bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroprotective Effects of Glycine for Therapy of Acute Ischaemic Stroke
Authors: Gusev E.I. , Skvortsova V.I. , Dambinova S.A. , Raevskiy K.S. , Alekseev A.A. , Bashkatova V.G. , Kovalenko A.V. , Kudrin V.S. , Yakovleva E.V.
Published: April 2003

The aim of this randomized, double-blind, placebo-controlled trial was to assess the safety and the efficacy of the pharmaceutic drug glycine in 200 patients with acute (<6 h) ischaemic stroke in the carotid artery territory. Fifty patients received placebo, 49 glycine 0.5 g/day, 51 glycine 1.0 g/day and 50 glycine 2.0 g/day for 5 days in each group. The efficacy of glycine was assessed by clinical analysis, by an enzyme-linked immunosorbent assay of levels of blood serum autoantibodies to NMDA-binding proteines, by detection of excitatory (glutamate, aspartate) and inhibitory (glycine, GABA) amino acid concentrations and lipid peroxidation products (TBARS) in CSF. The trial confirmed the safety profile of the glycine treatment. Slight sedation was observed in 9 patients (4.5%) as a side-effect. Other marked side-effects or adverse events were absent. The glycine treatment at the dose of 1.0–2.0 g/day was accompanied by a tendency to a decreased 30-day mortality (5.9% in 1.0 g/day glycine and 10% in 2.0 g/day glycine groups vs. 14% in the placebo and 14.3% in 0.5 g/day glycine groups), to an improved clinical outcome on the Orgogozo Stroke Scale (p < 0.01) and the Scandinavian Stroke Scale (p < 0.01) and to a favourable functional outcome on the Barthel index (p < 0.01 in 1.0 g/day glycine vs. placebo group in patients with no or mild disability). An early normalization of autoantibody titres to NMDA-binding proteins in serum was found (p < 0.01 vs. placebo), a reduction of glutamate and aspartate levels (p < 0.05 vs. placebo), an increase in GABA concentrations (p < 0.01 vs. placebo in severe stroke patients) and also a reduction of TBARS levels (p < 0.05 vs. placebo) in CSF by day 3. Thus, the trial suggests that sublingual application of 1.0–2.0 g/day glycine started within 6 h after the onset of acute ischaemic stroke in the carotid artery territory is safe and can exert favourable clinical effects. These results will be verified in further trials with a larger number of patients.
Measurement of Cerebral Circulation Time by Contrast-Enhanced Doppler Sonography
Authors: Hoffmann Olaf , Weih Markus , Schreiber Stephan , Einhäupl Karl Max , Valdueza José Manuel
Published: April 2003

We present a new, non-invasive ultrasound method for the measurement of cerebral circulation time. After injection of a galactose-based echo-contrast agent (Levovist) into an antecubital vein, cerebral circulation time is measured as the interval between the beginning of a stable signal enhancement of at least 5 dB in the internal carotid artery and in the ipsilateral internal jugular vein. Both vessels are insonated simultaneously at the mandibular angle using a single 2-MHz range-gated transducer. For this study, 25 healthy volunteers ranging in age from 23 to 55 years (30.1 ± 7.5 years; mean ± SD) were examined. Cerebral circulation time was 5.6 ± 1.7 s without significant side-to-side or sex-related differences. Measurement of circulation times offers a new possibility for the employment of echo-contrast agents in functional ultrasound.
Design of ESPRIT: An International Randomized Trial for Secondary Prevention after Non-Disabling Cerebral Ischaemia of Arterial Origin
Authors: De Schryver E.L.L.M.
Published: April 2003

The ESPRIT trial addresses the problem that aspirin, the standard therapy for secondary prevention of vascular complications after a transient ischaemic attack (TIA) or ischaemic stroke of arterial origin, reduces the risk of serious vascular events by only about 13%. Anticoagulants may be an alternative, as these have proved highly efficacious in trials after myocardial infarction and after cerebral ischaemia with atrial fibrillation. After cerebral ischaemia of presumed arterial origin, high-intensity anticoagulation (INR 3.0–4.5) is not safe, but the value of anticoagulation with an INR between 2.0 and 3.0 is still unknown. Secondly, a recent, large trial showed that the combination of aspirin and dipyridamole prevents more major vascular events than aspirin alone, but several earlier trials did not find such an advantage. In ESPRIT, patients with a TIA or minor ischaemic stroke (Rankin grade ≤3) will be randomized between oral anticoagulation (INR 2.0–3.0), the combination of dipyridamole (400 mg daily) plus aspirin (in any dose between 30 and 325 mg daily) and aspirin only. Primary outcome is the composite event ‘death from all vascular causes, non-fatal stroke, non-fatal myocardial infarction or major bleeding complication’, whichever occurs first. Outcome assessment will be blinded. The recruitment of a total of 4,500 patients from more than 10 countries is planned; the mean follow-up will be 3 years.
Effect of Nimodipine on Final Infarct Volume after Acute Ischemic Stroke
Authors: Fogelholm Rainer , Erilä Terttu , Palomäki Heikki , Murros Kari , Kaste Markku
Published: April 2003

Placebo-controlled clinical trials with nimodipine in acute ischemic stroke have not fulfilled the early optimistic expectations. Nimodipine has in some experimental studies, when administered either before or up to 90 min after induction of cerebral ischemia, resulted in a reduction of infarct size. No studies on the effects of nimodipine on infarct size in man have been published. We measured the infarct volumes in the admission and control CT examinations 3 weeks to 3 months later in 153 patients who had participated in a multicenter, randomized and placebo-controlled study. No statistically significant differences overall were found within or between the treatment groups. Subgroup analyses revealed in the placebo, but not in the nimodipine arm, an increase in the median infarct volumes if the treatment was started within 24 h of onset, and if the volume in the admission CT was less than median. A beneficial effect of nimodipine in prevention of infarct size increase in these circumstances cannot be excluded.
Acute Bilateral Arm Paresis
Authors: Stapf Christian , Mohr Jay P. , Straschill Max , Mast Henning , Marx Peter
Published: April 2003

Objective: To study pure motor bilateral arm paresis of acute onset. This syndrome is as yet a barely described clinical feature attributed to ischemia in the territory of the anterior spinal artery (ASA). Cases: We present 2 patients with acute onset of pure motor deficit in both upper extremities. Results: Magnetic resonance imaging of the cervical spinal cord revealed infarcts in the territory of the ASA. In 1 case, electrophysiology further suggested discrete gray matter involvement. Conclusion: In patients with acute weakness of both arms without further neurological deficits, an incomplete ASA syndrome should be considered with the anterior horns predominantly being affected. Magnetic resonance imaging and electrophysiology are valuable tools to further confirm both location and extension of the spinal lesion.
Relationship between Cerebral Blood Flow and Clinical Outcome in Acute Stroke
Authors: Rubin Giorgio , Firlik Andrew D. , Levy Elad I. , Pindzola Ronda R. , Yonas Howard
Published: April 2003

Objective: The purpose of this study was to determine the relationship between cerebral blood flow (CBF) measurements in acute stroke and early clinical outcome. Material and Methods: The xenon-enhanced computed tomography (XeCT) CBF studies performed in 50 patients in the acute stage (within 8 h) of a hemispheric stroke were retrospectively analyzed. The mean CBF of the symptomatic vascular territory was compared to the corresponding territory in the contralateral hemisphere. Clinical assessment on admission and discharge was performed using the National Institutes of Health stroke scale (NIHSS). Results: Three groups were defined according to the degree of CBF asymmetry between the symptomatic and the contralateral asymptomatic vascular region. The CBF asymmetry was mild in group A (≤20%), moderate in group B (>20% and <60%) and severe in group C (≥60%). Patients in group A (n = 18) had a good outcome with a mean NIHSS score of 2 ± 2 at discharge. In group B, the patients (n = 22) had intermediate but variable outcomes: 2 patients died and the mean NIHSS score for the survivors was variable (mean NIHSS score: 9 ± 6). The patients in group C (n = 10) had a very poor outcome: 4 patients died and the survivors had a mean NIHSS score of 15 ± 1. Conclusions: Quantitative XeCT CBF measurements may be useful for selecting subgroups of stroke patients with different clinical outcomes. The possibility of predicting patient prognosis as early as in the first hours after the ischemic event may help to identify the appropriate target population that will benefit from aggressive stroke therapy.
Hospital Costs for Stroke Care in Singapore
Authors: Venketasubramanian N. , Yin A.
Published: April 2003

We performed this prospective study to determine the cost of care for acute stroke patients admitted to hospital. Stroke was subtyped into subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), nonlacunar infarct (NLC), lacunar infarct (LAC) and transient ischemic attack (TIA). Cost of care was computed for the various services the patient received. At the time of the study, US$ 1 = S$1.50. 426 patients were studied. Mean length of stay (LOS) was 17 days. Mean cost/discharge was S$7,547. Ward charges accounted for 38.2%, radiology 14.5%, doctors’ fees 10.3%, drugs 8.4%, therapy 7.3%. Cost was highly correlated with LOS, r2 = 0.73. Mean cost/discharge was SAH S$28,539, IPH S$14,398, NLC S$7,476, LAC S$3,517, TIA S$1,962. Initial hospitalization cost for stroke is highly correlated with LOS. The bulk of cost is attributable to ward stay. Cost/discharge is highest with SAH, and in descending order IPH, NLC, LAC, TIA.
Tonic Downward and Inward Ocular Deviation Ipsilateral to Pontine Tegmental Hemorrhage
Authors: Pullicino Patrick M. , Wong Edward H.
Published: April 2003

A 61-year-old man presented with coma and left hemiparesis. He was found to have tonic downward and inward deviation of the right eye, and a right lateral gaze palsy. He also had occasional downward bobbing movements of the right eye, and a partial bilateral upgaze paresis. CT showed a right pontine tegmental hemorrhage extending to the ipsilateral midbrain. Tonic ocular downward and inward deviation associated with pontine tegmental hemorrhage may be due to irritation of mesencephalic downgaze and convergence centers by rostral extension of the hematoma. Although ‘eyes seeming to peer at the tip of the nose’ is characteristic of thalamic hemorrhage, it may also be seen secondary to pontine tegmental hemorrhage.
Epileptic Seizures Attributed to Cerebral Hyperperfusion after Percutaneous Transluminal Angioplasty and Stenting of the Internal Carotid Artery
Authors: Wah Ho David Sai , Wang Yan , Chui Michele , Ho Shu Leong , Fai Cheung Raymond Tak
Published: April 2003

Cerebral hyperperfusion syndrome as a complication of carotid endarterectomy (CEA) has been widely reported in the surgical literature. It may occur within hours to 3 weeks after CEA and is characterized by symptoms ranging from headaches, fits, confusion, focal neurological signs to intracerebral hemorrhage. Although percutaneous transluminal angioplasty (PTA) and stenting are increasingly performed as an alternative to CEA in the treatment of carotid artery stenosis, few cases of cerebral hyperperfusion injury following carotid stenting have been reported. We describe 2 cases of cerebral hyperperfusion syndrome following PTA and stenting for high-grade internal carotid artery (ICA) stenosis. Both cases involved a lesion of 95% in severity. The first case was a 73-year-old man who developed generalized convulsion 7 h following stenting to the left ICA. The second case was an 80-year-old woman who developed recurrent right periorbital headache and confusion 16 h after stenting to the right ICA, followed by left upper limb seizure 14 days later. Both patients fully recovered without any intracerebral hemorrhage or infarction. To our knowledge, this is the first report of cerebral hyperperfusion injury after carotid stenting without associated intracranial hemorrhage and with full recovery. In the patient with neurological symptoms following carotid stenting, it is important to consider cerebral hyperperfusion syndrome as a differential diagnosis to embolic or hemorrhagic stroke since early recognition and meticulous control of blood pressure may prevent progression to cerebral hemorrhage and death.
Chronological Changes in Cerebral Air Embolism That Occurred during Continuous Drainage of Infected Lung Bullae
Authors: Takizawa S. , Tokuoka K. , Ohnuki Y. , Akiyama K. , Kobayashi N. , Shinohara Y.
Published: April 2003

We present a 43-year-old man with cerebral air embolism that occurred during continuous drainage of infected lung bullae. This complication is extremely rare, and may have been caused by the passage of air into the pulmonary venous circulation through a bronchovenous fistula and/or damaged pulmonary vessels. Air densities were demonstrated along the right frontal gyri on a CT performed 1 h after the onset of embolism, then moved to the deep cortex after 2.5 h. Three days later, a cortical infarct accompanied with extensive white matter edema in the right frontal lobe was confirmed by MRI. These CT and MRI findings may indicate the passage of intravascular air from the superficial to the deep cortex and subsequent cerebral infarction.
Aphasia, Depression, and Non-Verbal Cognitive Impairment in Ischaemic Stroke
Authors: Kauhanen M.-L. , Korpelainen J.T. , Hiltunen P. , Määttä R. , Mononen H. , Brusin E. , Sotaniemi K.A. , Myllylä V.V.
Published: April 2003

Aphasia, depression, and cognitive dysfunction are common consequences of stroke, but knowledge of their interrelationship is limited. This 1-year prospective study was designed to evaluate prevalence and course of post-stroke aphasia and to study its psychiatric, neurological, and cognitive correlates. We studied a series of 106 consecutive patients (46 women and 60 men, mean age 65.8 years) with first-ever ischaemic brain infarction. The patients were clinically examined, and presence and type of aphasia were evaluated during the 1st week after stroke and 3 and 12 months later. Psychiatric and neuropsychological evaluations were performed 3 and 12 months after stroke. Aphasia was diagnosed in 34% of the patients during the acute phase, and two thirds of them remained so 12 months later. Seventy percent of the aphasic patients fulfilled the DSM-III-R criteria of depression 3 months and 62% 12 months after stroke. The prevalence of major depression increased from 11 to 33% during the 12-month follow-up period. The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia. One third of the patients with ischaemic stroke suffer from communicative disorders which seem to increase the risk of depression and non-verbal cognitive deficits. Although the prevalence of depression in aphasic patients decreases in the long term, the proportion of patients suffering from major depression seems to increase. We emphasize the importance of the multidimensional evaluation of aphasic stroke patients.
Extracranial Aneurysms of the Posterior Inferior Cerebellar Artery
Authors: Abrahams John M. , Arle Jeffrey E. , Hurst Robert W. , Flamm Eugene S.
Published: April 2003

Objective: Extracranial aneurysms of the distal posterior inferior cerebellar artery (PICA) are extremely rare and sometimes difficult to diagnose without an adequate angiogram. We present the first series of 3 patients who were evaluated by the senior author and treated surgically. Methods and Results: All 3 patients presented with subarachnoid hemorrhage (SAH). Clincial symptoms, included occipital headache, nuchal rigidity, abducens nerve palsy and rapid neurologic deterioration. A unilateral injection of the vertebral artery failed to show the distal contralateral PICA and the aneurysm in 1 patient. All patients underwent aneurysm clipping through a posterior fossa craniectomy and C-1 laminectomy. The aneurysms were located on the tonsillomedullary segment of the PICA, 10–12 mm below the level of the foramen magnum. Conclusions: It is important to adequately visualize the distal extent of both PICAs or these aneurysms may not be seen. Patients who present with SAH must have the entirety of both vertebral arteries evaluated to avoid missing these aneurysms. The aneurysms were located adjacent to the atlas necessitating an upper cervical laminectomy for adequate surgical exposure. In general, the patients did well postoperatively and none of the patients developed cerebral vasospasm.
Explorative Study of Costs, Effects and Savings of Screening for Female Fragile X Premutation and Full Mutation Carriers in the General Population
Authors: Wildhagen Mark F. , van Os Theo A.M. , Polder Johan J. , ten Kate Leo P. , Habbema J. Dik F.
Published: April 2003

Objective: Evaluation of the costs, effects and savings of three strategies for female fragile X premutation and full mutation carrier screening in the general population. Methods: We calculated the costs, effects and savings by using a general model for prenatal, preconceptional, and school carrier screening. Assumptions were based on literature data, expert opinions, prices and tariffs. Results: Prenatal screening will detect most carriers and will lead to the highest number of avoided fragile X syndrome patients. The costs per detected carrier are quite similar for all screening programmes (around USD 45,000). All screening strategies have a favourable cost-savings balance (USD 14 million for prenatal screening, USD 9 million for preconceptional screening and USD 2 million for school screening). Conclusions: From an economic point of view, there is no obstacle to fragile X screening. The decision to screen or not can (and should) therefore concentrate on discussion of medical, social, psychological and ethical considerations.
The UK’s Policy on Genetic Testing Services Supplied Direct to the Public – Two Spheres and Two Tiers
Authors: Holtzman Neil A.
Published: April 2003

In the guidance to its ‘Code of Practice on Human Genetic Testing Services Supplied Direct to the Public’, the United Kingdom’s Advisory Committee on Genetic Testing allows the public to obtain carrier testing for inherited recessive disorders direct from suppliers, including commercial laboratories. For other types of genetic testing, involvement of a medical practitioner is needed. Thus the Committee creates two spheres of genetic testing, the first for which it maintains that there are ‘no significant direct health implications for the customer’ and the second for which there are. This is an unwarranted distinction. By permitting people who can afford to pay for the test the opportunity to obtain it direct from the supplier, the Code contributes to two tiers of access to carrier testing. The first tier is available to those who can afford the supplier’s price. Everyone else falls into the second tier, being able to obtain the test only through the National Health Service (NHS). At present, the NHS covers carrier testing for relatives of patients with cystic fibrosis, not for the general public. In this situation, a two-tier system could widen disparities in health between rich and poor.
A Commentary on the NIH Consensus Development Statement ‘Genetic Testing for Cystic Fibrosis’
Authors: Schmidtke Jörg
Published: April 2003

A NIH Consensus Development Statement recommends implementation of a cystic fibrosis carrier screening in the general pregnant and pre-pregnant population. This suggestion is discussed in the light of missing or insufficient data about the reasons for high uptake rates in pilot projects, psychological and social risks, and optimal educational and counselling settings. It is concluded that the recommendation is not defendable and, at best, premature.
Reprogenetics Policy:Three Kinds of Models
Authors: Nordgren Anders
Published: April 2003

In any discussion about genetics and the future of society, a distinction must be made between two different questions: (1) How will genetics affect society, in the short run and in the long run? (2) How should genetics be allowed to affect society? The first question is a matter of anticipation, the second a matter of choice. In the present paper, the primary focus is on the second question. The aim is to discuss from an ethical perspective which applications of genetics we should try to realize in society and which we should try to avoid. Special attention is given to the role of governments in reproduction. Three different kinds of models for governmental policy concerning application of genetics to reproduction (‘reprogenetics’) are presented: (1) governmental steering of reproduction; (2) radical reproductive autonomy, and (3) reproductive autonomy with certain restrictions. It is argued that a disease-centered version of the third kind of model is to be preferred. Genetic intervention concerning nondisease traits should be discouraged by governments.
Study of 224 Cases of Oligohydramnios and Congenital Malformations in a Series of 225,669 Consecutive Births
Authors: Stoll C. , Alembik Y. , Roth M.P. , Dott B.
Published: April 2003

Objectives: To provide data on oligohydramnios associated with congenital anomalies in 225,669 consecutive pregnancies. Material and Methods: The malformations in this study came from births of known outcome recorded in our registry of congenital malformations. Routine ultrasonographic examination was performed. Diagnosis of oligohydramnios was made ultrasonographically. For each case, a control was chosen. Results: The prevalence of this association was 0.99 per thousand (224 cases). A case-control study allowed the examination of genetic and environmental factors for the origin of oligohydramnios associated with congenital malformations. Diagnosis of oligohydramnios associated with congenital malformations was made prenatally in 32.6% of the cases; 12.0% of the infants were stillborn. Fifty-nine percent of the cases had more than one malformation, 13.8% had a chromosomal aberration, and 27.6% had multiple malformations that do not constitute a syndrome. The more frequent malformations associated with oligohydramnios were urinary, musculoskeletal, digestive and cardiac. There was increased parental consanguinity. The frequency of oligohydramnios and congenital anomalies among first-degree relatives was 4.5% and first-degree relatives had more malformations than controls (8.0 vs. 3.1%, p < 0.05). Threatened abortions and diabetes mellitus were significantly more frequent among mothers of the children with congenital malformations associated with oligohydramnios than among the controls. Conclusions: Our study demonstrated that careful fetal examination has to be performed when oligohydramnios is diagnosed as congenital malformations are often associated with oligohydramnios. We recommend the use of fetal chromosome analysis and careful ultrasonographic examination in every pregnancy complicated by oligohydramnios.
Lack of Hispanics’ Involvement in Research – Is It Hispanics or Scientists?
Authors: Durán DeborahGuadalupe
Published: April 2003

The limited involvement of Hispanics in medical research programs, such as genetic studies, and their significant under-representation among scientists may contribute to racial and ethnic gaps in health, and retard scientific advancements. To initiate change, it may be necessary to understand ways scientists and Hispanics contribute to a dynamic that results in Hispanic lack of involvement in scientific research. Examining this situation may facilitate scientists exploring their own cultural and scientific presumptions, as well as inspiring changes that would facilitate Hispanic involvement in sciences.
Carrier Testing Program in a High-Risk Cystic Fibrosis Population from Northeastern Italy
Authors: Borgo Graziella , Castellani Carlo , Bonizzato Alberto , Rolfini Rossella , Altieri Sara , Zanolla Luisa , Mastella Gianni
Published: April 2003

Objective: To assess the practicability and monitor the results of an active carrier testing program among relatives of cystic fibrosis (CF) patients. Methods: Parents of CF patients in the Veneto and Trentino regions of northeastern Italy were asked to help recruit relatives aged between 18 and 45 years for CF mutation testing. Results: Of 409 enrolled CF parents, 59.6% agreed to send to the CF Center family composition data of relatives up to the third degree, and 28.8% recruited relatives to carrier testing, providing names and adresses of those who, being contacted, expressed a willingness to be tested. The participation of parents was higher if they were young and had a child recently diagnosed with CF. Recruiting parents indicated 333 close relatives (59%) for testing. When contacted by the CF Center, 170 of these 333 (51%) attended for testing. The percentage of close relatives who spontaneously asked for the test was 5.4% before the carrier testing program started; it rose to 25.3% following the introduction of the active strategy. Conclusions: The participation of the parents of CF patients is an important factor affecting the utilization of testing by relatives. Besides this, the influence of a favorable medical and cultural context (participation of gynecologists and family doctors in testing programs, genetic education of the general population) has to be considered.
Maternal Serum Screening for Down Syndrome: A Survey of Pregnant Women’s Views
Authors: Paravić Jadranka , Brajenović-Milić Bojana , Tišlarić Dubravka , Kapović Miljenko , Botica And-elko , Jurcan Vlatka , Milotti Sanja
Published: April 2003

Objectives: This study was undertaken to assess women’s self-reported awareness of Down syndrome before they became pregnant and after they were supposedly informed about screening. We investigated their understanding of the purpose of screening and what a high statistical risk for Down syndrome means, and if there was a high statistical risk whether they would undergo amniocentesis. Methods: Pregnant women (n = 274) ranging from 17 to 43 years of age, with different educational backgrounds, were surveyed by means of a questionnaire which was given to them immediately before blood samples were taken. Results: Women without a college education were significantly less likely than those with a college education to be aware of Down syndrome prior to pregnancy. Many of them reported being unaware of it even after they had been counseled and tested. Women with a lower level of education were also significantly less likely to have a clear understanding of purpose of screening. Fewer than 0.7% of women who were tested said they were not prepared to undergo amniocentesis, and 47.1% said they would consider amniocentesis only after receiving the screening test result. Conclusion: Procedures for educating women prior to maternal screening must be improved.
Prevalence of Pedigrees Suggestive of Hereditary Nonpolyposis Colorectal Cancer among a Community Sample of Women Eligible for Screening Mammography
Authors: Ramsey Scott D. , Freedman Andrew N. , Berry Kristin , Andersen M. Robyn , Urban Nicole
Published: April 2003

Objective: To determine from a large cohort of women eligible for screening mammography, the number who would meet criteria for genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC). Methods: Detailed personal and family cancer histories, obtained from 6,682 women aged 50–80 years randomly selected from communities in Washington State, were matched to the Amsterdam criteria, Bethesda guidelines, and Japanese criteria for HNPCC. Results: One (0.015%) respondent met the Amsterdam criteria, 2 (0.035%) met the Japanese criteria and 5 (0.075%) met the Bethesda guidelines. Conclusion: Using the time of presentation for initial mammography as an opportunity to screen for HNPCC would detect very few families at high risk for this condition.
Living with Machado-Joseph Disease in a Small Rural Community of the Tagus Valley
Authors: Paúl Constança , Martín Ignacio , do Rosário Silva Maria , Silva Mário , Coutinho Paula , Sequeiros Jorge
Published: April 2003

Objectives: In the context of our national program of predictive testing for Machado-Joseph disease (MJD), we have studied in a small rural community (1) discourses about the illness by individuals at risk and patients, and (2) how individuals at risk and patients plan to cope with the familial illness. Methods: We used qualitative methods, beginning with a group interview of individuals at risk, and followed by in-depth interviews (about 1 hour long) of at-risk and affected individuals, in their homes. The latter interviews were subjected to a content analysis. Results: The coexistence of two contradictory discourses about MJD (a scientific and a folk one) was found consistently among all individuals. The main metaphor was that of the ‘drunkard’. Knowledge about a precise diagnosis of their disease produced relief and hope, because it provided evidence that affected individuals were not drunkards. Conclusions: The understanding of beliefs about the disease and its social representation is essential in planning effective genetic and psychological counseling.
Utilization of Amniocentesis by Women Screening Positive for Down Syndrome on the Second-Trimester Triple Test
Authors: Chen Jieling , Heffley Dennis , Beazoglou Tryfon , Benn Peter A.
Published: April 2003

Objective: Second-trimester maternal serum screening for Down syndrome has become widely accepted in the United States. However, many women with screen-positive results forgo definitive diagnostic testing that involves chromosomal analysis of amniotic fluid cells. We have reviewed 2,879 cases of women with screen-positive results in an effort to identify determining factors for the utilization of amniocentesis. Methods and Results: The lowest rate of utilization of amniocentesis was seen among very young women, with peak utilization among women of age 33. Although all women in the study had screen-positive results, amniocentesis was most likely to be performed when the patient-specific risk for an affected pregnancy was high. Black or Hispanic women were less likely to receive amniocentesis than white or Asian women. Amniocentesis utilization was also negatively associated with gestational age, maternal weight and an ultrasound examination prior to screening. A sharp decline in the utilization of amniocentesis was noted between 1993 and 1998. A logistic regression model was estimated to assess the independent effect of the variables. The model predicted 67% of the observed amniocenteses and had 66.6% concordance in the evaluation of paired cases with different response values. Conclusions: Our observations indicate that there are multiple medical, social and demographic factors that influence the utilization of amniocentesis by women with screen-positive results. Early screening and a prompt response to screen-positive results, together with accessible and appropriate genetic counseling, should assist women in making an informed choice.
Salivary Findings, Daily Medication and Root Caries in the Old Elderly
Authors: Närhi T.O. , Vehkalahti M.M. , Siukosaari Päivi , Ainamo A.
Published: April 2003

Root caries is one of the main dental problems among the dentate old elderly. The aim of our study was to evaluate the occurrence of root caries in 196 dentate elderly (mean age 79.3) in relation to their salivary flow rate, buffering capacity and salivary microbial counts. These subjects participated in the oral health component of the Helsinki Aging Study in 1990–1991. Clinical oral examinations included assessment of the state of root surfaces and salivary flow rates, both paraffin-wax-stimulated and unstimulated. Salivary buffering capacity and the growth of salivary mutans streptococci, lactobacilli and yeasts were determined by means of commercially available kits. Root caries occurred in 52% of men and in 35% of women (p < 0.05). Number of decayed (DRS) and decayed or filled (DFRS) root surfaces correlated (r = 0.16 to 0.26) with salivary microbial counts. No correlation appeared between DRS and subjects’ salivary flow rates. Basic estimates on the association between DRS and salivary findings showed that microbial counts only produced significant odds ratios, from 2.0 to 3.5. However, in a log-linear model high salivary mutans streptococci and yeast counts together with male gender were associated with greater occurrence of root caries.
Root Caries and Some Related Factors in 88-Year-Old Carriers and Non-Carriers of Streptococcus sobrinus in Saliva
Authors: Lundgren M. , Emilson C.G. , Österberg T.
Published: April 2003

The prevalence of caries on exposed root surfaces in 88-year-old subjects with and without salivary levels of Streptococcus sobrinus was studied. Ninety-two individuals were examined with regard to root caries lesions and fillings. The root caries index (RCI) was calculated and related to salivary flow rate and buffer capacity, plaque score and salivary counts of Streptococcus mutans, S. sobrinus and lactobacilli. In 89 subjects with exposed root surfaces, all but 2 harbored mutans streptococci; 51 subjects carried S. mutans only, 35 both S. sobrinus and S. mutans, and 1 S. sobrinus only. The RCI was significantly higher in persons with than those without S. sobrinus (p < 0.05). Subjects with both S. sobrinus and S. mutans had higher counts of total mutans streptococci and lactobacilli than subjects with only S. mutans (p < 0.05). The RCI was significantly correlated to S. sobrinus and S. mutans (p < 0.05). The positive correlation between the RCI and S. sobrinus was still significant when the other tested variables were kept constant, whereas the correlation between the RCI and S. mutans was weaker when S. sobrinus and lactobacilli were kept constant. The D-component of the RCI (DSr%) was significantly correlated to S. sobrinus, S. mutans and lactobacilli, whereas the F-component of the RCI showed no significant correlation to any of the tested variables. A stepwise multiple correlation showed that the variance of DSr% was best explained in the S. sobrinus carriers by S. sobrinus and the salivary buffer effect, and in the non-carriers by S. mutans.
Human Enamel as a Substrate for in Vitro Acid Dissolution Studies: Influence of Tooth Surface and Morphology
Authors: Tucker K. , Adams M. , Shaw L. , Smith A.J.
Published: April 2003

The variation in susceptibility of enamel to acid dissolution has been quantitatively assessed in vitro by examination of different surfaces of both maxillary and mandibular teeth of different morphology obtained from a pool of sound human teeth. The lingual/palatal surfaces of all teeth showed greater susceptibility to acid dissolution than the corresponding labial/buccal surfaces. The palatal surface of the maxillary teeth appeared more susceptible to acid than the lingual surface of the corresponding teeth in the mandible. The palatal surfaces of the maxillary teeth showed least variation in acid susceptibility, whilst the lingual surfaces of mandibular teeth and buccal/labial surfaces of teeth from both jaws showed much more variation between teeth of different morphology. These differences in susceptibility to acid dissolution probably reflect both developmental differences and post-eruptive changes in enamel and may contribute to the clinical presentation of dental disease. Importantly, the data indicates that careful selection of teeth for in vitro study of enamel dissolution processes is essential to minimise inter-sample variation. For such purposes, the palatal surface of the maxillary teeth appears to be most suitable.
In vitro Quantitative Assessment of Enamel Microhardness after Exposure to Eroding Immersion in a Cola Drink
Authors: Maupomé Gerardo , Díez-de-Bonilla Javier , Torres-Villaseñor Gabriel , Andrade-Delgado Luz del Carmen , Castaño Victor Manuel
Published: April 2003

Studies assessing the erosive potential of soft drinks have employed long time intervals of immersion that may not accurately depict the impact of frequent soft drink consumption on enamel. This in vitro study assessed the effect of a cola drink on enamel, replicating an actual drinking pattern. Six groups of 4 human enamel slabs were immersed (5 min each bath) in fresh cola drink, with immersions taking place with or without agitation, and under 3 regimes of frequency intake (low intake, 1 immersion/day; medium, 5/day; high, 10/day). Quantitative assessments of surface erosion were done over an 8-day interval using surface microhardness testing (Vickers). Results showed a sharp decrease from baseline (mean value 352.1 Vickers Hardness Number, SD 32.5) to day 1 (269.3, SD 41.0) and then continued decreasing throughout the assay, although less markedly, to reach 204.5, SD 45.4 on day 8. Microhardness decreased regardless of frequency regime, except on day 8, on which slabs from the low intake group were harder (233.2, SD 25.0) than slabs from the high intake group (169.8, SD 49.5; p < 0.05). Results from the ANOVA on the factorial experiment indicated that the role of agitation was statistically significant (d.f. = 1, F = 7.2, p = 0.020) while the level of intake was of borderline significance (d.f. = 2, F = 3.2, p = 0.075). The main effect resulting from the joint roles of agitation and intake indicated that there was an important interaction between the two variables (d.f. = 3, F = 4.5, p = 0.023).
An in vitro Comparison between Laser Fluorescence and Visual Examination for Detection of Demineralization in Occlusal Pits and Fissures
Authors: Ferreira Zandoná A.  G. , Analoui M. , Beiswanger B.  B. , Isaacs R.  L. , Kafrawy A.  H. , Eckert G.  J. , Stookey G.  K.
Published: April 2003

It has been demonstrated that when excited by laser light carious enamel appears dark compared to luminescent sound enamel. The aim of this study was to compare the sensitivity and specificity of visual exams (V), laser fluorescence (LF) and dye-enhanced LF (DELF) for detecting demineralization in occlusal pits and fissures. The actual presence of lesions was determined by subsequent confocal laser microscopy (CM), which was compared to histology (H). Independent clinical examiners visually graded three sites on occlusal surfaces of extracted, human premolars as sound or carious and also rated the color of each graded site as: 0 = same as surrounding enamel; 1 = white; 2 = light brown, or 3 = brown/dark brown. An argon laser was used to illuminate the teeth for LF and DELF; the images were captured with a CCD camera and then analyzed. DELF images were captured after the teeth had been exposed to 0.075% sodium fluorescein. Sections were then cut from each specimen and analyzed by CM and H for the presence or absence of caries. Results showed that DELF (0.72) was significantly more sensitive (p < 0.05) than LF (0.49) and V (0.03) for detecting caries, but there were no significant differences among the methods in specificity (V 1.00; LF 0.67; DELF 0.60). When color was used as an indication of caries in V (VC, sensitivity 0.47; specificity 0.70), V exams were not different from LF. The area under the ROC curve, using H as the gold standard and CM as the test, was 0.78. Results indicated that DELF was the best diagnostic tool and that VC and LF were equally effective as diagnostic methods, when color of fissures was included as an indication of demineralization in the visual exam.
Influence of Nail Varnish on the Remineralization of Enamel Single Sections Assessed by Microradiography and Confocal Laser Scanning Microscopy
Authors: Iijima Y. , Takagi O. , Duschner H. , Ruben J. , Arends J.
Published: April 2003

Single–section techniques are attractive in enamel de– and remineralization investigations because they allow longitudinal studies in which mineral changes can be assessed by microradiography (TMR). Nail varnish (NV) is in general applied to coat the cut thin–section sides. The aims of this study were to investigate: (1) NV penetration depth in cut surfaces of demineralized enamel, (2) the influence of NV on cut surfaces of demineralized enamel on TMR, (3) the influence of NV penetration on a following remineralization. Cut surfaces of thin sections of demineralized enamel were NV coated; the NV was peeled off and the penetration depth assessed by confocal laser scanning microscopy. The NV penetration was 18±5 μm (mean±SD) in demineralized enamel. To evaluate the possible influence of NV on TMR, cut surfaces of thin sections of demineralized enamel were coated (twice) and microradiographed before and after nail varnishing. The NV effect (total effect of penetrated and surface NV) on the main parameters of TMR, Ld and ΔZ, was less than 5% of the mean values. In the remineralization experiment (remineralization with 1.5 mM Ca2+, 0.9 mM phosphate, pH 7, 1 ppm F for 1 and 2 weeks), lesions in bulk samples, lesions in thin sections with NV–coated cut surfaces and lesions in thin sections in a PMMA (polymethylmethacrylate) holder were compared. (1) The remineralization of bulk samples and of NV–coated thin sections is different in one aspect. The amounts of mineral deposited in the lesions expressed as ΔZ are comparable after 1 week. But because the NV penetrates part of the lesion outside, there was an Ld difference. The lesion depth difference between bulk lesions and NV–coated lesions in thin sections was statistically significant and was about 19% less in NV–coated lesions after 1 week; after 2 weeks of remineralization there was no difference in Ld between bulk– and NV–coated lesions any more. (2) There was no difference in remineralization efficacy between lesions in bulk samples and lesions in thin sections in the PMMA holder.
Dental Erosions in Subjects Living on a Raw Food Diet
Authors: Ganss C. , Schlechtriemen M. , Klimek J.
Published: April 2003

The aim of the study was to investigate the frequency and severity of dental erosions and its association with nutritional and oral hygiene factors in subjects living on a raw food diet. As part of a larger dietary study 130 subjects whose ingestion of raw food was more than 95% of the total food intake were examined. The median duration of the diet was 39 (minimum 17, maximum 418) months. Before the clinical examination, the participants answered questionnaires and recorded their food intake during a 7–day period. Dental erosions were registered using study models. As a control 76 sex– and age–matched patients from our clinic were randomly selected. The raw food diet records showed the median daily frequency of ingesting citrus fruit to be 4.8 (minimum 0.5, maximum 16.1). The median intake of fruit was 62% (minimum 25%, maximum 96%) of the total, corresponding to an average consumption of 9.5 kg of fruit (minimum 1.5, maximum 23.7) per week. Compared to the control group subjects living on a raw food diet had significantly (p≤0.001) more dental erosions. Only 2.3% of the raw food group (13.2% of the controls) had no erosive defects, whereas 37.2% had at least one tooth with a moderate erosion (55.2% of the controls) and 60.5% had at least one tooth with a severe erosion (31.6% of the controls). Within the raw food group no significant correlation was found between nutrition or oral health data and the prevalence of erosions. Nevertheless, the results showed that a raw food diet bears an increased risk of dental erosion compared to conventional nutrition.
High–Performance Liquid Chromatographic Analysis of Chlorhexidine in Saliva after Mouthrinsing
Authors: Tsuchiya H. , Miyazaki T. , Ohmoto S.
Published: April 2003

A high–performance liquid chromatographic method was developed to quantify chlorhexidine in human saliva. After addition of an internal standard and acidicdeproteinization, saliva samples were chromatographed by the reversed–phase ion–pair system using pentanesulfonate as a counterion and the eluates were detected by a diode array detector. Under optimal conditions, the baseline separation of analytes was achieved within 4.5min without interference from components in saliva matrix. The method showed high selectivity to salivary chlorhexidine, quantitative range (50.0ng/ml–50.0μg/ml), recovery (96.0–97.8%) and analytical precision (intra– and interassay CVs within 0.41%), permitting the effective application to both saliva and aqueous solutions. Chlorhexidine was found in saliva at microgram per milliliter levels for at least 8 h after mouthrinsing with 10 ml of an aqueous solution of chlorhexidine (0.1 or 1.0 mg/ml) for 1 min. The concentrations of salivary chlorhexidine were reduced by ingesting the acidic beverage and food, but not by ingesting the neutral beverage. The adsorption experiments in artificial saliva revealed that chlorhexidine was significantly adsorbed to saliva–coated hydroxyapatite, buccal epithelial cells and mucin. The proposed method will be a useful tool to study salivary chlorhexidine after oral application and its retention in the oral cavity.
A Low Concentration of Carbonic Anhydrase Isoenzyme VI in Whole Saliva Is Associated with Caries Prevalence
Authors: Kivelä Jyrki , Parkkila Seppo , Parkkila Anna-Kaisa , Rajaniemi Hannu
Published: April 2003

Carbonic anhydrases maintain pH homeostasis in various tissues of the human body by catalyzing the reversible reaction CO2 + H2O <=> HCO3– + H+. Carbonic anhydrase isoenzyme VI (CA VI) is secreted into human saliva by the serous acinar cells of the parotid and submandibular glands. Although it represents about 3% of the total protein in stimulated parotid saliva, its exact physiological significance in the saliva has not been established. In the present study, saliva samples were collected under strictly controlled conditions from young, healthy men and assayed for CA VI concentrations using a specific time–resolved immunofluorometric assay. Salivary secretion rate, pH, buffering capacity, α–amylase activity levels, lactobacillus and Streptococcus mutans counts were also determined, and the results were correlated with the dental status of the subjects. Salivary CA VI concentration, pH and buffering capacity values correlated negatively with the numbers of decayed, missing and filled teeth (DMFT index). The correlations between salivary CA VI concentration and DMFT index were most significant in subjects with poor oral hygiene. No correlation was found between salivary CA VI concentration and lactobacillus or Streptococcus mutans counts. As predicted, salivary lactobacillus and Streptococcus mutans counts showed a close positive correlation with the DMFT index. In contrast, no significant correlation was seen between salivary secretion rate or amylase activity and the DMFT index. The present results indicate that low salivary CA VI concentrations are associated with increased caries prevalence, particularly in subjects with neglected oral hygiene.