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To compare the anti-hypertensive efficacy, safety, and tolerability of irbesartan with those of the full dose range of enalapril in patients with mild-to-moderate hypertension.A total of 200 patients were randomised to irbesartan 75 mg or enalapril 10 mg (once daily). Doses were doubled at Weeks 4 and/or 8 if seated diastolic blood pressure (DBP) wasor = 90 mm Hg. Trough blood pressure was measured after completion of a 4- to 5-week placebo lead-in period and again after 2, 4, 8, and 12 weeks of treatment.Efficacy was evaluated by determining the change from baseline in trough seated blood pressure and the proportion of patients normalised (seated DBP90 mm Hg) at Week 12. Safety and tolerability were assessed by adverse events reported by physicians, by patients in response to a specific-symptoms questionnaire, by open-ended questioning of patients by physicians, and by clinical laboratory evaluations.Both treatments significantly lowered blood pressure with no significant difference in efficacy between treatment groups. At Week 12, the percentage of patients titrated to either enalapril 40 mg or irbesartan 300 mg was 24% and 28%, respectively. The frequency of overall adverse events was similar in both groups. The incidence of cough in the enalapril and irbesartan groups was 17% and 10%, respectively. In contrast to other AII receptor antagonists, there was no change in uric acid concentrations with irbesartan.Irbesartan was as effective as the full dose range of enalapril. Irbesartan also demonstrated an excellent tolerability profile.

The follow-up of initially non suspect thyroid nodules after fine needle biopsy is not completely worked out. Since 1985, we have entered upon a prospective study concerning the followup of thyroid nodules supposed to be benign after initial evaluation. What are the nature and the frequency of means to be used for their follow-up? Three hundred and eleven nodules are followed up on a mean duration of 2.44 years. The follow-up of 65 of them is 4 years or more. The follow-up of 120 others is 3 to 4 years; 197 nodules are followed up during 2 to 3 years. A physical examination, an ultrasonography completed with a fine needle biopsy or an ultrasonically guided fine needle biopsy are worked out every year. Twenty-three per cent of initial biopsies are non significant and 90% of them are ultrasonically guided biopsies. At the end of the study, the repeating biopsies reduce to 6% the non significant biopsies ratio. Four histological thyroid cancers are detected in three female patients 1 year, 2 years and 5 years after the initial evaluation. Ultrasound alterations of nodules are observed in case of very suspect biopsies. Ninety-six per cent of the followed up thyroid nodules remain not cytologically suspect. These findings allow us to propose the following guidelines for the assessment of a non suspect thyroid nodule: half-yearly or yearly physical examination, yearly or biennial ultrasonography, repeat biopsy after 2 or 3 years when clinical or ultrasound suspect modification is wanting.

Between October 1992 and September 1994, 70 patients presenting with primary unilateral hernia were randomly assigned to either a transabdominal preperitoneal laparoscopic (group L) repair (n = 35) with a 3 x 5 inch polypropylene mesh or a conventional Shouldice repair (group S) (n = 35). The series consisted of 60 men and 10 women, with a median age of 56 years and a BMI of 24. We used the Nyhus classification; there were 25 type 2, 24 type 3a and 21 type 3b hernias. Preoperative characteristics of both groups were equivalent. When comparing group L to group S, we noted a similar operative time (65 +/- 20 min) and a similar postoperative hospital stay (3.8 +/- 1.3 days). The postoperative pain that was evaluated on a visual analogue scale (score from 0 to 10) was lower in group L. On the first and third postoperative day, the mean score was 3.4 +/- 1.5 and 1.3 +/- 1.4 in (group L compared) to 5.3 +/- 1.9 (p0.001) and 2.8 +/- 1.8 (p0.005) in group S. Significant morbidity occurred in 7 patients of group L: 3 seromas and 4 cases of orchitis, and in 5 patients of group S: 1 wound abcess, 2 cases of chronic neuralgia and 2 cases of orchitis. We recorded a quicker return to home activities in group L: 6 +/- 2 versus 10 +/- 4 days (p0.05) in group S but time off work was similar in both groups (30 +/- 9 days). All patients were evaluated in April 1996: the median follow-up was 30 months (range: 19-42 months). We recorded 1 recurrence in group L and 3 in group S. Statistical analysis revealed that the recurrence rate, for patients older than 50 and presenting with type 3 hernia, was higher in group S (3/14 = 21%) than in group L (0/13 = 0%). In conclusion, compared to Shouldice repair, laparoscopic herniorrhaphy is associated with less postoperative pain, a quicker return to everyday activities and an equivalent postoperative morbidity. In our series, the recurrence rate was even lower for patients older than 50 with type 3 hernia.

The study aimed to examine the relationship between the subgingival flora around implants and their periodontal parameters. Plaque samples from 561 implants (279 patients) were analyzed by means of differential phase contrast microscopy and compared with the sample site's probing depth, bleeding tendency on probing, and plaque and gingivitis indices. If possible, one implant with deep and one with shallow pockets were selected within the same patient. The impact of the intraoral exposure time on the microbial composition around the implants was examined cross-sectionally, with the same group of patients. Only tendencies can be detected by the latter, and no concrete conclusions can be drawn. From the clinical parameters, increased probing depth was found to detrimentally increase the proportion of spirochetes and motile organisms, whereas the other parameters were found to be of minor importance. For partially edentulous patients only, there was a tendency for increased proportions of spirochetes and motile organisms the longer the intraoral exposure time. These observations emphasize the importance of the periodontal health of the remaining teeth (as a reservoir of pathogenic microorganisms) in partial edentulous patients rehabilitated by means of implants and indicate the importance of shallow pockets around implants (flap trimming when aesthetics and phonetics allow).

The hospital records of all the patients who underwent cholecystectomy because of specific biliary symptoms, between October 1990 and March 1993, were prospectively analyzed. The series consisted of 192 patients (159 women and 33 men), the mean age was 56 years and the mean body mass index was 26. Indication for surgery was uncomplicated gallstones in 113, common bile duct stones in 28 and cholecystitis in 51 patients. In those groups, respectively 94 (83%), 16 (57%) and 23 (45%) patients had a laparoscopic cholecystectomy. In total, laparoscopic cholecystectomy was successfully performed in 127 (95%) of the 133 patients in whom it was attempted. When compared with laparotomy, laparoscopic cholecystectomy was associated with shorter operative time: 88 +/- 41 min. (Mean +/- SD) versus 132 +/- 64 min. (p0,001), shorter postoperative hospital stay: 5 +/- 3 days versus 13 +/- 7 days (p0.001) and reduced cost of hospitalization: 103.301 +/- 51.062 BF versus 186.931 +/- 113.651 BF (p0.001). We noted an equivalent perioperative morbidity incidence in the two groups. The advantages of laparoscopy compared to laparotomy were recorded whatever the indication for cholecystectomy was. Therefore, with the increasing experience of surgeons and the improving quality of laparoscopic instruments, we think that laparoscopy can be considered for all patients requiring cholecystectomy.

The Periotest device was used to evaluate the damping characteristics of different bone-to-implant interfaces of Brånemark implants. Implant and abutment lengths were found to have a significant influence on Periotest value (PTV). There was no statistical difference between PTVs of implants located in the anterior and posterior areas of the same jaw at abutment connection. No differences were found between PTVs of standard and self-tapping implants. PTVs at abutment connection were highly influenced by the bone quality. The contact with two corticals, one at each extremity of the implant, was of a greater influence in the maxillary than in the mandibular jaw, indicating a firmer anchorage between the bi-cortical implants and the surrounding bone. A progressive decrease of PTVs over time was observed, significant up to 5 years of loading.

For several years, implant-supported overdentures have been used with excellent results in rehabilitation of the edentulous mandible. The effect on the antagonistic jaw bone resorption however, has not yet been evaluated. The aim of this study was to examine on orthopantomograms the anterior and posterior maxillary ridge resorption in three groups of patients with different mandibular prosthetic reconstructions: (1) overdentures supported by two implants, (2) fixed prostheses supported by four to six implants, and (3) complete dentures. The results indicated a more pronounced annual bone resorption in complete denture wearers compared to patients with implant-supported overdentures. A limited but continuing bone resorption was observed for the patients with implant-supported overdentures, and a slightly higher annual bone resorption occurred in the implant-supported fixed prosthesis group.

The aim of the present study was to evaluate the capability of the Periotest device in detecting and monitoring functional changes in the periodontal as well as in the pari-implant damping characteristics. In the first part of this study, 107 teeth were splinted by means of 40 full acrylic fixed prostheses (AFP) and another 37 teeth were splinted by means of 14 ceramometallic fixed prostheses (C-MFP). The Periotest measurements of individual teeth were done the day the fixed prostheses were cemented temporary (PTV 1), and again after a mean observation period of 27.4 days (PTV 2). In the 2nd part, 78 osseointegrated two-stage implants were splinted by means of 23 full acrylic fixed prosthesis (AFP) and other 18 implants were left without it. Using the same abutment length, Periotest measurements were performed, at abutment connections and before installation of the final prosthesis. In a 3rd part, using both implants and teeth as abutments, 29 osseointegrated implants were connected with 25 abutment teeth by means of 7 AFP. The measurements were performed at the beginning of the prosthetic treatment and 2, 4 and 6 weeks later. After splinting teeth by means of AFP for the observation period, no statistically significant reduction in PTVs was found. When on the other hand, a C-MFP was used, PTV 2 showed a significant reduction. The PTVs at abutment connection went down after a period of time, during which some implants were interconnected by means of an AFP and others were not.(ABSTRACT TRUNCATED AT 250 WORDS)