Clinical significance of the RT-PCR positive sentinel node in melanoma.

BACKGROUND: The clinical relevance of RT-PCR positivity for melanoma markers in the sentinel node remains controversial. Our purpose was to determine whether patients with a histologically negative but RT-PCR positive node were at an increased risk for recurrence than their RT-PCR negative counterparts. METHODS: Thirty-nine adult patients underwent sentinel node biopsies for melanoma between 1998 and 2000. Each sentinel node was bivalved. Half was serially sectioned and examined by routine hematoxylin and eosin (H&E) and immunohistochemistry (IHC; S100, HMB-45, melanA, and tyrosinase). The other half was analyzed by a nested RT-PCR assay for tyrosinase. RESULTS: Patients were followed for recurrence with a mean follow-up of 71.1 months. The odds ratio of recurrence for RT-PCR positive versus RT-PCR negative patients was 1.39 (0.34, 5.62; p = 0.73). Within the histology negative subgroups, the risk of recurrence in the RT-PCR positive group (26.7%) was not significantly different from the risk of recurrence in the RT-PCR negative group (22.2%) (p = 0.33 chi-squared). RT-PCR of the sentinel node was not a predictor for recurrence on multivariate analysis (p = 0.65). CONCLUSION: Sentinel node RT-PCR positivity did not risk stratify histologically negative melanoma patients beyond routine pathologic examination in this series.

The presentations and management of transposed teeth.

Tooth transposition is an uncommon dental anomaly that nevertheless has important implications regarding treatment. This article describes six types of transposition, discussing the problems and possible solutions. It is important to ensure that the results of any treatments for transposition are both aesthetic and functional.

An investigation into the standard of orthodontic treatment carried out by GDPs after completion of a clinical assistant training.

A sample of 172 orthodontic patients treated by 10 general dental practitioners in their practices was assessed in terms of treatment need and standard of treatment provided. The practitioners had been clinical assistants, for a minimum of 2 years, at a District General Hospital before starting any of the cases. Prior to treatment 70% of the cases had a 'clear need' for treatment on dental health grounds and 73% of the cases had a 'moderate' or 'great need' for treatment on aesthetic grounds. Using the Peer Assessment Rating nomogram to assess the treatment standard, 83% of patients could be classed as 'improved' or 'greatly improved' with treatment but 17% were 'worse or no different'. The standard of treatment produced by fixed appliances was found to be superior to that produced by removable appliances alone. When removable appliances were used the best results were obtained when consultant advice was given. The results for the clinical assistant sample are compared with the results for the GDS sample published in 1993. Ways of further improving the treatment standards produced by the general dental practitioners are considered.

An evaluation of the views of general dental practitioners who have participated in an extended orthodontic training scheme.

A questionnaire was sent to 255 dental practitioners who had participated in an extended orthodontic training scheme, incorporating formal teaching and supervised clinical sessions over a period of not less than 24 months. The response of the practitioners was good; 78 per cent of the forms returned were suitable for analysis. Overall, the practitioners responded favourably to the schemes and felt that they had been of benefit to their clinical practice. The majority undertook more orthodontic treatment as a result and on average, fixed appliances were used in half of these treatments.

An investigation into the response of palatally displaced canines to the removal of deciduous canines and an assessment of factors contributing to favourable eruption.

The effect of the removal of deciduous canines on palatally displaced maxillary canines was assessed and factors contributing to a successful outcome were analysed. Thirty-nine consecutive patients of mean age 11.2 years (standard deviation 1.43), with 47 palatally displaced canines were included in the study. The cases were examined clinically and radiographically for a maximum period of 2 years following deciduous canine removal. Twenty-nine (62 per cent) of the 47 ectopic canines achieved a normal eruptive position and nine (19 per cent) showed some improvement in eruptive position. The outcome of the removal of the deciduous canine depended on the position of the permanent canine. Horizontal overlap of the nearest incisor was found to be the most significant factor. If this exceeded half the tooth width, success was unlikely. The presence of crowding was found to affect adversely the favourable eruption of the canine. Discriminant analysis was carried out to try to identify clinical features which could act as prognostic indicators for the outcome of deciduous canine removal.