A clinical and microbiological evaluation of systemic and local metronidazole delivery in adult periodontitis patients

The present study describes results on selected clinical and microbiological parameters obtained by treatment with local (Elyzol) and systemic (Flagyl) use of metronidazole alone and/or mechanical subgingival debridement in adult periodontitis. Patients were randomly divided into local and systemic treatment groups each comprising 5 individuals in each of whom 4 sites (one site/ quadrant) with a probing depth of > or = 5 mm were selected and treated with separate treatment modalities. The overall treatment design provided 6 different test groups. Groups of quadrants received: (1) scaling and root planing; (2) local metronidazole treatment; (3) systemic metronidazole treatment; (4) local metronidazole combined with scaling and root planing; (5) systemic metronidazole combined with scaling and root planing; (6) no treatment. The microbiological and clinical effects of treatment modalities were monitored over a period of 42 days. All treatments resulted in clinical improvements (gingivitis, probing pocket depth, attachment level) except for the untreated group. Parallel to the clinical changes, all treatments reduced the number of total bacteria and proportions of obligately anaerobic microorganisms. Although both of the combined treatment groups responded to therapy with better resolution of infection that the pure mechanical and pure metronidazole treatments, local metronidazole in combination with scaling and root planing seems to be more effective in terms of producing both clinical and microbial improvements.     

A comparison between ketorolac and diclofenac in laparoscopic sterilization

We compared ketorolac and diclofenac for the prevention and treatment of post-operative pain in patients undergoing laparoscopic sterilization. Fifty ASA I or II women were allocated randomly to receive either diclofenac 75 mg or ketorolac 30 mg intramuscularly 30-90 min before general anaesthesia. Pain scores were assessed half-hourly in the recovery room and then at 2 h and 4 h in the ward. In the recovery room, pain was treated with a second dose of the study drug, followed by parenteral pethidine if necessary. Four patients in the diclofenac group and five patients in the ketorolac group requested no analgesics after surgery. Fifteen patients from each group had satisfactory analgesia after the second dose of study drug. Pain scores were similar between groups at all times. The median (range) initial pain score in the recovery room was 5 (0-9.5) in the diclofenac group and 5 (1-9) in the ketorolac group. Pain at the injection site was more common after diclofenac than ketorolac (12 vs. 3, P < 0.05). In conclusion, both intramuscular diclofenac and ketorolac were relatively ineffective in controlling the pain after laparoscopic sterilization. The drugs were equally well tolerated, but more patients complained of pain at the injection site after diclofenac.     

Clinical evaluation of systemic doxycycline and ibuprofen administration as an adjunctive treatment for adult periodontitis

The objective of this study was to compare the efficacy of a systemic antibiotic (doxycycline) and a non-steroidal anti-inflammatory drug (ibuprofen), administered either separately or combined, as an adjunctive treatment of scaling/root planing (SRP). Thirty-two subjects diagnosed with generalized moderate adult periodontitis and having at least 2 teeth with > or =5 mm probing depth were randomly divided into 4 groups. Each group was treated with oral doxycycline and/or ibuprofen for 6 weeks as follows: group 1, doxycycline 200 mg the first day followed by 100 mg per day; group 2, ibuprofen 800 mg per day; group 3, doxycycline plus ibuprofen scheduled as in groups 1 and 2; group 4, one placebo capsule/day (control). A split mouth design was utilized in each subject such that half of the teeth received one session of scaling/root planing (SRP), while the other half received no SRP. Plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) using a customized acrylic stent were recorded at baseline and at 3, 6, 12, and 24 weeks following SRP. Analysis using ANOVA and Student t-test showed statistical significance (P< or =0.05) from baseline data in: 1) gains of 0.4 mm and 0.5 mm of CAL for groups 1 and 3, respectively; 2) reduction of 0.7 mm PD for group 3; 3) reduction of 0.4 and 0.1 GI scores for groups 1 and 3, respectively; and 4) gain of 0.5 mm CAL and reductions of 0.4 mm PD and 0.2 GI score for the SRP group when compared to the no SRP group at 24 weeks. It may be concluded that the adjunctive use of systemic doxycycline alone or in combination with ibuprofen results in a statistically significant, yet modest clinical, improvement beyond that obtained by scaling/root planing.     

A comparison of omeprazole and placebo for bleeding peptic ulcer

BACKGROUND: The role of medical treatment for patients with bleeding peptic ulcers is uncertain. METHODS: We conducted a double-blind, placebo-controlled trial in 220 patients with duodenal, gastric, or stomal ulcers and signs of recent bleeding, as confirmed by endoscopy. In 26 patients the ulcers showed arterial spurting, in 34 there was active oozing, in 35 there were nonbleeding, visible vessels, and in 125 there were adherent clots. The patients were randomly assigned to receive omeprazole (40 mg given orally every 12 hours for five days) or placebo. The outcome measures studied were further bleeding, surgery, and death. RESULTS: Twelve of the 110 patients treated with omeprazole (10.9 percent) had continued bleeding or further bleeding, as compared with 40 of the 110 patients who received placebo (36.4 percent) (P<0.001). Eight patients in the omeprazole group and 26 in the placebo group required surgery to control their bleeding (P<0.001). Two patients in the omeprazole group and six in the placebo group died. Thirty-two patients in the omeprazole group (29.1 percent) and 78 in the placebo group (70.9 percent) received transfusions (P<0.001). A subgroup analysis showed that omeprazole was associated with significant reductions in recurrent bleeding and surgery in patients with nonbleeding, visible vessels or adherent clots, but not in those with arterial spurting or oozing. CONCLUSIONS: In patients with bleeding peptic ulcers and signs of recent bleeding, treatment with omeprazole decreases the rate of further bleeding and the need for surgery.     

A comparison of adult and adolescent rat behavior in operant learning, extinction, and behavioral inhibition paradigms.

Poor self-control, lack of inhibition, and impulsivity contribute to the propensity of adolescents to engage in risky or dangerous behaviors. Brain regions (e.g., prefrontal cortex) involved in impulse-control, reward-processing, and decision-making continue to develop during adolescence, raising the possibility that an immature brain contributes to dangerous behavior during adolescence. However, very few validated animal behavioral models are available for behavioral neuroscientists to explore the relationship between brain development and behavior. To that end, a valid model must be conducted in the relatively brief window of adolescence and not use manipulations that potentially compromise development. The present experiments used three operant arrangements to assess whether adolescent rats differ from adults in measures of learning, behavioral inhibition, and impulsivity, within the aforementioned time frame without substantial food restriction. In Experiment 1, separate squads of rats were trained to lever-press and then transitioned to two types of extinction. Relative to their baselines, adolescent rats responded more during extinction than adults, suggesting that they were less sensitive to the abolishment of the reinforcement contingency. Experiment 2 demonstrated similar age-related differences during exposure to a differential reinforcement of low rates schedule, a test of behavioral inhibition. Lastly, in Experiment 3, adolescent's responding decreased more slowly than adults during exposure to a resetting delay of reinforcement schedule, suggesting impaired self-control. Results from these experiments suggest that adolescents exhibit impaired learning, behavioral inhibition and self-control, and in concert with recent reports, provide researchers with three behavioral models to more fully explore neurobiology of risk-taking behavior in adolescence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A comparison of sustained-release bupropion and placebo for smoking cessation

BACKGROUND AND METHODS: Trials of antidepressant medications for smoking cessation have had mixed results. We conducted a double-blind, placebo-controlled trial of a sustained-release form of bupropion for smoking cessation. We excluded smokers with current depression, but not those with a history of major depression. The 615 subjects were randomly assigned to receive placebo or bupropion at a dose of 100, 150, or 300 mg per day for seven weeks. The target quitting date (or "target quit date") was one week after the beginning of treatment. Brief counseling was provided at base line, weekly during treatment, and at 8, 12, 26, and 52 weeks. Self-reported abstinence was confirmed by a carbon monoxide concentration in expired air of 10 ppm or less. RESULTS: At the end of seven weeks of treatment, the rates of smoking cessation as confirmed by carbon monoxide measurements were 19.0 percent in the placebo group, 28.8 percent in the 100-mg group, 38.6 percent in the 150-mg group, and 44.2 percent in the 300-mg group (P<0.001). At one year the respective rates were 12.4 percent, 19.6 percent, 22.9 percent, and 23.1 percent. The rates for the 150-mg group (P=0.02) and the 300-mg group (P=0.01) -- but not the 100-mg group (P=0.09) -- were significantly better than those for the placebo group. Among the subjects who were continuously abstinent through the end of treatment, the mean absolute weight gain was inversely associated with the dose (a gain of 2.9 kg in the placebo group, 2.3 kg in 100-mg and 150-mg groups, and 1.5 kg in the 300-mg group; P= 0.02). No effects of treatment were observed on depression scores as measured serially by the Beck Depression Inventory. Thirty-seven subjects stopped treatment prematurely because of adverse events; the frequency was similar among all groups. CONCLUSIONS: A sustained-release form of bupropion was effective for smoking cessation and was accompanied by reduced weight gain and minimal side effects. Many participants in all groups were smoking at one year.     

A comparison of ranitidine, droperidol or placebo in the prevention of nausea and vomiting after hysterectomy

Surgical procedures including the extent of systematic lymphadenectomy are still under discussion in the treatment of esophageal cancer. In the own patients' population 92 subtotal en bloc-esophagectomies with a standard two field lymphadenectomy were performed. A total of 1483 lymph nodes were resected in the thoracic and abdominal compartments with an incidence of 16.1% being metastatic. Stage pN1 disease occurred in 57.6% of the patients. The median number of lymph nodes resected in each specimen was 16, independent of tumor stage, -site or R-classification. The number of infiltrated nodes increased with tumor stages. R-classification, tumor stage and number of involved lymph nodes could be analyzed as prognostic factors. After R0-resection a median survival rate of 25.4 months could be achieved, following pN0-stage that of 27.4 months. In case of two metastatic lymph nodes the prognosis decreased significantly to 14.4 months (p < 0.01). Therefore, two field lymphadenectomy may show a therapeutic benefit only in a subgroup of patients with a limited number of lymph nodes infiltrated.     

Tooth loss and periodontal bone level in individuals of J?nk?ping County. A comparison between two adult populations living in the city and in the surrounding area

Cross-sectional and longitudinal studies were performed in the community (in this paper changed to city) of J?nk?ping, Sweden, over a period of 20 years to follow changes in oral health and oral health behaviour. To widen our knowledge about dental health and dental care among the adult population, we expanded the study in 1993 to cover the whole county. The specific aim of the present study was to describe tooth loss (excluding third molars) and periodontal bone level in adult residents of J?nk?ping County and to compare these two parameters in adults living in the city of J?nk?ping with the same in adults living in the rest of the county. Random samples of individuals 30, 40, 50, 60, and 70 years old were selected. A total of 484 persons from the city and 1219 subjects from the rest of the county were examined. A total of 32 (7%) and 27 (2%) persons were completely edentulous in the examined populations from the city and from the rest of the county, respectively. A majority belonged to the older age groups, 60 and 70 years, with 17% of the subjects in the city being edentulous compared with 13% in the rest of the county. The mean number of missing teeth in subjects in the city versus subjects in the rest of the county was 0.75/0.95, 1.37/1.60, 3.34/2.43, 6.34/7.40, and 9.95/10.26 in 30-, 40-, 50-, 60-, and 70-year-olds, respectively. Of all the different tooth types, the average number of molars per person decreased the most with increasing age from an average of 7.79/7.83 (city/county) to 3.06/3.09 (city/county) for 30- and 70-year-olds, respectively. The proportion of subjects without molars was higher in the older age groups in both the city and the rest of the county with 4.8/10.7% and 15.6/22.0% of the 60- and 70-year-olds, respectively, lacking molars. In both populations, the mean periodontal bone level decreased with age. It was concluded that no important differences in tooth loss and periodontal health could be seen between the two populations. When organising dental care, dental health administrators could apply the findings from the population in the city to the entire county.     

Effects of ketorolac on bone repair: A radiographic study in modeled demineralized bone matrix grafted rabbits

The treatment of instability of the multiply reoperated knee is a complex problem. The causes for failure are numerous and include repeated trauma, insufficient fixation and non-anatomic placement of the graft, inadequate replacement material, isolated anterior cruciate ligament (ACL) reconstruction in complex knee instability or the use of a ligament prosthesis. With every surgical procedure, however, the anatomical and technical conditions become worse. Problems like degenerative changes, joint stiffness and gait abnormalities occur and often become a more focal point than the instability itself. The purpose of this paper is to present the problems and the dilemma of instability of the multiply reoperated knee and the possible solutions. Between 1976 and 1996, a total of 1752 ACL reconstructions were carried out in Munich and Hannover. Of these, 228 (13%) were revision, mostly of failed ACL reconstructions performed elsewhere. Since 1989, we have chosen the severest cases from this group (more than three operations on the same knee) for this study. Seventeen patients were investigated who had undergone up to 25 operations. The mean number of operations was 7. All primary operations were performed in other hospitals. In 10 cases only the ACL reconstruction was performed as a final procedure, mostly in combination with other procedures like medial meniscus replacement, extra-articular stabilization or arthrolysis. In the other cases operations such as osteotomies, arthrodesis or amputation were necessary. The results present the main dilemma in instability of the multiply reoperated knee since they were not successful in all patients. Finally, 15 patients report still having instability, pain or swelling in isolation or in combination. Nine patients were satisfied with their subjective results. Even after the socalled definitive procedures, certain complications arose. The main goal in the treatment of instability of the multiply reoperated knee is to avoid a series of operations, hospitalization and history of illness. General revision surgery for the entire complaint is not the aim of the treatment. The specific problem of the patient should be extracted from the complex situation, and this should be solved with the most limited procedure possible only.     

A randomized, double-blind, placebo controlled comparison of droperidol, ondansetron, and metoclopramide for the prevention of vomiting following outpatient strabismus surgery in children

STUDY OBJECTIVE: To compare the efficacy of ondansetron, droperidol, or metoclopramide with placebo in preventing postoperative vomiting following strabismus surgery. STUDY DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: University outpatient surgery center. PATIENTS: 160 ASA physical status I and II children ages 1 to 12 years who were scheduled for strabismus surgery. INTERVENTIONS: Administration of either ondansetron 100 mcg/kg, metoclopramide 250 mcg/kg, droperidol 75 mcg/kg, or placebo intravenously after induction of anesthesia. MEASUREMENTS AND MAIN RESULTS: Both ondansetron and droperidol were superior to metoclopramide and placebo in preventing predischarge vomiting, with incidences of 5%, 5%, 32%, and 25%, respectively. However, there was no difference in the incidence of postdischarge vomiting among the groups (ondansetron 25%, droperidol 25%, metoclopramide 20%, and placebo 25%). CONCLUSIONS: While both ondansetron and droperidol are more effective than metoclopramide when compared with placebo in decreasing the incidence of predischarge vomiting, none of these drugs was more effective than placebo in decreasing the incidence of postdischarge vomiting. Recovery from anesthesia was not significantly different among the groups as assessed by time to awakening, initial Steward score, and time to discharge.     

Tonsillectomies, ketorolac, and the march of progress

The destructive effector functions of the immune system pose a problem that has aptly been described as 'horror autotoxicus'. This problem demands a solution that offers an effective self-nonself discrimination mechanism. Unlike all other defence mechanisms, the immune system makes the self-nonself discrimination somatically, and not at the germline level. This discrimination requires a way of separating self from nonself. Two proposals to accomplish this are based on separation in time or in space. In this paper the authors show that separation in time remains the only viable solution. A generally accepted solution to the mechanism of the self-nonself discrimination is overdue as it strongly influences the way in which much of immune regulation is interpreted.     

Pharmacodynamic comparison of the acute effects of nomifensine, amphetamine and placebo in healthy volunteers

In a double blind cross over trial the effects of single doses of 100 mg nomifensine, 15 mg racemic amphetamine and placebo were compared in 9 healthy volunteers. Assessments of choice reaction behavior, simple reaction time, critical flicker fusion and attention on continuous calculations were performed together with a series of self rating scales, a side-effect list and vital signs before and 90 min., 180 min. and 360 min. after each administration. While the only significant nomifensine effect was an increase of correct solutions in the continuous calculation task, amphetamine differed from nomifensine and placebor in a number of subjective variables which describe emotional changes typical for drug stimulation. Subjects also expressed the will to have amphetamine prescribed for fatigue and loss of drive, whereas preferences for nomifensine were virtually the same as for placebo. Under amphetamine heart rate and blood pressure were increased and side-effects were frequent. It is concluded that nomifensine showed none of those subjectively pleasant amphetamine effects which are responsible for the reinforcement function leading to amphetamine dependence.     

A comparison of topical anaesthesia and electronic nerve stimulation for reducing the pain of intra-oral injections

This paper describes a model for investigating the efficacy of different methods of alleviating the pain of intra-oral injections. The efficacies of the topical anaesthetic EMLA cream and electronic nerve stimulation as means of reducing the discomfort of palatal injections prior to the extraction of maxillary teeth were investigated using the model in one hundred patients. EMLA reduced the pain of injection compared with placebo (P < 0.05) whereas the pain reported after electronic nerve stimulation did not differ significantly from placebo. It is concluded that EMLA is useful in reducing the pain of palatal injections.     

Prevention of hearing loss in experimental pneumococcal meningitis by administration of dexamethasone and ketorolac

Pneumococcal meningitis remains a significant cause of morbidity, particularly sensorineural hearing loss. Recent literature has suggested that a vigorous host immune response to Streptococcus [corrected] pneumoniae is responsible for much of the neurologic sequelae, including deafness, after bacterial meningitis. This study used a rabbit model of hearing loss in experimental pneumococcal meningitis to evaluate the therapeutic effect of two anti-inflammatory agents, dexamethasone and ketorolac, coadministered with ampicillin. Both adjunctive drugs minimized or prevented sensorineural hearing loss compared with placebo. Dexamethasone, administered 10 min before ampicillin, was particularly effective in minimizing mean hearing threshold change compared with placebo for both clicks (dexamethasone: 6.7-dB sound pressure level [SPL] vs. placebo: 33. 4-dB SPL, P=.0078) and 10-kHz tone bursts (dexamethasone: 8.4-dB SPL vs. placebo: 53.4-dB SPL, P=.0003). These findings support the beneficial role of anti-inflammatory agents in reducing the incidence of hearing loss from pneumococcal meningitis, especially if therapy is instituted early in the course of infection.     

Vomiting after adenotonsillectomy in children: a comparison of ondansetron, dimenhydrinate, and placebo

We compared the effectiveness of ondansetron, dimenhydrinate, and placebo for the prevention of postoperative vomiting in children after adenotonsillectomy. In a randomized, placebo-controlled, double-blind study, 74 children, 2-10 yr of age scheduled for adenotonsillectomy as outpatients were given a single i.v. dose of ondansetron (0.1 mg/kg, n = 26), dimenhydrinate (0.5 mg/kg, n = 25), or placebo (saline, n = 23) at induction of anesthesia. The incidence of retching and vomiting (POV) and side effects observed 24 h after surgery were recorded. Demographic data were similar among the three groups. The 24-h incidence of POV was 42%, 79%, and 82% in the ondansetron, dimenhydrinate, and placebo groups, respectively (ondansetron compared with dimenhydrinate [P < 0.02] or placebo [P < 0.01]). The study was stopped after two children vomited large volumes of bloody fluid 9 and 22 h after surgery without previous signs of occult bleeding. Both children had received ondansetron. We conclude that ondansetron is superior to dimenhydrinate or placebo for the prevention of POV after adenotonsillectomy in children. Antiemetics may mask the signs of bleeding after adenotonsillectomy. IMPLICATIONS: I.v. ondansetron (0.1 mg/kg) is more effective than both dimenhydrinate and placebo in preventing vomiting after adenotonsillectomy in healthy children. However, antiemetics may also mask the presence of blood in the stomach by preventing vomiting, and this should be appreciated when adenotonsillectomy is performed on an outpatient basis.     

Clinical and microbiological effects of minocycline-loaded microcapsules in adult periodontitis

Clinical and microbiological effects of subgingival delivery of 10% minocycline-loaded (MC), bioabsorbable microcapsules were examined in 15 adult periodontitis patients. Patients received oral hygiene instruction 2 weeks prior to the study. At baseline (day 0) all teeth received supragingival scaling (SC); 2 quadrants received no further treatment and 1 quadrant received subgingival scaling and root planning (SRP). In the fourth quadrant, the tooth with the deepest probing sites (at least 1 site > or = 5 mm) was treated with minocycline microcapsules. The sites were evaluated at baseline and weeks 1, 2, 4, and 6. Clinical indices included bleeding on probing (BOP), probing depths (PD), and attachment loss (AL). Microbiological evaluations included percent morphotypes by phase-contrast microscopy; cultivable anaerobic, aerobic, and black-pigmented Bacteroides (BPB); and percent Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, and Actinomyces viscosus by indirect immunofluorescence. In the SC + MC group, BOP, PD, and AL were significantly reduced from baseline for weeks 1 to 6. BOP in the SC + MC group was significantly reduced compared to the SRP group from weeks 2 to 6. In the SC + MC group the percent of spirochetes and motile rods decreased and the percent of cocci increased after 1 week. The increased cocci and decreased motile rods were statistically greater at weeks 4 and 6 in the SC + MC group compared to the SRP group. This study demonstrates that local subgingival delivery of 10% minocycline-loaded microcapsules as an adjunct to scaling results in reduction in the percent sites bleeding on probing greater than scaling and root planning alone and induces a microbial response more favorable for periodontal health than scaling and root planing.     

Dynamics of serum immunoglobulin G avidity for Porphyromonas gingivalis in adult periodontitis

Sodium azide (NaN3, AZ) is a potent inhibitor and uncoupler of oxidative phosphorylation as well as a nitrovasodilator after being converted to nitric oxide (NO). We studied the effect of intratubular application of AZ on loop of Henle reabsorption and tubuloglomerular feedback (TGF) employing renal micropuncture experiments in nephrons with superficial glomeruli of anesthetized Munich-Wistar-Fromter rats. During perfusion of Henle's loop downstream from an obstructing wax block, AZ (3x10(-5) mol/l and 3x10(-4) mol/l) concentration-dependently increased early distal tubular flow rate and sodium and potassium ion concentration (V(ED), [Na+]ED, [K+]ED). In comparison, application of furosemide (10(-4) mol/l), the action of which is restricted to the water-impermeable thick ascending limb of Henle's loop (TALH) and the macula densa, similarly increased [Na+]ED and [K+]ED, but did not affect V(ED). The effect of AZ on loop of Henle reabsorption appeared to be predominantly localized upstream to the TALH since (1) AZ significantly inhibited net fluid reabsorption (the latter being completely abolished at 3x10(-4) mol/l), (2) the effect of AZ on [Na+]ED and [K+]ED could be mimicked by perfusing the Henle's loop at a flow rate that caused a comparable increase in V(ED) (reflecting a comparable load to TALH), and (3) the effects of AZ and furosemide were additive. In spite of the increase in [Na+]ED and [K+]ED, intratubular application of AZ caused a concentration-dependent inhibition of TGF response, the latter being assessed as the fall in early proximal tubular stop flow pressure during perfusion of Henle's loop at increasing flow rate. Like AZ and furosemide, the NO donor sodium nitroprusside (10(-4) mol/l) blunted the TGF response, but in contrast to furosemide or AZ, it caused a minor decrease in V(ED), without changing [Na+]ED or [K+]ED. The inhibitory effect of AZ on TGF was abolished by the NO scavenger carboxy PTIO. In summary, AZ inhibits both reabsorption in the water-permeable segment of Henle's loop and the TGF response. The effect on reabsorption may be linked to metabolic inhibition rather than NO release, whereas the blunted TGF response appears to involve conversion to NO.     

A study of topical and systemic prostaglandin E1 and survival of experimental skin flaps

A study has been undertaken to investigate Prostaglandin E1 administration procedure for improving flap survival. Whether the drug was administered continuously or transcutaneously using a silicone gel drug delivery system; or was topically injected into the critical zone of the flap; or was intraperitoneally administered intermittently over an hour after surgery a statistically significant improvement of flap survival occurred (P < 0.01, Student's t-test). However, no improvement of flap survival was seen when the drug was administered only once intraperitoneally immediately after flap elevation, although administered doses of the drug in those rats was equal to the doses in the rats which received intermittent administration of the drug intraperitoneally over an hour after surgery.