Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-142 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 1-300 300 100 from 98 keep 301-442 142 *************************** <1> UI - 94166018 AU - Metz JE AU - Brackett WW IN - Department of General Dentistry, University of Tennessee, College of Dentistry, Memphis. TI - Performance of a glass ionomer luting cement over 8 years in a general practice. SO - Journal of Prosthetic Dentistry 1994 Jan;71(1):13-5 AB - For this report, 1230 cast restorations luted with a glass ionomer cement were followed up for 8 years. The results show an absence of secondary caries, 99% retention of restorations, and a 4% incidence of irreversible pulpitis. The infrequent thermal sensitivity previously observed after cementation in this group of restorations did not recur. <2> UI - 94170465 AU - Bardy GH AU - Dolack GL AU - Kudenchuk PJ AU - Poole JE AU - Mehra R AU - Johnson G IN - Department of Medicine, University of Washington, Seattle. TI - Prospective, randomized comparison in humans of a unipolar defibrillation system with that using an additional superior vena cava electrode. SO - Circulation 1994 Mar;89(3):1090-3 AB - BACKGROUND: A unipolar defibrillation system using a single right ventricular (RV) electrode and the active shell or "CAN" of the implantable cardioverter-defibrillator itself situated in a left infraclavicular pocket has been shown to be as efficient in defibrillation as an epicardial lead system. The purpose of this study was to determine whether defibrillation efficacy can be improved further by adding a superior vena cava (SVC) electrode to this already efficient defibrillation system. METHODS AND RESULTS: We prospectively and randomly compared the defibrillation efficacy of a simplified unipolar defibrillation system, RV-->CAN, with that of one incorporating a high SVC electrode, RV-->SVC + CAN, in 15 consecutive cardiac arrest survivors undergoing implantation of a presently available transvenous defibrillation system. The RV defibrillation electrode was a 5-cm coil located on a 10.5F lead used as the anode in both lead configurations examined. The active CAN was a 108-cm2 surface area shell of a titanium alloy pulse generator used as the cathode in both configurations and placed in a left infraclavicular pocket. The SVC electrode was a 6F 5-cm-long coil and was used as an additional cathode positioned at the junction of the SVC and the left innominate vein. The defibrillation pulse used was a 65% tilt, asymmetric biphasic waveform delivered from a 120-microF capacitor. The defibrillation threshold (DFT) stored energy, leading edge voltage, current, and pulsing resistance were measured for both lead systems. The single-lead unipolar system, RV-->CAN, resulted in a stored energy DFT of 7.4 +/- 5.2 J, and the three-electrode dual pathway system, RV-->SVC + CAN, resulted in a DFT of 6.0 +/- 3.4 J (P = .20). There was no difference in defibrillation efficacy with the more complicated three-electrode system over the unipolar system despite a decrease in pulsing resistance to 48.6 +/- 3.5 omega compared with 61.2 +/- 5.9 omega for the unipolar system (P < .0001) and a slight rise in delivered current to 6.3 +/- 1.8 A compared with 5.5 +/- 2.0 A for the unipolar system (P = .062). CONCLUSIONS: The unipolar single-lead transvenous defibrillation system provides defibrillation at energy levels comparable to that reported with present epicardial lead systems. Coupling of this lead system to a third SVC electrode increases system complexity but offers little defibrillation advantage despite a large decrease in pulsing resistance and a modest increase in delivered current. <3> UI - 94188049 AU - Scarfe WC AU - Langlais RP AU - Nummikoski P AU - Dove SB AU - McDavid WD AU - Deahl ST AU - Yuan CH IN - Department of Diagnosis and General Dentistry, School of Dentistry, University of Louisville, Ky. TI - Clinical comparison of two panoramic modalities and posterior bite-wing radiography in the detection of proximal dental caries. SO - Oral Surgery, Oral Medicine, Oral Pathology 1994 Feb;77(2):195-207 AB - A clinical study was designed to examine whether the Philips OrthOralix SD (Gendex Dental Systems, Monza, Italy) orthogonal panoramic projection could improve diagnostic accuracy over standard projections in the detection of proximal surface caries. Thirty-five sets of radiographs that demonstrated optimal image characteristics were selected. Using a five-point scale, 18 viewers evaluated whether specified lesions were present or absent. Viewer data was then compared with a consensus radiographic assessment of the state of the proximal areas. Receiver operating characteristic curves were generated with the use of a maximum-likelihood method of fit. The area under the receiver operating characteristic curve was used as the index of diagnostic accuracy. The mean receiver operating characteristic areas for orthogonal and standard projection panoramic and bite-wing radiography to detect the presence of proximal dental caries were 0.68 +/- 0.03, 0.69 +/- 0.03, and 0.79 +/- 0.03 respectively. Critical ratio analysis was used to compare the means for all possible pairings of imaging modalities. In overall performance, conventional bite-wing radiographs gave a significantly greater diagnostic yield for proximal caries than the Philips OrthOralix SD orthogonal or standard panoramic modalities (p > 0.05). The orthogonal projection did not improve diagnostic accuracy in the detection of proximal carious lesions compared with the standard projection. <4> UI - 94188047 AU - Halse A AU - Espelid I AU - Tveit AB AU - White SC IN - School of Dentistry, Bergen, Norway. TI - Detection of mineral loss in approximal enamel by subtraction radiography. SO - Oral Surgery, Oral Medicine, Oral Pathology 1994 Feb;77(2):177-82 AB - The purpose of the present study was to determine whether digital subtraction radiography will improve detectability of small, mechanically prepared defects within dental enamel. Lesions with an extent of 1 mm in vertical direction and representing 5% to 10% mineral loss in the direction of the x-ray beam were prepared in eight extracted molars. Radiographs of teeth with defects were subtracted from radiographs taken before the lesions were prepared. Seven observers evaluated the images using a five-point confidence rating scale (receiver operating characteristic technique). Examination of the original radiographs showed increasing accuracy of radiographic interpretation with increasing mineral loss as judged from the areas beneath the receiver operating characteristic curves. The same observation was made using subtraction images with and without contrast enhancement. There was no indication that subtracted images provided better diagnostic validity than the original radiographs. In conclusion, subtraction images do not seem to improve the diagnosis of well-defined lesions within dental enamel. <5> UI - 94184921 AU - Dufour P AU - Bergerat JP AU - Barats JC AU - Giron C AU - Duclos B AU - Dellenbach P AU - Ritter J AU - Renaud R AU - Audhuy B AU - Oberling F IN - Departement d'Onco-Hematologie, Hopitaux Universitaires de Strasbourg, France. TI - Intraperitoneal mitoxantrone as consolidation treatment for patients with ovarian carcinoma in pathologic complete remission. SO - Cancer 1994 Apr 1;73(7):1865-9 AB - BACKGROUND. Stages II-IV ovarian cancer in pathologic complete remission (pCR) at second-look surgery have a high relapse rate (50%) during the first 2 years. Considering relapse sites (abdomen and/or pelvis), intraperitoneal (IP) therapy is a logical approach. Mitoxantrone is an effective drug against ovarian cancer cells in vitro and is an attractive agent for IP therapy because of its very low peritoneal clearance. The value of IP mitoxantrone was studied as consolidation treatment of ovarian cancer in pCR at second-look surgery. METHODS. Fifty patients with Stages II-IV ovarian cancer (8, Stage II; 37, Stage III; 5, Stage IV) were included in this Phase II study, which began in June 1988. All patients had undergone initial cytoreductive surgery followed by 6 cyclophosphamide, doxorubicin, and cisplatin cycles. All patients were in pCR, as confirmed by second-look surgery. Consolidation treatment consists of 20 mg (total dose per cycle) IP mitoxantrone every 3 weeks for six cycles. RESULTS. Toxicity was limited to mild abdominal pain not requiring dose reduction (90% pain grade < or = 2). With a median follow-up of 2 years, the 5-year predicted survival is 59.8% (95% confidence interval [CI], 48.3 - 71.3), and the disease-free survival (DFS) rate is 47.3% (95% CI, 36.7 - 57.9). Patients with no or microscopic residual disease after initial surgery had a better 5-year DFS rate (75.8%) than those with macroscopic residual disease (31.2%) (P = 0.01). CONCLUSION. IP mitoxantrone (20 mg/cycle) is feasible with an acceptable abdominal toxicity. The results in terms of DFS are encouraging, but a randomized study versus no treatment is necessary to prove the value of this consolidation treatment. <6> UI - 98169675 AU - Rudolph MJ AU - Chikte UM IN - Department of Community Dentistry, University of the Witwatersrand, Johannesburg, South Africa. TI - Dental caries experience and periodontal disease in institutionalised male psychiatric patients. SO - Journal of the Dental Association of South Africa 1993 Aug;48(8):451-4 AB - The prevalence of caries and the periodontal disease in 240 adult male psychiatric patients was determined in order to recommend appropriate treatment strategies. Twenty seven per cent of the sample were fully dentate and 12 per cent were caries free. The mean DMFT was 7.92 with the D component reflecting many untreated carious teeth. All age groups require simple restorative care for the treatment of dental caries. None of the subjects were totally free from periodontal disease. Calculus and moderate periodontal pocket formation was the most common manifestation. Seventeen per cent of the sample needed complex periodontal care. Health education aimed at professional and lay staff, the implementation of a suitable plaque removal regimen and the removal of subgingival calculus by auxiliary personnel were seen as important therapeutic measures to enhance the oral health of this population. <7> UI - 98172591 AU - van der Merwe WJ IN - Faculty of Dentistry, Medical University of Southern Africa, Medunsa. TI - Clinical evaluation of four dental amalgams over a three year period. SO - Journal of the Dental Association of South Africa 1993 Jun;48(6):329-32 AB - The aim of this study was to compare the clinical durability of four dental amalgams. In each of eighty-two patients one class 2 cavity was restored with Dispersalloy (Johnson and Johnson) which served as the control and all the other class 2 cavities were randomly restored with one of the following amalgams: Amalgaphase, Amalga 43 (Amalgam Alloys-South Africa) or Permite C (Southern Dental Industries). Matrix bands were placed and Kalzinol bases and Polyvar varnishes applied in all cavities. The amalgams were mixed according to the manufacturers' instructions, the cavities overpacked with amalgam, condensed by hand, carved and then burnished with a ball burnisher. Twenty-four hours later all restorations were polished and colour photographs taken. The restorations were evaluated using the Ryge and Snyder (1973) evaluation system, as well as comparison of the colour photographs. The Fisher's Exact Test was used for the statistical analysis. The two South African manufactured amalgams compared well with the two imported amalgams. However, at the end of the third year the score for the marginal integrity of Amalgaphase, one of the local products, was significantly different (p < 0.083) and inferior to that of the control, Dispersalloy. Evidence is produced to suggest that over a three year period Amalgaphase performed better than Dispersalloy, Amalga 43 and Permite C. <8> UI - 95373750 AU - Hakeberg M AU - Berggren U AU - Carlsson SG AU - Grondahl HG IN - Department of Endodontology, University of Goteborg, Sweden. TI - Long-term effects on dental care behavior and dental health after treatments for dental fear. SO - Anesthesia Progress 1993;40(3):72-7 AB - Three different treatments for dental fear were tested in a long-term perspective study. Twenty-nine patients with severe dental anxiety and avoidance behavior were assigned to Behavioral Therapy (BT, n = 12), PRemedication with bensodiazepine (PR, n = 8) or dental treatment under General Anesthesia (GA, n = 9). Ten years after initial treatment the patients were reexamined. Changes in dental anxiety and dental care attendance were reported. Patients' dental health status was assessed by radiographic survey. Regular dental attendance was reported by 19 patients (65.5%), with a significantly better result for the BT group (91.6%) compared to the GA group (33.3%). Reported level of dental anxiety, as measured by the Dental Anxiety Scale, revealed a significant reduction during the 10-yr period except among GA patients and those reporting irregular dental attendance behavior. A rise in mood as assessed by the Mood Adjective Checklist was revealed in the total group, with a better effect in the BT and PR groups as well as in patients who reported regular dental attendance. A substantial general improvement in oral health was seen during the 10-yr period, especially among patients receiving regular dental care. Thus, for a majority of patients in this study, directed treatment for dental anxiety and avoidance behavior made it possible to maintain regular dental care behavior during a 10-yr period. <9> UI - 95229181 AU - MacEntee MI AU - Clark DC AU - Glick N IN - Department of Clinical Dental Sciences, The University of British Columbia, Vancouver, Canada. TI - Predictors of caries in old age. SO - Gerodontology 1993 Dec;10(2):90-7 AB - This study measured the incidence of dental caries for one year and identified factors associated with the risk of caries in a sample of 156 elderly subjects. The subjects were examined at baseline and after one year to record the number of missing, filled and decayed teeth, to measure oral hygiene and flow of saliva, and to estimate the numbers of Streptococcus mutans and Lactobacilli cultured from samples of saliva. All subjects were interviewed on both occasions for information on their use of medications and dental services and on their ingestion of sugar. At baseline the elders had a mean of 19 natural teeth with 5 decayed surfaces (DS), 38 filled surfaces and a mean Plaque Index (PI) of 1. The independent group, on average, had more teeth and fillings but a lower PI and less caries. At the end of the year more than two-thirds (71%) of the 98 institutionalised subjects and over half (59%) of the 58 independent subjects had at least one new decayed/filled surface (DFS). The mean net DFS increment per subject was 4.6 and 2.0 respectively. Regression analyses on multivariate models identified caries at baseline, residence in long term care facilities, high numbers of Lactobacilli, poor oral hygiene and frequent sugar consumption as the variables contributing most significantly to the risk of caries in old age. <10> UI - 95101194 AU - Ianzano JA AU - Gwinnett AJ IN - Department of Oral Biology & Pathology, State University of New York, Stony Brook. TI - Clinical evaluation of Class V restorations using a total etch technique: 1-year results. SO - American Journal of Dentistry 1993 Aug;6(4):207-10 AB - The clinical performance of All Bond 2 and Bis-Fil M used with a total etch technique is being monitored in adult patients with erosion/abrasion lesions. 78 restorations were placed among 36 patients. After a prophylaxis, a short bevel was placed on the enamel margin. Using cotton roll isolation, both enamel and dentin were conditioned with 10% phosphoric acid for 20 seconds. Both tissues were moist at the time of primer application in which several applications of the latter resulted in a shiny surface upon gentle air drying. Bonding agent was added, brush thinned and polymerized for 20 seconds. The restoration was completed with the appropriate shade of composite placed in two increments and finished with fine grit diamonds and polishing paste. Evaluation criteria according to Ryge included retention, color match, visual and tactile margin integrity, secondary caries and postoperative sensitivity. A 1-year recall of 73 restorations showed 98.6% retention with 95.8% Alfa color match and stain-free margins. Tactile integrity was 83.1% Alfa. There was no secondary caries nor postoperative sensitivity. It was concluded that these preliminary findings offer cautious optimism for this system and the total etch procedure. <11> UI - 94131475 AU - Glantz PO AU - Nilner K IN - Department of Prosthetic Dentistry, University of Lund, Malmo, Sweden. TI - Patient age and long term survival of fixed prosthodontics. SO - Gerodontology 1993 Jul;10(1):33-9 AB - The possible relationship between patient age and the long term survival of fixed prostheses was studied in a randomised group of persons, who had received restorative treatment by general practitioners 15 years prior to this study. These fixed partial dentures had a mean extension of 6.9 units and a mean pontic/abutment ratio of 0.47. The group studied consisted of 77 persons who agreed to participate from an original group of 150 persons. Of the original group 20 had died, 17 were not traceable or unable to participate for medical reasons, and 36 declined to participate. The outcome of the treatment was compared between the following age subgroups (age as at the time of the original treatment) by division of the data at 37, 60 and 65 years. In these subgroups between 20 and 50 per cent of the prostheses had been lost or partially lost during the fifteen year period. Most of the failures and unacceptable quality ratings were found to be caused by fractures, loss of retention and/or dental caries. However, no systematic differences were found between any of the age subgroups studied. <12> UI - 94131130 AU - Wenzel A AU - Hintze H IN - Department of Oral Radiology, Royal Dental College, Aarhus, Denmark. TI - Perception of image quality in direct digital radiography after application of various image treatment filters for detectability of dental disease. SO - Dento-Maxillo-Facial Radiology 1993 Aug;22(3):131-4 AB - This study evaluated dentists' perception of the quality of digitally captured radiographs. Thirty radiographs were taken with the Visualix digital video radiographic system, 10 periapicals for tooth and bone anatomy, 10 periapicals for bone disease and 10 bitewings for dental caries. Three numeric copies were made of each image and treated with three different filters: 'optimize', 'enhance' and 'enhance + smooth', respectively. Four images of the same case were displayed simultaneously in a random sequence on the monitor. Twenty dentists ranked each set of four images on a scale from 1 to 4. In general, most dentists preferred a treated image to the original. The optimized and enhanced images were selected most frequently as first or second choice from the tooth and bone anatomy and bone disease groups. The original image was ranked lowest in more than half (55%) of the series. For the bitewings, the smoothed images were ranked significantly higher. In conclusion, image treatment possibilities should be offered in digital radiography as the majority of dentists preferred a treated image to the original version. The image treatment chosen seemed to be task dependent; less treatment was required to delineate the more subtle tissue differences. <13> UI - 94103432 AU - Kleisner J AU - Imfeld T IN - Department of Preventive Dentistry, Periodontology and Cardiology, University Dental Institute, Zurich, Switzerland. TI - Evaluation of the efficacy of interdental cleaning devices. How to design a clinical study [see comments]. [Review] [50 refs] CM - Comment in: J Clin Periodontol 1994 Oct;21(9):641 SO - Journal of Clinical Periodontology 1993 Nov;20(10):707-13 AB - A review of the literature was made, focusing on experimental designs used in clinical studies for assessment of the efficacy of interdental cleaning aids with regard to plaque removal and the prevention of caries and gingivitis. After careful consideration of the pros and cons of published procedures, an experimental design for such studies is proposed. [References: 50] <14> UI - 94092331 AU - Hersh EV AU - Cooper SA AU - Segal H AU - Greene J IN - University of Pennsylvania School of Dental Medicine, Philadelphia. TI - Analgesic onset time as a measure of topical anesthetic efficacy in spontaneous toothache pain: a pilot study. SO - Journal of Clinical Dentistry 1993;4(2):52-4 AB - The purpose of this pilot investigation was to determine the usefulness of analgesic onset time as a measure of topical anesthetic efficacy in patients with spontaneous toothache pain. Under blinded conditions, 20 patients with spontaneous toothache pain from an open tooth cavity were randomly assigned to receive either 20% benzocaine or placebo (80% polyethylene glycol). The medication was applied directly to the open cavity in a volume of 3 drops. Patients then depressed a stop watch when they initially experienced pain relief. Patients who did not obtain relief were assigned the maximum onset value of 600 seconds. The average analgesic onset time was 111.8 seconds in the benzocaine group and 289.0 seconds in the placebo group. In the benzocaine group, 90% of the patients reported some pain relief, while a surprisingly high 60% reported some pain relief in the placebo group. The results of this study suggest that in the spontaneous toothache pain model, analgesic onset time is a valuable measure of topical anesthetic efficacy. In addition, polyethylene glycol at a concentration of 80% may not be a totally inactive vehicle. <15> UI - 94065867 AU - Martelli M AU - Guglielmi C AU - Coluzzi S AU - Avvisati G AU - Amadori S AU - Giovannini M AU - Torromeo C AU - Mandelli F IN - Department of Human Biopathology, University La Sapienza, Rome, Italy. TI - P-VABEC: a prospective study of a new weekly chemotherapy regimen for elderly aggressive non-Hodgkin's lymphoma. SO - Journal of Clinical Oncology 1993 Dec;11(12):2362-9 AB - PURPOSE: To evaluate, in a prospective trial, a new combination chemotherapy specifically designed for elderly patients. PATIENTS AND METHODS: From October 1988 to December 1990, 60 previously untreated patients older than 60 years of age with aggressive non-Hodgkin's lymphoma (NHL) were treated at our institution with a new weekly alternating six-drug chemotherapy regimen, P-VABEC. The schedule consisted of doxorubicin, etoposide, and cyclophosphamide alternated weekly with vincristine and bleomycin. Oral prednisone was administered daily during the entire treatment period. Twenty-six of 60 patients were treated for a total of eight courses and 34 of 60 for 12 courses. RESULTS: A total of 45 patients (75%) achieved a complete response (CR), 10 (17%) a partial response (PR), and five (8%) no response. So far, 20 of 45 CR patients have relapsed, four of 10 PR patients have progressed, and three patients have died while in CR. Twenty-eight patients are still alive and responding (22 CRs, six PRs) after a median follow-up of 25 months. The projected overall survival (OS), disease-free survival (DFS), and event-free survival (EFS) rates at 2 years were 64%, 57%, and 55%, respectively. The outcome of patients treated with eight courses was similar to that of those who received 12 courses of P-VABEC in terms of CR rate and actuarial curves of OS, DFS, and EFS. Hematologic toxicity was mild in all patients. CONCLUSION: The P-VABEC regimen is active, well tolerated, and one of the briefest first-line chemotherapy regimens so far reported in the treatment of elderly patients with aggressive NHL. However, prospective randomized trials are needed to establish the real advantage of this regimen compared with other standard chemotherapy regimens. <16> UI - 94074073 AU - Saksena S AU - DeGroot P AU - Krol RB AU - Raju R AU - Mathew P AU - Mehra R IN - Eastern Heart Institute, Passaic, NJ 07055. TI - Low-energy endocardial defibrillation using an axillary or a pectoral thoracic electrode location. SO - Circulation 1993 Dec;88(6):2655-60 AB - BACKGROUND. A significant proportion of patients receiving endocardial defibrillation lead systems must accept either high defibrillation thresholds (DFTs) with lower safety margins or lead implantation by thoracotomy. We examined the feasibility of achieving universal application of endocardial leads and lower defibrillation energy requirements by optimizing the lead system location in conjunction with biphasic shocks. METHODS AND RESULTS. Two defibrillation catheter electrodes were positioned in the right ventricle and superior vena cava. Thoracic patch electrodes were placed at three sites (apical, pectoral, and axillary). Fifteen-joule, 10-J, and 5-J bidirectional simultaneous biphasic shocks were delivered across three different triple electrode configurations (right ventricle, superior vena cava, and patch) after inducing ventricular fibrillation (VF), and DFT was determined. All patients in whom VF was reproducibly inducible (14 patients) could be reproducibly defibrillated at 15 J at one or more patch electrode locations. Fifteen-joule shocks were effective at three thoracic electrode locations in 12 patients and at two electrode locations in 6 patients. The lowest mean single-shock DFT was 8.1 +/- 3.8 J. In 4 patients, ventricular flutter was reproducibly induced and reverted at 15 J in all patients. Mean DFT for the axillary location was 8.3 +/- 3.5 J and was significantly lower than apical (12.8 +/- 5.6 J, P = .008) and pectoral (11.6 +/- 4.1 J, P < .04) patch locations. The probability of success was significantly higher at 10 J with axillary location (78% of patients, P < .03 compared with both other sites) and at 15 J (P < .05 compared with the apical location). Low-energy endocardial defibrillation (< or = 10 J) was feasible in 10 of 14 tested patients at more than 1 thoracic electrode location at 10 J, whereas only 1 of 7 successful patients could be reverted at more than 1 electrode location at 5 J (P < .02). CONCLUSIONS. The use of axillary or pectoral patch lead location can allow endocardial defibrillation with biphasic shocks at energies < or = 15 J in this lead configuration. Virtually universal application of endocardial defibrillation lead systems can be predicted from these data. Reduction in maximum pulse generator output to < or = 25 J using these two thoracic electrode locations with bidirectional shocks can be feasible and maintain an adequate safety margin and permit thoracic pulse generator implantation. Lowering endocardial defibrillation energy < 10 J requires increasing specificity of thoracic electrode location. <17> UI - 94075742 AU - Hewlett ER AU - Atchison KA AU - White SC AU - Flack V IN - UCLA School of Dentistry 90024-1668. TI - Radiographic secondary caries prevalence in teeth with clinically defective restorations. SO - Journal of Dental Research 1993 Dec;72(12):1604-8 AB - Decisions to replace existing restorations are often based on clinical findings of margin discrepancies and other restoration defects. Previous studies have suggested that such findings do not correlate well with the actual presence of secondary caries, and that treatment should be deferred until caries is clinically or radiographically evident. The purpose of this study was to assess the frequency with which clinically defective restorations are associated with radiographic secondary caries. As part of a study to assess the efficacy of guidelines for the ordering of dental radiographs, 6285 restored teeth in 490 subjects were examined clinically and radiographically by three calibrated investigators. Specific criteria were used to determine whether restorations were intact or defective. Of the total, 822 teeth (13%) were judged to have clinically defective restorations. Of these, 113 teeth (14%) had radiographic secondary caries. Of the 5463 teeth with intact restorations, 5% had radiographic secondary caries. We found that the likelihood of radiographic secondary caries was nearly three-fold higher for defective restorations than for intact restorations. The large percentage (86%) of defective restorations with no radiographic secondary caries suggests, however, that replacement of all defective restorations due to risk of secondary caries may constitute overtreatment. The use of defective restoration status and presence of radiographic secondary caries as a combined criterion for replacement may potentially reduce such overtreatment. The prevalence of secondary caries under defective restorations should be determined clinically so that the usefulness of combining the criteria of defective restoration with those of radiographic secondary caries can be evaluated. <18> UI - 94082858 AU - van Houte J IN - Forsyth Dental Center, Department of Oral Microbiology, Boston, Massachusetts 02115. TI - Microbiological predictors of caries risk. [Review] [102 refs] SO - Advances in Dental Research 1993 Aug;7(2):87-96 AB - The prediction of caries risk has been of long-standing interest. Generally, few of the tests involving oral bacteria or their products have become accepted. Presently, the main focus is on counts of lactobacilli (L) and mutans streptococci (MS). Due to their positive numerical association with human caries and the linkage of this association to carbohydrate consumption, counts of L and MS may, potentially, serve not only as a caries risk predictor but also as an indicator of carbohydrate consumption, another caries-risk factor. The value of counts of L and MS as caries-risk predictors has been evaluated by means of studies providing data on test sensitivity, specificity, and predictive values. These and other studies indicate that their use for the prediction of caries risk of individuals is not possible but is more promising for that of the caries risk of groups (e.g., identification of high-caries-risk subjects); further, the prediction of low caries risk may be more reliable than that of high caries risk. The influence of test variables on the test results has been discussed. These include the level of caries increment, subject age, methods of caries evaluation, use of saliva or dental plaque as test sample, sampling frequency, type of bacterial growth medium, and the use of simplified methods rather than conventional laboratory procedures for microbial enumeration. An approach to optimize the use of microbiological caries-risk predictors in different populations as well as their use in conjunction with other caries-risk predictors has been discussed. The latter include the incipient caries lesion or past caries experience and salivary buffering capacity and flow rate. Due to the multifactorial nature of caries etiology, it is expected that multivariate approaches rather than the use of single parameters may improve caries risk prediction for individuals as well as groups of subjects. [References: 102] <19> UI - 94061906 AU - Lussi A IN - Department of Operative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland. TI - Comparison of different methods for the diagnosis of fissure caries without cavitation. SO - Caries Research 1993;27(5):409-16 AB - The aim of this study was to compare the accuracy of several common methods for the diagnosis of fissure caries. 63 human teeth without fillings and without any macroscopic carious cavitation but with different degrees of fissure discoloration and decalcification were selected from a pool. Dentists were asked to examine embedded teeth for fissure caries. The examination was done under standard conditions in a professional dental unit. The methods employed were: visual inspection (VI, n = 26 dentists), visual inspection with a magnifying glass (2x; VIM; n = 26), conventional bite-wing radiography (BW; n = 24), visual inspection combined with conventional bite-wing radiography (VI + BW; n = 10), and visual inspection combined with light pressure probing (VI + P; n = 23 dentists). In order to measure the reproducibility, VI and VI + BW were repeated. After the last inspection, the teeth were histologically prepared, serially sectioned perpendicular to the occlusal surface, and diagnosed for the presence of caries. The agreement between histological and clinical diagnosis was assessed. Specificities and sensitivities were: VI = 93 and 12%, VIM = 89 and 20%, BW = 83 and 45%, VI + BW = 87 and 49%, and VI + P = 93 and 14%, respectively. The following likelihood ratios were found: VI = 1.84, VIM = 1.86, BW = 2.6, VI + BW = 3.85, and VI + P = 2.05. It was concluded that the rather low sensitivity especially for VI and VI + P may lead to a significant number of teeth with dentinal caries being undetected.(ABSTRACT TRUNCATED AT 250 WORDS) <20> UI - 94037925 AU - Verdonschot EH AU - Wenzel A AU - Bronkhorst EM IN - Department of Cariology and Endodontology, TRIKON, The Netherlands. TI - Applicability of Receiver Operating Characteristic (ROC) analysis on discrete caries depth ratings. SO - Community Dentistry & Oral Epidemiology 1993 Oct;21(5):269-72 AB - Accuracy of diagnostic tests for caries detection is frequently evaluated by sensitivity and specificity values obtained from data acquired on an ordinal rating scale which classifies lesions according to the depth in enamel and dentin. The interpretation of these parameters may, however, be difficult. Receiver Operating Characteristic (ROC) analysis, on the other hand, yields an expression for overall diagnostic accuracy in a single parameter, facilitating a comparison of performance of several diagnostic tests. The basis for applying ROC analysis has been that data were collected on a confidence (likelihood) scale. The aim of this preliminary study was to investigate whether the application of ROC analysis would yield as valid parameters for diagnostic accuracy in assessment of approximal caries on a depth rating scale as on a likelihood rating scale. The results demonstrated that the accuracy of observer performance was not influenced by the type of rating scale employed, justifying the application of ROC analysis on discrete caries depth ratings. <21> UI - 94055639 AU - Glantz PO AU - Nilner K AU - Jendresen MD AU - Sundberg H IN - Department of Prosthetic Dentistry, Faculty of Odontology, University of Lund, Malmo, Sweden. TI - Quality of fixed prosthodontics after 15 years. SO - Acta Odontologica Scandinavica 1993 Aug;51(4):247-52 AB - Interviews and/or clinical examinations by means of the California Dental Association quality evaluation system were carried out in a group of persons who had received extensive restorative treatments with fixed partial dentures 15 years before this study. The studied group consisted of 77 persons who agreed to participate from an original group of 150 persons selected at random from the Swedish Dental Insurance System records. Of the original group 20 had died, 17 were not traceable or not able to participate for medical reasons, and 36 declined to participate. Thirty-two per cent of the recorded reconstructions had been lost, and 8% partially lost during the 15-year period. Thirty-five per cent of the reconstructions were rated as Satisfactory, whereas the remaining ones had mixed clinical quality ratings. Failures and Not Acceptable quality ratings were found to be caused mainly by fractures, loss of retention, and/or dental caries. <22> UI - 94006442 AU - Johnson MF IN - Biostatistics, G.H. Besselaar Associates, Princeton, NJ 08540. TI - Comparative efficacy of NaF and SMFP dentifrices in caries prevention: a meta-analytic overview. SO - Caries Research 1993;27(4):328-36 AB - An overview was conducted of all randomized, controlled studies comparing NaF to SMFP dentifrices in the prevention of caries development. Data from these separate trials were subjected to a pooling procedure, or meta-analysis, in order to obtain a more stable estimate of comparative treatment efficacy and to aid in interpreting the generalizability of results. Based on a pool of studies involving over 7,000 subjects, NaF was associated with a significantly greater reduction in caries development compared to SMFP. The increment in D(M)FS was reduced an average of 0.28 (95% confidence limits 0.10 to 0.46) with the use of NaF as compared to SMFP over a 2- to 3-year follow-up period. This difference represents a 6.4% reduction in the rate of caries development observed with SMFP. The numerical advantage conferred by NaF over SMFP in caries risk reduction must be judged clinically as to its public health implications. Alternative analytic techniques and rules for including studies in the pooling process yielded consistent conclusions. A similar analysis of data from dual-active studies indicated that NaF in combination with SMFP provides greater lowering of the D(M)FS increment (approx. 0.16 over 2-3 years) compared to SMFP at the same total fluoride dose, whereas the dual-active product demonstrated no advantage over NaF alone. <23> UI - 94006439 AU - Rudolphy MP AU - van Amerongen JP AU - Penning C AU - ten Cate JM IN - Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. TI - Validity of bite-wings for diagnosis of secondary caries in teeth with occlusal amalgam restorations in vitro. SO - Caries Research 1993;27(4):312-6 AB - This investigation was carried out to establish the validity of bite-wing radiographs for the diagnosis of secondary caries in teeth with occlusal amalgam restorations. One hundred and fifty-nine extracted molars with occlusal amalgam fillings and characteristics that might be indicative of the presence of secondary caries were selected. The characteristics were a blueish-gray discolouration of enamel, a brownish discolouration of the amalgam-enamel margin, marginal breakdown of the restoration, and/or deep fissures at the margin of the restoration. The teeth were radiographed in a bucco-lingual direction to obtain images comparable to bite-wings. Subsequently, the crowns were sectioned (700 microns) and glued on plastic sheets. The sections were recorded radiographically and then examined by independent examiners. Radiolucencies as well as radiopacities adjacent to the restoration were considered to be caries. The validation of the bite-wing radiographic diagnosis was achieved by comparison with the radiographs of the sections. A sensitivity of 64% and a specificity of 98% were calculated. Large lesions were always visible on the bite-wing radiograph (100%), the majority of medium-sized lesions (89%) and 40% of small lesions. Small radiopacities were detected more often than small radiolucencies. <24> UI - 94006438 AU - Peers A AU - Hill FJ AU - Mitropoulos CM AU - Holloway PJ IN - University Dental Hospital of Manchester, UK. TI - Validity and reproducibility of clinical examination, fibre-optic transillumination, and bite-wing radiology for the diagnosis of small approximal carious lesions: an in vitro study. SO - Caries Research 1993;27(4):307-11 AB - This study measured validity and reproducibility of unaided clinical diagnosis, fibre-optic transillumination (FOTI), and bite-wing radiology in the diagnosis of approximal caries. Sixty models were made using extracted premolars and molars, each containing four teeth with six contacting approximal surfaces. The teeth were examined first using unaided clinical examination and then using FOTI. Bite-wing radiographs were then taken of the teeth set in the models and examined. The three examinations were repeated after 1 week. Histological sections of the undecalcified teeth were prepared following their removal from the models, and those showing signs of caries were examined to give the valid state of disease in each surface. The diagnostic threshold was caries penetrating into dentine. The reproducibility of all three methods was acceptable with kappa values exceeding 0.6. All specificity values exceeded 0.95. Statistically significant differences were seen between sensitivities for clinical (0.38) and bite-wing (0.59) diagnosis and between clinical and FOTI (0.67) examination, but not between bite-wing and FOTI. It is concluded that the validity of FOTI is at least as high as that of bite-wing radiology, and both are superior to unaided clinical diagnosis. <25> UI - 94006433 AU - Benelli EM AU - Serra MC AU - Rodrigues AL Jr AU - Cury JA IN - Dentistry School of Piracicaba, State University of Campinas, Brazil. TI - In situ anticariogenic potential of glass ionomer cement. SO - Caries Research 1993;27(4):280-4 AB - The purpose of this study was to compare the amount of fluoride in plaque formed on glass ionomer cement or composite and to evaluate the effects of fluoride released on growth of cariogenic microflora, fluoride uptake, and secondary caries formation under in situ conditions of a high cariogenic challenge. Ten adult volunteers took part in this crossover study performed in two phases of 28 days. Eighty enamel blocks were randomly restored with glass ionomer cement (Chelon-Fil-Espe) or composite (Silux). During each phase of the study, an acrylic resin appliance, containing four enamel blocks restored with the same material, was constructed for each of the volunteers. During the experimental period, all subjects used fluoride-free dentifrice, refrained from brushing the restored enamel blocks, and immersed the appliances into 20% sucrose solution eight times a day. Fluoride levels, mutans streptococci, and lactobacilli were assessed in dental plaque. Fluoride uptake and microhardness profiles were determined in enamel around the restorations. Statistical analyses indicated a significantly higher level of fluoride (p < 0.05) and a lower level of mutans streptococci plaque formed on glass ionomer cement. Analysis of variance in a split-plot model indicated that in the enamel around the glass ionomer restoration the fluoride uptake was significantly greater (p < 0.025) and the mineral loss significantly lower (p < 0.01). The results show that glass ionomer cement presents a broad anticariogenic effect and may be of value in preventing secondary caries, even under conditions of a high caries risk. <26> UI - 93387789 AU - Benedetti-Panici P AU - Scambia G AU - Baiocchi G AU - Maneschi F AU - Greggi S AU - Mancuso S IN - Department of Obstetrics and Gynecology, Catholic University, Rome, Italy. TI - Radical hysterectomy: a randomized study comparing two techniques for resection of the cardinal ligament. SO - Gynecologic Oncology 1993 Aug;50(2):226-31 AB - To compare two different surgical techniques for the resection of the cardinal ligaments during radical operation for cervical cancer, 84 patients with locally advanced cervical cancer (FIGO stages IB-IIA > or = 4 cm, IIB-III) primarily treated with chemotherapy and then eligible for radical surgery underwent radical hysterectomy. Lateral parametria were resected by using the Meigs technique or a modified Magara technique. The procedure to be performed on the right hand side was randomly chosen, consequently the left cardinal ligament was resected with the other technique. Evaluation of the first 35 cases showed that the median size of the parametria resected with the modified Magara technique (52 mm) was significantly greater than that removed with the Meigs technique (34 mm) (P < 0.05). Therefore hemoclips were routinely adopted in the following 49 cases. In 11% of cases hemoclips could not be used due to a deep and narrow pelvis or varicosities of the hypogastric plexus, therefore clamps were necessary. Bleeding complicating parametrial dissection occurred independently of the adopted technique. Five-years DFS is 100, 80, and 52% for stage IB-IIA > 4 cm, IIB and III, respectively. The study showed that the modified Magara technique is feasible and safe and allows for a more radical resection of the parametrial tissue. Furthermore, this approach seems to improve the local control of disease. <27> UI - 93380287 AU - Verdonschot EH AU - Wenzel A AU - Bronkhorst EM IN - Department of Cariology and Endodontology, University of Nijmegen, The Netherlands. TI - Assessment of diagnostic accuracy in caries detection: an analysis of two methods. SO - Community Dentistry & Oral Epidemiology 1993 Aug;21(4):203-8 AB - The quality of a diagnostic tool for caries detection is usually evaluated by quantification of observer performance using sensitivity and specificity values calculated from data obtained from ordinal caries depth rating scales. The application of Receiver Operating Characteristic (ROC) analysis has been restricted to the use of confidence rating scales. The aim of this investigation was to study the appropriateness of ROC analysis using caries depth ratings by comparing sensitivity and specificity values to parameters of diagnostic performance obtained by ROC analysis. In two recent reports, sensitivity and specificity values were utilized to express diagnostic accuracy of observer performance from specified caries diagnostic systems. The raw data from these investigations were subjected to ROC analysis in the current study. The results illustrated that ROC analysis, producing estimates of sensitivities for all specificities, yielded more comprehensive measures of diagnostic performance than single values for sensitivity and specificity. In particular, the area under the ROC curve constituted a clearly interpretable parameter representing the quality of diagnostic performance. <28> UI - 93305545 AU - Anonymous TI - Prognostic value of Helix pomatia in breast cancer. International (Ludwig) Breast Cancer Study Group. SO - British Journal of Cancer 1993 Jul;68(1):146-50 AB - Six hundred and eighty-four primary breast cancers from the International (Ludwig) Breast Cancer Study Group (IBCSG) were studied for Helix pomatia lectin (HPA) binding. There was a weak correlation between lymph node-positive and HPA positive (P = 0.04). In our series there was a large advantage in disease-free survival (DFS) and overall survival (OS) for node-negative patients (P < 0.0001 DFS and OS). However, there was no such advantage for HPA-negative patients (P = 0.23 DFS and P = 0.32 OS). We conclude that in this randomised patient group HPA is of no clinical predictive value. <29> UI - 93294787 AU - McGuire SM AU - Fox CH AU - Douglass CW AU - Tennstedt SL AU - Feldman HA IN - Harvard School of Dental Medicine, Department of Dental Care Administration, Boston, MA 02115. TI - Beneath the surface of coronal caries: primary decay, recurrent decay, and failed restorations in a population-based survey of New England elders. SO - Journal of Public Health Dentistry 1993 Spring;53(2):76-82 AB - A cross-sectional study was conducted of the oral health status of a random sample of community dwelling elders, aged 70 and older, living within the six New England states. Four examining teams, each composed of a trained and calibrated dentist and a field technician, collected data during an in-home oral examination. The prevalence of carious, filled, recurrent decayed, and non-carious but failed restored coronal surfaces was recorded. For the 1,151 respondents, the mean DFT was 6.16 (SD = 6.96) and the mean DFS was 18.83 (SD = 23.37), with 37.6 percent of the sample edentulous. Eleven percent of the population had 70 percent of the coronal decay. Males (OR = 2.2, CI = 1.3-3.8) and elders with less education (OR = 1.8, CI = 1.0-3.0) were at higher risk for three or more surfaces of coronal decay. Recurrent decay was present in 16 percent of the dentate population. However, more noncarious but failed restored coronal surfaces (332) were recorded in the population of New England elders than were surfaces of recurrent decay (234). The New England elders have higher rates of decay than New England children, although the rates matched those of previous national studies. The findings signal a need to develop targeted preventive regimens for older adults and greater understanding of dental treatment needs of elders. <30> UI - 93288478 AU - Bretz WA AU - Krahn DD AU - Drury M AU - Schork N AU - Loesche WJ IN - Department of Cariology and General Dentistry, School of Dentistry, University of Michigan, Ann Arbor. TI - Effects of fluoxetine on the oral environment of bulimics. SO - Oral Microbiology & Immunology 1993 Feb;8(1):62-4 AB - The purpose of this study was to evaluate in a double-blind placebo-based study the effects of fluoxetine over a period of 16 weeks on the frequency of binging and purging and on fluctuations in the levels of cariogenic organisms and saliva secretion rate of patients (n = 30) with bulima nervosa. Profile analysis suggested that, over the course of the study, binging and purging frequency and Streptococcus sobrinus salivary levels decreased significantly in the fluoxetine group as compared with the placebo group. Our finding that S. sobrinus levels decreased 16 weeks after subjects were on medication suggests that the salivary levels of these organisms could serve as an objectively measured indicator of patient compliance with antibulimic therapy. <31> UI - 93285394 AU - Svenson B AU - Petersson A IN - Department of Oral Radiology, Postgraduate Dental Education Center, Orebro, Sweden. TI - Assessment of a new processor containing a self-cleaning synthetic-web transport mechanism. SO - Dento-Maxillo-Facial Radiology 1993 Feb;22(1):25-7 AB - The effect of two different types of automatic X-ray processing machines (a roller-based Pantomat P10 and the Velopex which has a novel web transport system) on the accuracy of radiographic diagnosis of caries in extracted premolars was evaluated. Seven observers graded the occurrence of caries and their findings were compared with actual prevalence of the disease. The accuracy was measured with the ROC technique. Kodak Ektaspeed dental X-ray film was used. The results showed no significant differences in diagnostic accuracy between the two developing machines. The Velopex gave a check pattern to the films, but it was not so marked as to have a major influence on diagnostic accuracy. <32> UI - 93301224 AU - Wenzel A AU - Pitts N AU - Verdonschot EH AU - Kalsbeek H IN - Department of Oral Radiology, Royal Dental College Aarhus, Denmark. TI - Developments in radiographic caries diagnosis. [Review] [91 refs] SO - Journal of Dentistry 1993 Jun;21(3):131-40 AB - The developments that have been taking place in radiographic caries diagnosis, within the context of the changes occurring in both the disease process and the available technology, are reviewed. The decline in caries prevalence seen in many western countries has been accompanied by changes in the pattern and behaviour of lesions. More lesions are now seen on occlusal surfaces, more are concealed (and thus imperceptible to conventional diagnostic techniques), while the average progression rates for approximal lesions have also slowed. Systems employed for caries diagnosis must take account of these changes and the varying needs of users employing different diagnostic thresholds. This paper reviews and discusses developments in: conventional film radiography; xeroradiography; indirect digital imaging (with computer image analysis and subtraction radiography), and direct digital imaging. It is concluded that: for the detection in high caries prevalence groups of both approximal caries (especially small lesions in enamel) and dentinal occlusal lesions in teeth with little or no surface breakdown, radiography is still a significant and reasonably accurate diagnostic method; and that, in spite of the more limited resolution, digital imaging methods seem to perform as well or better than conventional film radiography. Digital systems possess a number of advantages, primarily the possibility for image enhancement and significant dose reduction. It may be predicted that digital imaging techniques will enter the clinical routine in the near future. [References: 91] <33> UI - 93283239 AU - Dufour P AU - Lang JM AU - Giron C AU - Duclos B AU - Haehnel P AU - Jaeck D AU - Jung JM AU - Oberling F IN - Service Onco-Hematologie, CHU de Hautepierre, Strasbourg, France. TI - Sodium dithiocarb as adjuvant immunotherapy for high risk breast cancer: a randomized study. SO - Biotherapy 1993;6(1):9-12 AB - Sixty-four patients with non metastatic high risk breast cancer were randomized in a double blind trial of adjuvant immunotherapy with sodium dithiocarb (DDC) versus placebo. All patients underwent prior surgery (mammectomy according to Patey) then adjuvant FAC chemotherapy +/- DDC. With a median follow-up of 5 years we observed 6 relapses and 5 deaths in DDC group; 13 relapses and 12 deaths in control group. At 6 years, overall survival is 81% in DDC group versus 55%. Disease free survival (DFS) is 76% in DDC group versus 55%. DDC associated to chemotherapy and locoregional treatment can improve survival and probably DFS in this high risk breast cancer subgroup. <34> UI - 93298689 AU - Hupperets PS AU - Wils J AU - Volovics L AU - Schouten L AU - Fickers M AU - Bron H AU - Schouten HC AU - Jager J AU - Smeets J AU - de Jong J AU - et al IN - Department of Internal Medicine, Academic Hospital Maastricht, The Netherlands. TI - Adjuvant chemohormonal therapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) with or without medroxyprogesterone acetate for node-positive breast cancer patients. SO - Annals of Oncology 1993 Apr;4(4):295-301 AB - BACKGROUND: The Comprehensive Cancer Center trial 82-01 is a prospective randomized study to investigate the value of the addition of high-dose medroxyprogesterone acetate (MPA) to chemotherapy in patients with node-positive operable breast cancer. MPA may be of advantage in this setting because of its activity in estrogen receptor ER-positive as well as ER-negative tumors and since it may protect against chemotherapy-induced myelosuppression and thus enable maintenance of the appropriate chemotherapeutic scheduling. PATIENTS AND METHODS: Four hundred eight evaluable patients with node-positive (N+) operable breast cancer (T1-3, N1) were entered in a multicenter randomized trial. Two hundred nine patients were randomized in the MPA- arm and 199 in the MPA+ arm. CAF chemotherapy was given as a short i.v. bolus infusion: cyclophosphamide 500 mg/m2 i.v. day 1, doxorubicin 40 mg/m2 i.v. day 1, and 5-fluorouracil 500 mg/m2 i.v. day 1, q 4 wks x 6. MPA was given intramuscularly (i.m.) 500 mg q d x 28 days, followed by 500 mg i.m. twice weekly during 5 months. RESULTS: The main side effects of MPA were weight gain with a mean of 5.5 kg as opposed to 1.8 kg in the control group (p = 0.01) and vaginal bleeding in 30/199 in the MPA+ group and 0 in the MPA- group. MPA ameliorated vomiting grade III, IV (45% vs. 28%, p < 0.001), nausea grade III, IV (50% vs. 34%, p < 0.001) and leucocyte nadir grade III, IV (20% vs. 11%, p = 0.003). Disease-free survival (DFS) after 5 years was 59% in the MPA+ and 49% in the MPA- group (p = 0.12). Patients > or = 60 years benefitted most from MPA treatment, in particular if freedom from distant metastases was taken as the endpoint (p = 0.02). Overall survival (OS) was not significantly different between the two treatment groups (p = 0.18), but within subgroups analysed there was an advantage for MPA+ in patients > or = 55 years (p = 0.002) and in pT1 patients (p = 0.045). CONCLUSIONS: High-dose MPA ameliorates CAF side effects and reduces the risk of metastatic disease, especially in elderly breast cancer patients. <35> UI - 93251784 AU - Locker D IN - Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Effects of non-response on estimates derived from an oral health survey of older adults. SO - Community Dentistry & Oral Epidemiology 1993 Apr;21(2):108-13 AB - A major source of bias in health surveys is non-response on the part of those selected to take part in a study. In a survey of the oral health of older adults in Ontario, Canada, we used an initial telephone survey based on random digit dialing with a personal interview and clinical examination follow-up. The telephone survey was completed by 3033 individuals (78.0%) of those sampled. The follow-up was completed by only 907 (30.0%) of these subjects. Nevertheless, there were no major differences in the characteristics of those completing the telephone survey and those subsequently participating in the follow-up. Non-response bias analysis indicated that differences between crude and adjusted estimates of the prevalence of oral conditions were small and the effect of non-response on estimates of the relationship between socioeconomic status and oral health in this population were also small. These results indicate that response rates lower than those conventionally regarded as acceptable do not necessarily compromise the results of epidemiological studies. <36> UI - 93257727 AU - Isacson R AU - Safra T AU - Ben-Dor CG AU - Uziely B AU - Brufman G IN - Department of Clinical Oncology, Hadassah University Hospital, Jerusalem, Israel. TI - A preliminary report of a pilot randomized trial comparing cyclophosphamide, methotrexate and 5-fluorouracil with cyclophosphamide, mitoxantrone and 5-fluorouracil in the adjuvant therapy of stage II breast cancer with four or more positive axillary nodes. SO - Anti-Cancer Drugs 1993 Apr;4(2):189-92 AB - Thirty-eight patients with stage II breast cancer with four or more positive axillary lymph nodes were randomized to receive CMF (cyclophosphamide, methotrexate and 5-fluorouracil, every 3 weeks) or CXF (cyclophosphamide, mitoxantrone and 5-fluorouracil, every 3 weeks). Pretreatment characteristics were similar for both groups. The actuarial 5 year disease-free survival (DFS) was 36% for the CMF group and 23% for the CXF group. The actuarial 5 year survival was 60% for the CMF arm and 66% for the CXF arm. These differences were not statistically significant. Partial alopecia was observed in 42% of patients in the CMF arm and in 100% of those receiving CXF (p = 0.0002). No episodes of leucopenic fever were observed in patients receiving CMF, while they were present in 53% of patients treated with CXF (p = 0.0006). No stomatitis occurred in the CMF group, but it was observed in 90% of patients who received CXF (p < 0.0001). Treatment with CXF had to be discontinued in two patients because of toxicity. In this small group of patients with poor prognosis, it seems that CXF at the doses given here is more toxic but not more effective than CMF, as represented by a similar DFS and survival. <37> UI - 93236222 AU - Reintgen D AU - Cox C AU - Greenberg H AU - Baekey P AU - Nicosia S AU - Berman C AU - Clark R AU - Lyman G IN - Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa 33620. TI - The medical legal implications of following mammographic breast masses. SO - American Surgeon 1993 Feb;59(2):99-105 AB - Delay in breast cancer diagnosis continues to account for the highest percentage of medical malpractice cases in the United States. A retrospective, computer-aided study was undertaken to investigate a number of parameters used in making medical-legal decisions in missed breast cancer cases. Over a 5-year period, 435 women with invasive breast cancers were registered at the Comprehensive University Breast Cancer Center. A close correlation between mammographic and final histologic size was verified (R = 0.74). In 5-mm increments, starting with a 1.0-mm tumor, there was an increasing percentage of positive nodes identified with increasing size of the tumor. Major percentage increases in frequency of positive nodes were noted at tumor sizes of 11 and 21 mm. This corresponded to an increasing number of recurrences and a decreasing 5-year disease-free survival (DFS) between consecutive 5-mm increments, although the differences were not significant. A multivariate regression analysis confirmed that the most important predictor of DFS was lymph node status (p = 0.0046) and not tumor size. After adjusting for lymph node status, tumor size was not significant. It is concluded that a period of observation, in which a breast cancer may increase in size is not substandard care since tumor size, after accounting for lymph node status is not significant at predicting DFS. <38> UI - 93187677 AU - Kaufmann M AU - Jonat W AU - Abel U AU - Hilfrich J AU - Caffier H AU - Kreienberg R AU - Trams G AU - Brunnert K AU - Schermann J AU - Kleine W AU - et al IN - Gynecological Adjuvant Breast Group, Germany. TI - Adjuvant randomized trials of doxorubicin/cyclophosphamide versus doxorubicin/cyclophosphamide/tamoxifen and CMF chemotherapy versus tamoxifen in women with node-positive breast cancer. SO - Journal of Clinical Oncology 1993 Mar;11(3):454-60 AB - PURPOSE: We report two randomized trials of adjuvant systemic therapy in 747 patients < or = 65 years of age with histologically proven node-positive breast cancer. PATIENTS AND METHODS: Patients were selected for the two trials on the basis of lymph node and hormone receptor status. The only stratification was based on the treating institution. In patients with a lower probability of recurrence (n = 276), a comparison between endocrine therapy (tamoxifen [Tam] 30 mg/d for 2 years) and chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF] intravenously [IV], six cycles every 4 weeks) was performed. In patients with a higher risk of recurrence (n = 471), a comparison between chemotherapy alone (doxorubicin plus cyclophosphamide [AC] i.v., eight cycles every 3 weeks) and the same chemotherapy plus Tam was made. RESULTS: Overall, we found that CMF and Tam are equally effective in a subgroup of patients with a relatively good prognosis (low-risk patients). However, in the subset of women < or = 49 years old, a significantly greater disease-free survival (DFS) rate (P = .01) and overall survival (OS) rate (P = .002) was observed following therapy with CMF compared with Tam. In patients > or = 50 years old, the opposite was found, and Tam appeared to be superior to CMF (DFS, P = .003; OSm P = .5). These results must be interpreted cautiously, since a post-hoc stratification of patients by age (< or = 49, > or = 50) was performed, and significantly more younger, low-risk patients were randomized to receive chemotherapy alone and more older patients to receive Tam alone. Among patients with a relatively poor prognosis (high-risk patients), a combination of AC plus Tam was equivalent to AC and, when women were analyzed by age, this was found to be true of patients < or = 49 years as well. However, the addition of Tam to AC in women age > or 50 years resulted in a statistically significantly higher DFS (P = .01) and a trend toward better OS compared with women who received AC alone. CONCLUSION: Further trials are required to analyze the role of combined simultaneous or sequential chemoendocrine adjuvant treatment or each single therapy alone in defined risk-adapted subsets of node-negative and node-positive patients. <39> UI - 93164043 AU - Drake CW AU - Hunt RJ AU - Beck JD AU - Zambon JJ IN - Department of Diagnostic Sciences, University of North Carolina, Chapel Hill. TI - The distribution and interrelationship of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and BANA scores among older adults. SO - Journal of Periodontology 1993 Feb;64(2):89-94 AB - In a random sample of subgingival dental plaque samples from 375 blacks and 300 whites aged 65 and older, immunofluorescence assays for 3 target pathogens including Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia, and BANA enzyme analysis were carried out. Blacks had significantly greater proportions of P. gingivalis and P. intermedia in their subgingival plaque and had significantly higher BANA scores. These assay results were investigated for concordance with each other and with 2 cariogenic salivary bacteria, Streptococcus mutans and lactobacilli. In general for both races, the periodontal pathogens were more likely to occur in combination with each other than with either S. mutans or lactobacilli. P. gingivalis and P. intermedia were more frequently associated with each other than with A. actinomycetemcomitans. There was a significant negative concordance between BANA and A. actinomycetemcomitans in whites and a significant positive concordance between BANA and P. intermedia in blacks. <40> UI - 93228924 AU - Wendt SL Jr AU - Leinfelder KF IN - UCONN Health Center, School of Dental Medicine, Department of Restorative Dentistry and Endodontology, Farmington, CT 06032. TI - Clinical evaluation of a heat-treated resin composite inlay: 3-year results. SO - American Journal of Dentistry 1992 Oct;5(5):258-62 AB - The purpose of this study was to evaluate a resin composite inlay system in clinical trials involving human subjects. A total of 60 restorations were inserted equally in Class I and II preparations and in premolars and molars. A glass ionomer liner was applied to the dentin. Light-cured direct inlays were fabricated in the oral environment. Thirty inlays were heat-treated for 7.5 minutes at 125 degrees C in a dry heat oven. Enamel margins of the preparations were etched with 37% phosphoric acid gel. All inlays were cemented with a light-cured enamel bonding resin. Restorations were evaluated using the USPHS system and M-L indirect scale. Six, 12, 24 and 36-month recalls were compared to baseline. Color, interfacial staining, secondary caries, and wear were unchanged from baseline for all restorations. Marginal integrity and surface texture show a differential change from baseline and with respect to restoration type. Indirect wear was not significantly different between restoration types (P < 0.05). Wear resistance was not significantly improved with heat treatment, but marginal integrity and surface characteristics showed marked improvement in the heat-treated group at 24 and 36-month recalls. <41> UI - 93178744 AU - Freilich MA AU - Goldberg AJ AU - Gilpatrick RO AU - Simonsen RJ IN - University of Connecticut, School of Dental Medicine, Farmington. TI - Three-year occlusal wear of posterior composite restorations. SO - Dental Materials 1992 Jul;8(4):224-8 AB - The specific aims of this study were to: 1) measure the occlusal wear of four different dental composite materials placed in the posterior teeth of adults; and 2) evaluate the effect of the clinical parameters, cavity class and tooth type on occlusal wear. Four different visible light-cured composite materials were used to make the restorations in this study. The restorations placed for this randomized clinical trial were scored through the use of an indirect evaluation system (M-L scale). The total sample size per recall ranged from 90 to 142 restorations from baseline to 36 months. The mean wear at 36 months for Heliomolar, J&J Experimental (Adaptic II) and P-30 was 45-54 microns, which is rather low compared to the recently reported wear of other composite materials. Marathon exhibited significantly greater wear with a mean of 174 microns at 36 months. The data also showed that cavity class and tooth type had no significant effect on the occlusal wear of the restorations made with the three low wear-rate materials, while restorations composed of the high wear-rate material exhibited more wear in molars than premolars; this effect was again not statistically significant. These data support the hypothesis that the overall wear of a composite restoration is more dependent on the material's properties than clinical parameters such as cavity class and tooth type. <42> UI - 93193120 AU - Penning C AU - van Amerongen JP AU - Seef RE AU - ten Cate JM IN - Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. TI - Validity of probing for fissure caries diagnosis. SO - Caries Research 1992;26(6):445-9 AB - One hundred extracted molar teeth with discoloured fissures but without any visible carious cavitation were selected from a large supply, using standardized criteria. The teeth were mounted, placed on a mechanical balance, and probed with a force of 500 g in every fissure, at as many places as possible. Every time the probe was found to stick, the spot was marked. After probing colour slides were made of the occlusal faces. Subsequently, the crowns were embedded in epoxy resin. 700 microns thick sections were cut in a facial-lingual direction with a diamond wheel. From the sections X-rays were taken which were scored as follows: a measuring grid was placed on the X-ray image of a section, and the caries score (0-4) for every millimetre was determined. By scoring every section of a tooth in this way, an overview was obtained of the location of all caries lesions in the occlusal surface. By comparing this overview with the colour slide of the tooth, the relationship between the sticky spots and the lesions was visualized. The results indicate that only 24% of the caries lesions were discovered by probing for stickiness (low sensitivity), but that the probe seldom stuck in a sound fissure (high specificity, > 99%). Probing proved to be unreliable for the diagnosis of fissure caries. <43> UI - 93139342 AU - Anusavice KJ IN - Department of Dental Biomaterials, College of Dentistry, University of Florida, Gainesville 32610-0446. TI - Decision analysis in restorative dentistry. [Review] [74 refs] SO - Journal of Dental Education 1992 Dec;56(12):812-22 AB - Standardization of clinical decisions in restorative dentistry should be based on the tenets of the Hippocratic Oath. Although there is wide variability in preventive and operative treatment decisions, some of these decisions may lead along parallel courses to similar, clinically ethical outcomes. However, what parameters must be considered in judging the relative magnitude of positive and negative outcomes? This paper proposes several decision-making strategies for selecting optimum treatment plans for preventive and restorative situations. The caries-risk level of patients must first be identified in a systematic way and then it must be coupled with treatment options that are consistent with the potential future caries increment. A decision-tree approach and/or the treatment-index concept can then be applied to specific clinical conditions and preventive-restorative options to derive an "expected value" for each possible outcome. [References: 74] <44> UI - 93139344 AU - Hollender L IN - University of Washington, Department of Oral Medicine, Seattle 98195. TI - Decision making in radiographic imaging. [Review] [33 refs] SO - Journal of Dental Education 1992 Dec;56(12):834-43 AB - In 1987, the U.S. Department of Health and Human Services issued guidelines for prescription of dental radiographic examinations, and although these recommendations have been reprinted in several widely circulated publications, it seems that the adoption of these guidelines is far from common, even among U.S. dental schools. The recommended criteria are founded on the existing knowledge of prevalence and progression of the most common dental diseases and on the fact that occult diseases within the jaws are uncommon. There are, however, other factors that may influence the decision on the time and extent of a radiographic examination, which may lead to deviations from the suggested guidelines. These factors include: education, peer influence, patient's preference, legal considerations, the dentist's field of interest or specialty, the training of the staff, and practice routine. The diagnostic interpretation of radiographs is far from a completely objective process, even if it is a question as simple as the presence and/or extent of a carious lesion. Numerous studies have shown a large variation among observers, both with regard to the occurrence and extent of carious lesions, in bite-wing radiographs. Caries diagnosis is only one example of many situations where significant observer variation is found. The more complex the diagnostic task, the more variation can be expected. The effect of observer variation on treatment decisions regarding carious lesions is used as an example of the problems encountered daily in the dental practice. [References: 33] <45> UI - 93137132 AU - Haugejorden O AU - Klock KS IN - Department of Community Dentistry, University of Bergen, Norway. TI - The relative importance of reasons for tooth extraction in terms of potential tooth years of life lost (PYLL). SO - Community Dental Health 1992 Dec;9(4):369-79 AB - The aim of the present study was to introduce the potential tooth years of life lost (PYLL) approach to the analysis of data showing the incidence of tooth extraction according to the reason for extraction and to illustrate its use. Six sets of data from prospective nationwide questionnaire surveys of patients treated by systematic random samples of dentists in five European countries were translated into PYLL. Response rates ranged from 25 to 81 per cent and the number of extracted teeth from 959 to 29,397, according to the study. PYLL in Norway 1988 was calculated using the ages of 85 and 80 as cut-off points, or the average sex-specific remaining life expectancy at the age of extraction; otherwise the age of 85 was used. Mean PYLL for all reasons varied from 40.6 to 46.3 years for Norway in 1988 depending on the cut-off point used. For patients aged 21 and older PYLL85 ranged from 35.7 years for France in 1984 to 42.3 years for Sweden in 1959-61. Employing PYLL changed the rank order of the reasons for extraction based on the number of extracted teeth in some instances. It combined the two dimensions 'incidence of 'potential years of tooth function lost' into a continuous quantitative variable which was easy to understand and simple to handle analytically. <46> UI - 93084932 AU - Barr C AU - Lopez MR AU - Rua-Dobles A IN - Beth Israel Medical Center, Department of Dental Medicine, New York, NY 10003. TI - Periodontal changes by HIV serostatus in a cohort of homosexual and bisexual men. SO - Journal of Clinical Periodontology 1992 Nov;19(10):794-801 AB - These data represent 20 months of follow-up on 114 homo/bisexual men. Periodontal changes were analyzed in relation to HIV-1 serostatus, immune status, age and plaque. Gingival index (GI), plaque index (PI), and relative attachment levels recorded by the computerized Florida disk probe were performed every 4 months. A threshold of > or = 3.0 mm of relative attachment loss (RAL) was selected as a significant longitudinal change. RAL > or = 3 mm occurred 6.16 times (95% CI = 1.95, 19.40) more frequently among subjects with T4 counts < 200 compared to subjects with counts of 200 or more. Among older subjects (age > or = 35 years), the incidence (33%) of RAL > or = 3 mm was significantly higher (p = 0.004) in more immunosuppressed subjects (T4 < 200) compared to the incidence (5%) in less immunosuppressed subjects (T4 > or = 200); this association was not significant in younger subjects less than 35 years old (p = 0.55). In 78 subjects present at all follow-up visits, averaged GI increased and were significantly higher in the seropositive subjects compared to seronegative subjects, but, GI was not related to T4 cell counts within the seropositive group. Separate linear regression of GI by PI by HIV serostatus revealed a significantly higher slope in the seropositive group compared to the seronegative group (p = 0.04), suggesting greater sensitivity to plaque in the seropositive group. Conclusion: immunosuppression, especially in combination with older age, may be a risk factor for attachment loss, and HIV seropositivity, independent of T4 cell counts, may be a risk factor for gingival inflammation. <47> UI - 93068646 AU - Stiefel DJ AU - Truelove EL AU - Chin MM AU - Mandel LS IN - Department of Oral Medicine, University of Washington, Seattle. TI - Efficacy of chlorhexidine swabbing in oral health care for people with severe disabilities. SO - Special Care in Dentistry 1992 Mar-Apr;12(2):57-62 AB - Chlorhexidine is effective when used as an oral rinse, but many disabled people cannot use such a protocol. A double-blind cross-over study tested the efficacy of applying chlorhexidine with a sponge-swab, in a sample of 76 severely disabled adults, drawn from diverse rehabilitation settings. Two randomly assigned groups applied 10 mL 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) or 10 mL placebo, using a "Toothette" (Halbrand) once daily, 5 times per week for 10 weeks. All subjects received 10 mL 0.05% NaF, applied similarly but separately from the test/placebo agent. Pre- and post-trial measures included perceived level of function and oral status, that is, DMFS, plaque, calculus, pocket depth, and tooth stain. The protocol received high levels of compliance and acceptance. Compared with placebo, swabbing with chlorhexidine resulted in consistent, and, in part, significant improvements in plaque, gingivitis, and periodontal pocket depth. Side effects of chlorhexidine, that is, tooth stain and calculus, were relatively minor. Perceived improvements in dental health were associated with improved physical health, appearance, and mouth odor. The results indicate that chlorhexidine swabbing is a useful oral disease preventive protocol for persons with disability. <48> UI - 93012134 AU - McLean JW IN - Institute of Dental Surgery, Eastman Dental Hospital, London, England. TI - The clinical use of glass-ionomer cements. [Review] [31 refs] SO - Dental Clinics of North America 1992 Jul;36(3):693-711 AB - The use of glass-ionomer cements in clinical dentistry has expanded greatly over the last decade. Their use in treating early carious or erosion lesions has been investigated widely and established techniques include fissure filling, restoration of erosion lesions without cavity preparation, and the internal or tunnel restoration. Because of their adhesion to moist tooth structure, biologic compatibility, and fluoride release, increasing use also has been made of their anticariogenic properties in treating geriatric patients. Glass-ionomers have proved very successful as dentin substitutes for attaching composites to enamel without involving risk of pulpal damage in the deeper cavity. The deficiencies of glass-ionomer cements are well known, including lack of toughness, early water sensitivity, low abrasion resistance, and porosity, leading to poor surface polish. Solving these problems is formidable because inherently the strength of these cements is related to their water content. The clinician should be aware of these deficiencies and stay within the parameters of the techniques outlined in this article. In particular, clinical success depends on early protection of the cement from hydration or dehydration and the current use of light-cured bonding agents largely has solved this problem. The future probably lies in using laminate techniques in which materials that attach to dentin and form a biologic seal can be covered by tougher and harder enamel veneers, thus mimicking the structure of the tooth. It is possible that future materials will be developed on the lines of these polyelectrolyte cements in which higher molecular weight polymers are used in conjunction with polymers that contain photoinitiators to effect light curing and toughen the matrix. In addition, the possibility of developing laboratory-cured glass-ionomer inlays in which porosity can be reduced and tougher polymers used should be considered. [References: 31] <49> UI - 93012161 AU - Nummikoski PV AU - Martinez TS AU - Matteson SR AU - McDavid WD AU - Dove SB IN - University of Texas Health Science Center at San Antonio. TI - Digital subtraction radiography in artificial recurrent caries detection. SO - Dento-Maxillo-Facial Radiology 1992 May;21(2):59-64 AB - The diagnostic accuracy of digital subtraction radiography in detection of artificial recurrent caries lesions was assessed in this project. The use of digital subtraction radiography has been shown to markedly increase the accuracy of the detection of destruction in the periodontal bone, but the method has not been evaluated in secondary caries detection. Defects of three different sizes, simulating recurrent caries, were sequentially prepared in the interproximal cavity preparation margins of 28 teeth. Two composite restorative materials with different radiographic densities were used as posterior restorations, and a radiograph was obtained of each defect size and restorative material. The radiographs were digitized and subtracted from the reference images, and the conventional radiographs and the subtraction images were evaluated by seven observers. The data were analysed with ROC statistics. Subtraction radiography was found to be superior to conventional radiography in recurrent caries detection, mainly by reducing the false-positive diagnoses. The radiopacity of the restorative material had a significant effect on accuracy with conventional but not with subtraction radiography. <50> UI - 93019405 AU - Buzdar AU AU - Hortobagyi GN AU - Kau SW AU - Smith TL AU - Fraschini G AU - Holmes FA AU - Gutterman JU AU - Hug VM AU - Singletary SE AU - Ames FC AU - et al IN - Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston 77030. TI - Adjuvant therapy with escalating doses of doxorubicin and cyclophosphamide with or without leukocyte alpha-interferon for stage II or III breast cancer. SO - Journal of Clinical Oncology 1992 Oct;10(10):1540-6 AB - PURPOSE: A prospective study in breast cancer patients was undertaken to determine whether escalating doses of doxorubicin and cyclophosphamide would result in a higher fraction of patients free of disease, and to evaluate the role of leukocyte alpha-interferon. PATIENTS AND METHODS: Between 1982 and 1986, 319 consecutive patients with stage II or III breast cancer with one or more positive nodes were assigned randomly to receive adjuvant chemotherapy that consisted of escalating doses of doxorubicin and cyclophosphamide in combination with vincristine and prednisone or the same chemotherapy regimen followed by 1 year of leukocyte alpha-interferon. Doxorubicin was administered by 72-hour continuous infusion through a central venous catheter (maximum total cumulative dose, 430 mg/m2). All patients with positive or unknown estrogen receptor status were also given tamoxifen for 1 year. RESULTS: The median follow-up was 71 months (range, 35 to 99 months). Correlation of disease-free survival (DFS) with dose-intensity of cyclophosphamide and doxorubicin showed no improvement in DFS for patients who were able to receive escalated drug doses compared with those who were not. Doxorubicin administered by continuous infusion was associated with a negligible risk of cardiotoxicity in this study despite the administration of higher accumulative doses than in our previous adjuvant therapy studies. The DFS rates of patients who did and those who did not receive leukocyte alpha-interferon were similar. CONCLUSIONS: In this study, there was no real evidence that higher drug dose intensity was associated with longer DFS. Leukocyte alpha-interferon as it was used in this study had no therapeutic value. Doxorubicin administered by infusion was associated with a reduced risk of cardiotoxicity. <51> UI - 92379164 AU - Archimbaud E AU - Anglaret B AU - Thomas X AU - Jaubert J AU - Sebban C AU - Guyotat D AU - Fiere D IN - Service d'Hematologie, Hopital Edouard Herriot, Lyon, France. TI - Maintenance with low-dose cytarabine for acute myeloid leukemia in complete remission. SO - Annals of Hematology 1992 Aug;65(2):71-4 AB - Thirty-four patients with acute myeloid leukemia (AML) in complete remission (CR), 30 of them aged over 60, received maintenance therapy scheduling four courses of low-dose cytarabine (LDA) 20 mg/m2/day in two subcutaneous injections for 3 weeks every 6 weeks. Each course was stopped when hematologic toxicity occurred, and doses of LDA were subsequently reduced by 50% for the following courses. During the first course of LDA, 15 patients needed blood and four patients platelet transfusions. Overall, 28 patients received four courses of LDA: 11 did not require any dose reduction, while 14 required one dose reduction and three needed two successive dose reductions. Two patients were hospitalized during maintenance. Median disease-free survival (DFS) is 308 days, with 16% of patients surviving at 5 years. Seven patients relapsed during the 168 days of maintenance, while ten of the 27 patients remaining at risk on day 169 relapsed during the 168 days following maintenance. We conclude that in AML in CR, the maximal dose of LDA tolerated by ambulatory patients is 10 mg/m2/day for 3 weeks. LDA seemed to delay relapse; however, precise assessment of the efficacy of this approach would require a randomized trial. <52> UI - 92357976 AU - Daniels TE AU - Fox PC IN - Division of Oral Pathology, School of Dentistry, University of California, San Francisco. TI - Salivary and oral components of Sjogren's syndrome. [Review] [70 refs] SO - Rheumatic Diseases Clinics of North America 1992 Aug;18(3):571-89 AB - The intraoral symptoms and signs of SS are not specific to SS, being shared with other conditions in which salivary function is diminished. The decrease in saliva causes chronic oral discomfort and functional problems and predisposes patients to dental caries and oral candidiasis. Many methods have been used to assess SGs in SS objectively, but at present a labial salivary gland biopsy specimen showing focal lymphocytic sialadenitis provides the best diagnostic criterion for the salivary component of SS, in terms of its disease specificity, convenience, availability, and low risk. The treatment of xerostomia in patients with SS consists of (1) preventing new and recurrent dental caries by frequent and regular application of topical fluoride, careful dental supervision, and avoidance of sucrose and other metabolizable carbohydrates between meals; (2) reducing oral symptoms by diagnosing and treating oral candidiasis (repeatedly if necessary); and (3) attempting to replace lost saliva by stimulating salivary secretion with physiologic sialogogues or pilocarpine, or if adequate amounts of saliva cannot be stimulated, using some form of saliva substitute, especially for patients wearing complete dentures. [References: 70] <53> UI - 92329276 AU - Mansour EG AU - Eudey L AU - Tormey DC AU - Shatila AH AU - Osborne CK AU - Gilchrist KW AU - Cooper MR AU - Falkson G IN - MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. TI - Chemotherapy versus observation in high-risk node-negative breast cancer patients. SO - Journal of the National Cancer Institute. Monographs 1992;(11):97-104 AB - Postoperative women with breast cancer but without histopathological evidence of metastases to the axillary lymph nodes or clinical evidence of metastases were studied. Six hundred fifty-five "good-risk" patients who were estrogen receptor positive (ER+) with primary tumors less than 3 cm were registered for observation. Twenty-four of these patients were treated with chemotherapy. Five hundred thirty-six "poor-risk" patients who were either ER+ with primary tumors greater than or equal to 3 cm or estrogen receptor negative (ER-) with any primary tumor size were randomly assigned between chemotherapy and observation. Randomization was stratified by type of surgical procedure, number of lymph nodes examined, menopausal status, tumor size, and ER status. The chemotherapy (CMFP) consisted of six 4-week cycles of cyclophosphamide, 100 mg/m2 orally days 1-14; methotrexate, 40 mg/m2 intravenously (IV) days 1 and 8; fluorouracil, 600 mg/m2 IV days 1 and 8; and prednisone, 40 mg/m2 orally days 1-14. Treatment arms in the randomly assigned patients were balanced with respect to pretreatment characteristics. This analysis includes 445 eligible patients entered in the registration arm and 425 eligible patients entered into the randomized treatments. The median follow-up is 4.5 years in the randomly assigned cohort and 4.8 years in the registered cohort. The overall 5-year disease-free survival (DFS) among the randomly assigned patients was 83% with CMFP and 61% with observation (P less than .0001). A DFS treatment benefit was observed in premenopausal and postmenopausal patients as well as in patients with ER+ or ER- tumors. There were fewer local-regional and distant relapses among the CMFP-treated patients.(ABSTRACT TRUNCATED AT 250 WORDS) <54> UI - 92329275 AU - Goldhirsch A AU - Castiglione M AU - Gelber RD IN - International Breast Cancer Study Group, Bern, Switzerland. TI - A single perioperative adjuvant chemotherapy course for node-negative breast cancer: five-year results of trial V. International Breast Cancer Study Group (formerly Ludwig Group). SO - Journal of the National Cancer Institute. Monographs 1992;(11):89-96 AB - Twelve hundred seventy-five patients who were defined as having node-negative breast cancer were evaluated in a randomized trial that compared a single cycle of combination chemotherapy started within 36 hours of surgery (848 patients) with no adjuvant treatment (427 patients). The chemotherapy consisted of intravenous cyclophosphamide, methotrexate, and fluorouracil given on days 1 and 8. Leucovorin (given on days 2 and 9) was added to the regimen to decrease severe toxic effects attributed to drug interaction between nitrous oxide used in anesthesia and methotrexate given in the immediate postoperative period. At a median follow-up of 60 months, the 5 year disease-free survival (DFS) percentages (+/- SE) were 74% +/- 2% for the treated group, and 68% +/- 2% for the no adjuvant therapy group. The estimated hazard ratio [95% confidence interval (CI)] was 0.78 (0.63 to 0.96); P = .02, representing a 22% +/- 9% relative reduction in the risk of relapse. The overall survival (OS) difference was not statistically significant with 5-year OS percentages of 88% +/- 1% for the treated group, and 85% +/- 2% for the control group [estimated hazard ratio (95% CI) = 0.85 (0.62 to 1.16); P = .31]. A subgroup analysis by menopausal status and by estrogen-receptor (ER) status revealed that the treatment effect was largest among the postmenopausal women with ER-negative tumors. The 5-year DFS percentages were 79% +/- 4% and 56% +/- 7%, and the OS percentages were 91% +/- 3% and 70% +/- 6%, for the treated and control groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS) <55> UI - 92329252 AU - Fisher B AU - Redmond C IN - National Surgical Adjuvant Breast and Bowel Project Headquarters, Pittsburgh, PA 15261. TI - Systemic therapy in node-negative patients: updated findings from NSABP clinical trials. National Surgical Adjuvant Breast and Bowel Project. SO - Journal of the National Cancer Institute. Monographs 1992;(11):105-16 AB - This report updates findings from two National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trials conducted to evaluate the worth of systemic therapy for the treatment of node-negative breast cancer patients. In trial B-13, 737 women with estrogen receptor (ER)-negative tumors treated by sequential methotrexate and fluorouracil (MTX----5-FU) followed by leucovorin were compared with a control group treated by surgery alone. Findings for all patients through 5 years of follow-up indicate a 27% reduction in treatment failure as a result of MTX----5-FU (76% vs 67%). While patients 49 years old or less and 50 years old or more benefited significantly from MTX----5-FU, the effect on disease-free survival (DFS) was greatest in those 50 years or older, where a 50% reduction in treatment failure occurred (86% vs 72%). A 69% reduction in mortality resulting from MTX----5-FU was observed in the older group (95% vs 84%). Trial B-14 compared placebo with tamoxifen (TMX) in 2844 patients with ER-positive tumors. As originally reported, findings through 5 years of follow-up indicate a significant reduction (36%) in treatment failure as a result of the TMX (82% vs 72%). Improvement in DFS was highly significant in both age groups. In patients 49 years old or younger, there was a 44% reduction in DFS (81% vs 66%) and, in those 50 years old or more, a 31% reduction (82% vs 74%). A Cox proportional hazards model failed to indicate a benefit from MTX----5-FU and TMX in all patient subgroups. Both therapies reduced local-regional and distant recurrence, as well as breast tumor recurrence following lumpectomy. Updated findings from trials B-13 and B-14 continue to support our conclusions that (a) no subgroups of node-negative patients that we examined have such a good outcome as to preclude the use of effective systemic therapy in their treatment and (b) despite the benefits observed from MTX----5-FU and TMX, no subgroup of patients was so affected as to preclude use of a particular subgroup in assessing other therapy regimens in additional clinical trials. The identification and evaluation of markers to determine which patients should receive systemic therapy are of the highest priority. At present, however, the use of markers for therapeutic decision making regarding individual patients is tenuous. <56> UI - 92335779 AU - Nytun RB AU - Raadal M AU - Espelid I IN - Department of Pedodontics, School of Dentistry, University of Bergen, Norway. TI - Diagnosis of dentin involvement in occlusal caries based on visual and radiographic examination of the teeth. SO - Scandinavian Journal of Dental Research 1992 Jun;100(3):144-8 AB - The purpose of the present study was to examine the validity of visual, radiographic and combined visual-radiographic examination of occlusal caries, with special reference to the diagnosis of dentin lesions, using the microscopic diagnosis after sectioning the teeth as validating criterion. Thirty extracted permanent molar teeth with signs of occlusal caries were selected and radiographed using a standard method similar to bitewing. Ten dentists, five from the Department of Cariology and Endodontics and five from the Department of Pedodontics, were asked to make a visual, radiographic and combined visual-radiographic caries examination with an interval of at least 1 month between different examinations. The teeth were sectioned bucco-lingually and the caries assessed as enamel or dentin lesion in a stereomicroscope. The sensitivity/specificity of the diagnoses of dentin lesions was 0.72/0.41 for the visual, 0.66/0.50 for the radiographic, and 0.86/0.64 for the combined visual-radiographic examinations. The Receiver Operating Characteristic (ROC) method revealed a statistically significant difference between combined visual-radiographic examination and the two other, but not between the isolated visual or radiographic examination. It is concluded that the combined use of visual and radiographic examination is better than either visual or radiographic examination alone. <57> UI - 92336743 AU - Bjertness E AU - Eriksen HM IN - Department of Epidemiology, National Institute of Public Health, Oslo, Norway. TI - Design of a socio-ecologic caries model and testing on 50-year-old citizens of Oslo, Norway. SO - Acta Odontologica Scandinavica 1992 Jun;50(3):151-62 AB - The purpose of the present study was to design a socio-ecologic caries model based on a general health model and to test the fit of data collected from a random sample of 200 50-year-old Oslo citizens to this designed model. The intention was also to investigate the relative importance of the four items environmental, behavioral, human biology, and health care organization factors. The dependent variable, number of carious surfaces, was recorded clinically and radiologically. The mean number of carious surfaces was 3.0 (SD, 3.5), with a range from 0 to 17, and the four items explained 5%, 25%, 28%, and 13% of the variance in number of carious surfaces, respectively. The complete model explained 42%, whereas traditionally used variables on the basis of the Keyes triad explained only 22% of the variance. The findings from the present study indicate that dental caries is a multifactorial disease with both behavioral and biologic determinants, and the socio-ecologic caries model represents a relevant supplement to the Keyes triad. <58> UI - 92336146 AU - Karr RA AU - Kramer DC IN - University of Texas M.D. Anderson Cancer Center, Houston. TI - You can treat the chemotherapy patient. [Review] [25 refs] SO - Texas Dental Journal 1992 Jun;109(6):15-20 AB - Increased numbers of cancer patients are treated with chemotherapy. Patients who receive antineoplastic agents can be at serious risk from dental infections and should be provided appropriate dental care. In many instances, indicated treatment can be accomplished by the patient's private dentist. Certain precautions, however, are necessary when treating dental patients medically compromised by chemotherapy. Dental conditions which may increase morbidity are identified and treatment recommendations are made. Guidelines for dental intervention before, during, and after chemotherapy are discussed with emphasis on the hematologic parameters necessary for safe dental care. The cyclic relationship between chemotherapy and oral complications is also reviewed. [References: 25] <59> UI - 92276614 AU - Stephen KW IN - Department of Oral Medicine and Pathology, University of Glasgow Dental School, Scotland, United Kingdom. TI - Technical advances in intra-oral model systems used to assess cariogenicity: experimental design and analysis (reactor paper). SO - Journal of Dental Research 1992 Apr;71 Spec No:905-7 AB - In situ cariogenicity-testing models must show evidence of compliance with valid clinical parameters, and this has been achieved with respect to pyrophosphate-, monofluorophosphate-, and zinc citrate trihydrate-containing dentifrices, where earlier in vitro studies failed to predict clinical efficacy. Parameters for validity testing should include the use of enamel fluoride uptake, plaque and/or saliva fluoride assessments, re-/demineralization assays of appliance-borne enamel slabs or slices, and plaque microbial, biochemical, and pH studies. Model reliability must be capable of withstanding repeat calibration experiments where the dosage, frequency of application, and/or duration of exposure to a new product may be varied. Furthermore, the number of enamel slabs/slices carried per appliance (and the number of artificial caries lesions per enamel insert) requires to be defined. Such studies should be repeated, but whether in the same or different subjects, or with or without cross-over, has to be determined. However, the capability of reproducing a clinically proven dose-response is essential. Models must be sensitive enough to detect changes in any test product F-concentration, but only equivalence claims should be permitted. Thus, superiority cannot be established, since accuracy may not be assumed beyond the upward limits of a clinically validated range. Finally, models should not be so exclusive in design as to preclude independent verification of their findings. <60> UI - 92276596 AU - Vernon PG AU - Raven SJ AU - Gilbert RJ AU - Parr TA AU - Dundon KA IN - Unilever Dental Research, Port Sunlight Laboratory, Bebington, Wirral, United Kingdom. TI - The effect of study design on in situ treatment of carious enamel lesions. SO - Journal of Dental Research 1992 Apr;71 Spec No:814-8 AB - The aim of this exploratory study was to investigate the influence of several factors on changes in the mineral content of carious enamel lesions treated in situ. The study involved 36 adult volunteers who used either a non-fluoride toothpaste or one of two fluoride toothpastes (1000 or 1500 ppm F). Human enamel specimens were prepared and attached to partial dentures as described previously (Schafer, 1989) and treated in situ for between three and six weeks. The mineral content of lesions was determined by microradiography and computerized densitometry. The factors investigated in this study included study length, frequency of treatment, trial design, patient compliance, patient diet, and previous caries experience of the patient. The effects observed were small, relative to that of the treatment, and not statistically significant (p greater than 0.05). However, the trends in the data were all as would be intuitively predicted. Study duration correlated positively with observed lesion mineral content. Lesions worn by panelists using a fluoride toothpaste for six weeks contained greater levels of mineral with respect to placebo than did those in panelists on a three-week study. The residual variations in the three phases of the study were found to be similar, suggesting that there is no advantage in these studies having a cross-over design. Brushing frequency also correlated positively with observed lesion mineral content, with panelists brushing three times per day with a fluoridated dentifrice having lesions with greater levels of mineral, with respect to placebo, than those brushing twice per day. Overall, no clear relationship between reported diet and changes in lesion mineral levels was apparent.(ABSTRACT TRUNCATED AT 250 WORDS) <61> UI - 92245503 AU - Sauer R AU - Schauer A AU - Rauschecker HF AU - Schumacher M AU - Gatzemeier W AU - Sauerbrei W AU - Dunst J AU - Seegenschmiedt MH AU - Marx D IN - Universitats-Strahlenklinik, Erlangen. TI - Breast preservation versus mastectomy in early breast cancer--1991 update of the GBSG 1--protocol and prognostic factors. The German Breast Cancer Study Group. SO - Strahlentherapie und Onkologie 1992 Apr;168(4):191-202 AB - In 1983, the German Breast Cancer Study Group (GBSG), sponsored by the Federal Ministry of Research and Technology, started a prospective multicenter trial on the treatment of early breast cancer (pT1 pN0 M0). This was preceded by a three-year reviewing period because of some novelties of medical, juristical and ethical problems in the FRG. University and, in the majority, community hospitals participated, combining all together 69 different institutions. From 11/1983 to 12/1989, 1112 patients were recruited. From 1036 patients, 733 underwent breast preservation (71%) and 303 mastectomy (29%). The randomization rate was only 6%. In 268 patients (26%) the tumor size was less than or equal to 10 mm, in 765 patients (74%) 11 to 22 mm. In 129 cases, we subdivided the tumor grading II[3] into IIa and IIb. Moreover, the immunohistochemical detection of the transmembrane proteins EGFR, p-185 and p-148 by oncogene overexpression and c-myc oncogene were undertaken in 425 breast cancers. After tumorectomy (or wide excision) and a lower axillary dissection (at least eight lymph nodes) the breast was irradiated up to 50 Gy in 25 fractions. A boost of 12 Gy was given to the tumor bed. The medial located lymph nodes were also irradiated in case of medially or centrally tumors. Quality control was performed by pathological, radiotherapeutic and methodical reference centers. Significant correlations could be demonstrated between receptor status and tumor grading, patient age and grading, and tumor size and grading. The results emphasize the central role of tumor grading among the prognostic factors. Especially the differentiation of the Bloom and Richardson score II into IIa and IIb seems to play an important role. After a median follow-up of 41 months, the frequency of local recurrences (4.4%), regional recurrences (1%) and distant metastases (4.6%) was exactly the same in both treatment groups. In multivariate analysis, only tumor size and tumor grading had a significant impact on disease-free survival. 23 patients with tumor-involved margins had a higher recurrence rate (DFS 62% versus 85% after five years). Without any impact on DFS were the other conventionally evaluated prognostic factors: age, menopausal status, hormone receptor status, histological tumor type, tumor localisation, degree of differentiation, pleomorphism, mitotic index and degree of dissociation. Among the transmembrane proteins EGFR, p-185, p-148 and c-myc, only the impact of p-185 and EGRF positivity on DSF is significant.(ABSTRACT TRUNCATED AT 400 WORDS) <62> UI - 92272602 AU - Boyages J AU - Langlands AO IN - Department of Radiation Oncology, Westmead Hospital, New South Wales, Australia. TI - Breast cancer: the role of radiation therapy after treatment by conservative surgery. SO - Australian & New Zealand Journal of Surgery 1992 Jun;62(6):422-8 AB - The role of conservative surgery (CS) as definitive treatment of invasive breast cancer has not been established. Previous studies have demonstrated high rates of local tumour recurrence if CS is not followed by radiotherapy (RT). At present, it is impossible to identify subsets of patients who may be at acceptably low risk of recurrence after CS. The treatment of breast cancer by CS alone remains an important research question as this may avoid over-treatment by radiation for some patients. In Australia, a trial has been proposed by the ANZ Breast Cancer Trials Group, comparing CS alone to CS+RT. This paper reviews all available data on CS alone in order to stimulate debate as to the appropriateness of the trial and its end-points. Given that all prospective randomized trials have failed to show a survival disadvantage for CS alone it is essential to consider the value of all outcomes after CS or CS+RT. The conventional end-points proposed in the Australian study (mastectomy rate, disease-free survival (DFS) and overall survival (OS)) are selective. Without the addition of quality of life measures, the utilities of the strategies addressed in the trial cannot be evaluated. Data are presented on the desirability (utility) of the alternative approaches of CS or CS+RT based on data obtained from a questionnaire completed by Westmead Hospital staff. This preliminary study indicates that the majority of respondents to the questionnaire perceived that the strategy of CS+RT to have a higher utility than the strategy of CS alone. <63> UI - 92265909 AU - Blaise D AU - Maraninchi D AU - Archimbaud E AU - Reiffers J AU - Devergie A AU - Jouet JP AU - Milpied N AU - Attal M AU - Michallet M AU - Ifrah N AU - et al IN - Statistical Department, Institut Paoli Calmettes, Marseille, France. TI - Allogeneic bone marrow transplantation for acute myeloid leukemia in first remission: a randomized trial of a busulfan-Cytoxan versus Cytoxan-total body irradiation as preparative regimen: a report from the Group d'Etudes de la Greffe de Moelle Osseuse [see comments]. CM - Comment in: Blood 1992 Dec 1;80(11):2947-8 SO - Blood 1992 May 15;79(10):2578-82 AB - From October 1987 to December 1990, 101 patients with acute myeloid leukemia (AML) were randomized to be transplanted in first complete remission (CR1). Preparative regimen including Cytoxan (120 mg/kg) with total body irradiation (CYTBI) (N = 50) or busulfan (16 mg/kg) (BUSCY) (N = 51) was followed by allogeneic bone marrow transplantation (BMT) from an HLA-identical sibling. Mean time between diagnosis and BMT was 119 days. The outcome for CYTBI at 2 years is better for probability of disease-free survival (DFS) (72% v 47%) (P less than .01), survival (75% v 51%) (P less than .02), relapse (14% v 34%) (P less than .04), and transplant mortality (8% v 27%) (P less than .06). In multivariable analysis, higher relapse and decreased survival and DFS were associated with BUSCY regimen, while chronic graft-versus-host disease also influenced independently the probability of relapse. This demonstrates the present limitation of busulfan use in this setting, possibly due to probable individual variations in biodisponibility. Furthermore, besides the anti-leukemic effect of preparative regimens, this trial points out the progress accomplished in BMT management (transplant mortality = 8% in CYTBI) over the last 20 years as well as the effectiveness of transplant in early first CR after CYTBI (DFS = 72% at 2 years). <64> UI - 92193509 AU - Verdonschot EH AU - Kuijpers JM AU - Polder BJ AU - De Leng-Worm MH AU - Bronkhorst EM IN - Department of Cariology and Endodontology, TRIKON, Nijmegen, The Netherlands. TI - Effects of digital grey-scale modification on the diagnosis of small approximal carious lesions. SO - Journal of Dentistry 1992 Feb;20(1):44-9 AB - The aim of this study was to evaluate the accuracy of approximal caries diagnosis from digitized radiographs and digitally modified radiographic images, compared with conventional radiography. Twenty bitewing radiographs were digitized and from the digitized radiographs mirror-images were produced, resulting in 40 digital images. The caries progress at three approximal surfaces was graded by 12 dentists from conventional radiographs, digital unmodified images and digitally modified images. The image modifications were derived from the cumulative probability of grey values in the original digital image using one of five probability distributions: uniform, exponential, Rayleigh, hyperbolic cube root and hyperbolic logarithmic. Interobserver agreement was substantial. The unmodified digital images produced sensitivities comparable to radiographs but their specificities were lower. When the diagnostic task was to discriminate between 'caries' and 'no caries', the exponential, hyperbolic cube root and hyperbolic logarithmic modifications and radiographs performed equally well. With the decision cut off between 'dentinal caries' and 'no dentinal caries', the sensitivity of the hyperbolic logarithmic type of modification was statistically significantly superior to that of radiographs, but this modification was also associated with a statistically significant reduction of specificity. It is concluded that in particular the hyperbolic logarithmic modification can be an alternative to conventional radiography in incipient approximal caries diagnosis and restorative decision making. <65> UI - 92193970 AU - Allred DC AU - Clark GM AU - Tandon AK AU - Molina R AU - Tormey DC AU - Osborne CK AU - Gilchrist KW AU - Mansour EG AU - Abeloff M AU - Eudey L AU - et al IN - Department of Pathology, University of Texas Health Science Center, San Antonio 78284-7884. TI - HER-2/neu in node-negative breast cancer: prognostic significance of overexpression influenced by the presence of in situ carcinoma. SO - Journal of Clinical Oncology 1992 Apr;10(4):599-605 AB - PURPOSE: Amplification and/or overexpression of the HER-2/ne