Reply to the letter regarding NADPH oxidase inhibitor

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Practical guide for the management of systemic toxicity caused by local anesthetics

Abstract

Systemic toxicity from local anesthetics can occur in any of the wide range of situations in which these agents are used. This practical guide is created to generate a shared awareness of the prevention, diagnosis, and treatment of local anesthetic systemic toxicity among all medical professionals who perform nerve blocks. Systemic toxicity of local anesthetic is induced by an increase of its protein-unbound plasma concentration. Initial symptoms are characterized by central nervous system signs such as excitation, convulsions, followed by loss of consciousness and respiratory arrest. These symptoms are often accompanied with cardiovascular signs such as hypertension, tachycardia and premature ventricular contractions. Further increase of plasma concentration of local anesthetic induces bradycardia, conduction disturbances, circulatory collapse and asystole. The incidence of local anesthetic systemic toxicity is 1–11 cases per 10,000. Infants, patients with decreased liver function and low cardiac output are vulnerable to systemic toxicity. When performing regional anesthesia, the guideline-directed monitoring, securing a venous line, preparation of medication to treat convulsions and lipid emulsions are required. For prevention of local anesthetic systemic toxicity, small-dose, divided administration, using agents with low toxicity such as ropivacaine and levobupivacaine, performing an aspiration test are recommended. If systemic toxicity is suspected, halt administration of local anesthetic, request assistance, secure venous line, airway, administration of 100% oxygen and if necessary tracheal intubation and artificial respiration should be immediately performed. Benzodiazepines are recommended to treat convulsions. Administration of 20% lipid emulsion according to the protocol is recommended to treat severe hypotension and arrhythmia.

https://ift.tt/2PjDxAB

Recovery Pattern following Bimaxillary Orthognathic Surgery: Differences between Sexes

The investigators hypothesized there would be differences between the sexes in recovery pattern following bimaxillary orthognathic surgery as measured by patient responses at 5 weeks postprocedure. A total of 378 participants underwent bimaxillary orthognathic surgery with or without adjunctive procedures. Participants received questionnaires 5 weeks postsurgery when they visited the outpatient clinic. The questionnaires include variances in surgical factors by sex, and postoperative symptoms which were most difficult to tolerate experiences by sex, respectively.

https://ift.tt/2FoYW6C

Inhibition of dentin matrix‐bound cysteine cathepsins by potassium fluoride

Matrix metalloproteinases (MMPs) and cysteine cathepsins (CCs) can break down unprotected type I collagen fibrils in dentin matrix. This study investigated the use of potassium fluoride (KF) as a potential inhibitor of MMPs and CCs in dentin. Demineralized dentin beams were divided into groups (n = 10 in each group) and incubated in artificial saliva (AS, control), either alone or with one of seven concentrations of KF (6–238 mM fluoride) for 1, 7, and 21 d. After 21 d, all groups were further aged in AS for 6 months. Total MMP activity was screened using the colorimetric MMP assay. The activities of MMP‐2 and MMP‐9 were investigated using gelatin zymography. At the end of each incubation, changes in loss of dry mass and CC‐mediated or total dissolution of collagen peptides were measured via precision weighing, C‐terminal crosslinked telopeptide of type I collagen (CTX), and hydroxyproline (HYP) assays. The beams were examined using scanning electron microscopy. After 21 d, total MMP activities, dry mass loss, and CTX release for the groups exposed to 179 and 238 mM fluoride were significantly lower compared with the control group. After 6 months, all groups showed similar total MMP activity, dry mass loss, and HYP release, and CTX levels were significantly lower when the fluoride concentration was ≥24 mM. Calcium fluoride (CaF₂)‐like precipitates were observed over the beams. In summary, KF significantly inhibited the catalytic activity of dentin matrix‐bound CCs but did not seem to be effective for MMP‐mediated activity.

https://ift.tt/2Fg7yg5

High‐risk symptoms do not predict gastric cancer precursors

Abstract

Background & Study Aims

Gastric intestinal metaplasia (GIM) is the most common precursor of gastric cancer. Our aim is to determine if presenting symptoms predict gastric cancer precursor lesions in a high‐risk population.

Patient and Methods

Consecutive unique patients evaluated by endoscopy for upper gastrointestinal symptoms at the Los Angeles County Hospital between 2010 and 2014 were evaluated. Presenting symptoms were classified as low‐ or high‐risk depending on the procedure indication as coded using the Clinical Outcomes Research Initiative (CORI) system. Endoscopy and histology results were used to classify findings as benign, GIM, high‐risk GIM, or malignant. The primary outcome was the proportion of patients with premalignant or malignant gastric findings who had high‐risk clinical indications for endoscopy relative to those with benign results.

Results

A total of 3699 patients underwent endoscopy to evaluate upper gastrointestinal symptoms. There were 373 (10.1%) patients with GIM of which 278 had high‐risk GIM. One hundred and sixty (4.3%) patients were diagnosed with gastric cancer. High‐risk indications for upper endoscopy predicted gastric cancer (OR 1.8 [95% CI 1.3‐2.6]) but not GIM (OR 1.0 [0.8‐1.3]) or high‐risk GIM (OR 0.9 [0.7‐1.2]). Hispanic or Asian patients and patients >50 years old were more likely to have GIM, high‐risk GIM, and cancer.

Conclusions

Performance of upper endoscopy for high‐risk indications is inadequate to detect GIM and marginal for malignancy. At risk patients should undergo upper endoscopy for both low‐ and high‐risk symptoms. Screening certain populations deserve additional study and may, in fact, be cost‐effective.

https://ift.tt/2AZcLEW

Extragastric diseases correlated with Helicobacter pylori

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Is injury to the inferior alveolar nerve still common during orthognathic surgery? Manual twist technique for sagittal split ramus osteotomy

The osteotomy in a bilateral sagittal split ramus osteotomy (BSSRO) is made in close proximity to the inferior alveolar nerve (IAN), so direct damage to the nerve and irreversible neurosensory deficit may result. The aim of this study was to compare the incidence of injury to the nerve when a conventional osteotomy using an osteotome was made, with that after manual twist splitting. We retrospectively reviewed the casenotes of 769 consecutive patients who had bilateral SSRO either alone or with a simultaneous maxillary procedure by a single surgeon from May 2009 − October 2016.

https://ift.tt/2FgrIGz