Triptans for treatment of acute pediatric migraine: a systematic literature review.

The purpose of this article is to evaluate the effectiveness and safety of triptans for the treatment of acute migraine in children and adolescents. Randomized and open label trials of triptans in acute pediatric patients (ages 6-18 years) were identified by Medline (1966-2002) and PubMed (1991-2002). Additional reports were identified from the reference list of the retrieved studies. To study effectiveness, only randomized controlled trials were included, but open label studies were also included to study adverse effects. Pharmacokinetic studies of triptans in pediatric patients were also searched. Four randomized controlled trials were identified. One study reported oral sumatriptan, another oral rizatriptan, and two studies reported nasal spray sumatriptan. Rizatriptan is well tolerated but not clearly beneficial when used in adolescents. Effectiveness of nasal spray sumatriptan in acute pediatric migraine where other medications had failed was supported. Effectiveness of oral sumatriptan was not established. Adverse effects were minor for oral sumatriptan and rizatriptan and nasal sumatriptan. Pharmacokinetics of sumatriptan in pediatric patients has not been established. In conclusion, nasal spray sumatriptan should be considered in acute pediatric migraine in patients not experiencing adequate relief with other interventions.

An evaluation and comparison of orthodontic bracket bond strengths achieved with self-etching primer.

The bonding of orthodontic brackets to enamel is a multistep process. To simplify bonding and decrease chair time, Transbond Plus Self-Etching Primer (3M Unitek, Monrovia, Calif) has been introduced; the primer combines the etching, rinsing, and priming steps. This in vitro study evaluated the shear bond strengths and interoperator variability of self-etching primer, as compared with conventional phosphoric acid etching with 2 common orthodontic resins. A total of 214 teeth were bonded, according to the following protocols: group A: self-etching primer plus Transbond XT light-cured resin (3M Unitek); group B: 35% phosphoric acid (15 seconds) plus Transbond XT resin; and group C: 37% phosphoric acid (15 seconds) plus Enlight bonding resin (Ormco, Glendora, Calif). Significantly higher bond strengths were seen in group B than in group A (P =.004) and group C (P =.002). The mean shear bond strengths of group A were not significantly different from those of group C (P =.99). When 3 orthodontists bonded a total of 60 premolars using the protocols of groups A and B, significant differences in shear bond strengths and strength ranking were found. The mean values they obtained using the self-etching primer were not significantly different, but significant differences in mean values were found between operators when the phosphoric acid-etching technique was used.