Adverse reactions to patent blue V dye - The NEW START and ALMANAC experience

BACKGROUND

Blue dye with or without isotope has been widely used to identify the sentinel lymph node(s) in breast cancer. Patent blue V is used in the UK while its isomer isosulfan blue is used in the US. The allergic potential of isosulfan blue is well documented (1.4% adverse reactions) but that of patent blue V is less clearly defined.

METHODS

In this paper we review the adverse reactions of patent blue V in 7,917 patients who participated in the NEW START training programme and the ALMANAC trial. All patients underwent sentinel lymph node biopsy for breast carcinoma using patent blue V in combination with (99m)Tc-albumin colloid.

RESULTS

In total, 72 of 7,917 (0.9%) patients experienced adverse reactions : non-allergic reactions were observed in 4 (0.05%) patients, 23 (0.3%) patients had minor grade I allergic skin reactions (urticaria, blue hives, pruritus, or generalised rash) and 16 (0.2%) had grade II reactions (transient hypotension/bronchospasm/laryngospasm). Severe Grade III reactions (severe hypotension requiring vasopressor support and/or change/abandoning of planned procedure and/or HDU/ITU admission) were noted in 5 (0.06%) patients. The type of adverse reaction was not specified in 24 (0.3%) patients. No mortality was recorded.

CONCLUSION

The allergic potential of patent blue V dye compares favourably with isosulfan blue however both the surgeon and anaesthetist need to be alert to the risk of allergic reactions.

Oral fluid, a substitute for serum to monitor measles IgG antibody?

We have analyzed the suitability and potential of Oral Fluid (OF) to substitute serum in estimating measles IgG antibodies, during community surveys, by comparing the Optical Density (OD) of measles IgG antibodies in OF and serum of 100 apparently asymptomatic children. IgG antibody status was determined using commercially available - Measles IgG Capture ELISA. Sensitivity 89.5%, specificity 90.6% Concordance of 89%, coefficient of correlation r is equal to 0.97 (Karl Pearson's) and rho is equal to 0.86 (Spearman's), was found between OD value of OF and serum. The study emphasizes the potential of OF to surrogate serum in estimating Measles IgG antibody among children. The OF collection is advantageous over blood as it is painless. It is suitable for non-technical staff, easy to transport and less bio-hazardous.

Comparison of validity of DIAGNOdent with conventional methods for detection of occlusal caries in primary molars using the histological gold standard: an in vivo study

AIM

This study was conducted to compare the in vivo effectiveness of DIAGNOdent with other conventional methods (visual, tactile and bitewing radiographs) for the detection of occlusal caries in primary molars. Another objective of the study was to calculate new cut-off limits for the detection of caries by DIAGNOdent in primary teeth.

MATERIALS AND METHODS

Eighty-four primary molars in 52 children (aged 8-12 years), which were indicated for extraction, were selected and evaluated for dental caries using DIAGNOdent, visual and tactile examination and bitewing radiographs. Histological examination of the sections, prepared subsequent to extraction of the teeth, served as the gold standard for comparison of the above-mentioned methods.

RESULTS

When considering enamel caries, values obtained for sensitivity, specificity and accuracy were 48.15, 100 and 49.40% for visual examination, 48.15, 100.00 and 49.40% for tactile examination, 49.38, 50.00 and 49.40% for bitewing radiographs, 85.19, 50.00 and 84.34% for DIAGNOdent scores interpreted according to manufacturer's cut-off limits and 81.48, 100.00 and 81.93% for DIAGNOdent scores interpreted according to newly formulated cut-off limits, respectively. At dentin caries cut-off levels, the values of sensitivity, specificity and accuracy for visual examination were 52.78, 89.36 and 73.49%; 50.00, 91.49 and 73.49% for tactile examination; 30.56, 82.98 and 60.24% for bitewing radiographs; 72.22, 76.60 and 74.70% for DIAGNOdent scores when interpreted according to manufacturer's cut-off limits and 77.48, 74.47 and 75.90%, respectively, for the DIAGNOdent scores when interpreted according to the newly formulated cut-off limits.

CONCLUSIONS

DIAGNOdent showed higher sensitivity and accuracy as compared with other conventional methods for detection of enamel caries, whereas for detection of dentinal caries, even though the sensitivity was high, accuracy of the DIAGNOdent device was similar to other conventional caries diagnostic methods.

Proximate Composition and Functional Properties of Mushroom Flours from Ganoderma spp., Omphalotus olearius (DC.) Sing. and Hebeloma mesophaeum (Pers.) Quél. Used in Nasarawa State, Nigeria

The proximate composition and functional properties of three edible mushroom (Ganoderma spp., Omphalotus olearius (DC.) Sing. and Hebeloma mesophaeum (Pers.) Quél.) flours used in Nasarawa state, Nigaria were investigated using standard analytical techniques. The samples contained crude protein in the range of 18.5% in Omphalotus olearius to 21.5% in Ganoderma spp. Crude fat varied with values ranging from 6.9% in Ganoderma spp. to 8.7% in Omphalotus olearius. Other proximate composition values were in the following ranges: moisture content 10.0 - 11.1%, ash 7.3 - 8.3%, crude fibre 2.8 - 3.5% and carbohydrate (by difference) 50.3 - 50.9%. The range values of functional properties were: foaming capacity 101.8 - 131.5%, foaming stability 51.0 - 54.0%, water absorption capacity 260.0 - 390.0%, oil absorption capacity 450 - 480%, oil emulsion capacity 57.3 - 61.0mLg- 1, least gelation concentration 12.0 - 14.0% and bulk density 230.0 - 410.0gmL-1. The results showed that these nutrient rich mushroom flours under investigation may prove useful in the formulation of different food products where foaming, emulsification, retention of flavour and palatability as well as gel formation are required.

Plasma levels of 4-OHT with topical tamoxifen gel (afimoxifene) and therapeutic local antiestrogenic effect in premenopausal women with cyclical mastalgia

e14598

Background: 4-hydroxytamoxifen(4-OHT) is a potent anti-estrogenic metabolite of tamoxifen with a much higher affinity for estrogen receptors than tamoxifen. Methods: Plasma levels of 4-OHT in 19 premenopausal women taking 20 mg/d oral tamoxifen for at least 2 months were compared with those of 16 premenopausal women assigned to apply 4mg 4-OHT in a 0.228% Afimoxifene gel daily for 21 days in a pharmacokinetic(PK) study. To evaluate the clinical effectiveness of the gel, premenopausal women experiencing moderate-to-severe mastalgia were randomized to receive placebo, 2mg or 4 mg of Afimoxifene daily delivered as a transdermal hydroalcoholic gel for 4 menstrual cycles. The primary efficacy parameter was change in mean pain intensity, as measured by the VAS for the 7 worst pain score days within a cycle, from baseline to the 4th cycle. Results: In the PK studies, the 4-OHT plasma levels following oral tamoxifen were 16–18 times higher than 4-OHT levels following 4mg 4-OHT administration by topical gel. At steady state, mean Cmax levels in the Afimoxifene group and oral tamoxifen group were 149+99 pg/mL and 2398+901 pg/mL respectively. The Cave concentrations, derived from AUC0–24h/24, were 117+77 pg/mL (Afimoxifene) and 2078+811 pg/mL (oral tamoxifen). After 4 cycles of gel treatment, significant improvements relative to placebo were seen in mean VAS score in the 4-mg Afimoxifene group (-12.71 mm [95% confidence interval, -0.96 to -24.47; P = 0.034]). Patient global assessment of pain, physician assessment of pain, tenderness on palpation and nodularity following 4 cycles of treatment were significantly improved in the 4-mg group, compared with placebo (P = 0.010 [pain]; P = 0.012 [tenderness]; P = 0.017 [nodularity]). There were no changes in menstrual pattern or plasma hormone levels and no breakthrough vaginal bleeding in patients treated with Afimoxifene. Conclusion: Topical application avoids high systemic exposure to 4-OHT compared with oral tamoxifen, a 16–18-fold difference, thus reducing the risk of systemic side-effects. Afimoxifene is an effective treatment for moderate-to-severe mastalgia and potentially may be used for breast cancer chemoprevention and gynecomastia.

No significant financial relationships to disclose.

Topical tamoxifen gel (afimoxifene) is associated with low plasma levels of 4-OHT while achieving therapeutic local antiestrogenic effect in premenopausal women with cyclical mastalgia

Abstract #2154

Background:4-hydroxytamoxifen(4-OHT) is a potent anti-estrogenic metabolite of tamoxifen with a much higher affinity for estrogen receptors than tamoxifen.We compared the plasma levels of 4-OHT in subjects applying Afimoxifene gel with subjects on oral tamoxifen.We conducted a randomized clinical trial to evaluate the safety and efficacy of topical Afimoxifene gel for the treatment of moderate-to-severe cyclical mastalgia.
 Methods:Plasma levels of 4-OHT in 19 healthy premenopausal women taking 20 mg/d oral tamoxifen for at least 2 months were compared with those of 16 healthy premenopausal women assigned to apply 4mg 4-OHT in a 0.228% Afimoxifene gel daily for 21 days in a pharmacokinetic(PK) study.Plasma for PK sampling was obtained at multiple time-points.PK parameters of plasma 4-OHT Cmax, and AUC0-24ht were determined.
 To evaluate the clinical effectiveness of the gel, premenopausal women aged at least 18 years experiencing moderate-to-severe mastalgia were randomized to receive placebo, 2mg or 4 mg of Afimoxifene daily delivered as a transdermal hydroalcoholic gel for 4 menstrual cycles.The primary efficacy parameter was change in mean pain intensity, as measured by the Visual Analog Scale(VAS) for the seven worst pain score days within a cycle, from baseline to the fourth cycle.Plasma levels of 4-OHT were assessed once after the second and the fourth menstrual cycles.
 All plasma levels of 4-OHT were measured in the same central lab, with a GC-MS method with a lower limit of quantification of 5 pg/mL.
 Results:In the PK studies, the 4-OHT plasma levels following oral tamoxifen administration were 16-18 times higher than 4-OHT levels following 4mg 4-OHT administration by topical gel. At steady state, mean Cmax levels in the Afimoxifene group and oral tamoxifen group were 149+99 pg/mL and 2398+901 pg/mL respectively. The Cave concentrations, derived from AUC0-24h/24, were 117+77 pg/mL(Afimoxifene) and 2078+811 pg/mL(oral tamoxifen).
 After 4 cycles of gel treatment, statistically significant improvements relative to placebo were measured in mean VAS score in the 4-mg Afimoxifene group(-12.71 mm[95% confidence interval, -0.96 to -24.47; P = 0.034]).Patient global assessment of pain, physician assessment of pain, tenderness on palpation and nodularity following 4 cycles of treatment were significantly improved in the 4-mg group, compared with placebo(P = 0.010 [pain]; P = 0.012 [tenderness]; P = 0.017 [nodularity]).Systemic exposure was low, with mean 4-OHT plasma levels of 50±64 pg/mL. There were no changes in menstrual pattern or plasma hormone levels and no breakthrough vaginal bleeding in patients treated with Afimoxifene.
 Conclusion:Topical application avoids high systemic exposure to 4-OHT compared with oral tamoxifen, a 16-18-fold difference, thus potentially reducing the risk of systemic side-effects.Afimoxifene is an effective treatment for moderate-to-severe mastalgia in premenopausal women and has the potential to be used for breast cancer chemoprevention/gynecomastia in the future.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2154.

Early class III occlusal tendency in children and its selective management

Class III malocclusion may develop in children as a result of an inherent growth abnormality, i.e., true class III malocclusion, or as a result of premature occlusal contacts causing forward functional shift of the mandible, which is known as pseudo class III malocclusion. These cases, if not treated at the initial stage of development, interfere with normal growth of the skeletal bases and may result in severe facial deformities. The treatment should be carried out as early as possible with the aim of permitting normal growth. This paper deals with the selection of an appropriate treatment approach from the various current options available for early intervention in children developing class III occlusal tendencies; the different clinical features are depicted in the three case reports.

Evaluation of a mixture of zinc oxide, calcium hydroxide, and sodium fluoride as a new root canal filling material for primary teeth

Endodontic treatment was performed on 25 pulpally involved mandibular primary molars in 4 to 9-year-old children; the root canals were obturated with a new root canal filling material consisting of a mixture of calcium hydroxide, zinc oxide, and 10% sodium fluoride solution, using hand-operated lentulo-spirals. All cases were evaluated clinically every 3 months and also radiographically every 6 months to assess the success of the treatment; we also examined the resorption of the root canal filling material from the root canals and the status of overpushed material, if any, as the tooth resorbed with the passage of time. At 6 months, endodontic treatment in 2 of the 25 teeth had failed and one tooth had exfoliated; the remaining 22 teeth were without any signs or symptoms. At the end of 2 years, 14 teeth could be evaluated; out of these 12 had physiologically exfoliated. It was observed that the rate of resorption of this new root canal obturating mixture was quite similar to the rate of physiologic root resorption in primary teeth. In three cases, where there was an overpush of the mixture, a gradual partial resorption was noted.

Management of inverted impacted primary incisors: an unusual case

The prevalence of impacted primary teeth has been reported to be very rare and it has been reported to occur in 1:10,000 times, most commonly involving the primary second molars. This report discusses the presence of an impacted inverted maxillary primary incisors and their management by surgical intervention in a 5 year old boy. The inverted primary maxillary central incisors were extracted and prosthetic rehabilitation was done to improve the esthetics, speech and psychosocial behaviour of the child. Co-incidentally the permanent maxillary incisors were also found to be hypoplastic although the parents did not give any history of trauma to the maxillofacial complex. It is important for pediatric dental surgeons to carefully monitor the eruption of primary and permanent teeth for early identification and management of developmental anomalies.

Progressive multifocal leukoencephalopathy--as a presenting manifestation of AIDS

Progressive multifocal leukoencephalopathy (PML) is an opportunistic demyelinating disease caused by the ubiquitous, usually non pathogenic JC Polyomavirus. We report a case of PML as a presenting manifestation of AIDS in a forty five year old man on the basis of clinical features and neuroradiology.

Quality of life in lung cancer patients: impact of baseline clinical profile and respiratory status

As cure is attainable in very few cases of lung cancer, the imperative issue is to make quality of life (QOL) as good as possible as part of the palliative care package. The aim of this paper was to evaluate the baseline QOL of lung cancer patients and observe its association with various clinical parameters and overall respiratory status. A total of 101 patients were administered the European Organization for Research and Treatment of Cancer core quality of life (EORTC QLQ-C30, version 3) questionnaire. Clinical profile and measures of respiratory status, including spirometry, measures of dyspnoea, and 6-min walk test, were recorded. Higher Karnofsky Performance Status (KPS) significantly correlated with better global health status (P < 0.001) and healthy level of functioning (P < 0.001). The cumulative symptom burden was significantly associated with global QOL (P = 0.01) and physical, role and cognitive function scales (P < 0.05). All dyspnoea measures negatively correlated with global QOL and functioning scales. Spirometric indices showed a positive correlation with all functional scales (P < 0.05) except social. In conclusion, lung cancer patients have unsatisfactory QOL, with the global health status and physical functions being most affected. Number of symptoms, KPS, dyspnoea and spirometry significantly affect QOL.

Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years

The prevalence of dental caries in 6, 9, 12 and 15-year-old school children of Chandigarh, selected on a randomized basis was evaluated using Moller's criteria (1966) and correlated with the various risk factors. The mean deft was found to be 4.0 +/- 3.6 in 6 year old and 4.61 +/- 3.14 in 9 year old, whereas the mean DMFT in 12 and 15 year old was found to be 3.03 +/- 2.52 and 3.82 +/- 2.85 respectively. The high prevalence of dental caries in these children was attributed to the lack of use of fluoride toothpaste (80% children), lack of knowledge about etiology of dental caries (98%) and frequency of sugar exposures up to more than five times per day (30%).

Functional characterization and mutation analysis of family 11, Carbohydrate-Binding Module (CtCBM11) of cellulosomal bifunctional cellulase from Clostridium thermocellum

The non-catalytic, family 11 carbohydrate binding module (CtCBM11) belonging to a bifunctional cellulosomal cellulase from Clostridium thermocellum was hyper-expressed in E. coli and functionally characterized. Affinity electrophoresis of CtCBM11 on nondenaturing PAGE containing cellulosic polysaccharides showed binding with β-glucan, lichenan, hydroxyethyl cellulose and carboxymethyl cellulose. In order to elucidate the involvement of conserved aromatic residues Tyr 22, Trp 65 and Tyr 129 in the polysaccharide binding, site-directed mutagenesis was carried out and the residues were changed to alanine. The results of affinity electrophoresis and binding adsorption isotherms showed that of the three mutants Y22A, W65A and Y129A of CtCBM11, two mutants Y22A and Y129A showed no or reduced binding affinity with polysaccharides. These results showed that tyrosine residue 22 and 129 are involved in the polysaccharide binding. These residues are present in the putative binding cleft and play a critical role in the recognition of all the ligands recognized by the protein.

Recurrent and residual juvenile angiofibromas

INTRODUCTION

In the surgical management of juvenile nasopharyngeal angiofibromas the possibility of recurrences and residual tumours is always there. This study was undertaken to predict the prognostic factors determining recurrence of juvenile nasopharyngeal angiofibroma and to find out the usual sites of these tumours.

MATERIAL AND METHODS

The medical records of 95 patients with histologically proven juvenile nasopharyngeal angiofibroma were reviewed retrospectively. The commonest surgical approach used was a combined transpalatal and transmaxillary approach with a lazy S incision. A conservative lateral infratemporal approach was used in three cases.

RESULTS

Complete removal of the juvenile nasopharyngeal angiofibroma was achieved in 78 (82 per cent) of the cases in a single operation. A residual tumour was found in 17 (18 per cent) cases and recurrences occurred in 13 (13.7 per cent) cases.

CONCLUSIONS

Extensions into the pterygoid fossa and basisphenoid, erosion of the clivus, intracranial extensions medial to the cavernous sinus, invasion of the sphenoid diploe through a widened pterygoid canal, feeders from the internal carotid artery, a young age and a residual tumour were risk factors found associated with recurrence of juvenile nasopharyngeal angiofibroma.

Mesiodistal crown dimensions of the permanent dentition in North Indian children

This investigation was conducted on 110 individuals, (40 males and 70 females) in the age range of 12-18 years. The results revealed the mesiodistal crown dimensions of teeth of males to be more than that of the females. Further the ratio of the mesiodistal crown dimension of the maxillary lateral incisors to the maxillary central incisors was 80% in females and 78% in males. The total arch length in males was 117.77 mm in maxilla and 111.60 mm in mandible, while in females, the figures were 113.98 mm in maxilla and 107.10 mm in the mandible.