Oral prophylaxis and its effects on halitosis-associated and inflammatory parameters in patients with chronic periodontitis.

OBJECTIVE: A controlled clinical trial was conducted to evaluate the effects of oral prophylaxis on halitosis-associated, immunological and microbiological parameters. METHODS: Thirty subjects were included in this controlled clinical trial (patients with generalized chronic periodontitis and controls without clinical attachment loss; each n = 15). Before oral prophylaxis and 14 days after (including tongue cleaning) volatile sulphur compounds (VSC), organoleptic scores and a tongue coating index were evaluated. The levels of IL-1ß, IL-8, IL-10 and MMP-8 were measured in GCF, and also major periodontal pathogens were detected. Data were statistically analysed using anova and paired t-test. RESULTS: Supragingival plaque and calculus removal with combined tongue cleaning was able to reduce significantly (P < 0.05) the VSC values in both groups (no significant differences between both groups). Two weeks after periodontal debridement, the VSC values were observed in the periodontitis group, but not in the control group, similar to the baseline values. The difference between the groups was statistically significant (P < 0.05). Only a repeated prophylaxis session in the periodontitis group was able to reduce VSC values significantly in comparison with baseline (P < 0.05). Organoleptic scores (10 and 30 cm) were significantly different (P < 0.05) between both groups before and after the treatment. Periodontal pathogens and host-derived markers were not significantly affected by a single prophylaxis session. CONCLUSIONS: Oral prophylaxis may result in a significant decrease in VSC values. However, in periodontal diseases, a more complex treatment seems to be necessary.

A norovirus outbreak triggered by copper intoxication on a coach trip from the Netherlands to Germany, April 2010.

We report an unusual outbreak of norovirus infection on a coach trip. Overall, 30 of 40 people (including drivers and crew) developed nausea, vomiting and/or diarrhoea, 11 of them on the first day of the trip. The incidence epidemic curve showed a first peak on Day 1 and a second on Day 4. Nine passengers were hospitalised with gastrointestinal symptoms. Norovirus was found in stool samples from two patients, but the infection could not explain the first peak in the epidemic curve only a few hours after departure. Interviews with the passengers and an inspection of the coach and its water supply implicated the water used for coffee and tea as the potential source. Microbiological investigations of the water were negative, but chemical analysis showed a toxic concentration of copper. Blood copper levels as well as renal and liver function were determined in 28 of the 32 passengers who had been exposed to the water. One passenger who did not have gastrointestinal symptoms had an elevated copper level of 25.9 µmol/L, without loss of liver or renal function. It is likely that the spread of norovirus was enhanced because of vomiting of one of the passengers due to copper intoxication.

[The economic challenges of polytrauma care]. / Wirtschaftliche Herausforderungen der Polytraumaversorgung.

Following the introduction of DRGs ("diagnosis-related groups") in Germany, reimbursements changed from a per diem rate to a flat charge per patient. DRGs are defined by the German Institute for the Hospital Remuneration System (InEK, Institut für das Entgeltsystem im Krankenhaus) along with the respective reimbursement. The revenues are set according to the diagnoses and procedures. In complex cases like serious injury this applies for the average diagnoses and procedures. As a result, several groups reported costs of polytrauma care as high as 70,000 euro with losses as high as 20,000 euro. In the USA, a similar constellation has lead to the closure of trauma centers. The main reasons for the financial deficit are heterogeneity of polytrauma patients and contingency costs. Both are difficult to transfer to a case-based compensation system. Since the German DRG system was designed to learn during introduction, there were adjustments to reimbursements for polytrauma care in the initial phase. However, in recent years, no further improvements in the care of severely injured patients have been seen. The deficit per seriously injured patient currently runs at approx. 5000 euro. A renewed joint effort is required in order to avoid an economy-related reduction in quality of care.

Sliding multislice MRI for abdominal staging of rectal gastrointestinal stromal tumours.

Anorectal gastrointestinal stromal tumours (GISTs) are uncommon mesenchymal neoplasms. The objective of this report was to demonstrate the value of sliding multislice (SMS) as an upcoming method of continuously moving table MRI, providing detailed abdominal staging of rectal GISTs. Integration of SMS into a high-resolution pelvic MR imaging protocol allows for both detailed assessment of rectal GISTs and depiction of the entire abdomen with high image quality. The staging of liver, malignant lymph nodes and bone metastases is now possible, prolonging pelvic MRI for only one minute.

Lovastatin induces apoptosis in a primitive neuroectodermal tumor cell line in association with RB down-regulation and loss of the G1 checkpoint.

To develop a new approach to the treatment of primitive neuroectodermal tumors we evaluated the effect of the HMG-CoA reductase inhibitor lovastatin on the Ewing's sarcoma cell line CHP-100. Lovastatin induced neural morphology and markers including neuron-specific enolase and neurofilament protein. The acquisition of neural morphology required new mRNA synthesis, and cDNA microarray analysis confirmed that lovastatin altered the program of gene expression. After morphologic differentiation the cells underwent rapidly progressive apoptosis. In normal development of neuronal progenitors, differentiation signals trigger p21WAF1 accumulation, RB hypophosphorylation, enhanced RB-E2F-1 association, and G1 arrest, and these events have been shown to protect from apoptosis. In contrast, in the Ewing's sarcoma cells lovastatin triggered differentiation without causing cell cycle arrest: p21WAF1 was not induced, RB remained hyperphosphorylated, and RB protein expression and RB-E2F-1 association were markedly downregulated, suggesting that loss of an RB-regulated G1 checkpoint promoted apoptosis. Consistent with this hypothesis, adenoviral p21WAF1 decreased DNA synthesis and partially protected from lovastatin-induced cytotoxicity. The data demonstrate a new model for examining the genetic regulation of cell fate in a neural progenitor tumor and suggest a new approach to the treatment of this neoplasm.

Are Eskimos more or less obese than other Canadians? A comparison of skinfold thickness and ponderal index of Canadian Eskimos.

Skinfold thickness, height, and weight measurements were recorded from 1964 through 1970 for more than 1,000 adult Eskimos who resided in the Central and Eastern Canadian Arctic. Among the men and women of all age groups, 70 to 83% had a low ponderal index (PI less than 12.5). Nutrition Canada reported similar rates in 200 adult Eskimos and therefore considered Eskimos, especially Eskimo men, as more obese than other Canadians. Thin skinfolds were found in most Eskimo men, including those with a low PI. The usefulness of the PI or other height/weight indices for appraisal of body fatness and prevalence of obesity in different population groups is questioned. Marked sex differences were found in the ratio of the skinfold thickness over the triceps to the mean thickness of two sites on the trunk (subscapular and suprailiac). Thus, use of the arm plus trunk sites provides important information about subcutaneous fat distribution, and comparisons of prevalence of obesity in different sex and age groups based only on arm skinfold measurements may be inappropriate.

Twenty-four hour urinary excretion of vitamins, minerals and nitrogen by Eskimos.

In 1971-1972, urines were collected over 24 hours from ambulatory Iglooligmiut who ranged in age from 6 to 76 years. Collections were made every 3-4 months over a calendar year. The mean of each individual's two to four collections was used as the best estimate of that person's average daily excretion for nitrogen, thiamin, riboflavin, N'-methylnicotinamide, calcium, phosphorus, and magnesium. The excretion of the three B vitamins by all age groups was high when compared with interpretive standards. Urea nitrogen comprised 80-90% of total nitrogen excreted by all age groups. Twenty-four-hour mineral excretions did not differ with age and sex group except that adult men excreted significantly more phosphorus. Urinary urea nitrogen and phosphorus were linearly related, suggesting that they have a common source; namely, meat. Winter was generally the season of lowest excretion of the nutrients assayed. Since these nutrients are available from imported foods, particularly during the winter, it would appear that even in the winter the Iglooligmiut are more dependent on hunting and fishing for sources of these nutrients than on the well-stocked commercial grocery outlets.

Necrotizing tracheobronchitis with progressive airflow obstruction associated with paraneoplastic pemphigus.

Paraneoplastic pemphigus (PNP) is an autoimmune disease associated with leukemia and non-Hodgkin's lymphoma. A patient with stage IVB poorly differentiated lymphocytic lymphoma developed characteristic upper and lower airway involvement with profound mucocutaneous erosion and tracheobronchial epithelial desquamation. Immunofluorescence testing confirmed autoantibody deposition along the basement membrane of bronchial epithelium. Disruption of the cellular adhesion mechanisms, including desmosomes, hemidesmosomes, and possibly the integrin subunits, is presumed to have led to disruption and desquamation of the tracheobronchial epithelial barrier, severe obstruction of the airways and hypoxia, and possibly bacterial superinfection. As far as can be determined, the feature of airflow obstruction occurring in association with PNP has not been described. Physicians should be aware that these complications of PNP may rapidly lead to hypoxic respiratory failure and death.

Effects of salmeterol on muscarinic inhibition of adenylyl cyclase in bovine trachealis cells.

The goal was to assess whether salmeterol, a potent and long-acting beta-2-adrenergic agonist used in the treatment of asthma, also has non-beta-2-adrenergic effects on the stimulation or inhibition of adenylyl cyclase activity. Salmeterol (100 nM) maximally stimulated cAMP accumulation in enzyme dispersed bovine trachealis cells and this was entirely inhibited by propranolol, as expected for beta-adrenergic stimulation. However, the same concentration of salmeterol also antagonized carbachol inhibition of cAMP accumulation and altered binding of carbachol to muscarinic receptors. These effects of salmeterol were sensitive to washing of the cells and this was not consistent with a beta-2-adrenergic mechanism. The findings suggested that the maximal, beta-2-adrenergic stimulation of cAMP accumulation by salmeterol was accompanied by a non-beta-2-adrenergic interaction of salmeterol with muscarinic receptors that attenuated muscarinic inhibition of adenylyl cyclase.

Nutrient levels of some foods of Eskimos from Artic Bay, N. W.T., Canada.

Native food samples of caribou, seal, and arctic char were collected from resident Eskimos in Arctic Bay, N.W. T., and analyzed for nutrients. Caribou and seal meats were similar in protein and fat content in comparison with beef. Arctic char was above the average in protein and fat content for fish. Ascorbic acid was present in significant amounts only in baby seal liver. Thiamin, riboflavin, vitamin B12, folacin, and pantothenic acid content ranged from average to high for seal and carbiou meat, respectively, in comparison to published values for pork and beef. The vitamin B6 content of caribou meat was comparable to average values reported for pork and beef but was lower in seal meat. Baby seal liver contained similar levels of thiamin, riboflavin, vitamin B12, folacin, and pantothenic acid and less vitamin B6 than those reported for pork, beef, calf, and lamb liver. Arctic char was not appreciably different in these vitamins from other fish. The iron content of the Eskimo foods was higher than the meat group of the mixed Canadian diet. The macro mineral nutrients in these foods were comparable to those in beef and fish. The amino acid composition of caribou and seal meat was similar to beef, except that seal meat had a lower content of sulfur-containing amino acids and a much higher content of histidine. The sample of seal and arctic char were relatively high in concentrations of long-chain unsaturated fatty acids.

CT-guided radiofrequency ablation of a bronchogenic carcinoma.

We report on the successful use of percutaneous CT-guided radiofrequency ablation (RFA) of a peripheral bronchogenic carcinoma in a 73-year-old patient. RFA was the favoured treatment option in this patient, who owing to comorbid factors was not a candidate for surgery. A 15 G LeVeen Needle Electrode (RadioTherapeutics, Sunnyvale, USA) with an array diameter of 3.0 cm was connected to a 200 Watt Generator (RF 3000, RadioTherapeutics, Sunnyvale, USA) and inserted into a 3.5 cm squamous cell carcinoma of the axillary subsegment of the right upper lobe. RFA resulted in complete tumour necrosis confirmed by histopathological examination. No complications such as a pneumothorax or bleeding occurred. Further clinical experience and prospective studies are necessary to determine the long-term efficacy of RFA in the treatment of lung tumours.

Background suppression using magnetization preparation for contrast-enhanced 3D MR angiography of the pelvic and lower leg arteries.

PURPOSE: To develop and evaluate non-slab-selective magnetization preparation in contrast-enhanced 3D-MR angiography. METHODS: An ultrafast spoiled mr angiography sequence (FLASH) with non-selective inversion prepulses for background suppression was implemented on a 1.5 T MR system. In 11 patients gadobenate dimeglumine-enhanced mr-angiography of the pelvic and lower leg arteries was performed using the AngioSURF device. Source data was evaluated for contrast-to-noise-ratio, image quality and the extent of background suppression. RESULTS: Background suppression and selective vessel contrast was excellent in all vascular levels. The mr protocol was comfortable and easy-to-handle. Abandonment of precontrast-series acquisition simplified the examination procedure markedly. CONCLUSIONS: Magnetization preparation provides efficient suppression of the background signal in contrast-enhanced 3D mr angiography of the pelvic and lower leg arteries. Since no subtraction technique is needed, moving-bed and whole body MRA-protocols can be simplified significantly.

Cyclosporine monitoring in liver allograft recipients: two distinct patterns of blood level derangement associated with nephrotoxicity.

The parallel measurement of specific and nonspecific CyA levels by second generation radioimmunoassays based on monoclonal antibodies proved to be an effective procedure to monitor both parent CyA levels and the capacity to eliminate its metabolite. Using this monitoring procedure it could be shown that CyA-associated nephrotoxicity in the early course after liver transplantation is associated with two distinct patterns of blood level derangement. One pattern is characterized by increased parent drug levels, the other by an increased metabolite concentration resulting from severely disturbed CyA metabolite excretion. This raises the possibility that not only the parent drug but also some of its metabolites may exert nephrotoxic effects when present in excessively high concentrations. This finding provided the rationale for a therapeutic CyA-monitoring regimen taking into account both specific and nonspecific measurements. In liver transplant patients monitored according to this regimen and treated with quadruple immunosuppression the incidence and severity of CyA-associated nephrotoxicity was markedly reduced. The metabolite-associated type of nephrotoxicity was only found in patients with severely disturbed liver function.

[Injuries sustained in dinghy-sailing by beginners: an analysis]. / Verletzungen beim Jollensegeln--Eine Analyse im Anfängerbereich.

In the sailing season of 1998 536 students have been assigned to a study investigating injuries that happened during beginners courses of dinghy-sailing. They were advised to document all injuries even minor ones and their circumstances while being on the boat. Injuries of the upper extremities were found in 39.5%, the head was affected in 32.4%, the lower extremities was injured in 26.5% and 1.6% had injuries of neck and/or trunk. Various types of injuries were observed: contusions in 55.1%, graze of skin in 17.2%, cuts and tears in 14.3%, bruises in 6.3%, tender spots, blisters and callus in 4.6%, lacerations in 1.7%, pulled muscles in 0.4% and fractures were seen in 0.4%. Typical situations in which injuries occurred were the collision with the main boom (31.1%), the rigging up and down (13%), capsizing (10.50%), docking and casting off (9.7%), the handling of the sheets (9.2%), the conditions in the harbour (8.8%) and slipping while onboard (6.8%). It becomes apparent that contusions and gazes of the head are caused by the standing rigging in contrast to skin-graze, lacerations, cuts and bruises which are rather caused by the running rigging. There is a higher risk of injuries for the helmsman than for the foredeckhand. However the incidence is evenly distributed among the sexes. Moreover there are significant differences in the accident rate concerning the direction and the strength of wind. Stronger and onshore winds make the sailor more accident-prone.