Increased Prevalence of Polyneuropathy in Parkinson's Disease Patients: An Observational Study.

BACKGROUND: The independent contribution of levodopa exposure and Parkinson's disease (PD) to the risk of polyneuropathy is not established. OBJECTIVE: This study investigated whether patients with newly diagnosed PD without previous exposure to antiparkinsonian drugs have higher prevalence of polyneuropathy than the general population. METHODS: Using the UK General Practice Research Database, presence of polyneuropathy in the previous 3 years was assessed. RESULTS: Of 5089 PD patients and 19,897 controls, polyneuropathy was confirmed in 15 PD patients (0.29% ) and 24 controls (0.12% ). Polyneuropathy prevalence was 2.4-fold higher in PD patients than controls. CONCLUSIONS: In this observational study, PD patients had a higher prevalence of preexisting polyneuropathy that cannot be explained by adverse effects of antiparkinsonian drugs.

Clinical study comparing the effects of sequential hormone replacement therapy with oestradiol/dydrogesterone and conjugated equine oestrogen/norgestrel on lipids and symptoms.

UNLABELLED: A clinical study comparing the effects of sequential hormone replacement therapy with oestradiol/dydrogesterone and conjugated equine oestrogen/norgestrel on lipids and symptoms. OBJECTIVE: The objective of the study was to compare the effects of sequential 17beta-oestradiol/dydrogesterone and conjugated equine oestrogens (CEE)/norgestrel on lipid parameters, climacteric symptoms, bleeding patterns and tolerability. STUDY DESIGN: This double-blind study was conducted in 193 peri- and post-menopausal women randomised to receive six, 28-day cycles of oral sequential oestradiol 1 mg/dydrogesterone 10 mg or CEE 0.625 mg/norgestrel 0.15 mg. The change from baseline in serum lipids and hot flushes was analysed using a two-way analysis of variance. RESULTS: After 24 weeks there was a statistically significant increase in high-density lipoprotein (HDL) cholesterol in the oestradiol/dydrogesterone group and a significant reduction in the CEE/norgestrel group. The difference between the groups was significant (P=0.001). The number of hot flushes was reduced by 86% in both groups; this improvement was supported by the Greene Climacteric Symptom Scale score, the patients' opinion and quality of life assessments. The percentage of women experiencing cyclic bleeding was greater with CEE/norgestrel, as was the mean duration and severity of bleeding. Both treatments were well tolerated. CONCLUSION: Oestradiol/dydrogesterone and CEE/norgestrel were equally effective in treating climacteric symptoms, but oestradiol/dydrogesterone showed some advantages in terms of lipid profile and incidence of bleeding.

Age-related changes in sagittal relationship between the maxilla and mandible.

The aim of the study was to assess age-related changes in sagittal jaw relationship during pre-pubertal and pubertal development on the basis of angular [ANB, anteroposterior dysplasia indicator (APDI) and A-B plane angle] and linear (Wits, AF-BF, App-Bpp, and App-Pgpp) measurements. Lateral cephalograms of orthodontically untreated subjects were evaluated at 7, 9, 11, 13 and 15 years of age. Cephalometric standards and age-related changes were determined on the basis of Class I subjects with a good occlusion (n = 18, 10 males and 8 females). With respect to changes related to growth, the main findings were, in both genders, a statistically significant age-related decrease in ANB angle, App-Bpp and App-Pgpp, a significant increase in APDI, but no age-related change in Wits. A reduction of sagittal jaw distance during pre-pubertal and pubertal development was observed arising from a relative dominance of sagittal mandibular growth. For an evaluation of differences concerning jaw relationship in Class II subjects, a group with Class II division 1 malocclusions (n = 17) and a group with Class II division 2 malocclusions (n = 12 were compared with two control groups, i.e. the good occlusion group and a Class I group (n = 37). Conclusions about the sagittal discrepancy in Class II division 1 and Class II division 2 subjects depended on the geometric reference used in the various parameters, and further research is called for with respect to the diagnostic performance of the various measurements. Differences between Class II subjects and controls present at 15 years of age were already established at 7 years of age, but were less pronounced.

Sagittal and vertical growth of the jaws in Class II, Division 1 and Class II, Division 2 malocclusions during prepubertal and pubertal development.

AIM: The aim of the present study was to evaluate the sagittal and vertical development of the jaws in Class II, Division 1 (II/1) and Class II, Division 2 (II/2) malocclusions. In addition, facial morphology was to be investigated in probands with these malocclusions. PROBANDS AND METHODS: Maxillary and mandibular development was investigated with reference to lateral cephalograms of orthodontically untreated probands from the Belfast Growth Study at 7, 9, 11, 13 and 15 years of age. Moreover, development of facial width was assessed from the associated posteroanterior cephalograms, with radiographic magnifications being corrected in both the lateral and the posteroanterior cephalograms. A Class II/1 group (n = 17) and a Class II/2 group (n = 12) were compared with two control groups: a group with good occlusion (n = 18) and a Class I group (n = 37). RESULTS AND CONCLUSIONS: With respect to the sagittal position of the maxilla, no significant differences between the Class II groups and the controls were found. In the Class II/1 group, mandibular retrognathism was observed. The posterior position of the mandible present at 15 years of age had been present even at 7 years of age, and growth increments in the Class I and Class II/1 subjects were similar. In the Class II/2 groups no uniform pattern with respect to mandibular position was found. With respect to vertical development, a deficit in lower anterior facial height was found in the Class II/2 groups. In addition, between 7 and 15 years of age, growth increments in lower anterior facial height were significantly smaller in the Class II/2 subjects than in the controls. Furthermore, the Class II/2 groups displayed a more euryprosopic facial form on average. The cause of this characteristic facial morphology was the vertical deficit in lower anterior facial height. Overall, however, the broad variability and the small sample sizes, in particular of the Class II/2 groups, in the present study have to be seen as limitations.

Three-dimensional analysis of maxillary and mandibular growth increments.

OBJECTIVE: To analyze changes in the facial, maxillary, and mandibular skeleton in the vertical, sagittal, and transverse dimensions during an orthodontically relevant period of dentofacial development (i.e., between 7 and 15 years of age). SUBJECTS AND METHOD: This longitudinal study comprised posteroanterior (PA) and lateral cephalograms at 7, 9, 11, 13, and 15 years of 18 untreated Class I subjects with good occlusion. Transverse growth (width) was analyzed on the basis of PA cephalograms and sagittal (depth) and vertical (height) growth by means of lateral cephalograms. For each linear measurement, mean percentage increases were calculated relative to the size at 7 years of age. RESULTS AND CONCLUSIONS: Between 7 and 15 years of age, in the whole facial skeleton and the maxilla, percentage increases were most pronounced in the vertical dimension when compared with the sagittal and transverse dimensions. In the mandible, the largest percentage increases were found in both sexes for vertical growth of the ramus, followed by sagittal growth (body length) and then mandibular width. In the sagittal dimension, development was more pronounced in the mandible (at pogonion more than at B point) than in the maxilla (A point). With respect to vertical growth, percentage increases in posterior face height exceeded the increases in anterior face height. When facial shape changes were analyzed between 7 and 15 years of age in both sexes, the ratio facial height/facial width increased and the ratio facial depth/ facial height decreased, which points toward an age-related increasing influence of vertical development.

Effectiveness of Harpagophytum extracts and clinical efficacy.

Various preparations from Harpagophytum procumbens are used for the treatment of pain in the joints and lower back. Studies published in peer reviewed journals were examined for their clinical evidence. The studies offering preparations with 50-60 mg harpagoside in the daily dosage are of better quality and provide more reliable evidence on efficacy than a proprietary ethanol extract with half the amount of harpagoside per day. However, confirmatory studies are required for all extracts before they can gain a place in treatment guidelines.

Transverse development of the craniofacial skeleton and dentition between 7 and 15 years of age--a longitudinal postero-anterior cephalometric study.

The aim of this study was to identify the transverse growth pattern of the craniofacial skeleton and dentition from 7 to 15 years of age. The database for this longitudinal study comprised the postero-anterior (PA) cephalograms and dental casts at 7, 9, 11, 13 and 15 years of age of 18 untreated Class I subjects with good occlusion from the Belfast Growth Study. Differential magnification of the PA cephalograms was corrected using the method of similar triangles. Most of the craniofacial widths were larger in males than in females. At 15 years of age, the gender differences in craniofacial widths were more pronounced than at 7 years of age. The majority of the skeletal dimensions showed a progressive increase in width. In contrast, there was a deceleration in the increase in maxillary and mandibular intermolar widths after 11 years of age in males and even a slight decrease in the intermolar width beyond 11 years of age in females. Growth curves were calculated where the values of the respective variables were expressed in terms of percentage of attainment at 7, 9, 11 and 13 years of age when compared with 15 years of age. For mid-facial, bizygomatic and skeletal maxillo-mandibular widths, percentile attainments in the range of 84-91 per cent indicated a greater remaining growth potential at 7 years of age than for the cranial width where growth was almost complete. By the age of 7 years, over 95 per cent of the growth in the intermolar width had occurred.

Serum hyaluronate correlates with histological progression in alcoholic liver disease.

OBJECTIVES: Chronic alcohol consumption may lead to the development of liver cirrhosis. Serum concentrations of hyaluronate were suggested as a predictor in chronic liver disease, but its power to distinguish between severity of fibrosis and inflammation had not been assessed. In order to evaluate hyaluronate as a marker to detect early stages of alcoholic liver disease and to establish a possible correlation with hepatic histology, serum concentrations were measured by radioimmunoassay in 87 patients with biopsy-proven fatty liver, fatty liver and mild fibrosis, fatty liver and inflammation, severe fibrosis and inflammation, and cirrhosis, and in 12 non-alcoholic control subjects. In addition, serum hyaluronate was determined in 40 non-cirrhotic alcoholic patients with either a normal serum aspartate aminotransferase (AST) or an AST elevated at least two-fold. RESULTS: Serum hyaluronate increased significantly with advanced stages of alcoholic liver disease, while levels in patients with fatty liver were elevated only slightly without reaching significance. Hyaluronate correlated well with histological stage and was highly sensitive for detecting fibrosis in general and perivenular fibrosis as an indicator of progression to cirrhosis. Hyaluronate levels were not influenced by AST levels. CONCLUSION: Serum hyaluronate is a good predictor of the presence of even moderate hepatic fibrosis in alcoholic liver disease, justifying its clinical use to assess morphological alterations of the liver in alcoholics.

Prognostic impact of reoxygenation in advanced cancer of the head and neck during the initial course of chemoradiation or radiotherapy alone.

BACKGROUND: Previous studies have shown that radiation of hypoxic tumors can result in reoxygenation phenomenon. The relevance of this phenomenon for prognosis is unclear. This study analyzes whether the presence of hypoxia, or the extent to which reoxygenation occurs during the initial phase of primary chemoradiation or radiotherapy, can predict the clinical outcome in advanced tumors of the head and neck. METHODS: The distribution of oxygen partial pressures was determined using pO(2) histography (Kimoc 6650, Sigma pO(2)-Histograph, Eppendorf, Hamburg, Germany). In cervical lymph node metastases of 37 patients with advanced carcinoma of the head and neck (stage IV, UICC), these values were determined before the start of primary chemoradiation or radiotherapy alone (pO(2)x). Thirty-two of 37 patients were reexamined after 1 week of therapy, and measurements were taken again in the same nodes (pO(2)y). The results obtained from these measurements were correlated with both, the initial response to therapy and follow-up results (43 months). RESULTS.: In all patients, pronounced hypoxia (median pO(2), 3.2 mmHg) was found before therapy. In 19 of 32 patients, chemoradiation/radiotherapy induced reoxygenation (deltaO(2) = pO(2)y - pO(2)x), with median deltapO(2) increasing to 6.5 mmHg after 1 week (p =.049). The group of patients with a complete or partial response showed only a slight increase of median deltapO(2) (1 mmHg) compared with a strong reoxygenation effect in the group of patients with no change (mean value of median deltapO(2) = 10.3 mmHg; p =.0062). The group of patients with deltapO(2) values lower than median showed significantly better survival rates compared with the other group (p =.036). CONCLUSION: These data suggest that reoxygenation under therapy may have prognostic relevance in patients with advanced carcinoma of the head and neck treated by primary chemoradiation or radiation therapy. Remarkably, however, a poor outcome was associated with a higher degree of reoxygenation.

Dental arch widths and mandibular-maxillary base widths in Class II malocclusions between early mixed and permanent dentitions.

The aim of the study was to analyze the transverse morphology and development of the dental arches and skeletal mandibular-maxillary bases in untreated Class II malocclusions. Using the records of the Belfast Growth Study, a Class II division 1 group (II/1) and a Class II division 2 group (II/2) were compared with a Class I group and a control group with good occlusion. On posteroanterior cephalograms, maxillary skeletal base width and bigonial and biantegonial widths were determined at two-year intervals between seven and 15 years. Maxillary and mandibular intermolar widths were measured on the associated study casts. As a result, maxillary skeletal base widths were smallest in the Class II/1 subjects. No statistically significant differences were found among the groups for the skeletal mandibular widths. With respect to the development of the dental arches, maxillary intermolar widths were smaller in the Class II/1 group than in the Class I and the good-occlusion groups. These group differences were present for the total period of observation, ie, seven to 15 years, and statistically significant at most ages. When the relative difference between the maxillary and the mandibular intermolar widths was examined, the Class II/1 cases were found to have the largest average difference (about -2.5 mm for boys and -1.5 mm for girls), indicating a relatively narrow maxillary arch. Less pronounced molar differences were found in the Class II/2 group. In the Class II/1 subjects the deviations in molar differences observed at 15 years of age were established already at 7 years of age and maintained during 7 and 15 years of age.

Associations of dichlorodiphenyltrichloroethane (DDT) 4.4 and dichlorodiphenyldichloroethylene (DDE) 4.4 blood levels with plasma IL-4.

DDT (dichlorodiphenyltrichloroethane) reportedly induces cancer in animals, mimics estrogen activity, induces antiandrogen effects, and impairs Natural Killer (NK) cells and T lymphocyte responses. In this study, the authors attempted to determine associations of DDT, dichlorodiphenyldichloroethylene (DDE), and dichlorodiphenyldichloroethane (DDD) blood levels with several immune parameters in patients occupationally exposed to insecticides. The study subjects were 49 patients who worked as farmers or farmhands in the former German Democratic Republic and who had been occupationally exposed to insecticides for at least 6 mo; 80% of them had been exposed for more than 20 yr. Blood levels of DDT, DDE, DDD, 2,3,4,5,6-pentachlorophenol (PCP), polychlorinated biphenyls (PCBs), hexachlorobenzene (HCB), and gamma-hexachlorocyclohexanes (HCHs) were determined, and blood lymphocyte subpopulations, in vitro responses to mitogens or pooled allogeneic stimulator cells, plasma neopterin, and cytokine and soluble cytokine receptor levels were studied. The majority of patients were contaminated with more than 1 chemical--most commonly DDE, PCBs, and HCB. Linear-regression analysis showed that interleukin-4 (IL-4) plasma levels were associated with plasma levels of DDT 4.4 (p = .0001) and DDE 4.4 (p = .001). The data in this study suggest that PCBs, PCP, HCB, HCHs, DDE, and DDD suppress TH1 cytokines, such as IL-2 and interferon-gamma (IFN-gamma), and induce TH2 cytokines, such as IL-4. The authors hypothesized that clinical symptoms, such as the frequent infections reported by many patients, could be a consequence of these immunological abnormalities.

Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor.

Introduction: In recent years a new perforated PDS (poly-p-dioxanon) foil (0.15 mm) has become available and has not yet been proven to be successful in reconstruction of the orbital floor after blow-out-fractures in randomized studies. The main aim of this clinical trial is to compare this new PDS foil with titanium dynamic mesh (0.3 mm) (TD), which is well established in reconstruction of the orbital floor. Patients and Methods: In a prospective multicentre randomized trial, conducted between 1997 and 1998, out of 42 patients with fractures of the orbital floor, 28 patients needing material for reconstruction were randomized to receive either PDS foil or TD. In a comprehensive preoperative and postoperative protocol patients were monitored by the surgeon, radiologist and ophthalmologist with a postoperative follow-up of least 6 months. Results: Maximum defects of the orbital floor were comparable in both groups (PDS group: 13.3 mm, TD group: 13.9 mm). In both groups the surgical procedure was well tolerated, and functional and cosmetic results were evaluated as satisfactory by all patients. Ophthalmological evaluation, performed up to 6 months postoperatively, revealed double vision or vertical strabismus in nine patients (five PDS group, four titanium group). This was not confirmed subjectively in each single patient. Also ex- or enophthalmos, registered in seven patients of the PDS and four of the TD group (mainly +/-1 mm) were not considered as relevant by the patients. Conclusion: The new 0.15 mm perforated PDS foil was comparable to 0.3 mm titanium mesh concerning functional and cosmetic outcome. Obviously, persisting ophthalmometric disorders were compensated very well in both groups. PDS foil is felt to be the preferred material since it is bioresorbable and more convenient to handle. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.