Orthodontic eruption of furca-involved molars.

Guided tissue regeneration techniques, which are used in the treatment of certain advanced Class II and Class II furca-involved teeth, have progressed from promising to predictable. However, furca-modification techniques remain important aspects of treatment. Tooth eruption, combined with standard furca-modification techniques, improves the prognosis for both the treated and the adjacent teeth. Continued eruption of periodontally involved molars improves the crown-to-root ratio and maintains the periodontium of the adjacent dentition. These same concepts can be used to treat restoratively compromised molars, many of which were considered hopeless and subsequently extracted. Passive eruption can be useful in treating cases that need less than 3 mm of tooth eruption; orthodontic-active eruption with fixed appliances is advised if more than 3 mm of eruption is desired. Slower eruption rates (2 mm per month) allow the periodontal ligament to repair and the alveolar bone to remodel between orthodontic adjustments (3 to 4 weeks between adjustments). Periodic periodontal maintenance is accomplished during orthodontic treatment. After a retention period (8 weeks), periodontal++ surgery should be performed to reestablish the tooth's biologic width. After surgical wound healing (6 to 8 weeks), the tooth should be restored.

Oral cyclophosphamide for the management of hormone-refractory prostate cancer.

Thirty patients with hormone-refractory prostate cancer were treated with cycles of oral cyclophosphamide (100 mg/m2/day for 14 days, with a 14-day gap). Eighteen patients had a significant improvement in symptoms of advanced disease, 6 had objective partial remissions and 13 had stabilisation of disease (criteria of National Prostatic Cancer Project). The median survival from the time of diagnosis was 33.3 months, and from the commencement of cyclophosphamide 12.7 months. The treatment was well tolerated. oral cyclophosphamide is active in the treatment of advanced hormone-refractory prostate cancer and yields symptomatic and objective remissions without undue side effects. This observation requires validation, with further testing of its impact on survival in randomised clinical trials.

Benign prostatic hyperplasia--video image analysis and its relationship to androgen and epidermal growth factor receptor expression.

Androgens are essential for the development and maintenance of the prostate. However, prostatic growth may be mediated by epidermal growth factor (EGF) and the expression of the EGF receptor (EGFR) may be influenced by the androgenic milieu. We have characterized the expression of cytosolic androgen receptor (ARc), nuclear salt extractable androgen receptor (ARn) and EGFR in 89 consecutive cases of benign prostatic hyperplasia, 84 of which were treated by transurethral prostatic resections. Image analysis morphometry was performed on the histological sections to determine the epithelial content of the gland. Our results indicate that there is a vast heterogeneity of receptor expression in benign prostatic hyperplasia. Expression of ARc ranged from zero to 1312 fmol/gm. tissue (mean +/- SD 265 +/- 290), ARn ranged from zero to 531 fmol/gm. tissue (mean +/- SD 145 +/- 98) and EGFR ranged from zero to 316 fmol/gm. tissue (mean +/- SD 121 +/- 76). A statistically significant association was found between expression of ARn and EGFR, and these were both significantly correlated with the epithelial content of the gland.

Pre-emptive (neo-adjuvant) chemotherapy prior to radical radiotherapy for fit septuagenarians with bladder cancer: age itself is not a contra-indication.

Advanced age has often been cited as a contra-indication to the use of cytotoxic chemotherapy or aggressive combined treatment regimens. Fifteen patients, aged between 70 and 79 years (mean 73.1), have been treated for high grade, invasive bladder cancer using neoadjuvant intravenous cisplatin (80-100 mg/m2) plus radical radiotherapy (60 Gy in 6 weeks). Objective response was achieved in 14 patients. The median survival was 22 months, with 6 patients surviving 3 years or longer. Acute and late side effects were not excessive (no cases of W.H.O. grade IV toxicity), as demonstrated by clinical examination and the use of questionnaires (including linear analogue self-assessment scales) to assess quality of life. This aggressive treatment programme can achieve a high remission rate and prolonged survival in elderly patients with high risk bladder cancer without causing excessive morbidity.

Comments on the clinical application of fibronectin in dentistry.

Several studies have demonstrated that citric acid demineralization of the root surface promotes tissue attachment. Since demineralization exposes collagen to which fibronectin binds, the role of fibronectin in the attachment of cells to the tooth surface has been of considerable interest. It is clear that fibronectin and other cell adhesion proteins can promote cell attachment to the tooth surface; therefore, attempts have been made to utilize these findings in a clinical setting. Using a quantitative ELISA procedure to measure the binding of fibronectin to demineralized bone and tooth, we have found that 1 microgram fibronectin can saturate approximately 1 mg of either demineralized bone or demineralized tooth powder. Since serum contains 300 micrograms fibronectin per mL, the bleeding that occurs during oral surgery should saturate exposed tooth surfaces with amounts of fibronectin adequate for cell adhesion. Thus, exogenous fibronectin would appear to be of little clinical benefit.

First-line intravenous cisplatin for deeply invasive bladder cancer: update on 70 cases.

Seventy patients with T2-T4 NX MO bladder cancer were treated with intravenous cisplatin (100 mg/m2 q 3-weekly) followed by radiotherapy and/or cystectomy. Objective responses to cisplatin were seen in 57%. For the first group of 50 patients (treated between August 1981 and November 1983), the actuarial survival rate at 2 years was 64%, with a median survival of 20+ months: 81% of deaths occurred within 18 months of entry. Most relapses occurred in the bladder/pelvis. A randomised, controlled study is in progress to assess the true value of this approach to the treatment of invasive bladder cancer.

Herpes simplex virus type 2 encephalitis in two homosexual men with persistent lymphadenopathy.

Within a 5-month period, 2 homosexual men with persistent lymphadenopathy developed clinical findings consistent with herpes simplex virus (HSV) encephalitis. These signs included abrupt change in mental status, seizures, cerebrospinal fluid pleocytosis, and localized electroencephalographic abnormalities showing temporal lobe involvement. Initial computed tomographic scans were unremarkable. Treatment with adenine arabinoside was instituted and temporal lobe biopsies were performed. Although virus-specific antigens were detectable in only 1 patient, cultures of biopsy tissue from both patients yielded HSV type 2 organisms. Spiking fevers persisted and the patients failed to improve, prompting administration of acyclovir. Both patients recovered gradually after their second course of antiviral therapy and survived with severe neurological deficits. These patients should raise concerns about an increased incidence of type 2 encephalitic illness among homosexual men with persistent lymphadenopathy or acquired immune deficiency syndrome. In addition, the importance of using HSV type 2 antibody in the immunofluorescence test of brain biopsy tissue for rapid diagnosis of the disease is emphasized.

Transvesical Harris-Hryntschak prostatectomy with primary bladder closure and local vasoconstriction.

The simple, rapid and satisfactory method of the transvesical Harris-Hryntschak open prostatectomy is described. When this technique is used bleeding is reduced to an average of 85 ml. and visibility is improved by the local injection of a synthetic vasoconstrictor, ornithine-8 vasopressin, before enucleation. Hermostasis is obtained by tamponade with fine sutures occluding the bladder neck. Bladder closure is with heavy watertight, purse-string sutures. A "time and motion" study has reduced the usual operating time to 15 to 20 minutes with an intraoperative transfusion rate of 2.3%.