Cultural orientation: an emerging dimension of quality in women's health services.

There are many efforts underway to document the differences in health status and health services access of women in distinct cultural segments in the U.S. Along with the measurable aspects of health status and utilization, each cultural segment carries its unique perspective on what constitutes "quality" in women's health services. These definitions of quality may reflect access, interactions, process, and outcomes. Health care providers that aspire to provide quality women's health care need to identify the distinct cultural segments in their own communities; document the gaps in women's health services; and develop programs that are specific to clinical needs and quality criteria of these populations.

Coronal suture pathology and synostotic progression in rabbits with congenital craniosynostosis.

The purpose of the present study was to describe coronal suture pathology and cross sectional synostotic progression in an inbred strain of rabbits with congenital craniosynostosis. Calvaria from 102 perinatal rabbits (39 unaffected; 63 bilateral or unilateral synostosis) were collected at fetal days 21 (n = 12), 25 (n = 20), 27 (n = 22), 30 (term) (n = 32), and 3 days post-term (n = 16) for gross morphologic and histologic examination. Synostotic foci, the extent of relative bony bridging, and suture morphology were evaluated qualitatively and quantitatively. Of the 204 coronal sutures examined, 91 sutures were synostosed, and 113 were patent. All synostosed sutures showed similar foci by day 25, which originated as bony bridges in the middle of each suture on the ectocortic surface. Bony bridging width increased significantly (p < .001) from day 25 through 3 days post-term, and was best described by a linear regression equation. Osteogenic front areas of synostosed sutures were up to 2.5 times greater than patent sutures in term fetuses. Findings demonstrate that coronal suture synostosis in the congenital rabbit model (1) begins early during suture morphogenesis (before 25 days of gestation); (2) consistently radiates from a single focus corresponding to a normal interdigitating region (i.e., a high-tension environment); (3) varies in onset and rate as evidenced by low R2 value between age and extent of bony bridging; and (4) is the result of early hyperostosis of the osteogenic fronts and sutural agenesis. A number of possible pathogenetic mechanisms are discussed.

Combined subtraction hybridization and polymerase chain reaction amplification procedure for isolation of strain-specific Rhizobium DNA sequences.

A novel subtraction hybridization procedure, incorporating a combination of four separation strategies, was developed to isolate unique DNA sequences from a strain of Rhizobium leguminosarum bv. trifolii. Sau3A-digested DNA from this strain, i.e., the probe strain, was ligated to a linker and hybridized in solution with an excess of pooled subtracter DNA from seven other strains of the same biovar which had been restricted, ligated to a different, biotinylated, subtracter-specific linker, and amplified by polymerase chain reaction to incorporate dUTP. Subtracter DNA and subtracter-probe hybrids were removed by phenol-chloroform extraction of a streptavidin-biotin-DNA complex. NENSORB chromatography of the sequences remaining in the aqueous layer captured biotinylated subtracter DNA which may have escaped removal by phenol-chloroform treatment. Any traces of contaminating subtracter DNA were removed by digestion with uracil DNA glycosylase. Finally, remaining sequences were amplified by polymerase chain reaction with a probe strain-specific primer, labelled with 32P, and tested for specificity in dot blot hybridizations against total genomic target DNA from each strain in the subtracter pool. Two rounds of subtraction-amplification were sufficient to remove cross-hybridizing sequences and to give a probe which hybridized only with homologous target DNA. The method is applicable to the isolation of DNA and RNA sequences from both procaryotic and eucaryotic cells.

[Cyclosporine-induced gingival hyperplasia in renal transplant patients]. / Ciclosporin-induzierte Gingivahyperplasie bei Patienten mit Nierentransplantaten.

Cyclosporine-induced gingival hyperplasia was investigated in a clinical study of 80 renal transplant patients. 34% of the patients exhibited at least mild gingival hyperplasia in the anterior, and 9% presented this finding also in the posterior region. No direct correlation was found between the oral dose or the whole blood concentration of cyclosporine and the presence of gingival overgrowth. Young and female patients were at a significantly greater risk of developing cyclosporine-induced gingival hyperplasia than the other patients. The presence of dental plaque or gingival inflammation was not found to be related to the incidence of gingival hyperplasia.

Detection of EBV and HPV DNA sequences in oral "hairy" leukoplakia by in situ hybridization.

Oral "hairy" leukoplakia (OHL) is a white lesion of the oral mucosa, usually located on the lateral tongue among human immunodeficiency virus (HIV) positive acquired immunodeficiency syndrome (AIDS)-risk patients. The lesion has been reported to be associated with Epstein-Barr virus (EBV) and human papillomavirus (HPV). Twenty surgical biopsy specimens were evaluated for the presence of HPV genus-specific antigen, HPV 2/4, 6/11, and 16/18 DNA and EBV DNA by in situ hybridization employing formalin-fixed paraffin-embedded sections. Three cases exhibited immunoreactivity for HPV genus-specific antigen, with localization in cytopathically altered upper spinous layer keratinocytes. HPV 16, 18, or related DNA sequences were identifiable in a single case. Alternatively, employing an EBV long internal repeat subgenomic probe, 19 cases were found to harbor EBV DNA. In all positive cases, the hybrids were localized to upper spinous layer keratinocytes exhibiting nuclear/cytoplasmic vesiculation. It is concluded that OHL is consistently associated with EBV; furthermore, viral replication, as evidenced by DNA localization, corresponds to ultrastructural evidence of capsid and envelope assembly in the more differentiated layers of oral epithelium.

Vasogenic facial pain (cluster headache).

8 cases of vasogenic facial pain are presented with delineation of differentiating clinical features. These vasogenic syndromes include classic episodic cluster headache, chronic cluster headache, and indomethacin responsive chronic cluster headache. Open clinical trials employing inhalation O2 therapy as an abortive treatment strategy utilized in combination with prophylactic nifedipine therapy proved highly efficacious in controlling pain among most classic and chronic cluster headaches. A single case of chronic paroxysmal hemicrania responded favorably to indomethacin.

Oral condyloma planus (hairy leukoplakia) among homosexual men: a clinicopathologic study of thirty-six cases.

Thirty-six cases of oral condyloma planus (hairy leukoplakia) occurring in homosexual men are reported. The average age is 36.6 years, with a range from 24 to 51 years, and the disorder exhibits a predilection for the fourth decade. More than 86% of the cases are localized to the tongue (72% lateral border, 14% ventral surface). Microscopically, surface candidiasis could be detected with periodic acid-Schiff staining in 88% of the instances. Parakeratosis with koilocytotic atypia was the characteristic histologic finding; however, comparison with twenty-five cases of leukoplakias exhibiting parakeratosis and twenty-five cases of candidiasis among heterosexual individuals disclosed that koilocytotic changes are not specific for condyloma planus. Follow-up data were obtained in thirty-two cases with a mean of 11 months. During this period six patients died or were hospitalized with a diagnosis of acquired immunodeficiency syndrome.

Psychometric profiles and facial pain.

The myofacial pain-dysfunction syndrome and atypical facial pain are the most prevalent chronic pain disorders of the facial region. Previously, the myofacial pain-dysfunction syndrome included all TMJ/masticatory muscle pain, jaw dysfunction, and joint clicking. We have segregated two major subgroups subsumed within this diagnostic classification and have assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Significant age and personality differences were uncovered when these subpopulations were compared to subjects with atypical facial pain (AFP). Both MFP and TMJID groups are relatively homologous, involving younger persons than AFP subjects. Alternatively, when MFP, TMJID, and AFP subjects were compared for differences in MMPI psychometric scales, MFP and AFP subjects exhibited significantly higher scores, particularly for hypochondriasis, depression, and hysteria, than did TMJID subjects. It is concluded that subcategorization of myofascial pain-dysfunction patients into a myogenic pain group and a TMJ internal derangement group is justified on the basis of psychometric differences. Furthermore, psychopathologic factors are more significant among MFP and AFP subjects than among TMJID patients.

The lifetime economic costs of rheumatoid arthritis.

The lifetime economic costs of rheumatoid arthritis (RA) were estimated in a cohort with initial onset of RA in 1977. These costs included medical care expenses as well as the costs associated with illness-related work loss, overall and by age/sex category. The present value of the lifetime economic costs of RA was estimated to be $20,412/case in 1977 dollars, which is nearly as great as that for stroke and coronary heart disease. The study also highlighted the need for improved data on disease incidence, treatment costs, and survival experience of RA patients.

Focal sclerosing osteomyelitis/focal periapical osteopetrosis: radiographic patterns.

Forty-one histologically documented instances of focal sclerosing osteomyelitis and focal periapical osteopetrosis have been evaluated for radiomorphologic characteristics. These reactive lesions exhibit five distinct patterns that include periapical focal opacifications, target lesions, radiolucencies, multiconfluent configurations, and opacifications with concomitant root resorption. While an irritational origin can usually be detected in chronic sclerosing osteomyelitis, the cause of focal periapical osteopetrosis remains enigmatic.

Oral and gingival changes in systemic sclerosis (scleroderma).

Nineteen patients with systemic sclerosis, including two with CREST syndrome variant, were clinically evaluated for oral and gingival manifestations of their disease. Subjectively over 50% complained of xerostomia, limited opening, recurrent "mouth sores" and dysphagia. Four patients indicated that they had been refused dental care due to limited accessibility to the oral cavity. Objectively, physical examination disclosed prominent lingual and buccal mucosal crenations and loss of tongue mobility with fibrotic induration in 25% of the subjects examined. Three of the patients with advanced disease exhibited foci of severe gingival recession due to fibrous strictures and attached gingiva stripping. None of the patients showed any indication of uncontrolled dental disease secondary to xerostomia.