Combined exposure to endocrine disrupting pesticides impairs parturition, causes pup mortality and affects sexual differentiation in rats.

Risk assessment is currently based on the no observed adverse effect levels (NOAELs) for single compounds. Humans are exposed to a mixture of chemicals and recent studies in our laboratory have shown that combined exposure to endocrine disrupters can cause adverse effects on male sexual development, even though the doses of the single compounds are below their individual NOAELs for anti-androgenic effects. Consequently, we have initiated a large project where the purpose is to study mixture effects of endocrine disrupting pesticides at low doses. In the initial range-finding mixture studies, rats were gavaged during gestation and lactation with five doses of a mixture of the fungicides procymidone, mancozeb, epoxyconazole, tebuconazole and prochloraz. The mixture ratio was chosen according to the doses of each individual pesticide that produced no observable effects on pregnancy length and pup survival in our laboratory and the dose levels used ranged from 25 to 100% of this mixture. All dose levels caused increased gestation length and dose levels above 25% caused impaired parturition leading to markedly decreased number of live born offspring and high pup perinatal mortality. The sexual differentiation of the pups was affected at 25% and higher as anogenital distance was affected in both male and female offspring at birth and the male offspring exhibited malformations of the genital tubercle, increased nipple retention, and decreased prostate and epididymis weights at pup day 13. The results show that doses of endocrine disrupting pesticides, which appear to induce no effects on gestation length, parturition and pup mortality when judged on their own, induced marked adverse effects on these endpoints in concert with other pesticides. In addition, the sexual differentiation of the offspring was affected. This as well as the predictability of the combination effects based on dose-additivity modelling will be studied further in a large dose-response study.

Understanding "alternative" dental products.

Alternative, complementary, integrative, and holistic health care are matters of public interest and include oral and dental care products. There are a variety of dental products promoted as "alternatives" to the standard commercial dental products that most dentists recommend and most patients use. These alternative products can be categorized as standard dental products made with natural ingredients, herbal products, homeopathic products, and synthetic alternative products. Dental health care providers should be aware of the range of "alternative" dental products and be able to counsel their patients to understand the type of support and evidence needed to determine safety and efficacy of treatment. The use of dental care products should be based upon sound basic science and sufficient clinical evidence of safety and efficacy.

Herbal supplements: considerations in dental practice.

Over-the-counter natural herb products constitute a rapidly growing market in the United States. As with conventional medications, the health care provider needs to be aware of these products' effects, side effects, advantageous synergies, and possible or probable adverse drug reactions. This paper will present 20 of the most frequently used herbs in the United States and discuss appropriate precautions and herb-drug interactions of possible concern in clinical dental practice.

Alternative dental products.

Alternative, complementary or holistic health care is a growing area of medicine and dentistry. There are a variety of dental products promoted as an "alternative" to the standard commercial dental products that most dentists recommend and most patients use. These alternative products can be categorized as standard dental products made with natural ingredients, herbal products, homeopathic products, and synthetic alternative products. The use of dental care products should be based upon sound basic science and sufficient evidence of safety and efficacy. Dental health care providers should be aware of the range of alternative dental products and be able to help their patients understand the type of support/evidence needed to determine safety and efficacy of treatment.

Kidney function after withdrawal of long-term antihypertensive treatment in diabetic nephropathy.

Initiation of antihypertensive treatment in hypertensive non-insulin-dependent diabetic (NIDDM) patients with diabetic nephropathy induces a faster initial (0 to 6 months) and slower subsequent (6 months-end) decline in GFR [delta GFR (ml.min-1.1.73 m-2.month-1) approximately 1.5 vs. 0.4]. Whether this initial phenomenon is reversible (hemodynamic) or irreversible (structural damage) after prolonged antihypertensive treatment is not known. To elucidate these mechanisms we investigated 40 hypertensive NIDDM patients (age 61 +/- 7 years, mean +/- SD), known duration of diabetes 14 years (2 to 33 years) [median (range)] with diabetic nephropathy receiving antihypertensive treatment (angiotensin converting enzyme inhibition, N = 30) for 5 years (1 to 20 years). The following variables were measured the last day on antihypertensive treatment and one month after withdrawal of treatment; GFR (51Cr-EDTA), 24-hour arterial blood pressure (24 hr MABP, Takeda TM2420) and albuminuria (ELISA); the mean 24-hour MABP rose from 102 +/- 11 to 111 +/- 10 (P < 0.0001) and albuminuria [geometric mean (antilog SEM)] increased from 634 (1.3) to 1159 (1.2) (P < 0.0001), while GFR (mean +/- SD) remained unchanged (69 +/- 25 to 70 +/- 26 ml.min-1.1.73 m-2, P = 0.21), after withdrawal of antihypertensive treatment. A significant correlation between the relative change in the 24 hour MABP measurement and the relative change in GFR (r = 0.44, P < 0.01) was found. In conclusion, our results suggest that the faster initial decline in GFR after initiating antihypertensive treatment in hypertensive NIDDM patients with diabetic nephropathy is due to a irreversible effect, and should be accounted for when evaluating the beneficial effect of antihypertensive treatment on the progression of diabetic nephropathy in these patients.

Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer.

BACKGROUND: Patients with head and neck cancer who continue to smoke after diagnosis and treatment are more likely than patients who quit to experience tumor recurrence and second primary malignancies. Therefore, information about patients' smoking status and the factors associated with continued tobacco use are important considerations in the comprehensive care patients with head and neck cancer. METHODS: Study participants were 144 patients with newly diagnosed squamous cell carcinomas of the upper aerodigestive tract who underwent surgical treatment, with or without postoperative radiotherapy or chemotherapy, 3-15 months before assessment of their postoperative tobacco use. RESULTS: Among the 74 patients who had smoked in the year before diagnosis, 35% reported continued tobacco use after surgery. Compared with patients who abstained from smoking, patients who continued to use tobacco were less likely to have received postoperative radiotherapy, to have had less extensive disease, to have had oral cavity disease, and to have had higher levels of education. Hierarchical regression analysis indicated that most of the explained variance in smoking status could be accounted for on the first step of analysis by disease site. Interest in smoking cessation was high, and most patients made multiple attempts to quit. CONCLUSIONS: Although the diagnosis of a tobacco-related malignancy clearly represents a strong catalyst for smoking cessation, a sizable subgroup of patients continue to smoke. Patients with less severe disease who undergo less extensive treatment are particularly at risk for continued tobacco use. These data highlight the importance of developing smoking cessation interventions designed to meet the demographic, disease, treatment, and tobacco-use characteristics of this patient population.

An experimental analysis of classically conditioned nausea during cancer chemotherapy.

This study investigated classical conditioning in women undergoing outpatient adjuvant chemotherapy for breast cancer. Breast cancer chemotherapy outpatients were randomly assigned either to an Experimental Group (exposed to a distinctive stimulus before each infusion of chemotherapy) or to a Control Group. After repeated infusions of chemotherapy, patients' responses to the experimental stimulus were assessed in a location not associated with chemotherapy. Experimental Group patients had increased nausea (self-reported on a visual analog scale) following the presentation of the experimental stimulus at this test trial, whereas Control Group patients did not. Two other measures of nausea corroborated these results. Post hoc statistical analyses confirmed predictions based on conditioning theory. This conditioning model of anticipatory nausea bears witness to the relevance of classical conditioning in clinical medicine.

Reasons for local anesthesia failures.

U.S. dental practitioners administer about 4,000,000 local anesthetic blocks and infiltrations annually. The failure rate to achieve adequate anesthesia for the procedure is estimated to be 5 percent to 15 percent. This article describes five different categories of failures and suggest ways to troubleshoot them.

[Clinical environmental medicine. An examination of a case load from a 2-year project]. / Klinisk miljømedicin. Opgørelse af patientmaterialet fra et 2-årigt forsøgsprojekt.

In a two year experimental project, 38 persons were referred to clinical examination at a clinic for occupational medicine. Admission was based upon suspicion of health damage caused by environmental factors outside the occupational setting. Twentyseven persons were suspected of indoor exposure with unspecified dust as the dominating factor. In the general environment, suspected exposure from polluted soil was the main reason for admission of 11 patients. In 22 cases, a causal relation between complaints and exposure to environmental factors was considered likely and recommendations to eliminate exposure or to effectuate further investigations of exposure were made. It is concluded that there is a need for an arrangement whereby patients can be examined by doctors experienced in assessing relations between exposure from environmental factors and disease. Since only few patients are expected, the examinations can be carried out in clinics for occupational medicine within existing resources.

Etidocaine hydrochloride in surgical procedures: effects on postoperative analgesia.

Because early research has established the prolonged duration of the effects of etidocaine, this study was performed to determine whether the long-acting local anesthetic can reduce the need for postoperative analgesics after oral surgery.

Acute effects of nitrendipine in pregnancy-induced hypertension.

The acute effects of a single, 20 mg oral dose of nitrendipine were studied in 10 women at between 32 and 42 weeks gestation with stable pregnancy-induced hypertension (PIH). Blood pressure (BP), maternal heart rate and fetal heart rate (FHR) were assessed for 8 h after nitrendipine intake together with the plasma levels of nitrendipine, noradrenaline, adrenaline, plasma renin activity (PRA) and vasopressin. The mean initial systolic/diastolic BP was 158 (SEM 3.7)/108 (SEM 2.7) mmHg. Within 1 h stable, reduced mean BP-levels of 141-145/90-95 mmHg were reached and maintained for 4 h after medication. This antihypertensive effect was closely related to the maternal plasma concentration of nitrendipine, which reached a maximum of 9.1 (SEM 2.6) ng/ml 3 h after tablet intake. After 4 h, systolic and diastolic BPs slowly increased in parallel to a successive decrease in plasma concentrations of nitrendipine. Maternal heart rate increased by less than 10%, while FHR remained unchanged. No hypotensive incidents occurred. The initial mean plasma concentrations of noradrenaline, adrenaline, vasopressin and PRA did not change during the treatment. No major maternal and no fetal side-effects were observed. Three of 10 patients experienced mild, transient facial flushing.

Prophylactic coverage of dental patients with artificial joints: a retrospective analysis of thirty-three infections in hip prostheses.

Persons with total joint prostheses theoretically risk infection from the transient bacteremia that may accompany dental treatment, and the literature suggests that these patients be treated prophylactically with antibiotics. Effective prophylaxis requires that the most common infecting organisms be identified and tested for drug sensitivity. We reviewed thirty-three cases of infected hips out of a total of 1,855 hip prosthesis placements. The infections were classified as early (less than 6 months after placement) or late (greater than 6 months after placement). In the patients studied, the risk of infection associated with dental procedures was extremely low (0.05 percent). Staphylococcus aureus was the organism most often isolated from the infected hips, and its incidence was twice as high in the late as in the early infections. Based on the drug sensitivities of the most common infecting organisms, the recommended drugs of choice for prophylactic treatment of dental patients with artificial joints are erythromycin, clindamycin, or a penase-resistant penicillin.