[Aesthetic rehabilitation of a case of maxillary fibrous dysplasia in a child]

Fibrous dysplasia (FD) is a rare, congenital, benign bone disorder in which healthy bone tissue is replaced by abnormal scar-like (fibrous) connective tissue. The lesions may affect one or more bones, including the jawbones. A 13-year-old girl visited the dentist for failed eruption of her left maxillary permanent teeth and facial asymmetry. Radiological analysis revealed impactions of the permanent teeth in hypertrophic, hyperdense, weakly trabeculated bone tissue. To restore the aesthetics of the smile, a treatment combining decoronation and bonded restorations was performed. FD enlargement would slow down after puberty, allowing for long-term therapies. But there is no information about implantology in this type of bone lesion. The aesthetic and functional consequences of a maxillary FD should be managed as soon as possible. Treatment involves a multidisciplinary team and follow-up care into adulthood.

Primary failure of eruption: From molecular diagnosis to therapeutic management

Introduction

Primary Failure of Eruption (PFE) is a rare condition affecting posterior teeth eruption resulting in a posterior open bite malocclusion. Differential diagnosis like ankylosis or mechanical eruption failure should be considered. For non-syndromic forms, mutations in PTH1R, and recently in KMT2C genes are the known etiologies. The aim of this work was to describe the variability of clinical presentations of PFE associated with pathogenic variants of PTHR1.

Material and methods

Diagnosis of non-syndromic PFE has been suggested for three members of a single family. Clinical and radiological features were collected, and genetic analyses were performed.

Results

The clinical phenotype (type and number of involved teeth, depth of bone inclusions, functional consequences) is variable within the family. Severe tooth resorptions were detected. A heterozygous substitution in PTH1R (NM_000316.3): c.899T > C was identified as a class 4 likely pathogenic variant. The multidisciplinary management is described involving oral biology, pediatric dentistry, orthodontics, oral surgery, and prosthodontics.

Conclusion

In this study, we report a new PTH1R variant involved in a familial form of PFE with variable expressivity. Therapeutic care is complex and difficult to systematize, hence the lack of evidence-based recommendations and clinical guidelines.

Entrustable professional activities in dental education: a scoping review

Background Competency-based education has led to the introduction of entrustable professional activities (EPAs) in health sciences education. EPAs are assessment tools that serve to certify a trainee's preparedness to conduct a given clinical activity. Objective Given its modest introduction into dental education, we sought to examine the current situation of EPAs in our field and identify possible barriers and facilitators. This review aimed to summarise evidence about EPA introduction in dental education programmes.Data sources A review of articles published between January 2005 and December 2021 was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews methodology in three databases (PubMed, Cochrane and Embase).Data selection Keywords were 'entrustable professional activity' OR 'entrustable professional activities' AND 'dentistry' OR 'dental education'.Data extraction Eligibility criteria targeted papers published in English describing dental education EPA.Data synthesis Ten publications were selected: six reported on new EPAs, three discussed their relevance for dental education and one article described a process for developing validated EPAs. EPAs focused on clinical examination, health promotion, treatment planning, pain and/or anxiety control and topics related to a specific discipline or care procedures.Conclusion Topics covered by EPAs described in our study adequately reflect the specificities of today's dental professional. The benefits of EPAs will ensure tomorrow's dentists consistently meet societal expectations.

[Primary failure of eruption and tooth resorption]

INTRODUCTION

The number of adult patients who seek an orthodontic treatment is increasing. These Primary failure of eruption (PFE) is defined as the partial or complete failure of eruption of at least one posterior tooth, without any mechanical obstacle. A better understanding of the biological mechanisms involved in PFE would enable to refine the diagnostic and prognostic criteria. This rare disease is currently related to PTHR1 gene variants. This gene codes for a transmembrane receptor involved in bone metabolism. However, there is few evidence associating PFE and bone remodeling abnormalities such as external root resorption. External root resorption is the loss of cementum and dentin tissues, resulting from the activation of clastic cells.

MATERIALS AND METHODS

Human teeth affected by PFE were extracted and histological sections were made after fixation of the tissues in 4% PFA. The observations were correlated with three-dimensional imaging by cone beam computed tomography (CBCT) carried out in the preoperative phase.

RESULTS

Histological and radiographic analysis confirm the presence of ankylosis area in patients with no history of orthodontic treatment. Large areas of resorption of external root replacement were detected.

DISCUSSION

The results call the causal link between the appearance of ankylosis areas and the establishment of orthodontic traction in patients with PFE into question. The installation of an orthodontic force in this context could be only an aggravating factor, accelerating the processes of ankylosis or triggering them more prematurely.

CONCLUSION

With or without orthodontic treatment, teeth with PFE are likely to progress to ankylosis and resorption of replacement external root.

[Representation of the oral sphere in medical comics, the child's perception]

Medical comics are a suitable educational tool for paediatric populations. The emotions conveyed by the characters should not evoke negative feelings, which could then be associated with care or caregivers. The eyes and mouth are the first areas of the face to be analysed. One study attempted to assess the ability of children to perceive the emotions of one of the protagonists through the representation of their mouth.

Development of an innovative educational escape game to promote teamwork in dentistry

BACKGROUND

Escape games have proven to be an innovative pedagogical tool that allows students to use the professional skills they acquired. The appeal of the game lies in the stimulation of the players' minds and in the diversity of the puzzles.

PURPOSE/OBJECTIVES

To evaluate the effectiveness of an educational tool aimed at cultivating team spirit and group cohesion in dentistry students through a fun collaborative activity that mobilises their knowledge and skills.

MATERIALS AND METHOD

Twenty-four students participated to the escape game over a one-day period. In order to win, they had to solve dentistry-related puzzles.

RESULTS

Feedback was strongly positive. The balance between manipulations and theoretical questions stimulated them. Students did favour this type of activity which allows to increase interactions between students as well as with the teaching team.

CONCLUSION

Escape games in dental schools foster a supportive learning environment and stimulated students' motivation and group cohesion.

In vitro comparison of the mechanical behaviour of archwires after computer-assisted and conventional bracket positioning protocols

INTRODUCTION

The mechanical properties of orthodontic archwires can be defined using experimental setups incorporating brackets that provide conditions closer to those encountered in vivo. We aimed to compare a methodology based on computer-aided design with the gold standard protocol, performed when brackets are engaged to a full-size archwire to test the behaviour of wires in this condition.

METHODS

Three models simulating a dental arch with an orthodontic fixed appliance (0.018-inch aesthetic conventional brackets) were designed. The brackets were positioned with a stainless-steel full-size wire on the first two models, with different interbracket distances. The setup 3, based on a computer-assisted design, allowed individualized placement of each bracket. Mean forces recorded and standard deviation were compared for a 0.016×0.022-inch copper-nickel-titanium wire deflected until 2mm.

RESULTS

The inter-bracelet distances do not cause a statistical difference in the average maximum force recorded (12.6N and 11.4N; P=0.081) whereas the behaviour of the wires is affected. With setup 3, the recorded efforts (mean value: 8N) are statistically lower than with setup 1 and 2 respectively (P=0.018; P=0.012).

CONCLUSION

An individualization of the housings by CAD-CAM dedicated to each bracket optimizes their placement. In our test conditions, the mechanical behaviour of the wires is more influenced by the positioning methods of the brackets than by the value of the interbracket distance. In perspective, our innovative methodology can be extended to other types of brackets.

Eruption of Bioengineered Teeth: A New Approach Based on a Polycaprolactone Biomembrane

Obtaining a functional tooth is the ultimate goal of tooth engineering. However, the implantation of bioengineered teeth in the jawbone of adult animals never allows for spontaneous eruption due mainly to ankylosis within the bone crypt. The objective of this study was to develop an innovative approach allowing eruption of implanted bioengineered teeth through the isolation of the germ from the bone crypt using a polycaprolactone membrane (PCL). The germs of the first lower molars were harvested on the 14th day of embryonic development, cultured in vitro, and then implanted in the recipient site drilled in the maxillary bone of adult mice. To prevent the ankylosis of the dental germ, a PCL membrane synthesized by electrospinning was placed between the germ and the bone. After 10 weeks of follow-up, microtomography, and histology of the implantation site were performed. In control mice where germs were directly placed in contact with the bone, a spontaneous eruption of bioengineered teeth was only observed in 3.3% of the cases versus 19.2% in the test group where PCL biomembrane was used as a barrier (p < 0.1). This preliminary study is the first to describe an innovative method allowing the eruption of bioengineered tooth implanted directly in the jawbone of mice. This new approach is a hope for the field of tooth regeneration, especially in children with oligodontia in whom titanium implants are not an optimal solution.

Influence of parathyroid hormone on periodontal healing in animal models: A systematic review

OBJECTIVES

The purpose of this systematic review was to determine the potential interest of parathyroid hormone (PTH) as an adjunct to periodontal treatment based on studies performed in rodents.

MATERIALS & METHODS

Electronic databases (MEDLINE, Web of Science) were searched up to December 2019. Studies assessing the impact of PTH administration in experimental periodontitis in rodents have been identified.

RESULTS

Amongst the 247 identified articles, 10 met the inclusion criteria and were included in this systematic review. Experimental periodontitis was mainly induced by ligature placement or surgically with a dental bur. All studies considered bone healing after PTH administration at different frequencies as primary outcome. Results showed that an intermittent administration of PTH promoted bone healing and neovascularization. Nevertheless, a decrease of soft tissue inflammation was also observed.

CONCLUSION

Intermittent administration of PTH appears to enhance significantly periodontal healing and to promote alveolar bone regeneration. However, due to the risk of side effects, the development of scaffolds allowing its local and time-controlled delivery is of importance.

Efficacy, tolerability, and safety of an innovative medical device for improving oral accessibility during oral examination in special-needs patients: A multicentric clinical trial

Background

People with special needs have high unmet oral healthcare needs, partly because dentists find it difficult to access their oral cavity. The Oral Accessibility Spatula aims to improve oral accessibility. This prospective multicenter interventional open-label non-randomized patient-self-controlled trial assessed the ability of the spatula to improve the oral accessibility of special-needs patients during dental examinations.

Methods

The cohort was a convenience sample of minor and adult patients with special needs due to physical, intellectual, and/or behavioral disorders who underwent dental check-up/treatment in five French tertiary hospitals/private clinics in 2016–2018 and evinced some (Venham-Score = 2–4) but not complete (Venham-Score = 5) resistance to oral examination. After inclusion, patients underwent oral examination without the spatula and then immediately thereafter oral examination with the spatula. Primary outcome was Oral Accessibility Score (0–12 points; higher scores indicate visualization and probing of the tooth sectors). Secondary outcomes were patient toleration (change in Venham-Score relative to first examination), safety, and Examiner Satisfaction Score (0–10; low scores indicate unsatisfactory examination).

Results

The 201 patients were mostly non-elderly adults (18–64 years, 65%) but also included children (21%), adolescents (11%), and aged patients (3%). One-quarter, half, and one-quarter had Venham-Score = 2, 3, and 4 at inclusion, respectively. The spatula significantly improved Oral Accessibility Score (4.8 to 10.8), Venham-Score (3.1 to 2.6), and Examiner Satisfaction Score (3.4 to 7.2) (all p<0.001). There were no severe spatula-related adverse events.

Conclusion

The spatula significantly improved oral access, was safe and well-tolerated by the patients, and markedly improved oral examination quality.

A New Polycaprolactone-Based Biomembrane Functionalized with BMP-2 and Stem Cells Improves Maxillary Bone Regeneration

Oral diseases have an impact on the general condition and quality of life of patients. After a dento-alveolar trauma, a tooth extraction, or, in the case of some genetic skeletal diseases, a maxillary bone defect, can be observed, leading to the impossibility of placing a dental implant for the restoration of masticatory function. Recently, bone neoformation was demonstrated after in vivo implantation of polycaprolactone (PCL) biomembranes functionalized with bone morphogenic protein 2 (BMP-2) and ibuprofen in a mouse maxillary bone lesion. In the present study, human bone marrow derived mesenchymal stem cells (hBM-MSCs) were added on BMP-2 functionalized PCL biomembranes and implanted in a maxillary bone lesion. Viability of hBM-MSCs on the biomembranes has been observed using the "LIVE/DEAD" viability test and scanning electron microscopy (SEM). Maxillary bone regeneration was observed for periods ranging from 90 to 150 days after implantation. Various imaging methods (histology, micro-CT) have demonstrated bone remodeling and filling of the lesion by neoformed bone tissue. The presence of mesenchymal stem cells and BMP-2 allows the acceleration of the bone remodeling process. These results are encouraging for the effectiveness and the clinical use of this new technology combining growth factors and mesenchymal stem cells derived from bone marrow in a bioresorbable membrane.

[Primary failure of eruption: a French prospective survey among the orthodontists from the Grand Est and Bourgogne-Franche-Comté regions]

INTRODUCTION

 Primary failure of eruption (PFE) can be defined as the partial or complete failure of eruption of at least one posterior tooth, without any mechanical obstacle; isolated and syndromic forms exist. PFE results from an abnormal dental eruption process that can affect temporary teeth and / or permanent teeth. Molars are the main affected teeth, inducing posterior infraclusions. Orthodontists are the specialists most often concerned by this rare pathology. Unsuccessful orthodontic-surgical traction therapies are commonly reported.

MATERIALS AND METHODS

 The aim of our study using a prospective survey was to evaluate the level of knowledge reported by the orthodontists and the therapeutic difficulties they reported. An anonymous questionnaire was submitted to practitioners practicing in north-eastern France (Grand Est and Bourgogne-Franche-Comté regions).

RESULTS

 The participation rate was 33.5%. In France, until 2015, specialization in orthodontics was obtained thanks to a local qualification, the Certificat d'Etudes Cliniques Spéciales - Mention Orthodontie (CECSMO), which has now been replaced by specialization following a national ranking competition. Most respondents obtained their qualification between 1980 and 2009 (80%), via the CECSMO (87%). Eighty-six per cent were aware of PFE but only 20% of them knew that PTHR1 (Parathyroid Hormone Receptor 1) gene could be involved in this pathology. The wide range of proposed therapies and the variable satisfaction rates highlight the difficulties encountered by practitioners.

DISCUSSION

 Phenotypic variability complicates the diagnosis and makes any therapeutic systematization uncertain.

CONCLUSION

 New clinical research projects, particularly in the field of molecular diagnosis, may improve understanding of genotype-phenotype correlations, and may potentially pilot therapeutic management.

Bone Marrow Stromal Cells Promote Innervation of Bioengineered Teeth

Transplantation of bone marrow mesenchymal stem cells (BMDCs) into a denervated side of the spinal cord was reported to be a useful option for axonal regeneration. The innervation of teeth is essential for their function and protection but does not occur spontaneously after injury. Cultured reassociations between dissociated embryonic dental mesenchymal and epithelial cells and implantation lead to a vascularized tooth organ regeneration. However, when reassociations were coimplanted with a trigeminal ganglion (TG), innervation did not occur. On the other hand, reassociations between mixed embryonic dental mesenchymal cells and bone marrow-derived cells isolated from green fluorescent protein (GFP) transgenic mice (BMDCs-GFP) (50/50) with an intact and competent dental epithelium (ED14) were innervated. In the present study, we verified the stemness of isolated BMDCs, confirmed their potential role in the innervation of bioengineered teeth, and analyzed the mechanisms by which this innervation can occur. For that purpose, reassociations between mixed embryonic dental mesenchymal cells and BMDCs-GFP with an intact and competent dental epithelium were cultured and coimplanted subcutaneously with a TG for 2 wk in ICR mice. Axons entered the dental pulp and reached the odontoblast layer. BMDCs-GFP were detected at the base of the tooth, with some being present in the pulp associated with the axons. Thus, while having a very limited contribution in tooth formation, they promoted the innervation of the bioengineered teeth. Using quantitative reverse transcription polymerase chain reaction and immunostainings, BMDCs were shown to promote innervation by 2 mechanisms: 1) via immunomodulation by reducing the number of T lymphocytes (CD3+, CD25+) in the implants and 2) by expressing neurotrophic factors such as NGF, BDNF, and NT3 for axonal growth. This strategy using autologous mesenchymal cells coming from bone marrow could be used to innervate bioengineered teeth without treatment with an immunosuppressor such as cyclosporine A (CsA), thus avoiding multiple side effects.

Periodontal Tissues, Maxillary Jaw Bone, and Tooth Regeneration Approaches: From Animal Models Analyses to Clinical Applications

This review encompasses different pre-clinical bioengineering approaches for periodontal tissues, maxillary jaw bone, and the entire tooth. Moreover, it sheds light on their potential clinical therapeutic applications in the field of regenerative medicine. Herein, the electrospinning method for the synthesis of polycaprolactone (PCL) membranes, that are capable of mimicking the extracellular matrix (ECM), has been described. Furthermore, their functionalization with cyclosporine A (CsA), bone morphogenetic protein-2 (BMP-2), or anti-inflammatory drugs' nanoreservoirs has been demonstrated to induce a localized and targeted action of these molecules after implantation in the maxillary jaw bone. Firstly, periodontal wound healing has been studied in an induced periodontal lesion in mice using an ibuprofen-functionalized PCL membrane. Thereafter, the kinetics of maxillary bone regeneration in a pre-clinical mouse model of surgical bone lesion treated with BMP-2 or BMP-2/Ibuprofen functionalized PCL membranes have been analyzed by histology, immunology, and micro-computed tomography (micro-CT). Furthermore, the achievement of innervation in bioengineered teeth has also been demonstrated after the co-implantation of cultured dental cell reassociations with a trigeminal ganglia (TG) and the cyclosporine A (CsA)-loaded poly(lactic-co-glycolic acid) (PLGA) scaffold in the jaw bone. The prospective clinical applications of these different tissue engineering approaches could be instrumental in the treatment of various periodontal diseases, congenital dental or cranio-facial bone anomalies, and post-surgical complications.

Semaphorin 3A receptor inhibitor as a novel therapeutic to promote innervation of bioengineered teeth

The sensory innervation of the dental pulp is essential for tooth function and protection. It is mediated by axons originating from the trigeminal ganglia and is spatio-temporally regulated. We have previously shown that the innervation of bioengineered teeth can be achieved only under immunosuppressive conditions. The aim of this study was to develop a model to determine the role of Semaphorin 3A (Sema3A) in the innervation of bioengineered teeth. We first analysed innervation of the dental pulp of mandibular first molars in newborn (postnatal day 0: PN0) mice deficient for Sema3A (Sema3A^-/- ), a strong inhibitor of axon growth. While at PN0, axons detected by immunostaining for peripherin and NF200 were restricted to the peridental mesenchyme in Sema3A^+/+ mice, they entered the dental pulp in Sema3A^-/- mice. Then, we have implanted cultured teeth obtained from embryonic day-14 (E14) molar germs of Sema3A^-/- mice together with trigeminal ganglia. The dental pulps of E14 cultured and implanted Sema3A^-/- teeth were innervated, whereas the axons did not enter the pulp of E14 Sema3A^+/+ cultured and implanted teeth. A "Membrane Targeting Peptide NRP1," suppressing the inhibitory effect of Sema3A, has been previously identified. The injection of this peptide at the site of implantation allowed the innervation of the dental pulp of bioengineered teeth obtained from E14 dental dissociated mesenchymal and epithelial cells reassociations of ICR mice. In conclusion, these data show that inhibition of only one axon repellent molecule, Sema3A, allows for pulp innervation of bioengineered teeth.

Temporomandibular Joint Regenerative Medicine

The temporomandibular joint (TMJ) is an articulation formed between the temporal bone and the mandibular condyle which is commonly affected. These affections are often so painful during fundamental oral activities that patients have lower quality of life. Limitations of therapeutics for severe TMJ diseases have led to increased interest in regenerative strategies combining stem cells, implantable scaffolds and well-targeting bioactive molecules. To succeed in functional and structural regeneration of TMJ is very challenging. Innovative strategies and biomaterials are absolutely crucial because TMJ can be considered as one of the most difficult tissues to regenerate due to its limited healing capacity, its unique histological and structural properties and the necessity for long-term prevention of its ossified or fibrous adhesions. The ideal approach for TMJ regeneration is a unique scaffold functionalized with an osteochondral molecular gradient containing a single stem cell population able to undergo osteogenic and chondrogenic differentiation such as BMSCs, ADSCs or DPSCs. The key for this complex regeneration is the functionalization with active molecules such as IGF-1, TGF-β1 or bFGF. This regeneration can be optimized by nano/micro-assisted functionalization and by spatiotemporal drug delivery systems orchestrating the 3D formation of TMJ tissues.

Evaluation of an ethical method aimed at improving hygiene rules compliance in dental practice

BACKGROUND

The objective of this study is to determine the efficiency of an ethical method, based on a thought experiment in ethics, on hygiene rules compliance for dental health care team members.

METHODS

This is a prospective study that assesses hygiene compliance in dental practice before and after a thought experiment in ethics, using 2 questionnaires. Participants included 130 clinician students in dentistry at Strasbourg University Hospital, France.

RESULTS

The results emphasize a better implementation of hygiene rules after the thought experiment in ethics, when comparing the relative frequencies of completed hygiene items. A Wilcoxon signed-rank test shows significant differences between the first questionnaire and the second one after the thought experiment in ethics (P < .001).

CONCLUSIONS

This ethical method provides efficiency on hygiene rules compliance, which makes it beneficial to implement. However, far from being an absolute unit method, this thought experiment in ethics appears to be an original, supplemental, and complementary method.

[Late manifestation of radiation injury to the plexus brachialis and plexus lumbosacralis]

Radiotherapy of breast cancer, cervical cancer, testicular tumours and lymphoma is one of the most effective therapy options. Damage to the nervous system, in particular the brachial and lumbar plexus, is rare and typically leads to development of progressive sensory disturbances and motor weakness after years-long latency. We present two cases exemplifying the diagnostic problems in differentiating between radiation-induced injury and recurrence of the primary tumour. A clinical course with sensorimotor symptoms and signs progressing over months, electomyographic recording of myokymic discharges, and absence of a space-occupying mass suggest late-onset radiation-induced plexopathy. The literature on pathogenesis and incidence of radiation-induced plexopathy is reviewed.

Real-time, three-dimensional echocardiography: feasibility of dynamic right ventricular volume measurement with saline contrast

BACKGROUND

The asymmetry and complex shape of the right ventricle have made it difficult to determine right ventricular (RV) volume with 2-dimensional echocardiography. Three-dimensional cardiac imaging improves visualization of cardiac anatomy but is also complex and time consuming. A newly developed volumetric scanning system holds promise of obviating past limitations.

METHODS

Real-time, transthoracic 3-dimensional echocardiographic images of the right ventricle were obtained with a high-speed volumetric ultrasound system that uses a 16:1 parallel processing schema from a 2.5 MHz matrix phased-array scanner to interrogate an entire pyramidal volume in real time. The instrumentation was used to measure RV volume in 8 excised canine hearts; dynamic real-time 3-dimensional images were also obtained from 14 normal subjects.

RESULTS

Three-dimensional images were obtained in vitro and in vivo during intravenous hand-agitated saline injection to determine RV volumes. The RV volumes by real-time 3-dimensional echocardiography are well correlated with those of drained in vitro (y = 1.26x - 9.92, r = 0.97, P <.0001, standard error of the estimate = 3.26 mL). For human subjects, the end-diastolic and end-systolic RV volumes were calculated by tracing serial cross-sectional, inclined C scans; functional data were validated by comparing the scans with conventional 2-dimensional echocardiographic indexes of left ventricular stroke volume.

CONCLUSIONS

These data indicate that RV volume measurements of excised heart by real-time 3-dimensional echocardiography are accurate and that beat-to-beat RV quantitative measurement applying this imaging method is possible. The new application of real-time 3-dimensional echocardiography presents the opportunity to develop new descriptors of cardiac performance.

Phase I-II evaluation of intravesical novantrone (mitoxantrone) in superficial bladder cancer

The objective of this study was to determine the safety and efficacy of intravesical novantrone in refractory superficial bladder cancer. The eligibility criteria included proven carcinoma in situ or superficial transitional cell carcinoma of the bladder at stage Ta or T1 that was proven refractory to or in relapse after the use of at least one other standard anti-cancer agent. The patient was to have received no prior radiotherapy or intravesical therapy for at least 4 weeks prior to entry. Patients also did not suffer significant cardiac dysfunction, such as angina, congestive heart failure, or uncompensated cardiomyopathy. All patients were given 4-6 doses of intravesical novantrone at the same dose level at weekly dosing interval. Patients were required to retain the drugs in the bladder for 2 h. Baseline study included history/physical, hematology, blood chemistry, cystoscopy, bladder barbotage, urine cytology, cystometrogram to assess the bladder capacity, and finally, chest X-ray, EKG, and MUGA scan, if indicated. Weekly assessment involved toxicity notation, blood chemistry, hematology and urinalysis. Monthly assessment included physical examination, toxicity notation, hematology, urinalysis and blood chemistry. Within 4 weeks of completion of the last dose, patients underwent repeat cystoscopy to assess disease status. Patients who responded to the 4-6 week induction phase were entered in a monthly dose regimen for up to 5 months. A total of 23 patients were enrolled: 22 males and 1 female. One patient dropped out before receiving medication because of a protocol violation for entry criteria. Twenty-two patients were eligible for assessment of safety and 20 were eligible for assessment of efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)

Priapism associated with the sickle cell hemoglobinopathies: prevalence, natural history and sequelae

To determine the prevalence and characteristics of priapism associated with sickle cell hemoglobinopathic conditions we interviewed and examined 52 men with sickle cell anemia, 10 with sickle C disease, 3 with sickle B(+)-thalassemia and 19 with sickle cell trait. Of the men 20 with sickle cell anemia (38%) and 1 with sickle B(+)-thalassemia (33%) reported past priapism attacks. Average patient age at onset in the sickle cell anemia patients was 19 years (range 8 to 30 years). Four men had had only 1 attack. The average number of attacks per year in the remaining patients ranged from 1 to 52. Of the patients who reported multiple attacks the average duration of a typical episode and the duration of the longest self-limiting episode was 1.6 and 7.0 hours, respectively. Six patients had experienced 1 attack that persisted for longer than 24 hours. There were no significant differences between the clinical and hematological parameters of the sickle cell anemia patients who did and did not experience priapism or of the priapism patients who had and had not experienced episodes lasting greater than 24 hours. Six patients had been hospitalized for priapism and 4 were treated with a shunting procedure. Of the latter patients 2 were impotent but there was no significant alteration in the sexual function of the other study participants.

'Acute on chronic' effect of depot leuprolide in patients with stage D2 cancer of prostate

During a phase III open study of depot leuprolide for stage D2 cancer of the prostate, we studied the effect of depot leuprolide on chronic leuprolide users. To determine whether there was a transient elevation of testosterone or luteinizing hormone (LH) 4-24 h and 3-5 days following the monthly injections, we monitored the changes of testosterone and LH before injection and 24 h post-injection in 10 patients who have been under depot leuprolide Rx for 24-36 weeks, and in 35 patients before injection and 3-5 days post-injection who have received depot leuprolide for 8-24 weeks prior to monitoring. Comparison of the data between pre-injection within 24 h and 3-5 days post-injection showed no significant changes of testosterone and LH values between these levels for either testosterone (P = 0.31) or LH (P = 0.45). We therefore conclude that there was no 'acute on chronic' effect of depot formulation in chronic users of depot leuprolide.

Sensitivity to non-acetylated salicylates in a patient with asthma, nasal polyps, and rheumatoid arthritis

A woman experienced exacerbations of bronchial asthma after taking aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. On oral challenges, she developed an urticarial reaction after tartrazine; urticarial and bronchospastic reactions after salicylsalicylic acid; and urticarial and bronchospastic reactions after choline magnesium trisalicylate. Non-acetylated salicylates have been recommended for use in aspirin- and/or tartrazine-sensitive patients. The results of sensitivity studies of our patient indicates that such patients may also be sensitive to non-acetylated salicylates.