The effect of locally delivered controlled-release doxycycline or scaling and root planing on periodontal maintenance patients over 9 months.

BACKGROUND: This research report evaluates clinical changes resulting from local delivery of doxycycline hyclate (DH) or traditional scaling and root planing (SRP) in a group of patients undergoing supportive periodontal therapy (SPT). METHODS: In all, 141 patients received either DH (67) or SRP (74) treatment in sites > or =5 mm on one-half of their dentition at baseline and month 4. RESULTS: Clinical results were determined at month 9. Baseline mean probing depth recordings were similar between the two groups (DH = 5.9 mm; SRP = 5.9 mm). Mean month 9 results showed similar clinical results for attachment level gain (DH 0.7 mm; SRP 0.8 mm) and probing depth reduction (DH 1.3 mm; SRP 1.1 mm). Percentage of sites showing > or =2 mm attachment level gain at month 9 was 24.7% in the DH group and 21.2% in the SRP group. Thirty-nine percent (39%) of DH sites and 38% of SRP sites showed > or =2 mm probing depth reduction. When treated sides of the dentition were compared to untreated sides, DH showed a difference in disease activity (> or =2 mm attachment loss) from 19.3% (untreated) to 7.2% (treated); and SRP from 14.3% (untreated) to 8.1% (treated). CONCLUSIONS: Results show that both DH without concomitant mechanical instrumentation and SRP were equally effective as SPT in this patient group over the 9-month study period.

The time and ease of placement of the chlorhexidine chip local delivery system.

The first local delivery system for an antimicrobial agent was a nondegradable tetracycline-impregnated fiber introduced by Goodson et al in 1979. PerioChip, a biodegradable chip containing chlorhexidine, was recently approved by the Food and Drug Administration for the treatment of adult periodontitis. During several multicenter randomized clinical trials, this product, when used as an adjunct to scaling and root planing, was found to reduce probing depth and improve attachment level significantly more than scaling and root planing alone.

Prophylactic antibiotics for suction curettage in incomplete abortion.

OBJECTIVE: The purpose of this study was to investigate the efficacy of 200 mg of prophylactic doxycycline in preventing pelvic infection after curettage for spontaneous (incomplete) abortion. METHODS: A randomized, prospective, double-blinded study was carried out involving 300 women with an incomplete abortion who were given either placebo or 200 mg of doxycycline orally 30-60 min prior to curettage. A hematocrit, WBC count, pregnancy test, syphilis serology, Neisseria gonorrhoeae culture, and Micro Trak (monoclonal antibody test, Syba, San Jose, CA) for Chlamydia trachomatis were performed. The patients were scheduled for follow-up 2 weeks later. Antibiotic administration for any reason as well as the postoperative infection rate in these women was assessed. RESULTS: Eleven women were excluded from analysis, leaving 289 evaluable. N. gonorrhoeae was isolated from 6 (2%) women and C. trachomatis from 8 (3%) women, and the syphilis serology was serofast in 4 (1%) women. Endometritis complicated the procedure in 4 women who received placebo and in 1 woman who received doxycycline (P = 0.22). CONCLUSION: Prophylactic doxycycline is not effective in preventing pelvic infection after curettage for spontaneous (incomplete) abortion.

Marketing an investigational drug service.

The customer survey was a useful tool for marketing the IDS. It provided guidelines for making decisions about the best use of limited human and material resources. Analyzing the results of the survey provided new priorities and directions for the IDS. These results were then used in conjunction with pharmacy financial and operational data to focus on areas of greatest importance to the customers and the pharmacy. Physicians should not be reluctant to pursue compassionate use treatments because of the administrative programs responsibilities that accompany such programs. Every patient should have the opportunity to benefit from alternative therapies that are investigational. For the quality of patient care to be maintained or even enhanced when studies are conducted, nurses must be well trained. The marketing survey fulfilled its purpose of identifying service gaps and allowing us to improve our services.

Phenomenology of temporal lobe dysfunction: a link to atypical psychosis--a series of cases.

This report is a phenomenological study of 20 cases of temporal lobe disorders manifested as complex partial seizures. The major behavioral symptoms observed were episodic affective disturbances, episodic cognitive disturbances, and "spells," with normal functioning between episodes. The remarkable similarity of this phenomenology to what has been described as atypical or episodic psychosis provides a possible theoretical link to the etiology of atypical psychosis. These cases also establish atypical psychosis as an entity clearly different from the other major psychoses.