Trends in dental caries in 1‐ to 4‐year‐old children in a Brazilian city between 1997 and 2008

International Journal of Paediatric Dentistry 2010; 20: 125–131 Objective. The objective of this study was to assess trends in dental caries prevalence and severity in 1‐ to 4 year‐old children living in Diadema, Brazil, over a 11‐year period, from 1997 to 2008. Methods. In 2008 an epidemiological oral health survey was carried out and the results on caries were compared with five cross‐sectional studies carried out using the same methods and criteria in 1997, 1999, 2002, 2004, and 2006 in the same city. In all surveys, children were randomly selected from those attending a National Day of Children’s Vaccination. Calibrated dentists carried out the clinical examination using WHO criteria. Caries trends were assessed by time‐lag analysis. In total, 5348 children were examined in the six surveys over the 11‐year period. Results. Time‐lag analysis showed a marked and statistically significant decline in the prevalence (χ² for trends: P < 0.001) and severity (Kruskal–Wallis: P < 0.001) of dental caries between 1997 and 2008. Conclusion. In conclusion, the last cohort of preschool children in Diadema had much better dental caries status than those in 1997.     

Manifest Fast and Slow Pathway Conduction Patterns and Reentry in a Patient with Dual AV Nodal Physiology

Manifest Fast and Slow AV Nodal Conduction Patterns and Reentry. A 52-year-old woman with paroxysmal supraventricular tachycardias (PST) showed short and long PR intervals during sinus rhythm. Repetitive episodes of PST due to simultaneous anterograde conduction through fast and slow conduction pathways (one P-two QRS) were recorded. A self-limited episode of non-paroxysmal AV nodal reentry with anterograde slow and retrograde fast pathway conduction was initiated by a single atrial premature beat. Each pathway depicted distinct refractory periods, conduction velocities, unidirectional block, and Wenckebach-type block suggesting the possibility of a well-defined anatomical substratum.     

Long-Term Performance of Endocardial Pacing Leads

To assess the performance of endocardial pacemaker leads and to identify factors associated with structural lead failure, medical records of 2,611 endocardial pacing leads (in 1, 5W patients) implanted between 1980 and 1991, having at least 1 month of follow-up, were reviewed. Leads without structural failure had normal function at the last follow-up date, or were discontinued for reasons other than structural failure (patient death, infection, dislodgment, lead-pacemaker incompatibility, operative complication, or abandonment by telemetry not related to failure). Leads with suspected structural failures were invasively or noninvasively disconnected because of clinical malfunction (loss of capture or sensing, oversensing, elevated thresholds, or skeletal muscular stimulation). Leads with verified structural failures met the criteria for suspected lead failure and also had a visible defect seen in the operating room or on chest roentgenograms, a change in the impedance interpreted by the physician as lead disruption, or a manufacturer's return product report that confirmed structural failure. Variables analyzed included patients’ age and gender, paced chamber, venous access, insulation materials, fixation mechanism, coaxial design, polarity, and different lead models. The cumulative lead survival at 5 and 10 years were 97.4% and 92.9%, respectively, for suspected failures; and 98.7% and 97.3%, respectively, for verified failures. Leads in older patients (≥ 65 years old), and leads in atrial position had fewer verified failures (P = 0.014 and P = 0.007, respectively). Unipolar leads also tended to perform better according to the verified definition (P = 0.07). The lead Medtronic 4012 had more suspected (P < 0.05) and more verified failures (P < 0.01), the lead CPI 4010 had more verified failures (P < 0.05) than the entire group of ventricular leads. Conclusions: Endocardial pacing leads implanted in atrial position, and implanted in older patients (> 65 years old) seems to have better long-term survival. Some lead models (Medtronic 4012 and CPI 4010) had poor survival rates, that could not be explained by the analyzed variables. The expected performance of endocardial pacing leads varies according to how failure is defined.     

Chronic Amiodarone Reduces Transmural Dispersion of Repolarization in the Canine Heart

Amiodarone Reduces Transmural Dispersion. Introduction: Amiodarone is a potent antiarrhythmic agent used in the management of both atrial and ventricular arrhythmias. In addition to its β-blocking properties, amiodarone is known lo block the sodium, potassium, and calcium channels in the heart. Its complex electropharmacology notwithstanding, the reasons for the high efficacy of the drug remain unclear. Also not well understood is the basis for the low incidence of proarrhythmia seen with amiodarone relative to other agents with Class III actions. The present study was designed to examine the effects of chronic amiodarone in epicardial, endocardial, and M cells of the canine left ventricle. Methods and Results: We used standard microelectrode techniques to record transmembrane activity from endocardial, epicardial, mid-myocardial, and transmural strips isolated from the canine left ventricle. Tissues were obtained from mongrel dogs receiving amiodarone orally (30 to 40 mg/kg per day) for 30 to 45 days or from untreated controls. Chronic amiodarone produced a greater prolongation of action potential duration in epicardium and endwardium, but less of an increase, or even a decrease at slow rates, in the M region, thereby reducing transmural dispersion of repolarization. In addition, chronic amiodarone therapy suppressed the ability of the I_kr, blocker, d-sotalol, to induce a marked dispersion of repolarization or early afterdepolarization activity. Conclusion: Our data demonstrate for the first time a direct effect of chronic amiodarone treatment to differentially alter the cellular electrophysiology of ventricular myocardium so as to produce an important decrease in transmural dispersion of repolarization, especially under conditions in which dispersion is exaggerated. These results may contribute to our understanding of the effectiveness of amiodarone in the treatment of life-threatening arrhythmias as well as to our understanding of the low incidence of proarrhythmia attending therapy with chronic amiodarone in comparison with other Class III agents.     

ELEVATION OF PROSTATE SPECIFIC ANTIGEN IN CARDIAC SURGERY WITH EXTRACORPOREAL CARDIOPULMONARY CIRCULATION

Purpose

We evaluated the correlation of prostate specific antigen (PSA) and cardiac surgery in a group of patients with symptomatic benign prostatic hyperplasia operated on with or without extracorporeal cardiopulmonary circulation.

Materials and Methods

A total of 30 men 54 to 72 years old (mean age 62 years) undergoing cardiac surgery had PSA measured preoperatively and postoperatively. To provide the baseline PSA value a first serum sample was obtained before surgery, and PSA measurements were repeated 12 hours and 7 days postoperatively. Cardiac surgery was performed with extracorporeal cardiopulmonary circulation in 20 cases and without cardiopulmonary bypass in 10, constituted the control group. An 18F Foley catheter was left indwelling for the first 24 hours in both groups.

Results

In the study group there was a significant increase in PSA postoperatively (p = 0.01). However, in the control group the PSA was not statistically different before or after surgery (p = 0.16). These results indicate that there was a physiological relationship between the extracorporeal cardiopulmonary circulation and PSA.

Conclusions

Although the etiology of this elevation is unknown, based on our data we conclude that extracorporeal cardiopulmonary circulation can cause an alteration in serum PSA unrelated to cardiac operation without extracorporeal bypass.     

Effects of Thymosin and Evidence of Monocyte Suppression of Both T- and B-Cell Functions in Two Cases of 'Common Variable Immunodeficiency'

We have studied two patients with common variable immunodeficiency (CVID) impaired cell-mediated immunity. and high percentages of monocytes in their peripheral blood. Removal of monocytes from cultures of peripheral blood mononuclear cells from both patients increased the in vilro responses to phytohaemagglutinin (PHA) and concanavalin A (Con A) but not to purified protein derivative (PPD), as measured by [³H]thymidine uptake. Similarly, supernatants of monocyte cultures from both patients. unlike supernatants of normal monocytes, suppressed the in vitro responses to PHA and Con A but enhanced the response to PPD by cultured mononuclear cells from the patients and from normal donors. Addition of unfractionaicd mononuclear cells from both patients 10 normal mononuclear cells suppressed both pokeweed mitogen (PWM) stimulation and IgG production: this effect was abrogated by removal of monocytes from the patients' mono-nuclear cell populations. The effect of thymosin on both patients' mononuclear cells was assayed in vitro. Thymosin was ineffective in vitro with cells from the first patient: for the other patient. [³H]thymidine uptake by mononuclear cells stimulated with PPD increased. whereas uptake by Con A-stimulated cells decreased, as did the percentage of E rosette-forming cells, providing further evidence of heterogeneity of the CVID syndrome. The effects of thymosin were also dependent on monocytes.     

Pemphigoid and pemphigus antigens in cultured epidermal cells

Fractions of IgG from sera of patients with pemphigoid and pemphigus added to monolayer cultures of mouse epidermal cells resulted in a sparse distribution of cells. Direct immunofluorescence studies of these monolayers revealed epidermal cell surface antigens reacting with pemphigoid and pemphigus antibodies. We suggest that these antibodies may bind to epidermal cell surface antigenic molecules which are important in maintaining epidermal cell adhesion in culture.     

Pharmacological Treatment of Electrical Storm in Cathecolaminergic Polymorphic Ventricular Tachycardia

We present a case of a young boy who had an implantable cadrioverter defibrillator implanted for refractory syncope and cathecolaminergic polymorphic ventricular tachycardia (CPVT). The patient underwent an electrical storm with multiple shocks and serious compromise of quality of life and risk. The pharmacological options are discussed as well as the strategies of managing ventricular arrhythmias in CPVT. (PACE 2010; 33:e27–e31)