An attempt to explain why Tanzanian children drinking water containing 0.2 or 3.6 mg fluoride per liter exhibit a similar level of dental fluorosis

The aim of this study was to identify factors that might explain the similar level of prevalence and severity of dental fluorosis in two neighboring areas in Tanzania: Kibosho; 0.2 mg fluoride/l, n=96 and Arusha; 3.6 mg fluoride/l in drinking water, n=80. Subjects aged 8–16 years were examined for dental fluorosis using the Thylstrup and Fejerskov Index (TFI). Based on the score on the upper left central incisor, the prevalence was not significantly different between the communities (TFI≥1). The severity, however, was significantly higher in Arusha. The areas had different food habits, e.g., type of weaning food used, and the use of magadi, a fluoride containing salt. In Arusha, 99% of the children had been given lishe, which is a magadi-free weaning food. Conversely in Kibosho, 61% used lishe while 39% used the magadi-containing weaning food kiborou. Magadi was used as food tenderizer in ’adult food’ by 98% in Kibosho and 45% in Arusha. Residencial area and use of magadi explained 5% of the variance in TFI scores in inter-area analyses. In intra-area analyses, weaning food in Kibosho and use of magadi in Arusha had a significant effect, but the total explained variance was only 5 and 4%, respectively. Apart from fluoride in the drinking water, other sources of fluoride such as use of magadi in weaning food (kiborou) and in the adult food may partly explain the high prevalence and severity of dental fluorosis in the community with 0.2 mg fluoride per liter in the drinking water. Received: 3 July 2000 / Accepted: 22 August 2000     

Abnormal glucose tolerance is a predictor of steatohepatitis and fibrosis in patients with non-alcoholic fatty liver disease

OBJECTIVE: The majority of patients with non-alcoholic fatty liver disease (NAFLD) have simple steatosis. A minority, however, present with non-alcoholic steatohepatitis (NASH), a condition that can lead to advanced fibrosis and cirrhosis. The frequencies of NASH and fibrosis among patients with NAFLD and sustained elevation of liver function tests (LFT) are uncertain. Our aim was to estimate these frequencies. We characterize a population with NAFLD, with special emphasis on insulin resistance and the metabolic syndrome, and study possible predictors for different stages of the disease. MATERIAL AND METHODS: All referred patients with sustained elevation of LFT, radiological evidence or clinical suspicion of fatty liver, and absence of other liver disease, were invited to participate in our study in the period June 2002 to December 2004. RESULTS: Of 129 patients who met the inclusion criteria, 88 underwent liver biopsy. NAFLD was verified in 83 of them. Among these patients, 59 (71%) had the metabolic syndrome, 41 (49%) had NASH and 36 (43%) had fibrosis. Abnormal glucose tolerance (T2DM or impaired glucose tolerance) was the only independent risk factor for NASH (OR: 3.14; 95% CI: 1.20-8.23). Independent predictors for fibrosis were abnormal glucose tolerance (OR: 3.83; 95% CI: 1.29-11.40) and body mass index (OR: 1.20; 95% CI: 1.06-1.36) per kg/m2. CONCLUSIONS: Both NASH and fibrosis are frequently present among patients with NAFLD and sustained elevation of LFT. The probability of these potentially progressive stages of NAFLD increases with the presence of abnormal glucose tolerance.     

The complexity of the psychosocial situation in children and adolescents with heart disease

AIM: To describe the psychosocial situation of children/adolescents with heart disease and their families, an inventory method was worked out. METHODS: Ninety-seven children/adolescents with congenital heart disease (CHD) were graded into three categories with respect to complexity of CHD. Group I included 42 patients with malformations requiring standardized operations. Group II included 20 patients with more complicated malformations, and group III included 35 patients with very complex malformations. The patients were compared with controls without heart disease, matched for age and gender. The psychosocial impact of CHD was measured by the inventory. RESULTS: The most frequent problems in the patient group were healthcare and treatment-related needs (71/97) in the external sphere, family symptoms (68/97) in the interpersonal sphere, and somatic symptoms (19/97) in the personal sphere. Corresponding numbers in the controls were treatment-related needs (15/97), family (9/97) and somatic symptoms (25/97). Fifty per cent of the symptoms in the patient groups were mild, 30% moderate and 20% severe. The most severe symptoms were found in the interpersonal sphere, where family symptoms constituted the most severe variable. The frequency of severe problems in the personal sphere was 11% in the patients and 1% in the controls. This inventory method differentiates the grades of medical complexity both regarding number and severity of psychosocial symptoms. It indicates severe personal problems in the most complex group and shows that they have severe personal problems independent of family problems. CONCLUSION: This study elucidates the psychosocial complexity in children/adolescents with CHD, which has clinical implications in developing a psychosocial care programme.     

Spinal metastasis of submandibular gland adenoid cystic carcinoma: a case report

BACKGROUND: Adenoid cystic carcinoma is a rare malignant tumor of the salivary glands, with pulmonary metastasis being the most common site of distant metastasis. CASE DESCRIPTION: The author reports an unusual case of intradural adenoid cystic carcinoma metastasis of the lumbar spine in a patient with recent prostate carcinoma suffering from progressive back pain. The primary submandibular tumor was resected 7 years before the appearance of the spine metastasis, and a prostatic carcinoma had been detected 1 year before. The patient died of systemically advanced disease a few months after surgical decompression. CONCLUSION: Late submandibular gland adenoid cystic carcinoma recurrence may present as an intradural lumbar spine metastasis. The case further displays difficulty in diagnosis and differentiation of metastasis in case of metachronous tumors.     

Glomerulonephritis and malignancy: a population-based analysis

BACKGROUND: An association between glomerulonephritis and malignant tumors has previously both been found and discarded in clinical series, but to our knowledge never has been tested in a population-based setting. METHODS: The Danish Kidney Biopsy Registry includes all kidney biopsies performed from 1985. Using a unique personal identification number, each person in the registry to the National Population Registry and the Danish Cancer Registry were linked. Cancer occurrence after the biopsy was compared in patients with morphological, glomerular diseases with that of the general Danish population, taking into account sex, age, calendar period and time since biopsy, and the 95% confidence interval (95% CI) for the observed-to-expected rates was calculated, assuming a Poisson distribution. Cancer occurrence was stratified to <1 year, 1 to 4, and >or=5 years after a biopsy. RESULTS: A total of 102 de novo cancers were found in 1958 patients. These cancers represent a two- to threefold excess of the expected number at <1 and 1 to 4, but not >or=5 years after a biopsy. Non-Hodgkin's lymphomas were observed six to eight times more than expected. Cancer excess was seen in glomerulonephritides with a known or suspected virus etiology. CONCLUSIONS: The excess cancer rate could be the result of underlying undiagnosed tumors whose antigens have initiated glomerulonephritis, or the immunosuppressive therapy that initiated or energized tumor cells. Based on the findings in our study, there is some support for an association to persistent viruses causing first the glomerulonephritides and then the malignancies, perhaps through a common pathogenesis. This calls for other studies to be done that are specifically designed to investigate this issue, with more data on patient characteristics and confounders.     

Coxsackie B Virus Antibodies in Myocardial Infarction

ABSTRACT. Evidence for the association between Coxsackie B virus infections and myocardial infarction was studied in a prospective follow-up examination. Using the micro neutralization test, 9 (15%) of 59 patients with acute myocardial infarction and 1 (2.6%) of 38 control patients showed a fourfold, or higher, antibody increase in paired serum samples against Coxsackie B1-5 viruses. This difference is significant (p≤0.05). None of the patients or controls revealed symptoms of a viral infection during the blood sampling. Virus isolation from throat and feces was negative in all patients and controls. This finding agrees with some previous studies suggesting that the Coxsackie B group may in some cases have a causal role in myocardial infarction, or may act as a triggering factor.     

Reconstructive arterial surgery in peripheral obliterative atherosclerosis.

A series of 547 patients (678 extremities) subjected to reconstructive arterial surgery is presented, with a minimum observation period of 2 years. The incidence of associated diseases at the time of operation was high (39%) and accounted for an impressive mortality when the patients were observed for a longer period of time. The main indication for all types of reconstructions was intermittent claudication and the results are in accord with those reported in other larger series. In 244 patients subjected to open thrombendarterectomy the postopertive mortality was 10/244, with 55% of the reconstructions being open after a mean observation period of 76 months. In 158 patients undergoing femoro-popliteal vein bypass procedures, the postoperative mortality was 2/158, with 55% open grafts after a mean observation period of 61 months.     

Dental discolorations and side effects with iron and placebo tablets.

In a randomized double-blind cross-over study, 19 young women received iron tablets (Neo-Fer) containing 0.20 g ferrous fumarate (60 mg Fe++), and placebo tablets, twice daily during two periods of 8 weeks each. Development of discolorations on fillings and tooth surfaces was studied by careful clinical examination, and by paired comparison of color transparencies taken before and after each period of treatment. Any tendency of this oral iron preparation to cause dental discolorations could not be detected in the present group of women with good oral hygiene. Seven participants reported gastrointestinal discomfort, two of them only when receiving placebo tablets.     

OXIDATION OF GLUCOSE and D-B-OH-BUTYRATE BY THE EARLY HUMAN FETAL BRAIN

Abstract. Adam, P. A. J., Räihä, N., Rahiala, E.-L. and Kekomäki, M. (Departments of Pediatrics, Case Western Reserve University at Cleveland Metropolitan General Hospital, Cleveland, Ohio USA, and the University of Helsinki at the Children's Hospital, Helsinki, Finland). Oxidation of glucose and D-B-OH-butyrate by the early human fetal brain. Acta Paediatr Scand, 64:17, 1975.–The isolated brains of 12 previable human fetuses obtained at 12 to 21 weeks' gestation, were perfused through the interval carotid artery with glucose (3 mM) and/or DL-B-OH-butyrate (DL-BOHB), 4.5 mM, plus tracer quantities of either glucose-6-¹⁴C (G6¹⁴C) or β-OH-butyrate-3-¹⁴C (BOHB3¹⁴C). Oxidative metabolism was demonstrated by serial collection of gaseous ¹⁴CO₂ from the closed perfusion system, and from the recirculating medium. Glucose and BOHB were utilized at physiological rates as indicated (mean ±SEM): G6¹⁴C at 0.10±0.01 μmoles/min g brain (n=7) or 17.5±1.9 μmoles/ min kg fetus; and BOHB3¹⁴C at 0.16±0.05 μmoles/min g (n=5) or 27.3±7.4 μmoles/ min kg. Based on fetal weight, glucose metabolism by brain apparently accounted for about 1/3 of basal glucose utilization in the fetus. On a molar basis BOHB3¹⁴C was taken up at 1.47 times the rate of G6¹⁴C. Both BOHB3¹⁴C and G6 ¹⁴C were converted to ¹⁴C0₂. The rate of BOHB3¹⁴C conversion to ¹⁴CO₂ was equal to its rate of consumption, and exceeded the conversion of glucose to CO₂ because 45% of the G6¹⁴C was incorporated into lactate-¹⁴C. Accordingly, both substrates support oxidative metabolism by brain; and BOHB is a major potential alternate fuel which can replace glucose early in human development.     

The public opinion in Norway on water fluoridation

abstract A cluster sample designed to cover the total adult population in Norway was interviewed about adding fluorides to water supplies. Thirty-four per cent favored fluoridation, 36 % opposed it, and 30 % did not know. When responses were related to background characteristics, only slight variations appeared. The finding indicated that at present there is not a sufficient attitudinal basis for introducing water fluoridation in Norway.