bluuebunny/crossref_metadata_2025 huggingface dataset:
An Animal Model for Interface Tissue Formation in Cemented Hip Replacements
Authors: El‐Warrak Alexander O. , Olmstead Marvin , Apelt Detlef , Deiss Felix , Noetzli Hubert , Zlinsky Kathy , Hilbe Monika , Bertschar‐Wolfsberger Regula , Johnson Ann L. , Auer Joerg , Von Rechenberg Brigitte
Published: September 2004

Objective— To create a model in sheep for investigation of early changes related to the formation of an interface membrane in hip prosthesis.

Study Design— Experimental study.

Animals— Twenty‐four female adult Swiss Alpine sheep.

Methods— Sheep were divided into 2 groups of 12 for unilateral cemented total hip arthroplasty. In Group I, the prosthesis was fixed with retrograde cement gun injection to achieve a complete cement mantle, whereas in Group II a primary cement mantle defect was produced. Groups I and II were further divided into 2 sub‐groups with study end points of 2 and 8.5 months after surgery. Radiographs were evaluated postoperatively and at euthanasia for migration of the femoral component and bone resorption. Histologic sections were evaluated semiquantitatively for changes in cell types and numbers, and bone reactions; and quantitatively for size of interface membrane and new bone formation.

Results— Radiographically, there tended to be an increase in bone resorption and periosteal bone formation throughout the femoral shaft in Group II compared with Group I, but this was only statistically significant at the region of the femoral neck (R5) at both time periods (P<.05). Semiquantitative histologic evaluation revealed significant increases (P<.05) in cellularity, numbers of fibroblasts, giant cells, macrophages, and mononuclear cells, in Group II primarily at 2 months after surgery. This was also true for interface membrane formation and bone remodeling. Quantitative data showed an increased in the size of the interface membrane and area of bone formation at 8.5 months in Group II.

Conclusions— The cement defect model offered controlled and repeatable production of an interface membrane. The results suggest that a primary cement mantle defect could be a possible trigger for implant instability, eliciting a cascade of biomechanical and molecular events in bone tissue leading to aseptic loosening.

Clinical Relevance— The results show the effect of defects in the cement mantle in promoting interface membrane formation. Long‐term and biochemical studies are required to evaluate the relevance of this interface membrane formation.
Cosmetic Results of a Ventrally Based Advancement Flap for Closure of Total Ear Canal Ablations in 6 Cats: 2002–2003
Authors: Mcnabb Amanda Hillis , Flanders James A.
Published: September 2004

Objective—To report the outcome of a modified total ear canal ablation (TECA) technique to maintain normal ear carriage in cats.

Study Design—Case series.

Animals—Six cats with external ear canal disease.

Methods—Medical records were reviewed to identify cats in which a modified TECA using a single pedicle advancement flap was used to maintain normal ear carriage. Signalment, histopathologic diagnosis, complications, and outcome were retrieved. Owners were contacted to document long‐term outcome.

Results—Modified TECA procedures (7) were performed in 6 cats. Normal ear carriage was present immediately after surgery and was preserved at follow‐up interview. Owners were satisfied with cosmetic appearance. Histopathologic diagnosis of excised ear masses included ceruminous gland adenocarcinoma (2 cats), ceruminous gland adenoma (2 cats, 3 ears), and inflammatory polyp (2 cats).

Conclusions—Modification of the TECA skin incision preserved normal ear carriage in all cats. Owners were satisfied with overall outcome and with cosmetic result. Rate and nature of complications were similar to previously published data.

Clinical Relevance—A simple modification of the TECA skin incision to create a single pedicle advancement flap maintains normal ear carriage in cats.
Radiographic and Clinical Changes of the Tibial Tuberosity after Tibial Plateau Leveling Osteotomy
Authors: Kergosien David H. , Barnhart Matthew D. , Kees Christopher E. , Danielson Briana G. , Brourman Jeff D. , DeHoff William D. , Schertel Eric R.
Published: September 2004

Objective— To investigate radiographic changes of the tibial tuberosity after tibial plateau leveling osteotomy (TPLO) surgery and identify clinical findings and risk factors associated with such changes.

Study Design— Retrospective study.

Sample Population— Hundred and eighty‐six client‐owned dogs (219 stifles) that had TPLO surgery.

Methods— Patient data retrieved included radiographic changes of the tibial tuberosity during re‐examination, age, body weight, whether unilateral or single‐session bilateral surgery had been performed, location of the anti‐rotational pin, approximate tibial tuberosity area, and approximate average tibial tuberosity width.

Results— Fracture with resulting caudal displacement of the proximal tibial tuberosity (1.4%; 3 of 219) occurred less frequently than non‐displaced tibial tuberosity fractures (7.3%; 16 of 219). Age, weight, average tibial tuberosity width, location of the anti‐rotational pin, and single session bilateral surgery were identified as risks factors for non‐displaced fracture. Weight divided by the square of the average tibial tuberosity width may be a stronger risk factor than either weight or average tibial tuberosity width alone.

Conclusions— Dogs undergoing single session bilateral TPLO surgery are at greater risk for developing non‐displaced tibial tuberosity fractures. The non‐displaced tibial tuberosity fracture does not appear to adversely affect outcome or lead to tibial tuberosity avulsion. Significant risk factors for fracture of the proximal tibial tuberosity with caudal displacement were not identified.

Clinical Relevance— Factors including age, weight, tibial tuberosity thickness, and conditions that may enhance strain on the tibial tuberosity, such as single‐session bilateral procedures, may increase risk of fracture.
Transurethral Resection in the Management of Urethral and Prostatic Neoplasia in 6 Dogs
Authors: Liptak Julius M. , Brutscher Stephen P. , Monnet Eric , Dernell William S. , Twedt David C. , Kazmierski Kathy J. , Walter Claudia U. , Mullins Marie N. , Larue Susan M. , Withrow Stephen J.
Published: September 2004

Objective—To assess cystoscopic transurethral resection (TUR) for the palliative management of dogs with neoplastic infiltration of the urethra.

Study Design—Prospective clinical trial.

Animals—Six client‐owned dogs.

Methods—Cystoscopic examination and electrosurgical TUR were performed in dogs with urination difficulties caused by prostatic or urethral neoplasia. TUR was performed in a retrograde manner in female dogs and antegrade in male dogs via exploratory celiotomy and ventral cystotomy. Cystoscopic examination was used to determine the extent of neoplastic involvement of the urethra. TUR involved piecemeal removal of neoplastic tissue from the urethral lumen using an electrocautery cutting loop. Hemorrhage was controlled with a cystoscopic cauterized roller‐ball. In 2 male dogs, intraoperative radiation therapy (IORT) was used to treat both prostatic neoplasia and the sublumbar lymph node bed. Surgical technique, complications, adjuvant treatment, and outcome were recorded.

Results—TUR was performed in 3 male dogs with prostatic carcinoma and 2 female dogs with urethral transitional cell carcinoma (TCC). In 1 female dog, TUR was attempted but not successful because of cystoscope diameter. Iatrogenic urethral perforation occurred during TUR in 3 dogs. In 2 dogs, prolonged exposure to lavage fluid resulted in clinical and biochemical abnormalities consistent with TUR syndrome. Dysuria resolved in 5 dogs within 10 days of TUR. Treatment‐related complications included urinary tract infection and tumor seeding. Local tumor progression and metastasis occurred in all dogs.

Conclusions—TUR (in combination with chemotherapy±IORT) resulted in rapid palliation of urination difficulties in male dogs with prostatic carcinoma. In female dogs with urethral TCC, however, electrosurgical TUR cannot be recommended because of a high intra‐ and postoperative complication rate with no improvement in postoperative management compared with historical reports of tube cystostomy.

Clinical Relevance—TUR is a novel alternative for the palliation of male dogs with prostatic carcinoma. In female dogs with urethral TCC, electrosurgical TUR does not provide any advantages compared with tube cystostomy.
Intercalary Bone Grafts for Joint and Limb Preservation in 17 Dogs with High‐Grade Malignant Tumors of the Diaphysis
Authors: Liptak Julius M. , Dernell William S. , Straw Rodney C. , Jameson Vicki J. , Lafferty Mary H. , Rizzo Scott A. , Withrow Stephen J.
Published: September 2004

Objective—To evaluate postoperative complications, limb function, and tumor control after intercalary resection and reconstruction for preservation of limb and joint function in dogs with high‐grade malignant tumors of diaphyseal bone.

Study Design—Retrospective study.

Animals—Seventeen client‐owned dogs.

Methods—The bone tumor database and medical records were reviewed (1986–2002) for dogs with diaphyseal tumors treated with intercalary resection and reconstruction with either an allograft or irradiated autograft. Clinical presentation, diagnostic findings, surgical management, and outcome were determined from medical records and telephone interviews with veterinarians and owners. Statistical analyses included χ2to test associations between intra‐ and postoperative variables with complications, and Kaplan–Meier survival analysis for disease‐free interval, metastasis‐free interval (MFI), and median survival time.

Results—Intercalary limb‐sparing surgery was performed in 17 dogs with diaphyseal tumors: osteosarcoma (OSA) (15), histiocytic sarcoma (1), and solitary metastasis from a pulmonary adenocarcinoma (1). One dog was excluded from further analysis when the spared limb was amputated 4 days postoperatively because of incomplete tumor resection. In 16 dogs, limb function was good to excellent. Complications occurred in 5 dogs (31.3%) and included superficial infection in 2 dogs (12.5%) and implant failure in 4 dogs (25%). All implant failures occurred in the ulna and there was a significant association between implant failure and non‐cemented allografts (P=.042). Non‐union of 1 or both osteotomies was diagnosed in 10 dogs (83.3%) and, despite lack of clinical signs in all cases, was significantly associated with the use of intracavitary locally released cisplatin (P=.046) and cemented intercalary grafts (P=.046). Local tumor recurrence was diagnosed in 1 dog (6.3%) and metastatic disease in 12 dogs (75.0%), including 10 dogs with OSA. The median MFI was 137 days. The local disease‐free and overall limb‐salvage rate was 94% and 100%, respectively. Overall median survival time was 393 days and the median survival time for dogs with OSA was 449 days.

Conclusion—Intercalary limb‐sparing surgery results in better postoperative limb function with fewer and less severe complications than historical reports of dogs treated with non‐intercalary limb‐sparing surgery.

Clinical Relevance—In dogs with diaphyseal tumors, intercalary limb‐sparing surgery preserves normal joint function and results in good to excellent limb use with few complications and good local tumor control.
Comparison of 4 Blood Storage Methods in a Protocol for Equine Pre‐operative Autologous Donation
Authors: Mudge Margaret C. , Macdonald Melinda H. , Owens Sean D. , Tablin Fern
Published: September 2004

Objective—To compare viability of equine whole blood stored by 4 different methods, and to establish optimal storage protocols for an equine autologous blood donation program.

Study Design—In vitro study of stored equine whole blood.

Animals—Six healthy adult horses.

Methods—Blood from each horse was collected into 4 different containers: glass bottles containing acid–citrate–dextrose solution (ACD), plastic bags containing ACD, citrate–phosphate–dextrose (CPD), and CPD with supplemental adenine (CPDA‐1). Blood was stored for 5 weeks and sampled at 2‐day intervals. Standard hematologic and biochemical variables were evaluated, and adenosine‐5‐triphosphate (ATP) and 2,3‐diphosphoglycerate (2,3‐DPG) concentrations were measured and normalized to total hemoglobin content.

Results—Plasma hemoglobin, % hemolysis, lactate, potassium, ammonia, and lactate dehydrogenase (LDH) increased, whereas glucose concentration and pH decreased in all stored blood over 5 weeks. There was a temporal increase in hemolysis with all storage methods, but the increase was greatest in glass bottles. Lactate and ammonia were highest in CPD and CPDA‐1 samples, indicating more active red blood cell (RBC) metabolism. 2,3‐DPG concentrations decreased during storage, but were optimally preserved with CPDA‐1. ATP concentrations were significantly higher for blood stored in CPDA‐1, and were lowest in glass bottles.

Conclusions—Hematologic and biochemical values measured for blood stored in CPDA‐1 are suggestive of improved RBC viability compared with other storage methods. With the exception of ATP, results from stored equine blood were similar to those reported for other species.

Clinical Relevance—Commercial CPDA‐1 bags appear to be the optimal storage method for equine whole blood.
A Vaginal Mucosal Pedicle Flap Technique for Repair of Rectovaginal Fistula in Mares
Authors: Schönfelder Axel M. , Sobiraj Axel
Published: September 2004

Objective— To describe the use of a vaginal mucosal pedicle flap for repair of rectovaginal fistulae (RVF) in mares.

Study Design— Clinical case report.

Animals— Three mares with RVF.

Methods— After debriding the RVF, a dorsally based U‐shaped mucosal and submucosal pedicle flap (2–4 mm thick) was dissected from the vaginal wall, rotated approximately 90° angle to close the ventral aspect of the fistula and sutured in position with 10–13 single sutures that did not penetrate the rectal mucosa. This positioned the vaginal mucosa so that it was continuous with the rectal mucosa.

Results— Two RVF healed by 1st intention whereas for the 3rd RVF, 2 additional single sutures were required to repair partial dehiscence after 10 days. At 6 weeks and 6 months all RVF were healed. One mare subsequently foaled without complications.

Conclusions— RVF can be closed by use of a rotation flap of vaginal tissue.

Clinical Relevance— Tension‐free closure of RVF can be achieved by rotating a pedicle flap of vaginal mucosal tissue without undue wound tension, and should be considered as an alternative to conventional appositional techniques.
A Comparison of Knot Security of Commonly Used Hand‐Tied Laparoscopic Slipknots
Authors: Shettko Donna L. , Frisbie David D. , Hendrickson Dean A.
Published: September 2004

Objective— To compare the peak force required for failure of hand‐tied laparoscopic slipknot ligatures.

Study Design— In vitro mechanical evaluation of suture material/knot combinations.

Sample Population— Four hand‐tied laparoscopic slipknots were studied. Three suture materials and 2 suture sizes were evaluated. Twenty samples of each group were tested, for a total of 400 samples.

Methods— The 4S modified Roeder, modified Roeder, and Weston and Brooks laparoscopic slipknots using 0 polyglyconate, 0 polyglycolic acid, 1 polyglyconate, and 1 polydioxanone (PDS) were tested. A vertical distracting force (5 mm/s) was applied until failure. Mean peak force to failure was obtained for each suture material, size, and knot combination.

Results— Mean (±SEM) peak force to failure of hand‐tied ligatures ranged from 156.8±9.1 N to 4.8±.4 N. The 4S‐modified Roeder had the highest mean peak force to failure. Ligatures tied with polyglyconate and size 1 suture had the highest mean peak force to failure.

Conclusions— The 4S‐modified Roeder was significantly and consistently stronger than the other slipknots. Polyglyconate was superior to other suture materials. The 1 polyglyconate had the highest mean peak force to failure followed by 0 polyglyconate that exceeded the 1PDS.

Clinical Relevance— The 4S‐modified Roeder slipknot using 1 polyglyconate has the greatest breaking strength of sutures tested and should be considered when performing laparoscopic ligatures.
A Prospective Study of Postoperative Surgical Site Infections in Dogs and Cats
Authors: Eugster Simone , Schawalder Peter , Gaschen Frédéric , Boerlin Patrick
Published: September 2004

Objective—To assess postoperative surgical site infection (SSI) rate and to identify associated predictive factors.

Study Design—Prospective clinical study.

Animals—Dogs and cats that had surgery (1010 interventions) during 58 weeks from April 1999 to June 2000.

Methods—Data sheets were completed by clinicians. Patients were controlled for clinical evidence of SSI at suture removal. Two definitions of SSI (“infection” and “infection/inflammation”) were developed specifically for this study and used for statistical analysis. Logistic regression models were built in order to identify significant predictive factors for SSI.

Results—Wounds with “infection/inflammation” occurred in 5.8% and “infected” wounds in 3% of patients. The outcome “infection” was associated with 3 major risk factors (duration of surgery, increasing number of persons in the operating room, dirty surgical site) and 1 protective factor (antimicrobial prophylaxis). The outcome “infection/inflammation” was associated with 6 significant factors (duration of anesthesia, duration of postoperative intensive care unit stay, wound drainage, increasing patient weight, dirty surgical site, and antimicrobial prophylaxis).

Conclusions—SSI frequency in companion animals is comparable with the frequency observed in human surgical patients. Several significant predictive factors for SSI in small animals surgery were identified.

Clinical Relevance—Baseline information for SSI surveillance in our hospital and for comparison with other studies was defined. The factors identified may help to predict infections in surgical patients and to take adequate preventive measures for patients at risk.
Effects of Ovariohysterectomy on Canine Blood Neutrophil Respiratory Burst: a Chemiluminescence Study
Authors: Väisänen Misse , Lilius Esa‐Matti , Mustonen Leena , Raekallio Marja , Kuusela Erja , Koivisto Maarit , Vainio Outi
Published: September 2004

Objective— To examine blood neutrophil counts and luminol‐enhanced chemiluminescence (CL) responses in dogs undergoing ovariohysterectomy (OH), premedicated with 2 different drugs.

Study Design— Randomized clinical study.

Animals— Forty‐two healthy client‐owned bitches.

Methods— Dogs had OH under isoflurane anesthesia with either acepromazine or medetomidine, both in combination with butorphanol, administered as preanesthetic medication. Blood samples were collected when the dog was admitted, at the end of surgery, and the next day (approximately 20 hours after surgery). Blood neutrophils were counted automatically, and neutrophil oxidative activity was assessed by measuring blood CL responses (induced by opsonized zymosan and enhanced by luminol) at 37°C for 40 minutes.

Results— Number of circulating neutrophils was significantly increased the day after surgery reflected by enhanced blood CL responses. Neutrophil CL, however, was not significantly altered. No significant differences were detected for perioperative Polymorphonuclear neutrophil (PMN) characteristics between the 2 preanesthetic regimens.

Conclusions— In conclusion, despite clearly increasing the number of circulating neutrophils, OH did not significantly affect neutrophil respiratory burst, as measured by whole‐blood CL responses.

Clinical Relevance— Surgical operation of moderate intensity (e.g., OH) did not significantly alter one of the important immune functions, neutrophil oxidative activity. Further studies are warranted to confirm the significance of this finding, and to assess the value of following this variable in different animal patient populations.
Occult Subchondral Osseous Cyst‐like Lesions of the Equine Tarsocrural Joint
Authors: García‐López José M. , Kirker‐Head Carl A.
Published: September 2004

Objective—To report the clinical signs, diagnosis, management, and outcome of horses with occult sub‐chondral osseous cyst‐like lesions of the tarsocrural joint.

Design—Retrospective study.

Animals—Twelve horses with subchondral osseous cyst‐like lesions (SOCLs) in the tarsocrural joint.

Methods—Information about history, examination findings, diagnostic techniques, and surgical procedures as obtained from medical records. Outcome was determined by patient re‐evaluation and telephone communication with the referring veterinarian, owner, or trainer.

Results—Horses were aged from 3 to 29 years. Lameness (2 weeks to 1 year) varied from moderate to severe. Synovial fluid analyses (9 horses) yielded changes consistent with suppurative inflammation and positive bacterial culture was obtained in 4 horses. Eight of 9 horses that had intra‐articular analgesia had a dramatic reduction in lameness. No abnormalities were detected on tarsal radiographs in 10 horses. Scintigraphy identified foci of increased radiopharmaceutical uptake in the distal tibia or talus of all horses, and the lesion was further characterized by computed tomography in 7 horses. SOCLs were identified in the medial malleolus (5), intertrochlear groove of the talus (4), lateral malleolus (2), and distal intermediate ridge of the tibia (1). One horse was euthanatized, 6 horses had surgical debridement, and 5 horses were managed conservatively. Four horses treated surgically (67%) returned to soundness. Conservatively treated horses continued to exhibit lameness but 2 were sufficiently sound for light pleasure riding.

Conclusions—Occult lesions of the tarsus not visible on radiographs can be detected by computed tomography and scintigraphy and may be a source of lameness.

Clinical Relevance—SOCL, possibly of septic origin, should be a differential diagnosis for persistent lameness localized to the tarsocrural joint without radiographic abnormalities. Surgical debridement of the lesions may offer the best prognosis for a return to athletic soundness.
Endocannabinoids and Their Implications for Epilepsy
Authors: Alger Bradley E.
Published: September 2004

This review covers the main features of a newly discovered intercellular signaling system in which endogenous ligands of the brain's cannabinoid receptors, or endocannabinoids, serve as retrograde messengers that enable a cell to control the strength of its own synaptic inputs. Endocannabinoids are released by bursts of action potentials, including events resembling interictal spikes, and probably by seizures as well. Activation of cannabinoid receptors has been implicated in neuroprotection against excitotoxicity and can help explain the anticonvulsant properties of cannabinoids that have been known since antiquity.
Sleep Deprivation and Epilepsy
Authors: Malow Beth A.
Published: September 2004

A patient with epilepsy should “spend the day awake and the night asleep. If this habit be disturbed, it is not so good … worse of all when he sleeps neither night nor day.”—Hippocrates ( 1 )

This review summarizes the data for and against sleep deprivation as a facilitator of epileptic seizures and interictal epileptiform discharges. Much of these data are derived from clinical studies; however, basic science investigations are greatly needed to determine the influence of sleep deprivation on seizure susceptibility and neuronal function. Study of the effects of sleep deprivation on epilepsy may create a window of opportunity that could help decipher how seizures are triggered and facilitated, potentially providing an avenue for future interventions.
Spontaneous progression of experimentally induced periimplantitis
Authors: Zitzmann N. U. , Berglundh T. , Ericsson I. , Lindhe J.
Published: September 2004

Background: Periimplantitis represents an inflammatory condition that is associated with the presence of a submarginal biofilm and with advanced breakdown of soft and mineralized tissues surrounding endosseous implants. Animal models have been used to describe mechanisms involved in the pathogenesis and treatment of the soft and hard tissue lesions of periimplantitis.

Objective: The aim of the present experiment was to study the presence and progression of inflammatory lesions in tissues surrounding implants exposed to “experimental periimplantitis”.

Material and Methods: Five Labrador dogs were used. In each dog, 2 or 3 implants were placed in both the left and right edentulous premolar regions of the mandible. Abutment connection was performed 4 months later and a plaque control regimen was initiated and maintained for 5 months. “Experimental periimplantitis” was subsequently induced by ligature placement and plaque accumulation was allowed to progress until about 40% of the height of the supporting bone had been lost. The ligatures were removed, but plaque formation was allowed to continue for an additional 12 months. Radiographs of all implant sites were obtained before and after active “experimental periimplantitis” as well as at the end of the experiment. Biopsies were harvested from the implant sites in 3 of the dogs. The tissue samples were prepared for light microscopy and the sections were used for histometric and morphometric examinations.

Results: One implant was lost during the first 2 months of “experimental periimplantitis” and two implants were lost during the 12 months that followed ligature removal. The radiographic examination indicated that varying amounts of additional bone loss occurred in the majority of the implant sites also following ligature removal. The mucosa of all implant sites harbored inflammatory lesions that extended apically of the pocket epithelium. The lesions were separated from the marginal bone by a zone of apparently normal connective tissue.

Conclusion: A remission of the destructive inflammatory lesion in the periimplant tissues was seen in some sites following ligature removal, but in the majority of sites additional loss of supporting bone occurred.
Clinical and microbiological changes associated with the use of combined antimicrobial therapies to treat “refractory” periodontitis
Authors: Haffajee A. D. , Uzel N. G. , Arguello E. I. , Torresyap G. , Guerrero D. M. , Socransky S. S.
Published: September 2004

Background: The present investigation examined clinical and microbial changes after a combined aggressive antimicrobial therapy in subjects identified as “refractory” to conventional periodontal therapy.

Method: Fourteen subjects were identified as “refractory” based on full‐mouth mean attachment loss and/or >3 sites with attachment loss 3 mm following scaling and root planing (SRP), periodontal surgery and systemic antibiotics. After baseline monitoring, subjects received SRP, locally delivered tetracycline at pockets 4 mm, systemically administered amoxicillin (500 mg, t.i.d. for 14 days)+metronidazole (250 mg, t.i.d. for 14 days) and professional removal of supragingival plaque weekly for 3 months. Subjects were monitored clinically every 3 months post‐therapy for 2 years. Subgingival plaque samples were taken at the same time points from the mesial aspect of each tooth and the levels of 40 subgingival taxa were determined using checkerboard DNA–DNA hybridization. Mean levels of each species were averaged within a subject at each visit. Significance of changes in clinical and microbiological parameters over time were evaluated using the Friedman or Wilcoxon signed ranks test.

Results: On average, subjects showed significant improvements in all clinical parameters after therapy. Mean (±SEM) full‐mouth pocket depth reduction was 0.83±0.13 mm and mean attachment level “gain” was 0.44±0.12 at 24 months. Clinical improvement was accompanied by major reductions in multiple subgingival species during the first 3 months of active therapy that were maintained for most species to the last monitoring visit. Reductions occurred for three Actinomyces species, “orange complex” species including Campylobacter showae, Eubacterium nodatum, three Fusobacterium nucleatum subspecies, Peptostreptococcus micros, Prevotella intermedia as well as the “Streptococcus milleri” group, Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedus. Subjects differed in their response to therapy; six modest response subjects exhibited less attachment level gain and were characterized by reductions in the microbiota from baseline to 3 months, but re‐growth of many species thereafter.

Conclusions: The combined antibacterial therapy was successful in controlling disease progression in 14 “refractory” periodontitis subjects for 2 years.
Prognostic factors for alveolar regeneration: osteogenic potential of resident bone
Authors: Polimeni Giuseppe , Albandar Jasim M. , Wikesjö Ulf M. E.
Published: September 2004

Objectives: There is a limited understanding of the role of resident bone in periodontal regeneration. The objective of this study was to evaluate the influence of the resident alveolar bone on bone regeneration in conjunction with guided tissue regeneration (GTR) in the presence or the absence of cell occlusivity.

Methods: Critical‐size, 6‐mm, supra‐alveolar periodontal defects were created in six young adult Beagle dogs. Space‐providing, occlusive or porous expanded polytetrafluaroethylene devices were implanted to provide for GTR. Treatments were alternated between left and right jaw quadrants in subsequent animals. The gingival flaps were advanced for primary intention healing. The animals were euthanized at week 8 postsurgery. The histometric analysis assessed regeneration of alveolar bone relative to space‐provision by the GTR device and width of the alveolar crest at the base of the defect.

Results: There were no significant differences in mean alveolar regeneration between sites receiving the porous GTR device with a narrow versus a wide alveolar ridge after adjusting for wound area (2.22 versus 2.50 mm, respectively; p=0.36). In contrast, analysis using sites receiving the occlusive GTR device revealed significantly greater bone regeneration at sites with a wide compared with a narrow alveolar ridge (3.34 versus 2.53 mm, respectively; p=0.02). Regression analysis showed a significant relationship (p0.05) between space‐provision and bone regeneration for all groups except for sites with a wide alveolar ridge receiving the occlusive GTR device (p=0.5).

Conclusions: The resident alveolar bone may significantly influence the magnitude of alveolar bone regeneration. The relative presence of cells from the gingival connective tissue may attenuate this effect.
Comparative antiplaque and antigingivitis effectiveness of a chlorhexidine and an essential oil mouthrinse: 6‐month clinical trial
Authors: Charles C. H. , Mostler K. M. , Bartels L. L. , Mankodi S. M.
Published: September 2004

Objectives: The objective of this study was to compare the antiplaque and antigingivitis effectiveness and the side‐effect profiles of an essential oil‐containing mouthrinse and a chlorhexidine‐containing mouthrinse.

Material and Methods: One hundred and eight qualifying subjects, aged 20–57 years, were randomized into three groups: essential oil mouthrinse (Listerine® Antiseptic); 0.12% chlorhexidine mouthrinse (Peridex®); or 5% hydroalcohol negative control. At baseline, subjects received a complete oral soft tissue examination and scoring of the Loe–Silness gingival index (GI), Quigley–Hein plaque index (PI), Volpe–Manhold calculus index (CI), and Lobene extrinsic tooth stain index (SI). Following a complete dental prophylaxis, subjects started rinsing twice daily with their respective mouthrinse as an adjunct to their usual mechanical oral hygiene procedures. One of the rinses on each weekday was supervised. Subjects were reexamined at 3 and 6 months.

The treatment groups were compared with respect to baseline demographic and clinical variables. The primary efficacy variables were GI and PI. Intergroup differences for all clinical variables were tested at 3 and 6 months using appropriate statistical procedures.

Results: All of the 108 randomized subjects were evaluable at 3 months, and 107 subjects were evaluable at 6 months. There were no statistically significant differences among the three groups at baseline, with the exception that the control group PI was significantly lower than that of the essential oil group (p<0.05) and the chlorhexidine group (p<0.001), and the essential oil mouthrinse group had a significantly greater number of subjects than the control group with body region SI scores 1.0 (p=0.021). At 6 months, the essential oil and chlorhexidine mouthrinses produced statistically significant (p<0.001) GI reductions of 14.0% and 18.2%, respectively, and statistically significant (p<0.001) PI reductions of 18.8% and 21.6%, respectively, compared with the control and were not statistically significantly different from each other with respect to plaque and gingivitis reduction. The chlorhexidine mouthrinse group had significantly more calculus and extrinsic tooth stain than either the essential oil mouthrinse group or the control group.

Conclusion: This 6‐month controlled clinical study demonstrated that the essential oil mouthrinse and the chlorhexidine mouthrinse had comparable antiplaque and antigingivitis activity. Insofar as side effects associated with the chlorhexidine mouthrinse may limit patient compliance, it is suggested that each product can have a distinct role in the management of patients with periodontal diseases.
Plaque removal by professional electric toothbrushing compared with professional polishing
Authors: Van der Weijden G. A. , Timmerman M. F. , Piscaer M. , IJzerman Y. , Van der Velden U.
Published: September 2004

Objectives:This parallel examiner blind study was designed to compare the results of professional brushing with an electric toothbrush (ETB, Braun Oral‐B 3D Excel) to a professional polish session.

Material and Methods:For this study, 90 non‐dental students were selected. All received a single oral prophylaxis where plaque and calculus were removed and the teeth were polished so that all subjects started with equally clean teeth. Approximately 4 weeks later the subjects received a new appointment prior to which they were asked to abstain from oral hygiene procedures for at least 48 h. At baseline the examiner (M.P.) evaluated the amount of dental plaque (Sillness & Löe) at six surfaces of each tooth. Subsequently, in the absence of this examiner, the subject's teeth were brushed or polished by a dental hygienist (Y.I.J.). Three groups were formed; the subjects in Group 1 received 10 min of polishing with a rubber cup/point using dentifrice as abrasive paste, in Group 2 subjects were brushed for 2 min with an ETB and dentifrice by the hygienist and in Group 3 brushing for 10 min was performed with an ETB and dentifrice. Care was taken to call upon the examiner always >10 min after her leaving the room so that she was unaware of the treatment. Electric brushing was carried out carefully following the contour of the teeth and turning the brush head separately in the direction of the mesial and distal aspect of each tooth in each approximal space. After finishing with the brushing/polishing, the examiner re‐evaluated the amount of remaining dental plaque.

Results:The baseline plaque levels in Groups 1–3 were 1.54, 1.62 and 1.55, respectively. The reduction in plaque scores in Group 1 was 94.8% (±4.0), for Group 2 94.2% (±4.7) and for Group 3 99.4% (±0.5). The results in Group 3 were significantly better than in Groups 1 and 2. Explorative analysis revealed that these differences were due to a higher plaque removal from the approximal surfaces and molars.

Conclusion:Two minutes of professional brushing with an ETB was as effective as 10 min of professional polishing. Whereas 10 min with an ETB was even more effective.
Evaluation of a new periodontal probe tip design
Authors: Vartoukian S. R. , Palmer R. M. , Wilson R. F.
Published: September 2004

Aims: In the search for an accurate periodontal probe which does not frequently penetrate the pocket base, a new tip has been designed which is flattened, and of 1 mm width and 0.45 mm thickness. This study aimed to evaluate the physico‐mechanical and clinical properties of this probe (test) in comparison to a conventional 0.5 mm circular probe (control).

Methods: Photoelastic stress analysis was undertaken for test and control probe tips at 3.15 and 5 N loads. To assess probing validity, the clinical probing depth with each probe (0.25 N force) at 125 sites on 27 teeth (27 subjects), was compared with the post‐extraction connective tissue level measurement. Also evaluated were probing reproducibility (1200 sites in 25 subjects) and patient comfort (30 subjects).

Results: Using photoelastic stress analysis, the test probe demonstrated lower stresses and less local stress concentration than the control. Clinically, the test probe measured close to the post‐extraction gold standard in greater frequency than the control – 26 versus 11 readings (21% versus 9%) exactly matched, and 90 versus 67 (72% versus 54%) were within ±0.5 mm of the laboratory measurement. The test probe was, on average, 0.13 mm coronal to the connective tissue attachment level, whereas the control penetrated 0.27 mm past this level. The intraclass correlation between clinical and laboratory readings was greater for the test than the control (r=0.81 and 0.74, respectively). Although the control probe overestimated probing depth more markedly at bleeding (0.41 mm) than at non‐bleeding (0.15 mm) sites, the relative position of the test probe hardly differed with inflammatory status (−0.11 and −0.14 mm, respectively). Each probe demonstrated good clinical reproducibility. However, the test probe examination was more comfortable for the patient.

Conclusion: This new periodontal probe tip appears to have greater validity, good reproducibility and produces less patient discomfort.
HLA‐G Expression in Placenta in Relation to HLA‐G Genotype and Polymorphisms
Authors: Hviid Thomas Vauvert F. , Larsen Lise Grupe , Hoegh Anne Mette , Bzorek Michael
Published: September 2004

Problem:  The expression of the non‐classical human leukocyte antigen (HLA) class Ib gene, HLA‐G, seems to be important at the feto–maternal interface. The HLA‐G molecule is almost monomorphic and expressed in both membrane‐bound and soluble isoforms. It has been shown to inhibit natural killer cell ‐mediated lysis and influence cytokine expression. HLA‐G gene polymorphism has been linked to differences in gene expression profile of alternatively spliced HLA‐G transcripts and levels of specific HLA‐G messenger RNA (mRNA) isoforms. Furthermore, aberrant HLA‐G expression has been reported in preeclamptic placentas. On this background it is of general interest to further elucidate any associations between HLA‐G polymorphism and protein expression.

Methods:  We have investigated HLA‐G protein expression by immunohistochemistry in HLA‐G genotyped placentas from term. HLA‐G mRNA expression in preeclamptic placentas and in control placentas was also studied by microarray technology.

Results and conclusions:  The studies of HLA‐G protein expression in term placentas by immunohistochemical analysis showed no clear associations with HLA‐G genotypes although this could be because of the very semi‐quantitative nature of this technique. However, we found a tendency towards reduction of HLA‐G mRNA expression in placentas from preeclamptic cases compared to matched controls with the use of microarray technology.
The Placental Immunomodulatory Cytokine Regeneration and Tolerance Factor is also Expressed by Both Human Cycling and Early Pregnant Endometrium
Authors: Lattuada Debora , Mangioni Silvia , Viganò Paola , Ntrivalas Evangelos I. , Rossi Margherita , Palotti Francesco , Carinelli Silvestro , Beaman Kenneth D. , Di Blasio Anna M.
Published: September 2004

Problem:  Regeneration and tolerance factor (RTF) has been recently suggested to contribute to the control of fetal‐ablating immunity at the maternal–fetal interface through the induction of T helper 2 (Th2)‐dominated response. The protein consists of a membrane‐associated domain and an extracellular portion which is proteolitically cleaved to yield a soluble peptide. In humans, it has been shown to be expressed by invading cytotrophoblasts and decidual lymphoid cells, to be increased on peripheral blood B lymphocytes during a normal gestation and on circulating natural killer cells during unsuccessful pregnancies. However, the expression of RTF in other cell types and, specifically, in non‐hematopoietic maternal cells of the human uterus has not been characterized in detail. Thus, we have specifically studied the expression and modulation of the cytokine in human endometrium obtained in different phases of the cycle and in early pregnancy.

Methods:  The 20 kDa extracellular domain of RTF has been localized by immunohistochemical method and Western blot analysis. Levels of RTF messenger RNA (mRNA) in basal and stimulated conditions have been evaluated by semiquantitative reverse transcription‐polymerase chain reaction.

Results:  The extracellular domain of RTF could be detected in both the glandular epithelium and stroma with diffuse distribution in both cycling endometrium and first trimester decidua. Both cycling and pregnant endometrium expressed the gene for RTF but mRNA levels resulted significantly increased in secretory phase‐endometrial stromal cells when compared to proliferative phase samples. Inflammatory cytokines, interleukin‐1β and tumour necrosis factor α were able to directly increase endometrial RTF mRNA expression.

Conclusion:  These results indicate that RTF is constitutively expressed at endometrial and decidual level and its up‐regulation during the secretory phase of the cycle may be relevant in mediating some immune‐related aspects of uterine physiology.
Pharmacotherapy for Erectile Dysfunction
Authors: Padma-Nathan Harin , Christ George , Adaikan Ganesan , Becher Edgardo , Brock Gerald , Carrier Serge , Carson Culley , Corbin Jackie , Francis Sharon , DeBusk Robert , Eardley Ian , Hedlund Hans , Hutter Adolph , Jackson Graham , Kloner Robert , Lin Shin , McVary Kevin , McCullough Andrew , Nehra Ajay , Porst Hartmut , Schulman Claude , Seftel Allen , Sharlip Ira , Stief Christian , Teloken Claude
Published: September 2004

Introduction

Advances in understanding of the biochemistry and physiology of penile erection have led to breakthroughs in pharmacotherapy of erectile dysfunction.

Aim

To provide recommendations/guidelines concerning state-of-the-art knowledge for the putative molecular and cellular mechanisms of action of centrally and peripherally acting drugs currently utilized in pharmacotherapy of erectile dysfunction.

Methods

An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a two-year period. Concerning the Pharmacotherapy for Erectile Dysfunction Committee there were 25 experts from 10 countries.

Main Outcome Measure

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

Results

Selective and potent oral PDE5 inhibitors have significantly more affinity than cGMP and form broader molecular interactions with multiple amino acids, thereby blocking access to cGMP in the catalytic sites of the PDE5 enzyme. PDE5 inhibitors, which vary as to biochemical potency, selectivity and pharmacokinetics, lead to cGMP elevation and relaxation facilitation of penile corpus cavernosum smooth muscle cells following sexual stimulation. Various centrally acting drugs influence sexual behaviour. In particular, the dopaminergic substance apomorphine is a central enhancer that acts in the paraventricular nucleus of the hypothalamus as a dopamine (D2) receptor agonist, induces and increases penile erection responses via disinhibition, following sexual stimulation.

Conclusions

There is a need for more research in the pharmacotherapeutic development of central and peripheral agents for safe and effective erectile dysfunction treatment.
The Multinational Men's Attitudes to Life Events and Sexuality (MALES) Study Phase II: Understanding PDE5 Inhibitor Treatment Seeking Patterns, Among Men with Erectile Dysfunction
Authors: Fisher William A. , Rosen Raymond C. , Eardley Ian , Niederberger Craig , Nadel Andrea , Kaufman Joel , Sand Michael
Published: September 2004

Objective

The aim of Phase II of the Men's Attitudes to Life Events and Sexuality (MALES) Study is to explore PDE5 inhibitor treatment seeking among men with erectile dysfunction (ED).

Methods

Phase II of the MALES study involved 2912 men, aged 20–75 years, from 8 countries (U.S., U.K., Germany, France, Italy, Spain, Mexico, and Brazil), who reported ED. Participants were recruited from the MALES Phase I sample [1] and via booster methods (e.g., physician referral, street interception), and completed self-report questionnaires concerning the characteristics of their ED, their efforts to seek PDE5 inhibitor treatment for their sexual dysfunction, and attitudinal and referent influences that potentially affect treatment-seeking. Statistical analyses focus on identification of correlates of PDE5 inhibitor treatment seeking.

Results

PDE5 inhibitor utilization is strongly associated with ED sufferers’ assessment of the severity of their sexual dysfunction, with their belief that medication for ED is dangerous, and with their perceptions of whether physicians, other professionals, and spouses or family members are supportive of their seeking treatment. ED sufferers who evaluate their sexual dysfunction as severe, who believe that medication for ED is not dangerous, and who perceive support for treatment seeking from referent others, are more likely to utilize PDE5 inhibitor treatment.

Conclusion

Findings indicate that perceived ED severity, beliefs about ED medication, and referent influences are strongly correlated with utilization of PDE5 inhibitor therapy. These findings aid our understanding of factors that may incline men with ED to seek—or to avoid—PDE5 inhibitor therapy for their sexual dysfunction, and provide a basis for clinical and educational interventions to assist men with ED to seek appropriate treatment.