The effects of incubation length and temperature on the specificity and sensitivity of the BANA (N-benzoyl-DL-arginine-naphthylamide) test.

A previous multi-center study examining patients diagnosed as having at least four periodontally diseased teeth showed that when BANA (N-Benzoyl-DL-Arginine-Naphthylamide) hydrolysis by periodontal pathogens such as Treponema denticola, Porphyromonas gingivalis, and Bacteroides forsythus was evaluated versus clinical parameters such as clinical judgment of disease, bleeding on probing, and pocket depth, the sensitivity of the test was 84%, 82%, and 87%, respectively, while the specificity was only 42%, 41%, and 32%, respectively. The purpose of the present investigation was to improve the specificity of the test while retaining a high level of sensitivity in both gingivally healthy and periodontally diseased groups. One hundred forty-nine patients participated in this study providing 3,497 interproximal plaque samples. Gingival health was measured using the papillary bleeding score and this was compared with the presence or absence of detectable trypsin-like activity, as determined by the BANA hydrolysis of interproximal plaque samples, using a commercially-available test. Sensitivity and specificity were measured by varying the incubation time and temperature of the enzymatic assay. Using the correlated binomial model to analyze site-specific data within a patient, the specificity was highest at 35 degrees C and 5 minutes incubation (94%), and lowest at 45 degrees C and 15 minutes incubation (33%). Sensitivity was highest at 45 degrees C or 55 degrees C and 15 minutes incubation (90%) and lowest at 35 degrees C and 5 minutes incubation (47%).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of incubation temperature on the specificity of the BANA (N-benzoyl-DL-arginine-naphthylamide) test.

The hydrolysis of BANA by subgingival plaque samples is associated with the presence of either Treponema denticola, Porphyromonas gingivalis, and/or Bacteroides forsythus. A protocol in which pure cultures were incubated for 15 min at 55 degrees C detected about 5 x 10(5) CFU of P. gingivalis and 1 x 10(6) CFU of T. denticola. Clinical studies indicated that the BANA test in this configuration will detect about 10(4) organisms in vivo as compared with the 10(5) to 10(6) organisms found with in vitro grown cells. The BANA test can be made less sensitive by decreasing the time and/or temperature of incubation, which could improve the specificity of the test. In the present study we determined the incubation parameters that would give optimal specificity when the plaque samples were removed from sites of gingival health. Twenty-six approximal plaque samples were taken from each of 90 clinically healthy subjects and incubated with the BANA substrate on PerioScan cards (Oral-B Laboratories) for 5 and 15 min at 35 degrees, 45 degrees, and 55 degrees C. Subjects were randomly assigned to the various temperatures. Wooden toothpicks were inserted interproximally in all sites anterior to distal of the first molars and then each side of the toothpick was wiped onto the PerioScan card. The specificity of the BANA test relative to clinical health was 96% when the cards were incubated for 5 min at 35 degrees C, but decreased to 50-70% when the cards were incubated for 15 min at 35 degrees C or for 5 and 15 min at 45 degrees C and 55 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical injury to the lateral aspect of the knee. A comparison of transverse and vertical knee incisions.

We retrospectively evaluated postoperative straight lateral and anterolateral rotatory knee stability in patients having a lateral meniscectomy through vertical and horizontal capsular incisions. The knees of 20 patients with transverse (Bruser) and 20 patients with vertical (parapatellar) incisions were clinically and mechanically evaluated. Varus-vagus and anterior drawer measurements were obtained from our knee stress machine and clinical examinations. We found that (1) horizontal and vertical lateral capsular incisions do not produce straight lateral or anterolateral rotatory instability in patients with intact anterior cruciate ligaments, (2) a transverse lateral capsular incision may contribute to anterolateral rotatory instability, and (3) a vertical lateral capsular incision provides better visualization of the knee joint than a transverse incision.