RESUMEN
Hypertension, bradycardia, and severe headache have been associated with autonomic dysreflexia. Autonomic dysreflexia affects those with spinal transection above the level of T6 after plastic changes of the afferent pathways. This restructuring in the presence of noxious stimuli below the level of the lesion leads to autonomic dysreflexia. The onset of the first episode of autonomic dysreflexia has been documented as soon as 30 days and as late as 13 years after the injury. This report presents a case study of a paraplegic man 8 years after injury with autonomic dysreflexia associated with a urinary tract infection.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Cefalea/etiología , Adulto , Enfermedades del Sistema Nervioso Autónomo/etiología , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Humanos , Masculino , Paraplejía/complicaciones , Infecciones Urinarias/complicacionesRESUMEN
PURPOSE: Intraoral fluoride-releasing (IFR) devices provide elevated levels of fluoride in the mouth for extended periods of time. However, retention and protection of the devices have posed major challenges for clinical applications. The objectives of this study were to develop new methods for retaining and protecting IFR devices in the mouth and to assess their effects on salivary fluoride levels and distribution in adolescents. METHODS: Four different IFR systems (combinations of an IFR device and its retainer) were evaluated in four groups of 10 adolescents each, 12-15 years of age, for a period of six months. Each child wore two IFR systems of a given type affixed to the buccal surface of each permanent maxillary first molar. Unstimulated saliva samples were collected at each clinical examination and analyzed for fluoride. RESULTS: A significant increase in salivary fluoride concentration from a baseline mean of 0.07-0.69 microgram/mL was observed on day 14 postinsertion. IFR system retention was 85% after 6 months and, of the systems retained, 100% were functional. CONCLUSIONS: These findings suggest that IFR devices can be successfully protected and retained in the mouth for prolonged periods of time.
Asunto(s)
Cariostáticos/administración & dosificación , Sistemas de Liberación de Medicamentos/métodos , Fluoruros Tópicos/administración & dosificación , Adolescente , Análisis de Varianza , Cariostáticos/análisis , Cariostáticos/farmacocinética , Niño , Recubrimiento Dental Adhesivo , Sistemas de Liberación de Medicamentos/clasificación , Sistemas de Liberación de Medicamentos/instrumentación , Diseño de Equipo , Femenino , Fluoruros Tópicos/análisis , Fluoruros Tópicos/farmacocinética , Estudios de Seguimiento , Humanos , Masculino , Membranas Artificiales , Metacrilatos/química , Metilmetacrilato , Metilmetacrilatos/química , Boca/metabolismo , Diseño de Aparato Ortodóncico , Soportes Ortodóncicos , Índice Periodontal , Saliva/química , Saliva/metabolismo , Fluoruro de Sodio/administración & dosificación , Acero Inoxidable , Propiedades de SuperficieRESUMEN
OBJECTIVE: To determine whether i.v. pyelography (IVP) is required routinely for all patients presenting to the ED with ureteral colic. METHODS: A randomized prospective study was conducted with 2 patient group-a routine IVP group, in which all patients underwent IVP, and a selective IVP group, in which patients were treated, observed, and released without undergoing IVP unless they experienced continued symptoms. The study was performed in a large university-affiliated, community hospital ED. Participants were patients aged 18-65 years with signs and symptoms consistent with ureteral colic. RESULTS: Among the 40 patients enrolled in the routine IVP group, 26 had positive studies, 8 of which necessitated hospitalization. Among the 41 patients randomized to the selective IVP group, there were only 19 IVPs performed, of which 6 were positive and 4 necessitated hospitalization. Compared with the routine IVP group, there were 54% fewer IVPs performed and a 51% lower admission rate in the selective IVP group. Despite the fact that fewer IVPs were performed in the selective IVP group, clinical outcomes in the 2 groups were similar, without significant complication in either group. CONCLUSIONS: IVPs do not need to be routinely performed for all patients presenting to the ED with ureteral colic. The decision to perform an IVP may be dictated by symptoms that persist after initial evaluation and treatment.
Asunto(s)
Cólico/etiología , Cálculos Ureterales/diagnóstico por imagen , Enfermedades Ureterales/etiología , Obstrucción Ureteral/diagnóstico por imagen , Urografía/métodos , Adolescente , Adulto , Anciano , Protocolos Clínicos , Cólico/diagnóstico por imagen , Servicio de Urgencia en Hospital , Humanos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Cálculos Ureterales/complicaciones , Enfermedades Ureterales/diagnóstico por imagen , Obstrucción Ureteral/etiologíaRESUMEN
The formation of calcium (Ca) fluoride (CaF2) on bovine enamel blocks during clinically relevant treatment times using neutral fluoride (F) solutions (0.26 mol/l F) with and without 0.1 mol/l lactate was investigated. Uncoated and pellicle-coated blocks were evaluated for alkali-soluble (1 mol/l KOH, three consecutive 24-hour treatments) Ca, PO4, and F after treatment by the F solutions for 0, 5, 15, 30, and 60 min. There was an overall time-related increase in F recovery, while Ca tended to remain at baseline levels. Less F was recovered from the pellicle-coated blocks. The addition of lactate to the F treatment solution did not result in an overall increase in alkali-soluble F recovery, but did result in the formation of cuboidal shaped crystals which closely approached the morphology of pure CaF2. A 1:2 stoichiometric ratio Ca:2F (mol:mol) was not established based on chemical analyses. The ultrastructural and elemental composition of surface deposits on the samples, as determined using scanning electron microscopy, X-ray diffraction, and energy-dispersive spectroscopy, established the presence of CaF2 after 24-hour F treatments; however, it was not possible to directly demonstrate the formation of CaF2 after clinically relevant treatment times.
Asunto(s)
Fluoruro de Calcio/química , Esmalte Dental/ultraestructura , Lactatos/química , Fluoruro de Sodio/química , Animales , Calcio/análisis , Fluoruro de Calcio/análisis , Bovinos , Depósitos Dentarios/fisiopatología , Película Dental , Microanálisis por Sonda Electrónica , Fluoruros/análisis , Hidróxidos/química , Lactatos/administración & dosificación , Microscopía Electrónica de Rastreo , Compuestos de Potasio/química , Fluoruro de Sodio/administración & dosificación , Factores de Tiempo , Difracción de Rayos XRESUMEN
A series of rat caries experiments was carried out to test the relative cariogenic potential and to identify the major carcinogenic elements of 22 popular snack foods. Parameters that were measured included rat caries, number of cariogenic bacteria in plaque, salivary parameters including flow rate, buffering capacity, total protein, lysozyme and amylase content, and composition of test foods including protein, fat, phosphorus, calcium, fluoride, galactose, glucose, total reducing sugar, sucrose, and starch. Many interesting relationships were observed between food components, numbers of plaque bacteria, salivary components, and specific types of carious lesions. Protein, fat, and phosphorus in foods were all associated with inhibition of both sulcal and buccolingual (smooth-surface) caries. Food fluoride was associated with inhibition of buccolingual caries, whereas calcium was related to inhibition of sulcal caries. Glucose, reducing sugar, and sucrose in foods were all related to promotion of both sulcal and smooth-surface caries. The numbers of Streptococcus sobrinus in plaque were associated with promotion of smooth-surface caries only, whereas lactobacilli, non-mutans bacteria, and total viable flora were related to promotion of both smooth-surface and sulcal caries. The salivary flow rate was associated with inhibition of both buccolingual and sulcal caries. Salivary buffering capacity (at pH 7) and salivary lysozyme delivery were associated with inhibition of number and severity of sulcal caries, while the salivary amylase content was related to the promotion of the number of sulcal lesions.
Asunto(s)
Bacterias/aislamiento & purificación , Cariogénicos , Caries Dental/etiología , Caries Dental/microbiología , Placa Dental/microbiología , Análisis de los Alimentos , Alimentos , Saliva/fisiología , Amilasas/análisis , Animales , Fenómenos Fisiológicos Bacterianos , Tampones (Química) , Calcio/análisis , Recuento de Colonia Microbiana , Carbohidratos de la Dieta/análisis , Grasas de la Dieta/análisis , Proteínas en la Dieta/análisis , Lactobacillus/aislamiento & purificación , Lactobacillus/fisiología , Muramidasa/análisis , Fósforo/análisis , Ratas , Ratas Sprague-Dawley , Saliva/enzimología , Proteínas y Péptidos Salivales/análisis , Tasa de Secreción , Streptococcus sobrinus/aislamiento & purificación , Streptococcus sobrinus/fisiologíaAsunto(s)
Susceptibilidad a Caries Dentarias , Saliva/química , Saliva/microbiología , Apatitas/análisis , Calcio/análisis , Niño , Caries Dental/metabolismo , Caries Dental/microbiología , Humanos , Lactobacillus/aislamiento & purificación , Fosfatos/análisis , Factores de Riesgo , Streptococcus mutans/aislamiento & purificaciónRESUMEN
Our objective was to develop and perfect a model for the assessment of risk of dental caries onset in children. Even though dental caries prevalence in children is continuing to decline, there is still a significant minority for whom it is a problem. In this study, we sought to ascertain whether a set of variables selected in a previous cross-sectional study could be used to differentiate between caries-free six-year-olds who would or would not subsequently present with clinically-detectable caries. A total of 472 caries-free six-year-olds--286 from a fluoridated community and 186 from a fluoride-deficient community--was selected. Clinical examinations for DMFS, dental fluorosis, and plaque were conducted. Stimulated whole saliva was collected for analysis of mutants streptococci, lactobacilli, total viable flora, and fluoride, calcium, and phosphate concentrations. A questionnaire was used for collection of demographic data as well as information on prior fluoride exposure, dietary habits, and oral hygiene practices. By means of linear discriminant analyses, it was possible to predict correctly which children would develop caries within six to 12 months (sensitivity) in 82.8% of cases and which children would not develop caries during that period (specificity) in 82.4% of cases.
Asunto(s)
Caries Dental/epidemiología , Modelos Estadísticos , Apatitas/análisis , Fosfatos de Calcio/análisis , Niño , Índice CPO , Índice de Placa Dental , Análisis Discriminante , Durapatita , Fluoruración , Fluoruros/análisis , Fluoruros/uso terapéutico , Predicción , Humanos , Hidroxiapatitas/análisis , Lactobacillus/aislamiento & purificación , Estudios Longitudinales , Masculino , New Hampshire/epidemiología , New York/epidemiología , Valor Predictivo de las Pruebas , Factores de Riesgo , Saliva/química , Saliva/microbiología , Sensibilidad y Especificidad , Streptococcus mutans/aislamiento & purificación , Encuestas y CuestionariosRESUMEN
Although the prevalence of dental caries is continuing to decline, it still affects a majority of the US population and can be a serious problem for those afflicted. The objective of this project was to develop and perfect a model for assessment of risk of dental caries onset in children. In the first study, reported herein, a set of clinical, microbiological, biochemical, and socio-demographic variables was identified that distinguished, with an acceptable level of sensitivity and specificity, between children who had no previous caries experience and children who had high caries levels. A total of 313 children--age 12-15 years, 140 from a fluoridated community and 173 from a fluoride-deficient community--was selected on the basis of previous caries experience, either zero DMFS or high DMFS (> or = 6 in the fluoridated or > or = 8 in the fluoride-deficient community). Clinical exams for DMFS, dental fluorosis, and plaque were conducted. Stimulated whole saliva was collected for analysis of mutans streptococci, lactobacilli, total viable flora, and fluoride concentration. A questionnaire was used for collection of demographic data as well as information on prior fluoride exposure, dietary habits, and oral hygiene practices. By means of discriminant analyses, with use of seven key clinical and laboratory variables, it was possible for zero-DMFS subjects to e classified correctly (specificity) in 77.6% of cases in the fluoridated community and in 86.1% of cases in the fluoride-deficient community. High-caries subjects were classified as such (sensitivity) in 79.3% and 88.1% of cases, respectively.
Asunto(s)
Caries Dental/epidemiología , Modelos Estadísticos , Adolescente , Análisis de Varianza , Alimentación con Biberón/estadística & datos numéricos , Distribución de Chi-Cuadrado , Niño , Estudios Transversales , Índice CPO , Susceptibilidad a Caries Dentarias , Índice de Placa Dental , Análisis Discriminante , Estudios de Factibilidad , Femenino , Fluoruración , Fluoruros/análisis , Fluoruros/uso terapéutico , Fluorosis Dental/epidemiología , Predicción , Humanos , Lactobacillus/aislamiento & purificación , Masculino , New Hampshire/epidemiología , New York/epidemiología , Valor Predictivo de las Pruebas , Proyectos de Investigación , Factores de Riesgo , Saliva/química , Saliva/microbiología , Sensibilidad y Especificidad , Streptococcus mutans/aislamiento & purificación , Encuestas y CuestionariosRESUMEN
Chronic fluoride exposure in vivo results in alterations in the formation of mineralizing tissues. One possible mechanism for the formation of fluorosed tooth enamel and bone is a binding of fluoride to matrix proteins, resulting in an alteration in their structure and function. Studies were designed to investigate fluoride binding to matrix proteins in vivo and their possible role in fluorosis. Rats were given either 0 or 100 parts/10(6) fluoride in drinking water for 6 weeks to allow the formation of fluorotic mineralizing tissues. The animals were killed by CO2 inhalation, and the enamel and bone were analysed for fluoride and calcium. Matrix binding by fluoride in enamel was determined after extraction of proteins from undemineralized matrix. In bone, the matrix was demineralized and F, Ca and P were determined in both ashed and unashed samples. The studies showed ionic binding of fluoride to the matrix in both enamel and bone, possibly associated with calcium binding by the matrix. There was no difference in the amount of matrix-bound fluoride in control as compared to fluorosed bone or maturation-stage enamel. This indicates that although matrix proteins can bind fluoride, it is not likely that this mechanism is important in the formation of fluorosed mineralizing tissues.
Asunto(s)
Huesos/metabolismo , Proteínas del Esmalte Dental/metabolismo , Fluoruros/metabolismo , Proteínas/metabolismo , Animales , Matriz Ósea/química , Matriz Ósea/metabolismo , Huesos/química , Calcio/análisis , Esmalte Dental/química , Proteínas del Esmalte Dental/análisis , Fluoruros/análisis , Fósforo/análisis , Unión Proteica , RatasRESUMEN
STUDY OBJECTIVES: To study the treatment of moderate-to-severe hypothermia using a combination of core rewarming techniques. DESIGN: A prospective study. SETTING: The emergency department of an urban, community hospital. TYPE OF PATIENTS: Sixteen patients who presented with accidental hypothermia with a core temperature of less than 32 C. INTERVENTIONS: All patients were treated with warmed IV fluids either through central or peripheral IV lines and heated aerosol masks. MEASUREMENTS AND MAIN RESULTS: The patients had a mean rewarming rate of 1.16 C/hr; all survived. The majority were chronic alcoholic patients who presented with multiple medical conditions that required hospitalization. CONCLUSION: All patients recovered with this method of core rewarming.
Asunto(s)
Calefacción/métodos , Calor/uso terapéutico , Hipotermia/terapia , Adulto , Anciano , Alcoholismo/complicaciones , Presión Sanguínea , Urgencias Médicas , Femenino , Frecuencia Cardíaca , Humanos , Hipotermia/sangre , Hipotermia/etiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Población UrbanaRESUMEN
The anti-caries activity of fluoride is contributed to in several ways. Two major aspects of fluoride action are (i) the inhibition of demineralization at the crystal surfaces within the tooth, and (ii) the enhancement of subsurface remineralization resulting in arrestment or reversal of caries lesions. Fluoride present in the aqueous phase at the apatite crystal surface may play a determining role in the inhibition of enamel or dentin demineralization. In one part of the present study, the initial dissolution rate of synthetic carbonated-apatite in acetate buffers was measured with fluoride present in the buffer in the 0-2.6 mmol/L (0-50 ppm) range. Inhibition of demineralization was shown to be a logarithmic function of the fluoride concentration in solution. In the second part of the present study, an in vitro pH-cycling model was used for determination of the effect on net de/remineralization of enamel by treatment solutions containing fluoride in the 0-26 mmol/L (0-500 ppm) range. The net mineral loss was shown to be negatively related to the logarithm of the fluoride concentration. These studies have demonstrated an exponential quantitative relationship between fluoride concentration and inhibition of apatite demineralization or enhancement of remineralization. The clinical implications are (i) that simply increasing fluoride concentration may not necessarily give increased cariostatic benefit, and (ii) that improving the means of delivery of relatively low fluoride concentrations for longer times should be more appropriate for enhancing clinical efficacy.
Asunto(s)
Apatitas , Esmalte Dental/efectos de los fármacos , Fluoruros/farmacología , Remineralización Dental , Fluoruros/metabolismo , Modelos BiológicosRESUMEN
Fluoridated mouthrinses are not advised for preschool children who may swallow much of the agent. An alternate method of delivering topical fluoride to the interproximal tooth surfaces in these young patients may be fluoridated dental floss. The purpose of this study was to determine the fluoride levels of demineralized primary enamel both before and after the use of a commercially available dental floss impregnated with commercially available fluoride-containing products. The results showed that demineralized primary tooth surfaces treated with fluoride-impregnated dental floss exhibited significantly higher fluoride levels than those surfaces treated by immersion in a fluoridated mouthrinse or deionized water.
Asunto(s)
Dispositivos para el Autocuidado Bucal , Esmalte Dental/metabolismo , Fluoruros/farmacocinética , Humanos , Diente PrimarioAsunto(s)
Fluoruros/análisis , Alimentos Infantiles/análisis , Preescolar , Fluorosis Dental/etiología , Humanos , Lactante , Glycine maxRESUMEN
Carbonated apatites containing approximately 3.0 or 6.5% CO3 were precipitated in the presence of sodium, strontium, and/or fluoride at various concentrations. Almost all the available strontium and fluoride was incorporated into the crystals, whereas only a portion of the carbonate and sodium present was taken up. When incorporated together, Sr and F improved the crystallinity of carbonated apatites and markedly reduced their acid reactivity. This phenomenon may partially explain the observed reduction in caries for populations whose drinking water contains optimum levels of Sr at 5-10 mg/l and F at 1-2 mg/l.
Asunto(s)
Apatitas/metabolismo , Carbonatos/metabolismo , Fluoruros/metabolismo , Estroncio/metabolismo , Cristalografía , Solubilidad , Espectrofotometría Infrarroja , Difracción de Rayos XRESUMEN
It is shown that loss of radioactivity from labelled mercury(II) solutions is due to reduction of some mercury(II) by reductants adventitiously introduced, followed by disproportionation of mercury(I) and loss of metallic mercury in the gas phase. The loss can be prevented by addition of a small excess of an oxidant such as permanganate.