Endodontology – epidemiologic considerations

Abstract The limited information available from endodontic epidemiologic research indicates an increase in prevalence of apical periodontitis with increasing age. Furthermore, apical periodontitis seems mainly to be present in connection with already endodontically treated teeth. This finding should be of particular concern since there is a discrepancy between the quality and results of endodontic therapy performed in general practice compared with the results obtained in specialty clinics. Pulpitis and acute apical periodontitis are main reasons for seeking emergency treatment and affect many people. Dental trauma frequently involving the dentin/pulp organ are likewise prevalent, affecting 30% of children and adolescents. Most information available regarding endodontic treatment is derived from well-controlled clinical studies performed by specialists. Epidemiologic data should be considered a necessary complement to this source of knowledge regarding etiologic factors and proper treatment procedures in order to improve the results of endodontic practice.     

Influence of hormone application by subcutaneous injections or steroid-containing silastic implants on human benign hyperplastic prostate tissue transplanted into male nude mice

To study the influence of androgens and estrogens on human benign prostatic hyperplasia (BPH) tissue, BPH fragments were grafted subcutaneously (s.c.) into male nude mice. Testosterone alone (group I) or in combination with 17β-estradiol (group III) were administered either by s.c. injections as oil suspensions or continuously by s.c. implanted steroidcontaining Silastic implants (groups II and IV). Intact mice without transplants and treatment served as a control (group V). After 4 weeks of treatment, animals were exsanguinated, transplants were removed, and serum was obtained. Ninety-six percent of the BPH fragments were located; they displayed histologically typical BPH acini and stroma. In transplants of all treatment groups, the majority of secretory, as well as basal, cells displayed a proliferation comparable to the original tissue. In glandular cells of all transplants, prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) could be demonstrated immunohistochemically. Specimens removed from animals bearing testosterone implants displayed a very well preserved ultrastructure that was found less frequently in samples from injection-treated animals. Acini-bearing metaplastic epithelium were more often present in transplants treated by steroid injections and seemed to be due to lower androgen or higher estrogen serum levels. Endogenous serum testosterone levels (ng/ml ± SD; n) were lower and more variable (i.e., higher standard deviation) in groups treated by injections (group 1: 3.68 ± 2.12; n = 5 and group III: 3.86 ± 1.13; n = 5) and were similar to those seen in intact controls (3.93 ± 1.62; n = 6) compared with groups treated by Silastic implants (group II: 5.11 ± 1.14; n = 10 and group IV: 10.20 ± 0.52; n = 4). These results indicate that by application of steroids via Silastic implants, reproducible hormone effects can be obtained on BPH tissue transplanted into male nude mice, thus providing a reliable new model system for study. © 1993 Wiley-Liss, Inc.     

Handgelenksynovektomie und radiokarpale Stabilisierung durch Sehnentransfer

Summary Goal of Surgery Prevention of ulnar drift after synovectomy and resection of ulnar head through tendon transfer. Indications Chronic rheumatoid arthritis with incipient ulnar drift in stage I to III according to Larsen and al. (1983) [12]. Contraindications Absolute: Advanced destruction of radiocarpal joint. Relative: Marked palmar displacement of carpus. Preoperative Work Up If patient under corticosteroid treatment, continue this medication during surgery (see Tables 1 and 2). Anterior-posterior oblique and lateral radiographs of wrist including distal radius. Positioning and Anaesthesia Patient supine, arm on arm board. Tourniquet. Brachial plexus anaesthesia or general anaesthesia. Surgical Technique Synovectomy of extensor tendons and of radiocarpal, radioulnar and intercarpal joints through a dorsal approach. Division and resection of the interosseous branch of the radial nerve. Resection of ulnar head. Repositioning and stabilization of the extensor carpi ulnaris muscle. Reduction of the carpal bones and looping of the ulnar half of the extensor carpi radialis brevis tendon into the tendon of the extensor carpi ulnaris. Postoperative Management Palmar padded slab, with wrist in neutral position for 10 days. After 2 weeks active exercises of wrist, physiotherapy for approximately 6 weeks. Possible Complications Haematoma. Injury to sensory branch of radial nerve, tendons and/or vessels. Detachment of transferred tendon. Results From 1988 to 1992 64 patients underwent the combined synovectomy with tendon transfer. 59 of which had additionally a resection of the ulnar head. 56 patients could be followed up for an average of 46.8 months (15 to 72 months). All patients suffered from chronic rheumatoid arthritis. All patients had slight limitation of wrist motion, however, the pro- and supination was slightly improved. Pain was either markedly reduced or eliminated. Decrease of swelling and increase of strength in over half of the patients. The radiologic aspect was unchanged in 73%, deteriorated slightly in 25% and markedly in 2% of the patients. Index of ulnar translocation remained generally unchanged. Subjective assessment: 11 patients excellent, 36 good. 7 satisfactory and 2 poor.

Diakoniekrankenhaus Bad Kreuznach (Chefarzt: Dr. H. Thabe)     

Immunocytochemical localization of somatostatin receptor sst2A in the rat spinal cord and dorsal root ganglia

Intrathecal administration of octreotide, a stable somatostatin analogue, provides pain relief in patients, and locally applied somatostatin inhibits firing of nociceptive dorsal horn neurons. In the present study, we have raised polyclonal antibodies that specifically detect the somatostatin receptor sst_2A and used these antisera for immunocytochemical localization of the receptor protein in the rat spinal cord and dorsal root ganglia. In the superficial layers of the dorsal horn, sst_2A-like immunoreactivity (Li) formed a dense network consisting of neuronal perikarya and dendrites which were often closely apposed by, but not co-contained within, somatostatin-14-immunoreactive nerve fibres and terminals. sst_2A-Li was resistant to dorsal rhizotomy and did not colocalize with either substance P or calcitonin gene-related peptide suggesting that sst_2A-Li was not located to primary afferents, but rather confined to second-order spinal neurons. The position of sst_2A-Li perikarya and dendrites in the dorsal horn appeared to be similar to those containing μ-opioid receptor-Li; however, double labelling experiments revealed no instances of coexistence of these two receptors. sst_2A-Li was also observed in the dorsal root ganglia predominantly targeted to the somatic plasmalemma of medium size neurons distinct from those expressing somatostatin-14 or δ-opioid receptors. Thus, the present results not only provide a morphological substrate for spinal octreotide analgesia but also show that somatostatin and opioids are poised to modulate nociceptive transmission by distinct anatomical systems.     

BDNF overexpression induces differential increases among subsets of sympathetic innervation in murine back skin

Besides their recognized dependence on nerve growth factor (NGF) during development, the dependence of mature sympathetic ganglion neurons on other neurotrophins is still unclear. Here, we have investigated the sympathetic innervation of back skin in mice overexpressing brain‐derived neurotrophic factor (BDNF) under the alpha‐myosin heavy‐chain promoter, as well as in BDNF knockout (–/–) mice. Compared with wild‐type controls, the dorsal skin of BDNF overexpressing mice displayed a significantly enhanced number of adrenergic, tyrosine hydroxylase‐immunoreactive (IR) nerve fibres, while cholinergic or peptidergic sensory nerve fibres appeared unaltered. The adrenergic hyperinnervation in dorsal skin of BDNF overexpressing mice was most pronounced in the arrector pili muscle of hair follicles, while no increase of tyrosine hydroxylase‐or neuropeptide Y‐IR fibres associated with subcutaneous blood vessels was found. Instead, back skin of BDNF knockout (–/–) mice contained significantly fewer tyrosine hydroxylase‐IR dermal nerve fibres than wild‐type animals. This suggests that BDNF plays an important role in the control of different subsets of adrenergic innervation in murine back skin, and indicates that paravertebral sympathetic ganglia display a previously unrecognized differential BDNF‐dependence in vivo.     

Male breast cancer: Austrian experience

Data were collected on 169 men treated for breast cancer at 36 surgical departments in Austria between 1970 and 1991. We report here several of their clinical features and assess the importance of established prognostic factors. After a median observation period of 51 months 60 patients (35%) suffered a recurrence. The estimated 5-year recurrence-free survival for the entire group was 55%, and the estimated 5-year overall survival was 62%. Although stage-adjusted data are comparable to those for female breast cancer, the outcome in this series may be attributed to a relatively high frequency of advanced tumor stages. Tumor size (recurrence-free survival p=0.00001; overall survival p=0.03) and axillary lymph node status (recurrence-free survival p=0.0001; overall survival p=0.0001) proved to have a prognostic impact. Using a multivariate analysis, axillary lymph node status (recurrence-free survival p=0.001; overall survival p=0.01) still had prognostic influence. The various procedures used had no effect on local recurrence.

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Resumen Se recolectaron datos en 169 hombres tratados por cáncer mamario en 16 departamentos quirúrgicos de Austria en el período 1970 a 1991. En el presente estudio reportamos diferentes características clínicas y tratamos de definir la importancia de factores establecidos de pronóstico. Luego de un período promedio de observación de 51 meses, se observó recurrencia en 60 pacientes (35%). La tasa estimada de sobrevida libre de enfermedad recurrente para la totalidad del grupo fue 55% y la tasa estimada de sobrevida global a 5 años fue 62%. En tanto que la estadificación de los datos es comparable a la de las mujeres con cáncer mamario, el resultado final en esta serie puede ser atribuido a una frecuencia relativamente alta de tumor en estados avanzados. El tamaño del tumor (sobrevida libre de recurrencia p=0.0001; sobrevida global p=0.03) y estado de los ganglios axilares (sobrevida libre de recurrencia p=0.00001; sobrevida global p=0.0001) demostró tener impacto en cuanto al pronós neo. En el análisis multivariable, el estado de los ganglios linfáticos axilares (sobrevida libre de recurrencia p=0.0001; sobrevida global p=0.01) retuvo su influencia pronóstica. Los diferentes procedimientos operatorios de tratamiento local no demostraron efecto en cuanto a la recurrencia local.

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Résumé On a analysé les dossiers de 169 hommes traités pour un cancer du sein dans 36 centres chirurgicaux en Autriche entre 1970 et 1991. Les données cliniques ont été analysés et des facteurs pronostiques établis. Après une période d'observation médiane de 51 mois, 60 patients (35%) avaient une récidive. La survie à 5 ans sans maladie a été évaluée à 55% pour le groupe entier, alors que la survie à 5 ans globale a été de 62%. Lorsqu'on a comparé ces cas à des cancers de sein chez la femme, on s'est rendu compte que l'évolution dans cette série était peut-être en rapport avec un nombre plus important de stades avancés de patients avec cancer. On a démontré que la taille de la tumeur (survie sans récidive; p =0.0001; survie globale p=0.03) et l'état des ganglions axillaires (survie sans récidive p=0,00001, survie globale p=0,0001) avaient une valeur pronostique. En analyse multifactorielle, l'état ganglionnaire axillaire était toujours considéré comme facteur pronostique (survie sans récidive p=0.0001; survie globale p=0.01). Les interventions locales n'avaient aucune influence pronostique sur les récidives locales.