Three-year prospective study of developmental dysplasia of the hip at birth: should all dislocated or dislocatable hips be treated?

This article presents a 3-year prospective study that includes 103 consecutive patients (137 hips) diagnosed with developmental dysplasia of the hip (DDH) at birth. Treatment was started after 2 weeks only if the hips had not stabilized spontaneously. Sonographic studies were first used when clinical stability was confirmed to ensure a true concentric hip reduction. The authors conclude that most patients with DDH at birth (73.8%) do not need treatment at that time, presenting with normal hips at the end of follow-up. When instability was still present after 2 weeks and a splint was applied (26.2%), there were no significant hip differences when compared with a control group of 50 patients (69 hips) who underwent treatment in the first days of life. With this approach, the authors could safely reduce the number of patients to be treated, the amount of sonographic studies, and consequently the final cost of the whole treatment.     

Scavengers protection of cells against ALA-based photodynamic therapy-induced damage

. The exogenously stimulated formation of intracellularly generated protoporphyrin IX, a precursor of haem, is becoming one of the fastest developing areas in the field of photodynamic therapy (PDT). We tested the action of several free radical scavengers, amino acids, antioxidants and sulphur-containing compounds as protectors from photodamage induced by 5-aminolaevulinic acid (ALA)-mediated PDT, employing the LM2 cell line, derived from a mammary murine adenocarcinoma. We exposed the cells to different concentrations of the compounds, 24 h before PDT, during PDT, and 19 h after treatment. We defined the protection grade (PG) as the ratio between cell survival after ALA-PDT treatment in the presence of the protector and cell survival of ALA-PDT treatment alone. We found thatl -tryptophan (PG=9.2 at 2 mm ), reduced glutathione (GSH) (PG=5.8 at 0.8 mm ), N-acetyl-l -cysteine (PG=4.86 at 30 mm ), melatonin (PG=4.5 at 8 mm ) andl -methionine (PG=4.0 at 0.8 mm ) are the best protectors from PDT damage, followed byl -cysteine (PG=2.8 at 0.8 mm ), mannitol (PG=2.6 at 20 mm ) and glycine (PG=2.4 at 40 mm ) whereas oxidised glutathione and S-adenosyl-l -methionine do not exert any protection. We did not found any photoactive action of the protectors in absence of ALA. These results can be considered to modulate the photodamage induced by ALA-PDT. Paper received 24 October 2001; accepted after revision 5 May 2002. Correspondence to: Professor A. Batlle, Viamonte 1881 10A, 1056 Buenos Aires, Argentina. Fax: 54 11 4811 7447; e-mail: batlle@mail.retina.ar     

Avulsions and intrusions: the controversial displacement injuries

Avulsions and intrusions are the most complicated and controversial displacement injuries of permanent teeth. Clinical guidelines published by authorities such as the American Association of Endodontists, the Royal College of Surgeons of England and the International Association of Dental Traumatology are inconsistent. While a certain amount of inconsistency might be expected, some of these guidelines recommend treatments that are experimental or have not incorporated research information from the past 5 years, and in one case the guidelines incorrectly describe the nature of Hank's balanced salt solution. Recent laboratory studies support previous clinical outcome studies in emphasizing that only for teeth replanted within 5 minutes of avulsion is there a chance of regeneration of the periodontal ligament and normal function. Teeth replanted beyond 5 minutes will take another path, that of repair followed by root resorption, ankylosis and eventual extraction. Dentists should explain these outcomes at the time of the replantation decision. Severe intrusions also have predictable outcomes. Teeth intruded beyond 6 mm cannot regenerate a functional periodontal ligament and so are prone to root resorption and eventual extraction as well. In this situation the decision is one of immediate extraction or repositioning, with the understanding that it is inevitable that the tooth will eventually be extracted. Authoritative clinical guidelines available on the Internet provide the clinician with useful outlines for treatment. However, individual inconsistencies stimulate academic controversies and, in some cases, clinical misdirection.     

Impact of neoadjuvant hormonal therapy on dose-volume histograms in patients with localized prostate cancer under radical radiation therapy

Introduction Prostate volume involves a defined toxicity predictor in the radiation therapy of localized prostate cancer. Neoadjuvant hormone therapy (nHT) can reduce prostate volume and, therefore, the planned volume. The objective of this study was to establish if the value of nHT reduces the planned volume and if this reduction correlates with a reduction of the dose received in the target organs. Material and methods 28 patients diagnosed of localized prostate cancer and referred to our departments for radiation therapy with radical intention, in the period ranging between April 2002 and October 2003, were included prospectively. The patients received nHT (triptorelin+flutamide) for 2 months and adjuvant HT until completing 2 years in the high-risk cases. A transrectal ultrasound study was performed in all patients, simulation CT and planning before the start of HT and after 2 months of treatment. The radiation therapy was carried out with 6 or 18 MV LINAC photons, with a dose fractioning scheme of 5×180–200 cGy, a total dosage of 66–72 Gy to prostate, 56 Gy to seminal vesicles and, in the high-risk cases, 46 Gy to pelvic lymph nodes. Results The distribution according to risk group was: low risk 3.6%, intermediate risk 28.6% and high risk 67.9%. By transrectal ultrasound, prostate volume on diagnosis was 50.65 cc pre HT and 38.97 cc post HT (p<0.001), which means a volume reduction of 24%. The comparative analysis of the dose-volume histograms of the first versus the second CT shows a reduction in the planned volume GTV1 (prostate) (81.33 cc vs 63.96 cc, p<0.05), PTV1 (prostate and margin) (197.51 cc vs 168.38 cc, p<0.001) and PTV2 (prostate, vesicles and margin) (340.5 cc vs 307.26 cc, p<0.05), a reduction of the maximum dose in the seminal vesicles (70.2 versus 68.75 Gy, p<0.05), a reduction of the mean dose in the seminal vesicles (65.07 Gy versus 63.07 Gy, p<0.05), PTV2 (67.72 Gy versus 66.9 Gy, p<0.01) and PTV3 (prostate, vesicles, pelvic lymph nodes and margin) (58.86 Gy versus 57.21 Gy, p<0.01), a reduction of the D90 in the seminal vesicles (61.83 Gy versus 60.06 Gy, p<0.05) and PTV2 (61.04 Gy versus 59.45 Gy, p<0.05) and a reduction of V60 of the rectum (32.45% versus 28.22%, p<0.05) and V60 of the bladder (41.78% versus 31.67%, p<0.005). Conclusions Neoadjuvant hormone therapy reduces significantly prostate volume and as a result the planned volume and consequently the rectal and bladder V60 can be significantly reduced.     

The novel type B MAO inhibitor PF9601N enhances the duration of L-DOPA-induced contralateral turning in 6-hydroxydopamine lesioned rats

Summary. The present study examined the effect of the highly potent and selective MAO B inhibitor PF9601N on L-DOPA-induced rotational behavior in unilateral nigrostriatal 6-hydroxydopamine lesioned rats. Three doses of PF9601N (20, 40 and 60 mg/kg) were administered 30 min before an injection of L-DOPA (25 mg/kg), and both contralateral and ipsilateral rotational behavior was measured. In addition, we also studied the effect produced by another MAO B inhibitor, deprenyl (20 mg/kg), the MAO A inhibitor, clorgyline (20 mg/kg), and the dopamine reuptake inhibitor, GBR2909 (7.5 mg/kg) on L-DOPA-induced rotational behavior. The results showed that PF9601N plus L-DOPA significantly enhanced the duration of contralateral rotational behavior with respect to L-DOPA plus vehicle in a dose-related manner. At the dose of 40 and 60 mg/kg, PF9601N produced significantly more overall contralateral turning than L-DOPA plus vehicle, and at the dose of 60 mg/kg, PF9601N produced significantly more turning behavior than L-DOPA plus deprenyl. These results suggest that PF9601N may be used as a novel tool in the treatment of Parkinson's disease. Received March 18, 1999; accepted September 23, 1999     

Acoustic analysis after radiotherapy in T1 vocal cord carcinoma: a new approach to the analysis of voice quality

PURPOSE: The study of acoustic voice parameters (fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio) in extended vowel production, oral reading of a standard paragraph, spontaneous speech and a song in irradiated patients for Tis-T1 vocal cord carcinoma. METHODS AND MATERIALS: Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 nonirradiated subjects of the same age were included in a study of acoustic voice analysis. The control group had been rigorously selected for voice quality and the irradiated group had previous history of smoking in two-thirds of the cases and a vocal cord biopsy. Radiotherapy patients were treated with a 6MV Linac receiving a total dose of 66 Gy, 2 Gy/day, with median treatment areas of 28 cm(2). Acoustic voice analysis was performed 1 year after radiotherapy, the voice of patients in extended vowel production, oral reading of a standard paragraph, spontaneous speech, and in a song was tape registered and analyzed by a Kay Elemetric's Computerized Speech Lab (model CSL# 4300). Fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio were obtained in each case. Mann Whitney analysis was used for statistical tests. RESULTS: The irradiated group presented higher values of fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio. Mann-Whitney analysis showed significant differences for fundamental frequency and jitter in vowel production, oral reading, spontaneous speech, and song. Shimmer only showed differences in vowel production and harmonics-to-noise ratio in oral reading and song. CONCLUSIONS: In our study only fundamental frequency and jitter showed significant increased values to the control group in all the acoustic situations. Sustained vowel production showed the worst values of the acoustic parameters in comparison with the other acoustic situations. This study seems to suggest that more work should be done in this field.