Detection of white restorative dental materials using an alternative light source.

We assessed the value of an alternative light source for detecting white composite dental materials in burned and unburned teeth. Teeth filled with 18 different restorative materials (composite, glass ionomer or hybrid composite), were viewed with a Polilight. Between 415 nm and 555 nm, the glass ionomers showed distinctly different optical properties from the other materials: they either fluoresced or appeared darker. Wavelengths 415 nm to 530 nm gave a general enhancement in composite detection (17 of 18 materials). Light above 590 nm was of little value, enhancing detection in only 2 of 18 materials. After simulated burning of the teeth, there was enhanced visibility of 8 of 18 materials at wavelengths under 350 nm. Burning destroyed the previously distinct optical properties of the glass ionomers. Overall, this alternative light source aids the identification of white composite dental materials and could be used in routine forensic odontology practice.

Educating physicians about women's health. Survey of Canadian family medicine residency programs.

OBJECTIVE: To identify which women's health issues are taught in the 2-year core curriculum of Canadian family medicine residency programs and whether educators think their current teaching of women's health is adequate. DESIGN: Mailed survey using a questionnaire. PARTICIPANTS: All program and unit directors of the 16 Canadian family medicine residency training programs were surveyed. Replies were received from 63% (10 of 16) of program directors and 79% (55 of 70) of unit directors. MAIN OUTCOME MEASURES: Percentage of programs teaching specific women's health topics from a list of 21 possible topics; percentage offering educational opportunities with sexual assault teams and women's shelters; participants' assessment of the adequacy of current teaching in each training program; plans to increase women's health education. RESULTS: Topics such as violence against women and medical conditions more common among women were taught in more than 80% of programs, but poverty and the health care concerns of Native and immigrant women were included in fewer than 40% of programs. Half of the program directors indicated that residents were given educational opportunities with sexual assault teams or women's shelters. Unit directors gave a lower estimate. Most (90%) program directors thought their current teaching of women's health issues was inadequate and had plans to increase it, as did 64% of unit directors. CONCLUSION: Violence against women and the traditional medical topics of osteoporosis, weight disorders, and reproductive and breast cancer are frequently taught in family medicine training programs. However, the social and cultural aspects of health are addressed less often. It is encouraging that many family medicine programs plan to increase their teaching of women's health.

Efficacy of ketoprofen in treating primary dysmenorrhea.

A 6-month double-blind crossover trial compared ketoprofen with placebo in the treatment of primary dysmenorrhea in 27 women who satisfied explicit inclusion and exclusion criteria. The response to treatment was assessed with a pain scale and a disability scale and by noting amelioration of associated symptoms, such as nausea, vomiting, diarrhea, fatigue, dizziness and headache. Ketoprofen was significantly superior to placebo in relieving the pain (p less than 0.001), disability (p less than 0.001) and headache (p less than 0.01) associated with menstruation. No order effect of treatment was observed. Adverse effects were few and minimal.

Chlamydia trachomatis infections in women with urogenital symptoms.

Chlamydia trachomatis was isolated from 30 to 100 women attending a family physician's office with dysuria, frequency or vaginal discharge, compared with 2 of 30 asymptomatic women. Multiple infections were common: C. trachomatis coexisted with Gardnerella vaginalis, Candida albicans, Trichomonas vaginalis or a bacterial cause of urinary tract infection in 15 patients. C. trachomatis was isolated alone from 15 symptomatic women. The source of the positive culture was not always the site of symptoms. C. trachomatis was isolated from both the cervix and the urine of 9 patients, either simultaneously or sequentially. The probability of finding a chlamydial infection was 30% in young women with vaginal discharge alone, 33% in those with dysuria and frequency alone and 53% in those with abdominal or pelvic pain in addition to lower urogenital tract symptoms.

Chlamydial infection: a common sexually transmitted disease.

Chlamydia trachomatis infection is more prevalent than gonorrhea and causes a similar clinical picture. It is the prime cause of non-gonococcal urethritis in men and pelvic inflammatory disease in women. Its sequelae in women are ectopic pregnancy and infertility. It can be transmitted from an infected mother to her newborn child, leading to inclusion conjunctivitis and pneumonia. Tetracycline and erythromycin are effective in eradicating chlamydial infections, but the penicillins are not. Screening of high risk groups and special diagnostic facilities would help control this common sexually transmitted disease.

Prostaglandin inhibitors: rational therapy for dysmenorrhea.

Dysmenorrhea affects at least 50% of women at some time in their lives. Painful contractions of the uterine muscle (similar to labor pains) are triggered by increased endometrial synthesis of prostaglandins, which appear in elevated amounts in the plasma and menstrual fluid of women with dysmenorrhea. Non-steroidal anti-inflammatory drugs, which have been used for years in arthritis, are effective prostaglandin inhibitors. Taken by mouth at the onset of menstruation, they can relieve dysmenorrhea in the majority of cases. This is a major advantage for women in whom oral contraceptives are not indicated.

Mucosal iron-binding proteins in mice with X-linked anaemia.

The mouse with X-linked anaemia [sla] has a defect in iron absorption which can be temporarily reversee by feeding a low iron diet. Duodenal non-haem iron was significantly higher in the sla than in the normal mouse on an iron supplemented diet but non-haem iron was reduced to minute amounts when the mice were fed a low iron diet. Gel chromatography on Sephadex G-200 of th partial-free supernatant of pooled mucosal homogenates revealed the presence of three proteins binding 59Fe. Fraction I [mol wt 450 000] resembled ferritin and was present in both normal and sla mice fed an iron supplemented diet. Fraction II [mol wt 78 ooo] eluted in a similar position to transferrin and was evident in both normal and sla mice fed an iron deficient diet. Fraction III [mol wt less than 15 000] contained equivalent amounts of radioiron in normal and sla mice fed the iron deficient diet, whereas this fraction contained less radioactivity in sla animals in two of three experiments in which the animals were fed an iron supplemented diet. The iron transport defect in sla mice does not appear to reside in the iron-binding proteins in the supernatant fraction of the intestinal mucosa and the cause of the defect in iron absorption remains to be elucidated.

Gastrointestinal metabolism of cadmium in experimental iron deficiency;.

The average gastrointestinal uptake 4 h after an intragastric dose of 400 nmol of cadmium chloride labeled with 109CdCl2 in iron-deficient mice, 25%, was significantly greater than the result, 16%, in iron-normal animals, and more cadmium entered the body of the former, 3.8%, than the latter, 2% (P less than 0.05). Between 4 and 72 h, gastrointestinal radioactivity declined without further increase in body activity; however, more radiocadmium remained in the duodenum of iron-deficient than iron-normal animals (P less than 0.05). The radiocadmium sequestered in the duodenum was bound to a protein with a molecular weight of about 12,000. After subcutaneous injection of radiocadmium, the rate of excretion of radioactivity from the body was similar in iron-normal and iron-deficient mice; however, a greater proportion of the injected dose accumulated in the duodenum of the iron-deficient animals (P less than 0.05). Thus, the intestinal adapative response to iron deficiency may enhance cadmium toxicity, whereas sequestration and subsequent excretion of cadmium by the intestinal mucosa serves to protect the body against toxic effects. The duodenum, particularly in iron-deficient mice, is especially vulnerable to the toxic effects of cadmium.

Serum ferritin and the iron status of Canadians.

Serum ferritin concentration was determined in 1105 Canadians aged 1 to 90 years. Geometric mean values (ng/ml) were as follows: children 1 to 4 years old, 12; children 5 to 9 years old, 15; adolescent girls, 17; adolescent boys, 18; women 20 to 39 years, 23; women 65 years and older, 52; men 20 to 39 years, 93; and men 40 and older, 92. Ranges were side in all age groups, reflecting variations in size of body iron stores. From analysis of the ferritin values it is highly probably that iron stores were greatly reduced in approximately 25% of children, 30% of adolescents, 30% of menstruating women, 60% of pregnant women and 3% of men. Iron-deficiency anemia was noted in only 2% of subjects. If "normality" requires more than small amounts of storage iron to meet physiologic demands, the study results suggest a high probability of iron deficiency in 60% of the pregnant women and in 19% of the other subjects; but if normality is defined as maintenance of adequate iron stores for erythropoiesis, the prevalence of iron deficiency was zero in the pregnant women and 2% in the other subjects.

Serum ferritin, cobalt excretion and body iron status.

Serum ferritin concentration was measured by immunoradiometric assay in 64 subjects. It was closely related to the size of body iron stores measured by hemosiderin content of bone marrow in all subjects and by the deferoxamine test in 10 patients with iron overload. Urinary cobalt excretion, an indirect measure of iron absorption, was inversely related to hemosiderin content of bone marrow in 34 patients aged 18 to 72 with or without liver disease, but this relation did not hold in a group of 20 student volunteers aged 17 to 30, indicating that the test is unreliable in young people. A strong inverse correlation was demonstrated between values for cobalt excretion and serum ferritin in the 34 patients and between those for iron absorption and serum ferritin in the 20 students. Serum ferritin concentration appears to reflect accurately the iron status of the healthy individual but high values in liver disease must be interpreted with caution.

Cobalt excretion test for the assessment of body iron stores.

Iron absorption is under delicate control and the level of absorption is adjusted to comply with the body's need for iron. To measure the intestinal setting for iron absorption, and thereby indirectly assess body iron requirements, cobaltous chloride labelled with (57)Co or (60)Co was given by mouth and the percentage of the test dose excreted in the urine in 24 hours was measured in a gamma counter. Seventeen control subjects with normal iron stores excreted 18% (9-23%) of the dose. Increased excretion, 31% (23-42%), was found in 10 patients with iron deficiency anemia and in 15 patients with depleted iron stores in the absence of anemia. In contrast, 12 patients with anemia due to causes other than iron deficiency excreted amounts of radiocobalt within the normal control range. In patients with iron deficiency, replenishment of iron stores by either oral or parenteral iron caused the previously high results to return to normal.Excretion of the test dose was normal in portal cirrhosis with normal iron stores but it was markedly increased in patients with cirrhosis complicated by either iron deficiency or endogenous iron overload. It was also raised in primary hemochromatosis. Excretion of the dose was reduced in gluten-sensitive enteropathy. Gastrointestinal surgery and inflammatory disease of the lower small intestine had no effect on the results except that some patients with steatorrhea had diminished excretion.The cobalt excretion test provides the clinician with a tool for the assessment of iron absorption, the detection of a reduction in body iron stores below the level that is normal for the subject in question, the differentiation of iron deficiency anemia from anemia due to other causes, and the investigation of patients with iron-loading disorders.