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.

A case of hepatocellular carcinoma in pregnancy detected by routine screening of maternal alpha-feto-protein

A rare case of hepatocellular carcinoma in a 31-year-old woman is reported. The diagnosis was made at 16 weeks of pregnancy when very high levels of alpha-feto-protein were found upon routine examination. The pregnancy was terminated and cytostatic therapy was given. The patient died one year later.

Bilateral C shape configuration in maxillary first molars

The C-shaped canal is unusual. It is most frequently reported in mandibular molars. A case of bilateral C-shaped canals in maxillary molars is reported here.

Surgical results of intrathoracic gastric volvulus complicating hiatal hernia

From 1981 to 1988, 138 patients with hiatal hernia were treated surgically at our centre. Twenty-one (mean age 76.6 years, 17 women, four men) had an associated intrathoracic gastric volvulus. Eleven patients (mean age 73.2 years), of whom eight were asymptomatic, had an elective procedure. Ten patients (mean age 80.3 years) had emergency surgery, six for acute complications of the volvulus (five cases of strangulation and one of perforated ulcer) and four because of other, unrelated causes of acute abdomen. There were four deaths after operation, all in the emergency surgery group. Four other patients had significant morbidity, all in the emergency group. In the elective cases, all hernias were easily reduced. In one emergency case a gastrotomy was necessary for decompression, and in another gastrectomy was necessary because of gastric gangrene. Our results indicate the need for elective intervention when intrathoracic gastric volvulus is first diagnosed.

Staging non-small cell carcinoma of the lung using technetium-99m-labeled monoclonal antibodies

A technetium-labeled monoclonal antibody was administered to 52 patients with non-small cell lung carcinoma, either to stage the mediastinum preoperatively or to detect distant metastases. Results from planar and tomographic imaging are compared to CT and histologic confirmation. Differences in detection rates and predictive values between imaging modalities are discussed. The authors conclude that imaging with a technetium-labeled monoclonal antibody is safe and accurate and may be useful for staging patients with either operable or inoperable non-small cell lung cancer.

Endodontic retreatment--case selection and technique. 3. Retreatment techniques

The necessity to remove filling materials from the root canals is one of the major differences between primary endodontic therapy and retreatment. The obturating material has to be removed from the root canals before routine endodontic therapy can be performed. The removal of the material should not result in a change in the canal morphology, so that the objectives of endodontic therapy can be maintained. Numerous techniques may be used for removing filling materials and other obstructions from root canals. This article reviews the techniques that were suggested in the literature for this purpose and discusses their advantages and disadvantages.

Glycated proteins and gestational diabetes mellitus

The use of assays of glycated serum proteins (glycohemoglobin and fructosamine) as markers of glucose homeostasis is becoming a common modality in the evaluation of the pregnant diabetic patient. The purpose of this review is to provide basic information on the interactions between glucose and the protein molecules that lead to the formations of this complex, and to evaluate these tests for their efficacy in the screening and diagnosis of gestational diabetes mellitus, the identification of fetal congenital anomalies and in their relation to early fetal wastage, fetal macrosomia and neonatal complications.

Apical closure of mature molar roots with the use of calcium hydroxide

Calcium hydroxide may induce apical root closure in affected mature teeth as well as in immature teeth. Once an apical hard tissue barrier is formed, a permanent root canal filling can be safely condensed. Two cases are described in which calcium hydroxide induced apical root closure in mature molar teeth where the apical constriction was lost because of chronic inflammatory process.

Therapeutic strategies in inflammatory breast carcinoma based on prognostic factors

Prognostic factors were identified in a group of 210 patients with inflammatory breast carcinoma (IBC) treated at Institut Gustave Roussy from 1976-1985 with three successive induction protocols: Group A (n = 91), 1976-1980, doxorubicin, vincristine, methotrexate (AVM); Group B (n = 79), 1980-1982, doxorubicin, vincristine, cyclophosphamide, methotrexate, 5-fluorouracil (AVCMF); Group C (n = 40), 1983-1985, AVCMF. Groups A and B received 3 courses of respective chemotherapy (Ct) followed by radiotherapy (Rt), 45 Gy to breast and nodes and 65-70 Gy to the tumor. Group C after the third Ct course received split courses of Rt to equivalent doses so there was no time lag between Ct courses. Ct from fourth to ninth courses was AVM in all groups. Hormonal therapy, radiocastration (pre and perimenopausal) or tamoxifen (postmenopausal) was given all patients. Clinical characteristics of age, menopausal status, castration, N status, and degree of clinical inflammation (limited to tumor area [PEV 2] or involving the entire breast [PEV 3]) were similar in all groups. Groups B and C had identical disease-free and overall survivals, superior to Group A (p = 0.005). In multi-variate analysis, AVCMF was one of the important prognostic factors together with PEV and N status.(ABSTRACT TRUNCATED AT 250 WORDS)

Scanning electron microscope observation of canal cleanliness

The aim of this study was to evaluate the cleansing efficiency of three root canal preparation techniques. The distal root canals of mandibular molars, divided into three groups of four teeth each, were prepared according to the following techniques: manual (serial), ultrasonic (Cavi-Endo), and automated (Canal Finder). The canal wall surfaces were examined under a scanning electron microscope at three levels. No preparation technique was found to result in any characteristic microscopic features that distinguished it from the other techniques. The lack of such differences makes it impossible to establish objective criteria for comparing these techniques in terms of root canal cleanliness. It was established that even canals that appeared to be clean included areas coated with smear layer and having uninstrumented areas and even pulpal tissue debris.

Pancreatic carcinoma developing in chronic pancreatitis: a report of four cases

Although chronic pancreatitis microscopically surrounding pancreatic carcinoma is common, cancer developing in chronic pancreatitis has rarely been shown. We present four such cases seen between 1983 and 1988. All were male, mean age 56.7 years, and all had had previous surgery for complications of chronic pancreatitis (two a pancreatectomy, two a bypass). Chronic pancreatitis was caused by alcohol in three cases, and calcification was present in three. The delay between chronic pancreatitis and pancreatic carcinoma was 2 to 10 years, and in all, pancreatic carcinoma was at an advanced state, with post-surgical survival of 1.5 to 6 months. CA 19.9 level was very high in the three cases in which it was measured. That pancreatic carcinoma is more frequent in populations with chronic pancreatitis, occurring later in life than pancreatic carcinoma that has no coexisting chronic pancreatitis (sixth decade vs. fifth), often with intermediate histology, argues for chronic pancreatitis degenerating into pancreatic carcinoma rather than for a common toxic etiology. Pancreatic carcinoma occurs particularly in calcified chronic pancreatitis, and diagnosis is frequently quite late, due to the non-specificity of symptoms vs. chronic pancreatitis. Delay of appearance is variable, and previous surgery and histological examination excludes obvious coexisting pancreatic carcinoma. Aggressive surgery appears justified if needed for chronic pancreatitis, and chronic pancreatitis should be carefully followed, probably by serial CA 19.9 determinations and guided percutaneous fine needle biopsies when elevated, or when new symptoms are present in chronic pancreatitis.

In-vitro production of precursor peptides for thyrotropin-releasing hormone by human semen

Thyrotrophin-releasing hormone (TRH) and related peptides occur in high concentrations in human semen. TRH derives from a 242-amino acid precursor protein, prepro-TRH, with six repetitive sequences of -Lys-Arg-Gln-His-Pro-Gly-Lys/Arg)-Arg- connected by hydrophobic linking sequences. Antibodies to TRH-Gly (pGlu-His-Pro-Gly), a final precursor for TRH formation, were used to detect this tetrapeptide as well as other prepro-TRH fragments which cross-react with these antibodies. The total TRH-Gly immunoreactivity decreased significantly after vasectomy. The TRH-Gly immunoreactivity in semen increased significantly during in-vitro incubation at 0 or 37 degrees C, to a peak value at 5 h, followed by an exponential decline, with t 1/2 equal to 11 h at 37 degrees C. At 60 degrees C, however, the TRH-Gly immunoreactivity rose continuously, attaining, after 20 h, a level 2.2 times that at the start of the incubation (P less than 0.001). Reversed-phase high pressure liquid chromatography (HPLC) revealed both hydrophobic and hydrophilic TRH-Gly immunoreactive peptides in semen with both classes of peptides increasing significantly with heating to 60 degrees C. Cation exchange chromatography of pooled human semen incubated at 60 degrees C revealed a 4.3-fold increase in a TRH-Gly immunoreactive peak which co-eluted with synthetic TRH-Gly, and a 30% increase in another TRH-Gly immunoreactive peak identified as Glu-His-Pro-Gly. A minor, TRH-Gly immunoreactive peak increased 50-fold (P less than 0.001) during 20 h at 60 degrees C. This material co-eluted with Arg-Gln-His-Pro-Gly which is formed by enzymic cleavage of the paired basic residues flanking this sequence in prepro-TRH. When synthetic Arg-Gln-His-Pro-Gly was incubated with fresh semen at 60 degrees C a rapid conversion of most of this peptide to Glu-His-Pro-Gly, Gln-His-Pro-Gly and TRH-Gly occurred within 30 min. These data are consistent with thermal inactivation of the amidation and degrading enzymes at 60 degrees C while the trypsin-like enzymes which cleave the precursor peptide at the paired basic residues remain relatively unaffected. Because other investigators have found the C-terminal amidating enzymes to be associated with secretory vesicles and to be co-secreted with the vesicular contents, we suggest that secretory epithelia of the male reproductive system secrete TRH and TRH-related precursor peptides along with the alpha-amidating enzymes which continue processing of prepro-TRH in the post-ejaculatory seminal fluid.

Direct photolabeling of the EcoRII methyltransferase with S-adenosyl-L-methionine

Ultraviolet irradiation of EcoRII methyltransferase in the presence of its substrate, S-adenosyl-L-methionine (AdoMet), results in the formation of a stable enzyme-substrate adduct. This adduct can be demonstrated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis after irradiation of the enzyme in the presence of either [methyl-3H]AdoMet or [35S]AdoMet. The extent of photolabeling is low. Under optimal conditions, 4.5 pmol of [3H]AdoMet is incorporated into 100 pmol of enzyme. Use of the 8-azido derivative of AdoMet as the photolabeling substrate increases the incorporation by approximately 2-fold. However, this adduct, unlike the one formed with AdoMet, is not stable when treated with thiol reagents or precipitated with trichloroacetic acid. A catalytically active conformation of the enzyme is needed for AdoMet photolabeling. Heat-inactivated enzyme or proteins for which AdoMet is not a substrate or cofactor do not undergo adduct formation. Two other methyltransferases, MspI and dam methylases are also shown to form adducts with AdoMet upon UV irradiation. The binding constant of the EcoRII methyltransferase for AdoMet determined with the photolabeling reaction is 11 microM, which is similar to the binding constant of 9 microM previously reported (Friedman, S. (1986) Nucleic Acids Res. 14, 4543-4556). The AdoMet analogs S-adenosyl-L-homocysteine (Ki = 0.83 microM) and sinefungin (Ki = 4.3 microM) are effective inhibitors of photolabeling, whereas S-adenosyl-D-homocysteine (Ki = 46 microM) is a poor inhibitor. These experiments indicate that AdoMet becomes covalently bound at the AdoMet-binding site on the enzyme molecule. The EcoRII methyltransferase-AdoMet adduct is very stable and could be used to identify the AdoMet-binding site on DNA methyltransferases.

Immunohistochemical staining of bone marrow biopsies for detection of occult metastasis in breast cancer

Immunohistochemical (IHC) techniques should allow for a greater detection of bone marrow micrometastasis in patients with breast carcinoma. We studied a series of bone marrow (BM) biopsies negative by conventional histologic techniques from 93 patients with breast carcinoma. Prior to this study, twelve BM biopsies, positive by conventional histology, were stained with a panel of monoclonal antibodies (MoAb), directed either against cytokeratin (KL1, AE1-AE3, CAM5-2) or epithelial membrane antigen (EMA, HMFG2). KL1 appeared to be the most sensitive of the markers used in the detection of metastases and is available commercially. It therefore was the only MoAb used with the series of 93 BM biopsies negative by conventional examination. Within this series, among 45 patients clinically suspected of having bone marrow metastasis but with BM biopsies negative by conventional staining, one case showing myelofibrosis stained positive with KL1 demonstrating isolated tumor cells. For the 48 patients without suspicion of bone marrow metastasis at initial diagnosis for breast carcinoma, KL1 revealed no marrow metastasis. Single bone marrow biopsy techniques whether stained by conventional or IHC methods do not appear to be useful tests to detect occult bone marrow metastasis, especially at initial diagnosis of clinically Mo breast carcinoma patients.

HIV preventive medicine services and public health interventions: the Bethesda experience

A basic Public Health approach to the Human Immunodeficiency Virus (HIV) epidemic has been considered by many to be the most appropriate initial strategy against the spread of this infection. Comprehensive Preventive Medicine services were implemented at Naval Hospital Bethesda, which utilized a sexually transmitted disease (STD) model and included: counseling and education; sexual contact interviews and spouse evaluations; Blood Bank Look Back tracking of donated blood; reporting of notifiable diseases; and screening of transfusion recipients, STD cases, and other at-risk populations. This coordinated approach is highly efficient and capable of evaluating the increasing numbers of HIV-positive individuals.

Diagnostic and therapeutic problems of soft tissue tumors other than rhabdomyosarcoma in infants under 1 year of age: a clinicopathological study of 34 cases treated at the Institut Gustave-Roussy

Thirty-four cases of soft tissue tumors (STT) other than rhabdomyosarcoma in infants under 1 year of age were seen in our institution between 1955 and 1985. All were diagnosed initially as malignant tumors except for three cases of fibromatosis, and, thus, they received therapy appropriate at that time. During a recent pathologic review, four were seen to have had hemangioma, six hemangiopericytoma, one hamartoma, seven fibromatosis, eight fibrosarcoma, and eight unclassified sarcomas. Of these 34 cases, the initial histological diagnosis was confirmed in only 17. Sixteen patients were believed to have received inappropriately aggressive therapy; indeed, four of these cases diagnosed prior to 1975 had been benign. Major long-term side effects were seen in 7/16 treated patients (six radiotherapy, one surgery), who, in retrospect, should have received less aggressive treatment. The reasons for these initial errors in diagnosis included doubtful histologic features associated in some cases with alarming clinical presentation. We believe that difficulties still remain in distinguishing benign from malignant STT in this age group by histological examination. Therefore, we urge extreme caution in using aggressive therapy before the diagnosis is certain.

Pregnancy in a homozygous familial hypercholesterolemic patient treated with long-term plasma exchange

We describe the first pregnancy in a homozygous familial hypercholesterolemic woman who started plasma exchange therapy 3 years before she became pregnant. We especially studied the effects of plasma exchange on lipid profile, uteroplacental circulation, and pregnancy course.

Survival effect of systemic therapy on patients developing metastatic breast carcinoma

A multivariate analysis was performed to assess the effect of post-relapse systemic therapy on a series of patients with metastatic breast cancer who at initial presentation had no detectable metastases (Mo), were less than or equal to 70 years of age, presented with unilateral localized disease and no other associated malignancy, and were treated between 1965 and 1984 with successive protocols for primary disease and subsequently developed distant metastasis. All 760 patients analyzed relapsed with at least one metastasis, and were studied retrospectively with no selection criteria according to any specific protocol. All had recorded clinical data on menopause, stage, clinical tumor aggressiveness (PEV), initial chemo or hormonal therapy, and time to relapse, and had ongoing follow up at our Center, with salvage chemotherapy and/or hormonal therapy having been given to some but not all patients. A brief metastasis-free survival (p less than 0.000001), and factors associated with electing pre-relapse chemotherapy (p less than 0.000001) were associated with shortened post-relapse survival, while post-relapse therapy (chemo p less than 0.0001, and hormonal p less than 0.00001, replacing chemotherapy in the model) apparently increased post-relapse survival in the group overall. This result was similar in the inoperable patient group [with inflammatory breast carcinoma an additional risk factor (p less than 0.0005)], as well as the operable group. However, in the operable group, when the pathologic criteria of histologic grade and nodal status were introduced into the analysis, post-relapse therapy was not seen to be an important factor for survival in any subgroup.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of three distinct Ly6-A-related cDNA sequences isolated from rat kidney

Mouse Ly6A and Ly6C cDNA probes were hybridized to total RNA of rat tissues and, as in mouse, the highest level of Ly6-related transcripts was detected in kidney. Therefore, Ly6-related cDNA clones were isolated from a commercial rat kidney cDNA library in lambda gt11. Four of these (RK3, RK6, RK10, and RK11) have been fully characterized, and represent transcripts from three distinct genes. Each contains a reading frame encoding an amino acid sequence typical of the known Ly6 molecules: a 26aa leader (except in clone RK6 which has only two of its leader codons), followed by a sequence of 108 or 109aa containing 10 cysteines in excellent alignment with those of Ly6A. The three rat polypeptide sequences were more closely related to Ly6A than Ly6C, and more closely related to each other than to Ly6A. The most striking similarity between all these sequences is in the last 33aa at the C-terminal. Most of this is presumed to be cleaved off during post-translational addition of a phosphatidylinositol-glycan (PI-G) membrane anchor. Southern blot analysis of rat DNA probed with rat-Ly6 cDNA showed multiple band patterns indicative of a multigene family. No restriction fragment length polymorphism (RFLP) was evident amongst the six inbred rat strains tested. Anomalies in two of the rat cDNA clones, resulting from improper splicing of the original transcripts, correlated with Ly6Ca exon boundaries, thus suggesting conserved intron-exon organization.

CD 15 antigen in Hodgkin's disease

A retrospective analysis of 117 cases of Hodgkin's disease treated at the Centre G.F. Leclerc between 1976 and 1985 was performed with three objectives: 1): to re-evaluate the histologic subtype by the Lukes-Rye classification according to recent data; 2): to demonstrate the frequency of CD 15 antigen by an indirect, three stage immunoperoxidase technique on initial node biopsy histologic sections; 3): to study the prognostic value of this antigen. Histologic reclassification disclosed that 9 cases were in fact non Hodgkin's lymphoma. The remaining 108 cases were classified as lymphocyte predominant (n = 11), nodular sclerosis (n = 77), and mixed cellularity (n = 17), with no cases of either lymphocyte depletion or nodular paragranuloma of Poppema and Lennert identified. In these specimens, fixed in Bouin's solution and embedded in paraffin, CD 15 antigen was detected in the Reed-Sternberg cells and the mononuclear variety of Hodgkin cells in 64 patients (59%). The presence of this antigen was independent of histologic subtype, patient age or sex, clinical stage and the presence of systemic symptoms. Both actuarial disease-free and overall survivals showed that the prognosis of Hodgkin's disease is more favorable in CD 15 positive cases.

Prognostic value of histologic grade nuclear components of Scarff-Bloom-Richardson (SBR). An improved score modification based on a multivariate analysis of 1262 invasive ductal breast carcinomas

We did a multivariate analysis of 1262 patients with operable, invasive ductal breast carcinoma to assess the prognostic value of the Scarff-Bloom-Richardson (SBR) histologic grading system. Nodal metastasis and SBR were the two most important factors for metastasis-free survival (MFS), P = 10-9 and P = 10-5, respectively, for total study time. In patients who were node negative, the SBR and International Union Against Cancer (UICC) stages were the most important for MFS (P = 4 X 10-4 and P = 0.03). In order to try to improve the SBR prognostic value, we first studied the three components of the SBR separately: ductoglandular differentiation proved the least predictive and nuclear pleomorphism and mitotic index the most predictive. A rearrangement of the two nuclear scores alone produced higher risk values and better risk separation of patient subpopulations than SBR, and eliminated the SBR from the multivariate model. This rearrangement, modified SBR (MSBR), defined five new risk subgroups with statistically different risk ratios for MFS (P = 3 X 10-8). SBR grade II (55% of patients) was separated into three MSBR groups significantly different according to MFS (P = 0.008). In the patients who were node negative, MSBR replaced the SBR and was the most important factor for prediction of relapse of MFS (P less than 0.00001). The MSBR is more accurate and predictive than the standard SBR grade and is particularly useful when the nodal status of the patient is negative or unknown.