Peer approaches for increasing HIV awareness on a college campus

PURPOSE: To compare the accuracy of clinical examination performed with bitewing radiographs or clinical examination using tooth separation to identify carious lesion activity. MATERIALS AND METHODS: 320 surfaces from 40 bitewing radiographs were examined for approximal caries on the maxillary and mandibular primary molars of 20 patients 3-10 years old. The patients were divided into three groups: (1) Absence of the permanent first molar; (2) Partial eruption of the permanent first molar; and (3) Full eruption of the permanent first molar. Two examiners evaluated the radiographs using a megascope, a magnifying glass (x2), and an amplifying image screen. Approximal radiolucencies were identified on 72 surfaces. Following the radiographic examinations, the two examiners performed conventional clinical inspection using a No. 4 dental mirror, a No. 5 dental explorer, and an air-water syringe, with artificial light and relative isolation. The separation method was performed with elastic bands, which were removed after 24 hours, and the clinical examination conducted as in the non-separation group. RESULTS: The correlation between the extension of interproximal radiolucent lesions in primary dentition and their clinical diagnoses following separation of the teeth, was similar to findings on literature evaluating the permanent dentition. On radiographic findings for enamel lesions, white spots predominated both in the inner (100%) and in the outer (94%) half of enamel upon clinical examination with separation of teeth. For radiolucent lesions in dentin, on the other hand, cavities predominated over white spot lesions (84%). In Groups 1 and 2 (young primary), white spots occurred in cases where the radiolucent lesions reached the dentin (15% and 25%), similar to findings for young permanent teeth. Clinical diagnosis performed with the mechanical separation of teeth cannot be considered conclusive for the primary dentition.     

The use of bitewing radiographs in the management of dental caries: scientific and practical considerations

The objective of this paper is to synthesize published research on the use of radiographs in caries diagnosis in order to produce recommendations for guidelines that are clinically oriented but scientifically based. The options available include the use of various types of radiographic examination alone or in conjunction with other diagnostic aids. The outcomes should facilitate the optimal management of lesions as either preventive care advised (PCA) or operative care advised (OCA). Small initial lesions (PCA) require prompt detection, the application of appropriate preventive care and subsequent monitoring to maintain the most favourable tooth state achievable in the long term. Larger dentinal lesions (OCA) also require prompt detection so that appropriate high-quality operative care can be provided before further loss of tooth substance. Evidence was collected from the literature by updating several recent reviews by the author. The values employed were broadly analogous to those of the Canadian Task Force on the Periodic Health Examination. The use of ionizing radiation is always associated with a degree of risk: therefore all exposures must be kept as low as is reasonably achievable. Present evidence on the balance of risk and benefit indicates that the diagnostic yield for caries diagnosis is high enough to justify individualized examinations, particularly as changes in the morphology of caries have rendered clinical diagnosis of dentinal lesions less sensitive. This issue must be kept under review as alternative diagnostic technologies develop. There is good evidence that initial posterior bitewing radiographs are required for all new dentate patients over five years of age with posterior teeth. This procedure is required as an adjunct to clinical examination for the detection of caries on both the approximal and occlusal surfaces of the teeth. Although a 'blanket' regimen of routine radiographic examination at fixed intervals cannot be advocated, individualized bitewing examinations at varying frequencies determined on the basis of caries risk are supported. At the initial visit, an assessment of caries risk of the individual patient should be made. Varying intervals of first radiographic recall can then be suggested on the basis of differing degrees of risk. At present, risk assessment is imprecise, and risk status may change over time. Therefore, intervals between subsequent radiographic examinations must be re-assessed for each period. The purpose of detecting individual lesions should be to facilitate the planning of appropriate preventive treatment decisions based on lesion severity, caries risk and the patient. Different treatment should be employed for lesions in the PCA and OCA categories. Further rigorous studies are required to evaluate diagnostic methods appropriate for use in individual patient care, epidemiology and clinical research, and to increase the understanding of how findings from these applications inter-relate. Development and validation of reliable methods of caries risk assessment which are usable in general practice is a priority. Investigations of the processes involved in, and the outcomes of, dental decision-making are required to ensure that existing and new methods are used appropriately. Further work should develop and evaluate effective mechanisms of disseminating and implementing research findings by information transfer to dental educators and clinicians.     

Emerging infectious diseases--South Africa

OBJECTIVE: To determine prevalence of heartworm infection in a population of pet cats with cardiorespiratory abnormalities and to determine relative usefulness of clinical signs and tests in diagnosis of heartworm disease. DESIGN: Prospective case series. ANIMALS: 100 client-owned cats with clinical signs of cardiorespiratory abnormalities. PROCEDURE: Cats were evaluated using CBC, modified Knott test, ELISA for serologic detection of heartworm antigen and antibodies to heartworms, thoracic radiography, and echocardiography. Cats were considered infected if they had circulating microfilaria, heartworm antigens in serum, or if heartworms were detected by echocardiography or on necropsy. Cats were considered suspicious for infection if they had 2 of the following: serum antibodies to heartworms, eosinophilia or basophilia, or indicative radiographic findings. RESULTS: 9 cats were infected with heartworms, resulting in a prevalence of 9%; 26 cats had evidence of heartworm exposure (i.e., serum antibodies to heartworms). Twenty cats were considered suspicious for heartworm infection. Some outdoor exposure was reported twice as often in heartworm-infected cats, compared with noninfected and suspicious cats. However, a third of infected cats were reportedly housed totally indoors. Cough and dyspnea were strong indicators of heartworm disease. Eight of 9 infected cats had serum antibodies to heartworms and heartworm antigen in serum. Thoracic radiography and echocardiography indicated heartworm infection in 6 and 7 of the 9 cats, respectively. CLINICAL IMPLICATIONS: Cough or dyspnea may indicate heartworm disease in cats; serologic tests, echocardiography, and radiography are most useful diagnostic procedures. Although living indoors is protective, it may not preclude heartworm infection in cats.     

Predictive value of specimen radiography for core needle biopsy of noncalcified breast masses

OBJECTIVE: Our objective was to determine the predictive value of specimen radiography for large core (14-gauge) needle biopsy of noncalcified breast masses. SUBJECTS AND METHODS: Eighty-four biopsies of 83 breast masses yielded 403 specimens. Specimens showing dense material on specimen radiography were predicted to be diagnostic; specimens showing intermediate- or low-density material were predicted to be nondiagnostic. Specimen radiographic and histopathologic findings were correlated for each specimen using vital dyes to mark individual specimens. RESULTS: Of the 403 specimens, 307 (76%) contained diagnostic material representative of the lesion, with a specific diagnosis achieved for 82 (99%) of 83 lesions (62 benign, 20 malignant). Of the 293 passes containing dense material, 268 (91%) proved to be diagnostic; 11 (18%) of 62 specimens containing only low-density material proved to be diagnostic. Of the 25 (9%) of 293 specimens containing radiographically dense but nondiagnostic material, 18 (72%) showed focal fibrosis and had missed the lesion; 15 (83%) of 18 such specimens were obtained in dense parenchyma. The positive predictive value of specimen radiography was 13 (100%) of 13 in fatty breasts; 77 (96%) of 80 in breasts with minimal scattered fibroglandular elements; 91 (94%) of 97 in heterogeneously dense breasts; and 35 (70%) of 50 in breasts with extremely dense parenchyma. Of the 16 lesions sampled stereotactically, specimen radiography helped assess the inadequacy of initial sampling in three (19%). In six (9%) of 68 sonographically guided biopsies, only one or two specimens could be obtained; specimen radiography helped us predict whether material was adequate for diagnosis. CONCLUSION: Radiography of core specimens obtained from noncalcified breast masses accurately reveals the adequacy of sampling unless the breast parenchyma is extremely dense. Such immediate assessment can help ensure adequate material from lesions that are difficult to biopsy and can thereby improve the diagnostic yield of large core needle breast biopsy.     

Primary-care-based randomised placebo-controlled trial of antibiotic treatment in acute maxillary sinusitis

BACKGROUND: The value of antibiotics in acute rhinosinusitis is uncertain. Although maxillary sinusitis is commonly diagnosed and treated in general practice, no effectiveness studies have been done on unselected primary-care patients. We used a randomised, placebo-controlled design to test the hypothesis that there would be an improvement associated with amoxycillin treatment for acute maxillary sinusitis patients presenting to general practice. METHODS: Adult patients with suspected acute maxillary sinusitis were referred by general practitioners for radiographs of the maxillary sinus. Those with radiographic abnormalities (n = 214) were randomly assigned treatment with amoxycillin (750 mg three times daily for 7 days; n = 108) or placebo (n = 106). Clinical course was assessed after 1 week and 2 weeks, and reported relapses and complications were recorded during the following year. FINDINGS: After 2 weeks, symptoms had improved substantially or disappeared in 83% of patients in the study group and 77% of patients taking placebo. Amoxycillin did not influence the clinical course of maxillary sinusitis nor the frequency of relapses during the 1-year follow-up. Radiographs had no prognostic value, nor were they an effect modifier. Side-effects were recorded in 28% of patients given amoxycillin and in 9% of those taking placebo (p < 0.01). The occurrence of relapses was similar in both groups (21 vs 17%) during the follow-up year. INTERPRETATION: Antibiotic treatment did not improve the clinical course of acute maxillary sinusitis presenting to general practice. For these patients, an initial radiographic examination is not necessary and initial management can be limited to symptomatic treatment. Whether antibiotics are necessary in more severe cases warrants further study.     

Efficacy of surgical treatment in traumatic central cord syndrome

BACKGROUND: Controversy surrounds the treatment of traumatic central cord syndrome (TCCS), as there are strong advocates for nonsurgical treatment for most patients. However, conservative treatment has been shown to yield a longer period of discomfort from pain and weakness in certain cases. METHODS: In a retrospective review of 114 patients presenting with acute or chronic TCCS from 1988-94, four different age groups were separately observed under different treatments. Motor and sensory recovery were assessed. RESULTS: Better results were achieved in younger patients, with or without radiographic abnormalities, and in patients with clinically correlated encroaching cord lesions who received early surgical decompression. CONCLUSIONS: Surgical intervention for TCCS must be addressed with careful clinical and radiographic survey. Removal of offending lesions in the subacute period results in significant motor and sensory improvement in short-term and long-term follow-up.     

Early restenosis following percutaneous transluminal balloon angioplasty for the treatment of the superior vena caval syndrome due to pacemaker-induced stenosis

OBJECTIVES: To test the hypothesis that the outcome of temporomandibular disorders (TMD) is not influenced by condylar position, asymmetry, angle or structural bone changes. METHODS: Eighty consecutive patients (60 women, 20 men) with an age range of 6-81 years, referred to the Department of Stomatognathic Physiology, were included in the study. The patients were clinically and radiologically examined before and at least 1 year after treatment. RESULTS: The most common clinical diagnoses among the patients were TMD with a neuromuscular background in 35% and osteoarthritis in 21%. Seventy-two per cent of the patients were symptom-free or better, 24% unchanged and 1% worse 1 year or more after treatment. After treatment the bone structure of the TMJ was unchanged in 83% of the patients, in 12% erosions healed and in 5% erosions developed. Almost all patients had some degree of condylar displacement on tomography before treatment. In the majority the condylar position was unchanged after treatment. CONCLUSION: No single radiographic finding was found to be related to the treatment outcome and therefore plain radiography has a minor role in the management of TMD.     

Digital radiology in dentistry: experience with direct intraoral techniques (radiovideography)

The aim of this paper was to discuss the techniques for intraoral digital radiography (radiovisiography) and to compare their accuracy in dental radiographical diagnosis. Emphasis was given to their potential applications in oral radiology. Radiovisiography was compared with intraoral films and electronic magnifications from digital panoramic radiographs in 38 patients, for a total amount of 36 caries, 27 periapical conditions and 58 metal implants. Moreover, the accuracy of the measurements made with the three techniques was assessed on a specimen of mandibular and maxillary arches containing 28 extracted teeth with endodontic files of known length. Radiovisiography was as effective as intraoral films and more effective than digital panoramic radiographs in the diagnosis of caries and periapical lesions. Nevertheless, it produced a significant magnification and yielded unreliable measurements of root canals and metal implants. Radiovisiography is very easy to use and does not require dark room procedures nor chemicals of any kind. In addition, it reduces patient's X-ray exposure by over 50% with respect to film studies. For these reasons, this technique seems to be worthy of widespread use in dental radiography, with the exception of the conditions requiring an exact measurement of working length.     

Use of contrast-enhanced MR imaging to detect sacroiliitis in children

PURPOSE: To verify the diagnostic value of contrast-enhanced MR imaging compared with conventional radiography in the diagnosis of sacroiliitis in children. DESIGN AND PATIENTS: Radiography and MR imaging of the sacroiliac joints were performed in 185 children subdivided into the following groups according to the modified European Spondyloarthropathy (SpA) Study Group (ESSG) criteria: group 1, undifferentiated spondyloarthropathy (uSpA) (n=53, 94.5% HLA-B27+); group 2, differentiated SpA (n=45, 93.3% HLA-B27+); group 3, patients with no signs of SpA other than oligoarthritis (n=39, 92.3% HLA-B27+); group 4, HLA-B27+ controls with various other non-SpA diagnoses (n=22); and group 5, HLA-B27-controls with various other non-SpA diagnoses (n=26). Radiographs were evaluated on the basis of the modified New York criteria independently by three experienced radiologists masked to the clinical data. In a second step, the same radiologists independently evaluated the MR images without knowledge of the clinical data and radiographic findings using the recently published criteria developed by our group. These criteria allow differentiation of acute and chronic inflammatory changes. RESULTS: Radiography demonstrated sacroiliitis in 18 patients: 4 of 53 in group 1 (7.5%), 14 of 45 in group 2 (31%), but none in groups 3, 4 and 5. In contrast, MR imaging demonstrated acute and/or chronic sacroiliitis in 44 patients: 18 of 53 in group 1 (34%), 21 of 45 in group 2 (46.7%) and 5 of 39 in group 3 (12.8%), but none in groups 4 and 5. The percentage of sacroiliitis detected by MR imaging was significantly higher than that detected by radiography (P<0.001). CONCLUSION: Contrast-enhanced MR imaging is a useful method for detecting sacroiliitis in children. Advantages of contrast-enhanced MR imaging compared with conventional radiography are a higher sensitivity due to the ability to document early and acute changes and the absence of radiation exposure.     

CPITN, DMFT, and treatment requirements in a Nicaraguan population

WHO basic methods were used to assess CPITN, DMFT, and treatment requirements in a population of 178 persons aged 12-64 yr living in urban and rural areas of Nicaragua. Two groups were examined: individuals presenting for dental treatment at health clinics (30%) and subjects chosen randomly at other locations (70%). Mean ages of both groups were similar although females were found in higher percentages among those presenting for dental care. With the exception of one young individual, all subjects had calculus in at least one sextant. About 26% of the subjects who presented for treatment had a > or = 6 millimeter pocket compared to about 14% of the remainder of subjects. The mean DMFT for health clinic subjects was 16.1 compared to 10.3 for subjects from other locations. Subjects presenting for treatment had twice as many missing teeth and a mean of 0.5 filled teeth compared to 2.4 filled teeth for other subjects. Subjects at the clinics were in greater need of restorative care and extractions, while subjects from other locations were found to have more teeth that did not require any treatment. Health clinic subjects reported more visits to the dentist in the last year than other subjects. Only 80% of those presenting for treatment owned a toothbrush compared to 97% of those examined in other locations, and the latter group reported brushing their teeth more frequently. Attrition was a commonly encountered tooth disorder with 53% of all subjects exhibiting this condition.     

Computed radiography of the chest in patients with paraesophageal varices: diagnostic accuracy and characteristic findings

OBJECTIVE: The purpose of our study was to determine the diagnostic accuracy of computed radiography of the chest in the detection of paraesophageal varices and to describe the characteristic radiographic findings. SUBJECTS AND METHODS: From June 1995 through May 1997, in 100 consecutive patients, portal hypertension was diagnosed through both clinical and radiologic evidence. Computed radiographs of the chest and hepatic helical CT scans of these 100 patients with portal hypertension and 20 control subjects were analyzed by two chest radiologists and one abdominal radiologist, who were not aware of the results of the other study. RESULTS: On CT, paraesophageal varices were seen in 38 (38%) of 100 patients with portal hypertension. Overall, the sensitivity, specificity, and accuracy of chest computed radiography in the detection of paraesophageal varices were 53% (20/38), 90% (74/82), and 78% (94/120), respectively. In the patients with paraesophageal varices, splenomegaly (29/38, 76%), lateral displacement or obliteration of the inferior portion of the azygoesophageal interface (18/38, 47%), obliteration or nodularity of the inferior portion of the descending thoracic aorta interface (9/38, 24%), lateral displacement of the right inferior paraspinal interface (6/38, 16%), lateral displacement of the left inferior paraspinal interface (4/38, 11%), and varices in the left inferior pulmonary ligament (1/38, 3%) were seen on chest computed radiographs. Paraesophageal varices smaller than the diameter of the descending thoracic aorta (usually <2.5 cm) were not detected. CONCLUSION: Although chest computed radiography is only moderately sensitive for paraesophageal varices, the findings are characteristic when well developed, with a limited differential diagnosis. Splenomegaly, whether detected clinically or radiographically, eliminates most other diagnostic possibilities.     

Nosocomial hepatitis B virus, hepatitis C virus and HIV infections by infectious medial personnel

Radicular dentin dysplasia (DD-I) is a rare hereditary dental alteration. It is characterized clinically by almost normal looking crowns and severe hypermobility of the teeth. The radiographic analysis, on the other hand, discloses the obliteration of all pulp chambers, the short, malformed roots and plenty of periapical bone radiolucencies on noncarious teeth. A case of radicular dentin dysplasia is presented. In this 43-year-old woman the diagnosis was supported, besides the clinical and radiographic analysis, by the pedigree of the proband, which showed the autosomal dominant pattern of feature transmission. Further-more, the electron microscopic analysis of one extracted molar revealed the atubular structure of the secondary dentin, and its globular organization.     

Postoperative complications after Mainz pouch construction--with emphasis on measures to deal with narrowing of the duct aperture

Cutaneous sinus tracts in the face and neck region are often dental in origin. The purpose of this study was to characterize the clinical features and treatment of 37 consecutive cases of odontogenic cutaneous sinus tracts, collected and reviewed in a 15-year period. More than half of the patients (21 cases, 57%) were referred from medical doctors, particularly plastic surgeons and dermatologists. The sinus tracts were associated with caries (26 cases), incomplete endodontic treatment (7), crown fracture (2), vertical root fracture (1) and impacted mandibular third molar (1). They occurred most often in adolescents and adults (30 cases, 81%). The most common causative teeth were mandibular teeth (34 teeth, 85%). The chin, submental, and cheek areas were the most common sites of sinus tracts (30 cases, 81%). The majority of causative teeth (32 teeth, 80%) were treated endodontically. All fistulas healed uneventfully after proper dental treatment, without cosmetic surgery. In 63% (20 cases) of the recorded cases, complete resolution occurred within 8 weeks. Half of the patients had had fistulas for more than 6 months before receiving dental treatment, demonstrating that delays in proper diagnosis and treatment were common. As most patients suffered from unnecessary medication or surgery due to the delay of dental treatment, early dental consultation and treatment is important. Conventional endodontic treatment should be the treatment of choice if the tooth is salvageable. The increasing incidence of incomplete endodontic treatment in association with the occurrence of sinus tracts indicates that standardized endodontic therapy should be emphasized for prevention.     

The utilization of a paediatric emergency room in a general hospital in Kuwait

The objective of the study was to describe the ultrasonographic findings of urinary bladder urolithiasis and to determine the diagnostic value of the technique in feline lower urinary tract diseases (LUTD). Physical examination of the urinary system and routine clinicopathological analysis of the blood and urine were performed on 32 cats presented with clinical symptoms of LUTD. Cystosonography was done on all of the cats, while plain radiography was performed on 8 and double contrast cystography on 2 cats. Sonography of the bladder provided the following diagnoses: urolithiasis and chronic cystitis: 24 cases, chronic cystitis without urolithiasis: 4 cases, bladder neoplasm: 1 case, negative sonographic finding: 3 cases. Bladder calculi and/or plugs were diagnosed easily, up to a size of 2 mm, according to acoustic shadowing and/or reverberation and gravitation. When the bladder was empty, it was filled up with physiologic saline solution to visualise its contents more easily. Sonography proved to be a useful technique for diagnosing urinary bladder calculi and/or plugs even when they were radiolucent and for distinguishing among the different causes of LUTD. Although ultrasonography is a valuable diagnostic tool, radiography is still necessary to explore lower urinary tract diseases, especially when cystosonography provides negative results or urethral obstruction is suspected.     

Frameless stereotactic-directed tissue sampling during surgery of suspected low-grade gliomas to avoid histological undergrading

OBJECTIVE: To determine if the clinical and radiographic presentation of patients referred by their general dental practitioner requesting periradicular surgery fulfilled a set of predetermined guidelines as to the appropriateness of the procedure. DESIGN: Multicentre prospective study. SETTING: Maxillofacial departments of district general hospitals. METHOD: Consecutive analysis of referrals within four hospitals over a 1-year period between 1995 and 1996. RESULTS: From 205 referrals, mostly of patients in the 30 to 40 years age group, 79.5% (n = 163) of referrals failed to meet the criteria, mainly because of an unsatisfactory root canal filling, but also due to obvious coronal microleakage and adjacent teeth contributing to the disease process not yet having received endodontic treatment. In only 6.3% (n = 13) of patients had there been an attempt to retreat the pulp space infection by conventional means. CONCLUSION: The majority of referrals in this study did not fulfil the guideline criteria on the provision of periradicular surgery. The factors influencing failure in endodontics and periradicular disease did not appear to have been appreciated, or were not acted upon. Conventional retreatment of the pulp space needs to be considered or attempted prior to referral for surgery.     

Full- versus partial-mouth disinfection in the treatment of periodontal infections. A pilot study: long-term microbiological observations

A standard periodontal treatment consists of 4 to 6 scalings and rootplanings at a 1- to 2-week interval, which allows reinfection of a previously disinfected area before completion of the treatment. The present pilot study aims to examine the microbiological long-term effects of a full-mouth disinfection. 10 patients with advanced chronic periodontitis were randomly allocated to a test and control group. The patients from the control group received scaling and rootplaning and oral hygiene instructions at a 2-week interval. The full-mouth disinfection (test group) consisted of a full-mouth scaling and rootplaning in 2 visits within 24 h in combination with: tongue brushing with 1% chlorhexidine gel for 1 min, mouth rinsing with 0.2% chlorhexidine solution for 2 min and subgingival irrigation of all pockets (3x in 10 min) with 1% chlorhexidine gel. The patients of the test group were instructed to rinse 2x daily with 0.2% chlorhexidine. Plaque samples were taken at baseline and after 1, 2, 4 and 8 months. Differential phase-contrast microscopy showed a significantly larger reduction of spirochetes and motile organisms in the test group up to month 2 for the single-rooted and up to month 8 for the multi-rooted teeth. Furthermore, the culture data supported the effectiveness of the new treatment strategy. In both groups, the number of anaerobic CFU decreased 1 log around single- and 0.5 log around multi-rooted teeth. The number of anaerobic CFU remained low in the test group, in contrast to the control group. At 1 month, the test group harboured a significantly (p<0.01) lower proportion of pathogenic organisms, but this difference disappeared with time. Moreover, the test sites showed a significantly higher (p<0.02) increase in the proportion of beneficial micro-organisms up to 4 months. These findings suggest that a full-mouth disinfection leads to a significant microbiological improvement up to 2 months, which could be consolidated, although not significant, for the next 6 months.     

Comparative estimation of periodontal conditions by means of different index systems

The aim of the present study was to compare epidemiological data of periodontal disease obtained from a sample of adults by means of different, commonly employed, partial and full-mouth index systems, in order to explore the amount of discrepancy attributed to the methodology per se. 169 dentate subjects, aged 25-64 years, were subjected to a clinical examination, including circumferential probing assessments of pocket depth (PPD) and attachment level (PAL) at all teeth present. The individual mean % of tooth sites with PPD of > or = 6 mm and the % of subjects exhibiting at least one such deep pocket were calculated based on (i) full-mouth data, (ii) data derived from the buccal and mesial surfaces from 1 randomly selected upper and 1 lower quadrant, (iii) probing assessments at the 6 "Ramfjord teeth", (iv) the full-mouth community periodontal index for treatment needs (CPITN), and (v) the partial CPITN based on 10 index teeth. The PAL data were analyzed by means of 3 versions of the extent and severity index, 1 generated by full-mouth assessments and 2 by partial assessments based on 28 and 10 tooth sites, respectively. In the entire sample, the individual mean % of sites with PPD of > or = 6 mm generated by the different systems ranged between 5.0 and 4.2 sites/subject. By full-mouth CPITN scorings, an average of 1.0 score-4 sextants/subject was recorded, while the partial CPITN generated a corresponding value of 0.8 score-4 sextants/subject.(ABSTRACT TRUNCATED AT 250 WORDS)     

Constructivism: a characteristic of the psychic process

The diagnostic accuracy of detailed zonography using the Scanora multimodal X-ray system was compared with that of periapical radiography. The study was based on the detection of periapical bone lesions at 259 dental sites distributed evenly throughout the dentitions of 164 patients. Each site was examined by periapical radiography and zonography, in parallel. The zonograms consisted of four detailed images that could also be read as stereopairs, in either the horizontal or vertical direction. Five observers evaluated the sites for the presence or absence of periapical osteolysis or sclerosis and apical widening of the periodontal ligament space for the whole dentition, and for three dental regions. ROC analysis revealed no significant overall or regional differences between the diagnostic accuracies of the periapical and zonographic techniques, regardless of whether the zonograms were read as sets of four images (multiview) or stereoscopic images. The sensitivity of periapical radiography was 72%, that of multiview zonography 88%, and that of stereoscopic zonography 85%. Specificities were 93%, 84% and 89%, respectively. The energy imparted during detailed zonography was 0.98 mJ. It is concluded that zonography is as good as periapical radiography for the detection of periapical pathology.     

Guidelines for the selective ordering of admission chest radiography in adult obstructive airway disease

STUDY OBJECTIVE: To validate previously developed guidelines for the selective use of chest radiography in adults admitted for exacerbation of obstructive airway disease. DESIGN: Prospective, observational cohort study using criteria developed in a previous retrospective study. PARTICIPANTS: Unselected convenience sample of 128 adults with obstructive airway disease who did not respond to standard emergency department treatment and required admission. SETTING: Municipal hospital ED and inpatient medical service. INTERVENTIONS: Patients were categorized as "complicated" or "uncomplicated" according to previously developed criteria. Management was recorded as altered if the patient's physician answered the question, "Did the chest radiography alter your management of this patient?" affirmatively. RESULTS: Of 27 patients whose management was altered by the chest radiography, 26 were classified as complicated, for a sensitivity of 96% (95% confidence interval [CI], 81, 100). One of 44 admissions classified as uncomplicated had management altered by the chest radiography (negative predictive value, 98%, 95% CI, 88, 100). This chest radiography was later reread as normal. Classification as an uncomplicated patient with obstructive airway disease was strongly associated with either a normal chest radiography or a radiographic finding that was clinically unimportant (P = .0002). CONCLUSION: Patients with acute exacerbation of obstructive airway disease who are otherwise uncomplicated do not benefit from routine admission chest radiography. The use of this simple clinical strategy would safely reduce the number of chest radiographs by about one-third in this and similar patient populations, decreasing both health care costs and exposure to ionizing radiation.     

Acute liver failure

PURPOSE: This article reviews the literature on radiographic imaging techniques and image interpretation for dental implant treatment. MATERIALS AND METHODS: MEDLINE was used to identify published peer-reviewed literature for this report. RESULTS: Radiographic images are indispensable in the evaluation of osseous structures when planning treatment for dental implants. Potential bone sites for implant placement can be assessed clinically by means of palpation or probing through the mucosa; however, diagnostic imaging provides the best means for indirectly measuring bone dimensions. After healing of the implant site, the application of radiology is useful to verify the amount of bone adjacent to the implant and that the transmucosal abutments fit the implant. Upon completion of the implant prosthesis, radiology may be used to monitor initial and long-term success of implant treatment. CONCLUSION: Recommendations for the application of radiology over the course of treatment are made for various implant cases ranging from the overdenture to the single-tooth implant.