Risk stratification and dental management of the patient with cardiovascular diseases. Part II: Oral disease burden and principles of dental management.

Cardiovascular diseases are the leading cause of death in the United States and most other Western countries. In the United States alone, more than 1 million annual deaths and as many as three times that number of serious consequences can be attributed to these conditions. To provide care to patients with cardiovascular disease, oral health care providers must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care.     

Clusterlike Headache as a First Sign of Brain Metastases of Lung Cancer

We report on a patient with clusterlike headache and multiple brain metastases of lung cancer. Initially, cluster headache was suggested clinically by characteristic symptoms without any focal central nervous system signs. However, magnetic resonance imaging demonstrated multiple brain metastases. It is possible that tumor necrosis factor may have played a role in initiating the clusterlike headache.     

Variations in prolactin secretion in hyper- and normoprolactinaemia with or without galactorrhoea

The circadian variations and secretory rhythms in prolactin secretion were examined in 10 hyperprolactinaemic and 10 normoprolactinaemic women with or without galactorrhoea in order to establish a clearer picture of this secretion and to find, if exists, correlation between the prolactin level and galactorrhoea. In the normoprolactinaemic women a rhythmical rise and fall were observed within 20 min, with higher values during nocturnal sleeping; these changes were more marked in the galactorrhoeic group. In the hyperprolactinaemic group the diurnal and pulsation changes were less pronounced, galatorrhoea usually being accompanied by a higher degree of hyperprolactinaemia. In galactorrhoeic patients with a normal basal prolactin level, a relative prolactin excess may be reckoned with at certain times. A proportion of these women can in fact then be regarded as hyperprolactinaemic. In the hyperprolactinaemic cases without galactorrhoea, a decreased prolactin sensitivity and milk-forming ability of the breasts may be assumed.     

Clinicopharmacological examination of Anteovin

The effectiveness, side effects and serum FSH, LH, prolactin, estradiol and progesterone levels were monitored in 79 women taking Anteovin for a total of 506 cycles (mean 6.4 cycles). Anteovin is a biphasic oral contraceptive with 11 tablets containing 0.05 mg levonorgestrel and 0.05 mg ethinyl estradiol, and 10 tablets containing 0.125 mg levonorgestrel and 0.05 mg ethinyl estradiol. There were no pregnancies. 11 women dropped out because of hepatomegaly (1), bleeding disorder (3), gastric pain and nausea (1), breast pain (1), nausea and vomiting (1), and personal reasons (4). 10.3% of those continuing reported minor side effects. Menses occurred every 28 days for 3-5 days, with 2 cases of breakthrough bleeding but no oversuppression. Progesterone ranged from 1.5-2.0 nmol/1, estradiol varied between 68-93 pmol/1, LH stayed constant at 6.3-11 U/1, FSH remained at 5.8-6.8 U-1 without a peak, and prolactin levels were lower than those seen in control cycles. These hormone levels all resemble those observed in anovulatory cycles. This pill is especially suitable for teens and nulliparas.     

Prolactin release during nursing in early puerperium

The changes induced in prolactin levels during the first 6 days following delivery were studied. Blood samples for prolactin assay were taken from 9 women at 5-min intervals during breast feeding. The levels of lactation were followed via the amounts of milk produced during suckling. The highest prolactin levels were observed on days 2-4 following delivery. There appeared to be some correlation between the basal and breast-feeding-induced prolactin levels and the level of lactation. A relatively low basal level and a moderate feeding-induced response are early indicators of delayed and less productive lactation. In unfavourable cases the feeding-induced prolactin increases gradually disappeared and lactation stopped. The correlation between the prolactin level and the quantity of milk formed is not a close one, but the observed tendencies agree with the role of prolactin. From day 5 on, the prolactin demands of the breasts are lower.     

Comparative study in the Ames test of benzo[a]pyrene and 2-aminoanthracene metabolic activation using rat hepatic S9 and hepatocytes following in vivo or in vitro induction

We studied the replacement of hepatic S9 with in vivo and in vitro induced hepatocytes as a metabolic activation system with the aim of broadening the possibilities of mutagenic assays. Rats were pretreated with beta-naphthoflavone (BNF), phenobarbital (PB), 3-methylcholanthrene (MC) and a combination of BNF and PB (BNF + PB). Mutagenic activation of benzo[a]pyrene (BP) and 2-aminoanthracene (2AA) by hepatic S9 and hepatocytes was determined in the Ames test. Primary rat hepatocytes were used for in vitro induction and were used as the activating system in the Ames test. In vivo BNF treatment greatly increased the metabolic activation capacity of hepatic S9 and hepatocytes towards BP. With regard to 2AA activation, S9 and hepatocytes showed different BNF induction profiles. PB treatment reduced the mutagenicity of both compounds. Although ethoxyresorufin O-dealkylase (EROD) activity of S9 from BNF + PB-treated animals was almost 30-fold greater than the control, its effectiveness in activation of 2AA was below the control level. A large part of the EROD activity of control cells was lost during culture, together with the ability to activate 2AA, however, 72 h of MC induction increased EROD activity to 200-fold of the control, which corresponds to 28% of that of in vivo induced hepatocytes. The mutagenic potential of BP activated by in vitro induced hepatocytes was 10-fold above the control, which is 47% of the mutagenicity detected following in vivo induction. In vitro induced hepatocytes increased 2AA mutagenicity to 14.6-fold over the control, which corresponds to 68% of in vivo induction. Our results suggest that primary culture of hepatocytes provides a useful model for the study of the role of metabolic activation processes concerning enzyme activity of cytochromes P450 and other metabolic enzymes and induction profiles of different inducers.     

(ATT) trinucleotide repeats in the antithrombin gene and their use in determining the origin of repeated mutations

Two (ATT) trinucleotide repeat polymorphisms have been identified in the tails of Alu repeat elements in intron 5 of the antithrombin gene. The frequency and distribution of allele sizes for the Alu 5 and Alu 8 tail polymorphisms have been defined in a sample Caucasian population. The Alu 5 polymorphism has two alleles while that of Alu 8 has 10 alleles with a heterozygosity of 0.83. These polymorphisms have been used in combination with four previously described polymorphisms within the antithrombin gene to construct antithrombin gene haplotypes in the sample Caucasian population. Twenty-two different haplotypes were observed, with the Alu 8 polymorphism being particularly useful in subdividing the core haplotype based on the previously identified polymorphisms. The haplotype data were used to investigate the origin of repeat mutations within the antithrombin locus. We compared the haplotypes associated the mutant antithrombin genes in five families with the mutation 2759C→T (L99F) and five families with the mutation 5381C→T (R129Stop). The mutation 2759C→T (L99F), which occurs within a non-CpG dinucleotide, was carried on a gene associated with an identical haplotype in each of the five families. The mutation 5381C→T (R129Stop), a single base substitution within a CpG dinucleotide, was associated with at least two different haplotypes. The findings suggest a founder effect in the five families sharing the 2759C→T (L99F) and at least two independent origins for the CpG dinucleotide mutation 5381C→T (Rl29Stop). © 1994 Wiley-Liss, Inc.