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This case report presents an unusual complication, cervical root resorption, after a conventional connective tissue grafting procedure and tetracycline root conditioning. The recession was 7 mm high, with 0.5 mm of keratinized tissue present, a 2-mm probing depth, and was classified as Miller Class III. The clinical result was satisfactory and 5 mm of root coverage was achieved. However, after 20 months, cervical resorption was diagnosed. It is suggested that tetracycline root conditioning may cause root resorption in long-term evaluations. There is also a possibility of root resorption occurring in 1-year postoperative controls. Other factors will be discussed in relation to this negative clinical result.

Importance of the Field: The identification of molecules that inhibit protein deposition or reverse fibril formation could open new strategies for therapeutic intervention in misfolding diseases. Numerous compounds have been shown to inhibit amyloid fibril formation in vitro. Among these compounds, tetracycline and the disaccharide trehalose have been reported to inhibit or reverse amyloid aggregation but their efficiency as potential drugs is controversial., Areas Covered in This Review: The results obtained using tetracycline and trehalose, reported in the last 15 years, are described and discussed., What the Reader Will Gain: The conclusions have important implications for the development of therapeutic agents for protein deposition diseases. If fibrillar proteins contribute to cell degeneration, then the disassembly of fibrils may reverse or slow down disease progression; however, if the action of therapeutic agents produces intermediates of fibrillation and/or products of fibril disaggregation, then their accumulation could be harmful., Take Home Message: Care should be taken to ensure that strategies aimed at inhibiting fibril formation do not cause a corresponding increase in the concentration of toxic oligomeric species.

Objectives: Previous studies have shown an association between isotretinoin and inflammatory bowel disease (IBD). The majority of patients prescribed isotretinoin for their acne are previously on an extended course of antibiotics. Therefore, it is important to consider antibiotic use as a confounding variable for the development of IBD., Methods: We performed a retrospective cohort study using The Health Improvement Network database of the United Kingdom. We identified 94,487 individuals with acne who were followed up by a general practitioner for 406,294 person-years., Results: >A prescription for minocycline was received by 24,085 individuals, for tetracycline/oxytetracycline by 38,603 individuals, and doxycycline by 15,032 individuals. IBD was noted in 41 individuals exposed to minocycline, 79 individuals exposed to tetracycline/oxytetracycline, 32 individuals exposed to doxycycline, and 55 (0.11%) individuals not exposed to any of these antibiotics. The hazard ratio (HR) for developing IBD for any exposure to a tetracycline antibiotic was 1.39 (1.02, 1.90). HRs for individual antibiotics were 1.19 (0.79, 1.79) for minocycline, 1.43 (1.02, 2.02) for tetracycline/oxytetracycline, and 1.63 (1.05, 2.52) for doxycycline. For ulcerative colitis, the associations (HR) were 1.10 (0.76, 1.82) for minocycline, 1.27 (0.78, 2.07) for tetracycline/oxytetracycline, and 1.06 (0.53, 2.13) for doxycycline. For Crohn's disease (CD), the associations (HR) were 1.28 (0.72, 2.30) for minocycline, 1.61 (0.995, 2.63) for tetracycline/oxytetracycline, and 2.25 (1.27 4.00) for doxycycline., Conclusions: Tetracycline class antibiotics, and particularly doxycycline use may be associated with the development of IBD, particularly CD. Potential confounding by previous doxycycline exposure should be considered when assessing whether treatment with other acne medications increases the risk of IBD.

The popularity of dental bleaching has increased with the introduction of at-home whitening. Currently available whitening methods include those prescribed by a dental professional for use at home, those applied by the professional in the dental office, a combination of the two, or systems available over the counter. This article reviews the effect, efficacy, and safety of bleaching techniques and materials. Most whitening techniques are considered effective and safe when carried out under the supervision of a dental professional. This article also compares the efficacy and safety of some of the most popular bleaching techniques, including at-home whitening with carbamide peroxide, over-the-counter (OTC) systems, and in-office whitening. Some of these whitening techniques are illustrated in this article.

We report a symptomatic girl with reversible circumscribed cytotoxic oedema in the splenium of the corpus callosum (CC) that occurred, to our knowledge, for the first time in relation to tetracycline treatment. After stopping tetracycline therapy the girl recovered completely and the CC lesion, clearly visible on diffusion-weighted MR imaging (DWI), disappeared. Reversible circumscribed cytotoxic oedema (CCO) of the splenium of the CC is a well-defined entity that is found to be associated with administration of antiepileptic drugs, alterations in therapy using arginin-vasopressin and metronidazole or infections with influenza and rotavirus. CCO of splenium of the CC is clearly visible on DWI, shows no enhancement after administration of contrast medium and is completely reversible in most cases.

This article reviews the history of tooth whitening and its rapid evolution and briefly discusses tooth whitening agents and protocols. The active ingredients and mode of action during the whitening process are explained. The factors affecting the speed of whitening and its final results are discussed, as well as adverse effects and safety precautions. Protocols are explained in detail, and the predicted outcomes, including those for tetracycline-stained teeth, are covered.

Nightguard vital bleaching (NGVB) has been applied as a safe and effective bleaching procedure with a wide variety of commercial products consisting of carbamide peroxide-based gels, but there have been few reports on tooth bleaching for tetracycline-stained teeth. The purpose of this study was to evaluate the bleaching effects on teeth discolored by tetracycline with 3 months' active treatment, and to investigate the participant satisfaction, the shade stability, and the post-treatment side effects 2 years after the treatment. A custom-made tray with Polanight 10% carbamide peroxide gel was applied to both the incisal and premolar teeth (10 teeth of each participant), and the participants were directed to wear the tray every night over the course of the 3 months. The whiteness-blackness difference (L*) became lighter within 3 months and the lightness remained until 2 years later. Tooth color changes were remarkable in both redness-greenness difference (a*) and yellowness-blueness difference (b*). No obvious shade change or slight darkening was recognized 2 years post-treatment. The means of the color difference (DeltaE*) at 3 months, 6 months, 1 year, and 2 years were 13.74, 14.02, 12.17, and 11.81, respectively. All participants were satisfied with the shade change of their teeth, but three participants complained of slight hypersensitivity. One participant complained of cold or hot pain in daily life until 6 months after the treatment. These side effects were alleviated within 1 year. The results suggested that the standard treatment period of NGVB with Polanight for tetracycline-discolored teeth may be determined to be 3 months.

Background: The treatment of MRSA (methocillin resistant staphylococcus aureus) colonized middle ear is difficult. According to the guidelines, a MRSA colonized Patient is not to be treated with systemic antibiotics. The topical treatment shows the problem of the ototoxicity of most of the used antiseptic as well as antibiotic substances., Method: Selective literature review and consideration of the author's own clinical experience., Results and Conclusions: Antibiotic treatment options include aequeous Tetracyclin drops, aequeous chloramphenicol drops and quinolon ear drops (unfortunately the MRSA is resistent mostly). Antiseptics without ototoxic effects are the Burow's solution, Povidone-iode, acetic acid solutions and aequeous dequalinium solutions.

There is a great deal of evidence to support the use of tetracycline and doxycycline in the treatment of papulopustular rosacea. Nevertheless, these agents have shared and unique adverse effects and relative contraindications. Recently, subantimicrobial-dose doxycycline was demonstrated to be an effective treatment for rosacea, due to its inherent anti-inflammatory properties. Furthermore, subantimicrobial-dose doxycycline has a more preferable tolerability profile and a lower occurrence of bacterial resistance than traditional-dose doxycycline. To further elucidate the role of tetracycline agents in rosacea, clinical trials that compare these agents with each other as well as with other effective rosacea treatments are called for. Adherence studies comparing oral tetracycline treatment with topical metronidazole treatment may also enhance clinical decision making.

Objective: To evaluate the clinical application of the custom shade guide of tetracycline stained teeth in color matching., Methods: Forty-two patients with 59 tetracycline stained teeth were included in this study. Color matching was performed with Shofu shade guide and custom shade guide of tetracycline stained teeth. According to the two results, two porcelain fused to metal crowns were fabricated for each tooth. Evaluations were made both visually by dentists and patients and with ShadeEye NCC., Results: Color difference between prostheses made according to custom shade guide and natural teeth was (7.80 +/- 4.70). Color difference between prostheses made according to Shofu shade guide and natural teeth was (10.68 +/- 4.70). Both visual evaluation and ShadeEye NCC evaluation showed that the custom shade guide provided a more accurate shade selection than the Shofu shade guide did, and the difference between the two shade guides was significant (t = 7.328, P < 0.001)., Conclusions: The custom shade guide of tetracycline stained teeth provided a standard for clinical shade matching for the tetracycline stained teeth and could be a supplement to Shofu shade guide.

(1) Photosensitivity reactions are cutaneous disorders due to exposure to ultraviolet (UV) radiation of natural or artificial origin. They occur or are more prevalent on unprotected skin. The main clinical manifestations are burns, eczema-like rash, urticaria, pigmentation, or onycholysis; (2) Many drugs increase cutaneous sensitivity to UV, sometimes for therapeutic purposes, but it is generally an unwanted effect.

An ideal antibiotic regimen for Helicobacter pylori should achieve eradication rates of approximately 90%. Current 7-day triple therapy is successful in about two-thirds of patients. A novel treatment is required to achieve higher eradication with minimal induction of bacterial resistance. The aim of this article is to evaluate the safety and efficacy of a single triple capsule (Pylera) containing bismuth, metronidazole and tetracycline, given with omeprazole for the eradication of H. pylori infection. Extensive literature searches were conducted using PubMed data from 1982 to 2007. This search included headings of H. pylori, bismuth and eradication therapy. The triple capsule Pylera, when given with omeprazole, achieved eradication rates ranging between 84 and 97%. Eradication rates were similar for clarithromycin- and metronidazole-resistant strains. Eradication rates with an omeprazole, bismuth, metronidazole and tetracycline regimen appeared comparable for metronidazole-resistant and -sensitive strains. This effect is not seen with the use of triple therapy in cases of clarithromycin resistance. Clinical trials did not report any serious side effects from bismuth-based regimens and compliance was similar to standard triple therapy. Bismuth-based triple therapy using Pylera is a simplified, effective and well-tolerated regimen achieving cure rates of above 90%.

Objective and Background Data: Photodynamic bleaching is a recently developed method that may be suitable for photo-oxidation of difficult internal stains. This study examined the outcomes of photodynamic bleaching for treatment of confirmed cases of tetracycline discoloration, when used as a single-appointment procedure., Materials and Methods: Digital analysis of standardized pre- and post-treatment digital photographs of a total of 90 maxillary incisors from 23 adult patients undergoing photodynamic bleaching was undertaken. The patients were treated by a visible green KTP laser (wavelength 532 nm) combined with a rhodamine-B photosensitizer gel (Smartbleach) applied to the teeth and activated for 30 sec. Each tooth underwent four cycles of 30 sec of laser exposure. Digital image analysis was undertaken in a blinded manner, and we examined changes in the four maxillary incisors in terms of blue pixel intensity (yellowness)., Results: Least squares linear regression analysis and a one-tailed paired t-test using the matched pairs of pre- and post-treatment data for mean blue pixel intensity showed that a significant lightening effect was achieved by the bleaching treatment. Significant increases in blue pixel intensity (reductions in yellowness) occurred in 78% of the teeth treated., Conclusions: In-office KTP laser photodynamic bleaching provides a clinically useful improvement in tooth shade in teeth with tetracycline discoloration.

Background: Although porcelain veneer has been proposed as the treatment of choice in cases of severe tooth discoloration, clinicians should consider a multidisciplinary approach when treating complex cases. Clinicians also need to understand the masking ability of veneer restorations., Case Description: A 20-year-old woman had severe tooth discoloration, enamel hypoplasia and malocclusion. The patient first underwent orthodontic treatment to correct the dental alignment after the author extracted her hypoplastic first molars. The author then placed porcelain veneers with high-density alumina cores on the patient's maxillary and mandibular anterior teeth. The restorations were in service for seven years without complications., Conclusions: and, Clinical Implications: Managing severe tooth discoloration requires thorough consideration of all patient factors, treatment provided in a logical sequence and the use of porcelain veneers with adequate masking ability.

Background: In eradication of Helicobacter pylori infection, standard quadruple second-line therapy consisting of proton pump inhibitor (PPI), bismuth, metronidazole and tetracycline often fails and shows poor patient compliance. The aim of our study was to evaluate the efficacy and tolerability of moxifloxacin-based triple therapy as an alternative second-line protocol., Methods: A total of 160 patients, in whom the initial standard PPI triple therapy had failed to eradicate H. pylori infection, were included in the study. The initial H. pylori status was assessed using the (13)C-urea breath test. Patients were randomized to one of the following 7-day treatment regimens: (1) OMM: omeprazole 20 mg twice a day, moxifloxacin 400 mg/day, metronidazole 500 mg three times a day; and (2) OBMT: omeprazole 20 mg twice a day, colloidal bismuth subcitrate 120 mg four times a day, metronidazole 500 mg three times a day, tetracycline 500 mg four times a day. Patient compliance and adverse events were evaluated one week after completion of therapy. H. pylori status was re-assessed with the (13)C-urea breath test six weeks after the end of therapy., Results: The eradication rates were 73.2% (60/82) and 78.9% (60/76) with moxifloxacin-based triple therapy, and 53.8% (42/78) and 64.6% (42/65) with bismuth-based quadruple therapy, by intention-to-treat (p = 0.018) and per-protocol (p = 0.088) analyses, respectively. Adverse events/intolerability were described in 12/82 patients in the OMM group and 18/78 patients in the OBMT group. Compliance with treatment was 92.7% in the OMM group and 83.3% in the OBMT group., Conclusion: Moxifloxacin-based triple therapy is a highly effective second-line eradication treatment in H. pylori infection. Because of its high levels of safety and tolerability, this protocol represents an adequate alternative to the standard bismuth-based quadruple therapy.

Background: Tetracyclines are broad-spectrum antibiotics used by dental practitioners in the treatment of periodontal disease. They generally are safe in adults. However, caution is advised in patients who have pre-existing kidney disease., Case Description: A 42-year-old woman with polycystic kidney disease received a prescription for tetracycline (250 milligrams, four times daily) after undergoing tooth extractions. She developed nausea, vomiting and diarrhea within days and end-stage renal disease within two weeks of taking the antibiotic. Hemodialysis was required to stabilize the patient's condition. Use of the Naranjo nomogram demonstrated an association between the two events., Clinical Implications: This case illustrates the importance of obtaining a thorough medical history and understanding potential adverse drug effects before prescribing a common antibiotic.

The hepatoprotective action of Hepatophyt was studied on Wistar rats with experimental hepatitis caused by exposure of the animals to tetracycline. Hepatophyt was administered per os in a dose of 0.1 g/kg. Its significant pharmacotherapeutic action was due to the content of biologically active substances, mainly of polyphenol nature. As natural antioxidants, they provided stabilization of the biomembranes and increased the energetic potential of the hepatic cells and the contractile capacity of the pericanal microfilaments, thus stimulating the synthesis and transport of the cholates and excretion of bilirubin and cholesterol with bile.

Objective: Carbamide peroxide and hydrogen peroxide have been used as tooth whitening agents. The aim of this paper was to determine the efficiency of several enzyme-containing whitening systems. A method to determine the rate of 'in vitro' tetracycline whitening was also developed., Methods: We determined the tetracycline whitening ability of carbamide peroxide and hydrogen peroxide, and the influence of peroxidase and lactoperoxidase on this tetracycline whitening rate., Results: High peroxidase and lactoperoxidase concentrations increased the rate of tetracycline decoloration obtained with carbamide peroxide or hydrogen peroxide. The decoloration rate observed was lower when the glucose/glucose oxidase system was used to generate hydrogen peroxide 'in situ'. The presence of peroxidase increased the decoloration rate of extracted teeth obtained with carbamide., Conclusions: Enzymes such as peroxidase could be used as whitening catalysts to increase the rate of tetracycline decoloration.

Aim: To compare a lansoprazole-based triple versus quadruple therapy for Helicobacter pylori (H pylori) eradication with emphasis on side effect profile, patient compliance and eradication rate at a rural district general hospital in Wales, United Kingdom., Methods: One hundred one patients with H pylori infection were included in the study. Patients were randomised to receive triple therapy comprising of lansoprazole 30 mg, amoxycillin 1 g, clarithromycin 500 mg, all b.d. (LAC), or quadruple therapy comprising of lansoprazole 30 mg b.d., metronidazole 500 mg t.d.s., bismuth subcitrate 240 mg b.d., and tetracycline chloride 500 mg q.d.s. (LMBT). Cure was defined as a negative (13)C urea breath test 2 mo after treatment., Results: Seven patients were withdrawn after randomisation. Fifty patients were assigned to LAC group and 44 to LMBT group. The intention-to-treat cure rates were 92% and 91%, whereas the per-protocol cure rates were 92% and 97%, respectively. Side effects were common, with 56% experiencing moderate to severe symptoms in the LAC group and 59% in the LMBT group. Symptoms of vomiting, diarrhoea and black stools were significantly more common in the LMBT group. Patient compliance was 100% for triple therapy and 86% for quadruple therapy (P < 0.01). One-third of patients in both groups were still taking acid-reducing medications at six-month follow-up., Conclusion: One-week triple and quadruple therapies have similar intention-to-treat eradication rates. Certain side effects are more common with quadruple therapy, which can compromise patient compliance. Patient education or modifications to the regimen are alternative options to improve compliance of the quadruple regimen.

Tetracycline staining in the adult dentition has presented an esthetic challenge for many years. Many clinicians have treated the problem by utilizing invasive techniques that may involve crowns, veneers, and composite bonding. Some major disadvantages to these invasive techniques include the cost involved and the need to cut on sound tooth structures. This article showcases a protocol for treating tetracycline staining non-invasively.

Background: The eradication rates of Helicobacter pylori with standard treatments are decreasing worldwide., Objectives: The primary aim of this study was to compare the eradication success of a 14-day sequential regimen with proton pump inhibitor (PPI)-based triple treatment. The secondary objectives of the study were to evaluate the effect of gastritis score and smoking on eradication rates as well as evaluation of compliance and tolerability of both regimens., Methods: Consecutive H pylori-positive patients with nonulcer dyspepsia were randomized into 1 of 2 groups in this 14-day, open-label, randomized, prospective, parallel-arm study. An upper endoscopy with biopsy and (14)C-urea breath test ((14)C-UBT) were performed before enrollment. The first group was administered a sequential regimen consisting of pantoprazole 40 mg and amoxicillin 1 g for 7 days, followed by pantoprazole 40 mg, tetracycline 500 mg, and metronidazole 500 mg for the next 7 days. The second group was administered pantoprazole 40 mg, amoxicillin 1 g, and clarithromycin 500 mg (PAC group) for 14 days. All drugs were administered BID, with the exception of tetracycline, which was administered QID. Eradication was confirmed by (14)C-UBT 6 weeks after the end of the treatment. Histologic examination and (14)C-UBT were conducted by investigators blinded to the protocols. Patients were asked to report any adverse events (AEs) during the treatment period., Results: Three hundred white patients were enrolled in the study and evenly randomized into the sequential treatment group (98 males and 52 females; mean age, 40.2 years) and the PAC group (86 males and 64 females; mean age, 41.2 years). A total of 274 patients completed the study per protocol (PP). Twenty-six patients discontinued: lost to follow-up (16), withdrawn due to AEs (9); and noncompliance (1). The intent-to-treat (ITT) and PP H pylori eradication rates were 72.6% and 80.1% in the sequential group, and 58% and 63% in the PAC group, respectively. The eradication rate was significantly higher in the sequential group compared with the PAC group in both the ITT and PP populations (P=0.01 and P=0.002, respectively). The eradication rates were higher in nonsmoking patients compared with smoking patients both in the sequential group (85.8% vs 70.5%) and the PAC group (67.7% vs 53.3%), but the results were not statistically significant when the groups were analyzed separately. Overall, 32 patients (10.7%) reported an AE. Treatment was discontinued in 9 patients because of serious AEs (sequential group--abdominal pain [2 patients], diarrhea [1], chest pain [1], and vaginal pruritus [1]; PAC group--nausea/vomiting [2], chest pain [1], and numbness [1]). There were no significant between-group differences in regard to compliance or AEs. Univariate analyses found no significant effect of sex, age, alcohol consumption, antacid usage, or gastritis score on the eradication rates., Conclusions: A 14-day sequential treatment regimen achieved a significantly higher eradication rate of H pylori compared with standard PPI-based triple regimen in this small selected population. Large, double-blind, controlled studies are needed to confirm these results.

Background: There is no effective regimen for the eradication of Helicobacter pylori in our country. It may be due to the increasing prevalence of resistance to antibiotics used for the treatment of H. pylori. Recently, a study from Turkey has revealed that a new treatment scheme consisting of sequential administration of pantoprazole plus amoxicillin for 7 days followed by pantoprazole plus metronidazole, and tetracycline for the remaining 7 days was effective in the first-line treatment of H. pylori. Therefore, we aimed to confirm efficacy of a new therapy scheme in the first-line H. pylori eradication., Material and Methods: This is a prospective, open label, single center, pilot study and included 32 patients infected with H. pylori diagnosed by both histologic examinations, rapid urease test and (13)C-urea breath test (UBT). The patients received a 14-day sequential regimen (pantoprazole 40 mg b.d. plus amoxicillin 1000 mg b.d. for 7 days and pantoprazole 40 mg b.d., metronidazole 500 mg b.d. and tetracycline 500 mg q.d. for the remaining 7 days). Eradication was assessed with (13)C-UBT 4 weeks after completion of the therapy. Intention-to-treat and per-protocol eradication rates were determined., Results: At intention-to-treat analysis, the eradication rate was 50% (16/32). For the per protocol analysis, the eradication rate was 57% (16/28). There were no significant adverse effects and treatment compliance was good., Conclusion: A new therapy consisting of sequentially administered drugs for 14 days yielded unacceptably low eradication rates. This scheme was not efficient for H. pylori eradication in our region. Further investigations are needed to determine the effectiveness of this scheme in other regions of Turkey.

Operating time for idiopathic hydroceles and epididymal cysts is scarce as these conditions compete with an increasing caseload of more consequential surgical disease. Therapy is often relegated to repeated aspiration. Sclerotherapy appears to be effective in a majority of published trials, but comparative effectiveness, efficacy and safety of most agents, including phenol versus tetracycline, has not been established A deliberate strategy of re-treatment until cure is not universally practised, with surgery still being offered after single-treatment failures. Two trials, the first consisting of 53 scrotal cysts treated with 5% phenol-in-water and the second, 42 cysts treated with tetracycline, are compared for effectiveness, efficacy and safety of sclerotherapy per se and of re-treatment. Intention-to-treat analysis yields similar cure rates (no re-accumulation three months after last injection) for phenol and tetracycline (83% and 81% respectively, p = 0.8). Per-protocol analysis also yields similar cure rates (100% and 97% respectively, p = 0.26) and mean number of injections to cure (1.34 and 1.12 respectively, p = 0.069), with range 1-4 and 1-3 respectively. Severe pain following tetracycline injection required administration of pre-injection cord block. Other complications occurred equally (25% and 25.7% respectively, p = 0.94) and were trivial except for one case of chronic haematocele treated by orchiectomy in the tetracycline group. Phenol (5%) and tetracycline are equally efficacious sclerosants for idiopathic scrotal cysts, achieving almost 100% cure with re-treatment and matching the efficacy of surgery. Concern about post-treatment fertility applies equally to surgery and demands informed consent for both modalities.

Background and Aim: The aim of this study was to test the efficacy of 10-day moxifloxacin-based triple therapy versus 2-week quadruple therapy for the second-line treatment of Helicobacter pylori infection., Methods: One hundred and ninety-two patients who had failed previous H. pylori eradication on standard triple therapy were randomized to one of two regimens: 1, moxifloxacin (400 mg q.d.), amoxicillin (1000 mg b.i.d.), and esomeprazole (20 mg b.i.d.) for 10 days (the 10MEA group), or 2, esomeprazole (20 mg b.i.d.), tripotassium dicitrate bismuthate (300 mg q.i.d.), metronidazole (500 mg t.i.d.), and tetracycline 500 mg (q.i.d.) for 14 days (the 14EBMT group). The eradication rates, drug compliances, and side-effect rates of these two regimens were compared., Results: Eradication rates by intention-to-treat and per-protocol analyses in the 10MEA and 14EMBT groups were 71.9% and 82.6%, and 71.7% and 90.5% (p = .973 and .321), respectively. The 10MEA group was significantly superior to the 14EMBT group in terms of side-effect rates (12.2% vs. 39.6%, p = .001), and discontinuation rates due to side-effects were lower in the 10MEA group than in the 14EMBT group (0.7% vs. 13.2%, p < .001). Moreover, compliance was higher in the 10MEA group (94.2% (131/139)) than in the 14EBMT group (83.0% (44/53)) (p = .014)., Conclusion: The 10-day moxifloxacin-based triple therapy was found to have a high eradication rate with few side-effects and good drug compliance. These findings suggest that this regimen is a safe and effective second-line treatment option for H. pylori infection in Korea.

Background: Helicobacter pylori eradication rates have tended to decrease recently, mostly due to increasing antibiotic-resistance. The present study aimed to compare the efficacy of bismuth-based quadruple regimen with proton pump inhibitor-based triple regimen for eradication of H. pylori., Methods: Consecutive H. pylori-positive patients with non-ulcer dyspepsia were randomized into one of two regimens: (i) bismuth subsalicylate 300 mg q.i.d., lansoprazole 30 mg b.i.d., tetracycline 500 mg q.i.d. and metronidazole 500 mg t.i.d. (BLTM group) for 14 days; (ii) lansoprazole 30 mg b.i.d., amoxicillin 1 g b.i.d and clarithromycin 500 mg b.i.d. (LAC) for 14 days. Gastroscopy and (14)C-Urea breath test (UBT) were performed before enrollment, and UBT only was repeated for 6 weeks after treatment., Results: A total of 240 patients were randomized into groups and 212 of them completed the protocols. The 'intention-to-treat' (ITT) and 'per protocol' (PP) H. pylori eradication rates were 70% (95%CI 61-78) and 82.3% (95%CI 74-89) in the BLTM group, and 57.5% (95%CI 48-66) and 62.7% (95%CI 53-71) in the LAC group. The BLTM treatment achieved a significantly better eradication rate compared with LAC treatment in PP analysis (82.3% vs. 62.7%, P = 0.002). Mild to severe side-effects, which were more frequent in the BLTM group, were reported in 18.2% of the patients., Conclusion: The bismuth-based quadruple regimen achieved a better eradication rate compared with proton pump inhibitor-based triple regimens as a first-line eradication option for H. pylori in our population.

Unlabelled: Plaque bacteria are the primary initiators of periodontal disease in susceptible persons and therapy is largely based on mechanical bacterial biofilm disruption. Patients' response to periodontal treatment is unpredictable and periodontal stability is not always achieved. Locally delivered antimicrobials (LDAs) may be used as adjuncts to mechanical therapy in treatment of recalcitrant deep (> or = 5mm), active, non-responding sites, providing the patient's oral hygiene is adequate. Their use as a monotherapy cannot be justified. The literature reveals that LDAs are safe and that they achieve statistically significant, yet clinically modest, gains in clinical attachment and reductions in pocket depths., Clinical Relevance: It has been suggested that LDAs may improve the clinical outcome in the treatment of recurrent and refractory cases of periodontitis when used as an adjunct to scaling and root surface instrumentation. This paper examines and discusses the evidence.

Background and Objective: An FDA Working Group, along with representatives of PhRMA and the American Association for the Study of Liver Diseases, as well as the Institute of Medicine Report 'To Err is Human: Building a Safer Health Care System' have suggested that post-marketing drug surveillance is a important method to decrease adverse drug events. While tetracyclines are known to cause hepatotoxicity, no post-marketing drug surveillance studies have examined the risk of developing hepatotoxicity with tetracyclines. Therefore, the objective of this study is to determine the difference in risk of hepatotoxicity in patients receiving doxycycline or tetracycline using California Medicaid claims., Methods: This study used a retrospective, matched case-control study using California Medicaid claims data. The cases were defined as recipients who had at least one diagnosis of hepatotoxicity any time from 1 July 1999 to 31 December 2001. One control was identified for each case, matched on age, gender and race. Logistic regression was used to determine the adjusted odds ratio (OR) and 95% confidence intervals for current users and past users of tetracycline and doxycycline. Covariates controlled for in the analysis were age, use of other hepatotoxic drugs, renal dysfunction, pregnancy, and alcohol or illicit drug use., Results: A total of 3377 cases of hepatotoxicity were identified. Current users and past users of tetracycline had a statistically significant increased risk of developing hepatotoxicity (current use OR 3.70, 95% CI 1.19-11.45; past use OR 2.72, 95% CI 1.26-5.85). Current users or past users of doxycycline did not have an increased risk of developing hepatotoxicity (current use OR 1.49, 95% CI 0.61-3.62; past use OR 1.74, 95% CI 0.99-3.06). Tetracycline was commonly used for acne, acute bronchitis and upper respiratory infections. Doxycycline was commonly used for acute bronchitis, vaginitis and acne., Discussion and Conclusion: Doxycycline was potentially less hepatotoxic than tetracycline. Doxycycline could potentially be a safe substitute for tetracycline, when appropriate.

The effect of tetracycline, at two doses of 50 and 200 mg kg(-1) daily, was studied on pancreatic and liver tissue function for 14 and 21 days in adult male albino rats. For pancreatic function the parameters studied were content of amylase and lipase in pancreas, serum amylase and lipase, serum glucose and faecal fat excretion. For liver function, liver specific enzymes in serum, namely alanine amino transaminase, aspartate amino transaminase and lactate dehydrogenase were estimated. In addition, total lipid, antiperoxidative enzymes and lipid peroxidation were measured in pancreas and liver. The content of amylase and lipase in pancreas showed a small but significant decrease in the rats given 50 mg kg(-1) for 21 days and the decrease was much more significant in those receiving the 200 mg kg(-1) dose. In pancreas free radical levels show a significant increase and reduced glutathione shows a substantial decrease at the 50 mg kg(-1) level and a significant change in these parameters was observed at the 200 mg kg(-1) dose. Antioxidant enzymes, superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase, showed a small but significant decrease in the pancreas of the rats treated with 50 mg kg(-1) tetracycline. A significant decrease in the antioxidant enzymes level was observed at the 200 mg kg(-1) dose. In the liver, free radical levels and reduced glutathione were within the normal range at the 50 mg kg(-1) level and significant changes were observed at 200 mg kg(-1). The antioxidant status was unaffected in liver after treatment with tetracycline at the 50 mg kg(-1) level and a significant decrease was observed at the higher dose. Our results reveal the safe nature of tetracycline with respect to the liver at the lower dose tested, whereas, both the higher and lower doses seem to have detrimental effect on the pancreas as revealed by the rise in free radical levels and decrease in the antioxidant enzyme levels.

The diagnosis of drug-induced acute pancreatitis often is difficult to establish. Although some medications have been shown to cause acute pancreatitis with a large body of evidence, including rechallenge, some medications have been attributed as a cause of acute pancreatitis merely by a single published case report in which the investigators found no other cause. In addition, some medications reported to have caused acute pancreatitis have obvious patterns of presentation, including the time from initiation to the development of disease (latency). There also appear to be patterns in the severity of disease. After reviewing the literature, we have classified drugs that have been reported to cause acute pancreatitis based on the published weight of evidence for each agent and the pattern of clinical presentation. Based on our analysis of the level of evidence, 4 classes of drugs could be identified. Class I drugs include medications in which at least 1 case report described a recurrence of acute pancreatitis with a rechallenge with the drug. Class II drugs include drugs in which there is a consistent latency in 75% or more of the reported cases. Class III drugs include drugs that had 2 or more case reports published, but neither a rechallenge nor a consistent latency period. Class IV drugs were similar to class III drugs, but only 1 case report had been published. Our analysis allows an evidence-based approach when suspecting a drug as causing acute pancreatitis.

The aim of this study was to determine the extent of calcium removal on root canal dentin after 17% EDTA, 17% EGTA, 15% EDTAC, and 1% tetracycline-HCl treatment; with or without subsequent use of 2.5% NaOCl. Extracted single-rooted human teeth were bisected longitudinally and the root halves (n=100) were isolated with nail varnish, leaving the root canal exposed. The samples were immersed in the test solutions for 1 and 5 minutes, after which the amount of calcium ion (Ca(2+)) release into the solutions was determined by flame photometry. Regardless of treatment time, all single (treatment solution only) and combined (treatment solution with subsequent NaOCl application) irrigation regimens removed significantly more Ca(2+) than control treatment (distilled water). Compared with other groups, treatment with 17% EDTA and 17% EDTA + 2.5% NaOCl resulted in the maximum amount of Ca(2+) removal from root canal dentin (p<0.05). All combined-treatment groups except 17% EGTA + 2.5% NaOCl removed significantly more Ca(2+) than their single-treatment versions (p<0.05). Within each test group, extending the treatment time to 5 minutes resulted in significantly more Ca(2+) removal (p<0.05).

Objective: To describe the unusual finding of yellow-green-colored bone during routine orbital surgery, to detail its investigation, and to demonstrate its benign nature., Methods: When green bone was found, specimens were sent for light and fluorescent microscopy, ultraviolet photography, and spectrophotometry., Results: Yellow-green bone was encountered in 3 patients during orbital tumor excision or orbital fracture repair procedures. The only common cause was prior use of tetracycline during adolescence. All patients had healthy white dentition. In all cases, absence of neoplasia was demonstrated histologically. The bone fluoresced with a bright yellow-green color when exposed to 365-nm ultraviolet light. Histologic analysis demonstrated fluorescence located near the haversian canals. Spectrophotometry revealed absorption at 4 wavelengths specific to tetracycline: 230, 275, 380, and 440 nm., Conclusions: Fixation of tetracycline and ensuing fluorescence occurs mostly in areas of new bone growth and mineralization. This happens during childhood but also with bone remodeling associated with tumors or fractures. Once mineralized, teeth should therefore not be affected if tetracycline exposure occurs after ages 8 to 10 years. This paucity of external clues can lead to the surprising but innocuous surgical finding of green bone. Careful history and proper investigation can confirm its origin.

Objective: To systematically review the scientific evidence derived from randomized controlled trials (RCT) about prevention of alveolar osteitis (AO)., Study Design: Literature searches were conducted to locate RCTs about prevention of AO. The RCTs were scrutinized for methodological details and categorized according to the preventive intervention studied. Data were analyzed in relation to the frequency of AO. Absolute risk reductions (ARR), and numbers needed to treat were calculated with 95% confidence limits., Results: There was a wide variation in the design and quality of the RCTs (N = 32). The greatest risk reduction for AO was seen for local treatment with tetracycline (ARR, 12%-31%). For a majority of the preventive interventions, the evidence was absent or inconclusive., Conclusions: Local treatment with tetracycline, and also 0.12% chlorhexidine rinsing preoperatively and 7 days postoperatively, seem to have significant and clinically relevant preventive effect on AO following surgical removal of lower third molars.

Purpose: To analyze the colour range and distribution of tetracycline teeth, and the difference from normal teeth., Methods: 142 cases with 468 anterior tetracycline teeth and 100 cases with 200 normal anterior teeth were collected. The color was measured by a computer-aided Shade-Eye NCC colorimeter, and expressed in terms of 3 coordinate values (L,a,b) of the CIE-1976-Lab color system. Chroma (Cab)and hue (h(ab) degrees)were calculated according to the value of a and b. The data were analyzed with SAS6.12 software package for description, Student's t test and Duncan test., Results: The range of L, a, b Cab, h(ab) degrees of tetracycline teeth was 42.33-77.00, -0.6-9.6, 2.67-31.5, 5.24-31.89, 38.62 degrees-95.47 degrees, respectively. Significant difference of L value and hue (h(ab) degrees) was found between tetracycline teeth and normal teeth (P < 0.01), which indicated that tetracycline teeth were darker and redder than normal teeth. There was no difference of chroma (Cab) between tetracycline teeth and normal teeth (P > 0.05). Moreover there was significant difference of L value between canine and central incisor, and of H value (h(ab) degrees) between canine and lateral incisor in tetracycline teeth, which indicated that canine was darker and redder than incisor, and redder than lateral incisor, but there was no significant difference in chroma (Cab) among all anterior teeth and no difference in L, a, b between central incisor and lateral incisor., Conclusions: The study showed the color distribution of tetracycline teeth was wider and more dispersive than normal teeth, and much darker and redder than normal teeth. Supported by Shanghai Leading Academic Discipline

Bleaching tetracycline-stained teeth is the most challenging form of tooth lightening. This article reports on 44 subjects who bleached their tetracycline-stained teeth for 6 months using trays with reservoirs overnight in a half-mouth designed study and 2 of 3 different concentrations of carbamide peroxide (10%, 15% or 20%). The subjects were followed for 5 years. The area evaluated was the middle third of the teeth. More than 55% of tooth lightening occurred within 1 month; after 5 years, more than 65% of the maximum tooth whitening remained for all 3 gel concentrations. Tooth whitening can be accomplished with any of the 3 concentrations used.

Objective: This study tested the hypothesis that exposure of human molar teeth to tetracycline (TCN) derivatives in vitro results in tooth discoloration resembling the clinical presentation of TCN staining., Method and Materials: The effects of exposure of 20 extracted human molar teeth to distilled water, chlortetracycline, doxycycline, or minocycline were compared. The baseline color of each tooth was analyzed with a dental spectrophotometer. The pulp chambers were each filled with a TCN derivative solution and then sealed. The teeth were placed in a centrifuge tube and then centrifuged at 2800 rpm for 20 minutes. Color change was monitored weekly for 7 weeks. Digital images of the surfaces were recorded. For each specimen at every evaluation period, color change from baseline was calculated using Commission Internationale d'Eclairage (CIE) Delta E 2000 (deltae00)., Results: There was a significant association between the type of derivative used and deltae00, as well as between the evaluation period and deltae00. There was also a significant association between the interaction term, derivative x evaluation period, and deltae00. Results of the Holm-Sidak post hoc test demonstrated that all 3 TCN derivatives were associated with significantly larger deltae00 than the control group (P < or = .05)., Conclusions: All 3 TCN derivative solutions produced significant color changes as time progressed. Different TCN derivatives produced a different L* (lightness), C* (chroma), and H* (hue), with minocycline behaving distinctly differently from chlortetracycline and doxycycline. The model could be used to study the underlying mechanisms of TCN staining as well as many aspects of vital tooth

Purpose: The purpose of this paper is to report a case of corneal staining after treatment with topical tetracycline., Methods: A patient with crystalline keratopathy caused by Streptococcus viridans after corneal transplantation was treated topically with tetracycline eye drops, based on results of bacterial sensitivity testing. After 3 weeks of intensive treatment, the donor cornea was stained with a brownish hue, which was ascribed to the tetracycline drops., Results: One patient with crystalline keratopathy developed corneal staining after intensive treatment with topical tetracycline eye drops. After a year of follow-up, the staining of the cornea had not changed significantly., Conclusion: Hourly topical tetracycline eye drops may induce corneal pigmentation. To our knowledge, this is the first published case report of corneal staining caused by tetracycline eye drops.

Background: Acne vulgaris may occur as part of immune reconstitution in human immunodeficiency virus (HIV)-seropositive patients on highly active antiretroviral therapy (HAART). Tetracyclines are a common acne treatment. Hypertriglyceridemia has not been reported as a side effect of this drug class., Objective: We report a case of an HIV-seropositive man on HAART (CD4 count 450 cells/microL) who developed isolated hypertriglyceridemia (> 13 mmol/L) after three separate challenges with minocycline or tetracycline, improving each time therapy was discontinued., Results: Based on a review of the literature, this is the first reported case of hypertriglyceridemia with minocycline or tetracycline therapy. No published reports have examined the safety of tetracyclines in the setting of HIV or HAART., Conclusion: A strong temporal association between tetracycline use and hypertriglyceridemia was found without an alternate explanation for the observed lipid profile. Given the common use of tetracyclines in dermatology, we feel that this is an important observation to report.

Congenital anomalies of the face mainly originate in chromosomal and teratogenic factors. Cleft lip and cleft palate are common anomalies of the face and palate. Cleft lip, with or without cleft palate, occurs about once in 1000 births. Cleft palate occurs about once in 2500 births. Most cases of cleft lip and palate are determined by multiple factors, genetic and nongenetic, each causing only a minor developmental disturbance. This is called multifactorial inheritance. The purpose of this study is a review on teratogenic factors with action on the newborn face.

Hyperlactataemia in the setting of combination antiretroviral therapy for HIV infection occurs on a spectrum ranging from common, asymptomatic laboratory abnormalities to rare, potentially life-threatening lactic acidosis. Some other medications, including the biguanides, tetracycline, and even linezolid, have rarely been reported to cause lactic acidosis. Recently, cases of lactic acidosis or hyperlactataemia have been reported in patients receiving combination antiretroviral therapy that have been precipitated by the addition of other medications-eg, metformin or ribavirin. We report a case of symptomatic hyperlactataemia in a patient on combination antiretroviral therapy that was likely precipitated by the addition of tetracycline and discuss the broader implications of other medications with the potential to cause hyperlactataemia in the setting of combination antiretroviral therapy.

Objective: To assess the high-resolution computed tomography appearances of drug-associated organizing pneumonia (OP)., Materials and Methods: Nine patients with clinical and biopsy proven drug-associated OP were included in the study. High-resolution computed tomography exams were retrospectively reviewed by 2 observers for the presence, extent, and distribution of parenchymal abnormalities., Results: The commonest findings consisted of air space consolidation (n = 8) and ground-glass opacification (n = 7). The air space consolidation was bilateral and asymmetric in 7 patients, symmetric in 1 patient and in all cases involved mainly the peribronchial or subpleural regions or both. The ground-glass opacities were predominantly bilateral and asymmetric in 6 patients and unilateral in 1 patient. They had a patchy distribution in 4 patients, were diffuse in 2 patients, and subpleural in 1 patient., Conclusion: Drug-associated OP most commonly presents with bilateral, asymmetrical air space consolidation in a predominantly peribronchial and subpleural distribution.

Medication induced esophagitis (MIE) has been reported in dermatology patients taking tetracycline antibiotics. The symptoms of esophagitis, preventable with proper instruction, can create morbidity and lead to increased costs for patients. Our study sought to quantify the incidence of MIE in patients taking tetracycline antibiotics and to investigate how these patients develop MIE. A cross-sectional questionnaire survey was given at outpatient dermatology clinics. Ninety-three surveys from patients who had taken tetracycline antibiotics and 48 surveys from a control group were analyzed. Incidence of esophagitis symptoms (difficulty or pain with swallowing) was measured in both survey and control groups. We found that esophagitis is significantly more common in patients taking tetracycline and its derivatives as compared with a control group (p<.03). Patients should be counseled to take tetracycline antibiotics in an upright position with a large amount of fluid and to report esophagitis symptoms to the prescribing physician.

Aim: Eradication therapy with proton pump inhibitor, clarithromycin and amoxicillin fails in a considerable number of cases. A rescue therapy still fails in more than 20% of the cases. Our aim was to evaluate the efficacy and tolerability of a third-line levofloxacin-based regimen in patients with two consecutive Helicobacter pylori eradication failures., Design: Prospective multicenter study., Patients: In whom a first treatment with omeprazole-clarithromycin-amoxicillin and a second with omeprazole-bismuth-tetracycline-metronidazole (or ranitidine bismuth citrate with these antibiotics) had failed., Intervention: A third eradication regimen with levofloxacin (500 mg b.i.d.), amoxicillin (1 g b.i.d.), and omeprazole (20 mg b.i.d.) was prescribed for 10 days., Outcome: Eradication was confirmed with 13C-urea breath test 4-8 wk after therapy., Results: One-hundred patients were initially included, and nine were lost for follow-up. All patients but five took all the medications correctly. Per-protocol and intention-to-treat eradication rates were 66% (95% CI = 56-75%) and 60% (50-70%). Adverse effects were reported in 25% of the patients, mainly including metallic taste (8%), nausea (8%), myalgia/arthralgia (5%), and diarrhea (4%); none of them were severe., Conclusion: Levofloxacin-based rescue therapy constitutes an encouraging empirical third-line strategy after multiple previous H. pylori eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, and tetracycline.