bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Protein and Hypoalbuminemia in CAPD
Authors: Kaysen George A.
Published: October 2007

Despite a relatively high protein intake of 1.2 gl kglday, low levels of serum albumin are common in CAPD patients, presumably as a result of dialytic protein losses. Protein intakes of 1.5 glkglday have been recommended. Since this additional 0.3 glkgl day will result in an increase in BUN of about 30 mgldl (along with an increase in other unmeasured uremic toxins) I am concerned about the “risk:benet ratio” of raising the dietary protein intake in my CAPD patients. Will the higher intake raise serum albumin? Even if it does, will the higher albumin be of significant benefit to the patient considering the (unknown) risk?
Adequacy Guidelines for High Permeability Membranes
Authors: Levin Nathan W.
Published: October 2007

A Ktl V of 1.0 or greater has been oflered as a guideline for adequate dialysis treatment, independ‐ ent of the time of dialysis. Most of these studies have been performed with cellulosic‐based membranes, and recently the necessity for a KtlV of this magnitude has been questioned for membranes with high middle molecular clearances. Do you feel that diflerent Ktl V standards should apply for diflerent mem‐ brane materials? Are there any formal studies looking at Ktl V with noncellulosic membranes?
Falsely High Kt/V Values
Authors: Depner Thomas A.
Published: October 2007

In several patients undergoing rapid, high efficiency dialysis the percentage drop in BUN over the course of dialysis was much greater than expected (e.g., about 70%) which suggested that intracellular urea was not rapidly equilibrating with blood and that calculations of Kt/V urea will be falsely high. How prevalent is this problem and how can dialysis delivery be quantified in such patients?
Diagnosis of Malignancy in Acquired Cystic Disease
Authors: Levine Errol
Published: October 2007

What is the best radiologic method for recognizing malignant transformation of acquired cystic disease in dialysis patients?
Gynecomastia in a Male Hemodialysis Patient
Authors: Smith J. Douglas
Published: October 2007

As a result of one dramatic case, I've noted that gynecomastia is fairly common in male hemodialysis patients. Generally these patients are not receiving any medications associated with this problem. Should gynecomastia be investigated in dialysis patients? If so, when and how?
Refining the Model of Urea Kinetics: Compartment Effects
Authors: Depner Thomas A.
Published: October 2007

A 70‐year‐old female with chronic congestive heart failure requires maintenance hemodialysis because of end‐stage diabetic nephropathy. She is dialyzed on Monday, Wednesday, and Friday for 2 hours using a dialyzer with an average urea clearance of 250 ml/min. Dry weight is 50 kg. Predialysis blood urea nitrogen (BUN) on Wednesday is 50 mg/dl; postdialysis BUN is 15 mg/dl. A single‐compartment, variable‐volume model of urea kinetics revealed the following: 1.5 hours of dialysis are sufficient to maintain Kt/V at 1.1/dialysis; protein catabolism is 0.92 g/kg/day; her volume of urea distribution is 43% of body weight. Provided the blood access device and dialysis equipment are functioning properly and the blood specimens are drawn and measured correctly, are the model predictions valid?
Optimal Hemodialysis Access
Authors: Conlon Peter J. , Schwab Steve J.
Published: October 2007

The optimal provision of vascular access for the ESRD patient involves the following: early identification of such patients so that either a primary a/v fistula or a PTFE graft may be created; prospective monitoring of VDP and urea recirculation to detect venous stenoses; intervention with either angio‐plasty or surgical revision in cases found to have venous stenosis; and development of a quality assurance plan that monitors thrombosis and fistula replacement rates and seeks causes of fistula thrombosis in patients without an anatomic basis for the clotting.
Preventing and Managing Hypotension
Authors: Daugirdas John T.
Published: October 2007

Simple maneuvers to prevent dialysis hypotension include measures to help maintain blood volume and to limit interdialytic weight gain. After several years of development, the use of hematocrit sensors and intelligent feedback regulation of the ultrafiltration rate based on blood volume, on‐line measurement of cardiac output, or blood pressure, will soon be a reality. The use of acetate is fast becoming obsolete in the United States, because acetate has a number of adverse effects on the cardiovascular system. A preliminary report that acetate dialysis is associated with better solute removal from the body needs to be confirmed. Wider use of cool temperature dialysis is limited by frequent patient discomfort (feeling cold, shivering), and cool dialysis may adversely affect urea removal during dialysis, though this needs to be studied. In patients who experience sudden episodes of hypotension during dialysis, the mechanism may be sudden withdrawal of sympathetic tone. This may be related to generation of adenosine due to tissue ischemia. A rational approach to this type of patient would be to minimize tissue ischemia by increasing the baseline hematocrit if low, and by giving nasal oxygen during the treatment, Predialysis nasal administration of iysine vasopressin may help some patients with refractory dialysis hypotension.
Control of Renal Bone Disease
Authors: Sherrard Donald J.
Published: October 2007

In this review I have briefly described the patho‐physiology of renal osteodystrophy, the kinds of bone lesions which occur, and the current thoughts about management, pointing out that the major issue we need to solve is patient compliance. I have also discussed three areas of controversy: calcitriol dosing, the use of the bone biopsy, and the implications of the recently noted aplastic bone disorder.
Optimal Approach to the Prevention and Treatment of Peritonitis in Children Undergoing Continuous Ambulatory and Continuous Cycling Peritoneal Dialysis
Authors: Levy Maurice , Balfe J. Williamson
Published: October 2007

In this paper we have tried to discuss the optimal approach to prevention and treatment of peritonitis. Because prevention involves the knowledge of factors predisposing to peritonitis, we have examined some potential factors. Data are, however, very limited in this area.

The optimal management should be tailored to the patient. Basic guidelines are suggested, though a variety of successful approaches are used at different pediatric centers. One has to remember that overzealous treatment with antibiotics may be associated with candida infection, further complicating the treatment of peritonitis. Improvement of the dialysis technique, optimal home care, early identification of exit‐site infection and its management, increased use of CCPD or NIPD and optimal antibiotic management will prevent recurrent episodes of peritonitis and their associated complications.
What are the Important Considerations in the Care of Critically III Patients with Acute Renal Failure?
Authors: Tolkoff‐Rubin Nina E. , Paller Mark S. , Maroni Bradley J. , Harris David C. H. , Kaplan Andre A. , Eliahou H. E. , Priel I. E.
Published: October 2007

With the recent progress in molecular and cellular biology, the 1990s present a unique opportunity for understanding the cellular or humoral factors responsible for accelerated catabolism in ARF. This author believes that a greater priority should be placed on funding basic research directed at understanding the pathogenesis of protein catabolism in ARF. For example, identifying the intracellular pro‐teolytic pathways which are activated in experiment& ARF might lead to strategies to suppress accelerated proteolysis. Insight gained from these efforts could then be used to design clinical trials to test the efficacy of nutritional interventions in this patient population. In this era of increased economic constraints, practical solutions to this formidable problem are needed.
Risk of High‐Dose Erythromycin in End‐Stage Renal Disease
Authors: Foote Edward F.
Published: October 2007

Is high‐dose (i.e., over 2 g daily) intravenous erythromycin contraindicated in end‐stage renal disease (ESRD) because of the risk of ototoxicity?
Quantifying Hernodialysis and Peritoneal Dialysis: Examination of the Peak Concentration Hypothesis
Authors: Depner Thomas A.
Published: October 2007

In concert, the nonlinear effects and solute disequilibrium associated with hemodialysis may explain the differences between Kt/V required for patients receiving intermittent versus continuous dialysis who have a comparable average BUN. The above arguments may remove some of the mystery behind the benefits of CAPD, a form of dialysis that was discovered empirically and proved to be more successful than many would have predicted (6). To account for the surprising success of CAPD one need not postulate that uremic toxicity is related to high peak concentrations of urea, nor must one invoke an unknown effect of this type of dialysis; rather, the inefficiency of intermittent dialysis may be a sufficient explanation. When the factors that reduce the effectiveness of solute removal during hemodialysis are taken into account, these two forms of dialysis begin to look and behave similarly.
Recurrent Access Thrombosis
Authors: Beathard Gerald A.
Published: October 2007

A substantial fraction of clotted polytetrafluoroethylene (PTFE) grafts undergoing thrombolysis and angioplasty clot again within a few months. Is there a place for routine follow‐up fistulograms in these patients, or should we just retreat them as needed? Is there, perhaps, a subgroup that requires special management?
Continuous Renal Replacement Therapy for Burned Patients: Renal and Systemic Considerations
Authors: Leblanc Marline , Quérin Serge
Published: October 2007

Significant improvements in wound care have re‐sulted in decreased mortality rates in burned pa‐tients since the mid‐seventies. The main determi‐nants of survival remain the extent of the burn and the age. Infection is still the most frequent cause of mortality. Burned patients are prone to develop MOF, not only following sepsis, but from the sys‐temic inflammation associated with thermal injury. Many metabolic derangements occur after a burn:hypermetabolism with several hormonal changes, enhanced catabolism and gluconeogenesis, im‐paired ketogenesis and lipolysis. Aggressive nutri‐tional support is particularly important in burned patients and avoiding a negative nitrogen balance is priority. Since early aggressive fluid resuscitation is widely applied, ARF occurs later during the course hospitalization, often after 10 days. Its pathogen‐esis seems multifactorial, mainly related to sepsis and nephrotoxic agents, and is usually part of MOF. Dialytic support is challenged by the important fluid intake and removal required, the high catabolism, and the hemodynamic instability that characterize burned patients. Since they allow a better hemody‐namic tolerance, a more precise fluid balance, and a more stable metabolic control, CRRTs appear as modalities of choice for ARF burned patients. How‐ever, only three series report their usefulness for this selected population. In our experience, CRRTs have been performed over long periods and have allowed significant fluid loss over time. Bleeding complications from wounds have been much more frequent than for intensive care patients treated by CRRT with a similar anticoagulation regimen, and mandate prudent monitoring. Owing to limited vas‐ cular access sites and inherent risks of arterial cath‐eterization, venovenous might be preferred to arte‐riovenous modalities, if they are available. Despite more aggressive management, the mor‐tality rates of burned patients with ARF remain high80%, reflecting the associated MOF. From a sys‐temic point of view, considering the important vol‐ume loss required, the potential for enhanced cyto‐kine removal, and the important cumulative soluteclearances provided over time by CRRT, ARF burned patients should particularly benefit from continuous over intermittent modalities. When dia‐lytic support has to be initiated, we consider CRRT, particularly hemodiafiltration which provides a larger dialysis dose, as the modality of choice.
Continuous Renal Replacement Therapy: Cost Considerations and Reimbursement
Authors: Moreno Luz , Heyka Robert J. , Paganini Emil P.
Published: October 2007

Cost considerations with CRRT are important and vary substantially among centers. Major areas of concern are personnel, equipment, supplies, CRRT modality chosen and patients chosen. Costs are higher with CRRT than with either IHD or APD. These cost differences narrow as greater amounts of therapy are delivered. There are signif‐ icant areas for cost control in CRRT. Each center must evaluate its program to find the areas of cost control that are potentially available.
Using Egg White Powder as a Protein Supplement
Authors: Fosberg Suzanne
Published: October 2007

Protein supplements for dialysis patients are expensive and patients frequently dislike their taste. Are there any food products that are effective as supplements?
Withdrawing from Dialysis
Authors: Kjellstrand Carl M.
Published: October 2007

It is not a question of dying earlier or later, but of dying well or ill, and dying well means escape from the danger of living ill. (Seneca, 4 BC)
Effect of Increasing Dialysate Flow Rate on KoA and Dialyzer Urea Clearance
Authors: Leypoldt John K.
Published: October 2007

I've been told that increasing dialysate flow from 500 to 800 mL/min is of minimal benefit unless the blood flow is relatively high (400‐500 mL/min) and even then the effect is small. I've also been told that increasing dialysate flow changes the membrane properties (not just the solute gradient) and adds significantly to Kt/V. Which is it?
Indications for Nephrectomy of a Failed Transplant
Authors: Bia Margaret
Published: October 2007

In dialysis patients with a failed renal transplant that has been in place for over one to two years, what are the circumstances that might require removal of the transplant? How is the decision made?
Rechallenging Patients Allergic to Iron Dextran
Authors: Fishbane Steven
Published: October 2007

In patients who have had an allergic reaction to iron dextran, is it appropriate to try pretreatment with steroids and antihistamines and “rechallenge” them? Does it depend on the kind of reaction they've had?
The State of Kidney Transplantation in the United States
Authors: Wolfe Robert
Published: October 2007

Although transplantation is the preferred treatment for end‐stage renal disease (ESRD) patients compared to dialysis, the limited number of organ donors limits this treatment option for many patients. Various approaches to increase the number of donors are currently being investigated. While the quality of life and patient survival are far from optimal for ESRD patients, improvements have been seen recently in both dialysis and transplantation outcomes. Prevention of ESRD is preferred to either treatment option.
Increasing the Pool of Transplantable Kidneys Through Unrelated Living Donors and Living Donor Paired Exchanges
Authors: Spital Aaron
Published: October 2007

Renal transplantation is the best therapy for eligible patients with end‐stage renal disease (ESRD). Unfortunately the ability to perform this procedure is limited by a severe shortage of transplantable kidneys. One of the most successful approaches to this serious problem has been to expand the pool of living donors. This has been accomplished primarily by lifting restrictions on the use of genetically unrelated volunteers. As a result, acceptable living kidney donors now include individuals who are related to their recipients only through emotional bonds (e.g., spouses) and, at some centers, even people who are not related to their recipients at all. Living donor paired kidney exchanges provide a novel means for increasing further the number of kidneys available for transplantation. Each of these approaches will be reviewed.
Overcoming Immunologic Incompatibility: Transplanting the Difficult to Transplant Patient
Authors: Crew R. John , Ratner Lloyd E.
Published: October 2007

Immunologic incompatibilities between donor and recipient have limited the access to renal transplantation for many patients. Previously the presence of donor‐specific alloantibodies directed against donor major histocompatibility complex (MHC) antigens or natural antibodies directed against donor ABO blood group antigens was considered an absolute contraindication to renal transplantation. However, with the current understanding of humoral immune responses, superior immunosuppressive agents, and improved diagnosis and treatment of antibody‐mediated rejection, renal transplantation can be safely performed with outstanding results despite the presence of donor‐specific antibody. In this review we discuss the biology of antibody‐mediated rejection and sensitization. We discuss the diagnostic tests necessary to characterize the type, affinity, and avidity of the donor‐directed antibodies. Current methods for performing renal transplants across ABO and human leukocyte antigen (HLA)‐sensitized barriers are covered, including the potential morbidities. The rest of the review focuses on advances in managing these antibodies to increase the likelihood of receiving a deceased donor kidney or allow transplantation from a living donor against whom one has a prohibitive antibody.
Kidney Transplant Candidate Evaluation
Authors: Scandling John D.
Published: October 2007

The practicing nephrologist is an indispensable component in the evaluation of the candidate for kidney transplantation, from referral to the transplant center to eventual transplantation, which now may be years later. Early referral may lead to preemptive transplantation, the ideal that has been achieved in 25% of living donor transplant cases. Annually approximately 30% of U.S. deceased donor kidneys are now transplanted under the allocation policies for zero human leukocyte antigen (HLA) mismatch kidneys and expanded criteria donor kidneys. Under either of these programs, candidates may receive a kidney offer soon after entering the wait‐list, so prompt and complete evaluation and preparation by the practicing nephrologist is necessary for successful early transplantation. The remaining candidates require periodic review while ascending the wait‐list and thorough repeat evaluation when nearing the top, as years may have passed since initial evaluation. Wait‐list management is a major challenge faced by transplant centers, aggravated by the inexorable growth of the list. Active communication between the practicing nephrologist and the transplant center is essential to maintain the candidate's preparation for transplantation.
Surgical Complications After Kidney Transplantation
Authors: Humar Abhinav , Matas Arthur J.
Published: October 2007

Kidney transplants have become common surgical procedures, with thousands performed yearly around the world. The surgical techniques for the transplant are well established and the procedure is associated with high success rates. The complication rate associated with the procedure is low, especially when compared to other abdominal organ transplants such as liver and pancreas transplants. Nonetheless, the detection, accurate diagnosis, and timely management of surgical complications occurring after kidney transplant are important tasks of the team managing these patients. A delay in the diagnosis or management of these complications can result in significant morbidity to the recipient, with risk of graft loss and mortality. Most surgical complications involve either the wound or one of the three anastomoses (renal artery, renal vein, or ureter). Examples include wound infection, renal artery or vein thrombosis, and urine leak. Most of these complications will require surgical or radiologic intervention for appropriate management.
Managing the Failing Allograft
Authors: Kendrick Elizabeth A. , Davis Connie L.
Published: October 2007

Managing the failing allograft juxtaposes immunosuppressive management and routine chronic kidney disease care. The complications of immunosuppression can be more pronounced in those with renal failure (infection, anemia, bone disease). The withdrawal of immunosuppression may be associated with acute allograft rejection, arthralgias, and the development of antidonor antibodies. Likewise depression is prevalent. Improving well‐being and overall survival necessitates proper titration of immunosuppressive medications and control of blood pressure, anemia, lipids, and glucose along with attention to treatment of depression.
American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Stenosis Surveillance of Hemodialysis Grafts by Duplex Ultrasound Reduces Hospitalizations and Cost of Care
Authors: Dossabhoy Neville R. , Ram Sunanda J. , Nassar Raja , Work Jack , Eason J. Mark , Paulson William D.
Published: October 2007

Most recent randomized controlled trials (RCTs) have found that hemodialysis graft surveillance combined with preemptive correction of stenosis does not prolong graft survival. Nevertheless, such programs may be justified if they reduce other adverse outcomes or decrease the cost of care. This study tested this hypothesis by applying a secondary analysis to our original RCT. This study of 101 patients evaluated correction of stenosis based upon blood flow (Q) and stenosis surveillance. Patients were randomly assigned to control, flow, or stenosis groups, and were followed for up to 28 months. Q was measured monthly by ultrasound dilution; stenosis was measured quarterly by duplex ultrasound. Stenosis of  50% was corrected by percutaneous transluminal angioplasty (PTA) after referral for angiography. Referral criteria were: control group, clinical criteria; flow group, Q < 600 ml/min or clinical criteria; stenosis group, stenosis > 50% or clinical criteria. We compared access‐related hospitalizations and cost of care, and use of central venous dialysis catheters (CVCs), among the three groups. Hospitalization rates were higher in the control and flow groups than in the stenosis group (0.50, 0.57, 0.18/patient‐year, respectively [p < 0.01]), and hospitalization costs were lowest in the stenosis group (p = 0.026). The stenosis group had a trend toward lowest CVC rates (0.44, 0.32, 0.20/patient‐year, respectively [p = 0.20]). The costs of care were higher in the control and flow groups than in the stenosis group ($3727, $4839, $3306/patient‐year, respectively [p = 0.015]). The costs of stenosis ($142/patient‐year) and Q ($279/patient‐year) measurements were minimal compared to the total cost of access‐related care. In conclusion, stenosis surveillance by duplex ultrasound combined with preemptive correction yielded reduced hospitalization rates and costs, reduced total cost of access‐related care, and a trend of reduced CVC rates. In contrast, flow surveillance did not yield a significant benefit. Stenosis surveillance provides important benefits that may justify application of such programs.
American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Thresholds for Significant Decrease in Hemodialysis Access Blood Flow
Authors: Ram Sunanda J. , Nassar Raja , Sharaf Rashid , Magnasco Alberto , Jones Steven A. , Paulson William D.
Published: October 2007

During hemodialysis access surveillance, referral for evaluation and correction of stenosis is based upon determination that a significant decrease in blood flow (Q) has occurred. However, criteria for determining when a decrease is statistically significant have not yet been established. In this study we established such criteria by analyzing Q variation with the glucose pump test (GPT). We took nine Q measurements in each of 25 patients (18 grafts, 7 fistulas) during three dialysis sessions within a 2‐week period (predialysis and during hours 1 and 3). We determined thresholds that define a significant percentage decrease in Q (ΔQ) for various p values. In order to confirm the general applicability of these thresholds, we computed the average within‐patient Q variation during the three sessions (computed as a coefficient of variation and referred to as short‐term variation). We then determined the relative influences of biological (true) variation and analytical error on short‐term variation. We found that ΔQ must be > 33% to be significant at p < 0.05, whereas the threshold is > 17% for p < 0.20. Measuring Q at uniform versus different times during the sessions did not significantly reduce these thresholds. We also found that biological variation was nearly as large as short‐term Q variation, whereas analytical error contributed minimally to short‐term variation. In conclusion, this study defines thresholds for a significant ΔQ that have wide application in determining access referral for evaluation and correction of stenosis. Selection of a particular threshold should consider the relative importance of avoiding thrombosis versus avoiding unnecessary procedures. If avoiding unnecessary procedures is a priority, then we recommend a threshold of > 33%. These thresholds apply to other methods of measuring Q, provided analytical error is significantly less than biological variation.
Aplasia, supernumerary teeth and fused teeth in the primary dentition
Authors: RAVN J. J.
Published: October 2007

abstract – Numerical variations and fusions in the primary dentition were studied among 4,564 children from 3 to 31/2 years of age. The results of the examination showed that aplasia occurs in 0.5%, hyperodontia in 0.5%, and fusions in 0.9%. Patients with aplasia in the primary dentition nearly always showed aplasia of the successors. In patients with unilateral aplasia in the primary dentition, aplasia of the contralateral permanent tooth was often found also. Most cases of hyperodontia occurred in the maxilla. Half the supernumerary teeth were maxillary lateral incisors, and they were often followed by hyperodontia in the permanent dentition, whereas cases with supernumerary central incisors were less often followed by hyperodontia in the permanent dentition. Where a mandibular lateral incisor and canine were fused, aplasia of the permanent lateral incisor was always found, whilst cases with fused incisors only rarely involved changes in the permanent dentition. Cases with gemination in the primary dentition were as a rule followed by normal conditions in the permanent dentition.
Adrenergic vessel innervation in the rat incisor pulp
Authors: LARSSON PÄR‐ANDERS , LINDE ANDERS
Published: October 2007

abstract – The presence of adrenergic axons and nerve terminals has been demonstrated in the rat incisor pulp by means of the histochemical fluorescence method of Hillarp & Falck. Adrenergic, nerve terminals in close connection with blood vessel walls were observed at all levels in this tissue, although there was an excess in the apical region. Administration of a MAO‐inhibitor and noradrenaline increased the fluorescence intensity markedly, while reserpine and sympathectomy could abolish the fluorescence. The findings suggest the presence of an adrenergic regulation of blood flow in the rat incisor pulp and consequently an indirect nervous influence on the dentinogenesis. The possible relation between a suggested circadian rhythm in the activity of peripheral adrenergic neurons and the incremental pattern of the dentin is discussed.
Calcium hydroxide as an ectopic bone inductor in rats
Authors: RASMUSSEN PER , MJÖR IVAR A.
Published: October 2007

abstract – The effect of calcium hydroxide as a potential bone inductor in ectopic locations was studied by implanting calcium hydroxide subcutaneously or intraperitoneally in rats. The calcium hydroxide was either left in direct contact with the host tissue or separated from it by Millipore® filters. The observation periods ranged from 6 to 18 weeks. The present investigation could not verify previous reports of calcium hydroxide as a bone inductor when placed in ectopic locations. However, in some of the cases where direct contact was established between host tissue and calcium hydroxide, marked hyperplasia of the connective tissue and numerous multinuclear giant cells were observed. Occasionally some ill‐defined basophilic, von Kossa positive islands were observed which slightly resembled immature bone. If direct contact between calcium hydroxide and the host tissue was prevented by Millipore filters, no significant reactions were observed in the host tissue.
Immune adherence with keratinized human oral mucosa and human serum
Authors: KRISTOFFERSEN TORE , KROGH HANS‐KRISTIAN
Published: October 2007

abstract – All normal human sera examined have been shown to contain complement‐fixing antibody to an antigen present in stratum corneum of human skin. By immune adherence with human sera and sections of frozen biopsy specimens, the antigen was found to be present in sections of keratotic and parakeratotic areas of human gingiva, tongue, alveolar, buccal, and palatal mucosa. Serum from biopsy donors mediated the adherence reaction. Absorption with a phenol‐water extract (water phase) of stratum corneum of skin removed the antibodies. The antigen was not detected in non‐keratinized areas of human oral mucosa, including gingival crevice and cuff epithelium. Erythrocytes also adhered to keratinized epithelium in gingival biopsy specimens fixed in ethanol and cleared in xylene at 4° C prior to sectioning and incubation with human serum.
The affinity of fluoride for protein or protein ‐ dextran coated hydroxylapatite
Authors: BIRKELAND J. M. , RÖLLA G.
Published: October 2007

abstract – The affinity of fluoride for hydroxylapatite powder with or without coatings of salivary proteins or salivary proteins and dextrans was investigated. Solution of sodium fluoride was added to uncoated and coated samples of hydroxylapatite. Fluoride ion concentration of supernatants above the coated and uncoated samples was measured and used to evaluate the effect of the coatings. The coatings seemed to affect the fluoride‐hydroxylapatite interaction only to a very small degree.
Cytology of the inflammatory exudate in denture stomatitis
Authors: KAABER SVEND , BERTRAM ULRIK
Published: October 2007

abstract – Inflamed palatal mucosa in 28 patients with denture stomatitis has been studied by means of a cytologic replica technique. Samples were taken from both mucosa with simple inflammation and mucosa with inflamed papillary hyperplasia (granular inflammation), a distinction also being drawn between areas with and without visible ulcerations. The material permitted an analysis of migratory activity, cytologic composition, and phagocytic activity in the exudate. Areas with simple inflammation provided cytologic evidence of an acute inflammatory reaction, comprising strong migratory activity, a frequent occurrence of eosinophilic granulocytes and a tendency to increased phagocytic activity. Areas with granular inflammation provided signs of a chronic inflammatory reaction, comprising reduced migratory activity, an increase of macrophages, and a low phagocytic activity. There was a positive correlation between the occurrence of eosinophilic granulocytes and the registration of symptoms in the ulcerated mucosa. Basophilic granulocytes were not demonstrated. The immunologic significance of the observations is discussed and the possibility of selective migration through inflamed intact palatal epithelium mentioned.
The plaque‐inhibiting effect of chlorhexidine‐containing dentifrices
Authors: GJERMO PER , RÖLLA GUNNAR
Published: October 2007

abstract – In a double blind longitudinal study the plaque‐inhibiting effect of two chlorhexidine‐containing dentifrices was tested on 53 students for 2 months. The mean Plaque Index values of the groups employing active toothpastes were significantly lower than in a placebo group (p < 0.5). The differences tended to increase with time. Standardized color photographs were taken of all participants at the start and at the termination of the experiment. Brownish stains on silicate fillings and tooth surfaces were observed frequently. No damage to the oral mucosa or discoloration of the dorsum of the tongue could be detected. Storing of the dentifrices at room temperature up to 6 months caused no changes in the antibacterial activity against salivary bacteria in vitro. It is concluded that the use of a dentifrice as a vehicle for chlorhexidine might be of value in the general preventive application of the agent.
Effect of chlorhexidine on animal cells in vitro
Authors: HELGELAND KRISTEN , HEYDEN GUY , RÖLLA GUNNAR
Published: October 2007

abstract–When cultures of human epithelial cells were treated for 5 min at 37°C with chlorhexidine in Eagle's medium without serum added, concentrations from 0.05 mM were found to be toxic as measured by growth inhibition and differential staining. About 20 times higher concentrations were needed to obtain a toxic effect, however, when the cells were treated with chlorhexidine dissolved in calf serum. Human whole saliva collected from a single subject had no such protective effect. The intracellular activities of 5′‐nucleotidase, alkaline phosphatase, and NADPH2+ NADH2‐diaphorases decreased upon treatment of the cells with concentrations of chlorhexidine at 0.2 and 2 mM, whereas 0.02 mM had no measurable effect on these enzymes. Treatment with chlorhexidine at 10−4mM had no effect on the hypotonic hemolysis of human erythrocytes, 0.001–0.1 mM stabilized the cells, but increasing the concentration to 1 mM gave 100% hemolysis. A concentration‐dependent inhibition of the Na+–K+–ATPase activity was found when erythrocyte membranes were incubated with chlorhexidine in the range of 0.002–0.2 mM.
A method for the quantitation of the epithelium‐connective tissue interface of the oral mucosa
Authors: KARRING T. , LÖE HARALD
Published: October 2007

abstract – A method has been developed for quantitating, on the basis of histologic serial sections, the contact area between the epithelium and connective tissue of oral mucosa. Magnified (200 ×) paper replicas are produced from histologic sections (20 microns) and two consecutive paper replicas are superimposed on an illuminated grid. By means of the grid lines the area between the two basement membranes is divided into trapezoids (T1) which represent the projection of imaginary trapezoids (T2) connecting the basement membranes of two adjacent sections. The area of these T2‐trapezoids may be calculated and is considered as representative for the epithelium‐connective tissue interface. Depending on the appearance of the T1 ‐trapezoids, a certain amount of discrepancy occurs between the calculated and actual area of the T2‐trapezoids. The significance of this is examined in thirty gingival specimens. It is concluded that without producing accurate values, the method offers the possibility to study quantitative differences in the epithelium‐connective tissue interface.
In vitro studies on the influence of cements on the alkaline effect of calcium hydroxide
Authors: TRONSTAD LEIF , BIRKELAND JAN MAGNE
Published: October 2007

abstract – The influence of different base materials on the alkaline effect of calcium hydroxide as well as the alkaline effect of calcium hydroxide‐containing materials (Dycal® and Hydra®) was measured in an in citro system meant to imitate a cavity with a pulp exposure. The base materials did not appear to have any appreciable influence on the alkaline effect of calcium hydroxide as tested in this study. Like pure calcium hydroxide, Dycal and Hydrex seemed to have a lasting alkaline effect, i. e. the same effect before and after hardening of the materials. The alkaline effect of these materials, however, was lower than that of pure calcium hydroxide.
Distribution in developing rat enamel of simultaneously injected fluoride and calcium
Authors: HAMMARSTRÖM LARS
Published: October 2007

abstract – Radioactive sodium fluoride (NaF18) and calcium chloride (Ca45Cl2) were injected simultaneously into rats, eight to ten days old. Thirty minutes after injection, the animals were killed by rapid freezing and sectioned sagittally through the level of the teeth. Both F18 and Ca45 were accumulated in the. superficial zone of the enamel in those areas where matrix was being formed. There was a marked increase in the concentration both of F18 and Ca45 in the surface of the enamel, where matrix formation was just completed. However, at maturation only Ca45 was accumulated in the whole thickness of the enamel, and no F18 was found in this area. The results may indicate an association between fluoride and the organic matrix of the developing enamel. The distribution of F18 in the enamel was similar to that of tetracycline shortly after injection.
A preliminary study of blood group substances A and B in oral epithelium exhibiting atypia
Authors: DABELSTEEN E. , FULLING H. J.
Published: October 2007

abstract – Blood group substances A and B were demonstrated in paraffin sections of 6 cases of oral normal epithelium and in 9 cases of atypical (dysplastic) epithelium by use of immunofluorescence and immunoperoxidase staining methods. In normal mucosa the blood group substances appeared on all cells above the basal cell layer. In atypical epithelium, the blood group substances were absent or had a patchy distribution. Correlation was found between the degree of atypia and the absence of blood group substances.
Separation of enzymes from 2‐day‐old dental plaque material
Authors: SÖDER PER‐ÖSTEN , NORD CARL‐ERIK , LINDER LARS
Published: October 2007

abstract – Two‐day‐old dental plaque material was collected from 10 subjects, pooled, homogenized, and centrifuged. Isoelectric focusing was carried out with the supernatant in an Ampholine column 8,100. Range for the carrier ampholytes was pH 4–6. The fractions were tested for gelatinase activity, leucine aminopeptidase activity, and lysozyme. The isoelectric point (pI) was determined for the enzymes found. The enzymes from the different pH ranges were separated on Sephadex G‐100 superfine and Ve/Vo for the enzymes determined.
A diffusion method for determination of lysozyme activity
Authors: MODÉER THOMAS , SÖDER PER‐ÖSTEN
Published: October 2007

abstract – An agar plate method has been developed for determination of lysosyme activity. Micrococcus lysodeikticus cell walls were used as substrate. The method was found suitable for determining the lysozyme activity in human saliva.
Transverse strength and surface hardness of water‐contaminated acrylic and composite resins
Authors: VÄLIAHO M.‐L. , FORSTEN L.
Published: October 2007

abstract – Five composites and one acrylic resin were investigated. The strength specimens were contaminated with water during mixing and the hardness specimens after condensation. The transverse strength was tested after 24 hours and the surface microhardness after 24 hours and after two months. Water contamination reduced the transverse strength of the acrylic resin by ∼ 50 % and that of three of the composites by 21–26 %. The decrease of the surface hardness caused by moisture contamination was ∼ 45 % for the acrylic resin and 28–57 % for four of the composites. The microhardness values obtained after two months did not differ significantly from the respective values obtained after 24 hours.
Potassium content of cariogenic streptococci influenced by pH, fluoride, molybdenum, and ethanol
Authors: LUOMA HEIKKI
Published: October 2007

abstract – The nongrowing K‐1 streptococci of human origin contained less potassium after incubation at pH 5.2 and 8.4 than at pH 5.8 or 6.8. Net accumulation of potassium occurred in the presence of sucrose, especially at pH 6.8. Penicillin and molybdenum did not modify the potassium accumulation. Fluoride (50 ppm or more) caused a decrease in the potassium content in both the fermenting and nonfermenting organisms at pH 5.8. One hundred ppm reduced the accumulation at higher pH levels also. A lower concentration (20 ppm) lessened the potassium accumulation in fermenting organisms. Ethanol (6%) reduced the accumulation of potassium at pH 5.2, 6.8, and 8.4 and caused a potassium loss in nonfermenting cells at pH 5.8. The cellular total phosphorus content was altered similarly to potassium when studied in a part of series performed but the changes were relatively smaller. The decreases of the cellular potassium and phosphorus content and accumulation were greatest in the presence of both ethanol and fluoride. The “pretreat‐ments” of the cells with both ethanol and fluoride decreased their acid production capability.
The presence of Candida in 723 oral leukoplakias among Indian villagers
Authors: DAFTARY D. K. , MEHTA F. S. , GUPTA P. C. , PINDBORG J. J.
Published: October 2007

abstract – Among 50,915 individuals from 4 different states of India, 723 oral leukoplakias were biopsied and examined for the presence of Candida. Histologic sections were stained by hernatoxylin‐eosin and PAS; 6.8% of the biopsies showed Candida estimated on the basis of a single PAS stained section. All Candida‐positive cases were seen in males. The most striking observation was that out of 325 palatal biopsies in reverse smokers only one Candida‐positive case was seen on the palate and none was seen on the labial mucosa out of 33 biopsies. It was surprising that although the number of leukoplakias among tobacco chewers was high, all of the Candida‐positive cases, except one, were observed among smokers. Seven (14%) of the 49 Candida‐positive biopsies showed epithelial atypia. No significant association between Candida‐positive cases and atypia was found.
Effect of fluoride on the amount of dental plaque in children
Authors: BIRKEIAND J. M.
Published: October 2007

abstract – Fluoride mouth rinses (0.2% NaF) reduced significantly the amount (dried weight) of removable dental plaque in children, 11–13 years old. Boys had significantly more plaque than girls. The mean weight of removed plaque was 2.2 mg.
The prevalence of dental caries, plaque and gingivitis in 3‐year‐old Danish children
Authors: POULSEN S. , MØLLER I. J.
Published: October 2007

abstract – The purpose of the present study was to obtain an estimate of the prevalence of dental diseases in 3‐year‐old Danish children in areas with various fluoride concentrations in the drinking water. 449 children from one high‐fluoride area (1.1–1.5 ppm F) and three low‐fluoride areas (0.05–0.50 ppm F) were examined. The recording procedure allowed differentiation between initial carious lesions (“white spot”) and carious lesions with clinically detectable cavitation. Mean deft and defs were significantly lower in the high‐fluoride area than in any of the low‐fluoride areas when initial carious lesions (“white spot” were included in the calculations of the results. When only carious lesions reaching the stage of cavitation were included in the calculations, mean deft and defs were identical in the high‐fluoride area and two of the low‐fluoride areas. The third low‐fluoride area had significantly higher mean deft and defs than the high‐fluoride area. Differences in mean deft and defs were related to a low prevalence of carious lesions on smooth surfaces in the high‐fluoride area and a high prevalence of occlusal lesions in one of the low‐fluoride areas. The prevalence of plaque and gingivitis was higher than that reported in earlier studies. Approximately 25% of all gingival units showed bleeding after slight probing. No statistically significant differences in plaque accumulation or in the occurrence and severity of gingivitis were observed between the four groups of children. No cases of endemic dental fluorosis were found.
Excision wounds in palatal epithelium in guinea pigs
Authors: FEJERSKOV O.
Published: October 2007

abstract – Standardized excision wounds were made in the palatal mucosa of 112 adult, male guinea pigs in order to study the reaction to injury of orthokeratinized epithelium. The wound area was studied histologically 4, 6, 12, 24, 48, 72, 96 and 120 h postoperatively. Four and 6 h after wounding, a triangular eosinophilic «reactive zone» was found in the stratum granulosum and the upper half of stratum spinosum along the wound margins. This cellular reaction was interpreted as an «induced keratinization». After 12 h the reactive zone was delineated from the adjacent, normal epithelial cells by 2–4 rows of hyperchromatic, flattened cells – the demarcation zone. In the reactive zone a hypertrophic cell reaction was observed. The initial epithelial cell migration started from the lowest cell layers in the stratum spinosum and stratum basale 12 h postoperatively. The migrating epithelium moved out fan‐shaped into the fibrin network under accumulations of granulocytes. The migrating cells showed few intercellular bridges, few tonofibril bundles, but many cytoplasmic granules and vacuoles. Both migrating cells and stratum spinosum cells along the wound margins exhibited erythro‐phagocytosis. After 24 h and onwards the apices of the epithelial ridges along the wound margins turned away from the wound area indicating a sliding of the epithelial mass. Seventy‐two hours postoperatively distinct changes were found in the stratum corneum up to 800–1000 microns from the wound. To the same extent stratum granulosum was replaced by a 10–12 cell layer wide demarcation zone. Ninety‐six and 120 h postoperatively the migrating epithelial lips had fused. The epithelium in the wound area showed no differentiated stratification. The superficial cell layers consisted of remains of the reactive and demarcation zones which contained numerous granulocytes. No PAS‐positive basement membrane was re‐forrned within the period studied. From the basal cell layers downward multifocal cell migration was observed. At no stage of healing was glycogen demonstrated in the epithelium.
Copper‐tin phases in dental silver amalgam alloy
Authors: JENSEN STIG JORGO
Published: October 2007

abstract – The ternary equilibrium silver‐copper‐tin diagram has been investigated in the region 25–30 weight‐% Sn, 0–4 weight‐% Cu using an X‐ray diffraction technique. Phase fields containing Cu3Sn (ɛ) and Cu6Sn5 (η′) were indicated. In addition, the phases formed during non‐equilibrium treatment have been determined.
Treatment of hypersensitive root surfaces by calcium hydroxide
Authors: JORKJEND LARS , TRONSTAD LEIF
Published: October 2007

abstract – Hypersensitive root surfaces which were exposed after periodontal surgery, were covered with a paste of calcium hydroxide and water for 4 to 7 d. The treatment had some effect on all cases, probably because of an increase in the mineral content of the exposed tissues.
A comparison of the effectiveness of the Charters', scrub, and roll methods of toothbrushing in removing plaque
Authors: FRANDSEN ASGER M. , BARBANO JOSEPH P. , SUOMI JOHN D. , GHANG JAQUELINE J. , HOUSTON ROBERT
Published: October 2007

abstract – The effectiveness of the Charters', scrub, and roll methods of toothbrushing in removing plaque was studied in 182 college students. At an initial screening examination, plaque was assessed using the gingival index. These plaque scores were used to divide the group into those with poor and those with good oral cleanliness. Within each of the two groups, the subjects were randomly assigned to a toothbrushing method and to one of three instructors. Then the participants had their teeth cleaned and were asked to abstain from toothbrushing for one week. After this period of plaque accumulation the participants were again scored for plaque. The test subjects were carefully instructed in the particular tooth‐brushing method they were to use and the controls were asked to resume their usual methods. One week later the participants were again examined for plaque. An interaction between toothbrushing method and instructor was found indicating that the effectiveness of a particular method depended in part on the instructor. Nevertheless, the Charters’and scrub methods of brushing appeared to be more effective in removing plaque. Generally, subjects with cleaner teeth prior to the stu achieved grater plaque reductions than those with initially poor oral cleanliness. All methods of bruching were relatively ineffective in removing proximal plaque.