Bilateral congenital oral mucous extravasation cysts

This report documents the bilateral presentation of oral mucous extravasation cysts on the left mucobuccal fold and right buccal mucosa of a neonate. The lesions were noted at birth and subsequently enlarged to the point that they interfered with eating. The left lesion ruptured but persisted as an exophytic fibrotic mass. Both lesions were surgically removed at eight months and the diagnosis was confirmed by histopathologic examination. Post-operative follow-up after nine months shows no recurrence. The presentation and diagnostic considerations are discussed.

A brief motivational intervention to improve dietary adherence in adolescents. The Dietary Intervention Study in Children (DISC) Research Group

Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient's readiness to change health behaviors. Recently, elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters. This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children (DISC). DISC is a randomized, multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children. In the first 3 years of follow-up covering ages 8-13, intervention participants (n = 334) were exposed to a family-based group intervention approach to change dietary choices. To address adherence and retention obstacles as participants moved into adolescence (age 13-17), an individual-level motivational intervention was implemented. The DISC motivational intervention integrates several intervention models: stages of change, motivational interviewing, brief negotiation and behavioral self-management. A preliminary test of the intervention model suggests that it was acceptable to the participants, popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model.

Delusional ideation in religious and psychotic populations

OBJECTIVES

Previous research into schizotypy has shown that certain groups of people have similar experiences to the positive symptoms of schizophrenia but remain functioning members of society, such as those with profound religious experiences (Jackson & Fulford, 1997).

METHOD

The focus of the present study was to explore the incidence of delusional ideation in New Religious Movements (NRMs). Hare Krishnas and Druids were compared to two control groups (non-religious and Christian), and to deluded, psychotic in-patients on two delusions measures.

RESULTS

As predicted, individuals from the NRMs scored significantly higher than the control groups on all the delusional measures apart from levels of distress. They did not show as much florid symptomatology as the psychotic patients, but could not be differentiated from the deluded group on the number of delusional items endorsed on the Peters et al. Delusions Inventory (PDI; Peters, Day & Garety, 1996), or on levels of conviction. However, they were significantly less distressed and preoccupied by their experiences. No differences were found between the two control groups on any of the delusional measures, suggesting that religious beliefs per se do not account for the NRMs members' scores.

DISCUSSION

These findings provide further support for, first, the notion of a continuum between normality and psychosis and, second, for the necessity to consider the multidimensionality of delusional beliefs.

A template for cultural diversity workshops

PURPOSE/OBJECTIVES

To present a model for a series of workshops designed to improve the ability of oncology nurses to understand and fulfill culturally based needs of racially and ethnically diverse patients with cancer.

DATA SOURCES

Published literature and author experience.

DATA SYNTHESIS

Most nurses work with patients from a variety of ethnic or cultural backgrounds yet know little of how this affects patients' cancer experiences. Four workshops were presented that focused on the most common ethnic groups in the geographic area. A content template was developed that worked well to ensure complete topic coverage.

CONCLUSIONS

Workshops were well-received. Nurses identified barriers to care and interventions that are appropriate for diverse patient populations. The follow-up survey indicated that some anticipated program outcomes may not be feasible if attendees do not regularly work with target populations.

IMPLICATIONS FOR NURSING PRACTICE

The model can be modified for use in any geographic area. Such workshops should be repeated at regular intervals.

[Fundamentals of hygiene to be used for stallions in an instrumental artificial insemination]

Equine artificial insemination (AI) meanwhile has been widely established in the warm blood horse industry. Because of its importance consistent hygienic aspects and their significance for the use of stallions as semen donors in AI-programs are presented and clarified. Incidence as well as importance of equine venereal infectious diseases are considered. Data of physiological bacterial genital flora and treatment principles of therapeutic control of venereal infectious bacterial agents as well as a model of control of Equine Viral Arteritis are given. A prophylactic hygiene program for donor stallions in routine AI including special microbiological monitoring is presented.

Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck: long-term results

PURPOSE

A phase II trial of cisplatin, fluorouracil, and leucovorin (PFL) induction chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck region (HNCA).

PATIENTS AND METHODS

One hundred two patients (stage III/IV, previously untreated) were treated with induction PFL. Patients with resectable primary tumor site lesions and clinical complete response (CR) were offered radiotherapy (RT) without surgery to the primary tumor site. Response, toxicity, local-regional therapy, survival, and preservation of the primary tumor site were assessed.

RESULTS

Among 279 courses, the overall response rate was 81%. Nineteen (19%) failed to respond, including three who died during therapy. Sixty-seven (69%) of 97 with assessable primary lesions had a clinical CR at the primary tumor site. Pathologic CR was recorded in 46 of 55 (84%) clinical CR patients who had biopsies performed on the primary tumor site. Toxicities resulted in unexpected hospitalizations in 19% of cases. After definitive local-regional therapy, 84 (82%) were disease-free including 71 (69%) with preserved primary tumor site anatomy. With a median follow-up time of 63 months, the cause-specific, overall (OS), and failure-free survival (FFS) rates at 5 years are 58%, 52%, and 51%. Local failure occurred in 29 of 102 (29%) and the local control rate at 5 years was 68%.

CONCLUSION

PFL has significant activity with acceptable toxicity in patients with advanced disease who have a good performance status. Preservation of the primary tumor site could be achieved without apparent loss of local control or survival. Management of neck disease by surgery or RT must be individualized and separate from management of primary tumor. Survival compares favorably with similar trials of induction chemotherapy or chemoradiotherapy.

Oral mucosal melanomas: the WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology

A workshop to discuss primary oral melanomas was convened at the annual Western Society of Teachers of Oral Pathology meeting in Bannf, Alberta, Canada. Fifty oral melanomas, identified from the files of the participants, were reviewed in order to better understand the clinical features, histologic spectrum, and natural history of these perplexing lesions. Results confirmed that oral melanomas occur in adults almost three times more frequently in men than women and have a decided predilection for the palate and gingiva. Some lesions exhibit a clinically detectable and prolonged in situ growth phase, whereas others seem to lack this property and exhibit only or predominantly invasive characteristics. Recurrences, metastases, and death from tumor were characteristic of the follow-up of a limited number of patients. Until definitive prospective data are collected that elucidate natural history, oral mucosal melanomas should be tracked separately from cutaneous lesions. All oral pigmented lesions that are not clinically diagnostic should be biopsied. Lesions with equivocal histopathologic features might be referred to as "atypical melanocytic proliferation" and should be excised. Recognition of lesions in an early in situ phase and aggressive treatment should have a favorable effect on prognosis. To enhance future or prospective study of these rare neoplasms, guidelines for reporting oral melanomas are suggested.

Longitudinal radiographic assessment of dense bone islands of the jaws

OBJECTIVES

This study assessed dense bone island (DBI) inception and growth in jaws.

STUDY DESIGN

A population of 2991 patients (age range 5 to 35 years) was studied with at least two panoramic radiographs taken 1 to 10 years apart for each patient. Lesions were digitized and measured with computer measuring software. The size of the earliest DBI was compared with subsequent DBI measurements after the latter measurement was normalized with reference to the size of the nearest tooth.

RESULTS

Sixty-nine patients with DBIs were identified. A total of 3.1% of the patients with DBI were found in the 5- to 10-year age range, with the first patient in the DBI group found at 9.4 years. A significantly higher proportion (p = 0.002) of the unaffected patients (26%) was found in the same 5-to 10-year age range. The proportions of patients in the DBI and unaffected groups in older age ranges were similar. Assessment of DBI size changes showed that 43% of the 53 DBIs detected between 9.4 and 19 years enlarged (mean change, 212%), and 17% diminished (mean change, 49%). In comparison, 29.4% of 17 DBIs detected between 20 and 35 years enlarged (mean change, 153%), and 5.9% diminished (mean change, 60%).

CONCLUSION

Our results indicate that DBIs are labile lesions, develop during early adolescence, and retain a potential for enlargement, or to a lesser extent shrinkage, into adulthood.

alpha-Lactalbumin-enriched low-protein infant formulas: a comparison to breast milk feeding

Tryptophan (TRP) is the limiting amino acid in low-protein infant formulas. This is mainly due to lower alpha-lactalbumin (alpha LA) content in cow's milk whey as compared with human milk protein. To study the effect of alpha LA-enrichment on the TRP supply, cross-over studies were carried out in 20 healthy infants up to 3 months of age. In this study, two protein-reduced (1.3%) infant formulas (moderate TRP content of 1.88% and higher TRP content of 2.10%) were alternately fed over a 2 week period in two groups of infants. Serum TRP levels of the formula-fed infants with the higher TRP content did not differ significantly from an exclusively breastfed control group of 11 infants (10.5 +/- 4.8 versus 10.9 +/- 4.7 mg l-1, p = 0.841), whereas levels of the formula-fed infants with the moderate TRP content were significantly lower (7.4 +/- 3.9, p = 0.038). The supplementation of alpha LA resulting in a higher TRP supply to low-protein diets is a further step towards the production of infant formulas more closely adapted to human breast milk.

Insulin-like growth factor I and insulin down-regulate growth hormone (GH) receptors in rat osteoblasts: evidence for a peripheral feedback loop regulating GH action

The anabolic actions of GH are mediated by the production of insulin-like growth factor I (IGF-I) from the liver and by local production of IGF-I in extrahepatic tissues. Insulin facilitates the hepatic production of IGF-I by up-regulating GH receptors (GHRs) in the liver and augmenting the IGF-I response to GH. Although GHRs have also been identified in extrahepatic tissues that produce IGF-I, the possibility that IGF-I and insulin might partake in GHR regulation, thereby modulating the effects of GH locally has not received detailed study. The aim of this study was to investigate whether IGF-I and insulin are involved in the local regulation of GHRs, using osteoblasts as a model of GH-responsive extrahepatic tissues. We have used UMR106.06, a well differentiated rat osteoblast-like cell line that expresses GHRs and exhibits a mitogenic response to GH. IGF-I and insulin (0-10 nM) increased cell number and reduced [125I]GH binding in a concentration-dependent manner, with ED50 values of 0.8 and 0.3 nM, respectively. Although IGF-I increased cell number maximally by 36.9 +/- 1.2% (mean +/- SE) above the control value and insulin by 104.8 +/- 5.7% (P < 0.001), they decreased GH binding to 47.0 +/- 9.3% (P < 0.01) and 29.8 +/- 8.7% of the control value (P < 0.001), respectively. Scatchard analysis revealed that the down-regulation of GH binding was attributed to reduced receptor numbers and not binding affinity. The effects of IGF-I and insulin at submaximal concentrations were additive, although the combined effects did not exceed the maximal effect of either growth factor alone. Addition of an anti-IGF-I receptor antibody (alpha IR3) reversed the inhibition of GH binding induced by IGF-I, but not that caused by insulin; similarly, an antiinsulin receptor antibody (29B4) attenuated the inhibitory effect of insulin only. Addition of alpha IR3 alone or an ant-IGF-I antibody (Sm1.2) decreased cell number and increased GH binding in a concentration-dependent mode. GH at 1.5 nM significant increased cell number by 19.3 +/- 2.4% above the control level (P < 0.01), an increase that was reversed by alpha IR3. GH increased GH binding by 32.4 +/- 7.2% (P < 0.05) in cells treated with alpha IR3 to remove the secondary effect of IGF-I. In summary, IGF-I and insulin acted via specific receptors to stimulate cell proliferation and down-regulate GHRs in osteoblasts. GH stimulated cell proliferation, an action mediated by local production of IGF-I, and GH enhanced its own binding. The collective data suggest the presence of a peripheral negative feedback loop that allows IGF-I to limit locally the response of extrahepatic tissues to circulating GH.

Dental unit water contamination

Bacteria-laden biofilms located on the lumen surface of dental unit water lines have resulted in the persistent and widespread microbial contamination of dental unit water supplies. These biofilms are resistant to chemical disinfection. As such, they act as reservoirs that facilitate the continuous re-contamination of dental unit water. The microbial populations of the biofilms found in dental unit water lines include opportunistic pathogens of unknown significance. Strategies to control the contamination are discussed.

Mit Bor besetzte kondensierte Cluster in Ta5G e3By (y ≈ 0,7) / Boron Occupied Condensed Clusters in Ta5Ge3By (y ≈ 0.7)

Tantalum, Germanium, Cluster Bronze coloured, rod-shaped crystals of Ta5Ge3By have been prepared by CO2-LASER-techniques. X-ray-methods confirm the well known hexagonal Mn5Si3 type, space-group D3 6h-P63/mcm, a = 7.6276(6) and c = 5.2781(9) Å . The Ta6-clusters are centred by boron atoms.

Salivary gland duct involvement in oral epithelial dysplasia and squamous cell carcinoma

The clinical implications and prognostic significance of oral dysplastic or cancerous epithelium involving salivary gland ducts have not been previously investigated. Screened routine tissue sections of 1216 cases of oral epithelial dysplasias and squamous cell carcinomas revealed 26 examples (2.14%) that exhibited unequivocal ductal involvement. Ductal involvement was more likely to occur in floor of mouth lesions and in lesions exhibiting severe dysplasia or carcinoma in situ. Clinical follow-up on 23 cases showed that the recurrence rate of the preinvasive lesions that exhibited ductal involvement was equal to that of the squamous cell carcinomas. The depth of ductal dysplasia did not correlate with recurrence rate. These results suggest that the involvement of salivary gland ducts by oral epithelial dysplasias and carcinomas in situ is an uncommon but significant finding. Surgical stripping or ablation of such lesions should extend at least 3 mm below the surface to ensure eradication of these reservoirs of dysplastic cells.

Detection of premalignant oral lesions: a 10 year retrospective study in Alberta

A comprehensive review of all oral premalignant lesions and squamous cell carcinomas (SCC) diagnosed and biopsied by the oral pathology diagnostic service at the University of Alberta over two sequential five-year periods (1984-1988 and 1989-1993) was undertaken. There was a disproportionate increase in the number of premalignant biopsies conducted in 1989-93 relative to the number of SCC biopsies, suggesting an improvement in the detection of oral pre-malignancy by dentists.

Synthese eines Pyrochlors mit TiII: (Ta0.67TiII 0.33)2Sm2O7/ Synthesis of a Pyrochlore Containing TiII: (Ta0.67TiII 0.33)2Sm2O7

High temperature reactions using a CO2-LASER led to a TiII containing phase of the composition (Ta0.67TiII 0.33Sm2O7, space group O7 h - Fd3̄m (No. 227), a = 10.385(2) Å . The oxidation state TiII which is stabilized by incorporation into the cubic pyrochlore structure was proved by the statistical occupation of the 16c point position by a Ta:Ti ratio of 2:1.

Primary or established liver cells for a hybrid liver? Comparison of metabolic features

It is currently in discussion whether or not established liver cell lines can be used for an extracorporeal liver assist device. Thus, metabolic features of primary hepatocytes, immortalized hepatocytes, and hepatoma cells were compared. The ability of these cells to process toxic blood of patients with hepatic failure was investigated by testing their viability in toxin enriched medium that was obtained by toxin separation from patients' blood via a molecular adsorbents recirculating system (MARS). In addition, glucose metabolism, urea synthesis, P450 dependent verapamil metabolism using high performance liquid chromatography, and interleukin-6 induced "acute phase" reaction by sulfodesoxysalicylic acid-polyacrylamide gel electrophoresis detected changes of albumin synthesis were determined in primary hepatocytes and in established liver cells. The viability of hepatoma cells after contact with the toxic compounds coming from the patients' blood was significantly decreased in comparison to that of immortalized hepatocytes and primary hepatocytes. Immortalized hepatocytes and hepatoma cells showed a significantly higher consumption of glucose associated with a significantly higher lactate synthesis. A basic urea synthesis rate could be measured in immortalized hepatocytes and hepatoma cells, but it was significantly lower than that of primary cells. P450 with its subenzyme CYP2C was inducible only in primary hepatocytes and in immortalized cells, but in the latter the enzymatic activity was lower than that of primary cells. The incubation with acute phase mediators resulted in a decrease of albumin synthesis in primary hepatocytes and in hepatoma cells, but it increased the albumin synthesis in immortalized hepatocytes. Summarizing these data, partially beneficial effects can be assumed if established cells are used in an extracorporeal liver assist device. These might include synthesis of some compounds and basic metabolic activities, such as urea synthesis. However, established liver cells showed clearly altered metabolic characteristics. The sufficient removal of toxic compounds requires additional strategies for detoxification by primary hepatocytes in sufficient amounts.

Multicenter evaluation of arbitrarily primed PCR for typing of Staphylococcus aureus strains

Fifty-nine isolates of Staphylococcus aureus and a single strain of Staphylococcus intermedius were typed by arbitrarily primed PCR (AP-PCR). To study reproducibility and discriminatory abilities, AP-PCR was carried out in seven laboratories with a standardized amplification protocol, template DNA isolated in a single institution, and a common set of three primers with different resolving powers. The 60 strains could be divided into 16 to 30 different genetic types, depending on the laboratory. This difference in resolution was due to differences in technical procedures (as shown by the deliberate introduction of experimental variables) and/or the interpretation of the DNA fingerprints. However, this did not hamper the epidemiologically correct clustering of related strains. The average number of different genotypes identified exceeded those of the more traditional typing strategies (F. C. Tenover, R. Arbeit, G. Archer, J. Biddle, S. Byrne, R. Goering, G. Hancock, G. A. Hebert, B. Hill, R. Hollis, W. R. Jarvis, B. Kreiswirth, W. Eisner, J. Maslow, L. K. McDougal, J. M. Miller, M. Mulligan, and M. A. Pfaller, J. Clin. Microbiol. 32:407-415, 1994). Comparison of AP-PCR with pulsed-field gel electrophoresis (PFGE) indicated the existence of strains with constant PFGE types but variable AP-PCR types. The reverse (constant AP-PCR and variable PFGE patterns) was also observed. This indicates additional resolution for combined analyses. It is concluded that AP-PCR is well suited for genetic analysis and monitoring of nosocomial spreading of staphylococci. The interlaboratory reproducibility of DNA-banding patterns and the intralaboratory standardization need improvement.