A new simplified approach to the diagnosis of pheochromocytoma.

Blood catecholamine assays have been used for diagnosis and computerized axial tomography for localization of proved pheochromocytomas in a series of 16 patients. Blood catecholamine assays were obtained in 15 of the patients and were significantly elevated in every instance. Successful localization of the tumor was accomplished by excretory urography in only 40 per cent of the cases, by selective angiography in 84 per cent of the cases and by abdominal computerized axial tomography in 84 per cent of the cases studied. In 4 patients preoperative identification and localization of tumor were correctly determined by computerized axial tomography alone. Data in this series suggest that the diagnosis and localization of pheochromocytoma usually can be accomplished by a simple test and body scan. More elaborate and sometimes hazardous studies should be necessary only in exceptional cases, usually with tumors less than 3 cm. in diameter.     

Primary aldosteronism

Primary aldosteronism remains a diagnostic challenge. Despite the availability of sensitive and specific immunoassay techniques, the simplification of diagnostic testing, and the introduction of sensitive imaging techniques, there remain uncertainties about the optimal methods of screening, the sensitivity and specificity of various tests, diagnostic criteria, and differentiation among the growing number of etiologic subgroups of the disorder. The author stresses the differentiation of the surgically correctable lesion (adenoma) from the other etiologic subgroups.     

Fetal ovarian cyst. A report of a case

Fetal ovarian cyst is uncommon; it represents the second place of fetal abdominal tumors, after urinary tract tumors. The cause of fetal ovarian cysts still remains unclear, although it is likely to be promoted by hormones. Its prognosis is usually good. Differential diagnosis should rule out urinary tract malformations. A case of a female newborn with giant fetal ovarian cyst, diagnosed on week 37 of the pregnancy period, treated with exploratory laparotomy and cyst exeresis, with serum cystadenoma histopathology diagnosis is presented.     

The effect of a memory screening program on the early diagnosis of Alzheimer disease

CONTEXT: Alzheimer Disease (AD) is often diagnosed at a moderately advanced stage, even though its early detection has become increasingly important, because of the continuing development of treatments that may improve its outcome. OBJECTIVE: To determine if a free memory screening program is associated with an earlier diagnosis of AD, compared with traditional referral methods, such as by physicians and family members. DESIGN, SETTING, AND PARTICIPANTS: A retrospective study of 1489 consecutive patients with AD who presented to an outpatient memory disorders clinic between 1993 and 2002. Subjects were classified according to referral source (memory screening, physician, family/friend, other), and self-reported ethnicity (white non-Hispanic, white Hispanic). The associations between referral source and the presenting cognitive and behavioral status of subjects were evaluated using analysis of variance and logistic regression analyses, after controlling for potentially confounding factors. MAIN OUTCOME MEASURES: Score on the Folstein Mini-Mental State Examination (MMSE), duration of cognitive symptoms, and presence of psychosis, defined as delusions and/or hallucinations. RESULTS: After controlling for ethnicity, gender, and the year of diagnosis, subjects with AD, who were referred by the memory screening program, scored significantly higher at presentation on the MMSE (20.8 +/- 5.7), than those referred by physicians (18.8 +/- 6.6), family/friends (16.8 +/- 6.6), or other referral sources (15.3 +/- 7.1). Subjects with AD, referred by the memory screening program, also had a lower reported duration of illness at presentation, and a decreased frequency of psychosis compared with those referred by family/friend and other methods. Other factors related to a diagnosis of AD at a later stage included female gender, Hispanic ethnicity, and a diagnosis early in the 1993 to 2002 time period. CONCLUSIONS: The memory screening program referred patients with AD to a memory clinic at an earlier phase of illness compared with traditional methods such as physician referral.     

Thymidylate synthase promoter tandem repeat and MTHFD1 R653Q polymorphisms modulate the risk for migraine conferred by the MTHFR T677 allele

There is growing evidence that folate metabolism is involved in migraine pathophysiology, mainly in migraine with aura. Even though folate metabolism is regulated by a number of enzymes, only two functional polymorphisms have been tested in association studies with migraine. Here, we have explored the possible role in migraine of other folate-metabolizing enzymes which are in close interdependency with 5',10'-methylenetetrahydrofolate reductase analyzing functional polymorphisms of these enzymes in a case-control study. Individually, thymidylate synthase (TS), methenyltetrahydrofolate cyclohydrolase formyltetrahydrofolate synthase (MTHFD1), or methionine synthase (MS) polymorphisms did not modify the general risk for suffering migraine. Nevertheless, we observed a strong interaction between TS and MTHFR mutated genotypes, which increased over 8-fold the risk for experiencing aura among migraineurs; MTHFD1 and MTHFR mutated genotypes also increased together the risk for migraine in general (OR = 3.08; 95% CI = 1.3-7.4). We conclude that the pathogenetic role of the MTHFR T677 allele in migraine is modulated by functional polymorphisms of TS and MTHFD1.     

Influence of a nonrinse conditioner on the bond strength of brackets bonded with a resin adhesive system

The objective of this study was to compare the effect of a nonrinse conditioner (NRC) and the conventional acid-etch technique on the shear bond strength and the adhesive remnant on the tooth after debonding brackets bonded with the resin orthodontic adhesive system Transbond XT. A total of 40 human premolars were divided into group I, phosphoric Acid/Transbond XT (n = 25) and group II, NRC/ Transbond XT (n = 15). Shear bond strength was measured with a universal test machine with a crosshead speed of 1 mm/min. The adhesive remnant was quantified using image analysis equipment. Scanning electron microscope (SEM) observations were also carried out to observe enamel surfaces treated with each product. No significant differences were observed in the bond strengths of the two groups evaluated. The amount of adhesive remnant on the tooth after debonding was significantly less when conditioning the enamel with NRC compared with phosphoric acid. SEM observations showed that the NRC produced a more conservative etch pattern than phosphoric acid.     

A comparison of the shear bond strength of a resin cement and two orthodontic resin adhesive systems

The object of this study was to compare the shear bond strength and the quantity of adhesive remaining on the tooth after the debonding of brackets bonded with two light-cured orthodontic resin adhesive systems (Transbond XT and Light-Bond) and a dual-cured resin cement (RelyX Unicem). Seventy-five premolars were divided into three groups. In each group, brackets were bonded with one of the adhesives according to the manufacturer's instructions. Shear bond strength was measured using a universal test machine at a crosshead speed of one mm/min, and adhesive remnant was quantified using image analysis equipment. Our results showed that the resin cement produced significantly lower bond strength than the two orthodontic resin adhesive systems. It was also observed that the bond strength produced by Light-Bond was significantly greater than that of Transbond XT. RelyX left significantly less remnant adhesive than Transbond XT and Light-Bond. Between the two orthodontic systems, Light-Bond left significantly less adhesive on the tooth than Transbond XT.     

Discrimination of functional capacity for oral hygiene in elderly Spanish people by the Barthel General Index

OBJECTIVES: To explore, among the institutionalized elderly in Spain, the association between functional dependence in manipulating aids used in oral self-care (oral hygiene dependence) and general functional capacities, as measured by the Index of Activities of Daily Oral Hygiene (ADOH) and the Barthel Index (BI), respectively. METHODS: A cross-sectional study was performed in 2002 on 390 Spanish residents of a residential home for the elderly aged, 65-101 years. All study subjects underwent a oral examination and their ADOH and BI scores assessed. The association between the index scores was studied and the discriminant capacity of BI for oral hygiene dependence was calculated. RESULTS: The mean number of decayed, missing, or filled permanent teeth (+/-SD) was 26.6 +/- 7.3. The mean BI score was 68.31 (95% CI 64.35-72.27), and 172 individuals (44.1%; 95% CI 39.2-49.0%) were independent in all BI-measured functions. The mean ADOH score was 2.43 (95% CI 2.11-2.75), and 238 individuals (61.0%; 95% CI 56.2-65.9%) were independent for oral hygiene, 39 (10.0%; 95% CI 7.2-13.4%) required assistance (assistive devices), and 113 (29.0%; 95% CI 24.5-33.5%) were completely dependent. The BI scores were significantly correlated with the ADOH scores (r = -0.80, P < 0.001). The BI showed a high discriminant capacity to identify the individuals who were dependent for oral hygiene in this population (area under the ROC curve +/- SE = 0.929 +/- 0.013). Using the optimal cut-off point according to the Youden Index (<61), the sensitivity was 0.87 +/- 0.03 and specificity 0.87 +/- 0.02. CONCLUSION: There is a close association between BI and ADOH in this population, which could be useful to identify elderly individuals who are dependent for oral hygiene.