Tracing the geographic origins of weedy Ipomoea purpurea in the southeastern United States

Ipomoea purpurea (common morning glory) is an annual vine native to Mexico that is well known for its large, showy flowers. Humans have spread morning glories worldwide, owing to the horticultural appeal of morning glory flowers. Ipomoea purpurea is an opportunistic colonizer of disturbed habitats including roadside and agricultural settings, and it is now regarded as a noxious weed in the Southeastern US. Naturalized populations in the Southeastern United States are highly polymorphic for a number of flower color morphs, unlike native Mexican populations that are typically monomorphic for the purple color morph. Although I. purpurea was introduced into the United States from Mexico, little is known about the specific geographic origins of US populations relative to the Mexican source. We use resequencing data from 11 loci and 30 I. purpurea accessions collected from the native range of the species in Central and Southern Mexico and 8 accessions from the Southeastern United States to infer likely geographic origins in Mexico. Based on genetic assignment analysis, haplotype composition, and the degree of shared polymorphism, I. purpurea samples from the Southeastern United States are genetically most similar to samples from the Valley of Mexico and Veracruz State. This supports earlier speculation that I. purpurea in the Southeastern United States was likely to have been introduced by European colonists from sources in Central Mexico.

Two randomized, double-blind, placebo-controlled studies of fluticasone propionate lotion 0.05% for the treatment of atopic dermatitis in subjects from 3 months of age

A novel lotion formulation of fluticasone propionate 0.05% has recently become available. Two large, randomized, placebo-controlled, double-blind studies involving 438 subjects demonstrated its efficacy and safety when applied once daily in the treatment of atopic dermatitis in subjects from 3 months to 87 years of age. The studies were limited to 4 weeks duration of use of fluticasone lotion and did not assess longer term efficacy or side effects.

Efficacy and tolerance of adapalene cream 0.1% compared with its cream vehicle for the treatment of acne vulgaris

Adapalene gel 0.1% is approved for use in the treatment of acne vulgaris. A new cream formulation, adapalene cream 0.1%, has been developed. Our objective was to evaluate the efficacy and tolerability of adapalene cream 0.1% in comparison with its cream vehicle, applied once daily for 12 weeks to patients with facial acne vulgaris. We used a 12-week, multicenter, randomized, double-blind, vehicle-controlled, comparative phase 3 study of adapalene cream 0.1% and cream vehicle. The study enrolled 237 patients (125 males and 112 females), aged 12 through 30 years, with mild-to-moderate acne vulgaris. Adapalene cream 0.1% demonstrated superior efficacy compared with its cream vehicle. Significantly lower numbers of total inflammatory and noninflammatory lesion counts were observed at the end of the study period in patients using adapalene cream 0.1% as opposed to those using cream vehicle (P<.05 compared with baseline, for all 3 parameters). Adapalene cream 0.1% caused more cutaneous side effects than the cream vehicle, but these were tolerated in most patients. In summary, the results of this study indicate that adapalene cream 0.1% demonstrates superior efficacy over cream vehicle for the treatment of acne vulgaris. Adapalene cream 0.1% also has excellent tolerability and is associated with a low incidence of cutaneous adverse events.

Alterations in hypothalamic insulin-like growth factor-I and its associations with gonadotropin releasing hormone neurones during reproductive development and ageing

Insulin-like growth factor-I (IGF-I) is thought to play a role in the onset of reproductive ability at puberty and the control of reproductive function throughout adult life. It is believed that these effects are mediated at least in part by the activation of gonadotropin releasing hormone (GnRH) neurones by IGF-I, but the interactions of IGF-I with GnRH neurones in vivo are largely unknown. We first examined the anatomical relationship between GnRH and IGF-I cells in neuroendocrine regions. Using double-label immunocytochemistry, we observed that in the preoptic area-anterior hypothalamus (POA-AH), the site of GnRH perikarya, the majority (78%) of GnRH cell bodies expressed IGF-I immunoreactivity. IGF-I immunoreactivity was also high in the median eminence, the site of GnRH release, and GnRH neuroterminals were seen to interweave among IGF-I-immunopositive cells. Due to this substantial overlap of GnRH and IGF-I immunoreactive elements, we then tested the hypothesis that changes in IGF-I may regulate the GnRH system. Animals were examined at the two important reproductive life transitions: puberty and reproductive senescence. IGF-I mRNA levels were measured in POA-AH and medial basal hypothalamus-median eminence (MBH-ME) and effects of IGF-I treatment on GnRH mRNA levels were quantified by RNase protection assay. Although IGF-I treatment did not alter GnRH gene expression, there were significant alterations in hypothalamic IGF-I gene expression at both puberty and reproductive senescence. During puberty, IGF-I mRNA levels in the MBH-ME of rats increased from the juvenile stage (P25) to the day of vaginal opening (P35), and from the day of vaginal opening to young adulthood (P45) in the POA-AH. During reproductive ageing, IGF-I mRNA levels were significantly lower in middle-aged than young rats, particularly in the MBH-ME. At all ages, IGF-I expression was greater in the MBH-ME than in the POA-AH. These experiments demonstrate that: (i) the majority of adult GnRH neurones are immunopositive for the IGF-I protein; (ii) hypothalamic IGF-I levels increase at the onset of reproductive function and decrease at reproductive senescence in a regionally specific manner; and (iii) despite the presence of IGF-I in GnRH perikarya, IGF-I does not affect GnRH gene expression, suggesting that IGF-I may act at the level of GnRH release rather than gene expression.

Implant abutment screw rotations and preloads for four different screw materials and surfaces

STATEMENT OF PROBLEM

Chronic implant screw loosening remains a problem in restorative practices. Some implant manufacturers have introduced abutment screws with treated surfaces in an effort to increase preload and reduce potential loosening. Purpose. This study evaluated the materials and surfaces of 4 commercially available abutment screws on preload generation.

MATERIAL AND METHODS

Twenty of each of the following abutment screws-Gold-Tite (Gt), TorqTite (Tt), gold alloy (Ga), and titanium alloy (Ta)-were divided into 2 groups. Measurements were recorded for each abutment screw on a mounted 3.75 x 18 mm external hex implant with a titanium abutment. Rotational angle measurements were conducted on the 4 abutment screws at 20 and 32 Ncm. Removal torque values were recorded and used to indirectly generate preload values. Random implant block specimens were sectioned and qualitatively evaluated with an SEM.

RESULTS

At 20 and 32 Ncm, the largest rotational angles were recorded for the Tt groups: 21.2 +/- 3.1 degrees and 38.1 +/- 8.7 degrees, respectively. The greatest preload values at 20 and 32 Ncm were calculated for the Gt groups: 596.8 +/- 101.2 N and 1015.3 +/- 191.2 N, respectively. SEM analysis of the 4 implant block specimens revealed mating thread contacts located in the middle portion of the superior surface of the abutment screw thread. The greatest number of mating thread contacts were seen in the Gt implant block specimen (14 of 20 possible thread contacts).

CONCLUSION

The Gt and Tt abutment screws with enhanced surfaces that help reduce the coefficient of friction produced greater rotational angles and preload values than the conventional gold alloy and titanium alloy screws.

A comparison of shear bond strengths of three visible light-cured orthodontic adhesives

The purpose of this study was to evaluate the shear bond strength and the site of bond failure for 2 visible light-cured composites (Transbond XT and Enlight) and a resin-modified glass ionomer cement (RMGIC; Fuji Ortho LC). Seventy-five extracted human premolars were collected and randomly divided into 3 test groups. Brackets were bonded to the teeth in each test group with the respective adhesive according to the manufacturers' instructions. Each specimen was debonded using an Instron Universal Testing Machine at a crosshead speed of 0.1 mm/min. The mode of bond failure was observed by using light microscopy. The results of this study demonstrated that the light-cured composites had a higher shear bond strength than the RMGIC. The adhesive-remnant scores were similar for the composites with the mean values at about 2, which indicates that more than half of the adhesive remained on the tooth. The RMGIC had a mean score of 3, which was significantly different from the composites and indicated that all of the adhesive remained on the tooth with a distinct impression of the bracket.

In vitro tensile bond strength of adhesive cements to new post materials

PURPOSE

The purpose of this study was to measure the in vitro tensile bond strength of 3 types of adhesive resin cements to stainless steel, titanium, carbon fiber-reinforced resin, and zirconium oxide post materials.

MATERIALS AND METHODS

Disks of post materials were polished to 600 grit, air abraded, and ultrasonically cleaned. Zirconium oxide bonding surfaces were pretreated with hydrofluoric acid and silanated. Bis-Core, C&B Metabond, and Panavia cements were bonded to the post specimens and placed in a humidor for 24 hours. Post specimens were debonded in tension. Means and standard deviations (n = 5) were analyzed by 2-way analysis of variance. Tukey-Kramer intervals at the 0.05 significance level were calculated. Failure modes were observed.

RESULTS

Panavia 21 provided the highest bond strengths for all types of post materials, ranging from 22 MPa (zirconium oxide) to 37 MPa (titanium). C&B Metabond bonded significantly more strongly to stainless steel (27 MPa) and titanium (22 MPa) than to zirconium oxide (7 MPa). Bis-Core results were the lowest, ranging from 16 MPa (stainless steel) to 8 MPa (zirconium oxide). In most cases, bonds to carbon fiber post materials were weaker than to stainless steel and titanium, but stronger than to zirconium oxide. In general, higher bond strengths resulted in a higher percentage of cohesive failures within the cement.

CONCLUSION

Panavia 21 provided the highest bond strengths to all post materials, followed by C&B Metabond. In most cases, adhesive resins had higher bond strengths to stainless steel, titanium, and carbon fiber than to zirconium oxide.

Evaluation of Mycobacterium tuberculosis genes involved in resistance to killing by human macrophages

A coinfection assay was developed to examine Mycobacterium tuberculosis genes suspected to be involved in resistance to killing by human macrophages. THP-1 macrophages were infected with a mixture of equal numbers of recombinant Mycobacterium smegmatis LR222 bacteria expressing an M. tuberculosis gene and wild-type M. smegmatis LR222 bacteria expressing the xylE gene. At various times after infection, the infected macrophages were lysed and the bacteria were plated. The resulting colonies were sprayed with catechol to determine the number of recombinant colonies and the number of xylE-expressing colonies. M. smegmatis bacteria expressing the M. tuberculosis glutamine synthetase A (glnA) gene or open reading frame Rv2962c or Rv2958c demonstrated significantly increased survival rates in THP-1 macrophages relative to those of xylE-expressing bacteria. M. smegmatis bacteria expressing M. tuberculosis genes for phospholipase C (plcA and plcB) or for high temperature requirement A (htrA) did not.

Finding meaning through caregiving: development of an instrument for family caregivers of persons with Alzheimer's disease

Systematic assessment of the positive aspects of caregiving has been limited by the lack of comprehensive, theoretically based, and psychometrically sound measures. This study developed and tested a measure primarily designed to assess positive aspects and ways that caregivers find meaning through their experience of caring for a person with dementia. The measure has three subscales: Loss/Powerlessness, which identifies difficult aspects of caregiving; Provisional Meaning, which identifies how caregivers find day-to-day meaning; and Ultimate Meaning, which identifies philosophical/religious/spiritual attributions associated with the experience of caregiving. The measure is useful for understanding the close relationship between both the difficult and positive aspects of caregiving and also may be used to identify a caregiver's strengths in clinical and research settings.

Tazarotene gel is safe and effective in the treatment of acne vulgaris: a multicenter, double-blind, vehicle-controlled study

Retinoids reverse the abnormal pattern of keratinization seen in acne vulgaris. Tazarotene is the first of a novel family of topical receptor-selective acetylenic retinoids. This study evaluates the safety and efficacy of topical tazarotene 0.1% and 0.05% gels, in comparison to vehicle gel, applied once daily for 12 weeks, in the treatment of mild-to-moderate facial acne vulgaris. A total of 446 patients with facial acne vulgaris were enrolled, and 375 patients, ranging in age from 14 to 44 years, were evaluable in this multicenter, double-blind, randomized study. In comparison to vehicle gel, treatment with tazarotene 0.1% gel resulted in significantly greater reductions in noninflammatory and total lesion counts at all follow-up visits, and inflammatory lesion counts at Week 12. Tazarotene 0.05% gel resulted in significantly greater reductions in noninflammatory and total lesion counts than vehicle gel at Weeks 8 and 12. At Week 12, treatment success rates were 68% and 51% for tazarotene 0.1% and 0.05%, respectively (40% for vehicle gel). Tazarotene gel was an effective, safe, and generally well-tolerated therapy for the treatment of acne vulgaris.

Marginal discrepancy of screw-retained and cemented metal-ceramic crowns on implants abutments

This in vitro study quantified the marginal discrepancy of the implant-to-prosthetic-crown interface on nonsubmerged dental implants restored with either a cemented or a screw-retained approach. Metal-ceramic crowns were fabricated for 20 ITI 4.1 x 10 mm solid-screw titanium implants. Ten implants received octa abutments and screw-retained crowns fabricated on premachined gold cylinders. The remaining 10 implants were restored with 5.5-mm solid abutments and metal-ceramic crowns cemented alternately with a glass-ionomer or a zinc phosphate luting agent. Inspection of the implant-crown interface was conducted using light microscopy under x 50 magnification at selected stages in the process of crown fabrication. Statistical analysis revealed a significant difference (P < .001) in the mean marginal fit between screw-retained (8.5 +/- 5.7 microns) and luted implant-supported crowns. This difference was observed both before (54.4 +/- 18.1 microns) and after cementation with glass-ionomer (57.4 +/- 20.2 microns) or zinc phosphate (67.4 +/- 15.9 microns).

Strength and microstructure of gallium alloys

This study investigated the physical and mechanical properties and the microstructure of four different gallium alloys. For all gallium alloys, the compressive strengths measured at one hour (86-223 MPa) and 24 hours (265-286 MPa) after specimen preparation were found to be well within the range exhibited by many high-copper amalgams. The creep values and dimensional change of the gallium alloys were comparable to those of leading amalgams, except for the dimensional change value of one alloy. The set gallium alloys consisted of a multi-phase structure including beta-Sn, CuGa2, In4Ag9, Ag72Ga28, and Ga5Pd (except for one product that did not contain Pd) that was more complicated than the structure of dental amalgams. Although the gallium alloys had physical and mechanical properties comparable to those of high-copper amalgams, the microstructure, coupled with the instability of the element gallium itself, could make these materials more prone to corrosive attack compared to amalgams.

In vitro investigation of the wear of human enamel by dental porcelain

STATEMENT OF PROBLEM

Metal ceramic systems are advocated when both esthetics and strength are required. A major drawback to many porcelains is their wear and destruction of opposing natural dentition.

PURPOSE

This study evaluated the wear of enamel opposing 1 traditional and 2 recently introduced low-fusing feldspathic dental porcelains.

MATERIAL AND METHODS

Six blocks of Ceramco II, Finesse, and Omega 900 feldspathic porcelain materials were fabricated and fired according to manufacturer recommendations. Porcelain blocks were polished through 0.25 microm diamond polishing paste. Thirty-six enamel specimens were obtained and milled to a 2 mm (+0.5 mm) diameter. Enamel specimens were attached to an offset cam motor operating at 60 Hz. Enamel specimens were in constant contact with the stationary porcelain blocks under a load of 600 g and traversed a distance of 8 mm. Diameter and height of enamel specimens were measured at times of 0, 6, 12, 24, and 48 hours and subsequent determination of enamel volume loss recorded. Profilometric surface roughness of the ceramic blocks was also measured for the corresponding times.

RESULTS

Statistical analysis revealed that both Finesse and Omega 900 feldspathic porcelains caused significantly less enamel volume loss when compared with Ceramco II porcelain at all time intervals. Surface roughness revealed no consistent significant differences among porcelains.

CONCLUSION

Both Finesse and Omega 900 porcelains were not as destructive to human tooth structure as Ceramco II porcelain. These results suggest an advantage of the new, lower-fusing porcelains in conditions where natural dentition wear is a concern.

Marginal gap of crowns made with a phosphate-bonded investment and accelerated casting method

STATEMENT OF PROBLEM

Numerous materials and methods have been used for complete crown fabrication. Conventional investing and casting procedures for phosphate-bonded investments require a 2- to 4-hour process before completion. Accelerated laboratory techniques have been used, but may not result in castings with equal marginal accuracy.

PURPOSE

This study measured the marginal gap and determined the clinical acceptability of single castings invested in a phosphate-bonded investment with the use of conventional and accelerated methods.

MATERIAL AND METHODS

Forty-four individual stone casts were poured from impressions made from a master die. Conventional and accelerated methods of investing and casting were followed in the fabrication of 44 single-unit castings. Twenty-two casts were used in each of the 2 groups. Each casting and its respective stone die were examined with a microscope at 4 predetermined sites. Perpendicular and 25-degree tilted measurements of marginal gap were documented for each. Evidence of marginal gap was then evaluated by t test.

RESULTS

Measurements recorded on the perpendicular and on a 25-degree tilt showed no statistically significant difference between conventional and accelerated groups. All gap measurements except one were within the range of clinical acceptability. The measurements revealed that conventional and accelerated perpendicular gap means were 13.2 and 13.6 microm, respectively, and the average tilted gap means were 31.6 and 32.2 microm, respectively.

CONCLUSIONS

A phosphate-bonded investment (Ceramigold) selected for an accelerated casting technique produced single castings within 30 minutes with marginal gaps comparable to those found that used conventional methods.

Accuracy of CT for the detection of pleural adhesions: correlation with video-assisted thoracoscopic surgery

STUDY OBJECTIVE

The presence of pleural adhesions may render video-assisted thoracoscopic surgery (VATS) difficult or impossible. The aim of this study was to assess the value of chest CT in the detection of pleural adhesions prior to VATS.

DESIGN

Prospective study of the accuracy of chest CT in detecting pleural adhesions prior to VATS.

SETTING

Tertiary-referra; teaching hospital and Veterans Administration hospital.

PATIENTS

Between July 1994 and March 1995, 63 consecutive patients undergoing 64 VATS procedures were evaluated with chest CT prior to surgery.

MEASUREMENTS AND RESULTS

Preoperative scans were interpreted by consensus of two pulmonary radiologists prior to surgery. Suspected pleural adhesions and other findings related to the pleura were recorded on a form given to the surgeon prior to VATS. The surgeon confirmed or excluded each suspected adhesion during VATS, and documented any other lesions not identified preoperatively. Patient-by-patient and lesion-by-lesion analyses were performed. Pleural adhesions were correctly identified by CT in 28 of 39 cases (sensitivity, 71%) and excluded in 18 of 25 cases (specificity, 72%). On a lesion-by-lesion basis, 73 adhesions were identified during VATS, of which only 28 were identified prospectively at CT. There were 45 missed adhesions and 20 adhesions that were suggested falsely (sensitivity, 38%; specificity, 46%). Eighteen pleural spaces were correctly identified as being free of pleural adhesions.

CONCLUSIONS

CT is moderately sensitive and specific for preoperative identification of pleural adhesions in patients undergoing VATS but its accuracy is poorer for individual lesions.

Bond strength between cements and metals used for endodontic posts

OBJECTIVES

Adhesive cements used with metal endodontic posts may decrease fracture in non-vital teeth. Results from studies that evaluate cements for post retention by pulling posts out of extracted teeth are difficult to interpret owing to the number of interfaces where fracture might occur. The objective of this study was to isolate the metal/cement interface for tensile bond strength testing and microscopic observation.

METHODS

Three metals and seven cement treatments were examined for bond strength by using a truncated cone tensile test. The bond strength data were analyzed by a two-way ANOVA and Scheffé's multiple comparison test at p = 0.05. Specimens were examined at 50x magnification to determine the failure mode and with scanning electron microscopy (500x) to observe the surfaces after debonding.

RESULTS

Significant differences in tensile bond strengths were found among cements compared within two of the metal groups. One of the metal groups had no significant differences among cement bonds. When comparing within cement treatment groups, two groups had significant differences in bond strength among the metals. Microscopic observations revealed adhesive, cohesive and mixed failure modes that varied with cement treatment and metal combination. The interaction between metal and cement was a critical determinant of the strength and characteristic fracture mode of the bond achieved.

SIGNIFICANCE

Some of the cement treatments performed better (i.e., higher bond strength) with some metals than with others. Other cements had similar bond strengths with all three metals. Because of this interaction, careful consideration of the materials combination should help to maximize the bond at the metal/cement interface.

Intratumoral chemotherapy with fluorouracil/epinephrine injectable gel: a nonsurgical treatment of cutaneous squamous cell carcinoma

BACKGROUND

We attempted to originate a nonsurgical treatment alternative for cutaneous squamous cell carcinoma (SCC), and we evaluated intratumoral modified-release chemotherapy with fluorouracil/epinephrine injectable gel (5-FU/epi gel).

OBJECTIVE

To assess the safety and efficacy, we conducted an open-label pilot study of 5-FU/epi gel in 25 patients with biopsy-proven SCC lesions on the face, head, neck, trunk, arms, and hands.

METHODS

Each tumor site was injected intradermally with up to 1.0 ml of 5-FU/epi gel. One SCC per patient was treated weekly for up to 6 weeks, then observed for 4 months at which time the tumor site and margins were excised for histologic examination.

RESULTS

Overall, 96% (22 of 23) of evaluable treated tumors had histologically confirmed complete tumor clearing. No clinically significant systemic reactions or unexplained treatment-related adverse medical events occurred. The evaluations of the cosmetic appearance of the treated sites, judged subjectively by clinicians and patients, were mostly good to excellent and generally in close agreement.

CONCLUSION

Treatment of superficial SCC with 5-FU/epi injectable gel results in a high rate of histologically confirmed complete tumor responses and may provide a nonsurgical treatment alternative in selected patients.

Development of intralesional therapy with fluorouracil/adrenaline injectable gel for management of condylomata acuminata: two phase II clinical studies

OBJECTIVES

To evaluate a sustained release chemotherapy for treating condylomata acuminata with an injectable gel containing fluorouracil and adrenaline (5-FU/adrenaline gel). Study 1-- To assess contributions of the components of 5-FU/adrenaline gel to efficacy. Study 2--To assess therapeutic contribution of adrenaline and safety and efficacy of the formulations.

DESIGN

Randomised, double blind, placebo controlled studies.

SETTING

Private practices and university clinics in the United States.

PATIENTS

Men and women with new, recurrent, or refractory external condylomata acuminata.

INTERVENTION

Six injections over 8 weeks; follow up visits at weeks 1, 4, 8, and 12.

MAIN OUTCOME MEASURES

EFFICACY

patient/wart response, times to complete response, recurrence rates.

SAFETY

injection reactions, tissue conditions, other adverse events, laboratory studies.

RESULTS

Study 1: 132 evaluable patients. Complete response (CR) rate was highest for the 5-FU/adrenaline gel group, followed by the 5-FU/adrenaline solution group, then the 5-FU gel group. 5-FU, adrenaline, and the collagen gel vehicle (in the presence of 5-FU) significantly affected CR and strongly influenced time to CR. The effects of 5-FU and adrenaline were statistically significant. Cutaneous reactions were mild to moderate. Study 2: 187 evaluable patients. Patients treated with 5-FU/adrenaline gel had a significantly higher CR rate and lower cumulative 90 day recurrence rate than those treated with 5-FU gel without adrenaline. Treatments were generally well tolerated, with only three treatment related, serious adverse events.

CONCLUSION

5-FU/adrenaline gel is safe and efficacious for treatment of condylomata acuminata, and when compared with individual or various combinations of components, this formulation provided the greatest therapeutic advantage.

Race, finding meaning, and caregiver distress

This study investigated the relationship between race, finding meaning (as a positive psychological resource variable), and the outcomes of caregiver depression and global role strain among 77 African American and 138 White spouse caregivers of persons with dementia. Finding provisional meaning had a direct negative relationship with depression and global role strain. Although African American caregivers were less likely to report depression and role strain, there was no interaction by race in the process influencing caregiver distress.

The effect of cementing procedures on retention of prefabricated metal posts

Twelve prefabricated posts were cemented in extracted teeth with zinc phosphate cement, 14 with resin cement after the canals were acid etched and 14 with zinc phosphate cement after acid etching. After thermocycling, specimens were subjected to a straight-line tensile force. The posts cemented with resin cement had significantly higher tensile strength than those cemented with the two zinc phosphate cement treatments.

Handling characteristics of a gallium alloy triturated with alcohol

PURPOSE

To assess the handling characteristics of a gallium alloy triturated with one drop (10 microL) of ethyl alcohol and compare them to those of a high-copper amalgam.

MATERIALS AND METHODS

A commercial gallium alloy (Gallium Alloy GFII) and a high-copper amalgam (Tytin) were used. Ten dentists each restored four identical MO preparations in acrylic typodont teeth (two for each material). Each restoration was immediately evaluated by the operator for placement, condensation, proximal contact, carving, and resistance to fracture during matrix removal and overall quality according to a method used previously. The rating scale for each criterion ranged from 1 (very poor) to 5 (very good). Scores for each criterion for the amalgam and gallium alloy restorations were statistically compared.

RESULTS

The gallium alloy tested was still rated significantly worse (P < or = 0.05) than amalgam for placement, condensation and carving but there were no significant differences in scores for other criteria. The dentists judged the handling of the gallium alloy in all criteria as fair to good and evaluated it as better in placement, condensation and establishment of proximal contact compared to a previous study, mainly because the pre-set material was no longer sticky.

Manipulation effects on fluoride release from chemically-cured and resin-modified glass ionomers

PURPOSE

To examine the effect of mixing techniques (hand-mixing vs. trituration) on fluoride release from chemically-cured (Fuji II) and resin-modified (Fuji II LC) glass ionomer products.

MATERIALS AND METHODS

Fluoride measurements were determined and comparisons made between hand-mixed-type materials that were both hand-mixed (60 seconds) and triturated (10 seconds). Hand-mixed specimens were made using the manufacturer's recommended powder/liquid ratio. Triturated specimens of the same material were made using the same powder/liquid ratio. Disk specimens (8.5 mm diameter, 2 mm thickness; n = 6) were stored in deionized water for 23 hours to obtain Day 1 solutions. Solutions were also obtained at 2, 3, 4, 5, 6, 7, 14, 21, and 28 days after fabrication and were changed 24 hours before fluoride concentration was determined using a fluoride ion selective electrode. Daily rates of fluoride release and 28-day cumulative fluoride totals were calculated. Cumulative data were analyzed by two-way ANOVA and Scheffé's test (alpha = 0.05). Daily results were analyzed by the Mann-Whitney U-test.

RESULTS

A significant difference was observed between materials (P < 0.001). Depending on the kind of material used, the method of manipulation affected the fluoride release. Data analysis revealed that: (1) Fuji II LC released significantly more fluoride than Fuji II for both triturated (P = 0.005) and hand-mixed (P < 0.005); (2) the triturated Fuji II released significantly more fluoride than the hand-mixed (P = 0.02); and (3) the hand-mixed Fuji II LC released more fluoride than the triturated, but was not statistically significant (P = 0.16).

Computed tomography of malpositioned thoracostomy drains: a pictorial essay

Chest drain placement is essential to the management of patients with abnormal thoracic collections of air or fluid. Frequently, in these critically ill patients, drain position can only be assessed by portable frontal radiographs. However, evaluation by axial chest CT in some cases reveals unexpected malplacement that may prompt repositioning to reduce morbidity and improve drain function.

Nonsurgical treatment of basal cell carcinomas with intralesional 5-fluorouracil/epinephrine injectable gel

BACKGROUND

To develop a nonsurgical treatment alternative for basal cell carcinomas (BCCs), we evaluated intralesional sustained-release chemotherapy with 5-fluorouracil/epinephrine injectable gel (5-FU/epi gel).

OBJECTIVE

To optimize the dose and treatment schedule, we compared the safety, tolerance, and efficacy of six treatment regimens of 5-FU/epi gel in patients with BCCs.

METHODS

Two doses and four treatment schedules of 5-FU/epi gel were compared in an open-label, randomized study of 122 patients with biopsy-proven BCCs. One BCC per patient was treated for up to 4 to 6 weeks, then observed for 3 months at which time the tumor site was completely excised for histologic examination.

RESULTS

Overall, 91% of evaluable treated tumors (106 of 116) in all regimens had histologically confirmed complete tumor resolution. No clinically significant treatment-related systemic adverse events occurred. The best response rate, tolerance, and patient compliance with assigned dose were in patients receiving 0.5 ml of 5-FU/epi gel three times a week for 2 weeks. The complete response rate based on histologic assessment in this group was 100%.

CONCLUSION

Results demonstrate that treatment of BCC with 5-FU/epi gel is both safe and effective, may result in histologically confirmed complete response rates comparable to surgery, and provides a nonsurgical treatment alternative in selected patients.

Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center

PURPOSE

To review the literature and the authors' experience with admission contrast material-enhanced computed tomography (CT) in patients admitted after blunt trauma.

MATERIALS AND METHODS

From January 1990 to December 1994, thoracic CT was performed to evaluate traumatic aortic injury in 677 patients with positive or equivocal findings at chest radiography. CT scans positive for mediastinal hemorrhage or aortic injury were retrospectively reviewed and interpreted by consensus, with angiographic and surgical confirmation.

RESULTS

CT findings were negative for TAI in 570 (84%) of the 677 patients. Mediastinal hemorrhage was reported in 100 patients and was the only abnormality in 79 of them. Findings at angiography were negative for traumatic aortic injury in 77 (97%). CT signs of traumatic aortic injury in 21 patients included contour abnormality or pseudoaneurysm (n = 19), intimal flap(s) (n = 8), and pseudocoarctation (n = 3). Findings at angiography were positive for traumatic aortic injury in 19 (90%). For aortic injury and mediastinal hemorrhage, respectively, specificity for traumatic aortic injury was 99% and 87% and sensitivity was 90% and 100%; at meta-analysis of data from the authors and the literature, sensitivity was 97.0% and 99.3% and specificity was 99.8% and 87.1%. Reliance on findings at admission CT rather than radiography to indicate suspicion for traumatic aortic injury before angiography resulted in savings of more than $365,000.

CONCLUSION

The CT finding of mediastinal hemorrhage alone is sensitive for traumatic aortic injury, but the finding of aortic injury is more specific.

From the archives of the AFIP. Malignant pleural mesothelioma: radiologic-pathologic correlation

Malignant pleural mesothelioma (MPM) is a rare malignant neoplasm that typically affects individuals occupationally exposed to asbestos through a variety of industries. The patients experience an insidious onset of symptoms, including dyspnea, chest pain, cough, malaise, and weight loss. The pathologic diagnosis of MPM is difficult, and special stains or immunohistochemical or ultrastructural analysis may be required to differentiate MPM from metastatic adenocarcinoma. The tumor affects both the parietal and visceral pleural surfaces and progresses to encase the lung and invade the lung, mediastinum, and chest wall. Radiologically, MPM manifests as unilateral pleural effusion, pleural nodules, or pleural masses. Imaging studies are useful for diagnosis and staging in patients who are potential surgical candidates. Although a variety of multimodality therapies are available and radical surgical procedures have been developed, the prognosis remains dismal.

Primary carcinoma of the lung overlooked at CT: analysis of findings in 14 patients

PURPOSE

To describe the appearances of overlooked lung cancer at computed tomographic (CT) examination and to analyze the reasons for failure to diagnose these lesions.

MATERIALS AND METHODS

Fourteen patients with 15 overlooked lung cancers were identified by radiologists at three institutions. Location, shape, and cell type of each cancer were reviewed, and other relevant findings of CT examinations were assessed.

RESULTS

The missed tumors manifested as endobronchial lesion (n = 10), solitary parenchymal nodule (n = 2), area of focal peripheral air-space disease (n = 2), or pleural-based thickening (n = 1). Eleven (73%) of the 15 lesions were located in a lower lobe. In six (43%) of 14 patients, major distracting findings were present elsewhere in the thorax.

CONCLUSION

Endobronchial location and lower lobe predominance were the most common characteristics of overlooked lung cancer at CT. The presence of unrelated major abnormalities at CT may also have contributed to failure to diagnose the tumor.

Effect of glass ionomer manipulation on early fluoride release

PURPOSE

To determine the amount of fluoride released from several glass ionomer products [Fuji Cap II, Fuji Ionomer Type II, Ketac-Silver, Chelon-Silver, and Miracle Mix (hand-mixed and encapsulated)], and to compare them between triturated (5, 10, 15 seconds) encapsulated and hand-mixed glass ionomers.

MATERIALS AND METHODS

The amount of fluoride released at 1, 2, 3, 7, 14, 21 and 28 days after the start of immersion in deionized-distilled water at 37 degrees C was determined with a fluoride ion selective electrode. Rates of fluoride release and cumulative amounts of fluoride release were calculated.

RESULTS

Each glass ionomer released the greatest amount of fluoride during the first 24-hour period. Although there was some variation between products, generally the hand-mixed specimens released significantly (P < 0.05) less fluoride than those prepared by mechanical trituration (10 and 15 seconds). The cumulative amounts of fluoride released from the mechanically triturated glass ionomers were significantly (P < 0.05) greater than the amounts released from the hand-mixed glass ionomers. No significant differences in the cumulative amounts of fluoride released from triturated materials were found among the different trituration times.

Thoracic sarcoidosis: radiologic-pathologic correlation

Sarcoidosis is a systemic disease of unknown etiology with variable presentation, prognosis, and progression. At diagnosis, about 50% of patients are asymptomatic, 25% complain of cough or dyspnea, and 25% have skin lesions (erythema nodosum, lupus pernio, or plaques or scars) or eye symptoms (or develop them during the course of the disease). Bilateral hilar adenopathy is the most common radiographic finding. Other characteristic findings include interstitial lung disease, occasional calcification of affected lymph nodes, and pleural effusions and thickening. Computed tomography is more sensitive than radiography in the detection of adenopathy and subtle parenchymal disease; gallium-67 scintigraphy is useful in identifying extrathoracic sites of involvement, detecting active disease, and assessing response to treatment. The diagnosis is established most securely when clinicoradiologic findings are supported by histologic evidence of widespread noncaseating granulomas. The disease ranges from a self-limited subclinical process to chronic debilitation and death, with the major complications being fibrosis, mycetoma formation, and cor pulmonale. Because the disease so often involves thoracic structures, chest radiography plays a crucial role in the diagnosis, staging, and follow-up of sarcoidosis.

Handling characteristics of gallium alloy for dental restoration

The handling characteristics of a gallium alloy (Gallium Alloy GF) were compared to those of a spherical high-copper amalgam (Tytin). Ten dentists each restored four identical MO preparations in acrylic typodont teeth (no. 30), two with amalgam and two with gallium alloy. Each restoration was evaluated immediately following completion by the operator for six clinically relevant criteria. Each criterion was scored between 1 and 5, where 1 = very poor, 2 = poor, 3 = fair, 4 = good, and 5 = very good. Three two-sided Mann-Whitney tests were used to compare the median scores for significant differences (P < 0.05). The first test indicated no significant difference between scores for the first- and second-placed restorations, within criteria and within alloy type (n = 10). The second test indicated a significant difference between amalgam and gallium alloy, within criteria and within restoration sequence (n = 10), for each criterion except resistance to fracture during removal of the matrix band. The third test indicated a significant difference between amalgam and gallium alloy, within each criteria, combining scores for first- and second-placed restorations (n = 20). During simulated clinical placement, amalgam was rated significantly higher than gallium alloy in each handling characteristic evaluated.

Determining amalgam marginal quality: effect of occlusal surface condition

Currently there is no "standard" finishing and polishing procedure for dental amalgam restorations. This investigation evaluated the effect of four different finishing techniques on the durability of dental amalgam restorations as determined by the marginal breakdown. Burnishing immediately before carving or as part of the condensation process seems to improve the carving characteristics of the amalgam.

The effect of intralesional 5-fluorouracil therapeutic implant (MPI 5003) for treatment of basal cell carcinoma

BACKGROUND

Basal cell carcinomas (BCCs) are usually treated with ablative procedures. A nonsurgical treatment alternative would be of value in selected patients.

OBJECTIVE

We evaluated the safety and efficacy of a new preparation for intralesional sustained-release chemotherapy with MPI 5003, 5-Fluorouracil Therapeutic Implant, for treatment of BCCs.

METHODS

Two doses of intralesional MPI 5003 (0.25 and 0.5 ml) were compared in a double-blind study of 20 patients with biopsy-proven BCC. One BCC per patient was treated weekly for up to 6 weeks and followed up monthly for 3 months until excisional biopsy for histologic examination. Before excision the cosmetic appearance of the test site was graded.

RESULTS

Eighty percent of 10 BCCs treated with 0.5 ml of MPI 5003 had histologically confirmed cures as compared with 60% of 10 tumors treated with the lower dose (0.25 ml). Cosmetic assessments before excision were typically good to excellent. No systemic side effects occurred.

CONCLUSION

Results indicate the potential of MPI 5003 for targeted local chemotherapy for BCC.

Bond strengths of various materials to dentin using Amalgambond

This study evaluated the bond strength of four restorative materials to dentin using Amalgambond. Two high-copper amalgams [Tytin; spherical, (T) and Epoque 80; lathe-cute, (E)], a gallium alloy [Gallium Alloy GF (G) and a resin composite [P-50 (P)] were tested. The polished dentin surface was treated with dentin-enamel activator (10 seconds), washed, dried, and adhesive agent was applied (30 seconds). In group A, the dentin adhesive was placed onto the dentin and while still wet, T, E, or G was condensed in cylinders (4 mm diameter) with condensation forces suggested by the manufacturer for a clinical situation. In group B, the cylindrical specimens of restorative material were allowed to set and then adhered to the treated dentin using the adhesive system. For the composite (control), the adhesive was applied to the treated dentin and while still wet, P was layered into the cylinder and cured for a total of 90 seconds. After storage in water (37 degrees C) for 24 hours, all the specimens were tested for tensile bond strength. This study revealed that the bond strength of P was significantly higher than the other materials tested and also that amalgam allowed to set for 1, 6 or 24 hours before adhesion to dentin had a significantly greater bond strength than freshly condensed amalgam. Although the desired high bond strength did not develop in the bonding of the metallic restorative materials, signs of bonding were found.

Caregiver burden and nursing home admission of frail elderly persons

The National Long-Term Care Survey, 1982-1984, and the Informal Caregivers Survey were used to test the importance of caregiver burden for risk of admission to a nursing home. This study was based on a subsample of 940 older persons with sole spouse or adult child caregivers in 1982. Using logistic regression, nursing home entrants (127) were compared to 624 continuous community residents. Characteristics of the older person included age, race (White), and number of instrumental activities of daily living limitations. Predictors related to the caregiving context included caregiver burden and use of formal services.

Clinical features and history of the destructive lung disease associated with alpha-1-antitrypsin deficiency of adults with pulmonary symptoms

Alpha-1-antitrypsin (alpha 1AT) deficiency is a hereditary disorder characterized in adults by a high risk for the development of severe destructive lung disease at an early age. The present study was designed to draw conclusions concerning the characteristics of a referral population of 124 patients with alpha 1AT deficiency and symptomatic emphysema. Typically, the alpha 1AT level was 30 mg/dl, and the alpha 1AT phenotype was almost always PiZZ. The individuals in this population were most often male, caucasian, and ex-smokers, and they had become dyspneic between 25 and 40 yr of age. Most routine blood tests were normal. The chest radiographs and ventilation-perfusion studies typically showed abnormalities with a lower zone distribution, and about one third of the study population had evidence suggestive of pulmonary hypertension. Lung function tests were typical for emphysema; the FEV1 and DLCO were the parameters most dramatically reduced, and the annual rate of decline of those parameters was greater than that of the general population. The cumulative probability of survival of this population indicated a significantly shortened lifespan with a mean survival of 16% at 60 yr of age compared with 85% for normal persons.

Factors affecting the retention and fit of gold castings

A study was designed to simulate clinical conditions. Several factors were evaluated for effect on retention and fit (margin adaptation) of gold castings. Twenty-six castings (13 pairs) were made by different investigators using a standard preparation but with varying fabrication techniques. One of each pair of castings was made on a spaced die and one on an unspaced die. A significant difference in the postcementation retention was observed in the varying techniques of each investigator. Retentive values varied from 29 to 129 lbs. Complete seating of the castings during cementation was improved by the use of die spacer. Castings made on the spaced dies had more retention than corresponding unspaced castings. Die spacing has positive benefit when properly used. Moderate roughness of axial surfaces improves retention when zinc phosphate cement is used. Physical properties of restorative materials are important, but the individual technique and care of each investigator has a major effect on the ultimate fit and retention of the cast restoration.

The chest radiograph and sarcoidosis. Reevaluation of the chest radiograph in assessing activity of sarcoidosis: a preliminary communication

Classic radiographic staging of sarcoidosis, utilizing stages 0 through III, is a purely descriptive classification and bears no relation to the clinical activity of the disease. We propose a new method of determining sarcoidosis activity based solely on the chest radiograph. This "staging" is based on the presence or absence of air bronchograms, peribronchial cuffing, and subpleural thickening. Adenopathy, reticular, reticulonodular, and nodular opacities are not included in our methodology. Other diagnostic methods currently utilized for staging activity include Gallium scanning, bronchoalveolar lavage, and physiologic studies. In 85 studies performed in 51 patients with biopsy-proven sarcoidosis, this staging method agreed with Gallium scintigraphy results in 68.2%. The system failed in specific and identifiable subgroups of patients. We feel that the chest radiograph compares favorably with other staging methods in detecting the alveolitis phase of sarcoidosis, and is reproducible, noninvasive, and cost efficient.

The use of pressimmune in renal transplantation: a four-year study

Over a three year period, 22 diabetic and 87 non-diabetic patients received 120 cadaver kidney transplants at Dulwich Hospital. Horse antilymphocyte globulin (ALG), azathioprine and low-dose intra-muscular methyl prednisolone were used as immunosuppressive agents. A control group of 98 non-diabetic patients (113 transplants) at Guy's Hospital during the same period were treated with a standard azathioprine and oral steroid regime. Four main findings emerged: Firstly, survival rates for first grafts in the non-diabetic patients were similar in both centers. This suggests that neither the ALG or more conventional immunosuppressive regime holds any advantage in this patient group. Secondly, the first grafts in diabetic patients did significantly worse than similar grafts in the non-diabetics. Thirdly, in patients receiving the more conventional regime, second grafts did significantly worse than first grafts. Fourthly, and in contrast, the ALG regime gave similar survival figures for both first and second grafts. Thus, ALG had no apparent advantage over conventional steroid regimes on the survival of first grafts but it did produce a marked improvement in the outcome of subsequent grafts.

Pleural effusion as a sequela to aelurostrongylosis in a cat

A two-year-old domestic cat was admitted with dyspnea and coughing. Unilateral pleural effusion with characteristics of an eosinophilic exudate was demonstrated. A direct fecal smear was positive for Aelurostrongylus abstrussus larvae. Treatment with levamisole and fenbendazole was curative. Aelurostrongylosis should be suspected in any cat with dyspnea, coughing, or pleural effusion.

Canine pancreatic endocrine function after interruption of pancreatic exocrine drainage

Pancreatic endocrine function was studied in forty dogs after ligation or free i.p. drainage of the pancreatic duct, with or without simultaneous partial pancreatectomy. Shrinkage and fibrosis of the pancreas occurred in all dogs, with equal severity in the open duct and duct-tied groups. Fasting blood sugars remained within the normal range but fasting levels of plasma insulin and glucagon were reduced. Dynamic tests of endocrine function indicated that partial pancreatectomy reduced the insulin response to i.v. injection of dextrose or glucagon and delayed the reestablishment of glucose homeostasis. Glucose tolerance was normal in dogs with intact pancreases, but duct ligation was associated with deteriorating recovery after glucagon injection. The precise coordination of circulating glucose, insulin, and glucagon levels seen in normal dogs was lost in both partial and intact pancreas groups and these disturbances were attributed to the fibrotic changes arising from interference with the ductal drainage. Both ligation and free i.p. drainage of the pancreatic duct therefore resulted in abnormalities of islet function. When combined with partial pancreatectomy, both techniques were associated with significant pancreatic endocrine insufficiency.

Immunization of children with attenuated measles-rubella bivalent vaccine

The effects of simultaneous administration of Schwarz-strain measles virus vaccine and Cendehill-strain rubella virus vaccine as a single bivalent injection was evaluated in 346 children susceptible to both diseases. With placebo and monovalent controls, four bivalent preparations were used in a double-blind protocol to determine the effects of variations in the concentration of one or both components. No unusual reactions occurred and simultaneous administration did not enhance clinical reactivity. For measles, the seroconversion rate was 97% for monovalent vaccine and 97% to 100% (average 98%) for bivalent vaccines. For rubella, the rate was 100% for monovalent vaccine and 94% to 100% (average 99%) for bivalent vaccines. Thus, the vaccines were as safe and effective when given together as when given separately.