Evaluation of the efficacy of a redox agent in the treatment of chronic periodontitis.

A redox dye, methylene blue, was compared with subgingival root surface debridement and sterile water in the treatment of adult periodontitis. Plaque and gingival indices, bleeding on probing, and microbiological samples were obtained at baseline, and at 1, 4, 8 and 12 weeks following treatment. All subjects had matched pockets in each of the 4 quadrants, of 5 mm or more. One treatment consisted of 0.1% methylene blue gel irrigated professionally at 0, 1 and 4 weeks, and by subjects at days in between up to 4 weeks, at chosen sites within a randomly selected quadrant (split-mouth design). A 2nd treatment was sterile water irrigation as above. A 3rd quadrant received subgingival debridement, and sites in the 4th received methylene blue incorporated into a slow-release device of a biodegradable collagen alginate vicryl composite. All sites showed improvements in clinical and microbiological parameters. However, no statistically significant differences between treatment types were found for clinical measurements. Although plaque index tended to increase after week 1, gingival index was reduced, as was the papilla bleeding index. Probing depth reductions were approximately 1.2 mm for all treatments. Microbiological variables showed an increase in cocci and a decrease in motile organisms for all groups, the latter reaching statistical significance for subgingival debridement. The reductions in spirochaetes were significant for subgingival debridement and methylene blue by slow-release. Culture demonstrated an increase in the aerobe:anaerobe ratio for all groups, which was statistically significant initially (weeks 1 and 4) for subgingival debridement. Methylene blue was also effective statistically in improving this ratio, both by irrigation and slow-release (week 4). Methylene blue also significantly reduced the numbers of black-pigmented anaerobes during the trial period, both by irrigation and slow-release, which sterile water and subgingival debridement failed to do. No serious adverse experiences were seen, however, significantly greater morbidity was associated with subgingival debridement. These results clearly demonstrate that in altering the microflora to one that is more compatible with periodontal health, methylene blue treatment is comparable, or even better, than the currently standard treatment of subgingival debridement, and is better tolerated.

Effects of steroids on mood, edema, and ecchymosis in facial plastic surgery.

OBJECTIVE: To examine the effects of oral postoperative steroid therapy in facial plastic surgery on mood, edema, and ecchymosis. DESIGN: Double-blind randomized trial with placebo control. SETTING: Private practice, ambulatory care facility. PATIENTS: Any patient who was to undergo a procedure in which we had previously been employing postoperative steroid therapy was a potential participant. Any patient with known contraindications to steroid use was excluded. A consecutive, volunteer sample of 60 of 65 patients approached agreed to participate. Five patients of the 60 who participated were excluded from the final results owing to either study or participant errors, leaving a total sample of 55 patients. All 55 patients completed the study in the 7-day follow-up period. No patients were withdrawn owing to adverse effects. INTERVENTION: Taper of prednisone therapy from 60 mg orally and decreasing by 10 mg each day over a total of 6 days. MAIN OUTCOME MEASURES: Mood, edema, and ecchymosis. RESULTS: No significant differences were noted in mood, edema, or ecchymosis between the placebo and intervention groups. The study observer was blinded to patient groupings in the subjective measures of edema and ecchymosis. The patients rated any changes in mood and were also blinded to the group in which they belonged. CONCLUSIONS: The use of oral steroids given postoperatively in facial plastic surgery may be unnecessary and may subject the patient to undue risk. Further studies would be helpful to determine the potential benefit of steroids given in different dosages, routes, and timing in relation to the procedure.

Development of the Abbott MATRIX Aero assay for the measurement of specific IgE.

An enzyme immunoassay has been developed for the quantitation of specific immunoglobulin E (IgE) in human serum to a panel of allergens. The assay system, called the Abbott MATRIX Aero, includes an instrument, reagents and test cell disposables. Each test cell contains fourteen airborne allergens individually localized on a nitrocellulose solid phase. Individual calibration curves for each allergen are established by the manufacturer and included in barcode form with each test kit. Stable factory calibration eliminates the need to establish a calibration curve with each assay run. The instrument automatically incubates, washes, and reads the test cell and prints each result, which ensures assay reproducibility and provides ease-of-use. Analysis of test results shows good agreement with another in vitro assay for specific IgE. The Abbott MATRIX Aero is a sensitive, reproducible and easy-to-use system for the measurement of specific IgE to a panel of fourteen allergens simultaneously using a single, small volume of serum.

Systematic approach to correction of the nasal tip in rhinoplasty.

Surgical correction of the nasal tip is considered to be the most difficult component of rhinoplasty. We describe a systematic method of analyzing and operating on the tip, and discuss the anatomical factors that contribute to tip support. The "tripod" theory of tip projection, support, and rotation is described and illustrated. Altering tip support and excising portions of the lower lateral cartilages have a decided effect on the tripod and the eventual outcome of the nasal tip. We describe four categories of tip procedures, namely, complete strip, rim strip, lateral crural flap, and dome division. An attempt is made to provide the rhinoplasty surgeon with the different techniques from which to choose for each specific type of nasal tip deformity.

Sleep apnea, hypersomnolence, and upper airway obstruction secondary to adenotonsillar enlargement.

The authors examined four children with substantial adenotonsillar enlargement that caused intermittent severe upper airway obstructive episodes, documented by all-night polygraphic monitoring of sleep and respirations. Previously unreported complications of severe adenotonsillar enlargement that were demonstrated included prolonged obstructive apneic episodes and disturbed sleep patterns. The children also exhibited daytime hypersomnolence. Polygraphic sleep studies after adenotonsillectomy confirmed improved sleep patterns and relief of the obstructive episodes. None of our patienqs had developed pulmonary hypertension, cor pulmonale, or other reported complications of prolonged upper airway obstruction, all of which may have been averted by early diagnosis and treatment.