Cardiovascular and metabolic comorbidities in patients with thyroid nodules: the impact of incidental diagnosis.

PURPOSE: The prevalence of thyroid nodules (TN) in the general population has increased as screening procedures are implemented and an association with metabolic and cardiovascular disorders has been reported. The aim of this study was to investigate the reason leading to the diagnosis of TN and to compare the clinical characteristics of patients diagnosed incidentally with those of patients diagnosed for thyroid-related reasons. METHODS: We designed a retrospective cross-sectional study including consecutive patients with TN from two high-volume hospital-based centers for thyroid diseases (Pavia and Messina) in Italy. Data regarding reason leading to TN diagnosis, age, sex, BMI, presence of cardio-metabolic comorbidities were collected. RESULTS: Among the 623 enrolled subjects, the US diagnosis of TN was prompted by thyroid-related reasons in 421 (67.6%, TD group) and incidental in 202 (32.4%, ID group) with a similar distribution in the two centers (p = 0.960). The ID group patients were more frequently males (38.6% vs 22.1%, p < 0.001) and significantly older (58.9 ± 13.7 vs 50.6 ± 15.5 years, p < 0.001) than the TD group ones, and had a higher rate of cardiovascular comorbidities (73.8% vs 47.5%, p < 0.001), despite having a similar BMI (27.9 ± 5.2 vs 27.8 ± 13.5, p = 0.893). CONCLUSIONS: Stratification of patients with TN according to the diagnostic procedure leading to diagnosis allows a better epidemiological characterization of this inhomogeneous and large population.

Hospital nurses and home care providers' experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study.

BACKGROUND: A person-centred approach to nutritional care has the potential to increase an older person's role in making informed decisions about their own care and possibly improving their quality of life. However, despite the considerable interest shown in person-centred nutritional care in recent years, delivery of such care still appears to lack consideration for older persons' needs and preferences. The present study aimed to explore healthcare professionals' views on how older persons and their family caregivers participate in decisions about their own nutritional care and possible barriers for that participation. METHODS: Semi-structured in-depth interviews with 23 healthcare professionals in acute geriatric care and home care were conducted. Data were analysed thematically. RESULTS: The analysis of the interviews resulted in three main themes: (i) lack of shared decision-making in nutritional care; (ii) conflict between patient's preferences and standard nutritional care procedures; and (iii) the value of family caregivers who are seldom involved in nutritional care. CONCLUSIONS: Healthcare professionals were aware of the importance of actively engaging older persons and their family members in the nutritional care to achieve positive outcomes. However, they encountered individual and structural barriers, including resistance from patients and family caregivers, conflicts between the patients' nutritional wishes and standard nutritional procedures, a wish to shield the family caregivers from the stress of caring for a sick relative, and lack of time and caring structures that facilitate the older persons and their family's active participation.

Lean fish consumption is associated with lower risk of metabolic syndrome: a Norwegian cross sectional study.

BACKGROUND: Fish consumption may have a role in reducing the prevalence of metabolic syndrome (MetS). The aim of this study was to identify associations between fish consumption and MetS and its components, especially regarding differences concerning consumption of fatty and lean fish. METHODS: This cross sectional study uses data from the Tromsø 6 survey (2007-08), where a sample of 12 981 adults, aged 30-87 years (47 % men) from the Norwegian general population was included. Fish consumption was assessed using food frequency questionnaires (FFQ). Blood sample assessments, anthropometric and blood pressure measurements were carried out according to standard protocols. MetS was defined using the Joint Interim Societies (JIS) definition. All tests were two-sided. Analyses were performed using IBM SPSS Statistics 22 (Pearson's correlation, Chi-Square tests, analysis of variance (ANOVA), linear and logistic regression models). RESULTS: Mean age was 57.5, and the prevalence of MetS was 22.6 %. Fish consumption once a week or more was associated with lower risk of having MetS among men (OR 0.85, CI 95 % 0.74 to 0.98, P = 0.03). In the adjusted models, lean fish consumption was associated with a decreased risk of having MetS, whereas fatty fish consumption was not associated with a decreased risk of having MetS. Both an increased fatty and lean fish consumption (0-1 times per month, 2-3 times per month, 1-3 times per week, 4-6 times per week, 1-2 times per day) were associated with decreased serum triglyceride (TG), and increased high-density lipoprotein cholesterol (HDL-C). CONCLUSIONS: Fish consumption may be associated with a lower risk of having MetS and consumption of lean fish seems to be driving the association. Further investigation is warranted to establish associations between fish consumption and MetS.

Humans seem to produce arsenobetaine and dimethylarsinate after a bolus dose of seafood.

Seafood is the predominant food source of several organoarsenic compounds. Some seafood species, like crustaceans and seaweed, also contain inorganic arsenic (iAs), a well-known toxicant. It is unclear whether human biotransformation of ingested organoarsenicals from seafood result in formation of arsenicals of health concern. The present controlled dietary study examined the urinary excretion of arsenic compounds (total arsenic (tAs), iAs, AB (arsenobetaine), dimethylarsinate (DMA) and methylarsonate (MA)) following ingestion of a single test meal of seafood (cod, 780 µg tAs, farmed salmon, 290 µg tAs or blue mussel, 690 µg tAs or potato (control, 110 µg tAs)) in 38 volunteers. The amount of ingested tAs excreted via the urine within 0-72 h varied significantly among the groups: Cod, 74% (52-92%), salmon 56% (46-82%), blue mussel 49% (37-78%), control 45% (30-60%). The estimated total urinary excretion of AB was higher than the amount of ingested AB in the blue mussel group (112%) and also ingestion of cod seemed to result in more AB, indicating possible endogenous formation of AB from other organoarsenicals. Excretion of iAs was lower than ingested (13-22% of the ingested iAs was excreted in the different groups). Although the ingested amount of iAs+DMA+MA was low for all seafood groups (1.2-4.5% of tAs ingested), the urinary DMA excretion was high in the blue mussel and salmon groups, counting for 25% and 11% of the excreted tAs respectively. In conclusion our data indicate a possible formation of AB as a result of biotransformation of other organic arsenicals. The considerable amount of DMA excreted is probably not only due to methylation of ingested iAs, but due to biotransformation of organoarsenicals making it an inappropriate biomarker of iAs exposure in populations with a high seafood intake.

Effects of an eight-month weight-control program on body composition and lipid oxidation rate during exercise in obese children.

OBJECTIVE: To investigate the effects of an 8-month multidisciplinary weight-control program, including 2 h/week of moderate physical activity, nutritional education lessons and psychological follow-up, on body composition and lipid oxidation rate during exercise in obese children. DESIGN: Nineteen (7 boys and 12 girls) obese children, aged 8-12 yr [mean body mass index (BMI) z-score: 2.3 and fat mass: 35.8%] participated in this study. Before and at the end of the weight-control period body composition was assessed by bioelectrical impedance, lipid oxidation rate by indirect calorimetry during a graded exercise test, and time devoted to various activities and energy intake in free-living conditions by questionnaire. RESULTS: All children completed the study, at the end of which BMI decreased significantly by mean 0.6+/-0.5 and 0.5+/-0.8 kg/m2, in boys and girls, respectively (p<0.05), and fat mass (FM) decreased by 1.7+/-2.8 and 1.4+/-1.3 kg in boys and girls, respectively (p<0.05). In addition, lipid oxidation rate during exercise increased significantly throughout the graded exercise test up to 21% at maximal lipid oxidation rate which happened at 48+/-5% of maximal oxygen uptake (VO2max), corresponding to 64+/-5% of maximal heart rate. Time spent at sedentary and very light physical activities decreased (p<0.001) to the benefit of recreational activities at home. CONCLUSIONS: Multidisciplinary weight-control program, with moderate-intensity physical activities, induced decreases in FM without decreases in free FM, increases in VO2max, lipid oxidation rate during exercise, and time devoted to recreational activities in free-living conditions.

Implants and/or teeth: consensus statements and recommendations.

In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.

Bond strength of luting materials to ceramic crowns after different surface treatments.

The aim of present study was to evaluate the effect of different pre-treatments of alumina and zirconia copings on the bond strength of different luting materials. Pull out tests was performed on 60 alumina and 80 zirconia copings. Randomly selected, copings were divided in groups of i) un-treated alumina and zirconia copings, (n=20) ii) alumina and zirconia copings sandblasted with 50 or 110 microm alumina particles respectively (n=20), iii) zirconia copings treated with monolayer of glass pearls fused to the inner surface (n=20), iv) zirconia copings treated with silanized glass pearls (n=10). Zinc phosphate, Panavia 21 and VarioLink II were used for cementation. Pull out tests were done in an Instron universal testing machine with a speed of 0.5 mm/min and fracture loads was measured in N. Untreated zirconia copings cemented with zinc phosphate showed significantly higher bond strength values compared to those with sandblasted surfaces. No difference was seen between untreated alumina copings and those with sandblasted surfaces. Sandblasting decreased bond strength of zirconia and alumina copings. Glass pearls increased bond strength of zirconia copings, which was even better after silanization. Variolink II in combination with alumina gave significantly lower bond strength.

Cisplatin induces the proapoptotic conformation of Bak in a deltaMEKK1-dependent manner.

In a panel of four human melanoma cell lines, equitoxic doses of cisplatin induced the proapoptotic conformation of the Bcl-2 family protein Bak prior to the execution phase of apoptosis. Because cisplatin-induced modulation of the related Bax protein was seen in only one cell line, a degree of specificity in the signal to Bak is indicated. Little is known about upstream regulation of Bak activity. In this study, we examined whether the apoptosis-specific pathway mediated by a kinase fragment of MEKK1 (DeltaMEKK1) is involved in the observed Bak modulation. We report that expression of a kinase-inactive fragment of MEKK1 (dominant negative MEKK [dnMEKK]) efficiently blocked cisplatin-induced modulation of Bak and cytochrome c release and consequently also reduced DEVDase activation and nuclear fragmentation. Accordingly, expression of a kinase-active MEKK1 fragment (dominant positive MEKK) was sufficient to induce modulation of Bak in three cell lines and to induce apoptosis in two of these. dnMEKK did not block cisplatin-induced c-Jun N-terminal kinase (JNK) activation, in agreement with a specifically proapoptotic role for the DeltaMEKK1 pathway. Finally, we show that reduction of Bak expression by antisense Bak reduced cisplatin-induced loss of mitochondrial integrity and caspase cleavage activity in breast cancer cell lines. In summary, we have identified Bak as a cisplatin-regulated component downstream in a proapoptotic, JNK-independent DeltaMEKK1 pathway.

Chloroquine enhances the antimycobacterial activity of isoniazid and pyrazinamide by reversing inflammation-induced macrophage efflux.

Mycobacterium tuberculosis (MTB) is notorious for persisting within host macrophages. Efflux pumps decrease intracellular drug levels, thus fostering persistence of MTB during therapy. Isoniazid (INH) and pyrazinamide (PZA) are substrates of the efflux pump breast cancer resistance protein-1 (BCRP-1), which is inhibited by chloroquine (CQ). In this study, BCRP-1 was found to be expressed on macrophages of human origin and on foamy giant cells at the site of MTB infection. In the current in vitro study, interferon-gamma (IFNγ) increased the expression of BCRP-1 in macrophages derived from the human monocytic leukaemia cell line THP-1. Using a BCRP-1-specific fluorescent dye and radioactively labelled INH, it was demonstrated that efflux from macrophages increased upon activation with IFNγ. CQ was able to inhibit active efflux and augmented the intracellular concentrations both of INH and the dye. In agreement, CQ and specific inhibition of BCRP-1 increased the antimycobacterial activity of INH against intracellular MTB. Although PZA behaved differently, CQ had comparable advantageous effects on the intracellular pharmacokinetics and activity of PZA. The adjunctive effects of CQ on intracellular killing of MTB were measurable at concentrations achievable in humans at approved therapeutic doses. Therefore, CQ, a widely used and worldwide available drug, may potentiate the efficacy of standard MTB therapy against bacteria in the intracellular compartment.

Arsenic in seafood is associated with increased thyroid-stimulating hormone (TSH) in healthy volunteers - A randomized controlled trial.

BACKGROUND: Exposure to exogenous elements like arsenic (As) may influence thyroid enzymes, thyroid-stimulating hormone (TSH), and the two principal thyroid hormones, free thyroxine (FT4) and free triiodothyronine (FT3), but little is known about how this is related to organic arsenicals, the main form in seafood. AIM: To investigate whether a high intake of dietary arsenic from seafood can impact thyroid function and thyroid hormones by examining possible associations with changes in TSH, FT4, FT3 and the FT4:FT3-ratio in plasma. METHODS: Thirty-eight healthy subjects were randomized into four groups. During a 14-day semi-controlled dietary study, the subjects ingested daily portions of either 150g cod, salmon, blue mussels or potato (control). Plasma concentrations of total As, FT3, FT4, TSH and selenium (Se), and urinary concentrations of iodine were monitored. RESULTS: Plasma concentrations of TSH increased significantly in all seafood groups. The change in plasma As, with different coefficients for each seafood group, was the dominant factor in the optimal multiple regression model for change in TSH (R2=0.47). Plasma Se and iodine were negative and positive factors, respectively. There were also indications of changes in FT4, FT3 and the FT4:FT3 ratio consistent with a net inhibiting effect of As on FT4 to FT3 conversion. CONCLUSION: Ingestion of seafood rich in various organic As species was strongly associated with an increase of the TSH concentrations in plasma. Change in TSH was positively associated with total plasma As, but varied with the type of seafood ingested. These findings indicate that organic dietary As, apparently depending on chemical form, may influence thyroid hormones and function.

Associations between fish consumption and metabolic syndrome. A large cross-sectional study from the Norwegian Tromsø Study: Tromsø 4.

BACKGROUND: Fish consumption may prevent or improve metabolic health. The aim of this study was to identify associations between fish consumption, both fatty and lean, and metabolic syndrome and its components. METHODS: Associations between fish consumption and metabolic syndrome and its components were studied in a large sample from a Norwegian population (N = 23,907), using cross-sectional data from the Tromsø 4 survey (1994-1995). Metabolic syndrome was defined using the JIS definition, and dietary data was collected using food frequency questionnaires (FFQ). Blood samples were taken for biochemical assessments, and anthropometric and blood pressure measurements were carried out according to standard protocols. RESULTS: In this sample from an adult population (aged 26-70 years, mean age 44 years, SD 11.69, 48 % men), a higher fish consumption (≥1/week) was associated with a healthier lipid profile with increased HDL-C and decreased TG. Participants aged 60-70 years consuming fish once a week or more had significantly lower risk of having MetS, compared to those consuming fish less than once a week (OR 0.64, CI 0.45-0.91). When investigating fatty and lean fish separately, only lean fish consumption was associated with a reduced the risk of having MetS. Participants aged 60-70 years consuming lean fish once a week or more, had lower risk of having MetS compared to those consuming lean fish less than once a week (OR 0.65, CI 0.48-0.87). No association was found for consumption of fatty fish, or for lean fish in the age groups <45 or 45-59 years. CONCLUSIONS: These results indicates that fatty and lean fish consumption influences MetS risk differently, possibly also related to age. However, further investigation is needed to establish how various fish consumption may influence MetS and its components, particularly when stratified by fatty and lean fish.

Case management at an outpatient unit for severe and enduring eating disorder patients at Stockholm Centre for Eating Disorders- a study protocol.

BACKGROUND: Patients with severe and enduring eating disorders (SEED) are seriously ill and have a low quality of life. Case management (CM), originally developed for adult patients with severe mental disabilities, has been shown to enhance social functioning and improve quality of life, while reducing the number and length of hospitalizations. In 2014, a special unit based on CM, for patients with SEED (the Eira unit) was started at Stockholm Centre for Eating Disorders, Sweden. METHOD/DESIGN: This study aims to investigate if CM can improve SEED patients' quality of life, and reduce their eating disorder symptoms as well as their health care consumption. Methods for data collection are a semi-structured diagnostic interview, self-report questionnaires, and a qualitative interview. The diagnostic interview and the self-report assessments will be done at start of treatment and at follow-ups after 1, 2, and 3years. The qualitative interview will be conducted 1 year after start of treatment. The study is approved by the ethical review board in Stockholm in compliance with the Helsinki Declaration. DISCUSSION: CM is a possible new contribution to the treatment methods for SEED. It does not aim at remission, but rather to accept life as it is, and to enhance quality of life in the presence of the ED. This study will investigate the potential benefits of this novel intervention in a special unit for SEED patients. TRIAL REGISTRATION: Clinicaltrials.gov Id: NCT02897622.

In vivo parameters influencing 2-Cys Prx oligomerization: The role of enzyme sulfinylation.

2-Cys Prxs are H2O2-specific antioxidants that become inactivated by enzyme hyperoxidation at elevated H2O2 levels. Although hyperoxidation restricts the antioxidant physiological role of these enzymes, it also allows the enzyme to become an efficient chaperone holdase. The critical molecular event allowing the peroxidase to chaperone switch is thought to be the enzyme assembly into high molecular weight (HMW) structures brought about by enzyme hyperoxidation. How hyperoxidation promotes HMW assembly is not well understood and Prx mutants allowing disentangling its peroxidase and chaperone functions are lacking. To begin addressing the link between enzyme hyperoxidation and HMW structures formation, we have evaluated the in vivo 2-Cys Prxs quaternary structure changes induced by H2O2 by size exclusion chromatography (SEC) on crude lysates, using wild type (Wt) untagged and Myc-tagged S. cerevisiae 2-Cys Prx Tsa1 and derivative Tsa1 mutants or genetic conditions known to inactivate peroxidase or chaperone activity or altering the enzyme sensitivity to hyperoxidation. Our data confirm the strict causative link between H2O2-induced hyperoxidation and HMW formation/stabilization, also raising the question of whether CP hyperoxidation triggers the assembly of HMW structures by the stacking of decamers, which is the prevalent view of the literature, or rather, the stabilization of preassembled stacked decamers.

Intestinal fatty acid binding protein polymorphism at codon 54 is not associated with postprandial responses to fat and glucose tolerance tests in healthy young Europeans. Results from EARS II participants.

UNLABELLED: Polymorphism Ala54Thr of the intestinal fatty acid-binding protein 2 (FABP2) has been reported to have an effect on the protein's affinity for long chain fatty acids and to be associated with serum lipid and insulin levels in fasting and especially postprandial states. We wanted to test whether this genetic variation is associated with fasting and postprandial glucose, insulin or lipid levels in 666 male university students participating in the second European Atherosclerosis Study (EARS II). We also studied whether the subgroup of 330 students with paternal history of myocardial infarction (MI) before the age of 55 have different genotype distribution than 336 matched controls. RESULTS: No difference in genotype distribution was observed between offspring with and without paternal history of MI or between populations from 11 European countries. The frequency of the threonine encoding allele was 0.276 in cases and 0.266 in controls. There were no differences in fasting or postprandial serum lipid, glucose or insulin levels between subjects having different genotypes. CONCLUSIONS: In this study FABP2 Ala54Thr polymorphism was not associated with lipid or glucose metabolism. In addition to environmental and genetic factors, selection of study population also may explain the difference between this and earlier studies.

The management of splenic trauma in a trauma system.

Large teaching centers have reported splenic salvage rates of 40% to 50% in adults after splenic trauma. It is unknown whether similar salvage rates can be achieved safely in community trauma centers with a lower volume of patients and less experience. Between August 1984 and August 1988, 117 patients with splenic injury were treated at a level I center and 311 were treated at four level II centers. Splenectomy was performed in 252 patients (59%), splenorrhaphy was performed in 160 patients (37%), and 16 patients (4%) were observed. While the splenic salvage rate was higher at the level I center (50% vs 38%), selective splenorrhaphy was successful in the level II centers where the volume of splenic injury was lower (15 to 25 cases per year).

Interrelationships between low density lipoprotein receptor defect, serum fatty acid composition, and serum cholesterol concentration.

It is known that, in the general human population, serum fatty acid composition is correlated with serum triacylglycerol and cholesterol concentrations. The goal of the present study was to analyze whether the same is true of individuals who have a low density lipoprotein receptor (LDL-R) defect. Concentrations of 16 different fatty acids, cholesterol, triacylglycerol, and major lipoproteins in serum were determined in eight individuals who had (FH-North Karelia), the most common LDL-R defect in Finland, which causes familial hypercholesterolemia, and in their 30 relatives belonging to a single large pedigree as controls. The average number of double bonds (i.e., degree of desaturation) in serum fatty acids correlated negatively with the concentrations of serum total cholesterol (r = 0.27, P < 0.05) and total triacylglycerol (r = -0.71, P < 0.001) and positively with the number of fish meals per week (r = 0.50, P < 0.01), which was analyzed in all pedigree members jointly. These effects were similar in individuals having LDL-R defect, in which group the correlation coefficients were -0.31 (P = NS), -0.99 (P < 0.001), and 0.79 (P = NS) for serum total cholesterol, triacylglycerol, and weekly fish meals, respectively. Thus, LDL-R defect does not impair the correlation between serum fatty acid composition and serum triacylglycerol concentration. This result is in agreement with dietary studies that have shown that familial hypercholesterolemia patients respond very favorably to dietary therapy.

Management of splenic injuries.

The structure and function of the spleen are reviewed in the context of providing a rational basis for splenic salvage after trauma. Guidelines for operative and nonoperative management are provided, and the results of treatment from recent large series are summarized.

Mercury levels in plasma and urine after removal of all amalgam restorations: the effect of using rubber dams.

OBJECTIVE: The aim of the present study was to determine whether removal of all amalgam restorations might significantly affect mercury levels in plasma and urine and whether the use of rubber dams might reduce patient exposure to mercury during amalgam removal. METHODS: All amalgam restorations were removed from 18 subjects during a single treatment session in which a rubber dam was used and from 10 subjects when a rubber dam was not used. All amalgam restorations were removed by the same dentist using high-speed cutting, water coolant, and high-volume evacuation. The levels of mercury in plasma and urine were analyzed both before and during the subsequent twelve months after amalgam removal. In order to determine whether removal of all amalgam restorations might cause an exposure large enough to significantly increase the mercury levels in two indicator media for mercury exposure, i.e., plasma and urine, and to determine if the removal might cause a significant decrease in the mercury levels found over time, the one-tailed, paired Students' t-test was used. For each individual, the pre-removal levels were compared with both the levels found in plasma on d 1 and in urine on d 10, and also with the levels found 1 y after removal. Furthermore, in order to examine whether the use of rubber dams had any effect on the mercury levels found after removal, the changes in the mercury levels found were compared between the groups using the Wilcoxon-Mann-Whitney rank sum test. RESULTS: After removal of all amalgam restorations, only the non-rubber dam group showed significant increases in the mercury levels found in plasma (p = 0.012) and urine (p = 0.037). However, one year later, the mercury levels in plasma and urine had sunk significantly below the pre-removal levels for both groups. When the changes in the mercury levels found were compared between the groups, the non-rubber dam group showed a significantly higher increase of mercury in plasma than the rubber dam group the day after removal (p = 0.0010). Compared to the pre-removal mercury levels in plasma and urine, the levels found 1 y after removal of all amalgam restorations were on average 52 +/- 23% (range 4-89%) lower in plasma and 76 +/- 21% (range 20-94%) lower in urine. SIGNIFICANCE: The study showed that dental amalgam had a statistically significant impact on the mercury levels found in plasma and urine in the patients tested, and that the use of a rubber dam during removal of all amalgam restorations significantly reduced the peak of mercury in plasma following removal.

Influence of film thickness on joint bend strength of a ceramic/resin composite joint.

OBJECTIVES: The purpose of this study was to evaluate the influence of different film thicknesses of resin composite luting agents on the joint bend strength of a ceramic/resin interface. METHODS: Mirage FLC (Chamelon Dental Products) and Vita Cerec (Coltène AG) duo cement were used in combination with the ceramic materials, Mirage and Vita Cerec blocks. Cement layers with thicknesses of 20 microns, 50 microns, 100 microns and 200 microns were light-cured with a high-intensity curing light. Ten specimens of each ceramic/cement combination and thickness provided a total of 80 complete test specimens. Each specimen was placed in a four-point bending jig mounted in a universal tensile testing machine and underwent loading. A paired two-tailed Student's 1-test was used to evaluate differences between different series of film thicknesses and resin cement combinations. RESULTS: Within each ceramic/cement combination, the bond strength values were significantly lower for the 20 micron film then the thicker films. SIGNIFICANCE: Taking into account the physical and clinical properties of resin-based luting agents, available knowledge indicates that a marginal gap on the order of 50-100 microns seems to optimize performance.

Chronic vulvar dystrophies. Surgical therapy.

The Authors take up a proposal made in 1976 by the International Society for the Study of Vulvar Dystrophies (I.S.S.V.D.) and, with the help of clinical cases, consider the problem of vulvar dystrophic pathology from the point of view of clinico-histologic classification and terminology. The schematic analysis of the etiopathogenetic hypothesis (still uncertain) and the consequent not infrequent failures of clinical therapy suggest to consider indications for surgical treatment. This is particularly true for young patients because in these cases the treatment must also aim at an acceptable aesthetic result and the recovery of satisfactory sexual function. To show the possibility of meeting these requirements, the Authors report the results of plastic surgical treatment on a 28 year patient suffering from chronic vulvar dystrophy after many failures of medical therapy.