The dental management of patients with bipolar disorder

Bipolar disorder (manic depressive disease) affects 1% of the United States population. These persons suffer from prolonged episodes of extreme elation and depression. There is a significant incidence of dental pathosis and a need for dental care among these patients. The medications used for the treatment of this disease, their physiologic effects, and their interactions with the drugs used in dentistry are reviewed.     

Alcoholism and dental management

Alcohol is widely used and abused in the United States. Because alcohol affects all parts of the body, it is important for dentists as well as all other medical practitioners to be aware of the signs of alcoholism. Some dental problems occur more frequently in alcoholic patients, and often general dental care for these patients must be modified.     

Gastro-oesophageal reflux disease: Medical or surgical treatment? Report of an interactive workshop

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.     

Pseudocysts of the mandibular condyle.

The panoramic radiographs of 507 consecutive patients receiving comprehensive dental treatment were evaluated for the presence of radiolucencies in the mandibular condyles. Nine patients met the study criteria. Five patients had bilateral and four patients had unilateral circumscribed radiolucencies in the anterior aspect of the condyle. Computerized tomography confirmed that these radiolucencies were age-related anatomic variants that were accentuated and distorted during panoramic radiography.     

Intracorneal hemorrhage secondary to aphakic contact lens wear.

Two cases of intracorneal hemorrhage developing as a complication of aphakic contact lens use are reported. Patient 1 had a penetrating keratoplasty to restore vision and therefore the histologic examination could be performed on the corneal button. In patient 2 the contact lens use was discontinued with partial resolution of the intracorneal hemorrhage and the patient then underwent a secondary intraocular lens implantation with good visual results.     

Postnatal dendritic development of Y-like geniculocortical relay neurons.

We describe the dendritic development of neurons in the dorsal lateral geniculate nucleus (LGNd) projecting to cortical area 18 in the postnatal cat. LGN neurons were identified by retrograde labeling from area 18 with fluorescent latex microspheres and injected in the fixed slice with Lucifer yellow (LY) and horseradish peroxidase (HRP) to visualize their dendritic arborizations. Both topological (measures of the patterns of dendritic branching and their territorial coverage) and metric parameters (measures of the quantitative parameters describing the size, length, extent and diameter of the dendritic arbors) were measured in three-dimensions for 25 LGN neurons in cats between 1 and 18 postnatal weeks. In addition, dendritic growth was compared to the changing dimensions of the LGNd. At all ages, neurons projecting to area 18 have large somata and radiate dendrites. From 1 to 18 weeks neurons increase in size--both soma area and the length of all dendritic segments double during this period. Intermediate and terminal dendritic segments show comparable growth until 5 weeks. However, only terminal segments continue to grow significantly from 5 until 18 weeks. Dendrites become straighter during development, the angle between daughter branches decreases and dendritic segment diameter increases, with terminal segments showing a greater increase relative to intermediate segments. The density of dendritic appendages increases transiently at 5 weeks and a differential redistribution occurs, so that by 18 weeks dendrites further from the soma have a greater density of appendages than those near the soma. Some dendritic relationships remain invariant during development--intermediate segments are always shorter, thicker and straighter than terminal segments. During these changes however, area 18 projecting neurons maintain a constant number of primary dendrites and have, on average, a constant branching pattern. The relative volume of the LGNd occupied by an area 18 projecting neuron increases 2.4-fold between 1 and 18 weeks as the dendrites grow with the result that the coverage of a given point of the LGNd by dendrites of area 18 projecting nearly doubles from 24 to 45 neurons per unit volume. This increased net dendritic overlap provides a substrate for enhanced numerical synaptic divergence of the Y-cell pathway from a point source in the retina to the visual cortex.     

A laboratory study of spontaneous platelet aggregation

During studies on platelet aggregation using the EEL platelet aggregation meter, 8% of the individuals tested were found to have platelets which aggregated spontaneously when citrated, platelet-rich plasma was stirred at 37 degrees C. The EEL aggregation meter differs from other machines in that it incorporates a vertical stirrer which subjects platelets to greater mechanical force. When using this machine it is suggested that spontaneous platelet aggregation is related to increased mechanical fragility of the platelets and low levels of plasma ADP-inhibitor.     

Calcium is required for the expression of anthrax lethal toxin activity in the macrophagelike cell line J774A.1.

Anthrax lethal toxin, which consists of two separate proteins, protective antigen (Mr, 82,700) and lethal factor (Mr, approximately 83,000), is cytotoxic to the macrophagelike cell line J774A.1. Removal of calcium from the culture medium protected cells against the action of lethal toxin. Calcium depletion during the binding phase of intoxication afforded only partial protection. Further analysis showed that calcium removal caused some inhibition of protective antigen binding but that it had minimal effect on proteolytic conversion of protective antigen to the active 63-kilodalton fragment and that it had no effect on lethal factor binding. Cells to which lethal toxin had bound in the presence of calcium were protected when transferred to calcium-depleted culture medium, indicating a role for calcium at a postbinding stage. When ammonium chloride is present with lethal toxin, toxin accumulates in intracellular vesicles. Calcium-free medium protected these cells upon removal of the amine block, suggesting that calcium is also required at a step after internalization of lethal toxin. Calcium channel blockers inhibited 45Ca2+ uptake and protected cells against cytotoxicity. Calmodulin inhibitors also protected against the action of lethal toxin, suggesting involvement of calmodulin at a step during intoxication. We conclude that calcium is required at several steps in the intoxication of cells by anthrax lethal toxin.