Effects of implant healing time on crestal bone loss of a controlled-load dental implant

The universally accepted concept of delay-loaded dental implants has recently been challenged. This study hypothesizes that early loading (decreased implant healing time) leads to increased bone formation and decreased crestal bone loss. We used 17 minipigs to study implants under a controlled load, with non-loaded implants for comparison. Radiographic and histological assessments were made of the osseointegrated bone changes for 3 healing times (between implant insertion and loading), following 5 months of loading. The effect of loading on crestal bone loss depended on the healing time. Early loading preserved the most crestal bone. Delayed loading had significantly more crestal bone loss compared with the non-loaded controls (2.4 mm vs. 0.64 mm; P < 0.05). The histological assessment and biomechanical analyses of the healing bone suggested that loading and bioactivities of osteoblasts exert a synergistic effect on osseointegration that is likely to support the hypothesis that early loading produces more favorable osseointegration.     

Ultraviolet B-induced suppression of immune responses in interleukin-4-/- mice: relationship to dermal mast cells

Ultraviolet B radiation is immunosuppressive by multiple mechanisms. In interleukin-4-/- mice, ultraviolet B radiation was not able to suppress delayed-type hypersensitivity or contact hypersensitivity responses when the sensitizing antigen was applied to nonirradiated sites. In contrast, ultraviolet B significantly suppressed contact hypersensitivity responses to haptens applied to irradiated sites in interleukin-4-/- mice. In mast cell depleted Wf/Wf mice, ultraviolet B radiation also significantly suppressed contact hypersensitivity responses to sensitizing antigens applied to irradiated but not to unirradiated sites. In both interleukin-4-/- mice and Wf/Wf mice, the mast cell product, histamine, was immunosuppressive implicating mast cells as the dysfunctional cell in interleukin-4-/- mice. The prevalence of dermal mast cells was similar in wild-type and interleukin-4-/- mice. Dermal mast cells of interleukin-4-/- mice, however, express very low levels of c-kit and did not significantly degranulate in response to ultraviolet B. Ultraviolet radiation induced significant and similar levels of serum interleukin-10 in wild-type and interleukin-4-/- mice. We conclude that interleukin-4 indirectly affects ultraviolet B suppression of contact hypersensitivity and delayed-type hypersensitivity responses to sensitizing antigens applied at sites other than those irradiated by providing a critical differentiative signal for dermal mast cells. This study further emphasizes the central role of mast cells in the initial processes by which ultraviolet B radiation is immunomodulatory for immune responses to sensitizing antigens applied to nonirradiated sites.     

Chronic subdural hematoma in children

Chronic subdural hematoma (CSH) is generally a disease affecting the elderly and infants. In infants, the process is particularly confusing and frequently misunderstood. In the pediatric population, CSH is just one of a group of sometimes related conditions known as extracerebral fluid collections. In the past, extracerebral fluid collections, in general, and CSHs, in particular, have been inaccurately or incompletely described. Modern neuroimaging techniques, however, have greatly advanced our understanding of these conditions. Surprisingly little literature exists on the subject, and publications before the advent of modern computed tomography and magnetic resonance imaging should be interpreted with caution.     

Long-term results of permanent indwelling wallstents for benign mid-ureteral strictures

BACKGROUND: Benign ureteral strictures are a potentially difficult problem that typically has been solved by open surgery. However, minimally invasive methods would be preferable. PATIENTS AND METHODS: Three patients with benign ureteral strictures were treated with endoscopic placement of self-expanding permanent indwelling stents (Wallstents). The etiologies of the obstruction were multifactorial and included retroperitoneal fibrosis, stones, traumatic ureteroscopy, ureteral ischemia, and previous open surgery. RESULTS: One patient died with a functioning stent 1 year, 7 months after placement. The other two patients are doing well 5 years, 2 months and 5 years, 11 months afterward (mean 51 months). CONCLUSION: Insertion of a permanent indwelling self-expanding ureteral stent is relatively easy, and long-term successes are documented. Placement of Wallstents for benign ureteral strictures should be considered as a treatment alternative.     

Views of the dietetics profession on communication skills for behaviour change in dietetics

Background: There is strong evidence to suggest that the communication skills of the practitioner are an important factor in helping people to change health‐related behaviour (Najavits & Weiss, 1994; Stewart et al., 2003). Despite this, many UK dietitians perceive their pre‐registration training in communication skills to be inadequate (Rapoport & Nicholson Perry, 2000). Many new courses have recently been approved by the Health Professions Council, and the British Dietetic Association (BDA) has recently undertaking a curriculum review for dietetic training. This study aimed to explore the current views of the dietetic profession in relation to their training in this area. Methods: A cross sectional survey was completed in October 2007. All BDA members (n = 6013) were sent a questionnaire to ascertain their views on communication skills for behaviour change in dietetic practice and relevant training. The questionnaire had been piloted on dietetic colleagues and comments received from an expert on communication skills for behaviour change. Approval was obtained from the University of Nottingham Medical School Research Ethics Committee. Results: There were 1158 respondents (19% response rate) of whom 418 (36%) had qualified since 2000. All countries within the UK and a wide variety of specialist areas were represented. Some communication skills training had been completed by 89% of respondents. Communication skills were rated as either ‘very’ or ‘extremely’ important by 96% respondents. There was no difference between those who had qualified before the year 2000 and those who had qualified since. Respondents agreed that implementing communication skills had led to improvements in their relationships with patients (70%), job satisfaction (59%) and confidence in client interviews (69%). However, 21% felt time keeping in client interviews was worse. Time was also identified as a barrier to putting learning into practice (19%). The majority of respondents (89%) felt they would benefit from further training. Discussion: The results must be viewed in light of the relatively low response rate. However, respondents clearly endorsed the importance of good communication skills in practice and had personally experienced positive outcomes because of their use. Despite their positive attitude, the practice of good communication was felt to have had a negative effect on time‐keeping. Unsurprisingly, the majority of participants wanted further training. Conclusions: The negative effect of introducing changes of practice to improve communication skills upon time‐keeping was a major concern for BDA members. Further research and training is required to support the implementation of improved communication skills within the recognized time constraints of dietetic practice. References Najavits, L.M. & Weiss, R.D. (1994) Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review. Addiction 89, 679–688. Rapoport, L. & Nicholson Perry, K. (2000) Do dietitians feel they have had adequate training in behaviour change methods. J. Hum. Nutr. Diet. 13, 287–298. Stewart, M. et al. (2003) Patient centred medicine: Transforming the clinical method, 2nd edn. Oxford: Radcliffe Medical Press.     

Aspergillus endocarditis in chronic granulomatous disease

We report the first case, to our knowledge, of Aspergillus endocarditis in chronic granulomatous disease in a patient who also had an atrial septal defect. A diagnosis was made on culture of the organism from the mass despite extensive prior investigation. The presence of distinctive skin lesions as a diagnostic clue of fungaemia is highlighted. Possible advances in diagnosis by detection of fungal cell wall components and in prophylaxis by use of itraconazole are referred to. We conclude that fungal endocarditis should be considered in this condition, especially in the presence of a structural heart defect.     

Condom practices of urban teens using Norplant contraceptive implants, oral contraceptives, and condoms for contraception

OBJECTIVES: The availability of long-acting hormonal birth control methods has created new contraceptive options for adolescents. The purpose of this study was to determine whether teens initiating these methods use condoms less frequently than teens using oral contraceptive pills or condoms alone and may therefore be at an increased risk of acquiring sexually transmitted infections. STUDY DESIGN: To investigate ongoing condom behavior in teens using levonorgestrel (Norplant) contraceptive implants, oral contraceptives, and condoms alone, we examined data from a 2-year prospective cohort study of 399 urban teens. The study consisted of 3 clinic-based cohorts of adolescent female contraceptive users: Norplant contraceptive implants (n = 200), oral contraceptives (n = 100), and condoms alone (n = 99). Data were collected at an admission interview and at 1- and 2-year follow-up from method continuers. RESULTS: Norplant contraceptive implant users were less likely than oral contraceptive or condom users to report condom use at last sex or consistent condom use at 1- and 2-year follow-up. The implant group showed a significant decrease in condom use from admission to 2 years after method initiation. The proportion of implant users self-reporting new sexually transmitted infections at 2-year follow-up, however, was not significantly greater than that of oral contraceptive or condom users. CONCLUSIONS: Our findings indicate that teen users of Norplant contraceptive implants are less likely to use condoms than teens who choose oral contraceptives but, probably because of differences in sexual behavior, are no more likely to self-report sexually transmitted infections. Our findings also indicate that teens who choose oral contraceptives and condoms do not use them consistently enough to avoid pregnancies or sexually transmitted infections.