Evaluation by dental cone-beam computed tomography of the incidence and sites of branches of the inferior dental canal that supply mandibular third molars.

Our aim was to assess the incidence and anatomical site of branches of the inferior dental canal that supply mandibular third molars using dental cone-beam computed tomography (CT). We evaluated the incidence and diameter of branches of the inferior dental canal using 272 cone-beam CT mandibular scans from 172 patients referred for imaging before the extraction of impacted mandibular third molars. We found three typical branching patterns from the inferior dental canal in the third molar region: the retromolar canal (in the retromolar triangle), the dental canal (that courses directly beneath the socket of the third molar), and the accessory canal (that courses through the socket and leads from the inferior dental canal to a bony ridge). The incidences of retromolar, dental, and accessory canals were 75 (28%), 223 (82%), and 21 (8%), respectively, with mean diameters of 0.9 (0.4), 0.7 (0.5), and 1.1 (0.4) mm, respectively. Operative injury to the neurovascular contents within the branches of the inferior dental canal can lead to excessive bleeding and postoperative paraesthesia, so identification of its branches on preoperative cone-beam CT images may prove useful during extraction of impacted mandibular third molars or when harvesting bone blocks from the region of mandibular third molars. We also describe two cases of branches detected on panoramic and cone-beam CT images that prompted this research.

Validation of a bacteremia prediction model.

OBJECTIVE: To validate a previously published model for predicting bacteremia in hospitalized patients. DESIGN: Application of a published bacteremia prediction model to a prospective validation cohort of patients and comparison of its predictability to that found in the derivation cohort. SETTING: Urban, university-affiliated, 550-bed public hospital. PATIENTS: The validation cohort consisted of 342 patients with 559 blood culture episodes between October 14, 1992, and December 5, 1992. Each blood culture episode was scored based on the presence or absence of seven predictors of bacteremia and the findings compared with published results (derivation cohort). INTERVENTIONS: None. RESULTS: Application of the bacteremia prediction model to the validation cohort identified episodes with a low risk (3%) and a high risk (17%) for true bacteremia, similar to the findings in the derivation cohort (1% and 16%, respectively). Comparison of the predictions of the model in the two cohorts by receiver operator characteristic curve analysis revealed that the overall predictability of the model in the validation cohort was not as good as in the derivation cohort. CONCLUSIONS: Although the bacteremia prediction model did not perform as well overall in the validation cohort, the model still was able to clearly define two extreme groups: those with a low risk and those with a high risk for true bacteremia. This predictive capability may aid physicians in prescribing empiric antimicrobial therapy and also may be useful to hospital epidemiologists in assessing quality of care.

Analysis of expression of yeast enolase 1 gene containing a longer pyrimidine-rich region located between the TATA box and transcription start site.

Yeast ENO1 promoter was prepared by a chemical synthetic method. Two variant promoters containing a pyrimidine-rich region (CT block), located between the TATA box and the transcription start site, either 32 or 34 base pairs (bp) longer than the native ENO1 promoter were isolated during the chemical synthesis. Gene expression of variant promoters was compared with that of the native promoter by measuring the amount of mRNA and the activity of beta-galactosidase by constructing ENO1-lacZ gene fusions. No significant differences were observed between the native and variant promoters in transcription levels. The start site of transcription was mapped on CAAG, a consensus sequence of transcription start site of yeast glycolytic genes. The results suggest a longer CT block in ENO1 promoter may not affect the expression of the yeast ENO1 gene. In addition, the level of ENO1 gene expression was found to be higher in stationary phase cells than in log phase cells.

Nucleotide sequence of the 5' flanking region responsible for the enhancement of the expression of yeast enolase 1 gene.

Several plasmids carrying different length of the 5' flanking region of yeast (Saccharomyces cerevisiae) enolase 1 gene (ENO1) which is fused in frame to the Escherichia coli lacZ gene were constructed by recombination in vitro. Promoter activity of ENO1 was assayed by measuring beta-galactosidase activity of the fused gene product. Comparison of the promoter activity of these plasmids suggests that the sequences required for a strong promoter activity lie within the DNA segment -724 to -353 base pairs (bp) upstream from the start of ENO1 coding sequence. The nucleotide sequence of this region was determined.

Comparison of lipid composition of Candida guilliermondii grown on glucose, ethanol and methanol as the sole carbon source.

The carbon and energy source for aerobically grown cultures of Candida guilliermondii profoundly influenced the neutral lipid content and the fatty acid composition of the individual lipid components. Methanol (0.80%, w/v) grown cells cultivated at 30 C in presence of 0.025% ammonium sulfate contained 12% total lipids, 67% of which was neutral lipids. Glucose (0.74%), w/v) or ethanol (0.53%, w/v) grown cells contained 21--22% total lipids, 80% of which was neutral lipids, under the same conditions. Methanol-grown cells contained a decreased 18:1 acid (52--54% of total fatty acids) and an increased 18:2 acid (23--25%), as compared with glucose- or ethanol-grown cells which contained 57--66% 18:1 acid and 8--14% 18:2 acid, in both neutral and polar lipid fractions. The relationship between methanol metabolism and desaturation of fatty acid in yeast was discussed.

Treatment of arteriosclerotic obstruction by LDL adsorption.

According to the authors' clinical analysis, about half of the patients who suffer from arteriosclerotic obstruction (ASO) in the lower extremity(-ies) with clinical manifestation are dyslipidemic (total cholesterol > or = 220 mg/dL or LDL cholesterol > or = 140 mg/dL). As suggested by clinical success in regression of ASO in the coronary arteries as a result of aggressive removal of LDL, LDL adsorption utilizing an extracorporeal circulation technique with a dextran sulfate/cellulose adsorbent column was applied in 33 patients (22 men and 11 women) with ASO. Clinical results obtained after a series of 10 LDL adsorption procedures as a standard showed encouraging success. Improvement in subjective symptoms was achieved as follows: 88.5% for cold lower extremity, 87.1% for intermittent claudication, 53.8% for leg/toe pain at rest, and 60% for disappearance/size diminution of ulcer/necrosis. Improvements in objective examination findings supported subjective ones: 85.7% by plethysmography, 81% by thermography and 70% by ankle pressure index. No serious complications or untoward effects were observed during or after the adsorption procedures. In conclusion, LDL adsorption appears to be a useful and safe tool in treatment of ASO patients with dyslipidemia.

Conversion of treatment from cefoxitin to ampicillin/sulbactam: experience in a university teaching hospital.

A 12-month trial, conducted in a 650-bed university teaching hospital, evaluated the conversion from cefoxitin to ampicillin/sulbactam. This report discusses the methodology used to evaluate the feasibility of the change and the challenges encountered during the trial period. The effect of cost and overall therapeutic outcome were other aspects of the evaluation. Results indicate that a conversion from cefoxitin to ampicillin/sulbactam is not only feasible but is also a realistic approach to achieving high-quality, cost-effective care.

Got Health? The Hawaii Partnership for Standards-Based School Health Education.

The American Cancer Society (ACS), Hawaii Pacific, Inc., initiated the Hawaii Partnership for Standards-Based School Health Education in July 1999. The goal of the partnership is to implement standards-based school health education to promote child and adolescent health in Hawaii. The partnership includes representatives from the Hawaii Department of Education, the Hawaii Board of Education, the Hawaii Department of Health, the University of Hawaii College of Education, Meadow Gold Dairies, the Hawaiian Electric Companies, the Hawaii Medical Services Association, and local divisions of the American Cancer Society. During its first year, the partnership collaborated to sponsor 15 teacher workshops on the new Hawaii Health Content Standards. In addition, Meadow Gold Dairies initiated a Got Health? milk carton side-panel promotional campaign to publicize the standards. This article describes development of the Hawaii Health Content Standards, history of the partnership, activities to date, concurrent supporting efforts, future plans, and lessons learned during the first year.

[Transcatheter oily chemoembolization and intermittent hepatic artery infusion chemotherapy in the management of advanced hepatocellular carcinoma].

Between 1990 and 1997, 227 patients with hepatocellular carcinoma were treated by intrahepatic arterial injection of a Lipiodol-Epirubicin-Mitomycin C emulsion followed by intermittent hepatic artery infusion of Epirubicin, Mitomycin C and 5-FU, employing an implantable subcutaneous infusion port. A catheter was inserted percutaneously into the hepatic artery using the Seldinger technique. Objective remission was induced in 80% of the evaluable patients as evidenced by a decrease in their AFP and PIVKA II levels. These remissions were also confirmed by liver sonogram and CT scan showing decreased tumor volume. Transcatheter oily chemoembolization combined with intermittent hepatic artery infusion chemotherapy seems to be an effective treatment for unresectable hepatocellular carcinoma both for palliation of symptoms as well as prolongation of survival with good quality of life.

[Intra-arterial infusion chemotherapy for breast cancer].

In order to reduce toxic effects while attaining maximal therapeutic effects, epirubicin 10 mg/day, cyclophosphamide 100 mg/day and prednisolone 10 mg/day were administered through in indwelling catheter inserted into the internal mammary artery and/or subclavian artery for 3-4 weeks, employing the implantable port system for the treatment of unresectable breast cancer and recurrent cancer. Ten out of 11 patients (91%) with unresectable breast cancer showed a response (CR 3, PR 7, NC 1) to this modality of intra-arterial infusion chemotherapy. Seven out of 11 patients (64%) with recurrent cancer of the breast showed a response (CR 1, PR 6, NC 4). Intraarterial infusion chemotherapy for the unresectable advanced breast cancer and recurrent breast cancer proved to be an effective modality of treatment.

[Intra-arterial infusion chemotherapy for unresectable or recurrent breast cancer].

Epirubicin and 5-FU were administered through an indwelling catheter inserted into the internal mammary artery and/or subclavian artery employing an implantable infusion port system for the treatment of unresectable advanced breast cancer and recurrent breast cancer. Intraarterial infusion chemotherapy proved to be an effective treatment modality for unresectable advanced breast cancer and recurrent breast cancer.

Evaluation of hetastarch.

The indications, pharmacology, adverse reactions, clinical studies, dosage, and cost of hetastarch are reviewed. Hetastarch is a plasma volume expander used in adults for the treatment of shock caused by hemorrhage, burns, surgery, sepsis, or other trauma. It is a heterogenous macromolecular agent derived from starch and is composed primarily of amylopectin. The usual dose of 6% hetastarch is 500-1000 ml; total dosage should not exceed 1500 ml/day (20 ml/kg). The dose of hetastarch should be adjusted for patients with severe renal impairment because its major route of elimination is the urine. Adverse reactions associated with its use are minor defects in coagulation produced with recommended doses and dose-related hematologic abnormalities with infusions greater than 1500 ml. Elevations in serum alpha-amylase and indirect bilirubin levels have also been reported. Hetastarch appears to be comparable with albumin as a plasma volume expander and is substantially cheaper. Few controlled studies with hetastarch have been published, and more data are needed to evaluate its effectiveness compared with other plasma volume expanders.

A variety of clinical applicabilities of immobilized dextran sulphate as lipoprotein adsorbent and avoidance of anaphylactoid (anion-blood contact) reaction in its use.

Dyslipidemia including hyper-LDL(low density lipoprotein) cholesterol which is very often refractory to dietary/medical treatments is known to be a risk factor of many arteriosclerotic lesions. An extracorporeal procedure of plasma adsorption, LDL adsorption, utilizing dextran sulphate as a ligand immobilized on cellulose gel beads has been clinically applied in a variety of dyslipidemic conditions as listed below. Its usefulness in secure reduction of the serum LDL level and consequent symptomatic improvements has been confirmed. Familial hypercholesterolemia(FH): A regular repetition of the LDL adsorption ameliorates hyper-LDL cholesterolemia as resulting in regression of the multiple stenoses in the coronary arteries. Focal glomerulosclerosis(FGS): A seesion of the LDL adsorption improves kidney function and reduces a urinary protein excretion in FGS patients with dyslipidemia. Arteriosclerosis obliterans(ASO): More than 60 ASO patients with dyslipidemia have been treated by the LDL adsorption in our center. In over 80% of the patients, marked improvement in clinical symptoms such as leg pain/intermittent claudication has been brought out. Hemodialysis-relevant dyslipidemia(HDDL): HDDL which develops in the long-term HD patients has been treated. Transplantation-relevant dyslipidemia(TXDL): TXDL with deterioration of the transplanted kideny function has been treated by the LDL adsorption. Kidney function improves. Anaphylactoid reaction which is tentatively explained as a result of release of bradykinin in contact of blood with polyanionic material of the adsorbent, dextran sulphate, develops, in particular, while an angiotensin-converting enzyme inhibitor is administered as a depressant. However, it can be avoided in a use of nafmostat mesilate, a protease inhibitor, as an anticoagulant.