Prophylactic use of roxithromycin in dental procedures

In this study roxithromycin was applied for prophylactic treatment of 104 patients (implantology, dentoalveolar surgery, risk patients etc.) underwent dental surgery. The efficacy and side effects of roxithromycin were studied. The efficacy of this antibiotic was 92%, gastrointestinal complains, as the most common side effects were obtained in 2.8% of the patients treated with roxithromycin.     

Retention of three endodontic posts cemented with five dental cements

BACKGROUND: Although the use of extracorporeal life support (ECLS) following repair of congenital heart defects in children is increasing, the criteria for ECLS usage in these patients is not well defined. The overall survival of such patients is disappointingly low and may depend on both the indication for support and the time at which ECLS is commenced. METHODS: Between January 1993 and December 1996, 727 children underwent surgery for congenital heart defects at our institution with an overall hospital mortality of 5.8% (42 children). Nine of these children were treated with ECLS postoperatively. There were seven males and two females with a mean age of 7.2 months (range 2 weeks-3 years). Seven children could not be weaned from cardiopulmonary bypass (CPB) in the operating theatre. A further two were treated with ECLS later on during the postoperative period (commenced at 14 and 48 h). Full veno-arterial extra corporeal membrane oxygenation (ECMO) support was used in all children except one in whom a left ventricular assist device (LVAD) was used. RESULTS: The median duration of support was 121 h (range 15-648 h). Four children (44%) were weaned from support and two of these are long-term survivors. Of the seven children in whom ECLS was instituted because of failure to wean from CPB, there was one long term survivor (LVAD support). Of the two patients in whom ECLS was instituted during the post-operative period there is one long-term survivor. CONCLUSIONS: Weaning form ECLS and decannulation in 44% of our patients is comparable to other series of post-cardiotomy patients requiring ECLS. However, full veno-arterial ECMO instituted because of a failure to wean from CPB during corrective surgery is associated with an extremely poor outcome (zero long-term survivors in six patients).     

Use of laboratory animals in the teaching of emergency procedures

The Division of Emergency Medicine, University of Chicago Hospitals and Clinics uses animal laboratory sessions to train emergency medicine residents in manipulative skills. Certain animals realistically represent the human for these purposes and are delineated for various procedures. On the other hand, animal tissue characteristics and anatomical landmarks generally differ from those of humans. How procedures such as cricothyreotomy; tracheostomy, tube thoracostomy, thoractomy, cardiac repair, aortic cross clamping, venous cutdown, peritoneal lavage, abdominal stab wound exploration and laparotomy can be performed and must be modified is discussed. A rational procedural sequence is required to maintain the animal's vitality through the end of the session.     

Idiopathic dental root replacement resorption in old dogs

The roots of the teeth of 33 large dogs aged 10 years or older were radiographed. These dogs were euthanized for reasons other than oral diseases; dogs with obvious dental or periodontal diseases were excluded. The dogs had shown no clinical signs related to the teeth and the teeth were macroscopically normal. Of the 33 dogs, six had one or more teeth that had abnormally shaped and partially resorbed roots, with replacement of root structure by radiographically normal trabecular bone. Histological examination of radiographically abnormal roots revealed mid-root resorption, without signs of inflammation or hypercementosis. These findings are similar to the condition known as idiopathic dental root replacement resorption in the human dental literature. Possible etiologies of root resorption are discussed.     

How the trend to elective dental procedures influences your practice

Malignant mesenchymal tumours of the breast are rare neoplasms. Their incidence varies from 1%-3% of all malignant breast tumours (1). Stromal sarcoma of the breast is an extremely uncommon tumour (2). We present a rare case of advanced stromal sarcoma of the breast successfully managed with radical surgery and radiotherapy.     

Scanning electron microscopic evaluation of different endodontic procedures on dentin morphology of human teeth

Four manual endodontic instruments, an ultrasonic and an endosonic system were studied with a view to evaluating the morphology of the smear layer and the amount of debris and pulpal residues in the apical third of human extracted straight teeth from 55- to 75-yr-old patients. The manual instruments were K files, Ergoflex files used with the step-back technique, Canal Master with its own technique, and Flex-R with the Roane technique. The ultrasonic system was Suprasson Piezo and the endosonic was Excalibur. Human extracted teeth with straight canals were used and examined under a scanning electron microscope. All manual instrumentations showed a homogeneous compact smear layer and no pulp residues. No statistical differences were observed among the four manual techniques. Ultrasonic technique showed the complete removal of the smear layer, leaving small amounts of pulp debris at the apical third, while the Excalibur showed an almost complete elimination of the smear layer, leaving a homogeneous layer of pulpal residues along the canal.     

Use of the laryngeal mask in oral and dental surgery

Adduction between acrylamide and cysteine residues is a post-translational modification associated with proteins separated by gel electrophoresis. In the present article, three model peptides containing 2-4 cysteine residues were reduced with dithiothreitol, incubated with acrylamide monomers and examined by on-line liquid chromatography coupled to electrospray tandem mass spectrometry. Each of the solutions examined in this work revealed the presence of four distinct components: the free peptide, two different peptide-acrylamide 1:1 adducts involving two cysteine residues at different positions within the same sequence, and the peptide-acrylamide 1:2 adducts. The use of liquid chromatography allowed the separation of components which differed only by the site of complexation of acrylamide, while the application of tandem mass spectrometry furnished reliable sequencing information permitting the identification of most cysteine residues involved in such complexation.     

Pediatric dentists' attitudes regarding parental presence during dental procedures

A controversial aspect of pediatric dentistry today is parental presence. A number of authors report an increase in the number of parents who wish to accompany their children throughout the dental appointment. Dentists historically have excluded parents from the treatment area, while pediatricians routinely keep the parent and child together. The purpose of this survey was to determine the frequency that Florida pediatric dentists permit parental presence during children's dental visits and to relate the influence of patient age, dentist's years in practice, procedure type, and practitioner attitudes on parental presence. A high return rate (98.9%) was obtained, and results indicated a significant increase in parental presence in the dental operatory and that further increases in parental presence are expected. Younger children were more likely to be accompanied by a parent for each procedure. Parental presence for examination was more likely than for restorative or extraction. Analysis of variance (ANOVA) indicated that the most frequent attitudes influencing the pediatric dentist's choice to exclude parents were that their presence: wastes time (P < 0.001); disrupts the child (P < 0.05); and makes the dentist uncomfortable (P < 0.05).     

Use of streptokinase in four dogs with thrombosis

Four dogs with thrombosis were referred for diagnostic testing and were subsequently treated by the use of streptokinase. The range of duration of clinical signs associated with thrombosis was 6 to 120 days. Causes of thrombosis were heart disease (1 dog), protein-losing nephropathy and hyperadrenocorticism (1), hyperadrenocorticism (1), and idiopathic (1). Possible factors that predisposed dogs to hypercoagulability included hypertension (2 dogs) and diabetes mellitus (1). All dogs were treated for underlying disease by use of supportive care. The first dog was treated with a loading dose of 250,000 U of streptokinase, i.v., with a subsequent maintenance dosage of 100,000 U/h, i.v., and also was treated with anticoagulant. The subsequent 3 dogs were treated with a loading dose of 90,000 U of streptokinase, i.v., and maintenance dosage of 45,000 U/ h, i.v., at various intervals. These dogs also were treated with anticoagulant. Three dogs had minor hemorrhage as an adverse effect to streptokinase infusion, but they did not require treatment for the hemorrhage. Complete resolution of the thrombus was observed in 3 dogs, and partial resolution of the thrombus was observed in the other dog. In all dogs, partial or complete resolution of clinical signs associated with thrombosis was seen. Streptokinase may be an effective treatment for dogs with thrombosis.     

Use of carprofen for the treatment of pain and inflammation in dogs

Most studies of nonsteroidal anti-inflammatory drugs (NSAID) do not demonstrate appreciable differences in efficacy. As awareness of the adverse effects associated with NSAID use increases, safety is becoming the primary concern among physicians when selecting NSAID for use by their human patients. However, veterinarians may be less aware of the safety concerns associated with NSAID use. A wide range of NSAID is used to treat human beings with osteoarthrits; however, it is imperative to remember that dogs are especially sensitive to these drugs, and reports of serious, and occasionally fatal, complications are numerous. Carprofen is a propionic acid-derived NSAID that has anti-inflammatory, analgesic, and antipyretic activity. In animals, carprofen is as potent as indomethacina and more potent than aspirin or phenlbutazone, but carprofen appears to be safer than most other NSAID.     

Observations on electrocardiogram and plasma catecholamines during dental procedures: the forgotten vagus

Emotional stress is conventionally considered to be associated with tachycardia and enhanced sympathetic activity. The electrocardiogram and plasma catecholamine and lipid concentrations were observed in 21 young healthy women undergoing dental procedures. Ten of these received premedication with the beta-blocking agent oxprenolol and 11 with a placebo, administered on a double-blind randomised basis. Mild tachycardia occurred in the placebo group a few minutes before and a few minutes after dentistry, but there was a reduction in heart rate immediately before and during the procedure. The pattern was similar in the group who received oxprenolol, though the heart rates at each stage were lower. Plasma adrenaline concentrations were much higher in the samples taken during the procedure than in those taken shortly before and after it. Plasma noradrenaline and lipid concentrations remained unchanged. A decrease in heart rate in the face of intense emotional arousal and an increased plasma adrenaline concentration suggest that the expectation or experience of pain may be associated with parasympathetic dominance despite greatly enhanced sympathetic activity.     

Use of subepithelial connective tissue grafts in combined periodontal prosthetic procedures

INTRODUCTION: Occasional superinfection or co-infection with Staphylococcus aureus led us to search for S. aureus carriage prospectively in patients with non-necrotizing bacterial dermophypodermitis, in particular erysipelas. PATIENTS AND METHODS: This prospective study included immunocompetent patients with bacterial dermophypodermitis without signs of toxicity or local manifestations suggesting necrotizing fasciitis. Bacteriology tests included: 1) direct immunofluorescence for streptococcus (groups A, C, G) on skin biopsies taken on day 0, 2) samples from the nasal orifices, the intergluteal fold, and potential skin portals for bacteriology culture, and 3) assay of antistreptolysine O and antistreptodornase B on day 0 and 15. RESULTS: The study group included 42 patients (23 females, 19 males, mean age 64 +/- 3.5 yr). In 39 cases (93%) bacterial dermohypodermitis was located on the lower limb with a potential skin portal in 36 cases (86%). Sample culture, direct immunofluorescence or serology findings demonstrated presence of streptococci in 33 cases (79%). Nasal, intergluteal or potential portal were identified in 19 patients (45%) including 16 with demonstrated presence of streptococci. The rate of cure after oral pristinamycin did not vary significantly between carriers (79%) an non-carriers (91%) of Staphylococcus aureus. Drainage of a localized abscess was successful in 5 of 6 patients after initial failure of antibiotic treatment; 4 of them were carriers of S. aureus. CONCLUSION: This prospective study demonstrated that cutaneous-mucosal carriage of Staphylococcus aureus is frequent in patients with non-necrotizing dermohypodermitis. This carriage is not a factor of over-morbidity as shown in this group of infections largely dominated by erysipelas.     

Use of an open stereotactic ring for neurosurgical procedures

We describe an open ring as a new design to the Zamorano-Dujovny (Z-D) stereotactic unit. The titanium base ring has an opening of 45 degrees that can be located in any chosen position. Imaging studies such as computed tomography, X-ray, positron emission tomography, digital angiography, and digital substraction angiography can be performed with the open stereotactic ring for multimodality image localization. Preoperatively and intraoperatively, this open design provides the anesthesiologist with an unobstructed pathway for airway management. During the surgical procedure, it facilitates approach to any intracranial lesion, including orbitozygomatic, combined supra-infratentorial, and others. During awake craniotomies it not only allows for easy airway management, but also provides good access to the patient's face for intraoperative evaluation of speech and visual functions. Accuracy and reliability of this unit were similar to results obtained with the original circular ring. This system can be used in conventional stereotaxis with the Z-D arc, as well as a reference for intraoperative registration with any digitizer system. The open stereotactic unit is a relatively inexpensive, reliable, and easy-to-use solution for resections using conventional stereotaxis or interactive image guidance in any intracranial site.     

Use of the modified acrylic external fixator in 54 dogs and 28 cats

This paper describes the use of acrylic resin instead of a Kirschner clamp for treating bone fractures. The technique is cheaper than using Kirschner external skeletal fixator and allows greater flexibility for pin placement. It is also less prone to self mutilation by dogs than the entirely acrylic external fixator. The modified acrylic fixator gave results similar to those obtained with the Kirschner external fixator, when used in 54 dogs and 28 cats.     

Hemostasis in endodontic microsurgery

Although quantification of the lesion burden from serial MR examinations of patients with multiple sclerosis (MS) is a common technique to assess disease activity in clinical trials, pathologic change may occur within a lesion without a corresponding change in volume. Therefore, measures of lesion volume and composition may improve the sensitivity of detecting disease activity. A new technique has been developed that provides information about the intensity composition of MS lesions in standard spin-echo MR examinations. The new technique is based on the multispectral "feature space" intensity distributions of the lesions and normal tissues. Analysis of MR examinations of materials with known T1 and T2 times showed that feature space position from spin-echo examinations is largely determined from proton density (rho), T2, and the interecho delay. Information about intensity composition was obtained by reducing the multidimensional intensity distribution to one dimension while minimizing the loss of information. This technique was used to analyze eight lesions in standard spin-echo MR examinations of three patients with MS. Lesion distributions were compared between examinations by first calibrating the examinations based on the intensity distributions of cerebrospinal fluid (CSF), an internal reference tissue. Many of the lesion distributions had a distinctive peak at low intensity, corresponding to normal-appearing white matter (WM). Within the lesion distributions, increases in high intensity peaks generally were accompanied by reductions in the WM peak. Serial analysis of the lesion distributions revealed some dramatic fluctuations, even when lesion volume remained constant.     

Fluorescence of dental calculus from cats, dogs, and humans and of bacteria cultured from dental calculus

Recently we reported that feline and canine dental calculus fluoresced pink to red under long wavelength ultraviolet light due to the presence of porphyrin. Here we report the observation of such fluorescence in 30 of 30 cats, 30 of 30 dogs, and 8 of 13 supragingival samples and 5 of 5 subgingival samples of humans. The fluorescence spectra of the calculus dissolved in 9 M HCl show that it is due to three distinct metal-free porphyrins. Similar fluorescence is obtained from bacterial cultures grown from calculus deposits of cats and dogs and bacteria grown on blood agar containing hemin and vitamin K1. The results of the bacterial culture study suggest that the metal-free porphyrin is produced by bacteria in the mouth. The clinical observation of fluorescence can be used for diagnosis.     

Use of allopurinol for maintenance of remission in dogs with leishmaniasis

Current treatments for infected dogs with leishmaniasis do not always provide long-term control of the disease and clinical relapses are common. In this study, the usefulness of long-term allopurinol administration in the maintenance of clinical remission in canine leishmaniasis was evaluated. Fifteen dogs with natural leishmania infection were subjected to an initial treatment based on the simultaneous administration of meglumine antimoniate (100 mg/kg/day) and allopurinol (30 mg/kg/day). Once clinical remission was achieved, a maintenance treatment with allopurinol (20 mg/kg/day) administered for one week a month was instituted. Results were compared with those of a retrospective control group comprising 15 infected dogs which only followed the induction treatment. Relapses occurred in 86 per cent of control dogs within 14 months of discontinuing treatment. In contrast, those dogs on intermittent oral allopurinol administration were successfully maintained in clinical remission for a follow-up period of 10 to 44 months. In this latter group, specific antibody titres decreased or were unchanged, no side effects directly attributable to allopurinol were seen and treatment was well accepted by the owners. It is concluded that long-term intermittent administration of allopurinol is an effective way of maintaining clinical remission in dogs with leishmaniasis.