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Biomedical subjects

R J Berkowitz

Publications and source records attributed to R J Berkowitz.

At least 19 recordsLinked to original sources
PubMed2004

Clinical outcomes for Early Childhood Caries (ECC): the influence of health locus of control.

AIM: To assess the relationship between clinical outcomes for children treated for ECC and health locus of control. STUDY DESIGN AND METHODS: The study cohort consisted of 79 children (42 males, 37 females) treated for ECC; age range was 2.3-7.3 years (mean 4.2 years) at the time of entry into the study. A questionnaire [developed by DeVellis et al., 1993] was administered to each child's parent(s) on the day of dental surgery. This questionnaire examined the expectation that healthcare outcomes in children are influenced by one of the following loci of control: Professional, Parent, Child, Media, Fate and Divine. The cohort was evaluated for new caries lesions at 6 months post dental surgery. Relapse was defined as the presence of new smooth surface caries lesions. STATISTICS: For each locus, the scores for the Relapse versus Non-relapse groups (returning patients) and the scores for the returning versus non-returning patients were compared using t-tests. RESULTS: 57 children (72%) returned for follow-up and 21 of these 57 (37%) relapsed. No statistically significant difference for Relapse versus Non-relapse groups was indicated with respect to the scores for any locus parameter (p values ranged from 0.35 to 0.95). Returning parents (N=57) versus non- returning parents (N=22) exhibited statistically significant differences with respect to the Parent, Divine and Fate loci. Returning parents exhibited higher scores on the Parent locus (p=0.0392) and lower scores on the Fate (p=0.0024) and Divine (p=0.0031) loci. CONCLUSION: 1). The relapse rate (37%) was high and rapid for children treated for ECC; 2). no meaningful difference existed between the Relapse versus Non-relapse groups with respect to each health locus of control parameter; 3). parents who returned for follow-up care appeared to have an internal health locus of control while those who did not return had an external locus.

Child↗
PubMed2004

Clinical outcomes for Early Childhood Caries (ECC): the influence of salivary mutans streptococci levels.

AIM: To assess the relationship between clinical outcomes for children treated for Early Childhood Caries (ECC) and salivary mutans streptococci (MS) levels. STUDY DESIGN AND METHODS: The study cohort consisted of 79 children (42 males, 37 females) treated for ECC, aged from 2.3 to 7.3 years at time of entry. Whole non-stimulated saliva samples were obtained from each subject prior to dental surgery and at 6 mths post dental surgery, by saturating a cotton swab in the saliva pooled in the floor of the mouth. Samples were placed into PBS on ice and processed within 2 hours. Samples were sonicated, serially diluted and plated onto MSB and SBA agar plates, then incubated 48 hours anaerobically; SBA plates were incubated an additional 24 hours aerobically. The MS level in each sample was expressed as a percentage of the total cultivable flora. The cohort was evaluated for new caries lesions at 6 months post dental surgery. Relapse was defined as the presence of new smooth surface caries lesions. STATISTICS: Comparisons between Relapse (R) and Non-Relapse (NR) groups with respect to mutans streptococci levels were performed using Wilcoxon tests. Within group comparisons were performed using Wilcoxon signed-rank tests. RESULTS: 57 children (72%) returned for the 6 months examination and 21 of these subjects (37%) relapsed. No statistically significant difference in median salivary MS levels existed between the R (0.20%) and NR (0.033%) groups at baseline (p=0.647) or at 6 months post dental surgery (R=0.03%; NR=0.01%; p=0.273). A statistically significant difference between baseline and 6 months post dental surgery was noted in the median salivary MS level within the R group (p=0.0007) and within the NR group (P<0.0001). CONCLUSIONS: The relapse rate (37%) was high and rapid for children treated for ECC. Dental surgery resulted in a statistically significant reduction in salivary MS reservoirs for children treated for ECC. However, this did not translate into acceptable clinical outcomes.

Child↗
PubMed2000

Anaphylactoid reaction to muromonab-CD3 in a pediatric renal transplant recipient.

Muromonab-CD3 (OKT3), a murine IgG2a antibody directed against the T3 (CD3) complex on mature lymphocytes, triggers adverse immune reactions. Anaphylactic reactions have occurred in patients exposed to OKT3 and are mediated by anti-OKT3 IgE antibodies. The reactions are not antibody mediated and can occur within seconds of administration of a mast cell secretogogue. A renal transplant recipient became hypotensive and hypoxic immediately after receiving her first dose of OKT3 and required advanced life support. Serum antibody tests were negative for anti-OKT3 IgG, IgE, and antimouse protein antibodies. To our knowledge, this is the first published report of a patient with an anaphylactoid reaction to the initial infusion of OKT3.

Adolescent↗
PubMed1998

Chloral hydrate sedation: the additive sedative and respiratory depressant effects of nitrous oxide.

UNLABELLED: The combination of chloral hydrate and nitrous oxide (N2O) is often used for sedation in pediatric dentistry. The purpose of this study was to determine the extent to which N2O increases the level of sedation and respiratory depression in children sedated with chloral hydrate. Thirty-two children, 1-9 yr, received chloral hydrate, 70 mg/kg (maximum 1.5 g), and then received N2O (30% and 50%). Hypoventilation (maximal PETCO2 > 45 mm Hg) occurred in 23 (77%) children during administration of chloral hydrate alone, in 29 (94%) breathing 30% N2O (P = 0.08 versus control), and in 29 (97%) breathing 50% N2O (P = 0.05 versus control). Mean PETCO2 was increased during 30% (P = 0.007) and 50% (P = 0.02) N2O administration. Using chloral hydrate alone, 8 (25%) children were not sedated, 10 (31%) were consciously sedated, and 14 (44%) were deeply sedated. Using 30% N2O, 2 children (6%) were not sedated, 0 were consciously sedated, and 29 (94%) were deeply sedated (P < 0.0001). Using 50% N2O, 1 child (3%) was not sedated, 0 were consciously sedated, 27 (94%) were deeply sedated, and 1 (3%) had no response to a painful stimulus (P < 0.0001). We conclude that the addition of 30% or 50% N2O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children. IMPLICATIONS: Pediatric sedation in the dental office often consists of nitrous oxide (N2O) after chloral hydrate premedication. We found that the addition of 30% or 50% N2O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children.

Anesthesia, General↗
PubMed1997

Breathing patterns and levels of consciousness in children during administration of nitrous oxide after oral midazolam premedication.

PURPOSE: The combination of midazolam and nitrous oxide is commonly used to achieve sedation and analgesia during pediatric oral procedures, yet there are few, if any, data that illustrate the ventilatory effects of N2O in children, especially when used in combination with additional central nervous system (CNS) depressants. It was hypothesized that the addition of N2O inhalation to oral midazolam premedication would enhance the sedative effects of the midazolam and add analgesia without causing significant respiratory depression. The purpose of this study was to test this hypothesis. MATERIALS AND METHODS: Thirty-four healthy children about to undergo restorative dental treatment under general anesthesia were premedicated with oral midazolam, 0.7 mg/kg, and were then exposed to 40% N2O for 15 minutes after a 5-minute control period. The effect of adding N2O on SpO2, respiratory rate, PETCO2, VT, and VT/TI was examined and the levels of consciousness (conscious vs deep sedation) before and during N2O inhalation were determined. RESULTS: During the course of the study, no child developed hypoxemia (SpO2 < 92%) nor clinically significant upper airway obstruction. Four children who did not develop hypoventilation (defined as PETCO2 > 45 mm Hg) during the control period did so after initiation of N2O. Overall, there were no significant differences in SpO2, PETCO2, VT, or VT/TI between the control and study periods. However, respiratory rates were significantly higher in the first 10 minutes of N2O inhalation when compared with the control period. Before starting N2O administration, 14 children were not clinically sedated, 19 children met the criteria for conscious sedation, and one child met the criteria for deep sedation. At the end of 15 minutes of N2O inhalation, 12 children were not clinically sedated, 17 children met the definition of conscious sedation, three were deeply sedated, and one child had no response to IV insertion, implying a state of general anesthesia. There were no differences in sedation scores between the control and study periods (P = .6). Overall, seven children had an increase in their sedation score while breathing N2O, four had a decrease in their sedation score, and 22 had no change. CONCLUSIONS: The addition of 40% N2O to oral midazolam, 0.7 mg/kg, did not result in clinically meaningful respiratory depression nor upper airway obstruction, but did, in some children, cause an increase in the level of sedation beyond simple conscious sedation.

Adjuvants, Anesthesia↗
PubMed1996

Levels of consciousness and ventilatory parameters in young children during sedation with oral midazolam and nitrous oxide.

OBJECTIVE: To determine the ventilatory effects and levels of consciousness achieved during sedation with the combination of oral midazolam and inhaled nitrous oxide. DESIGN: Case series. SETTING: Surgical suite. PATIENTS: Twenty-two consecutive children, aged 1 to 3 years, were seen for elective, ambulatory surgery. INTERVENTIONS: Patients were premedicated with oral midazolam hydrochloride, 0.5 mg/kg, and then breathed 4 concentrations of nitrous oxide (N2O) in oxygen (15%, 30%, 45%, and 60%) for 4 minutes at each concentration prior to induction of general anesthesia. MAIN OUTCOME MEASURES: Levels of consciousness (conscious vs deep sedation) and ventilatory parameters: respiratory rate, end-tidal carbon dioxide tension (PETCO2), and oxyhemoglobin saturation (SPO2). Upper airway obstruction was diagnosed by clinical assessment by an experienced pediatric anesthesiologist (R.S.L.) and respiratory impedance plethysmography. RESULTS: During inhalation of N2O, 12 of the 20 children demonstrated a mild degree of ventilatory depression; PETCO2 values were equal to or greater than 45 mm Hg during at least 2 concentrations of N2O studied. There were no significant changes in SPO2 or PETCO2 with increasing concentrations of N2O (P > .05). Respiratory rates tended to be lower during inhalation of 15% N2O than at higher concentrations (P = .05). No child developed upper airway obstruction or hypoxemia (SPO2 < 92%) at any level of N2O inhalation. Sedation scores were significantly higher at 60% N2O than at all other concentrations of N2O (P < .02) At 15% N2O, 12 children were not clinically sedated, 8 children met the American Academy of Pediatrics definition of conscious sedation, and no child met the definition of deep sedation. At 30% N2O, 10 children were not clinically sedated, 9 met the definition of conscious sedation, and 1 child met the definition of deep sedation. At 45% N2O, 9 children were not clinically sedated, 9 met the definition of conscious sedation, and 2 met the definition of deep sedation. At 60% N2O, 6 children were not clinically sedated, 6 met the definition of conscious sedation, 6 met the definition of deep sedation, and 1 child progressed to a deeper level of sedation in that there was no response to a painful stimulus. One child was withdrawn from the study during inhalation of 45% N2O because of emesis. CONCLUSIONS: The combination of oral midazolam, 0.5 mg/kg, and up to 60% inhaled N2O caused mild ventilatory depression in some children and resulted in a progression from conscious to deep sedation beginning at 30% N2O. When using this particular combination of sedatives, practitioners should monitor each child's mental status continuously and adhere to the appropriate published guidelines for the monitoring and management of such patients.

Ambulatory Surgical Procedures↗
PubMed1994

Nucleus accumbens dopamine release increases during instrumental lever pressing for food but not free food consumption.

This experiment was undertaken to investigate the role of nucleus accumbens dopamine (DA) in instrumental and consummatory responses for food. In vivo microdialysis methods were used to study DA release and metabolism in the nucleus accumbens of behaving rats. Four behavioral conditions were used: performance on a fixed ratio 5 (FR 5) schedule of food reinforcement, consumption of Bioserve food pellets, consumption of laboratory chow, and food deprivation control. Groups of rats that were previously exposed to these conditions were implanted with dialysis probes in the nucleus accumbens and tested the day after implantation. The rats that pressed a lever on a FR 5 schedule showed significant increases in extracellular DA and DA metabolites compared to food-deprived control rats. In further analyses, rats that responded on the FR5 schedule were divided into three groups based upon their response rates. The rats with low response rates did not significantly differ from control rats, whereas rats with medium and high rates of responding showed significant increases in DA release relative to the control group. Rats that received massed presentation of food pellets or laboratory chow consumed large quantities of food, but showed no significant increases in DA release. This experiment demonstrated that performance of lever pressing behavior is accompanied by an increase in accumbens DA release and metabolism, and that DA release in nucleus accumbens is more closely related to the performance of highly active instrumental responses than it is to consumption of large quantities of food.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1989

Developmental orofacial deficits associated with multimodal cancer therapy: case report.

Multimodal cancer therapy for pediatric head and neck tumors may be associated with significant developmental orofacial morbidity. This report details these effects in a child (C.I.) diagnosed at 2.5 years of age with a rhabdomyosarcoma, primary to the left buccinator. This case is of interest as C.I. has an unaffected identical twin (D.I.) for comparative study. Both were assessed by comparing panoramic radiographs and lateral and frontal tracings of cephalometric radiographs obtained at 8.25 years of age. C.I. had multiple dental anomalies which included agenesis, ectopia, crown malformation, and root malformation. Root malformation, ectopia, and agenesis were restricted to the left dentition, whereas crown malformation was noted bilaterally. C.I. had a generalized craniofacial skeletal hypoplasia relative to D.I. in all three planes, growth defects were greater on the side of the tumor, and the mandible was affected more than the nasomaxillary complex.

Anodontia↗
PubMed1988

Dental management of children with cancer.

Dental management of pediatric oncology patients is an important component of comprehensive supportive care. Oral complications associated with tumor directed treatment may be a direct result of the stomatotoxic effects of cancer therapy or the indirect effects of myelosuppression. These complications may be immediate or long-term. Appropriate dental supportive care has been shown to minimize the morbidity and potential mortality associated with these complications.

Antineoplastic Agents↗
PubMed1985

Mouth-to-mouth transmission of the bacterium Streptococcus mutans between mother and child.

The production of bacteriocins by 314 Streptococcus mutans isolates from 20 mother-infant pairs was studied to test the likelihood of maternal transmission of this species. The patterns of inhibition were sufficiently different to allow differentiation of the 314 isolates into 41 bacteriocin types. The bacteriocin codes of isolates within one pair did not correspond to the codes of strains isolated from any other pair. The number of infant strains (per infant isolates) matching maternal strains within each mother-infant pair were 10/10, 10/10, 10/10, 12/12, 2/3, 10/10, 10/10, 10/10, 3/3, 5/10, 8/8, 3/3, 8/8, 3/3, 7/7, 4/4, 3/3, 8/8, 3/3 and 4/4 for pairs 1-20, respectively. Statistical analysis, utilizing a randomization test, generated a p value less than 0.0001, which is 12 standard errors above the level expected if the pairings were random.

Bacteriocins↗
PubMed1985

Oropharyngeal Candida prophylaxis in pediatric bone marrow transplant patients.

The effect of a multi-agent regimen on oropharyngeal candidiasis (OPC) prophylaxis in 16 consecutive pediatric bone marrow transplant patients was assessed. The multi-agent regimen consisted of: 1) debriding all mucous membrane surfaces within the oropharyngeal cavity with povidone-iodine 4 times a day, 2) swabbing all mucous membrane surfaces within the oropharyngeal cavity with nystatin 4 times a day, and 3) Ketoconazole given daily by mouth. Multi-agent regimen therapy was initiated on the day marrow ablative therapy began, and was terminated when the patient's absolute neutrophil count recovered to above 500/mm3. Baseline oropharyngeal fungal cultures indicated that 8 out of 16 (50%) of the patients were Candida carriers. Subsequent surveillance cultures indicated that 13 out of 16 (81.3%) of the patients had negative oropharyngeal fungal cultures during the entire period they were on the multi-agent regimen. The remaining three patients had negative oropharyngeal fungal cultures by the end of the experimental period. None of the patients developed Candida esophagitis or sepsis. The above regimen is an effective and non-toxic method to prevent oropharyngeal candidiasis in pediatric BMT patients.

Adolescent↗
PubMed1984

Microbial characteristics of the human dental caries associated with prolonged bottle-feeding.

Plaque samples from caries lesions, white spot margins of these lesions, and caries-free smooth enamel surfaces, obtained from seven subjects with nursing bottle caries, all contained unusually high proportions of Streptococcus mutans. The proportion of lactobacilli present in plaque from caries lesions was statistically greater (p less than 0.01) than the proportion present in plaque obtained from white spot margins of these lesions or caries-free smooth enamel surfaces.

Bottle Feeding↗
PubMed1983

Oral complications associated with bone marrow transplantation in a pediatric population.

The effect of dental evaluation and treatment prior to bone marrow transplantation in 11 pediatric patients was assessed. Oral complications associated with marrow ablative therapy and the immediate posttransplant period (Days 0-35) were also studied. Oral complications during marrow ablative therapy included: xerostomia (2/11 patients) and parotitis (1/11 patients). Oral complications in the immediate post-transplant period (Days 0-35) included: mucositis (11/11 patients); moniliasis (9/11 patients); and stomatitis associated with acute G.V.H.D. (3/9 patients receiving allogenic marrow transplants). The onset of the mucositis in the posttransplant period usually occurred at the nadir of the white blood cell count and resolved when the absolute neutrophil count was approximately 500/m3. The onset of moniliasis in the posttransplant period was usually 1-2 days after the onset of the mucositis. Resolution of the moniliasis usually paralleled resolution of the mucositis. No patient developed an infectious and/or hemorrhagic complication of odontogenic origin.

Adolescent↗
PubMed1982

Multiple microaerophilic streptococcal lung abscesses after orthodontic treatment.

An immunocompetent 12-year-old boy developed multiple microaerophilic streptococcal lung abscesses after application of orthodontic bands ("braces"). The dental work was done in the supine position. The data suggest that the patient aspirated the organisms and, possibly, flecks of dental cement, during orthodontic treatment. "Rubber dams" should be used to help prevent aspiration in children who receive dental work in the supine position. When a rubber dam cannot be used, as with orthodontic treatment, physicians should advise patients who are at risk for developing pulmonary infection (eg, patients with neuromuscular diseases which compromise cough and/or gag, cystic fibrosis, sickle cell anemia, primary immunodeficiency, etc) to have this dental work, including orthodontic treatment, performed in the erect position.

Child↗