Does an IV bolus of methylprednisolone relieve dyspnea in asthma exacerbations?

STUDY OBJECTIVES: To assess whether IV methylprednisolone exerts a specific early effect on dyspnea in patients with an exacerbation of asthma. DESIGN: Randomized, placebo-controlled, double-blind crossover trial. SETTING: Medium-sized university general hospital. PATIENTS: Twenty-five asthma patients attending the chest clinic with spontaneous complaints of increases in dyspnea and with a Borg scale dyspnea rating >/= 1 at rest. INTERVENTIONS: At 0 min, IV methylprednisolone (125 mg) vs saline solution; at 60 min, 5 x 500 microg terbutaline inhaled from an inhaler device. MEASUREMENTS AND RESULTS: Change in dyspnea was assessed with bipolar visual analog scale (VAS) (much more short of breath, -100%; much less short of breath, + 100%), FEV(1), and visual memory (using the Benton visual retention test). Eighteen subjects (mean age, 61 years) completed the study. At 5 min and 60 min, shortness of breath improved with no statistically significant difference between saline solution and methylprednisolone. The mean (SD) VAS rating at 60 min was 29% (39%) on the day that saline solution was administered and 36% (25%) on the day the steroid was administered. FEV(1) and Benton score did not significantly change from baseline on either study day. Shortness of breath and FEV(1) improved following terbutaline administration, with no significant difference between the days on which saline solution and the steroid were administered. In the seven subjects who were randomized to receive methylprednisolone on the first day, baseline dyspnea rated on the Borg scale was significantly lower on the second day (first day: median, 3; range, 3 to 4; second day: median, 2; range, 0.5 to 3; p = 0.040). CONCLUSIONS: We conclude that in patients with an exacerbation of asthma, an IV bolus of methylprednisolone does not reduce dyspnea more than saline solution after 5 min and 60 min.

Evidence based medicine and extradigestive manifestations of Helicobacter pylori.

A putative pathogenetic role has been ascribed to Helicobacter pylori in several extradigestive diseases, including vascular (atherosclerosis and ischaemic heart disease, primary Raynaud phenomenon, primary headache), autoimmune (Sjögren's syndrome, Henoch-Schönlein purpura, autoimmune thyroiditis, idiopathic arrythmias, Parkinson's disease, nonarterial anterior optic ischemic neuropathy), and skin diseases (chronic idiopathic urticaria, rosacea, alopecia areata), sideropenic anemia, growth retardation, late menarche, extragastric MALT lymphoma, diabetes mellitus, hepatic encephalopathy, sudden infant death syndrome, and anorexia of aging. We examine critically the strength of the evidence linking these diseases to Helicobacter pylori, using ischaemic heart disease as an example of epidemiological techniques, and skin diseases as an example of treatment studies. By the standards of evidence-based medicine, studies have been often of low quality. The best evidence usually is not indicative of a role for Helicobacter pylori in these diseases.

Prevalence of dentofacial characteristics in a belgian orthodontic population.

The aim of this retrospective study was to provide quantitative information on the prevalence of dentofacial characteristics to find correlations between them and to determine the orthodontic treatment need in a Belgian orthodontic population. Data were acquired from 1,477 patients who had initial records made at the Department of Orthodontics, Katholieke Universiteit Leuven, Belgium between February 1983 and June 1997. The prevalence of Angle Class I, Class II div. 1, Class II div. 2 and Class III malocclusions was, respectively, 31%, 52%, 11% and 6%. The male-to-female ratio was 4:6. Spacing and trauma to teeth occurred more in males than in females. The prevalence of the following dentofacial characteristics was significantly different between the Angle classes: segmental crossbite; crossbite of one tooth; facial asymmetry; protral and lateral mandibular shift; horizontal and vertical growth patterns, impacted teeth; traumatised teeth; ectopically erupting canines; age at first records. No significant difference in the prevalence of the Angle classes between the sexes was found. Several clinically relevant correlations were found between the examined dentofacial characteristics. This Belgian orthodontic population from the Leuven region seems to be comparable to other orthodontic populations in Europe.

Skeletal and dento-alveolar stability after surgical-orthodontic treatment of anterior open bite: a retrospective study.

The aim of this investigation was to assess skeletal and dento-alveolar stability after surgical-orthodontic correction of skeletal anterior open bite treated by maxillary intrusion (group A) versus extrusion (group B). The cephalometric records of 49 adult anterior open bite patients (group A: n = 38, group B: n = 11), treated by the same maxillofacial surgeon, were examined at different timepoints, i.e. at the start of the orthodontic treatment (T1), before surgery (T2), immediately after surgery (T3), early post-operatively (+/- 20 weeks, T4) and one year post-operatively (T5). A bimaxillary operation was performed in 31 of the patients in group A and in six in group B. Rigid internal fixation was standard. If maxillary expansion was necessary, surgically assisted rapid palatal expansion (SRPE) was performed at least 9 months before the Le Fort I osteotomy. Forty-five patients received combined surgical and orthodontic treatment. The surgical open bite reduction (A, mean 3.9 mm; B, mean 7.7 mm) and the increase of overbite (A, mean 2.4 mm; B, mean 2.7 mm), remained stable one year post-operatively. SNA (T2-T3), showed a high tendency for relapse. The clockwise rotation of the palatal plane (1.7 degrees; T2-T3), relapsed completely within the first post-operative year. Anterior facial height reduction (A, mean -5.5 mm; B, mean -0.8 mm) occurred at the time of surgery. It can be concluded that open bite patients, treated by posterior Le Fort I impaction as well as with anterior extrusion, with or without an additional bilateral sagittal split osteotomy (BSSO), one year post-surgery, exhibit relatively good clinical dental and skeletal stability.