bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Diclofenac Sodium Softgel 100 mg With or Without Caffeine 100 mg in Migraine Without Aura: A Randomized, Double‐blind, Crossover Study
Authors: Peroutka Stephen J. , Lyon James A. , Swarbrick James , Lipton Richard B. , Kolodner Ken , Goldstein Jerome
Published: July 2004

Objective.—A phase II, randomized, double‐blind, crossover study was designed to evaluate the efficacy of 100‐mg diclofenac sodium softgel (formulated using ProSorb technology) with or without 100‐mg caffeine versus placebo in migraineurs during migraine attacks.

Background.—Diclofenac has been demonstrated to be an effective migraine treatment in several placebo‐controlled studies. A rapidly absorbed softgel of diclofenac has been shown to be effective in the rapid relief of acute pain, and may have advantages in migraine treatment. In addition, caffeine has consistently been shown to increase both the efficacy and speed of onset of concurrently administered analgesics. The ability of caffeine to both enhance and accelerate analgesic effects has been documented with a variety of different medications (ie, aspirin, acetaminophen, ibuprofen, and ergotamine).

Methods.—The 3‐period crossover study was designed to compare diclofenac softgel 100 mg, diclofenac softgel 100 mg plus caffeine 100 mg, and placebo in the acute treatment of migraine. Subjects treated one moderate or severe attack with each study medication. The primary efficacy parameter was the percentage of subjects with headache relief at 60 minutes as defined by a reduction of headache severity from moderate or severe at baseline to absent or mild compared with placebo. Though the sample size estimate required that 72 subjects treat 3 separate attacks, 51 subjects treated 1 migraine attack, 44 treated 2 attacks, and 39 treated 3 attacks.

Results.—In the placebo group, 6 (14%) of 43 subjects reported headache relief at 60 minutes versus 12 (27%) of 45 subjects in the diclofenac softgel group, and 19 (41%) of 46 subjects in the diclofenac softgel plus caffeine group. Differences were statistically significant for the diclofenac softgel plus caffeine group versus placebo (odds ratio, 4.2; 95% confidence interval, 1.3 to 13.7). Rescue medication was used by 27 (63%) of 43 subjects treated with placebo, 15 (33%) of 45 subjects treated with diclofenac softgel, and 14 (30%) of 46 subjects treated with diclofenac softgel plus caffeine. This result is highly statistically significant (χ22= 11.56, P= .003). Both the diclofenac plus caffeine (P < .03) and diclofenac only (P < .03) groups were significantly different from the placebo group in terms of the visual analog scale score at 60 minutes.

Conclusions.—The major finding of the present study is that diclofenac softgel plus caffeine produces statistically significant benefits relative to placebo at 60 minutes. Diclofenac softgel alone did not differ significantly from placebo, perhaps due to limits in sample size. Nonsignificant trends support the analgesic adjuvant benefit of caffeine when added to diclofenac softgels.
Onset of Effect of 5‐HT1B/1D Agonists: A Model With Pharmacokinetic Validation
Authors: Fox Anthony W.
Published: July 2004

Objective.—To quantitate onset of effect of all formulations of sumatriptan, and to investigate whether this is related to rate, not extent, of drug absorption.

Methods.—From published literature, for 4 formulations of sumatriptan and matching placebos, response rates were modeled using a simple logarithmic equation, with a being a parameter of curve convexity and B, a location parameter (equal to response rate at 2 hours [the standard regulatory parameter]). The average rate of drug absorption (A) was estimated by dividing the maximal drug concentration by the time needed to achieve it (Cmax/Tmax). Least mean square correlation was then performed between the therapeutic gains and therapeutic ratios of curve convexity and rate of drug absorption.

Results.—Models closely fitted observed response rates (2 hours or less). Curve convexity correlated with rate of drug absorption. Sumatriptan response rates (0 to 2 hours) for formulations correlated with rate, not extent, of drug absorption. The range of rates of onset of effect among different routes of administration was greater than that for tablets with 4‐fold differences in dose size.

Conclusion.—Onset of effect is related to rate of absorption of sumatriptan. There is greater scope for improving onset of effect using an alternative route of administration than by increasing the oral dose.
Headache Induced by Chronic Substance Use: Analysis of Medication Overused and Minimum Dose Required to Induce Headache
Authors: Relja Giuliano , Granato Antonio , Maria Antonello Rodolfo , Zorzon Marino
Published: July 2004

Background.—The International Headache Society has defined the diagnostic criteria for headache induced by substance use. Recently, a revision to these criteria has been proposed.

Objective.—To consider whether the International Headache Society criteria for headache induced by substance use and the proposed revisions for the classification of daily and near‐daily headache with medication abuse permit classification of patients commonly seen in a headache center.

Methods.—One hundred fourteen consecutive patients (96 women [84.2%] and 18 men [15.8%]; mean age, 54.2 years [SD, 14]) with headache and chronic overuse of medications, admitted for detoxification to the inpatient unit of a headache center, participated in the study. The initial headache, medications and doses used, duration of daily medication use, and means of medication administration were studied.

Results.—Eighty‐one patients (71%) had an initial headache of migraine without aura, 13 patients (11.4%) had migraine without aura and coexistent tension‐type headache, 11 (9.7%) patients had migraine with and without aura, and 9 patients (7.9%) had episodic tension‐type headache. Medications overused by patients included analgesics combined with barbiturates or other nonnarcotic substances in 39.5%, simple analgesics in 38.6%, triptans in 11.4%, and ergotamine in 10.5%. Using the International Headache Society diagnostic criteria, we were able to classify only 28.1% of our patients; the proposed revised criteria for daily and near‐daily headaches with medication abuse permitted the classification of 46.4% of patients.

Conclusion.—The minimum dose of medication required to induce chronic headache should be revised because a high proportion of patients are not classifiable using either the International Headache Society diagnostic criteria or the revised criteria recently proposed. A more comprehensive definition for the required minimum dose might be used. Triptan abuse can cause chronic headache and should be included in the International Headache Society classification.
Relationship Between Chronic Tension‐type Headache, Cranial Hemodynamics, and Cerebrospinal Pressure: Study Involving Provocation With Sumatriptan
Authors: Hannerz Jan , Jogestrand Tomas
Published: July 2004

Objective.—To study the relationship between chronic tension‐type headache, cranial hemodynamics, and cerebrospinal pressure.

Background.—Cerebrospinal pressure has been found to be above 200 mm in about 50% of patients with chronic tension‐type headache.

Methods.—Heart rate, blood pressure, common carotid artery diameter and blood flow, and craniovascular resistance and pain at regular intervals before, during, and after head‐down tilt—a procedure which increases cerebrospinal pressure, were recorded. After head‐down tilt, subcutaneous injections of either placebo or 6 mg of sumatriptan were administered. Chronic tension‐type headache intensity before and after withdrawal of 20 mL of cerebrospinal fluid was documented. Cerebrospinal pressure and chronic tension‐type headache intensity were measured after subcutaneous injection of 6 mg of sumatriptan.

Results.—Head‐down tilt provoked an increase of headache compared with baseline. Common carotid artery blood flow decreased and craniovascular resistance increased after sumatriptan injection, but not after placebo injection. The pain decreased after head‐down tilt and placebo injection, but not after sumatriptan injection. Chronic tension‐type headache intensity decreased in all 4 patients studied after withdrawal of 20 mL of cerebrospinal fluid. Cerebrospinal pressure increased in 5 patients with chronic tension‐type headache after subcutaneous injection of 6 mg of sumatriptan with slight or no increase of pain.

Conclusion.—The results indicated that cerebrospinal pressure or intracranial venous pressure (or both) are related to chronic tension‐type headache.
Rofecoxib in the Prevention of Perimenstrual Migraine: An Open‐Label Pilot Trial
Authors: Von Seggern Randal L. , Mannix Lisa K. , Adelman James U.
Published: July 2004

Objective.—To investigate the effectiveness of rofecoxib in the prevention of perimenstrual migraine.

Background.—Nonsteroidal anti‐inflammatory drugs have demonstrated benefit in reducing the frequency and intensity of menstrual migraine when administered perimenstrually. Anti‐inflammatory drugs, however, may not be well tolerated and can produce gastrointestinal irritation. Rofecoxib, a selective cyclooxygenase‐2 inhibitor, has anti‐inflammatory and analgesic properties, and a significantly improved gastrointestinal tolerability profile.

Methods.—A pilot study was conducted in which patients with a history of menstrually associated migraine and experiencing at least one migraine monthly during the perimenstrual period were enrolled. Patients who completed a baseline diary for the first month were randomized to receive either rofecoxib 25 mg or 50 mg daily for 10 days, starting 5 days before menstrual flow. Headaches experienced during this 10‐day period were recorded in the patient's diary. Patients continued rofecoxib for 2 consecutive menstrual cycles. Mean migraine frequency, intensity, and duration as well as patient's level of functioning during the 2 cycles were compared with baseline.

Results.—Fourteen patients completed baseline and rofecoxib dosing for 2 menstrual cycles. Mean migraine frequency decreased from 5.6 to 2.6 migraines per menstrual cycle (P= .005). Eight (57%) of 14 patients had a ≥50% reduction in headache frequency. No significant improvement in headache intensity, duration, and functional impairment were observed. Both doses of rofecoxib were well tolerated with no statistical difference in patient response between the doses.

Conclusion.—Rofecoxib at a perimenstrual daily dose of 25 or 50 mg demonstrated a significant reduction in frequency of perimenstrual migraine. A double‐blind, placebo‐controlled trial of rofecoxib in the prevention of perimenstrual migraine is warranted.
Cranial Magnetic Resonance Imaging Findings in Patients With Migraine
Authors: Gozke Eren , Ore Ozgul , Dortcan Nimet , Unal Zeynep , Cetinkaya Mehmet
Published: July 2004

Objective.—To investigate the frequency of cranial magnetic resonance imaging abnormalities in patients with migraine and their relationship to type, duration, and frequency of migraine attacks.

Methods.—Forty‐five patients (43 women, 2 men) with migraine whose ages ranged between 19 and 53 years (mean, 40.91 [SD, 7.69]) were evaluated. Of the 45 patients, 20 had migraine with aura and 25 had migraine without aura, according to the diagnostic criteria of the International Headache Society.

Results.—In 13 (28.8%) of 45 patients, white matter foci were present on magnetic resonance imaging. Eight of these patients (61.5%) had migraine with aura, and 5 patients (38.4%) had migraine without aura. The presence of white matter foci was significantly higher in the patients with aura (8 [40%] of 20) than in those without aura (5 [20%] of 25). It was found that as the frequency of attacks per month increased, the number of patients with white matter foci also increased. Although the mean duration of migraine was longer in patients with white matter foci (149.5 months [SD, 87.9]) than in those without white matter foci (134.1 months [SD, 88.3]), there was no significant difference (P > .05).

Conclusion.—Although there are no specific magnetic resonance imaging findings peculiar to migraine, detection of white matter foci should be taken into consideration in patients with migraine (especially migraine with aura). Frequency of attacks is an important indicator of existence of white matter foci.
Idiopathic Intracranial Hypertension and PostlumbarPuncture Headache
Authors: Loh Yince , Labutta Robert J. , Urban Edward S.
Published: July 2004

Idiopathic intracranial hypertension and low cerebrospinal pressure are 2 conditions that are thought to be on opposite ends of the cerebrospinal pressure spectrum. Headache is the prominent component of both conditions. We describe a patient whose evaluation for idiopathic intracranial hypertension resulted in a postlumbar puncture headache. Although not entirely intuitive, we suggest that the 2 conditions can be present in the same patient.
Efficacy of Topiramate in Migraine Aura Prophylaxis: Preliminary Results of 12 Patients
Authors: Lampl Christian , Bonelli Silvia , Ransmayr Gerhard
Published: July 2004

Objective.—To evaluate the efficacy of topiramate in the treatment of migraine aura. Antiepileptic drugs may be useful in migraine prevention through such mechanisms as acting directly on the nociceptive system or by modulating the biochemical phenomena of aura. Topiramate acts directly on N‐methyl‐d‐aspartate and amino‐3‐hydroxy‐5‐methylisoxazole‐4‐propionic acid/kainate glutamate receptors and modulates calcium ion channel activity by inhibiting high‐voltage–activated L‐type calcium ion channels.

Methods.—Twelve patients with migraine with aura were enrolled in an open‐label study and treated with topiramate for 6 months. The dose of topiramate was increased weekly by 25 mg up to a daily dose of 100 mg after 4 weeks.

Results.—In all 12 patients after 6 months of treatment, topiramate did not statistically influence aura frequency (P= .317) or duration (P= .480) compared with baseline. Mild to moderate side effects were observed, but they did not interfere with treatment. Consistent with previous observations, migraine frequency as well as headache intensity and duration improved statistically significantly.

Conclusion.—Topiramate is not effective in preventing migraine aura.
Frequent Triptan Use: Observations on Safety Issues
Authors: Robbins L.
Published: July 2004

Objective.—To examine the safety of frequent triptan use over extended periods. For a small group of patients with refractory migraine plus chronic daily headache, triptans are effective.

Methods.—This retrospective study primarily evaluated the cardiac safety of daily triptan use in 118 patients and, in addition, hematologic tests were assessed. Each patient had utilized a triptan for a minimum of 4 days per week for at least 6 months. Patients with rebound headache had been withdrawn from the triptans. Most patients (97 of 118) averaged 1 tablet daily; most would occasionally go for several days without a triptan. Forty patients had taken a triptan for 6 months to 2 years, 37 patients from 2 to 4 years, and 41 for 4 or more years.

Results.—Routine hematologic tests were performed periodically on all patients, and no abnormalities were attributable to triptans. Almost all patients had an electrocardiogram, and no abnormal electrocardiograms were felt to be related to triptans. Cardiac echocardiography was performed in 57 patients. The 10 abnormal echocardiograms were not due to triptans. All 20 cardiac stress tests revealed normal findings. Adverse events were minimal; 9 patients described fatigue due to triptans, and 5 had mild chest tightness.

Conclusion.—This long‐term study of 118 patients indicates that frequent triptan use may be relatively safe.
Cluster Headache and the Sympathetic Nerve
Authors: Albertyn J. , Barry R. , Odendaal C. L.
Published: July 2004

Objective.—To determine the effect of a sympathetic block at C7 on cluster headache.

Backround.—Eleven patients presenting to a pain control unit with cluster headache were included in the study after giving informed consent.

Methods.—In all patients, a mixture of 5 mL of 0.5% bupivacaine hydrochloride and 1 cc of methylprednisolone acetate was injected onto the base of the C7 transverse process.

Results.—The injection was applied during the acute phase of headache in 6 patients and all experienced immediate and complete relief. The other 5 patients received the injection between attacks. Of the 11 patients treated, 8 went into remission by aborting the cluster. In some patients, repeated injections were given before the cluster was aborted. Three patients did not respond to treatment. One patient with chronic paroxysmal hemicrania experienced pain relief of the acute attack after treatment, but the procedure did not abort the subsequent attacks. A surgical sympathectomy removing the stellate ganglion rendered him pain‐free for 15 months after which he was lost to follow‐up.

Conclusion.—Blocking the sympathetic nerve aborts an acute attack of cluster headache and may play a major role in aborting the cluster. Although only one patient with chronic paroxysmal hemicrania responded to surgical sympathectomy, this procedure may be considered as an alternative if there is poor response to oral medication or a sympathetic block.
Fracture toughness of various core build‐up materials
Authors: Bonilla E. D. , Mardirossian G. , Caputo A. A.
Published: August 2004

Purpose The purpose of this investigation was to compare the fracture toughness of several core materials.

Materials and Methods Five core build‐up materials were tested: (1) glass ionomer, (2) resin‐modified glass ionomer, (3) titanium‐reinforced composite, (4) composite resin with fluoride, and (5) amalgam. Fracture toughness determinations were made using 3‐point flexure of beams with a central single‐edge notch. The notch was standardized by the use of a special mold into which each of the materials was condensed. Ten beams of each material were tested on an Instron test machine (Instron Corp, Canton, MA) at a crosshead speed of 1.25 mm/min. The maximum loads were determined from which the fracture toughness values (KIC) were calculated. The data were analyzed statistically using analysis of variance and t tests.

Results The mean fracture toughness value in MN·m−3/2 for each of them is as follows: (1) glass ionomer, 0.717 ± 0.071; (2) resin‐modified glass ionomer, 0.747 ± 0.061; (3) titanium‐reinforced composite, 1.409 ± 0.051; (4) composite resin with fluoride, 1.660 ± 0.086; and (5) amalgam, 1.521 ± 0.081. There was no significant difference in the KIC values for the glass ionomer‐based materials, and both of these were significantly lower than amalgam, titanium‐reinforced composite resin, and composite resin with fluoride (p < .001).

Conclusions The titanium‐reinforced composite resin, the composite resin with fluoride, and amalgam materials showed fracture toughness most likely to withstand the stresses generated during mastication.
An in vitro comparison of 5 techniques for impressing dowel space preparations
Authors: Chee Winston W. L. , Cho George C. , Marzola Riccardo
Published: August 2004

Purpose This in vitro study compared 5 different dowel space impression techniques using polyvinyl siloxane impression material to determine which method produced fewer voids in the dowel space impression.

Materials and Methods Five techniques were used to make impressions of a prepared dowel space in a simulated endodontically treated tooth. Technique I used a 25‐gauge anesthetic needle to act as a vent at the apex of the preparation to reduce voids produced during the expression of light body impression material. The anesthetic needle was removed after the impression material was injected, and an impression post was then inserted to the depth of the preparation. Twenty impressions made using this technique were compared with other techniques that used the vent without a post, no vent with a post, no vent without a post, and a lentulo spiral with a post (Techniques II through V, respectively). The percentage of impressions with voids from each group was compared to determine which technique consistently produced a void‐free impression of the complete preparation length. If voids were observed in the impression, the specimen was considered inadequate.

Results The percents of void‐free impressions using Techniques I through V were 100%, 70%, 40%, 60%, and 20%, respectively.

Conclusions Using a 25‐gauge needle as a vent while expressing impression material into the dowel space followed by placing the impression post consistently produced void‐free dowel space impressions.
The effect of triphenylbismuth on the radiopacity and performance properties of compression‐ and injection‐molded denture resins
Authors: Lang Lisa A. , Mattie Patrick A. , Rawis H. Ralph
Published: August 2004

Purpose Methods of incorporating radiopaque triphenylbismuth into an experimental compression‐molded and injection‐molded heat‐polymerized resins were determined. The transverse flexural properties, radiopacity, and color stability of the resins containing triphenylbismuth were then compared with a commercially available, compression‐molded denture resin.

Materials and Methods Varying levels of triphenylbismuth were added to both the monomer and polymer in heat‐polymerized denture resin systems to determine the level of the additive that was necessary to achieve a radiopacity similar to 0.2 mm of copper with minimum resin porosity. Specimens were then prepared by incorporating 0% or 30% wt/wt triphenylbismuth into resins. The commercially available polymethyl methacrylate resin served as a benchmark for physical property comparison, and no additive was included during its polymerization. At 30% wt/wt triphenylbismuth, resin color stability, transverse deflection, and radiopacity were evaluated using methods described in International Standards Organization Standard 4049 and American Dental Association Specification No. 12. The transverse deflection results among the resin groups were compared with a reference resin using the Kruskal‐Wallis method (α= 0.05).

Results Incorporation of triphenylbismuth into the monomer of the injection material, resulting in 30% wt/wt in the polymerized resin, produced a level of radiopacity similar to 0.2 mm copper. Although the injection‐molded resin with 30% wt/wt triphenylbismuth remained translucent, the compression‐molded resin was opaque, indicating excessive air‐entrapment porosity. The additive caused a faint yellowing in both types of resins, but color stability was not affected. Transverse deflection of the injection‐molded resin (4.5 ± 0.5 mm) and the injection‐molded resin with triphenylbismuth (3.8 ± 1.7 mm) was greater than that of the experimental resin (3.5 ± 0.2 mm), which was equal to the commercial resin (3.6 ± 0.2 mm). Triphenylbismuth at 30% wt/wt significantly reduced transverse deflection for the experimental resin (2.6 ± 0.5 mm).

Conclusions Triphenylbismuth at a final concentration of 30% wt/wt can be added to polymethyl methacrylate injection‐molded resins to provide a high level of detection on chest or abdominal radiographs without adversely affecting resin color stability and transverse deflection.
Adhesion testing of a denture base resin with 5 casting alloys
Authors: Clelland Nancy L. , van Putten Meade C. , Brantley William A. , Knobloch Lisa A.
Published: August 2004

Purpose This study compared denture base resin shear bond strengths to silicoated Au‐Pd, Au‐Pd‐Ag, Au‐Ag‐Pd‐Cu, high‐Pd, and Ni‐Cr‐Be alloys used to fabricate frameworks for hybrid implant prostheses. Microleakage between alloy and resin was also compared among groups after specimen fracture.

Materials and Methods Twelve cylindrical specimens were cast for each alloy. Each specimen was made from a ring‐shaped pattern (diameter [d] = 12 mm and height = 4 mm) and machined to achieve uniform hollow centers (d = 6.5 mm). Castings were abraded with 250‐μm aluminum oxide and ultrasonically cleaned in distilled water before silicoating. Denture base resin was processed to the internal surfaces of the silicoated specimens. All specimens were thermocycled (1,000 cycles) between 4°C and 50°C, and placed in basic fuchsin dye for a week. A punch (d = 3.8 mm) driven at a cross‐head speed of 0.5 mm/min was used to push out the resin specimens. The force required to cause failure was converted to the nominal shear bond strength for each specimen, and mean shear bond strengths for the 5 groups of specimens (N = 12) were compared using one‐way analysis of variance and the Tukey‐Kramer HSD multiple range test (α= 0.05). Six of the 12 debonded resin samples for each alloy were selected at random and evaluated for dye penetration. Using an 80‐square grid, the percentage of dye penetration was evaluated with an optical microscope ×25) to determine the percentage of grid area penetrated by the dye. One‐way analysis of variance was used to compare the degree of microleakage among groups.

Results The mean resin‐alloy shear bond strengths for the Au‐Pd (9.6 ± 3.7 MPa) and Au‐Ag‐Pd‐Cu (9.2 ± 1.5 MPa) alloys were significantly greater than mean resin‐alloy shear bond strength for the Au‐Pd‐Ag alloy (5.6 ± 1.9 MPa). No other significant differences in resin‐alloy shear bond strengths were noted among the alloy groups. No significant differences were noted for dye penetration into the resin specimens bonded to any of the 5 alloys. The mean grid area penetrated by the dye was 25% when results for the alloys were pooled.

Conclusions Alloy type influences the shear bond strength of a denture base resin to silicoated alloys, but no difference in bond strength was found between Au‐Pd, Au‐Ag‐Pd‐Cu, high‐Pd, and Ni‐Cr‐Be alloys. In addition, under the conditions of this study, all groups showed a similar degree of microleakage, which penetrated approximately 25% of the bonded specimen surface area.
Privileged Communication in Therapy: Special Problems for the Family and Couples Therapist
Authors: GUMPER LINDELL L. , SPRENKLE DOUGLAS H.
Published: August 2004

Misconceptions concerning the existence and scope of the legal privilege for communications in therapy are considered. Basic limitations on the protection afforded by the privilege are treated, as are some major specific exceptions and waivers, particularly as they raise special difficulties for the therapist who works with groups, couples, and families. Practical suggestions for the therapist and directions for policymaking by the helping professions are presented.
Variations and Extensions of Filial Therapy
Authors: Stollak Gary E.
Published: August 2004

Various procedures for training parents to be play therapists for their own young children are described. In their play encounters with the child, not only is each of the parents learning ways of being with the child that are indicative of empathy and caring, but they are also learning that the way each acts toward the child in the playroom (and in the home) is reflective of their own conflicts as persons and as spouses.
The Single‐Case Design in Family Therapy Evaluation Research
Authors: CLAIRE RABIN
Published: August 2004

This paper discusses the need for the development of new research designs for family therapy evaluation, and a manner for meeting that need. The single‐case research design has gained acceptance as bona fide experimental designs for evaluating the effectiveness of intervention techniques in drug and psychotherapy outcome research. Although the need for more outcome studies on the effectiveness of family therapy has been frequently noted, there has been virtually no use of the single‐case design in family therapy outside of the behavior modification literature on families. This paper presents potential benefits of the application of single case‐design for the practice of family therapy. Preliminary guidelines are suggested for the application of these designs.
Observations on the First International Conference on Children of Holocaust Survivors
Authors: PESKIN HARVEY
Published: August 2004

This first large‐scale gathering of children of Holocaust survivors revealed — more from the unanticipated group process of the conference than from its official proceedings — that the second generation seeks a collective identity subordinate neither to the older generation of parents nor of mental‐health authorities. Vital moments of tension and reconciliation at the conference between the children's self‐help movement (with a sizable membership of young mental‐health professionals) and distinguished mental‐health experts indicated the legitimacy of intergenerational encounter and the place that it will likely be accorded in future meetings.
A Theory‐Based Empirical Classification of Family Problem‐Solving Behavior
Authors: OLIVERI MARY ELLEN , REISS DAVID
Published: August 2004

A method for classifying family interaction behavior is presented that underlies several related studies of variation in families' modes of interpreting and interacting with the social environment. Evidence is presented for the existence of three dimensions of family problem‐solving behavior that: (a) are consistent with theory of variation in families' orientations to the environment; (b) are useful for interpreting differences within nonclinical as well as clinical samples of families; and (c) have been shown, within current samples' ranges, to be essentially independent of surface markers of family variation and accumulated skills of family members.
What Is an Epistemology of Family Therapy?
Authors: KEENEY BRADFORD P.
Published: August 2004

“Draw a distinction!”
A Theory of Systems Theories or The Case of Mistaken Identity
Authors: VIELAND CONSTANCE
Published: August 2004

The purpose of this paper is to suggest that it is possible, but probably undesirable, to bring order to the frequently noted chaotic state of theory within the field of family therapy. The basic assumption is that the field of family therapy can be viewed as a system. Methods familiar to family therapists are used: description and analysis of the problem, history, theory development, introduction of an organizing principle, and consideration of the consequences of problem resolution. The paper is in the form of a case presentation.
Transactional Theories but Individual Assessment: A Frequent Discrepancy in Family Research
Authors: FISHER LAWRENCE
Published: August 2004

Spiegel's (20) distinction between studies of relations and studies of transactions are reviewed and applied to the tendency of current research to assess transactional theory using methods that are focused on individual elements. Several of the complexities of transactional research are reviewed with a call for the utilization of methods that are more commensurate with the level of theory under test.
Staging Reciprocal Metaphors in a Couples Group
Authors: PAPP PEGGY
Published: August 2004

This paper describes an approach to couples therapy based on defining the reciprocal positions of each spouse in relation to a central theme. These positions and the theme around which they are organized are crystallized into visible forms through staged metaphors. When studied in relation to one another, the metaphors provide a holistic view of the relationship and are used as an artifice for change.
Transformations: A Blueprint for Narrative Changes in Therapy
Authors: SLUZKI CARLOS E.
Published: July 2004

When problematic‐symptomatic behaviors are conceived as embedded, retained, and maintained in collective stories, therapy can be described as the transformative process by which patients, families, and therapists co‐generate qualitative changes in those stories. An emphasis on narratives allows one to specify further how those transformations unfold at the more “micro” level of the exchanges that take place throughout the consultation. To that specification is devoted the core of this essay, which closes with a discussion of the clinical, training, and, especially, research potentials of this systematization.
The California Family Health Project: III. Family Emotion Management and Adult Health
Authors: FISHER LAWRENCE , NAKELL LINDA C. , TERRY HOWARD E. , RANSOM DONALD C.
Published: July 2004

This article explores the broad patterning of interrelationships between family Emotion Management and adult Health in a community‐based sample of 225 families. Emotion Management refers to how emotion is expressed, acknowledged, and managed by the marital partners. Fifteen reliable‐observer ratings of husband‐wife behavior were made during each of three 10‐minute Emotion Management Interaction Tasks (EMITs). Each of the three tasks “pulled” for the expression of a different emotional theme: loss, intimacy, or conflict. A principle components analysis of the 15 ratings yielded a poor solution. A nonmetric, multidimensional scaling analysis described a two‐dimensional, bipolar display with ordering among the variables in each of two wings. One dimension reflected positive versus negative Emotion Management characteristics, and the second reflected active and overt versus passive or covert emotional expression. The pattern of relationships among the couple ratings was similar for each of the three tasks. Using canonical correlation, the couple ratings demonstrated significant associations with 14 adult Health scores for both husbands and wives for the intimacy and conflict tasks, but not for the loss task. Specific gender patterns also emerged. In general, couple overt emotional aversiveness was negatively associated with husbands' health, and couple emotional avoidance/distance was negatively associated with wives' health.
Lives in a Balance: Perceived Family Functioning and the Psychosocial Adjustment of Adolescent Cancer Survivors
Authors: RAIT DOUGLAS S. , OSTROFF JAMIE S. , SMITH KAROLYN , CELLA DAVID F. , TAN CHARLOTTE , LESKO LYNNA M.
Published: July 2004

Childhood cancer patients have a greater likelihood of long‐term survival than ever before. This study examined both the perceived family functioning of adolescents who had successfully completed treatment for pediatric cancer and the relationship between family functioning and post‐treatment adjustment. Eighty‐eight adolescent survivors of hematologic malignancies were assessed regarding their family functioning, mental health, self‐esteem, global competence, and problem behaviors. Contrary to expectations about the influence of cancer on these families, adolescent cancer survivors reported lower levels of family cohesion than the normative sample of healthy adolescents and their families. While current age, gender, age at diagnosis, and time since treatment completion were generally not associated with adolescents' adjustment, perceived family cohesion and adaptability were strongly related to post‐treatment psychological adjustment.
Zoledronate‐induced remission of acute panmyelosis with myelofibrosis
Authors: Español I. , Romagosa V. , Berlanga J. , Domingo A. , Losa F. , Heras L. , Janáriz J.
Published: July 2004

Abstract:  Acute panmyelosis with myelofibrosis is a rare and aggressive form of acute myeloid leukemia. We describe a new case with a huge proliferation of megakaryocytes, blast cells and reticulin fibers. The patient was treated with zoledronate, a third‐generation bisphosphonate, and a gradual recovery from pancytopenia was observed. A new bone marrow biopsy performed 4 months later showed a surprising disappearance of the leukemic infiltration. Ten months after the diagnosis, the patient is still in healthy condition. This may support the recently described anti‐tumor activity of zoledronate.
Body depth variation in crucian carp Carassius carassius: an experimental individual‐based study
Authors: Vøllestad L. A. , Varreng K. , Poléo A. B. S.
Published: August 2004

Abstract –  Induced morphological defences, where individuals develop morphological structures as a response to signals from sympatric predators, are common among invertebrates. Such defences have also been reported in a freshwater fish, the crucian carp Carassius carassius. In crucian carp, the presence of piscivorous fish presumably induces the development of a deep body as a defence mechanism. We tested how the growth rate (in body depth, length and mass) of individually tagged crucian carp responds to pike Esox lucius odours and control water. In general, crucian carp exposed to pike odour grew better (both in length and mass) than control fish. The treatment crucian carp also developed deeper bodies than control crucian carp. Further, there was a strong positive relationship between individual growth rate and the rate of change in body depth and this relationship did not differ between control and treatment fish.
Reproductive roles predict sexual dimorphism in internal and external morphology of lake whitefish, Coregonus clupeaformis
Authors: Casselman S. J. , Schulte‐Hostedde A. I.
Published: August 2004

Abstract –  The different reproductive roles of the sexes can predict the direction and magnitude of sexual dimorphism of external and internal morphology. Males should have enlarged structures that enhance the acquisition of mating opportunities, whereas females are predicted to have enlarged organs that are associated with the production of eggs. We tested these predictions in male and female lake whitefish, a species in which both sexes have similar overall body size and shape. After controlling for body size, male lake whitefish had significantly longer jaws and pectoral and pelvic fins, larger hearts, and more muscle than females. Sexual dimorphism in relative muscle mass may be one of the most fundamental morphological differences between males and females. Females had relatively heavier livers than males. Because the liver is important for the breakdown of fats and vitellogenesis, selection should favour an enlarged liver in females for the processing of energy and the production of large numbers of eggs.
The 3020insC mutation of the NOD2/CARD15 gene in patients with periodontal disease
Authors: Folwaczny Matthias , Glas Jürgen , Török Helga‐Paula , Mauermann Daniel , Folwaczny Christian
Published: July 2004

The 3020insC mutation of the NOD2/CARD15 gene leads to impaired activation of nuclear factor‐kappa B (NF‐κB) in vitro. As the destruction of periodontal tissue is mediated via activation of NF‐κB, with subsequent transcription of proinflammatory cytokines, the c‐insertion mutation of the NOD2/CARD15 gene might contribute to the proposed genetic background of periodontitis. The present study analysed the frequency of this mutation in 80 patients with chronic periodontal disease and 122 healthy controls. The 3020insC mutation was identified by employing the polymerase chain reaction followed by restriction fragment length polymorphism analysis. The prevalence of the 3020insC mutation of the NOD2/CARD15 protein in patients with periodontitis was 1.9% (three of 160) and that for the control group was 2.0% (five of 244) (P = 0.942). Hence, unlike in Crohn's disease, the 3020insC mutation of the NOD2/CARD15 gene does not seem to influence the pathophysiology of periodontitis.
Supramolecular pellicle precursors
Authors: Vitkov Ljubomir , Hannig Matthias , Nekrashevych Yuriy , Krautgartner Wolf Dietrich
Published: July 2004

Saliva contacting with solid surfaces in the oral cavity forms a coat termed the pellicle. However, its formation is not fully understood. Although indications for the existence of supramolecular pellicle precursors have been reported, the possible relationship between them and pellicle formation is unclear. This study investigates the ability of supramolecular precursors to form the pellicle via interaction with a solid surface. Fixed and unfixed salivary globes were spread onto a microscopic grid and examined by transmission electron microscopy. Biochemical pretreatment of saliva revealed that neither disulphide links nor transglutaminase‐mediated crosslinking are responsible for maintaining the salivary globes, i.e. supramolecular pellicle precursors. However, the detergent, sodium dodecyl sulphate, caused dissociation of the salivary globes, indicating their micellar nature. Saliva contacting a formvar film for 10 s did not form a complete surface coating, but single supramolecular pellicle precursors were observed attached to the surface. After extension of the contact time to 60 s, a surface layer was formed by clustering and fusion of the supramolecular pellicle precursors. The supramolecular pellicle precursors are unstable and attain a thermodynamically more favourable state by adhesion to a solid surface. As a result, a layer of fused precursors covering the solid surface is formed – the salivary pellicle.
Effects of an inducible nitric oxide synthase inhibitor on experimentally induced rat pulpitis
Authors: Kawanishi Hiromi Nakano , Kawashima Nobuyuki , Suzuki Noriyuki , Suda Hideaki , Takagi Minoru
Published: July 2004

Nitric oxide (NO) is a biological effector molecule involved in a large variety of reactions and, as synthesized by inducible nitric oxide synthase (iNOS), has many important roles in inflammatory conditions. This study aimed to evaluate the anti‐inflammatory effects of an iNOS‐specific inhibitor, N‐(3‐(aminomethyl)benzyl)acetamidine (1400W), on experimentally induced rat pulpitis in the upper incisors of 6‐wk‐old male Wistar rats. 1400W (1 mg kg−1), the non‐specific NOS inhibitor NG‐nitro‐l‐arginine methyl ester (l‐NAME, 50 mg kg−1), or sterile saline (control) were administered before the application of lipopolysaccharide (LPS). Rats were killed 3, 6, 9, 12, 24, 48, and 72 h after LPS application, and immunocompetent cells were detected immunohistochemically. The numbers of granulocytes infiltrating into the pulp were significantly depressed in the 1400W group compared with the saline and l‐NAME groups. The kinetics of the macrophages and Ia+ cells in the 1400W group were similar to those in the l‐NAME group, while the maximum numbers in both groups were significantly reduced compared with those in the saline group. These results suggest that NO may be responsible for the infiltration of immunocompetent cells in the progress of pulpitis, and that 1400W is a promising candidate for controlling pulpal inflammatory reactions.
Prediction of success and failure of behavior modification as treatment for dental anxiety
Authors: Eli I. , Baht R. , Blacher S.
Published: July 2004

Behavior modification techniques are effective in the treatment of extreme dental anxiety, but their success is by no means absolute. In the present article, the Corah Dental Anxiety Scale (DAS), the self‐report symptom inventory SCL‐90R and a questionnaire accessing subjects' daydreaming styles (the Short Imaginal Process Inventory) were used to develop possible predictive measures for success and failure of behavior modification as a treatment for dental fear. The patients' level of distractibility and mind wandering, initial dental anxiety and somatization significantly predicted the success of therapy. The odds ratio indicated that the risk of therapy failure increased about 11 times with an increase of one scale of the Poor Attention Control Scale, about three times with an increase of one level of the mean DAS score, and 0.17 times with an increase of one level of somatization. The predictive value of the chosen scales was 80%. Thus, the use of these scales as part of an initial admittance process for patients who suffer from dental anxiety can enhance our ability to better recognize patients who are prone to fail behavior therapy as treatment for their problem, and enable their referral for other possible modes of treatment.
In vivo degradation of resin–dentin bonds produced by a self‐etch vs. a total‐etch adhesive system
Authors: Koshiro K. , Inoue S. , Tanaka T. , Koase K. , Fujita M. , Hashimoto M. , Sano H.
Published: July 2004

The purpose of this study was to evaluate the long‐term durability of in vivo bond strengths and the morphological changes of interfaces between dentin and two adhesive systems. Class V preparations were prepared on the facial surfaces of 14 intact teeth of two monkeys and restored with a combination of Unifil Bond/Z250 or Single Bond/Z250. One year later, 10 additional teeth were restored with the same materials and the monkeys were killed after 24 h. All of the restored teeth were subjected to microtensile bond strength (µTBS) testing. The debonded surfaces of the dentin sides were morphologically observed using Fe‐scanning electron microscopy (SEM), as were the polished cross‐sections of resin–dentin interfaces. For both Unifil Bond and Single Bond, the µTBS at 24 h was significantly higher than that at 1 yr. Fe‐SEM observations of polished cross‐sectioned and fractured surfaces showed that porosity within the hybrid layers produced by Single Bond increased over time. However, the interface produced by Unifil Bond revealed no noticeable changes in morphology between 24‐h and 1‐yr specimens. It is concluded that even though the bond strengths of both adhesive systems declined over time, the bonding interface using self‐etching primers was relatively stable over time compared to the wet bonding system.
The effect of a self‐etching primer on the continuous demineralization of dentin
Authors: Oliveira Sofia S. A. , Marshall Sally J. , Habelitz Stefan , Gansky Stuart A. , Wilson Robert S. , Marshall Grayson W.
Published: July 2004

Self‐etching primers (SEP), used for adhesion of resin restorations, contain an acidic monomer that is not rinsed off after application; therefore, residual acid could further demineralize dentin, jeopardizing adhesion. This study evaluated whether dentin demineralization continues after a 20‐s application of a SEP and also after polymerization of the adhesive. Surface recession was measured, using atomic force microscopy (AFM), between the masked surface and dentin etched with SEP (Clearfil SE Bond) or phosphoric acid (pH 1.94) immediately, 5 min, 2 h or 12 h after application. AFM‐based nanoindentations were performed to determine mechanical property profiles across resin‐bonded interfaces of two sequence groups: SG 1, where the adhesive was applied and polymerized immediately after application of the primer and specimens were immersed in Hank's solution after 5 min, 2 h and 12 h; or SG 2, where specimens were placed in an incubator before the application of the adhesive, for the same time periods. Significant surface recession occurred over time for all groups, except for SEP before desiccation. Nanoindentations yielded decreased hardness and elastic modulus below the hybrid layer after application of the initial primer, even after polymerization of the adhesive. The results reveal a demineralized dentin zone below the hybrid layer formed by the SEP, not fully protected by the adhesive, which could jeopardize bond strength.
Undermining of enamel as a mechanism of abfraction lesion formation: a finite element study
Authors: Rees J. S. , Hammadeh M.
Published: July 2004

Many workers have suggested that abfraction lesion formation is caused by the physical overloading of enamel. However, an alternative mechanism, involving undermining of the cervical enamel along the amelodentinal junction (ADJ), may be a more realistic explanation. The aim of this study was to examine what effect undermining of the buccal cervical enamel would have on the stress distribution in upper teeth. Two‐dimensional plain strain finite element meshes of an upper incisor, canine and first premolar and the supporting periodontal ligament and alveolar bone were developed. Each tooth was loaded with an oblique 100 N load, and the nodal maximum principal stresses (MPS) along a buccal horizontal sampling plane 1.1 mm above the amelo‐cemental junction was measured. A discontinuity between the cervical enamel and dentine elements was then introduced (0.1 mm wide) using gap elements. The vertical extent of this defect varied from 0.1 to 0.5 mm. The value of the MPS varied from 1.8 to 209 Mpa, and the lowest values were found for the intact teeth (range 0.6–30.3 MPa). The discontinuity caused a dramatic increase in the numerical values of the MPS, and in many instances these exceeded the known failure stress for enamel.