Treatment of severe peripheral arterial and vasospastic disease of the upper extremity by spinal cord stimulation

Spinal cord stimulation (SCS) has been successfully introduced for treatment of severe peripheral arterial disease of the lower limbs. However, the effect of SCS for treatment of severe vasospastic disease (VD) and peripheral arterial disease (PAD) of the upper extremities remains uncertain. Therefore, the efficacy of SCS for pain reduction and increase of blood supply was studied in four patients with severe PAD and in six patients with VD of the upper limbs. Transcutaneous oxygen tension index (chest TcpO₂/hand TcpO₂), Doppler wrist pressure index (WPI), capillary microscopy (CM), and a patients pain score (PS) graded from 1 to 10 (1=no pain) were used as follow-up parameters. Pain reduction after SCS was excellent in all patients and remained significant throughout the follow-up period. TcpO₂ index decreased significantly (2.01±0.79 prae-OP vs 1.57±0.62 at 18 months). Capillary microscopy improved regarding red blood cell velocity and capillary density. Doppler WPI remained unchanged throughout the course. The results demonstrate that treatment of severe PAD and VD by use of thoracic SCS reduces pain significantly in these patients and increases blood supply. SCS provides a successful method of treatment for refractory VD and PAD of the upper extremity.Presented at the 36th Annual World Congress of the International College of Angiology, New York City, New York, July 1994     

Development of severe thyroid-associated ophthalmopathy in a patient with disseminated thyroid cancer treated with recombinant human thyrotropin/radioiodine and retinoic acid.

We present a case in which a patient with disseminated well-differentiated papillary thyroid cancer developed severe thyroid-associated ophthalmopathy. Eight years after initial surgery and ablative radioiodine therapy the patient was found to have multiple pulmonary metastases. The metastases showed poor uptake of radioiodine. An attempt was made to use 13-cis-retinoic acid in order to achieve a redifferentiation of the thyroid cancer cells before recombinant human thyrotropin (rhTSH) stimulated radioiodine therapy. The treatment did not improve the uptake of radioiodine. However, approximately 2 weeks after completion of the treatment the patient experienced discomfort in her eyes and then over the next months she developed a severe ophthalmopathy. The analyses of TSH receptor antibodies and S-thyroglobulin simultaneously showed a pronounced increase. An association between therapy given and severe ophthalmopathy cannot be excluded.     

Impact sibutramine therapy in children with hypothalamic obesity or obesity with aggravating syndromes

OBJECTIVE: Behavioral treatment of children suffering from hypothalamic obesity or uncomplicated obesity in combination with syndromes that aggravate this condition has proven to be ineffective. The combination of comorbidities and severe obesity lower the quality of these children's lives drastically. The present goal was to determine whether treatment with sibutramine has a beneficial effect on such children. DESIGN AND SUBJECTS: A double-blind, placebo-controlled, cross-over study (20 + 20 wk), followed by a 6-month open phase, was performed. The primary indicator of efficacy was the body mass index (BMI) sd score (SDS) value, which was analyzed using an ANOVA repeated-measures design [intention to treat (ITT)]. The 50 children (7-20 yr of age) involved included 22 with hypothalamic obesity and 28 with uncomplicated obesity plus aggravating syndromes. Forty-five patients completed the first phase, and 42 participated in the entire study. RESULTS: The group that initially received the placebo demonstrated an insignificant decrease (-0.06) in BMI SDS during this treatment but a significant decrease (-0.68; P < 0.001) when treated with sibutramine. The other group demonstrated a reduction in their BMI SDS of -0.72 during administration of sibutramine and a rebound of +0.43 when placed on the placebo (P < 0.001 in both cases). The response of children with hypothalamic obesity was also significant but was less pronounced than that of children with nonhypothalamic obesity. During the open phase, a continuous reduction in weight was observed. The treatment was tolerated well. CONCLUSION: The clinically and statistically significant weight reduction caused by sibutramine in this short-term study indicates that treatment of hypothalamic and syndromal obesity with this drug may be beneficial.     

Salivary mutans streptococci and lactobacilli levels after ingestion of the probiotic bacterium Lactobacillus reuteri ATCC 55730 by straws or tablets

OBJECTIVE: Previous studies have suggested that lactobacilli-derived probiotics in dairy products may affect oral ecology, but the impact of different vehicles of ingestion has received little attention. The aim of the present study was to investigate the effect of the probiotic bacterium Lactobacillus reuteri ATCC 55730 on the levels of salivary mutans streptococci and lactobacilli in young adults when ingested by two different delivery systems. MATERIAL AND METHODS: The material comprised 120 healthy young adults (21-24 years) and a placebo-controlled study design with parallel arms was utilized. The subjects were randomly assigned to four equally sized groups: group A drank 200 ml of water through a prepared straw containing L. reuteri ATCC 55730 once daily for 3 weeks, while group B took 200 ml water through a placebo straw during the same period. Group C was given one tablet containing L. reuteri ATCC 55730 once daily for 3 weeks, while group D received placebo tablets without bacteria. Salivary mutans streptococci and lactobacilli were enumerated with chair-side kits at baseline and 1 day after the final ingestion. RESULTS: A statistically significant reduction of the mutans streptococci levels was recorded after ingestion of the probiotic bacteria via the straw (p<0.05) and the tablets (p<0.01), which was in contrast to the placebo controls. A similar but non-significant trend was seen for lactobacilli. CONCLUSIONS: A short-term daily ingestion of lactobacilli-derived probiotics delivered by prepared straws or lozenges reduced the levels of salivary mutans streptococci in young adults.     

Caries risk assessment in school children using a reduced Cariogram model without saliva tests

Background  

To investigate the caries predictive ability of a reduced Cariogram model without salivary tests in schoolchildren.     

Salivary mutans streptococci and lactobacilli in 9- and 13-year-old Italian schoolchildren and the relation to oral health

The prevalence and levels of mutans streptococci (MS) and lactobacilli (LB) in saliva and its possible correlation with dental caries and periodontal conditions was investigated in 473 Italian schoolchildren, 9 and 13 years of age. A clinical examination and sampling of stimulated whole saliva was carried out in the school and oral health was assessed as DMFT and CPITN using the WHO criteria. The saliva samples were frozen in liquid nitrogen and after thawing, cultivated on selective media. To test the influence of cryopreservation, fresh samples from 20 subjects were cultivated. Thirty-five percent of the children were caries-free with a mean DMFT of 1.9 at the age of 13. The majority exhibited healthy periodontal conditions. Salivary MS and LB were identified in 52% and 21% of the children, respectively. The prevalence of MS was higher among the 13-year-olds than the 9-year-olds while no such difference was found regarding LB. There was a statistically positive relationship (P<0.01) between the levels of MS and LB and both were significantly correlated to caries (P<0.01). The correlation coefficient of microbial recovery between frozen and unfrozen samples was 0.99. In conclusion, the data provided cross-sectional information of a clear positive relationship between selected micro-organisms in saliva and caries in 9- and 13-year-old children in spite of a relatively low prevalence of the disease. The findings are discussed in a risk selection perspective. Received: 10 November 1998 / Accepted: 14 January 1999