[Non-surgical peri-implantitis treatment with or without systemic antibiotics]. / Initiële behandeling van peri-implantitis met of zonder systemische antibiotica.

This study investigated the effect of initial nonsurgical treatment in patients with peri-implantitis with or without prescription of an antibiotic regimen consisting of amoxicillin and metronidazole. For this purpose, patients with peri-implantitis were randomized into a group of initial treatment with antibiotics and a group without antibiotics. They were re-evaluated 12 weeks after treatment. Analyses were performed at the patient level at 1 peri-implant pocket per patient. Both groups showed significant peri-implant pocket depth reductions after initial treatment. Treatment with antibiotics resulted in a higher mean reduction in peri-implant pocket depth than when no antibiotics were used, but this difference did not reach statistical significance. Only 2 implants, 1 in each group, showed a successful outcome of a peri-implant pocket depth ofunder ≤ 5 mm and with an absence of bleeding and pus after probing. Initial treatment with or without antibiotics is ultimately not sufficient to fully treat peri-implantitis; additional surgical procedures will often be required.

[A woman with a non-healing wound on the nose]. / Een vrouw met een niet-genezend wondje op de neus.

A 57-year-old woman presented with a progressive ulceration of her left nasal ala. We made the diagnosis of trigeminal trophic syndrome. This rare disorder may develop after injury of the trigeminal nerve, which causes local paraesthesia. Subsequent manipulation - whether intentional or unintentional - results in ulceration.

Transmission optical coherence tomography based measurement of optical material properties.

We present transmission optical coherence tomography (transmission OCT) as a versatile tool to measure optical material properties of turbid media. The transmission OCT signal is described in detail and it is demonstrated how the group refractive index (n(g)), group velocity dispersion (GVD) and optical attenuation can be determined from this signal. We experimentally validate the refractive index properties of glasses, liquids and glucose water solutions in terms of n(g) and GVD. Measurements of scattering coefficients are determined using transmission OCT for suspensions of silica particles. Quantitative agreement is obtained with a dependent scattering model, both for the average as well as the wavenumber resolved optical attenuation coefficient. Good agreement is observed between our measurements and literature values.

Comparing culture, real-time PCR and fluorescence resonance energy transfer technology for detection of Porphyromonas gingivalis in patients with or without peri-implant infections.

BACKGROUND AND OBJECTIVE: The aim of the study was to compare the detection of Porphyromonas gingivalis using a fluorescence resonance energy transfer (FRET) technology with commonly used diagnostic methods in salivary and subgingival plaque samples from subjects with dental implants. P. gingivalis was considered as a marker for a pathogenic microbiota. MATERIAL AND METHODS: Ninety-seven adult subjects were recruited, including periodontally healthy controls with no dental implants, implant controls with no peri-implant disease and patients with peri-implant disease. Saliva and subgingival/submucosal plaque samples were collected from all subjects and were analyzed using culture, real-time PCR and FRET technology employing P. gingivalis-specific substrates. RESULTS: It was found that the P. gingivalis-specific substrates were highly suitable for detecting the presence of P. gingivalis in saliva and in subgingival plaque samples, showing comparable specificity to culture and real-time PCR. CONCLUSION: We applied the FRET technology to detect P. gingivalis in implant patients with or without an implant condition and in controls without implants. The technique seems suitable for detection of P. gingivalis in both plaque and saliva samples. However, with all three techniques, P. gingivalis was not very specific for peri-implantitis cases. Future work includes fine-tuning the FRET technology and also includes the development of a chair-side application.

Pain-relieving properties of topically applied morphine on arterial leg ulcers: a pilot study.

OBJECTIVE: To assess whether topical morphine is pharmacologically effective in relieving pain from ulcers caused by arterial insufficiency and identify whether this effect is centrally or peripherally mediated. METHOD: The analgesic effect of a topically applied hydrogel containing 0.5% of morphine was evaluated in a double-blind, placebo-controlled, three-way crossover pilot study involving nine patients with painful arterial leg ulcers. All patients had a baseline pain intensity of at least 5 on a 10-point numeric rating scale. They received the following three treatments in random order: morphine hydrogel plus a subcutaneous (SC) placebo infusion; placebo gel plus a SC infusion of 5mg morphine over six hours and a placebo gel plus a SC placebo infusion. Each treatment lasted one day. Pain was assessed during the first 24 hours after application of the hydrogel and the start of the subcutaneous infusion. RESULTS: There was a statistically significant difference between average baseline pain scores and those reported during treatment, but this difference was not clinically relevant. The three treatments did not differ in terms of the pain relief provided. CONCLUSION: Topical morphine does not have a clinically relevant analgesic effect in patients with painful arterial leg ulcers. Further research should focus on ulcers of other aetiology.

The importance of patency of the infarct-related artery in treatment of patients with acute myocardial infarction.

OBJECTIVE: To study the impact of patency of the infarct-related artery on the coronary angiogram, both before and after primary angioplasty for acute myocardial infarction, on 30-day mortality. METHOD: Data of 1702 consecutive patients treated with primary angioplasty for acute myocardial infarction were collected prospectively from 1994 to 2000. RESULTS: Patients with a (partially) patent infarct artery before primary angioplasty had less damage to the myocardium and a lower 30-day mortality (1.6% versus 3.4%, p=0.04) compared with patients with an occluded artery. Patients with pre-hospital treatment with aspirin and heparin more often presented with a patent artery before angioplasty (31% versus 20%, p<0.001). After primary angioplasty, 95% of patients had a patent artery with a 30-day mortality of 2.2%. The 5% of patients with failed angioplasty had extensive myocardial damage and a 30-day mortality rate of 17%. CONCLUSION: Patency of the infarct-related artery on the coronary angiogram, both before and after primary angioplasty, has a major impact on 30-day mortality.

Myocardial ischaemia with a normal coronary angiogram due to the primary antiphospholipid syndrome.

In this case report, we describe a 33-year-old woman with a history of two unprovoked thrombo-embolic events presenting with acute myocardial ischaemia. She had a normal coronary angiogram (CAG). The diagnosis primary antiphospholipid syndrome (APS), an acquired hypercoagulability disorder, was established by the presence of antibodies directed against phospholipids. The primary APS should be considered as a cause of myocardial ischaemia in patients with a normal CAG and a history of unprovoked thrombo-embolic events.

[Anaphylactic shock after injection of patent blue for sentinel lymph node biopsy]. / Anafylactische shock na injectie van patentblauw voor schildwachtklieronderzoek.

After being diagnosed with a melanoma, an 18-year-old woman developed anaphylactic shock following an intracutaneous injection of patent blue during a sentinel lymph node biopsy procedure. Intracutaneous allergy tests revealed positive reactions with patent blue (Bleu patenté V 'Guerbet') as well as with several anaesthetics and morphine. It was concluded that patent blue was the most probable causative agent for the anaphylactic reaction and that the possibility of such a reaction should be taken into consideration during sentinel node procedures. After a few days the operation was completed under epidural anaesthesia with technetium Tc 99m sulphur colloid being used to detect the sentinel node.

[A female patient with Werner's syndrome]. / Een patiënte met het syndroom van Werner.

We describe a 42-year old female with Werner's syndrome, an autosomal recessive connective tissue disorder, characterised, in her case, by juvenile cataract, chronic ulcers on the feet, characteristic skin changes, a typical appearance of the face ('bird-like face'), severe deformities of the feet, generalised osteoporosis, soft tissue calcifications and a high pitched hoarse voice. Werner's syndrome has to be distinguished from systemic sclerosis in particular. No causal therapy is available.

[Validation of the gas exchange monitoring function of the Engström Elvira respirator]. / Validierung der Gasaustausch Monitoringfunktion des Engström-Elvira-Beatmungsgeräts.

Gas exchange monitoring (GEM) has only recently become available for routine use on ventilated patients. Engström has introduced a new concept of integrated gas exchange monitoring within the Elvira respirator, optionally combined with an external CO2 monitor. The following paper describes a laboratory validation of a prototype of this device with regard to the influence of respiratory variables within their specified ranges: FIO2 0.2-0.6, FIO2-FEO2 (DFO2) 0.02-0.05, FECO2 0.02-0.05, VI 5-20 l/min, p 10-60 mbar, respiratory rate 7-29, VT 500-2,000 ml, inspiratory flow 25-90 l/min, relative humidity 5% and 55%. VO2 and VCO2 (100-700 ml/min) were simulated by gas dilution at a respiratory quotient of 1 using a 'bag-in-the-bottle' test lung for 48 test situations. Two reference measurements per test situation were carried out by mass spectrometry and wet-gas spirometry. The Elvira GEM function uses a self-calibrating fuel cell for FO2 detection, an external infrared CO2 monitor (Eliza) for FECO2 measurement, and differential pressure detection on a venturi principle for inspiratory flow measurement. VI measurement necessitates the use of the Haldane transformation for VO2 and VCO2 calculation. The VO2 (VCO2) repeatability coefficient (2 s) for the reference method was 5.6 (5.5) ml/min compared to 10.3 (10.35) ml/min for the GEM function. The mean relative methodical difference for VO2 (VCO2) was +19% (+4.1%) with limits of agreement (+/- 2 s) of +/- 13% (+/- 8.7%). The systematical difference for VCO2 as well as the variability within different test situations was in an acceptable range for clinical measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

Extreme diffuse adenomatous hyperplasia of Brunner's glands: case report.

A case of extreme diffuse adenomatous hyperplasia of Brunner's glands was clinically manifested by melena and anemia. Diagnosis was established by barium studies, endoscopy, ultrasonography, computerized tomography, and histology. The radiologic, clinical, pathologic, and differential diagnostic features are reviewed.

Complement fixation and neutralization RS antibodies in maternal and neonatal sera.

RSV complement fixation antibodies were established in 200 paired maternal and cord blood sera. Geometric mean titres in cord sera were significantly higher than in matermal sera. The differences did not depend on the virus strain used. Half of the paired sera (taken at random) were also submitted to microneutralization tests. No differences were found between geometric mean titres in maternal and cord sera.

Infantile convulsions: transient infantile hypocalcemia associated with skeletal deformities.

An infant with skeletal deformities and hypocalcemic convulsions is described. The convulsions, which were first noted in the 5th week of life, as well as the low serum calcium level were transient. The skeletal deformities consited of deformation of the terminal phalanges of the right third finger and right second toe, syndactyly of the third and fourth finger of both hands and left pes equinovarus. X-ray examination revealed abnormal shape and structure of some bones of the hands. The most likely diagnosis is transient congenital idiopathic hypoparathyroidism, which has not yet been described in association with congenital skeletal anomalies.