- Email: [email protected]
Science and dental education
1500
CURRENT
Americans. In this report the author discusses the findings from the Japanese cases and the result of human lymphocyte antigen (HLA) typing that suggest a relationship between genetic background and SJS induced by methazolamide treatment. The average age of the patients was 38 with a higher number of females being affected. The patients in this study suffered from primary angle glaucoma, secondary glaucoma and Mooren ulcers of the cornea. Within 2 weeks after taking methazolamide the patients noticed mild swelling of the eyelids and gingiva, as well as ecchymotic eruptions on the lips and itching sensation of the genitals. Subsequently the skin and mucous membrane lesions progressed rapidly and spread over the entire body, even after discontinuing treatment with methazolamide and initiating steroid treatment. During the steroid treatment, the skin and mucous lesions became bullous or erosive, ruptured spontaneously, and dried with crusting. These are the typical symptoms and the time course of SJS induced by drugs. The results of HLA-typing carried out in these patients showed that all patients had HLA-B59, which is known to be specific to the Japanese or Korean population. According to the author, HLA-typing results in this article strongly suggest that HLAB59 contributes to the susceptibility to SJS induced by methazolamide treatment. In conclusion, methazolamide should be carefully prescribed in patients of Japanese and Korean descent. -H. PATINO Reprint requests to Dr Shirato: Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-l Hongo, Bunkyo-ku, Tokyo, 113 Japan.
Science and Dental Education. Goldberg
KJ, J Dent Ed
.59:428, 1995 Science was brought into dental education early in this century with the intent of transforming a trade with its folk myth and quacks into a true profession, where analytical clinicians would understand and be able to apply their knowledge of the scientific basis for disease processes to diagnostic and treatment problems. This paper discusses the impact and tensions of bringing science, scientists and the scientific method into dental schools because the clinician and the scientist play different roles in dental education. Clinicians teach technical skills, their positions are viewed as less prestigious among the larger university population that is made up of more “scholarly” researchers with advanced degrees. Tenure is more difficult for the clinician where the scientist can devote much time to research and published papers. The result is that each sees the other as overemphasizing his/her interests in dental education-clinicians are too technically oriented and research faculty curricula may not be relevant to the demands of clinical practice. The result of this tension is what is expected of a competent dentist-it is more important for a dentist to operate competently on a patient. Graduates who cannot remember specific scientific information still can provide excellent clinical care. A general tone results in dental schools that work toward reducing the importance of the science curriculum in the eyes of the students and clinical faculty. Many attempts at integration have been made including the organ-system based approach to learning, and the creation of oral biology departments. Both methods have not been successful. Recently a new method known as problem-based and care-based learning has been tested. This method replaces traditional lecture/lab and rote memorization with an interactive, integrated model where the student learns basic science in the course of solving clinical problems. Recent extraordinary advances in computer technology
LITERATURE
will make vast amounts of information readily accessible as text, voice, and high quality images. The author believes that the use of modern computers will enable dental educators to finally achieve many of the goals that were implicit in the introduction of science into our schools many years ago.T. BARTHOLOMEW Reprint requests to Dr Goldberg: School of Dental Medicine, State University of New York at Buffalo, 3435 Main St, Buffalo, NY 14214.
A Randomized, Prospective Trial of Deep Venous ThrombosisProphylaxis in Aortic Surgery. Killewich LA, Aswad MA, Sandager GP, et al. Arch Surg 132:499, 1997 Venous thromboembolism remains a notable cause of morbidity and mortality in the surgical patient. This study was performed to determine the incidence of major proximal deep vein thrombosis (DVT) after elective aortic surgery using venous duplex ultrasound (VDUS) surveillance. A randomized, prospective comparison of DVT prophylaxis using low dose unfractionated heparin (5000 U every 12 hours) and calf length systemic compression devices versus no DVT prophylaxis was completed. One hundred patients undergoing aortic reconstruction for aneurysmal or occlusive disease were randomized into the treatment and control groups consecutively. The occurrence of acute lower extremity DVT was diagnosed by venous duplex scan on post operative days 1, 3, and 7. The overall incidence of DVT was 2%. One case occurred in the treatment group and one in the control group without any significant statistical difference. Additionally, one patient in the control group had a non-fatal pulmonary embolus (1% of all patients). Conclusions drawn by the authors are that overall incidence of DVT in aortic surgical patients is low as compared to other types of general and orthopaedic surgery. In addition, the use of aggressive DVT prophylaxis did not reduce the risk of DVT in this study and that its use should be based on associated risk factors--J. BROKLOFF.
Reprint requests to Dr Flinn: University of Maryland Medical Systems, Division of Vascular Surgery, N4W66, 22 S Greene St, Baltimore, MD 21201.
Mutated p53 Gene is an Independent Adverse Predictor of Survival in Colon Carcinoma. Pricolo VE, Finklestein SD, Hansen K, et al. Arch Surg 132:371,
1997
The ~53 gene located on chromosome 17p is one of the most frequently mutated genes in human cancers and has been the subject of many studies in recent years. The purpose of this study is to determine the impact of p53 gene mutations on long-term survival in a homogeneous group of patients with stage II and stage III colorectal cancer. The surgical specimens from 141 patients who had tumor excision for a curative intent for colon cancer were analyzed using polymerase chain reaction for the ~53 gene mutation. The positive or negative results were then correlated with follow-up data on the patients. In patients with stage II carcinoma, the 5-year survival was 55% for those with p53-mutated tumors versus 71% for those with non-p53 mutated tumors. In patients with stage III colon carcinoma the 5-year survival was 63% for those with ~53 non-mutated cancers and a significantly reduced 26% survival in those with positive p.53 mutated cancers. To date, this is the first study to show significant correlation between ~53 mutations identified by
CURRENT
Americans. In this report the author discusses the findings from the Japanese cases and the result of human lymphocyte antigen (HLA) typing that suggest a relationship between genetic background and SJS induced by methazolamide treatment. The average age of the patients was 38 with a higher number of females being affected. The patients in this study suffered from primary angle glaucoma, secondary glaucoma and Mooren ulcers of the cornea. Within 2 weeks after taking methazolamide the patients noticed mild swelling of the eyelids and gingiva, as well as ecchymotic eruptions on the lips and itching sensation of the genitals. Subsequently the skin and mucous membrane lesions progressed rapidly and spread over the entire body, even after discontinuing treatment with methazolamide and initiating steroid treatment. During the steroid treatment, the skin and mucous lesions became bullous or erosive, ruptured spontaneously, and dried with crusting. These are the typical symptoms and the time course of SJS induced by drugs. The results of HLA-typing carried out in these patients showed that all patients had HLA-B59, which is known to be specific to the Japanese or Korean population. According to the author, HLA-typing results in this article strongly suggest that HLAB59 contributes to the susceptibility to SJS induced by methazolamide treatment. In conclusion, methazolamide should be carefully prescribed in patients of Japanese and Korean descent. -H. PATINO Reprint requests to Dr Shirato: Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-l Hongo, Bunkyo-ku, Tokyo, 113 Japan.
Science and Dental Education. Goldberg
KJ, J Dent Ed
.59:428, 1995 Science was brought into dental education early in this century with the intent of transforming a trade with its folk myth and quacks into a true profession, where analytical clinicians would understand and be able to apply their knowledge of the scientific basis for disease processes to diagnostic and treatment problems. This paper discusses the impact and tensions of bringing science, scientists and the scientific method into dental schools because the clinician and the scientist play different roles in dental education. Clinicians teach technical skills, their positions are viewed as less prestigious among the larger university population that is made up of more “scholarly” researchers with advanced degrees. Tenure is more difficult for the clinician where the scientist can devote much time to research and published papers. The result is that each sees the other as overemphasizing his/her interests in dental education-clinicians are too technically oriented and research faculty curricula may not be relevant to the demands of clinical practice. The result of this tension is what is expected of a competent dentist-it is more important for a dentist to operate competently on a patient. Graduates who cannot remember specific scientific information still can provide excellent clinical care. A general tone results in dental schools that work toward reducing the importance of the science curriculum in the eyes of the students and clinical faculty. Many attempts at integration have been made including the organ-system based approach to learning, and the creation of oral biology departments. Both methods have not been successful. Recently a new method known as problem-based and care-based learning has been tested. This method replaces traditional lecture/lab and rote memorization with an interactive, integrated model where the student learns basic science in the course of solving clinical problems. Recent extraordinary advances in computer technology
LITERATURE
will make vast amounts of information readily accessible as text, voice, and high quality images. The author believes that the use of modern computers will enable dental educators to finally achieve many of the goals that were implicit in the introduction of science into our schools many years ago.T. BARTHOLOMEW Reprint requests to Dr Goldberg: School of Dental Medicine, State University of New York at Buffalo, 3435 Main St, Buffalo, NY 14214.
A Randomized, Prospective Trial of Deep Venous ThrombosisProphylaxis in Aortic Surgery. Killewich LA, Aswad MA, Sandager GP, et al. Arch Surg 132:499, 1997 Venous thromboembolism remains a notable cause of morbidity and mortality in the surgical patient. This study was performed to determine the incidence of major proximal deep vein thrombosis (DVT) after elective aortic surgery using venous duplex ultrasound (VDUS) surveillance. A randomized, prospective comparison of DVT prophylaxis using low dose unfractionated heparin (5000 U every 12 hours) and calf length systemic compression devices versus no DVT prophylaxis was completed. One hundred patients undergoing aortic reconstruction for aneurysmal or occlusive disease were randomized into the treatment and control groups consecutively. The occurrence of acute lower extremity DVT was diagnosed by venous duplex scan on post operative days 1, 3, and 7. The overall incidence of DVT was 2%. One case occurred in the treatment group and one in the control group without any significant statistical difference. Additionally, one patient in the control group had a non-fatal pulmonary embolus (1% of all patients). Conclusions drawn by the authors are that overall incidence of DVT in aortic surgical patients is low as compared to other types of general and orthopaedic surgery. In addition, the use of aggressive DVT prophylaxis did not reduce the risk of DVT in this study and that its use should be based on associated risk factors--J. BROKLOFF.
Reprint requests to Dr Flinn: University of Maryland Medical Systems, Division of Vascular Surgery, N4W66, 22 S Greene St, Baltimore, MD 21201.
Mutated p53 Gene is an Independent Adverse Predictor of Survival in Colon Carcinoma. Pricolo VE, Finklestein SD, Hansen K, et al. Arch Surg 132:371,
1997
The ~53 gene located on chromosome 17p is one of the most frequently mutated genes in human cancers and has been the subject of many studies in recent years. The purpose of this study is to determine the impact of p53 gene mutations on long-term survival in a homogeneous group of patients with stage II and stage III colorectal cancer. The surgical specimens from 141 patients who had tumor excision for a curative intent for colon cancer were analyzed using polymerase chain reaction for the ~53 gene mutation. The positive or negative results were then correlated with follow-up data on the patients. In patients with stage II carcinoma, the 5-year survival was 55% for those with p53-mutated tumors versus 71% for those with non-p53 mutated tumors. In patients with stage III colon carcinoma the 5-year survival was 63% for those with ~53 non-mutated cancers and a significantly reduced 26% survival in those with positive p.53 mutated cancers. To date, this is the first study to show significant correlation between ~53 mutations identified by