Limited value of physical examinations in upper respiratory illness: account of personal experience and survey of doctors' views.

UNLABELLED: Medical tradition considers a physical examination (PE) an essential part of the clinical encounter. In real medical practice, however, a full PE may not be necessary when the diagnosis is clear after anamnesis and general impression. We assessed the value of PEs in 500 diagnoses of upper respiratory infection (URI) and the attitudes of 123 doctors regarding the utility of PEs in virtual cases. METHODS: Computerized files of consecutive cases with a diagnosis of URI over 8 months in two practices were reviewed and correlation studies between the extent of PE and clinical outcomes were performed. In addition, doctors' attitudes and declarations about PEs were compared. RESULTS: Five hundred paediatric and adult patients were included. Less than one-fifth underwent a full PE. More patients who underwent a full PE returned because they still felt unwell or their parents felt they were unwell. Fewer doctors declared actually having performed PEs than supported giving one in two virtual cases of URI. Specialized doctors were less inclined to perform PEs than doctors without a specialization. CONCLUSIONS: Our study suggests that in many cases presenting as URI, doctors may conduct limited PEs or even omit them entirely.

Mercury in traditional Tibetan medicine - panacea or problem?

UNLABELLED: Symptoms of mercury toxicity, biochemical changes, and blood/urine mercury levels were evaluated in a small group of patients. Six patients attending Delek Hospital, Dharamsala, India, taking mercury-containing traditional Tibetan medicine (TTM) (Group I), were compared with three patients taking non-mercury containing TTM (Group II) and healthy volunteers(Group II). Quantitative estimation of mercury ingestion based on chemical analysis was compared with US regulatory standards. RESULTS: Group I were significantly older (mean 55 years+/-SE 6.4) range 26-69 years, than Group II (26.7 years+/-SE 5) range 17-34 years and Group III (32.5 years +/-SE 0.5) range 33-34 years (P =0.05). Group I took TTM on average for 51 months and had a mean of 2.5 non-specific, mercury-related symptoms. Group I had higher mean diastolic pressures (85 mmHg) than Group II (73 mmHg) (P=0.06) and more loose teeth. Mean daily mercury intake for Group I was 674 microg, estimated as 10 microg/kg per day. (Established reference dose for chronic oral exposure: 0.3 microg/kg per day.) Blood mercury levels were non-detectable, but mean urinary mercury levels for Group I were 67 microg/L (EPA levels <20 microg/L). Renal and liver function tests were not significantly different between groups and within normal clinical range. CONCLUSIONS: Prolonged ingestion of mercury containing TTM is associated with absent blood levels, but relatively high urinary levels. Further studies are needed to evaluate toxicity and therapeutic potential.

Changes in psychological distress of women in long-term remission from breast cancer in two different geographical settings: a randomized study.

GOALS OF WORK: Psychological distress and coping styles in women diagnosed with stages I and II breast cancer have attracted substantial clinical and research attention over the last several decades. The contradictory and, at times, controversial findings stimulated the present randomized research whose purpose was to explore the possibility and probability of predicting which variables affect the psychological distress level of women with breast cancer 1 to 5 years after diagnosis (time period 1) and 6 to 8 months after period 1 (time period 2). PATIENTS AND METHODS: The study was conducted in two large oncology centers in Graz, Austria, and Jerusalem, Israel, with a sample population comprising 424 patients. MAIN RESULTS: The only variables that significantly predicted change in the psychological distress levels (Grand Severity Index, GSI; except for the GSI level during period 1) were Fighting Spirit (Mental Adjustment to Cancer, MAC) in the Graz sample and Perceived Family Support (PFS) in the Jerusalem sample. These results are discussed in relation to other findings. CONCLUSIONS: In light of these findings, it is highly important to preliminarily identify women with less adaptive psychological coping mechanisms and to provide them with efficacy tools for behavioral and cognitive changes within their own network of social and health resources.

Resin-bonded fixed partial denture retention: a retrospective 13-year follow-up.

A total of 51 resin-bonded fixed partial dentures (RBFPDs) were inserted under controlled clinical conditions and evaluated over a period of 13 years. Three levels of survival were defined: complete survival (no debonding); functional survival (loss of retention on one occasion with rebonding of the original RBFPD); and multiple survival (loss of retention on several occasions with rebonding of the original RBFPD). The effect of the aetiology, location (anterior/posterior or maxillary/mandibulary) and number of units of the missing tooth on RBFPD survival rates were investigated. The mean survival times and confidence levels were determined for each survival category, using the Kaplan-Meier procedure. The relative risks were calculated by the Cox regression procedure. The overall complete survival level of the study population at the end of the follow-up period was 85 months +/- 13%. Rebonding the RBFPDs once increased the overall functional survival rate to 112 months +/- 10% and multiple rebonding led to a further increase to 131 months +/- 8%. The RBFPD placement under conditions of good periodontal support in which orthodontic treatment was not required, such as trauma among other factors, showed significantly higher survival rates than those placed after periodontal or orthodontic treatment. This indicates that, under both these conditions, RBFPDs may serve as long-term or semi-permanent restorations.

Do different cultural settings affect the psychological distress of women with breast cancer? A randomized study.

Breast cancer is the most common malignant disease among women in developed countries. In Austria and Israel, it accounts for 15% and 18%, respectively, of all cancers and 30% of all cancers in women. The purpose of this study, conducted in Graz, Austria, and Jerusalem, Israel, was to determine whether different geographical and cultural settings differentially affect the psychological distress of women who have survived breast cancer and why. The dependence of psychological distress on psychosocial variables such as quality of life, body image, impact of cancer and coping styles was examined at time 1 in a randomized sample of 424 breast cancer women who were disease-free at the time of the study and were surveyed 1-5 years after diagnosis. The most contributing variables to the level of psychological distress in both populations were: the number of stressful life events during last year, financial problems and feeling uncomfortable with the body. Regarding coping styles, mental adjustment to cancer was the principal contributor to psychological distress level [determined by the Grand Severity Index (GSI) scores] in the Graz group, while intrusion was the principal contributor to the GSI level in the Jerusalem group.

Effects of age on coping and psychological distress in women diagnosed with breast cancer: review of literature and analysis of two different geographical settings.

Age-related differences in emotional distress were examined by studying two random samples (N=424) of women diagnosed with early stages of breast cancer in Graz, Austria and Jerusalem, Israel. We found that psychological distress, coping abilities, and different perceptions of illness are attributable to socialization differences of age experience according to young (49 or younger), intermediate (50-64) and old (65 and older) age groups. Patients were interviewed at home to obtain sociodemographic and medical background data. They also completed five standardized instruments (Brief Symptom Inventory, Psychological Adjustment to Illness Scale, Impact of Events Scale, Mental Adjustment to Cancer, and Perceived Family Support). A two-way MANOVA for all the demographic variables yielded significant main group (Graz vs. Jerusalem) effect (P<0.0001), significant main age effect (P<0.0001) and significant interaction (group by age) effect (P<0.001). Examination of the contribution of the age category to the level of the coping variables showed a different pattern in each group. The psychological distress variables revealed that, in the Jerusalem sample, there is a tendency toward decreasing distress levels with age and, in the Graz sample, elevated scores for the intermediate-age group. Age was found to be related to the level of Global Severity Index (GSI) and to the variables correlated to the GSI level. Psychological intervention should be guided to the different age groups.

Traumatic wound dehiscence after cataract extraction.

PURPOSE: To study the visual outcome and factors associated with it in patients with traumatic dehiscence of a cataract surgery wound. SETTING: Department of Ophthalmology and the Brown School of Public Health and Community Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel. METHODS: A retrospective observational study of 37 eyes of 37 consecutive patients with traumatic wound dehiscence of a cataract surgery wound was conducted. A complete ophthalmic evaluation was performed in all patients. Statistical analysis was done to identify factors associated with the best corrected visual acuity at the end of follow-up. RESULTS: Patients had extracapsular cataract extraction (n = 29), intracapsular cataract extraction (n = 4), or lensectomy (n = 4). No patient had phacoemulsification via a small incision. A univariate analysis showed that factors associated with a worse visual outcome included the presence at presentation of hyphema (P = .05), intraocular lens dislocation or loss (P = .006), vitreous hemorrhage (P = .0002), scleral rupture (P = .001), a long interval from surgery to trauma (P < .0001), and fall as the cause of trauma (P < .0001). In a multivariate model, only a surgery-to-trauma interval longer than 8 weeks was associated with a worse visual outcome (P < .0001). Visual acuity immediately after trauma was a poor predictor of final visual acuity. CONCLUSIONS: Visual outcome after traumatic wound dehiscence of a cataract surgery wound was strongly associated with the interval from surgery to trauma. Other factors were less reliable predictors of visual outcome. Traumatic wound dehiscence only moderately affected visual outcome after cataract surgery in most cases.

Overcoming the language barrier in visual field testing.

PURPOSE: To evaluate the effect of using recorded instructions in patients' native language compared with interpreter-assisted instructions on the reliability and duration of the visual field test. PATIENTS AND METHODS: Sixty patients referred for visual field testing were included in the study. Thirty-five had limited or no knowledge of the Hebrew language, and 25 control patients were fluent in Hebrew, the native language. None had previous experience with automated perimetry. Patients were randomized to receive recorded instructions on the visual field test in their native language or translator-assisted instructions by the technician before performing the test. For each patient, the time required for instructions and test performance and the reliability indices were documented. RESULTS: The method of instruction (recorded or interpreter-assisted) did not affect the time required for patient instructions (66 +/- 24 seconds and 57 +/- 30 seconds, respectively), the time for test performance (7.2 +/- 1.5 minutes and 7.8 +/- 1.8 minutes, respectively), and test reliability as measured by the rate of fixation losses. Regardless of the method of explanation, the time required for instructions and for performing the test were significantly shorter for Hebrew speakers than for non-Hebrew speakers. CONCLUSION: The use of a recorded explanation in the patient's native language before visual field testing is an applicable method for patient instruction. Clinics in areas with multilingual populations may use this method to save technicians time, without adversely affecting the time required for performing the test and its reliability.

Dental health behavior of children with BBTD treated using general anesthesia or sedation, and of their parents in a recall examination.

The aim of the study was to assess the dental status and dental health behavior of children with Baby Bottle tooth Decay treated using general anesthesia or sedation, and the dental health behavior of their parents in a recall examination. The study population consisted of sixty-five children, among whom thirty-four were treated using general anesthesia and thirty-one using sedation. The recall examination included a full dental examination from which the children's dif index could be drawn. Loe's plaque index was used to assess the amount of plaque on the teeth. Sociodemographic information and the dental health behavior of the parents and children were obtained. Plaque index was similar in the general anesthesia and sedation groups. The parents of the general anesthesia group were younger than the parents of the sedation group (35.0 +/- 6.7 and 38.8 +/- 6.2 for the fathers, and 32.4 +/- 5.9 and 34.9 +/- 5.3 for the mother, respectively). More firstborn children were treated using general anesthesia than using sedation. Significantly more siblings were treated in the sedation group. Children treated using sedation had significantly more siblings treated in the same mode. Parents of the children in the general anesthesia group were significantly more involved in brushing their children's teeth than the other group. In the sedation group, more children brush their teeth without parental help. Significantly more children in the general anesthesia group reduced their sweet consumption than in the sedation group. We conclude that preventive behaviors were more frequently adopted among the families of children treated using general anesthesia.

Children with baby bottle tooth decay treated under general anesthesia or sedation: behavior in a follow-up visit.

The purpose of the present study was to compare the behaviors of a group of children, who were treated for baby bottle tooth decay (BBTD) under general anesthesia (GA) or under sedation in a dental school environment in a routine follow-up examination, and to assess the dental anxiety levels of the parents. Sixty-five children, who were treated for BBTD in the Pediatric Dentistry clinic of the Hebrew University-Hadassah School of Dental Medicine between 1995-1997 under GA (34 children) or sedation (31 children). The parents of these children agreed to attend our clinic for recall examination 13 months post treatment following a telephone conversation. Frankl's behavioral scale and the sitting pattern were recorded for each child. In the sedation group, Frankl's scores of the present visits were then compared to the scores recorded at the initial examination visit that were obtained from the dental records. The accompanying parents were asked to note the number of visits to the dentist in the past two years, and to complete Corah's dental anxiety scale (DAS). No difference was observed between the children in both groups. Most of the children in the GA and in the sedation groups sat alone on the dental chair, without the assistance of the parents. Parents of the sedation group showed higher scores than the GA group in the total DAS (9.35 and 8.90 respectively), however these differences were not statistically significant. It is concluded that children treated for BBTD under GA or under sedation at a very young age behave similarly in a follow-up examination nearly 13 months postoperatively.

The distribution of gentamicin in the rabbit cornea following iontophoresis to the central cornea.

The purpose of this study was to evaluate the penetration of gentamicin into the central, midperipheral and peripheral cornea of rabbits following iontophoresis to the central 3 mm of the cornea. Four groups (groups 1-4) of five rabbits (one eye per rabbit) underwent corneal iontophoresis using gentamicin dissolved in agar. Low (1 mg/ml) and high (10 mg/ml) concentrations of gentamicin in agar were used for one or ten minutes. Two control groups (groups 5 and 6) of five eyes each underwent mock iontophoresis with low and high concentrations of agar-gentamicin mixture. Following sacrifice of the rabbits, the central, midperipheral and peripheral parts of each cornea were excised. Gentamicin concentration was determined in each part of every cornea. High concentrations of gentamicin (951.6 +/- 369.4 microg/ml to 26.6 +/- 41.34 microg/ml) were obtained in the central parts of all the iontophoresis-treated corneas. In each group, except group 6, central corneas had higher concentrations of gentamicin compared to midperipheral corneas (p = 0.038 to p = 0.021), and midperipheral corneas had higher levels than peripheral corneas (p = 0.038 to p = 0.021). Following iontophoresis, gentamicin is found in all portions of the corneas; however, the highest concentration of the drug remains in the central cornea.

Psychological distress in healthy women with familial breast cancer: like mother, like daughter?

OBJECTIVE: In 1977, the Israel Cancer Association held a one-day conference, on the subject of familial breast cancer, for healthy women with at least one first-degree relative diagnosed with breast cancer. The objective of this study was to assess the psychological distress of a sample of the women who attended. METHOD: Of the 333 healthy women present at the conference, 230 completed three questionnaires: one on sociodemographic data and the medical history of the first-degree relative(s) (mother and/or sister), and two that measure psychological distress: the Brief Symptom Inventory and the Impact of Events Scale. SAMPLE: The subjects were divided into three categorical groups: those whose mother had breast cancer (group A, N = 176), those whose sister had breast cancer (group B, N = 34), and those whose mother and sister both had the disease (group C, N = 20). In addition, subjects were divided into two groups according to the psychological distress level. RESULTS: Analysis of results (using ANOVA and a Chi square test for categorical variables and both univariate and multivariate procedures for psychological distress assessment) showed elevated levels of distress and persistent intrusive thoughts in all groups, and particularly in group C. CONCLUSION: There is a need to promote genetic diagnostic and appropriate counseling, notwithstanding the potential risks that genetic counseling poses for such women.

Antibodies to cytomegalo and Epstein-Barr viruses in human saliva and gingival fluid.

The prevalence of antibodies to EBV and CMV was studied in 34 samples of whole saliva and gingival crevicular fluids (GCF) obtained from clinically healthy volunteers and compared to the corresponding antibodies present in the serum of each individual. Higher prevalence of serum antibodies was found to EBV (85.2%) than to CMV (64.7%) (P < 0.04). The percentage of saliva samples containing IgG and/or IgA antibodies was not significantly different for the two viruses (79.4% for EBV and 58.8% for CMV). However, in the GCF the percentage to EBV was lower-32.3% as compared to 70.5% for CMV (P < 0.002). The prevalence of CMV in serum saliva and GCF was similar. However, while in the saliva similar levels of IgG and IgA were found, in the GCF IgA prevails. The picture for EBV is different: a similar percentage of antibodies was noticed in serum and saliva, but it was significantly lower in the GCF. However, antibodies to EBV were mostly IgA both in the saliva and the GCF. Although a similar number of samples were positive to both viruses in the saliva, the IgA response to EBV was higher than to CMV (P < 0.05), while in GCF IgA response was higher to CMV (P < 0.05). Passive transudation rather than active transport of plasma-derived Ig is probably responsible for the presence of IgG, while the IgA found in saliva and GCF is derived from local synthesis by plasma cells rather than from selective transport from blood.

Topical use of zinc desferrioxamine for corneal alkali injury in a rabbit model.

PURPOSE: To evaluate the efficacy of topical zinc desferrioxamine in acute corneal alkali injury in rabbits. METHODS: Twenty rabbits were anesthetized and a standardized alkali burn (1N NaOH) was performed in the center of the cornea (7.5-mm diameter). The animals were randomly divided into two groups and treated (double-masked) with topical zinc desferrioxamine, 220 microM, (group 1) or its vehicle (group 2). Drops were applied 7 times/day for 28 days. Topical gentamicin, 0.3%, was instilled twice a day. Animals were evaluated twice a week. At each examination (using the slit-lamp), the depth of corneal ulcer was graded as follows: 0, no ulcer; 1, tissue loss less than one third of corneal thickness; 2, one third to two thirds tissue loss; 3, more than two thirds tissue loss; 4, descemetocele; or 5, perforation. Ulceration area, vascularization, and epithelial defects also were measured. RESULTS: During the study period, the grading of mean corneal ulcerations in group 1 ranged from 0.2 to 1.00, whereas in group 2, it ranged from 1.4 to 2.7. The mean grade and area of ulceration in group 2 were greater than those in group 1 (p < 0.05). CONCLUSION: Topical zinc desferrioxamine may be an adjunctive treatment in protecting the cornea against induced alkali injury.

Accumulation of Streptococcus mutans on light-cured composites and amalgam: an in vitro study.

The aim of the in vitro study was to examine the accumulation of Streptococcus mutans on light-cured composite materials and amalgam. Bacteria cultures were grown in a brain heart infusion medium, and their growth rate was determined through turbidity measurements. The data, so obtained, were evaluated statistically by analysis of variance (ANOVA) followed by Scheffe test. Experiments on amalgam showed better results compared to those on composite materials. There were no statistically significant differences in plaque accumulation on different composite materials after finishing and polishing procedures, compared to plaque accumulation on composite materials against a Mylar strip.

Prevalence and risk factors of upper extremity cumulative trauma disorder in dental hygienists.

Cumulative trauma disorder (CTD) refers to a number of conditions arising from overuse of joints or soft tissues. The common risk factors that contribute to the development of these disorders are related to personal and occupational variables. Job analysis of the tasks performed by the dental hygienist have shown that this occupation is particularly at risk. The objectives of this study were to determine the prevalence of CTD symptoms amongst dental hygienists in Israel and to identify which are the factors that are related to CTD. A questionnaire including items concerning demographic data, employment history, professional occupational information, use of instrumentation, and CTD symptomatology was mailed to all 530 registered dental hygienists. Two hundred forty-six hygienists (46%) returned the questionnaire; 63% of the respondents were classified as CTD 'sufferers', Age, year of graduation, hours worked per week, and frequency of changing instruments were found to be significantly related to CTD symptoms. Hygienists at high risk included those aged 50 years or more (Odds ratio, OR = 6), those who graduated before 1986 (OR = 3), those who work more than 34 h per week (OR = 2.5) and those who change two or fewer instruments per patient (OR = 2). The major recommendation resulting from this study is to make dental hygienists aware that they work in a high-risk profession. It is hoped that increased awareness of the risk will spur the hygienist to make appropriate work practice, administrative, and engineering modifications and to seek treatment at the first indication of CTD symptoms.

Efficacy of iontophoresis in the rat cornea.

BACKGROUND: Iontophoresis can enhance penetration of drugs into tissues. We examined the extent of penetration of gentamicin into the cornea of rats during iontophoresis and the effect of varying the concentrations of gentamicin, the duration of iontophoresis and the current densities during iontophoresis. METHODS: Eight groups of rats underwent corneal iontophoresis using gentamicin dissolved in agar. Low and high concentrations of gentamicin were used, as well as low and high current densities and long and short durations of iontophoresis. Control groups received topical or subconjunctival gentamicin, topical saline solution and mock iontophoresis with the agar-gentamicin mixture. The Mann-Whitney test was used for statistical evaluation. RESULTS: Highly bactericidal concentrations of gentamicin were obtained in all the iontophoresis-treated corneas. The high concentration compared to the low concentration of gentamicin in agar significantly increased the concentration of gentamicin in the corneas, as did the longer duration of iontophoresis. However, higher current intensity did not significantly enhance the drug concentration in the cornea. CONCLUSION: Iontophoresis with a concentrated gentamicin-agar mixture may provide a rapid increase of gentamicin levels in the cornea.

Fluoride and hard cheese exposure on etched enamel in neck-irradiated patients in situ.

OBJECTIVES: The effect of a fluoride mouth rinse with hard cheese exposure was investigated on rehardening of an etched tooth enamel surface in subjects with radiation-induced hyposalivation in situ. METHODS: Ten patients, six males and four females of mean age 48 years, irradiated with 30 Gy per week for neck and head cancer, volunteered for the present intraoral study. The unstimulated saliva flow rate varied between 0.01 and 0.15 ml min-1. Enamel slabs, approximately 2 mm x 2 mm in size, cut from human molar teeth were embedded in self-curing acrylic resin to fit a microhardness tester. Hardness measurements were carried out on the polished and subsequently etched enamel surface, rinsed for 1 min in the mouth with 10 ml Meridol (GABA INT), containing 0.025% F as amine fluoride and stannous fluoride, and exposed alternatively to mastication of 20 g cheddar cheese for 5 min. RESULTS: Surface erosion of the enamel slabs decreased the mean hardness to a similar degree in all samples. The difference between the mean increased degrees of enamel microhardness following fluoride, fluoride and hard cheese, or repeated fluoride-cheese exposures was significant compared to the etched enamel values. The rate of rehardening derived from a second fluoride-cheese treatment was found to be improved significantly. It seems that the reduced saliva flow in xerostomic patients is sufficient to release bound calcium and phosphate from cheese products. CONCLUSIONS: It is suggested that for xerostomic patients frequent exposures to low-fluoride solutions combined with hard cheese consumption may prevent and remineralize initial demineralization.

Coping with additional stresses: comparative study of healthy and cancer patient new immigrants.

The adjustment and psychological distress of 166 cancer patients, who are new immigrants from the former Soviet Union, was assessed and compared to that of 288 healthy new immigrants from the the former Soviet Union. The healthy new immigrants had many adjustment problems and their psychological distress was fairly high. The cancer patients reported extremely severe psychological distress. In the healthy immigrants, age contributed to distress while family support had significant protective effects especially in the male immigrants. In the patients, these differences were even more extreme with family support being protective in the male group but not in the female group. Intrusiveness (IES) seems to be maladaptive adding to distress. The results clearly indicate that additional stresses, such as immigration, make cancer patients more vulnerable. The results also suggest possible interventions, especially those that will help to decrease intrusiveness.

Crossing new bridges: the process of adaptation and psychological distress of Russian immigrants in Israel.

Between the end of 1989 and June 1992, 380,152 Russian Jews left the former Soviet Union for Israel, swelling Israel's Jewish population by nearly 10%. Absorbing great waves of immigrants was not new to Israel. Since its establishment in 1948 and the enactment of its Law of Return, large population groups from dozens of different ethnic and cultural backgrounds had immigrated into the country. In 1992 Israel's Jewish population totaled 4,242,500. Of that number, 360,949 had been born in Asian countries, 458,009 in Africa, 1,252,131 in Europe, and 184,317 in America and Oceana.