Extreme oral manifestations in a Marfan-type syndrome.

A 12-year-old girl with an otherwise typical Marfan syndrome (Ghent criteria fulfilled) presented with highly unusual oral manifestations consisting of supernumerary teeth and severe dental crowding. Pathological examination of the supernumerary teeth revealed an elevated number of pulpoliths. No mutation in the FBN1, TGFBR1 and TGFBR2 genes was identified despite exhaustive screening, suggesting that another gene defect could explain this association of marfanoid features with dental abnormalities.

Flutamide versus orchidectomy in the treatment of metastatic prostate carcinoma.

PURPOSE: To compare in a randomized clinical trial the therapeutic efficacy of the nonsteroidal antiandrogen flutamide 250 mg tid to testicular androgen suppression by orchidectomy in patients with metastatic prostate cancer. PATIENTS AND METHODS: Between 1989 and 1991, 104 patients aged 74 +/- 8 years with newly diagnosed metastatic prostate cancer, an ECOG performance status 0-2 and no prior hormone manipulation or chemotherapy, were randomized to receive flutamide 250 mg tid (54 patients) or orchidectomy (50 patients). Patients were evaluated at entry and at months 3, 6, 12, 18 and 24. The primary endpoint was duration of progression-free survival, progression being defined as an increase in PSA> 50% over the nadir value at 2 consecutive months or a single PSA rise > 50% over the nadir value with another objective parameter. At progression, the treatment was left to the discretion of the attending urologist. RESULTS: 16 patients (10 flutamide, 6 orchidectomy) are not evaluable. 86 had a minimum follow-up of 36 months, 36/42 and 41/44 have progressed in the orchidectomy and flutamide group with a time of failure of 419 and 496 days (p = 0.32); median time to progression was almost identical in both groups (370 vs. 396 days p = 0.9); overall survival at 69 months irrespective of treatment at relapse was identical in both groups. Side effects were dominated by gynecomastia, hot flushes in both groups, breast tenderness and diarrhea in the flutamide group. Overall, 4 (10%) of the patients in the flutamide group withdrew from therapy because of side effects. The impact of flutamide on sexual potency was not assessed because of the advanced age of the patients. Serum testosterone rose by 50% over baseline level at month 3 to plateau at 25% over baseline level at month 12. CONCLUSION: Although affected by the lack of a clear statistical power due to the small number of patients in each arm, this study shows that in spite of a constant elevation of serum testosterone (25% over baseline) flutamide 250 mg tid may be a reasonable alternative to castration in highly selected patients with well to moderately differentiated low volume metastatic prostate cancer and wishing to avoid the side effects of androgen deprivation, provided they are closely monitored and ready to switch to standard androgen deprivation in the presence of untolerable side effects or suboptimal treatment efficacy as assessed by the inability to achieve a low PSA nadir.

Relevance of epidemiological indices for assessing dental fluorosis.

The aim of the study described in this article is to propose a suitable index for epidemiological surveys. The authors define the characteristics of a good index to evaluate a presumed pathology, dental fluorosis, whoever the examiner and whatever the circumstances. The earliest and most commonly used index is Dean's because it permits data comparison among studies. But it has shortcomings due to the low accuracy of its definitions. The TSIF proposed by Horowitz et al. does not bring any noteworthy improvement to the Dean index. The new TF index devised by Thylstrup & Fejerskov is a logical improvement of the Dean index and can reliably be compared with Dean's. The sensitivity of this index come from its 9 stages reflecting the histopathology and fluoride content in the enamel. At the moment it is the most outstanding index for evaluating the severity of fluorosis.

Comparison of the dental health status of 8 to 14-year-old children in France and in Jordan, a country of endemic fluorosis.

In the present paper, data obtained from a survey dealing with dental carie, dental fluorosis and gingival health, involving 2618 Jordanian schoolchildren, aged 8 to 14, were compared with data from another survey dealing with 1058 schoolchildren of the same age groups living in a non-fluoridated area in the west of France. As regards dental carie in temporary teeth, up to the age of 12, the dft and dfs scores were higher in France than in Jordan. Over the age of 12, the difference was no longer significant. As regards dental carie in permanent teeth, the data showing that Jordanian children are less subject to caries than the French were very highly significant. Also, it was shown that caries index in girls was higher than in boys. These data were not significant in the French survey, but highly significant in the Jordanian investigation. A possible explanation is that, due to the custom of the country, boys in Jordan drink much more tea (with high fluoride content) than girls. As regards gingival health, an interesting finding was that, compared to the French children, the percentage of Jordanian children presenting gingivitis is remarkably low. The fluoride content of the dental plaque might play a restricting and preventing role.

[The role of tea consumption in dental fluorosis in Jordan]. / Le rôle de la consommation du thé dans la fluorose dentaire en Jordanie.

2,516 children of both sexes, six to fourteen years old, were examined in Jordan in the course of an epidemiological study. 81.11% of girls and 76.43% of boys presented severe forms of dental fluorosis according to DEAN's index. Drinking water analysis revealed fluoride concentrations ranging from 0.27 to 1.4 mg F/l. These concentrations are neighbouring optimum tolerated fluoride supplementation in drinking water. However high annual temperature mean and ten hours daily sunshine must also be taken in consideration. For social and climatic reasons, Jordanian children drink daily high quantities of tea. Analysis of tea prepared on jordanian way revealed a concentration of 1.2 mg F/l. This continuous intake of fluoride might explain the high severity of dental fluorosis in Jordan.

[The oro-dental status of children 6-15-years of age in Pays de la Loire, Vienne and Deux Sèvres]. / Etat bucco-dentaire des enfants âgés de 6 à 15 ans des Pays de la Loire, de la Vienne et des Deux Sèvres.

This survey was conducted on a representative sample of schoolchildren aged 6 to 15 years from Pays de la Loire, Vienne and Deux-Sèvres. The results showed that the DMFT and DMFS indices increased with age. The girls had a higher caries experience. The children from rural zones had a higher caries prevalence than those of urban areas. However the differences were not statistically significant. Relatively low values were recorded between 6 and 15 years for the plaque index, the calculus index and the gingival index.