Efficacy of sugammadex in rocuronium-induced or antibiotic-induced anaphylaxis. A case-control study.

We report 13 cases of presumed rocuronium-induced anaphylaxis in which sugammadex was administered with the intention of reversing the immunological reaction. Of these 13 cases, eight (62%) were later confirmed to be type-1 hypersensitivity reactions to rocuronium, three (23%) were triggered by an antibiotic and two (15%) were non-immunologically mediated. Response to treatment was scored by the treating anaesthetist, and compared with haemodynamic and inotrope measurements from the resuscitation and anaesthetic records. Haemodynamic improvement was seen in only six (46%) cases, three of which were associated with a non-rocuronium trigger. Of the three cases in which the treating anaesthetist thought that sugammadex had been beneficial, one was not caused by rocuronium, one had no improvement in blood pressure and one required 8.5 times as much adrenaline in boluses after, compared with the period before, sugammadex administration. These data suggest that sugammadex does not modify the clinical course of a suspected hypersensitivity reaction.

Effects of supplementation of the diets with calcium and calcium-rich foods on bone density of elderly females with osteoporosis.

Diets of 20 elderly females with osteoporosis were supplemented daily with 2.25 oz of processed cheese, and 3 capsules of dicalcium phosphate + vitamin D containing 350 mg Ca, 270 mg P, and 399 IU vitamin D, for a 6-month period. The bone density of the 3-2 phalanx was measured densitometrically from the hand x-ray taken with a standard aluminum stepwedge. Fasting blood and urine were analyzed at the beginning and end of the experimental period. The mean bone density increased (p less than 0.05). There were 11 subjects with increased bone density, three with no changes and six with reductions in bone density. Calcium, P, and alkaline phosphatase in serum and Ca/creatinine and P/creatinine in urine were unchanged. The changes in bone density were correlated to the changes in body weight (r = 0.6529). The results suggested that, even with a mean age of 70 yr, some elderly persons can benefit from supplementary Ca and Ca-rich foods to improve bone density.

Analysis of preoperative intracavitary cesium application versus postoperative external beam radiation in stage I endometrial carcinoma.

Two groups of patients with surgical Stage I endometrial carcinoma treated at the LDS Hospital in Salt Lake City are analyzed. Group 1 comprises 112 patients treated from 1974 through 1976, during which time preoperative intracavitary cesium was routinely used in all patients. Group 2 comprises 117 patients treated 1981 through 1983 under the treatment policy of hysterectomy without preoperative cesium. High risk patients from each group (grade 3 and/or deep myometrial invasion) generally received similar postoperative external beam pelvic radiotherapy (4500-5000 cGy). While 5-year actuarial disease-free survival rates were similar in each group (94% Group 1 vs 91% Group 2), multivariate analysis by the Cox Regression Method revealed that inclusion within treatment Group 2 carried independent adverse prognostic significance (p = 0.018). Other independent predictors of adverse 5-year disease-free survival included deep myometrial invasion and increasing histologic grade. Group 1 patients with grade 3 lesions had a superior 5-year actuarial disease-free survival (76% vs 53%) compared to those from Group 2. Group 1 patients with deep myometrial invasion also had a superior 5-year disease-free survival (84% vs 69%). The remaining low risk patients (grade 1 or 2, less than 1/3 myometrial invasion) had an excellent 5-year disease-free survival with or without preoperative cesium. Immediate preoperative intracavitary cesium was well tolerated, did not obscure pathologic findings and in our experience, reduced the probability of recurrence in high risk Stage I endometrial carcinoma patients.

Bromfenac sodium, acetaminophen/oxycodone, ibuprofen, and placebo for relief of postoperative pain.

The objective of this double-masked, parallel-group, multicenter, inpatient study was to compare bromfenac with an acetaminophen/oxycodone combination and ibuprofen in patients who had pain due to abdominal gynecologic surgery. In the 8-hour, single-dose phase, 238 patients received single oral doses of bromfenac (50 or 100 mg), acetaminophen 650 mg/oxycodone 10 mg, ibuprofen 400 mg, or placebo. In the multiple-dose phase, 204 patients received bromfenac, acetaminophen/oxycodone, or ibuprofen for up to 5 days. In the single-dose phase, both bromfenac doses produced peak analgesic responses equivalent to acetaminophen/oxycodone, but the responses to bromfenac were longer lasting. Bromfenac produced significantly better overall (8-hour) analgesic summed scores than acetaminophen/oxycodone. Ibuprofen was less efficacious than the other analgesics. The remedication rate was lower in both bromfenac groups than in the other treatment groups. The acetaminophen/oxycodone group reported more somnolence and vomiting. Single doses of bromfenac provided analgesia at least equivalent to that of the acetaminophen/oxycodone combination, with a longer duration of action. Both doses of bromfenac and acetaminophen/oxycodone were superior to ibuprofen in this study.

Effect of admixed indium on mercury vapor release from dental amalgam.

The purpose of this study was to evaluate the effect of admixed indium on the amount of mercury vapor released from dental amalgam. We made amalgam specimens according to ADA Specification Number 1. We added various amounts (0-14% by weight) of indium to the alloy powder. We also tested the commercial amalgams Dispersalloy, Valiant, and Indiloy. Specimens were held at 37 degrees C and 100% humidity. We used a Jerome Mercury Vapor Analyzer (model 411) to measure the mercury vapor released. We analyzed the data by means of ANOVA and Student-Newman-Keuls procedures. Admixed indium significantly decreased the amount of mercury vapor released from dental amalgams; the period of the greatest effect on mercury vapor released was during the setting phase of amalgam; and dental amalgams with greater than or equal to 8% admixed indium released the least amount of mercury vapor.

Effect of admixed indium on properties of a dispersed-phase high-copper dental amalgam.

A new dental amalgam alloy containing admixed indium is available for clinical use. The purpose of this study was to conduct a full range of laboratory tests on two alloys containing differing amounts of admixed indium and on a similar alloy that did not contain indium. Results showed that less mercury was required to mix the alloys containing indium since admixed indium promotes wetting of the alloy. Back-scattered electron images showed the Ag-Hg matrix to be in good apposition to the Ag-Sn particles and to the Ag-Cu eutectic spheres, and there was no evidence of unreacted indium. The alloys containing admixed indium demonstrated improved resistance to creep and very little dimensional change upon setting. The early compressive strength was low for the alloys containing indium, but compressive strengths were significantly higher than those of the alloy without indium at 24 h and 7 d. Some improvement in resistance to marginal leakage and to corrosion was shown for the alloys containing indium.

Evaluation and control of post-cementation pulpal sensitivity: zinc phosphate and glass ionomer luting cements.

Many studies have documented pulpal sensitivity after crown cementation, but none have determined its cause. By controlling technique variables in a large-scale clinical trial, the authors evaluated the contribution of zinc phosphate and glass ionomer luting cements in causing pulpal sensitivity or necrosis.

Dentin bonding systems: a review of current products and techniques.

Many dentists are facing decisions regarding selection and use of dentin bonding systems. This article presents information on existing products and provides guidance on their use based on laboratory and clinical evidence.

Clinical success of class V composite resin restorations without mechanical retention.

The authors describe a study in which they placed 126 Class V composite resin restorations without mechanical retention, divided into three groups of 42, in 23 patients. They followed the performance of the restorations over a three-year period. For all three groups, restorations were placed using All-Bond 2 dental adhesive and Z100 composite resin; A.R.T. Bond and Brilliant Dentin composite; and Prisma Universal Bond 3 and Variglass VLC polyacid-modified composite resin. The authors evaluated retention as well as color stability, wear resistance, sensitivity, sulcular depth, loss of attachment, bleeding on probing and crevicular fluid flow. Based on their results, the authors propose that restoration of Class V lesions without using mechanical retention could be expected to succeed in seven of 10 restorations over a three-year period using these restorative systems.

Accuracy of elastomeric impressions disinfected by immersion.

This study evaluates the accuracy and surface quality of stone dies made from impressions that had been placed in disinfectants. Results indicated that selection of the type of impression material is more important than selection of the disinfectant. Addition silicone and polysulfide impressions were disinfected without a loss in accuracy, whereas polyether impressions were adversely affected. The surface quality of dies was acceptable with disinfection and one disinfectant contributed to an improvement in surface quality compared with the control.

Sensitivity restored of Class V abrasion/erosion lesions.

The effectiveness of restorative treatment in reducing sensitivity associated with the Class V erosion/abrasion lesion was evaluated and the efficacy of three tooth-colored restorative materials in reducing sensitivity was compared. The 108 lesions were restored with either glass ionomer restorative material, composite resin with a dentin bonding agent, or composite resin with a dentin bonding agent and a glass ionomer liner. Composite resin with glass-ionomer liner restorations significantly reduced sensitivity to air and hot and cold water. Glass ionomer restorations and restorations with composite resin and a dentin bonding agent significantly reduced sensitivity but were also associated with increased sensitivity to air and cold respectively in 20% to 30% of the lesions restored when evaluated at 6 months.

Tensile dislodgment evaluation of two experimental prefabricated post systems.

This study tested the tensile dislodgment forces of two experimental post designs that are threaded 7 mm into the most coronal aspect of the root. Experimental post systems ParaPost XT-7 (XT-7), and ParaPost XT-10 (XT-10) were compared to the Flexi-Post (FP) and to the Standard ParaPost (SP). The XT-7 prototype post measured 7 mm in length, while all other post systems were 10 mm. The XT-7 and the FP are active post systems that are threaded throughout their entire length. The SP is a passive serrated post system, and the XT-10 is a combination active/passive design that has a 7 mm coronal thread with a passive serrated apical end. All systems tested were titanium alloy except the SP system, which was stainless steel. The purpose of this study was to compare an active and a passive post design to the experimental designs of the XT-7 active post and the combined active/passive design of the XT-10. This study clearly demonstrated highest retention for the active post system, least retention for the passive post, with an intermediate retentiveness for the combined design.

Mercury vapor release during insertion and removal of dental amalgam.

During a clinical simulation of insertion and removal of dental amalgams, mercury vapor levels increased slightly, but never exceeded the TLV of 0.05 mg/m3. The addition of indium to dental alloy did not affect the amount of mercury vapor released under these conditions.

Effect of admixed indium on the clinical success of amalgam restorations.

The purpose of this study was to clinically evaluate two formulations of a dispersed-phase, high-copper dental amalgam alloy (Indisperse), which contained admixed indium. One alloy tested contained 5% indium, and the second alloy contained 10% indium. A similar alloy without indium, Dispersalloy, was also placed for comparison. Over the course of the five-year study, there were no differences clinically or statistically regarding texture and luster. The margins of the restorations containing indium incurred slightly less fracture than the non-indium-containing restorations; however, these differences were not clinically significant. It can be concluded that the admixture of 5-10% indium as well as the increased ratio of eutectic spheres to lathe-cut particles found in the indium alloys enhance the clinical performance of amalgam restorations.

The influence of dental alloys on three-body wear of human enamel and dentin in an inlay-like situation.

This in vitro study evaluated the effect of metal alloys on three-body wear resistance of enamel and dentin, and vice versa. Three-body wear of human enamel, dentin, a soft gold alloy (BiOcclus Inlay), a CoCr alloy (Remanium 2000), a resin cement (Variolink II) and a zinc oxide phosphate cement (Harvard) was investigated using the ACTA-machine. Sample chambers of eight sample wheels were prepared with pure materials or combinations of human tooth substance, alloys and cement, simulating an inlay-like situation. After 100,000 and 200,000 cycles in a millet suspension with a spring force of 20 N, the amount of abraded material was profilometrically measured and evaluated by 3D surface data analysis. After 200,000 cycles, the materials demonstrated a mean loss of 0.41 microm for CoCr, 51 microm for gold, 57 microm for enamel, 164 microm for dentin, 79 microm for Variolink and 369 microm for Harvard. Using ANOVA and the Games-Howell-test, resin cement, enamel and gold were a subset not shown to differ, as was zinc phosphate cement and dentin. CoCr demonstrated the least wear and differed significantly from all materials. Enamel wear was significantly reduced in mixed chambers with CoCr, and gold after 200,000 cycles compared to enamel in pure chambers. In summary, a soft gold alloy can be recommended for inlays when considering three-body abrasion since the wear rate of the "soft" gold alloy corresponded to that of human enamel.

Factors associated with clinical success of cervical abrasion/erosion restorations.

The purpose of this study was to evaluate the clinical performance of class 5 restorations according to USPHS criteria. Twenty-five patients and 116 abrasion/erosion lesions were restored with either a glass-ionomer cement restoration (Ketac-Fil), a composite resin restoration with a dentin bonding agent (Silux Plus, Scotchbond 2), or a composite resin restoration with a dentin bonding agent and a glass-ionomer liner (Silux Plus, Scotchbond 2, Vitrebond). At 3 years, 24 patients and 110 teeth were evaluated. All restorations were rated clinically acceptable for color match, cavosurface discoloration, surface texture, and caries development. Glass-ionomer cement restorations demonstrated a slightly rougher surface texture than the composite restorations (Friedman Two-way ANOVA, P=0.000). Significant differences were found with retention (Cochran Q test, P=0.012). Percentages retained were: glass ionomer, 97.3% (36/37); composite/dentin bonding agent, 75.7% (28/37); composite/dentin bonding agent/glass-ionomer liner, 100% (36/36). At 3 years class 5 restorations of glass-ionomer cement or composite with a dentin bonding and a glass-ionomer liner demonstrated significantly better retention than restorations of composite with a dentin bonding agent. Increased occlusal function, mobility, and mandibular arch were associated with a decrease in retention rate.

A geriatric program in practice.

The geriatric patient represents an underutilized resource for the small animal practitioner. Thorough examination of the pet annually in detail allows detecting problems before they are too advanced. By using the systems approach to patient evaluation, one is better able to detect diseases and proceed with techniques to diagnose them. The use of in-house hematology and serum chemistry equipment benefits the pet and owner through rapid return of information and provides an added source of revenue for the practitioner. Developing and maintaining a system to reevaluate the geriatric patient is one of the most important aspects of a geriatric practice. Reminding clients that you care about their pet through routine scheduled evaluations develops loyal clients, which in turn generates additional hospital income.

Clinical comparison of Class V resin composite and glass ionomer restorations.

Three techniques for restoring abrasion/erosion lesions were evaluated over a 2-year period: 1) glass ionomer restoration (Ketac-Fil); 2) composite restoration with a dentin bonding agent (Silux Plus, Scotchbond 2); 3) composite restoration with glass ionomer liner and a dentin bonding agent (Silux Plus, Vitrebond, Scotchbond 2). There were 116 lesions restored and 115 evaluated for color match, cavosurface discoloration, surface texture, caries development, and retention. Most restorations were rated clinically acceptable for color match, cavosurface discoloration, surface texture, and caries development when measured at 2 years. Glass ionomer restorations and composite restorations with a glass ionomer liner and a dentin bonding agent demonstrated better retention rates, 97.4% and 100% respectively, than the composite restorations with a dentin bonding agent only (86.8%) (Cochrane Q test, P = 0.07).

Clinical evaluation of high-copper dental amalgams with and without admixed indium.

High-copper amalgam alloys containing 5% and 10% admixed indium, shown in previous studies to have improved properties and acceptable biological behavior, were evaluated in a clinical study designed to examine factors relating to clinical success. One hundred and seventy-five Class I and Class II amalgam restorations were placed in 25 patients. Each patient received all three dispersed-phase amalgams tested: without indium (Dispersalloy), with 5% indium (Indisperse 5), with 10% indium (Indisperse 10). After 30 months, 22 patients were recalled and 146 restorations evaluated. The margins of the indium-containing amalgam restorations incurred slightly less marginal breakdown, an effect that could be attributed to the addition of admixed indium and to the increase in silver-copper eutectic spheres which is found in these alloys. These amalgams also demonstrated a slightly darker appearance, and were slightly rougher than the non-indium-containing amalgam. These differences were minor; at 30 months, all restorations were well within the clinically acceptable range for each parameter evaluated.

Clinical evaluation of direct esthetic restorations in cervical abrasion/erosion lesions: one-year results.

One hundred sixteen cervical abrasion/erosion lesions were restored with one of the following techniques: (1) glass-ionomer cement, (2) composite resin with a dentinal bonding agent, or (3) composite resin with a glass-ionomer cement liner and a dentinal bonding agent. The restorations were assessed at baseline and at 6 months and 1 year postrestoration for retention, caries, color match, marginal staining, and surface texture. No statistically significant differences were found in retention, caries, color match, or marginal staining. A statistically significant difference was found with regard to surface texture: glass-ionomer cement restorations demonstrated a rougher surface than did the composite resin restorations. A substantial number of restorations composed of composite resin with a dentinal bonding agent demonstrated a color shift towards mismatch when evaluated at 6 months. This difference was not significant at the 1-year followup.