The effects of racemic D,L-methadone and L-methadone in substituted patients--a randomized controlled study

AIMS: To test the hypothesis that switching from L-methadone to D,L-methadone is associated with more frequent withdrawal symptoms and side-effects than switching from D,L-methadone to L-methadone. DESIGN: Stratified, randomized 2 x 2 crossover study design over a time-period of 8 weeks. At study entry, every second patient was switched from the pre-study substance to the other medication, after 4 weeks all patients were subject to a (re-)switch. SETTING: The study was conducted as a multi-centre trial in three methadone maintenance therapy (MMT) clinics. PARTICIPANTS: Seventy-five patients previously treated with either D,L-methadone or L-methadone for at least 1 year took part in the study. MEASUREMENTS: Intra-individual changes in withdrawal symptoms (Short Opiate Withdrawal Scale, SOWS) and side-effects were defined as primary outcome criteria. Secondary outcome measures included necessity for methadone dose adjustment. FINDINGS: Complete data were available for 68 patients (91%). Sample strata were unbalanced at baseline: 15 patients (22%) were treated with L-methadone and 43 with D,L-methadone (78%). Thirty-five patients were randomized into the group treated with L-methadone and 33 into the group treated with D,L-methadone during the first 4 weeks. There were no significant differences in intra-individual change of withdrawal symptoms and side-effects between groups after crossover. However, patients treated with levomethadone tended to feel less withdrawal symptoms than patients treated with d,l-methadone. CONCLUSIONS: D,L-methadone and L-methadone can safely be replaced by each other on a 2:1 ratio. Withdrawal symptoms or side-effects due to conversion are of transient nature only.     

A hypothesis of calcium stone formation: an interpretation of stone research during the past decades

An interpretation of previous and recent observation on calcium salt crystallization and calcium stone formation provide the basis for formulation of a hypothetical series of events leading to calcium oxalate (CaOx) stone formation in the urinary tract. The various steps comprise a primary precipitation of calcium phosphate (CaP) at high nephron levels, establishment of large intratubular and/or interstitial (sub-epithelial) aggregates of CaP. These crystal masses subsequently might be dissolved during periods with low urine pH. On the denuded surface of subepithelial or intratubularly trapped CaP, release of calcium ions can result in very high ion-activity products of CaOx, particularly during simultaneous periods with peaks of CaOx supersaturation. Crystals of CaOx may result from nucleation in the macromolecular environment surrounding the apatite crystal phase. In the presence of low pH, low citrate and high ion-strength of urine, formation of large CaOx crystal masses can be accomplished by self-aggregation of Tamm–Horsfall mucoprotein. Following dislodgment of the initially fixed CaOx stone embryo, the further development into to clinically relevant stone is accomplished by CaOx crystal growth and CaOx crystal aggregation of the retained stone material. The latter process is modified by a number of inhibitors and promoters present in urine. The retention of the stone is a consequence of anatomical as well as hydrodynamic factors.     

Characteristics of patients referred for Cone Beam Computed Tomography (CBCT) of ectopically erupting maxillary canines

The aim was to study the characteristics of patients referred for tomographic examinations of maxillary canines suspected of ectopic eruption and evaluate whether the criteria used for referring the patients could be considered appropriate. During a 1-year-period all patients (n=63) referred for tomographic examinations of ectopically erupting maxillary canines, when intra-oral x-ray examinations were insufficient to describe the position of the canine and the conditions at adjacent teeth, were examined by means of Cone Beam Computed Tomography (CBCT). There was a statistically significant overrepresentation of girls (63.5%) among the referred patients. The mean age for the girls was 146.0 +/- 22.2 months and for the boys 151.8 +/- 17.8 months, a statistically non-significant difference. In total, 91 maxillary canine sites were examined and in 33 of the examined sites (36%) a resorption was found in the root surface of an adjacent tooth, in the vast majority the lateral incisor. Since more than one tooth was occasionally affected the total number of resorptions was 38 of which 14 had reached the pulp (37%). Considering the frequency of teeth, adjacent to ectopically erupting maxillary canines, that were affected by resorptions it can be concluded that the referral criteria used were appropriate. Given theyoung age of the patients it can be recommended that tomography should be performed with CBCT techniques that permit the examination of small volumes and result in high quality images.     

Pain-related impairment and health care utilization in children and adolescents: a comparison of orofacial pain with abdominal pain, back pain, and headache.

OBJECTIVE: The purpose was to compare orofacial (temporomandibular) pain with other pain complaints regarding impairment and health care utilization in a sample of 1,011 children and adolescents from a metropolitan area in Germany. METHOD AND MATERIALS: Individuals aged 10 to 18 years were sampled in schools using a 2-stage cluster technique. Orofacial pain in the previous month was assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Additionally, participants were questioned about headache, back pain, abdominal pain, pain-related impairment, and health care utilization (visits to doctors, analgesic consumption) in the previous month. RESULTS: Headache was reported by 50% (95% CI: 45% to 56%) of participants, stomach pain by 36% (95% CI: 32% to 41%), back pain by 31% (95% CI: 25% to 36%), and orofacial pain by 15% (95% CI: 12% to 18%). Girls were more affected than boys. The range of "severe" and "very severe" impairment lay between 8% (orofacial pain) and 22% (headache). The range of treatment demand was between 10% and 17% (orofacial pain: 15%), and the range for analgesic consumption between 18% and 24% (orofacial pain: 22%). The more pain experienced, the more impairment, doctor consultations, and analgesic consumption were reported (Chi2test: P < 0.05). Risk of orofacial pain was 60% higher for subjects with head, back, and/or abdominal pain (odds ratio: 1.6; 95% CI: 1.3 to 1.9). CONCLUSION: In children and adolescents, orofacial pain occurs about half as often as other pain complaints. However, relative to their prevalence the different pain complaints are similar regarding impairment and health care utilization.     

Is there a relationship between juvenile idiopathic arthritis and periodontitis?

AIM: The aim was to compare the prevalence of periodontal conditions in patients with juvenile idiopathic arthritis (JIA) (n=78, age 14.4 years) with those revealed in a healthy control group (n=75, age 15.5 years). MATERIAL AND METHODS: In both groups, the approximal plaque index (API), the modified sulcular bleeding index (SBI), and the clinical attachment loss (CAL) were determined. Laboratory parameters for JIA activity included the capsule-reactive protein (CRP) and the immunoglobulins A, G, M. RESULTS: JIA patients had a significantly higher API (64.6%versus 49.9%, p=0.004) and slightly higher mean percentages of sites with CAL>3.5 mm (0.58%versus 0.22%, p=0.041). There was no significant difference in the prevalence of patients and controls who had sites with CAL >3.5 mm (25.6%versus 17.3%, p=0.212). The mean CAL was slightly greater (0.2 mm; p=0.030) in patients with CRP> or =5.0 mg/l compared with patients with CRP<5.0 mg/l. Patients who took non-steroidal anti-inflammatory drugs (NSAIDs) had a significantly decreased SBI (26.2%versus 51.1%, p=0.019). CONCLUSION: After adjustment for microbial plaque, JIA is not a risk factor for periodontitis.     

Tensile bond strength of different adhesive systems between bone and composite compared: an in vitro study.

INTRODUCTION: The aim was to compare tensile bond strength of three dentine adhesive systems (Excite, Clearfil New Bond, Etch & Prime 3.0) and two cyanoacrylate adhesives (Cyano Veneer, Histoacryl) to animal bone in vitro. MATERIAL AND METHODS: Specimens from five porcine mandibles (diameter 9 mm) with a total thickness of 4mm (+/-0.5mm) and a cortical layer of 1.5mm (+/-0.2mm) were prepared using trephine burs under constant water cooling and under standardized conditions. They were assigned to five experimental groups. Tensile bond strength of five different adhesive agents (Clearfil New Bond, Etch & Prime 3.0, Excite, Histoacryl and Cyano Veneer was measured 15 min after application and after light curing of a composite material (Tetric Ceram, colour A2) added thereupon using a universal testing machine. Qualitative control was performed by scanning electron microscopy, while examining loaded and unloaded specimens. RESULTS: The measured tensile bond strength was as follows: Clearfil New Bond 8.00 MPa (+/-1.36 MPa), Etch & Prime 3.0 4.05 MPa (+/-1.52 MPa), Excite 2.96 MPa (+/-1.34 MPa), Histoacryl 5.22 MPa (+/-2.00 MPa), Cyano Veneer 4.56 MPa (+/-0.76 MPa). Clearfil New Bond showed significantly higher bond strength than the other four adhesives. Scanning electron microscopy analysis of unloaded specimens showed mixed modes of fracture. As regards the loaded specimens, no tag formation as known for dentine was found. CONCLUSION: Within the limitations of an in vitro investigation it can be concluded that dentine adhesive systems might be useful for bone bonding. Tensile bond strength of the dentine adhesive systems tested on bone is comparable to that evaluated for dentine in earlier investigations.     

Interactive role of trauma cytokines and erythropoietin and their therapeutic potential for acute and chronic wounds

If controllable, stem cell activation following injury has the therapeutic potential for supporting regeneration in acute or chronic wounds. Human dermally-derived stem cells (FmSCs) were exposed to the cytokines interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) in the presence of erythropoietin (EPO). Cells were cultured under ischemic conditions and phenotypically characterized using flow cytometry. Topical EPO application was performed in three independent clinical wound healing attempts. The FmSCs expressed the receptor for EPO. EPO had a strong inhibitory effect on FmSC growth in the absence of IL-6 and TNF-α. With IL-6, the EPO effects were reversed to that of growth stimulation. TNF-α had the strongest stimulatory effect. In contrast, IL-1β had an inhibitory effect. Topically applied EPO considerably enhanced wound healing and improved wound conditions of acute and chronic wounds. Site specificity of stem cell activation is mediated by IL-6 and TNF-α. In trauma, EPO ceases its inhibitory role and reverts to a clinically relevant boosting function. EPO may be an important therapeutic tool for the topical treatment of acute and chronic wounds.