A prospective pilot study was performed in order to assess the safety of treating recurrent malignant gliomas (MGs) with locally infused autologous tumor infiltrating lymphocytes (TILs) and recombinant interleukin-2 (rIL-2). Six patients were entered between June 27, 1994 and June 2, 1995 and followed until July 1, 1998. At surgery an Ommaya reservoir was placed for later infusion of TILs and rIL-2. Following surgery, autologous TILs were expanded in vitro in the presence of rIL-2 and infused on treatment days 1 and 14, with concurrent rIL-2 infusions performed three times each week for one month. Following completion of immunotherapy all patients were offered chemotherapy. Phenotypic analysis demonstrated TILs to be T-lymphocytes (87-99% CD3+). Of these, 4 of 6 cases (67%) phenotyped as cytotoxic/suppressor T-lymphocytes (CD8+) and 2 of 6 cases (33%) phenotyped as helper/inducer T-lymphocytes (CD4+). TILs demonstrated limited selective cytotoxicity, with dose dependent cytotoxicity against autologous tumor, allogenic tumor and long term MG cell lines. There were no significant (Grade 3 or 4) complications. One patient developed transient low grade fevers, and 2 developed asymptomatic hydrocephalus. All patients developed transient and asymptomatic cerebral swelling, noted on the immediate post-treatment imaging studies. At three and six month follow-up, 3 patients responded with partial response, 2 demonstrated stable disease and 1 patient progressed. At long term follow-up, 1 patient had a complete response (45 month follow-up), 2 had a partial response (48 and 47 month follow-up) and 3 patients expired as a result of progressive disease (at 12, 12 and 18 months following immunotherapy). A relationship between subsequent chemotherapy or extent of resection to outcome was not apparent but could not be excluded. This pilot study demonstrated that locally infused autologous TILs and rIL-2 could be delivered without serious toxicity. Further studies are indicated to determine the safety and long term efficacy of TIL immunotherapy.

Adult↗

PubMed1999

Moving towards a latex-free environment: advice from experiences in US dentistry.

Most dental practitioners now routinely wear gloves while treating patients. The most commonly used types of gloves contain latex. Latex is also present in other personal protective equipment, such as masks, eyewear and clinic gowns. Increased use of such items, unfortunately, has been linked to adverse skin and mucous membrane reactions. Latex proteins and chemicals associated with the material's production have been implicated. Exposure to such chemicals has also resulted in allergic responses in dental patients. There is a strong movement in the USA to limit exposure to latex in healthcare environments, including dentistry. The aim of this article is to describe past, present and future efforts to create low-latex or latex-free environments.

Dermatitis, Occupational↗

PubMed1999

Evaluation of an illuminated mirror.

The viewing of oral structures with an adequate level of illumination is necessary to make accurate diagnoses of normalities and abnormalities in the oral cavity. The purpose of this study is to determine if a device with an illuminated mirror is heat sterilizable, easy to use, and compares in illumination potential to a traditional overhead dental operating light. We sterilized the Denlite in both chemical vapor and autoclave units (including a group that was cleaned ultrasonically prior to autoclave), testing the illuminance level every 10 cycles, for 100 cycles. We installed devices in the Graduate Operative Dentistry Clinic and requested those operators assigned to the units to rate the devices. Their acceptance rate was high in visibility, ease of use, acceptable temperature of handle, and lack of problems with the device. The device had an illuminance level of 14,200 lux, which is just below the maximum level of illuminance required by the American Dental Association's Specification on Dental Operating Lights.

Dental Instruments↗

PubMed1998

Diagnosis of von Willebrand disease type 2N: a simplified method for measurement of factor VIII binding to von Willebrand factor.

Diagnosis of von Willebrand disease Type 2N (vWD 2N), which mimics hemophilia A and its carrier state, is important for accurate genetic counseling and appropriate therapy. To make testing for the disorder more clinically applicable, we developed a simplified method for measurement of factor VIII (FVIII) binding to von Willebrand factor (vWF) using commercially available reagents and standard clinical assays. FVIII binding to vWF was measured by capture of patient vWF by polyclonal antibodies on cyanogen bromide-activated Sepharose beads, reaction with recombinant FVIII, and assay of unbound FVIII by clotting methods. Unbound vWF was measured in patient plasma after capture by the Laurell method. The ratio of bound FVIII/bound vWF was normal in hemophilia A, vWD Type 1, and vWD Type 3 patients, and abnormal in 5 subjects from two families, all of whom had vWD 2N mutations. Patient 1, with FVIII 8 U/dl, vWF: Ag 61 U/dl, vWF:RC 74 U/dl, and FVIII binding nil, was homozygous for the Arg91 Gln mutation. She was followed during pregnancy and delivered an unaffected heterozygous son. Patient 2 had FVIII 8 U/dl, vWF:Ag 73 U/dl, and vWF:RC 71 U/dl, and very low FVIII binding. She was heterozygous for Arg91Gln, as were her mother and sister; no second vWD 2N mutation was found. Her brother, with FVIII 14 U/dl, vWF:Ag 113 U/dl, and vWF:RC 72 U/dl, has no evidence of vWD 2N. With an X-linked inheritance pattern of bleeding tendency, this family is the first reported with combined hemophilia A and vWD 2N.

Adult↗

PubMed1998

Bacterial leakage of mineral trioxide aggregate as compared with zinc-free amalgam, intermediate restorative material, and Super-EBA as a root-end filling material.

Several dye leakage studies have demonstrated the fact that mineral trioxide aggregate (MTA) leaks significantly less than other root-end filling materials. The purpose of this study was to determine the time needed for Serratia marcescens to penetrate a 3 mm thickness of zinc-free amalgam, Intermediate Restorative Material (IRM), Super-EBA, and MTA when these materials were used as root-end filling materials. Fifty-six, single-rooted extracted human teeth were cleaned and shaped with a series of .04 Taper rotary instruments (Pro-series 29 files). Once the canals were prepared in a crown down approach, the ends were resected and 48 root-end cavities were ultrasonically prepared to a 3 mm depth. The teeth were then steam sterilized. Using an aseptic technique, under a laminar air flow hood, the root-end cavities were filled with amalgam, IRM, Super-EBA, and MTA. Four root-end cavities were filled with thermoplasticized gutta-percha without a root canal sealer and served as positive controls. Another four root-end cavities were filled with sticky wax covered with two layers of nail polish and served as negative controls. The teeth were attached to presterilized (ethylene oxide gas) plastic caps, and the root ends were placed into 12-ml vials of phenol red broth. Using a micropipette, a tenth of a milliliter of S. marcescens was placed into the root canal of each tooth. To test the sterility of the apparatus set-up, the root canals of two teeth with test root-end filling materials and one tooth from the positive and negative control groups were filled with sterile saline. The number of days required for S. marcescens to penetrate the four root-end filling materials and grow in the phenol red broth was recorded and analyzed. Most of the samples filled with zinc-free amalgam leaked bacteria in 10 to 63 days. IRM began leaking 28 to 91 days. Super-EBA began leaking 42 to 101 days. MTA did not begin leaking until day 49. At the end of the study, four of the MTA samples had not exhibited any leakage. Statistical analysis of the data indicated Mineral Trioxide Aggregate to be a most effective root-end filling material against penetration of S. marcescens.

Aluminum Compounds↗

PubMed1998

Antimicrobial activities of dental impression materials.

OBJECTIVE: The aim of this study was to measure the in vitro killing effects five commercial alginate impression materials had on five test microorganisms. METHODS: Two alginates with no added disinfectant, one supplemented with chlorhexidine and two others containing quaternary ammonium compounds were tested. Challenge microbes included two gram-positive cocci, two gram-negative bacilli and a yeast. Saline solutions containing standardized concentrations of test microbes were used to mix the alginates. Some set specimens were immediately homogenized and the resulting fluids diluted and spread plated. Other specimens were processed 30 or 60 min after setting. After culturing, the numbers of colonies were counted and the levels of microbial reductions determined. RESULTS: Unsupplemented alginates had no antimicrobial effects. The quaternary-ammonium-containing alginates were completely effective against all five test microorganisms. The alginate with chlorhexidine killed all the gram-negative bacilli and the majority (95-99%) of the gram-positive cocci and yeast. SIGNIFICANCE: Results indicated that disinfectant-containing alginate impression materials could reduce the number of soiling microorganisms present on and within test specimens.

Alginates↗

PubMed1998

The prevalence of acute extrapyramidal signs and symptoms in patients treated with clozapine, risperidone, and conventional antipsychotics.

BACKGROUND: Acute extrapyramidal side effects (EPS) are a common phenomenon of treatment with conventional antipsychotics. Previous studies found that clozapine has little propensity to cause EPS, while risperidone produces some EPS, but at levels lower than those of conventional antipsychotics. METHOD: We compared the prevalence and severity of EPS in patients treated with clozapine, risperidone, or conventional antipsychotics for at least 3 months. Our main hypothesis was that there would be differences between the three treatment groups with regard to akathisia, measured with the Barnes Akathisia Scale, and extrapyramidal motor side effects (rigidity, rigidity factor, tremor, salivation), measured with the Simpson-Angus scale. Secondarily, we were interested in possible differences between the three groups with respect to the anticholinergic comedication and the subjective impression of the patients, measured with the van Putten scale. RESULTS: We studied 106 patients (41 patients treated with clozapine, 23 patients with risperidone, and 42 patients treated with conventional antipsychotics). The sample was 57.5% male and had a mean +/- SD age of 36.6 +/- 9.3 years. The mean dose of antipsychotics calculated in chlorpromazine equivalents was 425.6 +/- 197.1 mg/day in the clozapine group, 4.7 +/- 2.1 mg/day in the risperidone group, and 476.5 +/- 476.9 mg/day in the group treated with conventional antipsychotics. The point-prevalence of akathisia was 7.3% in the clozapine group, 13% in the risperidone group, and 23.8% in the group treated with conventional antipsychotics. The point-prevalence of rigidity and cogwheeling respectively was 4.9% and 2.4% in the clozapine group, 17.4% and 17.4% in the risperidone group, and 35.7% and 26.2% in the group treated with conventional antipsychotics. CONCLUSION: Our results indicate that risperidone is superior to conventional neuroleptics in that it causes fewer EPS. In comparison to clozapine, risperidone produces EPS levels that are intermediate between clozapine and conventional antipsychotic drugs.

Acute Disease↗

PubMed1998

Effect of ultrasonic cleaning on microorganisms.

PURPOSE: To establish a method to measure microbial kill caused by ultrasonic cleaning. Secondarily, to estimate the escape of bacteria from the ultrasonic cleaning solutions during operation of the unit. MATERIALS AND METHODS: Three commercial enzymatic detergents and saline were used as cleaners. Depending on detergent, initial operational temperature was 21 degrees C, 37 degrees C or 60 degrees C. Streptococcus mutans ATCC 25175 (S. mutans suspensions) was adjusted to a final concentration of 1.0 x 10(3) cells/mL in saline. Suspensions (2000 mL) at the desired temperatures were added to the cleaner. Aliquots were removed, serially diluted in letheen broth and spread plated over mitis salivarius agar. Appropriate amounts of detergent solutions were added to S. mutans suspensions and the cleaner operated for 20 minutes. Aliquots were then removed and plated. The process was repeated twice. Plates were aerobically incubated at 37 degrees C for 7 days and the colonies counted. The procedure was repeated using three temperatures of S. mutans suspensions (21 degrees C, 37 degrees C or 60 degrees C), but without detergent or ultrasound. Also, detergents were added to 21 degrees C S. mutans suspensions and allowed to sit for 20 minutes without ultrasonic cleaning. Microbial sampling was done as previously described. RESULTS: Results when ultrasound was used indicated that little kill (5-15%) occurred in 21 degrees C or 37 degrees C detergent solutions. Greater kill (25-35%) was noted with 21 degrees C and 37 degrees C saline. Complete kill was accomplished with 60 degrees C saline or the 60 degrees C detergent solution. When ultrasound and detergent were not used, there was no kill in 21 degrees C and 37 degrees C saline, but complete kill in 60 degrees C saline. In the absence of ultrasound no kill was noted in 21 degrees C S. mutans suspensions to which detergent had been added. Total kill of S. mutans was observed in 60 degrees C saline or 60 degrees C detergent with ultrasound or after a 20-minute exposure in 60 degrees C saline without ultrasonic cleaning. Very few bacteria escaped from the ultrasonic cleaning solutions into the air during the cleaning process. Placement of the unit lid effectively reduced emissions to zero.

Coenzymes↗

PubMed1997

Risk factors for the development of neuroleptic induced akathisia.

Neuroleptic induced akathisia (NIA) is a common and distressing side effect of antipsychotic treatment. Incidence rates are reported to be between 25% and 75%, depending on criteria used for diagnosis. The results of our four week prospective naturalistic study are based on the assessment of 73 inpatients, which were started on antipsychotic medication in one of the inpatient units of the Department of Psychiatry. NIA was rated with the Hillside Akathisia Scale. Assuming that both, objective as well subjective phenomena are necessary for a valid diagnosis of NIA, we calculated an incidence rate of 22.4%. 75% of all NIA cases occurred within the first three days of antipsychotic treatment. When attempting to determine risk factors for the development of NIA, we found a significant influence of dose increase in the first days of treatment.

Adult↗

PubMed1996

Reference intervals of CD3, CD4, CD8, CD4/CD8, and absolute CD4 values in Asian and Non-Asian populations.

A study to determine reference intervals in normal Asian and non-Asian populations for CD3 (T cells), CD4 (T helper/inducer cells), CD8 (T suppressor/cytotoxic cells), and for the CD4/CD8 ratio and absolute CD4 lymphocyte count was performed. Coulter Clone/Cytostat reagents were used. The samples were lysed using the Coulter Q-Prep and analyzed on the Coulter Profile II flow cytometer. The Asian population appeared to have a lower mean percentage of CD3 and CD4 cells, a lower CD4/CD8 ratio, and lower absolute CD4 lymphocytes. These findings indicate that race should be a consideration in determining reference intervals for immunophenotyping for CD3, CD4, and CD8.

Adult↗

PubMed1996

In vitro factor VIII recovery during the delivery of ultrapure factor VIII concentrate by continuous infusion.

Factor VIII (FVIII) replacement by continuous infusion has been advocated as a cost-effective method for maintaining stable plasma levels of FVIII in the hemophilia A patients during surgery or life-threatening hemorrhage. Continuous delivery of monoclonal or recombinant FVIII concentrates to our pediatric patients using a traditional delivery system (dilution in normal saline of 2-10 U/ml infused at a rate of 20 ml/hr) has frequently yielded higher than expected factor usage to achieve desired levels and unexpected variability in plasma levels under presumed steady-state conditions. To determine if diminished in vitro FVIII recovery was responsible for these observations, a study of four ultrapure concentrates during 8 hr of in vitro continuous delivery was performed using four delivery systems. When reconstituted concentrate was added to normal saline in polyvinylchloride bags at a concentration of 10 U/ml (method IA), monoclonal products showed a stable recovery of 84-109% of time 0 levels. Recombinant product recovery dropped to 57-76% of time 0 levels before reapproximating the time 0 level at 2 hr. The addition of 10 mg/ml human albumin to the bags (method IB) did not improve recoveries. When reconstituted concentrate was delivered undiluted (method IIA), the early drop in recombinant recovery was eliminated; stable recovery of 78-117% of time 0 level was achieved with all products. In using method IA, a large discrepancy was seen between the actual time 0 recoveries and those expected based on vial assays, most striking for recombinant products (49-57% of expected. Method IIA allowed 75-90% recovery; addition of 20 mg/ml albumin of reconstituted but undiluted concentrate (method IIB) maximized recovery at 85-98% of expected.

Albumins↗

PubMed1996

Infection control.

From an infectious disease point of view, dentistry has never been safer than it is today for both patients and the dental team. This state of affairs has resulted from the establishment and practice of strict infection control in the office using the concept of universal precautions. Infection control consists of a series of procedures directed at reducing the number of microbes shared among people. An approach to the management of infection control involves identification of an office safety coordinator and total involvement of everyone in the office. The procedures of infection control can be grouped into six major areas. 1. Handwashing and gloving provides protection to both patients and the dental team. 2. Protection against aerosols and spatter involves the use of a preprocedure mouthrinse, HVE, rubber dam, saliva ejection, mask, protective eyewear, and protective clothing. 3. Instrument processing provides instruments that are safe for patient use. 4. Surface asepsis eliminates the involvement of environmental surfaces in the spread of disease agents. 5. Management of sharps and other regulated waste reduces the chances for sharps injuries and contact with potentially infectious material. 6. Aseptic techniques include aseptic retrieval of supplies, reducing contamination from dental unit water, aseptic radiographic procedures, proper use of disposables, and preventing contamination of the dental laboratory.

Asepsis↗

PubMed1996

Microbes in dental unit water.

Microbes are present in dental unit water and exist in the biofilm that lines the inside walls of water tubing. Improving the microbial quality of dental unit water as means become available is a natural part of maintaining the high quality of patient care and staff protection for which dentistry is well-noted.

Bacterial Infections↗