Clinical Study to Assess the Stain Removal Effectiveness of a Tooth Whitening Regimen with Added Whitening Booster.

OBJECTIVE: This randomized, controlled clinical trial was conducted to assess the extrinsic stain reduction achieved by brushing with a whitening dentifrice and powered toothbrush, and to determine whether the addition of a whitening booster paste to this regimen would enhance its stain reducing effectiveness. METHODS: Sixty qualifying subjects were randomly assigned either to Regimen One, a whitening dentifrice (Arm & Hammer Truly Radiant [TR] toothpaste] and powered toothbrush (Arm & Hammer Truly Radiant [TR] Extra Whitening Spinbrush); Regimen Two, the dentifrice and powered toothbrush with the addition of a whitening booster; or Regimen Three, a negative control (Colgate Cavity Protection toothpaste and an ADA standard manual brush). They were instructed in the use of their assigned products and then brushed unsupervised at home for two minutes, twice daily, for 14 days. Extrinsic tooth stain was assessed at baseline and after two, five, and 14 days using a Modified Lobene Stain Index (MLSI) with Lobene inclusion criteria of ≥ 1.5. RESULTS: All three treatment groups had statistically significant (p < 0.0001) mean total MLSI reductions from baseline at each time point, in a time-dependent manner. Day 14 reductions were 22.2% for Colgate Cavity Protection, 29.1% for Regimen One, and 34.4% for Regimen Two. Reductions for Regimen One and Regimen Two were significantly greater compared to Regimen Three, the negative control, at each time period (p < 0.01), and those for Regimen Two were significantly greater compared to Regimen One on days 2 and 14 (p < 0.05) and directionally more effective on day 5 (p = 0.0673). CONCLUSION: The combination of Truly Radiant toothpaste and Truly Radiant Spinbrush provides safe and effective stain removal that can be further enhanced by the addition of the whitening booster.

Staged abdominal closure after small bowel or multivisceral transplantation.

Following paediatric SBMT, size discrepancy between the recipient's abdomen and the graft may lead to ACS, graft dysfunction, and death. We report our experience with SAC in these patients. Between 04/1993 and 03/2009, 57 children underwent 62 SBMTs. When abdominal wall tension seemed excessive for safe PAC, SAC was performed, using a Silastic® sheet and a vacuum occlusive dressing. Transplantations with SAC (23 combined liver and small bowel [CLB]) were compared with those with PAC [14 ISB and 25 CLB]. Indications for transplantation, preoperative status (after stratification for ISB/CLB transplants), age at transplantation, donor-to-recipient weight ratio, reduction in bowel and/or liver, and incidence of wound complications were not different in both groups. Post-operative intubation, stay in intensive care unit, and hospital stay were prolonged after SAC. Two deaths were related to ACS after PAC, none after SAC. Since 2000, one-yr patient survival is 73% after ISB transplantation and 57% vs. 75% after CLB transplantation with PAC vs. SAC, respectively (NS). SAC safely reduces severe ACS after paediatric SBMT and can be combined with graft reduction for transplantation of small recipients.

Anterior cervical microdiscectomy: is bone grafting and in-situ fusion with instrumentation required?

OBJECTIVE: Anterior cervical microdiscectomy is a procedure commonly performed for degenerative cervical spine disease. However, there is still controversy regarding whether a bone graft with rigid instrument fixation is necessary following single- or two-level discectomy. We review the results of surgery in 120 patients following anterior cervical microdiscectomy without fixation over the last 22 years. METHODS AND MATERIALS: Anterior cervical microdiscectomy was performed in 120 patients using the Smith-Robinson approach in those with definite MRI evidence of radicular or spinal cord compression by 'soft' or 'hard' disc protrusions. Bone grafting and instrumentation was not done in any of the patients because there was no demonstrable instability of the cervical spine on radiography. RESULTS: Out of the 100 cases operated by the first author, 95 patients had significant improvement in their symptoms and all returned to their normal employment. Four patients required repeat surgery with bone grafting and instrumentation. Of the 20 cases operated by the second author, 19 patients had significant improvement in their symptoms and returned to normal activities. One patient required repeat surgery for a residual disc causing brachalgia. Thus, only 3.3% of the patients required bone grafting with instrumentation for segmental kyphosis and resultant radiculopathy. The remaining patients were significantly improved, and during the follow-up period over 22 years have not developed recurrences or worsening of symptoms even though bone grafting and instrumentation was not done. CONCLUSIONS: Anterior cervical microdiscectomy without bone grafting and instrumentation is a safe and effective procedure following single- and two-level discectomy for cervical disc disease, with a success rate of 97.7%. Bone grafting and instrumentation in every case following anterior cervical microdiscectomy is questionable and should only be used in a few selected cases with demonstrated instability.

A neocentric isochromosome Yp present as additional small supernumerary marker chromosome--evidence against U-type exchange mechanism?

Here we report the first case of an inverted duplicated neocentric small supernumerary marker chromosome present in a karyotype 47,XX,+mar(Y). As expected a partial disomy of Ypter to Yp11.2 did not lead to any major malformations. However, the formation of an inverted duplicated chromosome from a Y chromosome is not possible by a U-type exchange, as has been suggested for such kind of neocentric marker chromosomes. Thus, some evidence is here provided that this concept might not always be true.

Intramedullary cervical neurenteric cyst mimicking an abscess.

We describe a cervical intramedullary neurenteric cyst in a 12-year-old male patient who presented with gradual onset and progressively worsening neck pain, spastic quadriparesis and impaired sensation in the C(2) dermatome. MR imaging revealed a well-defined peripherally enhancing cystic intramedullary lesion with a posteroinferior enhancing nodule at the C(2)-C(3) level mimicking an abscess. There was no evidence of spinal dysraphism. The lesion was completely resected through a posterior approach and the patient showed radical improvement in his symptomatology. At follow-up after 3 years, he was asymptomatic and the MR imaging showed no evidence of any residual or recurrent cyst. The case presented here is unique, since a spinal neurenteric cyst showing intense peripheral contrast enhancement mimicking an abscess is unusual. The radiological features, pathogenesis and surgical considerations in cervical intramedullary neurenteric cysts are discussed and the relevant literature is briefly reviewed.

Role of intralesional bleomycin sclerotherapy as the sole or adjunct treatment of superficial ocular adnexal lymphatic malformations.

ObjectiveTo report the role of intralesional bleomycin as sole or adjunct therapy in the management of superficial ocular adnexal lymphatic malformations.DesignRetrospective study.ParticipantsThree patients/three eyes.MethodsRetrospective chart analysis of patients receiving intralesional bleomycin sclerotherapy as sole or adjunctive treatment for superficial ocular adnexal lymphatic malformations at a single tertiary level eye care institution.ResultsDegree of clinical regression of the lesions (graded by percentage) and resolution of symptoms and signs associated with the lesions.ConclusionsUse of intralesional bleomycin sclerotherapy appears to be an effective sole or adjunct treatment in the management of superficial ocular adnexal lymphatic malformations.

Coupling of strain, stress, and oxygen non-stoichiometry in thin film Pr0.1Ce0.9O2-δ.

Stress and strain in thin films of Pr0.1Ce0.9O2-δ, supported on yttria stabilized zirconia (YSZ) and sapphire substrates, induced by large deviations from oxygen stoichiometry (δ = 0) were investigated by in situ high temperature X-ray diffraction and wafer curvature studies. The measured stresses and strains were correlated with change in δ, measured in situ using optical transmission spectroscopy of defect centers in the films and compared with prior chemical capacitance studies. The coefficient of chemical expansion and elastic modulus values for the films were found to be 18% less than, and 16% greater than in the bulk, respectively. Irreproducible stress and strain during cycling on YSZ substrates was observed and related to microstructural changes as observed by TEM. The enthalpy of defect formation was found to be similar for films supported on sapphire and YSZ, and appeared to decrease with tensile stress, and increase with compressive stress. Larger stresses observed for YSZ supported films as compared to sapphire supported films were found and accounted for by the difference in film orientations.

An imaging study of body composition including lipodeposition pattern in a patient of familial partial lipodystrophy (Dunnigan type).

Familial Partial Lipodystrophy, Dunnigan type (FPLD), is characterised by loss of subcutaneous fat from the limbs and an excessive accumulation of fat on the neck, shoulder girdle and face. Affected individuals have insulin resistance, dyslipidaemia and early cardiovascular events. Body composition (BC) with details of adipose tissue distribution were studied by Dual-Energy X-ray Absorptiometry (DEXA) and Magnetic Resonance Imaging (MRI) ina heterozygote for the FPLD mutation LMNA R482W, and in an age, sex and body mass index (BMI) matched normal control. DEXA revealed a marked decrease in total as well as regional fat percentage in the patient compared to a normal control. Marked reductions in subcutaneous fat in the extremities with substantial lipodeposition in the nape of the neck were confirmed with. MRI. The importance of increased perinephric, retroperitoneal and intermuscular fat in the thighs found in this patient, needs to be explored vis-à-vis the pathogenesis of insulin resistance found in FPLD.

The gene for autosomal dominant hidrotic ectodermal dysplasia (Clouston syndrome) in a large Indian family maps to the 13q11-q12.1 pericentromeric region.

Hidrotic ectodermal dysplasia (HED), Clouston syndrome (MIM No. 129500), is an autosomal dominant disorder affecting the skin and its derivatives. It is characterized by alopecia, dysplastic nails in hands and feet, and hyperkeratosis of the palms and soles. We have studied a large Indian pedigree (UR005), from Gujarat region, consisting of a total 127 individuals including 41 affected (12 males and 29 females). The phenotype in this family ranged from atrichosis to hypotrichosis, sparsity or absence of eyebrows, and thickening of palms and soles. In order to map the disease locus by linkage analysis, DNA polymorphisms were used in DNAs from 23 affected and 8 normal individuals. While genotyping was in progress, Kibar et al. [1996] reported mapping of the locus of a similar disease in French-Canadian families to 13q around marker D13S141. We then utilized markers on 13q to genotype the members of the Indian family. Linkage with 13q11-12.1 markers was confirmed with a maximum lod score of 3.27 (theta=0.00) with locus D13S1316. Multipoint linkage analysis yielded a lod score of 5.04 at theta=0.00 with D13S1316; haplotype analysis indicated that the gene for the Clouston syndrome in this family is localized proximal to D13S292. These data suggest that the gene for the Clouston syndrome in this Indian pedigree is probably the same as that described in the French Canadian families. The combination of data from all available families linked to 13q11-12.1 will make it possible to narrow the critical region and facilitate the positional cloning of the elusive gene.

Effect of etching glass-ionomer cements on bond strength to composite resin.

The use of glass-ionomer cement in restorative dentistry has seen a revival because of its capacity for being etched and bonded to composite resin. Past investigators compared an etched cement surface with an unetched surface that was set against a smooth surface. Clinically, however, a glassy smooth surface is not produced when the cement is used as a base. Using Scotchbond bonding resin, we developed this two-part study to evaluate the tensile bond strengths of P-30TM composite resin to several glass-ionomer cements that were (a) unetched but allowed to set in air and (b) etched for 30 s with orthophosphoric acid, and to compare them with the cohesive strength of the respective cement. Using a silver nitrate staining technique, we also evaluated the microleakage of class V cavities restored with SiluxTM composite resin under a base of etched or unetched Ketac Bond cement. Although there were significant differences among three cements between their cohesive strength and the resin bond strength after the two surface treatments (p less than 0.01), the bond to the unetched surface was generally similar to that of the etched surface of the cement. The remaining groups showed no statistical difference. The microleakage was similar in the two groups. SEM micrographs showed a rough topography of the unetched cement that resembled that of the etched surface. This in vitro study suggests that acid-etching a glass-ionomer base for resin-bonding may not be necessary for specific materials. Further clinical evaluation is recommended to validate this observation intra-orally.

Efficacy of two dentifrices on removal of natural extrinsic stain.

PURPOSE: To evaluate the 6-week effect on natural extrinsic dental stain from the use of a dentifrice containing 10% aluminum oxide, 1500 ppm sodium monofluorophosphate in a precipitated calcium carbonate (PCC) base or a second dentifrice containing 0.5% calcium peroxide (CP), 1500 ppm sodium monofluorophosphate in a PCC base compared to a fluoride placebo dentifrice without stain removal ingredients. MATERIALS AND METHODS: A total of 94 subjects were entered in the study, and stratified into three balanced groups according to their baseline mean Lobene Stain Index scores. The three groups were randomly assigned to use one of the two test dentifrices or the placebo dentifrice. The three groups were well balanced with regard to their mean baseline stain index scores, gender and tobacco habits. Subjects were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice and a commercially available soft bristled toothbrush. Extrinsic dental stain examinations, which included mean stain area and mean stain intensity, were conducted at baseline and 6 weeks. Examinations were conducted by the same dental examiner (F.A.) on the subjects at each examination. RESULTS: After 6 weeks' use of their assigned products, those subjects in the aluminum oxide/PCC dentifrice group and those subjects in the CP/PCC dentifrice group demonstrated statistically significant improvements, as compared to the fluoride placebo dentifrice group without stain removal ingredients.

Usefulness of cytogenetics in leukemias.

Present study consists of cytogenetic evaluation in 141 cases referred to our centre for various leukemias. This includes 110 cases of CML, 10 of ALL, 16 of AML (M3), 2 of AML(M2), 2 of MDS and 1 of CMML. The conventional cytogenetic study was carried out in all the cases using G Banding technique. Of the 141 patients studied, 17 patients showed secondary chromosomal alterations along with primary chromosomal alterations. In two patients of CML with secondary chromosomal alteration t(4:9:22), molecular cytogenetic technique (FISH) has been carried out which has confirmed the primary observations revealed by the conventional cytogenetic technique. Other secondary alterations were numerous and would have been missed if only FISH or PCR technique would have been used for diagnosis. We observed from our study that advanced molecular techniques like FISH and PCR cannot replace the conventional cytogenetic study but are useful as supportive and confirmative diagnostic tools.

Cytogenetics and fluorescence in-situ hybridization in detection of hematological malignancies.

BACKGROUND: The technique of Fluorescence In-Situ Hybridization (FISH), a hybrid of cytogenetics and molecular biology has increased the resolution and application of cytogenetics in various neoplastic processes. In various types of leukemias, primary investigation by conventional cytogenetic [CC] technique followed by FISH has increased our understanding of the abnormal clonal formation involving different gene region. AIMS: Present study is aimed to use different kinds of in-house FISH probes in various hematological malignancies and its correlation with conventional cytogenetic finding. MATERIAL AND METHODS: Cytogenetic study was carried out in 360 patients either from peripheral blood or from bone marrow cells suspected for various types of leukemias. Four of 360 cases were further selected for FISH study by using different types of in-house probes, such as BAC [Bacterial Artificial Chromosome], PAC [Phague Artificial Chromosome], alphoid, PCP [Partial Chromosome Paint] and WCP [Whole Chromosome paint]. RESULTS: The results confirmed breakpoints of inversion 16 and del 16 in case 2 and 3 respectively. Whereas, case 1 did not confirm the cytogenetic findings of t(15;17) by PML/RARa fusion signals as multiple cell lines were involved in the patients. PCP and WCP were helpful in the identification of the marker chromosome in case 1. Telomeric and centromeric probes confirmed the cytogenetic findings of t(5;7) in case 4. CONCLUSION: We observe from this study that, in addition to the conventional cytogenetic study, FISH study provide further confirmation of chromosomal rearrangements. This facilitates our understanding of the neoplastic process more precisely for the better prognostication of the patient.

Prevalence of microalbuminuria in diabetic subjects.

Total 193 diabetic patients were investigated to assess the prevalence of microalbuminuria. Urinary albumin excretion rate (UAER) was measured by radioimmunoassay (RIA) on 3 hours urine samples. The prevalence of microalbuminuria (UAER) > 15 micrograms/min was 41%. Microalbuminuria was commonly observed in patients having diabetes for more than 5 years. A significant correlation was found between duration of diabetes and microalbuminuria (p < 0.01). Glycemic control (fasting and postprandial blood sugar) did not show any correlation with UAER, whereas blood urea (r.39, p < 0.01), creatinine (r.26, p < 0.05) and chloride (r.24, p < 0.05) were positively correlated. A significant correlation was found between raised blood pressure and UAER (p < 0.01).

A newer avenue for evaluation of thyroid dysfunction.

Attempt has been made to rationalise the biochemical assessment of patients suspected to have thyroid dysfunction by introduction of a new rapid and supersensitive immunoradiometric assay (IRMA) for TSH. 294 patients were subjected to thyroid investigation viz; tT3, tT4 and TSH (IRMA). Of these, 51 (17.34%) were hypothyroid, 22 (7.48%) were hyperthyroid and 221 (75.1%) were euthyroid. The ratio of thyroid disorder in male to female was 1:3.38. In all patients with hyperthyroidism TSH (IRMA) was 0.05 to undetectable and it was more than 4.5 ulu/ml in hypothyroid patients. TSH (IRMA) was low in one euthyroid patient a 0.34% incidence of false negativity. In 2 patients with subclinical hyperthyroidism TSH (IRMA) was low while tT3 and tT4 were normal. TSH (IRMA) therefore may obviate the need for more time consuming and expensive TRH test and simplify the approach to thyroid function tests in patients suspected to have masked or overt hyperthyroidism.

Sub-biochemical hypothyroidism: an exaggerated thyroid stimulating hormone response to thyrotrophin releasing hormone.

BACKGROUND: The availability of sensitive and specific assays for evaluation of the thyroid axis has allowed definition of thyroid disorders at subclinical stage. This has almost obviated the use of thyrothrophin releasing hormone (TRH) study. We describe here a group of patients with minimal signs of hypothyroidism having normal thyroid function tests (T3, T4, thyroid stimulating hormone (TSH)) and have shown exaggerated TSH response to TRH. MATERIAL AND METHODS: Total 82 subjects were studied. Of these, 11 were age and sex matched controls, and 71 were patients. In all subjects TSH and other thyroid assays (T3, T4, FT4) were done by immunoradiometric assay (IRMA), and radioimmunoassay (RIA) respectively. Thyroid antibody was carried out by haemagglutination method. Results were compared to age and sex related normal ranges. To further investigate the status of thyroid axis, TRH study was carried out using standard protocol. RESULTS: Based on TRH study patients were grouped in three categories. Group 1 included 29 patients whose TSH response to TRH was normal. Group 2 included 20 patients with normal baseline TSH and exaggerated TSH response to TRH and Group 3 included 18 patients with baseline TSH in the range of 5 to 10 mu IU/ml and exaggerated TSH response to TRH. There was a significant difference to total T3 between group 1 and 3 (p < 0.05) but mean values were within normal limits. While no significant difference was observed in total T4 between controls and patient's group. Serum TSH values were high in group 3 as compared to controls and Group 1 and 2 (p < 0.0001). For Free T4 no statistical significance was observed between Group 1, 2 and 3. Thyroid antibodies were positive in 22.7% of patients in Group 2 and 33.33% in Group 3. CONCLUSION: We conclude from the present study that even with sensitive TSH assays TRH study still has a role to mark the early stage of hypothyroidism. Those with a normal or upper normal TSH with exaggerated response to TRH are termed as sub-biochemical hypothyroidism and can be considered for thyroid replacement therapy.

Serum leptin concentrations in hyperinsulinemia in the sets of obese, lipodystrophic and/or non-obese patients.

OBJECTIVE: To study the relationship between serum leptin and circulating insulin under basal and in response to oral glucose administration in hyperinsulinemic patients with or without obesity. MATERIAL AND METHOD: Fifteen female patients of known hyperinsulinemia provided material for the study. Leptin and insulin in sera were estimated by radioimmunoassay methods. RESULTS: Eight of the 15 hyperinsulinemic patients with high body mass index (BMI) (31 +/- 0.94 kg/m2) had significantly (p < 0.01) elevated serum leptin concentrations (26.1 +/- 2 ng/ml) as compared to the levels in the remaining seven non-obese hyperinsulinemic patients with BMI of 20 +/- 1.0 kg/m2; their mean levels of serum leptin were low 5.7 +/- 1.1 ng/ml. Four of the latter group had face-sparing partial lipodystrophy. The mean circulating leptin concentrations in the control group of seven healthy normoinsulinemic and regularly menstruating women with normal BMI (19 +/- 0.95 kg/m2) were 13.7 +/- 1.8 ng/ml. DISCUSSION: The results of the present study in 15 hyperinsulinemic patients show that circulating levels of leptin are not related to serum insulin. However, there was a positive correlation with BMI. An interesting observation of the study is that, notwithstanding the normal BMI, the group of hyperinsulinemic patients with face-sparing partial lipodystrophy had the lowest levels of circulating leptin concentrations. They were closer to the values found in prepubertal girls.

Clinical, endocrine and metabolic studies in the kindred of familial partial lipodystrophy--a syndrome of insulin resistance.

OBJECTIVE: To study clinical, endocrine and metabolic profiles in the kindred of subjects with familial partial lipodystrophy (FPLD, Dunnigan type). MATERIAL AND METHODS: Twenty two relatives (10 males, 12 females), from an extended family with FPLD, were assessed for the phenotypic features, impaired glucose tolerance (IGT)/diabetes mellitus (DM), dyslipidemia and the presence of insulin resistance. Plasma glucose and serum lipids were measured using glucose oxidase and standard colorimetric methods. Serum insulin was estimated by radioimmunoassay. RESULTS: The age was 12 to 67 years, two being adolescents. Two of the 20 adults were overweight and eight were underweight; BMI (adults) was 15.5 to 28.5. Features of FPLD were evident among eight out of 12 women. This typical phenotype was not obvious in all 10 male members. Varying degree of Hirsuitism was observed in four of 12 women, acanthosis nigricans in 11 out of 22 members and skin tags were present in only eight of 22; hypertension in six members and diabetes in four. Eleven members had either impaired glucose tolerance (IGT) (n=7), or DM (n=4). Ten of 20 members showed hyperinsulinemic response on oral glucose tolerance test (OGTT). Dyslipidemia was present in 13 family members. CONCLUSION: The majority (2/3rd) of female members showed typical phenotypic features of FPLD, with a clustering of cardiovascular risk factors and insulin resistance syndrome. More than half the men without phenotypic features of FPLD had either IGT/DM, dyslipidemia, hypertension or cardiovascular disease.

Investigation into the possible mechanisms involved in altered digoxin levels in diabetic patients.

The present study was undertaken to investigate the possible factors which may contribute to the altered digoxin levels in diabetic patients. The digoxin levels were found to be significantly higher in diabetics (1.74 +/- 0.09 ng/ml) as compared to non-diabetics (0.76 +/- 0.07 ng /ml). There was a positive correlation between digoxin levels and glycosylated haemoglobin levels. All diabetic patients had serum creatinine, urea and potassium levels within normal limits. However, serum TSH levels were found to be significantly higher in diabetics as compared to controls. Serum tri-iodo-1-thyronine (T3) levels were found to be lower in diabetics as compared to non-diabetics. Our data suggests that diabetes-mellitus causes alteration of digoxin levels. One of the causes of this increase in digoxin levels may be a tendency towards mild hypothyroidism associated with diabetes mellitus.