Caries experience and treatment response among groups of Finnish, German and Russian children. A retrospective study between 1995 and 1989

AIM

This study was designed to describe caries experience and treatment response in groups of children in three countries--Finland, Germany and Russia--with different systems of public dental care.

MATERIALS AND METHODS

Information concerning permanent teeth (carious and filled surfaces, type of restorative treatment and applied sealants) was collected retrospectively from existing dental records of 12-year-old children who had been treated in dental practices over six years, retrospectively between 1995 and 1989. Prior to conducting the study, research meetings were held among all participating personnel to standardise data collection and terminology as much as possible.

STATISTICS

The analysis of variance (ANOVA) was used to test the difference between the means of the various types of data derived from the three countries.

RESULTS

Sealants were most commonly used in Finland at a rate of 5.0/child and 3.3 in Germany, but only for a few children in Russia (0.1). Caries increments (cumulative figure of primary and secondary caries surfaces over the six follow-up years of the study) differed very much between these countries. It was very high in Russia (7.4) and in Germany (5.3), but low in Finland (1.6). All the caries surfaces were filled in Finland and in Germany; in Russia, the cumulated number of filled surfaces was smaller than the respective number of caries surfaces (6.4/7.4). The most commonly used restorative filling material was amalgam in Germany and in Russia, but composite or glass ionomer cements in Finland.

CONCLUSION

The cost effectiveness of sealant application programs should be considered as exemplified by the Finnish dental care system. The data showed a need for preventive programs in Germany, and this has actually been emphasised since 1993. In Russia, there is an urgent need to implement preventive programs for 6-year-old children and also to provide the necessary restorative treatment.

[Antireflux surgery in Germany. Results of a representative survey with analysis of 2,540 antireflux operations]

INTRODUCTION

Aim of this study was the evaluation of antireflux surgery in Germany.

METHODS

An anonymous questionnaire including 288 structured items about diagnostic and therapeutic approaches, complications and mortality was sent to 33% randomly selected German general surgeons (n = 546) at the end of 2000.

RESULTS

A total of 2,540 antireflux procedures was reported, 81% were performed laparoscopically; 65% were total, 31% partial fundoplications. The number of surgeons offering laparoscopic antireflux surgery increased from 0.3% in 1990 to 5% in 1995 and to 32% in 2000. Numerous modifications regarding esophageal mobilisation, crural repair, kind and extension of the wrap, use and size of a bougie, as well as an additional gastropexy were observed. Morbidity rates were significantly higher for open than for laparoscopic procedures (15.0% vs. 7.7%), mainly caused by wound healing problems (4.4% vs. 0.8%) and splenic lesions (3.1 vs. 0.6%). Gastric and esophageal perforations were similar in both groups (1.1 vs. 0.9%). Hospital mortality rate was 0.1%. We observed a frequency dependent learning curve regarding complication rates after laparoscopic antireflux surgery (< 11 fundoplication p.a.: 14.0%; 11-30 fundoplications: 7.3% (p = 0.05); > 30 fundoplications: 4.2% (p = 0.05%). Long-term-dysphagia occurred more often after 360 degrees-versus partial fundoplications (6.6% vs. 2.4%; p < 0.001) and after Nissen/Nissen-Rossetti--than after Floppy-Nissen-procedures (6.6% vs. 3.6%, p = 0.1). The recurrency rate was 9.3% without significant differences between the procedures.

CONCLUSION

Laparoscopy has replaced the open technique. Different technical approaches significantly affect the outcome after laparoscopic antireflux surgery in Germany.

Molecular and functional aspects of anionic channels activated during regulatory volume decrease in mammalian cells

The ability of cells to readjust their volume after swelling, a phenomenon known as regulatory volume decrease (RVD), is a fundamental biological achievement guaranteeing survival and function of cells under osmotic stress. This article reviews the mechanisms of RVD in mammalian cells with special emphasis on the activation of ion channels during RVD.

[Management of common bile duct stones--Results of a nationwide survey with analysis of 8 433 common bile duct explorations in Germany]

BACKGROUND

Aim of this study was the evaluation of the management of choledocholithiasis and outcome of laparoscopic as well as open cholecystectomy in Germany.

METHODS

A written questionnaire was sent to 449 randomly selected German surgeons annually from 1991 to 1994 and additionally to all German university hospitals until 1998.

RESULTS

A total of 98 482 operations for gallstone disease including 86 485 cholecystectomies (non-university hospitals 1991-1993: n = 60 246, university hospitals 1991-1996: n = 26 239) and 8 433 common bile duct (CBD) explorations (non-university hospitals: n = 6 919, university hospitals: n = 1 514) with or without cholecystectomy were reported. The overall complication rate for CBD explorations was 13.2 % (non-university hospitals) and 15.1 % (university hospitals), the overall hospital mortality rate was 0.64 % (non-university hospitals) and 0.58 % (university hospitals, n. s.). When choledocholithiasis was suspected, in 1998 all university hospitals used a two-stage management with preoperative ERC. In case of diagnosed isolated choledocholithiasis 93 % usually chose an endoscopic approach. When simultaneous cholecysto-choledocholithiasis was diagnosed preoperatively 86 % of the university hospitals used a two-stage management with preoperative ERC and stone extraction and secondary cholecystectomy (1991: 45 %). The percentage of CBD explorations decreased continuously from 7.4 % in 1991 to 3.8 % in 1996 (p < 0.01).

CONCLUSION

These results allow for the estimation of frequency and overall risks in surgical therapy of CBD stones. At the moment, laparoscopic CBD exploration does not play a significant role in Germany. Data show a trend to the two-stage "therapeutical splitting" with lower complication rates.

[How safe is intracorporeal anastomosis?]

A recent German multi-centre study comprising 3070 laparoscopic colorectal resections indicates that complete intracorporeal anastomoses are done in only 1.8%. In agreement with the literature, technically demanding hand-sutured anastomoses are no common practice either. Intracorporeal anastomosis is usually done using endoscopic linear stapling devices or the conventional circular stapler by performing end-to-end, end-to-side, and side-to-side anastomoses. These techniques are more frequently used in the upper than in the lower gastrointestinal tract. The date published so far, however, indicate that the complete intracorporeal anastomosis is a save technique in the hands of laparoscopically experienced surgical teams. This technique has very low rates of postoperative stenoses (0-10%) and, furthermore, very low rates of postoperative anastomotic leakages (0-8%).

Laparoscopic repair of an extrahiatal hernia caused by congenital dysplasia: a case report

A 40-year-old woman with complaints of relapse in the upper abdomen and dysphagia was referred for laparascopic hiatal hernia repair. Chest radiograph, barium-swallow, and upper endoscopy revealed a paraesophageal hernia. Esophageal manometry and 24-h-pH study showed no pathological findings. A laparoscopic gastropexy was planned. Intraoperatively, in contradiction to the preoperative findings, an extrahiatal hernia containing most of the stomach was found. After resection of the hernia sac, the beating heart without covering pericardium was seen. These findings were confirmed by an additional thoracoscopy at the end of the operation. The defect was closed by direct suturing. The postoperative course and 2-month follow-up were uneventful. The resected parts of the hernia sac showed an embryonic and dysgenetic etiology. This rare malformation has been reported in combination with complex syndromes, which appear with serious clinical and morphological signs in the neonatal period. In adults, the pericardial aplasia can be observed during diagnostic or surgical interventions. In these patients, complaints are usually not caused by the malformation but may be due to the occasional herniation of abdominal organs. We consider laparoscopic repair to be a gentle and safe procedure for the treatment of extrahiatal hernias.

[Postoperative endoscopy for the diagnosis and therapy of complications]

A variety of endoscopic methods are available as the main tools in the diagnostics and therapy of various complications after visceral and thoracic surgery. Indications for endoscopic interventions are anastomotic leaks, stenoses, Gl-tract bleedings, biliary lesions and functional problems after surgical procedures. The most common are fibrin sealing of fistulas, dilatation and bougienage, injection therapy for bleeding, bile duct interventions and stent implantations. In most cases operative revisions can be avoided by using endoscopic methods with an overall good success rate. No disadvantages are foreseen following conventional operative interventions if the endoscopic treatment is not successful.

Gallstone surgery in German university hospitals. Development, complications and changing strategies

A representative anonymous questionnaire was sent to all German university hospitals ( n=45) to address the development and outcome of laparoscopic gallstone surgery between 1991 and 1998. The response rate was 64%, and 28,753 operations for gallstone disease were analysed. Two-thirds of the procedures (67%) were performed laparoscopically. While a significant decrease of surgical complications (1991 vs 1998: 5.4% vs 3.4%; P<0.001) and re-laparotomy rate (1.0% vs 0.5%, P<0.05) was observed, no significant changes were detected with regard to the mortality rate. A learning curve regarding common bile duct (CBD) injuries was detected, showing a significant increase between 1991 and 1994 (0.3% and 0.7%, respectively, P<0.05) and a decrease to 0.2% in 1995 and 1996 ( P<0.05). The use of intraoperative cholangiography is compulsory in 10%, selective in 52%, while 38% of the university hospitals never use it. Most institutions use the Veress needle for pneumoperitoneum installation, and 93% use hook cautery for dissection. Since 1998, 45% of all institutions have also used the harmonic scalpel. The spectrum of indications for laparoscopic procedures has increased with time since acute cholecystitis, CBD stones and adhesions are not considered a general reason for a primary open approach. Our findings confirm a learning curve with regard to postoperative morbidity after laparoscopic cholecystectomy. This observation may be due to better training as well as surgical experience.

Prognostic factors and long-term results after surgery for gallbladder carcinoma: a retrospective study of 127 patients

BACKGROUND

The surgical management of gallbladder cancer is controversial, especially as to the indications for reoperation, extended resection, and aggressive treatment in advanced tumor stages.

METHODS

Records and follow-ups of 127 patients with gallbladder carcinoma who underwent surgery between 1980 and 1997 were examined according to the pTNM and Nevin staging systems. Factors predictive for survival were obtained from histopathologic staging and surgical procedures.

RESULTS

Surgery for gallbladder cancer was associated with an overall 5-year survival rate of 6.6%. Curative resection was possible in 35.5% of cases, which resulted in 5-year survival rates of 20%. Noncurative surgery revealed poor prognosis, with median survival time limited to 3.2 months, independently of macroscopic or microscopic tumor residues. None of the latter patients survived longer than 24 months. Surgery of stage I/II cancer showed a 5-year survival rate of 64.5%. In stage III/IV tumors, resectability was only 20.4%. However, curative surgery in advanced stages significantly increased median survival from 3.2 to 19.4 months.

CONCLUSIONS

Only complete tumor resection can provide long-term survival, even in advanced stages. Because negative surgical margins and UICC stage are the strongest predictors for survival, reoperation is required with all incidental findings above the T1b stage.

Simultaneous ligation of CD5 and CD28 with monoclonal antibodies restores impaired immunostimulatory function in human renal cell carcinoma

Tumor cells, including renal cell carcinoma (RCC) cells, do not effectively stimulate T lymphocyte responses against specific antigens presented on their surface. Reasons for this low immunogenicity may include low or absent expression of MHC class I and/or class II molecules, as well as accessory and costimulatory molecules. We used tumor cell pretreatment with cytokines, together with monoclonal antibodies (mAbs) directed at receptors for costimulatory molecules, to render RCC cells immunostimulatory. Interferon-gamma or tumor necrosis factor-alpha pretreatment enhanced expression of MHC class I and class II molecules, as well as CD54, but had only minimal effects on T cell activation. A CD28 mAb, or an even more effective combination of CD28 and CD5 mAb, induced strong primary proliferative responses of allogeneic resting T lymphocytes. Cytokine pretreatment further augmented this T cell response in vitro and allowed T cell expansion and establishment of T cell lines. Stimulation of T cells with autologous RCC cells resulted in a similar T cell activation but with the expansion of cytolytic T cells directed at autologous MHC class II molecules. These experiments demonstrate that cytokines combined with costimulatory mAbs are useful for increasing the immunogenicity of tumor cells. They also indicate. however, that autologous MHC class II expression on tumor cells, together with strong costimulation, may lead to the activation of autoreactive T cells.

Latency and reactivation of a glycoprotein E negative bovine herpesvirus type 1 vaccine: influence of virus load and effect of specific maternal antibodies

The effects of the vaccination of neonatal calves with a glycoprotein E (gE)-negative bovine herpesvirus type 1 (BHV-1) were investigated in naïve and passively immunised calves either with the recommended dose or a 5-fold concentrated one. After inoculation (PI), all calves excreted the virus vaccine except three passively immunised calves inoculated with the lower titre. No antibody response could be detected in passively immunised calves, whatever the dose used, and they all became BHV-1 seronegative and remained so after dexamethasone treatment (PDT). Nevertheless, as shown by a gamma-interferon assay, all calves that excreted the vaccine PI developed a cell-mediated immune response and a booster response was observed PDT, suggesting viral reactivation. The vaccine virus was recovered PDT from nasal secretions in two calves and BHV-1 DNA were detected in trigeminal ganglia from five calves belonging to all inoculated groups. The results show that the BHV-1 gE-negative vaccine can establish latency not only in naïve but also in passively immunised neonatal calves after a single intranasal inoculation. Moreover, this study shows for the first time that the gE-negative vaccine, when used in passively immunised calves, can lead to seronegative vaccine virus carriers.

The presence of NHE1 and NHE3 Na+-H+ exchangers and an apical cAMP-independent Cl- channel indicate that both absorptive and secretory functions are present in calf gall bladder epithelium

We investigated the transport systems that can sustain Na+ and Cl- movements across bovine gall bladder epithelium, focusing on the Na+-H+ exchanger (NHE) family and chloride conductive pathways. Experiments conducted using the fluorescent probe acridine orange (AO) with brush-border membrane vesicles (BBMV) or vesicles obtained from the total epithelium (EMV) demonstrated the presence of a Na+-H+ exchange in both preparations. The use of specific inhibitors indicated the presence of an apical NHE3 exchanger and a NHE1 isoform which should reside in the basolateral membrane. Using reverse transcriptase (RT) PCR, we identified cDNA fragments corresponding to the NHE1, NHE3, Cl--HCO3- (AE2a) transporters and to the CFTR channel. Using the patch-clamp technique, we investigated Cl- conductances on cultured epithelial cells. We found a 5 pS Cl- channel with a voltage-independent open probability, insensitive to stilbenes (SITS), Zn2+ and cAMP. The results suggest that absorption and secretion coexist in calf gall bladder epithelium. A Na+-H+-Cl--HCO3- double exchange may, at least partially, sustain the absorptive function, and a Cl- apical conductive pathway may be involved in secretion. The conductance we observed does not seem to be cAMP-regulated, unlike other mammalian gall bladders.

Apolipoprotein E polymorphism and lithogenic factors in gallbladder bile

BACKGROUND

Associations between the polymorphism of apolipoprotein E, which plays an important role in cholesterol metabolism and cholesterol gallstone formation, have been reported recently. Patients with the apo E4 isoform showed increased numbers and cholesterol contents of their stones, a higher frequency of cholesterol crystals in bile, increased susceptibility to gallstone fragmentation by extracorporeal shock-wave lithotripsy and an increase in recurrence rate after dissolution. A recent study, however, showed that fast cholesterol crystallization in bile is associated with multiple stones but not with apo E4. Therefore the mechanism for an increased risk of gallstone formation in patients with the apo E4 isoform still remains under debate.

DESIGN

To clarify this issue we investigated 37 patients with gallstones (10 with the apo E4 allele and 27 without the allele). Gallbladder biles were examined for total cholesterol and other lipids, cholesterol saturation index, crystal observation time, crystal mass, total protein and mucin. Moreover, number of gallstones and cholesterol in gallstones was compared in both groups.

RESULTS

The crystal observation time (2.5 vs. 2.0 days, median) and the cholesterol saturation index (1.34 +/- 0.45 vs. 1.43 +/- 0.74) did not differ significantly between the apo E4 and the non apo E4 group. Total biliary lipids (11.6 +/- 3.8 vs. 9.3 +/- 3.9 g 100 mL-1, P = 0.126) and total biliary cholesterol (21.8 +/- 9.7 vs. 15.7 +/- 7 mmol L-1, P = 0.067) tended to be elevated in the apo E4 group. Crystal mass (3.60 +/- 4.10 vs. 2.38 +/- 2.70 mmol L-1), biliary total protein (8.6 +/- 3.5 vs. 8.3 +/- 6.6 mg mL-1) and mucin (0.55 +/- 0.38 vs. 0.66 +/- 0.67 mg mL-1), number (solitary/multiple) of gallstones and cholesterol in gallstones were not different in both groups of patients.

CONCLUSIONS

In comparison to the non apo E4 patients the apo E4 group showed a trend to elevated biliary cholesterol whereas crystal observation time, cholesterol saturation index, crystal mass, number of gallstones, cholesterol content of gallstones and total protein and mucin were not different. These findings do not suggest an association of the apo E isoform and the formation of cholesterol gallstones

Recording intramolecular mechanics during the manipulation of a large molecule

The technique of single atom manipulation by means of the scanning tunneling microscope (STM) applies to the controlled displacement of large molecules. By a combined experimental and theoretical work, we show that in a constant height mode of manipulation the STM current intensity carries detailed information on the internal mechanics of the molecule when guided by the STM tip. Controlling and time following the intramolecular behavior of a large molecule on a surface is the first step towards the design of molecular tunnel-wired nanorobots.

Human neocortical development: the importance of embryonic and early fetal events

The identification of numerous genes involved in the development of the cerebral cortex has led to an increased interest in the early stages of corticogenesis, when the first postmitotic neurons migrate into the cortical plate to form the foundation of the adult cortex. However, the cellular substrate of gene expression in early human cortical development is widely unknown. This article analyzes the complex sequence of events in the differentiation of the preplate, the predecessor of the neocortex, and discusses the possible origin and migratory routes of the neuronal populations involved in the transition from preplate to cortical plate. The neuronal classes present in embryonic and early fetal stages are redefined in terms of their relationship with the Reelin-Dab1 signaling pathway whose integrity is essential for successful migration into the cortex. A timetable of developmental steps is provided, and the peculiarities of the preplate derivatives in the human brain, marginal zone, and subplate are discussed. The results presented here may contribute to a deeper understanding of the pathogenesis of migration disorders.

Comparative pathogenesis of acute and latent infections of calves with bovine herpesvirus types 1 and 5

This study was conducted to compare the pathogenesis of acute and latent infections with closely related bovine herpesvirus types 1 (BHV-1) and 5 (BHV-5) in their natural host. Two groups of eight calves were inoculated intranasally with BHV-1 or BHV-5. Although BHV-1 and BHV-5 similarly replicate in the nasal mucosa after inoculation, both viruses differ markedly in their ability to cause disease, BHV-5 being responsible of some fatal encephalitis while BHV-1 inducing rhinotracheitis. Virus isolation and immunohistochemistry demonstrated that BHV-5 replicates extensively in neurons of the central nervous system (CNS) and in respiratory cells of lungs, tracheal and nasal mucosae. Invasion of the CNS likely occurs through the trigeminal and olfactory pathways. Both groups developed cross-neutralising antibodies during this experiment suggesting partial clinical cross-protection afforded by the two infections. Three months after primary infection, experimental reactivation showed that BHV-5 was able to establish latency in the trigeminal ganglia but also the CNS of surviving calves. Moreover, laboratory findings suggested that BHV-5 could also persist in the tracheal and nasal mucosae. These results indicate that, after primary infection, BHV-1 and BHV-5 displayed similar biological features and consequently need to be considered together for the control of BHV-1 infection.

Diphenylamine-2-carboxylic acid (DPC), Usually an inhibitor of Cl- and non-selective cation channels, inhibits Cl-/HCO3- exchange and opens Cl- and cation conductances in rabbit gallbladder epithelium

In the apical plasma membrane of rabbit gallbladder epithelium various drugs (hydrochlorothiazide, phlorizin, phenylglyoxal) inhibit Cl-/HCO3- exchange and probably enhance the almost negligible intrinsic anion conductance of the exchanger. By radiochemical measurements of apical Cl- influx, the anion exchange is shown here to be directly and immediately inhibited by diphenylamine-2-carboxylic acid (DPC) too. Using conventional microelectrode techniques in intact tissue, DPC, with same dose/response curve, is shown to activate an apical anion conductance (GCl) that has similar properties and amplitude to the GCl activated by the other exchange inhibitors so far tested; the actions are not additive. Patch-clamp methods (cell-attached and excised inside-out patch configurations) reveal that GCl is due to anion channels that are non-rectifying, cytoplasm independent, sensitive to stilbene and dipyridamole and have conductance of a few picosiemens. All this strengthens the correlation between inhibition of anion exchange and the activation of GCl and channels with features similar to those of the almost negligible intrinsic anion conductance of the exchanger. Among the drugs tested, the effects of DPC and hydrochlorothiazide are even more similar, such that even their dose/response curves overlap. Moreover, both drugs also directly activate some verapamil-sensitive Ca2+ channels and consequently apamin-sensitive, Ca2+-activated K+ channels. Thus DPC, usually an inhibitor of Cl- and non-selective cation channels, is shown here to be capable of activating Cl- and cation conductances.

Rate and mechanism of the oxidative addition of phenyl iodide to Pd0 ligated by triphenylarsine: evidence for the formation of a T-shaped complex

The oxidative addition of phenyl iodide to the palladium(o) generated from [Pd0(dba)2] and n equivalents of AsPh3 (the most efficient catalytic precursor in Stille reactions) proceeds from [(solv)Pd0(AsPh3)2] (solv= solvent). However, the latter is present only in trace concentrations because it is involved in an equilibrium with the major, but nonreactive, complex [Pd0(dba)(AsPh3)2]. As regards the phosphine ligands, dba has a decelerating effect on the rate of the oxidative addition by decreasing the concentration of the reactive species. Relative to PPh3, the effect of AsPh3 is to increase the rate of the oxidative addition of PhI by a factor ten in DMF and seven in THF, independent of the value of n, provided that n > or = 2. In contrast to PPh3, the addition of more than two equivalents of AsPh3 to [Pd0(dba)2] (dba= trans,trans-dibenzylideneacetone) does not affect the kinetics of the oxidative addition because of the very endergonic displacement of dba from [Pd0(dba)(AsPh3)2] to form [Pd0(AsPh3)3]. The complex trans-[PhPdI(AsPh3)2], formed in the oxidative addition, is involved in a slow equilibrium with the T-shaped complex [PhPdI(AsPh3)] after appreciable decomplexation of one AsPh3. Under catalytic conditions, that is, in the presence of a nucleophile, such as CH2=CH-SnBu3 which is able to coordinate to [Pd0(AsPh3)2], a new Pd0 complex is formed: [Pd0(eta2-CH2=CHSnBu3)(AsPh3)2]; however, this complex does not react with PhI. Consequently, CH2=CH-SnBu3 slows down the oxidative addition by decreasing the concentration of the reactive species [(solv)Pd0(AsPh3)2]. This demonstrates that a nucleophile may be not only involved in the transmetallation step, but may also interfere in the kinetics of the oxidative addition step by decreasing the concentration of reactive Pd0.