bluuebunny/crossref_metadata_2025 huggingface dataset:
Posters. P12 Is there any role for routine cytology after chemoradiation for cervical cancer?
Authors: Singh N. , Taylor A. , Titmuss E. , Powell M. E. B
Published: September 2003

Aim  Cervical cytology is performed routinely as part of the follow‐up protocol following chemoradiation treatment for cervical cancer. This retrospective review assesses the impact cytology has on the management of patients.

Methods  Women treated with concurrent chemoradiotherapy for cervical cancer at St Bartholomew's hospital between April 1998 and December 2002 were identified. All cervical cytology results for these patients have been reviewed, and correlated with the site and timing of relapse.

Results  A total of 69 patients were treated: 58 (84%) had squamous cell carcinoma and 11 (16%) had adenocarcinoma. After median follow‐up of 16 months (4–53), 28 (40%) patients have relapsed. A total of 152 cytology results were available for 51 patients. 18 tests were reported as atypical and five suspicious of malignancy, but subsequent tests show no evidence of recurrence in these 13 (25%) patients. Seventeen patients have developed pelvic relapse. Of these, nine patients had cytology during follow‐up. One patient clinically had a vaginal mass confirmed as malignancy on cytology. The other eight patients had normal cytology within 6 months of clinical disease.

Conclusions  The pattern of relapse following radical chemoradiation is such that routine cervical and vaginal vault cytology has no indication in the absence of clinical suspicion of disease. The test has questionable sensitivity in this setting because there is a high incidence of false‐positive results that lead to unnecessary investigations. Cytology is valuable for detecting pre‐invasive and pre‐clinical disease, but neither role applies to this patient group.
Posters. P13 Cytohistological correlation in 212 FNAs of thyroid: analysis of discordant cases
Authors: Dina R.
Published: September 2003

Aim  To detect major pitafalls in thyroid FNA and to confirm its in a clinical sensitivity and specificity.

Methods  A total of 9251 fine needle aspirations biopsy carried out at Bellaria Hospital in Bologna from 1991 to 2000 by a pathologist in the FNA Clinic or by a clinician under ultrasonic guidance using a small needle (25–27 G); at least two passes have been made for each nodule. The specimen was considered satisfactory if at least five groups of follicular cells with at least 10 cells each, were seen. The cytological results were tiered in a four categories classification: inadequate, negative, suspicious and positive. Cyto‐histological correlations were available in 212 cases: 127 benign lesions and 85 malignant lesions.

An analysis of false positive cases and false negative cases was performed and discordant case reviewed according to the flowing criteria: architecture, cellularity, colloid, pseudoinclusions, nuclear groovings, chromatin pattern, nuclear membrane, cytoplasm, naked nuclei and lymphocytes.

Results  Diagnostic distribution in 9251 FNAs from the thyroid: 88.6% negatives, 2.8 suspicious, 2.4% positives and 6.2% inadequates. Specificity was 85.8% and sensitivity was 78.8%. Among the 18 false negative cases eight were papillary microcarcinomas, four papillary carcinomas, five follicular carcinoma and one a Hurtle cell carcinoma.

Four false positive cases were found: three reported as papillary carcinomas and one as carcinoma NOS. Review of false positives showed that in three cases the colloid was fluid, in three cases nuclear grooving was rare or absent, in two cases degenerative vacuoles at MGG were interpreted as nuclear inclusions and in three cases benign naked nuclei were present in the background. Review of false negatives confirmed lack of malignant features in 13 (eight papillary microcarcinomas and five follicular carcinomas), five were interpretation errors (three papillary carcinomas, one follicular, one Hurtle cell).

Conclusion  FNAC of the thyroid is a sensitive and specific method of assessment for thyroid nodules but false negative and false positive cases do occur. Use of all and only few criteria enhances diagnostic accuracy.
Mesothelioma Symposium  11.30–12.30 Tuesday 16 September 2003. Cytopathology of malignant mesothelioma
Authors: Whitaker Darrel
Published: September 2003

The diagnosis of malignant mesothelioma on the cytology of serous effusions is a two‐phase process. First is to determine that the effusion is malignant based on morphological features such as a highly cellular fluid with many large three dimensional cell aggregates, and/or the recognition of minor malignant criteria including prominent cell engulfment, uniformly present very prominent nucleoli, or the finding of very large (giant) cells. In cell block sections, strong positive staining with EMA often with cell membrane accentuation provides compelling support for a cytological diagnosis of malignancy. Second is to recognize that the malignant cells have a mesothelial phenotype and do not represent metastatic malignancy (usually adenocarcinoma). Criteria in support of mesothelioma include the lack of a ‘two cell’ population, that is one native (mesothelial) and one foreign (metastatic), cells with abundant dense staining cytoplasm, the presence of ‘windows’ where mesothelioma cells lie in close apposition and intracytoplasmic glycogen presenting either as small peripheral vacuoles on MGG stained smears or large yellow refractile crescents on Papanicolaou stained smears. In addition, mesothliomas often possess connective tissue stromal cores occurring as either well‐formed collagen within papillary aggregates or lying free as pink (MGG) or light green (Pap) amorphous material in the background of the smear or in loose association with mesothelioma cells. Finally small orange staining squamous‐like cells can occasionally be identified and sometimes this may be a very prominent finding and has resulted in the false impression of a squamous cell carcinoma. Almost certainly these cells represent apoptotic tumour cells. The connective tissue mucin hyaluronic acid may be found as a net‐like pattern in the smear background or as large hard‐edged magenta‐stained vacuoles on MGG‐stained smears. Cell block sections provide architectural information and it is usually possible to separate mesothelioma aggregates with their cuboidal cells, central nuclei and abundant dense cytoplasm arranged in solid, papillary or hollow clusters from those of adenocarcinoma with less dense, often foamy cytoplasm, often composed of columnar cells with elongated nuclei. Aggregate form in adenocarcinoma can be variable but true acini are a rare finding. These cell block sections provide an ideal medium for histochemistry (PAS with and without diastase digestion) and immunocytochemistry. By using a panel of antibodies (Calretinin and CK 5/6, BerEp4, CEA, B72.3) it is almost always possible to distinguish mesothelioma from metastatic adenocarcinoma. Calretinin and CK 5/6 positive staining and absent staining with BerEp4, CEA and B72.3 is considered diagnostic of mesothelioma.
Posters. P14 Adenocarcinoma of cervix a cyto‐histopathological correlation
Authors: Gupta Limci , Dina Roberto
Published: September 2003

Aim  The current study was undertaken to determine the sensitivity of cytology smears in the detection of cervical adenocarcinoma, to study the incidence of CIN lesions with adenocarcinoma and to estimate sampling, screening and diagnostic errors in this cohort of cytological smears.

Methods  Retrospective analysis of all cases of adenocarcinoma of cervix diagnosed in the histopathology department at Hammersmith hospital over the past 10 years (January 1993 till December 2002) either by biopsy or resection specimen. Initially 69 cases of adenocarcinoma of cervix were identified of which nine had several biopsies from the same patients and seven represented either local spread or metastasis. Thus 16 cases were excluded and thereby 53 cases met the criteria for inclusion.

Results  Fifty‐three adenocarcinomas were identified, either pure or combined with squamous lesions. The results showed the association of adenocarcinoma with CIN lesions to be 27.3% (one CIN1, three CIN2, 11 CIN3). Cervical smears were available for review in 25 cases.

Analysis of cervical smears

Total
Negative
Positive
Not done
Records not found

53
07
18
18
10

The sensitivity of cytology smears was 68% for all HGEA (High Grade Epithelial Abnormalities); 56% for all glandular lesions and 40% for pure adenocarcinomas. Upon review sampling error was calculated to be 4%; interpretation error was 4% and diagnostic error upon review 0%.

Conclusion  The current study provides an encouraging data regarding the sensitivity of Pap smears in detecting adenocarcinoma of cervix and shows a good cytopathological correlation.
Posters. P15 The presentation of papillary serous carcinoma of the endometrium in a cervical thinprep sample
Authors: Owen E. W. , Payne C. E. , Wallace A. , Sloan S. M.
Published: September 2003

Papillary serous carcinoma of the endometrium (PSCE) is a distinct but rare type of endometrial carcinoma. It has an aggressive nature and tumours with lympho‐vascular involvement are more likely to have extra‐uterine disease and poor prognosis.1 Post menopausal bleeding (PMB) is the most common presenting symptom. A liquid‐based cervical sample was received from a 77‐year‐old female with PMB. The sample was prepared using the ThinPrep technique. The specimen was heavily blood‐stained and the initial slide showed scattered, highly abnormal cell groups, which were difficult to assess. A glacial acetic acid wash was performed to optimize the preparation. The resultant slide showed numerous highly abnormal cell groups, with enlargement, pleomorphism and abnormal chromatin pattern and were frequently arranged in papillary clusters, many with prominent nucleoli and numerous bare nuclei with background necrosis. These characteristics are consistent with previous descriptions of the cytomorphology of PSCE in conventional cervical smears.2 The cervical biopsy and endometrial currettings showed the presence of high‐grade PSCE. Follow‐up peritoneal washings showed a few clusters of suspicious cell groups and the hysterectomy confirmed high‐grade PSCE with cervical involvement and positive left iliac lymph nodes, which is consistent with the aggressive pattern of the disease.
Posters. P16 Evaluation of user satisfaction questionnaire (cervical cytology service)
Authors: Marshall Janet
Published: September 2003

Introduction  A three‐part questionnaire was sent out to 429 clinics submitting smears to the cytology department to evaluate levels of satisfaction with the service provided. Part one dealt with areas including turnaround time, dealing with urgent requests, ease of telephone access for queries, attitude of staff and availability of smear taking equipment. Part two listed services that are currently available and users were asked to prioritize them in order of importance. Part three asked for developments or enhancements in the service that our users would like to see.

Results and discussion  A total of 429 questionnaires were issued and 62 were returned (response rate of 14.5%). At that time most clinics waited more than 6 weeks for reports to be returned (top priority for 95%). Over two‐thirds were happy/very happy with the response to urgent work and nearly 90% found it easy to access the department with 96% indicating that staff were very helpful or helpful. Twenty‐five per cent said smear‐taking equipment was not readily available and over 40% said they had problems obtaining extra supplies. The laboratory uses pre‐packaged kits that are sent directly from the manufacturer. Approximately, 95% requested a faster turnaround time for reports, followed by computer links between the laboratory and clinic (71.7%). Many users would like to have regular two‐way feedback between themselves and the laboratory (64.1%), more teaching/training courses (51.2%) and more information about the NHSCSP (48.7%). Other improvements and developments scored by the users include more readily available smear taking equipment, improved courier service, more visits to the laboratory and meetings between the laboratory and clinic. Other than those developments already listed, users would like: changes to the request form to record ‘cervix visualized’ and 360 ‘sweep taken’, a return to the provision of cytobrushes, return to the old‐style envelopes, changes to the report format, provision of standard letters to send to patients, change to LBC. The poor response rate suggests that overall, users are satisfied with the service.
Posters. P17 Accuracy of fine needle aspiration cytology in diagnosis of thyroid swellings
Authors: Mundasad B. , McAllister I. , Pyper P. C. , Carson J.
Published: September 2003

Introduction  Fine needle aspiration cytology is regarded as the gold standard investigation in diagnosis of thyroid swellings. Published data suggest an overall accuracy rate of 75%1 in the detection of thyroid malignancy. The aim of this study was to determine the accuracy of FNA cytology in detection of thyroid malignancy in our surgical unit.

Methods  Between 1989–2002, 144 patients who underwent thyroid resection by single consultant surgeon and who had pre‐operative FNA were enrolled in this retrospective study. The pre‐operative FNA results were compared with definitive histological diagnosis following thyroid resection. Fine needle aspiration cytology was performed using aspirate and non‐aspirate techniques on each thyroid swelling. The cytological sample was assessed by a single cytopathologist and was classified as inadequate, non‐neoplastic, neoplastic, suspicious or indeterminate. The histology was classified as non‐neoplastic (benign) and neoplastic (malignant).

Results  Fine needle aspiration cytology analysis revealed 94 (13.88%) non‐neoplastic, six (65.27%) neoplastic and 20 (4.16%) suspicious aspirates. Twenty (13.88%) samples were inadequate and four (2.77%) samples were indeterminate. Histological analysis showed 118 (81.94%) benign, 26 (18.05%) malignant specimens. Fine needle aspiration cytology had a sensitivity, specificity and accuracy rate of 52.6%, 86.6% and 79.1%, respectively for diagnosing thyroid malignancy.

Conclusion  The results are comparable with the current published data and demonstrate that FNA cytology in our hands is accurate investigation for pre‐operative diagnosis for the detection of thyroid malignancy.
Posters. P18 Ergonomic microscopes: can they reduce the risks of work‐related musculo‐skeletal disorders?
Authors: Gray Heather , MacMillan Fiona
Published: September 2003

Introduction  Microscopy work places a high level of musculo‐skeletal stress on the body of the user. Indeed, there are certain types of neck–shoulder disorders associated with microscope operation, especially during cytology work. This field study was carried out to investigate the differences in upper trapezius muscle activity, posture, pain and perceived exertion in cytologists while scanning cervical screening slides using both standard and ergonomic microscopes.

Method  The study employed a two‐period crossover experimental design. Thirteen cytologists (mean age 36.1 ± 8.8 years) from one acute NHS Trust consented to participate. Subjects screened eight slides with each microscope while four different measurements were taken: bilateral upper trapezius electromyography; posture, using a Rapid Upper Limb Assessment (RULA); pain, using a body part discomfort diagram and Visual Analogue Scale; and rating of perceived exertion (Borg CR‐10 RPE Scale).

Results  The results demonstrated that when operating the ergonomic microscope, there was significantly less upper trapezius activity for both the right (P = 0.015) and left (P = 0.000) shoulders, signifying reductions of 64% and 62%, respectively. However, there was not a statistically significant difference in postures adopted between the microscopes, using RULA (P = 0.173). Neither were there any statistically significant differences in neck (P = 0.084), upper back (P = 0.098) or lower back (P = 0.625) pain when using the ergonomic microscope, although, a statistically significant reduction in shoulder pain was reported (P = 0.043). Finally, the results revealed that the ergonomic microscope required significantly less perceived exertion to operate than the standard microscope (P = 0.009). An additional important finding was that screening took approximately 40 s less per slide using the ergonomic microscope.

Discussion  This study indicated that the ergonomic microscope was preferable to the standard microscope in terms of upper trapezius muscle activity, shoulder pain and perceived exertion. These findings have important implications for cytologists, of whom the majority are currently using standard microscopes, in terms of reducing potential risk factors for the development of work‐related musculo‐skeletal disorders. Furthermore, this evidence supports the ergonomic recommendations delineated in the National Health Services Cervical Screening Programme Standards (NHSCSP 1997).

Relevance to industry  Cytology laboratories should give close consideration to the types of microscopes purchased. Consideration should be given to adapting existing microscope workstations by providing microscopists with angle‐adjustable arm supports.
Posters. P19 Cervical carcinoma with metastases to the tympanic membrane: an unusual presentation
Authors: Doran J. R. , Kamel H. M. H
Published: September 2003

Cervical cytology is mainly part of the National Screening Programme. However, it is not uncommonly used as a diagnostic tool in patients with abnormal vaginal bleeding. We present a case of a middle‐aged female who had a normal screening history but defaulted on her last two smears. She subsequently complained of abnormal, vaginal bleeding. A cervical smear was taken and was reported as showing severe/?invasive squamous carcinoma. This was confirmed by histology. Shortly afterwards she presented with facial nerve palsy. In the course of the investigations, a biopsy was taken from the tympanic membrane and this showed involvement by metastatic squamous carcinoma. Although cervical cancer is recognized for its ability to metastasize to various organs, to our knowledge, this is the first case of reported cervical metastases to the tympanic membrane. This case highlights the importance of the screening programme in detecting cervical cancer, the use of cervical cytology as a diagnostic tool in pathology of the cervix and the ability of cervical cancer to metastasize to unusual anatomical sites.
Posters. P20 Fine needle aspiration of salivary glands in Beaumont Hospital: a 14‐year audit
Authors: Mulligan A. M. , O'Shea A. M. , Royston D.
Published: September 2003

Introduction  Fine needle aspiration (FNA) is a well‐established diagnostic technique which is frequently used to diagnose head and neck neoplasms. Clinical decisions concerning treatment of malignant salivary gland tumours, the extent of surgery and advisability of pre‐operative irradiation can be helped by prior knowledge of tumour type.

Aim The aim of this study was to do an audit of all salivary gland FNAs carried out in Beaumont Hospital over a 14‐year period.

Methods  All salivary gland FNAs between 1989 and 2002 were reviewed. Where available, the corresponding follow‐up histological specimens were studied.

Results  During this 14‐year period, 305 patients with salivary gland lesions had FNA of the lesion performed. The total number of aspirates performed was 343. Of these, 184 had histologies available for follow‐up. Eighty‐nine aspirates were reported as inadequate; 89 as inflammatory, normal or consistent with cyst contents. One hundred and thirteen aspirates were diagnosed as a benign entity. Thirty‐three aspirates were reported as malignant (21 of which were felt to be primary to the salivary gland and 12 metastatic). Sixteen cases were called suspicious. Good correlation between FNA findings and histology was seen in the majority of cases (145 of 183). Some diagnostic problem areas were identified. These included the following: lymphomas (seven called benign on FNA), Warthin's tumour (seven not diagnosed or misdiagnosed on FNA) and mucoepidermoid carcinoma (one reported as pleomorhic adenoma and one as benign/cystic on FNA). Seven pleomorphic adenomas were not diagnosed on FNA pre‐operatively, predominantly due to inadequacy of the specimen. Three other malignancies (acinic cell carcinoma, lymphoepithelial carcinoma and carcinoma ex‐pleomorphic adenoma), while not diagnosed on FNA, were called suspicious, with re‐biopsy advised.

Conclusion  FNA cytology of salivary glands is an accurate method for evaluation of both benign and malignant lesions, enabling optimum surgical and adjuvant therapy decision‐making pre‐operatively. Well‐defined problem areas are identified and, therefore, clinicopathological correlation is required in these cases.
Guest Lecture  9.00–9.45 Wednesday 17 September 2003. Molecular pathology – is it a mirage?
Authors: Hall Peter A.
Published: September 2003

The past decades have seen an explosion in our knowledge of the molecular events underpinning the pathogenesis of many disease processes. Furthermore, there have been enormous technical advances with the ability to identify, clone and sequence genes and to characterize their protein products now being common place in research settings. However, despite many claims as to the utility of molecular and biochemical methods in pathology only very few laboratories employ such methods in a clinical setting. Indeed the impact of molecular medicine has been more talked about than real. Why is this? The goal of this presentation is to address this question and present some perspectives on the future of Molecular Pathology. I shall overview, for the BSCC, the current state of the technology available for gene analysis and to explore the developments needed before the mirage of molecular pathology becomes a clinical reality.
Proffered papers  9.30–10.00 Monday 15 September 2003 1 British moderates or inconclusive Australians?
Authors: Knowles Simon , Linham Melanie , Harris Michael , Giles John
Published: September 2003

Both the original Bethesda system and the current UK classifications of cervical cytology have proved robust but each has a major weakness in the area of abnormalities of uncertain significance. Cytologists recognize that sometimes it is simply impossible to differentiate between reactive and dyskaryotic material. For this reason, the Australian version of the Bethesda system introduced a new category of ‘high grade inconclusive’ with a recommendation for referral to colposcopy. Approximately 60% of such cases are found to have high grade lesions at colposcopy (Schoolland M, Sterrett G, Knowles S et al.). The present UK system even with the proposed changes requires of the pathologist, a decision as to whether such cases are probably high grade (=a report of moderate dyskaryosis) or not (= a report of borderline). This continues to ignore the fact that sometimes you just cannot tell, even on review. We have taken a consecutive series of 50 referral smears, reported as moderate dyskaryosis, where the histological outcome (by loop cone) is known. These cases were rescreened and then reviewed blind by a pathologist with extensive experience of the Australian NH & MRC modified Bethesda system. On review, the material was reclassified along NH & MRC lines. The results were compared with the biopsy findings in order to determine whether the category of ‘inconclusive’ might be of value in the context of the NHSCSP.
Proffered papers  9.30–10.00 Monday 15 September 2003 2 Clinicopathologic significance of the ‘borderline nuclear change – high grade dyskaryosis not excluded’ report
Authors: Caroline Brodie , Ritu Kapur , Mary Murray , Derek Magee , Lesley Turner , David Gibbons
Published: September 2003

Introduction  Recent changes in terminology have recognized that cervical smears may contain cells with a high nuclear‐cytoplasmic ratio, suspicious for high grade dyskaryosis, which are not definitively diagnostic.

Aims  The correlation of cyopathological features present in a prospective series of cervical smears diagnosed as ‘borderline nuclear change – high grade dyskaryosis not excluded’ (BNCH) with clinical and histological follow‐up.

Methods  We have been using the BNCH diagnosis in our practice since June 1999. Cases of BNCH between June 1999 and June 2002 were retrieved from computerized laboratory records. Questionnaires were sent to referring clinicians regarding clinical follow‐up, including results of colposcopy, histology and follow‐up smears. Smears were reviewed for the presence of microbiopsies or single atypical cells. Numbers of atypical cells were quantified as less than/equal to or greater than 3.

Results  A total of 106 reports on conventional cervical smears diagnosed as BNCH from 1999 to 2002 were retrieved; they comprised of 0.098% of a total of 107 634 smears screened over that period. Clinical follow‐up, with histology (n = 54), colposcopy (n = 26) or repeat cytology (n = 10), was available in 88 of 106 cases. Thirty‐one (35%) showed a high grade abnormality (CIN2, CIN3 or invasive squamous or adenocarcinomas), 15 (17%) showed a borderline/low grade abnormality (repeat BNCH or CIN1) and 42 (48%) were negative. Eighty‐seven of these were reviewed cytologically (Table 1).

Microbiopsies
Single cells
Both
Total

High grade
6
18
7
31

BNC/low grade
3
8
4
15

Negative
6
31
4
41

Total
15
57
15
87

Conclusions  The BNCH category has a substantial yield of high grade abnormalities on follow‐up, which may be greater in cases where atypical cells are pre‐dominantly within microbiopsies. These findings support the introduction of the BNCH terminology.
Proffered Papers  10.30–11.15 Monday 15 September 2003 4 An audit of the positive predictive value of high‐grade dyskaryosis for CIN 2 or worse on histology
Authors: Wadehra V. , Johnson S. J.
Published: September 2003

The positive predictive value (PPV) of high‐grade dyskaryosis for CIN2 or worse on histology is published annually for the laboratories in the UK National Health Service Cervical Screening Programme (NHSCSP). The laboratories collect this data every year for a 3‐month period from April to June as part of the KC61 return. The laboratory PPV is expected to fall between 65% to 85% and provides an inter‐laboratory comparison figure for the specificity of the laboratory reporting. The PPV of individual consultants reporting the smears is monitored internally.

The RVI the PPV fell from 84.9% in 2000–2001 to 78.71% in 2001–2002. PPV for individual consultants showed a drop for four of the five consultants, including a fall from 91.6% to 77.94%. The reasons for the fall were investigated by pursuing data rechecking, accuracy of reporting, cyto‐histological correlation, histology and colposcopy factors and follow‐up cytology. The main cause of the fall lay outside the laboratory in the type of biopsy taken at colposcopy.

We conclude that the type of biopsy taken at colposcopy influences the PPV calculation. Informal discussions with others suggest comparison between laboratories is not reliable as departments vary in how the KC61 data is collected. As the type of data effects the correlation results, we conclude that caution must be exercised in inter‐laboratory comparisons until more standardization is introduced in histology data collection for PPV for the KC61. It is suggested that other laboratories view their PPV data with our findings in mind.
Simulated variations in atmospheric CO2 over a Wisconsin forest using a coupled ecosystem–atmosphere model
Authors: Scott Denning A. , Nicholls Melville , Prihodko Lara , Baker Ian , Vidale Pier‐Luigi , Davis Kenneth , Bakwin Peter
Published: August 2003

Ecosystem fluxes of energy, water, and CO2 result in spatial and temporal variations in atmospheric properties. In principle, these variations can be used to quantify the fluxes through inverse modelling of atmospheric transport, and can improve the understanding of processes and falsifiability of models. We investigated the influence of ecosystem fluxes on atmospheric CO2 in the vicinity of the WLEF‐TV tower in Wisconsin using an ecophysiological model (Simple Biosphere, SiB2) coupled to an atmospheric model (Regional Atmospheric Modelling System). Model parameters were specified from satellite imagery and soil texture data. In a companion paper, simulated fluxes in the immediate tower vicinity have been compared to eddy covariance fluxes measured at the tower, with meteorology specified from tower sensors. Results were encouraging with respect to the ability of the model to capture observed diurnal cycles of fluxes. Here, the effects of fluxes in the tower footprint were also investigated by coupling SiB2 to a high‐resolution atmospheric simulation, so that the model physiology could affect the meteorological environment. These experiments were successful in reproducing observed fluxes and concentration gradients during the day and at night, but revealed problems during transitions at sunrise and sunset that appear to be related to the canopy radiation parameterization in SiB2.
Simulated and observed fluxes of sensible and latent heat and CO2 at the WLEF‐TV tower using SiB2.5
Authors: Baker Ian , Denning A. Scott , Hanan Niall , Prihodko Lara , Uliasz Marek , Vidale Pier‐Luigi , Davis Kenneth , Bakwin Peter
Published: August 2003

Three years of meteorological data collected at the WLEF‐TV tower were used to drive a revised version of the Simple Biosphere (SiB 2.5) Model. Physiological properties and vegetation phenology were specified from satellite imagery. Simulated fluxes of heat, moisture, and carbon were compared to eddy covariance measurements taken onsite as a means of evaluating model performance on diurnal, synoptic, seasonal, and interannual time scales. The model was very successful in simulating variations of latent heat flux when compared to observations, slightly less so in the simulation of sensible heat flux. The model overestimated peak values of sensible heat flux on both monthly and diurnal scales. There was evidence that the differences between observed and simulated fluxes might be linked to wetlands near the WLEF tower, which were not present in the SiB simulation. The model overestimated the magnitude of the net ecosystem exchange of CO2 in both summer and winter. Mid‐day maximum assimilation was well represented by the model, but late afternoon simulations showed excessive carbon uptake due to misrepresentation of within‐canopy shading in the model. Interannual variability was not well simulated because only a single year of satellite imagery was used to parameterize the model.
Evaluation of root‐end cavity preparation using ultrasonic retrotips
Authors: Ishikawa H. , Sawada N. , Kobayashi C. , Suda H.
Published: September 2003

Aim  To evaluate and compare the efficiency of root‐end preparations using ultrasonic retrotips coated with diamond and zirconium nitride.

Methodology  Eighty‐five extracted single‐rooted teeth were root filled, and then resected 3 mm from their apices. Root‐end cavities were prepared with KiS (zirconium nitride‐coated retrotip), CT‐5 (stainless steel tip) or diamond‐coated (DC) ultrasonic retrotips, and 10 teeth served as controls. Thirty teeth were used for evaluation of the time required to prepare the root‐end cavity, the number of microcracks produced on the resected surface and the number of dentinal tubule openings on the root‐canal wall using scanning electron microscope (SEM) images. A further 55 teeth were used for evaluation of dye penetration following filling of the root‐end cavities with Super EBA. The degree of dye penetration in millimetres was measured under the microscope after 7 days of immersion in India ink. Statistical analyses were performed using the one‐way anova and Scheffe's F‐test as the post hoc test.

Results  There was no significant difference in the number of microcracks and dentinal tubule openings present in the root apices prepared by the three retrotips. The time required for root‐end cavity preparation using the DC retrotip was significantly less than that using the other groups (P < 0.01). Positive controls showed dye penetration throughout the length of the root‐end cavity, and negative controls showed no dye penetration. There was no significant difference between the three experimental groups in dye penetration.

Conclusions  In this laboratory study, the time required to prepare root‐end cavities using KiS retrotips was the same as that using CT‐5 retrotips, and longer than that using DC retrotips. There was no significant difference in the number of microcracks or dye penetration between the three kinds of retrotips.
Percentage of filled canal area in mandibular molars after conventional root‐canal instrumentation and after a noninstrumentation technique (NIT)
Authors: Ardila C. N. , Wu M‐K. , Wesselink P. R.
Published: September 2003

Aim  To compare the percentage of filled canal area in mandibular molar roots after using conventional root‐canal hand instrumentation or after a noninstrumentation technique (NIT).

Methodology  Forty mandibular molars were used shortly after extraction. The root canals of 20 molars in the manual group were conventionally prepared using hand instruments and then filled with warm vertical compaction of gutta‐percha. The 20 teeth in the second group were cleaned and obturated by NIT. In each case, the entire molar, including the crown and the roots, was embedded in an acrylic resin cylinder before NIT. Horizontal sections were cut at 2, 4, 6 and 8 mm from the apex. Images of the sections were taken using a microscope at ×40 magnification and a digital camera; the images were scanned as Tagged Image File Format (TIFF) images into a PC. The cross‐sectional area of the canal with the filling materials was measured using an image analysis programme. The percentage of filled area was calculated. The difference in the percentage of filled canal area between the two groups was analysed using a Student's t‐test.

Results  At all levels, 93–100% of the canal area was filled in both groups. No significant difference was found between the manual technique and the NIT technique at any level (P > 0.05).

Conclusions  Within the limitations of this study, following the cleaning and filling of root canals using NIT, the percentage of filled root canal was similar to that using warm vertical compaction of gutta‐percha after conventional root‐canal instrumentation.
Catalase activity in human healthy and inflamed dental pulps
Authors: Esposito P. , Varvara G. , Caputi S. , Perinetti G.
Published: September 2003

Aim  To examine the catalase activity in clinically healthy and symptomatic human dental pulps to verify if an active defence system against oxidizing agents is present as a response to bacterial invasion.

Methodology  Thirty‐three systemically healthy patients, 18 females and 15 males (ages: 11.0–25.9 years; mean 18.8 ± 3.6), were the source of the pulp tissue. The condition of the pulps was assessed using clinical and radiographic evaluations. The specimens were recovered by longitudinally grooving and splitting the teeth (if extracted) or during endodontic treatment, and were matched for age and sex between the healthy and inflamed specimen groups. Catalase activity was determined through spectrophotometric methods.

Results  Enzymatic activity was 1126 ± 343 and 3074 ± 698 mU mL−1 × mg of total protein in the healthy and inflamed pulp tissue specimens, respectively. This difference was statistically significant (P < 0.01).

Conclusions  These results indicate a role for catalase during dental pulp inflammation in humans, and may represent an inherent biological defence system against reactive oxidants of this tissue.
Evaluation of time required for recontamination of coronally sealed canals medicated with calcium hydroxide and chlorhexidine
Authors: Gomes B. P. F. A. , Sato E. , Ferraz C. C. R. , Teixeira F. B. , Zaia A. A. , Souza‐Filho F. J.
Published: September 2003

Aim  To determine in vitro the time required for recontamination of coronally sealed canals medicated with either calcium hydroxide (Ca(OH)2), 2% chlorhexidine gel (CG) or with a combination of both.

Methodology  Eighty intact, caries‐free, premolar teeth with straight roots and mature apices were selected for the study. After biomechanical preparation of 75 teeth, they were randomly divided into nine groups according to the intracanal medicament and the coronal seal with ‘Intermediate Restorative Material’ (IRM) as follows: (i) 10 teeth medicated with CG, coronally unsealed; (ii) 10 teeth medicated with Ca(OH)2, coronally unsealed; (iii) 10 teeth medicated with Ca(OH)2 + CG, coronally unsealed; (iv) 10 teeth medicated with CG + coronal seal; (v) 10 teeth medicated with Ca(OH)2 + coronal seal; (vi) 10 teeth medicated with CG + Ca(OH)2 + coronal seal; (vii) 10 teeth without intracanal medicament and coronally sealed; (viii) 5 teeth without intracanal medicament and coronally unsealed, used as the positive control group (PC); (ix) 5 teeth with intact crowns used as the negative control group (NC). Glass flasks were filled with Brain Heart Infusion broth (BHI), so that only the root apex was in contact with the broth, while the crown was immersed in human saliva + BHI (3 : 1). The flasks were then incubated at 37 °C in an atmosphere of 10% CO2, and microbial growth was checked daily.

Results  All specimens of the PC showed contamination within 1 day of incubation, while the NC showed no evidence of broth turbidity. Recontamination was detected after an average time of 3.7 days in the unsealed canals medicated with CG, 1.8 days in the group medicated with Ca(OH)2 and 2.6 days in the group medicated with Ca(OH)2 + CG. When the crowns were sealed with IRM, recontamination was detected within 13.5 days in the canals medicated with CG, after 17.2 days in the group medicated with Ca(OH)2 and after 11.9 days in the group medicated with CG + Ca(OH)2. The group with no medication, but sealed with IRM, showed recontamination after 8.7 days. There were statistically significant differences between the teeth with or without coronal seal (P < 0.05).

Conclusion  The coronal seal delayed but did not prevent leakage of microorganisms. There was no difference between the various medicaments.
A systematic review of in vivo retrograde obturation materials
Authors: Niederman R. , Theodosopoulou J. N.
Published: September 2003

Purpose  The aim of this study was to answer the question: For patients requiring apicoectomy (apicectomy/root‐end resection) and retrograde (root‐end) obturation (filling), which retrograde obturation (root‐end filling) material(s) is/are the most effective, as determined by reduction in periapical radiolucency and elimination of signs and symptoms?

Materials and methods  A MEDLINE and a Cochrane search (two specified searches) were conducted to identify randomised (RCT) and nonrandomised controlled clinical trials (CCT), cohort studies (CS) and case‐control studies (CCS), published between 1966 and 2002, October week 4, conducted on humans, and published in English, German and French language, relating to retrograde obturation materials following apicoectomy.

Results  The MEDLINE and the Cochrane search identified 324 and 21 published articles, respectively. The Cochrane search identified three additional articles to the MEDLINE‐search articles. Fourteen studies met the inclusion criteria: two were RCTs, six were CCTs, none was a CS and six were retrospective CCSs. Nine of the 14 studies compared a new retrograde (root‐end)‐filling material to amalgam, 4 of the 14 studies compared orthograde root canal fillings to retrograde (root‐end) amalgam and the fourteenth study compared variations of a resin composite (Retroplast) when used in combination with the bonding agent Gluma (Bayer AG, Gluma 1 and 2). The two RCTs indicated that glass ionomer cement appeared to be equivalent to amalgam. The six CCTs indicated that orthograde filling with gutta‐percha and sealer was more effective than amalgam retrograde (root‐end)‐filling (one trial). Similarly, retrograde (root‐end)‐filling with (i) composite and Gluma (Bayer AG, Leverkusen, Germany) as bonding agent (one trial), (ii) reinforced zinc oxide eugenol cement (EBA cement) (Stailine, Staident, Middlesex, England; one trial) and (iii) gold leaf (one trial) appeared to be better than amalgam retrograde (root‐end)‐filling. Finally, gutta‐percha retrograde (root‐end)‐filling appears to be less effective than amalgam (one trial) and Retroplast with ytterbium trifluoride is better than Retroplast with silver, when they are both used with Gluma as bonding agent (one trial).

Conclusions  For the highest level of evidence (RCT) retrograde (root‐end)‐filling with glass ionomer cement is almost as effective as amalgam. However, there was a significant caveat as there were only two RCTs. At the next highest level of evidence (CCT), and given the additional caveat that there was only one controlled trial for each material, retrograde (root‐end) EBA cement, composite with Gluma and gold leaf, as well as orthograde gutta‐percha, may be more effective than retrograde (root‐end) amalgam filling. In conclusion, these results suggest that additional validating CCTs and RCTs are needed.
Effect of apical root‐end filling materials on gingival fibroblasts
Authors: Pistorius A. , Willershausen B. , Marroquin B. Briseño
Published: September 2003

Aim  To determine the influence of root‐end filling materials on specific cellular responses of gingival fibroblasts (GF).

Methodology  The reactions of cells in contact with mineral trioxide aggregate (MTA), amalgam and a chemically inert titanium alloy were determined based on the assessment of prostaglandin (PGE2) release with and without arachidonic acid stimulation, protein and lactate synthesis, and cell proliferation. Cells cultured without test materials served as controls (100%).

Results  The fibroblasts showed a highly significant decrease in protein synthesis when in contact with amalgam (61.8 ± 13.6%); MTA (91.2 ± 5.9%) and titanium (92.4 ± 4.7%) had little effect on this parameter. The rate of cell proliferation in contact with MTA (98.0 ± 1.6%) and titanium (97.9 ± 7.4%) was only slightly influenced and showed similar values to that of the controls after 96 h of incubation. On the contrary, a significant and continuous reduction in the rate of cell proliferation was observed for cells in contact with amalgam (61.0 ± 2.5%) after 96 h. No significant increases in lactate synthesis values were registered for any of the materials (MTA 101.8 ± 1.7%, titanium 94.8 ± 8.6% and amalgam 105.8 ± 10.3%). There was a significant decrease in PGE2 synthesis potential when cells were in contact with amalgam (85.2 ± 3.5%). In comparison to the controls, titanium and MTA resulted in an elevated level of cellular PGE2 synthesis (titanium: 131.6 ± 19.1%; MTA: 147.3 ± 18.9%). The cell cultures stimulated with arachidonic acid (10−5 m) showed no significant differences with any material (MTA: 88.8 ± 17.6%, titanium: 97.6 ± 14.4%, amalgam: 85.5 ± 16.8%).

Conclusions  MTA demonstrated cellular responses similar to those of titanium. Amalgam showed an irritation rate higher than that of MTA and titanium.
The antimicrobial efficacy of ‘MGP’ gutta‐percha in vitro
Authors: Shur A. L. , Sedgley C. M. , Fenno J. C.
Published: September 2003

Aim  To determine whether ‘MGP’ gutta‐percha (Westport, CT, USA), a commercially available gutta‐percha containing iodoform, inhibits the growth of potential endodontic pathogens.

Methodology  Inocula of Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Streptococcus sanguis, Fusobacterium nucleatum and Actinomyces odontolyticus were spread onto the surface of agar plates. ‘MGP’ gutta‐percha cones presoaked in sterile water were transferred to the inoculated agar and incubated at 37 °C aerobically or anaerobically as required for optimal growth. Identical studies were performed using iodoform‐free gutta‐percha and sterile paper disks saturated with 10% povidone–iodine. Following incubation, zones of inhibition around the ‘MGP’ gutta‐percha, iodoform‐free gutta‐percha and disks were evaluated.

Results  Povidone–iodine inhibited all the strains. Iodoform‐free gutta‐percha inhibited S. sanguis and A. odontolyticus. ‘MGP’ gutta‐percha inhibited S. aureus, S. sanguis, A. odontolyticus and F. nucleatum. Neither iodoform‐free gutta‐percha nor ‘MGP’ gutta‐percha inhibited growth of E. faecalis, E. coli or P. aeruginosa.

Conclusions  Compared to iodoform‐free gutta‐percha, iodoform‐containing ‘MGP’ gutta‐percha had an inhibitory effect in vitro on S. aureus and F. nucleatum, but not on E. faecalis, E. coli or P. aeruginosa.
Acidity of conventional luting cements and their diffusion through bovine dentine
Authors: Hiraishi N. , Kitasako Y. , Nikaido T. , Foxton R. M. , Tagami J. , Nomura S.
Published: September 2003

Aim  To examine the changes in pH of luting cements and acid diffusion of luting cements through bovine dentine using a pH‐imaging microscope (SCHEM‐100; Horiba Ltd, Kyoto, Japan).

Methodology  The pH of the surface of three conventional luting cements, glass‐ionomer, zinc phosphate and zinc polycarboxylate was measured with SCHEM‐100 for 1 month. The acid diffusion from the three luting cements through bovine dentine was investigated by measuring pH changes during the application of each luting cement on the bovine dentine surface. Coronal bovine dentine disks were prepared to thicknesses of 0.50 and 0.25 mm. Each luting cement was placed on the labial dentine surface, and the pH change of the pulpal surface was observed every 3 min for 30 min with SCHEM‐100.

Results  Glass‐ionomer showed the lowest pH values for longer times. Neutralization proceeded furthest in zinc polycarboxylate. The 0.5‐mm‐thick dentine disks showed no pH change on the pulpal side with all the three cements. The 0.25‐mm‐thick disks revealed evidence of acid diffusion on the pulpal side of the cemented dentine and significantly lower pH when cemented with glass‐ionomer and zinc phosphate than with zinc polycarboxylates.

Conclusions  This study demonstrated that glass‐ionomer exhibited a lower setting pH than zinc phosphate and zinc polycarboxylate, and acid diffusions from glass‐ionomer and zinc phosphate cements were observed when placed on 0.25‐mm‐thick dentine disks.
A comparative study of selected physical properties of five root‐canal sealers
Authors: McMichen F. R. S. , Pearson G. , Rahbaran S. , Gulabivala K.
Published: September 2003

Aim  To investigate selected physical properties of five root‐canal sealers.

Methodology  The solubility, film thickness, flow, working and setting times of Roth 801®, Tubli‐Seal EWT®, AH Plus®, Apexit® and Endion® were evaluated. Solubility was measured by weight change of standard specimens in water over a 3‐month period. Film thickness was measured as the distance between weighted glass slides containing a standard quantity of sealer. Flow was assessed by rate of sealer extrusion through a standard bore diameter, after unit time. Working time was taken as the point at which flow rate was reduced by 10%. The indentation test using a modified Gilmore needle was employed to investigate the setting times.

Results  AH Plus® was the least soluble, whilst Apexit® was the most unstable in water. The solubility values in increasing order were: AH Plus® < Tubli‐Seal EWT® < Endion® < Apexit®. Also, AH Plus® had the highest film thickness. All sealers showed comparable flow rates. The working time varied from 50 min for Endion® to over 2 h for AH Plus® and Tubli‐Seal EWT®. The range of setting times recorded was from 70 min for Tubli‐Seal EWT® to 8 days for Roth 801®.

Conclusions 

AH Plus® showed the greatest stability in solution and Tubli‐Seal EWT® performed well, but Apexit® and Endion® had higher solubility values.

The film thickness values in increasing order were: Tubli‐Seal EWT® < Apexit® < Endion® = Roth 801® < AH Plus®.

The flow rates for all sealers were similar.

The working times for all sealers were greater than 50 min.

Roth 801® did not set when incubated in volumes sufficient to fill the test matrices.