3,941,763 3/1976 Sarantakis ............................ 260f2.5 4,546,082 10/1985 Kurjan et al......................... 435/1723 4,588,684 5/1986 Brake ........................................ 435/68 4,775,622 O/1988 Hitzeman et al. ... ... 435/68 4,945,039 7/1990 Suzuki et al. ... ... 4357.1 5,084,398 1/1992 Huston et al. ... ... 436/535 5,364.930 11/1994 Baumann et al. ...................... 530236

To the Editor This letter is in regard to the article recently published in Internal Medicine by Joshita et al (1) In that paper the authors report a case of “hepatocellular carcinoma who avoided tumor lysis syndrome following massive tumor lysis from treatment with sorafenib”. We share our experience managing a patient with tumor lysis syndrome (TLS) with advanced heptocellular carcinoma who received sorafenib. A 62-year-old Caucasian man with a past medical history of alcoholism and hepatitis B presented with right hypochondrial pain. The ultrasound of his liver showed a mass in the right posterior lobe measuring approximately 8.7 cm×8.0 cm. Pretreatment laboratory tests were as follows: aspartate aminotransferase 230 IU/L; alanine aminotransferase 53 IU/ L; lactate dehydrogenase 1,097 IU/L; creatinine 0.70 mg/dL; potassium 3.6 mmol/L; calcium 8.7 mg/dL; alphafetoprotein 133,316 ng/mL. He was started on sorafenib 800 mg/day. After 7 days of treatment he became somnolent and confused. His repeat laboratory tests were: aspartate aminotransferase 25,182 IU/L; alanine aminotransferase 4,839 IU/L; lactate dehydrogenase 35,906 IU/L; uric acid 17.2 mg/dL; phosphorous 15.6 mg/dL; creatinine 3.8 mg/dL; potassium 7.2 mmol/L; alpha-fetoprotein 66,734 ng/mL; calcium 6.4 mg/dL. We did not have his baseline uric acid and phosphorous levels. According to the diagnostic criteria for TLS as defined by Cairo-Bishop, the review of his laboratory tests suggested grade 2 clinical TLS. He chose comfort care and declined dialysis. He died on day 8. TLS is a metabolic disorder that results from the rapid breakdown of many tumor cells, usually on the start of chemotherapy. This breakdown leads to a significant release of intracellular metabolites that exceeds the ability of the kidney to excrete them. TLS rarely happens in solid tumors, including hepatocellular carcinoma, but occurs more frequently in hematologic malignancies. Phase 2 and 3 trials of sorafenib did not report patients with TLS (2). However, since this may be the fourth documented case of TLS using drug treatment, sorafenib may cause TLS or severe renal impairment in advanced hepatocellular carcinoma patients. Reduced-dose therapy and careful follow-up after the start of therapy may be needed in such patients for early diagnosis and treatment (1-3). Since sorafenib can be used for outpatients, it may be beneficial to perform baseline laboratory testing and to have laboratory work done more frequently within the first few weeks. If more cases such as we report are documented, pretreatment management for TLS may become the prudent standard of care.

The current demand for HIV diagnostic tests in resource-limited settings is not being fully addressed by the currently available nucleic acid test or enzyme-linked immunosorbent assay-based p24 antigen assays. This is primarily due to their high cost, their requirement for controlled laboratory conditions and/or personnel, or the relatively long turn-around time for test results. Self performing lateral flow assays address all of these issues but to date have not reached the level of analytical sensitivity for HIV p24 demonstrated by current generation enzyme-linked immunosorbent assay technology. This report presents an initial prototype lateral flow assay for HIV p24 antigen capable of achieving subpicogram per milliliter limits of analytical sensitivity and requiring less than 40 minutes to yield results.

Gracias a la preparacion del conducto radicular mediante los sistemas de limas de Ni-Ti de rotacion permanente, y el ya conocido, pero ultimamente merecedor de una atencion especial, acondicionamiento quimico por medio de NaDCl y EDTA, la preparacion del conducto radicular ha cambiado de forma sustancial a lo largo de los ultimos anos. Asimismo, ello ha modificado la forma del sistema de conductos radiculares a obturar, dotandolo de una mayor conicidad y exponiendo los conductos dentinarios y laterales. Esto supone una mayor adaptacion a la forma original del conducto y permite una obturacion mas congruente con la forma utilizando los pernos intrarradiculares prefabricados adecuados. Al mismo tiempo, la obturacion con gutapercha caliente, usada desde hace bastante tiempo en EE. Vv., ha sido objeto de una mayor atencion por parte de los clinicos alemanes. Por ultimo, existen tendencias que apuntan a la sustitucion de la gutapercha como material de obturacion. El presente articulo expone algunas de estas evoluciones y plantea sus ventajas e inconvenientes.

This study investigated the effect of immersion in sodium hypochlorite (NaOCl) on torque and fatigue resistance of two nickel-titanium files. Size 25 .04 ProFile and RaCe files were immersed in 5.25% NaOCl for 1 or 2 hours at temperatures of 21 degrees C and 60 degrees C. Torque and angle at failure were measured according to ISO 3630-1. Resistance to cyclic fatigue was determined by counting rotations to breakage in a 90 degrees curve with a 5-mm radius. Data were analyzed by 2-way analysis of variance. Torsional resistance of both rotaries was not significantly affected by immersion in NaOCl, except after 2 hours of immersion at 60 degrees C. Resistance to cyclic fatigue decreased significantly for ProFile and RaCe instruments after immersion in NaOCl. Spontaneous fractures occurred in 28 of 160 files during immersion in NaOCl. In conclusion, nickel-titanium rotaries have reduced resistance to cyclic fatigue after contact with heated NaOCl and may then be considered single-use instruments.

Endodontic TopicsVolume 10, Issue 1 p. 210-210 DR MICHAEL A. BAUMANN, UNIV-PROF. DR Med Dent Dr Michael A. Baumann Univ-Prof. Dr med dent, Dr Michael A. Baumann Univ-Prof. Dr med dent University of Cologne Köln GermanySearch for more papers by this author Dr Michael A. Baumann Univ-Prof. Dr med dent, Dr Michael A. Baumann Univ-Prof. Dr med dent University of Cologne Köln GermanySearch for more papers by this author First published: 18 August 2005 https://doi.org/10.1111/j.1601-1546.2005.00122.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume10, Issue1March 2005Pages 210-210 RelatedInformation

This article reviews the design and clinical use of the ProTaper NT file system.

The introduction of nickel-titanium (NiTi) as material for endodontic instruments about 15 years ago opened many new perspectives. Many dentists and scientists see a benefit in using NiFi files. Initial problems such as frequent fractures and the uncertainty of the best way to use them have been solved. Other challenges such as enhancing the cutting ability or optimizing the speed, torque, and fatigue are currently being addressed. Some clinicians are skeptical because they see this approach as too mechanical. Nevertheless, the combination of anatomic, biologic, and pathophysiologic knowledge with the use of NiTi instruments is a large step forward in optimizing the quality of root canal treatment worldwide.