A comparison of OHIP 14 and OIDP as interviews and questionnaires.

OBJECTIVE: To assess the completion rates and concurrent validity of the Oral Impacts on Daily Performance (OIDP) and the short form of the Oral Health Impact Profile (OHIP 14) in both questionnaire and interview formats. BASIC RESEARCH DESIGN: Cross sectional social and clinical study. Clinical setting Dental teaching hospital primary care department in London UK. Participants Two week consecutive sample of 183 patients attending setting. PARTICIPANTS: came from 19 ethnic groups, 53% were men and 32% had attended for a dental emergency. MAIN OUTCOME MEASURES: Completion rates and concurrent validity for each instrument and in each format. RESULTS: Completion rates for OHIP 14 and OIDP were similar in interview format. In questionnaire format usable data were provided on 92.9% of the OHIP 14 but only 86.5% of the OIDP questionnaires. Completion of both questionnaires was related to ethnicity. The number of impacts for both measures and total impact scores for OHIP 14 were related to the age of the participants, the presence of oral disease and the order of administration of the instruments. Analysis of the total score for OIDP was weakened by the severe skewness of these data. CONCLUSIONS: The psychometric properties of OHIP 14 and OIDP were not related to the method of administration. However, the use of OIDP in this questionnaire format may result in loss of data, particularly from people who are not White English.

A controlled study of relative periodontal attachment loss in people with HIV infection.

OBJECTIVE: To compare the progression of periodontal destruction in people with and without HIV. METHOD: Relative attachment loss on 6 index teeth was compared between 19 people with HIV and 17 people without HIV infection over 12 and 18 month follow ups. RESULTS: The proportions of sites with 1, 2 or 3 mm of relative attachment loss were similar in the study and control groups. Mean maximum relative attachment loss was similar in both groups after 12 months but greater in the study group after 18 months. CONCLUSIONS: The data are not compelling evidence of greater periodontal destruction associated with HIV infection. Large scale cohort studies or meta-analyses would be more conclusive.

Double gloving and a glove perforation indication system during the dental treatment of HIV-positive patients: are they necessary?

AIM: The aim of this study was to compare the incidence of glove perforation when double gloved or single gloved during the routine treatment of HIV-positive patients. In addition, a glove perforation indication system based on a double gloving technique was assessed. DESIGN: Prospective, randomised and open study of glove perforation. METHODS: 138 consecutive HIV-positive patients underwent routine dental treatment by senior dental staff and dental hygienists in a teaching hospital. Staff wore either single gloves (Regent Biogel D or standard surgical gloves) or double gloves (Regent 'Reveal' perforation indication system or standard surgical gloves). A subjective assessment of glove comfort, sensitivity and ease of donning was made using a visual analogue scale. RESULTS: The incidence of glove perforation/procedure was low, 2.9%. There were no skin penetrating injuries, visible exposure to body fluids or unnoticed perforations. Double gloving was subjectively less comfortable and sensitive than single gloving (P < 0.0001). The glove perforation indication system did not increase the detection of intra-operative perforations. CONCLUSIONS: There is unlikely to be any significant benefit from the use of a double gloving technique or perforation indication system during the routine dental treatment of HIV-positive patients.

Diversity of naturally occurring Epstein-Barr virus revealed by nucleotide sequence polymorphism in hypervariable domains in the BamHI K and N subgenomic regions.

The extent of nucleotide sequence microheterogeneity varies among subgenomic regions of Epstein-Barr virus (EBV). We examined, in EBV-carrying lymphoid cell lines, the extent of polymorphism in EBV DNA fragments amplified from the BamHI E, K, N and Z regions, and then investigated the diversity of the more hypervariable regions in tissues and body fluids. In cell lines, sequence dissimilarities in a genotype-specifying fragment of the EBNA-3C gene varied from < 1-4% within each genotype; dissimilarities in the first intron of the BZLF- 1 gene were < 2% within each genotype. By contrast, dissimilarities in a C-terminal unique domain of the EBNA-1 gene, and in a fragment that encompasses and is upstream of the LMP-1 start codon, varied between 2 and 7% and were not genotype-specific. The sequence diversity in BamHI K and N regions was then examined in tissues and body fluids by single-strand conformation polymorphism (SSCP) analysis and cycle sequencing. Extensive inter-host diversity was observed, whether the host was co-infected by human immunodeficiency virus (HIV) or not. In the oral cavity of HIV-infected patients, inter-compartmental EBV diversity could be demonstrated, even between sites that were anatomically proximate. Studies of BamHI K clones derived from EBV in oral lesions revealed infection by multiple variants. Identification of hypermutable loci within the EBV genome such as those located in the BamHI K and N regions should permit fine discrimination of individual EBV variants.

Resource implications for oral care of patients with HIV.

OBJECTIVES: The aim was to investigate the attitudes of people with HIV infection towards their own dental care provision and the possible implications for future resource allocation. DESIGN: Sixty-nine HIV positive subjects attending support groups in London were interviewed. Past and current dental visiting behaviour, problems encountered in obtaining dental care and preferred site of delivery for dental care were investigated. RESULTS: Showed that a majority (74%) changed dentist or stopped attending following diagnosis with HIV, either due to fear of or actual refusal of treatment, a desire to attend a more sympathetic dentist or to attend a specialist clinic. Forty-five per cent withheld information about their status. Subjects expressed a desire to receive regular dental care and had definite preferences as to the site of delivery, 45% preferring general practice, 48% specialist clinics. CONCLUSIONS: Future resource allocation should be used for continued support and education of general dental practitioners willing to treat HIV positive patients, and for accessible specialist referral centres. Hospital clinics could also provide regular routine care, especially in areas of large HIV populations. An improved awareness of and access to community dental clinics appears to be needed, with efforts focused on achieving an informed and educated patient population through education programmes.

Aetiological factors for oral manifestations of HIV.

OBJECTIVES: Describe the oral diseases in HIV-infected individuals in London, UK and identify social and medical factors related to the presence of specific oral diseases. DESIGN: Dental clinics. SUBJECTS: Consecutive sample of 456 patients with HIV infection. METHODS: Social and medical history and clinical examinations. Univariate and logistic regression analysis. OUTCOMES: Presence of HIV-associated oral disease. RESULTS: 80% of patients with AIDS and 50% of patients with HIV had a specific oral disease. The most common diseases were hairy leukoplakia (30%), erythematous candidiasis (24%), pseudomembranous candidiasis (14%), angular chielitis (6%), necrotising periodontal disease (8%) and non-recurrent ulceration (6%). CONCLUSIONS: The presence of erythematous candidiasis was not related to advanced HIV disease. Pseudo-membranous candidiasis, hairy leukoplakia and mucosal ulceration were significantly associated with advanced HIV disease. Smoking was also identified as a strong aetiological factor in oral diseases. Longitudinal studies are required to further explore the prognostic significance of oral diseases in HIV infection.

Risk factors associated with Epstein-Barr virus replication in oral epithelial cells of HIV-infected individuals.

OBJECTIVE: To examine risk factors associated with Epstein-Barr virus (EBV) replication in the oral epithelium of an HIV-infected cohort. DESIGN: Longitudinal study of behavioural, medication and immunological parameters of HIV-1-seropositive outpatients attending a genitourinary clinic. Outcome measure was EBV DNA positivity in curetted oral squames, as detected by in situ hybridization. Logistic regression for repeated observations of the same individuals was used to analyse how risk changed over time. RESULTS: Fifty six individuals were studied; 158 patient-visits were made in total (mean, 2.8). Of 137 samples curetted from the tongue, 36 were positive for EBV DNA. Recreational drug use, oral sexual practices, therapy with zidovudine and aciclovir, and changes in CD4 and total lymphocyte counts were not associated with changes in risk. Alcohol drinking, elevated CD8 lymphocyte counts and fluconazole therapy were associated with a decreased risk, and cigarette smoking with increased risk. CONCLUSION: Behavioural and HIV-specific immunological changes may play important roles in promoting and affecting the course of oral EBV replication. Rigorous anticandidal therapy and avoidance of cigarette smoking may retard the development of oral hairy leukoplakia.

Dental care for patients with HIV.

Awareness is growing among dental practitioners of the hazards of blood-borne pathogens, especially since the advent of HIV infection and AIDS. This awareness has promoted fundamental changes in the practice of dentistry. There is no reason, as long as infection control procedures are followed carefully, that otherwise well HIV-positive individuals should not be treated routinely in a standard clinical environment.

[Stripping of the external saphenous vein. Use of the Hall Chevallier stripper]. / Eveinage de la saphène externe. Utilisation du tire-veine de Hall Chevallier.

In more than 20 cases we used the Hall Chevallier stripper (initially devised to remove the valves of the internal saphenous vein in femoro-popliteal bypass) for stripping of the external saphenous vein. This routine procedure is not always easy to perform, owing to the irregular caliber of that vessel. There are three reasons why we used this particular stripper for this unusual purpose: its end is streamlined; strippers of different calibers are available and the instrument is rigid. In those exceptional cases where the external saphenous vein is not accessible from below (e.g. notably after sclerosis), stripping can be carried out from above.

Unilateral renal agenesis associated with vaginal or cervical fistula and anomalous uterine development.

Two patients with unexplained profuse vaginal discharge were noted to have anomalous uterine development associated with renal agenesis. Fistulous communication between a mesonephric duct remnant and the vagina or cervix was noted as the cause of the discharge. A previous report by one of the authors described two similar cases. Physicians should be alert to this syndrome as a cause of leukorrhea.

Bilateral pleural thickening: a manifestation of asbestos dust exposure.

Bilateral pleural thickening in a relatively asymptomatic patient without evidence of pulmonary disease is frequently a manifestation of asbestos dust exposure, particularly when it is localized or in the form of a noncalcified pleural plaque. Bilateral pleural thickening will be discovered with increasing frequency if specifically searched for on every radiograph. This radiographic finding is suggested as a more realistic indication of asbestos dust exposure, particularly when correlated with a complete occupational history.

Splenic subcapsular hematoma--ultrasonic diagnosis.

In five patients with varying histories of blunt abdominal trauma, examinations were carried out with ultrasonography and other imaging modalities. In all five patients, large, fluid-filled masses were noted in the left upper quadrant. Two patients had nonpalpable hematomas, but examinations were done because of history and vague clinical symptoms. Three patients had palpable masses. In all five patients there was surgical confirmation of the ultrasonic findings, and all recovered without complications. Ultrasonic tomography offers a convenient noninvasive method for assessing suspected splenic hematoma and can also exclude the possibility in a careful examination.

Adenocarcinoma in the columnar-lined (Barrett) esophagus. Case report and review of the literature.

As of 1975, forty-nine cases of adenocarcinoma arising in the columnar-lined lower esophagus (CLLE) were reported in the literature. We add three more cases, including the youngest male to our knowledge. All survived esophagogastrectomy and radiotherapy, but each had metastatic disease and a guarded prognosis. Review of the literature revealed a male/female ratio of 3:1 for this disorder with a mean age for men of 53 years, less than that for women, (61 women). Columnar-lined lower esophagus is seen in up to 11% of patients with reflux esophagitis and probably does not regress, once present. Adenocarcinoma later develops in 2.4% to 8.5%. The CLLE is not rare and should be followed up as carefully as any other premalignant lesion.