GEWF solution.

BACKGROUND: Lymph node status is an important prognostic factor in the staging of colorectal carcinoma. Several adjunctive solutions have been used to increase the yield of pericolic lymph nodes from colorectal cancer resection specimens. METHODS: During 1998 at the Grey Bruce Regional Health Centre (Owen Sound, Ontario), 67 colonic resections were performed for colorectal cancer. Lymph nodes were identified using GEWF solution (glacial acetic acid, ethanol, distilled water, and formaldehyde) in 35 cases, and by the conventional method of sectioning, inspection, and palpation in 32 cases. RESULTS: There were no significant differences between GEWF and non-GEWF cases with respect to patient age, length of resection, size of tumor, tumor histologic type, tumor differentiation, or depth of tumor penetration into the bowel wall. Use of GEWF led to a significant increase in the number of lymph nodes found (10.2 +/- 4.9 per case) compared with non-GEWF cases (6.8 +/- 3.9 per case) (P =.002). In GEWF cases 358 lymph nodes were identified, 82 with metastases, whereas in the non-GEWF cases 218 lymph nodes were found, 41 with metastases. The size of positive lymph nodes in the GEWF group (0.5 +/- 0.2 cm) was significantly smaller than in the non-GEWF group (0.7 +/- 0.4 cm) (P =.046). A greater percentage of positive lymph nodes in the GEWF cases (49/82, 60%) were 0.5 cm or smaller compared with the non-GEWF cases (17/41, 41%). CONCLUSIONS: GEWF increases the yield of lymph nodes recovered from colorectal cancer specimens and may lead to improved staging of this cancer; it is inexpensive and simple to use.

Basaloid carcinoma of the colon arising at the splenic flexure.

AIMS: Basaloid carcinomas typically arise in the anal canal and there are only three well-documented cases of this neoplasm reported outside the anal canal, none more proximally than the sigmoid colon. The first occurrence of a basaloid colonic carcinoma arising outside the sigmoid colon, at the splenic flexure, is presented. METHODS AND RESULTS: A splenic flexure mass was resected from a 54-year-old man with a 3-week history of abdominal discomfort, diarrhoea and weight loss. This tumour, like typical anal canal basaloid carcinomas, was composed of islands of basaloid cells with peripheral nuclear palisading; within many islands there was central necrosis and focal squamous differentiation. Ultrastructural and immunohistochemical studies confirmed the basaloid nature and focal squamous differentiation within this neoplasm. Basaloid carcinoma of the anal canal has been associated with human papilloma virus. Using in-situ hybridization, HPV DNA was not detected in this case. CONCLUSIONS: Outside the anal canal, it has been postulated that basaloid colonic carcinomas may arise from cloacogenic embryologic rests, squamous metaplastic epithelium, or totipotential basal cells. The location and pathological findings of this tumour suggest that this rare colonic neoplasm arises from a totipotential basal cell.

Plastic bread-bag clips in the gastrointestinal tract: report of 5 cases and review of the literature.

Plastic bread-bag clips have been identified as a cause of local perforation or obstruction at many sites in the gastrointestinal tract. This study is the largest case series yet reported, consisting of 3 cases presenting as small-bowel perforation, 1 case in which the clip was found incidentally in the small bowel at laparotomy during vascular surgery and 1 case in which the clip was found incidentally in the small bowel at autopsy. In all cases there was no radiographic evidence to suggest a foreign body in the gastrointestinal tract. People older than 60 years of age who have either partial or full dentures seem to be particularly at risk for the accidental ingestion of these devices. If accidentally ingested, plastic bread-bag clips represent a significant health hazard. As the population ages, small-bowel perforation secondary to ingestion of such clips may occur with increasing frequency. The authors recommend elimination or redesign of the clips, to prevent their being swallowed and becoming impacted in the small bowel or to allow them to be identified in the gastrointestinal tract by conventional radiography.

Adequacy of dental records in clinical practice: a survey of dentists.

PURPOSE: The purposes of the study were to determine Minnesota dentists' perception of the adequacy of their dental record documentation, assess the general format and contents of dental records they used, and compare the self-reported contents of dental records with guidelines established by the American Dental Association (ADA). METHOD: Using ADA's published recommendations for structure and guidelines of the dental record from 1987, a 20-item questionnaire was developed, pretested, and used to survey a random sample of 750 Minnesota dentists. Reminder postcards were sent two weeks after the initial survey mailing. A third mailing to nonrespondents, including cover letter and duplicate questionnaire, was conducted three weeks later. Of the surveys returned, 63% (N = 475) were analyzed. Data analyses, including frequencies and tests of chi-square, were conducted using Statview and SPSS. RESULTS: While 15% (N = 69) of respondents used a single-page record format, 44% (N = 209) used multiple forms filed in a specific location within the record. Of the dentists responding, 403 (85%) felt their record documentation was adequate without comparison to any specified criteria. However, statistically significant differences occurred between dentists' perception of record adequacy and the actual presence or absence of ADA criteria for all record components. Data analysis revealed that information was absent 9.4% to 87.1% of the time. CONCLUSION: A discrepancy exists between dentists' perception of dental record adequacy and the ADA recommendations for structure and guidelines. Inadequate dental record components should be targeted for improvement.

Modulation of matrilysin levels in colon carcinoma cell lines affects tumorigenicity in vivo.

The expression of the metalloproteinase matrilysin in the human colon carcinoma cell lines SW480 and SW620 correlates with the ability of the SW620 cells to invade an artificial basement membrane in vitro and metastasize to the liver following injection into the cecum of nude mice in vivo. Transfection of either wild-type or activated forms of matrilysin into the SW480 cells, which do not express endogenous matrilysin, did not reproducibly increase in vitro invasion but increased the tumorigenicity of the cells when injected into the cecum of nude mice. Antisense reduction of matrilysin levels decreased the tumorigenicity of the SW620 cells and subsequent metastasis to the liver. These results suggest that matrilysin gene expression by colon adenocarcinoma cells is not sufficient for tumor invasion and metastasis but contributes to the tumorigenicity and progression of colorectal tumors.

Expression and localization of matrix-degrading metalloproteinases during colorectal tumorigenesis.

The metalloproteinase matrilysin is widely expressed in the epithelial tumor cells of malignant colorectal adenocarcinomas. Approximately 50% of benign adenomas also express low levels of matrilysin that is focally localized. The expression of stromelysin-1, stromelysin-3, and gelatinase A was observed in the stromal component of several carcinomas and was not present in adenomatous tissue. The expression of interstitial collagenase and gelatinase B was observed in occasional adenomas and carcinomas. Stromelysin-2 transcripts were not detectable in any of the samples examined. Tissue inhibitor of metalloproteinase-1 gene expression was widespread and was observed in both epithelial and stromal cells of adenomas and carcinomas. These results indicate that matrilysin gene expression is an early event in colorectal tumorigenesis and that the expression of stromelysin-1, stromelysin-3, and gelatinase A is primarily a late event. The observed gene expression patterns suggest that matrilysin may participate in early events in tumor progression and that multiple members of the metalloproteinase family may work in concert to facilitate late-stage tumor invasion and metastasis.

The effect of a career planning workshop on graduate dental hygienists.

Purpose. The purpose of this study was to determine the effects of a career planning workshop on the career satisfaction, decisions, and plans of graduate dental hygienists. Method. A workshop was designed to teach graduate dental hygienists a systematic process for analyzing their needs and opportunities and making informed, realistic, and satisfying career decisions. This workshop incorporated vocational testing, interpretation by a professional counselor, lecture/discussion, small group interaction, and an accompanying manual of career planning resources and exercises. Sixty-nine dental hygienists attended a two-day workshop in fall 1990. Participants completed data collection instruments consisting of 42-item pre-assessment and 40-item follow-up questionnaires designed by the authors. Sixty-three completed the pre-workshop questionnaire. Fifty-four participants responded to the follow-up questionnaire mailed six months after the workshop. Data analyses included frequency distributions, percentages, means, and standard deviations. Paired t-tests and chi-square statistics were also calculated. Results. Findings from the pre-workshop questionnaire indicated that over 76% of participants had considered leaving their present position and 70% had considered leaving the profession. The six-month follow-up questionnaire revealed that four participants had changed dental hygiene employers and two had left the profession to pursue different careers. Forty-four percent reported that their feelings toward dental hygiene as a career had become more positive since attending the workshop. Pre-workshop to six-month follow-up responses indicated increased mean satisfaction in amount of challenge, compensation/rewards, and overall career satisfaction. Conclusions. The results of this study indicated that career planning workshops, in combination with other methods, are a useful strategy for helping dental hygienists maintain satisfaction, and have the potential to promote career longevity in the dental hygiene profession.

Dental hygiene students' and practitioners' resolution of professional issues.

The purpose of this study was to investigate the relationship among verbal ability, extent of education and professional experience, level of cognitive development, and age (separately and in combination) and dental hygiene students' and practitioners' ability to resolve professional issues. Forty-five dental hygiene students and graduates participated in this cross-sectional study (15 associate-degree subjects with no professional experience; 15 associate-degree subjects with professional experience; and 15 baccalaureate-degree subjects with professional experience). Ability to resolve professional issues was measured using two professional issues cases developed by the investigator. Protocols were rated separately and blindly by two raters, resulting in high interrater reliability (r = .69) and agreement estimates (80%). Results revealed that subjects with higher levels of education and professional experience achieved higher scores on the professional issues cases. Multiple regression and part correlation analyses revealed that the independent variables, in combination and separately, were of questionable value in predicting ability to respond to professional issues. While no single variable was overwhelmingly predictive, the combination variable extent of education and professional experience appeared to be the best predictor.

Predictors of position of intellectual development in dental hygiene students and practitioners.

The purpose of this study was to investigate the relationship between verbal ability, age, extent of education and professional experience (separately and in combination), and level of cognitive development of dental hygiene students and practitioners. Forty-five dental hygiene students and graduates (15 associate degree subjects without professional experience; 15 associate degree subjects with professional experience; and 15 baccalaureate degree subjects with professional experience) participated in this cross-sectional study. The Measure of Intellectual Development (MID), a semi-structured, generation cognitive task, was used to assess cognitive development (position/stage of intellectual development). MID protocols were scored separately and blindly by two raters resulting in high interrater reliability and agreement estimates. In general, subjects were functioning at a relatively low level (position 3 multiplicity) of cognitive development. Baccalaureate degree subjects tended to function at a higher position than subjects in the other two groups. There was a significant, positive correlation between extent of education and level of cognitive development.

Musculoskeletal pain among Minnesota dental hygienists.

Using a 33-item questionnaire, this study was conducted to determine the nature and prevalence of musculoskeletal pain in dental hygienists, and its effects on clinical practice. An 89% response was obtained from a random sample of 493 dental hygienists. Results revealed that 68% of the respondents reported having musculoskeletal pain in eight body locations the previous year. In addition, a large percentage of dental hygienists with a preexisting condition reported having musculoskeletal pain. Thirty-four percent stated that musculoskeletal pain had affected their clinical practice--forcing them to practice fewer days, decreasing their endurance, reducing speed and quality, and/or altering operating positions. The findings suggest that particular locations of pain could be related to dental hygiene practice. Further research is indicated to clarify specific patient-operator positions contributing to musculoskeletal pain so that prevention and early treatment become possible.

Carpal tunnel syndrome among Minnesota dental hygienists.

Because of inherent aspects of clinical practice, dental hygiene practitioners may be at risk for developing carpal tunnel syndrome (CTS). A study was conducted to determine the prevalence of CTS among dental hygienists and its effects on clinical practice. A 33-item questionnaire was mailed to a random sample of 493 dental hygienists. A 90% response rate was achieved. Results revealed that 7% of the respondents had been diagnosed as having CTS. However, 63% had experienced one or more symptoms. Six percent reported that CTS had affected their clinical practice in ways such as limiting the number of days practiced, diminishing their hand strength, or forcing them to leave the profession. The findings suggest a need for dental hygienists to obtain information on CTS symptoms to facilitate early diagnosis and treatment.

Dental hygienists' knowledge and opinions about fluorides and fluoridation.

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge and opinions about fluorides and water fluoridation. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a pretested, 42-item, mailed questionnaire. An 84 percent response was achieved with two followup reminders. These data provide baseline information about the caries prevention knowledge and attitudes of practicing dental hygienists in two states. Respondents from both states held similar levels of knowledge about fluorides and opinions about decision making on fluoridation. Fluoride topics, especially water fluoridation, were not receiving high priority in patient education, although nearly all believed that dental hygienists should promote water fluoridation actively. Two-thirds of respondents from both states believed fluoridation decisions should be made by health authorities, rather than by elected officials or through public vote. Greater attention to patient education about fluoride and community water fluoridation is needed by dental hygienists.

Reduction of intracellular pH as a possible mechanism for killing cells in acidic regions of solid tumors: effects of carbonylcyanide-3-chlorophenylhydrazone.

The environment of cells within solid tumors is known to be acidic relative to that in normal tissue, and the viability of tumor cells may depend on mechanisms which maintain intracellular pH (pHi) above the extracellular pH (pHe). We have assessed therefore the toxicity in vitro of the proton ionophore carbonylcyanide-3-chlorophenylhydrazone (CCCP), since this agent has been reported to be capable of transporting H+ equivalent through artificial lipid bilayers and mitochondrial membranes. CCCP was toxic to the human bladder carcinoma cell line MGHU1 and to the murine mammary sarcoma cell line EMT-6 only at pH, less than 6.5. CCCP transported H+ equivalents through cell membranes at physiological (7.35) and low pHc (6.20). Cell lines were found to have steady-state pHi values approximately 0.1 to 0.2 pH units above pHc at pHc less than 6.50. Addition of CCCP led to a decrease in steady-state pHi values as compared to untreated cells at pHc less than 6.50, whereas there was no apparent effect of CCCP on steady-state pHi values at pHc greater than 6.50. The CCCP-induced reduction in steady-state pHi combined with the uncoupling of oxidative phosphorylation by CCCP appeared to be the major mechanisms leading to cell death at pHc less than 6.50. The toxicity of CCCP under acidic conditions was enhanced by amiloride and 4,4'-diisothiocyanostilbene-2,2-disulfonic acid, agents which are known to inhibit membrane-based ion exchange mechanisms which regulate pHi under acidic conditions. When both agents were combined with CCCP, cell killing was observed at pHc less than 7.30. Our results suggest that mechanisms which regulate pHi under acidic conditions which occur in solid tumors may represent targets for new forms of tumor-specific therapy.

Dental hygiene student. Interest in advanced education.

This paper reports the results of a 1985 survey of certificate/associate degree students' interest in advanced education: baccalaureate degree completion and non-degree granting residency programs. Subjects included first- and second-year dental hygiene students enrolled in 12 vocational, community college, state, and research university institutions in a five-state region in the upper Midwest. The data collection instrument consisted of a 12-item mailed questionnaire. One hundred percent program and 78.7% student response rates were achieved. Results indicate that respondents are interested in degree completion and non-degree granting residency programs. Interest varied by age and by type of institution in which respondents were completing their dental hygiene education. While younger respondents were more likely to express interest in advanced education, respondents over the age of 30 were generally interested or undecided. Overall, respondents indicated slightly different areas of interest for degree completion versus residency programs. In general, respondents indicated an interest in pursuing advanced education on a part-time, evening basis, within five years of completion of their basic dental hygiene education. Cost, time, and family commitments were identified by respondents as major barriers to continuing their education.

Dental hygienists' knowledge, opinions, and use of pit and fissure sealants: a comparison of two states.

This article reports results of a study of 563 practicing Minnesota and Wisconsin dental hygienists' knowledge, opinions, and use of pit and fissure sealants. The study was carried out six months prior to the 1983 NIH Consensus Development Conference on Dental Sealants in the Prevention of Tooth Decay. It therefore provides baseline information for two states prior to the initiation of widespread public information about the positive value of sealants that occurred as a result of that conference. Such baseline information is relevant for future studies of the diffusion of adoption of this caries-preventive technology by dental hygienists. Two independent samples were selected randomly from the populations of licensed dental hygienists residing in the two states. Data were collected using a 42-item mailed questionnaire, with an 84 percent response. Data were analyzed for both interstate and intrastate comparisons. Respondents were generally knowledgeable and had favorable opinions about sealants, although they had low levels of training in their use. Sealants were being used in 54 percent of the offices in which respondents practiced, with the dentist placing them most often. Among hygienists who applied sealants at all, more than two-thirds did so three or fewer times per week. Eighty-four percent indicated they would like to apply sealants more often. The most frequent reasons given for nonuse were lack of acceptance by the dentist-employer and nondelegation.

Moral reasoning in dental hygiene students.

Sixty-five students participated in a study designed to identify the level of moral reasoning of dental hygiene students. Comparisons were made with typical college students and a normative group composed of individuals representing a cross-section of ages and educational levels. The relationships among level of moral reasoning and clinical performance, other selected academic measures, and cognitive style were also assessed. The results indicated that post-certificate dental hygiene students reasoned about moral dilemmas at a higher level than the normative group and at the same level as the college student group. In addition, clinical performance, National Board Dental Hygiene Examination scores, Dental Hygiene Aptitude Test (reading scores), high school rank, and cognitive style correlated positively with level of moral reasoning and specific stages of moral development for postcertificate students.