Defensive behavior? Also in dentistry?

The objective of this pilot-study was to investigate if defensive behaviour of dental practitioners occurs just as in the general practice of family physicians. On the basis of a survey, developed in the Department of General Practice of the University of Amsterdam, 38 dentists (mainly general-practitioners with an average of 20.9 years in practice), were interviewed. The dentists mention defensive practices, but the reasons are unrelated to fear of law-suits. They recommend unnecessary treatments, based on the wishes of their patients. The financial situation of the patient and defensive behaviour are closely related. The respondents avoid to give treatments because of dentally unmotivated patients or deviant behaviour of their visitors. Unnecessary referrals to specialists are also cited. Defensive behaviour was found to play a role in 3.5% of all patient encounters.     

C-reactive protein and complement depositions in human infarcted myocardium are more extensive in patients with reinfarction or upon treatment with reperfusion

BACKGROUND: Impaired perfusion of the heart induces a local inflammatory response, which involves deposition of C-reactive protein and complement activation products C3d and C5b-9. We investigated whether reperfusion or reinfarction enhances these phenomena in humans. MATERIALS AND METHODS: Depositions of C-reactive protein and complement were quantified in tissue samples of infarcted myocardium from 76 patients who had died after acute myocardial infarction. The extent of depositions in patients treated with reperfusion or suffering from reinfarction was compared with that in patients who had no reperfusion or reinfarction. RESULTS: Patients with reinfarction had significantly more extensive depositions of C-reactive protein and complement (C3d and C5b-9) in the infarcted myocardium than patients without reinfarction. Similarly, patients who received reperfusion therapy had more extensive depositions also than those who had not received this therapy. CONCLUSIONS: Both reinfarction and reperfusion therapy significantly increase the extent of C-reactive protein and complement depositions in human myocardial infarcts.     

Association of cowpea mosaic virus-induced double-stranded RNA with a cytopathological structure in infected cells

A cytopathological structure in cowpea mosaic virus (CPMV) infected cowpea leaves 4 days after inoculation was characterized ultrastructurally.The fraction of a homogenate of infected leaves sedimenting at 1000 g was fractionated on a discontinuous sucrose gradient consisting of layers of 20, 45, and 60% sucrose. The chloroplast fraction, which was found at the interface of the 20% and 45% sucrose layers, known to contain 70–90% of all CPMV-RNA hybridizable material, was further fractionated on a discontinuous gradient consisting of layers of 37, 39, 41, 43, and 45% sucrose. The material at the interface of the 37% and 39% sucrose layers (Fraction I) and that at the interface of the 39% and 41% layers (fraction II) contained 90% of all structures resembling the cytopathological structures and less than 30% of all chloroplasts. Fractions I and II contained together approximately 90% of all CPMV-RNA hybridizable material. The fractions collected from the 43% and 45% sucrose layers and the pellet (fraction III) contained more than 70% of the chloroplasts, less than 10% of the cytopathological structures, and less than 10% of the CPMV-RNA hybridizable material. It was concluded that the CPMV-dsRNA is associated with the cytopathological structures in the cytoplasm rather than the chloroplasts.Autoradiography performed on sections of intact tissue and on sections of pellets of fractions I, II, and III, from tissue treated with ³H-uridine, thymidine, and actinomycin D, presented strong evidence that CPMV-RNA replication is associated with the vesicular constituent of the cytopathological structures.     

Is age-related maculopathy associated with Alzheimer's Disease? The Rotterdam Study.

The authors examined the relation between age-related maculopathy and Alzheimer's disease in the Rotterdam Study, a prospective population-based study in the Netherlands. From 1990 to mid-1993, subjects aged 75 years or older (n = 1,438) were screened for the presence of age-related maculopathy and Alzheimer's disease, and follow-up examinations were conducted from mid-1 993 to the end of 1994. Subjects with advanced age-related maculopathy at baseline showed an increased risk of incident Alzheimer's disease (relative risk = 2.1, 95% confidence interval: 1.1, 4.3; adjusted for age and gender), but this risk decreased after additional adjustment for smoking and atherosclerosis (relative risk = 1.5, 95% confidence interval: 0.6, 3.5). These findings suggest that the neuronal degeneration occurring in age-related maculopathy and Alzheimer's disease may, to some extent, have a common pathogenesis.     

Incidence and progression rates of age-related maculopathy: the Rotterdam Study

PURPOSE: To describe the incidence rate of age-related macular degeneration (AMD) and the progression rates of early stages of age-related maculopathy (ARM), and to study the hierarchy of fundus features that determine progression. METHODS: A group of 4953 subjects aged 55 years and older living in Rotterdam, The Netherlands, was studied at baseline and at 2-year follow-up to determine the incidence of neovascular and atrophic AMD. A subgroup of 1244 subjects was studied for progression of early stages of ARM. Fundus transparencies were graded for features of ARM using the International Classification System. ARM was stratified in four exclusive stages, according to type of drusen and presence of pigmentary irregularities. RESULTS: The overall 2-year cumulative incidence of AMD was 0.2%, increasing to 1.8% in subjects of 85 years and older. Of those in the early stages, one fourth showed progression to a more severe stage. The most important predictors for progression were more than 10% of macular area covered by drusen (odds ratio [OR] 5.7, 95% confidence interval [CI] 2.9-11.3), presence of depigmentation (OR 4.0, 95% CI 2.5-6.4), and hyperpigmentation (OR 3.4, 95% CI 2.1-5.4). CONCLUSIONS: The incidence of AMD appears to be lower in The Netherlands than in the United States. Progression of early ARM stages occurs in a distinct pattern at a stable rate, with a large area of drusen and presence of pigmentary changes as the most important predictors.     

Safety and Tolerability of Nebulized Amoxicillin-Clavulanic Acid in Patients with COPD (STONAC 1 and STONAC 2)

The safety and tolerability of nebulized amoxicillin clavulanic acid were determined in patients with stable COPD and during severe exacerbations of COPD. Nine stable COPD patients received doses ranging from 50:10 mg up to 300:60 mg amoxicillin clavulanic acid and eight patients hospitalised for a COPD exacerbation received fixed doses 200/40 mg twice daily. Safety was evaluated by spirometry before and after inhalation. Tolerability was evaluated by questionnaire. Plasma and expectorated sputum samples were assayed for amoxicillin content.

Seventeen patients underwent in total 100 nebulizations with amoxicillin clavulanic acid. In this safety and tolerability study no clinically relevant deteriorations in FEV₁ were observed. Nebulized amoxicillin clavulanic acid produces sputum concentrations well above the Minimal Inhibiting Concentration of 90% for potential pathogenic micro-organisms, with low concentrations in the central compartment (low systemic exposure).

Based on spirometry and reported side effects, inhalation of nebulized amoxicillin clavulanic acid seems to be safe and well tolerated, both in stable patients with COPD as in those experiencing a severe exacerbation. Levels of amoxicillin were adequate.