Bullosis diabeticorum. A report of two cases with a review of the literature

Bullosis diabeticorum is a rare complication of long-standing diabetes mellitus. Bullous lesions, which appear like burn-induced blisters, occur suddenly without trauma in the feet. These bullae heal spontaneously without scarring; however, recurrence is common. The etiology of bullosis diabeticorum remains unknown. Several theories exist as to causal and contributory factors related to this cutaneous manifestation of diabetes mellitus.

Inhibition of recA-mediated strand exchange by adducts of azacytosine-containing DNA and the EcoRII methylase

Wild type Escherichia coli cells containing elevated levels of DNA (cytosine-5)methyltransferases have increased sensitivity to the toxic effects of 5-azacytidine. The methyltransferases form tight binding complexes with azacytosine in DNA which could interfere with the recA recBCD repair pathway which is largely responsible for cell survival after treatment with the drug. We therefore determined if these complexes interfered with recA-mediated strand exchange in vitro. 32P-Labeled DNA fragments containing a single EcoRII site, with cytosine in the (-) strand replaced by 5-azacytosine, were prepared. We investigated the effect of the EcoRII methyltransferase on recA-mediated strand exchange with homologous M13 DNA by electrophoresis in agarose gels. In the absence of the methylase the rate and extent of strand exchange of azacytosine-containing DNA is the same as control DNA. In the presence of the methyltransferase strand exchange is inhibited, but some incorporation of duplexes into recA-single-stranded DNA (ssDNA) complexes still occurs. The formation of these complexes is dependent on the length of the fragment 3' to the methylase binding site on the strand complementary to the ssDNA. The greater the length the greater the number of complexes that form. S-Adenosyl-L-methionine, which enhances binding of the methyltransferase to azacytosine-containing DNA, causes an increase in the inhibition of strand exchange and an increase in the number of inactive complexes formed. The complexes can be dissociated with guanidinium chloride which denatures the methyltransferase and leads to release of the (+) strand. The (-) strand remains associated with the ssDNA. This result implies that a plectonemic joint is formed between recA-ssDNA complexes and azacytosine-containing DNA-methyltransferase complexes. However, branch migration in these complexes is inhibited. Denaturation of the methyltransferase allows branch migration to proceed to completion, releasing the (+) strand.

Histological characterization of bleaching-induced external root resorption in dogs

External root resorption occasionally develops after intracoronal bleaching with hydrogen peroxide. In this study, an experimental model was established to study thermocatalytic bleaching-induced root resorption in dogs. Histological examination after 6 months revealed that 18% of the teeth had root resorption lesions. The lesions could be divided into three types. In type I, root excavations were associated with a dense inflammatory cell infiltrate. Type II lesions were characterized by granulation tissue formation. In type III, the lesions were filled with reparative cementum. The three types probably represent different phases of one process. Calcium hydroxide had no effect on the occurrence or type of resorption. The instability of hydrogen peroxide and the presence of inflammatory resorption lesions 6 months postoperatively suggest hydrogen peroxide-induced toxic radicals or denaturants as potential irritants.

Dye leakage in retrofilled dog teeth and its correlation with radiographic healing

In a previous study in beagle dogs, statistically significant differences in healing were observed radiographically 6 months after apicoectomy and retrofilling with amalgam and varnish, glass ionomer cement, or a composite resin. The purpose of this study was to compare the leakage of these retrofilling materials and to correlate leakage data with healing. After the dogs were sacrificed, 48 roots were extracted. Half of the roots had been irradiated with a CO2 laser on the bevelled root surface after retrofilling. The roots were coated with nail polish, except for their bevelled surface, and were suspended together with positive and negative controls in 2% methylene blue for 8 h. After the specimens were longitudinally split, they were ranked according to the severity of dye penetration, as observed with a dissecting microscope. The differences in dye leakage among the three retrofilling materials were not statistically significant. Consequently, dye leakage did not correlate with the previously assessed healing. Dye penetrated into the root through the bevelled root surface, regardless of CO2 laser exposure of that surface.

Prevalence of congenital anomalies and neonatal complications in the offspring of diabetic mothers in Israel

The prevalence of diabetes in pregnancy and its fetal and perinatal consequences in a large population of Israeli pregnant women during the last decade are presented. The study population consisted of 878 gestational diabetic women, 132 pre-gestational diabetic women, and 380 healthy pregnant women who served as controls. Minor congenital anomalies ranging between 19.4 and 20.5%, major congenital anomalies between 1.80 and 6.82%, and neonatal complications, such as macrosomia (5.6-25.0%), hypoglycemia (0.9-7.8%), hyperbilirubinemia (8.2-16.7%), hypocalcemia (2.7-5.5%) and polycythemia (3.8-13.3%), were observed in the study population. Despite meticulous maternal glucose control, we could not entirely eliminate fetal and neonatal complications. The definition of the normal and abnormal fetal intrauterine metabolic environment remains to be elucidated.

In vitro efficacy of sodium perborate preparations used for intracoronal bleaching of discolored non-vital teeth

Bleaching materials containing 30% hydrogen peroxide have been used successfully for the treatment of discolored non-vital teeth. Intracoronal application of these materials was occasionally associated with the development of external root resorption. Extracted human teeth with intact crowns were discolored in vitro and bleached with three preparations of sodium perborate. These preparations included: sodium perborate with 30% hydrogen peroxide, sodium perborate with 3% hydrogen peroxide and sodium perborate with water. The bleaching materials were placed in the pulp chamber of the discolored teeth and sealed with IRM for 14 days. They were replaced with fresh preparations after 3 and 7 days. The coronal tooth shades were evaluated after 3, 7 and 14 days and a comparison of the bleaching success of the groups was made at each interval. It was found that after 14 days and three bleachings there was no significant difference in success between the groups. It is therefore recommended that sodium perborate be used in combination with water rather than with hydrogen peroxide to reduce the risk of post-bleaching external root resorption.

Dynamic parameters of glycine metabolism in diabetic human pregnancy measured by [15N]glycine and gas chromatography-mass spectrometry

This study presents kinetic parameters of glycine metabolism during pregnancy and the influence of fuel availability in the maternal compartment. The effect of gestational diabetes mellitus (diet treated) and pre-gestational diabetes mellitus (diet and insulin treated), accompanied by increased fetal growth on [15N]glycine kinetic parameters, compared to normal pregnancies with normal fetal growth, has been determined. This process was measured by administration of a single-dose of [15N]glycine to post-absorptive normal and diabetic pregnant women during the third trimester of pregnancy. Gas chromatography-mass spectrometry was used to determine the 15N enrichment of plasma glycine, and to calculate the pool sizes, turnover rate constants, fluxes and metabolic clearance rates. Glycine pool sizes in pre-gestational diabetes were significantly larger than those in normal pregnancy and gestational diabetes. Glycine turnover rate constants and metabolic clearance rates were not significantly different between the normal pregnant women and the two diabetic groups of pregnant women. Glycine fluxes were significantly higher in the pre-gestational diabetic pregnant women than in gestational diabetes and normal pregnancy. The pre-gestational diabetic pregnant women delivered fetuses with higher birth weights than the other two groups.

The fetus of the diabetic mother: growth, malformations and methods of surveillance by ultrasonography--the Beilinson Medical Center experience

Some important issues continue to plague the perinatologist caring for the pregnant diabetic. These issues deal principally with fetal surveillance to prevent macrosomia, idiopathic prematurity and multiple congenital anomalies. In this report particular emphasis is placed upon the role of transvaginal and transabdominal ultrasonography in monitoring fetal growth and in early detection of congenital anomalies. New modalities, such as Doppler flow measurements and nuclear magnetic resonance imaging, are described in addition to our experience at the Beilinson Medical Center in monitoring diabetic pregnancies by these modalities.

Therapeutic implications and sites of relapse predicted by elevated posttherapy erythrocyte sedimentation rate in early stage Hodgkin disease

An analysis was performed of all 57 early relapses (ER) (within 18 months of therapy initiation) seen in a group of 301 patients treated on three successive European Organization for Research and Treatment of Cancer (EORTC) protocols from 1964 to 1981; to determine whether a posttherapy elevated erythrocyte sedimentation rate (ESR) (greater than or equal to 30 mm) could predict the type of relapse and the effect upon the relapse of different therapies received. Overall most ER occurred in extranodal (EN) (42%) or irradiated transdiaphragmatic nodal (TDN) (40%) sites. Compared to patients with normal posttherapy ESR (n = 12), patients with elevated posttherapy ESR (n = 45) had the same proportions of outfield and late relapses; more frequent multiple sites of ER (38% vs. 25%), increased proportions of early EN relapses (16% vs. 3%), TDN relapses (17% vs. 2%), and other ER (6% vs. 1%). ER were most frequently observed between 1964 and 1971, and "modern" radiotherapy (Rt) decreased ER overall from 27% to 13% and for elevated posttherapy ESR patients from 54% to 25%. When chemotherapy (Ct) was used as either adjuvant or initial therapy, ER were greatly reduced vs. Rt alone [overall (6% vs. 28%) and for patients with elevated posttherapy ESR (10% vs. 39%)]. Stepwise logistic regression showed Ct to be the most important factor "protecting" from EN relapse, but elevated posttherapy ESR was still significant. For early TDN relapse, elevated posttherapy ESR had the highest predictive value for relapse, greater than the types of radiation fields used and chemotherapy. An unexplained elevated posttherapy ESR, regardless of previous therapy, predicts for ER from aggressive HD, frequently in EN and irradiated areas, and warrants further early therapy.

pH variation among materials used for intracoronal bleaching

Intracoronal bleaching of pulpless teeth with 30% hydrogen peroxide may result in external cervical root resorption. One of several suggested etiological factors associated with this complication is the pH of the bleaching materials. Because the available data on the pH values of bleaching materials were conflicting, it was the purpose of this study to measure the pH of the materials commonly used for bleaching pulpless teeth. The pH of different concentrations of sodium perborate and 30% hydrogen peroxide, alone or in combination, were measured for a period of 14 days. Sodium perborate was confirmed to be alkaline, whereas 30% hydrogen peroxide was acidic. The pH of the materials when mixed together gradually changed from acidic to alkaline as the concentration of sodium perborate was increased. A thick clinical consistency mixture of both materials was alkaline, and its alkalinity increased with time. These results do not support the theory relating bleaching-induced root resorption to an acidic pH of the bleaching pastes.

Retrograde approaches in endodontic therapy

The routine use of retrograde fillings during apical surgery, as well as the material of choice for that purpose, have been debated. A retrograde filling is placed so as to seal an infected root canal causing periapical pathosis. Therefore, retrograde root canal fillings should be performed routinely during apical surgery regardless of the apparent technical quality of the root canal obturation, unless orthograde endodontic treatment is performed in conjunction with surgery. When orthograde treatment is not performed, retrograde root canal filling enhances the prognosis of apical surgery. An array of potential retrograde filling materials have been extensively investigated in vitro and in vivo. Once that the biocompatibility of the materials is confirmed a clinical comparison, rather than in vitro sealability studies, is the most valid evaluation method. Some of the difficulties encountered in long term clinical studies in patients may be avoided in animal studies. The review of the relevant literature of the past decade suggests that amalgam used in conjunction with cavity varnish is the retrograde filling material of choice. It must be stressed, however, that retrograde filling is not comparable to debridement and obturation of the entire root canal. Therefore, when the only way to approach the root canal is from the apical direction, rather than placing an apical retrograde filling, a retrograde endodontic treatment of the entire canal should be preferred, if it is feasible.

Relation of pre- and intraoperative factors to prognosis of posterior apical surgery

The relation of preoperative and intraoperative factors to the prognosis of apical surgery was studied in 136 premolar and molar roots. The evaluated factors were: clinical signs and symptoms, size of the periapical lesion, root canal obturation, tooth restoration, apical retrofilling, and the operating surgeon. A significantly higher success rate was found in roots obturated 2 mm or shorter of the apex, in roots without post restoration, and after retrofilling of roots with apparently well-condensed obturation. The prognosis differed significantly following treatment by various operators but was unrelated to their experience.

Refeeding of infants with acute diarrheal disease

The purpose of this study was to determine which infant formula among five would be the most efficacious for the refeeding of infants during an acute episode of diarrhea. Fifty male infants less than 12 months of age with severe diarrhea and at least 5% dehydration were admitted to a metabolic unit and studied in a prospective, single-blind protocol. Ten infants randomly received one of five types of formula: two-thirds diluted cow milk, cow milk formula (Nanon, Nestle, Inc., São Paulo, Brazil), Portagen, Pregestimil, or Prosobee (Mead Johnson & Co. Division, Evansville, Ind.). They continued to receive the same formula for 72 hours unless dehydration occurred. There were no associated infections, and they received no prior antibiotic treatment. Oral hydration together with intravenous fluid therapy was given to all patients during the initial treatment. During the first 72 hours of refeeding, patients fed Portagen excreted the least amount of stool and required reduced quantities of intravenous fluids or oral hydration. In contrast, patients fed diluted cow milk or any other formula had more severe diarrhea. Nine of the 10 patients fed Portagen completed the 72-hour treatment, whereas only 2 of 10 fed diluted cow milk tolerated it. Similarly, the cumulative proportions for high purging rate, dehydration, carbohydrate intolerance, and vomiting were more favorable for Portagen and least acceptable for diluted cow milk. No differences were found among the remaining three formulas tested. These data show that diluted cow milk is poorly tolerated by infants with severe diarrhea, whereas Portagen is more effective.

Dose-response effects of oral yohimbine in unrestrained primates

Six unrestrained bonnet macaques were each observed after oral administration of four dosages of yohimbine hydrochloride (0.10, 0.25, 0.50, and 0.75 mg/kg) and a placebo. Yohimbine significantly increased episodes of motoric activation and affective response interspersed with intervals of behavioral enervation. Yohimbine scores correlated closely with baseline levels; there was no dose-response relationship. Response to oral yohimbine differed in several ways from subcutaneous and intravenous sodium lactate infusions, including prominent enervative symptoms and the appearance of sexual arousal. In light of the appearance of cyclic enervative episodes, this study suggests limitations to primate models of panic disorder utilizing oral yohimbine.

Erythrocyte sedimentation rate predicts early relapse and survival in early-stage Hodgkin disease. The EORTC Lymphoma Cooperative Group

OBJECTIVE

To assess the value of an elevated (greater than 30 mm/h) Westergren erythrocyte sedimentation rate (ESR) for predicting early relapse and survival after therapy in patients with clinical stage I or II Hodgkin disease.

INTERVENTIONS

We studied 772 patients with early-stage Hodgkin disease who had participated in two separate multicenter clinical trials. Both trials used modern field radiotherapy and, in some patients, multi-agent chemotherapy.

MAIN RESULTS

The ESR patterns were based on pretherapy and post-therapy assessments: pattern 1, always normal (n = 261); pattern 2, elevated before therapy but normal immediately after therapy (n = 121); pattern 3, elevated before therapy but normal within 3 months after therapy (n = 89); pattern 4, always elevated (n = 48); pattern 5, normal before therapy but oscillating between normal and elevated after therapy (n = 150); pattern 6, elevated before therapy but oscillating between normal and elevated after therapy (n = 130). By multivariate analysis, independent of whether or not patients received chemotherapy in the initial therapy protocol, ESR patterns 4, 5, and 6 were shown to be the best predictors for early relapse and survival when patients were stratified according to the type of chemotherapy received and the number of involved nodal areas. Patients with ESR pattern 4 had a relative risk for death seven times that of patients with patterns 1, 2, or 3. Early relapse was the second most important factor predicting death, irrespective of ESR; patients with early relapse and ESR patterns 1, 2, or 3 had a relative risk for death of 4.5, and those with early relapse and ESR patterns 4, 5, or 6 had a relative risk for death of 15. Whether or not chemotherapy was given initially did not change the relative risk, which shows that ESR, not initial therapy, was the predictor for early relapse and death due to Hodgkin disease.

CONCLUSION

An unexplained elevated ESR after therapy, especially after modern radiotherapy, independent of other factors, strongly suggest the presence of aggressive and resistant Hodgkin disease. An elevated ESR is predictive of early relapse and poor prognosis; its presence justifies early aggressive therapy.

Leakage after lateral condensation with finger spreaders and D-11-T spreaders

The purpose of the study was to determine the leakage after lateral condensation with the use of finger spreaders and D-11-T spreaders. Fifty root canals were instrumented, and laterally condensed with gutta-percha and Grossman's cement. In 20 canals finger spreaders were used for the condensation and in a further 20 canals D-11-T spreaders were used. After 24 h in 100% humidity, the roots were painted with nail polish except for their apical 2 mm, which remained exposed. Five canals were not obturated (negative control) and five canals were obturated and the apices sealed with sticky wax (positive control). The expressed root tips were suspended in 2% methylene blue dye for 48 h. The teeth were then split longitudinally and the apical leakage measured and compared for each group. The results obtained by the positive and negative control teeth confirmed the effectiveness of the methodology used. Average dye penetration for the finger spreaders was statistically significantly less than for the D-11-T spreaders. Dye penetration of more than 0.5 mm occurred in 6 roots for the finger spreaders and in 12 roots for the D-11-T spreaders.

Identification of a highly conserved domain in the EcoRII methyltransferase which can be photolabeled with S-adenosyl-L-[methyl-3H]methionine. Evidence for UV-induced transmethylation of cysteine 186

DNA methyltransferases can be photolabeled with S-adenosyl-L-methionine (AdoMet). Specific incorporation of radioactivity has been demonstrated after photolabeling with either [methyl-3H]AdoMet or [35S]AdoMet (Som, S., and Friedman, S. (1990) J. Biol. Chem. 265, 4278-4283). The labeling is believed to occur at the AdoMet binding site. With the purpose of localizing the site responsible for [methyl-3H]AdoMet photolabeling, we cleaved the labeled EcoRII methyltransferase by chemical and enzymatic reactions and isolated the radiolabeled peptides by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and high pressure liquid chromatography. The labeled peptides were identified by amino-terminal sequencing. A common region was localized which accounted for 65-70% of the total label. This region includes a highly conserved core sequence present in all DNA (cytosine 5)-methyltransferases. One such fragment was digested further with chymotrypsin, and amino acid analysis of the resulting 3H-labeled peptide was consistent with the sequence Ala-Gly-Phe-Pro-(Cys)-Gln-Pro-Phe-Ser-Leu. However, the cysteine residue was not recovered as carboxymethylcysteine. The Pro-Cys bond was found to be protected from cleavage at cysteine residues after cyanylation. These results suggest that the cysteine residue is modified by the labeling reaction. The chymotryptic fragment was hydrolyzed enzymatically to single amino acids, and the labeled amino acid was identified as S-methylcysteine by thin layer chromatography. These results indicate that the cysteine residue is located at or close to the AdoMet binding site of EcoRII methyltransferase.

In vivo efficacy of various retrofills and of CO2 laser in apical surgery

The purpose of the present study was to radiographically assess the efficacy of various retrofilling materials and of the use of CO2 laser in apical surgery. The mandibular premolars of six beagle dogs were infected, resulting in periapical lesions. Apical surgery was performed without root canal treatment. Amalgam with cavity varnish, glass ionomer cement and a lightcured composite resin were the retrofilling materials used. In half of the material CO2 laser was used on the root surface and the bone, for occlusion of the dentinal tubuli and sterilization. The healing following surgery was observed radiographically for six months. The highest success rate (89%) was found in the roots retrofilled with amalgam and varnish, and the lowest (60%) in those retrofilled with the composite resin. The difference between these groups was statistically significant. The success rate following retrofilling with glass ionomer cement was 69%, and was not significantly different from both the other groups. Under the conditions of this study, the use of CO2 laser during surgery did not affect the treatment results.

In situ testing of CO2 laser on dental pulp function: effects on microcirculation

The effect of CO2 laser irradiation on pulpal microcirculation was studied in cat canines. The enamel surfaces of 4 teeth were exposed with energy densities of 304-1440J/cm2, using either a handpiece or a microslad, with a focal spot of 0.21mm and 0.33mm respectively. Pulpal blood flow (PBF) before and following lasing was recorded through the intact tooth surface by a laser Doppler flowmeter. CO2 laser irradiation caused an increase in PBF, which was immediate and transient. The PBF increase was higher in a large pulp than in a small pulp, and it was inversely related to the focal spot size. These findings confirm that the dental pulp is thermally affected by CO2 lasing of the tooth surface, however, without extensive pulp coagulation. It is concluded that the effects of laser irradiation on the pulpal microcirculation may be studied in situ by means of the presented methodology.

Micromanipulation in a center for reproductive medicine

Several variations of micromanipulation of the female gamete (zona drilling, zona cracking, ooplasmic sperm injection, partial zona dissection) have been applied recently to human IVF to overcome severe male factor. Of the first 16 cycles attempted using partial zona dissection, one pregnancy resulted leading to a normal term delivery. Careful removal of the coronal cells, as well as stepwise removal of sucrose postpartial zona dissection, will facilitate this procedure and greatly reduce potential damage to the oocyte by pH, mechanical, or thermal injury. Micromanipulation has become a routine service offered in our program in cases where the likelihood of a poor IVF outcome is either known or suspected, and also serves as a replacement for simple reinsemination in cases of failed fertilization.

Treatment results of apical surgery in premolar and molar teeth

The purpose of this investigation was to study long-term treatment results following apical surgery in premolars and molars. These results were assessed by reexamination of 136 roots on which apical surgery was performed. The observation period varied from 6 months to 8 yr. According to radiographic and clinical criteria, the treatment results were considered successful in 44.1% of the roots, doubtful in 22.8%, and unsuccessful in 33.1%. Clinical signs and symptoms were associated with 33.1% of the roots, occurring significantly more in roots demonstrating radiographically unsatisfactory healing. The results are discussed with reference to other studies on apical surgery in posterior and anterior teeth. However, methodological differences do not permit the drawing of direct comparisons to those studies.