Clinical pharmacokinetics of oxaliplatin in a hemodialysis patient with advanced gastric cancer

We administered FOLFOX (oxaliplatin (L-OHP) plus infusional 5-fluorouracil (5-FU) and leucovorin) to an hemodialysis (HD) patient with advanced gastric cancer (AGC), and investigated pharmacokinetics (PKs) and dialyzability of L-OHP. The patient was a 54-year-old Japanese man with a diagnosis of inoperable AGC. FOLFOX was instituted 3?h prior to the start of a 4?h HD period with the L-OHP and 5-FU doses reduced by 50% for the first cycle, and 30% reduced dose was administered for the second cycle. We performed an analysis of the PKs of L-OHP during these two cycles. Volume of distribution and area under the curve of the 30% reduced L-OHP dose were 56.7?L and 30.0?μg·h/mL, respectively. A dose reduction of L-OHP by 30%?50% may be advisable for the initial administration, given the need for careful administration of chemotherapy in HD patients, with particular attention to the development of hematological toxicities and neuropathy.     

Influence of patients perception on their acceptance and understanding of dental care within an education system

This study examined the effects of conditions (that is, the fee structure and the easy of obtaining a dental appointment) on patient understanding and cooperation in clinical practice for dental hygiene and dental students. A questionnaire was given sequentially to 1483 patients attending the Tokyo Medical and Dental University dental hospital on "clinical education and patient satisfaction". Direct participants consisted of 650 patients, of which 213 (32.8%) were male and 422 (64.9%) female. The remaining 15 (2.3%) did not specify their gender. Patients who were satisfied with care received by dentists tended to be older compared to patients who were dissatisfied with dentists. The difference was significant (p < 0.001). Acceptable conditions for patients such as fees and appointments at the clinical session had an effected on patient acceptance of clinical training. The findings of this study suggest that patient satisfaction should be considered as part of the reasons for patients accepting dental care by students in their clinical education programs. Fees and appointment schedules strongly affect patient acceptance of clinical education.     

Evaluation of 2 thione primers and 3 resin adhesives for silver-palladium-copper-gold alloy bonding.

OBJECTIVE: The purpose of this study was to evaluate 2 thione primers and 3 resin adhesives for enhancement of bonding strength to a silver-palladium-copper-gold alloy. METHOD AND MATERIALS: Two different sized disk specimens (10- and 8-mm diameter by 2.5-mm thick) were prepared from a silver-palladium-copper-gold alloy (Castwell M.C. 12, GC). The specimens were airborne-particle abraded with 50-microm-grain alumina, conditioned either with a thiouracil primer (Metaltite, Tokuyama Dental) or with a triazine dithione primer (V-Primer, Sun Medical), and then bonded with 1 of 3 acrylic resins: a benzoyl peroxide-amine redox-initiated resin adhesive (Multi-Bond, Tokuyama Dental) or a tri-nbutylborane-initiated resin adhesive (Super-Bond C&B and Super-Bond Quick, Sun Medical). For each adhesive, unprimed specimens were prepared as experimental controls. Shear bond strength was determined after thermocycling (100,000 cycles). RESULTS: Use of primers significantly (P < .05) enhanced the bond strength of specimens in all adhesives. Irrespective of the type of primer, the strength of Multi-Bond adhesive was significantly (P < .05) lower than that of Super-Bond C&B and Super-Bond Quick adhesives. The strength of the 2 tri-n-butylborane-initiated adhesives did not differ significantly (P > .05). The mean strength of the Super-Bond C&B adhesive was 40.4 MPa with Metaltite and 37.8 MPa with V-Primer; that of Super-Bond Quick adhesive was 40.9 MPa with Metaltite and 36.5 MPa with V-Primer. CONCLUSION: Use of thione primers effectively enhanced the strength of the bond to the silver-palladium-copper-gold alloy. Furthermore, the combinations of primers and tri-n-butylborane-initiated adhesives were found to be more efficient for bonding.     

Clostridial deep neck infection developed after extraction of a tooth: a case report and review of the literature in Japan

A rare case of severe deep neck infection caused by clostridia after extraction of the left lower canine is presented. The patient was a 63-year-old Japanese woman who had a history of diabetes. The pertinent literature in Japan is reviewed and discussed.     

Growth characteristics of ameloblastoma involving the inferior alveolar nerve: a clinical and histopathologic study

OBJECTIVE: Growth characteristics of ameloblastomas involving the inferior alveolar nerve were examined to determine the most appropriate surgical management of the nerve at the time of the surgical procedure. STUDY DESIGN: Clinical and histopathologic examinations were performed on 22 resected mandibles in which the inferior alveolar nerve was lying adjacent to, or contained within, the tumor. RESULTS: Patterns of tumor involvement of the nerve bundle were evaluated with respect to the presence of bone (11 patients) or connective tissue wall (7 patients) between the tumor and the nerve bundle, and tumor infiltration of perineural connective tissue (4 patients). Neither invasion into the nerve sheath nor invasion into the nerve itself by the ameloblastoma was detected. Tumor infiltration of the tissue surrounding the nerve was identified for the multicystic and solid types but not for the unicystic type. Presence of bone or connective tissue wall between the tumor and the nerve bundle was dominant in the unicystic and plexiform ameloblastomas, whereas tumor infiltration of the perineural tissue was frequently observed in ameloblastomas with the follicular pattern. CONCLUSION: The preservation of the inferior alveolar nerve may be possible in the management of the unicystic type of ameloblastoma. However, a more radical approach is necessary for treatment of multicystic or solid tumors, especially those exhibiting a follicular pattern.     

Quantitative study of fluoride transport during subsurface dissolution of dental enamel

Previous studies using bovine dental enamel as a model have shown that surface and subsurface dissolution of enamel may be governed by micro-environmental solution conditions. We have now investigated the demineralization phenomenon more rigorously with the primary objective of developing a method for deducing solution species concentration profiles as a function of time from appropriate experimental data. More specifically, in this report, a model-independent method is described for determination of the pore solution fluoride gradients in bovine enamel during subsurface demineralization. Microradiography was used to determine the mineral density profiles, and an electron microprobe technique to determine total fluoride (F) profiles associated with the enamel. In each case, matched sections of bovine enamel were exposed to partially saturated acetate buffers at pH = 4.5 containing 0.5 ppm F for various periods of time (from six to 24 hours). The treated enamel was found to have an intact surface layer and subsurface demineralization. The extent of the demineralization and the depths of the lesions increased with time in all cases. The data were first used to calculate (a) the total F gradients in the enamel at various times, and (b) the local uptake rate of F as a function of time and position. Then, by manipulation of the equations describing the uptake and transport of F, we calculated the pore diffusion rate of F and the micro-environmental solution F concentration in the aqueous pores as a function of time and of distance from the enamel surface. It was also possible to calculate an intrinsic F diffusion coefficient in the pores, which was about 1.0 X 10(-5) cm2/sec, in good agreement with reported values. 14C-sucrose uptake and release experiments with identically prepared demineralized enamel sections were also conducted to provide an independent check on the assumed dependence of porosity on mineral density. The results of this investigation, especially the outcomes relative to this new method for determination of pore solution F gradients during acid attack of the dental enamel, should be valuable in future studies of the mechanism(s) of the action of F in inhibiting dental enamel demineralization.     

The kinetics and mechanisms of reactions of human tooth enamel in buffered solutions of high fluoride concentrations

The experimental results were quantitatively compared with the theory based on a physical model representing the reaction and with the experiments involving synthetic hydroxyapatite discs. The experimental initial rates self-consistently compared well with the theoretical predictions. An analysis of the experimental initial rate data yielded a reaction constant, κ, for the reaction representing apatite dissolution and calcium fluoride precipitation. It is proposed that the value for κ is a result of both supersaturation with respect to calcium fluoride and undersaturation with respect to apatite at the apatite-calcium fluoride reaction sites. This finding is also consistent with the analysis of the experiments with synthetic apatite discs.Important similarities and significant differences were found between the experiments with the enamel sections and with synthetic apatite discs. The experiments with the synthetic apatite discs were reported to proceed “normally” as predicted by the physical model over the entire course of the reaction. In contrast to these findings, while the initial rates of the enamel-fluoride reaction were found to proceed relatively rapidly and according to the theoretical predictions, the rates at later times were drastically reduced. This “choking off” was observed to be most severe in the experiments at low pH and high fluoride concentrations, and little or no “choking oft” was observed at low fluoride concentrations and high pH.     

Applicability of osseointegrated oral implants in the rehabilitation of partial edentulism: a prospective multicenter study on 558 fixtures

Nine clinical centers using the Br?nemark System participated in a prospective study of 159 partially edentulous patients between 18 and 70 years of age. Clinical parameters evaluated were plaque index, gingivitis, pocket depth, bleeding index, tooth mobility, and stomatognathic function. Initially, 558 fixtures were placed and 521 remained in the study following prosthesis placement (199 prostheses in 154 patients). Fixtures were lost or unaccounted for because of nonintegration prior to prosthesis fabrication (19), patient withdrawal (11), prosthodontic reasons (6), and failure during prosthetic procedures (1). Failure was primarily attributable to unfavorable bone quality, sex (more in males), and smaller fixture size. Complications and failure related to other patient characteristics are presented. After 1 year of a 5-year study, preliminary results suggest that a success rate equal to or better than that obtained with edentulous patients may be expected.