Management of Endodontic Disease for Odontogenic Sinusitis.

Primary dental treatments for odontogenic sinusitis (ODS) due to endodontic infections (pulpal necrosis and apical periodontitis ± periapical abscess) include extraction and root canal treatment (RCT). Published evidence is lacking on the success of primary endodontic treatment for purulent ODS, with the majority of RCT-related series reporting on its success at resolving reactive maxillary sinus mucositis. Dental extraction is the most definitive treatment of endodontic disease causing ODS, but compromises the functional dentition and still often fails to resolve the purulent sinusitis. This article highlights key concepts of RCT and dental extraction techniques, as well as their published success at resolving ODS.

A new technique for nonsurgical retreatment of teeth with amalgam root end fillings: case series.

INTRODUCTION: The objective of this article was to show an alternative clinical approach to retreating teeth having had prior combined nonsurgical and surgical endodontic treatment with retrograde amalgam fillings. Nonsurgical retreatment performed alone has historically presented numerous challenges for the clinician and an uncertain outcome for the patient. Surgical retreatment has the potential disadvantages of additional root shortening, bone loss, and scarring. METHODS: Four cases are presented with recalls up to 5.5 years. RESULTS: The procedure was shown to be predictable and successful in this series. Root length was preserved, and surgery was avoided. CONCLUSIONS: Nonsurgical amalgam removal from the root end may provide a desirable alternative to the more common and complicated option of combined nonsurgical and surgical endodontic retreatment.

Chromatographic measurements of hemoglobin A2 in blood samples that contain sickle hemoglobin.

In the sickle cell syndromes, Hb A2 measurements aid in the differential diagnosis of sickle cell anemia from sickle-beta-thalassemia. The purpose of this study is to assess the Hb A2 levels in samples containing sickle hemoglobin (Hb S) by the use of an automated high performance liquid chromatography system (HPLC-Variant beta-thalassemia Short Program). The blood samples analyzed were from individuals of African descent living in the state of Tennessee who had either sickle cell trait (Hb AS), sickle cell disease (Hb SS), or sickle cell-hemoglobin C disease (Hb SC). Interestingly, the Hb A2 levels determined by HPLC were found elevated in samples containing Hb S. The Hb A2 mean in Hb AS samples (n=146) is 4.09% (SD +/- 0.42, range 2.20 to 5.20%); in Hb SS samples (n=33) it is 3.90% (SD +/- 1.08, range 0.60 to 5.90%); and in Hb SC samples (n=27) it is 4.46% (SD +/- 0.70, range 2.30 to 5.91%). The Hb A2 mean by HPLC in normal individuals (Hb AA, n=70) is 2.57% (SD +/- 0.25, range 2.1 to 3.0%), and the Hb A2 range in beta-thalassemia carriers is 4 to 9%. Our results show that the Hb A2 levels in Hb S-containing samples partially overlap with those expected from beta-thalassemia carriers. The hemoglobinopathy laboratory should be aware of this apparent elevation in Hb A2 levels determined by HPLC in individuals carrying Hb S. Other factors, such as family history and clinical symptoms, should be taken into account before a diagnosis of sickle cell trait, sickle-beta-thalassemia, or sickle cell anemia is made.

Prostate specific antigen measurements after minimally invasive surgery of the prostate in men with benign prostatic hypertrophy.

There is a trend of minimally invasive surgery in the treatment of benign prostatic hypertrophy (BPH). Studies have examined levels of prostate specific antigen (PSA) in patients after open prostatectomy or transurethral resection of prostate (TURP) and noted reset of PSA to lower values after surgery. We reviewed PSA levels in patients after minimally invasive procedures to determine if levels were reset. There were 120 patients (age 45-70) enrolled in the study. Fifty patients underwent laser ablation, 20 patients had electrovaporization (TVP) and 50 patients underwent TURP. PSA measurements were obtained prior to and after surgical procedures in a three-year follow-up. Mean pre-operative PSA was 2.8 (+/-0.34) ng/ml for laser cohort, 3.2 (+/-0.31) ng/ml for the TURP group and 2.3 (+/-0.42) ng/ml for TVP patients (P=0.33). At 1 y follow-up, mean PSA decreased 32% for laser patients, 46% for the TURP cohort and 8% for TVP group. The largest mean decrease in PSA velocity was-1.5 (+/-0.31) ng/ml per y for TURP followed by 0.9 (+/-0.29) ng/ml per y for laser patients and-0.1 (s.d.+/-1.2) ng/ml per y for TVP group in y 1. The TURP group maintained the largest decrease in PSA velocity in y 2,-0.6 (+/-0.26) ng/ml per y. Three patients (2-TURP, 1-TVP) were diagnosed with prostate cancer during follow-up. In conclusion, serum PSA levels were reset at lower levels following different surgical interventions. This lower level of PSA remained decreased for 2 y post-procedure. Urologists should be cognizant of this reset level and monitor PSA levels for possible increases to screen for prostate cancer in this patient population. Prostate Cancer and Prostatic Diseases (2000) 3, 200-202

Loneliness and fear of intimacy among adolescents who were taught not to trust strangers during childhood.

This study explored feelings of loneliness and fear of intimacy among adolescents as a function of whether they were taught not to trust strangers during childhood. Eighty college students and their parents completed the Revised UCLA Loneliness Scale, both versions of the Fear of Intimacy Scale (FIS-D and FIS-F), and a background information questionnaire. It was found that students whose parents taught them not to trust strangers during childhood had greater fear of intimacy. Further, females who were taught to distrust strangers also experienced more loneliness than did their male counterparts, as well as females and males who were not taught to distrust strangers.

A randomized prospective study of laser ablation of the prostate versus transurethral resection of the prostate in men with benign prostatic hyperplasia.

OBJECTIVES: To compare the safety and efficacy of laser ablation of the prostate, one of the minimally invasive treatments available for men with benign prostatic hyperplasia, to transurethral resection of the prostate (TURP). METHODS: A prospective randomized study of 100 men with benign prostatic hyperplasia, with 50 patients in each treatment arm, was conducted. All patients met the entry criteria: age older than 45 years, no history of carcinoma of the prostate, a peak flow rate less than 15 mL/s, medical therapy failure, and the ability to undergo regional or general anesthesia. All patients underwent a preoperative evaluation consisting of the American Urological Association (AUA) symptom score, uroflowmetry, pressure-flow study, transrectal ultrasound for prostate volume, and serum prostate-specific antigen determination. Patients underwent either TURP or laser ablation of the prostate using the potassium titanyl phosphate (KTP)/neodymium: yttrium-aluminum-garnet laser. Patients were seen for follow-up at 1, 3, 6, and 12 months. RESULTS: The mean age was 68.2 years (range 45 to 90) for the laser group and 67.4 years (range 54 to 82) for the TURP group. The mean AUA symptom score was 22 for the laser group and 21 for the TURP group. The mean peak uroflow rate was 7.6 +/- 3.4 mL/s for the laser group and 6.5 +/- 4.0 mL/s for the TURP group. At 12 months of follow-up, the mean AUA symptom score had decreased to 7 (-69.5%) for the laser group and to 3 (-80.9%) for the TURP group. The mean peak uroflow rate increased to 15.4 mL/s (+ 107.8%) for the laser group and to 16.7 mL/s (+ 150.7%) for the TURP cohort. Seventy-five percent of the laser group had a 50% or greater decrease in their individual AUA symptom score compared with 93% of the TURP group. Sixty-five percent of the laser cohort had a 50% or greater increase in their peak uroflow rate compared with 75% of the TURP cohort. CONCLUSIONS: Laser prostatectomy produced improvements in the peak flow rate and symptom score similar to those produced by TURP. The patients who underwent laser treatment required a longer period to reach maximum improvement, which probably reflects the lack of tissue debulking at the time of surgery. Further improvement in laser technology will be required to produce more immediate results.

Low-power v high-power KTP laser: improved method of laser ablation of prostate.

BACKGROUND AND OBJECTIVE: Current treatment technique for laser prostatectomy involve Nd:YAG wavelength at 60 to 80 W. Use of the KTP wavelength in addition to Nd:YAG allows for vaporization of more tissue, decreasing the amount undergoing coagulation necrosis. In this study, we compared 20 W and 40 W of KTP laser energy in conjunction with the Nd:YAG wavelength for the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND MATERIALS: A total of 50 consecutive patients underwent laser ablation of the prostate, with 38 patients (Group I) receiving treatment with 20 W of the KTP and 60 W of the Nd:YAG wavelengths. The other 12 patients (Group II) underwent treatment with 40 W of KTP and 60 W of Nd:YAG laser energy. The patients had an initial evaluation consisting of American Urological Association (AUA) Symptom Score, uroflowmetry, transrectal ultrasonography for prostate volume measurement, and assay of prostate specific antigen (PSA) serum level. The patients were seen in follow-up at 1, 3, and 6 months. RESULTS: The mean symptom score decreased from 23.4 to 8.9 from Group I and from 18.2 to 3.5 for Group II at the 6-month follow-up. The mean peak urinary flow rate increased from 8.4 to 15.4 mL/sec Group I and from 8.3 to 16.5 mL/sec in Group II at the 6-month follow-up. CONCLUSIONS: The patients treated with the 40 W of KTP laser energy experienced a more rapid and sustained improvement in symptom score than those treated at 20 W. The improvement in peak urinary flow rate was approximately the same in the two groups.

Co-morbidities and survival of men with localized prostate cancer treated with surgery or radiation therapy.

PURPOSE: We determined the impact of preexisting co-morbidities on survival of men with clinical stages T1b and T2NXM0 prostate cancer treated with surgery or radiation therapy. MATERIALS AND METHODS: A weighted co-morbidity score was determined for 276 consecutive men treated with surgery (138) or radiation therapy (138) at a Veterans Affairs medical center and was correlated with actuarial freedom from death due to co-morbid disease. RESULTS: After a median potential followup of 7.0 years 91 patients (33%) died of co-morbid disease and 20 (7%) died of cancer related causes. There were highly significant correlations between actuarial survival and weighted co-morbidity (p < 0.000001), and the 10-year actuarial survivals in men with no or severe co-morbidities were 66 and 9%, respectively. Associations between patient age and co-morbidity score were highly significant (p < 0.0001). The age adjusted risk of co-morbid death was 5.7 times greater in men with severe compared to no co-morbidities. There were also significant correlations between actuarial survival and weighted co-morbidity among patients treated with surgery (p = 0.02) and radiation therapy (p = 0.0002). Patient age and severity of co-morbidities were significantly greater among men treated with radiation therapy compared to surgery, and age adjusted risk of co-morbid death among men with a co-morbidity score of 1 was 3.8 times greater among men treated with radiation therapy (p = 0.025). CONCLUSIONS: Cancer related deaths are unusual within 5 to 10 years after surgery or radiation therapy in men with stages T1b and 2 prostate cancer. The risk of death during this interval is directly related to the severity of co-morbid conditions, which should be factored in an individual when assessing the advisability of therapeutic intervention. Since patient co-morbidities impact all cause survival, quantitative assessment of co-morbidities using validated instruments offers a method to control partially for the variabilities of health status among men receiving different treatments for localized prostate cancer.

Cancer diagnosis with prostate specific antigen greater than 10 ng./ml. and negative peripheral zone prostate biopsy.

PURPOSE: We assessed the results of additional diagnostic procedures in men with prostate specific antigen (PSA) more than 10 ng./ml. and a peripheral zone prostate biopsy negative for cancer. MATERIALS AND METHODS: A total of 68 men with PSA more than 10 ng./ml. and a peripheral zone biopsy negative for cancer was investigated with 1 or more peripheral zone biopsies (17), prostatectomy (18), or 1 or more peripheral zone biopsies and needle biopsy of the transition zone or prostatectomy (33). RESULTS: Cancer was detected in 20 of 68 patients (29%) with 1 or more additional diagnostic procedures. Of 51 patients whose transition zone was biopsied or who underwent prostatectomy 16 had cancer, and in 8 the malignancy appeared to be isolated to the transition zone. Mean PSA density and proportion of patients with PSA density more than 0.15 were significantly greater and mean prostate volume was significantly less in the 20 patients with compared to 31 without identifiable cancer. CONCLUSIONS: At least 30% of men with PSA more than 10 ng./ml. and a negative peripheral zone biopsy have prostate cancer. In approximately 50% of cases the cancer appears to reside in the transition zone, and transition zone biopsy or prostatectomy is required for diagnosis.

Survival in blacks and whites after treatment for localized prostate cancer.

PURPOSE: Racial differences were assessed in all cause and disease related actuarial survivals after treatment for localized prostate cancer. MATERIALS AND METHODS: We studied 148 black and 209 white men with clinical stages T1b to 4NXMO prostate cancer treated with surgery or radiation therapy between 1980 and 1991 at a Veterans Affairs medical center. RESULTS: After a median potential followup of 96 months, there were no significant differences in the all cause, cause specific, metastases-free, clinical disease-free or prostate specific antigen disease-free survivals in 109 black and 167 white men with stages T1b to 2 cancer treated with surgery or radiation therapy, or in 39 black and 42 white men with stages T3 to 4 cancer treated with radiation therapy. CONCLUSIONS: Race appears to have no impact on the stage specific actuarial survivals in men with localized prostate cancer treated with surgery or radiation therapy in an equal access health care system.

Implementation of a customized needleless intravenous delivery system.

Occupational exposure to human immunodeficiency virus (HIV), hepatitis, and other bloodborne pathogens concerns all health care workers, especially those in high-risk clinical settings such as the emergency room, operating room, intravenous therapy department, etc. In response to the increased attention to needlestick injuries in the workplace, hospitals are adopting a more proactive approach to establishing precautions to eliminate this occupational hazard. Many technologies to address the situation are available today, but most offer only a partial solution. The need for a comprehensive needleless IV delivery system recently sparked a collaboration between the IV therapy coordinator and a manufacturer's representative (Abbott Laboratories) that resulted in a new product design that was recently implemented house wide at our two hospitals.

Level of cultural mistrust as a function of educational and occupational expectations among black students.

The relationship between trust of whites and academic and occupational expectations of black students was explored. Black high school students were administered the Two-Factor Index of Social Position and the Cultural Mistrust Inventory. All students were also asked to indicate which occupation they expected to enter and the educational level they expected to attain. No differences were found between educational expectations and level of mistrust. However, students with lower occupational expectations had higher levels of mistrust. The implications of these findings are discussed.

Stress, coping style, and problem solving ability among eating-disordered inpatients.

Stress levels, coping style, and problem solving ability among bulimic and anorexic individuals were explored. Bulimics (n = 33) reported a greater number of negative life events and feelings of being pressured than did a non-eating-disordered group. Anorexics (n = 12) reported higher levels of anxiety and depression than the other groups. Both anorexics and bulimics reported higher levels of stress, lower levels of confidence in their ability to solve problems, a tendency to avoid confronting problems, a reluctance to share personal problems, and feelings of being driven. Implications are suggested.