Outcomes of direct pulp capping: interrogating an insurance database.

AIM: To evaluate the effectiveness of direct pulp capping under general practice conditions. It was hypothesized that direct pulp capping is an effective procedure in the majority of cases and prevents the need for root canal treatment or extraction. METHODOLOGY: Claims data were collected from the digital database of a major German national health insurance company. Only patients who had been insurance members for the entire 3 year period 2010 to 2012 were eligible. Kaplan-Meier survival analyses were conducted for all teeth with direct pulp capping. Success was defined as not undergoing root canal treatment. Survival was defined as not undergoing extraction. Differences between survival functions were tested with the log rank test. RESULTS: A total of 148 312 teeth were included. The overall success rate was 71.6% at 3 years. The overall survival rate was 95.9% at 3 years. The success rates for single-rooted teeth (71.8%) and multirooted teeth (71.5%) were similar although significantly different (P < 0.001). Best 3-year success rates were found at low (79.7%; <18 years.) and very high age (81.8%; >85 years.). CONCLUSIONS: After direct pulp capping, more than two-thirds of the affected teeth did not undergo root canal treatment within 3 years. Although this study has the typical limits of a claims data analysis, it can be concluded that direct pulp capping is an effective intervention to avoid root canal treatment and extraction in a general practice setting.

[Hereditary head and neck tumors]. / Hereditäre Tumoren des Kopf-Hals-Bereichs.

Hereditary paraganglioma, Gorlin-Goltz syndrome and Fanconi anemia are among the rare hereditary tumor syndromes of the head and neck. Patients with hereditary paraganglioma often develop multiple tumors of the glomus caroticum and glomus jugulotympanicum. The corresponding genetic defects of the mitochondrial succinate dehydrogenase complex induce autonomous tumor cell growth. In patients with Gorlin-Goltz syndrome basal cell carcinomas and keratocystic odontogenic tumors usually occur much earlier than in patients with sporadic tumors. The associated germline mutations are located in the patched gene which is a modulator of the cell cycle. Fanconi anemia represents a chromosomal instability syndrome which is characterized by early onset of pancytopenia, i.e. bone marrow failure and subsequent development of acute myeloid leukemia and/or squamous cell carcinomas, especially of the head and neck. A total of 13 different gene clusters have been identified in 2 DNA associated complexes which play an important role in DNA repair mechanisms.

Pharmacokinetics of pradofloxacin and doxycycline in serum, saliva, and tear fluid of cats after oral administration.

The pharmacokinetic properties of pradofloxacin and doxycycline were investigated in serum, saliva, and tear fluid of cats. In a crossover study design, six cats were treated orally with a single dose of pradofloxacin (Veraflox Oral Suspension 2.5%) and doxycycline (Ronaxan 100 mg) at 5 mg/kg body weight. Following administration, samples of serum, saliva, and tear fluid were taken in regular intervals over a period of 24 h and analysed by turbulent flow chromatography/tandem mass spectrometry. All values are given as mean +/- SD. Pradofloxacin reached a mean maximum serum concentration (C(max)) of 1.1 +/- 0.5 microg/mL after 1.8 +/- 1.3 h (t(max)). In saliva and tear fluid, mean C(max) was 6.3 +/- 7.0 and 13.4 +/- 20.9 microg/mL, respectively, and mean t(max) was 0.5 +/- 0 and 0.8 +/- 0.3 h, respectively. Doxycycline reached a mean C(max) in serum of 4.0 +/- 0.8 microg/mL after 4.3 +/- 3.2 h. Whilst only at two time-points doxycycline concentrations close to the limit of quantification were determined in tear fluid, no detectable levels were found in saliva. The high concentrations of pradofloxacin in saliva and tear fluid are promising to apply pradofloxacin for the treatment of conjunctivitis and upper respiratory tract infections in cats. As doxycycline is barely secreted into these fluids after oral application the mechanisms of its clinical efficacy remain unclear.

Inhibition of TEGDMA and HEMA-induced genotoxicity and cell cycle arrest by N-acetylcysteine.

OBJECTIVES: Dental resin monomers like triethylene glycol dimethacrylate (TEGDMA) and 2-hydroxyethyl methacrylate (HEMA) are able to cause an imbalance of the redox state in mammalian cells. The resulting oxidative stress originating from reactive oxygen species (ROS) has been associated with cytotoxicity. We hypothesized that ROS might contribute to the generation of genotoxicity by TEGDMA and HEMA as well. Therefore, we examined the formation of micronuclei in V79 cells by both resin monomers in the presence of the antioxidant N-acetylcysteine (NAC), which scavenges ROS. In addition, we analyzed the effects of TEGDMA and HEMA on the normal cell cycle in the presence of NAC. METHODS: V79 fibroblasts were exposed to increasing concentrations of TEGDMA and HEMA in the presence and absence of NAC for 24h. Genotoxicity was indicated by the formation of micronuclei. The modification of the normal cell cycle was analyzed by flow cytometry (FACS). RESULTS: A dose-related increase in the number of micronuclei in V79 cells-induced by TEGDMA and HEMA indicated genotoxicity of both chemicals. However, the formation of micronuclei was reduced in the presence of 10 mmol/L NAC, indicating its protective role. A cell cycle delay in G2 phase caused by TEGDMA was absent when cells were co-treated with NAC. Similarly, the presence of NAC led to a reversion of the cell cycle delay in HEMA-treated cell cultures. SIGNIFICANCE: Our results suggest that genotoxic effects and the modification of the cell cycle caused by TEGDMA and HEMA are mediated, at least in part, by oxidative stress.

[Bulimia nervosa]. / Bulimia nervosa.

Bulimia nervosa is characterized by episodes of binge eating and compensatory behaviours (self-induced vomiting, laxative misuse, dietary restriction). It has a complex aetiology and is mostly found in young women. Bulimia leads to substantial physical and psychosocial morbidity. Bulimia nervosa needs specialized psychotherapeutic treatment. In most cases outpatient treatment is sufficient, but comorbidity with other psychiatric disturbances has to be taken into account. Additional psychopharmacological interventions might be helpful. After 5 to 10 years about 50% of the patients show complete remissions, 30% partial remissions and about 20% a chronic course of the illness. General practitioners, dentists and gynaecologists should be informed about typical signs of the disorder that is often hidden by the patients.

Peripheral hemodialysis shunt with intracranial venous congestion.

BACKGROUND: Intracranial venous congestion is often caused by local venous thrombosis or brain arteriovenous fistulas. Hemodialysis shunts are known to cause venous enlargement in the arm or chest but have not been related to intracranial vascular pathology. Case Description- A 59-year-old woman who presented with increasing headache, gait instability, and memory loss was a renal transplant recipient who still carried a left upper arm shunt. Cranial CT scan showed enlarged veins in the posterior fossa with incipient hydrocephalus. Extracranial duplex sonography revealed reversed flow in the left internal jugular vein, which normalized on cuff inflation around the shunt-carrying arm. The reversed flow, intracranial venous congestion, and neurological status improved after surgical shunt ligation. CONCLUSIONS: To our knowledge, this is the first case description of an intracranial venous outflow obstruction caused by a peripheral arteriovenous shunt.

A comparison of the effect of povidone-iodine and 60% n-propanol on the resident flora using a new test method.

The efficacy and safety of povidone-iodine (PVP-I) and 60% v/v% n-propanol on the forehead of patient's were examined using a newly developed method. Significantly higher reduction factors (RFs) of the total resident flora were obtained using PVP-I immediately after and 3-6 h after application (1.4, 1.4, 1.4) than with isopropanol (0.6, 0.6, 0.8) using the detergent scrub method. No significant difference was found using the cyanoacrylate method. Propionibacter spp. showed similar results. With Staphylococcus epidermidis, RFs of 1.8 were obtained with both bath agents using the detergent scrub method, but using the cyanoacrylate method significantly higher RFs were obtained with isopropanol immediately and 3 h after application (1.3, 1.3) than with PVP-I (0.4, 0.5). This phenomenon seems to be due to the limit of complete elimination of the resident bacterial counts in vivo.

Adenosine-induced cardiac pause for endovascular embolization of cerebral arteriovenous malformations: technical case report.

OBJECTIVE: Extremely high flow through arteriovenous malformations (AVMs) may limit the safety and effectiveness of endovascular glue therapy. To achieve a more controlled deposition of glue, we used transient but profound systemic hypotension afforded by an intravenously administered bolus of adenosine to induce rapidly reversible high-degree atrioventricular block. METHODS AND CASE REPORT: A patient with a large high-flow occipital AVM fed primarily by the posterior cerebral artery underwent n-butyl cyanoacrylate glue embolization. Nitroprusside-induced systemic hypotension did not adequately reduce flow through the nidus, as determined by contrast injection in the feeding artery. In a dose-escalation fashion, boluses of adenosine were administered to optimize the dose and verify that there was no flow reversal in the AVM and no other unexpected hemodynamic abnormalities by arterial pressure measurements and transcranial Doppler monitoring of the posterior cerebral artery feeding the AVM. Thereafter, 64 mg of adenosine was rapidly injected as a bolus to provide 10 to 15 seconds of systemic hypotension (approximately 20 mm Hg). Although there were conducted beats and some residual forward flow through the AVM during this time, the mean systemic and feeding artery pressures were roughly similar and remained relatively constant. A slow controlled injection of n-butyl cyanoacrylate glue was then performed, with excellent filling of the nidus. CONCLUSION: Adenosine-induced cardiac pause may be a viable method of partial flow arrest in the treatment of cerebral AVMs. Safe, deep, and complete embolization with a permanent agent may increase the likelihood of endovascular therapy's being curative or may further improve the safety of microsurgical resection.

Inhibition of vasoactive agents by perfluorochemical emulsion.

Perfluorochemicals are widely used in clinical and experimental studies as volume expanders with high oxygen carrying capacity. We noticed that contractions of rabbit aortic strips, induced by norepinephrine, were inhibited in FC-43 emulsion as compared to Krebs-Henseleit solution (KH). To study this inhibition, a comparative evaluation was made of the contractile responses of norepinephrine, serotonin and histamine in FC-43 emulsion and KH. The effect of these agents was significantly diminished in FC-43 emulsion; concentration-response curves were shifted to the right and the maximum response was diminished. A search was made for the individual constituents of FC-43 responsible for diminution of contraction of vascular smooth muscle. After centrifugation of FC-43 emulsion, the supernatant caused a reduction of contractility and reduced EC50-values of norepinephrine to the same degree as the fully constituted emulsion. This excluded perfluorotributylamine, the oxygen carrying particles, as being responsible for this inhibition. When the detergent Pluronic F-68 was added to KH in concentrations equal to that in FC-43 emulsion, inhibition of contraction occurred and EC50-values increased. Contractions induced by norepinephrine were equally inhibited by the addition to KH of a volume expander, hydroxyethylstarch, in a concentration equal to that in FC-43 emulsion. It is concluded that FC-43 emulsion inhibits vasoactive agents and attenuates its pharmacologic effects on vascular smooth muscle. The fractions of FC-43 emulsion responsible for inhibiting the effect of vasoactive agents are Pluronic F-68 and hydroxyethylstarch.

Environmental effects on laser Doppler pulpal blood-flow measurements in man.

The increasing number of experiments using laser Doppler flowmetry in man for pulpal blood-flow recordings leads to questioning of the experimental recording conditions. The present study focused on three points: the design of the laser probe holder, the isolation of the tooth, and the influence of the recording site. A rigid polyurethane splint used in addition to different isolation devices (cotton roll, metal shield, rubber dam) was compared with a silicone splint. The silicone resulted in significantly higher values (+341%) than the polyurethane splint. The combination of the polyurethane splint with isolation devices decreased, in all cases, the flux values. The polyurethane/rubber-dam combination was the most efficient in individualizing the pulpal blood flow (-69% decrease). Recordings on non-vital teeth confirmed the hypothesis that there was periodontal contamination of the recorded flow, as the signal was abolished when using the polyurethane/rubber-dam combination. Cervical recording sites gave significantly higher values than occlusal sites (+42%). It is concluded that, in man, the part played by the periodontium may have been underestimated in previous recordings of pulpal blood flow. The use of a rubber dam in combination with a rigid splint to enhance the validity of recordings is proposed.

Direct examination of subgingival plaque from a diseased periodontal site using confocal laser scanning microscopy (CLSM).

Material taken directly from a periodontal site was investigated using immunofluorescence, acridine orange staining and confocal laser scanning microscopy (CLSM). Porphyromonas gingivalis was tracked by a specific polyclonal antibody and its pronounced occurrence in inflamed as compared to non-inflamed areas was demonstrated. Further accompanying microorganisms were counterstained with acridine orange which could provide information on the viability of individual cells. Optical sections by laser microscopy revealed the spatial arrangement of the investigated material. The combination of specific staining and CLSM allows a detailed microbiological investigation of clinical material obtained directly without cultivation.

[Modular reconstruction in acetabular revision with antiprotrusio cages and metal augments : the cage-and-augment system]. / Modulare Defektrekonstruktion beim Pfannenwechsel mit Abstützschale und metallischen Augmenten : "Cage-and-Augment"-System.

OBJECTIVE: Restore primary center of rotation and reconstruct extensive bone defects in hip revision surgery with a modular off-label implant combined with antiprotrusion cage and metal augment, thus, achieving improved hip function. INDICATIONS: Large segmental acetabular defects with nonsupportive columns (Paprosky type 3a and 3b) in cup loosening or Girdlestone situation. In case of pelvic discontinuity posterior column-plating is possible. CONTRAINDICATIONS: Persisting hip infection and severe systemic disorders impairing achievement of secondary stability through bony integration of metal augment. SURGICAL TECHNIQUE: Posterolateral (if dorsal column plating) or other approach. Remove loose implant and granulation tissue with sufficient exposure of bleeding bone. Size acetabular defect with trial components of augment and appropriate antiprotrusio cage. Fixation of selected metal augment with screws. Fill additional acetabular defects with morsellized bone graft. Open a slot into the ischium to fix the distal flange of the cage. If necessary, bend both flanges according to patient's anatomy. Enter the ischium with distal flange and gradual impaction of the antiprotrusio ring. Final stabilization of the ring with several screws aiming at the posterior column or the acetabular dome. Inject cement between ring and augment to stabilize the construction and avoid metal wear. Final cement fixation of a polyethylene liner or a dual-mobility cup into the antiprotrusio ring. In pelvic discontinuity with major instability osteosynthesis of the dorsal column can be performed prior to cementation. POSTOPERATIVE MANAGEMENT: Prophylaxis of periprosthetic infection, DVT and heterotopic ossification. Physical therapy with partial weight bearing (20 kp) for 6 weeks; in discontinuity initial wheel chair mobilization. RESULTS: Since 2008, 72 off-label implantations of a combined antiprotrusio cage and a Trabecular Metal™ Augment were performed. A total of 44 patients (46 operations) were investigated at 38.8 (36-51) months postoperatively. In all, 36 patients had a bone defect according to Paprosky type 3a/b and in 3/4 patients with pelvic discontinuity additional osteosynthesis was performed. The WOMAC score increased from 39.8 (8.7-75) points preoperatively to 57.9 (16.7-97.9) points at follow-up. Migration or failure of implant components was not observed. In 11 % of dislocations and 11 % periprosthetic infections surgical revision was necessary.

[Clinical and immunohistochemical findings of intra- and extraoral angiosarcomas]. / Klinische und immunhistochemische Befunde oraler und perioraler Angiosarkome.

PURPOSE: A clinico-pathologic study of typical symptoms of intra- and extraoral angiosarcomas and clinical course under therapy is presented as well as an analysis of the immunohistochemical differential diagnosis of the tumour specific formed spaces. PATIENTS AND METHODS: Four male patients aged 63-78 years suffered from angiosarcomas of the maxillary sinus, the bucca (two patients) and the alveolar ridge of the lower jaw. HISTOPATHOLOGY: For comparative analysis paraffin embedded tissue of the initial biopsies was available. The slides were stained with standardized H&E, PAS and Gömörri. For standardized immunohistochemistry following primary antibodies were applied: monoclonal antibodies to pancytoceratin clones AE1/AE3, alpha-smooth-muscle-actin clone 1A4, CD31 clone JC/70A, factor-VIII-related antigen clone F/86, Fli-1 (polyclonal, Zymed, USA), tenascin-C: BC4 (Prof. L. Zardi), oncofetal glucosylated fibronectin clone FDC6 (ACCR), laminin-5: D4B5. Detection using AP-ChemMate and Autostainer (Dako, Denmark). RESULTS: While the benign appearance of the lesions resulted primarily in wrong diagnoses the histopathologic examination of the biopsies revealed the characteristic pattern of angiosarcomas. Wide surgical excision, radiotherapy and/or antiangiogenic chemotherapy could not prevent tumour progression and death within two and a half years after primary diagnosis. All angiosarcomas reacted partially positive for factor-VIII-related antigen and CD31. The tumour associated structural defect of vascular lamina with partial loss of pericytes/vascular smooth muscle cells was identified immunohistochemically by alpha-smooth-muscle-actin and for the first time by tenascin-C. CONCLUSIONS: (1.) The variable presentation and the benign appearance of oral and perioral angiosarcomas may often delay diagnosis. Oral and perioral angiosarcomas show poor prognosis despite of multimodal therapy. (2.) Cytoceratin and laminin-5-positivity as typical epithelial antigens don't exclude angiosarcoma. Factor-VIII-related antigen, CD31 as well as Fli-1 identify angiosarcoma. (3.) alpha-smooth-muscle-actin and the loss of the tenascin-C-matrix indicate immunohistochemically the characteristic sarcomatous defect of differentiation.

[Drug therapy of hypertrophic cardiomyopathy]. / Medikamentöse Therapie der hypertrophischen Kardiomyopathie.

INTRODUCTION: Hypertrophy of the myocardium occurring in hypertrophic cardiomyopathy (HCM) may affect different locations of the left ventricle. If the hypertrophy is sited in the region of the basal septum, obstruction of the left ventricular outflow tract (hypertrophic obstructive cardiomyopathy [HOCM]) occurs. characteristic of left ventricular function in HCM is hypercontractility and disordered diastolic relaxation. THERAPEUTIC APPROACHES: In the medical treatment of HCM, the calcium antagonists play a leading role. They improve relaxation and, through their negative inotropic effect, decrease the intraventricular gradient. Although beta-blockers reduce the gradient in outflow tract obstruction, they do not improve relaxation. In individual cases the use of diuretics and anti-arrhythmic agents may be necessary; in the case of atrial fibrillation the use of marcumar is recommended. CAUTIONARY REMARK: In the event of dental treatment or invasive diagnostic procedures being necessary, prophylactic measures against endocarditis should be initiated.

[Hyperbaric oxygenation (HBO) in the treatment of radiogenic side effects]. / Hyperbare Oxygenierung (HBO) zur Behandlung radiogener Nebenwirkungen.

AIM: Many reports show that late complications of radiotherapy can be successfully treated by hyperbaric oxygen (HBO). This synopsis attempts to review the literature to identify areas of clinical use and further research. PATIENTS AND METHODS: Clinical and experimental data about HBO treatment of radiation late effects are analysed. Mechanisms of hyperbaric oxygen in the treatment of late radiation side effects are discussed. RESULTS: There is evidence in the literature that HBO is beneficial in the treatment of radiation cystitis, osteoradionecrosis of the mandible, hemorrhagic proctitis, soft tissue necrosis and neurologic deficits. The prophylactic use of HBO has shown to prevent the development of osteoradionecrosis after tooth removal and the loss of titanium implants in irradiated facial bones. The physiologic basis of HBO can be referred to induction of neoangiogenesis and revascularisation. CONCLUSIONS: Clinicians can be encouraged to use hyperbaric oxygen for the treatment of radiation cystitis, osteonecrosis of the mandible, hemorrhagic proctitis, soft tissue necrosis and neurologic deficits following radiation therapy.

[Circumscribed osteoatrophy of the skull--a late symptom in bruxism]. / Umschriebene Osteoatrophie des Schädels--Ein Spät-Symptom bei Bruxismus.

We present a case showing circumscribed osteoatrophy of the tabula externa and diploe of the skull following bruxism as a late symptom, which was induced by marked hypertrophy of the temporal muscle going with myogenic lockjaw.