Targeted prophylaxis with amphotericin B lipid complex in liver transplantation.

The purpose of this study is to prospectively evaluate a strategy in which prophylaxis with amphotericin B lipid complex at 3 different dosages was targeted to liver transplant recipients at high risk for the development of invasive fungal infection (IFI). High risk was defined as a postoperative requirement for prolonged (>/=5 days) intensive care unit (ICU) treatment. Consecutive high-risk patients were administered prophylaxis with amphotericin B lipid complex from day 5 after orthotopic liver transplantation (OLT) until ICU discharge or death. The first 10 eligible patients were administered 5 mg/kg/d, the next 10 patients were administered 2.5 mg/kg/d, and a final 10 patients were administered 1 mg/kg/d. Drug safety and efficacy were assessed before each dosage reduction. During the study period, 130 adult patients underwent 137 OLTs. Thirty patients fulfilled the entry criteria and were administered prophylaxis with amphotericin B lipid complex. No patient developed proven IFI during prophylaxis. Cultures from normally sterile sites (blood and abdominal drain fluid) always showed negative results. All fungal isolates were sensitive in vitro to amphotericin B. There was no significant difference in colonization scores among the groups of patients administered different dosages of amphotericin B lipid complex. No death, serious adverse reaction, or nephrotoxicity was attributed to amphotericin B lipid complex. We conclude that prophylaxis with amphotericin B lipid complex targeted to patients requiring prolonged ICU treatment after OLT appears to be well tolerated and may prevent IFI. Our current policy is to use amphotericin B lipid complex, 1 mg/kg/d, as antifungal prophylaxis in this high-risk group.

Caries resistance in enamel by laser irradiation and topical fluoride treatment.

PURPOSE: The purpose of this in vitro study was to compare caries resistance of sound human enamel following argon laser (AL) irradiation, as well as, combinations of topical fluoride foams and AL irradiation. METHODS AND MATERIALS: Thirty extracted human teeth were sectioned into four buccal windows and assigned to one of the following treatment groups: (1) no treatment/control; (2) low fluence (11.5 J/cm2) AL irradiation for 10 seconds; (3) 1.23% APF foam for 4 minutes followed by low fluence AL irradiation; (4) 2.0% NaF foam for 4 minutes followed by low fluence AL irradiation. Caries-like lesions were created by submerging the teeth in ten Cate solution (pH 4.5). Following a 96-hour exposure period, 100 microns longitudinal sections were prepared for polarized light evaluation. Visilog 5.1.1. image analysis software was used to obtain quantitative lesion depths. The Scheffe F-test was used to compare the lesion depths for each of the four treatment groups. RESULTS: Lesion depths were: 16.1 +/- 6 microns for control; 13.7 +/- 4 microns for AL irradiation alone; 12.1 +/- 4.3 microns for 1.23% APF foam before AL irradiation; and 11.4 +/- 5.9 microns for 2.0% NaF foam before AL irradiation. Significant difference (p < 0.05) was found between the control group and the 2.0% NaF foam before AL irradiation group. AL irradiation alone reduced lesion depth by 15% compared with the control lesion. When AL irradiation was combined with 1.23% APF foam treatment, lesion depth decreased by 25% compared with control lesions, and by 29% when combined with 2.0% NaF foam. CONCLUSION: Combining AL irradiation and 2.0% NaF foam treatment significantly enhances the resistance of sound enamel to an in vitro cariogenic challenge.

In vivo caries-like lesion prevention with argon laser: pilot study.

OBJECTIVE: This clinical pilot study was conducted to investigate the effectiveness of argon laser irradiation to reduce demineralization or loss of tooth structure in vivo. SUMMARY BACKGROUND DATA: In vitro research previously demonstrated the ability of argon laser irradiation to reduce demineralization or loss of tooth structure. METHODS: Using the Ogaard model of producing demineralization, the experimental teeth were irradiated with argon laser of 250 mW (producing approximately 12 J/cm2) prior to banding. Polarized light evaluation of the sectioned, extracted teeth was used to determine the amount of demineralization. RESULTS: Results showed a 29.1% reduction in demineralization in the experimental teeth as compared to the bilateral control teeth. CONCLUSION: Low-power argon laser irradiation significantly reduced demineralization clinically.