Effective treatment of herpes simplex labialis with penciclovir cream: combined results of two trials

BACKGROUND: Two randomized, double-blind, parallel-group clinical trials were conducted in Europe and North America to compare the efficacy and safety of topical 1 percent penciclovir cream with a placebo cream. METHODS: A total of 4,573 immunocompetent people with a history of recurrent herpes simplex labialis, or HSL, with three or more episodes a year that typically manifested as classical lesions, were enrolled and prospectively dispensed medication-either 1 percent penciclovir in a cetomacrogol cream base or a matching placebo. Patients self-initiated treatment and were required to apply study medication six times per day for the first day and every two hours while awake for four consecutive days. RESULTS: Of 4,573 enrolled patients, 3,057 initiated treatment (1,516 with penciclovir and 1,541 with placebo). Combined data from two trials revealed that penciclovir recipients lost classical lesions 31 percent faster than did placebo recipients (hazard ratio, or HR, = 1.31; 95 percent confidence interval, or CI, 1.20 to 1.42; P = .0001) and experienced 28 percent faster resolution of lesion pain (HR = 1.28; 95 percent CI, 1.17 to 1.39; P = .0001). Significant benefits were achieved with penciclovir use whether treatment was initiated in the early stages (P = .001) or later stages (P = .0055). CONCLUSIONS: The largest data set currently available on the treatment of recurrent HSL revealed that penciclovir cream significantly outperformed the placebo in healing classical lesions and resolution of pain. CLINICAL IMPLICATIONS: The authors found that penciclovir cream positively affects recurrent HSL, and dose frequency is vital to topical treatment. Even when penciclovir was applied late, it was effective in favorably altering the course of recurrent HSL.     

阿昔洛韦联合泼尼松治疗46例贝尔面瘫的疗效评价

目的：评价抗病毒药物阿昔洛韦（aciclovir）联合糖皮质激素泼尼松（prednisone）治疗贝尔面瘫的疗效。方法：46例贝尔面瘫病者被随机分成阿昔洛韦联合泼尼松组（A＋P组,n=23）和泼尼松治疗组（P组,n=23）。A＋P组口服阿昔洛韦每日3次,每次0．4g和泼尼松每日一次,每次50mg,P组口服泼尼松每日一次,每次50mg,连续5d,接着各组均将泼尼松减量为隔日一次,每次20mg。面神经功能指数（facial nerve functional index,FNFI）作为评判疗效指标。结果：治疗后第3周A＋P组中有12例（52.1％）面神经完全恢复（FNFI=1）,P组为5例（21.7％）两者有显著性差异（P〈0．05）;而治疗后第4周,A＋P组2l例（91．3％）和P组18例（78．3％）面神经完全恢复（P〉0．05）。结论：阿昔洛韦联合泼尼松治疗贝尔面瘫疗效确切,无明显副作用;疗程比单纯用泼尼松治疗有明显缩短。     

Clinical efficacy of prednisone in the treatment of patients with oral inflammatory ulcerative diseases: a study of fifty-five patients

An objective evaluation of 55 patients with chronic vesiculoerosive oral diseases was made to compare the beneficial and adverse effects of prednisone treatment. Patients were divided into groups of high, intermediate, and low drug dosages, as well as short and long periods of administration. Prednisone benefited 49 patients in spite of the fact that 55% had some adverse side effects. The duration of prednisone administration appeared to have a larger impact on side effects than the daily amount given. The most common side effects were gastrointestinal disturbances, mood alterations, polyuria and insomnia. There were no significant changes in blood pressure, blood sugar level, weight, or white blood cell counts. This study confirmed that systemic prednisone is a useful and beneficial treatment modality for patients with chronic oral inflammatory diseases.     

Long-term follow-up of patients with atypical facial pain treated with amitriptyline

OBJECTIVE: The aim of this study was to assess the efficacy of low-dose amitriptyline in patients with atypical facial pain for one-year follow-ups. PATIENTS AND METHODS: Sixteen patients, ten females and six males, ranging in age from 15 to 77 years (mean 46.6 +/- 15.95 years), participated in the study. The onset, duration and temporal pattern of pain, events related to pain, drugs used before treatment and side effects of amitriptyline were recorded. The severity of pain was evaluated by using the visual analogue scale (VAS). Patients were followed for up to 12 months. RESULTS: The results showed that the onset of pain was related to dental pain in half of patients; and 10 patients had continuous pain. The mean VAS scores for pretreatment, post treatment, and 1, 3, 6, and 12 months were 9.6, 4.8, 2, 0.8, 0.3 respectively. In 12 patients, pain was reduced at the first month (p<0.05). All patients, except one, were pain-free at 12 months. It was statistically significant in achieving pain relief for 12 months (p<0.05). The common side effects of the drug were dry mouth and drowsiness. CONCLUSION: Data obtained from this study suggested that amitriptyline may be preferred in patients with atypical facial pain for rapid, satisfying analgesic effects. Long-term follow-up should be conducted to determine the analgesic effects and to prevent recurrence, even if the analgesic effect occurs in a short time.     

The prevalence of cardiac valvular pathosis in patients with systemic lupus erythematosus

The purpose of this study was to determine the prevalence of valvular pathosis in a population of patients with SLE, to assess the candidacy of such patients for antibiotic prophylaxis before dental treatment. The hospital records of 112 patients with SLE were reviewed and screened for endocarditis, heart murmurs, and other valvular pathosis. Two of the 112 patients had confirmed cases of bacterial endocarditis. This prevalence is comparable to endocarditis prevalence rates in patients with prosthetic valves and is also three times that in patients with rheumatic heart disease. The high prevalence of endocarditis in this population of patients with SLE suggests that according to present perspectives on patient management, patients with SLE should be considered for antibiotic prophylaxis before dental therapies associated with formation of a bacteremia.     

Oral and perioral herpes simplex virus type 1 (HSV-1) infection: review of its management

Herpes simplex virus type 1 (HSV-1) gives rise to a variety of clinical disorders and is a major cause of morbidity and mortality worldwide. HSV-1 infections are common in oral and perioral area. The aim of the present report was to critically examine the published literature to evaluate the advantages and limitations of therapy of HSV-1 infection in both immunocompetent and immunocompromised patients. Systemic antiviral therapy has been widely accepted as effective for primary herpetic gingivostomatitis. Aciclovir (ACV) 5% cream seems to be the accepted standard topical therapy for herpes labialis, being both effective and well tolerated, although penciclovir 1% cream has been proposed as a potentially useful treatment. Systemic ACV may be effective in reducing the duration of symptoms of recurrent HSV-1 infection, but the optimal timing and dose of the treatment are uncertain. Aciclovir and famciclovir may be of benefit in the acute treatment of severe HSV-1 disease in immunocompromised patients. There is also evidence that prophylactic oral ACV may reduce the frequency and severity of recurrent attack of herpetic infection in immunocompromised patients, but the optimal timing and duration of treatment is uncertain and can vary in different situations.     

气压,气流测定仪对发音辅助器功能的评价

目的客观评价发音辅助器的功能。方法对１２例置发音辅助器患者进行了分析。结果用发音辅助器后增加了口腔压力，降低了鼻腔气流和缩减了腭咽腔闭合的面积。结论发音辅助器能改善腭咽闭合功能，为临床治疗腭咽闭合功能不全提供非手术方法。     

The effect of a modified functional appliance on obstructive sleep apnea

This study combined the use of cephalometrics and overnight polysomnographic monitoring to analyze the effects of a modified functional appliance on airway, sleep, and respiratory variables in patients with obstructive sleep apnea (OSA). Twelve patients without overt anatomic or pathologic evidence of obstruction were selected on the basis of an initial single night of polysomnographic monitoring, which confirmed the diagnosis of obstructive sleep apnea syndrome. The patients subsequently were fitted with a modified functional appliance designed to securely hold the mandible in an anterior-inferior position. A subsequent overnight polysomnographic study was obtained with each patient wearing the appliance. Lateral cephalometric radiographs with and without the appliance in place were also obtained. The mean vertical and horizontal changes in mandibular position while wearing the appliance were 8.49 mm and 2.28 mm, respectively. The findings indicate that 10 of the 12 patients had decreases in the rate of complete airway obstructions from a mean of 28.86 to 18.69 events per hour, and in the total apnea index from a mean of 53.81 to 35.99 events per hour. A reduction in the rate of obstructive events is attributed to the effect of the appliance on the oropharyngeal structures. Six cephalometric measurements are presented to provide a means of assessing effects of the appliance on the oropharynx and associated structures. The modified functional appliance is a conservative, successful treatment alternative that could benefit patients with obstructive sleep apnea syndrome.     

Periapical and endodontic status of permanent teeth in patients with hypophosphatemic rickets

Summary Hypophosphatemic rickets (HR) is a rare hereditary disease in which dental problems in terms of spontaneous periapical infections are frequently reported. Most previous reports have been based on a small number of HR patients and have been published before the disease could be confirmed genetically. The aim of the present study was to describe the periapical and endodontic status of permanent teeth in patients with genetically and/or biochemically confirmed HR. The patients were recruited from a medical study on HR patients. The patients underwent a dental examination including a digital panoramic radiograph, which was scored for endodontically affected teeth (i.e. teeth with periapical radiolucencies and/or endodontically treated teeth). A total of 52 patients (age range: 5·7–74·5 years; 17 males and 35 females) were included. HR patients were characterised by a high number of endodontically affected teeth (mean: 4·2; s.d.: 5·0). The number of affected teeth rose significantly with age (P < 0·01), and no statistically significant gender difference was found. The relative distribution of endodontically affected teeth in the three tooth groups (incisors and canines, premolars, and molars) varied according to age. In the youngest age group, only incisors and canines were affected, while the relative proportion of affected premolars and molars increased with age. Endodontically affected teeth are common in HR patients, and the number of affected teeth increased significantly with age. Hence, the need for endodontic treatment among HR patients is comprehensive.     

Spontaneous tooth exfoliation, maxillary osteomyelitis and facial scarring following trigeminal herpes zoster infection.

A case of trigeminal herpes zoster (HZ) infection affecting the left maxillary and ophthalmic divisions of the fifth cranial nerve in an immuno-competent patient is presented. Extremely rare complications such as osteonecrosis, spontaneous tooth exfoliation, secondary osteomyelitis and facial scarring were observed. Sequestrectomy, aciclovir and erythromycin stearate were effectively used in managing the case.     

MTA pulpotomy of human permanent molars with irreversible pulpitis

The histological success of mineral trioxide aggregate (MTA) pulpotomy for treatment of irreversible pulpitis in human teeth as an alternative treatment was investigated in this study. Fourteen molars which had to be extracted were selected from patients 16–28 years old. The selection criteria include carious pulp exposure with a history of lingering pain. After isolation, caries removal and pulp exposure, MTA was used in pulpotomy treatment. Patients were evaluated for pain after 24 h. Two patients were lost from this study. Twelve teeth were extracted after 2 months and were assessed histologically. Recall examinations confirmed that none of the patients experienced pain after pulpotomy. Histological observation revealed that all samples had dentin bridge formation completely and that the pulps were vital and free of inflammation. Although the results favour the use of MTA as a pulpotomy material, more studies with larger samples and a longer recall period are suggested to justify the use of MTA for treatment of irreversible pulpitis in human permanent teeth.     

The effects of diflunisal on bleeding time and platelet aggregation in a multidose study

Diflunisal, a potent nonsteroidal anti-inflammatory agent, has been confirmed as an effective analgesic in oral surgery. It is generally stated that there is only slight impairment of coagulation at the recommended dosage of diflunisal; however, only a few multidose studies have been conducted, most being single dose studies. This report is of a multidose study of the effects of diflunisal on coagulation in 15 oral surgery patients, being the first such study reported. The results showed that the bleeding time was increased in 53% of the group, but in no case did the increase exceed the upper limit of normal. Additionally, platelet aggregation studies were affected in 38% of patients with increased bleeding time. The overall results substantiate the safety of diflunisal in relation to effect on coagulation, and are directly applicable to postoperative use in oral surgery.     

Levels of interleukin-21 in patients with untreated chronic periodontitis

Background: A growing body of evidence suggested that interleukin (IL)‐21 enhances the effector phase during T‐cell responses. The aim of our study is to determine the levels of IL‐21 in periodontal sites from patients with chronic periodontitis and controls. Methods: The population studied consisted of 34 patients (15 with chronic periodontitis and 19 healthy patients). Twenty samples (10 gingival crevicular fluid [GCF] and 10 gingival biopsies) were collected from each group before the patients with periodontitis received periodontal treatment. Total protein concentrations were measured in all samples; the presence of IL‐21 was confirmed by immunohistochemistry and Western blot, and IL‐21 levels were quantified through an enzyme‐linked immunosorbent assay. Statistical analyses were performed using statistical software. Data were expressed as patient means ± SDs or medians (interquartile ranges) by using the χ², Student t, and Mann‐Whitney U tests. Results: GCF IL‐21 was mainly detected in patients with chronic periodontitis (P <0.05). Levels of IL‐21 in gingival tissues were significantly higher in patients with chronic periodontitis compared to healthy individuals (P <0.05). The Western blot and immunohistochemical staining confirmed the presence of IL‐21 in periodontal tissues and GCF. Conclusion: IL‐21 was highly expressed in patients with chronic periodontitis, especially in gingival biopsies; therefore, IL‐21 might play a role in the T‐cell response.     

The Korean version of the University of Washington Quality of Life Questionnaire for Patients with Head and Neck Cancer, and its use in an initial validation study of 56 patients

The University of Washington Quality of Life (UW-QOL) questionnaire is often used to assess health-related quality of life (HRQOL) of head and neck cancer patients. The aim of this study was to translate the UW-QOL version 4 into the Korean language and to carry out an initial validation study. A recognized methodology for translation of questionnaires was used. The validation study used the final Korean version between March and September 2009. Adult patients were recruited, with a confirmed diagnosis of head and neck cancer, therapy completed and disease-free for at least 1 year. The UW-QOL was successfully translated into Korean. 56 patients completed Korean versions of UW-QOL, the Beck Depression Inventory and the World Health Organization Quality of Life-BREF and various expected correlations were confirmed first between the two UW-QOL subscales (Spearman 0.54 p<0.001) and then of these subscales with the other concurrent measures. Lower (worse) UW-QOL scores were seen for later stage patients in all 12 domains. The Korean version of UW-QOL is ready for use in the assessment of HRQOL for Korean patients. Validation work needs to be continued to further establish psychometric properties of the questionnaire for use in this population.     

Survival benefit associated with postoperative PET–CT before adjuvant radiotherapy or chemoradiotherapy in patients with oral squamous cell carcinoma

The aim of this study was to analyse the impact of postoperative positron emission tomography–computed tomography (PET–CT) before adjuvant treatment in oral squamous cell carcinoma (OSCC) patients. Patients with OSCC requiring adjuvant treatment following surgery were divided retrospectively into two groups based on the implementation of PET–CT. The study endpoints were disease-specific survival (DSS) and overall survival (OS). A total of 123 patients underwent PET–CT examination; 28 had abnormal images, but only seven were confirmed to be pathologically positive. A total of 145 patients underwent computed tomography/magnetic resonance imaging (CT/MRI) examination; 20 had abnormal images, but only one was confirmed to be pathologically positive. The median OS time was 5.4 years in the PET–CT group and 4.3 years in the CT/MRI group, demonstrating a significant difference (P = 0.024). Findings were similar for the median DSS time. In patients with positive PET–CT results, the median DSS was 4.3 years and median OS was 3.5 years, and in those with negative PET–CT results, the median survival time could not be calculated as fewer than 50% of patients reached these endpoints; both differences were significant (P = 0.007 and P < 0.001). Although the false-positive rate of postoperative PET–CT is high, it improves the chance of survival through early and more frequent detection of recurrence.     

Edema in the upper airway in patients with obstructive sleep apnea syndrome

Objective. The purpose of this study was to investigate the histologic alterations in the upper airway in patients with obstructive sleep apnea syndrome.Study design. Surgical specimens were obtained during non-laser-assisted uvulopalatopharyngoplasty from 5 adult patients (4 male and 1 female) with polysomnographically confirmed obstructive sleep apnea syndrome.Results. In all of the specimens, interstitial edema was present with mild inflammatory reaction. Fat was not at all prominent.Conclusions. It is confirmed histologically that there is edema present in the upper airway in patients with obstructive sleep apnea syndrome. It is uncertain whether this edema is one of the causative mechanisms of the obstruction or a consequence of the syndrome.     

Bilateral surgical removal of impacted mandibular third molar teeth as a model for drug evaluation: a test with oxyphenbutazone (Tanderil).

Twenty-four healthy patients undergoing two separate operations for removal of an impacted third molar from one or the other side of the mandible, were included in a double-blind crossover study. On the two occasions either oxyphenbutazone (Tanderil) or placebo was given for 5 days, commencing on the day before surgery. Plasma analyses confirmed drug intake. A number of objective and subjective assessments were recorded for a paired comparison of the postoperative course, including swelling, trismus, local temperature and pain. On the 1st, 3rd and 5th postoperative days after the oxyphenbutazone-operation, the measured swelling averaged 86, 85 and 83%, respectively, of that after the placebo-operation; the corresponding P-values were less than or equal to 0.11, 0.03 and 0.06. Oxyphenbutazone did not significantly reduce the local hyperpyrexia. It exerted, however, an excellent pain relief, which may have contributed to less trismus and patient preference for the course with this drug. The results obtained with this model in humans showed considerable discrepancies with the analgesic and anti-inflammatory effects ascribed to oxyphenbutazone from results in animal models. Side effects were mild and infrequent, and no unfavorable effects on bleeding or wound healing were noted. Routine use of oxyphenbutazone in oral surgery, however, is not recommended.     

Effectiveness of exercise therapy in patients with internal derangement of the temporomandibular joint

This study intended in evaluating the effectiveness of exercise therapy in patients with craniomandibular disorders (CMD). Twenty consecutive patients suffering from CMD with anterior disc displacement without reduction consulting a CMD service were included in the study if they met following criteria: (i) pain in the temporomandibular region, (ii) reduced incisal edge clearance (<35 mm), (iii) magnet resonance imaging confirmed anterior disc displacement without reduction and (iv) evidence of postural dysfunction. All patients were assigned to a waiting list, serving as a no-treatment control period, according to a before-after trial. The treatment consisted of active and passive jaw movement exercises, correction of body posture and relaxation techniques. A total of 18 patients completed the study, no adverse effects occurred. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 6 month follow-up. As a result of treatment pain, impairment and mouth opening improved significantly more than during control period (paired samples t-test P < 0.05). After treatment four patients had no pain at all (chi-square: P < 0.05) and only seven patients revealed an impaired incisal edge clearance after treatment. (chi-square Test, P < 0.001). At follow up, seven patients had no pain and experienced no impairment. Exercise therapy seems to be useful in the treatment of anterior disc displacement without reduction.     

Bacteria interfere with A. actinomycetemcomitans colonization

It is known that beneficial bacteria can suppress the emergence of pathogenic bacteria, particularly in the gastrointestinal tract. This study examined the potential for a similar suppression of Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans colonization of epithelial cells, due to its potential relevance in periodontal diseases. Seven presumed beneficial bacteria were examined for their ability to interfere, exclude, or displace A. actinomycetemcomitans from epithelial cells in vitro. Streptococcus sanguinis, Streptococcus mitis, and Streptococcus salivarius showed prominent inhibitory effects on either A. actinomycetemcomitans recovery or colonization. These results confirmed the hypothesis that bacterial interactions interfere with A. actinomycetemcomitans colonization of epithelial cells in vitro, and demonstrated the potential beneficial effects of S. mitis, S. salivarius, and S. sanguinis.     

颞下颌关节镜下关节盘复位固定术患者的围手术期护理

目的探讨颞下颌关节镜下行关节盘复位固定术患者的围手术期护理措施。方法总结13例(18侧)颞下颌关节镜下行关节盘复位固定术的围手术期护理经验。术前做好患者的心理护理,增加患者对手术的认知和信心,全面评估患者情况,做好术前准备。术中正确调试仪器,配合医生操作,稳定患者情绪。术后做好仪器保养、教会患者和家属如何进行功能训练,做好患者和家属的心理护理。结果 13例患者无感染及不可复性神经损伤等重大术后并发症。随访3～12个月,手术伤口均恢复良好,磁共振成像检查显示关节盘均复位良好。结论熟练掌握颞下颌关节镜下关节盘复位固定术的护理要点,同时注意围手术期的心理护理和术后功能训练对提高术后疗效有重要意义。