Complication and failure rates in patients treated for chronic periodontitis and restored with single crowns on teeth and/or implants

Objectives: To assess the biological and technical complication rates of single crowns on vital teeth (SC‐V), endodontically treated teeth without post and core (SC‐E), with a cast post and core (SC‐PC) and on implants (SC‐I). Material and methods: From 392 patients with chronic periodontitis treated and documented by graduate students during the period from 1978 to 2002, 199 were reexamined during 2005 for this retrospective cohort study, and 64 of these patients were treated with SCs. Statistical analysis included Kaplan–Meier survival functions and event rates per 100 years of object‐time. Poisson regression was used to compare the four groups of crowns with respect to the incidence rate ratio of failures, and failures and complications combined over 10 years and the entire observation period. Results: Forty‐one (64%) female and 23 (36%) male patients participated in the reexamination. At the time of seating the crowns, the mean patient age was 46.8 (range 24–66.3) years. One hundred and sixty‐eight single unit crowns were incorporated. Their mean follow‐up time was 11.8 (range 0.8–26.4) years. During the time of observation, 22 biological and 11 technical complications occurred; 19 SC were lost. The chance for SC‐V (56) to remain free of any failure or complication was 89.3% (95% confidence interval [CI] 76.1–95.4) after 10 years, 85.8% (95% CI 66–94.5) for SC‐E (34), 75.9% for SC‐PC (39), (95% CI 58.8–86.7) and 66.2% (95% CI 45.1–80.7) for SC‐I (39). Over 10 years, 95% of SC‐I remained free of failure and demonstrated a cumulative incidence of failure or complication of 34%. Compared with SC‐E, SC‐I were 3.5 times more likely to yield failures or complications and SC‐PC failed 1.7 times more frequently than did SC‐E. SC‐V had the lowest rate of failures or complications over the 10 years. Conclusions: While SCs on vital teeth have the best prognosis, those on endodontically treated teeth have a slightly poorer prognosis over 10 years. Crowns on teeth with post and cores and implant‐supported SCs displayed the highest incidence of failures and complications. To cite this article :
Schmidlin K, Schnell N, Steiner S, Salvi GE, Pjetursson B, Matuliene G, Zwahlen M, Brägger U, Lang NP. Complication and failure rates in patients treated for chronic periodontitis and restored with single crowns on teeth and/or implants
Clin. Oral Impl. Res. 21 , 2010; 550–557.
doi: 10.1111/j.1600‐0501.2009.01907.x     

Effects of muscle fatigue on gait characteristics under single and dual-task conditions in young and older adults

Background  

Muscle fatigue and dual-task walking (e.g., concurrent performance of a cognitive interference (CI) while walking) represent major fall risk factors in young and older adults. Thus, the objectives of this study were to examine the effects of muscle fatigue on gait characteristics under single and dual-task conditions in young and older adults and to determine the impact of muscle fatigue on dual-task costs while walking.     

Structure of intracorneal femtosecond laser pulse effects in conical incision profiles

PURPOSE: As the applicative potential of femtosecond lasers is to be extended from LASIK-flap creation into intrastromal ablation uses, the interdependency of influencing factors has to be understood. We therefore evaluated the relationship between focus depth, energy level, spatial distribution and morphology of fs-Laser pulse effects at a given repetition rate in corneal tissue. METHODS: The experimental study included five porcine corneae obtained from slaughterhouse pigs. Using a prototype of a femtosecond laser (FEMTEC; 20/10 Perfect Vision AG, Heidelberg, Germany), a conical circular cut was performed in posterior-anterior direction through the entire corneal profile. The laser energy applied ranged from 4.0 to 8.5 muJ. Histological sections (n = 337) of a thickness of 7 mum were obtained, stained with hematoxylin/eosin, and morphometrically evaluated. RESULTS: The intrastromal femtosecond laser effects were aligned throughout the corneal stroma in a line that followed the dissection line programmed for the laser. The lesions were mostly of roughly elliptic shape with a fine dense lining at the inner wall, without evidence of a collateral damage beyond the disruption cavity. The mean maximal diameter of the intrastromal laser effects was 34.2 +/- 18.6 mum (range: 9-120 mum), and the mean maximal lesion diameter was 60.8 +/- 42.6 mum. In multivariate analysis, the lesion type (single shot cavity, partly confluent lesions, and fully confluent lesions) was significantly associated with the laser energy applied (P = 0.027) and the lesion diameter (P = 0.01). CONCLUSIONS: At higher laser energies, the intrastromal laser lesions were larger and more confluent, suggesting that, with the prototype of femtosecond laser used, a higher laser energy may lead to more confluent intrastromal laser effects. It may facilitate the complete cutting of the corneal tissue with the laser. Neither discernable debris nor stainable collateral damage were detected, suggesting a purely mechanical action of the laser.     

Intravitreal bevacizumab for myopic choroidal neovascularization.

BACKGROUND AND OBJECTIVE: To evaluate the effect of intravitreal bevacizumab on visual acuity in patients with myopic choroidal neovascularization. PATIENTS AND METHODS: The retrospective case series study included 13 patients with myopic choroidal neovascularization who received three intravitreal injections of 1.5 mg of bevacizumab. RESULTS: At 1, 3, and 6 months after the first injection, mean visual acuity improved significantly from 0.63 +/- 0.41 logarithm of the minimum angle of resolution units (LogMAR) to 0.39 +/- 0.22 (P< .001), 0.47 +/- 0.49 (P= .002), and 0.52 +/- 0.49 LogMAR (P = 0.009), respectively. The increase in visual acuity was correlated with a significant decrease in central retinal thickness (P = .003) as measured by optical coherence tomography. Mean intraocular pressure did not change significantly (P> .05) during follow-up. CONCLUSION: Intravitreal injections of bevacizumab may be a therapeutic option for exudative myopic macular degeneration.     

The double-stranded RNA-activated protein kinase mediates radiation resistance in mouse embryo fibroblasts through nuclear factor kappaB and Akt activation.

PURPOSE: Activation of the double-stranded RNA-activated protein kinase (PKR) leads to the induction of various pathways including the down-regulation of translation through phosphorylation of the eukaryotic translation initiation factor 2alpha (eIF-2alpha). There have been no reports to date about the role of PKR in radiation sensitivity. EXPERIMENTAL DESIGN: A clonogenic survival assay was used to investigate the sensitivity of PKR mouse embryo fibroblasts (MEF) to radiation therapy. 2-Aminopurine (2-AP), a chemical inhibitor of PKR, was used to inhibit PKR activation. Nuclear factor-kappaB (NF-kappaB) activation was assessed by electrophoretic mobility shift assay (EMSA). Expression of PKR and downstream targets was examined by Western blot analysis and immunofluorescence. RESULTS: Ionizing radiation leads to dose- and time-dependent increases in PKR expression and function that contributes to increased cellular radiation resistance as shown by clonogenic survival and terminal nucleotidyl transferase-mediated nick end labeling (TUNEL) apoptosis assays. Specific inhibition of PKR with the chemical inhibitor 2-AP restores radiation sensitivity. Plasmid transfection of the PKR wild-type (wt) gene into PKR(-/-) MEFs leads to increased radiation resistance. The protective effect of PKR to radiation may be mediated in part through NF-kappaB and Akt because both NF-kappaB and Akt are activated after ionizing radiation in PKR+/+ but not PKR-/- cells. CONCLUSIONS: We suggest a novel role for PKR as a mediator of radiation resistance modulated in part through the protective effects of NF-kappaB and Akt activation. The modification of PKR activity may be a novel strategy in the future to overcome radiation resistance.     

The cephalosporin compounds in severe neonatal infection

The new cephalosporin compounds have increased in vitro activity against gram-negative enteric bacilli and penetrate well into cerobrospinal fluid. Moreover, their pharmacokinetic properties are favorable and their safety seems adequate, although insufficiently evaluated to date. Interest has been focused on them as therapeutic agents for neonatal sepsis and meningitis caused by Enterobacteriaceae. In this review the third generation cephalosporins are evaluated for their possible use in the neonates; opinions are based on currently available data. It is concluded that moxalactam and cefotaxime and probably also ceftriaxone and ceftazidime represent valuable alternatives to aminoglycosides for therapy of severe neonatal infection. Curriculum vitae. Urs B. Schaad was born 1945 in Switzerland. He graduated 1971 from the Medical Faculty of the Bernese University and his postgraduate training included 1 year General Surgery (Lugano), 11/2 years Internal Medicine (Langenthal) and 41/2 years Pediatrics (Berne). From 1978 to 1980 he completed a Research Fellowship in Pediatric Infectious Diseases at the University of Texas at Dallas, USA (Directors of Program: Prof. George H. McCracken, Jr., and Prof. John D. Nelson). Since 1981 he is back at the Department of Pediatrics, University of Berne (Head: Prof. E. Rossi), conducting clinical, research and teaching activities in Pediatric Infectious Diseases. In June 1983 he was promoted to Privatdozent and received the Venia Docendi in Pediatrics with special regard to Infectious Diseases. Main topics of research have been experimental meningitis and studies on pharmacokinetics and efficacy of different antimicrobial agents in pediatric patients. Previous reviews included recrudescence and relapse in bacterial meningitis, atypical myobacterial lymphadenitis, melioidosis, pyogenic sacroiliitis, arthritis in meningococcal disease, infantile chlamydial pneumonia, Campylobacter-reactive arthritis, prophylaxis against pneumococcal, meningococcal and H. influenzae type b infections in childhood, neonatal sepsis and meningitis, and infectious diarrhea in the pediatric age group.     

Autologous bone marrow transplantation in the treatment of children and adolescents with advanced malignant tumors

Nineteen patients with advanced malignant tumors, less than 20 years old were treated with intensive chemotherapy (vincristine 2 mg/m² i.v. and adriamycin 60 mg/m² i.v. on day ?7; cyclophosphamide 45 mg/kg i.v. on days ?6 to ?3), total body irradiation (TBI, 600 rads on day ?1) and autologous bone marrow transplantation (ABMT, day 0). Prior to this procedure induction of complete or partial remission by conventional therapy was attempted. Ten patients had intra-abdominal non-Hodgkin's lymphoma (NHL); three, yolk sac tumor; three, Ewing's sarcoma; and three, neuroblastoma. The supportive care included reverse isolation, immunoglobulin 400 mg/kg i.v. q 2 weeks, cotrimoxazole per os, and cell support as needed. No correlation between the bone marrow dose and the time of hematological reconstitution could be established. Five of seven patients with intraabdominal NHL stage III (transplanted in first remission) are surviving disease-free for 5 +, 5 +, 20 +, 23 +, and 35 + months after ABMT. None of three patients with intra-abdominal NHL stage IV is surviving (two of them were transplanted in second remission). One of three patients with yolk sac tumor is surviving disease-free for 27+ months. There are no survivors among the patients with Ewing's sarcoma and neuroblastoma. Only one of 19 patients was lost due to therapeutic complications, while 12 died due to tumor. Regarding treatment results for advanced intra-abdominal NHL, the procedure described here is comparable to the best conventional regimens. In vitro methods for tumor cell eradication in the collected bone marrow might further improve the results of ABMT.