Expectant management of intramural ectopic pregnancy.

BACKGROUND: Intramural ectopic pregnancy is unusual, difficult to diagnose, and associated with a high rate of uterine rupture. CASE: A 35-year-old, gravida 3, para 0-0-2-0 was diagnosed with intramural ectopic pregnancy by ultrasound showing a gestational sac surrounded completely by myometrium. It was confirmed by laparoscopy. With expectant management, the gestation resolved spontaneously. CONCLUSION: Early diagnosis by ultrasound of intramural ectopic pregnancy permits expectant management which, if successful, would aid in maintaining fertility.

Actinomyces viscosus colonization of mouse teeth.

The implantation of Actinomyces viscosus strain T14V-J1 was studied in mice in vivo. The optimum age range for implantation was from 40 to 80 days. The minimum infective dose of strain T14V-J1 required for colonization in all inoculated animals (ID100) was 5 X 10(8) CFU for 40-day-old mice and 1 X 10(9) CFU for 100-day-old mice. The high ID100 required for implantation of strain T14V-J1 in these mice is consistent with the finding that tooth surfaces of these animals are not colonized by detectable indigenous Actinomyces. The infection could also be transmitted to non-infected mice housed with infected mice. This in vivo model can be used to evaluate the potential for reducing or preventing Actinomyces colonization on teeth by vaccination with fimbrial adhesins.

Antigenic variation of indigenous streptococci.

Isolates of Group D streptococci indigenous to the murine oral cavity were studied to detect the occurrence of antigenic variation. Group D streptococci cultured from molar homogenates of Balb/c mice were randomly selected for study on the basis of distinctive colony morphology. Isolates obtained over a 12-week period were biotyped using the API 20S system, and subjected to Lancefield extraction and rocket immunoelectrophoresis for serotyping. All isolates were compared with an arbitrarily selected standard test strain (W1S-1) isolated the first week of the first experimental series. Four biotypes were encountered during the first week of two experimental series. Two very unusual biotypes detected during the first experimental series persisted throughout that series, as did two more common biotypes throughout the second experimental series. Anti-W1S-1 serum produced three precipitin bands (antigens O, D, and K) against W1S-1 Lancefield extract and against the respective biotypes detected during the first week of the two series. Of the three antigens detected, only the group antigen (D) did not vary during either experimental series. Antigenic variants lacking the O or K antigen and bearing these distinctive phenotypes were repeatedly isolated in subsequent weeks. Ultimately, 16% of 190 strains isolated during the first series and 26% of 167 strains isolated during the second series proved to be antigenic variants of the predominant biotypes detected in both series.

Actinomyces adsorption mediated by type-1 fimbriae.

Monospecific antibody against the type-1 fimbriae of Actinomyces viscosus T14V reacted with 12 strains of A. viscosus (serotype 2), 12 strains of A. naeslundii (serotype 2 or serotype 3), but not with 11 serotype 1 strains of A. naeslundii. All strains positive for the type-1 fimbrial antigen adsorbed strongly to saliva-treated hydroxyapatite, and in many instances (18 of 24 strains) this interaction was inhibited by the monospecific antibody. These findings strongly suggest that only those strains of actinomyces which possess type-1 fimbriae adhere to the tooth surfaces, and that these fimbriae constitute the principal adhesin involved in this interaction.

Specific antibodies and their potential role in periodontal diseases.

Periodontal diseases are thought to result from inflammatory responses to bacterial challenges in the gingival crevicular area. Antibodies are a major host-protective mechanism in many bacterial infections. Consequently, the antibody responses to suspected periodontal pathogenic bacteria have been extensively measured as to their relationship to diseases and specificity for suspected pathogens associated with progressing disease sites. Recently, studies on the bacterial immunogen characterization, antibody-subclass identification, and antibody biological capabilities have been reported. Although increased antibody levels to certain suspected periodontal pathogens were associated with periodontal diseases in humans, little evidence exists as to the role of these antibodies in the infectious process. In vivo experiments in animals indicated that specific antibodies against certain suspected periodontal pathogens were associated with suppression of bacterial colonization, limiting the spread of infection, and a decrease in alveolar bone loss. However, in vitro as well as in vivo experiments suggested that phagocytic cells are required for efficient bactericidal activity of antibodies and that the presence of other sensitized immune cells may either have inhibited or enhanced the infectivity of certain periodontal pathogens. Possible explanations for the observed inconsistencies are presented and the potential for utilization of specific anti-periodontal pathogen responses in the understanding and prevention of diseases is discussed.

Measuring clinical attachment: reproducibility of relative measurements with an electronic probe.

During the past few years, improvements in detecting longitudinal changes in clinical attachment or alveolar bone density have been introduced. For example, constant-force electronic probes and computer-assisted subtraction analysis of longitudinal radiographs have been reported to be more sensitive and reproducible in detecting changes in clinical attachment or alveolar bone density, respectively. Use of these new technologies requires that sources of measurement error be identified and their contribution quantified. This study investigated the reproducibility of a constant-force electronic probe in a careful clinical setting. Measurements were performed from individually fabricated acrylic stents. Three groups of subjects were selected for the study: 10 adults without oral disease, 10 adults with gingivitis, and 10 adults with moderate periodontitis. Four probing designs were employed to investigate the reproducibility of the probe. In design A, the probe tip was left in the sulcus between successive probings. In design B, the probe tip was removed from the gingival margin between probings but the next probing followed immediately. In design C, successive whole-mouth probings were interrupted by a 5-minute interval and a mouth rinse. In design D there was a 4-week interval between each successive probing. Three measurements were taken at each site for each design. The main purpose of this study was to identify variance components in the attachment level variation. The maximum probing error standard deviation ranged from 0.2 to 0.3 mm depending on the periodontal health of the subject. This level of variation is considerably smaller than that found in most previous studies.(ABSTRACT TRUNCATED AT 250 WORDS)

A role for antibiotics in the treatment of refractory periodontitis.

Refractory periodontitis is considered by many investigators to be a separate disease entity that is descriptive of a particular patient who has multiple sites, rather than a few individual sites, that do not respond to conventional periodontal treatment modalities. Such patients continue to demonstrate loss of attachment and alveolar bone despite frequent periodontal treatment which includes surgical intervention, scaling and root planing, and often systemically-administered tetracycline. Controlled clinical studies have demonstrated that both clindamycin-hydrochloride and amoxicillin/clavulanate potassium (Au) are beneficial when used in conjunction with periodontal scaling. Gordon et al. found improvements in attachment levels, inflammation, suppuration, and a decrease in pocket depths for up to 2 years following a 7-day course of clindamycin given in conjunction with a full-mouth scaling. The incidence of disease activity decreased from an annual rate of 8% of all sites prior to antibiotic treatment to 0.5% after treatment. Magnusson, reporting on a similar group treated with a 14-day course of Au, found an average loss of attachment of 2.2 mm and an increase in pocket depth of 1.5 mm in sites demonstrating disease progression prior to antibiotic treatment. At 3 months post-antibiotic therapy, these sites had regained an average of 2 mm of attachment and pocket depths had decreased an equivalent amount. Both attachment levels and pocket depths remained relatively stable for up to 12 months post-therapy. In an ongoing study, 30 subjects with refractory periodontitis were treated with either clindamycin or Au in conjunction with scaling or scaling plus a placebo. Prior to antibiotic treatment, but while being scaled at 3-month intervals, sites with disease activity lost an average 2.4 mm of attachment. At 3 months post-treatment, the clindamycin-treated group showed an average gain of 2.1 mm, the Au-treated group gained 1.9 mm, and the scaling group gained 1.4 mm in attachment. The clindamycin group remained relatively stable for up to 21 months and the Au group remained stable for about 15 months without additional treatment. Five of the 6 subjects treated with scaling alone required additional treatment within 9 months. Preliminary analyses have indicated that at least two patterns or rates of attachment loss may be associated with refractory periodontitis and that each pattern may be indicative of a different microflora. The pattern associated with a relatively rapid loss of attachment was characterized by a Gram-negative flora which contained spirochetes, P. intermedia, and Fusobacterium species.(ABSTRACT TRUNCATED AT 400 WORDS)

Modeling the relationship between clinical, microbiologic, and immunologic parameters and alveolar bone levels in an elderly population.

A cross-sectional periodontal study of 74 subjects aged 65 to 75 years was performed. Clinical data were collected and related to microbiological and immunological data. A statistical model (step-wise multiple regression) of factors related to bone loss was created initially using clinical data only; then by adding either the microbiologic or immunologic data; and then by using clinical, microbiologic, and immunologic data together. When only clinical data were considered, three factors were found to have significant positive correlations with bone loss. Tooth mobility accounted for 17% of the variability in the alveolar bone level measurements, probing depth for 12%(r2), and plaque index for 3%, for a total of 32% of the variability explained by these clinical factors. Tooth mobility and probing depth were clinical factors which remained significant in the model when the microbiological data were also considered. As percentages of the total cultivable microbiota, E. corrodens (r2 = 14%) and black-pigmenting Prevotella intermedia (r2 = 4%) correlated positively with alveolar bone loss. The addition of the microbiologic data only increased the r2 to 33%. When immunological data were considered with the clinical data, pocket depth and tooth mobility were the clinical parameters which remained in the model. IgG antibody levels to P. gingivalis W83 and/or 381 (r2 = 24%) A. actinomycetemcomitans 627 (r2 = 2%) were the significant immunologic measures having a positive correlation with bone loss. Anti-F. nucleatum levels had a significant negative correlation. A total of 50% of the variability in alveolar bone level was accounted for in the model by the addition of specific serum antibody levels to subgingival plaque microorganisms. When clinical, microbiological, and immunological measurements were all considered together, antibody to P. gingivalis W83 and/or 381 (r2 = 42%), percentage of B-lymphocytes (r2 = 3%), probing depth (r2 = 4%), anti-E. corrodens levels (r2 = 2%), and anti-P. gingivalis 33277 levels (r2 = 4%) all had significant positive correlation with loss of alveolar bone. The number of enteric bacteria, anti-F. nucleatum levels, and anti-P. intermedia levels each had a significant negative correlation with alveolar bone heights. The r2 for this model was 75%. These results indicated that antibody levels to subgingival plaque microorganisms and tooth mobility were the best predictors of bone loss in the elderly patients tested in this study.

A multi-center clinical trial of a new chairside test in distinguishing between diseased and healthy periodontal sites. II. Association between site type and test outcome before and after therapy.

The aim of the present study was to evaluate the association between the outcome of a chairside test measuring gingival crevicular fluid (GCF) levels of the enzyme aspartate aminotransferase (AST) and other clinical measures of disease including probing depth, severity of inflammation, and GCF flow before and after therapy. We studied 91 patients with moderate to severe periodontitis. Eight sites with probing depths between 5 mm and 8 mm and obvious signs of inflammation were selected and designated diseased sites. Four sites with probing depth < or = 3 mm with no or minimal signs of inflammation were selected and designated non-diseased sites in patients. Thirty healthy individuals were enrolled and four sites in each were selected and designated healthy controls. Patients were treated with scaling and root planing and control subjects with supragingival prophylaxis. Measurements including GCF volume, gingival inflammation, and probing depth were performed at screening baseline, 1 week later at pretreatment baseline, and at weeks 2 and 4 after treatment. AST content of GCF was measured using a chairside colorometric test. It was concluded that the outcome of the test is an effective objective measure distinguishing between diseased sites and non-diseased sites in patients and control subjects when evaluated both prior to and following application of therapy. Use of this simple chairside test, when combined with other standard diagnostic procedures, provides an objective measurement permitting improved capacity to distinguish between diseased and non-diseased periodontal sites, and to better assess and monitor the outcome of therapy.

Loss of control, heavy drinking and drinking problems in a longitudinal study.

The utility of conceptualizing alcoholism as a typically progressive disease process with regular, predictable stages is questioned. "Loss of control" was found to be only one variable among others in predicting drinking problems. It was not possible to confirm the importance that some disease conceptions of alcoholism assign to it.

Changes in American drinking patterns and problems, 1967-1984.

Data from a 1984 general population survey of drinking practices and problems in the United States are compared with those from identically worded items in a 1967 survey. Results indicate that beverage preference changed between 1967 and 1984. Americans consumed more wine and beer but fewer distilled spirits in 1984. However, the volume of drinks consumed did not change significantly. There were few significant differences in drinking patterns with the exception of a small increase in the percentage of men who were abstainers in 1984. Mixed findings were obtained with regard to drinking problems. Little difference was found over time in the proportion of respondents experiencing any of nine possible problem consequences, but there was an increase in the proportion who reported experiencing one of four possible dependence problems. Implications of this survey for the single distribution theory of consumption are discussed.

Drinking-related problems in the United States: description and trends, 1984-1990.

OBJECTIVE: This study uses two national alcohol surveys to assess rates of drinking problems from 1984 to 1990, to examine any changes in reports of drinking problems within demographic subgroups, and to evaluate the role of alcohol use versus demographic variables in predicting drinking problems in the 1990 survey only. METHOD: Data were obtained from two national alcohol surveys that utilized household probability samples within the 48 contiguous states in 1984 and 1990. Weights to adjust for design effects and nonresponse were applied to both samples of current drinkers. RESULTS: No significant changes were found for reports of three or more dependence symptoms (6.7% in 1984, 7.6% in 1990) or two or more social consequences (10.9% in 1984, 12.8% in 1990). Significant increases in reports of two or more social consequences were found for younger people, never married individuals and respondents who were not employed. A significant increase in reports for three or more dependence symptoms was also found for the unemployed group. Based on a cross-sectional analysis of the 1990 survey only, alcohol use variables were significant predictors of drinking problems. With the exception of younger age, demographic characteristics did not significantly predict alcohol problems. CONCLUSIONS: Although drinking problems are pervasive, they may not be sensitive to immediate changes in alcohol consumption. One explanation may be the changing social climate around drinking to which most drinkers have been, and are continuing to be, exposed.

Microbiology of otitis externa.

Microbiologic and clinical data from 26 patients with otitis externa were prospectively evaluated. Specimens were processed for aerobic and anaerobic bacteria. Bacterial growth was noted in 23 specimens. A total of 33 aerobic and 2 anaerobic bacteria were recovered. Aerobic bacteria only were isolated in 21 (91%) patients, anaerobic bacteria only in 1 (4%), and mixed aerobic and anaerobic bacteria in 1 (4%). The most common isolates were Pseudomonas aeruginosa (14 instances), Staphylococcus aureus (7), Acinetobacter calcoaceticus (2), Proteus mirabilis (2), Enterococcus faecalis (2), Bacteroides fragilis (1), and Peptostreptococcus magnus (1). One isolate was recovered in 13 (57%) patients, 2 isolates in 8 (35%), and 3 isolates in 2 (9%). These data illustrate the polymicrobial nature of otitis externa in about half of the patients and the role of anaerobic bacteria in 8% of them. Further studies are warranted to evaluate the therapeutic implications of these findings.

Myospherulosis of the mastoid antrum: a case report.

Myospherulosis is a recently discovered iatrogenic disease caused by the implantation during surgery of mineral oil- or petrolatum-based products into various tissues. The condition results from the action of lipid substances on extravasated erythrocytes. The case report presented is the first detailed description of this uncommon, unique inflammatory lesion occurring in the mastoid and is the second otitic case reported in the literature. The lesion mimicked recurrent cholesteatoma 6 years following an intact canal wall mastoidectomy. As in myospherulosis of the paranasal sinuses, the symptoms and findings of otitic myospherulosis are those of the preceding disease.

Research, technology transfer, and dentistry.

The periodontal discipline illustrates the need for dentists to be doctors specializing in oral medicine. Research findings are tending toward more complex and possibly lengthy treatment with drugs and/or growth factors, necessitating a curriculum with more emphasis on pharmacology, medical management, critical review of clinical trial results, and evaluation of risk-benefit ratios.

Integration of the basic, behavioral, and biomaterials sciences with the clinical curriculum.

An approach to effective integration of the basic, behavioral, and biomaterials sciences with the clinical curriculum is described. Teaching is accomplished by both scientists and clinicians on multidisciplinary teams. The instructional format is based on terminal objectives that are stated in behavioral terms. Examples of the objectives and the manner in which they are fulfilled are presented.

Anti-thymocyte globulin for conditioning in matched unrelated donor hematopoietic cell transplantation provides comparable outcomes to matched related donor recipients.

Rabbit anti-thymocyte globulin (ATG) is used as prophylaxis against GVHD following allogeneic hematopoietic cell transplantation (HCT). At our institution, ATG is exclusively used in the conditioning of matched unrelated donor (URD) transplant recipients. A total of 50 URD HCT recipients who received ATG (ATG group) were retrospectively compared with 48 matched related donor (MRD) HCT recipients who did not receive ATG (no ATG group). There were no significant differences between the groups in rates of day 100 mortality, acute GVHD or relapse. Chronic GVHD incidence was significantly lower in the ATG group (P = 0.007). At a median follow-up of 36 months in the entire cohort, 50% patients are alive in the ATG group and 63% of the patients are alive in the no ATG group (P = 0.13). We conclude that the administration of ATG to patients undergoing URD HCT preserves the anti-leukemia benefit of the transplant, while reducing the risk of developing GVHD, resulting in OS rates that are comparable to MRD HCT recipients.