A randomized,double-blind crossover trial of paracetamol 1000 mg four times daily vs ibuprofen 600 mg: effect on swelling and other postoperative events after third molar surgery

AIMS: To evaluate the effect of a 3-day regimen of ibuprofen 600 mg x 4 on acute postoperative swelling and pain and other inflammatory events after third molar surgery compared with a traditional regimen of paracetamol 1000 mg x 4. METHODS: A controlled, randomized, double-blind, cross-over study where 36 patients (26 females, 10 males) with mean age 23 (range 19-27) years acted as their own controls. All patients were subjected to surgical removal of bilateral third molars. After one operation the patients received tablets of ibuprofen 600 mg x 4 for 3 days. After the other operation they received an identical regimen of paracetamol 1000 mg tablets. Swelling was objectively measured (mm) with a standardized face bow and the patients scored their pain intensity (PI) on a 100-mm visual analogue scale. RESULTS: There was no statistically significant difference between paracetamol and ibuprofen treatment with respect to effect on acute postoperative swelling. Swelling after paracetamol on the third postoperative day was 1.8% less than that after ibuprofen. Mean (95% CI) difference between treatments was -0.3 (-4.7, 4.1) mm. On the sixth postoperative day swelling after ibuprofen was 2.3% less than that after paracetamol. Mean (95% CI) between treatments was 0.2 (-2.4, 2.8) mm. There was no statistically significant difference in pain intensity between the paracetamol and the ibuprofen regimen on the day of surgery. The mean (95% CI) difference between the treatments for summed pain intensity on the day of surgery (SUMPI 3.5-11) was 3.31 (-47.7, 54.3) mm. Two patients developed fibrinolysis of the blood clot (dry socket) after receiving ibuprofen while none did this after paracetamol treatment. There was no noticeable difference between treatments with respect to appearance of haematomas/ecchymoses or adverse effects which all were classified as mild to moderate. CONCLUSIONS: A 3-day regimen of ibuprofen 600 mg x 4 daily does not offer any clinical advantages compared with a traditional paracetamol regimen 1000 mg x 4 daily with respect to alleviation of acute postoperative swelling and pain after third molar surgery.     

Tissue engineering in plastic reconstructive surgery

Tissue engineering (TE) is a new interdisciplinary field of applied research combining engineering and biosciences together with clinical application, mainly in surgical specialities, to develop living substitutes for tissues and organs. Tissue engineering approaches can be categorized into substitutive approaches, where the aim is the ex vivo construction of a living tissue or organ similar to a transplant, vs. histioconductive or histioinductive concepts in vivo. The main successful approaches in developing tissue substitutes to date have been progresses in the understanding of cell-cell interactions, the selection of appropriate matrices (cell-matrix interaction) and chemical signalling (cytokines, growth factors) for stimulation of cell proliferation and migration within a tissue-engineered construct. So far virtually all mammalian cells can be cultured under specific culture conditions and in tissue specific matrices. Future progress in cell biology may permit the use of pluripotent stem cells for TE. The blueprint for tissue differentiation is the genome: for this it is reasonable to combine tissue engineering with gene therapy. The key to the progress of tissue engineering is an understanding between basic scientists, biochemical engineers, clinicians, and industry.     

Modeling the output ratio in air for megavoltage photon beams.

The output ratio in air, OR, for a high-energy x-ray beam describes how the incident central axis photon fluence varies with collimator setting. For field sizes larger than 3 x 3 cm2, its variation is caused by the scatter of photons in structures in the accelerator head (primarily the flattening filter and the wedge, if one is used) and by the backscatter of radiation into the monitor ionization chamber. The objective of this study was to evaluate the use of an analytical function to parametrize OR for square collimator setting c: OR = (1 + a1.c).[1 + a2.erf(c/lambda)2].H0. For open beams, these parameters can be attributed to explicit physical meanings within the systematical uncertainty of the model: a1 accounts for backscatter into the monitor, a2 is the maximum scatter-to-primary ratio for head-scattered photons, and lambda represents the effective width of the "source" of head-scatter photons. H0 is a constant that sets OR = 1 for c = 10 cm. This formula also fits OR for wedge beams and a Co-60 unit, although the fitting parameters lose their physical interpretations. To calculate the output ratio for a rectangular field, cx x cy, an equivalent square can be used: c = (1 + k).cy x cx/(k.cx + cy), where k is a constant. The study included a number of different accelerators and a cobalt-60 unit. The fits for square fields agreed with measurements with a standard deviation (SD) of less than 0.5%. Using k = lx.(f - ly)/ly.(f - lx), where lx and ly are the source-to-collimator distances and f is the source-to-detector distance, measurements and calculations agreed within a SD of 0.7% for rectangular fields. Sufficient data for the three parameters are presented to suggest constraints that can be used for quality assurance of the measured output ratio in air.     

The applicability of the Antonovsky Sense of Coherence Scale to a group of Pentecostalists

A methodological issue concerning the Antonovsky of Sense of Coherence (SOC) scale was raised in an earlier study questioning the applicability of the scale in different populations, and among these the Pentecostalists. The question was raised when a group of Pentecostalists had had difficulties in filling in another scale intended to measure the SOC. Therefore, the aim of this study was to test the applicability of the 29-item Antonovsky SOC scale in a group of people (n = 37) belonging to a church of the Pentecostal Movement and to compare the results with those of a randomized group (n = 145) from a general population. The Pentecostalists filled in the scale with no obvious difficulties. No significant differences were found between the Pentecostal group and the group of a general population regarding the total SOC scale scores (mean 152, SD 16 and mean 151, SD 18, respectively). The applicability difficulties found in the earlier study, however using an other SOC scale, could not be confirmed in the present study. To conclude, the Antonovsky SOC scale has so far not shown to have applicability weakness.     

Mobility provocation radiostereometry in anterior cervical spine fusions

This study aimed to evaluate the use of mobility-provocation radiostereometry (RSA) in anterior cervical spine fusions and compare the results to deformation studies on the same patients and plain flexion-extension radiographs. Mobility-provocation RSA was used to evaluate anterior cervical spine fusions in 45 patients. The motions recorded at 3 and 12 months postoperatively were compared to RSA measurements of deformation of the fusion over time and to plain flexion-extension radiographs in the same patients taken 3 months postoperatively. Studies of rotations from right to left revealed ten cases with significant motion at 3 months, and three at 12 months. With motion from flexion to extension, ten cases showed significant motion at 3 months and three at 12 months. In only three cases was the mobility-provocation RSA considered to add any information on the stability of the fusions compared to that obtained with the deformation studies. In 37 patients mobility-provocation radiography in flexion-extension using conventional technique was done to evaluate the accuracy. The mean difference between angular motions recorded on plain radiographs and rotations around the transverse axis in flexion to extension recorded with RSA was 1.6° (range 0.04°–8.04°, SD 2.1°). The corresponding 95% and 99% confidence limits for the difference between the two methods were 5.8° and 7.2°. The study showed that the use of mobility-provocation RSA did not add any information over that obtained by deformation RSA studies. Conventional radiography is too inaccurate to measure inducible displacement in this patient population.     

Epilepsy and pregnancy: Report of an Epilepsy Research Foundation Workshop

Pregnancy in women with epilepsy (WWE) is known to be associated with a higher risk of congenital malformations than is associated with pregnancy in non-epileptic women. Several factors have been identified to account for the increased risk, including the direct teratogenic effects of antiepileptic drug (AED) therapy, indirect effects of these drugs by interfering with folate metabolism, genetic abnormalities in drug or folate metabolism, and possibly an arrhythmogenic effect of maternal drug therapy on the embryonic heart, leading to ischaemia in developing tissues. A harmful effect of maternal seizures on the developing embryo has not been proven, although seizures and status epilepticus account for most of the excess maternal mortality in women with epilepsy. Abrupt withdrawal of drug therapy by the mother may be an important contributory factor. Less is known about the psychomotor development of children born to mothers with epilepsy because few studies have been designed to follow their progress throughout childhood. Retrospective studies suggest that impaired cognitive development may be associated with maternal drug therapy, particularly valproate. There is an urgent need to evaluate these risks and, with this in mind, several prospective registers have been set up to collect data from pregnancies in women with epilepsy.     

Decreased production of reactive oxygen species by blood monocytes caused by clozapine correlates with EEG slowing in schizophrenic patients

We have earlier reported an increased theta-power value in clozapine (CLO)-treated patients with schizophrenia, nonresponsive to conventional antipsychotics. We also found that the decrease in the production of reactive oxygen species (ROS), induced by CLO, by peripheral blood monocytes (MO) of these patients correlates with clinical improvement. MO share the capability of ROS production with their more mature descendants, microglia of the brain. We hypothesized that the CLO-related changes in peripheral blood MO might be related to a parallel process in microglia and thus be reflected in brain activity. In those 8 patients for whom both QEEG and MO data were available, we explored possible relationships between these parameters. A clear-cut correlation between ROS production (R(2) = 0.929, p < 0.05) for nonstimulated MO, and (R(2) = 0.907, p < 0.001) for stimulated MO and theta-power values in the central frontal electrode (F(z)) was found. It is intriguing to speculate that the EEG slowing is a result of the modulatory action of the activated microglial cells in the central nervous system via production of ROS or cytokines or both. However, this proposition has to be confirmed by future research.     

Growth hormone-insulin-like growth factor-1 axis,leptin and sleep in anorexia nervosa patients

The present study characterizes the relationships between severe malnutrition, sleep, growth hormone-insulin-like growth factor-1 (GH-IGF-1) axis, and leptin levels in anorexia nervosa (AN) patients before and after weight gain. Eleven restricting-type anorectic females (mean age = 19.7 years) with severe starvation state [mean body mass index (BMI) = 13.3] were studied using polysomnography and spectral power analysis. The hormone levels were measured in the morning after sleep recording. Eleven normal-weight, age- and gender-matched healthy volunteers without a history of any eating disorder served as controls. After nutritional treatment for about 2 months (65.7 +/- 6.4 days), sleep examinations and blood tests were repeated. At this stage, the study group consisted of 5 patients (mean BMI = 15.6). Higher IGF-1 and leptin levels were associated with longer and deeper sleep among anorectics. The sleep parameters including the percentages of stage 1 sleep and SWS as well as IGF-1 tended to normalize after only limited weight gain. Sleep disturbances in anorectics may be mediated through changes in the levels of the GH-IGF-1 axis hormones, as well as the levels of leptin.     

Risk factors for drug addiction and its outcome. A follow-up study over 25 years

The aim of the study was to investigate factors related to initiation and abandonment of illegal drugs. A follow-up study on 53 drug addicts originally hospitalized because of parenterally acquired hepatitis was performed using questionnaires. The majority stated that curiosity and peer pressure were the main reasons for starting drug use. Family conflicts, school and mental problems were each reported by about 40% of the subjects. Thirty-nine patients (74%) had abandoned addictive drugs during the approximately 25 years that had elapsed since the hospital stay. All of these thought that own efforts had been most important in this achievement. Other important factors were help and support from family and friends, establishing a family or experiencing acute hepatitis or an overdose.