Database: EMBASE <: international biomedical and pharmaceutical literature, 1988 - May 2000. [Trial access until 3/2001. Feedback welcome to medical.library@umich.edu] Search Strategy (You Saved Citations 1-135 From Set 95): ----------------------------------------------------------------------------- 1 Reproducibility of results/ 8828 2 exp risk/ 142555 3 Models, statistical/ 3445 4 Prevalence/ 28128 5 Discriminant analysis/ 1694 6 Forecasting/ 840 7 exp Cohort studies/ 6595 8 Evaluation studies/ 746 9 Risk-taking/ 9719 10 exp Health behavior/ 12119 11 reproducib:.mp. 30773 12 risk:.mp. 292899 13 forecast:.mp. 2095 14 or/1-13 359129 15 False negative reactions/ or False positive reactions/ 4291 16 (sensitivity or specificity).ti,ab. 171235 17 (predictive adj value$1).mp. 15190 18 (predictive adj validit:).mp. 597 19 (likelihood adj ratio:).mp. 1149 20 (false adj (negative$1 or positive$1)).ti,ab. 13376 21 double blind method/ or single blind method/ 32928 22 random$.ti,ab. 140380 23 random allocation/ 2503 24 (single blind$3 or double blind$3 or triple blind$3).ti,ab. 38568 25 exp "sensitivity and specificity"/ 173587 26 (controlled adj trial:).mp. 104667 27 (practice adj guideline:).mp. 19351 28 (consensus adj development adj conference:).mp. 169 29 or/15-28 564723 30 exp Tooth demineralization/ 7492 31 demineralization.mp. 879 32 caries.mp. 1798 33 caires.mp. 0 34 craies.mp. 0 35 careis.mp. 1 36 carise.mp. 0 37 (teeth adj3 cavit:).mp. 32 38 (tooth adj3 cavit:).mp. 97 39 (dental adj3 cavit:).mp. 85 40 (dentin adj3 cavit:).mp. 19 41 (enamel adj3 cavit:).mp. 10 42 (teeth adj3 decay:).mp. 58 43 (tooth adj3 decay:).mp. 58 44 (dental adj3 decay:).mp. 47 45 (dentin adj3 decay:).mp. 0 46 (enamel adj3 decay:).mp. 1 47 (active adj decay).mp. 5 48 (rampant adj3 decay:).mp. 4 49 (recurrent adj3 decay:).mp. 5 50 (white adj spot:).mp. 231 51 carious.mp. 109 52 cariology.ti,ab. 2 53 (non-cavitated adj3 lesion:).mp. 0 54 (noncavitated adj3 lesion:).mp. 1 55 Tooth remineralization/ 788 56 (dental adj3 fissure:).mp. 14 57 (tooth adj3 fissure:).mp. 8 58 (teeth adj3 fissure:).mp. 1 59 caries-free.mp. 29 60 cariesfree.mp. 0 61 Cariogenic agents/ 3 62 precavit:.mp. 2 63 (filled adj3 teeth).mp. 45 64 (filled adj3 tooth).mp. 9 65 (oral adj fissure:).mp. 17 66 (tooth adj3 remineraliz:).mp. 1 67 (teeth adj3 remineraliz:).mp. 5 68 dft.mp. 542 69 dfs.mp. 980 70 dmf:.mp. 1235 71 cariogeni:.mp. 164 72 or/30-71 12313 73 72 and 14 and 29 413 74 limit 73 to (human and english language) 356 75 limit 74 to (child < unspecified age > or preschool child < 114 1 to 6 years > or school child < 7 to 12 years > or adolescent < 13 to 17 years >) 76 exp Tooth, deciduous/ 142 77 Dentition, primary/ 411 78 Dentition, mixed/ 411 79 ((primary or deciduous or mixed) adj5 (tooth or teeth or 650 dent: or odont:)).mp. 80 or/76-79 1002 81 74 and 80 13 82 75 or 81 118 83 from 82 keep 1-118 118 84 74 not 82 238 85 "Root caries"/ 1483 86 ("root" adj3 (carie: or lesion:)).mp. 382 87 exp Tooth root/ 302 88 ((tooth or teeth or enamel or dentin) adj5 ("root" or apex 613 or apices)).mp. 89 ((amelocemental or cemental or cementum) adj5 (carie: or 21 lesion:)).mp. 90 Dental cementum/ 120 91 or/85-90 2448 92 84 and 91 26 93 84 not 92 212 94 (disease adj (free or specific) adj3 (patient: or 7574 survival:)).mp. 95 93 not 94 135 96 from 95 keep 1-135 135 *************************** <1> UI - 2000169962 AU - Valantine H IN - Dr. H. Valantine, Stanford University Hospital, CVRC, Heart/Lung Transplantation Division, Palo Alto, CA 94305; United States. TI - Neoral use in the cardiac transplant recipient. SO - Transplantation Proceedings Vol 32(3 SUPPL. 1) (pp 27S-44S), 2000. AB - Special Considerations in the Cardiac Transplant Patient: CyA is the core immunosuppressant of choice for the majority of transplant patients. The introduction of Neoral, a new microemulsion formulation of CyA, and more recently a range of adjunctive immunosuppressants have further enhanced the efficacy and tolerability of CyA-based immunosuppression. In the first year following transplantation the major causes of morbidity and death are graft failure, acute rejection, and systemic infection. Patients with deteriorated pulmonary circulation before transplantation are at increased risk of early postoperative death. Risk factors for early acute rejection include female donor sex, young donor age, and multiple HLA-DR mismatches. The principal cause of death in the long term is graft vasculopathy which accounted for 40% of all deaths. Risk factors that have been hypothesized to play a role in the pathogenesis of graft vasculopathy 4 include hyperlipidemia, recipient age and gender, donor age, the number of HLA AB and DR mismatches, and CMV infection. Strategies proposed to reduce the risk of graft vasculopathy include aggressive use of lipid-lowering agents, avoidance of low CyA doses, and the use of adjunctive rapamycin or RAD therapy. Rejection surveillance therefore relies on routine serial endomyocardial biopsy. Recent research suggests that a more accurate assessment of the state of the graft can be obtained by considering the results across a number of biopsy samples obtained from different parts of the heart, rather than basing clinical judgment on the worst single result obtained. New molecular markers such as granzyme A mRNA are likely to improve the power of histology to diagnose and predict rejection. Neoral Immunosuppression in De Novo Patients: Neoral pharmacokinetics give greater bioavailability and less intrapatient variability than Sandimmune. In the keynote OLN 351 study comparing Neoral with Sandimmune in de novo heart transplant recipients, fewer Neoral patients needed antilymphocyte therapy to treat rejection, fewer female patients had rejection episodes in the Neoral group, the tolerability of the two formulations was equivalent, and there was a lower incidence of infections in the Neoral group. The clinical impact of Neoral in comparison with Sandimmune in de novo heart transplant patients has been investigated in a number of additional trials, including long-term studies, which have confirmed that Neoral is associated with: Lower CyA doses than Sandimmune. Equal or greater antirejection efficacy than Sandimmune. Comparable tolerability to Sandimmune. During the administration of intravenous CyA as an induction therapy in the days immediately following transplantation, there is evidence to suggest that a 6-hour infusion given twice daily, which mimics the pharmacokinetic profile of oral dosing, may be clinically more effective than a continuous 24-hour infusion. Neoral Immunosuppression in the Maintenance Patient: Milligram-for-milligram dose conversion from Sandimmune to Neoral is feasible. Following conversion, a reduction in the CyA dose may be required in the majority of patients to maintain target levels. In pediatric patients, the rate of elimination of CyA is greater and bioavailability increases with increasing age. Younger patients (less than 8 years of age) may be managed more effectively with a 3-times-daily, rather than a twice-daily dosing schedule. A number of studies have compared the clinical effects of Sandimmune and Neoral in maintenance therapy for cardiac transplant patients. As with de novo patients, these studies have found the new formulation of CyA to be associated with lower rates of acute rejection, lower therapeutic doses, and comparable tolerability. Milligram-to-milligram conversion from the old to the new CyA formulation is generally well tolerated, although in a minority of patients there is a significant increase in CyA levels. These may be associated with a transient increase in side effects which resolve on dose reduction. There is a dose-sparing effect with Neoral. Routine monitoring of both CyA and serum creatinine levels are advisable to optimize the tolerability and safety of therapy. Recent research indicates that drug monitoring 2 hours after CyA dosing provides a more accurate indication of AUC than trough level measurements. Patients with persistently low CyA levels are likely to be at increased risk of graft loss due to both acute rejection and chronic graft vasculopathy. New evidence suggests the use of C-2 CyA level monitoring to determine whether adequate drug is being absorbed. This TDM approach is not only recommended as a diagnostic tool but as a method for optimising Neoral immunosuppression. Long-term Side Effects of CyA Therapy: The major long-term safety problems directly associated with CyA-based immunosuppression include nephrotoxicity, hypertension, diabetes mellitus, and PTLD. CyA nephrotoxicity No clear risk factors for CyA nephrotoxicity have been identified and no correlation has been observed between CyA levels and serum creatinine levels. Overactivation of the renin-angiotensin system may play a role in the development of CyA nephrotoxicity, in which case early introduction of an ACE inhibitor would be expected to be of benefit. This possibility has yet to be investigated in a clinical trial. Reducing the CyA dose to treat renal dysfunction should be carried out with care, because this increases the risk of acute rejection. The introduction of additional, non- nephrotoxic adjunctive therapies such as MMF should be considered when substantially reducing the CyA dose. Hypertension: Management of hypertension requires careful attention to dietary sodium intake. Reducing the dose of CyA - as well as steroids, which also contribute to the problem - is important although care must be taken to avoid increasing the risk of rejection. The use of nonsteroidal anti-inflammatory agents should be avoided in hypertensive patients receiving CyA, because this may lead to further impairment of renal function. Because hypertension is often at its greatest in the early morning in cardiac transplant patients and the normal diurnal variation in blood pressure is absent, optimal management is often achieved by giving larger doses of antihypertensive agents at bedtime. PTLD: The optimal treatment for PTLD has not yet been determined, but strategies involving a reduction of immunosuppression in combination with aggressive chemotherapy have reported significant success. Prophylactic use of antiviral therapy is also recommended. Diabetes and Steroid Withdrawal: Steroid-sparing protocols are an important strategy for reducing posttransplant diabetes and should especially be considered in patients judged on the basis of preoperative metabolic parameters to be at a high risk of developing diabetes. Although steroid-sparing protocols are undoubtedly beneficial to many patients receiving immunosuppression with CyA or other agents, there is continuing debate over the clinical benefits of complete steroid withdrawal. Adjunct Immunosuppression Agents: Although CyA remains the cornerstone of maintenance immunosuppression therapy, the use of new adjunctive agents can reduce the risk of rejection; enable lower, better-tolerated doses of CyA and steroids to be administered; and enable therapy to be better tailored to clinical needs. Simulect (basiliximab) and daclizumab induction therapy within a CyA-based protocol has been shown to be highly effective in reducing the incidence of early acute rejection episodes in two major trials in renal transplantation, and similar results are anticipated in heart transplantation. Substitution of MMF for azathioprine reduces the frequency and severity of acute rejection episodes, may delay the development of chronic graft vasculopathy, and may improve patient survival in CyA-treated heart transplant patients. Sirolimus (rapamycin) and RAD have complementary mode of action to CyA. Early indications are that they offer significant clinical benefits in heart transplantation, including reduced rejection rates, lower CyA toxicity through reduced doses, and possibly a reduced incidence of chronic graft vasculopathy. Tacrolimus has a similar mode of action to CyA and the two agents should not be used in combination. In terms of clinical outcomes, no clear advantage has been demonstrated for either agent in comparison with the other. However, in some circumstances it may be appropriate to switch patients from CyA to tacrolimus-based therapy or vice versa, either to treat refractory rejection in CyA patients, or to treat severe tacrolimus toxicity. A range of options is available for the treatment of acute rejection; these options vary according to rejection severity and persistence. Many of these use adjunctive immunosuppressants including MMF, rapamycin, or RAD. [References: 80] <2> UI - 2000169346 AU - Langeron O AU - Masso E AU - Huraux C AU - Guggiari M AU - Bianchi A AU - Coriat P AU - Riou B IN - Dr. O. Langeron, Departement d'Anesthesie-Reanimation, Groupe Hospitalier Pitie-Salpetriere, 47 Boulevard de l'Hopital, 75651 Paris Cedex 13; France. E-Mail: olivier.langeron@psl.ap-hop-paris.fr. TI - Prediction of difficult mask ventilation. SO - Anesthesiology Vol 92(5) (pp 1229-1236), 2000. AB - Background: Maintenance of airway patency and oxygenation are the main objectives of face-mask ventilation. Because the incidence of difficult mask ventilation (DMV) and the factors associated with it are not well known, we undertook this prospective study. Methods: Difficult mask ventilation was defined as the inability of an unassisted anesthesiologist to maintain the measured oxygen saturation as measured by pulse oximetry > 92% or to prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia. A univariate analysis was performed to identify potential factors predicting DMV, followed by a multivariate analysis, and odds ratio and 95% confidence interval were calculated. Results: A total of 1,502 patients were prospectively included. DMV was reported in 75 patients (5%; 95% confidence interval, 3.9-6.1%), with one case of impossible ventilation. DMV was anticipated by the anesthesiologist in only 13 patients (17% of the DMV cases). Body mass index, age, macroglossia, beard, lack of teeth, history of snoring, increased Mallampati grade, and lower thyromental distance were identified in the univariate analysis as potential DMV risk factors. Using a multivariate analysis, five criteria were recognized as independent factors for a DMV (age older than 55 yr, body mass index > 26 kg/m2, beard, lack of teeth, history of snoring), the presence of two indicating high likelihood of DMV (sensitivity, 0.72; specificity, 0.73). Conclusion: In a general adult population, DMV was reported in 5% of the patients. A simple DMV risk score was established. Being able to more accurately predict DMV may improve the safety of airway management. [References: 26] <3> UI - 2000125870 AU - Song Q AU - Lange T AU - Spahr A AU - Adler G AU - Bode G IN - Dr. G. Bode, Department of Internal Medicine I, University of Ulm, Ulm; Germany. TI - Characteristic distribution pattern of Helicobacter pylori in dental plaque and saliva detected with nested PCR. SO - Journal of Medical Microbiology Vol 49(4) (pp 349-353), 2000. AB - The precise mode of transmission and the natural reservoir for Helicobacter pylori are unknown. PCR assays have proved to be highly sensitive and specific and are regarded as the method of choice for detecting H. pylori DNA in the oral cavity. The aim of this study was to investigate the prevalence and distribution of H. pylori in the oral cavity. Forty-two patients undergoing gastroscopy were investigated for the presence of H. pylori in dental plaque and saliva by nested PCR, and in the stomach by the 13C-urea breath test. Samples tested comprised dental plaque from molars, premolars and incisors and saliva. Two sets of primers homologous to the 860-bp fragment of H. pylori DNA, which have been shown previously to be highly sensitive and specific, were used for nested PCR. Eleven patients (26.2%) were infected with H. pylori in the stomach. H. pylori DNA was identified in dental plaque samples from 41 patients (97%) and in 23 saliva samples (55%), The prevalence in dental plaque from molars, premolars and incisors was 82%, 64% and 59%, with an odds ratio of 3.18, 1.24 and 1 (reference), respectively. In conclusion, H. pylori was present in the oral cavity of 97% of tested patients, with a characteristic distribution that was independent of the infection status of the stomach. Thus H. pylori may belong to the normal oral microflora. [References: 38] <4> UI - 2000118364 AU - Kaye D IN - Dr. D. Kaye, MCP Hahnemann School of Medicine, Philadephia, PA; United States. TI - Infective endocarditis: Keeping a killer at bay. SO - Consultant Vol 40(3) (pp 622-626), 2000. <5> UI - 2000117356 AU - Ashcroft DM AU - Po ALW AU - Griffiths CEM IN - Prof. A.L.W. Po, Ctr. Evidence-Based Pharmacotherapy, School of Life and Health Sciences, Aston University, Birmingham B4 7ET; United Kingdom. E-Mail: a.liwanpo@aston.ac.uk. TI - Therapeutic strategies for psoriasis. SO - Journal of Clinical Pharmacy & Therapeutics Vol 25(1) (pp 1-10), 2000. AB - Psoriasis is a chronic, inflammatory, hyperproliferative skin disease that affects approximately 1-2% of the general population in the U.K. and U.S.A. It is rarely life-threatening, but causes considerable patient morbidity. The disease waxes and wanes, with substantial variability both between and within individual patients. There is no cure for psoriasis; therefore, the aim of treatment is to minimize the extent and severity of the disease to the point at which it no longer disrupts substantially the patient's quality of life. We review the current treatment options, which include topical therapies, phototherapy and systemic agents. Lack of efficacy, adverse effects and aesthetic problems limit the use of many topical therapies. Likewise, the risk of toxicity is a major problem with currently available phototherapies and systemic treatments. Advances in understanding the aetiology and pathogenesis of psoriasis allude to the possibility of innovative, targeted therapies in the future. [References: 38] <6> UI - 2000106072 AU - Canavan TP AU - Radosh L IN - Dr. L. Radosh, Dept. of Family and Community Med., Lancaster General Hospital, 555 N Duke St, Lancaster, PA 17604-3555; United States. E-Mail: radosh@pol.net. TI - Managing endometriosis: Strategies to minimize pain and damage. SO - Postgraduate Medicine Vol 107(3) (pp 213-224), 2000. AB - Endometriosis is a common condition affecting a significant number of women of childbearing age. The diagnosis is clinical and thus can be difficult to make. History taking is generally most helpful, and diagnostic tests have a limited role. Diagnostic laparoscopy remains the 'gold standard' for diagnosis of endometriosis. Treatment is geared toward improving fertility and controlling pain and is often not curative. However, both medical and surgical therapies are of value in controlling the disease. Attention to the psychosocial needs of the patient are also critical. Future therapies will be based on a further understanding of the pathogenesis of endometriosis and the effect of hormones on the disease. For the primary care physician who may not be comfortable prescribing GnRH analogs or other medical therapies, referral to a gynecologist or endocrinologist should be considered. [References: 34] <7> UI - 2000096276 AU - Taylor DO IN - Dr. D.O. Taylor, Department of Medicine, Division of Cardiology 4A-100, University Utah Health Sciences Ctr., 50 N. Medical Drive, Salt Lake City, UT 84132; United States. TI - Immunosuppressive therapies after heart transplantation: Best, better, and beyond. SO - Current Opinion in Cardiology Vol 15(2) (pp 108-114), 2000. AB - Despite the significant advances in transplantation immunology and immunosuppressive therapies over the past 30 years, current immunosuppressive regimens are still inadequate in the majority of cardiac transplant recipients. Although short- and long-term survival rates have improved significantly, only 50% will survive 10 years and very few will survive 20 years. Complications of overimmunosuppression and underimmunosuppression account for the majority of these deaths. Only true 'immunologic' tolerance can provide the outcome we pursue, namely, prolonged allograft function and otherwise normal immune function without chronic immunosuppressive therapy and its risks. Until a successful tolerance-inducing protocol is developed, we must use the current and upcoming immunosuppressive agents and techniques. (C) 2000 Lippincott Williams and Wilkins, Inc. [References: 35] <8> UI - 2000074953 AU - Vargas CM AU - Macek MD AU - Marcus SE IN - C.M. Vargas, Analys., Epidemiol./Hlth. Prom. Off., National Ctr. for Health Statistics, Centers for Dis. Control/Prevention, 6525 Belcrest Road, Hyattsville, MD 20782; United States. E-Mail: cav5@cdc.gov. TI - Sociodemographic correlates of tooth pain among adults: United States, 1989. SO - Pain Vol 85(1-2) (pp 87-92), 2000. AB - This study presents the sociodemographic distribution of tooth pain and the dental care utilization of affected individuals. Data for adults 20 years of age and over were derived from the 1989 National Health Interview Survey's supplements on dental health, orofacial pain, and health insurance (n=33 073). Prevalence of tooth pain by socioeconomic status (SES) and adjusted odds ratios of reporting tooth pain in the past 6 months and of having no dental visits in the past year among persons reporting pain in the previous 6 months were computed taking into account the survey's complex sample design. Tooth pain in the past 6 months was reported by 14.5% (95% CI 14.0, 15.0) of adults aged 20-64 years and by 7.0% (95% CI 6.1, 7.9) of those 65 years and over. In the younger age group, tooth pain was more likely to be reported by those with low SES than it was by those with high SES; in the older age group, tooth pain was more likely reported by non-Hispanic blacks than it was by non-Hispanic whites or Hispanics. Of those reporting pain, younger and older non-Hispanic blacks and persons with lower educational attainment were more likely not to have a dental visit in the previous 12 months. Persons with low SES characteristics were more likely to report tooth pain and to endure their pain without the benefit of dental care while the pain was present. [References: 24] <9> UI - 2000017574 AU - Truong TL AU - Menard C AU - Mouton C AU - Trahan L IN - Dr. L. Trahan, Groupe Recherche en Ecologie Buccale, Faculte de Medecine Dentaire, Universite Laval, Quebec, Que. G1K 7P4; Canada. E-Mail: Luc.Trahan@greb.ulaval.ca. TI - Identification of mutans and other oral streptococci by random amplified polymorphic DNA analysis. SO - Journal of Medical Microbiology Vol 49(1) (pp 63-71), 2000. AB - The identification and classification of the non-haemolytic or viridans group of streptococci have long been recognised as difficult and unsatisfactory. Phenotypic and genotypic heterogeneity have resulted in ambiguous speciation, particularly with mutans streptococci and other oral streptococci. This study was done to determine whether random amplified polymorphic DNA (RAPD) analysis is useful to identify and even classify oral and other streptococci. DNA was prepared and purified from 25 strains of mutans streptococci including 11 reference strains of Streptococcus mutans, seven of S. sobrinus, three of S. rattus and one each of the four other species of the mutans group, together with 20 other reference species, mostly streptococci, and from 49 fresh isolates of mutans streptococci and of S. mutans from human saliva and dental plaque. DNA amplification was primed with each of three arbitrarily selected primers nine or 10 nucleotides in length. The amplified DNA fragments (amplicons) obtained were compared by agarose gel electrophoresis. Species- and strain-specific RAPD fingerprints were obtained not only from pure genomic DNA, but also from the supernates of crude cellular or colony extracts. Pending the analysis of numerous other strains, the data suggest that RAPD may be of value: (i) to distinguish the species S. mutans and S. sobrinus from each other and potentially from other species of oral streptococci, (ii) to differentiate and possibly classify oral streptococci and (iii) as a valuable tool in mutans streptococci epidemiology and transmission studies, by virtue of its rapidity, efficiency and reproducibility in generating genetic fingerprints of streptococcal isolates. [References: 41] <10> UI - 2000017433 AU - Donaldson D AU - Tremble J TI - Diabetes mellitus - Oral manifestations and dental disease. SO - J R SOC PROMOT HEALTH, Vol 119(4) (pp 211-212), 1999. <11> UI - 1999419382 AU - Edwards JE AU - McQuay HJ AU - Moore RA AU - Collins SL IN - J.E. Edwards, Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, Oxford OX3 7LJ; United Kingdom. TI - Reporting of adverse effects in clinical trials should be improved: Lessons from acute postoperative pain. SO - Journal of Pain & Symptom Management Vol 18(6) (pp 427-437), 1999. AB - We assessed the quality of assessment and reporting of adverse effects in randomized, double-blind clinical trials of single-dose acetaminophen or ibuprofen compared with placebo in moderate to severe postoperative pain. Reports were identified by systematic searching of a number of bibliographic databases (e.g., MEDLINE). Information on adverse effect assessment, severity and reporting, patient withdrawals, and anesthetic used was extracted. Compliance with former guidelines for adverse effect reporting was noted. Fifty-two studies were included; two made no mention of adverse effects. No method of assessment was given in 19 studies. Twenty trials failed to report the type of anesthetic used, eight made no mention of patient withdrawals, and nine did not state the severity of reported adverse effects. Only two studies described the method of assessment of adverse effect severity. When all adverse effect data were pooled, significantly more adverse effects were reported with active treatment than with placebo. For individual adverse effects, there was no difference between active (acetaminophen 1000 mg or ibuprofen 400 mg) and placebo; the exception was significantly more somnolence/drowsiness with ibuprofen 400 mg. Ninety percent of trials reporting somnolence/drowsiness with ibuprofen 400 mg were in dental pain. All studies published after 1994 complied with former guidelines for adverse effect reporting. Different methods of assessing adverse effects produce different reported incidence: patient diaries yielded significantly more adverse effects than other forms of assessment. We recommend guidelines for reporting adverse effect information in clinical trials. Copyright (C) 1999 U.S. Cancer Pain Relief Committee. [References: 27] <12> UI - 1999414609 AU - Ponticelli C AU - Passerini P IN - Dr. C. Ponticelli, Divisione di Nefrologia e Dialisi, IRCCS Ospedale Maggiore di Milano, Via Commenda 15, 20122 Milan; Italy. E-Mail: croff1@polic.cilea.it. TI - The place of cyclosporin in the management of primary nephrotic syndrome. SO - BIODRUGS, Vol 12(5) (pp 327-341), 1999. AB - The 3 main causes of primary nephrotic syndrome are minimal change nephropathy, focal segmental glomerulosclerosis and membranous nephropathy. Corticosteroids result in remission of proteinuria in most patients with minimal change nephropathy. Many patients, however, develop corticosteroid dependency. A course of cytotoxic drugs can also achieve remission but these agents cannot be administered for prolonged periods or in repeated cycles because their toxicity is cumulative. Review of the available literature indicates that cyclosporin may maintain remission of nephrotic syndrome in about 80% of patients with corticosteroid-sensitive disease, indicating an important role for this drug in patients with frequent relapses or corticosteroid dependency. Although cyclosporin is less effective in patients with focal segmental glomerulosclerosis, which is often corticosteroid- resistant, a number of studies indicate that it may be successful both in the few steroid-sensitive patients with frequent relapses and in some corticosteroid-resistant patients. In patients with membranous nephropathy, a 6-month course of corticosteroids and cytotoxic agents may favour remission of nephrotic syndrome and protect renal function. Several studies have shown that cyclosporin can improve proteinuria, and there is a tentative suggestion that it might also protect against renal function deterioration. The risk of nephrotoxicity can be minimised if cyclosporin is used at the correct doses and if renal function is carefully monitored during treatment. In summary, cyclosporin can be considered a useful tool for treating patients with nephrotic syndrome associated with primary glomerulonephritis. [References: 117] <13> UI - 1999403894 AU - Gibbs CH AU - Karpinia K AU - Moorhead JE AU - Maruniak JW AU - Heins PJ IN - C.H. Gibbs, Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL 32610; United States. E-Mail: cgibbs@dental.ufl.edu. TI - An algometer for intraoral pain tolerance measurements. SO - Journal of Neuroscience Methods Vol 88(2) (pp 135-139), 1999. AB - An algometer was developed to provide a variable probing force (0-200 g force) which could be used intraorally. This algometer consisted of an autoclavable probe handpiece attached to an optical encoder, which recorded probing force to a computer when a button was pressed. The probe handpiece included a 0.40 mm diameter hemispherical tip which was placed in contact with the experimental site. The probe tip was pressed against the tissue with increasing force until the subject pressed the button, at which point the pain tolerance (PT) value was recorded by the computer. Intraoral soft tissue, PT values were obtained from nine healthy adult subjects during 6 weekly visits to determine the reproducibility of PT measurements. Five gingival sulcus sites and three gingival surface sites, all adjacent to the maxillary premolars constituted the experimental area. The reproducibility of PT values using the force stimulus from the algometer was evaluated using interclass correlation coefficients (R) for each of the eight sites. Visits 1 and 2 were training and calibration visits. Visits 3 through 6 were experimental visits. The R values ranged from 0.40 to 0.79 when data from all six visits were included. R values for Visits 3 through 6 were 0.63-0.97 indicating good to excellent correlation after subjects became familiar with the procedure. A complete repeated measures analysis of variance (ANOVA) showed no significant interaction between site and visit. Duncan's multiple range test was used to compare sensitivity across the eight sites. The results indicated that the three most anterior sites were significantly (P<0.05) more sensitive than four of the posterior sites. When the sites were grouped into: (1) gingival surface sites; (2) mid-facial sulcus sites; and (3) interproximal sulcus sites, no significant differences were found in their PT values. The algometer is well suited for intraoral investigations because of its precision, computerized data entry and easily positioned, autoclavable handpiece. This new algometer may be useful for sensory and pain studies for other parts of the body. Copyright (C) 1999 Elsevier Science B.V. [References: 19] <14> UI - 1999370184 AU - Hoyer JR AU - Pietrzyk RA AU - Liu H AU - Whitson PA IN - Dr. J.R. Hoyer, 1107 Abramson Research Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104-4318; United States. E-Mail: hoyer@email.chop.edu. TI - Effects of microgravity on urinary osteopontin. SO - Journal of the American Society of Nephrology Vol 10(SUPPL. 14) (pp S389-S393), 1999. AB - Increased risk of renal stone formation during space flight has been linked primarily to increased calcium excretion from bone demineralization induced by space flight. Other factors contributing to increased risk include increased urinary calcium oxalate supersaturation, while urinary citrate, magnesium and volume are all decreased. The aim of this study was to increase the predictive value of stone risk profiles for crew members during space flight by evaluating the excretion of urinary protein inhibitors of calcium crystallization so that more comprehensive stone risk profiles could relate mineral saturation to the concentrations of inhibitor proteins. Levels of urinary osteopontin (uropontin) are reported in a series of 14 astronauts studied before, during, and after space flights. During space flight, a compensatory increase in uropontin excretion was not observed. However, the uropontin excretion of a majority of astronauts was increased during the period after space flight and was maximal at 2 wk after landing. The downward shift in the molecular size of uropontin observed in samples obtained during space flight was shown to result from storage at ambient temperature during flight, rather than an effect of microgravity on uropontin synthesis. [References: 13] <15> UI - 1999355289 AU - Guo YL AU - Yu M-L AU - Hsu C-C AU - Rogan WJ IN - M.-L. Yu, National Cheng Kung University, Medical College, 138 Sheng Li Road, Tainan; Taiwan. TI - Chloracne, goiter, arthritis, and anemia after polychlorinated biphenyl poisoning: 14-Year follow-up of the Taiwan Yucheng cohort. SO - Environmental Health Perspectives Vol 107(9) (pp 715-719), 1999. AB - In 1979, a mass poisoning involving 2000 people occurred in central Taiwan from ingestion of cooking oil contaminated by polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs). We studied the prevalence of medical conditions in the exposed individuals and in a neighborhood control group. Starting with a registry of the exposed individuals from 1983, we updated the addresses of exposed individuals and identified a control group matched for age, sex, and neighborhood in 1979. In 1993, individuals 30 years of age or older were interviewed by telephone. We obtained usable information from 795 exposed subjects and 633 control subjects. Lifetime prevalence of chloracne, abnormal nails, hyperkeratosis, skin allergy, goiter, headache, gum pigmentation, and broken teeth were observed more frequently in the PCB/PCDF-exposed men and women. The exposed women reported anemia 2.3 times more frequently than controls. The exposed men reported arthritis and herniated intervertebral disks 4.1 and 2.9 times, respectively, more frequently than controls. There was no difference in reported prevalences of other medical conditions. We conclude that Taiwanese people exposed to high levels of PCBs and PCDFs reported more frequent medical problems, including skin diseases, goiter, anemia, and joint and spine diseases. [References: 26] <16> UI - 1999345018 AU - Bouabdallah R AU - Lefrere F AU - Rose C AU - Chaibi P AU - Harousseau J-L AU - Vernant J-P AU - Castaigne S AU - Bauduer F AU - Zini J-M AU - Coso D AU - Varet B AU - Robert J AU - Fenaux P IN - R. Bouabdallah, Department of Hematology, Institut J. Paoli-I Calmettes, 232 Boulevard Sainte-Marguerite, 13273 Marseille Cedex 09; France. TI - A phase 11 trial of induction and consolidation therapy of acute myeloid leukemia with weekly oral idarubicin alone in poor risk elderly patients. SO - Leukemia Vol 13(10) (pp 1491-1496), 1999. AB - We have conducted a phase II outpatient trial testing weekly oral administration of idarubicin (ZAVEDOS-ZVD) alone to determine the rate of objective response and toxicity in poor risk acute myeloid leukemia (AML) patients over 60 years of age. The treatment consisted of three phases: induction, with 20 mg/m2 of ZVD on days 1, 8, 15 and 22; consolidation with 20 mg/m2 of ZVD for 4 weeks; and maintenance with six cycles lasting 3 months and consisting of oral 6 mercapto-purine 2 mg/kg/day, 4 days a week for 2 months; subcutaneous cytarabine 1 mg/kg, once a week for 2 months; and oral ZVD 20 mg/m2 on day 1 and day 8 of the third month. In case of failure after induction course, patients received salvage treatment with 4 weekly oral doses of 40 mg/m2 ZVD. Fifty-one patients with a median age of 76 years were enrolled and could receive induction course. Of these 51 patients, 37 could receive subsequent courses, which consisted either of consolidation, or salvage. Only 11 patients underwent maintenance treatment. Sixty-three percent of patients had to be hospitalized during induction, for a median duration of 14.5 days, and 87% required hospitalization during salvage for a median duration of 17.5 days. Only five patients (38%) required hospitalization during consolidation. There were three toxic deaths (6%), two from hemorrhage and one from pulmonary embolism. The overall response rate was 29%, with 12 patients in complete response (25%) and two in partial response (4%). The median overall survival rate is 4 months for the whole population, and the median DFS is 9.6 months among the 14 responding patients. The results of this trial show that this new weekly schedule of oral ZVD chemotherapy is feasible and effective in poor risk elderly patients with AML. This regimen may be helpful for patients unable to tolerate intensive intravenous regimens, and is a real alternative to palliative treatments. [References: 20] <17> UI - 1999258340 AU - Littleton J IN - J. Littleton, Department of Anthropology, University of Auckland, Private Mail Bag 92019, Auckland; New Zealand. E-Mail: J.Littleton@auckland.ac.nz. TI - Paleopathology of skeletal fluorosis. SO - American Journal of Physical Anthropology Vol 109(4) (pp 465-483), 1999. AB - Skeletal fluorosis is one of a range of conditions causing excessive ossification and joint ankylosis in skeletons. It is rarely considered, however, in differential diagnoses of palaeopathological lesions. This paper considers the identification of skeletal fluorosis in a skeletal sample from the island of Bahrain, Arabian Gulf, dating to ca. 250 BC-AD 250. Approximately 4% of 255 adult skeletons in the sample have hyperostosic lesions resulting in joint ankylosis primarily of the lumbar vertebrae, as well as the major joints. These lesions most frequently occur among males in the 50+ age group. Chemical analysis on a small series of bone and dental samples confirmed the presence of high levels of fluoride, while staining of the teeth is evidence of dental fluorosis. The level of dental fluorosis is comparable with a naturally occurring fluoride level in water of between 1-2 ppm. The prevalence of hyperostosic lesions, however, appears higher than expected, and two possible reasons are suggested: confusion between a diagnosis of diffuse idiopathic skeletal hyperostosis and skeletal fluorosis on partial or less severely affected skeletons; and the presence of predisposing factors for skeletal fluorosis on the island in the past. [References: 75] <18> UI - 1999244495 AU - Meunier PJ AU - Delmas PD AU - Eastell R AU - McClung MR AU - Papapoulos S AU - Rizzoli R AU - Seeman E AU - Wasnich RD IN - Dr. P.J. Meunier, Hopital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437 Lyon Cedex 03; France. TI - Diagnosis and management of osteoporosis in postmenopausal women: Clinical guidelines. SO - Clinical Therapeutics Vol 21(6) (pp 1025-1044), 1999. AB - The authors, all physicians involved in clinical research on bone and practicing clinicians, propose practical guidelines for identifying persons with osteoporosis or those at high risk of developing the disease and for managing patients who may benefit from therapy. These guidelines are based on an analysis of peer-reviewed articles published before November 1998. A flowchart of women who might benefit from treatment is provided, including clinical presentation (recent fracture of the spine, hip, or other bone or no fracture; risk factors for osteoporosis); relevant investigations (bone mineral density measurement and laboratory tests required for the differential diagnosis); and therapeutic management (general measures such as calcium and vitamin D supplementation and specific pharmacologic interventions such as estrogen, bisphosphonates, intranasal calcitonin, raloxifene, fluoride salts, and other compounds that have been assessed in randomized clinical trials). The strongest evidence for antifracture efficacy (reduction of vertebral and nonvertebral fracture risk) was observed with alendronate. [References: 104] <19> UI - 1999213463 AU - Scully C AU - Porter SR AU - Mutlu S AU - Epstein JB AU - Glover S AU - Kumar N IN - Dr. C. Scully, Eastman Dental Institute, Oral Health Care Sciences, University of London, 256 Gray's Inn Rd., London WC1X 8LD; United Kingdom. E-Mail: CScully@eastman.ucl.ac.uk. TI - Periodontopathic bacteria in English HIV-seropositive persons. SO - AIDS Patient Care & STDS Vol 13(6) (pp 369-374), 1999. AB - Selected periodontopathic bacteria were sought in 20 HIV-infected English patients and eight noninfected control subjects with similar periodontal status, using highly specific DNA probes. Actinobacillus actinomycetemcomitans (A. a), Porphyromonas gingivalis, Campylobacter rectus, Prevotella intermedia, and Fusobacterium nucleatum were more frequently detected and were found at higher levels in HIV-infected individuals than in controls. Significantly increased levels of Treponema denticola but, in contrast, lower levels of Eikenella corrodens were found in nonbleeding sites of HIV-infected patients compared with controls. The results of the present investigation on English patients suggest a periodontopathogenic role for A. a, P. gingivalis and C. rectus, and possibly P. intermedia and are in general accord with most previously reported data from the United States. Longitudinal studies are now required to determine more precisely the association between periodontopathic microflora, immune competence and periodontal health and disease in HIV-infected persons. [References: 43] <20> UI - 1999203816 AU - Lefkowith JB IN - Dr. J.B. Lefkowith, G.D. Searle and Company, Research and Development, 4901 Searle Parkway, Skokie, IL 60077; United States. TI - Cyclooxygenase-2 specificity and its clinical implications. SO - American Journal of Medicine Vol 106(5 B) (pp 43S-50S), 1999. AB - Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation by inhibiting the synthesis of prostanoids. However, these drugs inhibit both cyclooxygenase-1 (COX-1), which is essential for the regulation of homeostasis in many tissues, as well as COX-2, which is an important mediator of pain and inflammation. Disruption of COX-1 enzymatic activity by NSAIDs leads to such side effects as interference with platelet functions and gastric ulcers. The recent development of COX-2-specific inhibitors, such as celecoxib, raises the possibility of relieving pain and inflammation with reduced risk of gastrointestinal complications. In Phase II and III studies, celecoxib has demonstrated efficacy in alleviating dental pain and the signs and symptoms of osteoarthritis and rheumatoid arthritis. This COX-2-specific inhibitor was also associated with a markedly lower rate of gastroduodenal injury than is seen typically with NSAIDs. Incidence of most adverse events (including gastrointestinal) and withdrawal rates resulting from adverse events with celecoxib were similar to placebo. Celecoxib appears to be both safe and effective in the treatment of osteoarthritis and rheumatoid arthritis. Its COX-2-specific inhibitory properties thus introduce the possibility of effective relief of arthritic and other types of pain and inflammation with less risk of the mechanism-based toxicities observed with conventional NSAIDs. [References: 14] <21> UI - 1999142798 AU - Amano A AU - Nakagawa I AU - Kataoka K AU - Morisaki I AU - Hamada S IN - A. Amano, Division of Special Care Dentistry, Osaka Univ. Faculty of Dentistry, 1-8 Yamadaoka, Suita-Osaka 565-0871; Japan. E-Mail: amanoa@dent.osaka-u.ac.jp. TI - Distribution of Porphyromonas gingivalis strains with fimA genotypes in periodontitis patients. SO - Journal of Clinical Microbiology Vol 37(5) (pp 1426-1430), 1999. AB - Fimbriae (FimA) of Porphyromonas gingivalis are filamentous components on the cell surface and are thought to play an important role in the colonization and invasion of periodontal tissues. We previously demonstrated that fimA can be classified into four variants (types I to IV) on the basis of the nucleotide sequences of the fimA gene. In the present study, we attempted to detect the four different fimA genes in saliva and plaque samples isolated from patients with periodontitis using the PCR method. Four sets of fimA type-specific primers were designed for the PCR assay. These primers selectively amplified 392-bp (type I), 257-bp (type II), 247-bp (type III), and 251-bp (type IV) DNA fragments of the fimA gene. Positive PCR results were observed with reference strains of P. gingivalis in a type- specific manner. All other laboratory strains of oral and nonoral bacteria gave negative results. The sensitivity of the PCR assay for fimA type- specific detection was between 5 and 50 cells of P. gingivalis. Clinical samples were obtained from saliva and subgingival plaque from deep pockets (>=4 mm) of 93 patients with periodontitis. Bacterial genomic DNA was isolated from the samples, and the targeted fragments were amplified by PCR. The presence of P. gingivalis was demonstrated in 73 patients (78.5%), and a single fimA gene was detected in most patients. The distribution of the four fimA types among the P. gingivalis-positive patients was as follows: type I, 5.4%; type II, 58.9%; type III, 6.8%; type IV, 12.3%; types I and II, 6.8%; types II and IV, 2.7%; and untypeable, 6.8%. P. gingivalis with type II fimA was detected more frequently in the deeper pockets, and a significant difference of the occurrence was observed between shallow (4 mm) and deep (>=8 mm) pockets. These results suggest that P. gingivalis strains that possess type II fimA are significantly more predominant in periodontitis patients, and we speculate that these organisms are involved in the destructive progression of periodontal diseases. [References: 31] <22> UI - 1999135823 AU - Walker JM AU - Gill JS IN - J.S. Gill, Cardiothoracic Centre, Guy's and St Thomas Hospitals, London; United Kingdom. TI - Cariology. The modern treatment of ventricular arrhythmias: Drugs or defibrillators. SO - Journal of the Royal College of Physicians of London Vol 33(2) (pp 116-119), 1999. <23> UI - 1999087417 AU - Epstein JB AU - Emerton S AU - Le ND AU - Stevenson-Moore P IN - J.B. Epstein, Department of Dentistry, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6; Canada. TI - A double-blind crossover trial of Oral Balance gel and Biotene(TM) toothpaste versus placebo in patients with xerostomia following radiation therapy. SO - Oral Oncology Vol 35(2) (pp 132-137), 1999. AB - Following therapeutic irradiation of the head and neck, patients with profound xerostomia have complaints associated with oral dryness, effects upon use of oral prosthesis, speech, and taste. In addition, xerostomia may lead to risk of oral infections and rampant demineralization of teeth. The use of topical Oral Balance gel and Biotene(TM) toothpaste (Laclede Professional Products, Gardena, CA) versus carboxymethylcellulose gel and commercial toothpaste applications was assessed in a 2-week double-blind, crossover design. The palliative effects of Oral Balance gel and Biotene toothpaste were superior to the effects of a placebo. No effect on oral colonization by Candida species and cariogenic oral microflora was seen with use of the topical agents. [References: 45] <24> UI - 1999095907 AU - Hadgu A AU - Koch G IN - A. Hadgu, Centers for Dis. Control/Prevention, 1600 Clifton Road, Atlanta, GA 30333; United States. TI - Application of generalized estimating equations to a dental randomized clinical trial. SO - Journal of Biopharmaceutical Statistics Vol 9(1) (pp 161-178), 1999. AB - Longitudinal data present statistical problems of interest in clinical trials and epidemiologic studies. In this article, we consider a dental clinical trial in which the outcome measurements are taken on each subject at two follow-up times, and the primary interest is in the dependence of the outcome variable on covariates. The common data structure of these studies is the presence of an intraclass or serial correlation within primary sampling units or subjects. Recently generalized linear models have had extensions to methods for generalized estimating equations that take correlations within primary sampling units into account. We review and apply the Liang-Zeger methodology to a dental clinical trial. In this study, 109 adult male and female volunteers with preexisting dental plaque were randomized to two mouth rinses (A and B) or a control mouth rinse with double blinding. The major research question in this analysis was: Are the two experimental mouth rinses more effective than the control mouth rinse in inhibiting the development of dental plaque? And if so, what is the effect of baseline plaque measurement?. [References: 16] <25> UI - 1999090413 AU - Flack JM AU - Hamaty M IN - Dr. J.M. Flack, Cardiovasc Epidemiol Clin Apps Prog, Detroit Medical Center, Central Region Hospitals, Detroit, MI 48201; United States. E-Mail: jflack@oncgate.roc.wayne.edu. TI - Difficult-to-treat hypertensive populations: Focus on African-Americans and people with type 2 diabetes. SO - Journal of Hypertension - Supplement Vol 17(1) (pp S19-S24), 1999. AB - The awareness, treatment, and control of hypertension has risen steadily over the past three decades, until the early 1990s. However, blood pressure control to < 140/90 mmHg is attained in fewer than 25% of all hypertensive patients and fewer than 50% of drug-treated hypertensive patients, except for white women. Two special populations, African-Americans and diabetics, share several important attributes. First, they both have a high prevalence of hypertension, including stage 3 hypertension (as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension VI: >= 180/110 mmHg), relative to other subgroups. African-Americans have an approximate 8% prevalence of stage 3 hypertension, and elevated systolic blood pressure is highly prevalent among diabetic people, particularly older African-American women. Second, both groups have high levels of blood-pressure-related target-organ damage, which contributes to their inordinately high absolute risk for cardiovascular disease complications (i.e. stroke, congestive heart failure, renal failure) at a given level of blood pressure. Moreover, the reduced natriuretic capacity common to each group contributes to the attenuated efficacy of antihypertensive drug monotherapy, particularly for drug classes other than diuretics and calcium antagonists. These two special populations are also typically salt-sensitive, an intermediate blood pressure phenotype that raises blood pressure medication requirements. This phenomenon has been associated with an attenuation in the normal nocturnal fall in blood pressure. The high absolute risk for cardiovascular disease among diabetics led to the formulation of more aggressive treatment recommendations for antihypertensive drug therapy. In diabetics, blood pressure therapy is initiated at blood pressures >= 130/85 mmHg, and treatment goals are at least to this level, unless proteinuria is >= 1 g/day (in which case the goals are < 125/75 mmHg). The more aggressive treatment targets for diabetics will not be reached with most currently available single antihypertensive agents in many African-Americans. While at best only 50-60% of hypertensive patients can be controlled with single drug therapy, that percentage falls dramatically in persons with stage 3 hypertension and renal insufficiency, thereby necessitating the use of combination drug therapy. Treatment alone is not enough; treatment to goal blood pressure is an essential first step towards optimal target-organ protection. While circulating levels of renin are suppressed, in general, in these special populations, each group manifests an inordinate burden of blood-pressure-related target-organ damage that has been linked to excessive levels of angiotensin II or a reduced bradykinin and nitric oxide tissue effect. The renin-angiotensin-aldosterone-kinin system is therefore an attractive therapeutic target that might conceivably provide target-organ protection over and above that attributable solely to lowering the blood pressure. [References: 45] <26> UI - 1999051178 AU - Narasimhan C AU - Panotopoulos PTh AU - Deshpande S AU - Jazayeri MR AU - Dhala A AU - Blanck Z AU - Akhtar M AU - Sra J IN - Dr. J. Sra, 2901 W. Kinnickinnic River Pkwy 470, Milwaukee, WI 53219; United States. TI - Reversing the initial phase polarity in biphasic shocks: Is the polarity benefit reproducible?. SO - Pacing & Clinical Electrophysiology Vol 22(1 I) (pp 60-64), 1999. AB - The effect of initial phase polarity (IPP) reversal using biphasic shocks on DFT at the time of implantation of implantable cardioverter defibrillator and the reproducibility of this effect during predischarge testing was evaluated in a randomized fashion. Twenty-two patients with ventricular tachycardia or ventricular fibrillation (VF) who received either the Medtronic 7219D (7 patients), 7219C (12 patients), 7223 (1 patient), or CPI Ventak MINI (2 patients) were studied. The DFT was determined in a randomized fashion at implantation and during predischarge testing using a binary search protocol. Initial shock was delivered at 12 J. If successful, subsequent shock was delivered at 6 J, following which the shock was incremented or decremented by 3 J depending upon the success. The DFT for right ventricular (RV)and RV + IPP was 10. 9 +/- 4.1 J and 11.1 +/- 4.0 J, respectively, at implant (P = ns) and 9.7 +/- 4.3 J and 8.4 +/- 6 J, respectively, (P = ns) at predischarge testing. Of the six patients who had better DFT with RV+ at implantation, only one patient maintained the benefit during predischarge testing. The differences observed in IPP in individual patients may not be demonstrable during repeated testing. These findings may have implications on how these devices should be programmed. [References: 15] <27> UI - 1999037451 AU - Van Wely M AU - Stoss M AU - Gorter RW IN - R.W. Gorter, Hardenbergstrasse 19, D-10623 Berlin; Germany. TI - Toxicity of a standardized mistletoe extract in immunocompromised and healthy individuals. SO - American Journal of Therapeutics Vol 6(1) (pp 37-43), 1999. AB - Iscador is being used by many patients as unconventional anticancer and immunomodulating therapy. To determine the toxicity profile and biochemical effects of Iscador Qu Spezial (Weleda AG Schwabisch Gmund, Germany) in human immunodeficiency virus (HIV)-positive patients and healthy controls, we performed a phase I/II study. Escalating doses of Iscador Qu Spezial, standardized for its lectin and viscotoxin content, were administered to 16 HIV-positive patients and 8 healthy subjects during a period of 6 to 8 months. Iscador Qu Spezial preparations were administered twice per week subcutaneously in increasing doses (ie, 0.01 mg, 0.1 mg, 1.0 mg, 2.0 mg, 5.0 mg, and 0.1 mg/kg for 2-6 weeks per dose). Drug-related adverse effects were flulike symptoms, gingivitis, fever, local erythema, and eosinophilia. These side effects were never severe. The incidence of systemic adverse events was highest in HIV-positive patients. Furthermore, increased urea levels and slightly decreased total protein caused by a minor decrease in albumin were observed. None of the HIV-positive patients progressed in disease stage. Iscador Qu Spezial can be administered safely to immunocompromised patients. [References: 20] <28> UI - 1999009299 AU - Liede KE AU - Haukka JK AU - Saxen LM AU - Heinonen OP IN - Dr. K.E. Liede, Institute of Dentistry, University of Helsinki, PO Box 41, Helsinki; Finland. E-Mail: kliede@hammas.helsinki.fi. TI - Increased tendency towards gingival bleeding caused by joint effect of alpha-tocopherol supplementation and acetylsalicylic acid. SO - Annals of Medicine Vol 30(6) (pp 542-546), 1998. AB - alpha-tocopherol (vitamin E) may play a role in the treatment of arterial thromboembolic disease, possibly by inhibiting platelet aggregation. Thus far, no clinical evidence exists for this effect. The objective of this study was to assess the effect of alpha-tocopherol supplementation on gingival bleeding either in combination with acetylsalicylic acid (ASA) or without it. This study was an end-point examination of a random sample of male smokers who had participated in a controlled clinical trial, the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study) for 5-7 years. The study included 409 men aged 55-74 years of whom 191 received alpha-tocopherol supplementation (50 mg/day); 56 used ASA, 30 received both and 132 received neither. Gingival bleeding was examined by probing with a WHO probe and reported as a percentage of bleeding sites adjusted by the logistic regression model. Gingival bleeding was more common in those who received alpha-tocopherol compared with nonreceivers among subjects with a high prevalence of dental plaque (P < 0.05). ASA alone increased bleeding only slightly. The highest risk of gingival bleeding was among those who took both alpha-tocopherol and ASA (33.4% of probed sites bleeding vs 25.8% among subjects taking neither alpha-tocopherol nor ASA, P < 0.001). In the ATBC Study, more deaths from haemorrhagic stroke and fewer from ischaemic heart disease were observed among those participants who received alpha-tocopherol compared with those who did not. Based on the results of the present study and the ATBC Study, we conclude that alpha-tocopherol supplementation may increase the risk of clinically important bleedings, particularly when combined with ASA. [References: 21] <29> UI - 1998371975 AU - Portyansky E TI - New antibiotic controls periodontal disease. SO - DRUG TOPICS, Vol 142(19) (pp 29), 1998. <30> UI - 1998377757 AU - Berkey CS AU - Hoaglin DC AU - Antczak-Bouckoms A AU - Mosteller F AU - Colditz GA IN - C.S. Berkey, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115; United States. E-Mail: catherine.berkey@channing.harvard.edu. TI - Meta-analysis of multiple outcomes by regression with random effects. SO - Statistics in Medicine Vol 17(22) (pp 2537-2550), 1998. AB - Earlier work showed how to perform fixed-effects meta-analysis of studies or trials when each provides results on more than one outcome per patient and these multiple outcomes are correlated. That fixed-effects generalized-least-squares approach analyzes the multiple outcomes jointly within a single model, and it can include covariates, such as duration of therapy or quality of trial, that may explain observed heterogeneity of results among the trials. Sometimes the covariates explain all the heterogeneity, and the fixed-effects regression model is appropriate. However, unexplained heterogeneity may often remain, even after taking into account known or suspected covariates. Because fixed-effects models do not make allowance for this remaining unexplained heterogeneity, the potential exists for bias in estimated coefficients, standard errors and p-values. We propose two random-effects approaches for the regression meta-analysis of multiple correlated outcomes. We compare their use with fixed-effects models and with separate-outcomes models in a meta-analysis of periodontal clinical trials. A simulation study shows the advantages of the random-effects approach. These methods also facilitate meta-analysis of trials that compare more than two treatments. [References: 19] <31> UI - 1998366126 AU - Saiag P AU - Pavlovic M AU - Clerici T AU - Feauveau V AU - Nicolas J-C AU - Emilie D AU - Chastang C IN - P. Saiag, Service de Dermatologie, Hopital Ambroise Pari, 9 Avenue Charles-de-Gaulle, 92104 Boulogne Cedex; France. TI - Treatment of early AIDS-related Kaposi's sarcoma with oral all-trans-retinoic acid: Results of a sequential non-randomized phase II trial. SO - AIDS Vol 12(16) (pp 2169-2176), 1998. AB - Objective: To assess the efficacy and safety of all-trans-retinoic acid (ATRA), a retinoid with antitumour activity that inhibits in vitro the growth of Kaposi's sarcoma cells, in patients with low-risk AIDS-associated Kaposi's sarcoma. Design: Non-randomized phase II study, using a group sequential procedure to determine whether the response rate to ATRA was above 10%. Setting: Nine referral French centres. Patients: Twenty HIV-seropositive men with CD4 cells >= 200 x 106/l, low-risk Kaposi's sarcoma [T0I0S0 according to the classification of AIDS Clinical Trials Group (ACTG)] not previously treated with systemic anti-Kaposi's sarcoma agents, and with at least four measurable lesions were included. Interventions: ATRA was given orally 45 mg/m2 daily for 12 weeks. Main outcome measure: Tumour response evaluated according to ACTG criteria. Results: Nineteen patients were evaluated for response: partial response, stabilization and progression were found in eight (42%), seven (37%), and four (21%) patients, respectively. Gradual flattening and lightening of lesions was observed in responders after at least >= months of ATRA. All patients with partial response at week 12 pursued ATRA for another 15 +/- 7 weeks. Further improvement was observed in six patients. Median duration of response was 332 days. Cheilitis, transient headaches and skin dryness were the main toxicities noted. No significant changes in HIV viral burden or serum interleukin-6 pathways were observed. Conclusions: ATRA is well tolerated and effective enough in Kaposi's sarcoma patients to warrant further evaluation. [References: 30] <32> UI - 1998359538 AU - Piaggio G AU - Ba'aqeel H AU - Bergsjo P AU - Carroli G AU - Farnot U AU - Lumbiganon P AU - Pinol A AU - Villar J IN - Dr. J. Villar, UNDP-UNFPA-WHO, World Bank Special Programme Res, Dev Res Training Human Reproduction, 1211 Geneva 27; Switzerland. TI - The practice of antenatal care: Comparing four study sites in different parts of the world participating in the WHO Antenatal Care Randomised Controlled Trial. SO - Paediatric & Perinatal Epidemiology Vol 12(SUPPL. 2) (pp 116-141), 1998. AB - In the preparation of a randomised controlled trial to evaluate a new programme of antenatal care (ANC) in different parts of the world, we conducted a baseline survey of the ANC procedures in all 53 clinics participating in the trial. There were two components of this survey: (1) description of clinic characteristics and services offered: the staff of each clinic was interviewed and direct observation was made by field supervisors, and (2) the actual use of services by pregnant women attending these clinics: we reviewed a random sample of 2913 clinical histories. The clinical units surveyed were offering most of the activities, screening, laboratory tests and interventions recommended as effective according to the Cochrane Pregnancy and Childbirth Database (PCD), although some of these were not available in some sites. On the other hand, some tests and interventions that are considered not effective according to these criteria are reportedly offered. There was a difference across sites in the availability and offer to low-risk women of vaginal examination, evaluation of pelvic size, dental examination, external version for breech presentation and formal risk score classification and a notable difference in the type of principal provider of ANC. There was a large variation in the actual use of screening and laboratory tests and interventions that should be offered to all women according to Cochrane PCD criteria: some of these are simply not available in a site; others are available, but only a fraction of women attending the clinics are receiving them. The participating sites all purport to follow the traditional 'Western' schedule for ANC, but in three sites we found that a high percentage of women initiate their ANC after the first trimester, and therefore do not have either the recommended minimum number of visits during pregnancy or the minimum first trimester evaluation. It is concluded that the variability and heterogeneity of ANC services provided in the four study sites are disturbing to the profession and cast doubts on the rationale of routine ANC. [References: 16] <33> UI - 1998351360 AU - Griffen AL AU - Becker MR AU - Lyons SR AU - Moeschberger ML AU - Leys EJ IN - A.L. Griffen, Department of Pediatric Dentistry, College of Dentistry, Ohio State University, 305 W. 12th Ave., Columbus, OH 43210; United States. E-Mail: griffen.1@osu.edu. TI - Prevalence of Porphyromonas gingivalis and periodontal health status. SO - Journal of Clinical Microbiology Vol 36(11) (pp 3239-3242), 1998. AB - Periodontitis is a common, progressive disease that eventually affects the majority of the population. The local destruction of periodontitis is believed to result from a bacterial infection of the gingival sulcus, and several clinical studies have provided evidence to implicate Porphyromonas gingivalis. If P. gingivalis is a periodontal pathogen, it would be expected to be present in most subjects with disease and rarely detected in subjects with good periodontal health. However, in most previous studies, P. gingivalis has not been detected in the majority of subjects with disease, and age-matched, periodontally healthy controls were not included for comparison. The purpose of the study reported here was to compare the prevalence of P. gingivalis in a group with periodontitis to that of a group that is periodontally healthy. A comprehensive sampling strategy and a sensitive PCR assay were used to maximize the likelihood of detection. The target sequence for P. gingivalis-specific amplification was the transcribed spacer region within the ribosomal operon. P. gingivalis was detected in only 25% (46 of 181) of the healthy subjects but was detected in 79% of the periodontitis group (P < 0.0001). The odds ratio for being infected with P. gingivalis was 11.2 times greater in the periodontitis group than in the healthy group (95% confidence interval, 6.5 to 19.2). These data implicate P. gingivalis in the pathogenesis of periodontitis and suggest that P. gingivalis may not be a normal inhabitant of a periodontally healthy dentition. [References: 21] <34> UI - 1998344625 AU - Chiang C-P AU - Chueh L-H AU - Lin S-K AU - Chen M-Y IN - Dr. C.-P. Chiang, School of Dentistry, National Taiwan University Hospital, No. 1, Chang-Te Street, Taipei 100; Taiwan. TI - Oral manifestations of human immunodeficiency virus-infected patients in Taiwan. SO - Journal of the Formosan Medical Association Vol 97(9) (pp 600-605), 1998. AB - To understand the characteristic clinical features of human immunodeficiency virus (HIV)-related oral lesions and determine the prevalence of various oral lesions in HIV-infected patients in Taiwan, we conducted a cross-sectional study of 207 HIV-infected patients at the Taipei Municipal Institute for Venereal Disease Control. Overall, 108 (52.2%) patients had at least one oral lesion. The most common oral manifestation of HIV infection among these 207 patients was oral hairy leukoplakia (OHL, 29.5%), followed by candidiasis (12.1%), xerostomia (10.6%), aphthous ulcers (8.7%), and linear gingival erythema (5.8%). Less frequently encountered oral lesions included leukoplakia (1.9%), papilloma (1.4%), necrotizing ulcerative periodontitis (1.0%), Kaposi's sarcoma (1.0%), herpes simplex (0.5%), Burkitt's lymphoma (0.5%), and parotid gland enlargement (0.5%). Thirty-one (15%) patients had multiple oral lesions. Patients with oral candidiasis or multiple oral lesions had significantly lower mean CD4 lymphocyte counts and CD4/CD8 lymphocyte ratios than those without any oral lesions (p < 0.05). Chi-square analysis revealed that patients with CD4 lymphocyte counts below 200 cells/mm3 were more prone to have OHL (p < 0.002), oral candidiasis (p < 0.001) and multiple oral lesions (p < 0.001). Those with CD4/CD8 lymphocyte ratios below 0.4 were more likely to have OHL (p < 0.02), oral candidiasis (p < 0.01) and multiple oral lesions (p < 0.02) than those with higher counts. In conclusion, the occurrence of oral lesions, especially OHL and oral candidiasis, is fairly common in Taiwanese HIV-infected patients. [References: 30] <35> UI - 1998333903 AU - Waddington JL AU - Youssef HA AU - Kinsella A IN - Prof. J.L. Waddington, Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2; Ireland. E-Mail: jwadding@rcsi.ie. TI - Mortality in schizophrenia. Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study. SO - British Journal of Psychiatry Vol 173(OCT.) (pp 325-329), 1998. AB - Background: Although increased mortality is one of the most consistent and accepted epidemiological findings in schizophrenia, a high rate of suicide appears unable to account fully for this burden which remains poorly understood. Method: A cohort of 88 in-patients was followed prospectively over a 10-year period and predictors of survival sought among demographic, clinical and treatment variables. Results: Over the decade, 39 of the 88 patients (44%) died, with no instances of suicide. Reduced survival was predicted by increasing age, male gender, edentulousness and time since pre- terminal withdrawal of antipsychotics; additionally, two indices of polypharmacy predicted reduced survival: maximum number of antipsychotics given concurrently (relative risk 2.46, 95% CI 1.10-5.47; P=0,03) and absence of cotreatment with an anticholinergic (relative risk 3.33, 95% CI 0.99- II.II; P=0.05). Conclusions: Receiving more than one antipsychotic concurrently was associated with reduced survival, in the face of little or no systematic evidence to justify the widespread use of antipsychotic polypharmacy. Conversely, over-cautious attitudes to the use of adjunctive anticholinergics may require re-evaluation. [References: 27] <36> UI - 1998340262 AU - Anonymous TI - The expanding role of tacrolimus in organ transplantation. SO - Drugs & Therapy Perspectives Vol 12(8) (pp 1-6), 1998. AB - The efficacy of tacrolimus as an immunosuppressant in patients undergoing liver transplantation is well established. Further data have now confirmed the drug's efficacy in patients undergoing kidney transplants. As would be expected, tacrolimus has also shown immunosuppressive efficacy in patients undergoing heart, lung and pancreas transplants. As primary immunosuppression, tacrolimus-based regimens produce similar 1-year graft and patient survival rates as cyclosporin-based regimens. The risk of rejection appears to be lower with tacrolimus, but the clinical value of this is yet to be established. Importantly, tacrolimus can salvage a good proportion of grafts in patients experiencing rejection or toxicity when receiving cyclosporin. The adverse event profile of tacrolimus is typical of that of an immunosuppressive agent. The diabetogenic potential of tacrolimus is greater than that of cyclosporin, and the incidence of neurotoxicity and nephrotoxicity also appears to be higher. However, tacrolimus causes less disturbance of the lipid profile and hypertension than cyclosporin, and hirsutism and gingival hyperplasia are less problematic. [References: 16] <37> UI - 1998328420 AU - Florence E AU - Van Gompel A AU - Colebunders R AU - Kedjarune U AU - Leggat PA IN - E. Florence, Institute of Tropical Medicine, Antwerp; Belgium. TI - Dental precautions for travelers [3] (multiple letters). SO - J TRAVEL MED, Vol 5(3) (pp 159), 1998. <38> UI - 1998286810 AU - Scopinaro N AU - Adami GF AU - Marinari GM AU - Traverso E AU - Camerini G AU - Baschieri G AU - Simonelli A IN - Dr. N. Scopinaro, Istituto Clinica Chirurgica Univ., Ospedale S Martino, I-16132 Genova; Italy. E-Mail: scopinar@unige.it. TI - Long-term results of biliopancreatic diversion in the treatment of morbid obesity. SO - Acta Chirurgica Austriaca Vol 30(3) (pp 166-171), 1998. AB - Background: The continuing evolution and the mechanisms of actions of biliopancreatic diversion (BPD) as malabsorptive approach to the surgical treatment of obesity are evaluated. Methods: In a series of 2273 patients operated on during the last 21 years, BPD was progressively modified in order to adapt the operation to the individual patients' characteristics. Results: There was a mean permanent reduction of about 75% of the initial excess weight. The other beneficial effects, besides those consequent to weight loss and/or reduced nutrient absorption, included permanent normalization of serum glucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of the operation. Operative mortality was less than 0.5%. Specific late complications included: anemia, less than 5% with adequate iron and/or folate supplementations; stomal ulcer, reduced to 3.0% by oral H2-blockers prophylaxis; bone demineralization, increasing up to the fourth year and tending to decrease thereafter, with need of calcium and vitamin D supplementation; neurological complications, totally avoidable by prompt vitamin B administration to patients at risk; protein malnutrition, which was reduced to a minimum of 2.8% with 1.2% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gastric remnant and the length of the alimentary limb to the patient's individual characteristics. Conclusions: The correct use of BPD, based on the knowledge of its mechanisms of action, can make the procedure a very effective and safe one in all hands. [References: 30] <39> UI - 1998285585 AU - Mignogna MD AU - Lo Muzio L AU - Favia G AU - Mignogna RE AU - Carbone R AU - Bucci E IN - Dr. M.D. Mignogna, Via Domenico Fontana 81 pal. 10, 80128 Naples; Italy. TI - Oral lichen planus and HCV infection: A clinical evaluation of 263 cases. SO - International Journal of Dermatology Vol 37(8) (pp 575-578), 1998. AB - Background: Hepatitis C virus (HCV) infection induces variable dermatologic manifestations. Our purpose was to determine whether there is an association between HCV infection and oral lichen planus (OLP). Methods Antibodies to HCV were determined in patients with OLP (263 patients; 156 women and 107 men, with a mean age of 55.5 years) and in a control population. Results: Seventy six cases (28.8%) were positive for HCV antibodies with the second-generation enzyme-linked immunosorbent assay (ELISA II) test. All of these cases were confirmed with the second-generation recombinant immunoblot assay (RIBA II) test. In 61 cases (23.1%), high levels of serum transaminase were found. Positivity for hepatitis B virus (HBV) markers was found in 31 patients (11.7%) and for hepatitis A virus (HAV) markers in 43 patients (16.3%). None had positivity for hepatitis D virus (HDV) markers; As a control group, we used 100 patients (58 women and 42 men, with a mean age of 55.3 years) referred to the School of Dentistry of the University of Naples 'Federico II,' and treated for general dental caries. In the control group, HCV antibody positivity was found in three cases. Conclusions The high prevalence of HCV antibody in this group of patients with OLP, higher than in the healthy population, suggests a link (p = 1.423 x 10-7, chi-squared test) between these two diseases. These findings Stress the importance of liver examination in OLP patients, and the need for other studies on the high susceptibility to hepatitis viruses in the population in the southern part of Europe. [References: 34] <40> UI - 1998268945 AU - Gaiser RR AU - Castro AD IN - Dr. R.R. Gaiser, Department of Anesthesiology, Univ. of Pennsylvania Health System, 3400 Spruce St., Philadelphia, PA 19104; United States. TI - The level of anesthesia resident training does not affect the risk of dental injury. SO - Anesthesia & Analgesia Vol 87(2) (pp 255-257), 1998. <41> UI - 1998277786 AU - Sananes C AU - Giaroli A AU - Soderini A AU - Guardado N AU - Snaidas L AU - Bermudez A AU - Ferreira M AU - Di Paola G AU - Sardi J IN - Prof. J. Sardi, Pringles 1430, Buenos Aires; Argentina. TI - Neoadjuvant chemotherapy followed by radical hysterectomy and postoperative adjuvant chemotherapy in the treatment of carcinoma of the cervix uteri: Long-term follow-up of a pilot study. SO - European Journal of Gynaecological Oncology Vol 19(4) (pp 368-373), 1998. AB - Objective: The aim of the study was to determine if ACH given after NCH followed by RH could decrease the incidence of distant metastases in patients with locally advanced carcinoma of cervix uteri. Material: 56 pts (34 Ib, 18 IIb, 4 IIIb) with confirmed diagnosis of squamous cervical cancer were enrolled in this phase II trial. The methodology used was: 1) Figo clinical staging; 2) Ultrasonographic determination of tumor volume in < or > 4 cms; 3) V.B.P. scheme: cis-platinum 50 mg/m2/day 1; vincristine 1 mg/m2/day 1; bleomycin 25 mg/m2/days 1-2-3 (3 courses with 10 days interval); 4) Clinical and sonographic tumor response evaluation following U.I.C.C. response criteria; 5) Radical hysterectomy; 6) Pathalogical risk factor evaluation; 7) ACH with P.M.C. (cis-platinum 50 mg/m2, methotrexate 30 mg/m2, ciclophosfamide 500 mg/m2) 3 courses every 21 days; 8) Comparison and location of recurrences with a neoadjuvant group (NCH + RH + RT to whole pelvis), and with a control group treated with conventional radiotherapy were done. For statistical analysis the Chi-Square was used and D.F.S. and overall survival (O.S.) were calculated according to the Kaplan Meier and Log Rank Test. Results: After a median follow-up of 75 months (range 42-108), O.S. for stage Ib was 88%, Stage IIb 78%, and 50% for IIIb. The recurrences were 12% (4/34) for Stage Ib (3 pelvic and 1 distant); 28% for IIb (5/18) (4 pelvic and 1 distant); 50% (2/4) for IIIb (2 pelvic recurrences). When residual tumor volume was < 2 cm in the surgical specimen (n = 39) there were 4 recurrences (3 pelvic and 1 distant), and 7 (6 pelvic and 1 distant) for tumors > 2 cm. (p < 0.01 for pelvic recurrences). For the stage Ib with residual tumor < 2 cm (n = 14) there were no pelvic recurrences and only 1 distant. Comparing for Stage Ib with previous tumor volume > 4 cm of the ACH Group (n = 17) with a classical NCH (n = 51) and control (n = 51) groups, there were observed 2 (11.7%) pelvic and 1 (5.8%) distant relapses for the 1st. Group, 3 (5.9%) pelvic and 3 (5.9%) distant relapses for the 2nd, and 11 (21.6%) pelvic and 5 (9.8%) distant relapses for the 3rd. Group. From the comparison of locally advanced tumors (Stages IIb + IIIb) of ACH group (n = 22), with a Stage IIIb surgically removed of classical NCH group (n = 38) and with a control group of conventional RT (n = 51), there were observed 6 (27%) pelvic and 1 (4.5%) distant relapses for the 1st Group, 4 (11%) pelvic and 7 (18.4%) distant relapses for the 2nd, and 31 (60.7%) pelvic and 5 (9.8%) distant for the 3rd one. Conclusion: ACH after NCH + RH could be used for stage Ib with tumor volume > 4 cm, with complete clinical response or residual tumor < 2 cm. The results of this group of tumors suggest the importance of going on phase III trials comparing NCH + RH alone vs. NCH + RH + ACH. ACH could also be used to try to obtain better control of distant metastases in Stages IIb and IIIb. In these cases radiotherapy to the whole pelvis must not be excluded. [References: 38] <42> UI - 1998276136 AU - Lin J-D AU - Kao P-F AU - Weng H-F AU - Lu W-T AU - Huang M-J IN - J.D. Lin, Division of Endocrinology Metabolism, Chang Gung Memorial Hospital, 5 Fu-Shin St., Kweishan County, Taoyuan Hsien; Taiwan. TI - Relative value of thallium-201 and iodine-131 scans in the detection of recurrence or distant metastasis of well differentiated thyroid carcinoma. SO - European Journal of Nuclear Medicine Vol 25(7) (pp 695-700), 1998. AB - Radioactive iodine 131I has been found to be more sensitive and more specific than thallium-201 for the detection of distant metastases and thyroid remnants in the neck in cases of well-differentiated thyroid carcinoma. 201T1 has been deemed particularly useful in localizing metastases or recurrence in patients with a negative 131I scan and abnormal levels of serum thyroglobulin (Tg). This study aimed to: (1) determine the value of 201Tl imaging in localizing metastases or recurrence in patients with well-differentiated thyroid carcinoma, and (2) evaluate the false-positive and false-negative results of 131I and 201Tl scintigraphy. Sixty-two thyroid remnant ablated patients who underwent simultaneous postoperative 201Tl and 131I scans and and serum Tg determinations were evaluated. Fifty patients had papillary thyroid carcinomas and 12 had follicular thyroid carcinomas. 201Tl imaging was performed before the 131I studies. Of the 62 patients who underwent 201Tl imaging studies, 24 were found to have positive results, with local recurrence or distant metastases. Patients with positive results in the 201Tl imaging studies tended to be older, were mor often male, had higher Tg levels and had a higher recurrence rate. Of these 24 patients, ten had negative diagnostic or therapeutic 131I scans. Concurrently, serum Tg levels were less than 5 ng/ml in five of these ten patients. Three patients were deemed false positive by 201Tl scans; one had a parotid tumour, one a periodontal abscess and one lung metastasis. Among the 38 patients with negative 201Tl scans, 11 had positive findings on 131I scans. Three had distant metastases: two with lung metastases and one with bone metastases. Patients with false-positive results on 131I scans included those with biliary tract stones, ovarian cysts, and breast secretion. Of the 27 patients with negative (2O1)Tl and 131I scans, 15 had elevated serum Tg levels. Among these, local recurrence followed by lung metastases was manifested in a 49-year-old male with papillary thyroid carcinoma. In conclusion, both 131I and 201Tl scans are useful in the detection of recurrence or distant metastasis of well differentiated thyroid cancers. 201Tl scan could in particular be used in patients with a negative 131I scan in conjunction with an elevated Tg level. [References: 27] <43> UI - 1998238940 AU - Schuman P AU - Ohmit SE AU - Sobel JD AU - Mayer KH AU - Greene V AU - Rompalo A AU - Klein RS IN - Dr. P. Schuman, Division of Infectious Diseases, Wayne State Univ. School of Medicine, 4160 John R, Detroit, MI 48201; United States. TI - Oral lesions among women living with or at risk for HIV infection. SO - American Journal of Medicine Vol 104(6) (pp 559-564), 1998. AB - PURPOSE: Our objectives were to compare the prevalence of oropharyngeal mucosal lesions among human immunodeficiency virus (HIV) seropositive and demographically similar seronegative women, and to determine the association of oral lesions with immunosuppression, substance abuse, use of medications, and utilization of dental services. POPULATION AND METHODS: Participants in a multicenter, longitudinal cohort study of HIV infection in women were evaluated at baseline by interview, physical examination, and laboratory studies. RESULTS: Oropharyngeal pathology was found in 40% of seropositive and 23% of seronegative women. Oral candidiasis was identified in 15% of seropositive and 3% of seronegative women. Among seropositive women, history of previous oral candidiasis, lower CD4 lymphocyte counts, and current antibiotic use were associated with oral candidiasis. Hairy leukoplakia was identified in 5% of seropositive women and was significantly associated with lower CD4 lymphocyte counts. Gingival erythema and ulcerative gingivitis were found in 23% of participants Overall, but were unrelated to HIV serostatus or CD4 lymphocyte count. Substance abuse, lack of dental care, and African- American race were associated with gingival pathology. CONCLUSION: The high prevalence of oral lesions among HIV seropositive and at-risk seronegative women underscores the need for routine oral examination and targeted treatment of this population. [References: 25] <44> UI - 1998225660 AU - Jednak MA AU - Nostrant TT IN - Dr. T.T. Nostrant, University of Michigan, 3912 Taubman Center, Ann Arbor, MI 48109-0362; United States. E-Mail: dmharris@medmail.med.umich.edu. TI - Screening for colorectal cancer. SO - Primary Care; Clinics in Office Practice Vol 25(2) (pp 293-308), 1998. AB - Randomized, controlled trials have shown with certainty that screening for colorectal cancer reduces morbidity and is cost-effective. Factors that increase the risk of colorectal cancer include a personal or family history of adenomatous polyps or colorectal cancer, certain genetic syndromes and chronic inflammatory bowel disease. [References: 93] <45> UI - 1998237894 AU - Gilbert GH AU - Duncan RP AU - Vogel WB IN - G.P. Gilbert, College of Dentistry, CD Pepper Ctr Res Oral Health Aging, University of Florida, PO Box 100416, Gainesville, FL 32610-0416; United States. TI - Determinants of dental care use in dentate adults: Six-monthly use during a 24-month period in the Florida Dental Care Study. SO - Social Science & Medicine Vol 47(6) (pp 727-737), 1998. AB - The objective of this study is to describe for a diverse sample of dentate adults the incidence of dental care use and predisposing, enabling, and need correlates of that use. The Florida Dental Care Study (FDCS) is a prospective longitudinal cohort study of persons who at baseline had at least one natural tooth, were 45 years or older, and who resided in north Florida, U.S.A. An in-person interview and clinical dental examination were conducted at baseline and 24 months after baseline, with 6-monthly telephone interviews between those times. Seventy-seven percent of subjects reported one or more dental visits during the 24 months of follow-up. Six-monthly use ranged from 46% to 55%. Incident perceived need for care and certain incident self-reported oral signs and symptoms were strongly predictive of incident dental care use. Decrements in oral functional limitation, oral disadvantage, and self-rated oral health were predictive of less care bivariately, but were not salient in a multivariate model, with two notable exceptions: two measures related to esthetics. The conclusions are that certain measures of need (perceived need and specific self-reported signs and symptoms) were important predictors of incident dental care. However, persons with need as determined by direct clinical examination and persons with need as determined by self-reported decrements in the more distal measures of oral health (oral functional limitation, oral disadvantage, and self-rated oral health) were actually less likely to seek dental care. The salience of esthetics in predicting use is consistent with cross-sectional findings that dental esthetic cues are important to oral 'health'. Typical approach to care, dental attitudes, ability to pay for care, race, and sex were also important for understanding incident dental care use. [References: 33] <46> UI - 1998228403 AU - Comandini UV AU - Tossini G AU - Longo MA AU - Ferri F AU - Cuzzi G AU - Noto P AU - Zaccarelli M AU - Visco G IN - Dr. U.V. Comandini, Via Flaminia 195, I-00196, Rome; Italy. TI - Sporadic Hepatitis C virus infection: A case-control study of transmission routes in a selected hospital sample of the general population in Italy. SO - Scandinavian Journal of Infectious Diseases Vol 30(1) (pp 11-15), 1998. AB - A case-control study was performed on 9,175 Italian adult outpatients in 5 hospitals in Rome. The study was carried out to clarify the role of some less investigated risk factors (RF) in the spread of hepatitis C virus (HCV) infection. All subjects were contacted by interviewers, who completed a questionnaire. Their sera were stored and subsequently tested for both HCV and hepatitis B virus core (HBc) antibodies. 365 subjects, positive for anti-HCV and anti-HBc-negative, and who had denied intravenous drug use (IDU) (cases) were compared with an equal number of suitable random controls negative for anti-HCV and anti-HBc. Gender, age and region of birth and residence mere matched. The prevalence of 13 RFs were statistically compared by univariate and multivariate analysis. A positive anti-HCV test was significantly associated, by multivariate analysis with intravenous treatments and minor surgical procedures (both before 1975) (p < 0.001), blood transfusions (before 1991) (p < 0.01), diabetes (p < 0.01), and deliveries in hospital (p < 0.05) (both before 1975). After 1975 (1991 for transfusions), all associations lost their significance. Intra-familial (sexual and non sexual), occupational RFs and dental care were not significantly associated with the presence of anti-HCV. We suggest that non-disposable syringes, commonly used until 1975 in Italy for i.v. treatments, have been the major route for HCV transmission in Italy among non-IDU subjects. [References: 32] <47> UI - 1998132205 AU - Stephenson J TI - Rising stroke rates spur efforts to identify risks, prevent disease. SO - JAMA Vol 279(16) (pp 1239-1240), 1998. <48> UI - 1998129085 AU - Anonymous TI - Gingival hyperplasia due to calcium antagonists. SO - PRESCRIRE INT, Vol 7(34) (pp 54-55), 1998. <49> UI - 1998082357 AU - Chisick MC AU - Poindexter FR AU - York AK IN - M.C. Chisick, U.S. Army Center, Hlth. Promotion and Prev. Medicine, Aberdeen Proving Ground, MD; United States. TI - Comparing annual dental utilization rates of active duty U.S. military personnel and their employed civilian cohorts. SO - Military Medicine Vol 163(3) (pp 148-150), 1998. AB - This study compares annual dental utilization rates between a representative sample of active duty U.S. military personnel (N = 11,765) and a national sample of employed U.S. civilians (N = 10,798). Military data were collected between April 1994 and January 1995 at 26 sites using self- administered questionnaires on a prestratified, random sample of Army, Air Force, Navy, and Marine personnel. Women and blacks were oversampled. Civilian data are from the most recent U.S. oral health survey of working adults. Results show that annual dental utilization rates of service members exceed those of their employed civilian cohorts. Overall, 86% of active duty military personnel have seen a dentist in the past year versus barely half of employed civilians. For service members, annual dental utilization is invariant across age, sex, race, education, branch of service, and rank. Dental health class and perceived need for dental care are inversely related to annual dental utilization. [References: 4] <50> UI - 1998058268 AU - Fourrier F AU - Duvivier B AU - Boutigny H AU - Roussel-Delvallez M AU - Chopin C IN - Dr. F. Fourrier, Service de Reanimation Polyvalente, Hopital Roger Salengro, CHRU, 59037 Lille; France. TI - Colonization of dental plaque: A source of nosocomial infections in intensive care unit patients. SO - Critical Care Medicine Vol 26(2) (pp 301-308), 1998. AB - Objective: To study the dental status and colonization of dental plaque by aerobic pathogens and their relation with nosocomial infections in intensive care unit (ICU) patients. Design: A prospective study in a medical ICU of a university-affiliated hospital. Patients: Consecutive patients admitted to the ICU during a 3-mo period. Interventions: Dental status was assessed by the same investigator using a score adapted from the 'Caries- Absent-Occluded' (CAO) index (referred to in the U.S. as DMFT [Decayed- Missing-Filled Teeth] index). The amount of dental plaque on premolars was assessed using a semiquantitative score. Quantitative cultures of dental plaque, nasal secretions, tracheal aspirates, and urine were done at admission (day 0) and every fifth day until death or discharge. An additional study was done in eight patients to serially compare dental plaque, salivary, and tracheal aspirate cultures during a 2-wk period. Measurements and Main Results: Fifty-seven patients were included in the main study. Due to the variability in their ICU stay, 29 patients could be examined on day 0 only (group A), 15 patients on days 0 and 5 (group B), and 13 patients on days 0, 5, and 10 (group C). The mean dental CAO score was 16 +/- 8 and did not change during the ICU stay. The dental plaque score was <=1 in 70% of patients on day 0; <=2 in 50% of patients on day 5; and <=2 in 90% of patients on day 10. Dental plaque cultures were positive at 103 colony-forming units/mL for aerobic pathogens in 23% of patients on day 0; 39% of patients on day 5; and 46% of patients on day 10. In groups B and C, mean dental plaque score and frequency of plaque colonization increased from days 0 to 5 and from days 5 to 10. A high bacterial concordance was found between dental plaque and tracheal aspirate cultures, and in the additional study, between salivary and dental plaque cultures. Twenty-one patients developed a nosocomial infection in the ICU. Dental plaque colonization on days 0 and 5 was significantly associated with the occurrence of nosocomial pneumonia and bacteremia (sensitivity 0.77; specificity 0.96; positive predictive value 0.87; negative predictive value 0.91; relative risk 9.6). In six cases of nosocomial infection, the pathogen isolated from dental plaque was the first identified source of nosocomial infection. Conclusions: The amount of dental plaque increased during the ICU stay. Colonization of dental plaque was either present on admission or acquired in 40% of patients. A positive dental plaque culture was significantly associated with subsequent nosocomial infections. Dental plaque colonization by aerobic pathogens might be a specific source of nosocomial infection in ICU patients. [References: 18] <51> UI - 1998058888 AU - Robinson PG IN - Dr. P.G. Robinson, Department of Dental Public Health, King's College, School of Medicine and Dentistry, Bessemer Road, London SE5 9PJ; United Kingdom. TI - The oral manifestations of HIV infection. SO - International Journal of STD & AIDS Vol 8(11) (pp 668-674), 1997. <52> UI - 1998004816 AU - Mirowski GW AU - Bettencourt JD AU - Hood AF IN - Dr. G.W. Mirowski, Dept of Dermatology, Indiana Univ. School of Medicine, 550 N University Blvd, Indianapolis, IN 46202-6267; United States. TI - Oral infections in the immunocompromised host. SO - Seminars in Cutaneous Medicine & Surgery Vol 16(4) (pp 249-256), 1997. AB - The prevalence of infections in the immunocompromised host is increasing. The oral cavity is a primary or sole site in many cases. It is important for the practicing clinician to recognize the more common infections in this growing patient population. Oral examinations are an essential component of all physical examinations, especially when immunosuppression is known or suspected. We recommend that all patients starting immunosuppressive therapy receive a comprehensive oral examination before the institution of such therapy to eliminate potential sources of oral and odontogenic infections. The examination should include full mouth dental radiographs and a complete soft-tissue examination. Timely, accurate diagnoses may have important implications with regard to management, prognosis, cost, morbidity, and mortality. [References: 34] <53> UI - 1998002089 AU - Wallace JI AU - Schwartz RS IN - Dr. J.I. Wallace, Harborview Medical Center, Box 359755, 325 Ninth Avenue, Seattle, WA 98104; United States. TI - Involuntary weight loss in elderly outpatients: Recognition, etiologies, and treatment. SO - Clinics in Geriatric Medicine Vol 13(4) (pp 717-735), 1997. AB - Weight loss appears to occur frequently in older adults and has been associated with increased morbidity and mortality. However, the significance of weight loss per se and the optimal clinical approach to older outpatients who are losing weight is not completely understood. This article reviews the existing literature on weight loss in older people and outlines a basic approach for the clinician faced with the common, but often difficult, diagnostic and management issues presented by an elderly patient with weight loss. [References: 105] <54> UI - 97350092 AU - Tsuchida M AU - Mineshita S AU - Okonogi H AU - Sugimori K AU - Hoshi K AU - Horiuchi T AU - Wang L-M AU - Fujimoto EK IN - M. Tsuchida, Major in Health Science, Faculty of Human Sciences, Aichi Mizuho College, 86-1, Haiwa, Hiratobashi-cho, Toyota 470-03; Japan. TI - The role of an uncommon type of oral streptococcus sanguis in the etiology of Behcet's disease. SO - Environmental Health and Preventive Medicine, Vol 2(2) (pp 59-63), 1997. AB - The relationships of Behcet's disease (BD) with oral diseases and the prevalence of an uncommon type of oral Streptococcus sanguis (Str. sanguis) in the oral cavity were investigated in a case-control study. BD patients were compared to patient controls (collagen disease) and healthy controls. An interview questionnaire survey of BD and oral diseases showed that during the pre-onset, onset, and post-onset periods, the incidences of tonsillitis and dental caries, or the history of dental treatment, were greater in BD cases. Typological analysis showed a higher prevalence of an uncommon type of Str. sanguis, differing from the common type, among BD cases compared to control groups. These results, showing a higher incidence of tonsillitis and dental caries during the presymptomatic period, a greater frequency of dental treatments during the symptomatic period, and the presence of an uncommon type of Str. sanguis, indicate that Str. sanguis of an uncommon type is related to increased risk of BD, and the possibility of a causal role is suggested. [References: 32] <55> UI - 97323176 AU - Chaudhuri K AU - Torley H AU - Madhok R IN - R. Madhok, Sandoz Research Institute, East Hanover, NJ; United States of America. TI - Cyclosporin. SO - British Journal of Rheumatology Vol 36(9) (pp 1016-1021), 1997. <56> UI - 97310674 AU - Peach HG AU - Pearce DC AU - Farish SJ IN - Prof. H.G. Peach, Dept. Public Health Community Med., University of Melbourne, Ballarat Health Services Base Hosp., PO Box 577, Ballarat, Vic. 3353; Australia. E-Mail: a.temperley@phcm.unimelb.edu.au. TI - Helicobacter pylori infection in an Australian regional city: Prevalence and risk factors. SO - Medical Journal of Australia Vol 167(6) (pp 310-313), 1997. AB - Objective: To investigate the prevalence of Helicobacter pylori infection and potential risk factors for infection in an adult Australian population. Design: Cross-sectional study. Setting: Ballarat, a major regional city in Victoria (population, 78,000; 92% born in Australia), November 1994 to July 1995. Participants: 217 adults randomly selected from the electoral roll. Main outcome measures: H. pylori IgG antibody status by enzyme immunoassay; amount of dental plaque; sociodemographic and other potential risk factors; odds ratios for risk factors determined by logistic regression analysis. Results: Age-standardised prevalence of H. pylori infection was 30.6%. After adjustment for age, sex and socioeconomic index, positive H. pylori status was significantly associated with increasing number of tooth surfaces with a high plaque score (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.7), increasing number of years in a job with public contact (OR, 1.7; 95% CI, 1.3-2.3), blood group B antigen (OR, 3.1; 95% CI, 1.1-9.1), and having lived in a household with more than six members during childhood (OR, 2.5; 95% CI, 1.1-5.5). Negative H. pylori status was significantly associated with increasing education, having ever lived on a farm, and having teeth scaled less than once a year. Conclusions: H. pylori infection is common. Dental plaque may be a reservoir for H. pylori, which is probably transmitted by person-to-person contact, and blood group B antigen may predispose to infection. Community education about effective oral hygiene and adoption of good hygiene practices by those with regular public contact may be important to prevent acquisition and transmission of H. pylori. [References: 24] <57> UI - 97272549 AU - Wismeijer D AU - Van Waas MAJ AU - Vermeeren JIJ AU - Kalk W IN - D. Wismeijer, Zutphensestraatweg 26, 6995 AH Ellecom; Netherlands. TI - Patients' perception of sensory disturbances of the mental nerve before and after implant surgery: A prospective study of 110 patients. SO - British Journal of Oral & Maxillofacial Surgery Vol 35(4) (pp 254-259), 1997. AB - In a randomized controlled clinical trial 110 edentulous patients with severe mandibular bone loss have been treated with ITI-dental implants using three different treatment strategies: (1) a mandibular overdenture supported by two implants with ball attachments, (2) two implants with an interconnecting bar or (3) by four interconnected implants. As implant surgery involves elevation of the mucoperiosteum, bone remodeling at the implant site and insertion of implants close to the mental foramen, altered sensations of the mental nerve caused by the surgery are to be expected. An altered sensation of the lower lip can also be caused by pressure of an ill-fitting lower denture on the mental foramen, or in the case of severe bone loss of the alveolar ridge, on the alveolar nerve itself. This article presents the results of the patients' perception of the sensation of their lower lip before, 10 days after and 16 months after implant surgery in the mandible. It shows that 25% of the patients describe a sensory disturbance before treatment. This 25% also showed high scores on the Hopkins Symptoms Check List indicating a tendency to somatize complaints. Eleven percent of the patients report a sensory disturbance in the lower lip 10 days after surgery. Ten percent report a sensory disturbance 16 months after surgery of which one third also reported a disturbance before the treatment. This implies the risk of a sensory disturbance of the lower lip to be a possible complication after implant surgery. Therefore patients must be informed about this phenomenon before treatment. [References: 18] <58> UI - 97253245 AU - Fiorito A AU - Larese F AU - Zanin S AU - Molinari T IN - Dr. F. Larese, Istituto di Medicina del Lavoro, Universita di Trieste, Trieste; Italy. TI - Liver function alterations in synthetic leather workers exposed to dimethylformamide. SO - American Journal of Industrial Medicine Vol 32(3) (pp 255-260), 1997. AB - A cross-sectional study of the prevalence of chronic liver function alterations was performed in 75 workers employed in a synthetic leather factory, exposed to dimethylformamide (DMF) air concentrations below threshold limit values (30 mg/m3). Biological monitoring among workers revealed acceptable urine levels of monomethylformamide (NMF) on average, but the very wide range indicated that occasional overexposure was possible. The worker survey slowed a high percentage of disulfiram -like symptoms (50%) and liver function abnormalities (22.7%), compared with a demographically similar group of unexposed workers. Covariance analysis (ANCOVA) revealed that enzyme levels were significantly higher in exposed workers than in controls after data were corrected for age, alcohol consumption, body mass index, and cholesterol levels. The authors conclude that DMF can cause liver diseases even if air TLVs are respected, because accidental contact with liquid DMF can significantly increase DMF uptake. In this situation, air monitoring is no longer sufficient to evaluate worker exposure. [References: 38] <59> UI - 97244090 AU - Jorgensen MG IN - M.G. Jorgensen, c/o Clinical Investigation Dept., Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134-5001; United States of America. TI - Prevalence of amlodipine-related gingival hyperplasia. SO - Journal of Periodontology Vol 68(7) (pp 676-678), 1997. AB - CALCIUM CHANNEL BLOCKERS ARE KNOWN to contribute to gingival hyperplasia. The vest majority of reports discuss patients taking the drug nifedipine. During the past few years a newer calcium channel blocker, amlodipine, has been used with increasing frequency. To date, six cases have been published indicating that amlodipine may also promote gingival hyperplasia; however, no data have been reported regarding the prevalence of this phenomenon. The purpose of this study was to examine a large group of patients taking amlodipine and determine the prevalence of gingival hyperplasia. One hundred fifty dentate patients who had been taking amlodipine, 5 mg per day for at least 6 months, volunteered to undergo a screening examination for gingival hyperplasia. Mild hyperplasia (<1/3 clinical crown) was found in five patients - a prevalence of 3.3%. This is significantly different (P < .001) than rates reported for patients taking nifedipine, and not significantly different from rates previously reported in control groups of cardiac patients not taking calcium channel blockers. The results from this group of patients indicated that amlodipine, 5 mg per day, did not induce gingival hyperplasia. [References: 30] <60> UI - 97233825 AU - Markowitz AJ AU - Winawer SJ IN - Dr. A.J. Markowitz, Memorial Sloan-Kettering Can. Ctr., 1275 York Avenue, New York, NY 10021; United States of America. TI - Screening and surveillance for colorectal carcinoma. SO - Hematology - Oncology Clinics of North America Vol 11(4) (pp 579-608), 1997. AB - Screening and surveillance examinations are effective in lowering colorectal cancer risk. Screening tests have been demonstrated to reduce colorectal cancer mortality. Colonoscopic removal of adenomatons polyps has been determined to reduce colorectal cancer incidence. High-risk individuals and their family members should be identified and offered more aggressive recommendations for appropriate screening and surveillance guidelines. Colorectal cancer screening strategies are in an acceptable range of cost effectiveness. [References: 128] <61> UI - 97217652 AU - Krall EA AU - Dawson-Hughes B AU - Hannan MT AU - Wilson PWF AU - Kiel DP IN - Dr. B. Dawson-Hughes, Calcium/Bone Metabolism Laboratory, Jean Mayer USDA, HNRCA at Tuffs University, 711 Washington Street, Boston, MA 02111; United States of America. TI - Postmenopausal estrogen replacement and tooth retention. SO - American Journal of Medicine Vol 102(6) (pp 536-542), 1997. AB - PURPOSE: To determine if estrogen replacement therapy (ERT) is associated with improved tooth retention and lower risk of edentulism (no natural teeth remaining) in a cohort of elderly women. PATIENTS AND METHODS: Subjects were 488 women, aged 72 to 95, who participated in the 23rd examination cycle (1994 to 1995) of the Framingham Heart Study, a population- based study begun in 1948. The number of teeth remaining and their location were recorded by a trained observer. History and duration of ERT were obtained from records kept since cycle 10 (1960 to 1963). Third molars were excluded from all analyses. RESULTS: Women who ever used ERT were younger than nonusers by i year (80 +/- 4 years, n = 184, versus 81 +/- 4 years, n = 304, P = 0.019). Estrogen users had more teeth remaining than nonusers (12.5 +/- 0.8 versus 10.7 +/- 0.8 versus 10.7 +/- 0.6 teeth, P = 0.046, mean +/- SE) after controlling for age, smoking status, and education. Duration of estrogen use was an independent predictor of the number of teeth remaining (P = 0.015) such that each 4.2-year interval of use was associated with an increased mean retention of 1 tooth. Long-term estrogen users (more than 8 years, n = 48) had an average of 3.6 more teeth than women who never used estrogen (14.3 +/- 1.5 versus 10.7 +/- 0.6 teeth, P <0.02). The association with duration of use was present among different types of teeth (incisors, canines, and premolars) but less strong for molars. The odds of being edentulous were reduced by 6% for each 1-year increase in duration of estrogen use (odds ratio = 0.94, P = 0.038, 95% confidence interval = 0.90 to 0.99). CONCLUSIONS: These data suggest that ERT protects against tooth loss and reduces the risk of edentulism. The associations of estrogen use and tooth retention are evident for all but the molars. [References: 30] <62> UI - 97200016 AU - Naslund GK IN - G.K. Naslund, Dept of Clinical Neuroscience, Karolinska Hospital Z6, SE-171 76 Stockholm; Sweden. TI - Relationships between health behavior, knowledge, and beliefs among Swedish blue-collar workers. SO - Scandinavian Journal of Social Medicine Vol 25(2) (pp 100-110), 1997. AB - The main objective of this study was to assess the health behavior, risk awareness and beliefs concerning the importance of positive health practices among blue-collar workers, and to examine the relationships between behavior, knowledge and beliefs. Data were gathered from 1359 workers aged 18-65 years using a postal questionnaire to 2493 randomly selected members of two labor unions. A high prevalence of negative health practices was noted among the respondents. While no relationship was found between health behaviors and awareness of risks associated with such behaviors, there was a relationship between positive health practices and strong beliefs about the importance of those practices. Awareness of the influence of a positive behavior on disease risk was associated with a stronger belief concerning the importance of that behavior. Women were characterized by having more positive health behavior, a higher level of risk awareness and stronger beliefs concerning the importance of positive health practices. It was concluded that while relationships were found between behavior and beliefs, and between beliefs and risk awareness, further research to establish the direction of the relationships is warranted. [References: 40] <63> UI - 97171957 AU - Lamster IB AU - Grbic JT AU - Bucklan RS AU - Mitchell-Lewis D AU - Reynolds HS AU - Zambon JJ IN - Dr. I.B. Lamster, Division of Periodontics, School of Dental and Oral Surgery, Columbia University, 630 W 168th Street, New York, NY 10032; United States of America. TI - Epidemiology and diagnosis of HIV-associated periodontal diseases. SO - Oral Diseases Vol 3(SUPPL. 1) (pp S141-S148), 1997. AB - A review of periodontal disease as a manifestation of HIV infection suggests a shift in emphasis over the past 5 years. Initially the focus was on newly described forms of periodontal disease (ie, HIV-associated gingivitis or linear gingival erythema (LGE); HIV-associated periodontitis or necrotizing ulcerative periodontitis (NUP)). While the clinical definition of LGE varies from study to study, an association between LGE and Candida infection has been described. Furthermore, the prevalence of NUP is quite low and this disorder is associated with severe immunosuppression. In contrast, the focus today is on the accelerated rate of chronic adult periodontitis occurring in seropositive patients. While the organisms that characterize adult periodontitis in seronegative individuals are present in subgingival plaque from seropositive individuals, reports suggest that atypical pathogens are also present (ie, Mycoplasma salivarium, Enterobacter cloacae). Recent studies from our laboratory have identified a novel strain of Clostridium isolated from the subgingival plaque of injecting drug users that has pathologic potential. This organism, however, was found in both seropositive and seronegative individuals in this cohort, suggesting an association with lifestyle rather than serostatus. In addition, data has been published examining the local host response in periodontitis in seropositive individuals. Distinctly elevated levels of IgG in gingival crevicular fluid (GCF) have been observed in seropositive patients. Furthermore, data from our laboratory examining inflammatory mediators in GCF (polymorphonuclear leukocyte lysosomal enzyme beta-glucuronidase and the pro-inflammatory cytokine interleukin-1 beta) suggests an altered response in patients with HIV infection. The alteration manifests as the absence of the expected strong correlation between polymorphonuclear leukocyte activity in the gingival crevice and clinical measures of existing periodontal disease, as well as elevated levels of interleukin-1 beta in sites with deeper probing depths. Therefore, it can be concluded that the progression of periodontal disease in the presence of HIV infection is dependent upon the immunologic competency of the host as well as the local inflammatory response to typical and atypical subgingival microorganisms. [References: 49] <64> UI - 97080719 AU - Baldini M AU - Vigna L AU - Gallazzi M AU - Orsatti A AU - Legnani L AU - Peracchi G AU - Poletto C AU - Cantalamessa L IN - Prof. M. Baldini, Istituto di Medicina Interna, Malattie Infettive e Immunopatologia, Ospedale Maggiore, Via F. Sforza, 35, 20122 Milano; Italy. TI - Age and postmenopausal state related risk of axial bone demineralization in goitrous women treated with L-thyroxine. A longitudinal study. SO - Rivista Italiana di Biologia e Medicina Vol 16(3-4) (pp 85-90), 1996. AB - The demineralizing effect of L-thyroxine (L-T4) treatment at lumbar spine level was prospectively evaluated in 27 nontoxic goiter women (14 premenopausal, 13 postmenopausal; age 34-65 years) before and after one year of therapy. All the patients admitted had normal densitometric parameters for age and sex. The L-T4 dose was adjusted to reduce circulating TSH without suppressing it below the limit of sensitivity of the method, and to maintain FT3 and FT4 within normal range throughout treatment. At the control after therapy, mean densitometric parameters were decreased; in particular, the mean bone mineral density (BMD) percentage change was -1.85 [2.6]%, a decrease not significantly different from the expected change due to the physiological rate of bone loss at lumbar spine. However, a relevant individual variability was observed, with an annualized BMD decrease > 3.0%, suggestive of increased risk of osteoporosis, in 5 out of 27 women. By logistic regression analysis, the elevated BMD decrease (> 3.0% year) was positively correlated with age and postmenopausal state, but not with other parameters examined (body mass index, TSH levels during treatment, bone Gla-protein, L-T4 daily dose pro kg, L-T4 cumulative dose). Our longitudinal study indicate