Simultaneous bleaching of vital teeth and an open-chamber nonvital tooth with 10% carbamide peroxide

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of bleaching a nonvital tooth with an open pulp chamber while simultaneously bleaching the other vital teeth with 10% carbamide peroxide. METHOD AND MATERIALS: Ten discolored nonvital teeth were treated. Each nonvital tooth was prepared as in the conventional "walking bleaching" fashion, so that the gutta-percha was sealed from the pulp chamber. The 10% carbamide peroxide was injected into the chamber of the nonvital tooth and loaded into the custom-fitted tray for all teeth. The nonvital teeth were bleached from both the inside and the outside. The patient closed the orifice with a cotton pellet during the day and changed the cotton pellet after meals. The patient applied fresh solution nightly. RESULTS: All teeth were successfully lightened. The time required to lighten the nonvital tooth was related to the duration of the discoloration. CONCLUSION: With proper patient selection and education, this technique can provide an effective way to lighten nonvital and vital teeth simultaneously, especially where extended treatment time may be required for difficult discolorations.     

English teaching in the Italian medical faculties: results of a survey

BACKGROUND: Although a compulsory examination in medical English has been present in the medical degree curriculum in Italy since 1990, guidelines indicating what should be learnt and suggesting some means of overcoming the various problems this entails are still lacking. OBJECTIVE: To investigate the main features of teaching English in the Medical Faculties and enquire into how the various problems are solved in the individual English teaching units. METHOD: A questionnaire addressing the above issues was sent out to all the Italian Universities with a Medical Faculty. RESULTS: The first finding of our survey was that response was very poor: less than 30% of the survey volunteered any reply. Within the very reduced sample which responded, there was a high degree of variation among the solutions adopted, although the underlying problems were perceived to be much the same throughout Italy. CONCLUSIONS: The general objective of the English course for medicine should be more precisely defined, together with a series of specific minimum skills the student should possess to pass the final examination. A closer collaboration among the English teaching units might help to standardize these requirements, improve the quality of the teaching and hence the level of proficiency in English for the specific purpose of medical practice.     

The contribution of noncatalytic phosphate-binding subsites to the mechanism of bovine pancreatic ribonuclease A

The enzymatic catalysis of polymeric substrates such as proteins, polysaccharides or nucleic acids requires precise alignment between the enzyme and the substrate regions flanking the region occupying the active site. In the case of ribonucleases, enzyme-substrate binding may be directed by electrostatic interactions between the phosphate groups of the RNA molecule and basic amino acid residues on the enzyme. Specific interactions between the nitrogenated bases and particular amino acids in the active site or adjacent positions may also take place. The substrate-binding subsites of ribonuclease A have been characterized by structural and kinetic studies. In addition to the active site (p1), the role of other noncatalytic phosphate-binding subsites in the correct alignment of the polymeric substrate has been proposed. p2 and p0 have been described as phosphate-binding subsites that bind the phosphate group adjacent to the 3' side and 5' side, respectively, of the phosphate in the active site. In both cases, basic amino acids (Lys-7 and Arg-10 in p2, and Lys-66 in p0) are involved in binding. However, these binding sites play different roles in the catalytic process of ribonuclease A. The electrostatic interactions in p2 are important both in catalysis and in the endonuclease activity of the enzyme, whilst the p0 electrostatic interaction contributes only to binding of the RNA.     

Eukaryotic DNA topoisomerase and in vitro recombination between circular supercoiled plasmid DNA's in an in vitro system

Eukaryotic DNA topoisomerase II was shown to catalyze recombination between circular supercoiled plasmid DNAs in vitro. The results obtained are discussed with regard to the organization of eukaryotic chromosomes in the form of topologically independent domains (loops).     

The frequency of illegitimate V(D)J recombinase-mediated mutations in children treated with etoposide-containing antileukemic therapy

Etoposide is among the most widely used anti-cancer drugs. Its use, however, has been associated with increased risk of secondary acute myeloid leukemia (AML) which is characterized by chromosomal translocations suggesting involvement of recombination-associated motifs at the breakpoints. A PCR-based assay was developed to quantitate the frequency of two illegitimate V(D)J recombinase-mediated genomic rearrangements-a 20-kb deletion in the hprt gene and the bcl2/IgH translocation (t(14;18)) found in non-Hodgkin's lymphoma. We examined both lymphocyte and non-lymphocyte blood cell DNA of children with acute lymphoblastic leukemia (ALL) for changes in the frequencies of these biomarkers during etoposide therapy to determine the level of illegitimate V(D)J recombination changes during therapy. A low level of t(14;18) was found in the lymphocytes before etoposide treatment, which was significantly reduced during etoposide therapy. In before-etoposide samples, no t(14;18) were found among 7.72x107 non-lymphocytes; during treatment none were found among 1.87x108 non-lymphocytes. Deletions were not found before etoposide treatment in either the lymphocytes (6.67x107) or non-lymphocytes (5.43x107) and were non-significantly elevated during etoposide therapy (1 in 1.4x108 lymphocytes and 1 in 1.39x108 non-lymphocytes). It is interesting to note the one patient with an hprt deletion mutation in non-lymphocytes; V(D)J recombination is not normally found in this cell type, but is the cell type from which AML derives. Several patients had clones of t(14;18)-bearing cells as determined by DNA sequence analysis. These results suggest that this etoposide-based chemotherapy was ineffective in producing genomic rearrangements mediated by illegitimate V(D)J recombination in these patients.     

Long-term follow-up after subtotal parathyroidectomy in patients with renal failure

OBJECTIVES/HYPOTHESIS: The most appropriate type of surgery for hyperparathyroidism secondary to renal failure remains controversial. We report a 5-year experience of patients with hyperparathyroidism secondary to end-stage renal disease who underwent subtotal parathyroidectomy. We believe that this is the procedure of choice, offering several advantages over total parathyroidectomy with and without reimplantation. STUDY DESIGN: Retrospective review. METHODS: Review of 14 consecutive renal failure patients who underwent subtotal parathyroidectomy by one surgeon (A.K.) was performed. Follow-up ranged from 4 to 54 months. All patients were receiving chronic maintenance dialysis. All patients came to surgery with clinical symptoms of parathyroid bone disease, elevated serum calcium levels (10.1-12.4 mg/dL), and intact parathyroid hormone levels (619-4160 pg/mL), despite maximal medical therapy. At exploration four glands were identified in all patients and three and a half were removed. RESULTS: All patients experienced symptomatic relief postoperatively with normalization or near-normalization of serum calcium concentration and intact parathyroid hormone concentrations. One patient developed recurrent disease 4 months after surgery, and on re-exploration a supernumerary substernal gland was identified. A second patient developed recurrent symptoms 4 years after surgery and at the time of this writing was awaiting re-exploration. CONCLUSIONS: All patients had either resolution of or marked improvement in their subjective complaints. There have been no cases of permanent hypoparathyroidism. We believe that subtotal parathyroidectomy is the best procedure for patients with refractory symptoms of secondary hyperparathyroidism.     

Flat adenoma: are western colonoscopists careful enough?

There has been recent interest in the risk of various cancers in cystic fibrosis (CF) patients and carriers of cystic fibrosis transmembrane conductance regulator (CFTR) mutations. It has been proposed that a CFTR mutation may protect against breast cancer, based on evidence that elevated extracellular adenosine triphosphate (ATP) is known to inhibit breast cancer cell line growth and that CFTR pumps ATP out of epithelial cells. A CFTR mutation would therefore result in higher concentrations of serum ATP. A CFTR knockout mouse model had high serum concentrations of ATP and showed reduced breast tumour implantibility and decreased breast cancer growth rates. We have evaluated the relationship between the deltaF508 CFTR mutation and the risk of breast cancer before the age of 40. The deltaF508 CFTR mutation carrier rate in 272 cases (2.2%) was no different from the carrier rate observed in 171 controls (1.8%). If there was a protective effect resulting from the postulated elevation in serum ATP levels, tumours arising in deltaF508 CFTR carriers would have been expected to be generally less aggressive. When the histological features of the breast cancers with a deltaF508 CFTR mutation were reviewed and graded using a combined architectural and cytological grading system, all were found to be grade III, poorly differentiated tumours, contrary to the predictions. A combination of our data with other large population-based samples of cases and controls is required to resolve this issue.     

Arterial-phase three-dimensional gadolinium magnetic resonance angiography of the renal arteries. Strategies for timing and contrast media injection: original investigation

RATIONALE AND OBJECTIVES: The authors review different imaging and contrast-media infusion strategies for arterial-phase three-dimensional (3D) gadolinium-enhanced magnetic resonance angiography (Gd-MRA). METHODS: The influence of physicochemical factors on the infusion of contrast media, including viscosity, flow rate, inline pressure, and cannula size, is assessed. The combination of manual or automated contrast-media administration with timing-dependent or -independent 3D Gd-MRA techniques is reviewed regarding the aspects of effectiveness, robustness, image quality, and costs. RESULTS: For effective bolus delivery with high flow rates, the type and temperature of the contrast media, the size of the cannula, and an immediate saline flush must be considered. Timing-dependent techniques based on a test bolus and using automated contrast-media infusion as well as timing independent techniques such as MR SmartPrep or multiphase 3D Gd-MRA by using a manual injection with a SmartSet tubing set, are all effective procedures for arterial phase 3D Gd-MRA. CONCLUSIONS: Manual contrast-media injection with a tubing set can be used for timing-independent MRA techniques. The multiphase 3D Gd-MRA approach seems to be favorable for different MR systems, robustness, and speed.