Plasminogen activator inhibitor-1 expression by brain microvessel endothelial cells is inhibited by elevated glucose.

Patients with diabetes are predisposed to microvascular disease. In the retina and brain, this is characterized by neovascularization and new capillary formation. Because of the potential importance of plasmin generation in these processes, we evaluated the effect of elevated glucose concentrations on expression of plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), and urokinase (uPA) in cultured bovine brain endothelial cells (BBEC) versus cultured bovine aortic endothelial cells (BAEC). We observed that BBEC PAI-1 mRNA levels were decreased fivefold in cells cultured in media containing 20 mM glucose compared with BBEC cultured in media with 5.5 mM glucose, whereas expression of PAI-1 mRNA in BAEC, bovine mesenteric endothelial cells, and human umbilical vein endothelial cells was not modulated under these conditions. Expression of PAI-1 protein was also inhibited by growth of BBEC in elevated glucose, but the effect was less marked than at the mRNA level. Elevated glucose did not decrease expression of PAI-1 protein by BAEC. Withdrawal of acidic fibroblast growth factor enhanced expression of PAI-1 mRNA and protein in BBEC. Expression of tPA mRNA was not affected by the glucose concentration of the medium, and uPA mRNA was not detected in our BBEC cultures. A decrease in the local tissue activity of PAI-1 by elevated glucose concentrations, with no effect on tPA or uPA expression, would lead to an increase in the plasmin activity and thereby predispose neural tissues, such as the cerebrum and retina, of diabetic patients to neovascularization.

Analgesic efficacy and side-effect profile of paracetamol/codeine and paracetamol/dextropropoxyphene after surgical removal of a lower wisdom tooth.

A double-blind randomized analgesic trial was carried out on 180 patients undergoing surgical removal of an impacted lower wisdom tooth. The patients took their first dose of either 1000 mg paracetamol plus 60 mg codeine or 650 mg paracetamol plus 65 mg dextropropoxyphene when pain appeared after the decline of the local anaesthesia. If needed, another two doses were available during the observation period (less than or equal to 10 h). The analgesic efficacy of paracetamol/codeine was overall superior to paracetamol/dextropropoxyphene in all variables. Sufficient pain relief was obtained in most patients. The pain reduction after the first dose was 64% in the group receiving paracetamol/codeine compared with 53% in the group receiving paracetamol/dextropropoxyphene and the mean durations of effect of the first dose were 6.6 and 5.8 h, respectively. Side-effects appeared in all patient groups but were most frequent in women taking paracetamol/codeine.

Voltaren as an analgesic after surgical removal of a lower wisdom tooth.

In a controlled trial, before having a lower wisdom tooth surgically removed, 190 patients were blindly randomized to 2 parallel groups. One group received 100 mg Voltaren (diclofenac-sodium) before surgery and then 50 mg 3 times a day for 5 days; the other group in Sweden widely used fixed combination tablets (acetylsalicylic acid 500 mg, caffeine 50 mg, aprobarbital 20 mg, codeine phosphate 10 mg) in the highest recommended dose, 2 tablets when needed at most 3 times a day. Twice a day the patients recorded pain and swelling on 100 mm visual analogue scales. Patients treated with Voltaren had significantly less pain and swelling (p less than 0.001). Furthermore, they had significantly fewer days away from work (p less than 0.01). The study indicates that visual analogue scales may also be useful in assessment of swelling and that Voltaren in a fixed dosage offers a promising alternative against postoperative pain and swelling.

Periapical surgery.

A retrospective study of 572 teeth treated with periapical surgery was undertaken in order to evaluate the influence of preoperative, operative and postoperative factors in the healing process as well as the operation method used. It was also the aim to assess whether the histophatological diagnosis of biopsies taken at the operation could be correlated to healing. Statistical analyses by the AID method and conventional cross-classification methods were performed. Factors of importance were found to be the extent of the destrucion, the operation method used, the bone surrounding the destruction, the quality of the orthograde root filling, the age of the patient, and the marginal bone buccally. The operation method was of importance in large destructions where root fillings were considered as not having properly sealed the canals, and when treating inflamed cysts. The histopathological diagnosis could not be ascribed any definite prognostic value.

Analgesic efficacy and safety of Fenbufen following surgical removal of a lower wisdom tooth: a comparison with acetylsalicylic acid and placebo.

In a double-blind clinical trial a new, non-steroidal anti-inflammatory agent with analgesic properties, Fenbufen, was compared to acetylsalicylic acid (ASA) and placebo. Six hundred (600) out-patients, following surgical removal of an impacted lower wisdom tooth, were divided into three groups and randomly given either Fenbufen (500 mg capsules), ASA (750 mg capsules), or placebo. One capsule was taken immediately after the surgical procedure, followed by another capsule every 6 hours. The duration of treatment was 24 hours. Thus, a total of 4 capsules were taken. Self-evaluation forms were provided to the patients and were returned to the investigators the following day. The results were statistically analyzed. Both Fenbufen and ASA were statistically superior (p less than or equal to 0.01) to placebo in relieving pain. A comparison of the Fenbufen and ASA groups demonstrated a statistically significant (p less than or equal to 0.05) superiority for Fenbufen in relieving pain. Also sleep was less disturbed in the Fenbufen group. Side-effects reported were few, minor in character, and fewer in number in the Fenbufen group.