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PubMedDate not supplied

Localized aggressive periodontitis in a six-year-old: a case report.

The purpose of this report was to describe an approach to diagnose and effectively treat a pediatric patient with localized aggressive periodontitis. A 6-year-old female presented with clinical and radiographic evidence of severe attachment loss around several primary teeth. She had no history of systemic disease, periodontal disease, or caries prior to the periodontal abscess that prompted her referral. Routine immunological tests did not reveal any functional defects, but DNA testing for periodontal pathogens revealed the presence of all 8 aggressive periodontal pathogens assayed. Treatment consisted of the extraction of 2 severely affected primary teeth, increased frequency of recall appointments, and administration of systemic antibiotics. The patient's periodontal condition was stabilized 18 months post-treatment, and the 8 pathogens were no longer at detectable levels. With a treatment goal of preventing disease progression into the erupting permanent dentition, this treatment regimen provides an effective alternative to more aggressive strategies.

Aggregatibacter actinomycetemcomitans↗
PubMed2006

Greater influence of age than co-morbidity on primary treatment and complications of prostate cancer patients: an in-depth population-based study.

We investigated the influence of age and co-morbidity on treatment, the occurrence of serious non-urological complications of treatment and prognosis for prostate cancer patients diagnosed and treated in community hospitals. Additional information from a random sample of 505 prostate cancer patients (aged 40 years or older) from the Eindhoven Cancer Registry diagnosed between 1995 and 1999 was collected. In all, 43% of the prostate cancer patients aged 40-69 years and 64% of those aged 70 or older suffered from one or more serious concomitant disease that barely affected primary treatment choice. However, compared to patients without co-morbidity, patients with cardiovascular diseases underwent radical prostatectomy less often (P=0.01). In all, 38% of the patients undergoing radical prostatectomy suffered from complications during the first year after diagnosis versus about 20% of those receiving radiotherapy. The number of complications did not seem to be affected by co-morbidity. After adjustment for age, stage, grade, prostate-specific antigen level and treatment, the cumulative risk of death was almost two times higher for patients with two or more concomitant diseases than for patients without co-morbidity. After adjustment for age, prostate cancer patients with co-morbidity were not treated differently, did not suffer from more complications but had a worse prognosis, compared to those without co-morbidity.

Adult↗
PubMed1984

Individual variations in the sleep of depression.

Variations in the intensity or severity of affective disorders were evaluated relative to perturbations in nocturnal sleep physiology. Individual variations in polygraphic features of the sleep cycle based upon psychopathologic scale ratings were investigated in two constituencies (Ns = 6) for 8 hr during 1-3 consecutive nights. The constituencies consisted of twelve young adult (18-25 years) nonpsychotic unipolar depressed psychiatric patients with a primary affective illness and an age-matched normal healthy control group (N = 8). The severely versus mildly depressed patient subgroups scored significantly higher on the Hamilton, Beck and Zung psychopathologic rating scales, indicating a larger magnitude of depressive symptomatology. The average value for total time asleep was 6.1 hr in severely versus 7.8 hr among the mildly depressed patients and controls. EEG-sleep of the severely versus mildly depressed patients and controls contained significantly less stages 2 and 3. Although total time asleep was almost identical in the mildly depressed constituency compared with controls, patients accumulated significantly more of stages 2 and 3. Both patient subgroups exhibited a significantly shorter REM latency than controls. REM latency was reduced to a significantly lower level in the severely versus mildly depressed patients. A significant decrease of REM cycle duration occurred in the polygraphic sleep recordings of severely depressed patients compared with the age-matched controls. The shortened REM latencies indicate a disinhibition of neural processes that would normally delay appearance of the initial REM episodes during nocturnal sleep. The present study generally extends and confirms finding on nocturnal EEG-sleep disturbances in depression associated with the severity of affective illness, particularly the disrupted REM cycle and shorter REM latency.

Adolescent↗
PubMed1994

Thyroid hormone rapidly increases cholesterol 7 alpha-hydroxylase mRNA levels in hypophysectomized rats.

The induction of hepatic cholesterol 7 alpha-hydroxylase mRNA by triiodothyronine was investigated in hypophysectomized rats. These rats exhibited markedly decreased levels of cholesterol 7 alpha-hydroxylase mRNA compared to normal controls. An increase in this mRNA could be detected within 30 min after giving triiodothyronine. A triiodothyronine dose of 0.25 microgram per 100 g of body weight, which produces 50% occupancy of hepatic nuclear thyroid hormone receptors, caused significant increases in hydroxylase mRNA levels. The half-life of cholesterol 7 alpha-hydroxylase mRNA was about 30 min and was not affected by thyroid hormone. Administration of the protein synthesis inhibitor, cycloheximide, after triiodothyronine caused superinduction. Hepatic HMG-CoA reductase mRNA levels, which are also low in livers from hypophysectomized rats, were unaffected by these doses of hormone within the 2 h time-frame examined in these studies. The results suggest that thyroid hormone may exert a primary affect on the expression of the hepatic cholesterol 7 alpha-hydroxylase gene. This could explain, in part, the hypocholesterolemic effect of thyroid hormone.

Animals↗
PubMed1977

Dentin dysplasia, type II: a rare autosomal dominant disorder.

Dentin dysplasia, Type II, is a rare autosomal dominant disorder. The primary teeth are amber and translucent and the pulp chambers are obliterated. The permanent teeth have a normal to brown-gray coloration and a thistle-tube pulp configuration with multiple true denticles. To date, only five families with this disorder have been reported. This article presents two additional families. Light and scanning electron microscopy of an affected primary incisor showed the dentin, including the mantle layer, to be highly disorganized throughout. Possible pathogenic events associated with the phenotype are discussed.

Adolescent↗
PubMed1999

The effect of the first manic episode in affective disorder: a case register study of hospitalised episodes.

BACKGROUND: It is poorly understood how the course of illness in depressive patients is affected by a manic episode. METHOD: The course of hospitalised episodes was compared for patients with depressive episodes only, patients who presented with a manic or circular first episode and patients who presented with a depressive first episode and later developed mania. The Danish psychiatric central register was used as a study base, including all hospital admissions with primary affective disorder in Denmark during 1971-1993. RESULTS: A total of 17,447 patients presented with a depressive first episode and 2903 patients with a manic or circular first episode. Among the 17,447 depressive patients, 762 patients presented with mania at later episodes (4.4%). Younger age at onset was associated with increased risk of developing mania. Patients who had a late first manic episode had the same rate of subsequent recurrence as patients with mania at first episode and this rate was higher than the rate of recurrence for patients who remained having depressive episodes only. Time since first manic episode was without importance in relation to the risk of subsequent recurrence. CONCLUSION: Patients who present with depression and later develop mania have from onset the same risk of recurrence as initially bipolar patients. LIMITATION: The data relate to admissions rather than episodes. CLINICAL RELEVANCE: Younger patients who present with depression have increased risk of developing bipolar disorder.

Bipolar Disorder↗
PubMed1999

Recurrence in affective disorder: analyses with frailty models.

The risk of recurrence in affective disorder is influenced by the number of prior episodes and by a person's tendency toward recurrence. Newly developed frailty models were used to estimate the effect of the number of episodes on the rate of recurrence, taking into account individual frailty toward recurrence. The study base was the Danish psychiatric case register of all hospital admissions for primary affective disorder in Denmark during 1971-1993. A total of 20,350 first-admission patients were discharged with a diagnosis of major affective disorder. For women with unipolar disorder and for all kinds of patients with bipolar disorder, the rate of recurrence was affected by the number of prior episodes even when the effect was adjusted for individual frailty toward recurrence. No effect of episodes but a large effect of the frailty parameter was found for unipolar men. The authors concluded that the risk of recurrence seems to increase with the number of episodes of bipolar affective disorder in general and for women with unipolar disorder.

Age Distribution↗
PubMedDate not supplied

A nurse practitioner and primary care.

As a nurse practitioner employed by a community health care center, I find that I am able to practice primary care the way I imagined I might when I was a student. The characteristics and needs of the particular population I serve have given me ample opportunities. The community health center administrators have not always prioritized expenditures the way my colleagues and I think they should, and we are not immune from the financial and market forces that affect primary care in private practices. However, the essence of primary care is valued by the organization, and it offers me the opportunity to provide this care to a community that needs it.

Community Health Services↗
PubMed2006

Smoking, smoking cessation, and risk of cardiovascular disease.

Cigarette smoking increases the risk of atherothrombotic clinical events such as myocardial infarction and the effect is dose dependent for persons who continue to smoke. Reductions in smoking habit and smoking cessation are important ways to improve cardiovascular risk and favorably affect primary and secondary prevention of clinical disease. Therapeutic methods to improve smoking reduction and cessation include nicotine replacement, behavioral interventions, and medications (bupropion, clonidine). Improved cessation rates are under active study and include behavioral methods, targeting smokers immediately after myocardial infarction, consideration of depression in smokers, pharmacogenomics to identify persons who may respond more favorably to specific interventions, and newer medications that affect endocannabinoid receptors.

Journal Article↗
PubMed1999

Mutations in the CCN gene family member WISP3 cause progressive pseudorheumatoid dysplasia.

Members of the CCN (for CTGF, cyr61/cef10, nov) gene family encode cysteine-rich secreted proteins with roles in cell growth and differentiation. Cell-specific and tissue-specific differences in the expression and function of different CCN family members suggest they have non-redundant roles. Using a positional-candidate approach, we found that mutations in the CCN family member WISP3 are associated with the autosomal recessive skeletal disorder progressive pseudorheumatoid dysplasia (PPD; MIM 208230). PPD is an autosomal recessive disorder that may be initially misdiagnosed as juvenile rheumatoid arthritis. Its population incidence has been estimated at 1 per million in the United Kingdom, but it is likely to be higher in the Middle East and Gulf States. Affected individuals are asymptomatic in early childhood. Signs and symptoms of disease typically develop between three and eight years of age. Clinically and radiographically, patients experience continued cartilage loss and destructive bone changes as they age, in several instances necessitating joint replacement surgery by the third decade of life. Extraskeletal manifestations have not been reported in PPD. Cartilage appears to be the primary affected tissue, and in one patient, a biopsy of the iliac crest revealed abnormal nests of chondrocytes and loss of normal cell columnar organization in growth zones. We have identified nine different WISP3 mutations in unrelated, affected individuals, indicating that the gene is essential for normal post-natal skeletal growth and cartilage homeostasis.

Adolescent↗
PubMed2004

Metal ion modulated electron transfer in photosynthetic proteins.

Photosynthetic purple bacterial reaction center (RC) proteins are ideal native systems for addressing basic questions regarding the nature of biological electron transfer because both the protein structure and the electron-transfer reactions are well-characterized. Metal ion binding to the RC can affect primary photochemistry and provides a probe for understanding the involvement of local protein environments in electron transfer. The RC has two distinct transition metal ion binding sites, the well-known non-heme Fe(2+) site buried in the protein interior and a recently discovered Zn(2+) site located on the surface of the protein. Fe(2+) removal and Zn(2+) binding systematically affect different electron-transfer steps in the RC. Factors involved in the metal ion alteration of RC electron transfer may provide a paradigm for other biological systems involved in electron transfer.

Binding Sites↗
PubMed2002

An international taxonomy for errors in general practice: a pilot study.

OBJECTIVES: To develop an international taxonomy describing errors reported by general practitioners in Australia and five other countries. DESIGN AND SETTING: GPs in Australia, Canada, the Netherlands, New Zealand, the United Kingdom and the United States reported errors in an observational pilot study. Anonymous reports were electronically transferred to a central database. Data were analysed by Australian and international investigators. PARTICIPANTS: Non-randomly selected GPs: 23 in Australia, and between 8 and 20 in the other participating countries. MAIN OUTCOME MEASURES: Error categories, and consequences. RESULTS: In Australia, 17 doctors reported 134 errors, compared with 301 reports by 63 doctors in the other five countries. The final taxonomy was a five-level system encompassing 171 error types. The first-level classification was "process errors" and "knowledge and skills errors". The proportion of errors in each of these primary groups was similar in Australia (79% process; 21% knowledge and skills) and the other countries (80% process; 20% knowledge and skills). Patient harm was reported in 32% of reports from Australia and 30% from other countries. Participants considered the harm "very serious" in 9% of Australian reports and 3% of other countries' reports. CONCLUSIONS: This pilot study indicates that errors are likely to affect primary care patients in similar ways in countries with similar primary healthcare systems. Further comparative studies are required to improve our understanding of general practice error differences between Australia and other countries.

Australia↗
PubMedDate not supplied

[Change of isoforms' spectrum of alpha-L-fucoside secreted by affected cells in some hereditary lysosomal diseases].

In vitro it was studied the isoform spectra of the intracellular and secreted alpha-L-fucosidase from skin fibroblasts of patients with Fabry disease (glycolipidosis), Hurler and Sanfilippo D diseases (mucopolysaccharodosis, types I and III) and in the normal state was studied. It was shown that the multiple form profile of secreted alpha-L-fucosidase in patients fibroblasts was changed as compared to that in control: the pathological cells were characterized by expression of more basic isoforms of alpha-L-fucosidase. The changes were similar to those in sucrose-loaded normal cells, modelling storage disease. The data obtained allow the suggestion that the intracellular accumulation of compounds whose hydrolysis was disturbed on a hereditary deficiency of enumerated glycosidases can influence the posttranslational processing of alpha-L-fucosidase, the enzyme which is not primary affected in these disorders. These data allow the conclusion that the high phenotypic heterogenity of lysosomic storage diseases is possibly due to the influence of so-called epigenetic factors involving the changes in properties of such glycosidases as are not associated with a primary hereditary defect.

Cells, Cultured↗
PubMed1996

Stainless steel crown versus multisurface amalgam restorations: an 8-year longitudinal clinical study.

Two alternative methods of restoring primary teeth that had multisurface lesions were examined in a clinical longitudinal study. In a paired comparison, stainless steel crowns proved far superior to multisurface amalgam restorations with respect to both lifespan and replacement rate. Stainless steel crowns are not only more acceptable to the patient and more cost effective, but also more acceptable to the dentist because of the comparatively simple procedures involved in restoring even severely affected primary molars.

Child↗
PubMed1998

Predictors of recurrence in affective disorder. A case register study.

BACKGROUND: The risk of recurrence in affective disorder is affected by socio-demographic variables such as gender, age at onset and marital status and by illness related factors as the length of previous episodes and the total duration of the illness. The present study investigated how the effect of these variables changed with the progression of the illness. METHOD: Using survival analysis, the risk of recurrence was estimated in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971-1993. RESULTS: Totally, 20350 first admission patients had been discharged with a diagnosis of affective disorder, depressive or manic/circular type. Initially in the course of the illness, bipolar patients had a substantial greater risk of recurrence compared with unipolar patients. At this time, gender, age and marital status together with the total duration of the illness predicted the risk of recurrence in both unipolar and bipolar illness. Some variables had different predictive effect in the two types of illness. Later, especially the duration of the previous illness predicted the risk of recurrence. CONCLUSION: It seems as initially in the course of affective disorder socio-demographic variables such as gender, age at onset and marital status act as risk factors for further recurrence. Later, however, the illness itself seem to follow its own rhythm regardless of prior predictors. LIMITATION: The data relate to re-admissions rather than recurrence and the findings may be due to decreasing sample sizes during the course of illness. CLINICAL RELEVANCE: The study underscores the importance of the illness process itself.

Adult↗
PubMed1975

Diagnostic subgroups of affective disorders and their urinary excretion of catecholamine metabolities.

Previous reports have indicated that some depressed patients excrete less than normal quantities of 3-methoxy-4-hydroxyphenyl glycol (MHPG). The authors present data indicating that a subgroup of depressed patients who excrete less than normal quantities of MHPG may be identified by the application of explicit clinical criteria. They found no significant difference in the excretion of normetanephrine (NM), metanephrine (M), and 3-methoxy-4-hydroxymandelic acid (VMA) among any of the diagnostic subgroups or between each patient group and a healthy comparison group. However, depressed patients diagnosed as having primary affective disorder and bipolar illness excreted significantly less MHPG than did the healthy comparison group.

Bipolar Disorder↗
PubMed1981

Depressed mood and other psychiatric manifestations of Cushing's syndrome: relationship to hormone levels.

Thirty-five consecutive patients with Cushing's syndrome were studied prospectively prior to treatment. A consistent constellation of psychiatric disturbances was found, including impairments in affect (depressed mood and crying), cognitive functions (decreased concentration and memory), and vegetative functions (decreased libido and insomnia). A statistically significant relationship was found between the overall psychiatric disability rating and cortisol and ACTH level. The relationship of depressed mood and hormone levels was examined. Low ACTH levels were significantly associated with milder rather than pronounced depressed mood. The implications of the similarities in psychiatric manifestations between Cushing's syndrome and the primary affective disorders are discussed.

Adrenocorticotropic Hormone↗
PubMed1994

Mode of inheritance in families of patients with lithium-responsive affective disorders.

A better understanding of the role of genetic factors in affective disorders is likely to result from investigating more homogeneous populations. To achieve this goal, we have systematically studied patients who are excellent responders to long-term lithium treatment and their relatives. In the families of 71 such probands, we have analyzed the mode of inheritance by comparing the observed morbidity risks with the risks expected under different genetic models. The results demonstrate major-gene effects in the transmission of primary affective disorders; the polygenic model with sex-specific thresholds could be rejected. Discrimination between the autosomal and X-chromosome models was not possible, but the autosomal recessive model predicts more realistic, gender-specific frequencies of affective disorders in the general population. These results suggest that autosomal recessive inheritance deserves serious consideration in molecular genetic investigations.

Adult↗