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Biomedical subjects

A Garfunkel

Publications and source records attributed to A Garfunkel.

At least 19 recordsLinked to original sources
PubMed2002

[Emergencies evolving from local anesthesia].

Local anesthesia is without doubt the most frequently used drug in dentistry and in medicine. In spite of records of safety set by using these drugs, there is evidence to adverse reactions ranging from 2.5%-11%. Most of the reactions originate from the autonomic system. A recent, well-planned study indicates that adverse reactions are highly correlated to the medical status of the patient: the higher the medical risk, the greater the chance to experience an adverse reaction. This study also found that adverse reactions highly correlated to the concentration of adrenalin. Another recent study found a direct relationship between adverse reactions and the level of anxiety experienced by the patient and to the dental procedure. Most of the reactions in this study occurred either immediately at injection time and within 2 hours following the injection. Since the beginning of last century, vasoconstrictors have been added to local anesthesia solutions in order to reduce toxicity and prologue activity of the LA. However, today it is commonly agreed that this addition to local anesthesia should not be administered to cardiac patients especially those suffering from refractory dysrhythmias, angina pectoris, post myocardial infarction (6 months) and uncontrolled hypertension. Other contraindications to vasoconstrictors are endocrine disorders such as hyperthyroidism, hyperfunction of the medullary adrenal (pheochromocytoma) and uncontrolled diabetes mellitus. Cross reactivity of local anesthetic solutions can occur with MAO inhibitors, non specific beta adrenergic blockers, tricyclic antidepressants, phenothiazides and cocaine abusers. Noradrenaline added to local anesthetics as a vasoconstrictor has been described as a trigger to a great increase in blood pressure and therefore has been forbidden for use in many countries. This paper describes 4 cases of severe complications following the injections of local anesthesia of which three ended in fatality.

Anesthesia, Dental↗
PubMed2002

[Syncope in the dental environment].

Syncope or Fainting is, by far, the most common emergency situation in the dental practice. Syncope is defined as an abrupt, transient, short term loss of consciousness and postural tone, followed by spontaneous and complete recovery. The pathophysiology of syncope consists of a sudden cessation or decrease in cerebral perfusion. Differential diagnosis of these medical conditions is of paramount importance in uncovering unrecognized systemic diseases. The dental team plays an important role in the process of establishing the correct diagnosis by its ability to recognize and document all the clinical symptoms and signs evident at the time of fainting. The dental surgeon is expected to be familiar with the various etiologies of syncope and should be able to differentiate between them. This article provides the essentials of the diagnostic procedure and an approach to the evaluation of the unconscious patient.

Dental Care↗
PubMed2002

[Respiratory distress].

Dental treatment is usually conducted in the oral cavity and in very close proximity to the upper respiratory airway. The possibility of unintentionally compromising this airway is high in the dental environment. The accumulation of fluid (water or blood) near to the upper respiratory airway or the loosening of teeth fragmentations and fallen dental instruments can occur. Also, some of the drugs prescribed in the dental practice are central nervous system depressants and some are direct respiratory drive depressors. For this reason, awareness of the respiratory status of the dental patient is of paramount importance. This article focuses on several of the more common causes of respiratory distress, including airway obstruction, hyperventilation, asthma, bronchospasm, pulmonary edema, pulmonary embolism and cardiac insufficiency. The common denominator to all these conditions described here is that in most instances the patient is conscious. Therefore, on the one hand, valuable information can be retrieved from the patient making diagnosis easier than when the patient is unconscious. On the other hand, the conscious patient is under extreme apprehension and stress under such situations. Respiratory depression which occurs during conscious sedation or following narcotic analgesic medication will not be dealt with in this article. Advanced pain and anxiety control techniques such as conscious sedation and general anesthesia should be confined only to operators who undergo special extended training.

Central Nervous System Depressants↗
PubMed2002

[Chest pains in the dental environment].

Chest pain does not necessarily indicate cardiac disease. The most common causes of acute chest pain encountered in dental situations include hyperventilation, pulmonary embolism, angina pectoris and myocardial infarction. Stress and fear often cause rapid breathing or hyperventilation. This usually occurs in young adults and although the hyperventilating patient often complains of chest pain, this is rarely a manifestation of cardiac disease. Pulmonary embolism usually indicates the occlusion of a pulmonary artery causing severe chest pain. The primary clinical manifestation of angina pectoris is chest pain. Although most instances of anginal pain are easily terminated, the dentist must always consider the possibility that the supposed anginal attack is actually a sign of acute myocardial infarction (AMI). AMI is a clinical syndrome caused by a deficient coronary arterial blood supply to a region of myocardium that results in cellular death. There is a high incidence of mortality among AMI with death often occurring within 2 hours of the onset of signs and symptoms. The initial clinical manifestations of all types of chest pain can be similar. Therefore the dentist must develop proficiency in constituting a differential diagnosis and an efficient management protocol. As in most medical situations prevention is the most powerful tool. However, if chest pains do occur, measures such as airway management, oxygen supplementation, coronary artery dilation, analgesis and in extreme cases, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.

Adult↗
PubMed2002

[Allergy-related emergencies].

Allergic reactions can develop to any of the drugs or materials commonly used in dentistry. They exhibit a broad range of clinical signs and symptoms ranging from mild, delayed reactions to immediate and life-threatening reactions developing within seconds. Allergies usually manifest themselves in reactions that are related to histamine release in one of three ways: skin reactions, respiratory problems and anaphylaxis. Anaphylaxis is the most critical allergic reaction in the dental environment. Measures such as airway management, oxygen supplementation, antihistamine, adrenaline and corticosteroid medication, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.

Dental Materials↗
PubMed2002

[The potential dangers of endocrinal disorders].

The symptoms of most endocrine system diseases are usually clearly recognizable and most of the times are accompanied by a rich medical history. Many general practitioners are reluctant to treat such cases and prefer to refer these patients to specialists who are trained in management of the medically compromised thus increasing the chances of dental treatment without complications. However, sometimes endocrinal diseases develop slowly and their clinical manifestations are hidden or subclinical in nature. In these cases, neither the patient nor the dentist are aware of the condition and there is the potential of life threatening, emergency situations in what at first seem as simple, straightforward dental procedures. Therefore, the dentist must be able to recognize the clinical problem, differentiate between the different symptoms and initiate the proper management protocol. The most unstable endocrinal disorders that should be treated with great care are diabetes mellitus, mainly hypoglycemia, hyperthyroidism and adrenal insufficiency. The general practitioner dentist can treat patients suffering from these disorders providing the disease is well controlled and balanced and that the dental treatment is not very traumatic.

Adrenal Insufficiency↗
PubMed2002

[Legal and ethical considerations of emergencies in the dental office].

The dentist has the ethical and legal responsibility to anticipate emergency situations in correlation with the patient's medical status. He has the obligation to do all in his power to prevent emergencies from happening and to be prepared to manage any emergency that might occur. This article also discusses the importance of monitoring and documentation.

Dental Care for Chronically Ill↗
PubMed1994

Salivary immunoglobulins in recipients of bone marrow grafts. II. Transient secretion of donor-derived salivary IgA following transplantation of T cell-depleted bone marrow.

Patients undergoing bone marrow transplantation (BMT) have decreased levels of salivary Ig over long periods of time. However, shortly after transplantation, a transient rise of Ig concentration in their saliva gland is detected. In order to trace the origin of this Ig, seven BM donors were immunized with tetanus toxoid (TT) 4-7 days prior to BMT harvesting. Four patients received BM from non-immunized donors. All but one of the patients had no detectable anti-TT IgA in their parotid saliva prior to BMT. Recipients of T cell-depleted BM from pre-immunized donors transiently displayed high titers of salivary anti-TT IgA 7-28 days after transplantation. No significant anti-TT IgA titers were detected in saliva of patients grafted with non-immunized BM. We conclude that antibody-producing cells activated in the donor are passively transferred with the BM to the recipient. IgA committed cells home to the mucosa-associated lymphoid tissues (MALT) and continue to secrete antibodies until senescence.

Adolescent↗
PubMed1992

Gram-negative enteric bacteria in the oral cavity of leukemia patients.

We examined changes in the bacterial flora in hospitalized patients with leukemia. This study placed special emphasis on enteric microorganisms and their relation to the general status of the patient. One hundred thirty bacterial cultures from 16 leukemia patients and 16 control subjects, were obtained. The organisms were isolated on MacConkey agar and identified by the API-20E system. Enteric microorganisms were isolated from 62.2% of the leukemia patients as compared with 28% from the control group (p < 0.001). The enteric positive cultures were identified as Klebsiella (42.7%), Enterobacter (18.8%), and Pseudomonas (15.6%). In contrast to the negative cultures (1342), enteric microorganisms were cultured from 2948 specimens (p < 0.005).

Adult↗
PubMed1985

Calcification of non-collagenous matrix in human gingiva: a light and electron microscopic study.

Tissue samples obtained from human gingiva with soft tissue calcification were processed for light and transmission electron microscopy. The stroma in these specimens revealed numerous foci of calcification in a matrix that consisted of closely packed branching microfibrils, 12 nm in diameter and a maximum of 2.5 micron in length. Calcospherites, 0.25-1.11 micron in diameter, were present within the matrix. They were constructed of needle-like units shown by high resolution electron microscopy and energy dispersive X-ray microanalysis to be apatite. Larger calcified masses were composed of calcospherites which were fused together. Matrix vesicles or other forms of membraneous material could not be found. The relationship between the mineral and non-collagenous microfibrils may suggest a role for the latter in the onset of calcification in this ectopic site.

Amelogenesis Imperfecta↗
PubMed1981

Burkitt's lymphoma cell leukemia. Radiology and cytotoxic medication.

A 15-year-old girl presented with swelling and spontaneous bleeding of the gingiva. The lower anterior teeth were sensitive to percussion, and the lower lip and chin showed lack of sensation. Radiographically, gross loss of the alveolar and basal bone in both jaws was evident. The lamina dura and periodontal ligament had lost their morphology. Based on the clinical, radiographic and laboratory findings, the diagnosis of Burkitt's lymphoma cell leukemia was made. While cytotoxic medication brought about an immediate clinical improvement, radiographically, jaw bone repair became evident one month following initiation of treatment.

Adolescent↗
PubMed1977

Familial hypoparathyroidism with candidiasis and mental retardation.

Five new cases of the syndrome of hypoparathyroidism, candidiasis, and mental retardation are described and the importance of the dental findings in contributing toward a definite diagnosis is stressed. The close consanguineous relationship of the parents, first cousins in all of these cases, makes imperative the consideration of the concept that the syndrome is a congenital defect, transmitted by a recessive gene.

Adolescent↗
PubMed1975

The effectiveness of sodium fluoride treatment with and without iontophoresis on the reduction of hypersensitive dentin.

The effectiveness of topical sodium fluoride applied with and without iontophoresis was compared in patients complaining of tooth hypersensitivity. Reduction of sensitivity to cold and mechanical stimuli was evaluated during a period of 8 months by pain scoring in the exposed cervical dentin of homologous teeth on the two sides of the jaws. There was a significant decrease in the sensitivity of the exposed cervical dentin after treatment with sodium fluoride solution, with or without iontophoresis, during the whole experimental period. There was no striking difference between the two forms of treatment with respect to the reduction of sensitivity to mechanical and cold stimuli.

Adult↗