Resolution of oral lichenoid lesions after replacement of amalgam restorations in patients allergic to mercury compounds

The significance of contact allergy in patients with various oral symptoms was studied. Positive patch-test reactions to mercury compounds were found in 21/91 patients. Of these, 18 had lichenoid lesions in oral mucosa in close contact to amalgam fillings, and three patients with contact allergy had neither amalgam fillings in their teeth nor visible oral lesions. Amalgam replacement was carried out in 15/18 symptomatic patients. The fillings were replaced with gold in three cases, composite resin fillings in six, glass ionomer in three and both gold and composite materials in three cases. In 10 patients there was complete replacement and in five it was restricted to the fillings adjacent to the mucosal lesions. After a mean follow-up period of 3.2 years a complete cure was seen in seven patients, each of whom had had all their fillings changed. A marked improvement occurred in six patients, and there was no change in two.     

Randomized comparison of differing periods of twice-a-day triple therapy for the eradication of Helicobacter pylori

Background : We assessed the efficacy, compliance, and tolerability of the twice-a-day triple therapy, amoxycillin, omeprazole, and clarithromycin, for Helicobacter pylori and studied the effect of treatment duration (7, 10 or 14 days) on these factors.
Methods : One-hundred and fifty subjects with H. pylori infection documented by ¹³C-urea breath test were randomly assigned to a 7, 10 or 14-day course of amoxycillin 1 g b.d., omeprazole 20 mg b.d. and clarithromycin 500 mg b.d. Subjects returned at the end of therapy for pill count and assessment of side-effects. Subjects returned for a repeat ¹³C-urea breath test 4 weeks after the end of therapy.
Results : Poor compliance (<80% of medications taken) was seen in 0 subjects at 7 days, 6% at 10 days, and 10% at 14 days ( P =0.03 by χ² test for trend; difference for 7 vs. 14 days=10%; 95% CI, −2% to 18%; P =0.056). Intention-to-treat eradication rates were 86% at 7 days, 90% at 10 days and 92% at 14 days. Per-protocol eradication rates were 86% at 7 days, 91% at 10 days, and 95% at 14 days ( P =0.11; difference for 7 vs. 14 days=9%; 95% CI, −2% to 21%; P =0.17).
Conclusions : One week of twice-a-day amoxycillin, omeprazole and clarithromycin is well tolerated and provides a good rate of H. pylori eradication. Increasing the duration of therapy decreases compliance but has the potential to modestly improve efficacy if the patient takes the full complement of medication.     

Prospective study of fluconazole suspension for the treatment of oesophageal candidiasis in patients with AIDS

Background: Oesophageal candidiasis is the most common cause of oesophageal symptoms in patients with AIDS. Antifungal therapy, given as a suspension, may be better tolerated than capsules or tablets in children or patients with oesophageal symptoms. We performed a prospective study of the safety and efficacy of fluconazole suspension. Methods: Patients with HIV infection; odynophagia, dysphagia, or retrosternal pain; endoscopic evidence of white plaques or exudate in the oesophagus; and microscopic confirmation of fungal infection on biopsy or brushing specimens were eligible. Patients received fluconazole oral suspension (200 mg loading dose followed by 100 mg q.d.s.). Therapy was continued for 2 weeks after symptom resolution. Repeat endoscopy was performed after completion of therapy. Results: Forty-two patients enrolled in the study: 40 were male, mean (± s.e.) age was 37 ± 2 years and mean CD4 cell count was 67 ± 14/mm³. One patient was not evaluable because he received amphotericin during the first week of therapy. Symptoms resolved in all 41 evaluable patients; 17 (41%) had resolution by 1 week, 37 (90%) by 2 weeks, and 40 (98%) by 3 weeks. Endoscopic resolution occurred in 35 (95%) of 37 patients who underwent repeat endoscopy. Adverse events (skin rash in 1, nausea/vomiting in 2, elevated liver tests in 2) Ied to early termination of therapy in 5 patients, all of whom had clinical and endoscopic cure. Conclusions: Symptoms resolved in 100% of patients with AIDS and oesophageal candidiasis receiving an oral suspension of fluconazole, and 90% of patients had symptom resolution within 2 weeks. Determining whether the more rapid clinical cure in this study, compared with a previous trial which employed capsules, is related to an additional topical antifungal effect of the suspension, will require further study.     

Interaction of NSAIDs and Helicobacter pylori on gastrointestinal injury and prostaglandin production: a controlled double-blind trial

Background: H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) are major causes of gastroduodenal injury in man. We assessed the effect of daily NSAID ingestion on gastric histology and the interaction of H. pylori infection and NSAID ingestion on gross and histological injury and prostaglandin production. Methods: Fifty-two healthy volunteers with normal baseline endoscopy were randomly assigned to receive identical-appearing naproxen 500 mg b.d., etodolac 400 mg b.d., or placebo b.d. for 4 weeks. The number and size of all erosions and ulcers were recorded by endoscopy at weeks 1 and 4. Biopsies taken at baseline, week 1 and week 4 were assessed for H. pylori, histology and gastric prostaglandin E₂ production. Results: No significant changes occurred with treatment in any histological feature in the three study groups or in H. pylori positive or negative subsets. Antral inflammation scores (scale, 0–6) for the NSAID group were: week 0-1.2 ± 0.3; week 1—1.1 ± 0.3; week 4—1.3 ± 0.3; findings of ‘chemical gastritis’ were not seen. No significant difference in gross gastroduodenal injury (number or total surface area of ulcers or erosions) was seen between H. pylori positive and negative subjects in the three groups at week 1 or 4. Baseline prostaglandin E₂ production was significantly higher in H. pylori positive subjects (2398±400 vs. 1064±255 pg/mg protein) and decreased significantly with 1 week of naproxen in H. pylori positive and negative subjects. Conclusions: NSAID ingestion does not cause diffuse histological injury. Any diffuse histological injury in the gastric mucosa is related to the presence of H. pylori, and this H. pylori-associated gastritis is not altered by NSAID ingestion. Furthermore, the development of gross gastroduodenal damage with 4 weeks of NSAID use is not influenced by underlying H. pylori infection.     

Extensive Variation in the Signal Amplitude of the Atrial Floating VDD Pacing Electrode

The dependence of atrial signal amplitude on the site of the ntrial sensing dipole of a single-pass lead was examined in 29 patients. The vertical location of the dipole was documented in supine fluo-roscopy during quiescent and deep breathing and in upright chest roentgenogram, and was expressed as a proportion of the, right atrial height. As the group average, the atrial signal amplitude was equal when tested in supine, sitting, standing, and right- or left-side positions in follow-up determinations. The signal amplitude varied markedly between postures, showing a coefficient of variation of 45%± 24% within the group. Coefficient of variation within the 6-month fallow-up period in each tested position ranged from 31%−4 4%, Correlation between postures was weak (range of r = 0.53–0.81). Vertical location of the atrial dipole had no relationship to the signal amplitude. At least in one posture or test occasion the atrial signal amplitude was very low, ≤ 0.35 mV in 20 patients, and below detection limit (0.25 mV) in 5 patients. Programmed to high sensitivity, atrial undersensing was rare in ambulatory electrocardiography, ranging from 0–9,000 missed atrial beats (0%–8%), with a median of 100 beats/24 hours. In conclusion, temporary variation in atrial signal amplitude is extensive. Despite occasionally measured large signal amplitudes atrial sensitivity in single lead VDD pacemakers should be programmed high, and if poor atrial tracking is suspected, other methods besides routine sensitivity testing should be adapted.     

Age and maintenance of removable dentures in Finland

The age and maintenance of dentures, and denture-cleaning habits, were studied by an interview survey. The material represented nation-wide the Finnish population aged greater than or equal to 15 years old, and there were 957 interviewees, of whom 328 were denture wearers. In total, 45% of the upper and 40% of the lower dentures were over 10 years old. More than one-third of the dentures more than 5 years old had never been maintained during that time. Individuals whose dentures had been made and fitted by dental technicians visited dentists less frequently than individuals whose dentures had been made by dentists. Over 80% of the denture wearers reported cleaning their dentures by brushing at least once a day, and women cleaned them more frequently than men. The present findings suggest that denture wearers should be a special target group for dental health education, for the development of the latter, and for the development of dental health care services in the future.