Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report.

BACKGROUND: Drug-induced aseptic meningitis is a rare, but challenging diagnosis, most commonly reported with nonsteoroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Trimethoprim/sulfamethoxazole (TMP/SMX) is a sulfonamide that is widely used in clinical practice for the treatment and prophylaxis of various infections. The most common side effects associated with TMP/SMX are generally mild and self-limited, but serious side effects have been reported, including liver injury and aseptic meningitis. CASE PRESENTATION: We report a 2,5 year old Dutch girl with both drug-induced aseptic meningitis and drug-induced liver injury while using TMP/SMX prophylaxis. Ursodeoxycholic acid was started because of cholestatic injury. After cessation of TMP/SMX, full convalescence was reached within weeks. CONCLUSIONS: This is the first report of a young patient with both aseptic meningitis and drug-induced liver injury caused by TMP/SMX. Drug-induced aseptic meningitis and cholestatic hepatitis constitute a considerable diagnostic challenge to clinicians. In addition to a thorough evaluation for infectious causes, clinicians should be aware of drug-induced aseptic meningitis and cholestatic hepatitis.

Postoperative pain after ultrasonically and laser-activated irrigation during root canal treatment: a randomized clinical trial.

AIM: To compare the intensity of postoperative pain after primary root canal treatment of asymptomatic teeth when using ultrasonically (UAI) or laser-activated irrigation (LAI). METHODOLOGY: In this superiority randomized clinical trial (ClinicalTrials.gov ID: NCT03981237) with parallel design, fifty-six patients with an asymptomatic tooth in need of primary root canal treatment were enrolled. After chemo-mechanical canal preparation using rotary instruments and NaOCl irrigation, teeth were randomly assigned to two groups and patients were blinded to the final irrigation protocol. In the UAI group (n = 28), 60s activation with an Irrisafe tip was done per canal. In the LAI group (n = 28), NaOCl was activated with a pulsed Er:YAG (2940 nm) laser, equipped with a conical tip, with settings of 50 µs, 20 mJ at 15 Hz for 60 s. Patients recorded their pain intensity 6, 24, 48 and 72 h after treatment on a 100 mm visual analogue scale (VAS), as well as their analgesic consumption. Pain levels and incidence were compared across groups using the Mann-Whitney U-test and chi-square test. RESULTS: Overall, mean postoperative pain intensity was low, with the majority of patients having no or minimal pain 24 h postoperatively. At 6 h postoperatively, pain intensity and incidence were significantly higher in the UAI group compared to the LAI group (P < 0.05). For the other time intervals, no significant differences in postoperative pain incidence or intensity were found. The frequency of analgesic intake did not differ significantly between the two groups. Neither of the activation methods resulted in any adverse effects. CONCLUSIONS: Ultrasonically and laser-activated irrigation resulted in low and comparable levels of postoperative pain in asymptomatic patients receiving primary root canal treatment.

Biofilm model systems for root canal disinfection: a literature review.

The aim of this review was to present an overview of laboratory root canal biofilm model systems described in the endodontic literature and to critically appraise the various factors that constitute these models. The electronic databases MEDLINE, Web of Science and EMBASE were searched up to and including December 2016 to identify laboratory studies using endodontic biofilm models. The following search terms were used in various combinations: biofilm, root canal, in vitro, endodontic, bacteria, root canal infection model, colony-forming unit. Only English papers from journals with an impact factor were selected. The records were screened by two reviewers, and full-text articles were assessed according to pre-defined criteria. The following data were extracted from the included studies: the microbial composition of the biofilm, the substrate, growth conditions, validation and quantification. Seventy-seven articles met the inclusion criteria. In the majority (86%) of the studies, a monospecies biofilm was cultured. In two studies, a dual-species biofilm was grown; others cultivated a multispecies biofilm, containing at least three species. Enterococcus faecalis was the most frequently used test species (in 79% of all studies, 92% of the monospecies studies). Four studies used an inoculum derived directly from the oral cavity. Human dentine was the most frequently used substratum (88% of the studies). Incubation times differed considerably, ranging from one to seventy days. The most common quantification method (in 87% of the studies) was bacterial culturing, followed by microscopy techniques. The variation in laboratory root canal biofilm model systems is notable. Because of substantial variation in experimental parameters, it is difficult to compare results between studies. This demonstrates the need for a more standardized approach and a validated endodontic biofilm model.

Efficacy of sonically, ultrasonically and laser-activated irrigation in removing a biofilm-mimicking hydrogel from an isthmus model.

AIM: To evaluate the efficacy of sonically, ultrasonically and laser-activated irrigation (LAI) in removing a biofilm-mimicking hydrogel from the isthmus in a root canal model. METHODOLOGY: Transparent resin blocks containing two standardized root canals (apical diameter of 0.3 mm, 6% taper, 16 mm long, with a coronal reservoir) connected by an isthmus (0.15 mm wide, 2 mm high) were used as the test model. The isthmus was filled with a hydrogel-containing dentine debris. The canals were filled with irrigant, and the models were randomly assigned to the following activation groups (n = 20): EndoActivator (EA), Eddy, ultrasonically activated irrigation (UAI) with an Irrisafe 25 mm length, size 25 file and LAI with a 2940 nm Er:YAG-laser (20 Hz, 50 µs, 20 mJ, PIPS tip at the canal entrance). All protocols were executed for 3 × 20 s. Needle irrigation (NI) with a 27G needle served as the control. Standardized images of the isthmus were taken before and after irrigation, and the amount of removed hydrogel was determined using image analysis software and compared across groups using Welch anova (P ≤ 0.05). RESULTS: Hydrogel removal was greatest in the LAI group (90.2%) and was significantly greater than that with UAI, EA and NI (P ≤ 0.014), but not significantly different from Eddy (P = 0.498). Hydrogel removal with Eddy (85.9%) was significantly greater than that with NI and EA (P < 0.05), but not significantly different from UAI (P = 0.07). There was no significant difference between the NI and EA groups (P = 1). CONCLUSIONS: Laser-activated irrigation and Eddy resulted in the greatest hydrogel removal and performed better than EA and UAI. The effect of LAI was also not dependent on deep intracanal tip placement.

Effect of laser-activated irrigation on biofilms in artificial root canals.

AIM: To evaluate the antimicrobial effect of laser-activated irrigation (LAI) on biofilms formed in simulated root canals. METHODOLOGY: A dual-species biofilm of Enterococcus faecalis and Streptococcus mutans was grown in a resin root canal model. Biofilms were formed over 48 h and subsequently subjected to the following treatments, all executed for 20 s: syringe irrigation (SI) with a 27G needle, ultrasonically activated irrigation (UAI) with a size 20 Irrisafe file, and LAI with a 2940 nm Er:YAG laser (20 Hz, 50 µs, 20 or 40 mJ, conical fibre tip at two positions). Tests were performed with both sterile saline as well as NaOCl (2.5%) as the irrigant. Surviving bacteria were harvested and the number of CFU was determined by plate counting and compared across groups (anova, P ≤ 0.05). RESULTS: Using saline as the irrigant, significant reductions in viable counts compared to untreated controls were observed for ultrasonically activated irrigation (0.52 log10 reduction) and for all laser-activated irrigation groups (>1 log10 reduction), but not for syringe irrigation (<0.25 log10 reduction). The reductions in the laser-activated irrigation groups were significantly greater than those of ultrasonically activated irrigation. With NaOCl as the irrigant, significant reductions (>2.2 log10 units) in the number of attached bacteria were observed for all treatment groups with no significant differences between laser-activated and ultrasonically activated irrigation. CONCLUSIONS: Within the limitations of this in vitro set-up, laser-activated irrigation removed more biofilm than ultrasonically activated irrigation when using saline as the irrigant, indicating greater physical biofilm removal. The use of NaOCl resulted in greater biofilm reduction with no significant differences between treatment groups.

Hard tissue debris removal from the mesial root canal system of mandibular molars with ultrasonically and laser-activated irrigation: a micro-computed tomography study.

This study is to investigate the efficacy of different irrigant activation techniques on removal of accumulated hard tissue debris (AHTD) in mesial roots of human mandibular molars. Extracted human mandibular molars with an isthmus between the mesial root canals were selected based on micro-CT (µCT) scans. The mesial canals were instrumented to an apical diameter ISO30 using ProTaper rotary files. Teeth were randomly assigned to three irrigant activation groups (n = 10): ultrasonically activated irrigation (UAI) using a size 20 Irrisafe for 3 × 20 s, laser-activated irrigation (LAI) with an Er:YAG laser (2940 nm) and plain 300 µm fiber tip inside the canal (20 mJ, 20 Hz, 3 × 20 s), and laser-activated irrigation with identical parameters with a 400 µm photon-induced photoacoustic streaming (PIPS) tip held at the canal entrance. All teeth were scanned with µCT before and after instrumentation and after irrigant activation. After reconstruction and image processing, the canal system volume filled with hard tissue debris before and after irrigant activation was calculated. Changes in hard tissue debris volumes were compared between groups using one-way ANOVA. The percentage volume of hard tissue debris (vol%) was significantly lower after irrigant activation in all groups. Although the lowest debris values were observed in the laser groups, no significant differences in the vol% of accumulated hard tissue debris after activation were observed between groups. Accumulated hard tissue debris was reduced significantly in all activation groups. Ultrasonically and laser-activated irrigation regimens performed similarly in this respect. None of the tested methods was able to render the root canal systems free of debris.

Endodontic performance by Flemish dentists: have they evolved?

AIM: To gather information on aspects of endodontic practice and referral behaviour by Flemish (Dutch-speaking Belgian) dentists and to compare the results with an earlier investigation. METHODOLOGY: A postal questionnaire was distributed to 4468 active Flemish dentists. It consisted of multiple-choice questions on endodontic practice and endodontic referral need. Basic information on age, gender, year of qualification and clinical specialty was also obtained. The questionnaire was free of charge to return. Data were imported in a database, subjected to descriptive and analytical statistics and compared to those of an earlier, comparable survey. RESULTS: The response rate was 18.5%. Of all respondents, 95% were general practitioners. More than half (56%) of the respondents never or seldom used rubber dam during endodontic treatment. The use of sodium hypochlorite as an irrigant was well established (80% of respondents using it), whereas the use of EDTA was limited. Female respondents were more likely to refer to an endodontist than male (70 versus 49%). Referrals for treatment of root canal obstruction (48%), perforations and root resorption (42%) and retreatment (39%) were rated 'very important'. Younger respondents more frequently made use of magnification, rotary instruments and rubber dam. Activation of irrigants was incorporated by a small number of respondents (50% never, 12.6% seldom). Cold lateral condensation was used by most GDPs (35.3% always, 19.5% frequently). CONCLUSIONS: Endodontic practice of general dentists in Flanders did not always comply with quality guidelines. However, when comparing the present data with those of a previous study, an obvious trend towards a more present-day treatment protocol is noticeable, as well as an increased appeal for endodontic referral.

Effects of root surface debridement using Er:YAG laser versus ultrasonic scaling - a SEM study.

OBJECTIVE: Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment. MATERIALS AND METHODS: Sixty-four teeth were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60, 100, 160 or 250 mJ pulse(-1) and at 10 Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration (d) was also recorded. RESULTS: Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was n 60 mJ = n 100 mJ < n 160 mJ < n 250 mJ (P < 0.001). Also 160 and 250 mJ lasers led to significantly more dentinal exposure than ultrasound under in vivo condition. Within the in vitro laser groups, dentinal tubules exposure was n 60 mJ < n 100 mJ < n 160 mJ < n 250 mJ (P ≤ 0.0015). Furthermore, in vitro laser treatments at 100, 160 and 250 mJ led to significantly more dentinal denudation than ultrasound. Treatment duration (d) for the in vivo groups was d 60 mJ > d 100 mJ > d Ultrasound = d 160 mJ > d 250 mJ (P ≤ 0.046), while for the in vitro groups it was d 60 mJ > d 100 mJ = d Ultrasound = d 160 mJ >d 250 mJ (P ≤ 0.046). CONCLUSIONS: Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250 mJ pulse(-1), respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160 mJ pulse(-1) seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.

Evaluation of Nd:YAG and Er:YAG irradiation, antibacterial photodynamic therapy and sodium hypochlorite treatment on Enterococcus faecalis biofilms.

AIM: To compare the antimicrobial efficacy of two-high power lasers (Nd:YAG and Er:YAG) and two commercial antimicrobial photodynamic therapy (aPDT) systems with that of sodium hypochlorite (NaOCl) action on Enterococcus faecalis biofilms grown on dentine discs. METHODOLOGY: Enterococcus faecalis biofilms were grown on dentine discs in a microtiter plate, incubated for 24 h and subjected to the following treatments: aPDT (Denfotex and Helbo system), Er:YAG laser irradiation (2940 nm, 50 mJ or 100 mJ, 15 Hz, 40 s), Nd:YAG laser irradiation (1064 nm, 2 W, 15 Hz, 40 s) and immersion in 2.5% (w/v) NaOCl for 1, 5, 10 and 30 min. Surviving bacteria were harvested, and the number of CFU per disc was determined by plate counting. RESULTS: Significant reductions (anova, P ≤ 0.05) in viable counts were observed for aPDT (Helbo) (2 log(10) reduction), Er:YAG irradiation using 100 mJ pulses (4.3 log(10) reduction) and all NaOCl treatments (>6 log(10) reduction). NaOCl (2.5%) for 5 min effectively eliminated all bacteria. aPDT (Denfotex), Er:YAG irradiation using 50 mJ pulses and Nd:YAG treatment caused a reduction in the viable counts of <1 log(10) unit; these results were not significantly different from the untreated controls. CONCLUSION: Within the limitations of this particular laboratory set-up, NaOCl was the most effective in E. faecalis biofilm elimination, while Er:YAG laser treatment (100 mJ pulses) also resulted in high reductions in viable counts. The use of both commercial aPDT systems resulted in a weak reduction in the number of E. faecalis cells. Nd:YAG irradiation was the least effective.

Long-term sealing ability of Resilon apical root-end fillings.

AIM: To evaluate ex vivo the long-term sealing ability of the SE Resilon Epiphany system as an apical root-end filling material. METHODOLOGY: A total of 60 standardized horizontal bovine root sections were divided into three groups filled with either gutta-percha with AH 26, tooth-coloured mineral trioxide aggregate (MTA) or Resilon pellets with Epiphany SE, and submitted to capillary flow porometry at 48 h, 1 and 6 months to assess the minimum, mean flow and maximum pore diameters. Results of the different materials and results by material and time were analysed statistically using nonparametric tests; the level of significance was set at 0.05. RESULTS: Resilon had smaller pore diameters than gutta-percha and MTA at 48 h and smaller mean flow and maximum pore diameters than gutta-percha and MTA at 1 month. At 6 months Resilon had larger minimum pore diameters than gutta-percha. Although not always statistically significant, the minimum, mean flow and maximum pore diameters of gutta-percha and MTA diminished with time. This was not the case for Resilon, where the same parameters increased. CONCLUSIONS: All materials leaked at all times. Resilon performed better than gutta-percha and MTA in the short-term, but the seal of MTA and gutta-percha improved over time whereas the seal of Resilon deteriorated. It is critical to evaluate the performance of materials in the long-term contrary to most studies which are short-term.

Effectiveness of different laser systems to kill Enterococcus faecalis in aqueous suspension and in an infected tooth model.

AIM: To assess the antibacterial action of laser irradiation (Nd:YAG, KTP), photo activated disinfection (PAD) and 2.5% sodium hypochlorite (NaOCl) on Enterococcus faecalis, in an aqueous suspension and in an infected tooth model. METHODOLOGY: Root canals of 60 human teeth with single straight canals were prepared to apical size 50, autoclaved, inoculated with an E. faecalis suspension and incubated for 48 h. They were randomly allocated to four treatment and one control groups. After treatment, the root canals were sampled by flushing with physiological saline, and the number of surviving bacteria in each canal was determined by plate count and solid phase cytometry. The same experimental or control treatments were completed on aqueous suspensions of E. faecalis, and the number of surviving bacteria was determined in the same way. RESULTS: In aqueous suspension, PAD and NaOCl resulted in a significant reduction in the number of E. faecalis cells (P < 0.001), whilst Nd:YAG or KTP had no effect. In the infected tooth model, only the PAD and NaOCl treated teeth yielded significantly different results relative to the untreated controls (P < 0.001). CONCLUSIONS: The laser systems as well as PAD were less effective than NaOCl in reducing E. faecalis, both in aqueous suspension and in the infected tooth model.

Frequency doubled neodymium:yttrium-aluminum-garnet and diode laser-activated power bleaching--pH, environmental scanning electron microscopy, and colorimetric in vitro evaluations.

Corrosiveness of enamel surfaces of Smartbleach, Opus White, Opalescense Xtra Boost and a gel containing titanium dioxide (TiO(2)) particles, activated either by a frequency doubled neodymium: yttrium-aluminum-garnet (Nd:YAG) laser (532 nm) or a diode laser (810 nm) was evaluated by environmental scanning electron microscopy (ESEM). Changes in teeth color shades and the pH were also evaluated. Each bleaching agent was laser activated for 30 s and removed after 1 min or 10 min. This procedure was repeated up to four times, the bleaching agent receiving a maximum application time of 40 min, with total irradiation times of 0.5 min to 2 min of laser activation. The results of the pH measurements showed that only Smartbleach was in the alkaline pH range, whereas the other three were acidic. The surface effects were unrelated to the pH of the bleaching agents. With the exception of Opus White, no severe alterations on the enamel surface were detected. Although short application times were chosen, improved changes in brightness of up to ten steps on the Vitapan classical shade guide were detected.

Laser-induced vapor nanobubbles improve diffusion in biofilms of antimicrobial agents for wound care.

Being responsible for delayed wound healing, the presence of biofilms in infected wounds leads to chronic, and difficult to treat infections. One of the reasons why antimicrobial treatment often fails to cure biofilm infections is the reduced penetration rate of antibiotics through dense biofilms. Strategies that have the ability to somehow interfere with the integrity of biofilms and allowing a better penetration of drugs are highly sought after. A promising new approach is the use of laser-induced vapor nanobubbles (VNB), of which it was recently demonstrated that it can substantially enhance the penetration of antibiotics into biofilms, resulting in a marked improvement of the killing efficiency. In this study, we examined if treatment of biofilms with laser-induced vapor nanobubbles (VNB) can enhance the potency of antimicrobials which are commonly used to treat wound infections, including povidone-iodine, chlorhexidine, benzalkonium chloride, cetrimonium bromide and mupirocin. Our investigations were performed on Pseudomonas aeruginosa and Staphylococcus aureus biofilms, which are often implicated in chronic wound infections. Pre-treatment of biofilms with laser-induced VNB did enhance the killing efficiency of those antimicrobials which experience a diffusion barrier in the biofilms, while this was not the case for those compounds for which there is no diffusion barrier. The magnitude of the enhanced potency was in most cases similar to the enhancement that was obtained when the biofilms were completely disrupted by vortexing and sonication. These results show that laser-induced VNB are indeed a very efficient way to enhance drug penetration deep into biofilms, and pave the way towards clinical translation of this novel approach for treatment of wound infections.

Safety Irradiation Parameters of Nd:YAP Laser Beam for Endodontic Treatments: An In Vitro Study.

Objective. Nd:YAP laser has several potentialities of clinical applications in endodontics. The aim of our study is to determine the safety range of irradiation parameters during endodontic application of Nd:YAP laser that can be used without damaging and overheating the periodontal tissue. Material and Methods. Twenty-seven caries-free single-rooted extracted human teeth were used. Crowns were sectioned to obtain 11 mm root canal length. Temperature increases at root surfaces were measured by a thermocouple during Nd:YAP laser irradiation of root canals at different energy densities. Canal irradiation was accomplished with a circular and retrograde movement from the apex until the cervical part of the canal during 10 seconds with an axial speed of 1 mm/s. Each irradiation was done in a canal irrigated continuously with 2.25% NaOCl solution. Results. Periodontal temperature increase depends on the value of energy density. Means and standard deviations of temperature increases at root surfaces were below 10°C (safe threshold level) when the average energy densities delivered per second were equal to or below 4981 J/cm(2) and 9554 J/cm(2), respectively, for irradiations using a fiber diameter of 320 µm and 200 µm. Conclusions. Within the limitations of this study and under specific irradiation conditions, Nd:YAP laser beam may be considered harmless for periodontal tissues during endodontic applications.

Prospective assessment of clinical symptoms associated with enterovirus and parechovirus genotypes in a multicenter study in Dutch children.

BACKGROUND: Human non-polio enterovirus (EV) and human parechovirus (HPeV) are important pathogens of viral infection and aseptic meningitis in children. The aim of this study is to prospectively compare the incidence, clinical signs, blood and cerebrospinal fluid in EV and HPeV infected children. OBJECTIVES: To compare the clinical symptoms and laboratory data of children with different EV and HPeV genotypes. STUDY DESIGN: This study is part of a multicenter prospective cohort study. Children were included in 3 different hospitals in The Netherlands from 2008 to 2011. RESULTS: Of 285 included patients, 140 (49%) had EV and 44 (15%) HPeV infection. Of children with EV infection 9 (6%) had EV-A, 109 (78%) EV-B, 12 (9%) had a non-type able EV and in 10 (7%) no genotyping was performed. Of children with HPeV infection, 24 (55%) had HPeV-3, 6 (14%) HPeV-1, 2 (5%) HPeV-4 and 1 (2%) HPeV-6. Meningitis was more frequent in EV than in HPeV infected children (54% vs. 36%, p=0.046), and in EV-B than EV-A infected children (60 vs. 33%). In contrast gastroenteritis was more frequent in HPeV than EV infected children (30% vs. 15%, p=0.030), and significantly more in HPeV-1 than HPeV-3 infected children (p<0.001). CONCLUSIONS: EV infection is more often associated with meningitis and HPeV infection more often with a gastro-enteritis. EV genotype B infection is more often associated with meningitis than EV genotype A infection. HPeV-1 infection was more often associated with gastroenteritis than HPeV-3 infection.

A Belgian Survey on Geriatric Assessment in Oncology Focusing on Large-Scale Implementation and Related Barriers and Facilitators.

OBJECTIVES: The aim of this study is to describe a large-scale, Belgian implementation project about geriatric assessment (=GA) in daily oncology practice and to identify barriers and facilitators for implementing GA in this setting. Design / setting / participants: The principal investigator of every participating hospital (n=22) was invited to complete a newly developed questionnaire with closed- and open-ended questions. The closed-ended questions surveyed how GA was implemented. The open-ended questions identified barriers and facilitators for the implementation of GA in daily oncology practice. Descriptive statistics and conventional content analysis were performed as appropriate. RESULTS: Qualifying criteria (e.g. disease status and cancer type) for GA varied substantially between hospitals. Thirteen hospitals (59.1%) succeeded to screen more than half of eligible patients. Most hospitals reported that GA data and follow-up data had been collected in almost all screened patients. Implementing geriatric recommendations and formulating new geriatric recommendations at the time of follow-up are important opportunities for improvement. The majority of identified barriers were organizational, with high workload, lack of time or financial/staffing problems as most cited. The most cited facilitators were all related to collaboration. CONCLUSION: Interventions to improve the implementation of GA in older patients with cancer need to address a wide range of factors, with organization and collaboration as key elements. All stakeholders, seeking to improve the implementation of GA in older patients with cancer, should consider and address the identified barriers and facilitators.

Dental and oral complications of lip and tongue piercings.

Piercing of the tongue and perioral regions is an increasingly popular expression of body art, with more patients coming in for a routine check-up with tongue and/or lip piercings. Several complications of oral piercing have been reported, some of which are life-threatening. In the present clinical survey the prevalence of both tongue and lip piercing complications in oral health was assessed in a group of 50 patients. The most common dental problem registered was chipping of the teeth, especially in association with tongue piercing. Gingival recession was seen as a result of lip piercing with studs. Post-procedural complications included oedema, haemorrhage and infection. Therefore, dentists and oral and maxillofacial surgeons should be given more authority to advise patients with oral and facial piercings or those who plan to acquire this type of body art.

[Urinary retention in 2 children after the use of antiemetic agents during acute gastroenteritis]. / Urineretentie bij 2 kinderen na gebruik van anti-emetica tijdens een acute gastro-enteritis.

Two girls, aged 2 and 4 years, with acute gastroenteritis and vomiting, received domperidone and metoclopramide, respectively. Urinary retention developed, but after catheterisation of the bladder was performed once and the medication was withdrawn, both children recovered without further sequelae. Anti-dopaminergic antiemetic agents should be prescribed with caution, especially in young children.

Kinetics of MPF and histone H1 kinase activity differ during the G2- to M-phase transition in mouse oocytes.

Maturation promoting factor (MPF) is universally recognized as the biological entity responsible for driving the cell cycle from G2- to M-phase. Histone H1 kinase activity is widely accepted as a biochemical indicator of p34cdc2 protein kinase complex activity and therefore MPF activity. In this paper we present results which indicate that during the G2- to M-phase transition in mouse oocytes the dynamic of p34cdc2 related histone H1 kinase activity differs markedly from the biological activity of MPF as measured by classical cell fusion procedures. MPF is activated just before germinal vesicle breakdown (GVBD) whereas histone H1 kinase is activated 5-7 h later coincident with the formation of the definitive first metaphase plate. The biological activity of MPF is merely reduced to about 50% of control levels by a short period of protein synthesis inhibition (1-2 h) and completely suppressed after a prolonged period of inhibition (4-5 h). By contrast, inhibition of protein synthesis in mouse oocytes results in a rapid and complete suppression of histone H1 kinase activity. Therefore, biological MPF and histone H1 kinase activity should not be used in an interchangeable manner during the G2- to M-phase transition in mouse oocytes.