Biomedical subjects
Publications and source records attributed to D A Miles.
OLP has many clinical presentations. Some lesions of OLP require no treatment. Some must be managed for 20 years or more. The differential diagnosis of OLP is difficult and varied. Dermatologists should consider consultation with a dentist or specialist in oral medicine for diagnosis and management of lesions of OLP.
Lacrimo-auriculo-dento-digital syndrome is an autosomal dominant malformation complex that affects craniofacial structures including the teeth and salivary glands. There have been several cases of this syndrome reported to date. A family with three affected members is presented. In addition to several of the clinical manifestations of lacrimo-auriculo-dento-digital syndrome, these subjects also show previously unreported radiographic features of the syndrome as demonstrated by panoramic radiographic examination and corrected axis linear tomography of the temporomandibular joints.
In Australia an increasing proportion of active general practitioners (GPs) are women. Overseas research showing differences between male and female GPs in practice style, the reasons patients consult them, or in the nature of the medical conditions they manage has failed to adjust for confounders. In Australia, such differences have never been investigated. This study assessed differences between male and female GPs in terms of their personal characteristics, patient mix, patient reasons for consultation, and the medical conditions they manage. It also considered the extent to which differences are accounted for by the effect of confounders. A secondary analysis was done of data from the Australian Morbidity and Treatment Survey 1990 to 1991 (n = 113,000 general practice encounters). In addition, univariate analysis was followed by multivariate analysis, with adjustments for GP and patient characteristics and (in analysis of conditions managed) for patient reasons for encounter. Significant differences were found in the work patterns and patient mix of male and female GPs. Patients' selectivity in the problems presented to the two groups remained after adjustment for confounders. Female GPs managed more female-specific, endocrine, general, and psychosocial problems even after multivariate adjustment. Although male GPs managed more cardiovascular, musculoskeletal, male genital, skin, and respiratory problems at the univariate level, these differences were no longer apparent after adjustment. Male and female GPs manage different types of medical conditions. Although some differences are due to their patient mix and to patient selectivity, others are inherent to the sex of the physician. Extrapolation of results to Australian general practice suggests that these two groups of GPs could become semispecialized.
The adeno-associated virus (AAV) Rep78 protein is required for many aspects of AAV's life cycle including its DNA replication and the regulation of its gene expression. Because of increasing utilization of AAV as a gene therapy vector and its possible use as an anti-cancer/anti-viral agent, the complete characterization of its Rep78 regulatory protein is important. In order to study various functional aspects of Rep78, we have cloned and expressed the Rep78 gene in Escherichia coli using an inducible expression plasmid. The entire Rep78 open reading frame (nt 321 to 2185) was cloned into the LacZ inducible expression vector pMALc2. Upon induction of the Ptac promoter with isopropyl thio-beta-D-galactopyranoside (IPTG), Rep78 is produced as a fusion protein with maltose binding protein (MBP). This recombinant MBP-Rep78 protein displayed all the biochemical activities which are described for the wild type protein including binding to the AAV terminal repeats (TR), endonuclease activity, and helicase activity. Furthermore, for the first time, ATP binding by Rep78 is demonstrated.
A case of chemical injury to the oral mucosa that resulted in obstructive sialadenitis of the submandibular glands is presented. The injury occurred when a patient chewed, swished, and expectorated an immersion-type denture-cleansing tablet attempting to clean a fixed bridge. The literature is reviewed for similar oral mucosal injury caused by improper use of denture-cleansing products. Suggestions for the prevention of such injuries are made.
The most cost-effective method to measure the morbidity managed and treatments provided in general practice is from records of a cluster of consultations (encounters) from each general practitioner (GP) in a random sample. A cluster sampling method is proposed for future surveys for analysis of encounter-based general practice data. The sample sizes needed to measure the most common problems managed and drugs prescribed were estimated using ratio-estimator models for cluster sample surveys. Morbidity and treatment rates were estimated from the Australian Morbidity and Treatment Survey in General Practice 1990-1991 (AMTS). The 20 most common problems in the AMTS were managed at estimated rates of 1.5 to 9.5 per 100 encounters. The 20 most common drugs were prescribed at estimated rates of 0.7 to 3.6 per 100 problems. These rates were used to determine precision as a percentage of each true value for future surveys, that is, as relative precision. If we want to be 95 per cent confident that these rates will be within 5 per cent of each true rate, sample sizes of 552 to 5675 GPs are needed. If we fix the sample size at 1000 GPs, relative precision lies within 12 per cent of these rates. If the sample size is increased to 1500 GPs, relative precision improves only marginally. The differences in sample size for each of the most frequent morbidity and treatment data are largely due to their variable distributions and relatively infrequent occurrence in general practice. A sample size of 1000 GPs will enable measurement of the most common morbidity and treatments at 95 per cent confidence.
Arthritis is the ninth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and draws some comparisons with an earlier study.
RadioVisioGraphy is an imaging modality that uses a charge-coupled device electronic sensor. Dental charge-coupled device imaging can be used to detect dental caries; however, it was not known what effect beam collimation, added filtration, or variable target-receptor distance has on this task. The purpose of this investigation was to study these effects were imaged by conventional radiography and RadioVisioGraphy varying exposure time, target-receptor distance, collimation, and filtration. Printed RadioVisioGraphy images without enhancement and E-speed radiographs were evaluated by five viewers. The number of true-positives and false-positives were compared as were sensitivity, specificity, positive and negative predictive values, accuracy, and entrance level radiation exposure. Added filtration reduced the false-positives regardless of collimation or target-receptor distance. True-positives and false-positives were greater at a target-receptor distance of 8 inch at exposures < 0.10 seconds (F < 0.0151). E-speed radiographs had a greater specificity and positive predictive value than RadioVisioGraphy images without image enhancement; however, no significant differences were found between RadioVisioGraphy images and E-speed radiographs in true-positive or false-positive identifications without image enhancement.
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Density and gray-scale changes in radiographs are important visual features the clinician uses to evaluate changes in bone pattern. With the advent of a new direct digital radiology system, RadioVisioGraphy (RVG), the controlled adjustment of contrast is now possible. The purpose of this study was to compare RVG's diagnostic potential for detecting periapical lesions with that of conventional radiography. Lesions were created in human cadaver specimens and radiographed conventionally and with RVG. Images were evaluated by three endodontists. Results were: (a) when no lesion existed, conventional radiographs were more diagnostic than RVG at a significance level at p < or = 0.05; (b) when lesions were enlarged to involve lamina dura and medullary bone, RVG was superior at p < or = 0.05; and (c) no difference was found between conventional radiography and RVG when the lesion involved cortical bone.
A number of improved dentin bonding agents have recently become available, but have not been evaluated on apical radicular dentin. The purpose of this study was to compare the tensile bond strengths of four adhesive resins on resected root ends before and after blood contamination. Forty single-rooted human incisors were cleaned and shaped and obturated. The apical 3 mm was then resected at a 45-degree angle, bonded, and tested for tensile bond strengths using an Instron machine. The bonding systems evaluated included Prisma Universal Bond 3, Scotchbond MultiPurpose Dental Adhesive, Amalgambond, and All Bond 2. All bonding systems were then covered with Prisma APH light-cure composite resin. Results indicated that the bond strengths of the blood contaminated groups were significantly less than those of the control groups, except in the case of Amalgambond where no significant difference was noted. When the surface was contaminated with blood, Prisma Universal Bond 3 had significantly lower bond strengths, whereas Amalgambond had significantly higher bond strengths than the other subgroups.
The purpose of this investigation was to compare RadioVisioGraphy (RVG) imaging with conventional radiography in determining endodontic file length adjustment. Human cadaver sections with first or second molars were used. Files were inserted into canals at randomly selected lengths, from 4 mm short of the radiographic apex to 3 mm beyond. Radiographs and RVG images were evaluated to determine the adjustment needed to place the file 0.5 mm from the radiographic apex. Results showed no significant difference in the ability of endodontists to make accurate file length adjustments using conventional radiography versus RVG. In this study, it was found that: (a) accurate file length adjustments can be made from an image two times larger than the actual tooth; (b) RVG is not significantly better than conventional radiography; and (c) if both methods are available, RVG is preferred because of the significant reduction in radiation dose.
Asthma is the third most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.
Acute bronchitis is the fifth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.
Upper respiratory tract infection is the second most frequently managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.
This paper is a summary of a report of a comparison of country and metropolitan general practice undertaken by the Family Medicine Research Unit, University of Sydney, and published as a supplement to the Medical Journal of Australia. The identified differences were not consistent across small medium and large country towns. The morbidity patterns were similar between all areas, but country GPs were generally busier and undertook more hospital and procedural work.
Hypertension is the most frequently managed problem in general practice in Australia. This paper provides an overview of its management in general practice and draws some comparisons with an earlier study.