Computer-assisted generation of all-ceramic crowns and fixed partial dentures.

The successful application of the concept of computer-assisted manufacturing in restorative dentistry requires that computer-assisted design (CAD) and computer-assisted machining (CAM) not only meet but actually exceed currently accepted standards for the material and clinical quality of dental restorations. In addition, the continued development of systems for polyvalent processing of disparate materials and objects must be assured. With these critical requirements in mind, the Precident system is a clinically proven and competitive system. The resolving power of the CCD chip is much improved compared to conventional cameras or charge-coupled devices. The scanner is able to scan entire casts in a fully automated process. In principle, this facilitates the production of frameworks for fixed prosthetic devices (FPD) of any size. It is also possible to create at least partial frameworks for removable prosthetic devices (RPD). A factor of great clinical and economic importance is the polyvalence of the process in materials processing: the numeric control (NC) machine can be programmed for metal alloys and ceramic materials as well as fiber-reinforced resins. At Aeskulap Klinik, the Precident System is routinely used for producing all single crowns and FPDs with up to four units. CAD/CAM all-ceramic crowns and FPDs currently cost about the same as metallo-ceramic or conventional all-ceramic restorations.

Comparison of pantoprazole versus omeprazole in the treatment of acute duodenal ulceration--a multicentre study.

METHODS: In this randomized, double-blind, multicentre study, the proton pump inhibitors pantoprazole and omeprazole were compared in patients with active duodenal ulcers. Two hundred and seventy-six protocol-correct patients received either pantoprazole 40 mg (n = 185) or omeprazole 20 mg (n = 91), once daily for 2 or 4 weeks, depending on the progress of ulcer healing. RESULTS: Rates of complete ulcer healing after 2 weeks were 71% in patients given pantoprazole and 74% in patients given omeprazole. After 4 weeks the figures were 96% and 91%, respectively. These differences were not significant. There was no significant difference in ulcer pain prior to treatment, and 85% of the pantoprazole group and 86% on omeprazole were pain-free after 2 weeks (not significant). The time until complete pain relief with pantoprazole or omeprazole, based on data from diary cards, was not significantly different (P > 0.05, Uleman's U-test). Both treatments were equally well tolerated. Changes in routine laboratory parameters were minimal in both groups. CONCLUSION: Pantoprazole was shown to be a highly-effective and well-tolerated treatment for acute duodenal ulcer. Pantoprazole 40 mg and omeprazole 20 mg were equally effective with respect to ulcer healing and pain relief, and have similar adverse event profiles.

Low-dose antacid therapy in the treatment of duodenal ulcer--a multicentre double-blind trial vs. misoprostol.

We conducted a 4-week double-blind randomized controlled multicentre trial to compare low-dose-antacid (AA) therapy (225 meq total neutralizing capacity per day) with therapy using the prostaglandin E1-analogue, misoprostol (MS) (400 micrograms bid), on ulcer healing and relief of symptoms in 100 outpatients with endoscopically proven duodenal ulcer (DU, 49 patients on AA, 51 patients on MS). Of the 100 patients enrolled in the study 96 could be evaluated; 49 received AA, 47 MS. Endoscopies were performed before treatment, 2 and 4 weeks after initiation of treatment. Healing rates of AA- and MS-treatment were 36.7% vs. 25.5% (2 weeks) and 79.6% vs. 74.4% (4 weeks) and did not differ as much as relief of pain during the daytime. Rates of relief of nighttime pain were significantly higher on AA-treatment after 2 weeks of treatment (81.1% vs. 48.6%; p less than 0.05), but not during the later course of treatment. Thus, it can be concluded that low-dose AA-treatment using an aluminum/magnesium hydroxide preparation in tablet form represents an effective and safe therapy for duodenal ulcer.

[Significance of microsurgery revascularized soft tissue and bone transplants in plastic reconstructive interventions of the extremities]. / Die Bedeutung mikrochirurgisch revaskularisierter Weichgewebs- und Knochentransplantate bei plastisch rekonstruktiven Eingriffen im Extremitätenbereich.

By using the fixateur externe in the fixation of bone fractures in the presence of heavily damaged soft tissue, we now have to tackle the challenge of adequate soft tissue coverage besides osteosynthesis of bone fracture. Free microvascular tissue transfer now increasingly replaces the previous method of management in which the soft tissue was reconstructed step by step. This technique is undoubtedly the solution for a lot of earlier problems, but now other questions have come up, particularly regarding time for tissue transfer. The article reports on the experience collected by us.

Treatment of duodenal ulcer with low-dose antacids.

The aim of the present investigation was to compare the efficacy of a low-dose antacid (Maalox 70, 280 mmol/day) with that of the H2-receptor antagonist cimetidine (Tagamet, 200 mg three times daily and 400 mg/day) after 14 and 28 days in the treatment of duodenal ulcer. The prospective multicentre study included 171 patients with endoscopically confirmed duodenal ulcers. The patients were randomly assigned to the treatment groups with antacid containing Mg and Al hydroxide (M)(4 X 70 mmol/day; n = 86) or to the group receiving cimetidine (T) (1000 mg/day; n = 85). The two treatment groups were matched for age, sex, drinking and smoking habits, and drug use. Endoscopic examinations were carried out before the start of treatment and 14 days later. If the ulcer was still present at this time, the second endoscopic examination was done after a further 14 days. Endoscopically, the ulcer had healed at 14 days in 38.8% (M) and in 34.9% (T) and at 28 days in 80.0% (M) and 74.7% (T), respectively. The healing rate did not differ significantly between the two treatment groups. Complaints, measured as percentage of days per week with upper abdominal pain, were significantly reduced in both groups. No significant differences were found between the two treatment groups with regard to pain relief or side effects. Treatment had to be abandoned in one patient receiving antacid because of diarrhoea and in one patient receiving cimetidine because of the absence of any response.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of active duodenal ulcers with famotidine. A double-blind comparison with ranitidine.

In a double-blind multicenter trial, 100 patients with active duodenal ulcer were treated with a single nocturnal dose of famotidine 40 mg or ranitidine 300 mg. Antacid tablets were allowed as additional treatment if needed for pain relief. Endoscopy was repeated after two weeks, and again after four weeks if the ulcer had not healed earlier. Two patients in the famotidine group were withdrawn from the study because of non-compliance with the protocol. After two weeks, ulcers in 64 percent of the patients receiving famotidine and 46 percent of the patients receiving ranitidine were healed (p = 0.072). After four weeks, healing rates were 94 percent (famotidine) and 90 percent (ranitidine). Pain relief was rapid in either treatment group, with a tendency for better response during the day in the famotidine group. Mean antacid consumption during the first week was 3.0 tablets (34.5 mmol) in the famotidine group and 4.1 tablets (47.2 mmol) in the ranitidine group. Famotidine provides excellent healing and relief of symptoms in patients with duodenal ulcer disease.

Comparative clinical trial of enprostil and ranitidine in the treatment of gastric ulcer.

In a randomized, double-bind, parallel, multi-clinic study, the safety and efficacy of enprostil (35 micrograms twice daily) and ranitidine (150 mg twice daily) were compared in the treatment of active gastric ulcer in 93 outpatients (47 enprostil-treated patients and 46 ranitidine). The two treatment groups were well matched for demographic characteristics. The healing rates in the enprostil group were 22, 58, 80, and 86 percent at two, four, six, and eight weeks, respectively. The corresponding rates in the ranitidine group were 22, 66, 84, and 89 percent. None of these differences was statistically significant. The area of the ulcer at baseline and smoking status did not appear to influence healing rates. There were no significant differences between treatment groups in time to relief of ulcer symptoms, frequency of daytime or nighttime ulcer pain, or antacid use. Side effects attributable to enprostil treatment were diarrhea (10 percent versus 6 percent with ranitidine), gastrointestinal pain, and vomiting. These side effects, however, did not influence the patients' assessments of their overall response to enprostil and ranitidine therapy. Six enprostil-treated patients and one ranitidine-treated patient withdrew from the trial prematurely because of adverse experiences. Monitoring of clinical laboratory test results showed no significant changes in the two treatment groups. This study demonstrates that a prostaglandin E2 analogue, enprostil, in a dose of 35 micrograms twice daily, is similarly safe and effective as ranitidine in the treatment of active gastric ulcer.

[2 or 1 daily doses of ranitidine in the treatment of reflux esophagitis]. / Zwei oder eine Tagesdosis Ranitidin zur Behandlung der Refluxösophagitis?

In a randomized multicentre study 96 patients with mild to moderate types of reflux esophagitis (stages I and II according to Savary-Miller) the effect of 150 mg ranitidine b.i.d. (49 patients) was compared to that of 300 mg ranitidine nocte (47 patients). In both patient groups similar healing rates were observed. 81.6% and 74.5%, respectively, of the patients with esophagitis healed within 6 weeks, and 95.9% and 93.6%, respectively, within 12 weeks. Reflux symptoms disappeared in both treatment groups in 91.8% and 80.9%, respectively, within 6 weeks, and 98.0% and 100%, respectively, within 12 weeks. Drug safety was good. Thus, in mild to moderate types of reflux esophagitis treatment with ranitidine can be reduced to one single dose of 300 mg at night.

[Stomach ulcer healing with enprostil, an orally effective prostaglandin E2 analog: direct comparative study with ranitidine]. / Ulcus-ventriculi-Abheilung unter Enprostil, einem oral wirksamen Prostaglandin-E2-Analog: Eine direkte Vergleichsstudie mit Ranitidin.

In a randomized, endoscopically controlled double-blind trial the effectiveness of a twice daily dose of the prostaglandin E2-analogue enprostil was compared with ranitidine given to 93 ambulatory patients with benign gastric ulcers. Under 35 micrograms b.i.d. enprostil the ulcer healing rates after 2, 4, 6 and 8 weeks averaged 22% (10/46), 58% (26/45), 80% (35/44) and 86% (37/43). The corresponding values for ranitidine 150 mg b.i.d. were 22% (10/46), 66% (29/44), 84% (38/45) and 89% (41/46). The differences were not statistically significant. Both drugs had a similar influence on the ulcer symptoms and were well tolerated. The findings suggest that enprostil can be given in a twice daily dosage in the treatment of benign gastric ulcers.

[Enprostil in the acute treatment of duodenal ulcer: direct comparative study with pirenzepin]. / Enprostil in der Akutbehandlung des Ulcus duodeni: Eine direkte Vergleichsstudie mit Pirenzepin.

In a randomized, endoscopically controlled double-blind trial the effectiveness of a twice daily dose of the prostaglandin E2-analogue enprostil was compared with pirenzepine given to 97 ambulatory patients with duodenal ulcers. Under 35 micrograms b.i.d. enprostil the ulcer healing rates after 2, 4 and 6 weeks averaged 41%, 82% and 92%. The corresponding values for pirenzepine were 44%, 72% and 89%. The differences were not statistically significant. Both drugs had a similar influence on the ulcer symptoms.

20 versus 30 mg omeprazole once daily: effect on healing rates in 115 duodenal ulcer patients.

In a double-blind, dose comparison multicenter trial 115 patients with duodenal ulcer were treated with either 20 or 30 mg oral omeprazole once daily for 4 weeks. There was no difference in the healing rates for the two groups after 2 and 4 weeks. After 2 weeks with 20 and 30 mg healing frequencies were 79.0 and 72.7%, after 4 weeks 96.5 and 92.7%. No difference was observed between the groups in the number of pain episodes during day and night. No side effects to the drug occurred. A daily dose of 20 mg omeprazole may be effective in ulcer therapy.

Factors predicting the therapeutic outcome of duodenal ulcer treatment with H2-receptor antagonists.

In a prospective trial 37 duodenal ulcer patients were treated daily with 1 g cimetidine. Personal and clinical data were obtained for all patients, acid secretion studies performed before and during treatment, and pharmacokinetic parameters of cimetidine determined. The healing rate after 4 weeks was 64.9% (24 patients). Non-Responders included a higher proportion of smokers, patients with a history of ulcer and previous treatment with H2-receptor antagonists than Responders. Basal acid output (BAO) and peak acid output (PAO) values were not different between the two groups, nor was the reduction of BAO and PAO under cimetidine. However, more Responders had complete suppression of BAO than Non-Responders. A correlation existed in both groups between cimetidine plasma concentration and PAO suppression but not with BAO suppression. Regular drug intake (compliance) was found in about 90% in both groups. Cimetidine bioavailability parameters were identical in both groups, but Non-Responders had a higher peak concentration and a shorter time of peak concentration. Discriminant analysis enabled a prediction of treatment response in 89.2% of the patients by using five factors: time of peak concentration of cimetidine, previous H2-receptor-antagonist treatment, peak concentration, smoking, and alcohol use. Prediction of treatment response is increased by use of drug related variables.