).mp. 20 48 (active adj decay).mp. 9 49 (rampant adj3 decay:).mp. 14 50 (recurrent adj3 decay:).mp. 30 51 (white adj spot:).mp. 509 52 carious.mp. 2077 53 cariology.ti,ab. 56 54 (non-cavitated adj3 lesion:).mp. 15 55 (noncavitated adj3 lesion:).mp. 2 56 Tooth remineralization/ 478 57 (dental adj3 fissure:).mp. 99 58 (tooth adj3 fissure:).mp. 50 59 (teeth adj3 fissure:).mp. 98 60 caries-free.mp. 603 61 cariesfree.mp. 17 62 Cariogenic agents/ 728 63 precavit:.mp. 8 64 (filled adj3 teeth).mp. 510 65 (filled adj3 tooth).mp. 117 66 (oral adj fissure:).mp. 6 67 (tooth adj3 remineraliz:).mp. 28 68 (teeth adj3 remineraliz:).mp. 24 69 dft.mp. 413 70 dfs.mp. 1258 71 dmf:.mp. 6397 72 cariogeni:.mp. 1787 73 or/31-72 32256 74 73 and 30 5368 75 74 and 29 1059 76 75 or 1 1059 77 limit 76 to (human and english language and yr=1980-2000) 970 78 limit 77 to (preschool child < 2 to 5 years > or child < 6 459 to 12 years > or adolescence < 13 to 18 years >) 79 exp Tooth, deciduous/ 5992 80 Dentition, primary/ 369 81 Dentition, mixed/ 1066 82 ((primary or deciduous or mixed) adj5 (tooth or teeth or 5759 dent: or odont:)).mp. 83 or/79-82 9322 84 77 and 83 87 85 78 or 84 466 86 from 85 keep 1-300 300 87 from 85 keep 310-466 157 88 from 85 keep 301-466 166 89 77 not 85 504 90 "Root caries"/ 297 91 ("root" adj3 (carie: or lesion:)).mp. 1180 92 exp Tooth root/ 7047 93 ((tooth or teeth or enamel or dentin) adj5 ("root" or apex 3443 or apices)).mp. 94 ((amelocemental or cemental or cementum) adj5 (carie: or 74 lesion:)).mp. 95 Dental cementum/ 1911 96 or/90-95 11043 97 89 and 96 62 98 89 not 97 442 99 from 98 keep 1-300 300 *************************** <1> UI - 20265404 AU - Nummikoski PV AU - Steffensen B AU - Hamilton K AU - Dove SB IN - Department of Dental Diagnostic Science, University of Texas Health Science Center at San Antonio, 78284, USA. nummikoski@uthscsa.edu TI - Clinical validation of a new subtraction radiography technique for periodontal bone loss detection. SO - Journal of Periodontology 2000 Apr;71(4):598-605 AB - BACKGROUND: Diagnostic subtraction radiography (DSR) is a new digital radiographic image subtraction method designed to enhance detection of crestal or periapical bone density changes and to help evaluate caries progression in teeth. In this clinical study, the performance of the DSR method was evaluated for its ability to detect periodontal bone loss and was compared with that of conventional evaluation of radiographs and the standardized cephalostat-guided image acquisition and subtraction technique (LRA) which served as the "gold standard." METHODS: In each of 25 subjects with alveolar crestal bone loss created by periodontal surgery, one set of DSR radiographs and one set of LRA radiographs were obtained before and after the surgery. Subtraction images were then generated by both the proprietary DSR and the LRA techniques. Four viewers evaluated the paired film sets and both subtraction image sets using a 5 point confidence scale to determine the presence or absence of crestal bone loss. Receiver operating characteristics (ROC) statistical procedures were applied to analyze the diagnostic accuracy and statistical differences between the three imaging modalities. RESULTS: The DSR subtraction viewing generated an ROC area of 0.882. For 2 of the viewers this represented a statistically significant gain (P <0.05) over the conventional viewing of the radiographs which had an average ROC area of 0.730. In comparison, the LRA method achieved an area of 0.954. The differences between the LRA and the DSR subtraction methods were not statistically significant, but the statistical power for claiming equality was low ranging from 0.2 to 0.6. CONCLUSIONS: The use of the DSR technique in clinical radiographic image acquisition and subsequent subtraction analysis clearly enhanced the accuracy of alveolar crestal bone loss detection when compared to conventional film viewing. Because this methodology is less resource demanding than LRA and the film exposure techniques and computer-based image analysis skills may be acquired with only a few hours of training, the DSR has potential in clinical practice. <2> UI - 20269630 AU - Trope C AU - Kaern J AU - Hogberg T AU - Abeler V AU - Hagen B AU - Kristensen G AU - Onsrud M AU - Pettersen E AU - Rosenberg P AU - Sandvei R AU - Sundfor K AU - Vergote I IN - Department of Gynecologic Oncology, The Norwegian Radium Hospital, Oslo. claes.trope@klinmed.uio.no TI - Randomized study on adjuvant chemotherapy in stage I high-risk ovarian cancer with evaluation of DNA-ploidy as prognostic instrument [see comments]. CM - Comment in: Ann Oncol 2000 Mar;11(3):259-61 SO - Annals of Oncology 2000 Mar;11(3):281-8 AB - PURPOSE: Adjuvant chemotherapy versus observation and chemotherapy at progression was evaluated in 162 patients in a prospective randomized multicenter study. We also evaluated DNA-measurements as an additional prognostic factor. PATIENTS AND METHODS: Patients received adjuvant carboplatin AUC 7 every 28 days for six courses (n = 81) or no adjuvant treatment (n = 81). Eligibility included surgically staged and treated patients with FIGO stage I disease, grade 1 aneuploid or grade 2 or 3 non-clear cell carcinomas or clear cell carcinomas. Disease-free (DFS) and disease-specific (DSS) survival were end-points. RESULTS: Median follow-up time was 46 months and progression was observed in 20 patients in the treatment group and 19 in the control group. Estimated five-year DFS and DSS were 70% and 86% in the treatment group and 71% and 85% in the control group. The hazard ratio was 0.98 (95% confidence interval (95% CI): 0.52-1.83) regarding DFS and 0.94 (95% CI: 0.37-2.36) regarding DSS. No significant differences in DFS or DSS could be seen when the log-rank test was stratified for prognostic variables. Therefore, data from both groups were pooled for the analysis of prognostic factors. DNA-ploidy (P = 0.003), extracapsular growth (P = 0.005), tumor rupture (P = 0.04), and WHO histologic grade (P = 0.04) were significant independent prognostic factors for DFS with P < 0.0001 for the model in the multivariate Cox analysis. FIGO substage (P = 0.01), DNA ploidy (P < 0.05), and histologic grade (P = 0.05) were prognostic for DSS with a P-value for the model < 0.0001. CONCLUSIONS: Due to the small number of patients the study was inconclusive as regards the question of adjuvant chemotherapy. The survival curves were superimposable, but with wide confidence intervals. DNA-ploidy adds objective independent prognostic information regarding both DFS and DSS in early ovarian cancer. <3> UI - 20338721 AU - McClay EF AU - McClay ME AU - Monroe L AU - Baron PL AU - Cole DJ AU - O'Brien PH AU - Metcalf JS AU - Maize JC IN - Department of Medicine, University of California, San Diego, La Jolla 92093-0063, USA. TI - The effect of tamoxifen and cisplatin on the disease-free and overall survival of patients with high risk malignant melanoma [see comments]. CM - Comment in: Br J Cancer 2000 Jul;83(1):6-7 SO - British Journal of Cancer 2000 Jul;83(1):16-21 AB - The adjuvant treatment of high-risk malignant melanoma remains problematic. Previously we reported moderate success in the treatment of metastatic disease using tamoxifen, cisplatin, dacarbazine and carmustine. Based upon data that suggested tamoxifen and cisplatin were the active agents in this regimen, we initiated a phase II trial of this combination in the adjuvant setting. We treated 153 patients with 4 cycles of tamoxifen (160 mg day(-1), days 1-7) and cisplatin (100 mg m(-2), day 2) for 28-day intervals. Patients received an anti-nausea regimen of dexamethasone with ondansetron or granisetron. During the first 2 years of follow-up, patients were evaluated every 2 months with a history, physical exam, laboratory work and computed tomography scans of the chest, abdomen and pelvis every 4 months. Thereafter, patients were evaluated every 3 months and radiographic studies were performed if necessary. Currently, with a median follow-up of 36 months, the disease-free survival (DFS) is 68.4% and overall survival (OS) is 84.5%. Kaplan-Meier analysis predicts a 5-year DFS of 62% with an OS of 79%. Relapses after 20 months have been rare. No effect of gender or number of positive lymph nodes was noted, however, stage of disease prior treatment was a factor. The major toxicity proved to be gastrointestinal in nature with nausea the most prevalent symptom. Minimal renal, haematologic and neurologic toxicity occurred. These preliminary results suggest that there is a positive impact of tamoxifen and cisplatin on both the DFS and OS of high-risk malignant melanoma patients. The 5-year projected DFS and OS compare favourably with those reported for the ECOG 1684 trial and warrant confirmation in a prospective randomized trial. <4> UI - 20323656 AU - Wichmann MG AU - von Brenndorff AI IN - Department of Prosthodontics, Medical University, Hannover, Germany. TI - Use of the direct magnification technique in dental radiology. SO - Dento-Maxillo-Facial Radiology 1999 Jul;28(4):249-55 AB - OBJECTIVE: To investigate the potential use of the direct magnification (DIMA) technique in dental radiology. METHODS: Radiographs of anatomical specimens and extracted teeth were prepared under clinical conditions using a microfocus (8 and 16 microns focal diameter) X-ray tube. Entrance dose was measured using an ionization chamber. Image quality was assessed in a single-blind test of pairs of images of extracted teeth with and without caries by ten observers. RESULTS: At 7.3 x magnification the values for exposure time and entrance dose were comparable with those for conventional intraoral radiography, 0.1 and 0.25 s and 1.5 and 2.9 mSv respectively. Diagnostic accuracy using the DIMA images was significantly (P < 0.0001) better compared with dental radiographs. CONCLUSION: DIMA images with significantly enhanced diagnostic accuracy can be obtained at comparable exposure times and entrance doses to conventional intraoral radiographs. <5> UI - 20323648 AU - Cederberg RA AU - Frederiksen NL AU - Benson BW AU - Shulman JD IN - Baylor College of Dentistry/Texas A&M University System, Dallas 75266-0677, USA. TI - Influence of the digital image display monitor on observer performance. SO - Dento-Maxillo-Facial Radiology 1999 Jul;28(4):203-7 AB - OBJECTIVE: To assess the influence of the display monitor on observer performance. MATERIAL AND METHODS: Artificial enamel lesions were created in 40 extracted teeth at random using 1/4 and 1/2 round burs. Teeth were mounted in dental stone blocks to simulate a hemidentition. Approximate exposures were recorded at 70 kVp using a Digota (Soredex, Orion Corp, Helsinki, Finland) digital imaging system, calibrated to achieve optimum density. Six dentists rated each image on a five-point scale for the presence or absence of a lesion. Radiographic images were viewed on the following monitors: (1) AlphaScan 711 (Sampo Corp.); (2) Multiscan 17 Se II (Sony Electronics Inc.); (3) DS 2000 (Clinton Electronics Corp.) and (4) Latitude CP Laptop (Dell Computer Corp.). Raters were allowed to magnify and to adjust density and contrast of each image at will. Receiver Operating Characteristic (ROC) analysis was performed and curves were plotted for each image. Data was subjected to repeated measures analysis of variance and ordinal logistic regression to test for significance between variables and to determine odds ratios. RESULTS: Mean ROC curve areas ranged from 0.8728 for the Sampo monitor to 0.8395 for the Sony. Repeated measures analysis of variance showed significant differences between observers (P < 0.0001), lesion size (P < 0.0001), examiner/monitor interaction (P < 0.033) and examiner/block interaction (P < 0.013). However, no significant difference was found between monitors. CONCLUSION: This study suggests that observer performance is independent of the visual characteristics of the display monitor. <6> UI - 20229982 AU - Fountzilas G AU - Zisiadis A AU - Dafni U AU - Konstantaras C AU - Hatzitheoharis G AU - Papavramidis S AU - Bousoulegas A AU - Basdanis G AU - Giannoulis E AU - Dokmetzioglou J AU - Katsohis C AU - Nenopoulou E AU - Karvounis N AU - Briassoulis E AU - Aravantinos G AU - Kosmidis P AU - Skarlos D AU - Pavlidis N IN - 1st Department of Internal Medicine, Oncology Section, AHEPA Hospital, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece. fountzil@med.auth.gr TI - Fluorouracil and leucovorin with or without interferon alfa-2a as adjuvant treatment, in patients with high-risk colon cancer: a randomized phase III study conducted by the Hellenic Cooperative Oncology Group. SO - Oncology 2000 Apr;58(3):227-36 AB - BACKGROUND: It has been shown in randomized studies that adjuvant treatment with the combination of fluorouracil (FU) and levamisole reduced the risk of recurrence and deaths of patients with stage III colon cancer. Pharmacological studies of FU led to its use in combination with a number of modulating agents including interferon-alpha and leucovorin (LV) that appear to enhance its activity in vitro. Furthermore, a meta-analysis suggested that the combination of FU with LV increased the response rate as compared to FU monotherapy in patients with advanced colorectal cancer. PURPOSE: To evaluate the impact of adjuvant treatment with the combination of FU and LV with or without interferon alfa-2a (IFN) on disease-free survival (DFS) and overall survival (OS) for patients with stage II or III colon cancer. PATIENTS AND METHODS: From August 1989 to July 1997, 280 patients with stage II and III colon cancer entered the study and were randomly assigned to receive either the combination of FU (600 mg/m(2)/week x 6, followed by a 2-week rest) and LV (500 mg/m(2)/week x 6 as a 2-hour infusion, followed by a 2-week rest) for 4 cycles (group A, 139 patients), or the same chemotherapy plus recombinant IFN (3 MU subcutaneously 3 times a week) for 1 year (group B, 141 patients). RESULTS: A total of 109 patients (78.9%) of group A and 119 (84.4%) of group B completed four cycles of chemotherapy. Also, 51.4% of patients of group A and 53.9% of group B received > or =80% of the planned dose of FU. One patient (group A) was found to be ineligible and was not included in the analysis. The median relative dose intensity of FU in the two groups was 0.90 and 0.85, respectively. As of August 1998, after a median follow up of 4 years, there was no significant difference in either 3-year DFS (group A, 83.1%; group B, 75.9%, p = 0.14) or OS (group A, 84.5%; group B, 80.0%, p = 0.27). In the Cox model, stage of disease, number of infiltrated nodes, tumor grade and presence of regional implants were identified as significant prognostic factors for OS. Grade 3-4 toxicities, mainly diarrhea, were observed in 26.1% of patients of group A and in 24.8% of group B. There were no treatment-related deaths. CONCLUSIONS: The addition of IFN to the combination of FU with LV postoperatively does not improve DFS and OS of patients with stage II or III colon cancer. Copyright 2000 S. Karger AG, Basel <7> UI - 20291717 AU - Browning WD AU - Johnson WW AU - Gregory PN IN - Medical College of Georgia, School of Dentistry, Department of Oral Rehabilitation, Augusta, Ga. 30912-1260, USA. TI - Clinical performance of bonded amalgam restorations at 42 months. SO - Journal of the American Dental Association 2000 May;131(5):607-11 AB - BACKGROUND: Despite a lack of data based on clinical research, many positive characteristics have been attributed to the placement of amalgam restorations with an adhesive resin liner. METHODS: For 42 months, and authors followed two groups of subjects who had amalgam restorations placed in a previous study. In this double-blind study, these subjects had been randomly assigned to have amalgam restorations placed with an adhesive liner or with a copal varnish placed under all restorations and a bulk base of zinc phosphate cement for deeper lesions. The authors evaluated anatomical form, marginal adaptation, retention and the presence of secondary caries at six, 18, 30 and 42 months. RESULTS: At 42 months, the authors found that all restorations in both groups still were retained, were free of secondary caries and were rated clinically acceptable. No difference between the groups was found for any category (P > .05; analysis). CONCLUSIONS: Placement of amalgam restorations with adhesive liners was found to produce results equivalent to that of traditional methods over a 42-month period. CLINICAL IMPLICATIONS: Practitioners wary of using new methods that have not undergone thorough clinical testing can feel comfortable placing adhesive liners under amalgam restorations. <8> UI - 20237506 AU - Lussi A AU - Schaffner M IN - Department of Operative, Preventive and Paediatric Dentistry, University of Bern, School of Dental Medicine, Bern, Switzerland. TI - Progression of and risk factors for dental erosion and wedge-shaped defects over a 6-year period. SO - Caries Research 2000 Mar-Apr;34(2):182-7 AB - It has been shown that dental erosion is not a very rare condition. Careful observation and clinical experience led us to hypothesize a progression of these lesions with time despite dietary counselling and oral hygiene instruction. The purpose of this study was to determine the progression rate and risk factors of dental erosion and wedge-shaped defects over a 6-year period. In the year 1987, 204 randomly selected persons living in Bern from two age groups (26-30 and 46-50 years) were examined for frequency and severity of dental erosion and wedge-shaped defects. In the year 1993, 55 persons could be re-examined by the same dentist using the same indices. Further, detailed case histories of the patients were recorded and the flow rate and buffering capacity of the saliva were determined. The results indicated a distinct progression of erosion on facial and occlusal surfaces and wedge-shaped defects over the 6-year period. The increase in the defects was more marked in the older age group. Surprisingly, nutritional habits did not change despite thorough informative discussion about erosive foodstuff with every patient during the first session. Multiple linear regression analysis revealed consumption of nutritional acids and age as significant risk factors explaining 28% of the variability of the progression of erosions. The significant factors for the progression of wedge-shaped defects were identified to be frequency of tooth brushing and age, explaining 21% of the variability of the progression of wedge-shaped defects. In summary, there was a definite statistically significant progression of non-carious dental hard tissue defects in our sample. This progression was correlated with age (erosion and wedge-shaped defects), consumption of dietary acids (erosion) and frequency of toothbrushing (wedge-shaped defects). <9> UI - 20285616 AU - Wilder AD Jr AU - May KN Jr AU - Bayne SC AU - Taylor DF AU - Leinfelder KF IN - Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, USA. TI - Seventeen-year clinical study of ultraviolet-cured posterior composite Class I and II restorations. SO - Journal of Esthetic Dentistry 1999;11(3):135-42 AB - OBJECTIVES: To compare the clinical performance of four commercial ultraviolet light-cured composite materials, and to evaluate curing-system effects on long-term wear resistance of Class I and II restorations. MATERIALS AND METHODS: Approximately 32 samples of each of four different ultraviolet light-cured composites (n = 130) were inserted into conventional Class I and II cavity preparations by two clinicians. Cavosurface margins of the preparations were not beveled. Enamel walls of the preparation were etched, and the respective bonding agent was applied. Each restoration was evaluated by two clinicians at 5, 10, and 17 years. Direct evaluations were performed using modified United States Public Health Service (USPHS) criteria. Indirect evaluations were performed using the Leinfelder cast evaluation method. RESULTS: After 17 years, 65% of the restorations were recalled and pooled direct evaluations were conducted for color matching (94% alfa), marginal discoloration (100% alfa), marginal integrity (100% alfa), secondary caries (92% alfa), surface texture (72% alfa), and anatomic form (22% alfa). Mean occlusal wear from indirect evaluations at 5, 10, and 17 years was 197 +/- 85 microns, 235 +/- 72 microns, and 264 +/- 80 microns, respectively. For direct and indirect evaluations there were significant differences (p < or = .05) between the baseline and 5-year recall evaluations. CLINICAL SIGNIFICANCE: This study demonstrated that the mean pooled occlusal wear of four ultraviolet light-cured posterior composites at 17 years was 264 microns (approximately 0.25 mm), and that most wear (75%) occurred in the first 5 years. Of all recalled restorations, 76% were judged clinically acceptable at 17 years, and 22% of those exhibited no clinically detectable wear. <10> UI - 20270717 AU - Pichon MF AU - Moulin G AU - Pallud C AU - Pecking A AU - Floiras JL IN - Laboratoire d'Immunoanalyse, Centre Rene Huguenin De Lutte Contre Le Cancer, Saint-Cloud, France. TI - Serum bFGF (basic fibroblast growth factor) and CA 15.3 in the monitoring of breast cancer patients. SO - Anticancer Research 2000 Mar-Apr;20(2B):1189-94 AB - BACKGROUND: Basic fibroblast growth factor (bFGF) is a potent angiogenetic factor which may influence breast cancer evolution. MATERIALS AND METHODS: Serum bFGF, (cut-off 10 pg/ml), was assayed in 166 breast cancer patients at all stages and compared with CA 15.3. RESULTS: In 99 pre-treatment (PT) sera, 39/99 (39.4%) were bFGF positive, 9/99 (9.1%) CA 15.3 positive (> 30 U/ml), and not correlated. No correlations were found between bFGF and age, menopausal status, TNM or pTNM, histology, SBR grading or steroid receptors. A postoperative decline in bFGF positivity, from 30.8 to 7.7% (n = 39), was observed. An abnormal CA 15.3 after primary treatment (n = 2/39) was of bad prognosis (P < 0.0001), whereas positive bFGF (n = 3/39) had no univariate prognostic value (median follow-up 5.5 years). During follow-up, positive bFGF was recorded in 6/92 (6.5%) disease-free patients (DFS), 13/15 (86.7%) regressions, 8/16 (50.0%) stable disease, and 46/67 (68.7%) progressive disease (significant differences between PT or DFS and post recurrence levels (P < 0.001), and between relapse before and after treatment (P = 0.002)). CONCLUSION: Serum bFGF is more often elevated before treatment or after relapse than in DFS, and rises under systemic treatments. Its pattern of variations does not add to CA 15.3 for breast cancer monitoring. <11> UI - 20274758 AU - Brunton PA AU - Cowan AJ AU - Wilson MA AU - Wilson NH IN - Unit of Operative Dentistry and Endodontology, University Dental Hospital of Manchester, UK. paul.brunton@man.ac.uk TI - A three-year evaluation of restorations placed with a smear-layer-mediated dentin bonding agent in non-carious cervical lesions. SO - Journal of Adhesive Dentistry 1999;1(4):333-41 AB - PURPOSE: To evaluate the handling characteristics, clinical behavior, and effectiveness of Coltene ART Bond/Brilliant restorations in mixed Class V preparations in maxillary premolar and canine teeth of adult patients over a three-year period. MATERIALS AND METHODS: Single-center, uncontrolled, clinical evaluation of 50 restorations in 26 patients extending over 36 months. RESULTS: At three years, 34 restorations, or 68% of those originally placed, in 20 patients were available for review. One of the 34 restorations had been lost 15 months after placement. In terms of marginal integrity and staining, anatomic form, surface texture and staining, and postoperative sensitivity, over 90% of the restorations reviewed at three years were rated alpha. Following difficulties in obtaining excellent color match in relation to 14 (28%) of the restorations at the time of placement, only 44% of the restorations were rated alpha at three years. CONCLUSION: It was concluded that with the possible exception of excellent color match, ART Bond/Brilliant restorations may be found to perform favorably in mixed Class V lesions in selected adult patients over a period of at least three years. The findings indicate that resin composite restorations placed with a smear-layer mediated dentin bonding agent may be found to have a favorable clinical outcome in non-carious cervical lesions. <12> UI - 20274757 AU - Setcos JC AU - Staninec M AU - Wilson NH IN - Dental School, University of Manchester, UK. TI - A two-year randomized, controlled clinical evaluation of bonded amalgam restorations. SO - Journal of Adhesive Dentistry 1999;1(4):323-31 AB - PURPOSE: The clinical performance of adhesively bonded dental amalgam restorations was compared with that of traditionally placed non-bonded control amalgams in a randomized prospective study. MATERIALS AND METHODS: One-hundred thirteen Class II Dispersalloy amalgams were placed in permanent molars and premolars of 31 (21 males, 10 females) human subjects with their informed consent. By random assignment, 60 amalgam restorations were adhesively bonded using ED Primer and Panavia 21 TC (both Kuraray Co, Japan), and 53 traditional non-bonded restorations were placed. Most preparations involved replacement of defective amalgam restorations. Clinical recalls were conducted by experienced evaluators using modified USPHS criteria for occlusal and proximal anatomic form, occlusal and proximal marginal adaptation, and occlusal and proximal surface roughness. RESULTS: For the categories of anatomic form, marginal adaptation, surface quality, and temperature sensitivity, there were no significant differences between bonded and non-bonded amalgam restorations (chi-square analysis, p > 0.05). Three non-bonded restorations were lost at 4, 7, and 24 months from preparations with no deliberate retention. CONCLUSION: After two years' clinical service, there were no failures among the amalgam restorations adhesively bonded using ED Primer and Panavia 21 TC, but three non-bonded restorations failed due to lack of retention. For traditional preparations, adhesively bonded amalgams of the type investigated perform as well as non-bonded amalgams over two years' clinical service. <13> UI - 20274720 AU - Hamilton FA AU - Davis KE AU - Blinkhorn AS IN - Salford Community Health Care NHS Trust, UK. TI - An oral health promotion programme for nursing caries. SO - International Journal of Paediatric Dentistry 1999 Sep;9(3):195-200 AB - AIM: To evaluate an oral health promotion programme involving health visitors and mothers of 8-month-old babies in order to address some of the risk factors associated with nursing caries. DESIGN: Two cross-sectional studies using postal questionnaires. SAMPLE: A random sample of 250 mothers who had not received the oral health promotion programme and 250 mothers who had received the programme. SETTING: The City of Salford. RESULTS: The oral health promotion programme significantly improved mothers recall of advice given by health visitors encouraging the use of a feeder cup, brushing their babies' teeth with fluoride toothpaste and restricting sugary foods and drinks. Significant improvements were also found in recall of advice regarding the use of sugar-free medicine and registering babies with a dentist. The programme encouraged a higher proportion of the mothers to bring their children to clinics for a hearing check. CONCLUSION: A simple oral health promotion programme facilitated by health visitors improved recall of advice and clinic visiting behaviour. <14> UI - 20016240 AU - Gaworski M AU - Weinstein M AU - Borislow AJ AU - Braitman LE IN - Albert Einstein Medical Center, Philadelphia, PA 19141-3098, USA. TI - Decalcification and bond failure: A comparison of a glass ionomer and a composite resin bonding system in vivo [see comments]. CM - Comment in: Am J Orthod Dentofacial Orthop 2000 Mar;117(3):19A-20A SO - American Journal of Orthodontics & Dentofacial Orthopedics 1999 Nov;116(5):518-21 AB - Decalcification during orthodontic treatment is a serious problem. A glass ionomer agent is now available to bond orthodontic brackets as an alternative to composite resins. This prospective study was a clinical trial to determine if a glass ionomer bonding system (Fuji Ortho LC) decreases the incidence of decalcification without increasing the amount of bonding failures. A prospective clinical trial with 16 patients encompassing a total of 298 teeth was conducted. The 149 control teeth were bonded with a light-cured composite resin (Reliance Light Bond) whereas the 149 experimental teeth were bonded with the light-cured glass ionomer agent. Patients were followed for a period of 12 to 14 months. All teeth were evaluated for breakage (bonding failure rate), and all maxillary anterior teeth (96) were evaluated for decalcification on a graded scale. The glass ionomer failure rate was 24.8%, and was higher than the composite resin failure rate of 7.4% (P <.001). There were more glass ionomer bond failures in 12 of 16 patients (P <.001). Enamel decalcification was similar in the 2 bonding systems. <15> UI - 20205728 AU - Fine DH AU - Furgang D AU - Barnett ML AU - Drew C AU - Steinberg L AU - Charles CH AU - Vincent JW IN - Dental Research Center, New Jersey Dental School, Newark 07103, USA. TI - Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels. SO - Journal of Clinical Periodontology 2000 Mar;27(3):157-61 AB - BACKGROUND: Clinical studies in which antimicrobial mouthrinses were shown to have significant antiplaque activity most frequently have used gingivitis as the clinically relevant endpoint. However, there is evidence to suggest that mouthrinses containing active agents effective against Streptococcus mutans, such as chlorhexidine, may also have a role in inhibiting dental caries. This clinical study was conducted to determine the effect of 2x-daily rinsing with an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic) on levels of recoverable S. mutans and total streptococci in supragingival interproximal plaque and in saliva. Additionally, a follow-up in vitro study is reported which determined whether a differential susceptibility to the antiseptic mouthrinse exists among different strains of streptococci. METHOD: Following baseline saliva and plaque sampling for quantification of recoverable S. mutans and total streptococci, 29 qualifying subjects were randomly assigned either the essential oil mouthrinse or a sterile water control. They rinsed with 20 ml for 30s 2 x daily for 11 days and once on the 12th day, in addition to their usual oral hygiene procedures. On day 12, saliva and plaque samples were again collected and microbiological quantification performed. The procedures were repeated with the alternate rinse after a 1-week washout period. RESULTS: The essential oil mouthrinse produced respective reductions of 69.9% and 75.4% in total recoverable streptococci and in S. mutans in plaque, and corresponding reductions of 50.8% and 39.2% in saliva. The in vitro study revealed that streptococci from the mutans group were more susceptible to the bactericidal activity of the essential oil mouthrinse than streptococci from the mitis group. CONCLUSIONS: As antimicrobial mouthrinses are most frequently recommended to patients whose mechanical oral hygiene procedures are not adequate for the control of supragingival plaque and gingivitis, this study provides an additional rationale for the inclusion of the essential-oil mouthrinse as an adjunct to daily oral hygiene procedures. <16> UI - 20249647 AU - McComb D IN - Faculty of Dentistry, University of Toronto, ON. d.mccomb@utoronto.ca TI - Caries-detector dyes--how accurate and useful are they?. [Review] [28 refs] SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 2000 Apr;66(4):195-8 AB - Commercially available caries-detector dyes are purported to aid the dentist in differentiation of infected dentin, yet research has established that these dyes are not specific for infected dentin. They are non-specific protein dyes that stain the organic matrix of less mineralized dentin, including normal circumpulpal dentin and sound dentin in the area of the amelo-dentinal junction. A considerable body of evidence indicates that conventional tactile and optical criteria provide satisfactory assessment of caries status during cavity preparation. There is reason for concern that subsequent use of a caries-detector dye would result in unnecessary removal of sound tooth structure. The use of caries-detector dyes has also been suggested as a diagnostic aid for occlusal caries. Although diagnosis of carious dentin beneath apparently sound enamel can be challenging, there is a lack of substantive evidence supporting the use of dyes for this purpose and false positives are a significant concern. Careful visual inspection combined with bitewing radiographic diagnosis has been shown to be the most reliable diagnostic method for the presence of infected dentin requiring operative treatment. [References: 28] <17> UI - 20225598 AU - Jackson JS AU - Olivotto IA AU - Wai M D E AU - Grau C AU - Mates D AU - Ragaz J IN - Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. TI - A decision analysis of the effect of avoiding axillary lymph node dissection in low risk women with invasive breast carcinoma. SO - Cancer 2000 Apr 15;88(8):1852-62 AB - BACKGROUND: Evidence that avoiding axillary lymph node dissection (AxD) strikes an appropriate balance between morbidity and recurrence risk in patients with invasive breast carcinoma generally is anecdotal and without a formally quantified basis. The current study presents a decision analysis of the difference in 5-year disease free survival (DFS) rate between treatment scenarios with and without routine AxD. METHODS: To derive quantitative estimates of the effect of avoiding AxD on 5-year DFS, the authors examined outcomes for women undergoing 2 treatment scenarios: AxD or no AxD with adjuvant therapy decisions based on risk factors in the primary tumor. Eligible patients belonged to 2 lymph node metastases risk groups: low (patients without palpable lymph nodes and lymphatic or vascular invasion [LVI] negative tumors < or = 0.5 cm in greatest dimension) and moderate (patients with mammographically detected, LVI negative tumors, between 0.6-2.0 cm in greatest dimension or patients with palpable LVI negative tumors between 0.6-1.0 cm in greatest dimension with nonpalpable lymph nodes). Along with observed data regarding treatment and recurrence, the authors employed estimates of the efficacy of chemotherapy, tamoxifen, and regional radiation therapy derived from published randomized trials to estimate the 5-year DFS rate for treatment scenarios with and without AxD. RESULTS: Patients in the low risk group had a 5% risk of lymph node metastases. In these women, eliminating AxD and treating no patients with chemotherapy and/or tamoxifen resulted in a < 1% decrease in the 5-year DFS rate. Patients in the moderate risk group had a 10% risk of lymph node metastases. Eliminating AxD and treating only those women with Grade 3 tumors > 1 cm in greatest dimension with chemotherapy and/or tamoxifen resulted in a 1.8% decrease in the 5-year DFS rate. However, if all patients in this group were treated with chemotherapy and/or tamoxifen and no AxD, the 5-year DFS rate increased by 2.7%. CONCLUSIONS: In patients with a low risk of lymph node metastases, it was estimated that eliminating AxD may result in only minimal changes in the estimated 5-year DFS rate. Copyright 2000 American Cancer Society. <18> UI - 20200510 AU - Wolff AC AU - Davidson NE IN - Johns Hopkins Oncology Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21231-1000, USA. awolff@jhmi.edu TI - Primary systemic therapy in operable breast cancer. [Review] [69 refs] SO - Journal of Clinical Oncology 2000 Apr;18(7):1558-69 AB - PURPOSE: Laboratory studies suggest that primary systemic therapy (PST) could improve control of micrometastatic disease and impact on overall survival (OS). This article examines the rationale for and preclinical and clinical data of PST in operable breast cancer and the potential role of intermediate biomarkers as predictive and/or prognostic factors for response and survival. DESIGN AND METHOD: We conducted an extensive literative review (including MEDLINE) on preclinical studies, single-arm feasibility studies, large randomized single- and multi-institutional trials, and laboratory correlate studies of PST in breast cancer. RESULTS: Small trials in locally advanced disease showed high initial rates of response and local control. Six randomized clinical trials (RCTs) of PST for palpable, operable breast cancer have been reported since 1991 (from 204 to 1,523 patients each). These data clearly show a small but significant (less than 10%) absolute increase in the use of breast-conservation treatment (BCT) with similar rates of local control. Although one study showed better disease-free survival (DFS) and another showed better OS, most studies did not show any survival advantage of primary versus adjuvant systemic therapy. Thus far, pathologic complete response seems to be the best predictor of survival, but clinical response assessment correlates poorly with pathologic response. Pilot studies demonstrated feasibility of procuring tissue at diagnosis and after treatment for assays of potential intermediate biomarkers. Initial data suggest a potential correlation between markers of proliferation and apoptosis and in vivo chemotherapy sensitivity. CONCLUSION: Thus far, RCTs of PST versus standard adjuvant therapy have not shown any clear benefit for DFS or OS in early breast cancer. Ongoing trials should determine if specific subsets of patients at risk would benefit from additional systemic therapy and the potential role of intermediate biomarkers in identifying such women. Although PST results in a small increase in the rate of BCT with similar rates of local control, current PST strategies should not replace standard adjuvant approaches. Rather, they represent an acceptable alternative to women with palpable, operable tumors and an excellent arena for clinical trials. [References: 69] <19> UI - 20200498 AU - Jeremic B AU - Shibamoto Y AU - Milicic B AU - Nikolic N AU - Dagovic A AU - Aleksandrovic J AU - Vaskovic Z AU - Tadic L IN - Departments of Oncology and Otorhynolaryngology, University Hospital, Kragujevac, Yugoslavia. bjeremic@med.uni-tuebingen.de TI - Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. SO - Journal of Clinical Oncology 2000 Apr;18(7):1458-64 AB - PURPOSE: To investigate whether the addition of cisplatin (CDDP) to hyperfractionation (Hfx) radiation therapy (RT) offers an advantage over the same Hfx RT given alone in locally advanced (stages III and IV) squamous cell carcinoma of the head and neck. PATIENTS AND METHODS: One hundred thirty patients were randomized to receive either Hfx RT alone to a tumor dose of 77 Gy in 70 fractions in 35 treatment days over 7 weeks (group I, n = 65) or the same Hfx RT and concurrent low-dose (6 mg/m(2)) daily CDDP (group II, n = 65). RESULTS: Hfx RT/chemotherapy offered significantly higher survival rates than Hfx RT alone (68% v 49% at 2 years and 46% v 25% at 5 years; P =.0075). It also offered higher progression-free survival (46% v 25% at 5 years; P =.0068), higher locoregional progression-free survival (LRPFS) (50% v 36% at 5 years; P =.041), and higher distant metastasis-free survival (DMFS) (86% v 57% at 5 years; P =.0013). However, there was no difference between the two treatment groups in the incidence of either acute or late high-grade RT-induced toxicity. Hematologic high-grade toxicity was more frequent in group II patients. CONCLUSION: As compared with Hfx RT alone, Hfx RT and concurrent low-dose daily CDDP offered a survival advantage, as well as improved LRPFS and DMFS. <20> UI - 20200493 AU - Crivellari D AU - Bonetti M AU - Castiglione-Gertsch M AU - Gelber RD AU - Rudenstam CM AU - Thurlimann B AU - Price KN AU - Coates AS AU - Hurny C AU - Bernhard J AU - Lindtner J AU - Collins J AU - Senn HJ AU - Cavalli F AU - Forbes J AU - Gudgeon A AU - Simoncini E AU - Cortes-Funes H AU - Veronesi A AU - Fey M AU - Goldhirsch A IN - Centro di Riferimento Oncologico, Aviano, Italy. sfrustaci@ets.it TI - Burdens and benefits of adjuvant cyclophosphamide, methotrexate, and fluorouracil and tamoxifen for elderly patients with breast cancer: the International Breast Cancer Study Group Trial VII. SO - Journal of Clinical Oncology 2000 Apr;18(7):1412-22 AB - PURPOSE: Information on the tolerability and efficacy of adjuvant chemoendocrine therapy for older women is limited. We studied these issues using the data collected as part of the International Breast Cancer Study Group Trial VII. PATIENTS AND METHODS: Postmenopausal women with operable, node-positive breast cancer were randomized to receive either tamoxifen alone for 5 years (306 patients) or tamoxifen plus three consecutive cycles of classical cyclophosphamide (100 mg/m(2) orally days 1 to 14), methotrexate (40 mg/m(2) intravenous days 1 and 8), and fluorouracil (600 mg/m(2) intravenous days 1 and 8) every 28 days (CMF; 302 patients). The median follow-up was 8.0 years. RESULTS: Among the 299 patients who received at least one dose of CMF, women 65 years of age or older (n = 76) had higher grades of toxicity compared with women less than 65 years old (n = 223) (P =.004). More women in the older age group compared with the younger women experienced grade 3 toxicity of any type (17% v 7%, respectively), grade 3 hematologic toxicity (9% v 5%, respectively), and grade 3 mucosal toxicity (4% v 1%, respectively). Older patients also received less than their expected CMF dose compared with younger postmenopausal women (P =.0008). The subjective burdens of treatment, however, were similar for younger and older patients based on quality-of-life measures (performance status, coping, physical well-being, mood, and appetite). For older patients, the 5-year disease-free survival (DFS) rates were 63% for CMF plus tamoxifen and 61% for tamoxifen alone (hazards ratio [HR], 1.00; 95% confidence interval [CI], 0.65 to 1.52; P =.99). For younger patients, the corresponding 5-year DFS rates were 61% and 53% (HR, 0.70; 95% CI, 0.53 to 0.91; P =.008), but the test for heterogeneity of CMF effect according to age group was not statistically significant. The reduced effectiveness of CMF among older women could not be attributed to dose reductions according to dose received. CONCLUSION: CMF tolerability and effectiveness were both reduced for older patients compared with younger postmenopausal node-positive breast cancer patients who received tamoxifen for 5 years. The development and evaluation of less toxic and more effective chemotherapy regimens are required for high-risk elderly patients. <21> UI - 20228705 AU - Calabrese JM AU - Friedman PK AU - Rose LM AU - Jones JA IN - Boston University Goldman School of Dental Medicine, MA, USA. TI - Using the GOHAI to assess oral health status of frail homebound elders: reliability, sensitivity, and specificity. SO - Special Care in Dentistry 1999 Sep-Oct;19(5):214-9 AB - A pilot study assessed the clinically determined and self-reported oral health status of 50 randomly selected homebound patients served by Boston's Home Medical Service. The sample was largely female, low-income, and edentulous. The median age of the patients was 81 years (range, 64-101). While 76% deemed themselves to be in good to excellent oral health, 80% of the patients had not seen a dentist within the last two years, and 80% were found to be in need of routine dental care. To assess whether the Geriatric Oral Health Assessment Index (Atchison and Dolan, 1990) could be used by non-dental health professionals to determine the need for requesting dental consultation, the study physician repeated the administration of the GOHAI for 23 of the 50 subjects within eight weeks of the initial examination. For the 23 subjects having both dentist- and physician-administered GOHAI scores, the intraclass correlation coefficient was r = 0.61 (p = 0.002), indicating good agreement between the dentist's and physician's administrations of the GOHAI. However, given the high prevalence of need for care, the GOHAI appears to be of less value than an examination for identifying persons who need dental care in this population. Future research is needed to examine the GOHAI's sensitivity and specificity in populations with low to moderate prevalence of treatment need. <22> UI - 20227017 AU - Alanen P TI - Are all clinical caries prevention studies biased? [editorial]. SO - Journal of Dental Research 2000 Mar;79(3):796-7 <23> UI - 20191321 AU - Mattila KJ AU - Asikainen S AU - Wolf J AU - Jousimies-Somer H AU - Valtonen V AU - Nieminen M IN - Dept of Medicine, Helsinki University Central Hospital, Finland. kimmo.mattila.km@bayer.fi TI - Age, dental infections, and coronary heart disease. SO - Journal of Dental Research 2000 Feb;79(2):756-60 AB - Epidemiological and intervention studies have suggested that infections are risk factors for coronary heart disease (CHD). Dental infections have appeared as cardiovascular risk factors in cross-sectional and in follow-up studies, and the association has been independent of the "classic" coronary risk factors. This case-control study aimed at detailed assessment of the dental pathology found in various CHD categories (including elderly patients). Altogether, 85 patients with proven coronary heart disease and 53 random controls, matched for sex, age, geographic area, and socio-economic status, were compared with regard to dental status, assessed blindly with four separate scores, and to the "classic" coronary risk factors (seven of the controls had CHD, and they were not included in the analyses). The dental indices were higher among CHD patients than in the controls, but, contrary to previous studies, the differences were not significant (between the CHD patients and their matched controls or among the different CHD categories). This result could not be explained by potential confounding factors. The participants in the present study were older and had more often undergone recent dental treatment in comparison with subjects in our earlier studies. Age correlated with the severity of dental infections only in the random controls but not in the coronary patients who, although young, already had high dental scores. We believe that the higher age of the participants in the present study is the most likely reason for the results. Other possible explanations include an age-related selection bias among older CHD patients, and the fact that those participating in studies like this may have better general health and thus also less severe dental infections. Thus, the role of dental infections as a coronary risk factor varies according to the characteristics of the population studied. <24> UI - 20204647 AU - Wenzel A AU - Hintze H IN - Department of Oral Radiology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark. TI - Comparison of microscopy and radiography as gold standards in radiographic caries diagnosis. SO - Dento-Maxillo-Facial Radiology 1999 May;28(3):182-5 AB - OBJECTIVES: To compare the effect of the choice of gold standard on the diagnostic outcome of approximal caries detection in original and compressed digital radiographs. METHODS: 116 extracted teeth radiographed with a storage phosphor system constituted the original images. These images were compressed at 1:20 and 1:33 with the JPEG irreversible compression standard. Five radiologists scored the three sets of images for the presence of approximal caries on a five-rank confidence scale. The radiographic scores were validated by stereomicroscopy (the true gold standard). The individual ROC areas for the five observers were used to select the worst (obsworst) and the best (obsbest) performer: Their scores in the original images were used as the second and third 'gold standards' for the remaining observers. Mean ROC areas for the three observers with the three types of images were calculated using these two new 'gold standards'. Differences between the ROC areas when using microscopy, obsworst, and obsbest as the 'gold standard' were compared. RESULTS: The mean ROC areas in the original images were 0.66, 0.74 and 0.91 using the true gold standard and obsbest and obsworst as the 'gold standards' respectively. The difference between the true gold standard and obsworst was statistically significant (P < 0.001). The mean ROC areas using the true gold standard decreased with increasing compression whereas they were constant or increased using obsworst and obsbest as 'gold standards', respectively. CONCLUSIONS: Accuracy in approximal caries diagnosis was significantly higher when an observer was the 'gold standard' than when the true gold standard was obtained by microscopy. Paradoxically, the compressed, degraded images were more accurate than the originals when an observer was the 'gold standard' while they were less accurate with the true gold standard. Thus, results obtained using observers' scores from the radiographs which are being evaluated, as validation for the presence of caries may mislead the clinician. <25> UI - 20204642 AU - Abreu Junior M AU - Tyndall DA AU - Platin E AU - Ludlow JB AU - Phillips C IN - Division of Maxillofacial Radiology, Federal Unversity of Santa Catarina School of Dentistry, Florianopolis, Brasil. TI - Two- and three-dimensional imaging modalities for the detection of caries. A comparison between film, digital radiography and tuned aperture computed tomography (TACT). SO - Dento-Maxillo-Facial Radiology 1999 May;28(3):152-7 AB - OBJECTIVES: To compare the diagnostic performance provided by two- (film and digital radiography) and three-dimensional imaging modalities (TACT slices and TACT pseudoholograms) in the detection of primary caries. METHODS: Forty-two extracted human posterior teeth were mounted and imaged with conventional film and direct digital radiography. Free-hand positioning of a dental X-ray source was used for all exposures. From the digital images, iteratively restored TACT slices and TACT pseudoholograms were generated. Film images were viewed on a viewbox. Digital format images were viewed on a high-resolution monitor. Eight observers used a five-point scale to score the presence or absence of occlusal and proximal caries using the four image modalities. Observers' assessments were compared with the histological examination of tooth sections. Possible differences in ROC curve areas among image modalities, observers, and surfaces were assessed by ANOVA. Intra- and interobserver reliability as indicated by intraclass correlation was also calculated. RESULTS: There were no statistically significant differences between the diagnostic performances of film, digital radiography, TACT slices and TACT pseudoholograms in the detection of caries (P = 0.310). Intraclass correlation indicated the highest concordance both within and between observers when film was used for the evaluation. CONCLUSIONS: Under the experimental conditions of this study, three-dimensional TACT images did not improve caries detection over film or digital radiography. Further research should investigate the effects of imaging variables on TACT's diagnostic efficacy. <26> UI - 20204638 AU - Wenzel A AU - Hintze H TI - The choice of gold standard for evaluating tests for caries diagnosis [editorial]. [Review] [85 refs] SO - Dento-Maxillo-Facial Radiology 1999 May;28(3):132-6 <27> UI - 20197555 AU - Ito Y AU - Monden M AU - Takeda T AU - Eguchi H AU - Umeshita K AU - Nagano H AU - Nakamori S AU - Dono K AU - Sakon M AU - Nakamura M AU - Tsujimoto M AU - Nakahara M AU - Nakao K AU - Yokosaki Y AU - Matsuura N IN - Department of Surgery II, Osaka University Medical School, Japan. TI - The status of Fas and Fas ligand expression can predict recurrence of hepatocellular carcinoma. SO - British Journal of Cancer 2000 Mar;82(6):1211-7 AB - The status of Fas and Fas ligand (Fas L) expression was investigated in this study for 103 hepatocellular carcinomas (HCC). We studied the expression of the following three factors, Fas and Fas L expression in carcinoma cells and Fas L expression in stromal mononuclear cells (defined as stromal Fas L index). Fas expression in HCC cells was significantly decreased in cases with poor differentiation (P < 0.0001) and of larger size (P = 0.0058). Fas L expression in carcinoma cells was observed exclusively in moderately or poorly differentiated cases. Furthermore, each factor had prognostic significance for disease-free survival (DFS) (P< 0.0001, P = 0.0222 and 0.0027 respectively). We then scored the results of each factor and defined the total score as 'Fas-Fas L risk score'. The P-value of the score for DFS was even lower than that of the clinical stage by multivariate analysis. These results suggest that the evaluation of Fas and Fas ligand expression potentially has a significant prognostic value for DFS of HCC patients, in addition to the clinical stage, and can be regarded as a new prognostic marker. <28> UI - 20188959 AU - Hilton MF AU - Bates RA AU - Godfrey KR AU - Chappell MJ AU - Cayton RM IN - Circadian, Neuroendocrine & Sleep Disorders Section, Brigham & Womens' Hospital, Harvard Medical School, Boston, Massachusetts, USA. TI - Evaluation of frequency and time-frequency spectral analysis of heart rate variability as a diagnostic marker of the sleep apnoea syndrome. SO - Medical & Biological Engineering & Computing 1999 Nov;37(6):760-9 AB - The sleep apnoea/hypopnoea syndrome (SAHS) elicits a unique heart rate rhythm that may provide the basis for an effective screening tool. The study uses the receiver operator characteristic (ROC) to assess the diagnostic potential of spectral analysis of heart rate variability (HRV) using two methods, the discrete Fourier transform (DFT) and the discrete harmonic wavelet transform (DHWT). These two methods are compared over different sleep stages and spectral frequency bands. The HRV results are subsequently compared with those of the current screening method of oximetry. For both the DFT and the DHWT, the most diagnostically accurate frequency range for HRV spectral power calculations is found to be 0.019-0.036 Hz (denoted by AB2). Using AB2, 15 min sections of non-REM sleep data in 40 subjects produce ROC areas, for the DFT, DHWT and oximetry, of 0.94, 0.97 and 0.67, respectively. In REM sleep, ROC areas are 0.78, 0.79 and 0.71, respectively. In non-REM sleep, spectral analysis of HRV appears to be a significantly better indicator of the SAHS than the current screening method of oximetry, and, in REM sleep, it is comparable with oximetry. The advantage of the DHWT over the DFT is that it produces a greater time resolution and is computationally more efficient. The DHWT does not require the precondition of stationarity or interpolation of raw HRV data. <29> UI - 20155132 AU - Lah TT AU - Cercek M AU - Blejec A AU - Kos J AU - Gorodetsky E AU - Somers R AU - Daskal I IN - Department of Genetic Toxicology and Cancer Biology, National Institute of Biology, Ljubljana, Slovenia. tamara.lah@uni.lj.si TI - Cathepsin B, a prognostic indicator in lymph node-negative breast carcinoma patients: comparison with cathepsin D, cathepsin L, and other clinical indicators. SO - Clinical Cancer Research 2000 Feb;6(2):578-84 AB - New prognosticators are needed for breast cancer patients after the initial surgical treatment to make therapeutic decisions that ultimately will affect their DFS. These consist of specific proteolytic enzymes including lysosomal endopeptidases. In this study, the activity and protein concentrations of cathepsins (Cats) D, B, and L were measured in 282 invasive breast tumor cytosols. These potential biological prognostic indicators were compared with other histopathological parameters, such as tumor size, lymph node involvement, tumor-node-metastasis stage, histological grade, DNA analysis, and steroid receptors. CatD protein concentration correlated with lymph node involvement. CatB and CatL levels correlated significantly with Scarf-Bloom-Richardson histological grade and were also higher in estrogen-negative tumors, and CatB was higher in larger tumors. As prognostic markers, CatB concentration was significant for increased risk for recurrence in the entire patient population and specifically also in lymph node-negative patients as follows: high CatB concentration (above 371 micrograms/g) in tumor cytosols was significant (P < 0.00) for high risk of recurrence but was of only borderline prognostic significance (P < 0.06) for overall survival of all patients. In lymph node-negative patients, CatB (above 240 micrograms/g, P < 0.003) was highly significant for recurrence-free survival, followed by CatL (above 20 micrograms/g, P < 0.049) and CatD (above 45 nmol/g, P < 0.044) concentrations. For overall survival of node-negative patients, only CatB was a significant (P < 0.014) prognosticator. We conclude that CatB is useful as a prognostic indicator in lymph node-negative patients. This suggests that selective adjuvant therapy should be applied in this lower risk group of patients when high levels of CatB are determined. <30> UI - 20166392 AU - Soikkonen K AU - Wolf J AU - Salo T AU - Tilvis R IN - Department of Diagnostics and Oral Medicine, Institute of Dentistry, University of Oulu, Finland. TI - Radiographic periodontal attachment loss as an indicator of death risk in the elderly. SO - Journal of Clinical Periodontology 2000 Feb;27(2):87-92 AB - OBJECTIVES: Oral infections have been associated with serious systemic diseases and an increased risk of death. Our aims were to investigate whether radiographically-observed apical periodontitis lesions, carious teeth, periodontal attachment loss (horizontal bone loss, furcation lesions, number of teeth with infrabony periodontal pockets, the extent of infrabony periodontal pockets) and the sum of all these findings have any relationships with all-cause mortality within 4-year follow-up. MATERIAL AND METHODS: 292 community-dwelling elderly persons aged 76, 81 and 86 years. The number of deaths within 4 years was 54 (18.5%). In the dentate 169 subjects, of whom 32 (18.9%) deceased within 4 years, the mean number of teeth was 15.5 in men and 13.2 in women. The imaging method used was panoramic radiography supplemented by intraoral radiographs. RESULTS: 51% of the dentate subjects had infrabony pockets (mean 1.5, s.d. 2.2), and 40% had periapical periodontitis lesions (mean 1.0, s.d. 1.6). After controlling for age and gender, vertical bone loss judged as advanced infrabony pockets was associated with 4-year all-cause mortality (Odds ratio 2.2,1.0-4.7). Other associations were statistically insignificant. CONCLUSION: Periodontal attachment loss may indicate an increased risk of death in the elderly. <31> UI - 20106111 AU - Brennan DS AU - Spencer AJ IN - AIHW Dental Statistics and Research Unit, University of Adelaide, South Australia. TI - Variation in dental service provision among adult migrant public-funded patients. SO - Australian & New Zealand Journal of Public Health 1999 Dec;23(6):639-42 AB - OBJECTIVE: To examine type of care, oral health status and service patterns by country of birth and language. METHODS: A random sample of public-funded patients (n = 6, 109) was surveyed in 1995-96. RESULTS: Emergency care was highest among overseas-born patients who spoke a non-English language at home; edentulism was highest among Australian-born/English only patients; while a higher percentage of Australian-born persons were in the periodontal health category (chi 2; p < 0.05). Differences in caries experience were generally small (ANOVA; p < 0.05). Service provision varied by country of birth/language after controlling for socio-demographic characteristics, type of care, and oral health status in six service areas (logistic regression; p < 0.05). CONCLUSIONS: Service patterns may reflect behavioural and cultural factors of patients or providers operating independently of socio-demographic and oral health status variables. IMPLICATIONS: Variation and potential inequality in service patterns related to cultural factors existed within a group of disadvantaged patients. <32> UI - 20129042 AU - Heimann R AU - Lan F AU - McBride R AU - Hellman S IN - Department of Radiation and Cellular Oncology, The Pritzker School of Medicine, The University of Chicago, Illinois 60637, USA. heimann@rover.uchicago.edu TI - Separating favorable from unfavorable prognostic markers in breast cancer: the role of E-cadherin. SO - Cancer Research 2000 Jan 15;60(2):298-304 AB - Distant metastases are the major cause of morbidity and mortality in women with breast cancer. The ability to predict the metastatic proclivity is essential in choosing the optimal treatment. Tumor size and grade, which are frequently used markers in node-negative breast cancer patients, are inadequate markers for prognosis and individualized treatment design. The steps in metastatic progression include angiogenesis, invasion, and changes in adhesion characteristics. We developed a strategy for choosing biomarkers representing these steps in malignant progression to identify patients with occult metastases who will need chemotherapy and spare those women whose tumors have not developed the capacity to spread. To evaluate the added significance of E-cadherin to that of nm23-H1 and angiogenesis in determining metastatic proclivity, we used archival material from 168 node-negative breast cancer patients who were treated with mastectomy without any adjuvant chemotherapy or hormone therapy. Immunohistochemistry was used to detect E-cadherin and nm23-H1 expression, whereas angiogenesis was determined by microvessel count (MVC) after immunohistochemical staining. The median follow-up is 14 years. We found that E-cadherin is better in identifying the poor prognosis patients. The 14-year disease-free survival (DFS) is 84%, 80%, and 56% in patients with high, intermediate, and low E-cadherin. The worst prognosis group using nm23-H1 and MVC as biomarkers has a 14-year DFS of 62%. In this group, if E-cadherin is low, the 14-year DFS is further decreased to 44%. Nm23-H1 and MVC are better in identifying the good prognosis patients. The long-term DFS is >90% if MVC is low or if nm23-H1 is high. Multivariate analysis shows that E-cadherin, nm23-H1, and MVC are more significant prognostic biomarkers than tumor size or grade. Loss of E-cadherin appears to be a latter step in the metastatic progression compared to angiogenesis and the loss of nm23-H1 expression. <33> UI - 20137368 AU - Inoue R AU - Natazuka T AU - Shimoyama M AU - Tamekane A AU - Kajimoto Y AU - Iwata N AU - Matsuoka H AU - Chihara K AU - Matsui T IN - Department of Medicine, Kobe University School of Medicine, Japan. TI - Feasibility of high-dose chemotherapy without stem cell support as a first-line treatment for non-Hodgkin's aggressive lymphoma: a pilot study. SO - Leukemia & Lymphoma 2000 Jan;36(3-4):315-21 AB - A regimen which incorporates cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) is the standard treatment for patients with non-Hodgkin's lymphoma (NHL), but it has not been effective in patients with aggressive NHL who are at high risk. The aim of the present trial was to investigate the feasibility of high-dose chemotherapy (HDC) without stem cell support as a first-line treatment. The primary endpoint was a complete remission rate. The second endpoint was survival. Fourteen patients with aggressive NHL entered the study and were treated according to the K93 protocol (3 cycles of CHOP, high-dose etoposide and ifosfamide, and high-dose methotrexate) Eleven patients (79%) achieved complete remission (CR) and two (14%) achieved partial remission (PR). Overall survival (OS) after five years was 79%. The actuarial five year disease free survival (DFS) for the eleven cases of CR was 75%. During chemotherapy, grade IV hematologic toxicity was observed in all patients and grade IV non-hematologic toxicity in only one patient, who experienced oral ulcers. Peripheral blood stem cell (PBSC) apheresis was performed in eight cases. One harvesting was enough to provide an adequate number of CD34+ cells for the subsequent PBSC transplantation (PBSCT). In conclusion our study confirmed the efficacy of the K93 protocol in obtaining a good response (CR + PR) rate and a very good DFS rate in most cases of aggressive NHL, with acceptable toxicity. This regimen may improve the outcome in cases of aggressive NHL without stem cell support. It seems worthwhile to conduct a randomized controlled study comparing the K93 protocol with the standard CHOP regimen. <34> UI - 20125408 AU - Curry BJ AU - Farrelly M AU - Hersey P IN - Oncology and Immunology Unit, Mater Misericordiae Hospital, Newcastle, NSW, Australia. TI - Evaluation of S-100beta assays for the prediction of recurrence and prognosis in patients with AJCC stage I-III melanoma. SO - Melanoma Research 1999 Dec;9(6):557-67 AB - We performed prospective serial studies on 266 melanoma patients undergoing surgery for high risk primary or lymph node metastases to assess the predictive value for recurrence of melanoma of S-100beta detection in the serum using immunoradiometric assay (IRMA) or Immunoluminometric assay (LIA-mat). The tests for S-100beta were most frequently positive in the first 3 months after surgery. Results of the assays did not show a strong correlation with clinical stage of the disease. Studies on a cohort of 147 patients who had been followed for a minimum of 2 years post-surgery were carried out to assess the sensitivity of the assays for identifying patients who develop recurrence of their melanoma. The LIA-mat and IRMA assays detected S-100beta in the serum of 47.5% and 23%, respectively, of the subset of 61 patients who developed recurrence of disease. By Kaplan Meler analysis, patients positive for S-100beta by LIA-mat assay in the first 3 months post-surgery were shown to have an approximately 2.7 times shorter disease-free survival (DFS) period than patients negative for S-100beta. This was significant by log rank analysis. Multivariate analysis indicated that the presence of S-100beta was an independent prognostic determinant of DFS, and was independent of tumour thickness and lymph node status. This prospective analysis in a large number of patients suggests that assays for S-100beta in patients following surgical resection of AJCC stage I-III melanoma are of limited value for identifying patients who will develop recurrence of their disease. The results of the LIA-mat assays, but not the IRMA assays, do however provide an additional measure of prognosis that is independent of existing measures. <35> UI - 20113837 AU - Bader JD AU - White BA AU - Olsen O AU - Shugars DA IN - Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. jim:bader@unc.edu TI - Dentist reliability in classifying disease risk and reason for treatment. SO - Journal of Public Health Dentistry 1999 Summer;59(3):158-61 AB - OBJECTIVES: The reliability of practicing dentists' classifications of patients' caries risk and periodontal disease risk and reason for treatment for individual teeth were determined. The risk classification protocols had been in use in a group practice for more than a year, and the reason-for-treatment protocol had been introduced six months previously. METHODS: Eight dentists' classifications for caries (n = 66) and periodontal disease risk (n = 66), and six dentists' classifications for reason for treatment (n = 73) were compared to those of a nominal standard examiner. Reliability was expressed as percent agreement and kappa values. RESULTS: Percent agreement was 76 percent, 83 percent, and 74 percent for caries, periodontal disease, and reason for treatment, respectively, with kappa values of 0.56, 0.70, and 0.69. CONCLUSIONS: Dentists can attain reasonable levels of reliability using simple classification protocols with little formal training, although misclassification may be problematic for specific administrative or research-related purposes. <36> UI - 20137424 AU - Cugini MA AU - Haffajee AD AU - Smith C AU - Kent RL Jr AU - Socransky SS IN - Department of Periodontology, The Forsyth Institute, Boston, MA, USA. TI - The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results. SO - Journal of Clinical Periodontology 2000 Jan;27(1):30-6 AB - BACKGROUND/AIMS: Previously, we reported that SRP resulted in a decrease in mean pocket depth and attachment level and reduced prevalence and levels of Bacteroidesforsythus, Porphyromonas gingivalis, and Treponema denticola at 3 and 6 months post-SRP in 57 subjects with adult periodontitis. 32 of the 57 subjects were monitored at 9 and 12 months. Thus, the purpose of the present investigation was to evaluate the microbial and clinical effects of SRP in 32 (mean age 48+/-11) subjects over a 12-month period. METHOD: Clinical assessments of plaque, gingival redness, suppuration, bleeding on probing, pocket depth and attachment level were made prior to SRP and at 3, 6, 9, and 12 months post-therapy. Subgingival plaque samples were taken at each visit and analyzed using the checkerboard DNA-DNA hybridization technique for the presence and levels of 40 subgingival species. Each subject also received maintenance scaling at each of the subsequent monitoring visits. Differences in clinical parameters and prevalence and levels of bacterial species were analyzed pre- and post-therapy using the Wilcoxon signed ranks test. The Quade test for related samples was used for analysis of multiple visits. RESULTS: Mean pocket depth (mm+/-SEM) decreased from 3.2+/-0.3 at baseline to 2.9+/-0.3 at 12 months (p<0.01). Mean attachment level showed significant reduction at 6 months, but did not diminish further. Bleeding on probing and plaque were significantly reduced at 12 months (p<0.001, p<0.05, respectively). P. gingivalis, B. forsythus and T. denticola decreased in prevalence and levels up to the 6-month visit and remained at these lower levels at 9 and 12 months. Significant increases in levels and prevalence were noted at 12 months for Actinomyces naeslundii genospecies 2, Actinomyces odontolyticus, Fusobacterium nucleatum ss polymorphum, Streptococcus mitis, Capnocytophaga sp, and Veillonella parvula. CONCLUSIONS: The data suggest that the maintenance phase of therapy may be essential in consolidating clinical and microbiological improvements achieved as a result of initial therapy. <37> UI - 20124956 AU - Buchholz TA AU - Tucker SL AU - Moore RA AU - McNeese MD AU - Strom EA AU - Jhingrin A AU - Hortobagyi GN AU - Singletary SE AU - Champlin RE IN - Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. tbuchhol@notes.mdacc.tmc.edu TI - Importance of radiation therapy for breast cancer patients treated with high-dose chemotherapy and stem cell transplant. SO - International Journal of Radiation Oncology, Biology, Physics 2000 Jan 15;46(2):337-43 AB - PURPOSE: To determine local-regional failure rates in breast cancer patients treated with surgery and high-dose chemotherapy with stem cell transplant and to relate local-regional failure to the use and timing of radiation treatment. METHODS AND MATERIALS: We retrospectively reviewed the records of 165 breast cancer patients treated on institutional protocols with surgery and high-dose chemotherapy with stem cell transplant. All patients had either Stage III disease, 10 or more positive axillary lymph nodes, or 4 or more positive axillary lymph nodes following neoadjuvant chemotherapy. Twelve patients had inflammatory breast cancer. Thirteen patients treated with breast preservation and 5 patients who died from toxicity within 30 days of transplant were excluded from the analyses of local-regional recurrences. In the remaining 147 patients, 108 were treated with adjuvant radiation and 39 were not. The disease stage distribution for these two groups was comparable. The median follow-up for surviving patients was 35 months. RESULTS: The 3- and 5-year actuarial disease-free survival (DFS) for the entire group was 60% and 51%, respectively. The 5-year rates of freedom from isolated local-regional recurrence were 95% in the patients treated with adjuvant radiation and 86% in the patients who did not receive radiation (p = 0.014, log rank comparison). The 5-year rates of any local-regional recurrence as a first event (isolated recurrences plus those with simultaneous local-regional and distant recurrences) were 92% versus 82%, respectively for patients whose treatment did and did not include radiation (p = 0.038). We could not demonstrate a correlation of the timing of radiation with the risk of local-regional recurrence. CONCLUSIONS: These data indicate that high-dose chemotherapy does not negate the importance of radiation in optimizing local-regional control in patients with high-risk breast cancer. Given the results of recent randomized trials studying postmastectomy radiation, which show that improving local-regional control improves overall survival (OS), we believe that all breast cancer patients with high-risk primary breast cancer who are treated with high-dose chemotherapy with stem cell transplant should receive radiation as a component of their treatment. <38> UI - 20116147 AU - Perry R AU - Kugel G AU - Leinfelder K IN - Department of Biomaterials, University of Alabama, School of Dentistry, Birmingham, USA. TI - One-year clinical evaluation of SureFil packable composite. SO - Compendium of Continuing Education in Dentistry (Jamesburg, NJ) 1999 Jun;20(6):544-50, 552-3 AB - The purpose of this trial was to clinically evaluate SureFil high-density posterior composite for Class II restorations of permanent first and second molars. All teeth were restored in occlusion with the natural dentition. After cavity preparation, the enamel was etched for 15 seconds with 34% phosphoric acid. No liner/base material was used for the dentin. Two applications of Prime and Bond 2.1 were placed for adhesion to the exposed dentin and etched enamel. One coat of adhesive was cured for 10 seconds with a curing light, and one thin coat was spread with a gentle jet of air. The cavity was restored in 3-mm to 5-mm increments. Evaluation was assessed immediately after placement (baseline), and at 3 months, 6 months, 9 months, and 1 year for retention, leakage, marginal integrity, color stability, abrasive resistance, surface staining, surface texture, postoperative sensitivity, and secondary caries. The restorations were evaluated indirectly for wear using a modified USPHS and indirect cast comparison method. At baseline, 25 restorations were graded Alfa in all categories. At 3-, 6-, and 9-month recalls (N = 24), all restorations were graded Alfa in all categories. At the 1-year recall (N = 20), there were three Bravos for surface staining. <39> UI - 20098172 AU - Fyffe HE AU - Deery C AU - Nugent ZJ AU - Nuttall NM AU - Pitts NB IN - Dental Health Services Research Unit, Dental Hospital and School, Dundee, Scotland, UK. h.e.fyffe@dundee.ac.uk TI - In vitro validity of the Dundee Selectable Threshold Method for caries diagnosis (DSTM). SO - Community Dentistry & Oral Epidemiology 2000 Feb;28(1):52-8 AB - OBJECTIVES: It is not generally possible to assess diagnostic accuracy in dental surveys as no histological 'gold standards' are available, therefore examiner agreement tends to be used as a proxy for accuracy. The aim of this study was to investigate, using extracted teeth in arch models, the in vitro validity of a diagnostic system to assess caries at the D1 (enamel and dentine) and D3 (dentine) diagnostic thresholds, for epidemiological purposes. METHOD: Two groups of 10 dental examiners trained in the use of the Dundee Selectable Threshold Method for caries diagnosis (DSTM) each examined (on two occasions) 160 extracted permanent molar and premolar teeth set in arch models in phantom heads according to the codes and criteria of the DSTM. The teeth were subsequently radiographed and sectioned to provide validation of the diagnoses. RESULTS: Intra-examiner agreement according to the kappa statistic was substantial. In general terms the results of the in vitro validation exercise demonstrated significantly higher sensitivity values at the D1 diagnostic threshold than were found at the D3 diagnostic threshold with a consequent loss of specificity. CONCLUSIONS: The results of this in vitro validation exercise demonstrate that at the D1 diagnostic threshold the sensitivity of the DSTM was greater than at the D3 threshold indicating no loss of diagnostic accuracy at the D1 threshold. <40> UI - 20078610 AU - Belhabri A AU - Thomas X AU - Troncy J AU - Assouline D AU - Michallet M AU - Wattel E AU - Tigaud JD AU - Blanc M AU - Fiere D AU - Archimbaud E IN - Service d'Hematologie Clinique, Hopital Edouard Herriot, Lyon, France. belhabri@laennec.univ-lyon1.fr TI - Continuous-infusion carboplatin in combination with idarubicin or mitoxantrone for high-risk acute myeloid leukemia: a randomised phase II study. SO - Leukemia & Lymphoma 1999 Dec;36(1-2):45-55 AB - Fifty-three patients of median age 66 years (39 patients > 60 yrs), including 5 with FAB unclassified or secondary acute myeloid leukemia (AML) at diagnosis, 14 with resistant AML, 19 in first and 15 in subsequent relapse, were treated with carboplatin (CBP), 200 mg/m2/day, as a continuous infusion, (days 3 to 7) with mitoxantrone (MIT) or idarubicin (IDA), (12 mg/m2/day) as an i.v. bolus, on days 1 to 3. Results were evaluated after one induction course. Overall, 15 patients (28% [95% confidence interval (CI), 17-42%], 8/28 with IDA and 7/25 with MIT) achieved complete remission (CR). There was no statistical difference between IDA and MIT arms. Fourty-nine percent (95% CI, 35-63%) had resistant disease (53% IDA versus 44% MIT respectively) and 23% (95% CI, 12-36%) died from toxicity (18% IDA versus 28% MIT). Median durations of neutrophils less than 0.5 x 10(9)/l and platelet counts less than 20 x 10(9)/l were 32 and 32 days respectively in the IDA arm and 31 and 26 days respectively in the MIT arm. Severe toxicity included infections (45%), diarrhea (21%), bleeding (9%), vomiting (7%), hyperbilirubinemia (6%), mucositis (4%) (no statistical difference was seen between both arms). Nephrotoxicity was observed in only one case in the IDA arm. Cardiac toxicity included reversible pulmonary oedema in one patient in the IDA arm. No severe ototoxicity was noted. CR patients received maintenance courses with 3 days of CBP and one day of IDA or MIT. Median survival was 2 months (range, 1-30+ months) and 2.5 months (range, 0.5-19.5 months), and median disease-free survival (DFS) 2 months (range, 1-30+ months) and 2.5 months (range, 1-14 months) in the IDA and MIT arms respectively. We conclude that CBP at a cumulative dosage of 1 g/m2 together with intercalating agents (IDA/MIT) has antileukemic efficacy in elderly patients. <41> UI - 20038247 AU - Mauri FA AU - Maisonneuve P AU - Caffo O AU - Veronese S AU - Aldovini D AU - Ferrero S AU - Cozzaglio F AU - Dalla Palma P AU - Galligioni E AU - Barbareschi M IN - Department of Histopathology, SS. Trinita Hospital, Borgomanero, Italy. TI - Prognostic value of estrogen receptor status can be improved by combined evaluation of p53, Bcl2 and PgR expression: an immunohistochemical study on breast carcinoma with long-term follow-up. SO - International Journal of Oncology 1999 Dec;15(6):1137-47 AB - Steroid receptor analysis is the only widely accepted prognostic/predictive marker in breast cancer (BC) treatment. In the present study we evaluated the prognostic role of ER/PgR with p53 and Bcl2, in a series of 277 BC (153 pN1/2, 122 pNO, 2 pNx) with a long-term follow-up (67 months for DFS, 75 months for OS). Our results, besides confirming the usefulness of ER immunohistochemical expression as a prognostic marker, showed that PgR expression alone had a borderline/not significant prognostic value in the whole series (p=0.08 for DFS and p=0.09 for OS), while showed to be prognostic in N+ cases (p=0.02 for DFS and p=0.03 for OS). PgR prognostic value, however, was not independent at the multivariate analysis. By combining ER with PgR, p53 and Bcl2, we showed that ER/p53 and ER/Bcl2 phenotypes had a better discriminant role than ER/PgR phenotype. The ER+/p53+ phenotype was at higher risk of relapse/death as compared with ER+/p53- phenotype. Conversely ER-/p53+ phenotype showed the most unfavourable prognosis. Similar results could be observed concerning ER/Bcl2 phenotypes. Our study showed that the combined evaluation of ER/PgR weakly enhanced the prognostic/predictive power of ER status alone. On the contrary, the combined evaluation of ER/p53 and ER/Bcl2, improved this prognostic/predictive capability and allowed the separation of ER positive and ER negative cases into subgroups with different prognosis. <42> UI - 20006947 AU - Helminen SE AU - Vehkalahti M AU - Ketomaki TM AU - Murtomaa H IN - Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Finland. sari.helminen@helsinki.fi TI - Dentists' selection of measures for assessment of oral health risk factors for Finnish young adults. SO - Acta Odontologica Scandinavica 1999 Aug;57(4):225-30 AB - Dentists' selection of measures for assessing oral health risk factors for young adults, in relation to their oral health status and to those dentists' characteristics, was studied in one administrative unit of the Finnish public oral health service. A random selection (n = 239) was made of all young adults born in the period 1966-71 and clinically examined during 1994. On the original oral health records of those selected, all notes were scrutinized concerning the most recent clinical examination and treatment course; in total 208 (87%) records. We found that assessment of risk factors to oral health was rare. The patient's diet had been recorded as assessed in 7% of all cases, use of fluoride in 8%, and oral hygiene habits in 14%. No salivary tests were performed; nor was patients' use of tobacco assessed. No correlation was detected between measures used by these dentists and their patients' oral health status (DMFT and DT scores, number of approximal incipient lesions, and number of healthy sextants by CPITN). The oral health status impelled only slightly assessments by bite-wing radiographs. Fewer than half (44%) of the dentists performed and recorded any kind of assessment measure; 4% assessed diet, hygiene, and use of fluoride for all their patients in our sample. A dentist's gender showed no correlation with number of measures used; younger dentists tended to perform and record assessments slightly more often than did older dentists, but in all age groups there were those who had not done this. The practice of risk-factor assessment should be more widespread and standardized, contributing to needs-based treatment and allocation of resources. <43> UI - 20020552 AU - Cantero R AU - Torres AJ AU - Maestro M AU - Fernandez C AU - Hernando F AU - del Barco V AU - Sanz T AU - Balibrea JL IN - Department of Surgery II, San Carlos University Hospital, Complutense University of Madrid, C/Martin Lagos s/n, 28040 Madrid, Spain. TI - Use of possible synergistic expression of p53 and p185 as a prognostic tool for stage I non-small-cell lung cancer. SO - World Journal of Surgery 1999 Dec;23(12):1294-9; discussion 1299-300 AB - The possible interaction between the quantified overexpression of the oncoproteins p53 and p185 was evaluated. These proteins have already been independently defined as prognostic factors in non-small-cell lung cancer (NSCLC). p53 and p185 levels were determined in stage I patients (n = 40) from a sample of 102 NSCLC sufferers who underwent surgery for precocious disease during the period October 1991 to June 1994. The resected tumors were histologically classified and included 15 adenocarcinomas (37.5%), 1 large-cell carcinoma (2.5%), and 24 epidermoid (60%) carcinomas. The p53 concentration of tumor specimens was determined by luminescence immunoanalysis and was defined as positive if it was above the minimum value detectable by the method (0.01 ng/mg). The p185 protein was quantified by enzyme-linked immunoassay, and the 80th percentile of the frequency distribution was used as the reference cutoff value (348.8 U/mg). Survival and disease-free-survival (DFS) rates were estimated at 24 months after intervention. There were no significant differences in survival or DFS of patients with adenocarcinoma-type tumors for subjects with independent p185 values < 348.8 U/mg and those showing values >/= 348.8 U/mg. Neither were there differences observed between patients with positive and negative p53 values. In patients with epidermoid-type tumors the cumulative survival was significantly higher in p53-negative than in p53-positive patients (p = 0.03) and was also higher in patients with p185 levels < 348.8 U/mg than in those with values >/= 348.8 U/mg (p = 0.00001). These patients showed no significant differences with respect to recurrence rate. The possible synergistic behavior of p53 and p185 levels as a prognostic factor was evaluated in patients with epidermoid-type tumors. p53-negative and p53-positive patients were grouped according to a p185 level of less than or more than 348.8 U/mg. Significant differences were seen in both survival rates and DFS between groups. Individual analysis of relative risks showed an increased risk of death and greater recurrence rate in patients with p185 levels >/= 348.8 U/mg and a greater recurrence rate in patients with p53-positive values. Multivariate analysis established that the multiplicative, synergistic, prognostic effect of p53 and p185 was not significant. The existence of a significant, synergistic, prognostic effect of the p185 and p53 proteins in NSCLC could not be proven. However, a greater prognostic potential of the quantified overexpression of p185 with respect to that of p53 was established. An additive effect in the prognostic potential of both proteins was also observed (stratified analysis). <44> UI - 99421599 AU - Granena A AU - Castellsague X AU - Badell I AU - Ferra C AU - Ortega J AU - Brunet S AU - Punti C AU - Sureda A AU - Picon M AU - Valls A AU - Rutllant M AU - Garcia J IN - Hematology Department, 'Institut Catala d'Oncologia', Barcelona, Spain. TI - Autologous bone marrow transplantation for high risk acute lymphoblastic leukemia: clinical relevance of ex vivo bone marrow purging with monoclonal antibodies and complement. SO - Bone Marrow Transplantation 1999 Sep;24(6):621-7 AB - Herein we describe our experience with 75 consecutive autologous BM transplants for patients with high-risk ALL, with special attention to the clinical impact of BM purging. Fifty-two patients received purged BM using monoclonal antibody (MoAb) cocktails and complement, and 23 patients received untreated BM. The distribution of prognostic factors was similar in both groups. Hemopoietic reconstitution was adequate and did not differ in the two groups. Transplant-related mortality was 9.6% and 13% in 'purged' and 'unpurged' groups. Median follow up was 11 months (2-71) and overall actuarial probability of disease-free survival (DFS) at 5 years was 40% (53% relapse probability). We found a beneficial effect of purging in patients over 15 years of age and in patients needing more than 1 month to reach CR1. Patients in CR1 receiving purged marrow had a longer DFS and a lower relapse probability (52% vs 12%, P = 0.02 and 35% vs 86%, P = 0.005, respectively) which were related to the efficacy of the purging procedure (more or less than one log of depletion). In further CR, no advantage of purging has been found. Our data strongly suggest the clinical relevance of BM purging in autologous BMT in high-risk ALL patients and support the need for prospective randomized studies. <45> UI - 99370777 AU - Fountzilas G AU - Zisiadis A AU - Dafni U AU - Konstantaras C AU - Hatzitheoharis G AU - Liaros A AU - Athanassiou E AU - Dombros N AU - Dervenis C AU - Basdanis G AU - Gamvros O AU - Souparis A AU - Briasoulis E AU - Samantas E AU - Kappas A AU - Kosmidis P AU - Skarlos D AU - Pavlidis N IN - Aristotle University of Thessaloniki Medical School, Greece. hecogoff@otenet.gr TI - Postoperative radiation and concomitant bolus fluorouracil with or without additional chemotherapy with fluorouracil and high-dose leucovorin in patients with high-risk rectal cancer: a randomized phase III study conducted by the Hellenic Cooperative Oncology Group. SO - Annals of Oncology 1999 Jun;10(6):671-6 AB - BACKGROUND: Randomized studies have shown that postoperative chemotherapy with or without radiation therapy (RT) improved local control and survival of patients with stages II or III rectal cancer. However, the optimal sequence of treatments and the optimal chemotherapeutic regimen have not been defined. Modulation of fluorouracil (FU) by leucovorin (LV) has yielded a highly significant difference in response rate from that of FU monotherapy, as suggested by an overview of randomized trials in patients with advanced colorectal cancer. However, this difference in response rate did not translate into a survival benefit. PURPOSE: To evaluate the impact on the disease-free survival (DFS) and overall survival (OS) of patients with stages II or III rectal cancer of postoperative RT and concomitant bolus FU administration alone or with additional chemotherapy using FU and high-dose LV. PATIENTS AND METHODS: From October 1989 until February 1997, 220 patients were randomized postoperatively to receive either one cycle of chemotherapy with FU (600 mg/m2/week x 6 followed by a two-week rest) and leucovorin (LV, 500 mg/m2/week x 6 as a two-hour infusion) followed by pelvic RT with concomitant FU (400 mg/m2) as a rapid intravenous injection during the first three and last three days of RT, and three more cycles of the same chemotherapy with FU and LV (standard, group A, 111 patients) or pelvic RT with concomitant FU only (experimental, group B, 109 patients). RESULTS: As of August 1998, after a median follow-up of 4.9 years, there was no significant difference in either three-year DFS (Group A, 70.3%; group B, 68.2%, P = 0.53) or OS (group A, 77%; group B, 73.3%. P = 0.75). Cox multivariate analysis revealed stage of disease, number of infiltrated nodes, tumor grade, presence of regional implants and perforation to be significant prognostic factors. The incidence of severe side effects was significantly higher in the patients in group A than in those in group B (32.4% vs. 4.6%, P < 0.0001). CONCLUSIONS: The incorporation of additional chemotherapy with FU and LV into postoperative concomitant RT and bolus infusion of FU does not offer a > or = 10% three-year survival benefit over that of concomitant RT and bolus infusion of FU, and significantly increases toxicity in patients with stages II or III rectal cancer. <46> UI - 99435632 AU - Yu H AU - Levesque MA AU - Clark GM AU - Diamandis EP IN - Section of Cancer Prevention and Control, Feist-Weiller Cancer Center, Louisiana State University Medical Center, Shreveport 71130, USA. TI - Enhanced prediction of breast cancer prognosis by evaluating expression of p53 and prostate-specific antigen in combination. SO - British Journal of Cancer 1999 Oct;81(3):490-5 AB - p53 gene mutation is the most common genetic alteration in neoplastic diseases, including breast cancer, for which p53 alteration may indicate poor prognosis. Recent clinical evidence suggests that prostate-specific antigen (PSA) expression may identify breast cancer patients with favourable outcome. Assessment of p53 and PSA in combination, potentially offering improved prediction, has not yet been performed. Extracts from 952 primary breast carcinomas were assayed for PSA and p53 by quantitative enzyme-linked immunosorbent assays (ELISAs) developed by the authors. Concentrations of each marker were classified as negative or positive on the basis of median and 30th percentile cut-off points for p53 and PSA respectively. Patients followed for a median of 6 years having different combinations of negative or positive status for PSA and p53 were compared with respect to the relative risks (RRs) for relapse and death by Cox proportional hazards regression analysis, in which an interaction term was also evaluated, and with respect to disease-free survival (DFS) and overall survival (OS) probabilities by Kaplan-Meier plots and log-rank tests. Multivariate models were adjusted for oestrogen and progesterone receptor status, nodal status, patient age, tumour size, DNA ploidy, S phase fraction and receipt of chemotherapy. Interactions were not found between the status of PSA and p53 in the Cox models, in which PSA-negativity (RR = 1.47, P = 0.020 for DFS, and RR = 1.49, P = 0.023 for OS) and p53-positivity (RR = 1.46, P = 0.017 for DFS, and RR = 1.41, P = 0.033 for OS) were individually associated with prognosis. Evaluation of a combined three-level variable revealed that PSA(-)/p53(+) patients had significantly higher risks for relapse (RR = 2.13, P < 0.001) and death (RR = 2.08, P = 0.001) than PSA(+)/p53(-) patients, and that patients positive or negative for both markers had intermediate risks for the outcome events in the same multivariate analysis (RR = 1.45 for both DFS and OS). The results of our study demonstrate that the assessment of combined PSA and p53 expression status by ELISAs, easily applicable to breast tumour extracts prepared for steroid hormone receptor analyses, may stratify breast cancer patients into groups differing by relapse and death risks of greater magnitude than offered by the assessment of either p53 or PSA alone. <47> UI - 99390389 AU - Favale S AU - Dicandia CD AU - Tunzi P AU - Rizzon P IN - Department of Metodologia Clinica e Tecnologie Medico-Chirurgiche, University of Bari, Italy. SFAVALE@TIN.IT TI - A prospective, randomized, comparison in patients between a pectoral unipolar defibrillation system and that using an additional inferior vena cava electrode. SO - Pacing & Clinical Electrophysiology 1999 Aug;22(8):1140-5 AB - The decrease of defibrillation energy requirement would render the currently available transvenous defibrillator more effective and favor the device miniaturization process and the increase of longevity. The unipolar defibrillation systems using a single RV electrode and the pectoral pulse generator titanium shell (CAN) proved to be very efficient. The addition of a third defibrillating electrode in the coronary sinus did not prove to offer advantages and in the superior vena cava showed only a slight reduction of the defibrillation threshold (DFT). The purpose of this study was to determine whether the defibrillation efficacy of the single lead unipolar transvenous system could be improved by adding an electrode in the inferior vena cava (IVC). In 17 patients, we prospectively and randomly compared the DFT obtained with a single lead unipolar system with the DFT obtained using an additional of an IVC lead. The RV electrode, Medtronic 6936, was used as anode (first phase of biphasic) in both configurations. A 108 cm2 surface CAN, Medtronic 7219/7220 C, was inserted in a left submuscular infraclavicular pocket and used as cathode, alone or in combination with IVC, Medtronic 6933. The superior edge of the IVC coil was positioned 2-3 cm below the right atrium-IVC junction. Thus, using biphasic 65% tilt pulses generated by a 120 microF external defibrillator, Medtronic D.I.S.D. 5358 CL, the RV-CAN DFT was compared with that obtained with the RV-CAN plus IVC configuration. Mean energy DFTs were 7.8 +/- 3.6 and 4.8 +/- 1.7 J (P < 0.0001) and mean impedance 65.8 +/- 13 O and 43.1 +/- 5.5 O (P < 0.0001) with the RV-CAN and the IVC configuration, respectively. The addition of IVC significantly reduces the DFT of a single lead active CAN pectoral pulse generator. The clinical use of this biphasic and dual pathway configuration may be considered in patients not meeting implant criteria with the single lead or the dual lead RV-superior vena cava systems. This configuration may also prove helpful in the use of very small, low output ICDs, where the clinical impact of ICD generator size, longevity, and related cost may offset the problems of dual lead systems. <48> UI - 99371658 AU - Dazzi C AU - Cariello A AU - Maioli P AU - Solaini L AU - Scarpi E AU - Rosti G AU - Lanzanova G AU - Marangolo M IN - Oncology Department, Ospedale Santa Maria delle Croci, Ravenna, Italy. c.dazzi@ra.nettuno.it TI - Prognostic and predictive value of intratumoral microvessels density in operable non-small-cell lung cancer. SO - Lung Cancer 1999 May;24(2):81-8 AB - Experimental evidence suggests that tumor growth and progression depend on angiogenesis. In a retrospective study we evaluated the relationship between tumor angiogenesis and survival in patients with NSCLC treated with potentially curative surgery between 1992 and 1997. The study population consisted of 76 patients. An anti-CD34 monoclonal antibody was used to measure angiogenesis in tumor samples. Angiogenesis was quantified in terms of microvessel count (MVC): in each sample the three most intense regions of neovascularization were identified under low microscopic power. A x250 field in each of the three areas was then counted and the highest count of the three fields was recorded. Disease free (DFS) and overall survival (OS) during follow up were evaluated. Gender, age, stage, histologic type and KI-67 were the other factors considered for analysis. The median MVC in our series was 41.5. Among the clinicopathologic parameters examined the microvessel count was the only one to show a significant association with disease free survival in univariate analysis (P = 0.04). MVC value is a new indicator of tumor aggressiveness in patients with NSCLC who underwent potentially curative surgery and should be taken into consideration in selecting patients for adjuvant treatment. <49> UI - 99276434 AU - Lussi A AU - Imwinkelried S AU - Pitts N AU - Longbottom C AU - Reich E IN - Department of Operative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland. TI - Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro. SO - Caries Research 1999 Jul-Aug;33(4):261-6 AB - The diagnosis of occlusal caries at non-cavitated sites remains problematic, especially since clinical visual detection has limited sensitivity. Electrical methods of detection show considerable promise, but specificity is reduced. The aims of this in vitro study were: (1) to assess the validity of a new laser fluorescence device--the DIAGNOdent--(and compare the values with those of a fixed-frequency electrical device); (2) to determine the optimum cut-off points of the new device for different stages of the caries process, and (3) to assess the reproducibility of the new laser device. For validity and determination of optimum cut-off points, 105 extracted teeth with macroscopically intact occlusal surfaces were measured by a single examiner, using both the laser fluorescence device (on both moist and dried teeth) and an Electronic Caries Monitor. The teeth were subsequently examined histologically to determine the specificity, sensitivity and likelihood ratio at the D2 (caries extending through more than half of the enamel thickness) and D3 (caries involving dentin) levels. The values obtained for the laser device ranged from 0.72 to 0.87 (specificity), 0.76 to 0.87 (sensitivity) and 3.0 to 5.6 (likelihood ratio). Those for the ECM ranged from 0.64 to 0.78 (specificity), 0. 87 to 0.92 (sensitivity) and 2.4 to 4.1 (likelihood ratio). To determine intra- and interexaminer reproducibility of the DIAGNOdent, 11 dentists recorded two different measurements at the same site on a separate set of 83 extracted molar teeth, and these were compared using Cohen's kappa (at D2 and D3 levels) and Spearman's correlation coefficient. The average intra-examiner kappa scores were 0.88 (D2) and 0.90 (D3), with a Spearman correlation of 0.97. For interexaminer reproducibility, the average kappa values were 0.65 (D2) and 0.73 (D3), with a Spearman correlation of 0.84. It is concluded that for occlusal caries (1) the new laser device has a higher diagnostic validity than the ECM, and (2) in vitro, measurements using the device are highly reproducible. Thus, the laser device could be a valuable tool for the longitudinal monitoring of caries and for assessing the outcome of preventive interventions. <50> UI - 99401579 AU - Zambelli A AU - Da Prada GA AU - Pedrazzoli P AU - Ponchio L AU - Robustelli della Cuna G IN - Divisione di Oncologia Medica, IRCCS Fondazione S Maugen, Pavia, Italy. TI - Poor outcome of patients with resectable breast cancer receiving adjuvant high-dose sequential chemotherapy following preoperative treatment. SO - Anticancer Research 1999 May-Jun;19(3B):2373-6 AB - BACKGROUND/OBJECTIVES: The prognosis of resectable high risk breast cancer (BC) patients (N+ > 10) is poor with a five-year disease-free survival (DFS) after standard adjuvant ADM/CMF chemotherapy (CT) of about 40%. An improvement in survival has been reported when high-dose chemotherapy with autologous stem cell support is given. It has been recently suggested that nodal status and the degree of pathological remission following preoperative CT administered in patients harbouring tumors larger than 3 cm represent the most important prognostic factors for DFS. Since no data are available regarding the impact of primary CT in the high dose CT adjuvant setting, we retrospectively evaluated the efficacy of administering megadoses of cytotoxic drugs with stem cell support in the subgroup of patients showing poor response to preoperative CT., PATIENTS AND METHODS: Fourteen women with high risk BC, N+ > 10 and tumor size > 3 cm following antracyclin-based primary CT, received high dose sequential chemotherapy (HDS). The median number of positive axillary nodes at surgery was 18 and tumor size was greater than 5 cm in 6 patients. HDS chemotherapy consisted of cyclophosphamide (7 gr/m2), methotrexate (8 gr/m2) plus vincristin (2 mg), 2 courses of carboplatin (360 mg/m2), and Thiotepa (600 mg/m2) plus L-PAM (160 mg/m2) as final myeloablative regimen requiring stem cell support. RESULTS: At a minimum follow up of 12 months (median 18 months, range 12-40) 5 patients remained disease free (36%) and 9 (64%) have relapsed (7 within the first 10 months). CONCLUSION: Our retrospective analysis suggests that BC patients showing poor response to primary CT might fail to achieve the benefits expected from high dose intensification. <51> UI - 99360010 AU - Forsling JO AU - Halling A AU - Lundin SA AU - Paulander J AU - Svenson B AU - Unell L AU - Wendt LK IN - Community Dental Health Unit, Orebro County Council, Sweden. TI - Proximal caries prevalence in 19-year-olds living in Sweden. A radiographic study in four counties. SO - Swedish Dental Journal 1999;23(2-3):59-70 AB - A random sample of all 19-year-olds in four counties in the middle of Sweden in 1994 constituted the group studied. The material consisted of posterior bitewing radiographs from 511 19-year-old patients. The purpose was to study the prevalence and distribution of initial and manifest caries. It was found that on the manifest caries level 56% of the subjects were 'free from caries', in good correspondence with the official epidemiological data from the Swedish National Board of Health and Welfare, but only 27% when initial caries was added. Initial caries lesions constituted 90% of all lesions. The distribution of caries was highly skewed on the manifest caries level whereas initial caries had a broader distribution. Thus, on the surface level 75% of the individuals had 16% of all manifest caries and restorations, and 33% of all initial caries. A high correlation was found between initial and manifest caries, besides increasing with the number of initial lesions. Thus, only 2.5% of individuals without initial caries had manifest caries, compared to 54% of individuals with more than eight affected surfaces. A correlation was also found between the prevalence of manifest caries and restoration. The prevalence of initial caries and its obvious significance for further caries development should be a reason for finding new strategies in caries prevention on a population basis. <52> UI - 99351672 AU - van Dijken JW IN - Department of Oral Biology, Dental School, Umea University, Sweden. Jan.van.Dijken@oralbio.umu.se TI - Longevity of new hybrid restorative materials in class III cavities. SO - European Journal of Oral Sciences 1999 Jun;107(3):215-9 AB - The aim of this study was to evaluate the durability of two new tooth-colored restorative materials, a polyacid-modified resin composite (compomer) and a resin-modified glass ionomer cement. In an intra-individual comparison with a resin composite, the materials were studied during a 5-yr period. In 50 patients, 154 large class III restorations were placed. Most patients received one of each of the three materials. The restorations were evaluated by modified United States Public Health Service (USPHS) criteria. Of the 144 restorations evaluated, 15 were found unacceptable. No significant differences were seen between the materials concerning recurrent caries incidence. The resin composite showed a significantly better color match. No difference was found between resin composite fillings in enamel- or total-etched cavities. Significantly higher surface roughness was found in the aged resin-modified glass ionomer cement restorations. Fracture of the incisal enamel corner was observed adjacent to 10 restorations. None of the three total-etch techniques resulted in postoperative sensitivity or loss of vitality. All the restorative techniques showed a low failure rate during the 5-yr follow-up. <53> UI - 99407384 AU - Grossman ES AU - Matejka JM IN - Dental Research Institute, South Africa. 078esg@cosmos.wits.ac.za TI - Reliability of outer lesion secondary caries as a predictor of wall lesions. SO - American Journal of Dentistry 1999 Feb;12(1):31-6 AB - PURPOSE: To assess the reliability of in vitro developed secondary caries outer lesions as an indicator of presence and extent of wall lesions. MATERIALS AND METHODS: Class I occlusal cavities were cut in 132 extracted premolars: 12 teeth were not restored, 120 restored with one of 20 different restoration combinations of silver amalgam, base and varnish. Specimens were aged in 1% NaCl for up to 1 year where after 80 restored and 12 unrestored teeth were subjected to an in vitro bacterial challenge for 36 days, the other 40 specimens were similarly incubated in an acidified broth (pH = 4.0). Sections were prepared for polarized light microscopy and outer and wall lesion areas, outer lesion width, wall lesion length and enamel thickness measured. Data were subjected to Fisher's exact test and Pearson Correlation. RESULTS: There was a significant association (P < 0.05) between outer and wall lesions in all cariously challenged specimen groups. Sensitivity was high 95-96% but specificity was 26% for acid broth, 68% for restored bacterial and 100% for unrestored specimens. Restoration variables impacted widely on specificity. Correlation values were too low to show clinically relevant associations between wall and outer lesion size. Frequency distribution showed that wall lesions extending beyond the dentin-enamel junction were generally associated with potentially remineralizable outer lesions. <54> UI - 99312082 AU - Worthington H AU - Clarkson J AU - Davies R IN - Dental Health Unit, Turner Dental School, Manchester, UK. helen.worthington@man.ac.uk TI - Extraction of teeth over 5 years in regularly attending adults. SO - Community Dentistry & Oral Epidemiology 1999 Jun;27(3):187-94 AB - OBJECTIVES: This prospective study was conducted to describe the incidence of tooth extraction in a group of regularly attending adults and to assess factors that are predictive of tooth loss. METHODS: Baseline and annual incremental clinical data were obtained from 23 general dental practitioners on a group of their regularly attending, dentate adult patients over a 5-year period. The patients completed a postal questionnaire with questions relating to dental health behaviours, attitudes and knowledge, and social factors. RESULTS: Complete clinical data were obtained from 2799 patients. Four hundred and seventy (17%) patients underwent extractions, 72% of which were posterior teeth. The majority of extractions were for reasons other than caries (79%). Bivariate analyses revealed many significant differences between patients who underwent extractions and those who did not, with respect to the clinical, social, behavioural and attitudinal variables. The logistic regression model for tooth loss included three clinical variables, number of teeth, crowns and sites with recession. Other variables in the final model included the dentist's and patient's prediction of treatment need, having sensitive teeth, having a sweet tooth, living alone and smoking. The sensitivity for the model was 0.57 with specificity 0.72. CONCLUSIONS: This study is unique in its examination of patients and has highlighted that both clinical and other factors are important in predicting who will undergo extractions. Future investigations should assess the consequence of having extractions in terms of health benefit or detriment. <55> UI - 99364004 AU - Epstein JB AU - Emerton S AU - Le ND AU - Stevenson-Moore P IN - Department of Dentistry, British Columbia Cancer Agency, Vancouver, Canada. TI - A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy. SO - Oral Oncology 1999 Mar;35(2):132-7 AB - Following therapeutic irradiation of the head and neck, patients with profound xerostomia have complaints associated with oral dryness, effects upon use of oral prosthesis, speech, and taste. In addition, xerostomia may lead to risk of oral infections and rampant demineralization of teeth. The use of topical Oral Balance gel and Biotene toothpaste (Laclede Professional Products, Gardena, CA) versus carboxymethylcellulose gel and commercial toothpaste applications was assessed in a 2-week double-blind, crossover design. The palliative effects of Oral Balance gel and Biotene toothpaste were superior to the effects of a placebo. No effect on oral colonization by Candida species and cariogenic oral microflora was seen with use of the topical agents. <56> UI - 99300297 AU - van Dijken JW AU - Olofsson AL AU - Holm C IN - Department of Oral Biology, Dental School, Umea University, Sweden. Jan.van.Dijken@oralbio.umu.se TI - Five year evaluation of class III composite resin restorations in cavities pre-treated with an oxalic- or a phosphoric acid conditioner. SO - Journal of Oral Rehabilitation 1999 May;26(5):364-71 AB - An oxalic acid solution has been proposed as a conditioning agent for resin composite restorations in two commercial adhesive systems. The durability of 163 class III restorations, including 12 class IV restorations, in cavities pre-treated with an oxalic acid total etch technique or an enamel etch with phosphoric acid was studied. Each of 52 patients received at least one of each of three experimental restorations. The restorations were evaluated yearly with slightly