Acute effects of caffeine and cigarette smoking on ventricular long-axis function in healthy subjects

<p>Abstract</p> <p>Background</p> <p>Few data exist regarding the direct effects of caffeine and smoking on cardiac function. We sought to explore the acute effects of caffeine assumption, cigarette smoking, or both on left ventricular (LV) and right ventricular (RV) function in a population of young normal subjects.</p> <p>Methods</p> <p>Forty-five healthy subjects aged 25 ± 2 years underwent echocardiography. Fifteen of them were non-smokers and habitual coffee consumers (group 1), 15 were smokers and not habitual coffee consumers (group 2), and 15 were smokers and habitual coffee consumers (group 3). Peak systolic (S_a), early diastolic E_a, and late diastolic (A_a) velocity of mitral annulus were measured by pulsed Tissue Doppler, and left atrioventricular plane displacement was determined by M-mode. Tricuspid annular velocities and systolic excursion (TAPSE) were also determined. Measurements were performed at baseline and after oral assumption of caffeine 100 mg in group 1, one cigarette smoking in group 2, and both in group 3.</p> <p>Results</p> <p>No changes in ventricular function were observed in group 1 after caffeine administration. In group 2, cigarette smoking yielded an acute increase in mitral A_a(+12.1%, p = 0.0026), tricuspid S_a(+9.8%, p = 0.012) and TAPSE (+7.9%, p = 0.017), and a decrease in the mitral E_a/A_aratio (-8.5%, p = 0.0084). Sequential caffeine assumption and cigarette smoking in group 3 was associated with an acute increase in mitral A_a(+13.0%, p = 0.015) and tricuspid A_a(+11.6%, p < 0.0001) and a reduction in mitral E_a/A_aratio (-8.5%, p = 0.0084) tricuspid E_a(-6.6%, p = 0.048) and tricuspid E_a/A_aratio (-9.6%, p = 0.0003). In a two-way ANOVA model controlling for hemodynamic confounding factors, changes in the overall population remained significant for mitral A_aand E_a/A_aratio, and for tricuspid A_aand E_a/A_aratio.</p> <p>Conclusion</p> <p>In young healthy subjects, one cigarette smoking is associated to an acute impairment in LV diastolic function and a hyperdynamic RV systolic response. Caffeine assumption alone does not exert any acute effect on ventricular long-axis function, but potentiates the negative effect of cigarette smoking by abolishing RV supernormal response and leading to a simultaneous impairment in both LV and RV diastolic function.</p

Reattachment of a subgingivally fractured central incisor tooth fragment: Report of a case

PubMed ID: 10204451A case report of a 9-year-old boy with a fractured maxillary right incisor and ulcerated pulp at the fracture line is presented. On satisfactory completion of a root canal filling one week later, the access cavity was restored with glass ionomer cement. The fragment was reattached by a light activated hybrid composite during the flap surgery. Tetracycline hydrochloride was applied on open root surface for a better healing

The treatment of a localized osseous sequestrum with porous bone mineral in combination with a collagen membrane and resorbable bone pins.

PubMed ID: 2000134006The ultimate goal of periodontal therapy should not be limited to the establishment and maintenance of periodontal health. The potential regeneration of the hard and soft periodontal tissues lost due to disease also should be considered. This case presentation evaluated a new surgical technique for the treatment of a variety of localized bone defects, utilizing porous bone mineral in combination with collagen membrane and resorbable bone pins

Effectiveness of periodontal therapy in patients with drug-induced gingival overgrowth. Long-term results

WOS: 000082644500003PubMed ID: 10505798Background: Drug-induced gingival overgrowth (DGO) is one of the well-recognized side effects of cyclosporin A (CsA) or nifedipine (Ni). After surgical periodontal therapy, the incidence of DGO recurrence is not known. The aim of this study was to evaluate the results of surgical periodontal therapy in patients receiving CsA or Ni and who exhibit severe long-term DGO. In addition, the relationship between various variables and the recurrence of severe DGO after periodontal surgery was investigated. Methods: A total of 38 patients, 22 with CsA-induced DGO and 16 with Ni-induced DGO, were included in this study. At baseline, patients received initial periodontal therapy, after which either the upper or lower anterior segment in each patient was surgically treated. Surgical periodontal therapy consisted of the flap technique with a 90 degrees gingivectomy incision. Following surgery, patients were placed on a maintenance therapy recall program and were monitored for 18 months. Patients were seen once a month for the first 3 months and once every 3 months for the following 15 months, Plaque index (PI), papilla bleeding index (PBI) and DGO scores in the treated segments were recorded at each recall appointment. Attendance at recall appointments was also noted for each patient. Results: Recurrence of severe DGO was observed in 13 of the 38 patients (34%) 18 months following periodontal surgery. Multiple regression analysis indicated that age, gingival inflammation, and attendance at recall appointments were significant determinants of the recurrence of severe DGO. Conclusions: This study suggests that regular re-motivation and professional care at frequent recall appointments after periodontal surgery are of great importance in patients receiving CsA or Ni. By maintaining periodontal health, the life quality of these patients may be raised

The acute effects of chemotherapy upon the oral cavity: Prevention and management

The oral and dental complications arising in cancer patients can be attributable to the malignant disease itself and to the various modalities of cancer therapy. Up to 40% of all patients receiving cancer chemotherapy develop acute oral complications. Oral complications may result in significant morbidity, impaired nutrition, treatment delays, and dose reductions which are affecting the prognosis of the primary disease. Many investigators have developed a series of clinical trials designed to study treatment modalities for these pathologic processes. These trials have demonstrated clinically helpful therapies and also have demonstrated lack of benefit for other proposed treatments. In this article we aimed to assess acute oral complications in cancer patients due to chemotherapy and review the recent treatment modalities for prevention and management of those complications since these changes in physiologic process are still problems that need further investigation

The role of serum lipids on cyclosporine-induced gingival overgrowth in renal transplant patients

Cyclosporine-A (CsA) is widely used to prevent organ rejection in recipients of transplanted organs and also in the treatment of various systemic diseases. CsA has a number of side effects, including gingival overgrowth (GO). However, the pathogenesis of CsA-induced GO remains uncertain. It has been postulated that CsA alters fibroblast activity. CsA is transported in plasma by binding to lipid components. It is possible that changes in serum lipid levels could alter the interaction between the CsA and gingival fibroblasts within the gingival tissues. It has also been reported that CsA may alter serum lipid levels in the transplant population. The aim of this study was to investigate the relationship between the serum lipids and CsA-induced GO. A total of 47 renal transplant recipients receiving CsA, azathioprine and prednisolone were the subjects of this study. Periodontal measurements were taken including plaque index (PII) and GO scores (GO). GO was classified into four categories according to the clinical changes. The whole blood CsA concentration, serum total cholesterol, triglyceride and ceratinine levels, and duration of CsA therapy of these patients were obtained from the subject's medical records. These were assessed monthly. CsA-treated recipients were divided for statistical purposes into two groups according to their GO scores. The recipients having sites with clinically significant GO (scores of 2 and 3) were classified as respondents, and those without evidence of overgrowth (GO score=0) as non-responders. There were no differences in age, plaque scores, duration of CsA therapy, and azathioprine and prednisolone dosage between responders and non-responders. Similarly, no statistically significant differences in serum lipids and whole blood CsA concentration were found between these two groups. These data indicate that CsA-induced GO is unrelated to serum lipid components. To our knowledge, this is the first report describing the relationship between the serum lipids and CsA-induced GO. We believe that additional studies will be necessary for complete understanding of the mechanism of gingival overgrowth

Acellular dermal matrix allograft used to gain attached gingiva in a case of epidermolysis bullosa

WOS: 000186174700013PubMed ID: 14761125Background: Epidermolysis bullosa (EB) is an acquired disease or inherited as either autosomal dominant or recessive with an incidence of 1/50,000. The prominent clinical characteristic of the disease is the development of bullae or vesicles in mucosa or skin in response to minor trauma. Aim: A female patient with a dystrophic type of EB had been put in a maintenance regimen after completion of the initial phase of periodontal therapy and followed for 7 years. The purpose of this report is to document acellular dermal matrix allograft application to increase the width of the attached gingiva in this patient experiencing difficulty in chewing and performing plaque control due to the dramatic loss of attached gingiva after 7 years of supportive periodontal therapy. Methods: Under local anaesthesia and antibiotic coverage, the acellular dermal matrix allograft was applied in the anterior region of the upper jaw in order to increase the width of attached gingiva, thereby improving patient comfort. Results: The healing was uneventful and a significant gain in attached gingiva dimensions was observed 9 months after the periodontal surgery. The procedure avoided a second surgical site, provided satisfactory results from an aesthetic point of view, and improved patient comfort. Conclusion: Acellular dermal matrix allograft may be regarded as an alternative in the treatment of EB cases to increase the width of attached gingiva and facilitate maintenance of the dentition