High ovulatory rates with use of troglitazone in clomiphene-resistant women with polycystic ovary syndrome.

This preliminary report reviews our experience with 18 infertile patients with clomiphene-resistant polycystic ovary syndrome (PCOS). In the first treatment cycle, troglitazone was administered alone. During cycles 2-5, clomiphene was added with increments of 50 mg (up to 200 mg/day) if the previous cycle was anovulatory. Basal body temperature charts and serum progesterone were obtained to confirm ovulation. In a total of 66 treatment cycles, ovulation occurred in 44 (67%) and pregnancy in seven (11%). There were no significant changes in body weight, waist:hip ratio or liver enzymes during treatment. Troglitazone, alone or with clomiphene, induced ovulation in 15 of 18 patients (83%) and seven (39%) of them achieved pregnancy. This is the first report on ovulatory rates in clomiphene-resistant women with PCOS when troglitazone was used alone or with clomiphene. Recently, metformin and clomiphene were successfully used in women with PCOS. However, our patients represent a more resistant population of women with PCOS, with each patient serving as her own historical control by previous resistance to clomiphene. Although the pregnancy rate (39%) was promising for clomiphene-resistant women with polycystic ovary syndrome, it does not seem to have a definite advantage over gonadotrophins.     

Nerve-sparing radical hysterectomy for cervical carcinoma

With the concept of the improvement of quality of life in the field of surgical oncology, recent studies have questioned the place of radical hysterectomy (RH) in the treatment of cervical carcinoma due to a high rate of long-term postoperative complications involving the pelvic autonomic nerve system. It has been demonstrated that RH frequently causes bladder dysfunction, anorectal mobility disorders, and sexual dissatisfaction in cervical cancer survivors due to surgical trauma involving the sympathetic and parasympathetic branches of the autonomous innervation of the pelvic organs. Nerve-sparing RH was first pioneered by Takashi Kobayashi in Japan and then other Japanese gynecologic surgeons introduced and improved this concept to Western countries. However, nerve-sparing RH has only become popular among gynecologic surgeons during the last two decades. Recently, European gynecologic surgeons modified this concept. Herein, a review of the evolution of nerve-sparing RH, a quick overview of long-term pelvic organ dysfunctions associated with RH, and the technical details of different authors and their oncological outcomes are presented. Today, the lack of randomized studies comparing the effectiveness and complications of RH with nerve-sparing RH is an important barrier to the widespread use of this concept. Nonetheless, while nerve-sparing RH still awaits prospective randomized trials in order to prove that its effectiveness is equal to or greater than that of conventional treatment modalities, and that is has fewer long-term complications, this surgical approach remains attractive for the patients and gynecologic oncologists based on the published results.     

Physical Functionality and Self-Rated Health Status of Adult Patients With Knee Osteoarthritis Presenting in a Primary Care Clinic

Background

Knee osteoarthritis is a chronic medical condition of public health importance in Nigeria which causes disability and impacts daily activities in the sufferers. This study aimed to describe the physical functionality and self-rated health status of adult patients with clinical knee osteoarthritis presenting at the Family Medicine Department, University College Hospital, Ibadan, Nigeria.

Methods

This was a cross-sectional study of 400 respondents. Knee osteoarthritis was diagnosed clinically using the criteria of the American College of Rheumatology. Morbidities, self-rated health status and physical functionality of the respondents were also assessed.

Results

Knee osteoarthritis was diagnosed in 46(11.5%) respondents. Respondents with knee osteoarthritis significantly rated their health worse than those without knee osteoarthritis (p <0.0001). Experience of pain, stiffness and performance of daily activities were significantly worse among respondents with knee osteoarthritis. Those who had knee osteoarthritis had significantly higher waist (p <0.0001), hip (p <0.0001) and knee circumferences (p <0.0001) respectively. Logistic regression analysis showed increasing age (OR=1.103; 95% CI=1.022 – 1.191), self-rated health worse than six months ago (OR=12.562; 95% CI=1.178–125.243), experience of stiffness after waking up in the morning (OR=12.758; 95% CI=3.572–45.569), stiffness after sitting/lying down/resting (OR=21.517; 95% CI=2.213–209.220) and waist circumference (OR=1.225;95% CI=1.017–1.477) to be the most significantly associated with knee osteoarthritis.

Conclusion

Knee osteoarthritis significantly impairs the health and daily activities of adult patients in Ibadan, Nigeria. Healthcare workers need to screen adult patients routinely at first-contact to detect knee osteoarthritis clinically early and manage appropriately.     

Correlation between functional assessment staging and the 'Basic Age' by the Binet scale supports the retrogenesis model of Alzheimer's disease: a preliminary study

Background: In the progression of their disease, Alzheimer's disease (AD) patients have been observed to demonstrate various clinical features reminiscent of children. Based on behavioral, neurological and neuropathological findings, Reisberg et al. noted the relationships between development and dementia and proposed the ‘retrogenesis’ model. Methods: The functional assessment staging procedure (FAST) was used for assessment of functional ability, and the Tanaka–Binet intelligence scale (TB scale) was used to assess intellectual ability in 24 patients with moderate to severe AD. Results: Overall, there was a significant Spearman's correlation between the FAST stage and the basic age (BA) value (r = ?0.85, P < 0.01). The BA by the TB scale was significantly different between FAST stages 5 and 6 to 7. The mean (standard error [SE]) BA values of FAST stages 5 and 6 were 4.2 (0.9) and 2.3 (0.7), respectively, the latter being significantly lower than the former (F = 10.2, P < 0.01 one‐way anova ). The TB scale could not assess the BA of the FAST stage 7 patients because of floor effects. Conclusion: Although further investigation using larger samples would be needed, the findings support the general concordance of intellectual and functional decline in AD with the converse developmental acquisition of the same capacities, as hypothesized in the retrogenesis model.     

不同焦虑水平的操作员在有目的竞争活动中的心理生理参数

研究并讨论了在模拟状态下飞行员的心理－生理活动的焦虑水平。焦虑指的是一种特定的性格状态，从事危险职业的人由于经常性地受到紧张因素的影响，会产生长期的或暂时的焦虑。研究结果表明，当选拔在复杂环境条件下工作的操作者时，应优先考虑低焦虑水平的人；而当小组共同完成任务时，应着重考虑焦虑水平相当的人。     

Prevalence of dental caries and tooth wear in a Byzantine population (13th c. A.D.) from northwest Turkey

Dental caries and wear are important conditions to record in archaeological collections. Reconstruction of the life of ancient peoples can be accomplished by studying their dental remains. The aim of the present paper was to determine the frequency, distribution, and characteristics of dental caries, dental wear and related diet in the mediaeval Byzantine population of Iznik in northwest Turkey. The analysed sample consisted of the dental remains of 56 individuals with the total of 280 teeth. The majority (261 or 93.2%) of the teeth belonged to the permanent dentition. The frequency of antemortem tooth loss in the sample was 6.5% and the frequency of caries was 6.8%. The most frequent recorded caries were mesial (3.3%), followed by buccal (3%). The frequency of dental wear was rather high (84.2%) exhibiting presence of dentin clusters mostly. This finding is consistent with the hypothesis of caries attrition competition based on the assumption that a beneficial effect of tooth wear is to avoid development of caries. High wear in the archaeological population can be linked to the fact that the cumulative effects of attrition as a result of the Byzantine diet.     

Effect of chewing gums containing xylitol or probiotic bacteria on salivary mutans streptococci and lactobacilli

The aim was to evaluate the effect of xylitol and probiotic chewing gums on salivary mutans streptococci (MS) and lactobacilli (LB). The material consisted of 80 healthy young adults (21–24 years) who volunteered after informed consent. They were assigned by random into one of four parallel study groups: A, probiotic gum group; B, xylitol gum group; C, probiotic + xylitol gum group; and D, placebo gum group. The gums were taken three times daily after meals, and the intervention period was 3 weeks. The probiotic gums contained two strains of Lactobacilli reuteri (ATCC 55730 at a dose of 1 × 10⁸ CFU/gum and ATCC PTA 5289 at a dose of 1 × 10⁸ CFU/gum), and each pellet of the xylitol gum contained ≈1.0 g xylitol as single sweetener. Pretreatment and posttreatment samples of stimulated whole saliva were collected and quantified for MS and LB with chair-side kits. A statistically significant reduction (p < 0.05) of salivary MS was displayed in group A and B after the intervention when compared with baseline. A similar but nonsignificant tendency was seen in group C. No alterations of salivary LB was demonstrated in any group. In conclusion, daily chewing on gums containing probiotic bacteria or xylitol reduced the levels of salivary MS in a significant way. However, a combination of probiotic and xylitol gums did not seem to enhance this effect.     

Use of Pre-Injection Diffusion of Local Anaesthetic as a Means of Reducing Needle Penetration Discomfort

Aim

To determine if pre-injection diffusion of local anaesthetic solution influences the discomfort of needle penetration in the palate.

Methods

A placebo-controlled, randomised, double-blind split-mouth investigation was conducted. 25 healthy adult volunteers were recruited and each received two needle penetrations in a random order during one visit. The penetration sites were 1 cm from the gingival margin of the first maxillary premolars on each side of the mouth. 30 gauge-13 mm needles which were attached to syringes that contained either 2% lidocaine with 0.125mg/ml epinephrine or physiological saline were used. For each penetration an operator encouraged a drop of solution to appear at the end of the needle and placed this drop with the bevel of the needle flat on the palate for 20 seconds. The discomfort was noted on a 100 mm visual analogue scale with end points marked “No pain” and “Unbearable pain”.

Results

There was no significant difference in penetration discomfort between solutions, (mean VAS = 26.80±19.36mm for lidocaine and 26.20±18.39mm for saline) however the 2nd penetration was significantly more uncomfortable than the first (mean VAS = 31.00±19.84 mm and 22.00±16.65 mm respectively).

Conclusion

Pre-injection diffusion of local anaesthetic solution did not influence the discomfort of needle penetration in the palate.Key words: diffusion, pre-injection, local anaesthesia, pain     

Four year Evaluation of Proximal Resin Infiltration in Adolescents

Aim

Resin infiltration of proximal lesions is a new approach to stopping caries progression. Therefore, the aim of the present study was to evaluate four-year efficacy of proximal infiltrates in adolescents.

Materials and methods

In ten adolescents, a total of 21 proximal infiltrates (ICON® (DMG, Germany) were applied to initial proximal lesions of permanent incisors and premolars according to the manufacturer’s instruction. The clinical quality of resin infiltration was assessed at 1 week, 1, 2, 3 and 4 years after the treatment and the evaluation of the therapeutic effect was analyzed by radiographs.

Results

Ten patients were followed up clinically for four years. The majority of the infiltrated lesions were located on permanent incisors. Teeth which were proximally infiltrated did not exhibit dental plaque and gingival bleeding in most cases. At annual recalls, plaque scores remained constant. The gingival status remained steady and no differences in tooth shape and contour were detected. Discoloration was detected in four teeth (19%) in 1st year recall and was constant at annual intervals. The radiographic evaluation of the bitewing radiographs showed no progression in 21 lesions (100%) from baseline to the 4-year recall. Overall oral hygiene of the patients was satisfactory.

Conclusion

In conclusion, proximal infiltration is an effective prophylactic measure in adolescents.Key words: dental caries, resin infiltration, proximal caries