Comparing topiramate with naltrexone in the treatment of alcohol dependence

To compare the efficacy of topiramate with naltrexone in the treatment of alcohol dependence. The investigation was a double-blind, placebo-controlled, 12-week study carried out at the University of Sao Paulo, Brazil. A total of 155 patients, 18-60 years of age, with an International Classification of Diseases (ICD-10) diagnosis of alcohol dependence. After a 1-week detoxification period, patients were assigned randomly to receive topiramate (induction to 300 mg/day), naltrexone (50 mg/day) or placebo. Time to first relapse (consumption of > 60 g ethyl alcohol), cumulative abstinence duration and weeks of heavy drinking. In intention-to-treat analyses, topiramate was statistically superior to placebo on a number of measures including time to first relapse (7.8 versus 5.0 weeks), cumulative abstinence duration (8.2 versus 5.6 weeks), weeks of heavy drinking (3.4 versus 5.9) and percentage of subjects abstinent at 4 weeks (67.3 versus 42.6) and 8 weeks (61.5 versus 31.5), but not 12 weeks (46.2 versus 27.8). Results remained significant after controlling for Alcoholics Anonymous attendance, which was higher in topiramate than in other groups. There were no significant differences between naltrexone versus placebo or naltrexone versus topiramate groups, but naltrexone showed trends toward inferior outcomes when compared to topiramate. The results of this study support the efficacy of topiramate in the relapse prevention of alcoholism. Suggestive evidence was also obtained for superiority of topiramate versus naltrexone, but this needs to be verified in future research with larger sample sizes.

Photodynamic therapy for acne vulgaris: A critical review from basics to clinical practice Part II. Understanding parameters for acne treatment with photodynamic therapy

Photodynamic therapy requires a photosensitizer, oxygen, and activating light. For acne, pilosebaceous units are ""target"" structures. Porphyrins are synthesized in vivo from 5-aminolevulinic acid (ALA), particularly in pilosebaceous units. Different photosensitizers and drug delivery methods have been reported for acne treatment. There are a variety of porphyrin precursors with different pharmacokinetic properties. Among them, ALA and methyl-ester of ALA (MAT.) are available for possible off-label treatment of acne vulgaris. In addition, various light sources, light dosimetry, drug incubation time, and pre- and posttreatment care also change efficacy and side effects. None of these variables has been optimized for acne treatment, but a number of clinical trials provide helpful guidance. In this paper, we critically analyze clinical trials, case reports, and series of cases published through 2009. (J Am Acad Dermatol 2010;63:195-211.)

Cost Effectiveness of Positron Emission Tomography in Patients With Hodgkin`s Lymphoma in Unconfirmed Complete Remission or Partial Remission After First-Line Therapy

Purpose To assess the cost effectiveness of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with Hodgkin`s lymphoma (HL) with unconfirmed complete remission (CRu) or partial remission (PR) after first-line treatment. Patients and Methods One hundred thirty patients with HL were prospectively studied. After treatment, all patients with CRu/PR were evaluated with FDG-PET. In addition, PET-negative patients were evaluated with standard follow-up, and PET-positive patients were evaluated with biopsies of the positive lesions. Local unit costs of procedures and tests were evaluated. Cost effectiveness was determined by evaluating projected annual economic impact of strategies without and with FDG-PET on HL management. Results After treatment, CRu/PR was observed in 50 (40.0%) of the 127 patients; the sensitivity, specificity, and positive and negative predictive values of FDG-PET were 100%, 92.0%, 92.3%, and 100%, respectively (accuracy of 95.9%). Local restaging costs without PET were $350,050 compared with $283,262 with PET, a 19% decrease. The incremental cost-effectiveness ratio is -$3,268 to detect one true case. PET costs represented 1% of total costs of HL treatment. Simulated costs in the 974 patients registered in the 2008 Brazilian public health care database showed that the strategy including restaging PET would have a total program cost of $56,498,314, which is $516,942 less than without restaging PET, resulting in a 1% cost saving. Conclusion FDG-PET demonstrated 95.9% accuracy in restaging for patients with HL with CRu/PR after first-line therapy. Given the observed probabilities, FDG-PET is highly cost effective and would reduce costs for the public health care program in Brazil.

Fractional Photothermolysis for the Treatment of Hypertrophic Scars: Clinical Experience of Eight Cases

Hypertrophic scars are common problems and represent a challenging condition to treat. Fractional photothermolysis has been effective at resurfacing photodamaged skin, acne scars, and atrophic scars, but there are few reports on its use for hypertrophic scars. To evaluate the safety and efficacy of 1,550-nm erbium-doped fiber laser treatment of hypertrophic scars in eight patients. Eight patients (skin phototypes II-IV) with hypertrophic scars received monthly treatments with a 1,550-nm erbium-doped fiber laser. Energy settings ranged from 35 to 50 mJ, and eight to 10 passes were applied with treatment levels 6 to 8. An independent physician evaluator assessed the treatment response by comparing pre- and posttreatment clinical photographs using a quartile grading scale (grade 1, <= 25%=minimal to no improvement; grade 2, 26-50%=moderate improvement; grade 3, 51-75%=marked improvement; grade 4, > 75%=near total improvement. At four weeks after the last treatment session, a mean grade of 2.4 was achieved based on an independent physician`s clinical assessment. Improvement in pigmentation occurred in all hyperpigmented scars. Hypertrophic scars can be effectively and safely improved with 1,550-nm erbium-doped fiber laser treatment. The authors have indicated no significant interest with commercial supporters.

DIVERGENT ROLE OF HEME OXYGENASE INHIBITION IN THE PATHOGENESIS OF SEPSIS

The reduction of neutrophil migration to an infectious focus is associated with a high mortality in severe sepsis. Previously, we showed that heme oxygenase (HO) products downregulate neutrophil recruitment in a noninfectious inflammatory model. The present study was designed to determine the role of HO in sepsis induced by cecal ligation and puncture (CLP) model. We demonstrated that pretreatment, but not the combination of pretreatment plus posttreatment with zinc protoporphyrin IX (ZnPP IX), an HO inhibitor, prevented the reduction of CXCR2 on circulating neutrophils and the failure of intraperitoneal neutrophil migration to the site of infection. Consequently, bacterial dissemination, systemic inflammatory response, and organ injury were prevented. In addition, pretreatment with the HO inhibitor avoided hypotension and consequently increased survival. Moreover, in mice subjected to severe CLP, the pretreatment, but not the combination of pretreatment plus posttreatment with ZnPP IX, prevented the increase of plasmatic free heme observed in nontreated severe CLP. The administration of exogenous hemin to mice subjected to moderate sepsis consistently increased the mortality rate. Furthermore, hemin resulted in a reduction of neutrophil migration both in vivo and in vitro. Altogether, our results demonstrated that pretreatment with the HO inhibitor prevents the pathological findings in severe CLP. However, the combination of pretreatment plus posttreatment with ZnPP IX enhances sepsis severity because of an increase in circulating levels of heme, which is deleterious to the host tissues and also inhibits neutrophil migration.

Effects of the levonorgestrel-releasing intrauterine system on cardiovascular risk markers in patients with endometriosis: a comparative study with the GnRH analogue

Background: The study was conducted to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intrauterine system (LNG-TUS) compared with the GnRH analogue (GnRHa) leuprolide acetate on these risk markers after 6 months of treatment. Study Design: This was a randomized, prospective, open clinical Study, with 44 patients with laparoscopically and histologically confirmed endometriosis. Patients were randomized into two groups: the LNG-IUS group, composed of 22 patients who underwent LNG-IUS insertion., and the GnRHa group, composed of 22 patients who received a monthly GnRHa injection for 6 months. Body mass index systolic and diastolic arterial blood pressure; heart rate; and laboratory cardiovascular risk markers such as interlelikin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP), homocysteine (HMC), lipid profile, total leukocytes and vascular cell adhesion molecule (VCAM) were measured before and 6 months after treatment. Results: After 6 months of treatment, a significant reduction in pain score occurred in both groups with no significant difference in improvement between the two medications evaluated. In the LNG-IUS group, from pretreatment to posttreatment period, there was a significant reduction in the levels (mean +/- SD) of VCAM (92.8 +/- 4.2 to 91.2 +/- 2.7 ng/mL, p=.04), CRP (0.38 +/- 0.30 to 0.28 +/- 0.21 mg/dL, p=.03), total cholesterol (247.0 +/- 85.0 to 180.0 +/- 31.0 mg/dL, p=.0002), triglycerides (118.0 +/- 76.0 to 86.5 +/- 41.5 mg/dL, p=.003), low-density lipoprotein cholesterol (160.5 +/- 66.0 to 114.5 +/- 25.5 mg/dL, p=.0005) and high-density lipoprotein cholesterol (63.0 +/- 20.5 to 48.5 +/- 10.5 mg/dL, p=.002). The GnRHa group showed an increase in HMC levels (11.5 +/- 2.9 to 13.0 +/- 2.7 mu mol/L, p=.04) and a reduction in IL-6 levels (4.3 +/- 3.9 to 2.3 +/- 0.8 pg/mL, p=.005), VCAM (94.0 +/- 3.8 to 92.0 +/- 1.6 ng/mL, p=.03) and total leukocytes (7330 +/- 2554 to 6350 +/- 1778, p=.01). In the GnRH group, the remaining variables, including lipid profile, did not show any statistical difference. Conclusions: This study shows that some cardiovascular risk markers are influenced by both GnRHa and the LNG-TUS, but the latter had a greater positive impact on the lipid profile, which could lead to a favorable effect during long-term treatment. (C) 2010 Elsevier Inc. All rights reserved.

Treatment stability in patients with Class II malocclusion treated with 2 maxillary premolar extractions or without extractions

Introduction: The purpose of this study was to compare the occlusal stability of Class II malocclusion treatment with and without extraction of 2 maxillary premolars. Methods: A sample of 59 records from patients with complete Class II malocclusion was used. This sample was divided into 2 groups with the following characteristics: group 1, comprising 29 patients treated without extractions, and group 2, comprising 30 patients treated with extraction of 2 maxillary premolars. Dental cast measurements were obtained before and after treatment and at a minimum of 2.4 years after treatment. The pretreatment, posttreatment, and postretention occlusal statuses were evaluated with the peer assesment rating index. The occlusal indexes at the postretention stage and the posttreatment changes and percentages of posttreatment changes were compared with t tests. Results: The nonextraction and the 2 maxillary premolar extraction treatment protocols of complete Class II malocclusions had no statistically significant differences in occlusal stability. Conclusions: Finishing Class II malocclusion treatment with the molars in a Class II relationship has similar occlusal stability as finishing with the molars in a Class I relationship. (Am J Orthod Dentofacial Orthop 2010;138:16-22)

Influence of rapid palatal expansion on maxillary incisor alignment stability

Introduction: The purpose of this retrospective study was to compare the long-term stability of maxillary incisor alignment in patients treated with and without rapid maxillary expansion (RME). Methods: The sample comprised 48 subjects with Class I and Class II malocclusions, treated without extractions with fixed edgewise appliances, divided into 2 groups according to the treatment protocol: group 1 comprised 25 patients (15 girls, 10 boys) at a mean initial age of 13.53 years (SD, 1.63), who had RME during orthodontic treatment. Group 2 comprised 23 patients (13 girls, 10 boys) at a mean initial age of 13.36 years (SD, 1.81 years), treated with fixed appliances without RME. Maxillary dental cast measurements were obtained at the pretreatment, posttreatment, and long-term posttreatment stages. Variables assessed were the irregularity index and maxillary arch dimensions. Intergroup comparisons were made with independent t tests. Results: Greater transverse increases were found during treatment in the group treated with RME. However, during the long-term posttreatment period, no significant difference was observed in the amount of incisor crowding relapse between the groups. Conclusions: RME did not influence long-term maxillary anterior alignment stability. (Am J Orthod Dentofacial Orthop 2010; 137: 164. e1-164.e6)

Cephalometric evaluation in different phases of Jasper jumper therapy

Introduction: The aim of this study was to evaluate the dentoskeletal and soft-tissue effects of Class II malocclusion treatment with the Jasper jumper followed by Class II elastics at the different stages of therapy. Methods: The sample comprised 24 patients of both sexes (11 boys, 13 girls) with an initial age of 12.58 years, treated for a mean period of 2.15 years. Four lateral cephalograms were obtained of each patient in these stages of orthodontic treatment: at pretreatment (T1), after leveling and alignment (T2), after the use of the Jasper jumper appliance and before the use of Class II intermaxillary elastics (T3), and at posttreatment (T4). Thus, 3 treatment phases could be evaluated: leveling and alignment (T1-T2), use of the Jasper jumper (T2-T3), and use of Class II elastics (T3-T4). Dependent analysis of variance (ANOVA) and Tukey tests were used to compare the durations of the 3 treatment phases and for intragroup comparisons of the 4 treatment stages. Results: The alignment phase showed correction of the anteroposterior relationship, protrusion and labial inclination of the maxillary incisors, and reduction of overbite. The Jasper jumper phase demonstrated labial inclination, protrusion and intrusion of the mandibular incisors, mesialization and extrusion of the mandibular molars, reduction of overjet and overbite, molar relationship improvement, and reduction in facial convexity. The Class II elastics phase showed labial inclination of the maxillary incisors; retrusion, uprighting, and extrusion of the mandibular incisors; and overjet and overbite increases. Conclusions: The greatest amount of the Class II malocclusion anteroposterior discrepancy was corrected with the Jasper jumper appliance. Part of the correction was lost during Class II intermaxillary elastics use after use of the Jasper jumper appliance. (Am J Orthod Dentofacial Orthop 2011;140:e77-e84)

Long-term stability of Class II malocclusion treated with 2-and 4-premolar extraction protocols

Introduction: The objective of this study was to cephalometrically compare the stability of complete Class II malocclusion treatment with 2 or 4 premolar extractions after a mean period of 9.35 years. Methods: A sample of 57 records from patients with complete Class II malocclusion was selected and divided into 2 groups. Group 1 consisted of 30 patients with an initial mean age of 12.87 years treated with extraction of 2 maxillary premolars. Group 2 consisted of 27 patients with an initial mean age of 13.72 years treated with extraction of 4 premolars. T tests were used to compare the groups` initial cephalometric characteristics and posttreatment changes. Pearson correlation coefficients were calculated to determine the correlation between treatment and posttreatment dental-relationship changes. Results: During the posttreatment period, both groups had similar behavior, except that group 1 had a statistically greater maxillary forward displacement and a greater increase in the apical-base relationship than group 2. On the other hand, group 2 had a statistically greater molar-relationship relapse toward Class II. There were significant positive correlations between the amounts of treatment and posttreatment dentoalveolar-relationship changes. Conclusions: Treatment of complete Class II malocclusions with 2 maxillary premolar extractions or 4 premolar extractions had similar long-term posttreatment stability. (Am J Orthod Dentofacial Orthop 2009;136:154.e1-154.e10)

Stability and relapse of maxillary anterior crowding treatment in Class I and Class II Division 1 malocclusions

Introduction: The maxillary anterior teeth are the most important to facial esthetics because they are the first to show on a smile. Therefore, stability of the maxillary anterior teeth alignment is an important issue. The objective of this study was to compare the stability of maxillary anterior tooth alignment in Class I and Class II Division 1 malocclusions. Methods: The sample comprised dental casts of 70 patients with Class I and Class II Division 1 malocclusions and a minimum of 3 mm of maxillary anterior crowding measured by an irregularity index. The patients were treated with extractions and evaluated at pretreatment and posttreatment and at least 5 years after treatment. The sample was divided into 3 groups: group 1, Class I malocclusion treated with 4 first premolar extractions comprising 30 subjects, with an initial age of 13.16 years and 8.59 mm of initial maxillary irregularity; group 2, Class II malocclusion treated with 4 first premolar extractions comprising 20 subjects, with an initial age of 12.95 years and 11.10 mm of maxillary irregularity; and group 3, Class II malocclusion treated with 2 first maxillary premolar extractions comprising 20 subjects, with an initial age of 13.09 years and 9.68 mm of maxillary irregularity. Results: The decrease in the maxillary irregularity index was significantly greater in group 2 than in group 1 during treatment. The stability of maxillary anterior alignment was 88.12% over the long term; 77% of the linear displacement of the anatomic contact points tended to return to their original positions. Conclusions: Stability of maxillary anterior alignment between the 3 groups was similar. The stability of maxillary anterior alignment was high over the long term, but a high percentage of teeth tended to return to their original positions. (Am J Orthod Dentofacial Orthop 2011; 139: 768-74)

Comparison of the effects produced by headgear and pendulum appliances followed by fixed orthodontic treatment

This study compared the effects produced by two different molar distalizers, namely cervical headgear (CHG) and the intraoral pendulum appliance, associated with fixed orthodontic appliances. The headgear group comprised 30 patients (19 females, 11 males), with an initial age of 13.07 years [standard deviation (SD) = 1.3], treated with CHG and fixed orthodontic appliances for a mean period of 3.28 years, and the pendulum group 22 patients (15 females, 7 males), with initial age of 13.75 years (SD = 1.86), treated with the pendulum appliance followed by fixed orthodontic appliances for a mean period of 4.12 years. Lateral cephalograms were taken at the start (T1) and on completion (T2) of orthodontic treatment. The pendulum and CHG groups were similar as to initial age, severity of the Class II malocclusion, gender distribution, initial cephalometric characteristics, and initial and final treatment priority index (TPI). Only treatment time was not similar between the groups, with a need for annualization for data for the pendulum group. The data were compared with independent t-tests. There was significantly greater restriction of maxillary forward growth and improvement of the skeletal maxillomandibular relationship in the CHG group (P < 0.05). The maxillary molars were more mesially tipped and extruded and the mandibular molars more uprighted in the CHG group compared with the pendulum group (P < 0.05). There was more labial tipping of the mandibular incisors and greater overbite reduction in the pendulum group. The pendulum appliance produced only dentoalveolar effects, different from the CHG appliance, which restricted maxillary forward displacement, thus improving the skeletal maxillomandibular relationship.

Evaluation of anterior open-bite treatment with occlusal adjustment

Introduction: The purpose of this study was to evaluate the cephalometric and occlusal changes, the functional occlusion, and the dentinal sensitivity of anterior open-bite treatment with occlusal adjustment. Methods: The sample comprised 20 patients who experienced relapse of the anterior open bite (mean, -1.06 mm). Occlusal adjustment was performed until a positive overbite was established. Cephalometric changes were evaluated on lateral cephalograms taken before and after the occlusal adjustment. The functional occlusion analysis consisted of evaluating immediate anterior and canine guidance and the number of teeth in contact before and after the procedure. Dentinal sensitivity was evaluated before, shortly after, and 4.61 months after the occlusal adjustment. Pretreatment and posttreatment cephalometric changes and the number of teeth in contact were compared with dependent t tests. Percentages of anterior and canine guidance before and after the adjustment procedure were compared with the McNemar test. To compare dentinal sensitivity at several stages, the nonparametric Friedman test was used, followed by the Wilcoxon test. Results: Significant increases in overbite and mandibular protrusion were seen, as were significant decreases in apical base discrepancy, facial convexity, and growth pattern angles. The percentages of immediate anterior and canine guidance increased significantly, as did the number of teeth with occlusal contacts. Dentinal sensitivity increased immediately after the adjustment but decreased to normal levels after 4.61 months. Conclusions: Occlusal adjustment is a viable treatment alternative for some open-bite patients; it establishes positive vertical overbite and improves the functional occlusion with only transient dentinal sensitivity.

Influence of root parallelism on the stability of extraction-site closures

Introduction: In premolar extraction cases, root parallelism is recommended to preserve the stability of space closures. The influence of the degree of root parallelism on relapse of tooth extraction spaces has been a controversial topic in the literature. The aim of this study was to compare the angle between the long axes of the canine and the second premolarin patients with and without stability of extraction-space closures. Methods: A sample of 56 patients, treated with 4 premolar extractions, was divided into 2 groups: group 1, consisting of 25 patients with reopening of extraction spaces; and group 2, consisting of 31 patients without reopening of extraction spaces. Panoramic radiographs of each patient were analyzed at the posttreatment and 1-year posttreatment stages. The data were statistically analyzed by using chi-square tests, t tests, analysis of variance (ANOVA), and Pearson correlation coefficients. Results: The results showed that the groups did not differ regarding the angle between the canine and the second premolar, and there was no correlation between angular changes and reopening of extraction spaces, showing that dental angular changes are not determining factors for relapse, and other factors should be investigated. Conclusions: The final angle and the posttreatment changes observed in the angle between the long axes of the canine and the second premolar showed no influence on the relapse of extraction spaces. (Am J Orthod Dentofacial Orthop 2011; 139: e505-e510)

Effects of accentuated and reversed curve of Spee on apical root resorption

Introduction: In this study, we evaluated the influence of intrusion mechanics with accentuated and reversed curve of Spee on root resorption of the maxillary and mandibular incisors. Methods: A sample of 60 patients with Class I and Class II Division 1 malocclusions having nonextraction treatment was divided into 2 groups with the following characteristics: group 1 comprised 30 deepbite patients, treated with accentuated and reversed curve of Spee intrusion mechanics, with an initial mean age of 12.8 +/- 1.23 years (range, 10.01-15.32 years), and group 2 comprised 30 patients with normal overbite treated without intrusion mechanics, with an initial mean age of 12.87 +/- 1.43 years ( range, 10.02-15.36 years). Pretreatment and posttreatment periapical radiographs were used to evaluate root resorption. The groups were compared by using the Mann-Whitney U test. Correlation between root resorption and tooth movement was investigated with the Spearman correlation coefficient. Results: The deepbite group treated with accentuated and reversed curve of Spee had statistically greater root resorption ( 1.87) than the normal overbite group ( 1.54), at P=.017. Changes in overbite and vertical displacements of the maxillary central incisor apices had significant correlations to root resorption ( r = 0.30, P =.019; r = 0.27, P =.037, respectively). Conclusions: Accentuating and reversing the curve of Spee in the archwires to correct deep overbite causes more root resorption than nonintrusive mechanics.