Behavioral clusters and coronary heart disease risk.

The purpose of the present study was to empirically identify individuals who differed in their patterns of components derived from the structured interview (SI), and to evaluate whether individuals characterized by the different patterns varied in terms of their risk for coronary heart disease (CHD). The present study represents a reanalysis of data from the Western Collaborative Group Study in which components of Type A were individually related to risk for CHD. Subgroups of individuals who differed in the patterns of their component scores were identified by means of cluster analytic techniques and were found to vary in their risk of CHD. As expected, a pattern of characteristics in which hostility was salient was found to be predictive of CHD. Moreover, another pattern of characteristics that appears to reflect pressured, controlling, socially dominant behavior in which hostility was not salient also was found to be predictive of CHD. Further, two patterns of characteristics were identified that were unrelated to CHD risk. Finally, two patterns of characteristics were identified that were related to reduced risk of CHD. Overall, these results suggest that future research should investigate variables in addition to hostility in regard to risk for and protection from CHD.


Cognitive processing of contradictory statements: an experimental study of reasoning on proverbs in schizophrenia.

Twenty schizophrenic patients and 20 normal subjects matched for age, sex and verbal level were asked to identify, from a list of alternatives, the statement that was the most contradictory to each of 8 proverbs. Schizophrenics (whether severely disturbed or not) were found to be less accurate in detecting the contradictions [F(1,18) = 29.21; p less than 0.0001]. No significant differences between undifferentiated and disorganized DSM-III subtypes were observed. The greatest tolerance of contradictory statements was interpreted in terms of violation of the 'no contradiction principle' and examined in the light of a deficit in logical abilities.


Psychomotor activity in unipolar and bipolar depressive patients.

Findings on the psychomotor activity of unipolar versus bipolar depressive patients and on the relationship between psychomotor activity and sleep are divergent. In this study, the psychomotor activity of 37 depressive patients (25 unipolar, 12 bipolar) was examined by means of continuous actometric monitoring (48 h). The mean activity level of the unipolar depressives is higher (though not at a significant level) than that of the bipolar group. There is a weak but significant negative correlation between psychomotor activity and self-rated sleep time. Elderly and female patients display greater psychomotor activity than younger depressives and male patients. After matching for age and gender, the psychomotor activity of unipolar and bipolar patients is virtually identical; a significant correlation between psychomotor activity and sleep time cannot be established any more.


Power spectral analysis of heart rate variability in Type As and Type Bs during mental workload.

Recently several studies have suggested that there are differences in autonomic balance between Type As and Type Bs. This study evaluates a sympathovagal interaction in Type A (n = 8) and Type B (n = 11) male students during a mental arithmetic task by power spectral analysis of heart rate variability. The low-frequency component to high-frequency component ratio was significantly greater in Type As than in Type Bs during a resting period. No significant differences were found in heart rate changes and blood pressure between the two kinds of subject groups. The present findings indicate that there was a significant difference in sympathovagal balance between Type As and Bs. Type As showed dominant sympathetic activity.


Deficit of birthrates in winter and spring months in distinct subgroups of mainly genetically determined schizophrenia.

The birthrates of 507 schizophrenic patients with high familial loading were compared to the general population. The patient group showed a clearcut decrease in births within a defined winter and spring period. In particular, this was obvious if Leonhard's classification of schizophrenia was applied. The hypothesis is proposed that, in some fetuses at high genetic risk for schizophrenia, an exaggerated level of abortions or stillbirths occurs if additional environmental noxious agents are present in a crucial period of brain maturation. Pertinent evidence in support of this is found in literature.


Patterns of abnormal processing of emotional information in panic disorder and major depression.

Studies showing interference with color naming threat-related words in patients with anxiety disorders suggest a bias towards processing threatening material in these patients. We assessed the specificity of this finding to anxiety disorders and to threatening stimuli by administering Stroop cards with a variety of types of emotional stimuli to 24 panic disorder patients with no history of major depression, 30 patients with major depression and no history of panic attacks and 25 controls with no history of an axis I disorder. Our findings suggest that the abnormal information processing seen in panic disorder may be characterized by a more general bias towards processing emotional stimuli than previously thought. They also suggest that this more general bias may illustrate differences in information processing in panic disorder and major depression.


On the descriptive validity of DSM III schizophrenia.

The study sample is drawn from patients seeking evaluation in a psychiatric intake facility. It concentrates on those who are assigned a diagnosis of psychosis as stipulated in DSM III. The aim is to elucidate the distinguishing characteristics of patients diagnosed as Schizophrenia Disorder. The descriptive validity of this disorder is pursued by systematically comparing clinical and demographic characteristics of patients with this disorder to those diagnosed as Paranoid Disorder, Atypical Psychosis, Brief Reactive Psychosis, Schizoaffective Disorder and Schizophreniform Disorder. These comparisons uncover special characteristics pertaining to the demography and impact of schizophrenia. The results obtained are explained using generalizations drawn from the epidemiology, natural history and clinical manifestations of schizophrenia and other psychoses.


"Person under train" incidents: medical consequences for subway drivers.

From the subway driver's point of view, a "person under train" (PUT) incident is a serious life event. This study focuses on the 1-year consequences of such events. Follow-up was made 3 weeks, 3 months, and 1 year after the event. Forty consecutive PUT subway drivers were followed. For each PUT driver, a control driver matched with regard to gender, age, and country of birth was followed at identical intervals. The PUT group had significantly more sick days during the interval from the event to 3 weeks later. During the period 3 weeks to 3 months after the event no difference between the groups was observed. From 3 months to 1 year after the PUT significantly more days were again reported by the PUT group. Thirty-eight percent in the PUT group versus 14% in the control group had at least 1 month of sickness absence during this period. A mild acute psychophysiological reaction was observed 3 weeks after the event, with elevated prolactin and increased sleep disturbance in the PUT group. Such acute reactions were transitory and not correlated with long-term sick leave, which was predicted independently, however, by a high plasma cortisol level (analyzed in men) and a high depression score. Drivers in the group with seriously injured victims were absent from work for longer periods than drivers in the groups with mildly injured or dead victims.


Family stress and coronary risk in children.

This study examined children of 64 families for associations between a) family conflict and cohesion and b) plasma lipids, lipoproteins, and aggressiveness. Ratings of conflict and cohesion were obtained from parents. Children rated themselves on aggressiveness, one component of Type A behavior. The presence of conflict in the family was positively related to an unfavorable lipid profile (total plasma cholesterol/high-density lipoprotein cholesterol) among boys, but not girls. Family conflict predicted increased levels of aggression in girls, and in boys whose family cohesion was low. These findings suggest that stress in the family may play an important role in the development of coronary risk.


Sex differences and distinct subgroups in schizophrenia. A study of 54 chronic hospitalized schizophrenics.

Sex differences with regard to age at first hospitalization and residual symptomatology were investigated in 54 long-term hospitalized chronic schizophrenics. Patients fulfilled diagnostic criteria of DSM-III, Kraepelin's dementia praecox and Leonhard's group of schizophrenias as well. The severe residual psychopathology necessitated continuous hospitalization in all the patients. The 27 women and 27 men neither differed in duration of illness or period of hospitalization nor in their social environment. We found that women were older than men at their first hospitalization and exhibited more marked positive symptomatology during the course and in the residual state than men. However, regardless of the residual symptomatology, men generally received more neuroleptics. A classification of the schizophrenic patients by means of the Leonhard criteria revealed that unsystematic schizophrenics (affect-laden paraphrenia, periodic catatonia, cataphasia) of both sexes were significantly (p less than 0.001) more often married at the time of first hospitalization than were systematic schizophrenics. Further, there was an overwhelming preponderance of women among the group of affect-laden paraphrenia and, conversely, of men in the group of periodic catatonia. Presuming different etiology in affect-laden paraphrenia and periodic catatonia, our findings suggest a significantly varied frequency in the rate in which women and men are afflicted by heterogeneous subgroups of schizophrenia.


Effects of psychological treatment on cancer patients: a critical review.

Twenty-two studies on the effects of psychological treatment on cancer patients are reviewed. Only studies that compared one or more experimental conditions with at least one control group have been considered. The studies were evaluated with respect to a) research methods, b) psychological interventions, and c) results. Tailored counseling has been shown to be effective with respect to distress, self-concept, (health) locus of control, fatigue, and sexual problems. Structured counseling showed positive effects with respect to depression and distress. Behavioral interventions and hypnosis were effective with respect to specific symptoms such as anxiety, pain, nausea, and vomiting. The research methods, interventions and results of the studies are reviewed critically. Several recommendations for future research are made.


Composite resin veneers: a new technique.

A new technique for the fabrication of composite resin direct veneers is presented. In this technique, a transparent acrylic resin matrix is fabricated before preparation of the facial surface of the tooth, to allow the adequate reproduction of contour, shape, and surface texture originally exhibited by the tooth. Advantages, as well as limitations, of the procedure are also presented.


The use of adhesive metal partial crowns to restore attrition defects: a case report.

A patient presented with severe loss of enamel on the palatal surface of the maxillary anterior teeth, resulting from attrition. After correction of the mandibular occlusal position, the palatal defects were restored with metal partial crowns cemented with an adhesive cement. One of the six restorations dislodged during 4 years of observation, but was replaced successfully.


Treatment of gingival lichen planus with a free gingival graft: a case report.

Lichen planus is an inflammatory dermatosis affecting the skin and mucous membrane. In oral lichen planus, the gingival tissue is often involved. Treatment is symptomatic and depends mostly on the administration of corticosteroids and tranquilizers. This report presents the case of a patient with gingival lichen planus who was treated with free gingival graft. Followup after 3 1/2 years showed that the lesions had completely disappeared.


A new technique for the custom fabrication of mouthguards with photopolymerized urethane diacrylate.

The use of protective mouthguards in athletes has proven to be an effective and inexpensive means of preventing traumatic injuries to the teeth and supporting structures. Of the three general types of mouthguards available currently, the custom-fabricated type is considered superior to stock and mouth-formed protectors. A new technique is introduced for the fabrication of custom-made mouthguards with light-curing urethane diacrylate material.


Reparative dentin: factors affecting its deposition.

Results of this study showed no correlation between the thickness or amount of reparative dentin deposited and the type of dental restorative material placed at either 5 or 8 weeks in controlled Class V cavity preparations in monkey teeth. Factors such as preparation trauma from the bur, operator hand instrumentation, and microleakage of bacterial toxins played a greater role in the stimulation of reparative dentin than did material irritation or toxicity. Some differences in the thickness of the reparative dentin deposited were noted when teeth were grouped according to the amount of remaining dentin.


In vitro evaluation of marginal fit and morphology of fired ceramic inlays.

The marginal adaptation of fired ceramic inlays prepared by three dental technicians in two ceramic materials was evaluated in vitro. The thickness of the sealing gap varied between 46.4 and 57.6 microns, and the percentage of marginal ceramic defects ranged between 8.6% and 25.0% of the total inlay circumference. The incidence of marginal defects increased in areas of complex occlusal morphology. Differences observed in inlay adaptation were related to the technician rather than to the material used. The accuracy of ceramic inlays was comparable to that of metallic and porcelain-fused-to-metal crowns with butt-joint margins and fell within the range of clinically acceptable adaptation.


In vitro corrosion behavior of 13 prosthodontic alloys.

The corrosion behavior of 12 high-gold, low-gold, palladium-silver, and nickel-chromium alloys was tested using electrochemical techniques. A 22-carat-gold alloy was used as a control. High-gold alloys were extremely resistant to corrosion, but the resistance of the alloys decreased with decreasing mobility (from high-gold, to palladium-silver, to low-gold, to nickel-chromium alloys). Tests were also made to determine the type of corrosive attack; nickel-chromium alloys exhibited pitting, and palladium-silver alloys demonstrated the selective dissolution of the silver-rich phases. The corrosion resistance of noble alloys was far superior to that of nickel-chromium-based alloys; therefore, the palladium-silver alloys, which have a moderate price range, may be more suitable for restorations.


Preventive resin restorations: indications, technique, and success.

Although preventive resin restorations have been reported since 1977, there is little uniformity concerning the indications for this procedure, nor is there a standard technique. This article proposes diagnostic criteria for pit and fissure occlusal caries and diagnosis-related considerations for treatment planning for preventive resin restorations. A step-by-step "laminate" technique, which includes, successively, a glass-ionomer cement liner, a posterior composite resin, and a sealant, is described. The success rates reported for several clinical studies of preventive resin restorations are presented, although the criteria for this restoration, treatment methodology, and the determinates of success vary from study to study.


Enamel microabrasion followed by dental bleaching: case reports.

Certain enamel coloration defects can best be eliminated by a combination of treatment methods. This report describes the treatment of two patients whose enamel discoloration was corrected with a combination of enamel microabrasion and patient-administered dental bleaching with a carbamide peroxide gel solution.


Treatment of Class II open bite in the mixed dentition with a removable functional appliance and headgear.

Early diagnosis of patients exhibiting open bites that are complicated by skeletal Class II and vertical growth problems can facilitate subsequent treatment. Eight patients with Class II skeletal open bite were treated with the high-pull activator appliance and compared to reasonably matched controls to determine the effects of the appliance. The high-pull activator was found to reduce forward growth of the maxilla and increase mandibular alveolar height, transforming the Class II molar relationship into a Class I molar relationship. The overjet and open bite were decreased, and, in addition, the appliance reduced the amount of forward and downward movement of the maxillary molars, providing vertical control of the maxilla during Class II orthopedic correction. These results demonstrated that open bite complicated by a Class II vertical growth pattern can be treated during the mixed dentition with favorable results by a combination of a removable functional appliance and high-pull headgear.


In vitro growth of periodontal fibroblasts on treated cementum.

The aim of the present study was to assess the ability in vitro of phosphoric and citric acids, applied on human root cementum, to neutralize noxious plaque and calculus and to allow the growth of human gingival fibroblasts. Fibroblasts grown on cementum treated with phosphoric acid appeared typically elongated and aligned parallel to the root surface. Fibroblasts grown on cementum treated with citric acid, in both normal and periodontally diseased teeth, lost their elongated shape, acquiring polygonal borders with irregular cytoplasmic extrusions, and the cell density was significantly lower. These findings suggest that phosphoric acid cleaning of both normal and diseased root surfaces may result in an oriented, high rate of fibroblastic growth with more effective periodontal cellular proliferation than that observed after citric acid treatment.


Tooth buildup prior to endodontic treatment.

Inadequate isolation will greatly compromise routine endodontic therapy. Loss of coronal tooth structure to caries or trauma often makes adequate rubber dam isolation difficult to achieve. This article presents some techniques for placing a buildup prior to endodontic therapy. The few minutes spent placing a buildup prior to the initiation of root canal therapy are an excellent investment in time. The time spent will be repaid by the ease of placement of the rubber dam, the quality of isolation achieved, the reduced chance of losing the provisional restoration, and the increased quality of the completed endodontic treatment.


Bilateral transposition of maxillary canines and first premolars: case report.

Transposition of teeth is a rare phenomenon. A case of bilateral transposition of maxillary canines and first premolars in a 27-year-old man is described.


Color vision and dentistry.

Color vision is a critical component of restorative and esthetic dentistry, but dentists, as a group, do not have their color vision tested at any time during their careers. A study was undertaken to ascertain the color-vision status of practicing dental personnel at the University of Tennessee, College of Dentistry. One hundred fifty individuals, 75 men and 75 women, were screened. The results corroborated the existing medical data for the general population. It was found that 9.3% of the men and none of the women exhibited color-vision defect. Since most dentists are male, this study demonstrates an area of potential weakness for some practitioners. Once a color-vision problem is found, it is simple to remedy by employing a team approach to shade matching or mechanical means of matching shades (by the practitioner). No ethnic or racial distinctions were detected, although these have been reported in other studies.


In vitro evaluation of dentinal bonding agents in mixed Class V cavity preparations.

The effect of ten dentinal bonding agents on composite resin restorations was tested in mixed Class V cavity preparations. The marginal quality of the restorations was quantified under a scanning electron microscope before and after thermocycling. In addition, the marginal seal was semiquantitatively evaluated with a dye penetration technique. Marginal adaptation in dentin was poor in seven test groups. Three products showed values of excellent margin in dentin exceeding 50% after thermocycling. Furthermore, some dentinal bonding agents had a deleterious effect on marginal adaptation to the etched enamel surfaces.


The prevalence of nonrepaired fractured incisors in visually impaired Chinese children and young adults in Hong Kong.

The purpose of this study was to determine the prevalence of nonrepaired fractured incisors in visually impaired Chinese children and young adults in Hong Kong. Eighty-eight children were examined, and it was found that there were significantly more fractures of anterior teeth in the totally blind than in the partially blind. The totally blind seem to be at greater risk of sustaining a fractured anterior tooth than were the sighted.


The influence of environmental pressure on retentiveness of prosthetic crowns: an experimental study.

To determine the effect of pressure variations on the retention of prosthetic crowns, 36 identical, cast metal crowns were fixed to simulated, epoxy resin crown preparations with zinc oxyphosphate cement. Eighteen specimens were placed in a hyperbaric chamber and subjected to 15 cycles of simulated immersion at 30 m and decompression, as usually carried out by scuba divers. The untreated specimens served as controls. When the force required to dislodge the crowns was measured, the treated crowns were dislodged at about one third the load that was required to dislodge the control group, indicating that a statistically significant decrease in cement strength follows pressure variations.


Zinc oxide-eugenol pulpotomy and stainless steel crown restoration of a primary molar.

The most durable and reliable method of retaining a primary molar in the mouth after a pulpotomy procedure is complete-coverage restoration with a preformed stainless steel crown. This paper describes a method for performing pulpotomy and stainless steel crown restoration of a primary molar. Neither formocresol, glutaraldehyde, nor calcium hydroxide is used during the pulpotomy phase of the treatment.


Corrosion of a nonprecious metal post: a case report.

This paper describes a case in which an endodontically treated molar, which was restored with a post-retained cast restoration, was eventually lost following corrosion of the nonprecious metal post and fracture of the distal root.


Orthodontic forced eruption: case report of an alternative treatment for subgingivally fractured young permanent incisors.

Subgingivally fractured incisors are still a challenge to treat. A case report is used as a basis for reviewing the different treatment options, which involve either extraction or preservation of the root. A multidisciplinary approach, using orthodontic forced eruption, is presented in detail.


A guide for tooth resection with a used reamer or file.

Tooth resection is an important procedure, frequently encountered in dental treatment. A surgical guide is essential to providing the direction for tooth resection. A used (dulled) endodontic reamer or file can be utilized as directional guide for tooth resection, because it is economical, autoclavable, and safe. The clinical use of this surgical guide is described.


Overdentures and the periodontium.

Several periodontal factors are critical to the prognosis of overdenture abutment teeth. This literature review outlines these factors and discusses the documented effects of long-term overdenture use on periodontal health. The efficacy of a professional periodontal maintenance program, which is coordinated with a home oral hygiene program, is related to the success of overdenture therapy.


A new method for positioning the maxillary anterior arch, orienting the occlusal plane, and determining the vertical dimension of occlusion.

A new method for positioning the maxillary anterior arch, orienting the occlusal plane, and establishing the vertical dimension of occlusion in edentulous patients is described. The procedure uses a newly developed registration pin assembly that is fixed to the maxillary acrylic resin baseplate. The vertical dimension of occlusion is determined by having the patient swallow. This approach eliminates the tedious and time-consuming process of trimming the occlusion wax rims. The accuracy of the new method is currently being evaluated.


Fabrication of a fixed provisional restoration utilizing a light-curing acrylic resin.

The properly fabricated provisional restoration must take into account the following interrelated factors: pulpal protection, periodontal health, occlusion, esthetics, and phonetics. The techniques advocated for construction of a provisional restoration include direct, indirect, and a combination of direct and indirect techniques. Two simple techniques that use light-curing acrylic resin for the fabrication of fixed provisional restorations are presented, and advantages and disadvantages of these techniques are discussed.


Effect of bonded gold inlays on fracture resistance of teeth.

The purpose of this study was to determine if bonding gold inlays to tooth structure with an adhesive resin cement would increase the fracture resistance of restored teeth. Extracted paired maxillary premolars were prepared for mesio-occlusodistal inlays, and the inlays were cast in type II gold. In one tooth of each pair, the inlay was sandblasted with aluminium oxide, tin plated, and cemented with an adhesive resin into the etched preparation. For the other (control) tooth in each pair, the inlay was sandblasted and then cemented into the preparation with zinc phosphate cement. The teeth were thermocycled and loaded until fracture. The teeth in the bonded group had a statistically significantly higher fracture resistance than did the teeth in the control group. Scanning electron microscopic examination revealed that failure in the bonded group occurred predominantly within the resin.


Calcium release after acid pretreatment of fluoridated and nonfluoridated enamel.

Spectrophotometric analysis of calcium released by the acid-etching procedure was used to evaluate the effect of topical fluoride on the acid resistivity of enamel. The influence of superficial enamel surface reduction (chamfering) on the efficacy of the etching procedure was investigated.


Comparative investigation of dynamic loading of prepared and intact human premolars.

The aim of this study was to obtain some data on the dynamic strength of premolar teeth. Experiments were performed on three groups of human premolars: intact teeth, teeth prepared for partial veneer crowns with flat occlusal surfaces, and teeth prepared for partial veneer crowns with rounded occlusal surfaces. The loading procedure was performed in a modified Amslers high-frequency pulsator. The greatest dynamic strength was exhibited by the intact specimens. The highest continual (unlimited number of loading cycles) dynamic stress withstood by all three groups of premolars was about 300 N. A statistically significant negative correlation was found between Fmax and the number of cycles in all three tested groups.


A scanning electron microscopic observation of inner carious dentin after cleansing and of the dentin-resin interface.

Inner carious dentin after cleansing and the dentin-resin interface were observed with scanning electron microscopy. Results suggested that, similar to 10% citric acid-3% ferric chloride solution, 10% ethylenediaminetetraacetic acid may thoroughly remove the smear layer on the surface of inner carious dentin and make it possible for the dentinal bonding agent to penetrate the cleansed dentin to form an acid-proof layer and dense resin tags. These changes may improve the bond strength as well as tubule aperture seal. Ethylenediaminetetraacetic acid is not destructive to collagen, and may be of negligible toxicity to the pulp of intact dentin.


LET, track structure and models. A review.

Swift heavy ions when penetrating through matter strip off those electrons having a smaller orbital velocity than the ion velocity. The remaining electrons screen the nuclear charge yielding an effective charge. The effective charge of the ions interacts predominantly with the target electrons causing excitation and ionizations of the target atoms. Using the Bethe Bloch formula for the energy loss combined with the Barkas formula for effective charge, the energy loss values as well as unrestricted and restricted linear transfer can be calculated within a few percent of accuracy. From the primary energy loss only a small fraction of 10% or less is transformed into excitation. The major part of the energy loss is used for the ionization of the target atoms and the emission of the corresponding electrons with a high kinetic energy. These electrons form the track around the trajectory of the primary ion in which two thirds of the primary energy is deposited by collisions of primary, secondary and later generations of electrons with the target molecules. In the electron diffusion process the energy is transported from the center of the track into the halo. The radial dose decreases with the square of the radial distance from the center. The diameter of the track is determined by the maximum range of the emitted electrons, i.e. by the maximum energy electrons. All ions having the same velocity i.e. the same specific energy produce electrons of the same energy and therefore tracks of the same diameters independent of the effective charge. But the dose inside the track increases with the square of the effective charge. Track structure models using this continuous dose distributions produce a better agreement with the experiment than models based on microdosimetry. The critical volume as used in microdosimetry is too large compared to the size of the DNA as critical structure inside the biological objects. Track structure models yield better results because the gross-structure of the track i.e. its lateral extension and the thin down toward the end of the track is included in these calculations. In a recent refinement the repair capacity of the cell has been included in a track structure model by using the complete shouldered x-ray survival curve as a template for the local damage produced by the particle tracks. This improved model yields presently the best agreement with the experiment.


Cell inactivation by heavy charged particles.

The inactivation of cells resulting in lethal or aberrant effects by charged particles is of growing interest. Charged particles at extremely high LET are capable of completely eliminating cell-type and cell-line differences in repair capacity. It is still not clear however whether the repair systems are inactivated, or merely that heavy-ion lesions are less repairable. Studies correlating the particle inactivation dose of radioresistant cells with intact DNA analyzed with pulse field gel electrophoresis and other techniques may be useful, but more experiments are also needed to assess the fidelity of repair. For particle irradiations between 40-100 keV/microns there is however evidence for particle-induced activation of specific genes in mammalian cells, and certain repair processes in bacteria. New data are available on the inactivation of developmental processes in several systems including seeds, and cells of the nematode C. elegans. Future experimental and theoretical modeling research emphasis should focus on exploring particle-induced inactivation of endpoints assessing functionality and not just lethality, and on analyzing molecular damage and genetic effects arising in damaged but non-inactivated survivors. The discrete nature of selective types of particle damage as a function of radiation quality indicates the value of accelerated ions as probes of normal and aberrant biological processes. Information obtained from molecular analyses of damage and repair must however be integrated into the context of cellular and tissue functions of the organism.


Light ion accelerators for cancer therapy.

The paper concentrates on the accelerator choices for light ion cancer irradiation facilities, as outlined in several proposals over the last 15 years and concludes with the description of a modern synchrotron facility. Further summary papers on the same subject are cited in references [14, 19].


Beam delivery systems for charged particles.

Heavy charged particle therapy, started at research institutes three decades ago, is now on the verge of entering a clinical phase. This phase has resulted from the evolution and development of various beam delivery systems and techniques with existing research accelerators and with newly built accelerators. For the first thirty years, heavy charged particle therapy was administered with a fixed horizontal beam line. In 1991, the first treatment with an isocentric gantry was administered. The development of the isocentric gantry, the newest beam delivery system, and clearly a consequence of all the experience gained at the earlier facilities has many advantages. It offers advantageous physical properties of the particles as well as being equal in the flexibility of dose delivery to the modern photon radiotherapy gantries.


Clinical gain from improved beam delivery systems.

The feasibility of dynamic conformal heavy charged particle radiotherapy has been investigated at UCLBL, and shows high promise of: 1. an improved therapeutic ratio and 2. reduction in the number of treatment portals required for efficient treatment delivery. Assessment of dose to tumor and critical structures for several anatomical sites have been carried out using a normal tissue complication algorithm developed at LBL. For high-LET charged particle treatment delivery, dynamic conformal therapy using a raster scanned beam with variable modulation and multileaf collimator appears to be the optimal technique for treatment delivery.


3D treatment planning for heavy charged particles.

The comments herein describe, at a necessarily superficial level, a number of issues which must be addressed in developing plans for heavy charged particle therapy. Programs now exist which provide the needed capabilities. The challenge now is to make the planning process easier and faster--and possibly more effective. It seems likely that this will be achieved in the next few years.


Dopamine functions in appetitive and defensive behaviours.

The data reviewed here are compatible with the hypothesis that telencephalic dopamine activity is elicited by motivationally significant stimuli which in turn creates a neural state in which animals are more prepared to respond to significant stimuli in the environment. This analysis may be viewed as extensions of both the sensorimotor hypothesis, which depicts dopamine as potentiating the ability of stimuli to elicit responses (Clody and Carlton, 1980; Marshall et al., 1974; White, 1986) and of the incentive motivational hypothesis, which emphasizes the importance of dopamine in responding to stimuli that serve as signals of biologically significant events (Blackburn et al., 1989a; Crow, 1973; Mogenson and Phillips, 1976). In addition, we have sought to emphasize that not all responses are equally dependent upon the integrity of forebrain dopamine activity. Some responses, such as ingestion of standard foods by hungry animals, copulation, and escape, are relatively impervious to dopamine disruption. Further, once other behaviours, such as avoidance or appetitive operant responses, have been acquired, they can be maintained at an initially high rate despite perturbation of dopamine systems, although performance deteriorates with repeated testing. This analysis has emerged from the joint consideration of how both appetitive and defensive behaviours are influenced by dopamine antagonists, along with an examination of dopamine release during sequences of behaviour. The data reviewed suggest that dopamine is involved in fundamental psychological processes through which environmental stimuli come to exert control over certain aspects of behaviour. In the future, as knowledge in this field advances, there will have to be an integration of the literature on dopamine and motivation with the literature on dopamine and motor systems. We expect that dopamine release will be seen as a mechanism by which important environmental cues, of innate or learned significance, lead to a general enhancement of motor skeletal responses directed towards distal cues. We conclude with a caveat: Caution must be exercised when attempting to infer a general role of any neurotransmitter in motivated behaviour based on the study of a limited number of motivational systems. Although neurotransmitter pathways may figure prominently in the control of certain behaviours, it is incorrect to think of neurotransmitters as having a single role in behaviour. However, when comparative analyses reveal a common thread among different motivational systems, as is becoming apparent for the general role of mesotelencephalic dopamine pathways in behaviour, then the goal of generating coherent and comprehensive theory concerning a neurotransmitter's function in behaviour will begin to be realised.(ABSTRACT TRUNCATED AT 400 WORDS)


[Magnetic resonance in trigeminal neuralgia].

One of the possible causes of the so-called "essential" trigeminal neuralgia is a neurovascular compression of the fifth cranial nerve root at the pons. The demonstration of this hypothesis could orientate the surgical treatment to microvascular decompression. In order to evaluate the role of MRI in the diagnosis of trigeminal neuralgia due to neurovascular compression, the authors present the results of a prospective evaluation of the cranial MR studies of 18 neuralgic patients in comparison with a retrospective evaluation of the cranial MR studies of 50 healthy control subjects. The results show that neurovascular compression can be demonstrated in 83.3% of the neurological patients. In all cases a good correlation between the clinical symptoms, the side of positive MR findings and the surgical findings, when available, was demonstrated. On the other hand, neurovascular compression was demonstrated in 28% of the healthy control subjects. The authors conclude that neurovascular compression can be demonstrated in a high percentage of patients with the so-called "essential" trigeminal neuralgia. Compared with the other imaging modalities (angiography, Computed Tomography) MRI is the best technique in the diagnosis of this disease. In fact, MRI is not only able to differentiate the symptomatic from the essential type of neuralgia, but is also very sensitive in the identification of trigeminal neuralgia due to neurovascular compression. This diagnosis could direct the surgical treatment to microvascular decompression.


[Magnetic resonance in the study of the facial nerve: methodological approach and normal anatomy].

The authors report their experience in the study of facial nerve anatomy by means of MR Imaging. The seventh pair of cranial nerves was studied in 6 healthy and informed volunteers with a super-conductive MR unit at 0.5 T using surface and head coils. Slices were 3 mm thick and were acquired on the axial and sagittal planes, when the petrous and the mastoid bones were studied. The parotid gland was studied with 5-mm slices acquired on the axial, angled axial, and sagittal planes. In all cases T1-weighted images (TR 450, TE 30) were performed. If the above research protocol, which is relatively simple and direct, is applied, the whole course of the facial nerve up to its main distal branches can be almost completely demonstrated.


[Technical principles of solid tridimensional modeling with computerized tomography for the study of maxillofacial diseases].

3DCT allows the solid modeling of body structures from contiguous slices. The 3D images are free to rotate on the x, y, and z axes. It is possible to evidentiate structures with various densities by means of threshold operators, which allow a 3D model of both soft tissues and bones to be obtained. Shading operations allow image quality to be improved by varying the elementary units to surface units ratio. Implemented 3D rendering reduces the spatial edges by means of anti-aliasing functions. The 3D images allow the study of the complexity of maxillofacial bony structures, and they are especially useful in both surgical planning and in postoperative follow-up. We studied 58 patients with maxillofacial diseases (34 traumatic, 14 malformations, 4 dysplastic, and 6 neoplastic). In most cases (96.5%), we obtained high-quality images, which allowed both the site and the extension of the lesions to be evaluated, together with their relationships to adjacent structures. In 65% of traumatic cases, the 4 basic views thoroughly demonstrated lesion spread, while in the extant 35% of cases cutting operations and rotatory translations were necessary. In all malformation cases a clear visualization of somatic asymmetries was obtained. In both dysplastic and neoplastic cases, the best lesion evidence was obtained in superficial lesions with cortical bone involvement. This technique was always easy and quick to perform, with no need for supplemental dose exposure to the patient.


[Diffuse idiopathic skeletal hyperostosis. Review of diagnostic criteria and analysis of 915 cases].

DISH is a common systemic skeletal disease, probably of dysmetabolic and/or degenerative origin, yet of unknown etiology. It is observed in middle-aged or elderly patients of both sexes, and is characterized by ossification of the anterior longitudinal ligament on the antero-lateral aspect of the spine, and by ossifying enthesopathy, in both the central and the peripheral skeleton. Diagnosis is solely based on radiographic abnormalities, according to the so-called Resnick criteria. In the present study, the spines of 915 patients (414 males, 501 females, mean age: 65 years) were considered, and the peripheral entheses (heel, patella and elbow) of 494 of them (234 males and 260 females). The incidence of DISH was 14.09% (129 cases): 17.6% in males (73 cases) and 11.7% in females (56 cases). DISH strikes in the VI and VII decades of life most. The most affected sites of the spine were: the dorsal portion (100%), especially in the D7-D11 segment (93%); the lumbar spine in L1-L3 (81%), and the cervical spine, in the C5-C7 segment (69%). Peripheral areas of involvement were: pelvis (90%), heel (76%), elbow (46%) and knee (29%). The symptoms of DISH must be promptly detected: the disease is not asymptomatic, but presents with pain and stiffness in the spine, recurrent tendinitis and bursitis, and myelopathy.


[Ultrasonic assessment of the capsular-ligamentous structures of the ankle. Normal features].

The study of normal ankles by means of US has enabled the authors to define the articular system so as to obtain a useful reference for the study of pathological ankles. A real-time (Ansaldo AU 530) unit with a 10 MHz sectorial probe was employed together with a Toshiba unit with a 7.5 MHz sectorial probe. In 6 cases, the stretching of the capsuloligamentous system before arthroscopy was examined. The authors' attention focused on 3 major functional anatomic areas: the talofibular ligament area, the calcaneofibular ligament area, and the deltoid ligament area. The comparison of US scans before and after stretching the capsula with a physiological solution allowed the most interesting structures to be recognized and quantified from a US-anatomical point of view. Useful parameters were both the length of the lateral aspect of the ligament (mean difference in length between rest and exercise conditions: 15 mm for the anterior talofibular ligament and 14 mm for calcaneofibular ligament) and the thickness of intra-articular echoes (mean value: 5 mm).


[Mammography and echography in the study of breast prosthesis].

Between October 1990 and December 1991, the authors studied 58 women with breast implants (46 monolateral and 12 bilateral prostheses) by means of clinical examination, mammography, and US. The patients' age ranged 31-56 years (mean: 32). Thirty women had undergone subpectoral implantation, 22 subcutaneous and 18 retroglandular. In the group of subpectoral prostheses, 4 women had periprosthetic fibrosis and 3 presented benign calcifications; in 1 case both fibrosis and calcifications were observed. In the depiction of retroglandular implants, US appeared to be very useful: indeed, it detected 3 fibroadenomas and 5 cysts that had been missed at mammography. The only 2 breast carcinoma recurrences (1 non-palpable lesion, confirmed at surgery) were observed in patients with retrocutaneous prostheses. Both mammography and US currently play a major role in the follow-up of women with breast implants. Benign complications and breast cancers can be promptly detected even in patients with no palpable findings.


[Mammary ductal system. Echographic features].

Real-time breast US is useful in the evaluation of localized lesions. Our study was aimed at examining the US features of the ductolobular system in physiological condition. To this purpose, all breasts were imaged on the radial plane by rotating the probe around the nipple, thus depicting the ductal system from nipple to gland periphery. The patients were made to lie supine or to sit down. In order to depict small lobular excrescences, TV magnification was employed on the target areas. Five hundred and twenty asymptomatic women were evaluated with US; preliminary mammograms had been obtained in 440 of them. Any subject with prominent duct shadows on mammography or mammographic and/or US demonstration of focal lesions was excluded from the study. Different US patterns were observed in the ductolobular system, depending on patients' age, mammographic patterns, physiological hyperplasia during pregnancy and/or involution after pregnancy and lactation. The ductal branches were demonstrated by US only in mammographically dense areas. Thus, US has been observed to allow the evaluation of the physiological changes in the ductolobular system.


[Invasive pulmonary aspergillosis: possibility of radiologic diagnosis].

The incidence of invasive pulmonary aspergillosis is increasing in the patients with malignant hematologic diseases; this occurs in the phase of granulocytopenia induced by chemotherapy. In these cases an early diagnosis is mandatory to start a prompt antimycotic treatment. The authors reviewed the personal series of 56 patients with malignant hematologic diseases who, in the phase of granulocytopenia, developed a pulmonary lesion: 32/56 with invasive pulmonary aspergillosis; 8/56 with Candida and 16/56 with bacterial infection. All patients underwent several conventional radiologic controls: 9 cases with invasive pulmonary aspergillosis were also studied with Computed Tomography (CT). After a short pathologic introduction, the conventional radiologic and CT patterns of invasive pulmonary aspergillosis are analyzed, both at onset and over its evolutive phase. The most significant feature for an early conventional radiologic diagnosis is the nodular pattern--single or multiple--; this allowed a correct diagnosis, at onset, of 20/32 (62%) invasive pulmonary aspergillosis cases. CT provided a further diagnostic contribution by showing a peri-nodular halo. Of interest was also the CT demonstration of high-density pleural thickening adjacent to the mycotic lesion, probably due to fungal involvement of the sub-pleural space. The routine chest roentgenogram is the modality of choice; CT may be useful in questionable cases.


[Atkinson prosthesis in esophageal carcinoma. Radiologic study: when CT?].

The endoscopic palliative treatment of esophageal and esophagocardial neoplastic stenoses is generally performed in the patients in whom surgery is not indicated for oncological and general reasons and endoscopic dilatation is uneffective. Our experience is reported concerning 92 patients submitted to palliative therapy through placement of Atkinson prostheses; the patients underwent radiologic studies--i.e. (a) plain chest radiographs (before and after intubation), (b) esophagogastric studies with iodate cm, and (c) CT (performed in the last 20 cases only). The mortality rate at 30 days was 6.5% (6 cases), in no case due to specific complications related to intubation. The mean survival was 3.6 months (range: 1-12). As to the complications specifically related to intubation, they were basically 3: perforation, dislocation, and obstruction (of the prosthesis). As to the methods allowing best demonstration of the same: a) CT proved to be superior in revealing perforation, which usually occurs early after intubation. However, considering its low incidence (2 cases only, in our series), the routinary use of CT does not seem justified. CT should be reserved to selected patients in whom the shape of the neoplasm or peculiar anatomical conditions make intubation difficult, with high risks of perforation--e.g., kiphoscoliosis, hiatal hernia, previous surgery or radiotherapy, angulation of the prosthesis, neoplasm of scirrhous or necrotic type or causing luminal deviation; b) if dislocation occurs, as it more often happens (9 cases in our series) in the presence of soft neoplastic tissue or in cases of mild or asymmetrical stenosis, CT seems likewise unnecessary. Conventional radiology proved superior thanks to its more comprehensive view, and therefore sufficient to suggest the correct treatment--e.g. repositioning of the prosthesis by means of fiberoscopy, or withdrawal after gastrostomy; c) CT appeared useless in the cases due to alimentary causes (easily detectable from the clinical history), but proved useful in the cases due to neoplastic overgrowth. In the latter, CT can yield information as to the site and size of the neoplasm, as well as to its relationship to surrounding tissues, and thus help suggest proper treatment--e.g. dilatation and repositioning of the prosthesis, gastrostomy, recanalization by means of NdYAG laser, no treatment at all.


[Radiologic assessment of extent of ulcerative colitis in acute phase].

One of the major reference points for both prognosis and treatment of ulcerative colitis is the assessment of its extent. Plain abdominal radiographs were performed on 97 patients previously diagnosed, by means of rectoscopy and histobiopsy, as having acute ulcerative colitis. Within the following 36 hours they underwent either full colonoscopy or colectomy. The extent of colitis was evaluated by means of double-blind radiography. The results were then statistically compared with those obtained from endoscopy or from direct study of surgical colonic specimens. There was agreement between the final X-ray results and the actual extent of ulcerative colitis in 78 of 97 patients (80.4%, r = 0.86). The highest agreement was observed in those patients whose lesions were localized in the rectosigma (81%) and in those with fully extended colitis (90%). The most useful radiological findings in predicting the extent of colic lesions were irregular mucosal profile and thickening of colic wall. The presence of these two signs, together with the flattening or swelling of interhaustral folds and the impossible visualization of the right colon, are invariably suggestive of fully extended colitis. On the contrary, no abnormal findings were present on plain abdominal films in 74% of proctosigmoiditis cases. Plain abdominal radiography seems to be useful for the initial evaluation of acute ulcerative colitis. It allows the early discrimination between diffuse and localized forms, and makes it possible to postpone more invasive and dangerous investigations to a remissive phase of the disease.


[Role of MR in characterizing expansive lesions of the adrenal gland].

Five patients with adrenal tumors (20 metastases, 12 adenomas, 8 myelolipomas, 6 primary tumors, 4 pheochromocytomas, and 1 hyperplasia) were studied by means of MRI with SE sequences. Twenty of them underwent dynamic study with GE sequences after i.v. injection of paramagnetic contrast media. Sixteen of 20 metastases exhibited low signal intensity on T1 and high signal on T2. One patient had low signal on both T1 and T2. Two lesions in patients with melanoma showed high signal in T1; in 1 case, the lesion exhibited a hemorrhagic area. Signal from adenomas was low in T1- and T2-weighted pulse sequences in 10/12 patients, while in the extant 2 cases signal was higher in T2. Myelolipomas had hyperintense signal on T1-weighted images in 5 cases and isointense signal with the renal cortex in the extant 3 cases. Pheochromocytomas and primary tumors appeared hypointense on T1 and hyperintense on T2. In 3 CT questionable cases, MRI showed the adrenal origin of the lesion. Dynamic study with GE sequences after Gd-DTPA injection showed low enhancement and fast washout in adenomas, while malignant lesions had higher enhancement and slower washout. In our study, MRI allowed to correctly characterize 11/12 adenomas, with only 1 false negative in a metastatic lesion.


[Hydronephrosis and peripelvic cysts. A new echographic sign for the differential diagnosis].

The differential diagnosis of peripelvic cysts and hydronephrosis by means of US sometimes presents some problems; in fact, the use of urography to solve a diagnostic doubt is not uncommon. This study was aimed at demonstrating that another US sign, which we have called the "convexity" sign, can be useful in allowing peripelvic cysts to be distinguished from hydronephrosis. Thus, cysts exhibit convex walls and curved outline, whereas in hydronephrosis the walls of the dilated calices are linear. The latter feature is present in all degrees of hydronephrosis, except in severe cases. Forty-nine adult patients, a total of 98 kidneys, were examined with US and urography; 69 kidneys were found to be pathologic: 48 presented with cysts, and 21 with hydronephrosis. In addition to the new sign, the classic signs of peripelvic cysts were also considered, that is the separate areas and the non-visualization of the ureter. The sensitivity of the new sign was 97% and its specificity was 95%. The sensitivity and the specificity of the classic signs were 97% and 95%, respectively for the separated areas, and 100% and 91% for the non-visualization of the ureter. The cumulative sensitivity of the 3 signs was 99%, and their specificity 96%. Our results show how the integrated analysis of the considered signs (especially those with high specificity) is useful for the differential diagnosis, and therefore to avoid the indiscriminate use of urography.


[Echographic features of urachal cysts].

The authors discuss the anatomical, clinical, and US patterns of 5 cases of urachal cysts observed in pediatric patients (average age: 9.2 months) over the last 4 years. All cases had surgical confirmation. Linear and convex probes with 3.75, 5, and 7.5 MHz frequency were employed. Most of the observed lesions were oval in shape, their size ranging 3-6 cm; they were found in ventral-epivesical regions and had no mobility. Liquid echotexture with hyperechoic deposits on the lower layers was observed in 2 cases, and inhomogeneous solid or complex mass-like echotexture in 3 cases (suppurated cysts). Differential diagnosis includes mesenteric cyst, simple and teratomatous ovarian cyst, bladder diverticulum and hydrometrocolpos. Echotomography exhibited high accuracy in detecting this kind of lesion and allowed guidance of percutaneous drainage for the preoperative treatment of infected cysts. Both cystography and CT appeared to be useless.


[Percutaneous transcatheter embolization of deep visceral pseudoaneurysms].

The authors present their experience with the percutaneous embolization of 13 splanchnic aneurysms and pseudoaneurysms (2 pseudoaneurysms of gastroduodenal artery, 3 of the hepatic artery, 7 renal pseudoaneurysms, 1 aneurysm of the splenic artery). In 9 of 13 cases the lesions were iatrogenic. Embolizing devices and techniques are described. Percutaneous embolization was successful in 12 of 13 cases, and useless in 1 case of renal pseudoaneurysm. In the 12 successfully treated cases the lesions were still occluded in the follow-up period. Transcatheter percutaneous embolization is the elective treatment in splanchnic aneurysms and pseudoaneurysms; surgery must be performed only when embolization fails.


[Comparison of acceptance tests of 5 linear electron accelerators for radiotherapy].

The acceptance tests of five electron linear accelerators have been analyzed to compare their completeness, the standards specified by the manufacturers and the measured deviations. Involved tests were relative to geometrical and mechanical parameters, photon and electron beam characteristics, dose monitoring systems, treatment table and safety systems. The comparison of acceptance tests has shown a significant nonuniformity, also due to the absence of a specific legislation; anyway, the measured deviations generally appeared to be within internationally recommended values.


Structure and parameterization of pharmacokinetic models: their impact on model predictions.

There has been an increasing interest in physiologically based pharmacokinetic (PBPK) models in the area of risk assessment. The use of these models raises two important issues: (1) How good are PBPK models for predicting experimental kinetic data? (2) How is the variability in the model output affected by the number of parameters and the structure of the model? To examine these issues, we compared a five-compartment PBPK model, a three-compartment PBPK model, and nonphysiological compartmental models of benzene pharmacokinetics. Monte Carlo simulations were used to take into account the variability of the parameters. The models were fitted to three sets of experimental data and a hypothetical experiment was simulated with each model to provide a uniform basis for comparison. Two main results are presented: (1) the difference is larger between the predictions of the same model fitted to different data sets than between the predictions of different models fitted to the dame data; and (2) the type of data used to fit the model has a larger effect on the variability of the predictions than the type of model and the number of parameters.


The role of cancer risk in the regulation of industrial pollution.

The extent of carcinogen regulation under existing U.S. environmental statutes is assessed by developing measures of the scope and stringency of regulation. While concern about cancer risk has played an important political role in obtaining support for pollution control programs, it has not provided the predominant rationale for most regulatory actions taken to date. Less than 20% of all standards established to limit concentrations of chemicals in various media address carcinogens. Restrictions on chemical use are more frequently based on concerns about noncancer human health or ecological effects. Of the chemicals in commercial use which have been identified as potential human carcinogens on the basis of rodent bioassays, only a small proportion are regulated. There is an inverse relationship between the scope of regulatory coverage and the stringency of regulatory requirements: the largest percentages of identified carcinogens are affected by the least stringent requirements, such as information disclosure. Standards based on de minimis cancer risk levels have been established for only 10% of identified carcinogens and are restricted to one medium: water. Complete bans on use have affected very few chemicals. The general role that carcinogenicity now plays in the regulatory process is not dramatically different from that of other adverse human health effects: if a substance is identified as a hazard, it may eventually be subject to economically achievable and technically feasible restrictions.


Bivariate distributions for height and weight of men and women in the United States.

For the U.S. population, we fit bivariate distributions to estimated numbers of men and women aged 18-74 years in cells representing 1 in. intervals in height and 10 lb intervals in weight. For each sex separately, the marginal histogram of height is well fit by a normal distribution. For men and women, respectively, the marginal histogram of weight is well fit and satisfactorily fit by a lognormal distribution. For men, the bivariate histogram is satisfactorily fit by a normal distribution between the height and the natural logarithm of weight. For women, the bivariate histogram is satisfactorily fit by two superposed normal distributions between the height and the natural logarithm of weight. The resulting distributions are suitable for use in public health risk assessments.


An analysis of the uncertainties in estimates of radon-induced lung cancer.

A recent report by the National Academy of Sciences estimates that the radiation dose to the bronchial epithelium, per working level month (WLM) of radon daughter exposure, is about 30% lower for residential exposures than for exposures received in underground mines. Adjusting the previously published BEIR IV radon risk model accordingly, the unit risk for indoor exposures of the general population is about 2.2 x 10(-4) lung cancer deaths (lcd)/WLM. Using results from EPA's National Residential Radon Survey, the average radon level is estimated to be about 1.25 pCi/L, and the annual average exposure about 0.242 WLM. Based on these estimates, 13,600 radon-induced lcd/yr are projected for the United States. A quantitative uncertainty analysis was performed, which considers: statistical uncertainties in the epidemiological studies of radon-exposed miners; the dependence of risk on age at, and time since, exposure; the extrapolation of risk estimates from mines to homes based on comparative dosimetry; and uncertainties in the radon daughter levels in homes and in the average residential occupancy. Based on this assessment of the uncertainties in the unit risk and exposure estimates, an uncertainty range of 7000-30000 lcd/yr is derived.


Interspecies extrapolation: a reexamination of acute toxicity data.

We reanalyze the acute toxicity data on cancer chemotherapeutic agents compiled by Freireich et al.(1) and Schein et al.(2) to derive coefficients of the allometric equation for scaling toxic doses across species (toxic dose = a.[body weight]b). In doing so, we extend the analysis of Travis and White (Risk Analysis, 1988, 8, 119-125) by addressing uncertainties inherent in the analysis and by including the hamster data, previously not used. Through Monte Carlo sampling, we specifically account for measurement errors when deriving confidence intervals and testing hypotheses. Two hypotheses are considered: first, that the allometric scaling power (b) varies for chemicals of the type studied; second, that the same scaling power, or "scaling law," holds for all chemicals in the data set. Following the first hypothesis, in 95% of the cases the allometric power of body weight falls in the range from 0.42-0.97, with a population mean of 0.74. Assuming the second hypothesis to be true-that the same scaling law is followed for all chemicals-the maximum likelihood estimate of the scaling power is 0.74; confidence bounds on the mean depend on the size of measurement error assumed. Under a "best case" analysis, 95% confidence bounds on the mean are 0.71 and 0.77, similar to the results reported by Travis and White. For alternative assumptions regarding measurement error, the confidence intervals are larger and include 0.67, but not 1.00. Although a scaling power of about 0.75 provides the best fit to the data as a whole, a scaling power of 0.67, corresponding to scaling per unit surface area, is not rejected when the nonhomogeneity of variances is taken into account. Hence, both surface area and 0.75 power scaling are consistent with the Freireich et al. and Schein et al. data sets. To illustrate the potential impact of overestimating the scaling power, we compare reported human MTDs to values extrapolated from mouse LD10s.


Microenvironmental analysis of residential exposure to chromium-laden wastes in and around New Jersey homes.

The purpose of this study was to identify the significant microenvironments that can lead to chromium exposure in Hudson County, New Jersey residential settings near or on soil contaminated with chromium waste. Measurements were made in indoor air, outdoor air, and house dust. Surface dust was found to be the best index of potential Cr exposure. The values of Cr in Hudson County household dust ranged from 3.25-320 ng/cm2 in wipe samples and 1.0-12 ng/cm2 in vacuum samples. Elevated Cr in household dust was found to be related to residential locations near large chromium waste sites, household cleaning habits, and house renovation activities. Outdoor Cr air levels were similar to those obtained in other urban areas at these seasons of the year, approximately 5-7 ng/m3. Comparisons with measurements of the Cr levels in urine found that the elevated Cr in dust was associated with elevated excretion of Cr. Site-specific Cr differences in household dust suggest different sources and routes of exposure. Within the total group of homes in the present study, Cr in household dust was the major influence on household exposure.


[Study of 94 cases of sarcoidosis with special reference to erythema nodosum].

We studied 94 patients diagnosed of sarcoidosis in order to establish the incidence of erythema nodosum (EN), in the course of sarcoidosis, in our setting and to check if it induces different clinical and analytical characteristics in patients. 37 patients (39%) showed EN with a mean age of 41 +/- 1.62 years and with a marked female predominance (81%). Its presence was associated with a higher frequency of general symptoms (p less than 0.01), articular manifestations (p less than 0.001), specially in knees and ankles (p less than 0.01), subacute evolution (p less than 0.001), raise in GSR and of alpha-one-globulin (p less than 0.01) and hypoalbuminemia (p less than 0.05). On the other hand, those patients without EN showed higher frequency of dermal lesions different from EN (p less than 0.001) and the articular manifestations were localized preferentially in knees and proximal interphalangeal articulations of hands (p less than 0.05). We underline the high incidence of EN in sarcoidosis in our setting, which originates a more benign clinical type with a more favorable prognostic, embedded in the course of sarcoidosis, to which EN would transfer its clinical, analytical and immunopathogenic characteristics.


[Evaluation of the incidence of nephrotoxicity associated with the use of aminoglycosides in patients with extrahepatic biliary obstruction].

In the present publication we discuss nephrotoxicity (NT) incidence by reviewing all the clinical histories of one year (May 1989-May 1990) with diagnosis of obstructive jaundice or cholangitis. Of a total of 90 patients. 53 were treated with aminoglycosides and 37 received other antibiotics. Nephrotoxicity developed in nine patients of the group that received aminoglycosides (17%), versus only three patients (8%) in the other group. Both groups were comparable regarding sex, age and liver and renal basal functions. Analysis of the variables that could be associated with a higher incidence in the nephrotoxicity group that received aminoglycosides showed that there were no differences regarding age, sex, dosage, duration of treatment, plasmatic levels of aminoglycosides and liver and renal basal functions. Only simultaneous administration o furosemide was significantly associated with the development of nephrotoxicity. Results of this study underline the need of a prospective follow-up of patients with biliary obstruction during treatment with aminoglycosides. Meanwhile the evidence available allows us to recommend the monitoring of renal function in this type of patients.


[Primary pulmonary leiomyoma. Presentation of 3 cases].

Pulmonary leiomyoma is a benign tumor of mesodermal origin, very rare of which only three cases have been described on the Spanish scientific literature. We present our experience with three new cases and discuss the clinical and therapeutic characteristics of these neoplasms according to their topographical localization. We insist on the need of a gynecological revision when females are affected, because its possible association with uterine tumors.


[Bisalbuminemia and bisalbuminuria: a study of a familial case].

We present one case of hereditary bisalbuminuria and bisalbuminemia in a Spanish family with three affected members. The double band of albumin was detected accidentally in an routine analytical study of a patient who showed hyperuricemia, this originated the study of the rest of the members of the family. Protein electrophoresis, in serum as well as in urine, showed a double band of albumin, which as in most published cases corresponded to the slow migration type. With immunoelectrophoresis its immune identity with common albumin was established. The biochemical parameters assessed did not show any alteration which could correlate the protein disorder with any associated pathology.


[Lyme disease: 4 reported cases in the Autonomous Community of Aragon].

Lyme's disease (LD) is a multisystemic infection due to Borrelia Burgdorferi transmitted through the byte of a vector arthropod of the Ixodes genre. Until now we do not know exactly which is the geographical distribution in our setting, no case have been published in the Aragon Community. We present four patients diagnosed of Lyme's disease following clinical and serological criteria (IFI) according to the recommendations of the Spanish Group for the study of Lyme's disease. A patient with Chronic Migratory Erythema (ECM); two others in stage II--one with predominant dermal lesions and other with predominant neurological symptoms--and finally, a patient in stage III with polyarticular symptoms and with antecedent of having showed a lymphocytic meningoencephalitis.


[Multiple pulmonary nodules as an unusual manifestation of pulmonary tuberculosis. Description of 3 cases].

Pulmonary tuberculosis is still one of the more frequent diseases in our setting, adopting a wide variety of clinic as well as radiologic presentations. We present three cases of pulmonary tuberculosis with multiple bilateral pulmonary nodules of segmentary localization, one of them requiring thoracotomy to perform the diagnosis.


[Alimentary factors and gastric cancer: design of a hospital based case-control study].

One of the most widely used design in etiologic research is the case-control study. In the present work the methodology used in the design of a case-control study, performed in a hospital setting, which objectives was to verify etiological hypothesis related with food-intake and gastric adenocarcinoma and 234 controls from the population--188 selected through a randomized selection on the phone book and 46 following neighborhood criteria--are studied. The methodology and the development of the field work are described, with a special interest in the possible bias incurred during its design and development.


[Analysis of energy intake, macronutrients and micronutrients in a child population].

With the objective to know precisely the qualitative and quantitative food intake of the infant population of a Health Care Area, the weekly intake of Energy, Proteins, Total and Saturated Fat, Food Fiber, Cholesterol, Calcium, Phosphorus, Magnesium. Iron, Zinc and Vitamin A is studied in 187 pupils, representative of the whole (835 children) population of two schools of Fuenlabrada and Leganés (Madrid), following the Weekly Register technique. Total consumption is quantified, and stratified according to sex and age groups. In order to perform a proper evaluation of these parameters, their adequacy to the Intake Recommendations for age and sex is analyzed, finding an excessive intake of calories, proteins and lipids in all age groups: being saturated Fat a third of the total daily Fat; Carbohydrates intake less than 50% of total energy, which would be desirable to maintain the nutritional ratio. Calcium intake, insufficient in some age group, together with the strong correlation proteins-phosphorus as well as total and saturated Fat with Cholesterol of the diet, allow to conclude that the excessive protein intake is predominantly due to meat products. It is also noted the lower intake of Zinc, Calcium, Magnesium, as to the recommended in certain age groups, therefore said individuals are at risk to suffer deficit of these micronutrients.


[Epidemiology of acute poisoning: a study of 851 cases detected in the southern area of the Madrid community in 1990].

Epidemiology of acute intoxication (AI) must be reviewed periodically to know its trends, therefore, following a line of RESEARCH, we have studied the AI's attended on the Emergency Ward of Internal Medicine at Hospital Doce de Octubre (Madrid). We found that most of them are voluntary (93%): in females being predominant the suicide attempt and in males the AI secondary to illegal drugs use. Toxic drugs have been used in 96% on suicide attempts; the relative incidence of each drug does not vary, but AI with more than one toxic diminish. Within the non-drug toxics, illegal drugs come first, followed by alcohol. Drug-addiction is the numerically most frequent antecedent; depression is predominant in suicide attempts, alcoholism is infrequent in ethyl AI. ICU admissions represent an intermediate figure in our country, mortality (most of them due to overdose) is similar to those of non-Spanish series.


[Preliminary results of a program of home oxygen therapy using transtracheal catheter].

We present our experience with oxygen-therapy with transtracheal catheter in the period between January 1990 and December 1991. This procedure was offered to 130 patients who met criteria of home oxygen-therapy being accepted only by twelve. Ten patients maintained oxygen-therapy with transtracheal catheter with excellent results and a notable improve in their quality of life. One patient died twenty-three days after beginning the procedure, due to evolution of main disease finding no role of the catheter in the disease. Another patient showed a vagal reaction after placement of the catheter, which forced to perform resuscitation with connection to mechanical ventilation taking the catheter off because familiar request. Patients who benefit this type of oxygen-therapy the trans-tracheal catheter has showed its usefulness. With few complications and showing no problems in its home handling. Oxygen savings with this technique have been of 55%. Trans-tracheal catheter was much more effective than face mask to correct desaturation after exercise (p less than 0.001).


[Mixed semi-specific cutaneous myiasis].

A case of mixed semi-specific cutaneous myiasis produced by larvae from Calliphora vicina Rob.-Desv. and Lucilia sericata Mg, in their third development stage, is described, as the first case in humans, although there is a precedent described in domestic animals. Main taxonomic characteristics and diagnostic features of the parasites are discussed, together with the implications of their biology in the observed clinical case, discussing, as well the prophylaxis and therapy.


[Pulmonary lymphangiomatosis associated with renal angiomyolipoma. Presentation of a case and review of the literature].

The case concerned is one of lymphangiomyomatosis (LAM) in a woman aged 39, that after a episode of spontaneous pneumothorax was subject to medical research for progressive dyspnea of medium efforts and bloodstained sputum. High resolution CT showed numerous thin-walled cystic airspaces of varying sizes distributed diffusely throughout the lungs. The abdominal CT and ultrasound developed multiple right renal angiomyolipomas. The histopathological study of the sample obtained by open lung biopsy was conclusive of LAM. The main feature of this rare disease, which occurs almost exclusively in women of reproductive age, is the abnormal proliferation of immature smooth muscle at the level of the distal airway, small blood vessels and lung lymphatic system, including sometimes the mediastinal and retroperitoneal lymphatic system. The clinical, functional, radiological and differential diagnostic aspects with entities histopathologically similarities are discussed and the therapeutic possibilities are reviewed.


[Yellow nail syndrome: presentation of a case and review of the literature].

We discuss the yellow nails syndrome which is constituted by yellow nails, pleural effusion and lymphedema. After reviewing the literature, it can be said that nail disorders are an early and constant sign, and its absence could put in doubt the diagnosis of this syndrome. The most frequent pleuro-pulmonary disorder is the pleural effusion, chylous or exudative type. It is believed that the origin of this disease could be a congenital hypoplasia of the lymphatic vessels. Lymphography and the morphologic study performed show a diminution in the number and size of the lymphatics vessels (lymphedema) which are hypoplastic, varicosities and tortuous dilations are sometimes observed.


[Determination of glycosylated hemoglobin in clinical practice care of diabetes].

At the end of 1989 a transversal study to know the availability of glycosylated hemoglobin as a control parameter in diabetic patients was done. Two hundred and three physicians-specialists in diabetes-provided information on the fraction, technique and reference interval used in their clinical practice. 90 +/- 4% of the participants were able to obtain, in their settings, the determination of glycosylated hemoglobin. Regarding work-places it is outstanding that 36 +/- 15% of the physicians in primary care did not have the possibility to get this parameter determined. Fraction and technique more widely used were, respectively, HbA1 and Ionic Interchange Chromatography performed with HPLC. There was no homogeneity in the reference intervals for HbA1 and HbA1c, considering different methodologies. The possibility to obtain different glycosylated hemoglobin determined, depends on the setting where the health care is being provided. It is important to know the reference interval of the Center where the determination is being done, in order to correctly interpret the glycosylated hemoglobin values of each patient.


[The role of free oxygen radicals in myocardial damage from ischemia/reperfusion, in chronic obstructive bronchopneumopathy and in aging].

During the last few years, several observations point out that oxygen-free radicals may play a pivotal role in the development of myocardial ischaemic/reperfusion injury, chronic obstructive pulmonary disease (COPD) and aging. With particular reference to acute myocardial ischaemic syndrome, these compounds may account for reperfusion-mediated ventricular arrhythmias, myocardial stunning and cell death. Such molecules may also be involved in lung damage during the course of COPD. In this regard, polymorphonuclear cell (PMN) recruitment at myocardial and/or lung level play an important role in oxygen-free radical overproduction. Several factors may, in fact, trigger PMN adhesion, respiratory burst and/or lysosomal enzyme release, this leading to a deleterious effect for the host. As far as elderly is concerned, evidence has been provided for a strict relationship between oxygen-free radical generation and metabolic rate. Nevertheless, the occurrence of PMN impaired functions and malnutrition in aged subjects gives rise to an enhanced synthesis of these compounds. All together, these findings outline the toxicity of oxygen-derived radicals and suggest the usefulness of a therapeutical approach to antagonize their effects.


[Skin manifestations in 140 kidney transplants].

Cutaneous lesions can be a significant problem in kidney transplant recipients. The AA report a clinical spectrum of iatrogenic, infectious, preneoplastic and neoplastic skin diseases in 140 renal transplant recipients observed, from march 1988 to july 1991, at the Catholic University in Rome. Iatrogenic skin manifestations were the most common, followed by infections of the skin and preneoplastic and neoplastic cutaneous lesions.


[Food allergy and asthma].

The prevalence of asthma in patients suffering from food allergy or food intolerance had been studied in 1339 subjects. Of them, 165 patients (12.8%) were affected by asthma. However only 77 (5.7%) had positive prick tests for food antigens and 52 of these have a significant benefit when a suitable oligoallergenic diet was introduced. 35 out of patients were positively tested with a double-blind food challenge. The most frequent food antigen involved were milk and its derivatives and cereals, but some importance have also the additives to the food. In conclusion, in our patients suffering from food allergy or food intolerance asthma was present in 12.8% of the cases, but in only 77 (5.7%) the symptoms might be due to diet. When tested with oligoallergenic diet or with food challenge the percentage of positivity fall to 3.9% and 2.6% respectively.


Adrenomyeloneuropathy and hypothyroidism. A 15 year follow-up case report.

A case of adrenomyeloneuropathy with diffuse focal demyelination throughout the entire central nervous system, is described in a 29 years old, an adult male, who developed Addison's disease at 14 years of age. Since the age of 23 he has been affected by a progressive spastic paraparesis of the inferior limbs associated with urine incontinence. In the last two years reduced cerebral function, peripheral neuropathy, impotence, primary hypothyroidism and high levels of VLCFA plasma concentration have appeared.


Primary empty sella syndrome and hypogonadotropic hypogonadism in young male patients.

Twelve male patients with absence of pubertal development and hypogonadotropic hypogonadism underwent a contrast-enhanced computed tomography of the sellar region and dynamic endocrine testing consisting of insulin-induced hypoglycemia, GnRH and TRH test. In two patients, clinically indistinguishable from the others, the presence of an empty sella turcica was demonstrated. They also showed, in comparison with patients with normal sellar morphology, an absent prolactin response to hypoglycemia with otherwise normal pituitary function. Empty sella, either due to congenital incompetence of the diaphragma sellae or to pituitary shrinkage due to regressive changes by hemorrhage, infarction and possibly autoimmune phenomena, may rarely be associated with hypogonadotropic hypogonadism.


[The articular sequelae of rheumatic fever: Jaccoud's dislocation arthritis. A case report].

A case of rheumatic fever with severe heart involvement, in which articular rheumatoid-like features involving both hands appeared many years after clinical onset, is described. After reviewing the articular sequelae of rheumatic fever and describing the clinical features of each form, the authors point out the main differences between rheumatic fever and rheumatoid arthritis, and diagnose Jaccoud's arthritis.


[Osteosclerotic micromolecular plasmacytoma].

We describe a patient with a k light-chain myeloma revealed by an apparently solitary mixed lytic and sclerotic rib lesion. This rare manifestation may be explained by a still balanced bone remodeling in the early phases of the disease.


[The locoregional treatment of neoplastic ascites with interferon-beta].

Peritoneal effusion recurrence is one of the most important problem in the palliative management of patients with gastrointestinal malignancies and ovarian cancer. Ten patients with recurrent malignant ascites (three with ovarian cancer, two with pancreas cancer, two with gastric adenocarcinoma and one affected by colon cancer, one patient with peritoneal carcinomatosis, one subject with pleural mesothelioma surgically treated that after three years showed a peritoneal metastases and ascites), were treated with intraperitoneal beta interferon. In all patients a Tenckoff's catheter for peritoneal dialysis was introduced and peritoneal effusion extracted and measured. Three millions of beta interferon in saline solution was infused in peritoneal cavity every three days for nine days. Successively twenty millions every three days for nine days. In the 50% of patients a significant reduction of peritoneal effusion was observed. The locoregional therapy with beta interferon is proposed in palliative management of malignant ascites.


[The nimodipine therapy of acute focal cerebral ischemia (minor stroke). A clinical study with an assessment of regional cerebral blood flow by SPECT].

Aim of the study is the evaluation of therapeutic effectiveness of nimodipine in acute focal cerebral ischaemia. Thirty patients affected by minor ischaemic stroke divided in two randomized groups have been studied consecutively: all the patients were treated with standard therapy, nimodipine was delivered in addition only to the patients of the first group. Both clinical evaluation using Mathew scale, modified by Gelmers, and flowmetric evaluation with SPECT were performed at different times. The results haven't shown any significant statistical difference in the effectiveness of the therapy between the two groups even if a positive clinical trend was evidenced in the group treated with nimodipine. The flowmetric study has shown the poor homogeneity of the groups from a physiopathological point of view not-with-standing the two groups were similar for the clinical severity, sex, age and vascular risk factors. We conclude that is advisable to carry out further trials in which the comparison study groups are more numerous and balanced also from a physiopathological point of view.


The neuro-immune network. Some recent developments.

Neuroimmunomodulation encompasses, by definition, numerous components and activities primarily derived from the immune system, and treats the immunoneuroendocrine interconnections at different levels of the integrated whole functioning organism. The arbitrary unit of the immunoneuroendocrine network is the immune microenvironment composed of lymphocytes, neurons, endocrine cells, nonlymphoid accessory cells, humoral factors from immune, nervous, endocrine and other tissues, receptors for endogenous and exogenous ligands, pathways for transduction of biological signals, physiological ions, various magnetic and electromagnetic compartments, and impulses from the higher nervous activity (the mind, the psyche). The neuroimmunomodulation is a marvelous mechanism from which arises an amazing quantity of variables and intercommunications in the living organism. Being a multidisciplinary science par excellence, neuroimmunomodulation is strongly antidogmatic and favors multidirectional organization of research. That means that actions of the immune, nervous and endocrine systems should be studied together in terms of intercommunications among identifiable structures and processes. Therefore, research endeavors in neuroimmunomodulation have different directions with seminal discoveries much too numerous to list here. This mini-review is confined to some recent findings dealing with the immunomodulatory activity of micromagnetic fields when applied to the brain, the humoral and cell-mediated components of certain neurological and psychiatric diseases, the autoimmune features in heroin addicts in relation to dementia and HIV infection, the neuroimmunobiology of lithium cation, and the in vivo immune function of enkephalins, and methionine-enkephalin in particular.


[The knowledge of pharmacological therapy of a group of Calabrian nurses. The Cultural Association of Nurses of Catanzaro and the Ospedale di Matera Working Group].

Results of a surveys on nurses' knowledge on drugs, conducted by a group of nurses from 10 hospitals of Calabria Region, are presented. Data were specifically collected on: a. drug cocktails in parenteral infusions, b. antibiotic prophylaxis for medical and surgical patients, c. side effects of drugs, according to nurses perception and d. conflicts between nurses and doctors on drug therapy. Results, though not to be considered representative of the real practice, on the large number of cocktails administered to patients and the wide range of antibiotics used for medical and surgical prophylaxis, evidence how wide is the gap between theoretical principles and practice. The importance of a sound pharmacological knowledge on drugs in order to enable nurses to monitor practice and open a constructive dialog with doctors on drug therapies is stressed.


[Reconstruction of the function and shape of the middle region of the face].

The anatomical structures and biomechanical features of the middle third of the face require various methods of osteosynthesis in case of fracture. Compression osteosynthesis is mainly confined to the lateral margin of the orbits, where the transverse section of the bone is made so as to resist the force applied to attach the osteosynthetic material. If thin bone blades are fractured, as is often observed in the middle level of the face, adapting osteosynthesis is a method operating without compression. It can be regarded as the method of choice for this type of fracture.


[Traumatic rupture of the levator tendon of the upper eyelid].

We report on two cases of traumatic desinsertion of levator aponeurosis. After a blunt trauma diagnosis between levator aponeurosis desinsertion and neurogenic ptosis is important in planing the treatment: early surgery for the first and foregoing for the later.


[The value of computer reconstruction of the frontal and sagittal planes of the facial structures].

The authors evaluate the merits of computer reconstructions in the coronal and sagittal planes to assess the anatomy of the facial structures. If the patient can be kept motionless, the coronal plane provides information similar to those obtained by a study with direct sections. The ethmoidofrontal recesses, the lamina cribrosa, the thin relief of the middle meatus, the floor of the orbit are perfectly examined. The sagittal plane provides a new approach of the anterior and posterior cortical bone, of the frontal sinus, of the nasofrontal canal, of the ethmoidal cells, of the sphenoid sinus and of the vault of the palate.


[The maxillofacial surgeon faced with the HIV-positive patient: risks and prevention].

Prevention against the transmission of the HIV must be universal today, which means that it applies to all patients. Blood, tissues, the CSF are infected, but nasal secreta, tears and saliva are not contaminated unless they contain blood. The statistical risk of an HIV serological conversion when making an injection is an estimate of 0.1 to 0.3%, one hundred times less than with the hepatitis B virus. The best protection for maxillofacial surgeons, who are very exposed by the manipulation of objects (needle, wires) and by considerable projections of blood (rotary motor) is not a systematic HIV serological test for all patients, but goggles with side screens, a double pair of gloves and the use of an antiseptic acting on the HIV in case of staining.


[Group educational intervention in diabetic foot: the objectives, pedagogical strategies, level of knowledge and results].

Detailed contents and aims of an educational intervention for diabetic foot are presented, together with evaluation tools and results at 3, 6 and 12 month interval after the course. Knowledge level and "health" of the foot were assessed at 12 month interval on 2/3 of the 100 diabetic patients originally exposed to the educational intervention. After 12 months 80% of patients showed a good retention of knowledge on practical issues related to foot care, while 77% of patients with persistent foot problems were not independent (because of hypo-mobility or sight problems) in foot care.


[Current evaluation of a self-snapping screw system in traumatologic and orthodontic surgery].

Since the first description in 1970, by F. X. Michelet, of the use of the mini plate system in maxillo-facial surgery, if the fundamental principles remain the same, the equipment has been constantly improved. The plates have been modified in structure and shape, the screws becoming self-tapping and self-drilling and finally self-breaking. The head of the screw has diminished to the point of not going over the level of the plate. The ancillary material is now more performing and easier to use. The authors have presented 3 years ago a new self breaking screw of which they now explain the technical and biomechanical bases, the necessities and the indications insisting on the numerous advantages of this system.


[Initiatives of the Rivista dell'infermiere].

Several research, reflection and work proposals had been published in Rivista dell'infermiere during the past 6 years, with the double aim of starting a dialogue with the reading public and activating research projects. Some of the proposals were carried out and published, some are still at proposal level. A list of proposals presented, divided according main subjects, are presented together with a request to readers to suggest which one Rivista dell'infermiere should develop in the next two years.


[Calcinosis of the temporomandibular joint: apropos of a case and critical review of the literature].

We report a case of calcinosis of the temporo-mandibular joint. This microcrystalline arthropathy by deposits of calcium pyrophosphate crystals is exceptional at this level; it is necessary to look for other localizations joints to diagnose articular chondrocalcinosis. The local prognosis is the same with surgical treatment in case of articular destruction or significant deposits.


[Mountain sports: their role in 2200 facial injuries occurring over 4 years at the University Hospital Center in Grenoble].

Injuries caused by mountain sports account for many of the injuries admitted to the University Hospital of Grenoble. Out of 4,490 traumas, 470 were injuries sustained during the practice of mountain sports. While the frequency of these accidents does not evolve much, the etiological distribution depends on fashion. Thus an increasing number of lesions caused by cross-country biking has been noted during the past two years. We find it urgent to propose protective measures adapted to this new sport.


[Severe atrophy of the alveolar ridge in edentulous patients. Combined treatment using bone grafts and screw implants].

In cases of advanced alveolar ridge atrophy, when the bone available for endosseous implants is not sufficient, endosseous implants are combined with augmentation of the alveolar ridge by means of autologous bone transplants. Depending on the type of atrophy found, the authors use three different surgical procedures: onlay technique, sandwich technique and alveolar extension technique. In all cases functional loading of the implants was performed by way of an entirely implant-supported bridgework. Results to date indicate that initial postoperative resorption is followed by a virtual standstill once the implants have been loaded.


Tumour markers CA 19-9 and CA 50 in digestive tract malignancies.

CA 19-9 and CA 50 are tumour marker tests measuring the same carbohydrate structure, sialosyl-fucosyl-lactotetraose--that is, the sialylated Lewis blood group antigen. In addition, the C50 antibody reacts with sialosyl-lactotetraose, which may be expressed in small amounts in some carcinomas. In this study we compared these tests in sera from patients with benign and malignant digestive tract diseases. The sensitivity of the markers for different cancers was also compared at several specificity levels with patients with benign diseases as reference groups. Both markers showed a high sensitivity for pancreatic cancer (77% for CA 19-9; 69% for CA 50) and biliary cancer (88%). The figures in colorectal cancer were almost as high as those reported for CEA; 16-21% elevated values in Dukes A and B tumours and 44-47% in Dukes C and D tumours. The sensitivity for gastric cancer was 48% for both markers. CA 50 had a higher sensitivity for liver cancer (55%) than CA 19-9 (9%), but the proportion of elevated values in benign liver diseases was also higher (33% versus 15%, respectively). Overall, there was good correlation between the CA 19-9 and CA 50 levels, and the difference in sensitivity and specificity was marginal. In clinical practice the greatest value of CA 19-9 and CA 50 is in the diagnosis of pancreatic cancer.


Effect of cisapride on relapse of reflux oesophagitis, healed with an antisecretory drug.

Maintenance treatment with cisapride was evaluated in 298 patients in whom reflux oesophagitis had been healed with antisecretory drugs. Initially, 34% of the patients had grade-I oesophagitis, 33% had grade II, and 33% had grade III. The patients were treated with 20 mg cisapride twice daily or placebo for 6 months or until endoscopic relapse was shown if this occurred earlier. Survival analysis showed that cisapride significantly prolonged the time to endoscopic relapse in grade-I patients (P = 0.02). The intergroup difference in symptomatic relapse in all patients was also significant (P = 0.010). The effect of cisapride was less clearcut in grade II or III, and/or in patients healed with omeprazole. Factors associated with early relapse were placebo therapy, prior omeprazole therapy, duration of pre-trial symptomatic period, and initial endoscopic severity grade. Adverse experiences were limited; diarrhoea was reported by 9% of the cisapride patients.