Treatment of ibuprofen intoxication with charcoal haemoperfusion in two dogs.

Case history: Two dogs presented separately to the Small Animal Hospital, University of Florida (Gainsville, FL, USA) for ingestion of ibuprofen. The first dog ingested 561.8 mg/kg ibuprofen in addition to paracetamol and caffeine and vomited prior to admission. This patient also received fluid therapy for 8 hours prior to charcoal haemoperfusion. The second dog ingested 500 mg/kg of ibuprofen and the owners induced vomiting with hydrogen peroxide prior to presentation. Due to the severity of clinical signs, both patients were treated with charcoal haemoperfusion.Clinical findings: The concentrations of ibuprofen in the blood of the dogs prior to treatment were 478 and 301 mg/L. During the treatment ibuprofen concentrations were reduced by 95.8% and 45.5%, respectively, with no treatment side effects and minimal clinical signs after treatment.Diagnosis: Toxicity due to ingestion of ibuprofen toxicity that was successfully treated with charcoal haemoperfusion.Clinical relevance: In the cases described here minimal benefit was seen after 3 hours of treatment using one haemoperfusion cartridge. This is in contrast to a previously published report in which dogs were treated for 6 hours with two charcoal haemoperfusion cartridges. This suggests that one cartridge may be sufficient. The amount of ibuprofen ingested was not a reliable predictor of the concentration in blood at the initiation of treatment. Charcoal haemoperfusion is an effective means of reducing plasma concentrations of ibuprofen, however, its use may be limited by its cost and availability.

Liver and blood postmortem tricyclic antidepressant concentrations.

Tricyclic antidepressants (TCAs) are one of the major causes of death from drug ingestions. Because TCAs are highly tissue bound, it has been postulated that postmortem tissue release would give rise to elevated blood levels. This study examines the authors' experience with TCAs as a cause of death and the reliability of postmortem liver and blood levels. Postmortem liver and blood TCA levels (parent drug and active metabolite) were quantitated by high-pressure liquid chromatography (HPLC) and gas chromatography mass spectrometry (GC-MS). From 1977 through 1985 the number and percentage of deaths caused by TCA overdoses have remained constant in regard to the total number of deaths caused by poisonings and overdoses: range: 4-17; 5.6-20.2%, respectively. During a six-month period in 1986-1987, nine deaths were caused by six different TCAs. Substantial increases in blood TCA levels were observed as the postmortem interval increased. The mean liver and blood levels were as follows: 232 micrograms/g of tissue (SD, 168) and 6.2 mg/L (SD, 2.4). The liver to blood ratio for the nine cases was 37 (SD, 22):1. In comparison, in cases (n = 4) in which the causes of death were not TCA related but the patients were taking therapeutic doses of TCA, the mean liver and blood levels were 10.8 micrograms/g (SD, 6.0) and 0.26 mg/L (SD, 0.06), respectively. The liver to blood ratio of 39.2 (SD, 17.9): 1 was not different than in the overdose cases. This large tissue to blood gradient in both TCA overdose and therapeutic ingestion cases indicates that postmortem release of tissue-bound TCAs into the blood might falsely show elevated postmortem blood levels that could be indicative of a manner of death even in the nonoverdose, therapeutic ingestion. Thus, only liver TCA levels should be quantitated to specify the manner of death.

Measuring and interpreting increases in probing depth and attachment loss.

Increases in probing depth and attachment level measurements are used by clinicians and clinical scientists for assessing the periodontal status and/or change in status of patients. Interpretation of these measurements has implications with respect to our understanding of periodontal disease, treatment of patients and the implementation of clinical investigations. Measurements of probing depths and attachment loss were made on 204 teeth in 34 patients. The measurements were repeated after short periods of time by different examiners as well as the same examiners. Using these data, sensitivities and specificities of several potential diagnostic thresholds were calculated. It is concluded that observing an increase of probing depth greater than 1 mm serves as a diagnostic test with high sensitivity and specificity.

Microbial interpretation of plaque relative to the diagnosis and treatment of periodontal disease.

It has been suggested that monitoring microbial forms in plaque with the microscope may prove useful to the clinician in assessing periodontal status. In this regard, the microbial interpretation of plaque relative to the diagnosis and treatment of periodontal disease has recently received considerable attention. However, questions remain to be answered before the microscope is accepted for routine use in the diagnosis and treatment of periodontal disease. This report addresses a number of these questions surrounding the use of the microscope in evaluating plaque and its role in the diagnosis and treatment of periodontal disease.

Relative error (variability) associated with an improved instrument for measuring gingival crevicular fluid.

This investigation was undertaken to compare the variability in a new Periotron model 6000 to the variability in the previous Periotron model 600 and to the variability of the ninhydrin area method (NAM) for measuring quantities of fluid collected on filter paper strips. A Hamilton microliter syringe was used to deliver normal human serum to filter paper strips. Strips receiving varying quantities were randomly and blindly assigned to Periotron models 6000 and 600 until 10 strips containing each of 0.15, 0.30, 0.45, 0.60, 0.75, 0.90 and 1.05 microliter had been read using model 6000 and 10 strips containing each of 0.15, 0.30 and 0.45 microliter had been read using model 600. All strips were subsequently read using the NAM. The entire procedure was repeated using distilled water containing 0.1% methyl green. Coefficients of variation (CV) were computed for all sets of data. In all cases the CVs for the Periotron 6000 were significantly smaller than those for the Periotron 600 or the NAM. Pooled estimates of CVs (0.15-0.45 microliter) for the Periotron models 6000 and 600 were 0.054 and 0.116, respectively, (P less than or equal to 0.005) with serum and 0.059 and 0.095, respectively, (P less than or equal to 0.05) with distilled water containing 0.1% methyl green. Pooled estimates of CVs (0.15-1.05 microliter) for the Periotron model 6000 and the same strips subsequently measured with the NAM were 0.046 and 0.069, respectively, (P less than or equal to 0.005) with serum and 0.055 and 0.076, respectively, (P less than or equal to 0.001) with distilled water containing 0.1% methyl green.(ABSTRACT TRUNCATED AT 250 WORDS)

Porous hydroxyapatite grafts in chronic subcrestal periodontal defects in rhesus monkeys: a histological investigation.

The purpose of this investigation was to evaluate the histologic response to replamineform (porous) hydroxyapatite grafts in chronically inflamed, surgically created, periodontal pockets in Rhesus monkeys. Forty-eight subcrestal defects were surgically created in 8 Rhesus monkeys. Orthodontic wires were adapted to the base of the defects and left in place for 8 weeks. The defects were randomly assigned a treatment modality so that 8 granular porous and 8 block porous hydroxyapatite grafts were done. Eight sites were left as unoperated controls. Twenty-four contralateral sham-operated sites were treated by open curettage. Histometric measurements of the length of regenerated connective tissue attachment were recorded. Block hydroxyapatite, granular hydroxyapatite, and sham-operated sites exhibited similar amounts of regenerated connective tissue attachment, which was significantly greater than that which occurred in unoperated controls. Newly formed bone was observed within the porous channels of the hydroxyapatite grafts as well as in direct apposition on the surface of implant particles. New bone, cementum, and periodontal ligament was observed in grafted sites and in defects treated by open curettage. In some instances healing occurred by means of a long junctional epithelium. Histology confirmed that unoperated defects remained as unhealed, inflamed periodontal pockets. The results of this study suggest that porous hydroxyapatite grafts have the potential to regenerate the attachment apparatus in primates.

Salt and peroxide compared with conventional oral hygiene. III. Patient compliance and acceptance.

This study was undertaken to evaluate patient compliance with, and acceptance of, a salt and peroxide oral hygiene regimen compared with conventional oral hygiene regimens without or with the use of phase-contrast microscope viewing of subgingival plaque over a period of 2 years. A total of 231 subjects with early to moderate periodontitis were randomly divided into four groups. All groups were repeatedly instructed and motivated in their respective regimens. Subjects also received scaling and root planing using clinical and microbial criteria. Compliance with, and acceptance of, the two oral hygiene regimens were determined at the end of the study using a structured self-administered questionnaire. Results indicated that 74% and 58% (P less than or equal to 0.01) of subjects in the conventional and salt/peroxide groups, respectively, used their assigned regimen 4 to 7 days a week during the entire study. More than half of the subjects (54%) using each of the oral hygiene regimens indicated that they flossed once daily. Inconvenience was cited by 23% of the conventional and 43% of the salt/peroxide groups (P less than or equal to 0.01) as the main reason for not using their regimens. Twenty-three per cent of conventional group and 14% of salt/peroxide group indicated that shared their oral hygiene supplies with others. Eighty per cent and 57% (P less than or equal to 0.01) of the conventional and salt/peroxide groups, respectively, stated that they liked their regimens. Ninety-six per cent of all subjects felt that their regimen helped their periodontal status.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of scaling and root planing on subgingival microbial proportions standardized in terms of their naturally occurring distribution.

This investigation included a cross-sectional component (284, 20-40-year-old subjects/568 sites) and a longitudinal component (19 subjects with moderate to advanced periodontitis/76 sites). Subgingival plaque samples and clinical data were obtained from all upper second bicuspids and first molars in the longitudinal subjects and from both upper first molars in the cross-sectional subjects. The purpose was to: determine/confirm changes in proportions of selected subgingival microorganisms following root planning combined with conventional oral hygiene procedures in the longitudinal subjects, evaluate those changes in terms of an estimate of the naturally occurring distribution of subgingival microorganisms based on data obtained from the cross-sectional subjects and relate shifts in the subgingival microorganisms to changes in clinical measurements. Changes following treatment at sites with pre-instrumentation probing depths greater than or equal to 4.5 mm included cocci, 18.3 to 46.9%; spirochetes, 20.9 to 3.1%; total motile organisms, 28.5 to 5.9%; Fusobacterium spp., 10.2 to 2.2%; and dark-pigmented Bacteroides spp., 14.0 to 9.7%. Translating proportions of microorganisms in samples from subjects in the longitudinal treatment study to equivalent percentile ranks within the large cross-sectional data base demonstrated that at probing depths greater than or equal to 4.5 mm cocci moved from below the 50th percentile in our estimate of the naturally occurring distribution of subgingival microorganisms to above, and spirochetes, total motile organisms and Fusobacterium spp. moved from above the 50th percentile to below. The microbiological findings were consistent with statistically significant improvements in clinical measurements. Statistically significant changes also occurred in microorganisms at sites with initial probing depths less than 4.5 mm.

Salt and peroxide compared with conventional oral hygiene. I. Clinical results.

The purposes of this 2-year longitudinal study were to: compare the clinical effectiveness of patient applied sodium bicarbonate, hydrogen peroxide, and sodium chloride (S/P) to the use of conventional oral hygiene methods and to investigate the motivational effect of using phase-contrast microscopy in teaching effective oral hygiene. Initially, 972 subjects were screened for signs of periodontitis. From these, 347 with early to moderate periodontitis were selected and each was randomly assigned to one of four home treatment regimens after scaling and root planing. The four treatment regimens included: conventional oral hygiene procedures, conventional oral hygiene procedures plus phase-contrast demonstration of subgingival microbial forms for oral hygiene motivation, S/P oral hygiene, and S/P oral hygiene plus phase-contrast demonstration of subgingival microbial forms for oral hygiene motivation. Plaque, bleeding, gingival inflammation, probing depth, and clinical attachment level were recorded at baseline, 8, 16, and 24 months. Subjects were recalled for reinforcement of oral hygiene and periodontal prophylaxis at various intervals. Data were analyzed based on disease severity, location of index sites and compliance. The results indicated that both conventional oral hygiene procedures and the S/P regimen were effective in reducing clinical signs of disease when combined with professional care. There were no differences between the two regimens in clinical effectiveness and trends favoring microscopic viewing of subgingival plaque for motivational purposes were not statistically significant.

Salt and peroxide compared with conventional oral hygiene. II. Microbial results.

This study was designed to investigate the effect of conventional oral hygiene (n = 116 subjects) versus a salt and peroxide oral hygiene regimen (n = 115 subjects) on subgingival microorganisms. Subgingival plaque for microscopic evaluation was obtained from eight index tooth sites in each of 231 adult subjects. Microbial forms were microscopically identified at baseline, 8, 16, and 24 months. For both oral hygiene groups, cocci were increased (P less than 0.05) and motile rods were decreased (P less than 0.05) at 8 months and returned to baseline by 16 months. Spirochetes were decreased (P less than 0.05) and remained low through 24 months in both oral hygiene groups. The frequency of agreement between clinical (bleeding) and microbial (greater than or equal to 15% spirochetes or motile rods or greater than or equal to 20% spirochetes + motile rods) criteria for instrumentation was 59.8%. It was also found that fewer total instrumentations for test subjects were observed when microbiological criteria were used as compared with clinical criteria. The greater number of instrumentations based on clinical criteria was highly significant (P less than or equal to 0.001). A significant change in microbial signs associated with peridontal disease may be obtained with either a conventional oral hygiene or a salt and peroxide oral hygiene home care regimen.

Multi-center comparative evaluation of subgingivally delivered sanguinarine and doxycycline in the treatment of periodontitis. I. Study design, procedures, and management.

The design and conduct of a 9-month multi-center clinical trial to evaluate the safety and efficacy of subgingivally delivered 5% sanguinarium chloride (SC) and 10% doxycycline hyclate (DH) from a biodegradable drug delivery system in the treatment of adult periodontitis is described. The 3-group randomized study of 180 adults with moderate to severe periodontitis was a modified double-blind parallel design. One group received DH, one group received SC, and the other group received the vehicle control (VC). Patients selected had two quadrants with a minimum of four periodontal pockets > or = 5 mm in depth with two sites > or = 7 mm. All qualifying sites exhibited bleeding on gentle probing. Qualifying sites were treated at baseline and again at 4 months. Clinical response was assessed by measuring attachment level, probing depth, and bleeding on probing at monthly examinations at qualifying sites and the entire dentition. The plaque index was measured monthly to verify oral hygiene status. The parallel design afforded the opportunity to distinguish between treatment effectiveness of SC, DH, and VC independent of possible crossover effects. Also the effectiveness of oral hygiene in untreated sites of the mouth could be evaluated. Finally, treatment effects in moderate (5 to 6 mm) and deep (> or = 7 mm) pockets in both treated and untreated sites could be compared. The design was capable of simulating a periodontal practice maintenance program and assessing the response according to maintenance and treatment history. Study management procedures that emphasized center examiner and therapist training and adherence to protocol and procedures to reduce variability are described.

Multi-center comparative evaluation of subgingivally delivered sanguinarine and doxycycline in the treatment of periodontitis. II. Clinical results.

The clinical safety and effectiveness of a subgingivally delivered biodegradable drug delivery system containing either 10% doxycycline hyclate (DH), 5% sanguinarium chloride (SC) or no agent (VC) was evaluated in a 9-month multi-center trial. The study was a randomized parallel design with 180 patients who demonstrated moderate to severe periodontitis. All patients had at least two quadrants with a minimum of four qualifying pockets > or = 5 mm that bled on probing. Two of the qualifying pockets were required to be > or = 7 mm. At baseline and at 4 months all qualified sites were treated with the test article administered via syringe. Probing depth reduction (PDR), attachment level gain (ALG), bleeding on probing reduction (BOP), and plaque index were determined monthly. Analysis of efficacy data from the 173 efficacy-evaluable patients indicated that all treatments gave significant positive clinical changes from baseline at all subsequent timepoints. DH was superior to SC and VC in PDR at all timepoints (P < or = 0.01 to 0.001) with a maximum reduction of 2.0 mm at 5 months. For ALG, DH was superior to VC at months 2, 3, 4, 5, 6, 8, and 9 (P < or = 0.04 to 0.002) and superior to SC at months 5, 6, 7, 8, and 9 (P < or = 0.01 to 0.001) with a maximum ALG of 1.2 mm at 6 months. For BOP reduction, DH was superior to VC at all time points (P < or = 0.05) and to SC at months 3, 5, 6, 8, and 9 (P < or = 0.03). For DH, the maximum ALG in deep (> or = 7 mm) pockets was 1.7 mm and PDR 2.9 mm compared to 0.8 mm and 1.6 mm, respectively for moderate (5 to 6 mm) pockets. Test articles were applied without anesthesia and no serious adverse events occurred in the trial. The results of this study indicate that 10% doxycycline hyclate delivered in a biodegradable delivery system is an effective means of reducing the clinical signs of adult periodontitis and exhibits a benign safety profile.

Two multi-center studies evaluating locally delivered doxycycline hyclate, placebo control, oral hygiene, and scaling and root planing in the treatment of periodontitis.

BACKGROUND: The clinical efficacy and safety of doxycycline hyclate (8.5% w/w) delivered subgingivally in a biodegradable polymer (DH) was compared to placebo control (VC), oral hygiene (OH), and scaling and root planing (SRP) in 2 multi-center studies. METHODS: Each study entered 411 patients who demonstrated moderate to severe periodontitis. Patients had 2 or more quadrants each with a minimum of 4 qualifying pockets > or =5 mm that bled on probing. At least 2 of the pockets were > or =7 mm. Treatment with DH, VC, OH, or SRP was provided at baseline and again at month 4. Clinical parameters were recorded monthly. RESULTS: DH and SRP resulted in nearly identical clinical changes over time in both studies. Mean 9 month clinical attachment level gain (ALG) was 0.8 mm for the DH group and 0.7 mm for the SRP group in Study 1, and 0.8 mm (DH) and 0.9 mm (SRP) in Study 2. Mean probing depth (PD) reduction was 1.1 mm for the DH group and 0.9 mm for the SRP group in Study 1 and 1.3 mm for both groups in Study 2. Frequency distributions showed an ALG > or =2 mm in 29% of DH sites versus 27% of SRP sites in Study 1 and 31% of DH sites versus 34% of SRP sites in Study 2. PD reductions > or =2 mm were seen in 32% of DH sites versus 31% of SRP sites in Study 1 and 41% of DH sites versus 43% of SRP sites in Study 2. Comparisons between DH, VC, and OH treatment groups showed DH treatment to be statistically superior to VC and OH. Safety data demonstrated a benign safety profile with use of the DH product. CONCLUSIONS: Results of this trial demonstrate that treatment of periodontitis with subgingivally delivered doxycycline in a biodegradable polymer is equally effective as scaling and root planing and superior in effect to placebo control and oral hygiene in reducing the clinical signs of adult periodontitis over a 9-month period. This represents positive changes resulting from the use of subgingivally applied doxycycline as scaling and root planing was not limited regarding time of the procedure or use of local anesthesia.

A descriptive survey of signs and symptoms associated with the myofascial pain-dysfunction syndrome.

The signs and symptoms of 56 patients with myofascial pain-dysfunction syndrome were tabulated. Patients were classified by age, sex, education and professional background, frequency of complaints of pain, occlusal relationships, oral habits, and specific muscles that were tender on palpation. A coincidence of stress and tension and the onset of myofascial pain was observed. It is suggested that myofascial pain may be more common in women than in men. Muscle tenderness was associated particularly with the masseter, temporal, and lateral and medial pterygoid muscles.

Effect of toothbrushing with 0.4% stannous fluoride and 0.22% sodium fluoride gel on gingivitis for 18 months.

This study determined the effect of brushing with 0.4% stannous fluoride (SnF2) or 0.22% sodium fluoride (NaF) on clinical and microbial parameters associated with gingivitis. The study included three groups of 281 subjects. Subjects in all three groups were instructed to brush twice daily with an ADA-accepted fluoride dentifrice, rinse their mouths with water, and subsequently brush with 0.4% SnF2, 0.22% NaF, or a fluoridefree placebo gel. More stain was detected in the SnF2 group than in the other two groups at all periods except at baseline. However, no differences were observed in gingivitis, bleeding, or mean proportions of microbial forms in the SnF2 or NaF groups when compared with the placebo group at 18 months. Results indicate that 0.4% SnF2, or 0.22% NaF is no more effective than a placebo in reducing gingivitis.

Four-year investigation of salt and peroxide regimen compared with conventional oral hygiene.

This study of 171 subjects compared the effectiveness of a patient-applied salt and peroxide oral hygiene regimen with the use of conventional oral hygiene methods on clinical measures of periodontal disease, and determined patient compliance with and acceptance of using these two oral hygiene regimens. Results indicated that both regimens, when combined with professional care, were effective in changing clinical measures of periodontal disease to a state favoring periodontal health.

Occurrence of myocarditis in sudden death in children.

This study suggests that the prevalence of "silent" myocarditis may be higher in the pediatric population than is generally suspected and may contribute to a significant number of sudden and unexpected deaths in children, particularly those older than one year of age. The incidence of histologic myocarditis in children dying a violent death is similar to that reported as an incidental finding in adults.

The effect of professional and home subgingival irrigation with antimicrobial agents on gingivitis and early periodontitis.

The purpose of this investigation was to study the effect of a professionally applied subgingival antimicrobial agent (stannous fluoride) delivered at periodontal prophylaxis, combined with home personal subgingival delivery of an antimicrobial agent (iodine) on patients with gingivitis and early periodontitis. A control group of 32 individuals was instructed to use dental floss and a sulcular toothbrushing method as a regular oral hygiene regimen. The test group of 42 subjects received professional subgingival irrigation with a 1.64% stannous fluoride solution delivered after scaling. These subjects were also instructed in the home subgingival delivery of an iodine solution along with the use of dental floss and sulcular toothbrushing. Subjects were clinically evaluated at baseline and again after eight weeks. Individuals in the test group, when compared to the control group, had a significantly lower gingival index score at eight weeks. In addition, the test group had significantly lower bleeding and gingival index scores at eight weeks when compared to baseline. Professional subgingival irrigation with stannous fluoride, when combined with home subgingival delivery of an iodine solution, was effective in improving gingival health for patients with gingivitis and early periodontitis.

Two communication lines in a 3 × 3 matrix speller.

In a matrix speller both eye fixation and attention are reflected in the event-related potentials to highlighting of characters. We consider the question of whether this can be used to open up two parallel channels by dissociating the attended character from the fixated one. Complementary classifiers for both characters are established and their relationship is investigated.