Clinical endodontic and surgical management of tooth and associated bone resorption

Summary. The management of root and bone resorption has been divided on clinical grounds into four categories:
(i)conditions that respond to conservative endodontics;
(ii) conditions that require surgical endodontics;
(iii) conditions that require combined therapy, e.g. endodontics, orthodontics, periodontics, prosthodontics;
(iv) conditions that will not respond to, or do not require any, treatment.
Using this classification, a conservative treatment rationale based on an understanding of the underlying disease can be evolved.
The diagnosis of whether the lesion is internal, external or combined is essential if rational therapy is to be carried out. Internal resorption requires the removal of the blood supply supporting this resorptive defect; the process should cease, provided that this can be effectively achieved.
External root resorption is more complicated, requiring either stimulation of natural repair processes by removing the aetiological agents, artificial repair involving the curettage of the defect and the placement of a suitable repair material, or partial or complete resection. Combined therapy involving orthodontic extrusion is useful in some defects at or near the cervical region.
Treatment should not be instituted where there is no therapeutic advantage or where the process would naturally cease with the removal of the initiating cause.     

Intranasal steroid aerosol in perennial rhinitis: comparison with an antihistamine compound

Intranasal betamethasone valerate aerosol, given for 28 days, was compared with an oral antihistamine compound in a double-blind, double-dummy, cross-over trial involving thirty patients with perennial rhinitis. The steroid aerosol was more effective in reducing symptoms and was preferred by the patients (P < 0·01). Nasal blockage index, calculated from oral and nasal peak expiratory flow measurements, did not provide useful or additional information. There were no side effects from the steroid and Candida albicans was not cultured from nasal swabs. It is concluded that beta-methasone valerate aerosol is a suitable short-term alternative for patients whose perennial rhinitis fails to respond to conventional therapy.     

Sacrococcygeal teratoma

Abstract Eight cases of sacrococcygeal teratoma are described. Seven patients were diagnosed at birth, and one presented at 3 1/2 months of age with urinary retention. Two patients had associated congenital anomalies (arachnoid cyst, external angular dermoid and bifid sacrum), while one had a family history of sacrococcygeal teratoma. All had the tumour removed together with the coccyx as soon as the diagnosis was made. None had recurrence of the tumour.     

Rickets in extremely low birthweight infants

ABSTRACT. The effects of increasing the concentration of supplemental vitamin D was studied in two groups of ELBW infants (babies with a birth weight less than 1000 g) during the periods of July 1977 to December 1979 and throughout 1980. There were 21 ELBW infants in the first study period, with 7 infants developing active or Stage III rickets. A prospective study of ELBW infants during 1980 revealed 3 infants out of the 12 studied developing active or Stage III rickets. A new radiological classification for rickets of prematurity, Stage I to IV, is presented. Serial serum alkaline phosphatase levels were then compared with these radiological stages and a serial ALP of 500IU/l was found to be statistically significant in the biochemical diagnosis of rickets. As a result of our findings, we suggest that all ELBW should be supplemented with at least 800 IU of vitamin D daily.     

Different effects of short- and long-term dietary choline-deficiency on hepatic microsomal phospholipids and drug oxidation

Prolonged administration of a choline-deficient diet to male rats results in the development of hepatic cirrhosis and alterations in oxidative drug metabolism. The present study was designed to assess whether the changes in drug metabolism were related to the development of cirrhosis or merely to the effects of choline-deficiency on hepatic microsomal lipid composition. Male rats were given a synthetic choline-deficient diet for either 1 week (short-term) or 30 weeks (long-term), and results at each time were compared with age-matched control rats given the same diet but with supplementary choline.
After both 1 week and 30 weeks of the choline-deficient dietary regimen, the proportion of microsomal phospholipid present as phosphatidylcholine was significantly decreased, and that present as phosphatidylethanolamine was significantly increased, compared with appropriate controls. However, microsomal cholesterol content (per mg of microsomal protein) was not significantly changed at either time. Cytochrome P-450 levels and the turnover of ethylmorphine N -demethylase (enzyme activity/nmol cytochrome P-450) were significantly reduced in the cirrhotic (30 week) model whereas short-term intake of the diet did not alter the levels of cither enzyme. These findings suggest that the effects of changes in phosphatidylcholine and phosphatidylethanolamine levels in choline-deficiency cirrhosis have minimal importance with respect to changes in drug oxidation. Instead, altered regulation of specific cytochrome P-450 isozymes appears to be the principal cause of impaired oxidation.     

Portal vein thrombosis associated with prolonged ingestion of oral contraceptive steroids

The case is described of a 38 year old woman who developed severe right upper quadrant abdominal pain that was associated with partial portal vein occlusion, as confirmed by flow Doppler ultrasonography and dynamic contrast computed tomography. The patient was a cigarette smoker and had taken combined oestrogen/progestagen oral contraceptive steroids (OCS) continuously for 24 years. There were no other risk factors for portal vein thrombosis or for thromboembolic disease. Following anticoagulant therapy and discontinuation of OCS complete recovery occurred. The case is reported to draw attention to portal vein thrombosis as an extremely rare complication of OCS.     

Long-term follow-up of gastric histology after Helicobacter pylori eradication

Helicobacter pylori causes chronic active gastritis and is thought to be associated with the development of gastric atrophy, intestinal metaplasia and carcinoma. As the effect of H. pylori eradication on this process is poorly understood, we sought to determine the long-term effects of H. pylori eradication on gastric histology. Fifty-four patients with duodenal ulceration associated with H. pylori infection received H. pylori eradication therapy in 1985/86 and either remained infected (n= 22) or had the infection eradicated (n= 32); patients were followed up by endoscopy with gastric antral biopsy for 7.1 years (mean). Histopathological analysis of gastric antral mucosa from patients rendered H. pylori-negative revealed a marked decrease in both inflammatory cells within the lamina propria and intraepithelial neutrophils and an increase in epithelial mucinogenesis. Gland atrophy remained unchanged in both H. pylori-positive and -negative patients. When examined for the presence and severity of intestinal metaplasia, there was neither a difference between the two patient groups nor a change with time. These data demonstrate that significant long-term improvements in gastric histology accompany H. pylori eradication when compared with histology in patients with persistent infection. Whether this confers a protective effect by reducing the risk of gastric carcinoma remains unknown.