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Our aim was to assess the incidence and anatomical site of branches of the inferior dental canal that supply mandibular third molars using dental cone-beam computed tomography (CT). We evaluated the incidence and diameter of branches of the inferior dental canal using 272 cone-beam CT mandibular scans from 172 patients referred for imaging before the extraction of impacted mandibular third molars. We found three typical branching patterns from the inferior dental canal in the third molar region: the retromolar canal (in the retromolar triangle), the dental canal (that courses directly beneath the socket of the third molar), and the accessory canal (that courses through the socket and leads from the inferior dental canal to a bony ridge). The incidences of retromolar, dental, and accessory canals were 75 (28%), 223 (82%), and 21 (8%), respectively, with mean diameters of 0.9 (0.4), 0.7 (0.5), and 1.1 (0.4) mm, respectively. Operative injury to the neurovascular contents within the branches of the inferior dental canal can lead to excessive bleeding and postoperative paraesthesia, so identification of its branches on preoperative cone-beam CT images may prove useful during extraction of impacted mandibular third molars or when harvesting bone blocks from the region of mandibular third molars. We also describe two cases of branches detected on panoramic and cone-beam CT images that prompted this research.

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Abstract We compared efficacy of magnetic resonance arthrography (MRA) and magnetic resonance imaging (MRI) for the detection of superior glenoid labral detachment, and especially unstable superior labrum anterior-posterior (SLAP) type 2 lesions. MR imagings and MR arthrograms of 90 shoulders of 90 patients, including 30 shoulders of unstable SLAP 2 lesions, were interpreted by a novice and an expert observer. These results were correlated with arthroscopic findings. For the expert observer, MRI had a sensitivity of 53%, a specificity of 93%, and an accuracy of 80%, which were improved to 60%, 98%, and 85%, respectively, by MRA. These increases were statistically insignificant. For the novice observer, MRI had a sensitivity of 45%, a specificity of 80%, and an accuracy of 64%, which were significantly improved to 76%, 83%, and 80%, respectively, by MRA. In detecting unstable SLAP 2 lesions, MRA proved to be useful to a novice interpreter, but not significantly useful to an experienced interpreter, compared with unenhanced MRI. We advocate MRA as the examination of first choice for detecting unstable SLAP 2 lesions if they are strongly suspected clinically.

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The American Cancer Society (ACS), Hawaii Pacific, Inc., initiated the Hawaii Partnership for Standards-Based School Health Education in July 1999. The goal of the partnership is to implement standards-based school health education to promote child and adolescent health in Hawaii. The partnership includes representatives from the Hawaii Department of Education, the Hawaii Board of Education, the Hawaii Department of Health, the University of Hawaii College of Education, Meadow Gold Dairies, the Hawaiian Electric Companies, the Hawaii Medical Services Association, and local divisions of the American Cancer Society. During its first year, the partnership collaborated to sponsor 15 teacher workshops on the new Hawaii Health Content Standards. In addition, Meadow Gold Dairies initiated a Got Health? milk carton side-panel promotional campaign to publicize the standards. This article describes development of the Hawaii Health Content Standards, history of the partnership, activities to date, concurrent supporting efforts, future plans, and lessons learned during the first year.

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Between 1990 and 1997, 227 patients with hepatocellular carcinoma were treated by intrahepatic arterial injection of a Lipiodol-Epirubicin-Mitomycin C emulsion followed by intermittent hepatic artery infusion of Epirubicin, Mitomycin C and 5-FU, employing an implantable subcutaneous infusion port. A catheter was inserted percutaneously into the hepatic artery using the Seldinger technique. Objective remission was induced in 80% of the evaluable patients as evidenced by a decrease in their AFP and PIVKA II levels. These remissions were also confirmed by liver sonogram and CT scan showing decreased tumor volume. Transcatheter oily chemoembolization combined with intermittent hepatic artery infusion chemotherapy seems to be an effective treatment for unresectable hepatocellular carcinoma both for palliation of symptoms as well as prolongation of survival with good quality of life.

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Epirubicin and 5-FU were administered through an indwelling catheter inserted into the internal mammary artery and/or subclavian artery employing an implantable infusion port system for the treatment of unresectable advanced breast cancer and recurrent breast cancer. Intraarterial infusion chemotherapy proved to be an effective treatment modality for unresectable advanced breast cancer and recurrent breast cancer.

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In order to reduce toxic effects while attaining maximal therapeutic effects, epirubicin 10 mg/day, cyclophosphamide 100 mg/day and prednisolone 10 mg/day were administered through in indwelling catheter inserted into the internal mammary artery and/or subclavian artery for 3-4 weeks, employing the implantable port system for the treatment of unresectable breast cancer and recurrent cancer. Ten out of 11 patients (91%) with unresectable breast cancer showed a response (CR 3, PR 7, NC 1) to this modality of intra-arterial infusion chemotherapy. Seven out of 11 patients (64%) with recurrent cancer of the breast showed a response (CR 1, PR 6, NC 4). Intraarterial infusion chemotherapy for the unresectable advanced breast cancer and recurrent breast cancer proved to be an effective modality of treatment.

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Dyslipidemia including hyper-LDL(low density lipoprotein) cholesterol which is very often refractory to dietary/medical treatments is known to be a risk factor of many arteriosclerotic lesions. An extracorporeal procedure of plasma adsorption, LDL adsorption, utilizing dextran sulphate as a ligand immobilized on cellulose gel beads has been clinically applied in a variety of dyslipidemic conditions as listed below. Its usefulness in secure reduction of the serum LDL level and consequent symptomatic improvements has been confirmed. Familial hypercholesterolemia(FH): A regular repetition of the LDL adsorption ameliorates hyper-LDL cholesterolemia as resulting in regression of the multiple stenoses in the coronary arteries. Focal glomerulosclerosis(FGS): A seesion of the LDL adsorption improves kidney function and reduces a urinary protein excretion in FGS patients with dyslipidemia. Arteriosclerosis obliterans(ASO): More than 60 ASO patients with dyslipidemia have been treated by the LDL adsorption in our center. In over 80% of the patients, marked improvement in clinical symptoms such as leg pain/intermittent claudication has been brought out. Hemodialysis-relevant dyslipidemia(HDDL): HDDL which develops in the long-term HD patients has been treated. Transplantation-relevant dyslipidemia(TXDL): TXDL with deterioration of the transplanted kideny function has been treated by the LDL adsorption. Kidney function improves. Anaphylactoid reaction which is tentatively explained as a result of release of bradykinin in contact of blood with polyanionic material of the adsorbent, dextran sulphate, develops, in particular, while an angiotensin-converting enzyme inhibitor is administered as a depressant. However, it can be avoided in a use of nafmostat mesilate, a protease inhibitor, as an anticoagulant.

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OBJECTIVE: To validate a previously published model for predicting bacteremia in hospitalized patients. DESIGN: Application of a published bacteremia prediction model to a prospective validation cohort of patients and comparison of its predictability to that found in the derivation cohort. SETTING: Urban, university-affiliated, 550-bed public hospital. PATIENTS: The validation cohort consisted of 342 patients with 559 blood culture episodes between October 14, 1992, and December 5, 1992. Each blood culture episode was scored based on the presence or absence of seven predictors of bacteremia and the findings compared with published results (derivation cohort). INTERVENTIONS: None. RESULTS: Application of the bacteremia prediction model to the validation cohort identified episodes with a low risk (3%) and a high risk (17%) for true bacteremia, similar to the findings in the derivation cohort (1% and 16%, respectively). Comparison of the predictions of the model in the two cohorts by receiver operator characteristic curve analysis revealed that the overall predictability of the model in the validation cohort was not as good as in the derivation cohort. CONCLUSIONS: Although the bacteremia prediction model did not perform as well overall in the validation cohort, the model still was able to clearly define two extreme groups: those with a low risk and those with a high risk for true bacteremia. This predictive capability may aid physicians in prescribing empiric antimicrobial therapy and also may be useful to hospital epidemiologists in assessing quality of care.

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A 12-month trial, conducted in a 650-bed university teaching hospital, evaluated the conversion from cefoxitin to ampicillin/sulbactam. This report discusses the methodology used to evaluate the feasibility of the change and the challenges encountered during the trial period. The effect of cost and overall therapeutic outcome were other aspects of the evaluation. Results indicate that a conversion from cefoxitin to ampicillin/sulbactam is not only feasible but is also a realistic approach to achieving high-quality, cost-effective care.

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According to the authors' clinical analysis, about half of the patients who suffer from arteriosclerotic obstruction (ASO) in the lower extremity(-ies) with clinical manifestation are dyslipidemic (total cholesterol > or = 220 mg/dL or LDL cholesterol > or = 140 mg/dL). As suggested by clinical success in regression of ASO in the coronary arteries as a result of aggressive removal of LDL, LDL adsorption utilizing an extracorporeal circulation technique with a dextran sulfate/cellulose adsorbent column was applied in 33 patients (22 men and 11 women) with ASO. Clinical results obtained after a series of 10 LDL adsorption procedures as a standard showed encouraging success. Improvement in subjective symptoms was achieved as follows: 88.5% for cold lower extremity, 87.1% for intermittent claudication, 53.8% for leg/toe pain at rest, and 60% for disappearance/size diminution of ulcer/necrosis. Improvements in objective examination findings supported subjective ones: 85.7% by plethysmography, 81% by thermography and 70% by ankle pressure index. No serious complications or untoward effects were observed during or after the adsorption procedures. In conclusion, LDL adsorption appears to be a useful and safe tool in treatment of ASO patients with dyslipidemia.

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Of 124 patients with oral squamous cell carcinomas treated during the past 14 years, 13 developed second primary cancers with clinical symptoms in the same tissues or in organs different from those of the initial lesions during follow-up. The second primary tumors also appeared in the oral cavity in 3 of the patients, the hypopharynx in 1, the esophagus in 2, the stomach in 2, the colon in 1, the thyroid gland in 2 and the lung in 2. Of the 3 patients with second tumors in the oral cavity, 1 underwent surgery after chemo- and radiotherapy and 2 underwent laser surgery or chemo- and radiotherapy only. The second primary cancers appeared on the contralateral or ipsilateral side, completely separate from the sites of the primary lesions during a period of 1 to 3 years. One patient with triple cancers involving the oral cavity, esophagus and hypopharynx is still alive after 15 years. The other two patients died of cervical or lung metastases after 3 years.

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Yeast ENO1 promoter was prepared by a chemical synthetic method. Two variant promoters containing a pyrimidine-rich region (CT block), located between the TATA box and the transcription start site, either 32 or 34 base pairs (bp) longer than the native ENO1 promoter were isolated during the chemical synthesis. Gene expression of variant promoters was compared with that of the native promoter by measuring the amount of mRNA and the activity of beta-galactosidase by constructing ENO1-lacZ gene fusions. No significant differences were observed between the native and variant promoters in transcription levels. The start site of transcription was mapped on CAAG, a consensus sequence of transcription start site of yeast glycolytic genes. The results suggest a longer CT block in ENO1 promoter may not affect the expression of the yeast ENO1 gene. In addition, the level of ENO1 gene expression was found to be higher in stationary phase cells than in log phase cells.

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Several plasmids carrying different length of the 5' flanking region of yeast (Saccharomyces cerevisiae) enolase 1 gene (ENO1) which is fused in frame to the Escherichia coli lacZ gene were constructed by recombination in vitro. Promoter activity of ENO1 was assayed by measuring beta-galactosidase activity of the fused gene product. Comparison of the promoter activity of these plasmids suggests that the sequences required for a strong promoter activity lie within the DNA segment -724 to -353 base pairs (bp) upstream from the start of ENO1 coding sequence. The nucleotide sequence of this region was determined.

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A patient with diabetes mellitus and acute renal failure requiring hemodialysis developed Candida sepsis which was effectively treated with the oral antifungal drug, ketoconazole. Plasma drug levels during hemodialysis suggested that ketoconazole was not dialyzed, but that its pharmacokinetics, specifically gastrointestinal absorption, may be altered in renal failure.

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