Dental health of Irish alcohol/drug abuse treatment centre residents.

OBJECTIVES: This study examines the independent and combined impact of 'alcohol only' and 'alcohol plus drug' abuse on the dental health of Irish alcohol/drug abuse treatment centre residents, comparing their dental caries experience. METHODS: Four Irish treatment centres were visited periodically over a year. Data was collected on residents' alcohol, tobacco and drug habits. Participants underwent comprehensive oral examination. RESULTS: Of 210 participants (148 males and 62 females), 53% reported an 'alcohol plus drug' abuse; 44% had an 'alcohol-only' abuse. 'Drug-only' abusers (n = 7) were excluded. Ages ranged from 18-73 with 59% aged under 40. 'Alcohol-only' abusers were significantly older than "alcohol plus drugs" abusers (p < 0.001). Mean DMFT (14.4, sd 7.3) and MT scores (7.3, sd 6.8) were above the national averages. "Alcohol-only" abusers had higher DMFT scores (p < 0.001), more missing teeth (p < 0.001) and more filled teeth (p < 0.01) than "drugs plus alcohol" abusers. DT scores did not vary significantly between study groups. Multivariate analysis confirmed the significance of gender (males OR = 2.31, p = 0.009) on DT scores and highly significant influence of age (age < 36, OR = 0.08, p < 0.001) on MT status. However, study group was not a significant influence once age was taken into consideration. CONCLUSIONS: The study reveals a high level of dental disease among Irish alcohol/drug abusers. While some authors have suggested that 'alcohol-only' abusers may experience less decay than 'alcohol plus drug' abusers, this study found no significant difference in the caries experience of the two groups once age was taken into consideration.

Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review.

BACKGROUND: Irradiation-induced xerostomia seriously reduces quality of life for patients with head and neck cancer (HNC). Anecdotal evidence suggests that acupuncture may be beneficial. OBJECTIVE: To systematically review evidence on clinical effectiveness and safety of acupuncture in irradiation-induced xerostomia in patients with HNC. METHODS: A detailed search was performed to identify randomised controlled trials (RCTs) and systematic reviews of RCTs on acupuncture in irradiation-induced xerostomia, using AMED, BNIA, CINAHL, Cochrane, Embase, HPSI, PsycInfo and Medline. Grey literature was explored and 11 journals hand searched. Search terms included: acupuncture, xerostomia, salivary hypofunction, hyposalivation, dry mouth, radiotherapy, irradiation, brachytherapy, external beam. Two authors independently extracted data for analysis using predefined selection criteria and quality indicators. RESULTS: 43 of the 61 articles identified were excluded on title/abstract. 18 articles underwent full-text review; three were deemed eligible for inclusion. Two trials had moderate risk of bias; one had high risk. Two trials compared acupuncture with sham acupuncture; one control arm received 'usual care'. Outcome measurements included salivary flow rates (SFRs) in two trials and subjective questionnaires in three. All three trials reported significant reduction in xerostomia versus baseline SFR (p<0.05); one reported greater effect in the intervention group for stimulated SFR (p<0.01). Subjective assessment reported significant differences between real acupuncture and control in two trials (p<0.02-0.05). Insufficient evidence was presented to undertake risk/benefit assessment. CONCLUSIONS: Limited evidence suggests that acupuncture is beneficial for irradiation-induced xerostomia. Although current evidence is insufficient to recommend this intervention, it is sufficient to justify further studies. Highlighted methodological limitations must be dealt with.

A comparison of acidic dietary factors in children with and without dental erosion.

The results of the UK Child Dental Health Survey of 1993 indicated that dental erosion was a problem in children, with acidic dietary components thought to be the main etiological factor. The aim of this study was to compare, in the form of a case control study, the diets of children with dental erosion with those who were caries-active or caries-free. Structured dietary histories were taken from 309 age and gender matched children to determine the type and frequency of intake of acidic foods and drinks, together with any drinking habits that prolonged exposure of the teeth to dietary acids. Results showed that the children with erosion drank acidic beverages significantly more frequently than children who either had caries or were caries-free. Children with erosion also drank milk or water significantly less often than the control groups, and were more likely to have a swishing or holding habit associated with drinking. Fruit and vinegar consumption was higher in the erosion group, as was the taking of vitamin C supplements. The results of this study suggest that the increased consumption of acidic foods and drinks, particularly when associated with a swishing or holding habit, may contribute to the development of erosion in some children. Dietary advice should emphasize the dangers of a highly acidic as well as that of a cariogenic diet.

Attachments of the ligamentum nuchae to cervical posterior spinal dura and the lateral part of the occipital bone.

OBJECTIVE: To describe previously unrecorded attachments of the ligamentum nuchae to the cervical posterior spinal dura, and to posterolateral parts of the occipital bone in an anatomical study, with particular reference to the deep aspects of the suboccipital triangle and upper cervical region. DESIGN: Dissections of 10 heads and necks from embalmed cadavers were made in the suboccipital and upper cervical region, either in whole specimens or in parasagitally sectioned specimens. RESULTS: In parasagittally sectioned material, continuity was observed between the ligamentum nuchae and the posterior cervical spinal dura as the latter passed deeply from the midline toward the dura, but only at the first and second cervical vertebral levels. The ligamentum nuchae also passed bilaterally on to the occipital bone as far as the sutures between the occipital bone and the temporal bones, approaching the inferior nuchal line superiorly. CONCLUSION: The present study is the first to describe the full morphology of the relationship between the ligamentum nuchae and the cervical posterior spinal dura and the lateral aspects of the occipital bone. This is of significance for understanding the biomechanics of the cervical spine, particularly rotational movements of the head in the sagittal or transverse planes. This may have implications in manipulative therapy for conditions as cervicogenic headache and for various degenerative disorders affecting the cervical spine.

A case report of an unusual mandibular swelling in a 4-year-old child possibly caused by a jellyfish sting.

Animal bites and stings may not figure highly in the differential diagnosis of facial swelling in the United Kingdom but should be considered in those who have been in a tropical area. This case report documents details of the presentation and investigation of a case of jellyfish sting that appeared as a facial swelling in a 4-year-old girl who had recently been on holiday in Greece. The report emphasizes the requirement to consider unusual aetiological factors in cases of facial swelling.

Bartter's syndrome in pregnancy: a case report and review.

Bartter's syndrome is a rare autosomal recessive disorder characterized by hypokalemia, hyperaldosteronism, sodium wasting, normal blood pressure, hypochloremic alkalosis, and hyperplasia of the juxtaglomerular apparatus. We present a 21-year-old African-American nulliparous patient who was referred to our clinic at 9 weeks' gestation with a history of Bartter's syndrome. Her antenatal course was complicated by muscle cramps, which required increasing potassium supplementation. She developed hypomagnesemia in the third trimester of pregnancy, which necessitated magnesium therapy. She delivered an unaffected infant at term. Bartter's syndrome, although extremely rare in pregnancy, requires prompt recognition and careful management, as it may have significant maternal and neonatal implications.

Rapid detection of rabies and rabies-related viruses by RT-PCR and enzyme-linked immunosorbent assay.

A rapid detection method for the six established genotypes of rabies and rabies-related viral RNA using RT-PCR-ELISA is described. The detection of digoxigenin-labelled amplified products is performed by solution hybridization to two specific, biotin-labelled, capture probes, which are complementary to the inner region of the amplification products. The capture probe and amplified product hybrid are then immobilised on a streptavidin-coated microtitre plate, bound products are detected by an anti-DIG Fab fragment conjugated to peroxidase, and colorimetric reaction automatically measured. This method was up to 100-fold more sensitive than Southern blot hybridization, detecting 0.00002 TCID50/ml of a genotype 1, classical rabies virus strain. The complete detection methodology from RT-PCR to PCR-ELISA detection could be completed within 10 h. Using this procedure, we were 100% successful in detecting 60 isolates from a representative selection of the six established genotypes from all over the world. This test is a useful additional tool for the detection of the rabies and rabies-related viruses, which is easy to perform, rapid and highly sensitive.

Prevalence and site characteristics of dental caries in primary molar teeth from prehistoric times to the 18th century in England.

A total of 1,974 primary molar teeth from the skeletal remains of 373 children from Prehistoric times to the 18th century were examined for caries prevalence and site characteristics. Results showed that caries in primary teeth was initiated more often at the cemento-enamel junction than the contact point in most time periods and that caries prevalence values recorded were comparable to those in other reports based upon much smaller sample sizes. Caries prevalence and site characteristics for primary molar teeth were found to be similar to those of permanent dentitions of corresponding periods, a finding that contradicts many previous studies. This study showed a higher caries prevalence in primary molars during the Romano-British period than recorded previously.

Successful treatment of heart transplant rejection with photopheresis.

Photopheresis is a potential therapy for rejection in which reinfusion of mononuclear cells exposed to ultraviolet-A light ex vivo, after treatment with 8-methoxypsoralen in vivo, initiates host immune responses that specifically inhibit the cytotoxicity of the photomodulated mononuclear cells. Between May 1990 and January 1991, 7 heart transplant (HT) patients (age 42.2 +/- 16.7 [mean +/- SD] years) on triple immunosuppression (cyclosporine, corticosteroids, and azathioprine) had 9 episodes of non-hemodynamically compromising moderate rejection that were treated with photopheresis. These episodes of rejection occurred at an average of 114.4 +/- 180.5 (range 8-575) days after HT. After oral administration the mean serum level of 8-methoxypsoralen achieved was 129.0 +/- 72.4 ng/ml. An average of 10.4 +/- 9.6 x 10(9) mononuclear cells were treated with each photopheresis procedure. Photopheresis was performed twice when less than 5 x 10(9) mononuclear cells had been treated with the first procedure. Of 9 rejection episodes treated with photopheresis, 5 required 1 procedure and 4 required 2 procedures. Photopheresis was used to treat a single episode of rejection in 5 pts. and 2 separate rejection episodes in 2 additional pts. Eight of 9 episodes of rejection were successfully reversed by photopheresis as assessed by endomyocardial biopsy (EMB) performed 7 days after treatment. Immunohistochemical analysis of EMB samples revealed that postphotopheresis cell counts for T cells, B cells, and macrophages were reduced compared to pretreatment values and correlated with the histopathologic resolution of rejection. Hemodynamics were normal prephotopheresis and remained unchanged at the time when the postphotopheresis EMB showed no evidence rejection No adverse effects have been observed with photopheresis. Over a follow-up period of 5.3 +/- 4.0 months, rejection and infection rates/pt./follow-up months were 0.3 +/- 0.4 and 0.04 +/- 0.07, respectively. The preliminary, short term results of this pilot study indicate that photopheresis may be efficacious in the treatment of moderate rejection in hemodynamically stable HT patients and thus may be an alternative to corticosteroid pulses.

Dental caries in relation to nutritional stress in early English child populations.

This research studied an association between dental caries prevalence in the primary dentition and cribra orbitale, an indicator of nutritional stress in archeological populations. Skeletal remains of 221 British children (Pre-Roman to Late Medieval) were examined, of whom 100 had orbital material available. Dental caries, as dmfs, was related to the presence of cribra orbitale (none, slight, moderate, or severe). Thus, data for 50 children showed a statistically significant association (P less than 0.005) between caries prevalence and cribra orbitale using the Fisher Exact Test, suggesting that nutritional stress is an associated factor in caries etiology in children.