Response to Schoen

This article uses data from 190 patient records in 18 dental practices to conduct a shortterm assessment of the effectiveness and costs of the Keyes technique, a nonsurgical method for treating and preventing periodontal disease. The results of this study, based on nonexperimental data, suggest that controlled clinical trials are called for in assessing the long-term effectiveness of the Keyes technique. If clinical trials support the study's short-term results, then the Keyes technique would provide a cost-effective alternative to surgery for the prevention and treatment of periodontal disease.     

MACULAR ELECTRORETINOGRAMS: THEIR ACCURACY, SPECIFICITY AND IMPLEMENTATION FOR CLINICAL USE

The pattern and the focal electroretinogram (ERG) are both non-invasive, electrophysiological responses recorded from circumscribed retinal areas and are most easily recorded from the macula. This paper describes how our department has incorporated these tests into our clinical protocol, shows how the recording technique and the method of electrode construction may be improved, and describes the normal limits of the macular responses we obtain. The ERG signal-noise ratio we obtained was better than that of the binocular visual evoked potentials (VEPs) recorded simultaneously. Pattern and focal ERGs, using improved methods of recording, show promise of being a valuable addition to the clinical investigation of subtle maculopathies and some forms of optic nerve dysfunction. Three illustrative cases are described. The first demonstrates normal macular ERG responses with abnormal Ganzfeld ERGs due to peripheral retinal damage. The second reveals differential pattern ERG reduction with normal focal ERG in recent optic neuritis. The third case demonstrates reversible simultaneous loss of Ganzfeld ERGs and macular ERGs in vitamin A deficiency.     

Renal allografts: evaluation by MR imaging

The value of magnetic resonance (MR) imaging in assessing renal transplants was prospectively studied in 45 patients with 46 allografts. Four allografts were imaged at two different times, and separate diagnoses were given for both examinations. Therefore, this study was based on 50 proved diagnoses: nine normally functioning allografts, four allografts with acute tubular necrosis (ATN), 29 with acute rejection, one with chronic rejection, five with cyclosporin nephrotoxicity, and two with local inflammation secondary to adjacent abscess. Twenty-seven of the allografts had concomitant fluid collections. Normal renal structures with preservation of corticomedullary contrast (CMC) on T1-weighted images were demonstrated in all the normally functioning allografts. Decreased or absent CMC on T1-weighted images, reflecting a long T1 relaxation time for cortex, was found to be the most consistent sign of acute renal allograft rejection (27/29). No abnormalities on on MR images were observed in allografts compromised by cyclosporin nephrotoxicity. Hydronephrosis of the renal allograft was easily diagnosed with MR. Perirenal abscess (three cases) and perirenal hematomas (five cases), because of their higher MR signal intensity on T1-weighted images (TR = 0.5 sec, TE = 28 msec), could be differentiated from clinically insignificant postoperative fluid seromas (seven cases), lymphoceles (11 cases), and urinoma (one case).     

An analysis of worldwide safety experience with auranofin

A total of 3,475 patients with rheumatoid arthritis have received auranofin (AF) during clinical trials in 27 countries. Over a 4-year period, treatment with AF was relatively well tolerated. Most reactions were mild, easily managed and occurred during the first few months of treatment. Gastrointestinal side effects were the most common problems reported with AF followed by mucocutaneous reactions. Less frequently observed were conjunctivitis, proteinuria and, rarely, thrombocytopenia. The percentage of patients withdrawn for adverse effects per patient-year was less with AF when compared to injectable gold (14 vs 40%). These results confirm previous reports of AF safety and improved tolerance versus parenteral gold.     

Possible pathogenesis of swimming sinusitis

To investigate the pathogenesis of swimmer's sinusitis, a group of 20 swimmers and 20 controls were interviewed and examined. Clinical examination was followed by rhinomanometry, sonography of the maxillary sinuses, a saccharin test to assess mucociliary transport in the nose, and a viable cytological sampling of the nasal mucosa. Anamnesis showed a preponderance of symptoms of sinusitis and chronic rhinitis in the swimmer group, as well as a reddening of the nasal mucosa and a swelling of the adenoids. Sonography showed mucosal thickening in the antrum in more cases among the swimmers. Rhinomanometry, the saccharin test, and viable cytological sampling revealed no significant differences between the groups. It is argued that pathogenesis is more probable through cooling of the skin of the face and the whole body than through entrance of water into the upper respiratory tract.     

Impact factors of dermatological journals for 1991 – 2000

Background

The impact factors of scientific journals are interesting but not unproblematic. It is speculated that the number of journals in which citations can be made correlates with the impact factors in any given speciality.

Methods

Using the Journal Citation Report (JCR) for 1997, a bibliometric analysis was made to assess the correlation between the number of journals available in different fields of clinical medicine and the top impact factor. A detailed study was made of dermatological journals listed in the JCR 1991–2000, to assess the relevance of this general survey.

Results

Using the 1997 JCR definitions of speciality journals, a significant linear correlation was found between the number of journals in a given field and the top impact factor of that field (rs = 0.612, p < 0.05). Studying the trend for dermatological journals 1991 to 2000 a similar pattern was found. Significant correlations were also found between total number of journals and mean impact factor (rs = 0.793, p = 0.006), between the total number of journals and the top impact factor (rs = 0.759, p = 0.011) and between the mean and the top impact factor (rs = 0.827, p = 0.003).

Conclusions

The observations suggest that the number of journals available predict the top impact factor. For dermatology journals the top and the mean impact factor are predicted. This is in good agreement with theoretical expectations as more journals make more print-space available for more papers containing citations. It is suggested that new journals in dermatology should be encouraged, as this will most likely increase the impact factor of dermatological journals generally.     

Slow clearance gadolinium-based extracellular and intravascular contrast media for three-dimensional MR angiography

The objective of this study was to assess two new slow-clearance contrast media with extracellular and intravascular distribution for magnetic resonance angiography (MRA). Extracellular Gd-DTPA-BC(2)glucA and intravascular Gd(DO3A)(3)-lys(16) were developed within the European Biomed2 MACE Program and compared with two reference compounds, intravascular CMD-A2-Gd-DOTA and extracellular GdDOTA, in 12 rats. Pre- and post-contrast three-dimensional MR (TR/TE = 5 msec/2.2 msec; isotropic voxel size 0.86 mm(3)) was acquired for 2 hours. Signal-to-noise enhancement (DeltaSNR) was calculated. Two minutes after injection, all contrast media provided strong vascular signal enhancement. The DeltaSNR for Gd-DTPA-BC(2)glucA, Gd(DO3A)(3)-lys(16), CMD-A2-Gd-DOTA, and GdDOTA were 13.0 +/- 1.8, 25.0 +/- 3.2, 25.0 +/- 4.0, and 18.0 +/- 3.4, respectively. Gd-DTPA-BC(2)glucA, Gd(DO3A)(3)-lys(16), and CMD-A2-Gd-DOTA cleared slowly from the circulation, whereas GdDOTA cleared rapidly. Vascular DeltaSNR at 2 hours were 2.9 +/- 0.6, 25.0 +/- 3.2, 25.0 +/- 4.0, and 0.4 +/- 1.0. Gd(DO3A)(3)-lys(16) provided strong vascular and minor background enhancement, and thus may be useful for MRA or perfusion imaging. Gd-DTPA-BC(2)glucA produces persistent enhancement of extracellular water, and thus may allow quantification of extracellular distribution volume and assessment of myocardial viability.     

Paget-Schroetter syndrome in sports activities--case study and literature review

The authors report 7 patients with thromboses in the upper extremity resembling Paget-Schroetter syndrome. According to their case histories, all patients had a temporal and causal relationship between partially unusual sports activities and the genesis of the thrombosis. The cause of this condition is a strain on the subclavian and axillary veins by retroversion or hyperabduction of the arm. This can entail microtraumatizations of the venous intima, consequently leading to a consecutive local activation of coagulation and to a possible thrombosis of the vessel. A mechanical compression of the vein by adjoining bone, ligament, and muscle structures can intensify the effects. Further primary diseases and risk factors as secondary causes for thromboses where taken into consideration when examining the patients. The Paget-Schroetter syndrome should be considered as a possible cause for unspecified trouble in the upper extremity reported by athletes. If such prolapses occur, they can be categorized as accidents by private and statutory insurance companies that cover accidents.