We investigated the effect of probiotic supplements on oral wound healing, swelling, pain and discomfort after surgical removal of mandibular third molars. A second aim was to evaluate if the intervention could influence the concentrations of oxytocin in saliva. Sixty-four consecutive volunteers (18-34 years) were enrolled to a double-blind randomised placebo-controlled trial with two parallel arms. Following surgery, the patients were asked to take three lozenges per day containing two strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) or placebo for two weeks. The clinical healing and extra-oral swelling were scored two weeks post-operatively. Samples of wound exudate were cultivated for the presence of Staphylococcus aureus and β-haemolytic streptococci. Salivary oxytocin concentrations were analysed from pre- and post-surgery samples using ELISA technique. Compliance and the subjective perception of swelling, pain and discomfort were reported daily through visual analogue scales in a logbook. All patients except three completed the protocol and the postoperative course was uneventful in most cases. Minor extra-oral swellings were noted in five patients, but none required antibiotic treatment. At the 2-week follow-up, there were no significant differences in clinical wound healing index, extra-oral swelling, bacterial growth or salivary oxytocin levels between the groups. The self-reported data unveiled, however, a significantly reduced sense of swelling, in particular during the second week after surgery in the probiotic test group (P<0.05). Likewise, significantly fewer nights with disturbed sleep and fewer days with sick-leave from work were reported among the participants in the test group (P<0.05). No differences were found in the post-operative use of analgesics. In conclusion, we found no significant influence of probiotic supplements on objective wound healing after surgical extraction of impacted mandibular third molars. However, since the patients’ perceived significant post-operative ameliorations, further studies are needed to explore the patient’s value of the intervention.

Guided bone regeneration (GBR) describes the use of membranes to regenerate bony defects. A membrane for GBR needs to be biocompatible, cell-occlusive, non-toxic, and mouldable, and possess space-maintaining properties including stability. The purpose of this pilot study was to describe a new method of GBR using individualized ceramic sheets to perfect bone regeneration prior to implant placement; bone regeneration was assessed using traditional histology and three-dimensional (3D) volumetric changes in the bone and soft tissue. Three patients were included. After full-thickness flap reflection, the individualized ceramic sheets were fixed. The sites were left to heal for 7 months. All patients were evaluated preoperatively and at 7 months postoperative using cone beam computed tomography and 3D optical equipment. Samples of the regenerated bone and soft tissue were collected and analyzed. The bone regenerated in the entire interior volume of all sheets. Bone biopsies revealed newly formed trabecular bone with a lamellar structure. Soft tissue biopsies showed connective tissue with no signs of an inflammatory response. This was considered to be newly formed periosteum. Thus ceramic individualized sheets can be used to regenerate large volumes of bone in both vertical and horizontal directions independent of the bone defect and with good biological acceptance of the material.

Aim: The first aim of this study was to evaluate the healing outcome after periapical surgery performed using an ultrasonic cleaning technique in conjunction with the use of either Intermediate Restorative Material (IRM) or mineral trioxide aggregate (MTA) as a retrograde root-end seal in teeth with apical periodontitis. A second aim was to determine if the type of coronal restoration had any impact on the healing outcome. Methodology: One hundred eighty-six consecutive teeth in 177 patients referred for periapical surgery were randomly allocated into two parallel groups, receiving either IRM or MTA as a retrograde root-end seal. The patients were reviewed 12 months after surgery. Fisher's exact test and Z-test analysis were performed. Results: One hundred sixty-six teeth in 158 patients were reviewed 12 months after surgery. Radiological evaluation and clinical examination revealed an 86% success rate for the IRM group and 85% for the MTA group. There was no statistically significant difference (p=0.829) between the two groups regarding the healing outcome (Fisher's test). The type of coronal restoration (p=0.575) had no impact on the healing outcome (Z-test). Conclusions: The tested materials, IRM and MTA, are both suitable as retrograde root-end filling materials in conjunction with an ultrasonic root-end preparation technique according to the results at the 12-month follow-up. The results of this study also show that the type of coronal restoration had no impact on the healing outcome following periapical surgery.

OBJECTIVES:The presence of a patent foramen ovale (PFO) has been associated with recurrent cryptogenic cerebrovascular event (CVE). The BioSTAR is a partly biodegradeable atrial septal repair implant. We investigated the feasibility and efficacy of the BioSTAR PFO-occluder.DESIGN:From October 2007 to December 2008, 59 consecutive patients underwent PFO closure at our institution with a history of at least one cryptogenic CVE defined by a neurologist. During the study period, all patients, who fulfilled our institutional criteria for PFO closure, were included. No patients were lost to follow-up.RESULTS:Of the 59 patients treated, a BioSTAR device could be implanted in 30 and in 29 patients another device, almost exclusively an Amplatzer, had to be used. No serious complications were observed during implantation of either. Four of 30 patients suffered a recurrent CVE after BioSTAR implantation as compared to 2/29 in the comparison group. At long-term follow-up 29/30 patients in the BioSTAR group had complete closure of their PFO as compared to 23 of 29 in the comparison group.CONCLUSIONS:The BioSTAR device could be selected for use in small shunts less than 10 mm while the Amplatzer may be chosen for larger defects or more complicated anatomy.

Aims: The aim of this study was to investigate the influence of diabetes on treatment and outcome in acute myocardial infarction (AMI), during two time periods, in two countries, and to assess whether this influence has changed over the past decades.Methods: Patients, aged 30 to 74, with a diagnosis of AMI in two urban areas-Goteborg, Sweden and Minneapolis-St. Paul, Minnesota, USA-hospitalized during 1990-1991 and 1995-1996 were included. The primary endpoint was 7-year all-cause mortality.Results: The study included 3824 patients, 734 (19%) had diabetes. Age-adjusted in-hospital mortality of diabetic patients was nearly twofold higher compared with non-diabetic patients (9.8% vs. 5.0%, p<0.05). Between 1990-1991 and 1995-1996 in-hospital mortality declined for both diabetic (11.9% vs. 7.6%, p=0.07) and non-diabetic (6.3% vs. 3.6%, p=0.002) patients. A history of diabetes was associated with nearly twofold higher long-term mortality rate (48.5% vs. 26%, p<0.05). Seven-year mortality was reduced between 1990-1991 and 19951996 in both diabetic (51.6% vs. 45.2%, p=0.13) and non-diabetic patients (29.3% vs. 22.1%, p<0.0001) (The results did not reach statistical significance for diabetic patients, due to smaller sample size.) During their hospital stay, diabetic patients received significantly less aspirin, beta-blockers and thrombolysis. After adjustment, a history of diabetes remained significantly associated with 7-year mortality following AMI, doubling the hazard of death (hazard ratio (HR)= 2.11; 95% confidence interval (CI): 1.80-2.46).Conclusion: A history of diabetes is associated with nearly twofold higher long-term mortality rate and is independently associated with 7-year mortality following AMI. Short-and long-term mortality decreased from 1990 to 1995 in both non-diabetic and diabetic patients. Underutilization of evidence-based treatments contributes to the remaining increased mortality in diabetic patients with acute coronary disease. (C) 2006 Elsevier Ireland Ltd. All rights reserved.

AIMS The study evaluated the associations between glycometabolic parameters at admission and during hospitalization and 2 year all-cause mortality risk in an unselected cohort of consecutive patients with diabetes admitted for unstable angina or non-Q-wave myocardial infarction to a university hospital during 1988-98. METHODS AND RESULTS A total of 713 consecutive patients with diabetes were included. During 2 years of follow-up, 242 (34%) patients died. All analyses were retrospective using prospectively collected clinical data. The primary study endpoint was 2 year all-cause mortality collected from the Swedish cause-specific mortality register. In unadjusted analyses, high admission blood glucose (highest vs. lowest quartile: hazard ratio (HR) 2.66; 95% confidence interval (CI) 1.83, 3.86) and hypoglycaemia recorded during hospitalization (hypoglycaemia vs. normal: HR 1.77; 95% CI 1.09, 2.86) were both significantly associated with increased 2 year all-cause mortality risk. These associations remained significant after multivariable adjustment. CONCLUSION In the setting of acute coronary syndromes (ACS) among patients with diabetes, hyperglycaemia on arrival and hypoglycaemia during hospitalization are both independently associated with worse adjusted all-cause 2 year mortality risk. These observations suggest that the avoidance of both hyper- and hypoglycaemia during ACS events may be of similar importance, and glucose modulation remains an important objective to address in future randomized trials.

Objective: To examine the long term prognostic characteristics of troponin T testing and continuous multilead ST segment monitoring in combination with clinical and 12 lead ECG risk indicators in patients with acute coronary syndromes (ACS).Patients and design: Patients with suspected ACS (n = 213) were studied. Troponin T was analysed in blood samples collected during the first 12 hours after admission. Continuous vectorcardiography ST segment monitoring was performed for 24 hours and the number of ST vector magnitude episodes was registered. Patients were followed up for a median of 28 months. The end point was a composite of cardiac death and acute myocardial infarction.Results: Thirty eight (18%) patients reached the composite end point. The median ( interquartile range) time from study inclusion to the time of the composite end point was longer for patients predicted to be at risk by troponin T testing ( n = 27) than for those predicted to be at risk by ST segment monitoring ( n = 20) (8.4 (0.2 - 15) months v 0.3 ( 0.1 - 4.3) months, p = 0.04). Significant univariate predictors of the composite end point were age greater than or equal to 65 years, diabetes, previous myocardial infarction, congestive heart failure, use of beta blockers or diuretics at admission, 12 lead ECG ST segment depression at admission, troponin T concentration greater than or equal to 0.10 mug/l, and greater than or equal to 1 ST vector magnitude episodes. Age greater than or equal to 65 years, previous myocardial infarction, and troponin T concentration greater than or equal to 0.10 mug/l provided independent prognostic information after multivariate analysis of potential risk variables. The prognostic value of transient ischaemic episodes in ACS seems to be confined to the short term.Conclusions: Both biochemical and continuous ECG markers reflect an increased risk for patients with ACS; however, the methods exhibit different temporal risk characteristics.

Objective-The aims of this study were to investigate the prognostic influence of diabetes after an episode of unstable angina pectoris or non-Q-wave myocardial infarction (MI) and to investigate whether diabetes is independently associated with increased short- and long-term mortality risk following these episodes.Design-Consecutive patients with a diagnosis of unstable angina pectoris or non-Q-wave MI, admitted to the Coronary Care Unit at Ostra Hospital, Goteborg, Sweden during 1988-1998 were included. The primary endpoint was 2-year mortality collected from the Swedish cause-specific mortality register.Results-The study included 4341 patients, 722 (17%) had diabetes. Diabetes was associated with increased mortality during initial hospitalization (10.2% vs 5.7%, p < 0.0001), after 30 days (13% vs 7.5%, p < 0.0001), and at 2 years (33.7% vs 20.2%, p < 0.0001). After adjustment for potentially confounding factors, diabetes remained an independent predictor of 2-year mortality following unstable coronary syndromes, the hazard ratio (HR) of death (HR = 1.6; 95% CI 1.4-1.9).Conclusions-Among patients with unstable coronary syndromes, diabetes is an independent risk factor associated with increased mortality during hospitalization, short- and long-term follow-up.

AIMS:Prolongation of anticoagulant treatment might reduce subsequent cardiac events in patients with unstable coronary artery disease. Multilead ST-segment monitoring identifies patients with a high risk of adverse outcome. The aim was to assess the value of multilead ST-monitoring in prospectively identifying patients who respond to extended anticoagulant treatment with low-molecular weight heparin when treated by a primarily non-invasive strategy.METHODS AND RESULTS:In this substudy of the FRISC II trial, ST-monitoring with a continuous 12-lead ECG or vectorcardiography was performed for 24 h in 629 patients with unstable coronary artery disease randomized to receive either the low-molecular weight heparin dalteparin, or placebo for 3 months after at least 5 days' dalteparin treatment in all patients. Ischaemic episodes were detected in 34% during ST-monitoring. In the group with ischaemic episodes, the extended dalteparin treatment was associated with a lower rate of death, myocardial infarction, or revascularization (35.2% vs 53.4%, relative risk reduction: 34%, P=0.01). In patients without ischaemic episodes, long-term dalteparin treatment had no effect.CONCLUSIONS:In patients with unstable coronary artery disease treated primarily with a non-invasive strategy, ischaemic episodes revealed while on multilead ST-monitoring identifies patients who benefit most from extended treatment with anticoagulants.

Background Continuous vectorcardiography (cVCG) and continuous 12-lead electrocardiography (c12ECG) are important tools for assessing patients with unstable coronary artery disease.Objective To compare the incidences of ischemia detected by the two methods, and examine whether the patients identified belonged to the same population, with respect to various clinical variables.Methods Within a randomized prospective trial (FRISC II) including patients with unstable coronary artery disease, ST-segment monitoring was performed either by cVCG or by cl 2ECG for 24 h after admission for 1016 patients,Results cVCG and c12ECG were performed for 730 and 286 patients, respectively. Transient ischemic episodes in 253 (34.7%) patients were detected by cVCG and such episodes were detected in 91 (31.8%) patients by c12ECG. When patients in whom transient ischemic episodes had been detected by cVCG and cl 2ECG were compared, the groups were similar with respect to baseline characteristics, signs of myocardial damage (67.5 versus 70.5%), occurrence of exercise-induced ischemia (59.0 versus 60.0%), and presence of severe coronary lesions (57.0 versus 51.3%).Conclusions Results of this study suggest that these two methods identify the same high-risk population, and that these patients can be considered one group when results obtained using either system are analyzed in multicenter studies. This also implies that results concerning the occurrence of episodes of resting ischemia obtained using one system may also be applicable for the other. Coron Artery Dis 12:187-195 (C) 2001 Lippincott Williams & Wilkins.

A total of 323 patients who took part in the TRIM trial underwent an initial 24 h continuous electrocardiogram ST-segment monitoring. A ST vector magnitude (ST-VM) maximum > or = 144 microV predicted death or myocardial infarction within 1 year with a 78% specificity and a 52% sensitivity, an area under the ST-VM trend curve > or = 162 mu with a 86% specificity and a 42% sensitivity and presence of ST-VM episodes with a 70% specificity and a 68% sensitivity. Patients who had neither ST-VM episodes nor a ST-maximum > or = 144 microV had only a 4.5% incidence of death or myocardial infarction within one year as compared to 18% among those patients who met any of these criteria. ST-segment monitoring with continuous vectorcardiography is feasible for risk stratification at least up to 1 year after an episode of unstable coronary artery disease and several vectorcardiographic parameters may be used.