Complete meningioma resolution following endovascular embolization of chronic subdural hematoma.

We present the first reported case that describes the complete resolution of a meningioma following endovascular embolization. A man in his 70s who presented with gait abnormalities and recurrent falls was diagnosed with normal pressure hydrocephalus (NPH) and found to have a small incidental meningioma. Due to ventriculoperitoneal (VP) shunt placement for cerebrospinal fluid diversion, the patient developed a bilateral subdural hematoma (SDH) requiring evacuation and drain placement. The patient also underwent bilateral middle meningeal artery (MMA) embolization. During the embolization, the known right frontal meningioma was embolized as it was supplied by the right MMA. The patient remained neurologically stable after this procedure. His follow-up magnetic resonance imaging (MRI) 1 year and 2 years after the procedure demonstrated complete resolution of the meningioma.

3D Accuracy of a Conventional Method Versus Three Digital Scanning Strategies for Completely Edentulous Maxillary Implant Impressions.

PURPOSE: To compare the 3D accuracy of three scanning strategies and conventional impressions using an edentulous model with six implants. MATERIALS AND METHODS: An edentulous maxillary master model was fabricated with six equigingival internal connection implants at 0 degrees of angulation. Ten conventional open-tray splinted implant-level impressions were made and poured in stone. A master model and conventional casts were digitized with a reference scanner. Digital impressions were made by calibrated clinicians with a TRIOS 3 intraoral scanner ([IOS] 3Shape) according to three scanning strategies: DIG1 (occlusal-palatal-lingual), DIG2 (S-type motion from buccal to palatal), and DIG3 (scanning two half arches and connecting them at the midline). Each technique was repeated 10 times on the master model. Deviations from the STL datasets (N = 40) were compared to those of the reference master model using the Hexagon Metrology software system PC-DMIS CAD++. Linear distortions (dX, dY, dZ), global linear distortion (dR), and angular distortions (Absdθx, Absdθy) were calculated. Kruskal-Wallis test and mixed linear and logistic regression models were used to compare the original and binary distortion measures between the techniques. RESULTS: The mean dR ranged from 91 µm (conventional method) to 183 µm (DIG1). The mean angular distortion ranged from 0.20 degrees (Absdθx for DIG2) to 0.69 degrees (Absdθy for DIG3). No scan pattern resulted in a more accurate reproduction in any of the measured parameters than the conventional impression method. There were significant differences between the methods for all distortion measures. CONCLUSIONS: No group reproduced the 3D position of the six-implant master model below the thresholds for both global linear and angular distortions. All the digital strategies tested were less accurate than the conventional open-tray splinted implant-level impression technique.

Endovascular Thrombolysis or Thrombectomy for Cerebral Venous Thrombosis: Study of Nationwide Inpatient Sample 2004-2014.

BACKGROUND AND PURPOSE: 15% of cerebral venous thrombosis (CVT) patients have poor outcomes despite anticoagulation. Uncontrolled studies suggest that endovascular approaches may benefit such patients. In this study, we analyze Nationwide Inpatient Sample (NIS) data to evaluate the safety and efficacy of endovascular therapy (ET) versus medical management in CVT. We also examined the yearly trends of ET utilization in the United States. METHODS: International Classification of Diseases, Ninth Revision, Clinical Modification codes were utilized to identify CVT patients who received ET. To make the data nationally representative, weights were applied per NIS recommendations. Since ET was not randomly assigned to patients and was likely to be influenced by disease severity, propensity score weighting methods were utilized to correct for this treatment selection bias. Outcome variables included in-hospital mortality and discharge disposition. To determine if our primary outcomes were associated with ET, we used weighted multivariable logistic regression analyses. RESULTS: Of the 49,952 estimated CVT cases, 48,704 (97%) received medical management and 1248 (3%) received ET (mechanical thrombectomy [MT] alone, N = 269 [21%], MT ± thrombolysis, N = 297 [24%], and thrombolysis alone, N = 682 [55%]). Patients who received ET were older with more CVT associated complications including venous infarct, intracranial hemorrhage, coma, seizure, and cerebral edema. There was a significant yearly rise in the use of ET, with a trend favoring MT versus thrombolysis alone. ET was independently associated with an increased risk of death (odds ratio 1.96, 95% confidence interval 1.15-3.32). CONCLUSIONS: Patients receiving ET experienced higher mortality after adjusting for age and CVT associated complications. Large, well designed prospective randomized trials are warranted for further evaluation of the safety and efficacy of ETs.

Sinus Augmentation and Simultaneous Implant Placement Success: Pilot Study (2008-2011).

OBJECTIVE: 1) To describe implant success in the posterior maxillary when a sinus augmentation procedure was performed simultaneously with implant placement and then compare differences in success when sinus augmentation was delayed in patients attending the maxillofacial surgery clinic of the University of Puerto Rico, 2008 through 2011. 2) To determine sociodemographic characteristics, ASA classification, graft material, and final restoration and, using a questionnaire, determine as well patient satisfaction. METHODS: A retrospective cohort study was conducted (approved by IRB) with 172 patients, using medical records. A total of 102 implants were placed in grafted maxillary areas, 55 placed simultaneously and 47 delayed. Patients were contacted, invited to participate, and, upon agreement, instructed to sign an informed consent. RESULTS: A total of 45 implants were evaluated clinically (22 immediate and 23 delayed), all with 100% success (according to Buser and Weber criteria). In the sample group, 72.5% of the participants were women and 26.8% were men; their ages ranged from 42 to 87 years, with a mean age of 57 years. Patient participation was low (44%). The categories of appearance and esthetics and function were both rated at 86.2%; cost of restoration came in at 86.1%, and maintenance was rated at 71.2%. CONCLUSION: Implant placement with simultaneous sinus augmentation was successful, and no differences were found between implants that were placed immediately and those that were delayed, which is similar to what has been found by previous studies. Patients reported being satisfied with the final cost of the implant restoration.

Reliability of isometric and isokinetic peak torque of elbow flexors and elbow extensors muscles in trained swimmers / Reprodutibilidade do pico de torque isométrico e isocinético dos músculos flexores e extensores de cotovelo em nadadores treinados

Abstract In this study, it was hypothesized that the peak torque reliability would depend on the type of muscular action. The aim of this study was to analyze and to compare the reliability of isometric peak torque (IPT) and isokinetic peak torque at speeds of 60º.s-1 and 180º.s-1 (CPT60 and CPT180, respectively) of elbow flexors (EF) and elbow extensors (EE) muscles in trained swimmers. Twenty trained male swimmers (23 ± 5 years) performed the following protocols in different days: 1) Familiarization to isokinetic dynamometer; 2) Two maximal isometric voluntary contractions to determine IPT and five maximal concentric isokinetic contractions at 60º.s-1and 180º.s-1 to determine CPT60 and CPT180, respectively (T1). The tests for IPT, CPT60 and CPT180 determination were performed in random order, and; 3) The same tests were performed in the same order of those performed on the second day (T2). There was no significant difference of IPT, CPT60 and CPT180 values between T1 and T2. Higher intraclass correlation coefficient (ICC) and lower typical error (TE) of IPT (ICC - 0.87 - 0.92; TE - 6.9 - 10.9%) in relation to CPT60 (CCI - 0.66 - 0.79, TE - 12.0 - 12.8%) and CPT180 (ICC - 0.85 - 0.85; TE - 8.5 - 9.2%) was observed. Based on these results, it could be concluded that the peak torque of EF and EE muscles presents moderate to excellent reliability, and can be influenced by the type of muscular action performed by trained swimmers.

Resumo Neste estudo, hipotetizou-se que a reprodutibilidade do pico de torque poderia depender do tipo de ação muscular. O objetivo do presente estudo foi analisar e comparar a reprodutibilidade do pico de torque isométrico (PTI) e do pico de torque isocinético concêntrico nas velocidades de 60º.s-1 e 180º.s-1 (CPT60 e CPT180, respectivamente) dos músculos flexores (FC) e extensores do cotovelo (EC) em nadadores treinados. Vinte nadadores treinados do gênero masculino (23 ± 5 anos) realizaram os seguintes protocolos, em diferentes dias: 1) Familiarização ao dinamômetro isocinético; 2) Duas contrações isométricas máximas para a determinação do PTI e cinco contrações isocinéticas máximas concêntricas a 60º.s-1 e 180º.s-1 para a determinação do CPT60 e CPT180, respectivamente (T1). Os testes para a determinação do PTI, CPT60 e CPT180 foram realizados de forma aleatória e; 3) Foram realizados os mesmos testes e na mesma ordem dos realizados no segundo dia (T2). Não houve diferença significante dos valores de PTI, CPT60 e CPT180 entre T1 e T2. Foi observado maior coeficiente de correlação intraclasse (CCI) e menor erro típico (ET) do PTI (CCI - 0,87 - 0,92; ET - 6,9 - 10,9%) em relação ao CPT60 (CCI - 0,66 - 0,79, ET - 12,0 - 12,8%) e CPT180 (CCI - 0,85- 0,85; ET - 8,5 - 9,2%). Com base nestes resultados, é possível concluir que o pico de torque dos músculos FC e EC apresenta reprodutibilidade entre moderada e excelente, podendo ser influenciada pelo tipo de ação muscular realizada em indivíduos treinados na natação.

Increasing opportunistic oral cancer screening examinations: findings from focus groups with general dentists in Puerto Rico.

This study aims to identify educational and training modalities that dentists in Puerto Rico (PR) believe will increase the quality and quantity of opportunistic oral cancer screening examinations (OCS) in dental offices on the island. The study was conducted in three phases: a systematic search of relevant literature, an expert review and consensus panel, and focus groups (FG) involving PR general dentists. To increase OCS by dentists in PR, the FG participants proposed a small group, hands-on OCS training, an integrated oral cancer course, and readily available videos, photographs, and computer simulations to further demonstrate OCS performance and facilitate differential diagnosis. OCS training requirements for licensure and re-licensure, improving OCS dentist-patient communication skills, and establishment of an oral lesion referral center were also viewed favorably. In conclusion, general dentists in our FGs believed the quality and quantity of OCS in Puerto Rico can be increased through the application of specific continuing education and training modalities.

Micronutrient Intake among Children in Puerto Rico: Dietary and Multivitamin-Multimineral Supplement Sources.

BACKGROUND: Micronutrients are critical for healthy growth and development of children. Micronutrient intake from dietary sources is inadequate among some children and may be improved by use of multivitamin and multimineral (MVMM) supplements. OBJECTIVE: To assess micronutrient intake from dietary and MVMM supplement sources among 12-year-old children in Puerto Rico. METHODS: A representative sample of 732 children enrolled in an oral health study in Puerto Rico, who completed dietary and MVMM assessments through one 24-h recall, were included in this analysis. Micronutrient intake sources were described and compared to the Dietary Reference Intakes (DRIs) using the Estimated Average Requirement when available (used Adequate Intake for vitamin K and pantothenic acid). Micronutrient profiles of MVMM users and non-users were compared using t-tests. RESULTS: Mean intakes of vitamins A, D, E, and K, pantothenic acid, calcium, and magnesium from food and beverage sources were below the DRIs. From food and beverage sources, MVMM users had higher intakes of riboflavin and folate compared to non-users (p < 0.05). When MVMM supplements were taken into account, users had higher intakes of all nutrients except vitamin K. With the help of MVMM, users increased intake of vitamins E, A, D, and pantothenic acid to IOM-recommended levels but calcium, magnesium, and vitamin K remained below guidelines. CONCLUSION: Micronutrient intake from diet was below the IOM-recommended levels in the total sample. MVMM use improved intake of selected micronutrients and facilitated meeting recommendations for some nutrients. Public health measures to improve micronutrient intake among children in Puerto Rico are needed.

Diet quality, social determinants, and weight status in Puerto Rican children aged 12 years.

Diet quality may be influenced by social determinants and weight status. This has not been studied in Puerto Rico; therefore, our cross-sectional study examined whether diet quality, assessed by the Healthy Eating Index-2005 (HEI-2005), differs by social determinants (sex, school type, and region) and weight status in children in Puerto Rico. As part of an island-wide study to evaluate oral health in 1,550 children aged 12 years, dietary intake was assessed in a representative subset (n=796) using a 24-hour diet recall. Diet quality was evaluated from the diet recall results using the HEI-2005. Overall mean HEI-2005 score was 40.9, out of a total maximum score of 100. Girls had significantly higher scores for whole fruit, total vegetables, whole grains, and sodium but lower scores for total grains and milk compared with boys (P<0.05). Children from public schools had higher scores for total fruit, whole fruit, and dark green and orange vegetables and legumes, but lower scores for whole grains and milk compared with those from private schools (P<0.05). Children from the central mountains had higher scores for the dark green and orange vegetables and legumes and for whole fruit compared with the other regions (P<0.05). Overweight children had significantly higher scores for total vegetables and milk, but lower scores for total fruit and sodium compared with non-overweight children (P<0.01). Some components of diet quality were associated with the social determinants studied and with weight status in our sample. Overall diet quality needs improvement in Puerto Rican children so that it is better aligned with dietary recommendations.

Correlation of thrombus formation on 7 T MRI with histology in a rat carotid artery side wall aneurysm model.

BACKGROUND/PURPOSE: Various aneurysm animal models have been utilized to study the histological reaction post coil embolization. Our aim was to evaluate the imaging findings at day 14 of a rat external carotid artery side wall aneurysm treated with coil embolization using a gradient echo sequence on 7 T MRI and to correlate this with the histological findings. MATERIALS AND METHODS: Male Sprague Drawley rats were utilized to create a sidewall external carotid artery blind pouch aneurysm. A 5 mm segment of hydrocoil or bare platinum coil was inserted into the created aneurysm. Five sham operated rats were used as controls. The arterial construct was harvested on day 14. The block of tissue was evaluated with histopathology and immunohistochemistry. Prior to sacrifice, the animal underwent 7 T MRI. Statistical analysis was then performed to assess the correlation of signal abnormality with intra-aneurysmal thrombus formation on histology. RESULTS: 10 rats were used for the experiment. Five rats had implantation of hydrocoils and five of bare platinum coils. There was a statistically significant linear correlation between the intra-aneurysmal thrombus on histology and gradient echo 7 T MRI sequences. There was no correlation demonstrated in the hydrocoil implanted group. No thrombus or abnormal signal was seen in the sham group. CONCLUSIONS: In our experiment, thrombus formation in aneurysms treated with bare platinum coils is well correlated with the presence of abnormal signal on 7 T MRI at 14 days. No correlation was appreciated in the hydrocoil implanted group due to the presence of intra-aneurysmal reactive tissue instead of thrombus.

Diagnóstico histopatológico de colitis microscópica: enfoque práctico / A practical approach to histopathologic diagnosis of microscopic colitis

La colitis linfocítica y la colitis colagenosa son las dos formas histológicas de la colitis microscópica (CM), condición médica reconocida hace más de 30 años, habitual en pacientes adultos con diarrea crónica acuosa, sin cambios endoscópicos en la mucosa del colon y cuyo diagnóstico se establece exclusivamente en el examenhistopatológico de las biopsias de colon. El objetivo de la presente revisión es familiarizar a los médicos patólogos quirúrgicos en práctica general con la morfología de la colitis linfocítica y la colitis colagenosa, así como con la importancia de los informes de patología y la de una buena comunicación con el médico endoscopista para el correcto diagnóstico de estas entidades, y brindar a estos pacientes el tratamiento adecuado.

Lymphocytic colitis and collagenous colitis are two histologic forms of microscopic colitis, a condition whichwas first recognized over 30 years ago. It is often found in adults with chronic, watery diarrhea although endoscopic examination of the colon is frequently normal. The diagnosis is based on microscopic examination of colonic biopsies. The aim of this review is to familiarize general surgical pathologists with the morphologic features of lymphocytic and collagenous colitis. In additional, this review emphasizes good communication with the endoscopist to allow correct recognition and ensure appropriate treatment.

Endovascular methods for the treatment of intracranial cerebral aneurysms.

This article briefly discusses the clinical features, natural history, and epidemiology of intracranial cerebral aneurysms, along with current diagnostic imaging techniques for their detection. The main focus is on the basic techniques used in endovascular coiling of ruptured and nonruptured saccular intracranial cerebral aneurysms. After a discussion of each technique, a short review of the results of each form of treatment is given, concentrating on reported large case series. Specific complications related to the endovascular treatment of saccular intracranial aneurysms are then discussed.

Endovascular treatment of cerebral vasospasm: vasodilators and angioplasty.

Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a delayed, reversible narrowing of the intracranial vasculature that occurs most commonly 4 to 14 days after aneurysmal SAH and can lead to permanent ischemic injury. Angiographic spasm occurs in up to 70% of patients following SAH, and approximately half become symptomatic. Estimates of patients who are disabled by vasospasm, or die because of it, range from 5% to 9%, with vasospasm accounting for 12% to 17% of all fatalities or cases of disability after SAH. This article discusses the multiple medical and endovascular therapies used to prevent or treat vasospasm.

Intracranial endovascular balloon test occlusion: indications, methods, and predictive value.

Abrupt interruption of the internal carotid artery without a balloon test occlusion (BTO) carries a 26% risk of cerebral infarction. BTO is a test used to decrease this risk by evaluating the efficacy of the collateral circulation. Clinical tolerance of parent vessel occlusion can be assessed by a BTO with several variables, including the clinical examination, angiographic assessment, stump pressure, induced hypotension, perfusion scanning, transcranial Doppler ultrasonography, and neurophysiologic monitoring. This review discusses the indications, methods, predictive value, and complications of BTO.

MR spectroscopy using normalized and non-normalized metabolite ratios for differentiating recurrent brain tumor from radiation injury.

RATIONALE AND OBJECTIVES: To compare the ability of normalized versus non-normalized metabolite ratios to differentiate recurrent brain tumor from radiation injury using magnetic resonance spectroscopy (MRS) in previously treated patients. MATERIALS AND METHODS: Twenty-five patients with previous diagnosis of primary intracranial neoplasm confirmed with biopsy/resection, previously treated with radiation therapy (range, 54-70 Gy) with or without chemotherapy and new contrast enhancing lesion on a 1.5 T magnetic resonance imaging at the site of the primary neoplasm participated in this retrospective study. After MRS, clinical, radiological, and histopathology data were used to classify new contrast-enhancing lesions as either recurrent neoplasm or radiation injury. Volume of interest included both the lesion and normal-appearing brain on the contralateral side. Non-normalized metabolic ratios were calculated from choline (Cho), creatine (Cr), and N-acetylaspartate (NAA) spectroscopic values obtained within the contrast-enhancing lesion: Cho/Cr, NAA/Cr, and Cho/NAA. Normalized ratios were calculated using the metabolic values from the contralateral normal side: Cho/normal creatinine (nCr), Cho/normal N-acetylaspartate (nNAA), Cho/normal choline, NAA/nNAA, NAA/nCr, and Cr/nCr. Results were correlated with the final diagnosis by Wilcoxon rank-sum analysis. RESULTS: Two of three non-normalized ratios, Cho/NAA (sensitivity 86%, specificity 90%) and NAA/Cr (sensitivity 93%, specificity 70%) significantly associated with tumor recurrence even after correcting for multiple comparisons. Of the six normalized ratios, only Cho/nNAA significantly correlated with tumor recurrence (sensitivity 73%, specificity 40%), but did not remain significant after correcting for multiple comparisons. CONCLUSION: Cho/NAA and NAA/Cr were the two ratios with the best discriminating ability and both had better discriminating ability than their corresponding normalized ratios (Area under the curve = 0.92 versus 0.77, AUC= 0.85 vs. 0.66), respectively.

Smoking and drinking in relation to oral potentially malignant disorders in Puerto Rico: a case-control study.

BACKGROUND: Oral cancer incidence is high on the Island of Puerto Rico (PR), particularly among males. As part of a larger study conducted in PR, we evaluated smoking and drinking as risk factors for oral potentially malignant disorders (OPMDs). METHODS: Persons diagnosed with either an OPMD (n = 86) [oral epithelial dysplasia (OED), oral hyperkeratosis/epithelial hyperplasia without OED] or a benign oral tissue condition (n = 155) were identified through PR pathology laboratories. Subjects were interviewed using a standardized, structured questionnaire that obtained information, including detailed histories of smoking and drinking. Odds ratios (ORs) for smoking and drinking in relation to having an OPMD, relative to persons with a benign oral tissue condition, were obtained using logistic regression and adjusted for age, gender, education, fruit/vegetable intake and smoking or drinking. RESULTS: For persons with an OPMD and relative to individuals with a benign oral tissue condition, the adjusted OR for current smoking was 4.32 (95% CI: 1.99-9.38), while for former smokers, the ORadj was 1.47 (95% CI: 0.67-3.21), each ORadj relative to never smokers. With regard to drinking, no adjusted ORs approached statistical significance, and few point estimates exceeded 1.0, whether consumption was defined in terms of ever, current, level (drinks/week), or beverage type. CONCLUSIONS: In this study, conducted in Puerto Rico, current smoking was a substantial risk factor for OPMDs while former smokers had a considerably reduced risk compared to current smokers. There was little evidence suggesting that alcohol consumption was positively associated with OPMD risk.

Perspectives of San Juan healthcare practitioners on the detection deficit in oral premalignant and early cancers in Puerto Rico: a qualitative research study.

BACKGROUND: In Puerto Rico, relative to the United States, a disparity exists in detecting oral precancers and early cancers. To identify factors leading to the deficit in early detection, we obtained the perspectives of San Juan healthcare practitioners whose practice could be involved in the detection of such oral lesions. METHODS: Key informant (KI) interviews were conducted with ten clinicians practicing in or around San Juan, Puerto Rico. We then triangulated our KI interview findings with other data sources, including recent literature on oral cancer detection from various geographic areas, current curricula at the University of Puerto Rico Schools of Medicine and Dental Medicine, as well as local health insurance regulations. RESULTS: Key informant-identified factors that likely contribute to the detection deficit include: many practitioners are deficient in knowledge regarding oral cancer and precancer; oral cancer screening examinations are limited regarding which patients receive them and the elements included. In Puerto Rico, specialists generally perform oral biopsies, and patient referral can be delayed by various factors, including government-subsidized health insurance, often referred to as Reforma. Reforma-based issues include often inadequate clinician knowledge regarding Reforma requirements/provisions, diagnostic delays related to Reforma bureaucracy, and among primary physicians, a perceived financial disincentive in referring Reforma patients. CONCLUSIONS: Addressing these issues may be useful in reducing the deficit in detecting oral precancers and early oral cancer in Puerto Rico.

Analysis of three-dimensional distortion of two impression materials in the transfer of dental implants.

STATEMENT OF PROBLEM: In dental implant restorations, a lack of passivity may be associated with mechanical failure. Passivity can be compromised during impression making. PURPOSE: The purpose of this study was to compare the distortion of mechanically mixed polyether and hydrophilic addition silicone impression materials, and to evaluate the effect of intercoping distance on distortion. MATERIAL AND METHODS: Twenty impressions (10 polyether and 10 silicone) were made from a single mandibular definitive cast with 5 abutment analogs using standardized laboratory and technique protocols. The direct impression technique and mechanical mixing were used. A precision measuring machine established spatial coordinates of the impression copings in 3 dimensions, with the operator blinded to materials. Linear distances (concentricity) and angular inclinations (perpendicularity, parallelism) were calculated to measure impression distortion relative to the positions/angulations of the implants in the definitive cast. Distortion differences between materials and implant intercoping distances were tested using 2-factor ANOVA with an interaction term. A Bonferroni 2-sided test was used (alpha=.05). RESULTS: No significant difference was found between the impression materials for parallelism (P=.91) and concentricity (P=.85). For perpendicularity, the silicone material had an average of 0.643 degrees less distortion (P=.004). With respect to intercoping distances, no significant differences were found for perpendicularity (P=.234), parallelism (P=.114), or concentricity (P=.346). An interaction term for material and coping distance was not significant. CONCLUSIONS: Hydrophilic addition silicone and polyether impression materials have similar distortion effects for transfer procedures when using the direct impression technique and machine mixing. Silicone demonstrated superiority for perpendicularity distortion, though of a magnitude unlikely to have clinical significance.

A deficit in biopsying potentially premalignant oral lesions in Puerto Rico.

BACKGROUND: Intraoral lesions clinically suspicious for cancer/precancer should be biopsied and diagnosed histopathologically. We evaluated whether the frequency of oral cancer (OC) cases diagnosed in Puerto Rico (PR) is disproportionately high relative to the frequency of persons with histopathologic diagnoses that would have appeared clinically suspicious for OC/precancer at biopsy. METHODS: All pathology reports for oral (ICD-O-3 C01-C06) soft tissue biopsies generated during 1/2004-5/2005 by seven PR and two New York City (NYC) pathology laboratories were reviewed. The analysis was restricted to persons diagnosed with invasive oral squamous cell carcinoma (OSCC), epithelial dysplasia, or hyperkeratosis/epithelial hyperplasia (HK/EH), i.e., diagnoses associated with lesions clinically suspicious for OC/precancer. The OC relative frequency measured the percentage of persons diagnosed with OSCC among persons with OSCC, dysplasia, or HK/EH. OC relative frequencies for PR and NYC laboratories were compared. RESULTS: Overall, the OC relative frequency was 67% in PR and 40% and 4% in the NYC general and oral pathology laboratories, respectively (each p<0.001). In PR, the OC relative frequency was highest for males (80%). When OC relative frequencies were stratified by pathology laboratory type (general/oral) and compared across PR and NYC, age/gender-specific OC relative frequencies were always higher in PR; however, differences were consistently statistically significant for males only. CONCLUSION: A disparity in the OC relative frequency exists in PR vs. NYC indicating a shortfall in biopsying potentially precancerous oral lesions in PR. PR residents with intraoral lesions suspicious for oral cancer/precancer are most likely to be biopsied only after developing an invasive OC.

Tensile bond strength of an adhesive resin cement to different alloys having various surface treatments.

STATEMENT OF PROBLEM: The ability of a resin cement to bond to a restorative alloy is critical for maximal crown retention to nonideal preparations. Surface treatment and metal type may have an important role in optimizing resin-to-metal strength. PURPOSE: The purpose of this study was to examine the effect of surface pretreatment on the tensile strength of base and noble metals bonded using a conventional resin cement. MATERIAL AND METHODS: Cylindrical plastic rods (9.5 mm in diameter), cast in base (Rexillium NBF) or noble metal (IPS d.SIGN 53), were divided into rods 10 mm in length (n=10-12). Specimens were heated in a porcelain furnace to create an oxide layer. Test specimens were further subjected to airborne-particle abrasion (50-microm Al(2)O(3) particles) alone or with the application of a metal primer (Alloy Primer). Similarly treated rod ends were joined using resin cement (RelyX ARC), thermocycled (x500, 5 degrees -55 degrees C) and stored (24 hours, 37 degrees C) before debonding using a universal testing machine. Debond strength and failure site were recorded. Rank-based ANOVA for unbalanced designs was used to test for significant interaction (alpha=.050). Each pair of treatments was compared separately for each metal (Bonferroni-adjusted significance level of .0083, overall error rate for comparisons, .05). The 2 metals were compared separately for each of the 3 treatments using an adjusted significance level of .017, maintaining an overall error rate of .05. A multinomial logit model was used to describe the effect of metal type and surface pretreatment on failure site location (alpha=.05). RESULTS: Interaction between metal type and surface pretreatment was significant for stress values (P=.019). Metal type did not significantly affect tensile bond strength for any of the compared surface pretreatments. Metal primer significantly improved tensile bond strength for each metal type. Most failures tended to occur as either adhesive or mixed in nature. CONCLUSIONS: Metal primer application significantly enhanced tensile bond strength to base and noble metal. No significant differences in tensile strength were found between alloys. Differences in failure site incidence were found to be related to metal type and surface pretreatment.