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PubMed2000

Clinical performance of an in-line point-of-care monitor in neonates.

OBJECTIVE: To evaluate the bias, precision, and blood loss characteristics of an ex vivo in-line point-of-care testing blood gas and electrolyte monitor designed for use in critically ill newborn infants. STUDY DESIGN: Study participants included consecutive neonates with an umbilical artery catheter (UAC) in use for clinical laboratory testing. The in-line monitor (VIA LVM Blood Gas and Chemistry Monitoring System, VIA Medical, San Diego, CA) was directly connected to the participant's UAC and the monitor's determinations of pH, PCO(2), PO(2), sodium, potassium, and hematocrit (Hct) were compared with those simultaneously drawn and measured with a standard bench top laboratory instrument (Radiometer 625 ABL; Radiometer America, Inc, Westlake, OH). The bias (the mean difference from the reference method) and precision (1 standard deviation of the mean difference) performance criteria of the in-line monitor were derived using standard laboratory procedures. RESULTS: Sixteen neonates monitored for a total of 37 days had a total of 229 paired blood samples available for comparison by the 2 methods. Bias and precision performance characteristics of the in-line monitor were similar to reports of other point-of-care devices (ie, pH: -.003 +/-.024; PCO(2):.35 +/- 2.84 mm Hg; PO(2):.39 +/- 7.30 mm Hg; sodium:.52 +/- 2.34 mmol/L; potassium:.17 +/-.18 mmol/L; and Hct:.61 +/- 2.80%). The range of values observed for each parameter included much of the range anticipated among critically ill neonates (ie, pH: 7.15-7.65; PCO(2): 25-75 mm Hg; PO(2): 25-275 mm Hg; sodium: 127-150 mmol/L; potassium: 2.6-5.5 mmol/L; and Hct: 32%-60%). Mean blood loss (+/- standard deviation) per sample with the in-line monitor was approximately one-tenth that of the reference method: 24 +/- 7 microL versus 250 microL, respectively. There was no evidence of hemolysis and no patient related safety issues were identified with use of the in-line monitor. CONCLUSIONS: Repeated laboratory testing of critically ill neonates using an ex vivo in-line monitor designed for use in neonates provides reliable laboratory results. The blood loss and hemolysis data obtained suggests that this monitoring device offers potential for reducing neonatal blood loss-and possibly transfusion needs-during the first weeks of life. Before this promising technology can be routinely recommended for care of critically ill neonates, greater practical experience in a variety of clinical settings is needed.

Blood Gas Analysis↗
PubMedDate not supplied

ENDO-LAB: an integrated, portable endocrinology laboratory software system.

ENDO-LAB is an IBM PC-based system which performs calculations and record-keeping for the Vanderbilt University Medical Center Endocrinology Laboratory. It manages maintenance and quality control, and prints reports for regulatory agencies. The system was designed to minimize paperwork without changing laboratory procedures in any way. Key features of ENDO-LAB include a uniform user interface, and error detection mechanisms. The system is designed to detect data which has been incorrectly entered. In addition, where the efficacy of a test can be determined on the basis of limited data, preliminary graphs are screened as soon as possible, so that the user can terminate lengthy calculations whose outcome would be invalid or inconclusive. ENDO-LAB is an integrated system in that the same statistical and calibration programs can be applied to all of the analyses. The system is both extensible and portable; it has been successfully implemented outside Vanderbilt.

Clinical Laboratory Information Systems↗
PubMed2002

Comparison of microbial cultivation and a commercial PCR based method for detection of periodontopathogenic species in subgingival plaque samples.

OBJECTIVES: Microbiological laboratory procedures are involved in diagnosis and therapy control of progressive and refractory forms of periodontitis. In recent years techniques have been developed based on the detection of nucleic acids. The purpose of this study was to validate the commercially available micro-Dent(R) test which employs probes for A. actinomycetemcomitans, P. gingivalis, P. intermedia, B. forsythus and T. denticola. METHODS: 122 plaque samples obtained from periodontal pockets with various depths from 33 early onset periodontitis (EOP) patients and 15 periodontally healthy subjects were analysed by cultivation and the microDent(R) kit. RESULTS: Both cultivation and the nucleic acid based assay showed a positive correlation of pocket depth with the frequency and quantity of periodontopathogenic species. T. denticola was found only in pockets > 4 mm in EOP patients. Comparison of the two methods revealed that the microDent(R) kit identified both P. gingivalis and B. forsythus more often than did the cultivation method. CONCLUSIONS: Nucleic acid techniques should replace cultivation methods as gold standard in microbiological diagnosis of progressive periodontitis. The micro-Dent(R) kit can be recommended for microbiological laboratories analysing subgingival plaque samples.

Adolescent↗
PubMed1996

Hantaviral biosafety issues in the autopsy room and laboratory: concerns and recommendations.

The need to perform autopsies on and examine laboratory specimens from patients with hantavirus pulmonary syndrome (HPS) has raised questions about biosafety. Human illness associated with hantaviruses is usually the result of exposure to infectious aerosols from saliva or excreta of wild rodents. It is unclear whether or nor certain autopsy and laboratory procedures can also generate similar potentially infectious aerosols. As the biosafety information developed for the HPS agent is limited and the consequences of infection are serious we recommend a cautious approach. Autopsy prosectors should use N-95 particulate respirators as a minimum standard. If aerosols will be generated they should use N-100 particulate respirators or powered air purifying respirators with high-efficiency particulate air (HEPA) filters. Centrifugation and cytocentrifugation of blood or body fluid samples should be performed in bio-contained systems and these specimen containers should be opened in a class II biological safety cabinet.

Autopsy↗
PubMed2006

2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci - from disaster to ongoing control.

The first hospital outbreak of a vancomycin-resistant enterococcus (VRE) in Western Australia (WA) started in the Royal Perth Hospital in July 2001 and initially involved the Intensive Care Unit (ICU) and the Nephrology and Dialysis Units. The outbreak was caused by vancomycin-resistant Enterococcus faecium (VREF) of the vanB genotype. Pulsed-field gel electrophoresis and plasmid analysis of the isolates demonstrated a single-strain outbreak. Despite the isolation of carriers and implementation of all the additional precautions recommended to control VRE, VREF spread rapidly. Two months after the index patient was detected, the epidemic strain had spread to 22 wards and units and one outpatient unit (Satellite Dialysis). Four patients were infected and 64 were colonized. A Hospital VRE Executive Group, which included the Chief Executive and Directors of Clinical Services and Nursing, was formed to eradicate the outbreak and to prevent the epidemic strain from becoming endemic in the hospital. The WA Department of Health agreed to provide substantial extra funding to enable the hospital to use expensive enhanced infection control practices, as follows. Control was handicapped by the slowness of conventional laboratory methods, which took four to five days to identify VRE and allowed environmental contamination and nosocomial transmission to occur before carriers were detected and isolated. A laboratory procedure to make rapid provisional identification of VRE within 30-48h was developed by performing multiplex polymerase chain reaction (PCR) for vanA and vanB genes directly on 24-h selective enrichment broth cultures. On average, four rectal swabs, each collected on separate days, were needed to detect >90% of carriers. In total, 1977 ward contacts were screened after discharge from hospital and 54 (2.73%) were found to be carrying VREF. The electronic labelling and active follow-up of ward contacts resulted in a significant number of carriers being detected who otherwise posed a risk of initiating further outbreaks in hospital if they were re-admitted. The outbreak was terminated after five months and the cost of the enhanced infection control practices was 2,700 000 Australian dollars (1,000,000 pounds sterlings). Ongoing control has been facilitated by targeted active surveillance cultures: on admission to high-risk units (ICU, Burns, Nephrology, Haematology, Bone Marrow Transplant Unit), on transfer out of the ICU to other hospital units, by monthly screening of patients regularly attending Dialysis Units, and by opportunistic laboratory screening of inpatient faecal specimens submitted for Clostridium difficile culture and toxin. Vigilance needs to be maintained as the epidemic strain of VREF remains in the Perth community. Ward contacts of the first outbreak have caused small outbreaks in two hospitals, and seven to 19 sporadic new carriers have been detected annually since the first outbreak. The key elements of the VRE control programme are as follows: To date, this programme has prevented VRE from becoming established in any WA hospital.

Bacterial Proteins↗
PubMed2004

Listeria monocytogenes: comparative interpretation of mouse virulence assay.

Being an opportunistic bacterial pathogen, Listeria monocytogenes demonstrates significant strain variations in virulence and pathogenicity. The availability of laboratory procedures to ascertain the pathogenic potential of L. monocytogenes bacteria would greatly enhance the control and prevention of listerial infections. As a method that measures all virulent determinants, mouse virulence assay has been frequently used for assessing L. monocytogenes virulence. The pathogenic potential of a given L. monocytogenes strain as determined by mouse virulence assay is often calculated from mouse mortality data in combination with colony forming units (CFUs) derived from plate counts, and expressed by medium lethal dose (LD(50)). In this report, we describe an alternative method [i.e., relative virulence (%)] that does not involve CFU estimation, and is comparable to LD(50) for interpretation of mouse virulence assay for L. monocytogenes. The relative virulence (%) is obtained by dividing the number of dead mice with the total number of mice tested for a particular strain using a known virulent strain (e.g., L. monocytogenes EGD) as reference. Besides providing a more direct interpretation in comparison with LD(50) values for mouse virulence assay, this method requires fewer dosage groups per L. monocytogenes strain, and eliminates CFU estimation that is step subject to variations between runs and also between laboratories.

Animals↗
PubMedDate not supplied

The efficacy of pediatric blood culture sets in the determination of burn bacteremia.

A blood culture is an essential laboratory procedure necessary to confirm a septic episode. However, it is important to collect the blood sample at the appropriate time with an acceptable technique. The standard method is to collect at least 5 to 10 ml blood per culture bottle from patients with fevers. However, this volume of blood is an unrealistic amount to take from the frequently febrile pediatric patient. Alternatively, the pediatric blood culture bottle allows the collection of 1 ml blood per bottle to perform the same evaluation. We evaluated the two techniques of blood-culture collection over a 9-month period and compared the results between adult and pediatric blood culture bottles. Seventy-six patients, from November 1988 through February 1989, had blood cultures performed with the adult culture bottles, which produced a total of 1314 samples. A total of 113 patients, from March through July 1989, had blood cultures performed with the pediatric culture bottles, which produced a total of 758 samples. Percent recovery for the adult bottles versus the pediatric bottles was 13.95% versus 22.8% (p less than 0.0001). Since the amount of blood necessary to isolate an infectious agent is critical not only for laboratory identification but also for the volume of blood of pediatric patients, these data clearly establish the efficacy of pediatric blood culture bottles and the utilization of smaller amounts of blood. Not only did this approach significantly enhance organism recovery rate, but it may well be more cost-effective because fewer cultures need to be performed to isolate the infectious organism.

Adult↗
PubMed2006

The effect of adding a stone base on the accuracy of working casts using different types of dental stone.

AIM: Gypsum products are used for the preparation of stone casts of oral and maxillofacial structures and as important adjuncts to dental laboratory operations involved in the production of dental prostheses. The aim of this study was to determine the effect on the dimensional accuracy of a working cast of adding a stone base using different stone products. METHODS AND MATERIALS: A total of forty impressions of a mandibular dentoform were made. The impressions were dried with compressed air and stored at room temperature for 24 hours before pouring stone casts. The forty impressions were randomly divided into four groups of ten each. All forty impressions were poured once using one pre-weighed 140 Gm package of Silky Rock (SR) Type IV improved stone (Whip Mix Corporation, Louisville, KY, USA ) per impression. All working casts and the die setups were prepared according to the manufacturer's recommendations for pin placement (M.R. Dual pin and sleeve). Four different types of dental stone (II, III, and IV) and Flow Stone (FS) were used as bases for the working models. They were mixed according to the manufacturer's recommendations. The lower posterior teeth were flattened on the dentoform prior to taking the impressions. All were indexed using a mounted abrasive disc. Four teeth were selected as follows: 21, 28, 30, and 18. These represented A, B, C, and D landmarks, respectively. All measurements (five times for each specimen) were made with a Universal measuring microscope (Unitron Instruments, Inc., Bohemia, NY, USA). After the pre-sectioned measurements were recorded, the stone base was poured. A manual hand saw was used to section and fabricate removable dies for the mandibular landmarks A, B, C, and D. The dies were later seated and removed ten times to simulate the average amount of handling during laboratory procedures. Each die was carefully seated and measurements were made using the same technique as for the master model and unsectioned casts. Multivariate repeated measures analysis of variance (MANOVA) was used to test the difference in three different landmark distances (AB, AC, and AD) among the master model before and after sectioning of the working dies and among the four different base materials. Univariate analysis of variance (ANOVA) was conducted for each measurement, AB, AC, and AD to test the difference in landmark distances on the master model at pre sectioning and then at post sectioning using four different base materials. When there was a significant main effect (p < .05), the Student-Newman-Keul's (SNK) were used to test for pair wise comparison of means (P<0.05). RESULTS: The results of the MANOVA indicated there was a significant difference in three landmark measurements on the master model before and after sectioning of the working dies for the four different base materials (F = 6.60, p = 0.0001). In addition there was a significant difference in three landmark measurements on the master model at: (1) pre sectioning (p = 0.0001), (2) between the master model and SR material (p = 0.0002), (3) between the master model and Laboratory Plaster (LP) material (p = 0.0001), (4) between the master model and Quick Stone (QS) material (p = 0.0001), and (5) between the master model and FS material (p = 0.0001).

Calcium Sulfate↗
PubMed1998

The changing patterns of antimicrobial susceptibility of urinary pathogens in Trinidad.

OBJECTIVE: The prevalence of antimicrobial resistance in urinary pathogens is increasing worldwide. Accurate bacteriologic records of culture results may provide guidance on empirical therapy before sensitivity patterns are available. We report the changing antibiograms of pathogens associated with urinary tract infections (UTI) over a 4-year period at a newly commissioned hospital complex diagnostic laboratory in Trinidad. METHODS: From January 1992 to December 1995, kept records of antibiograms of all urinary pathogens isolated were examined. Samples were derived from hospital sources (wards and out-patient clinics) and general practice sources (health centers and general practitioners). Quantitative bacteriologic cultures were performed according to standard laboratory procedures, and identification of isolates were based on Gram reaction, morphology and biochemical characteristics. Significant bacteriuria was defined as the presence of greater than 100,000 organisms per mL of a midstream urine specimen or more than 3000 bacteria per mL in a catheter specimen of a single specie. Antimicrobial sensitivities were done using the following antibiotics: norfloxacin, ampicillin, tetracycline, nitrofurantoin, gentamicin, co-trimoxazole (sulfamethoxazole-trimethoprim), trimethoprim, nalidixic acid, cephalexin and augmentin (amoxicillin-clavulanic acid). Control organism was E coli NCTC 10,418 strain. RESULTS: The total number of specimens for the 4-year period in hospital was 14,181 with an isolation rate of 17%, and a general practice isolation rate of 67% from a total of 5,088 specimens. E coli was the most frequent isolate in both hospital (40%) and general practice (30%). There was an increase isolation of P aeruginosa from community practice reflecting an increase in home care catheterised male patients. Resistance to tetracycline was most significant in hospital (99%) and general practice (81%). Similar trend was observed for trimethoprim in hospital, and co-trimoxazole in both practices. Resistance to ampicillin, augmentin and cephalexin was relatively stable over the 4-year period. CONCLUSION: We conclude that laboratories should encourage accurate bacteriologic record keeping of urinary isolates and their antibiograms to serve as guidance in empirical treatment in UTI. Also, urine microscopy may reduce the number of specimens sent for culture which are not cost-effective.

Anti-Bacterial Agents↗
PubMed1989

Statistical evaluation of agreement between two methods for measuring a quantitative variable.

Methodologic research is often concerned with determining whether two methods (procedures, laboratory instruments) can be used interchangeably for measuring some quantitative variable of interest. Logically, one method can be used as a surrogate of another provided the methods show high agreement on the measured results. Although the product-moment correlation (r) is often used as an indicator of agreement, this index is in fact inappropriate for this purpose. The intraclass correlation (r1) is the correct statistic for assessing agreement or consistency between two methods. Another criterion sometimes used for supporting interchangeability is the similarity of the mean measured results obtained by the two methods. However, similarity of means (aggregate agreement) does not necessarily indicate individual-subject agreement, and it is the latter that is the pre-requisite for interchangeability. On the other hand, a marked difference between two means (lack of aggregate agreement) does necessarily indicate lack of individual-subject agreement and therefore non-interchangeability. Herein we suggest that two methods for measuring a quantitative variable can be judged interchangeable provided all of the following conditions are met: first the methods must not exhibit marked additive or nonadditive systematic bias; second the difference between the two mean readings is not "statistically significant"; third, the lower limit of the 95% confidence interval of the intraclass correlation is at least 0.75. Statistical procedures to evaluate these conditions of interchangeability are described in detail. A computer program coded in SAS to carry out the procedures is listed in the Appendix. A similar program coded in DBASE III PLUS for the microcomputer is available upon request.

Analysis of Variance↗
PubMed1975

An unexpected incidence of convulsive attack in male mice after long-term isolated condition.

Unexpected convulsive attacks were observed in male dd-D mice which were reared for a long-term experiment. After three months from the onset of rearing, some of mice showed convulsive attacks when they were handled in such routine laboratory procedures as weighing, clearing of cage and feeding. The convulsive attack was observed only among the mice being reared individually in each of sections of cage and did not occur in the mice which had been reared as a colony. The incidence rate of convulsive attack increased as the rearing period was prolonged. Our finding was similar to King and coworkers' report (1955) in which convulsions were observed in the singly housed C3H mice. The one thing particular in our observation was the difference of incidence rate according to the extent of isolation, i.e., the higher rate was observed on the condition of mice without other mice in the neighbouring sections than those with neighbouring mate. The neighbouring mate acted some roles to change susceptibility to convulsive attack, even though separated by a sheet of wire-netting.

Animals↗
PubMed2004

Evaluation of vaginal complaints.

CONTEXT: Vaginal symptoms are one of the most common reasons for gynecological consultation. Clinicians have traditionally diagnosed vaginal candidiasis, bacterial vaginosis, and vaginal trichomoniasis using some combination of physical examination, pH, the wet mount, and the whiff test. OBJECTIVES: To evaluate the role of the clinical examination and determine the positive and negative likelihood ratios (LRs) for the diagnosis of vaginal candidiasis, bacterial vaginosis, and vaginal trichomoniasis. DATA SOURCES: Using a structured literature review, we abstracted information on sensitivity and specificity for symptoms, signs, and office laboratory procedures. We chose published (1966 to April 2003) articles that appeared in the MEDLINE database and were indexed under the combined search terms of diagnosis with vaginitis, vaginal discharge, candidiasis, bacterial vaginosis, and trichomoniasis. STUDY SELECTION: Included studies of symptomatic premenopausal women seen in primary care settings. Tests were evaluated only if they would provide diagnostic information during the office visit and were compared with an acceptable criterion standard. DATA EXTRACTION: All 3 authors extracted the data and computed sensitivity and specificity from each article independently. The absence of standard definitions for symptoms and signs made it impossible to combine results across studies. DATA SYNTHESIS: Symptoms alone do not allow clinicians to distinguish confidently between the causes of vaginitis. However, a patient's lack of itching makes candidiasis less likely (range of LRs, 0.18 [95% confidence interval [CI], 0.05-0.70] to 0.79 [95% CI, 0.72-0.87]) and lack of perceived odor makes bacterial vaginosis unlikely (LR, 0.07 [95% CI, 0.01-0.51]). Similarly, physical examination signs are limited in their diagnostic power. The presence of inflammatory signs is associated with candidiasis (range of LRs, 2.1 [95% CI, 1.5-2.8] to 8.4 [95% CI, 2.3-31]). Presence of a "high cheese" odor on examination is predictive of bacterial vaginosis (LR, 3.2 [95% CI, 2.1-4.7]) while lack of odor is associated with candidiasis (LR, 2.9 [95% CI, 2.4-5.0]). Office laboratory tests, particularly microscopy of vaginal discharge, are the most useful way of diagnosing these 3 conditions. CONCLUSIONS: The cause of vaginal complaints may be easily diagnosed when typical findings appear in microscopy. However, the poor performance of individual symptoms, signs, and office laboratory tests often makes it problematic to identify the cause of vaginal symptoms.

Candidiasis, Vulvovaginal↗
PubMed1981

Evaluation of single cell protein from pulp mills: laboratory analyses and in vivo digestibility.

Single cell protein (SCP) derived from secondary clarifiers of pulp mills is a potential commercial protein supplement in many areas. Samples of SCP were collected from several pulp mills in the Pacific Northwest and evaluated by laboratory procedures. Six in vivo digestion trials were conducted to determine the relative nutritive value of SCP that was dewatered by centrifugation or by the addition of a polyacrylamide polymer before being put through a belt press and dried with a sonic dehydrator. Amino acid analyses showed that SCP was higher in methionine than was cottonseed meal (CSM) and had a similar level of lysine. True protein, based upon amino acids recovered in SCP samples, ranged from 51.6 to 65.9% of the crude protein (CP). Pepsin digestibility of the CP ranged from 16.2 to 36.8%. Pepsin digestibility increased by 6.3 to 11.3 percentage units when SCP were incubated in a buffered rumen fluid for 24 hours. Solubility of the nitrogenous components in 10% Burroughs' buffer solution ranged from 12.4 to 36.5%. The range in mineral composition was : P, .62 to 1.55%; Ca, .14 to .99%; K, .21 to 5.52%; Mg, .07 to .59%. The concentration of trace minerals and heavy metals varied considerably from sample to sample. Digestion trials were conducted with sheep to compare SCP with CSM; 20 to 50% of the total CP was provided by the SCP sources. The CP digestibilities of the centrifuged and the polymer-dewatered SCP were 70.5 to 70.8% and 66.3 to 69.9%, respectively, of that observed for CSM. In all digestion trials, sheep consumed the SCP diets readily, and no digestive disturbances were observed. On the basis of laboratory and in vivo results, pulp mill SCP has the potential to be a viable protein supplement for livestock.

Amino Acids↗
PubMed2000

Evaluation of interarch space for implant restorations in edentulous patients: a laboratory technique.

This article describes a laboratory procedure for the visual evaluation of interarch space and its effect on implant prosthesis design. The method is applicable to patients presenting with completely edentulous arches. Silicone impression material is used to form a resilient cast and an external mold from an existing denture. The denture is duplicated using autopolymerizing acrylic resin. The duplicate denture and resilient cast are mounted on an articulator. Spatial relationships of anatomic landmarks can be evaluated, and a quantitative evaluation of available space can be made. The duplicate denture can also be used as a surgical template to direct implant placement. Reference tables are provided to serve as guidelines in the correlation between available space and minimum space required for various implant-assisted restorations.

Acrylic Resins↗
PubMed1979

Pneumocystis carinii pneumonia. An approach to rapid laboratory diagnosis.

Laboratory procedures used to establish the diagnosis of Pneumocystis carinii pneumonia were evaluated using an experimental murine model. Touch preparations and suspension smears were prepared from lung tissue know to contain Pneumocystis cysts. These preparations were stained by a variety of methods known to demonstrate either cyst forms or sporozoites and trophozoites. Suspension smears proved to be superior to touch preparations in terms of cyst content and homogeneity of staining. Also, methods that stain cyst forms were superior to those that stain sporozoites and trophozoites for location and identification of organisms. The authors believe that suspension smears prepared from lung tissue and stained with toluidine blue O should be examined initially as a rapid screening method for Pneumocystis cysts. When the results of this initial screen are negative or inconclusive, additional suspension smears stainded by the modified Gomori methenamine silver nitrate method should be examined, pending availability of histologic sections.

Animals↗
PubMed2001

Dynamic fatigue properties of the dental implant-abutment interface: joint opening in wide-diameter versus standard-diameter hex-type implants.

STATEMENT OF PROBLEM: The clinical long-term success of single-tooth implant restorations depends, in part, on a stable connection between the prosthetic restoration and the implant body. PURPOSE: The purpose of this experiment was to investigate the fatigue life of UCLA-style abutment screws in wide-diameter versus conventionally sized dental implant restorations. MATERIAL AND METHODS: Five 3.75 x 15-mm and five 6.0 x 15-mm hexed dental implants were used. Ten frameworks were fabricated, 5 with a single UCLA-style, 3.75-mm hexed gold alloy cylinder, and 5 with a single UCLA-style, 6.0-mm hexed gold alloy cylinder. To simulate a common laboratory procedure, 2 abutment interfaces were relieved with a one-quarter round bur for both diameters. The 3.75-mm implant used a Gold-Tite central abutment screw torqued to 32 Ncm, and the 6.0-mm implant used a titanium central abutment screw torqued to 25 Ncm. Frameworks were dynamically loaded ( approximately 10 Hz) with a 120 +/- 10-N, 4-mm off-axis force. Liquid metal strain gauges were used to measure joint opening. Measurements were made at intervals of 10(3), 10(4), 10(5), and 5x10(5) cycles. Gauge output data were converted to displacement with a conversion factor determined by calibration. Linear regression analysis then was performed. RESULTS: Two observations were made in this study. Two of three 3.75-mm nonadjusted specimens and all three 6.0-mm nonadjusted specimens maintained joint closure (range of opening 0-20 microm) while measured under dynamic loading. The median joint opening at 5x10(5) cycles for 3.75-mm nonadjusted specimens was 14 +/- 7 microm; for 6.0-mm specimens, it was 11 +/- 10 microm. Both 3.75-mm adjusted specimens and 1 nonadjusted specimen failed to maintain joint closure (excess joint opening >50 microm). One of the 3.75-mm adjusted specimens had abutment screw fracture. One of two 6.0-mm adjusted specimens failed to maintain joint closure because of screw fracture. CONCLUSION: The dental implant-abutment interface of 3.75-mm and 6.0-mm externally hexed implants experienced similar joint opening after periods of dynamic loading. Laboratory adjustment of the interface significantly decreased the service life of the abutment screw joint.

Analysis of Variance↗
PubMed1999

Costs and benefits of diagnosing familial breast cancer.

Based on results from our surveillance program for women at risk for inherited breast cancer, we have calculated cost per year earned. Norwegian National Insurance Service reimbursement fees were used in the calculations. The calculated costs are based on empirical figures for expanding already established medical genetic departments and diagnostic outpatient clinics to undertake the work described. Cost per year earned was estimated at Euro 753 using our current practice of identifying the high-risk women through a traditional cancer family clinic. A strategy of identifying the high-risk families through genetic testing of all incident breast and ovarian cancers for founder mutations in BRCA1, will increase the cost to Euro 832. Costs related more to genetic counseling and clinical follow-up than to laboratory procedures. This potential economic limiting factor coincides with a shortage of personnel trained in genetic counseling. The number of relatives counseled to identify one healthy female mutation carrier (i.e. the uptake of genetic testing) is more important to cost-effectiveness than family size. Costs will vary depending upon the penetrance of the mutations detected and the prevalence of founder mutations in the population examined. Prevalences of BRCA1 founder mutations in some high incidence areas of Norway may be sufficiently high to consider population screening. Unlike mutation screening of cancer genes, founder mutation analysis will not identify DNA variants of uncertain clinical significance. Identification of high-risk families through founder mutation analysis of BRCA1 ensures that families with maximum risks are given first access to the limited resources of the high-risk clinics. This may be the greatest contribution to increased cost effectiveness of such a strategy. The assumptions underlying the calculations are discussed. The conclusion is that inherited breast cancer may be managed effectively for the cost of Euro 750-1,600 per year earned.

Biopsy↗
PubMed1983

Cancer detection in the periodic physical examination.

The periodic physical exam is the ideal time for the primary physician to detect cancer at an early stage. With certain points in mind the physician can rapidly screen for suggestive signs of cancer during the physical examination. Certain procedures, laboratory and x-ray examinations, aid in this detection and should be part of the total examination.

Abdominal Neoplasms↗