Health-related quality of life in patients with polycystic ovary syndrome: validation of the German PCOSQ-G

PURPOSE

Patients with polycystic ovary syndrome (PCOS) report a decreased health-related quality of life (HRQOL) and higher levels of psychological distress. Validated questionnaires are necessary to assess the impact of PCOS on patients' lives. The aim of the present study was to evaluate the German "Polycystic Ovary Syndrome Questionnaire" (PCOSQ-G).

METHODS

The psychometric properties of the PCOSQ-G were investigated in PCOS patients with item-total correlation, internal consistency and test-retest reliability. Correlations with the Short-Form-36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS-D) were calculated to evaluate the validity of the PCOSQ-G. Discriminatory validity was investigated through a receiver operating characteristic curve and independent sample t tests compared with healthy controls.

RESULTS

Good psychometric properties were found for most items. Acceptable to high internal consistency was found for the total score (α = 0.94-0.95) and all subscales (α = 0.70-0.97). High test-retest reliability was found for the total score (0.86) and all subscales (0.81-0.90). The validity analyses showed that the PCOSQ-G total score was positively correlated with both SF-36 summary scales and was negatively correlated with both HADS subscales. Patients reported significantly lower values for the PCOSQ-G total score (p < 0.001) and all subscales, and the PCOSQ-G discriminated well between patients and healthy controls (AUC = 0.81, p < 0.001).

CONCLUSIONS

PCOSQ-G is a reliable and valid tool to assess the HRQOL in patients with PCOS and can be used in future clinical research. Patients with PCOS exhibited an impaired HRQOL, which indicates the need for psychosomatic counseling.

[Delusion and Gender in Paranoid Schizophrenia: Results of a Clinical Study]

Aim: The aim of the present study was to investigate whether men and women differ in the frequency and phenomenology of delusions. Sample: Medical records of all patients who had been admitted to a psychiatric hospital in Germany between 2008 and 2011 for paranoid schizophrenia were analyzed. The sample consisted of 182 delusional inpatients (90 women, 92 men) with the diagnosis of a paranoid schizophrenia. Results: Men and women did not differ in the frequency of delusional themes. Analysis of delusional content, however, revealed considerable differences between them. Women with delusion of reference felt more often as being under constant surveillance compared to men. Men with delusion of reference showed a tendency to involve unspecified persons in their delusions and more often had the feeling of being talked about. Delusion of grandeur in women was more often built upon significant relationships with others.

Outcomes of direct pulp capping: interrogating an insurance database

AIM

To evaluate the effectiveness of direct pulp capping under general practice conditions. It was hypothesized that direct pulp capping is an effective procedure in the majority of cases and prevents the need for root canal treatment or extraction.

METHODOLOGY

Claims data were collected from the digital database of a major German national health insurance company. Only patients who had been insurance members for the entire 3 year period 2010 to 2012 were eligible. Kaplan-Meier survival analyses were conducted for all teeth with direct pulp capping. Success was defined as not undergoing root canal treatment. Survival was defined as not undergoing extraction. Differences between survival functions were tested with the log rank test.

RESULTS

A total of 148 312 teeth were included. The overall success rate was 71.6% at 3 years. The overall survival rate was 95.9% at 3 years. The success rates for single-rooted teeth (71.8%) and multirooted teeth (71.5%) were similar although significantly different (P < 0.001). Best 3-year success rates were found at low (79.7%; <18 years.) and very high age (81.8%; >85 years.).

CONCLUSIONS

After direct pulp capping, more than two-thirds of the affected teeth did not undergo root canal treatment within 3 years. Although this study has the typical limits of a claims data analysis, it can be concluded that direct pulp capping is an effective intervention to avoid root canal treatment and extraction in a general practice setting.

Management of shortened dental arches and periodontal health: 5-year results of a randomised trial

In a multicentre randomised trial (German Research Association, grants DFG WA 831/2-1 to 2-6, WO 677/2-1.1 to 2-2.1.; controlled-trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre-molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior-most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL-V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL-V and PPD, significant differences were also found for the study jaw as a whole. For CAL-V, the estimated group differences over 5 years amounted to 0.27 mm (95% CI 0.05; 0.48; P = 0.016) for the study jaw and 0.25 mm (95% CI 0.05; 0.45; P = 0.014) for the distal sites of the posterior-most teeth. The respective values for PPD were 0.22 mm (95% CI 0.03; 0.41; P = 0.023) and 0.32 mm (95% CI 0.13; 0.5; P = 0.001). It can be concluded that even in a well-maintained.patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.

[Preventive strategies in prosthetic dentistry]

Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.

Intrapyloric injection of botulinum toxin a for the treatment of persistent gastroparesis following successful pancreas transplantation

Intrapyloric injection of botulinum toxin A (BoTx) successfully improved symptoms in idiopathic and diabetic gastroparesis (DGP) refractory to medical treatment. Therefore, we used it in three pancreas transplant patients done in our institution during the last 18 months. They had severe, persistent DGP despite successful pancreas transplantation. They received 100 units of BoTx during the first injection. The clinical effect became evident within 2 weeks after the treatment, and lasted for an average of 29 weeks (range 14-44 weeks). The patients' subjective evaluation showed improvement of their symptoms and quality of life following BoTx. Patients 2 and 3 had recurrent symptoms at 44 and 24 weeks, respectively, after the first injection; they required a second dose of 90 and 80 units, respectively. They are doing well at 3 months follow-up. Intrapyloric injection of BoTx is safe and efficient. It should be considered for treating residual DGP following successful pancreas transplantation.

Multivariate analysis of oral hygiene data from a representative sample

BACKGROUND

This analysis was based on an oral health survey with dental examination and interview by questionnaire.

METHOD

The data set comprised a representative random sample of the over 14-year-old residents of the German Federal State of Saxony (n=714), in which a multivariate logistic regression analysis was conducted. The dependent variable was the debris index (DI) score of the oral hygiene index scoring system. The subjects were split into 2 groups by dividing DI scores into tertiles: those with acceptable oral hygiene (1st tertile, DI 0.00< or =1.20) and unacceptable oral hygiene (2nd and 3rd tertile, DI>1.20). The most important explanatory variable was the community periodontal index of treatment need (CPITN).

RESULTS

The higher the CPITN score, the lower the probability of acceptable oral hygiene. In relation to the reference category score 0, higher CPITN scores were associated with acceptable oral hygiene, with an odds ratio 0.05 (95% confidence interval (CI)=0.01-0.23) for CPITN score 1, and an odds ratio 0.02 (95% CI: 0.01-0.08) for score 4. Further significant variables were: self-evaluation of tooth condition, gender, and the number of missing teeth.

Prosthetic treatment need in a representative German sample

Regarding declining resources epidemiological data on needs for oral rehabilitation are required. Within the framework of an oral health survey a non-stratified two-stage random sample was taken to represent the over 14-year-old population of Saxony/Germany. The participation rate was 55%. Normative need was determined by dental assessment and guidelines developed in a consensus process, subjective prosthetic treatment need by self-complete questionnaire. About 97% of the realized sample could be planned within the guidelines. About 81% had normative prosthetic treatment need. Compared with the rate of normative need the rate of subjective need (13%) was considerably lower (chi(2) P < 0;01). Different predictive parameters of subjective need were identified by logistic regression. Besides other factors subjective need was associated with giving dentist's recommendation as significant reason for prosthetic restorations [odds ratio (OR)=5;43], not believing that the own teeth were all right (OR=0;17), and the existence of prosthetic restorations (OR=3;87 for fixed restorations; OR=4;05 for removable dentures). The guidelines proved their suitability to assess normative prosthetic treatment need in oral health surveys. Further research is necessary to find adequate options for including patients' preferences in an adequate need definition.

Plaque, gingival health and post-operative sensitivity in titanium inlays and onlays: a randomized controlled clinical trial

OBJECTIVES

Few clinical data on the use of titanium for restorative appliances are available. The aim of this study was to clinically evaluate titanium restorations compared to gold alloy restorations with regard to plaque, gingival health and post-operative sensitivity.

METHODS

In 54 patients, 99 titanium restorations were placed. The control group comprised 56 patients with 96 high gold alloy restorations. The material was chosen by random. Each patient received one or two Class II restorations. Plaque Index (Silness and Löe, 0-3), Gingival Index (Löe and Silness, 0-3), and post-operative sensitivity (1-4, 1=none) were rated at 2 weeks, 3 months, 6 months, 12 months, and 18 months, post-operatively.

RESULTS

The mean plaque scores ranged from 0.89 to 0.99 in the titanium group, and from 0.88 to 1.04 in the gold group. The mean gingival scores ranged from 0.91 to 1.07 in the titanium group, and from 0.82 to 0.99 in the gold group. The mean plaque and gingival scores of the titanium and gold group did not differ significantly at any visit (P>0.05). To evaluate post-operative sensitivity, patients with one MOD restoration each were included, resulting in 46 titanium and 44 high gold restored teeth. Mean values of the post-operative sensitivity scores in the titanium group were significantly higher than in the gold group (P<0.05). The restoration material was found to be the dominating variable with regard to post-operative sensitivity, which was not influenced by age, sex and the application of calcium hydroxide liner.

CONCLUSIONS

It is concluded that neither higher plaque scores nor adverse effects on gingival health are to be expected in titanium restorations.

Burs with guide pins for standardized tooth preparation

OBJECTIVE

The aim of this study was to develop and test self-limiting diamond burs to ease precise chamfer preparation and to fulfill the special requirements of computer-aided design/computer-aided manufacturing and all-ceramic restorations.

METHOD AND MATERIALS

Rounded cylinder (based on ISO 881) and torpedo (based on ISO 879) diamond burs with a polished guide pin, 0.5 mm in length and 0.15 mm in radius, at the front end were developed in cooperation with an industrial partner. The in vitro testing involved a total of 140 human teeth. Experimental variables were the quality of the finish line, the microhardness of the enamel, and the thermal alteration of the dentin. Conventional diamonds served as a control.

RESULTS

No mechanical or thermal damage related to the bur design was found in the hard tissues that had potentially been in contact with or in close proximity to the guide pin. Microhardness of the enamel at the finish line was significantly higher when prepared with burs with a guide pin compared to conventional burs. The results of using the guide pin might indicate the beneficial effect of reduced vibration.

CONCLUSION

The guide pins of the self-limiting diamond burs reduce, rather than increase, the risk of hard tissue damage at the preparation margin. No adverse effects were found. Clinical use is justified.

Accuracy of mechanical digitizing with a CAD/CAM system for fixed restorations

PURPOSE

Most research on the accuracy of dental computer-aided design/manufacturing (CAD/CAM) systems focuses on the marginal gap. A detailed analysis of the various components of CAD/CAM systems (digitizer, software, and milling machine) using this approach is nearly impossible. The purpose of this study was to determine the accuracy of the manual mechanical digitizer of the Precident-DCS system.

MATERIALS AND METHODS

Gauge blocks were aligned to the coordinate planes of the digitizer to determine the point and length measurement uncertainty. The values for each measuring point were compared for statistical differences concerning first versus second operator, pressure, and mode of sensing using analysis of variance. The measurement uncertainty was given by 95th percentiles.

RESULTS

The mean one-dimensional point measurement uncertainty in the Y direction was 11 microm for the first, 8 microm for the second, and 37 microm for both operators. The three-dimensional point measurement uncertainty in the Y direction was 10 microm for the first, 33 microm for the second, and 60 microm for both operators. The point measurement uncertainty was significantly influenced by the pressure during sensing and by the operator as well. There were significant differences between the first and second recordings. The length measurement uncertainty in the Y direction for a gauge block of 20 mm was 52 microm for both operators.

CONCLUSION

The reliability of the manually guided Precident-DCS digitizer is limited because of the significant influence of the operator and the mode of sensing (one or three dimensional). Compared with an automatic digitizing system, the measurement uncertainty of the manually guided digitizer exceeds the values published in the literature.

[Patients' need for information before surgery]

Frequently, prior to surgery, patients are provided with information in order to meet legal and hospital requirements, but without taking their psychological needs into consideration. In order to learn how to improve this situation, the present study was performed. By means of a semi-structured interview including a newly constructed card system, that avoids giving patients undemanded and possibly harmful implicit information, the need for information of 60 patients before hip- or knee-replacement surgery were investigated in great detail. The results show that 83.3% of the patients want to be prepared by the surgeon, preferably by means of an oral communication (75.0%). Most frequently the day when decision for surgery is made and the day of hospitalization were preferred as point of time for preparation (30% each). Patients were more interested in information about the operation and recovery (43.3% each) than about risks (33.3%). Only 11.7% wanted to get psychological preparation prior to surgery. We conclude that coming into contact and establishing a trustful relationship with the surgeon who does the operation is the most crucial need of surgical patients. He should give presurgical information according to the patient's needs, which often do not focus on the risks, as legal regulations do. By providing psychological preparation for the small number of patients in need, psychological specialists may contribute to improve satisfaction and outcome of surgical patients.

Clinical fit of Procera AllCeram crowns

STATEMENT OF PROBLEM

Color stability, strength, and accuracy of fit are the main requirements for complete-ceramic crowns. The Procera AllCeram crown system is a CAD/CAM system used to fabricate individual complete-ceramic crowns that have a dry sintered, aluminum oxide core and appear to match clinical requirements. However, there are few articles about the clinical fit of all-ceramic crowns.

PURPOSE

This in vivo study measured the accuracy of fit of Procera AllCeram crowns in anterior and posterior teeth.

MATERIAL AND METHODS

The clinical fit of 80 anterior and posterior Procera AllCeram crowns was evaluated by a replica technique with a light body silicone to fill space between crown and tooth and a heavy body silicone to stabilize the light body film. After removal from the artificial crowns, the replicas were segmented, and measurements of the film thickness were performed with a light microscope.

RESULTS

Medians of mean marginal gap widths were between 80 and 95 microm in anterior teeth and between 90 and 145 microm in posterior teeth. Medians of maximal marginal gap widths ranged from 80 to 180 microm in anterior teeth and from 115 to 245 microm in posterior teeth.

CONCLUSION

The accuracy of fit achieved by Procera AllCeram was comparable to other conventional and innovative systems.

Arbuscular mycorrhizal fungi induce the non-mevalonate methylerythritol phosphate pathway of isoprenoid biosynthesis correlated with accumulation of the 'yellow pigment' and other apocarotenoids

Plants and certain bacteria use a non-mevalonate alternative route for the biosynthesis of many isoprenoids, including carotenoids. This route has been discovered only recently and has been designated the deoxyxylulose phosphate pathway or methylerythritol phosphate (MEP) pathway. We report here that colonisation of roots from wheat, maize, rice and barley by the arbuscular mycorrhizal fungal symbiont Glomus intraradices involves strong induction of transcript levels of two of the pivotal enzymes of the MEP pathway, 1-deoxy-D-xylulose 5-phosphate synthase (DXS) and 1-deoxy-D-xylulose 5-phosphate reductoisomerase (DXR). This induction is temporarily and spatially correlated with specific and concomitant accumulation of two classes of apocarotenoids, namely glycosylated C13 cyclohexenone derivatives and mycorradicin (C14) conjugates, the latter being a major component of the long-known 'yellow pigment'. A total of six cyclohexenone derivatives were characterised from mycorrhizal wheat and maize roots. Furthermore, the acyclic structure of mycorradicin described previously only from maize has been identified from mycorrhizal wheat roots after alkaline treatment of an 'apocarotenoid complex' of yellow root constituents. We propose a hypothetical scheme for biogenesis of both types of apocarotenoids from a common oxocarotenoid (xanthophyll) precursor. This is the first report demonstrating (i) that the plastidic MEP pathway is active in plant roots and (ii) that it can be induced by a fungus.

Margin quality of titanium and high-gold inlays and onlays--a clinical study

OBJECTIVES

Unalloyed titanium may be an economical substitute for gold alloys. The purpose of this study was to evaluate the suitability of unalloyed titanium as an alternative to gold alloys for posterior inlay and onlay restorations.

METHODS

Fifty-four patients received 99 titanium restorations, 56 patients 96 gold alloy restorations. All titanium restorations were cast in a vacuum-pressure casting machine. Two weeks after insertion the clinical margin integrity was evaluated by replica technique. The maximum marginal gaps were assessed under the optical measuring microscope. The two tailed t-test for independent samples was used for statistical analysis.

RESULTS

Accuracy of fit was significantly better in gold alloy than in titanium restorations. Mean maximum marginal gap between restoration margin and tooth structure were 72 +/- 18 microns (mean +/- S.D.) for titanium and 64 +/- 18 microns (mean +/- S.D.) for gold restorations.

SIGNIFICANCE

Though marginal gap widths in titanium restorations did not yet match the gold standard, the data justify the use of titanium as an alternative to gold alloy for inlay and onlay restorations.

Clinical significance of surface activation of silicone impression materials

OBJECTIVES

Surface activation of silicone impression materials enhances impression accuracy as well as the quality of stone casts. This study examined the relation between impression quality and the hydrophilicity of silicone impression materials used in a two-stage putty and wash technique.

METHODS

The study included 14 silicone impression materials with and without surface activation. The contact angles of the light body materials were measured using deionised water. Free surface energies were calculated. A total of 140 impressions of wet intact permanent molar teeth were examined for definition of the gingival sulcus reproduction and then classified in a quality ranking. The percentage of the sulcus reproduction ability of each material was calculated from the sulcus depths of cross-sectioned resin casts from the impressions and clinically measured sulcus depths.

RESULTS

Free surface energies (mJ/m2) of hydrophobic materials (contact angle > 90 degrees) ranged from 16.8 to 26.8 mJ/m2. Surface activated materials (contact angle < 90 degrees) exhibited free surface energies from 38.1 to 55.7 mJ/m2. Not all materials described as surface activated showed hydrophilic properties. Medians of impression quality ranking ranged from 1.75 (best) to 13.25 (worst), mean sulcus reproduction ranged from 30 to 52%. Significant differences (P < 0.05) in quality ranking and sulcus reproduction were found between certain materials but correlations were found neither between sulcus reproduction and free surface energy nor between quality ranking and free surface energy.

CONCLUSIONS

For clinical impression recording, surface activation seems to be of minor relevance, at least in the two-stage putty and wash technique investigated and is superimposed by other material properties.

Bean ribonuclease-like pathogenesis-related protein genes (Ypr10) display complex patterns of developmental, dark-induced and exogenous-stimulus-dependent expression

The intracellular pathogenesis-related (PR) proteins of common bean (Phaseolus vulgaris L.) are encoded by a highly polymorphic family of at least 20 genes. One member, the Ypr10*c gene, has been isolated and characterised. The deduced amino acid sequence of the encoded protein, PR-10, exhibits similarities to tree-pollen allergens, to food allergens from celery and apple and to ginseng ribonuclease peptide sequences. We show by RNA blot analysis that the Ypr10 gene family, including Ypr10*c, is strongly expressed in bean roots. In leaves Ypr10 transcript levels are low in young and mature stages but are elevated during senescence and in diseased states. Dark treatment of leaves causes strong induction of Ypr10 transcripts, which is reversible by light, and diurnal rhythms of transcript accumulation during the night are observed. Ypr10 genes are responsive to external stimuli related to pathogen-defence such as glutathione or salicylic acid. Transcriptional activity of a Ypr10*c promoter-beta-glucuronidase fusion gene in transgenic tobacco was observed in roots, in developing xylem and phloem of stems, and in the blade of senescent leaves, with highest levels at the onset of senescence. The most striking characteristic of developmental expression was the specific localisation of beta-glucuronidase activity in the transmitting tract of styles in flowers at anthesis. Feeding of various pathogen-related and stress-related stimuli to young tobacco leaves led to accumulation of GUS activity in leaf blades. We identify considerable spatio-temporal similarities between reported expression patterns of Ypr10 genes and ribonuclease genes, which, together with the significant sequence similarity to the ginseng ribonuclease, support the hypothesis of a ribonuclease function for PR-10 proteins and allow the prediction of possible biological roles.

Primary Metabolism in Plant Defense (Regulation of a Bean Malic Enzyme Gene Promoter in Transgenic Tobacco by Developmental and Environmental Cues)

NADP-dependent malic enzyme (NADP-ME, EC 1.1.1.40) catalyzes the oxidative decarboxylation of malate to pyruvate, producing CO2 and NADPH. We have examined regulatory properties of a 2.8-kb promoter-leader fragment of a bean (Phaseolus vulgaris L.) NADP-ME gene (PvME1) predicted to encode a cytosolic form of the enzyme by expression analysis of promoter-[beta]-glucuronidase fusions in transgenic tobacco plants. The PvME1 promoter directed strong expression in stems, which was confined to vascular and pith tissues, and was also active in floral and reproductive tissues. Wounding caused a marked induction of promoter activity, which was further strongly enhanced upon application of stimuli related to pathogen defense. Glutathione (reduced form) was the strongest inducer, but oxidized glutathione, fungal elicitor, cellulase, catalase, ascorbic acid, and NADPH were additional potent promoter-stimulating agents. Responsiveness to reduced glutathione was also shown at the level of PvME1 mRNA accumulation in bean plants. The putative contributions of NADP-ME gene expression to the plant defense response and possible mechanisms of defense gene regulation by conditions of oxidative stress as well as by H2O2 and antioxidant levels are discussed.

Characterization of a bean (Phaseolus vulgaris L.) malic-enzyme gene

We have isolated a genomic clone encoding a plant NADP(+)-dependent malic enzyme (NADP-ME). This clone, isolated from bean (Phaseolus vulgaris L.), covers the entire gene (exons, introns) and 5'-flanking regions. DNA sequencing defines 20 exons spanning approximately 4.5 kb, which range over 48-235 bp in size. All 19 introns are fairly small (79-391). The first intron resides in the 5'-untranslated leader sequence. Introns 10, 11 and 16 are located at positions identical to a rat malic-enzyme gene. In the promoter region, a TATA box (TATATATA) is easily recognized 41 bp upstream of a single transcription-initiation site. Two potential cis-acting elements with homology to elements from plant genes, activated by UV light and fungal elicitors, were identified at positions -153 and -312, respectively. Southern-blot analysis suggests a single gene copy, but also other distantly related genes, in the bean genome. The deduced NADP-ME protein of 589 amino acids exhibits features consistent with a cytoplasmic location. We describe the organization of the NADP-ME protein into functional domains located on separate exons. The evolution of malic-enzyme genes coding for isoforms in different cellular compartments of plants and animals is discussed.

Endoscopic sphincterotomy-induced pancreatitis: increased risk associated with nondilated bile ducts and sphincter of Oddi dysfunction

OBJECTIVE

to evaluate the relationship between common bile duct diameter and the risk of sphincterotomy-induced pancreatitis.

METHODS

Two hundred and ten consecutive patients were prospectively investigated. Patients were divided into three groups according to the indication for sphincterotomy: Group I had common bile duct stones (n = 108), group II had sphincter of Oddi dysfunction (n = 48), and group III had sphincterotomy for other indications (n = 54) (i.e., stent, dilation).

RESULTS

There were 62 males and 148 females with a mean age of 60 yr (range 15-93 yr). Eleven of the 210 patients (5.2%) developed pancreatitis. Other sphincterotomy-induced complications were bleeding (n = 2), cholangitis (n = 2), retroperitoneal duodenal perforation (n = 1), and bile duct leakage (n = 1). The percentages of pancreatitis in groups I (3.7%), II (12.5%), and III (1.9%) were significantly different (p = 0.03). Patients with nondilated common bile ducts (< or = 10 mm) had more pancreatitis than patients with dilated common bile ducts (8.8% vs. 2.8%), but the difference was not significant (p = 0.07). However, when group III was excluded from the analysis, there was a significant difference in the percentage of pancreatitis between the patients with nondilated bile ducts and those patients with dilated bile ducts (13.1% vs. 2.2%, respectively; p < 0.01). Analysis for trend did not show a significant inverse relationship between bile duct diameter and the rate of sphincterotomy-induced pancreatitis. However, for all complications combined, the inverse relationship between bile duct diameter and rate of sphincterotomy-induced complications was significant: < or = 5 mm (23.1%), > 5-10 mm (13.8%), > 10-15 mm (3.2%), > 15 mm (2.4%) (p = 0.002).

CONCLUSIONS

Endoscopic sphincterotomy is more hazardous in patients with nondilated bile ducts and sphincter of Oddi dysfunction. Further studies are needed to determine whether pancreatic stenting reduces the risk of sphincterotomy-induced pancreatitis in those clinical settings.

The impact of a 'guided self-help group' on bulimic women: a prospective 15 month study of attenders and non-attenders

Bulimic women (N = 19) interested in a 'guided self-help group' were assessed by structured interviews and standardized tests. Eleven decided to attend the group, eight did not. Ten attenders (regular attendance of at least 6 months) and five non-attenders were followed for up to 6 months (mail questionnaires) and for 15 months (interviews) respectively. All the attenders and four non-attenders initially fulfilled DSM-III-R criteria for bulimia nervosa. After 15 months five attenders still met these criteria, whereas five improved to the point that they no longer did. Attenders showed significant improvement in specific psychopathology (drive for thinness, bulimia), general psychopathology (depression) and psychosocial adjustment, whereas non-attenders did not. However, three of five non-attenders also improved to a subclinical level, thus reflecting the natural course of the illness. Despite the small sample size our study indicates self-help as a valuable tool in overcoming an eating disorder.

[Coping and life satisfaction in patients with Hodgkin's disease in remission. A contribution to the question of adaptive aspects of coping processes]

Widening the focus from survival time to the "quality of survival" this cross-sectional study was designed to find correlations between coping strategies, quality of life, sociodemographic and medical data. 61 patients (31 women, 30 men; mean age 41 [22-74] with Hodgkin's disease receiving no treatment since 1 month to 16 years (mean 5 years) were assessed for coping and quality of life. Two standardized questionnaires were used: "Freiburg Questionnaire of Coping with Chronic Illness" (FKV 102) and "Questions for Life Satisfaction" (FLZ). Coping strategies were evaluated. The most used strategies were compliance strategies and trust in doctors. Some coping strategies correlated significantly with age, sex, marital status, education, and medical data as B symptoms and occurrence of recidivs. The scores for life satisfaction were absolutely high in comparison with postoesophagectomy patients and healthy controls from other studies. Life satisfaction was correlated with age, B symptoms and type of therapy. These correlations and correlations between FKV and FLZ were discussed and basic problems were reflected.

Studies on laser- and plasma-welded titanium

In recent years, titanium has become a material of major interest in prosthetic dentistry. Due to its chemical properties, titanium has to be processed differently from conventional alloys. In this paper, two different methods of welding were investigated. Specimens machined from pure titanium rods were fused either by laser welding or plasma welding. Hardness profiles and light microscopy images were taken in the region of the weld. The mechanical properties were tested by alternating bending fatigue tests up to 3 million cycles. Light microscopy images and hardness profiles showed a larger heat-affected zone after plasma welding compared to laser welding. No significant differences comparing fatigue strength could be found between the two methods of welding. However, extreme loads led to earlier fatigue in the plasma-welded specimens. SEM images of the laser-welded joints showed fractures in the welding zone, while the plasma-welded specimens fractured mostly beyond the heat-affected zone. From these results, it can be assumed that both methods are suitable for welding titanium. At the moment, laser welding is the more suitable technique in dentistry because of its lower thermal alteration of the workpieces.

Non-cast titanium restorations in fixed prosthodontics

The problems encountered in casting titanium in dentistry have not been completely resolved. The Procera system forms crowns by means of a combination of spark-erosion and milling. The accuracy of fit was examined before and after ceramic veneering both in vitro and in vivo. Before veneering, on conical surfaces space widths were approximately 53 microns in vitro and 69 microns in vivo. At shoulders and occlusal surfaces, spaces of about 430 microns were measured in vitro and of about 500 microns were measured in vivo. After ceramic veneering, slight increases in space widths could be observed. The metal-ceramic compound was tested by the 3-point bending test (DIN) and the bending test (ISO). The DIN test was satisfactory, but not the ISO test. It is concluded that titanium crowns processed by the Procera System are suitable for clinical usage, if the space widths at shoulders and the occlusal surface and the special requirements of tooth preparation are taken into account.

Addition of enemas to oral lavage preparation for colonoscopy is not necessary

To evaluate whether the addition of enemas to oral electrolyte lavage is helpful for colonoscopic preparation, we conducted a prospective, randomized, observer-blinded trial to compare oral lavage plus enemas with oral lavage alone. The quality of preparation, mucosal visualization, and the volume of retained colonic fluid did not differ between the two groups. Twenty-two percent of the patients in the group who received oral lavage plus enemas compared with 12% of the patients in the group that only received oral lavage stated that they would refuse to repeat the preparation for future colonoscopic examination. Seventeen percent of the patients in the group that received oral lavage plus enemas demonstrated anorectal trauma or inflammation compared with only 5% in the group that received oral lavage alone (p = 0.09). These results indicate that the addition of enemas to oral lavage preparation for colonoscopic evaluation cannot be routinely recommended. However, enemas may be considered on an individual basis in the occasional patient unable to consume the complete oral lavage or in whom residual stool is found during colonoscopic evaluation after oral lavage preparation.

Computer-aided evaluation of occlusal load in complete dentures

A computerized diagnostic system was tested for its capability to evaluate the occlusal equilibrium of complete dentures. Its electronic sensor foil was calibrated to intraorally compute a load index for the left and right sides of the denture. The index is calculated by the measured force and number of occlusal contacts. Perfect equilibrium is given by a ratio of load left-to-load right of 1:1. Centric occlusion of complete dentures was examined before and after remounting. A good correlation between load index and the occlusal relationship on the articulator could be observed. The system appears to be suitable for verifying the need for occlusal adjustment. However, improvements concerning the hardware and software are necessary.

[The multidisciplinary outpatient pain clinic in relation to anesthesia. An important task for the anesthesiologist]

Anesthesiologists have always played a leading role in research into pain and its treatment. Their efforts, however, have been focused on acute or postoperative pain problems. It was the American anesthesiologist John J. Bonica who fought for an increased interest in chronic pain. The establishment of the first Multidisciplinary Pain Center at the University of Washington in Seattle, the foundation of the International Association for the Study of Pain (IASP) and Melzack and Wall's now 25 year old gate control theory were the driving forces behind rapid developments in research and treatment in the area of chronic pain. The realization that chronic pain was the most frequent cause of disability in the United States also gave an impetus for new efforts in treatment. The classic anesthesiological topics, such as operative anesthesia emergency medicine and intensive care, have been extended to include acute pain services and chronic pain treatment facilities. This reflects the understanding that anesthesiological knowledge and techniques can be valuable to patients in severe acute pain and those in lingering long-term chronic pain phases. Anesthesiologists are skilled in the use of opioid narcotics and in the administration of strong analgesics. Many severe pain problems can be solved by correct use of the analgesic regimen. Special ways of administering narcotic analgesics, such as epidural infusion or patient-controlled analgesia, have already alleviated the pain problems of many patients. Anesthesiological techniques are also crucial in diagnosis. Sequential differential blockade and simple nerve blocks can be helpful in the diagnosis and classification of the pain problems. Anesthesiological contributions to a chronic pain service are not restricted to medical interventions. Organizational skills are also needed for efficient running of multidisciplinary pain treatment facilities. Clinical practice in surgical anesthesia means that anesthesiologists are experienced in interdisciplinary work and familiar with the advantages and dangers of team work. Despite international acceptance of the multidisciplinary approach to chronic pain, there is still a lack of appropriate facilities in the German-speaking countries, and we consider it important that anesthesiologists commit themselves to increasing general awareness of what is needed.

Steady-state infusions of opioids in human. II. Concentration-effect relationships and therapeutic margins

We used computer-controlled individually tailored infusions to study relationships between plasma drug concentration and opioid effects, and to evaluate the therapeutic margins of alfentanil, fentanyl and morphine in human subjects. In order to compare the 3 drugs, we infused each opioid to 3 different steady-state target plasma concentrations during separate 8 h test periods so that concentration-effect curves could be defined for each opioid and subject. Dental electrical stimulation produced a consistent degree of baseline experimental pain, and we measured the influence of increasing plasma opioid concentrations on pain intensity and the magnitude of pain-related evoked potentials. We also quantified ventilatory function and subjective side-effects during baseline (no drug), at the 3 target plasma concentrations with each drug. Finally, we measured actual plasma opioid concentrations during each phase of the infusion period. This procedure allowed us to calculate for each opioid the plasma concentration required to produce a 50% decrease in reported pain intensity and evoked potential amplitude (IC50). Subsequent calculation of side-effect magnitudes at the analgesic IC50s permitted direct comparisons of therapeutic margins between alfentanil, fentanyl and morphine. We found a robust relationship between plasma drug concentration and analgesic, ventilatory, and subjective-effect magnitudes for each opioid in this study. We conclude that the magnitudes of individual side-effects associated with equianalgesic, steady-state plasma concentrations of these 3 mu receptor-selective opioids do not differ across drugs.

Bean pathogenesis-related (PR) proteins deduced from elicitor-induced transcripts are members of a ubiquitous new class of conserved PR proteins including pollen allergens

We have searched for induced transcripts in a cDNA library derived from bean cell supension cultures treated with an elicitor from Colletotrichum lindemuthianum. Six independently isolated cDNAs corresponding to rapidly induced small mRNAs have been classified by their DNA sequence and slightly different induction behaviour into two groups. 5'- and 3'-untranslated regions exhibit little similarity, but the deduced small acidic proteins designated PvPR1 and PvPR2 are 89% identical. No relationship was found with the well-characterized PR1 proteins from tobacco. However, the PvPR proteins are closely related to pI49 in pea (64% identity), pSTH2 in potato (41% identity) and PcPR1-1 in parsley (39% identity), which are also induced in response to elicitor or microbial attack. Moreover, a major pollen allergen in birch (BetvI) has a 44% identity with PvPR1 proteins. These similarities establish a ubiquitous class of conserved defense-related proteins and suggest a common yet still unknown function. Southern blot analysis indicates that PvPR protein gene organization is highly complex with an estimated copy number of more than 12 genes.

Crystallization of tuna ferricytochrome c at low ionic strength

Previous crystallographic studies of tuna ferricytochrome c have employed crystals grown from solutions of ammonium sulfate, corresponding to an ionic strength of 9.5 M (Takano, T., and Dickerson, R. E. (1981) J. Mol. Biol. 153, 95-115). To obtain a structure at a lower ionic strength, the ferric tuna protein was crystallized at neutral pH with polyethylene glycol at an ionic strength of 45 mM, These crystals (space group P2(1), a = 37.11 A, b = 107.66 A, c = 55.75 A, beta = 105.3 degrees) contain four molecules/asymmetric unit and grow to dimensions of 0.2 X 0.4 X 1.0 mm in 2-4 weeks. They diffract to beyond 1.8 A and are stable in the x-ray beam. We have recorded 28,198 unique Bragg reflections (83% of those possible) to a resolution of 1.89 A from a native crystal. We are undertaking a solution of this structure by the molecular replacement method.

The induction of phenylpropanoid biosynthetic enzymes by ultraviolet light or fungal elicitor in cultured parsley cells is overriden by a heat-shock treatment

The normal (25° C) response of parsley (Petroselinum crispum Mill.) cell suspension cultures to ultraviolet (UV) light was suppressed by a simultaneous 37° C heat-shock treatment, as indicated by the loss of the inducibility of two enzymes of flavonoid biosynthesis, phenylalanine ammonia-lyase (EC 4.3.1.5) and chalcone synthase. The effects on enzyme activity and on enzyme synthesis in vitro and in vivo were similar, indicating that regulatory control is at an early step of gene expression, presumably transcription. When heat shock was given during the course of an ongoing UV induction, both enzyme synthesis and enzyme activities ceased rapidly. Likewise, the induction of phenylalanine ammonia-lyase by an elicitor from Phytophthora megasperma f. sp. glycinea was terminated upon transfer from 25° C to 37° C. Based on these and previously published data, it is concluded that stress responses in this system are preferentially expressed in the order of heat shock, fungal elicitor and UV light.

Cinnamyl-alcohol dehydrogenase, a molecular marker specific for lignin synthesis: cDNA cloning and mRNA induction by fungal elicitor

Cinnamyl-alcohol dehydrogenase (CAD; EC 1.1.1.195) catalyzes the final step in a branch of phenylpropanoid synthesis specific for production of lignin monomers. We have isolated a full-length cDNA clone encoding CAD, as a molecular marker specific for lignification, by immunoscreening a lambda gt11 library containing cDNAs complementary to mRNA from elicitor-treated cell cultures of bean (Phaseolus vulgaris L.). The clone comprises a single long open reading frame of 1767 base pairs, 31 base pairs of 5' leader, and 152 base pairs of 3' untranslated sequence. The deduced 65-kDa CAD polypeptide has several features that are strongly conserved in alcohol dehydrogenases. Addition of fungal elicitor to cell cultures stimulates CAD transcription, which leads to a remarkably rapid, but transient, accumulation of CAD mRNA, with no detectable lag and maximal levels after 1.5 hr. Southern blot analysis of bean genomic DNA indicates that elicitor-induced CAD is encoded by a single gene. The regulatory significance of the rapid activation of this CAD gene and the possible existence of a second, divergent CAD gene involved in lignification during xylogenesis are discussed.

Dose effects of alfentanil in human analgesia

Alfentanil, a rapidly acting opioid, was given in subanesthetic doses to 10 subjects in a laboratory setting. Analgesia was assessed from the subjects' responses to painful dental stimulation. A subjective pain report (PR) and brain evoked potential (EP) amplitude were obtained repeatedly before and after injection on each of 4 testing days, on which the following intravenous doses were administered: 0 (saline solution), 5, 10, and 15 micrograms/kg. Significant dose effects were observed for EP amplitude during but not beyond the distributional t1/2 of the drug, but significant effects on the PR extended beyond this time point. Mean volume of distribution, total body clearance, and distribution t1/2 did not differ significantly across the doses of alfentanil. Strong correlations between each effect measure and plasma drug concentration were observed at all doses and were significant at P less than 0.01. The EP scores tracked the distribution of alfentanil very closely, but the correlation between EP amplitude and plasma alfentanil concentration was lower during the elimination phase. In contrast, the PR effects closely tracked the elimination of alfentanil but not its distribution. These findings suggest that EP amplitude and the PR represent two different central effects in opioid analgesia.

Synthesis of characteristic proteins in nutrient-depleted cell suspension cultures of parsley

Cell suspension cultures of parsley (Petroselinum crispum) exhibited an altered pattern of protein synthesis after transfer from complete growth medium to water or medium containing no macronutrients. Similar changes occurred when cultures were grown in the original medium until the nutrients were depleted. The effect was reversible upon transfer to fresh medium and was not observed during regular subculturing of the cells. While total protein synthesis decreased sharply after nutrient depletion, the synthesis of a few characteristic proteins (starvation-related proteins, STPs) increased strongly. The protein labeled at highest rates with [(35)S]methionine in vivo (STP 62) had an apparent molecular weight of about 62000 and a pI of about 6.3. Although its increased rate of synthesis was therefore easily detected by labeling in vivo, translation of mRNA in vitro did not give comparable results. Thus, regulatory control may be exerted mainly at the level of translation. Synthesis of STP ceased rapidly when heat shock (37° C) was applied under conditions of nutrient depletion, whereas heat-shock proteins were strongly induced.

Dermodress: a new, temporary skin substitute for extensive deep burn coverage

A chemically treated bovine skin, Dermodress, is presented as a long-term skin substitute. Dermodress was applied over denuded surfaces of debrided deep burns and was kept in place for up to 56 days. Dermodress adheres to all contours of the debrided surfaces, has hemostatic effect and does not present any signs of infection or rejection. Dermodress can be removed in stages according to the availability of autografts, which may be applied immediately, since the exposed areas are clean and suitable for immediate grafting. Our clinical experience shows that Dermodress has most of the required properties of a long-term temporary skin substitute.