Long-term effects of CO2 laser irradiation on treatment of hypersensitive dental necks: results of an in Vivo study.

OBJECTIVE: The present in vivo study was performed to examine the long-term effects of combined CO2 laser treatment and fluoridation on hypersensitive dental necks. SUMMARY BACKGROUND DATA: Attempts have been made to treat dental hypersensitivity by sealing exposed dentinal tubules, primarily using fluoride preparations, strontium chloride, and hydroxyapatite. However, these treatment methods have the disadvantage that the preparation is effective only for a limited period of time and must be applied repeatedly, at short intervals. The CO2 laser has been shown to have an excellent sealing effect on hypersensitive dentinal surfaces. METHODS: Test subjects suffering from dentinal hypersensitivity were recruited from the patients of the Department of Conservative Dentistry, School of Dentistry of the University of Vienna, Austria and treated with combined laser irradiation and fluoridation with stannous fluoride gel. The patients were followed up for a period of 18 months. In vivo examinations were supplemented by atomic absorption spectroscopy (AAS) of tiny dentin samples obtained from the dental necks 6 weeks and 18 months after laser treatment and by scanning electron microscopy (SEM). RESULTS: Compared to conventional fluoridation, combined laser irradiation and fluoridation was shown to be effective in the treatment of hypersensitive dental necks. When success was defined as complete freedom from pain, the success rate in the laser group was 96.5%. Furthermore, examinations of irradiated teeth under the scanning electron microscope still revealed complete closure of the dentinal tubules four and six months after laser treatment. AAS showed that tin was present in the samples, which indicates that combined laser treatment and fluoridation result in permanent integration of fluoride in the dentin surface. CONCLUSIONS: Based on these results, the CO2 laser can be recommended as an ideal tool for desensitization of dental necks.

Use of prostaglandin I2 in three small children at high risk of early renal graft thrombosis.

We report the use of prostaglandin I.2. (PGI2) in three small children weighing less than 15 kg at high risk of graft thrombosis after cadaveric renal transplantation complicated by acute tubular necrosis. PGI2 was started at a dose of 5 ng/kg per min within the first 6 h after transplantation, and was continued for 12-15 days. Before and during PGI2 infusion, color-coded and pulsed Doppler sonography was performed. We found immediate restoration of diastolic flow, consistent with a decrease in vascular resistance. During the subsequent days, the sonographically assessed flow pattern and clinical graft function improved gradually. None of the three consecutively treated children developed graft thrombosis or lost his graft; no clinically relevant bleeding or adverse hemodynamic or pulmonary effects were seen.

Estimation of total creatinine clearance is unreliable in children on peritoneal dialysis.

OBJECTIVE: To test the reliability of creatinine clearance in children on peritoneal dialysis (PD). DESIGN: Longitudinal, case-controlled. SETTING: Routine clinic visits at the pediatric dialysis unit of the Universitätskinderklinik of Vienna. PATIENTS: Eleven children (2-13 years, 10-55 kg) with end-stage renal disease on PD. INTERVENTIONS: Creatinine clearance (CCr) was determined by measuring creatinine excretion (ECr) over 24 hours in both dialysate and urine. Each child had three to five separate measurements of their CCr. At the same time we also calculated the Schwartz formula clearance from the patient's height and serum creatinine, using a modified correlate. MAIN OUTCOME MEASURES: Reliability of CCr was assessed by two approaches. First, we compared each serial measurement with the mean value for each patient and thereby assessed the "intramethodical" variability. Second, we compared each CCr with the simultaneous formula clearance and assessed the "intermethodical" disagreement. RESULTS: Twenty-seven percent of the measurements of CCr were classified as unreliable based on a comparison with the mean value for each patient. Reliability was closely correlated with residual renal function (p < 0.01); only 12% of the measurements in the anuric patients were classified as unreliable (vs 31% in the patients with residual renal function). The simultaneous formula clearance was less variable than the CCr. The formula clearance had a sensitivity of 93% and a specificity of 60% for detecting unreliable values of CCr. CONCLUSION: Estimation of total CCr is unreliable in pediatric patients on PD. A simultaneous formula clearance can be used to detect which values are unreliable.

[Formula creatinine clearance as a substitute for 24-hour creatine clearance in children with kidney transplantation]. / Formula-Kreatininclearance als Ersatz der 24-Stunden-Kreatininclearance bei nierentransplantierten Kindern.

Despite many theoretical advantages, formula-creatininclearance (Schwartz et al, Journal of Pediatrics 1976) has not found broad clinical acceptance in everyday pediatric patient care. In this study we report our results of long term observations (11.7 +/- 6.8 (1.7-24.8) months) of measured and computed creatininclearance in 27 children after renal transplantation (15 boys, 12 girls, mean age 14.5 +/- 4.2 (5.5-20) years) at the Kinderdialyse of the Universitäts-Kinderklinik of Vienna. We found a wide scattered correlation between the measured and computed creatininclearance values with a 90% confidence interval between -30% to +60% of the 24 hour creatininclearance. Formula creatininclearance (SD 17.8%) was markedly better reproducable than the 24 hour creatininclearancethe (SD 37.8%), the intraindividuell collecting error (36.1%) was almost twice the interindividuell "coefficient" error (20.27%). We therefore conclude that the 24 hour creatininclearance is by far not as accurate as the complexity of the procedure pretends and support broad clinical acceptance for the formula creatininclearance.

Subcutaneous recombinant human erythropoietin in children with renal anemia on continuous ambulatory peritoneal dialysis.

Subcutaneous recombinant human erythropoietin (rHuEpo) treatment of renal anemia was performed in four boys and eight girls on CAPD, aged 0.8-12.5 (mean 7.4) years. In contrast to previous studies, our therapeutic goal was not set with a hematocrit of 30% but with full correction of anemia. Following a maximum weekly rHuEpo dosage of median 120 (range 100-240) IU/kg body weight, hematocrit increased in 10 children from 24 (14-29)% within 12 (4-17) weeks to 40.1 (33.5-48.4)%. The weekly increase in hematocrit was 1.27 (0.5-3.1)%. The corrected reticulocyte count increased from 1.3 (0.7-1.8)% to 2.3 (1.4-3.9)% within 4 (2-6) weeks. Eight children fulfilled the protocol; six with an uncomplicated course were able to maintain a hematocrit of 37.1 (35.1-42.7)% with only one sc medication per week of approximately two-thirds of their highest weekly rHuEpo dosage. No serious adverse effect of rHuEpo therapy was observed.

[The anion gap--screening for hyperlactatemia in critically ill children?]. / Anionenlücke--ein Screening auf Hyperlaktatämie bei kritisch kranken Kindern?

Serum lactate provides important information about tissue perfusion in critically ill patients. Aim of this study is to evaluate anion gap as a screening method to detect hyperlactatemia at a pediatric intensive care unit. In infants and children of different ages and diagnosis we determined blood gases, electrolytes and lactate. Sensitivity of anion gap was increasing with increasing hyperlactatemia. For the total population the test exhibited a sensitivity of 64% and a specificity of 76%, respectively. The power of anion gap as a screening method to detect hyperlactatemia was similarly fair for all age groups. Therefore hyperlactatemia has also to be included in the differential diagnosis of non-anion gap metabolic acidosis.

[Are omega-3-fatty acids essential for newborn infants?]. / Sind omega-3-Fettsäuren für das Neugeborene essentiell?

omega-3 fatty acids have recently been placed into the center of interest because of their different effects on fatty acid metabolism as well as on blood coagulation. We do not know if omega-3 fatty acids are essential during childhood, because it was seen that they may have positive effects on the development of the brains of rats and are also present in breast milk. The following report presents the recent state of the scientific knowledge. In fish and grain oil one can find not only omega-6 fatty acids as e.g. arachidonic acid (AA: C 20: 4 omega-6), but also omega-3 fatty acids (e.g.: linolenic acid: C 18:3 omega-3). They are always in a specific ratio to the other: If there are higher concentrations of omega-3 fatty acids, one can find less amounts of omega-6 fatty acids, and vice versa. The most important representatives of the omega-3 fatty acids are metabolites of linolenic acid, such as docosahexaenoic acid: C 22: 6 omega-3 (DHA) and eicosapentaenoic acid: C 20: 5 omega-3 (EPA). The beneficial influence, especially of DHA, on the postnatal development of the retina and brain has been demonstrated in rats and rhesus monkeys. It could be shown that the fatty acid composition of phospholipids of red blood cells conforms to that of the CNS. Nearly the same values could be achieved in infants with both, a diet enriched with fish oil and a feeding with breast milk; this seems to be essential especially for preterm infants, who always have a DHA-deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)