Prophylaxis of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Using Temporary Pancreatic Stents Versus Rectal Nonsteroidal Anti-inflammatory Drugs: A Randomized Controlled Trial

OBJECTIVES

Both pancreatic stenting and rectal nonsteroidal anti-inflammatory drugs (NSAIDs) prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of the study was to compare post-ERCP pancreatitis (PEP) prophylaxis using pancreatic stents and/or rectal NSAIDs prospectively.

METHODS

A total of 321 patients undergoing ERCP were studied. Each patient was randomly allocated to receive pancreatic stent placement (PS), 50 mg of rectal diclofenac (NSAID), or both (PS + NSAID) for PEP prophylaxis. The primary outcome was the occurrence rate of PEP, and secondary outcomes included the severity of PEP and serum pancreatic amylase and lipase levels on the day after ERCP.

RESULTS

Five patients (PS: 2/101, NSAID: 1/106, PS + NSAID: 2/102) developed PEP, and the overall occurrence rate of PEP was 1.6% (5/309). The occurrence rates of PEP in the PS, NSAID, and PS + NSAID groups were statistically equivalent with an equivalent margin of 10%. The severity of PEP was mild in all 5 patients. Median serum pancreatic amylase and lipase levels in the NSAID group were significantly lower than those in the PS and PS + NSAID groups.

CONCLUSIONS

Rectal administration of 50 mg of diclofenac may become a first-line therapy for PEP prophylaxis in our country.

Efficacy of Upper Gastrointestinal Endoscopic Examination to Identify Patients with Obstructive Sleep Apnea Syndrome: A Retrospective Cross-Sectional Study

BACKGROUND/AIMS

Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS.

METHODS

After endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated.

RESULTS

Of 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65-10.2, p < 0.001), body mass index ≥25 kg/m2 (OR 4.98; 95% CI 2.23-11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34-18.2, p < 0.001) were significant independent predictors of severe OSAS.

CONCLUSION

A conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS.

[Undifferentiated carcinoma of the jejunum producing granulocyte colony-stimulating factor]

An 80-year-old man presented with abdominal fullness and vomiting. Laboratory data revealed severe anemia, an inflammatory response, and elevated white blood cell counts. Abdominal computed tomography indicated ileus caused by a jejunal tumor measuring 8cm in diameter. Although small-bowel endoscopy enabled visualization of the tumor, adequate biopsy specimens could not be obtained for accurate diagnosis. The patient's condition rapidly deteriorated, because of which surgical treatment could not be initiated. The patient died approximately 3 weeks after admission. High serum granulocyte colony-stimulating factor (G-CSF) levels were detected at autopsy. Immunohistochemical staining of the autopsy specimen indicated positive G-CSF levels in the jejunal tumor. On the basis of these findings, a final diagnosis of undifferentiated carcinoma of the jejunum producing G-CSF was made.

Reproducibility of a method for analysis of morphological changes in perioral soft tissue in children using video cameras

The purpose of the present study was to determine the appropriate reference facial expression and to examine the reproducibility of our system using two commercially available video cameras in consideration of functional diagnosis of perioral muscles. The following items were investigated: 1) influence of forward and backward movements and the experiment sequence from measurement to analysis, 2) usefulness of head fixation by a restraining device during video recording for evaluation of morphological changes in facial expression, 3) conditions for establishment of reference points for determination of movements of perioral soft tissue, and 4) reproducibility of perioral soft tissue movements as assessed by changes in landmarks. The results of this study showed that accurate static and dynamic evaluation of perioral soft tissue is possible by using our method of video recording with the subject's head restrained and our method of analysis. The results also showed that centric occlusion of the most appropriate reference facial expression as for measurement of perioral soft tissue movements and that protrusion of the lips and lateral extension of the angel of the mouth are facial expressions with high degrees of reproducibility.

Autistic children: experience and severity of dental caries between 1980 and 1995 in Kagoshima City, Japan

The present study indicates that experience and severity of dental caries in 1995 showed a clear decrease from observations in 1980 in Kaogsima City, Japan. This decline may be attributed to several factors such as the qualitative and quantitative improvements in treatment of caries, more regular visits to dental clinics, improved daily oral hygiene, and changes in dietary pattern.

Effect on electroencephalogram of chewing flavored gum

The objective of the present study was to evaluate the effect on the electroencephalogram (EEG) of a chewing gum with and without our prepared new flavor. Electroencephalograms were obtained after the following three tests: chewing pure gumbase with sucrose (standard gumbase), chewing flavored standard gum and the inhalation of flavored aromatic oil. As the control, we used the pre-stimulus control EEG record without a stimulus. We examined the relationship between the pre-stimulus control record and the post-stimulus record using the changes of power in four bands. Chewing the standard gumbase led to an increase in the alpha wave and a decrease in the beta wave. Chewing the flavored standard gum and inhaling the flavored aromatic oil each increased the alpha and beta waves. In addition, chewing the flavored standard gum led to a change in the ratio of theta wave in the frontal area. The difference in the theta, alpha and beta bands in chewing gum with and without the added flavor suggested that the flavor as well as chewing could induce concentration with a harmonious high arousal state in brain function.

The relationship between gingivitis and colonization by Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans in children

BACKGROUND

Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans are closely associated with the onset and severity of adult periodontal disease. However, little is known regarding the colonization by, and host antibody response to, these microorganisms in children.

METHODS

Plaque and sera were obtained from 40 healthy children, 2 to 18 years old. Gingival health was assessed by the periodontal disease index (PDI), papillary bleeding score (BS) and the modified total papillary margin attachment index (M-PMA). P. gingivalis and A. actinomycetemcomitans in plaque samples were detected by slot immunoblotting (SIB). Serum antibody levels against these microorganisms were evaluated using ELISA.

RESULTS

More than 60% of the children had detectable levels of P. gingivalis in their plaque. Those having detectable levels had more gingival inflammation than those having none; however, these differences were significant only in children over the age of 12 years (PDI, BS). In contrast, while 75% of the children had detectable A. actinomycetemcomitans, there were significant differences in gingival inflammation associated with colonization in children from 3 to 7 years of age (PDI) and over 12 years of age (M-PMA). Serum antibody levels to P. gingivalis were inversely correlated with gingival inflammation in all age groups, while A. actinomycetemcomitans titers were positively correlated with gingival inflammation only in the children over 12 years. No significant relationship between the presence of either A. actinomycetemcomitans or P. gingivalis and antibodies to them was found.

CONCLUSIONS

Our findings show that P. gingivalis and A. actinomycetemcomitans are readily detected as early as 3 years of age and that their presence is associated with the onset and severity of gingivitis.

Effects of three principal constituents in chewing gum on electroencephalographic activity

The effects of three principal constituents (sugar, spearmint, and gumbase) in chewing gum on EEG findings in 20 normal subjects were investigated. After they chewed the gumbase, theta activity decreased significantly at Fp2, O1, T3, T4, F4, P3, and Pz; alpha activity increased significantly at O1 and decreased significantly at Fpl, and beta activity increased significantly at Fpl, Fp2, O1, T3, T4, P3 and Pz. After they inhaled the spearmint, alpha activity decreased significantly at 02, F3, P4, and Fz, and beta increased significantly at 02, F3, P4, and Fz. The mean frequency of the alpha band was significantly higher than after 1 min at rest without inhalation. After the subjects chewed the gumbase with sucrose, theta activity increased at Fp2 and Fz; alpha activity increased significantly at T3; and beta activity decreased significantly at Fpl, Fp2, F4, P3, P4, Fz, and Pz. The mean frequency of the alpha band was significantly lower than after 1 min at rest without it at almost all the positions. These results suggest that the gumbase with sucrose induced relaxed concentration effects while inhalation of spearmint induced arousal effects. The chewing of gumbase showed arousal tendency.

Spectral analysis of changes in electroencephalographic activity after the chewing of gum

The present study aimed to examine the psychosomatic effect in the chewing of marketed gum using electroencephalogram (EEG) as an index. The EEG were taken in two sets: (i) a resting period before chewing (control recording) and a resting record (post-resting recording) for examining reproducibility; and (ii) a control recording and resting period after gum-chewing for 3 min (post-chewing recording). The ratio of each frequency band to the total frequency power, the mean frequency of the alpha band and laterality of the frequency power was calculated. In the examination of the reproducibility, no statistically significant differences were observed between control recording and post-resting recording in all indices. In the reflection of EEG after gum-chewing, there were no significant differences between control recording and the post-chewing recording. However, a significant interaction was observed among these indices by analysis of variance. In addition, the alpha power in the post-chewing recording was significantly higher than that in the control recording at almost all the positions. In conclusion, the intra-individual reproducibility of EEG was confirmed in the recording method. Furthermore, it was suggested that a significant interaction and a rising trend of the mean frequency of the alpha band after gum-chewing reflected 'arousal' psychosomatic responses by the chewing of marketed gum.

Examination of the diagnostic value and estimation of the chaos phenomenon in masticatory movement using fractal dimension in patients with temporomandibular dysfunction syndrome

The aim of this study was to estimate the chaos phenomenon (chaos) in masticatory movements using the fractal dimension (FD), and to examine the diagnostic value of the fractal dimension in comparing stomatognathic functional disturbances with normal stomatognathic function. The subjects were all high school students and included nine subjects presenting with acceptable normal occlusion, 18 subjects with TMJ dysfunction syndrome and seven subjects with tooth crowding. Masticatory movements were obtained during free, right side, and left side gum-chewing and were used to calculate the capacity dimension in the FD. Chaos in the masticatory movement was estimated by the FD saturated with some constant value to an increase of embedding dimension (approached a plateau). In the crowding group, the FD was also significantly high on the sagittal plane in comparison with the normal. In the patients with pain, the FD on the sagittal plane was significantly high. In the patients with pain and closed lock, the FD on the frontal plane was significantly high. However, in the patients with pain and with reduction of anterior disc displacement, the FD was significantly low on the horizontal plane. These findings suggest that chaos is present in masticatory movements and the difference in the FD are of diagnostic value in evaluation of the relationship between FD and stomatognathic functional disturbance.

The relationship between gingivitis and the serum antibodies to the microbiota associated with periodontal disease in children with Down's syndrome

Gingival inflammation in Down's syndrome children (DS) develops earlier and is more rapid and extensive than in non-DS children. Abnormalities in host response to the oral flora have been proposed as etiological factors of this gingival inflammation. However, the relationship between gingivitis and the host response to oral microorganisms in DS by age has not been determined. The objective of this study was to clarify this relationship. Sera were obtained from 75 DS subjects (aged 2 to 18 years) and their gingival health assessed using a modified PMA Index (M-PMA). Antibody titers to Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Treponema denticola (Td), Fusobacterium nucleatum (Fn), Selenomonas sputigena (Sel), Actinobacillus actinomycetemcomitans (Aa), and Streptococcus mitis (Mi) were determined using the micro-ELISA. DS subjects under 4 years old were found to have significantly more gingival inflammation than did normal children the same age. A significant positive correlation (r = 0.548, P < 0.0001) existed in the relationship between M-PMA score and plaque score for subjects in the G1 age group (deciduous dentition). At G1, the average antibody titers to Aa, Mi, and Fn exceeded those of the normal adult reference serum pool. In addition, IgG antibody titers to Pg, Aa, Fn, Sel, and Mi correlated significantly with the M-PMA scores in the G1 age group. There was a correlation between age (2 to 18 years) and these antibody titers. IgG antibody titers to Pg, Aa, Sel, and Mi increased significantly with increasing M-PMA score. Furthermore, the IgG antibody titers to Pg were higher (P < 0.05) in the most extensive disease group compared to the DS no-disease group. The IgG antibody titers to Pg at G3 (early puberty) were significantly higher when compared to G1 (preschool children). The IgM antibody titers to Aa at G3 were higher (P < 0.05) when compared to G1. This study suggests that colonization by Aa and Fn are closely associated with the onset of gingival inflammation in DS patients under 5 years old. Colonization by Pg, Aa, Sel, and Mi in DS appears to be associated with gingivitis at puberty.

The relationship between dental caries in the primary dentition and anti S. mutans serum antibodies in children with Down's syndrome

The purpose of this study was to evaluate the status of dental caries in seventy-five subjects with Down's Syndrome, ages two to eighteen years and to evaluate the relationship between dental plaque or caries experience and serum antibody titers against S. mutans and S. mitis. These antibodies were examined since an enhanced host response to S. mutans might be responsible for the low caries prevalence in Down's Syndrome. Antibody titers were determined using the enzyme-linked immunosorbant assay (ELISA) and titers were expressed in ELISA units. The frequency of all subjects who were caries-free was 46.1%, while 61.4% of the subjects under five years were caries-free. The average DMFT score in the subjects of Hellman Dental Age group I (primary dentition) was 15.9. The highest frequency of caries occurred on occlusal surfaces, followed by proximal surfaces of the upper incisors and smooth surfaces on incisors. The severity of dental caries in the subjects with Down's Syndrome was bipolar and could be categorized as either mild or severe. In the subjects having a primary dentition, a significant positive correlation was found in the relationship between the Original Caries Severity Score (OCSS) and the plaque score. There was also a significant positive correlation between OCSS and IgM antibody titer to S. mutans. In contrast, no correlation between antibody titers to S. mitis and these variables was found. It is not clear if these antibodies are protective and responsible for the reduced caries rate seen in Down's Syndrome.

Masticatory function in normal and crowded occlusion using Hellman's dental stages

As a consequence of this study, the following conclusions were obtained by means of an estimate of the interocclusal point number of the integrated value of the electromyographs, of the masticatory rhythm with 40 subjects in each group (the normal groups: IIA 10. IIIA 10, IIIC 10, IVA 10; the crowding groups: IIA 10, IIIA 10, III C 10, IVA 10). 1. From the view of the integrated value of the electromyographs. In the normal groups with a normal occlusion. TA% to the total active potentials turned out to be less in proportion to the advancement of the dental stages, while TP% remained as the same. M% should an increase, whose ratio turned out to be high enough to take TA's place. 2. In the crowding groups, in spite of the indication of TA's decrease, M's increase, a comparison with the normal groups' that even after the stage IIIC TA-M-type masticatory pattern had to be maintained. 3. Regarding the interocclusal point number, in IIIC, IVA, the total amount and number at the molar segments indicated a significantly smaller value in the crowding groups. 4. Concerned with the integrated value of the masticatory muscle, the most related factor to yield the characteristic masticatory pattern observed in the crowding groups could be considered the number of the interocclusal points, which proved that great importance should be paid to the maintenance of the well harmonized status of the upper and lower occlusion.

Two year longitudinal study of the fluctuation of clinical signs of TMJ dysfunction in Japanese adolescents

Signs of TMJ dysfunction syndrome were monitored longitudinally from the age of 12 to 14 years in 160 junior high students and 15 to 17 years in 480 senior high school students. Thirty-one percent of the junior high school students and 39.6% of the senior high school students presented with one or multiple signs of TMJ dysfunction syndrome at least once during the examination period. The percentage of subjects presenting continuously with one or multiple signs at all examinations was 8.9% among junior high school students and 12.9% among senior high school students. The predominant sign in the subjects, who continuously presented with one or multiple signs of TMJ dysfunction syndrome was TMJ sounds. The number of subjects presenting with TMJ clinical signs for the first time at the third examination (third year student) was high compared to the other examinations. When intra-individual longitudinal results were examined in subjects, who at least once during the examination period presented with one or multiple signs of TMJ dysfunction syndrome was found to be high (75.0% among junior high school students and 86.5% among senior high school students). In the subjects presenting with one or multiple signs of TMJ dysfunction syndrome continuously over the two year period, the percentage of subjects, who at least once presented with multiple signs was 90.9% among junior high school students and 22.0% among senior high school students.

Humoral immune response to selected subgingival plaque microorganisms in insulin-dependent diabetic children

Juvenile diabetics have been shown to have an increased susceptibility to gingivitis and periodontitis following puberty. However, little data are available on changes in the microbial flora that occur at the onset of puberty. This study was performed to determine if antibacterial antibody titers to selected periodontal disease-associated microorganisms might be helpful in revealing changes in plaque flora at the onset and conclusion of puberty. Sera was obtained from 35 subjects (ages 7 to 18 years) selected from a population of insulin-dependent diabetics. The subjects were given a thorough medical examination which included an assessment of sexual maturation and a dental examination which included the recording of onset and magnitude of bleeding according to the papillary bleeding score. Antibody titers to A. naeslundii (AN), B. intermedius (BI), B. gingivalis (BG), F. nucleatum (FN), A. actinomycetemcomitans (AA), C. ochracea (CO) and T. denticola (TD) were determined using the microELISA. Stratification of antibody titers by age groups (less than or equal to 12 years, 12 to 15 years, greater than 15 years) revealed that titers to AN increased significantly (P less than 0.025, ANOVA) and progressively (P less than 0.05, regression analysis) with increasing age. In contrast, the titers to FN were maximal in the under 12 year group and decreased with age (ANOVA, P less than 0.05; regression analysis, P less than 0.05). There were no significant variations in titers observed for the other microorganisms. Stratification by sexual maturity revealed a similar progressive decrease of the titer to FN (ANOVA, P less than 0.05; regression analysis, P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative subjective evaluation and prevalence study of TMJ dysfunction syndrome in Japanese adolescents based on clinical examination

The purpose of this report was to investigate the actual need, as opposed to patient demand, for treatment of TMJ dysfunction syndrome in adolescents. For this investigation, 2198 Japanese schoolchildren, aged 10-18 yr (1095 boys and 1103 girls), were examined by questionnaire. In addition, each subject was given a clinical examination. The results of the subjective evaluations were compared with the frequency of actual occurrence of TMJ dysfunction syndrome. The results were: 1) Subjective recognition of TMJ dysfunction syndrome symptoms involved 253 students (11.5%): 129 boys (11.8%) and 124 girls (8.2%), with no significant difference in number between the sexes, 2) by comparing subjective assessment with clinical examination, the junior high school age was found to be the proper age for the introduction of preventive medical care, because these pupils were able to recognize the symptoms of TMJ dysfunction syndrome as accurately as adults, 3) the results obtained from the questionnaire and the clinical examination showed evidence of higher frequency of accurate recognition on the part of girls.