[Epicutaneous tests in suspected adverse reactions to dental material].
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Biomedical subjects
Publications and source records attributed to S Helland.
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A total of 172 patients referred to the Norwegian National Adverse Reaction Group were patch-tested with a dental series. Of these, 25% showed a positive reaction to gold sodium thiosulfate or potassium dicyanoaurate. There was a statistically significant correlation (p=0.0019) between the presence of dental gold and a positive patch test to gold. There was a statistically significant correlation between ear piercing and a positive patch test to gold (p=0.04). In most cases, we did not find clinical correlates to positive patch tests to gold. 2 patients with objective and subjective oral/perioral and general symptoms are described as case reports. Their symptoms disappeared when gold restorations were removed. We conclude that there is an overrepresentation of gold allergies among those with dental restorations containing gold.
Occupational dermatological problems are common among dental health personnel. We conducted a questionnaire survey to investigate the frequency of occupational dermatological problems among dental health personnel in Hordaland county, Norway. 333 of 394 employees (85%) answered the questionnaire. 148 of 333 respondents (44%) reported skin complaints. The proportion of respondents with skin complaints was lower among those with more than 20 years experience in dental health care. Hands were almost always involved. Use of gloves were reported to be the main cause of skin problems, especially the use of powdered gloves. Other frequently reported causes were soaps and methacrylates. Skin complaints from methacrylates occurred more often among employees wearing gloves most past of the working day. 3% of the respondents reported test-proven rubber allergy and 1% a methacrylate allergy. Our study confirm that occupational dermatological problems among dental health personnel are frequent. Irritant reactions are probably much more common than allergy. The most important allergens causing allergic contact dermatitis are rubber and methacrylates. Dental personnel should use non-powdered non-latex gloves and use non-touch techniques while handling methacrylates.
BACKGROUND: Although potent, topical corticosteroids offer effective and rapid healing of psoriatic lesions. Their long term use is limited because of the risk of side effects. Calcipotriol is safe for long-term treatment, but its initial efficacy is lower than with topical corticosteroids. OBJECTIVES: To investigate whether 2 weeks of treatment with clobetasol propionate 0.05% ointment bd followed by 4 weeks of treatment with calcipotriol 50 microg/g bd would offer therapeutic advantages over 6 weeks of continuous treatment with calcipotriol. METHODS: Forty-nine patients with moderate to severe plaque psoriasis were recruited from five centres in Norway. In a randomised, double-blind, right- versus left-side comparison, ointments were applied to two symmetrically-located areas. RESULTS: Two weeks of treatment with clobetasol propionate produced a significantly greater decrease in total symptom score (combined scores of erythema, induration and scaling) than calcipotriol treatment (P < 0.0001). This improvement on the clobetasol propionate-treated side of the body was maintained throughout a subsequent 4-week treatment period when calcipotriol was applied to both sides of the body (P < 0.0001). The superiority of the clobetasol propionate followed by calcipotriol treatment was maintained during a 4-week, treatment-free, observation period. Treatments were well tolerated with no rebound effect. CONCLUSIONS: Clobetasol propionate ointment bd for 2 weeks followed by treatment with calcipotriol ointment bd for 4 weeks was superior to calcipotriol ointment alone in the treatment of plaque psoriasis.
The purpose of this study was to investigate whether fish oil and/or corn oil had a beneficial effect on the clinical state of atopic dermatitis, and to evaluate the dietary intake of nutrients in this group of patients. In a double-blind, multicentre study lasting 4 months, during wintertime, 145 patients with moderate to severe atopic dermatitis were randomly assigned to receive either 6 g/day of concentrated n-3 fatty acids, or an isoenergetic amount of corn oil. As local treatment, only an emollient cream or hydrocortisone cream was allowed. The fatty acid pattern in serum phospholipids, and the dietary intake of nutrients were monitored in a subgroup of patients, and the results were compared with a group of patients with psoriasis. The overall clinical score, as evaluated by the physicians, improved during the trial by 30% in the fish oil (P < 0.001) and 24% in the corn oil group (P < 0.001). This was also consistent with the results from a selected skin area, and it was further confirmed by the total subjective clinical score reported by the patients. There were no significant differences in the clinical scores between the two groups at baseline, and at the end of the study. In the fish oil group, the amount of n-3 fatty acids in serum phospholipids was significantly increased at the end of the trial, compared with pretreatment values (P < 0.001), whereas the level of n-6 fatty acids was decreased (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
The renal effects of low-dose cyclosporin A (CsA) treatment in severe psoriasis was investigated in 10 patients treated with a mean CsA dose of 3.23 (range 1.94-4.10) mg/kg/day for 12 months. The psoriasis area and severity index was reduced by 63-76%. Ambulatory GFR (iothalamate-125I), ERPF (hippuran-131I), RVR and MAP were examined at 3-months intervals. A control renal biopsy was performed shortly before treatment start and a second biopsy was taken after 12 months of therapy. GFR was slightly but significantly reduced after 6 and 9 months; after 12 months the decrease was not significant (121.0 +/- 7.6 versus 115.2 +/- 7.8 ml/min/1.73M2, P > 0.10). After 12 months serum creatinine increased from 82 +/- 4 to 94 +/- 7 mumol/litre (P < 0.05), while an insignificant increase of ERPF was seen and FF decreased from 0.29 +/- 0.01 to 0.26 +/- 0.01 (P < 0.05). MAP remained unchanged. GFR and serum creatinine correlated significantly within each 3-month interval. A slight de novo interstitial fibrosis was seen in the second biopsy in 4 of 10 patients receiving a mean CsA dose of 3.2-4.1 mg/kg/day. In three of these patients a concomitant rise in serum creatinine was seen. In conclusion, low-dose CsA was associated with reversible fall in GFR and potentially progressive structural changes not always accompanied by corresponding functional alterations. One should consider reducing the daily dose of CsA to 3.0 mg/kg bodyweight or less in CsA therapy up to 1 year.
BACKGROUND: In several studies dietary fish oil has been found to have beneficial effect on psoriasis, but the results are contradictory and based mainly on open studies or studies of small numbers of patients. METHODS: In a four-month double-blind, multicenter trial, we randomly assigned 145 patients with moderate-to-severe psoriasis to receive in their diet either highly purified ethyl esters of n-3 fatty acids ("fish oil"; 6 g of oil per day, containing 5 g of eicosapentaenoic and docosahexaenoic acid) or an isoenergetic amount of corn oil containing mainly n-6 fatty acids. All the patients were advised to reduce their intake of saturated fatty acids. A 48-hour dietary recall was performed, and the fatty-acid pattern in the serum phospholipids was monitored in a subgroup of patients. RESULTS: In the fish-oil group, n-3 fatty acids were increased in serum phospholipids (P < 0.001), the ratio of arachidonic acid to eicosapentaenoic acid decreased (P < 0.001), and the level of n-6 fatty acids decreased (P < 0.001). In the corn-oil group, only docosahexaenoic acid increased significantly (P < 0.05). The ratio of polyunsaturated to saturated fatty acids increased in both groups. Plasma concentrations of triacylglycerol decreased from base line in the fish-oil group (P < 0.05). The score on the Psoriasis Area and Severity Index, as evaluated by the physicians, did not change significantly during the trial in either group. This was also true of a total subjective score reported by the patients, but a selected area of skin in the corn-oil group showed a significant reduction in the clinical signs (P < 0.05). Scaling was reduced from base line in both groups (P < 0.01). The fish-oil group had less cellular infiltration (P < 0.01), and the corn-oil group had improvement in desquamation and redness (P < 0.05). There was no significant difference in clinical manifestations between the groups. Among the patients in the fish-oil group, an increase in the concentration of n-3 fatty acids in serum phospholipids was not accompanied by clinical improvement, whereas in the corn-oil group there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids. CONCLUSIONS: Dietary supplementation with very-long-chain n-3 fatty acids was no better than corn-oil supplementation in treating psoriasis. Clinical improvement was not correlated with an increase in the concentration of n-3 fatty acids in serum phospholipids among the patients in the fish-oil group, whereas there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids in the corn-oil group.
This article reviews the different lasers used in dermatology. Special emphasis is placed on the treatment of naevus flammeus ("portwine stain") where lasers are the treatment of choice. Argon laser and pulsed dye laser are the main lasers used in vascular skin diseases, and the article focuses on these two types. Copper vapour laser, neodymium-YAG-laser and CO2-laser are also presented. Information is provided about the availability of laser technology in the different health regions in Norway.
Isotretinoin is a highly effective drug in the treatment of nodulocystic acne. The most common side effects are mucocutaneous. An uncommon complication is excess granulation tissue response to isotretinoin therapy. We present a case history and summarize different methods of treatment.
A multicenter clinical, double-blind crossover trial was conducted in 65 men and 31 women experiencing recurrent episodes of genital herpes in order to compare the effect of acyclovir in propylenglycol (40% cream) with that of cream alone (placebo). 59.4 of the patients on acyclovir experienced a beneficial effect in relation to the usual clinical course of their herpetic eruptions. The corresponding figure for placebo was 34.4%. These percentages were 76.6 and 33.3 respectively if the treatment started within four hours after appearance of symptoms or skin lesions. Pain and burning lasted less than four days in 70.8% of the patients on acyclovir and in 36.4% of those on placebo cream (p less than 0.001). The average duration until complete healing of all skin lesions was 32 hours shorter for patients on acyclovir. In 42 patients on acyclovir and 31 patients on placebo (p less than 0.001) it was less than four days. As regards duration of symptoms and skin lesions, the effect was significantly better if treatment was started early (e.g. less than 4 h). Slight to moderate side-effects were reported in 13.5% of the patients on both treatment regimens.
We have investigated the effect of low-dose methotrexate (25 mg weekly) on plasma homocysteine in 13 patients who had psoriasis. Total, free, and protein-bound homocysteine were determined both during fasting and after methionine loading. Psoriasis patients had significantly higher basal plasma homocysteine levels than age-matched control subjects. In addition, the methionine loading test was abnormal in four of the patients, but this was not significant. Psoriasis patients, although not folate deficient, did have lower serum folate levels than control subjects. There was a significant and transient increase in fasting plasma homocysteine levels within 48 hours after administration of low-dose methotrexate. This response was repeated after each administration and was observed eight to 20 times in three patients whose progress was monitored for 2 to 6 months. Notably, methotrexate did not affect the plasma profile for homocysteine after methionine loading. This study showed the level of fasting plasma homocysteine to be a sensitive and responsive parameter of antifolate drug treatment.
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Using a modification of the radioenzymic assay described previously (J Biol Chem 259: 2360-2364, 1984) we measured homocysteine in freshly prepared plasma and urine from volunteers. The concentration of free homocysteine--i.e., the amount measurable in plasma after deproteinization by strong acid--was 2.27 (SEM 0.11) mumol/L for 18 men and 1.95 (SEM 0.13) mumol/L for 16 women (p greater than 0.05, not significant). About 70% of the total homocysteine in human plasma was associated with plasma proteins, and was precipitated with strong acid. The concentration of protein-bound homocysteine in plasma was 6.51 (SEM 0.32) mumol/L for men and 7.29 (SEM 0.65) mumol/L for women, a significantly (p less than 0.01) different spread. Homocysteine was rapidly released from plasma proteins in the presence of a reducing agent, dithioerythritol. By gel filtration of plasma on a "high-performance" liquid-chromatographic column, albumin was shown to be the sole carrier of homocysteine in plasma. Because the fraction bound to protein as determined by this procedure equaled that obtained by precipitation of plasma proteins with acid, we conclude that homocysteine is bound to albumin in vivo. The concentration of homocysteine in urine ranged from 3.5 to 9.5 mumol/L, about 6 mumol of homocysteine being excreted per 24 h.
A method for the determination of L-homocysteine (Hcy) in tissues is described, which involves adsorption of adenosine and S-adenosyl-L-homocysteine (AdoHcy) in the tissue extract to dextran-coated charcoal, while leaving Hcy in solution. Sufficient dilution of the tissue homogenates and the presence of a reducing agent during the adsorption step are required to obtain high recovery of Hcy. Hcy is condensed with radioactive adenosine, and labeled AdoHcy is quantified by high performance liquid chromatography on a 3-micron reversed phase column. The amount of Hcy was determined in several tissues (liver, kidney, brain, heart, lung, and spleen) of mice and rats, and the concentrations of Hcy were in the range 0.5-6 nmol/g, wet weight. Hcy concentration was about 1 microM in mouse plasma. In mice, liver contained the highest amount of Hcy, and kidneys were also rich in Hcy. Similar concentrations were found in rat tissues. S-Adenosylhomocysteine (AdoHcy) hydrolase (EC 3.3.1.1), the enzyme which is believed to catalyze the only pathway leading to Hcy formation in vertebrates, was nearly completely inactivated in mice injected with the drug combination 9-beta-D-arabinofuranosyladenine plus 2'-deoxycoformycin. This treatment induced a massive accumulation of AdoHcy in all tissues (Helland, S., and Ueland, P. M. (1983) Cancer Res. 43, 1847-1850). The amount of Hcy increased several-fold in kidney, whereas no change was observed in liver, heart, brain, lung, and spleen.
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Binding of adenosine to S-adenosyl-L-homocysteine (AdoHcy) hydrolase (EC 3.3.1.1.) and partial conversion of bound adenosine to a substance liberating adenine has been demonstrated under conditions of enzymatic synthesis and hydrolysis of ADoHcy (Ueland, P. M., and Helland, S. (1980) J. Biol. Chem. 255, 7722-7727). Gel filtration of cytosol from isolated rat hepatocytes treated with [14C]adenosine on a high performance liquid chromatography protein column showed that labeled adenine/adenosine eluted as a peak which co-chromatographed exactly with AdoHcy hydrolase. Formation of this peak was inhibited by exposure of the cells to compounds (ara-A, 3-deazaadenosine, and homocysteine) interacting with the catalytic site of the enzyme. Furthermore, the adenine/adenosine-protein complex and AdoHcy hydrolase focused at exactly the same pH (pI = 5.76) in a granulated bed. On this basis it was concluded that labeled adenosine formed a stable complex with AdoHcy hydrolase. A substantial portion (about 50%) of endogenous adenosine in rat hepatocytes seemed to be associated with AdoHcy hydrolase, and this portion equaled the amount of cellular adenosine which was not readily mobilized by high level of extracellular adenosine deaminase. Exposure of the hepatocytes to compounds which block the formation of the adenosine-AdoHcy hydrolase complex (ara-A, 3-deazaadenosine, and homocysteine) for 1 to 2.5 h only slightly reduced the amount of adenosine associated with the enzyme, indicating a slow turnover of the complex under the conditions of the experiment. It was concluded that adenosine is sequestered in rat hepatocytes through the interaction with AdoHcy hydrolase. The physiological implication of this process may be related to the metabolism and biological effects of adenosine as well as the regulation of AdoHcy hydrolase activity.