MRI of the renal veins: assessment of nonneoplastic venous thrombosis. Nonneoplastic renal vein thrombosis (RVT) is a clinical dilemma that poses a problem both from a clinical and diagnostic imaging perspective. An accurate noninvasive study to diagnose nonneoplastic RVT would be desirable. Magnetic resonance flow imaging is a noninvasive method of assessing vascular patency and depiction of thrombus. Its use for detection of nonneoplastic RVT is reviewed and our experience illustrated. We reviewed retrospectively the MRI studies in 41 patients evaluated for RVT and correlated them with other imaging studies where possible. Twenty patients had either ultrasound or venography. There were no correlative imaging studies done in 21 patients, 19 of whom had normal MRI, with normal clinical follow-up. In others there was good agreement between MRI and ultrasound in 16 of 19 cases. There were five patients with renal venography, of which the MRI agreed with the results in 3 of 5. Magnetic resonance imaging offers a noninvasive approach to the difficult diagnostic dilemma of RVT.


CT findings after hepatic chemoembolization. Hepatic arterial chemoembolization (CE) with a mixture of particulate collagen and chemotherapeutic agents was evaluated as therapy for hepatic metastases from colorectal carcinoma. This article describes the characteristics sequential pattern of change seen on liver CT scans following CE. Thirty CT scans were performed on seven patients who had undergone a total of 11 CE procedures. All patients had baseline, immediate postprocedural, and follow-up CT exams at 1 to 2 month intervals following CE. Immediate post-procedural CT scans mapped the area of embolization owing to the density of the contrast mixed with the CE agents. Some lesions seen easily on baseline were more difficult to see as they became isodense with normal liver. Reflux of embolic material into the cystic artery and gallbladder wall was also observed on postprocedural scans in three patients. In all patients, early follow-up scans (1 month after CE) demonstrated changes in lesions seen on baseline scans consistent with tumor necrosis. This was corroborated by a decrease in carcinoembryonic antigen (CEA) levels. In three patients, however, low attenuation regions developed in areas in which there had been no lesion before. The significance of these is uncertain, but the low CEA values and the subsequent evolution in appearance of these sites on CT suggest that they were regions of hepatic ischemia/infarction as opposed to heretofore unidentifiable metastases, now "unmasked." Intermediate follow-up scans (2-3 months) revealed maximal effect on tumor volume, with a decrease of > or = 25% in five of seven patients (71%). Late follow-up scans (> or = 3 months after the last CE) confirmed recurrent disease and new lesions in all cases.


Use of nutritional support formula as a gastrointestinal contrast agent for MRI. The objective of this study was to evaluate the potential utility of a nutritional support formula to serve as a practical means of enhancing the gastrointestinal tract on abdominal MR images. Nutritional support formula (Ensure Plus) was administered to 29 patients prior to abdominal MRI. Standard T1-weighted and T2-weighted pulse sequences were performed, in addition to fat suppression and inversion recovery sequences in selected patients. Images in these patients were evaluated for degree and uniformity of gastrointestinal tract enhancement and delineation of the bowel wall and pancreas. Results were compared with those obtained in 10 control patients. Marked enhancement of gastric contents was present in nearly all patients who received nutritional support formula on both T1-weighted and T2-weighted sequences, with mild to moderate enhancement of small bowel and colon in most patients. Although gastrointestinal and respiratory motion artifacts often limited bowel wall delineation, excellent delineation of the gastric wall and pancreas was provided. Phantom experiments demonstrated that gastrointestinal tract enhancement with nutritional support formula is due to the paramagnetic trace elements, corn syrup, and lipid material it contains. Such a formula requires no preparation, is safe, inexpensive, palatable, readily available, and represents a practical means of enhancing the gastrointestinal tract on MRI.


Infarction of the kidney: role of contrast enhanced MRI. Magnetic resonance imaging was performed on nine kidneys in six patients with renal infarction caused by renal arterial embolism secondary to cardiac valvular disease. The time interval between the onset of the symptoms attributable to renal infarction and the date of MRI was 2-23 days. On both T1- and T2-weighted images the signal intensity of the infarcted area was lower than that of the noninfarcted area in six kidneys and higher in three kidneys. Postcontrast T1-weighted images demonstrated the extent of the infarction except in the kidney in which the infarcted areas had high signal intensity on precontrast T1-weighted images.


CT and MRI of mycotic aneurysms of the abdominal aorta. In two of three patients with mycotic aneurysms of the abdominal aorta, diagnosis was delayed, with a fatal outcome in one patient. A combination of studies, such as indium white blood cell scanning, and anatomical imaging modalities, such as CT and MRI, may be necessary to arrive at the correct diagnosis.


Hypointense boundary layer between slow flow and mural thrombus on spin-echo MR. To evaluate the ability of spin-echo MRI to differentiate between slow flow and mural thrombus in aortic diseases, we reviewed the spin-echo MRI of 10 patients with intraaortic thrombus that had been documented by CT in 8 patients and aortography in 2 patients. Six patients had aortic aneurysms with mural thrombi, and four had aortic dissections with adherent mural thrombi within the false lumen. Five of seven gated oblique sagittal or coronal T1-weighted studies demonstrated hyperintense slow flow signal within the residual lumen. This hyperintense slow flow signal was accompanied by a parallel hypointense rim due to a boundary layer dephasing phenomenon. Eight axial T2-weighted MR studies demonstrated a hypointense zone due to fresh clot at the edge of a mural thrombus on even-echo images consistently. The hypointense boundary layer between slow flow and mural thrombus on either gated T1-weighted MRI or second-echo T2-weighted MRI not only predicted the presence of flow within the residual lumen but also clearly separated the area of slow flow from that of mural thrombus in 9 of 10 patients. Proper interpretation of spin-echo images may obviate the need for phase display imaging or gradient-echo imaging in differentiating between slow flow and mural thrombus.


Bone marrow edema of the hip: MR findings after core decompression. Magnetic resonance imaging is an extremely sensitive technique for evaluation of bone marrow changes at an early stage of avascular necrosis (AVN) of the hip. We therefore examined 11 painful hips whose clinical symptoms led us to suspect idiopathic AVN. The radiographs of all of these either were normal or demonstrated a minimal decrease in radiodensity. Magnetic resonance demonstrated diffuse signal loss of the bone marrow at short TR/TE images of the femoral head in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions turned iso- to hyperintense on long TR/TE images compatible with bone marrow edema (BME). Focal abnormalities characteristic for AVN were not seen in any of the cases. Radionuclide studies performed in six cases were positive. All patients underwent core decompression treatment. Hydrostatic bone marrow pressure measurement and intraosseous venography were positive in five cases when measured. Histology available in eight cases confirmed the presence of BME. Furthermore, the bone changes corresponded to those of early AVN. Follow-up examinations after core decompression with MR showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for BME and can monitor the therapeutic success of core decompression. Whether BME of the femoral head constitutes a distinct transient syndrome or represents an early form of AVN is controversial at present. Our findings support those who believe that BME may represent an initial stage of idiopathic AVN.


Diffuse neonatal hemangiomatosis: CT findings in an adult. Diffuse neonatal hemangiomatosis (DNH) is a rare disorder that usually presents in infancy and has a high mortality rate. We report a long-term adult survivor of DNH who presented with multiple calcifications in the bowel wall, liver, spleen, and adrenal glands on CT. Diffuse neonatal hemangiomatosis needs to be added to the causes of visceral calcifications.


Method for registering brain SPECT and MR images. We have developed a simple method for locating functional regions of interest on successive SPECT scans obtained at different times and for locating neuroanatomical regions defined with MR on functional images obtained with SPECT. Plastic molds are made for each external auditory meatus and the glabella. A pocket is then made in each mold in which either a 57Co disk (for SPECT) or an identical disk containing CuSO4 solution (for MRI) can be placed. Transaxial tomographic slices are reconstructed with the same slice thickness in the two modalities. The SPECT software rotates both SPECT and MRI reconstructed images so that the three 57Co markers lie in one SPECT reference plane and the three CuSO4 markers lie in one MRI reference plane. Corresponding SPECT and MR images may then be displayed simultaneously to locate chosen regions of interest. The technique was validated by taping test markers to the forehead of 12 subjects; the difference between the positions of the centers of the test markers on SPECT and MR scans was within 1 SPECT acquisition pixel size.


Calcified intrahepatic portal vein thrombus: distinction from intrahepatic choledocholithiasis. In a case of calcified intrahepatic portal vein thrombus CT demonstrated a branching calcified intrahepatic mass with peripheral enhancement following dynamic bolus contrast medium administration. The distinction from intrahepatic choledocholithiasis was made with normal cholangiography. Calcified portal vein thrombus should be considered an unusual cause of branching calcified intrahepatic mass on CT.


MR-guided focused ultrasound surgery.

MR-guided focused ultrasound surgery. Magnetic resonance guided focused ultrasound surgery provides a minimally invasive controlled method for selectively destroying deep-lying tissue. A thermal analysis of focused ultrasound provides an estimate of the time-dependent temperature distribution and thermal dose required for ultrasound surgery. The temperature distribution is estimated by accumulating heat sources, considering the effects of thermal conductivity, heat content, and perfusion. In this study, both gel phantoms and excised in vitro bovine muscle specimens were imaged in a 1.5 T MR system while heated with a 5 cm diameter, 10 cm focal length, 1.1 MHz transducer. During sonication, the thermal effects were observed with T1-weighted pulse sequences. Below a critical temperature, the heat zone appeared as a dark spot that moved with the focal spot. Above a critical thermal dose, the in vitro tissue was irreversibly altered and the focal lesion was observed on both the MR image and the specimen slice.


Primary extraosseous pulmonary osteogenic sarcoma: CT findings. This is a report of a primary extraosseous osteogenic sarcoma of the lung. The patient presented with fever and productive cough. Chest radiography and CT showed a cavitary lesion with an air-fluid level. The lesion was treated as an abscess. Despite aggressive antibiotic therapy and drainage, the patient continued to deteriorate rapidly. At autopsy the lesion was found to be a primary extraosseous pulmonary osteogenic sarcoma.


Inflammatory pseudotumor of the spleen: MR findings. Inflammatory pseudotumor of the spleen is an unusual lesion often mistaken preoperatively for other masses. Isolated inflammatory pseudotumors of the spleen are rare. We report a proven case examined with ultrasound, CT, single photon emission CT, and MRI.


Intrapancreatic accessory spleen mimicking pancreatic mass on CT. Accessory spleens occur in approximately 10% of the population and are usually located in the region of the splenic hilum. In 16% of patients the accessory spleen will be located within the pancreatic tail. The diagnosis of an intrapancreatic accessory spleen can be suggested when CT, with and without intravenous contrast agent, demonstrates that the mass enhances in a manner identical to the spleen.


Amyloid deposition in seminal vesicles mimicking tumor invasion from bladder cancer: MR findings. Amyloid deposition in the seminal vesicle is a not unusual finding at autopsy. A case of MR findings of amyloid deposition in the seminal vesicles with urinary bladder cancer is reported. Invasion of the seminal vesicle could not be excluded on T2-weighted imaging, but gadopentetate dimeglumine may be useful in its ability to differentiate amyloid deposition from seminal vesicle tumor invasion.


Gastroschisis: prenatal CT diagnosis.

Gastroschisis: prenatal CT diagnosis. The prenatal sonographic findings of gastroschisis are well defined. This report describes the CT appearance of fetal gastroschisis discovered as an incidental finding when a 25-year-old pregnant woman underwent CT for blunt abdominal trauma.


Program characteristics influencing nurse selection of CE offerings. The purpose of this study was to identify program characteristics that influence decision-making in the selection of continuing education (CE) offerings by registered nurses licensed in a state with mandatory CE. A sample of 238 nurses were asked to identify the level of importance for 35 CE program characteristics on a Likert-like scale. The data indicated that all characteristics were of some importance to participants, with high levels of importance given to items demonstrating professional values. The findings suggest that even though CE may be mandatory, nurses still select educational offerings on the basis of quality and contribution to their professional practice.


Nurses and adult educational philosophy: a comparison of nurses and non-nurses in a graduate adult education program. A sample of 90 students enrolled in a graduate program in adult education completed three instruments examining adult education philosophies during a related course. There were no significant differences between the nurse educators and the non-nurses on any of the three instruments or on any of their components. This finding contradicts previous research suggesting that nurse educators do not generally incorporate adult learning methods into their courses. Intercorrelations were computed among all the variables. One unanticipated finding was the significant relationship between age and congruence with adult learning principles.


Ten common-sense teaching strategies for effective inservice presentation by staff nurses. Staff nurses are currently being given the opportunity to present inservice offerings as a criterion for the professional performance evaluation. Unfortunately, staff nurses, even those with baccalaureate preparation, generally have not been prepared in strategies for effective teaching. Consequently, many staff nurses either avoid this opportunity altogether or may proceed with the "seat of the pants" approach, making learning a chance event. This article sets forth 10 common-sense teaching strategies for effective inservice education presentations with the goal of encouraging and empowering staff nurses to share their particular area of expertise with their peers.


Mutant p53 expression in solar keratosis: an immunohistochemical study. Thirty-eight solar keratoses from 32 patients were studied for expression of mutant p53 protein by an immunohistochemical technique. Twenty-eight of the 38 solar keratoses (73.7%) showed positive and variable nuclear labelling, whereas 10 specimens were immunonegative. The nuclear immunopositivity which was seen in all variants was mostly diffuse in distribution. The adjacent "normal" epidermis of 8 keratoses showed positive mutant p53 labelling. Eight of the keratoses were associated with invasive squamous cell carcinoma of which only two were immunopositive. Cytoplasmic labelling was never a feature. The study demonstrates that mutant p53 protein is commonly expressed in all variants of solar keratosis and that its expression correlates with atypical keratinocyte proliferation. It is proposed that the demonstration of mutant p53 in the adjacent normal epidermis may be a potential marker of early neoplastic transformation.


An overview of nursing ethics for nurse educators. Nursing ethics is a topic included in most health care institutions as a requirement for accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This article provides an overview of nursing ethics in a format that allows the reader to understand the basic principles while applying the information to daily work situations in a format for use in a classroom environment. The issue of dilemma recognition is addressed as well as mechanisms that may be used to facilitate dilemma resolution. Information is also provided for use in the development of skills in ethical decision-making.


A comparison of educational methods to enhance nursing performance in pain assessment. The purpose of this study was to identify an effective method of teaching nurses to assess and document pain severity using a numerical rating scale prior to narcotic administration. Nurses received a combination of educational methods. Although overall nurse performance using the pain scale was low, nurses receiving video were significantly more likely to use the scale, a finding that remained significant after controlling for nurses' education and years of experience, and for patient age and acuity.


Immunohistochemical distribution of aromatase and 3B-hydroxysteroid dehydrogenase in human hair follicle and sebaceous gland. Human hair follicles (HF) and sebaceous glands (SG) were assessed for the presence and distribution of the cytochrome P-450-aromatase (AR) and 3B-hydroxysteroid dehydrogenase (3B-HSD) enzymes. Immunohistochemical methods were used to examine both enzymes in male and female human skin specimens at various ages and different body sites. AR was found in the external root sheath of anagen, terminal HF, and in SG, whereas the 3B-HSD was found only in the SG. AR was rarely found in telogen HF. The expression of both enzymes, AR and 3B-HSD, did not vary with body site or sex. Localizing AR in the external root sheath of anagen HF suggests that AR may have a function in the HF cycle. We hypothesize that AR may be one of many enzymes or factors that play a role in the HF cycle by regulating the level of androgens formed locally, whereas 3B-HSD is localized in SG, converting weak androgen precursors to potent androgens, stimulating lipogenesis.


Cutaneous manifestations of measles in AIDS. In immunocompetent patients, infection by the measles (rubeola) paramyxovirus produces fever, cough, coryza, Koplik's spots, and, on the skin, a macular erythema that can become confluent. The erythema has a striking cephalocaudal spread and clearing. The diagnosis of measles on a skin biopsy and the distinction from an erythema multiforme type of drug eruption can be difficult. We studied a skin biopsy from a patient with the acquired immunodeficiency syndrome (AIDS) who presented with measles. In contrast to erythema multiforme, the measles biopsy has necrosis of clusters of keratinocytes in the high spinous layer and granular layer of the epidermis, whereas erythema multiforme has necrosis of basal keratinocytes. Multinucleated keratinocytes may or may not be prominent in the measles biopsy. Cytoplasmic swelling of the keratinocytes in the granular layer may be present even when multinucleated cells are sparse. Immunoperoxidase reactivity for measles virus protein is present in intranuclear inclusions and in the cytoplasm of infected upper spinous keratinocytes. There were more cells with positive staining in the biopsy from the AIDS patient than in another biopsy from an immunocompetent patient with measles. The AIDS patient was seronegative for measles throughout the course of the illness. The examination of the skin biopsy can be very important in the diagnosis of measles in AIDS patients or immunocompromised patients who may not develop the usual diagnostic serology.


Organizational models and staff preparation: a survey of staff development departments. A national survey of staff development (SD) departments of hospitals was conducted to determine the organizational models (centralized, decentralized, or combination) used. The survey asked about departmental organization, instructor role, staff title, core responsibilities, percentage of work for various departments, SD department head and staff educational preparation, and demographic data. This article discusses the data obtained from the 48 responses (41%) that pertain to the organizational model (26 or 54% used combination model) and staff preparation (master's degree was most prevalent). The data and survey approach could be used by a SD department when choosing an organizational model.


Angiotropic malignant melanoma. Report of two cases. Two cases of malignant melanoma are described that showed focal perineural invasion and exhibited striking tropism for small and medium-sized vessels, primarily veins. The melanoma cells proliferated within the vessel walls, expanding and replacing the muscle layer but sparing the endothelia. Intravascular invasion was not seen. Immunohistochemical studies confirmed the pattern of growth within vessel walls and the integrity of their endothelia. In one of the cases, similar vascular tropism was encountered in a capsular vein from a regional lymph node. We propose the term "angiotropic malignant melanoma" for this phenomenon and suggest that angiotropism may be a rare mechanism for melanoma spread and progression.


Pleomorphic lipoma. Case report and discussion of "atypical" lipomatous tumors. A case of pleomorphic lipoma is described. Pleomorphic lipoma is included in the "atypical" lipoma classification. Because of its atypical microscopic appearance, it must be differentiated from liposarcoma. We will discuss pleomorphic lipoma and its position in the classification of atypical fatty tumors.


Multiple sclerotic fibromas of the skin. A cutaneous marker of Cowden's disease. Multiple hamartoma syndrome, or Cowden's disease, is a rare genodermatosis with multiple organ system involvement in which malignancy, particularly of breast and thyroid, may develop. Multiple trichilemmomas have been classically regarded as the cutaneous hallmark of this disease. We here emphasize multiple sclerotic fibromas of the skin as another specific cutaneous marker of this entity, which may also be helpful in an early diagnosis.


Long-term care nurses identify educational needs regarding quality assessment and improvement. An increasing demand is being placed on nurses who are practicing in long-term care settings to conduct and/or participate in quality assessment and improvement (QAI) activities. A local survey of directors of nursing in long-term care indicated both personal interest and interest on the part of their staff nurses to attend continuing education (CE) programs regarding quality of care to increase their competencies in this area. Specific interest areas and recommendations for an educational offering regarding quality assessment and improvement for long-term care nurses are described.


Biochemical activities of Bacillus species isolated from flat sour evaporated milk. Forty strains of bacilli were isolated from flat sour evaporated milk and were characterized as Bacillus stearothermophilus (5 strains), Bacillus licheniformis (10 strains), Bacillus coagulans (15 strains), Bacillus macerans (5 strains), and Bacillus subtilis (5 strains). The hydrolases of these strains were examined with the API ZYM system, and the ability of these strains to produce acid in milk incubated at different temperatures was also examined. Esterase, esterase lipase, lipase, valine aminopeptidase, phosphoamidase, beta-glucuronidase, and beta-glucosidase were the activities found in all strains tested; they were strain-dependent and ranged between 1 and 5 by the API ZYM test. The same strains produced various concentrations of acid in milk. These organisms may be responsible for the flat sour spoilage in evaporated milk.


Northern and in situ hybridization analyses of the effects of somatotropin on bovine mammary gene expression. We investigated the potential roles of insulin-like growth factor-I and epidermal growth factor, both multifunctional regulators of mammary physiology, in somatotropin-stimulated lactation of dairy cattle. One insulin-like growth factor-I mRNA (7.4 kb) was detected in lactating mammary tissue; however, it became undetectable after somatotropin administration. Four type I insulin-like growth factor receptor mRNA (11.3, 6.2, 4.9, and 3.3 kb) were detected in mammary tissue and primarily expressed in alveolar epithelial cells. All of these receptor mRNA markedly decreased in mammary tissue from somatotropin-treated animals, although the cellular distribution pattern of receptor gene expression did not change. One epidermal growth factor receptor mRNA (10.5 kb) was present in mammary tissue and predominantly expressed in alveolar epithelial cells. Epidermal growth factor receptor mRNA decreased after somatotropin administration. The results from this study are consistent with the idea that the stimulatory effect of somatotropin during lactation is in part due to its ability to regulate the expression of specific genes or the stability of their mRNA in mammary tissue. The data also suggest roles for insulin-like growth factor-I and epidermal growth factor, as well as their homologous receptors, in controlling cellular changes in the mammary gland during somatotropin-stimulated lactation.


Use of augmented cultural techniques in the diagnosis of the bacterial cause of clinical bovine mastitis. Preculture incubation, preculture freezing, and increased plate inoculation volumes were tested in an attempt to increase the recovery rate of pathogens in milk from cases of clinical bovine mastitis. Culture of milk from 291 cases of clinical bovine mastitis was performed using standard milk culture techniques (.01 ml of fresh milk streaked on trypticase soy agar plates with 5% sheep blood and .1% esculin). The sensitivity of this method was compared with that of cultures performed using augmented techniques: 4 and 18 h of preculture incubation; preculture freezing of samples overnight at -20 degrees C; and increasing the plate inoculation volume to .05 and .1 ml for fresh, incubated, and frozen samples. Preculture incubation and larger plate inoculation volumes significantly increased the recovery rate of bacterial pathogens over the standard culture method. The greatest improvement in sensitivity without a concomitant increase in contamination was achieved when samples were incubated for 4 h and plates were inoculated with .1 ml of the sample. Recovery was enhanced significantly by this method for several organisms, including environmental streptococci and coliform bacteria. Freezing milk before culture yielded a significantly higher positive culture rate overall, but freezing did not affect the positive culture rate of any individual bacterial species.


Effects of a prostaglandin F2 alpha synchronization program in lactating dairy cattle. A comparison was made between two different methods of reproductive management in the dairy cow. One protocol administered prostaglandin to open cows weekly; the other administered prostaglandin to open cows with a corpus luteum identified by rectal palpation. Survival analysis was used to analyze the data. Cows receiving weekly doses of prostaglandin had a 30% higher pregnancy rate (number of pregnancies per time) than the cows receiving prostaglandin based on rectal palpation of a corpus luteum. The average number of days to first insemination was shorter in cows given prostaglandin weekly.


Effects of voltages on cows over a complete lactation. 1. Milk yield and composition. The effect of long-term voltage exposure on milk yield and composition was assessed. Forty cows in second to fifth lactation were used. Four groups of 10 Holstein cows were exposed to either 0, 1, 2, or 4 V throughout an entire lactation. Each group was housed in a free-stall environment with bunk feed and water provided for ad libitum intake. Voltages (AC, 60 Hz) were applied between waterers and a metal grid. Cows could not drink without placing their front hooves on the metal grid. Individual records were maintained for milk weights, milk fat, protein, and somatic cell counts. Average actual (7312, 8527, 6938, and 7725 kg for groups exposed to 0, 1, 2, or 4 V, respectively) and mature equivalent (7802, 9281, 7308, and 8911 kg for groups exposed to 0, 1, 2, or 4 V, respectively) milk weights for 305 d showed no significant differences between groups exposed or unexposed to voltage. Average actual milk yields for 305 d in the previous lactations were 8016, 8163, 7679, and 7876 kg for groups exposed to 0, 1, 2, or 4 V, respectively. Somatic cell counts, milk fat, and protein showed no significant differences between groups exposed or unexposed to voltage. Feed and water intakes were not affected by voltage.


Effects of voltages on cows over a complete lactation. 2. Health and reproduction. For the effects of voltages on health and reproduction, 40 cows in second to fifth lactation were divided into four groups of 10. These included a control group that was not subjected to voltages and three treatment groups that were given either 1, 2, or 4 V at the water bowl. Cows in the treatment groups were exposed during the entire lactation to voltage whenever they drank. Voltages did not sufficiently affect milk yield. General health parameters studied were mastitis, hoof problems, and changes in body weight. Reproductive and calving parameters examined were days to first breeding, days open, services per conception, response to PGF2 alpha, calving intervals, visible abortion, and calves born dead. Voltages did not significantly influence cow health or reproductive performance.


Cow sensitivity to electricity during milking. Alternating currents were delivered to lactating cattle through the milk during milking. Electrodes were placed at the top of each short milk tube and jointed for one electrical contact. A metal grid on which the cows' rear hooves stood during milking was the second contact. Constant voltages (0 to 16 V) applied to contacts showed first lactation cows to be more sensitive than multiple lactation cows. First lactation cows kicked milking machines at 8 V (currents greater than 5 mA), and multiple lactation cows kicked at 16 V (currents greater than 8 mA). At lower voltages, there were no consistent significant differences in milking duration, milk yield, or composition for primary or residual milk. Application of constant currents of 5 mA for first lactation cows and 8 mA for multiple lactation cows produced no undesired behaviors but did result in some differences in production variables. Milking duration decreased during application of constant current to first lactation cows. Blood cortisol monitored in the multiple lactation cows during trial 2 showed a significant increase during milking but was equivalent or less during application of current. This study demonstrates that currents of 5 mA or less, delivered through the milk line, did not produce any direct economic effect. To produce this current, voltages on the milk pipe line would have to be in excess of 125 V (obvious human safety hazard) or in excess of 5 V on the claw of the milking cluster.


Evaluation of pearl millet and field peas plus triticale silages for midlactation dairy cows. A mixture of field peas and triticale was planted in spring, harvested as silage, and followed by a double crop of pearl millet, which also was harvested as silage. Eighteen Holstein cows were fed diets based on pea with triticale, pearl millet, or alfalfa plus corn silages. Dry matter digestibility of the pea with triticale diet was higher than for control (71.1 vs. 66.9%), but DM digestibility was not different between control and pearl millet diets. Milk production was not affected by diets containing pea with triticale or pearl millet compared with control diets (25.2, 23.2, and 24.5 kg/d). Cows fed pea with triticale produced milk with a higher concentration of fat (4.59 vs. 3.35%) and more FCM (27.3 vs. 22.1 kg/d) than those fed the control diet. However, cows fed the control diet gained more BW than those receiving pea with triticale or pearl millet diets. Partitioning of energy between body stores and milk production was different between cows fed pea with triticale and control diets; however, total energy use was not different (32.4 vs. 30.5 Mcal of NE(L)/d). Differences in energy partitioning may have been caused partly by differences in ruminal fermentation of the respective diets.


Dietary cation-anion balance and cation source effects on production and acid-base status of heat-stressed cows. Two 4 x 4 replicated Latin square studies, each containing 8 lactating Holstein cows, were conducted simultaneously in south Georgia during the summer. The effects of dietary cation source (Na or K) and increasing dietary cation-anion balance (milliequivalents of Na + K - Cl per kilogram of feed DM) within cation source (control = 120.4 meq/kg of feed DM; Na source = 219.7, 347.8, 464.1 meq/kg of feed DM; K source = 231.2, 352.6, 456.0 meq/kg of feed DM) were determined on performance and acid-base chemistry during hot, humid weather. Cow body temperatures were elevated by environmental conditions but were not affected by dietary cation-anion balance. Differences in body temperature from dietary cation source probably were related to differences in cow BW. Intake of DM increased linearly, but yields of milk and FCM did not change with increasing dietary cation-anion balance, and cation source had no effect. Milk fat and protein percentages were not altered by dietary cation-anion balance, and greater milk fat and protein percentages from cows offered the Na versus K source diets probably were due to differences between cows in the two Latin squares. Alterations in blood acid-base chemistry with increasing dietary cation-anion balance were as expected. Greater blood buffering capacity, indicated by blood base excess and bicarbonate content, may be responsible for the improved feed intake.


Effect of graded concentrations of gossypol on calf performance: toxicological and pathological considerations. The effects of feeding diets containing 0, 100, 200, 400, or 800 ppm of free gossypol were examined in 60 Holstein bull calves from 1 to 120 d of age. The concentrations of free gossypol were varied by varying amounts of cottonseed meals from three different sources. Cottonseed meal totaled 31% of each treatment ration. Feed consumption, BW, and blood parameters were collected on all calves at 30-d intervals throughout the trial. There were no significant differences between the groups for feed consumption, BW, or average daily gain. Changes in the group means for hematology and chemistry variables examined were modest and insufficient to distinguish diagnostically between safe and unsafe free gossypol concentrations for the different groups. Clinical evidence of disease was limited to the calves fed 400 or 800 ppm of free gossypol after 90 d of age. One calf in the group fed 400 ppm and 4 in the group fed 800 ppm died as a result of circulatory failure associated with gossypol consumption. We conclude from this study that a ration containing up to 200 ppm of free gossypol is safe, 400 ppm of free gossypol is toxic, and 800 ppm of free gossypol results in death losses. These results are compatible with previously reported naturally occurring toxicological outbreaks.


Estimation of heterogeneous variances using empirical Bayes methods: theoretical considerations. Procedures are described to estimate variances when heterogeneity of genetic and residual dispersion parameters exists for some criterion. Genetic and residual variances are considered to follow distributions with either known or unknown parameters. The estimates of variances obtained are weighted averages of the corresponding parameter and of a data-based statistic. Although the techniques presented are largely inspired by Bayesian ideas, the procedures can be given a frequentist interpretation, and the parameters of the prior distributions can be estimated from the data at hand. Techniques are described and illustrated for situations in which animals are related or unrelated across herds. We conjecture that the proposed estimators have smaller mean squared error than those obtained by grouping observations in some way and then applying REML within each group.


Estimation of heterogeneous within-herd variance components using empirical Bayes methods: a simulation study. Genetic evaluation using BLUP can accommodate heterogeneous variances if the necessary variance components are known; this may require estimation of variance components within each heterogeneous subclass. Properties of sire and residual variance estimates obtained by an empirical Bayes approach, which combines within-herd and prior estimates, were examined via simulation. Prior estimates were obtained using REML across herds, as if variances were homogeneous. Convergence was improved by incorporation of prior information such that variance component estimates could be obtained in within-herd situations for which a REML algorithm failed to converge. Accuracy of sire variance estimates was greatest when both within-herd and prior information were used, but improvement in accuracy of residual variance estimates associated with incorporation of prior information was minimal. Correlations between sires' standardized true transmitting abilities and PTA that used empirical Bayes variance estimates were larger than those obtained when heterogeneity was ignored. Proportions of sires selected, based on standardized PTA, from environments with differing genetic and residual variances became more uniform as the relative weight placed on within-herd data in variance estimation increased. Thus, useful variance component estimates can be obtained within individual herds by using empirical Bayes methods with across-herd estimates as prior information; this may allow prediction of breeding values that are less influenced by heterogeneous variances.


A method for combining United States and Canadian bull evaluations. Canadian and US genetic evaluations for July 1991 were combined for 3304 Holstein bulls evaluated in Canada that had US progeny or a cross-reference code. Canadian evaluations of the bulls and their sires and dams were converted to US PTA. Combined PTA were weighted averages of progeny information from both countries and parent average. Parent average was recomputed from the sire's combined evaluation and the dam's evaluation with the most daughter equivalents. Bulls were processed in birth year order so that combined evaluation of sire was available. Progeny contribution was adjusted to remove the influence of the bull's evaluation on progeny evaluations through their parent averages, which left only the portion that was due to progeny records and grandprogeny information. A weighted average of adjusted progeny contributions was combined with parent average to form a combined PTA more accurately than possible by averaging domestic and converted PTA. Combined reliability was computed by summing daughter equivalents from progeny and from updated evaluations of parents. Canadian daughter equivalents were multiplied by .9 to approximate US values. Combined evaluations simplify bull selection by providing comparable and complete information for bulls evaluated in two countries.


Timing of insemination in dairy heifers. Data representing 676 AI of 372 virgin dairy heifers during 1984 to 1987 at the University of Illinois were analyzed by analysis of variance to determine the effect of timing of AI on conception rate. Standing to be mounted, bawling, and attempting to mount were the three criteria used for determining the presence of estrus. More than 90% of the observations were conducted by one herdsperson between 0700 and 1600 h daily. Heifers were artificially inseminated with frozen semen from 58 bulls by one of two technicians. Conception rate on first AI was 56%, determined by return to estrus or 33- to 50-d rectal palpation for pregnancy. Conception rate to second and later AI was near 40%. Eighty-six percent of the heifers conceived during the trial. The average interval between first observation of standing estrus and AI was 10.5 h; the range was 15 min to 33 h. The model discussed contained six variables: time interval between first observation of standing estrus and AI (group), breed, sire within breed, year bred, season bred, and inseminator. The analysis of variance of conception to first AI showed timing of AI and service sire as the two most significant effects. Conception to first AI was worst when AI occurred 13.5 to 33 h after first observation of estrus. No factors considered were significant sources of variation for second or later AI.


Current status and potential of embryo transfer and reproductive technology in dairy cattle. Significant use of embryo transfer in dairy cattle commenced with the introduction of nonsurgical embryo recovery in the mid-1970s and developed with the use of nonsurgical transfers in the late 1970s. Numbers of registered Holstein calves from embryo transfer doubled yearly through 1980, after which the rate of increase slowed; the total reached nearly 19,000 calves in 1990. However, the efficacy of superovulation procedures and commercial success rates of transferred fresh embryos have not improved the past 10 to 15 yr. Fertilization rates in superovulated donors remain low. Although embryo-splitting techniques were perfected in the early 1980s, they are not used widely. A practical, commercial embryo-sexing procedure remains unavailable. Recent significant improvement is apparent in the technology of ultrasound-guided oocyte collection and in vitro oocyte maturation, fertilization, and embryo culture. In the future, this technology may be used in conjunction with sperm separated by sex with a flow cytometer. Modest numbers of embryo clones have been produced in several commercial programs via nuclear transfer techniques. However, the efficiency of gene transfer experiments involving ova of cattle and other domestic species has been low. Recently, DNA probe technology has begun to provide genotype information for cattle and will ultimately be applied to embryos.


Structure of breeding programs to capitalize on reproductive technology for genetic improvement. Potential rates of genetic progress are limited by biological constraints, which along with genetic parameters determine the structure of breeding programs to be employed for maximum genetic improvement. The objective here is to determine whether current progeny-testing programs in dairy cattle, which have been dictated and constrained by low female reproductive rates, need to be changed to capitalize on new reproductive technologies and how these changes should be implemented. Many differences between breeding programs diminish when selection on animal model genetic evaluations across all age and population groups is adopted as a strategy. Progeny-testing schemes then evolve toward dispersed open nucleus breeding schemes when multiple ovulation and embryo transfer is used on bull-dams. Nucleus breeding schemes have been advocated to capitalize on embryo transfer technology. In nucleus breeding schemes utilizing high reproductive rates, inbreeding, rather than reproductive rate, poses a limit to genetic progress, and strategies that maximize response to selection while limiting inbreeding need to be employed. One strategy is mating each dam to several sires rather than only one sire. In vitro embryo production techniques can be used to facilitate such mating strategies. Large-scale in vitro embryo production programs, in which large numbers of embryos per female are tested in the commercial population, offer the greatest potential for genetic gain with low rates of inbreeding. Cloning has an impact mainly on methods for dissemination of genetic improvement. Breeding herds, genetically inferior to marketed clones, are needed for continuous genetic gain. Reproductive technologies offer the potential for genetic improvement. Whether new breeding programs require changes in population structure, e.g., by creation of nucleus breeding herds, depends mainly on logistics and on quantity and quality of field information.


Use of reproductive technology to estimate variances and predict effects of gene interactions. Advanced reproductive techniques are creating the large numbers of close relatives needed to study gene interactions. Identical triplets, a set of 26 full sisters, a family of 4215 three-quarter sisters (same sire and maternal grandsire), a family of 76,698 half sisters, and 1.6 million granddaughters of Round Oak Rag Apple Elevation now have lactation records. Similarity of closest relatives might be explained by similar nonadditive as well as additive genetic merit. The 23,015 families of full sisters with mean family size of 3 provide nearly as much information about dominance variation as do the 55,779 families of three-quarter sisters with mean family size of 13; the 79 families of clones provide little information by comparison. Hypothetically, REML analysis of all US Holstein data could provide estimates of dominance and additive x additive variance with standard errors approximately 1% of phenotypic variance, but estimates of any higher order interactions would have standard errors greater than 10%. The tilde-hat approximation proved to be incompatible with animal models but was used for sire-maternal grandsire analysis of 765,868 first lactation records. Dominance variance was estimated as 3.5% of phenotypic variance for milk and 3.3% for fat with standard error of 4.2%. With constant data set size, variances are estimated most precisely if family sizes equal 1 plus ratio of within-family to between-family variance. An animal model evaluation including dominance relationships for 581,670 animals was computed, but gene interactions from distant ancestor pairs were ignored. Mating advice and improved additive predictions, especially for clones, could be obtained by including dominance in models.


Optimal effective population size for the global population of black and white dairy cattle. The replacement of other black and white cattle strains by the North American Holstein breed, which itself is dominated by a small number of elite sires, has reduced the genetic diversity of the global population. Intense selection on a global basis leads to rapid genetic improvement but reduces effective population size. The optimal global effective population size was chosen to maximize the net present value of all future benefits from the breeding program. Two separate discount rates were used to reflect concerns about the long-term costs of small effective population size. This led to a higher optimal number of bull-sires than in past analyses. The optimum was sensitive to the magnitude of inbreeding depression and to the discount rates, but not to the variance caused by new mutations and the size of the world population. The genetic correlation between the breeding objectives of different AI studs controls the extent to which they all select the same sires of sons and, hence, affects the global effective population size. The prediction is made that different countries will select partially different sires, but genetically isolated strains will not reemerge. A better global breeding program is likely when selection of sires takes account of inbreeding depression and small genotype by environment interactions.


Preventive measures and caries progression: an in vitro study on fissures and smooth surfaces of human molars. The aim of this study was to compare pit-and fissure sealants with fluoride treatments in their effectiveness to inhibit or reduce the progression of enamel lesions, particularly in the fissure region. The effects of fissure probing as used in diagnosis were compared with in the same protocol. Using a combination of image analysis of X-ray pictures of full crowns and a light microscopic evaluation of cross-sections provided information on the three dimensional spread of enamel demineralization. Pit-and-fissure sealants were superior in protecting enamel against progression of demineralization, as long as the walls of the fissures were well covered. The protection against demineralization offered by fluoride was mainly restricted to the smooth enamel surfaces; in fissures no protection could be measured. Surface defects of the enamel caused by probing or abrasion aided the progress of the lesion.


Hereditary dentinogenesis imperfecta: a treatment program using an overdenture. The aim of treatment in cases of dentinogenesis imperfecta is to improve the esthetic appearance and maintain the oral masticatory apparatus in a healthy and functional state. In the growing child, it was decided to maintain the teeth for as long as possible under an overdenture, until such time when a permanent prosthetic solution can be decided upon.


Sealing of occlusal hidden caries lesions: an alternative for curative treatment? The bacterial composition of the dentine of thirty molars with sealed occlusal surfaces (Delton tinted) was examined. Undiagnosed hidden caries was present at the time of treatment. Although clinically assessed as good (age 3.4 years, s.d. 2.1), 47 percent of the sealants had a marginal defect, when assessed with SEM. The dentine of the treated teeth was of a soft consistency. The median of the number of microorganisms was 400 (range 0-3.10(5)) cfu per sample. Mutans streptococci and lactobacilli were found in 53 percent of the samples. No relationship was found between the number of microorganisms and the marginal adaptation of the sealant, when examined under SEM; neither was a relationship found between the age of the sealant and the number of microorganisms (Kendall's Tau-C = 0.17, n.s. and -0.01, n.s., respectively). At present, there are insufficient grounds for treating nonvisible lesions (with a radiolucency on the bitewing) with a resin sealant.


Dental biomechanics and the dental curriculum. Attention is drawn to the numerous biomechanical concepts which provide the scientific basis for the many precepts taught in the various branches of clinical dentistry. It is suggested that dental biomechanics should logically be a subject area in its own right and that a practical way to achieve this would be for it to be gradually incorporated into the allied and complementary subject of dental materials science.


Increasing interest in pediatric dentistry? Increasing numbers of senior dental students anticipate careers in pediatric dentistry. A review is provided of the evolving dental student interests and some insight into these developments--particularly in terms of the increasing numbers of women in dental programs.


Teenage luxation injury: report of case. The endodontic, restorative, and orthodontic treatment sequence of the accidental injury of three maxillary incisors has been presented. The treatment objective was to achieve an esthetically acceptable result for a young adult, until a definitive fixed prosthetic restoration can be planned. The ankylosed maxillary right permanent central incisor (11) is being maintained for reasons of arch-length space and alveolar bone height.


Assessment of elderly people on entry to residential homes and continuing care arrangements. Increasing numbers of elderly people are entering private residential homes in the UK. Results of surveys show poor oral health in this group. A survey was therefore conducted of 50 residential homes (housing 1337 residents) to determine assessment on entry and continuing care provision. In 38 per cent of homes no written notes were made of the initial assessment. Topics of dental interests were infrequently assessed on entry (only 16 per cent of carers examined the oral cavity, 52 per cent assessed the subject's ability to care for their dentures). Medical topics (mobility, incontinence, eyesight, etc) were all assessed in more than 80 per cent of subjects. Suggestions are made for utilization of an easy assessment questionnaire and improved denture naming arrangements. The importance of regular check-ups, education and publicity for this group is stressed.


Finishing of amalgam restorations: a three-year clinical study. Class I and Class II amalgam restorations were placed in the permanent teeth of 66 patients, each of whom received a minimum of three restorations. At least one of these restorations was carved-only, at least one was immediately finished (using a prophylaxis paste on rubber cups at low speed, 8 or 10 min after trituration), and at least one restoration was polished (using finishing burs and polishing points, more than 24 h after placement). The number of restorations available for assessment of marginal fracture using the 11-unit photographic scale developed by Mahler was 253 at baseline, 249 at 1-year and 2-year recalls and 228 at the 3-year recall. Although polished restorations exhibited greater initial (baseline) marginal fracture, at 1-year, 2-year and 3-year recalls the restorations were found to exhibit a similar amount of marginal fracture regardless of the finishing technique. The amount of perceived marginal fracture increased steadily after 1 year. The immediate finishing of amalgam restorations showed no long-term benefit over the other techniques and has little to commend it. The clinical finishing of amalgam restorations is discussed in the light of this and other research.


Dental anxiety and attendance in the north-west of England. The aim of this study was to record the level of anxiety and last recorded visit for a dental check-up of a random sample of 300 workers at three sites in the North-west of England. All subjects were asked to complete a short written questionnaire and 255 (85 per cent) usable forms were returned. The mean level of anxiety using the Corah Dental Anxiety Scale (DAS) (N.L. Corah, 1969, J. Dent. Res. 48, 596) was 9.1. Females had a statistically higher mean DAS than males but there was no correlation between DAS and either age or occupational status. Those subjects who claimed not to have had a check-up in the past year had a significantly higher mean DAS than those who claimed to have been in the past year. Multiple regression analysis showed that the reported time interval since the last check-up was the most important predictor of the DAS score. The implications of the results are considered for the future of restorative dentistry.


Cardiopulmonary performance following changes in position and the administration of intravenous Diazemuls. Twenty healthy volunteers entered a study to assess cardiopulmonary responses, as measured by pulse oximetry, following changes in posture in the dental chair and the administration of Diazemuls (diazepam) in doses sufficient to instill sedation (up to a maximum dose of 20 mg) in the volunteers to a degree such that ptosis was seen. The results indicate that SaO2 values remained above 95 per cent throughout the study. It is concluded that although changes in SaO2 and pulse rate do occur, these differences are not important in healthy individuals, although they may be more serious in patients with pre-existing cardiopulmonary disease.


Predictions of restoration deterioration. This study evaluated the application of a mixture model involving a Weibull distribution function to predict the median times for restorations of three dental restorative materials to achieve unsatisfactory rating scores for six clinical factors. The accuracy of the method was assessed graphically against the known actuarial long-term deterioration observations of 1813 amalgam, 1774 anterior resin composite and 474 glass polyalkenoate (ionomer) cement restorations, assessed over periods of up to 20, 18 and 14 years, respectively. Of the six clinical factors investigated (which included marginal fracture), only four had sufficient long-term unsatisfactory rating score data to enable their median times to be predicted. These predicted times were: for amalgam restorations, surface roughness 32.5 years and surface tarnishing 16.0 years; for resin composites, marginal staining 25.4 years and colour mismatch 14.2 years; and for glass polyalkenoate (ionomer) cements, marginal staining 17.6 years and colour mismatch 3.6 years. The known and predictive unsatisfactory rating score results were generally in close agreement. However, it was not possible to predict median times for unsatisfactory rating scores associated with very slowly deteriorating restoration factors. The actual replacement rates of the amalgam restorations were too low to obtain their median survival time. However, for the faster failing resin composites this time was 7.9 +/- 0.5 years, and for the glass polyalkenoate (ionomer) cements 2.2 +/- 0.2 years. The relationship of restoration deterioration to restoration replacement and dental health requires further analysis.


Effect of APF gel on a glass ionomer cement: an SEM study. This SEM study evaluated the micromorphological effect of a 1.23 percent acidulated phosphate fluoridated gel (Oral B)(APF) on the surface of a glass ionomer cement (Ketac-Fil). Glass ionomer (GI) cylinders (area 6.69 mm) were prepared and divided into seven groups of ten specimens each: Group 1, glaze, no polishing; Group 2, glaze, polishing, glaze; Group 3, glaze, no polishing, APF for four minutes; Group 4, glaze, polish, glaze, APF for four minutes; Group 5, no glaze, no polish, APF for four minutes; Group 6, no glaze, polish, APF for four minutes; Group 7, glaze, polish, two coats of glaze, APF for four minutes. The glass ionomer was handled according to manufacturer's instructions, except for groups 5 and 6, where no glaze was used. Polishing was done with medium Sof-Lex discs, using slow-speed and water. The glaze resin (Ketac-Glaze) was painted with a brush over the GI surface and cured with visible light (Demetron) for thirty seconds. In Group 7, the first coat was cured and then the second coat was applied. The APF was applied with a cotton applicator for four minutes, rinsed, and dried. All specimens were then mounted on aluminum stubs, coated, and evaluated under the SEM. The results indicated that the glaze tends to contract or incorporate into the GI matrix in all groups. When APF was used over the GI, the amount of glaze remaining over the surface was diminished, exposing the GI surface. When two coats of the glaze were used, minimal GI surface was exposed after APF treatment.


The relationship of the changing structure of families and the health of children. The changing family structure impacts on the physical and mental health, emotional state and academic performance of children. Children reared in other than a family with both biological parents have increased difficulties. Pediatric dentists will need to consider these realities in their treatment of an increasing diverse population of children.


A preliminary investigation into the effect of increased occlusal vertical dimension on mandibular movement during speech. Current methods of determining whether a patient will accommodate to an increased occlusal vertical dimension rely on a largely subjective assessment of the mandibular rest position and capacity to adapt whilst wearing a temporary appliance. The purpose of this preliminary study was to establish if mandibular movement during speech may provide an objective criterion in the assessment of adaptation to increases in occlusal vertical dimension. The closest speaking space, measured as the vertical distance between an incisor point and centric occlusion, as determined during pronunciation of sibilant speech sounds was chosen to depict mandibular movement. The closest speaking space was determined using a Sirognathograph for six young adult subjects and varied from a mean of 1.0 to 3.3 mm. An acrylic splint covering the entire occlusal surface of the lower arch, designed to increase the occlusal vertical dimension by 4 mm in the incisor region, was then cemented on each subject's mandibular arch. The closest speaking space was again determined after 5 days continuous wear of the splint and the mean values found to have decreased to a range of 0.0-1.0 mm. The differences between the mean values for the closest speaking space for each subject before and after splint wear were statistically significant. It was postulated that this method may lead towards an objective basis for deciding if patients will adapt to an increase in occlusal vertical dimension.


Dentine bonding agents--characteristic bond strength as a function of dentine depth. The tensile bond strength to dentine of four dentine bonding agents has been measured at various depths within dentine and the results analysed using Weibull analysis. There were significant differences in the bond strength values among the four products particularly with near-surface dentine. Despite the differences in chemical composition among the materials the trend of decreasing bond strength with increasing depth of dentine was common to them all. This suggests that the underlying mechanism of adhesion may be common to all four products despite their differing chemical compositions.


Caries preventive effect of high fluoride and xylitol containing dentifrices. Dental examinations were conducted in 1987 on 520 of the 753 children who fully participated in a three-year field-trial, 1983-1986, of the anticaries effect of dentifrices containing fluoride and xylitol. The prevalence of decayed (D), missing (M) and filled (F) permanent teeth differed significantly among the five treatment groups. Caries prevalence was inversely related to the level of fluoride, 1250, 2500 and 5000 ppm, in the dentifrice used, but was not associated with the presence or absence of 15 mg percent xylitol. The age, number of children, and number of erupted teeth were unequally dispersed among treatment groups. The DMF teeth scores showed non-normal distributions and nonhomogeneous variances. Following an exploratory scrutiny, the DMFT data were transformed to normal distributions for intra- and inter-treatment-group evaluation. All groups showed positive, significant regressions of DMF scores with the age of the children and an inverse significant regression with DMFT scores in relation to the fluoride content of the dentifrice under test.


The assessment of two oral sedation drug regimens in pediatric dental patients. Oral sedation remains a common method for managing uncooperative and/or extremely fearful pediatric patients requiring dental treatment. The purpose of this retrospective review is to report on the adverse reactions associated with the use of two oral sedation drug regimens commonly employed in pediatric dental patients. Of a combined total of 73 different patient records, 112 sedation cases from the pediatric dental program at the University of Alabama School of Dentistry were reviewed for this report. The two drug regimens were (1) chloral hydrate/promethazine and (2) meperidine/promethazine. Documentation was taken from the sedation cases, which included the following: (1) age, (2) weight, (3) the drug regimen and dosages, (4) the use of nitrous oxide, (5) the effectiveness rating of each sedation, and (6) adverse reactions. The adverse reactions included emesis and oxygen desaturation (hypoxemia) the latter being determined by the use of a pulse oximeter. The results of the study revealed that approximately 48 percent of the sedation cases with pulse oximetry recordings experienced mild to moderate hypoxemia, and in 6.2 percent of the cases, emesis occurred. The review and statistical analysis of the sedation ratings using the nonparametric analog of the t-test indicated no significant difference of effectiveness between the two drug regimens. This study shows that oxygen desaturation occurs frequently in pediatric dental patients being treated with conscious oral sedation techniques and that the prevalence of adverse reactions was similar for the drug regimens evaluated.


Close range photogrammetry--a clinical dental research tool. Photogrammetry is the art, science and technology of obtaining reliable information about physical objects through processes of recording and interpreting photographic images. This review outlines the principles of the technique and summarizes the various methodologies and applications in clinical dental research.


Bonding characteristics of a phosphonated anaerobic adhesive to amalgam. The shear bond strength of a phosphonated anaerobic resin dental adhesive (Panavia-Ex) to amalgam was determined and clinically important parameters affecting the bond strength: amalgam type, surface finish and corrosion, were investigated. It is possible to bond to high copper set amalgam using this adhesive with a clinically useful shear bond strength. Three copper-enriched, single composition alloys were studied. One was a spherical alloy and two were lathe cut. The bond strength to one of the lathe-cut alloys was significantly lower than to the other two alloys. A significantly higher bond strength to aged lathe-cut amalgam than to fresh amalgam was found. However, Weibull analysis indicated that these latter changes were less consistent and indicated patchy, localized changes in the amalgam surface. The bond strength to the spherical alloy was significantly reduced by polishing with a finishing bur or Prophy-Jet. Therefore when bonding to a large amalgam restoration with such a phosphonated anaerobic adhesive, no polishing of the amalgam should be undertaken.


A denture base resin with low water absorption. The aim of this study was to investigate poly(isobutyl methacrylate) as a potential denture base material. It was found to have very low water absorption but poor mechanical properties and a low glass transition temperature. The latter features render the material itself unsuitable for use as a denture base material, but indicated that isobutyl methacrylate may be a useful co-monomer for reducing water absorption.


The continuing education business.

The continuing education business. The success and potential of school-based continuing dental education programs has been limited because they are based on an inappropriate model. The information needs of practicing professionals are quite different from the needs of students preparing for licensure. This article describes four purposes served by information: (a) education, (b) certification, (c) network building, and (d) decision support. Dental education focuses on the first two while a broader view with emphasis on the latter two is appropriate for continuing education. The business of educating professionals is different from the business of educating candidates for the profession. An alternative conception of continuing dental education is presented based on the needs of its clients.


Setting a standard on the pilot National Board Dental Examination. Norm-referenced and criterion-referenced approaches to setting a standard, or minimum passing score, were used with the pilot Part II National Board Dental Examination. The criterion-referenced approach used with the pilot is based on the Rasch measurement model. The standards and associated failure rates were found to be similar for both approaches. These findings as well as the advantages associated with using the Rasch model suggest that this criterion-referenced approach to setting a standard on the restructured Part II examination is appropriate.


Dental students' self-assessed competence in geriatric dentistry. This study measured the self-assessed confidence levels of four classes of dental students (n = 172) exposed to both didactic and clinical training regarding geriatric patients. It was found that after completing a two-term (20-week) didactic course in their junior year, and a five-week clinical course with geriatric patients in their senior year, dental students graduating from this university between 1987 and 1990 perceived significant improvements in their abilities to manage geriatric patients in all areas assessed, most notably in their treatment planning skills, in coordinating preventive dentistry programs, in referring patients to appropriate community resources, and in providing dental care in alternative settings. Greatest self-assessed improvements were exhibited between pre-didactic and post-didactic assessments, with a tendency to stabilize rather than improve after the clinical experience. Interestingly, this study found that the students' self-assessed changes between post-didactic training and post-clinical training were significant in only one area--their ability to manage the medical emergencies of elderly patients, including a patient's death in the dental chair. No differences were found between students who completed the clinical course early in their senior year with those who took it later; nor did differences emerge among the four classes. Clinical teaching in geriatrics may be an opportunity to practice skills and reinforce knowledge that has been gained in didactic courses, not necessarily a place to enhance perceived competence.


Determinants of dentists' geographic distribution. Practice location may have greater economic importance today for dental students and dentists who are considering relocation and/or expansion to new sites than in the past. Yet, a literature review easily leads to the inference that practice location decisions are far too complicated and individualistic for there to be any systematic pattern of dentists' geographic distribution. This paper specifies and estimates an economic model that attempts to explain the distribution of dentists in particular market areas in the state of Connecticut and to test the hypothesis that the distribution, rather than exhibiting randomness, adheres to the prediction of theory. The findings show that the geographic distribution of dentists is significantly related to a few key variables. Given these results, and because this model can be applied to other areas and uses data that are readily available for any market area, it may be useful for educators involved in helping dental students with their practice location decisions.


Instrument effects on smoothness discrimination. Dental and dental hygiene faculty must select instruments to be used for root surface evaluation during scaling and root planing procedures. Because little information has been reported comparing the effectiveness of various instruments for this task, selection is based on subjective opinions. This study examined differences in the ability of 30 experienced and 32 inexperienced dental hygiene clinicians to differentiate degrees of surface smoothness using five different dental instruments. The relative smoothness test consisted of a set of ten paired abrasive strips of different or the same grit size. Repeated measures ANOVA revealed significance for both main effects, instrument used and experience level. All subjects made more correct assessments with the Williams probe, 3A explorer and Moffitt-MD probe than with the #17 explorer. There was no significant difference between the 3CH explorer and the other four instruments. Experienced clinicians scored significantly higher than students on the relative smoothness test. Instrument selection could affect the end products achieved by clinicians, as well as affecting validity and reliability of current clinical evaluation mechanisms.


Trichloroacetic acid peel of molluscum contagiosum in immunocompromised patients. Seven human immunodeficiency virus-(HIV) positive patients with biopsy proved extensive facial molluscum contagiosum were treated with trichloroacetic acid peels. Peels were performed with 25 to 50% trichloroacetic acid (average 35%) and were repeated every 2 weeks as needed. A total of 15 peels were performed with an average reduction in lesion counts of 40.5% (range 0 to 90%). No spread of molluscum lesions, scarring, or secondary infection developed at 2 months' follow-up. Trichloroacetic acid peeling in concentrations of 35% or less appears to be a safe, effective, adjuvant therapy in the treatment of extensive molluscum contagiosum in immunocompromised patients.


EMLA. A new and effective topical anesthetic. A eutectic mixture of local anesthetics (EMLA) contains 2.5% lidocaine and 2.5% prilocaine in an oil and water emulsion and has been found to give effective, safe analgesia on normal and diseased skin, making it useful for numerous medical and surgical procedures, such as anesthesia for superficial surgery, split-thickness skin grafts, venipuncture, argon laser treatment, epilation, and debridement of infected ulcers. Other indications have included use in postherpetic neuralgia, hyperhidrosis, painful ulcers, and inhibition of itching and burning. To be effective, EMLA should ideally be applied to the desired area for at least 1 hour under an occlusive dressing. The medication has been approved since May 1991 in Canada for use on intact skin and has been available in Europe for many years. This study discusses the background, efficacy, and current and potential uses of EMLA.


Restoration of curved earlobe configuration with scar tissue advancement flap combined with second-intention wound healing. Reconstruction of earlobe curvature in a scar-deformed and displaced earlobe was accomplished by a combination of 1) hypertrophic scar debulking, 2) partial defect closure by scar tissue flap advancement to re-establish the cephalic extent of the neck at the infralobular crease, and 3) second-intention healing of the noncovered lower earlobe, preserving its surgically re-established curved configuration. Although this article specifically addresses scarring deformities of the earlobe, the same principles could be applied to congenital, noncicatricial tenting deformities.


Efficacy of double gloving as a protection against blood exposure in dermatologic surgery. Double gloving has been widely suggested as a means of decreasing exposure to blood and other body fluids. However, most dermatologists do not routinely follow this practice when performing surgical procedures because it reduces manual dexterity and increases costs. To determine whether double gloving should be routinely practiced in dermatologic surgery, pairs of sterile surgical gloves worn during weekly UCLA dermatologic surgery clinics were collected over a period of 3 months and examined for perforations. The procedures gloves were used for ranged from excision of benign lesions, lasting 15 minutes, to hair transplants, lasting 3 hours. Upon completion of the procedures, 8 (5.5%) of 144 pairs of single gloves, 2 (3.7%) of 54 pairs of double inner gloves, and 3 (5.5%) of 54 pairs of double outer gloves were found to have perforations. There were no instances of both the double outer and the double inner gloves having perforations when worn on the same hand. This suggests that double gloving offers a protective advantage by providing extra protection for both the surgeon and the patient during dermatologic surgery.


Dissecting folliculitis of the scalp. A case report of combined treatment using tissue expansion, radical excision, and isotretinoin. Dissecting folliculitis of the scalp can develop into an extensive, hypertrophic scarred lesion that is unresponsive to routine treatment. In these situations, radical excision of the affected area and concurrent perioperative treatment with isotretinoin (13-cis-retinoic acid) may be effective. The authors describe a case, illustrating the successful clinical application of this technique.


Predisposing factors of varicose and telangiectatic leg veins. Presented is an epidemiologic study on predisposing factors in telangiectatic and varicose leg veins on 500 female patients. Genetic predisposition, hyperestrogenemic states, standing vocations, and obesity were found to be the major predisposing factors. Recognition of these factors may help to prevent further progression of proliferative venous disease after sclerotherapy in susceptible individuals.


Influence of estrogens and progesterone on the venous system of the lower limbs in women. Treatments with estrogens and progestogens are suspected of causing vascular complications either directly or by metabolic consequences. Although many studies have demonstrated an increased incidence of arterial and deep venous thrombosis, since 1970 the dose of estrogens and progesterones have been lowered with a proportional lowering of side effects. After classification of estrogens and progestogens, we studied their peripheral vascular effects. In our study, we demonstrated that the effects of estroprogestogen treatment on the superficial venous system depend on the dose of estrogen and progestogen.


Recurrent varicose veins. Part 2: Injection of incompetent perforating veins using ultrasound guidance. Treatment options following duplex evaluation of recurrent varicose veins are discussed and a method of injecting incompetent perforating veins using ultrasound guidance is described. The results of duplex evaluation 6 months postinjection using this technique are presented. These early results indicate that sclerosant injection employing ultrasound guidance is an effective and safe method of treating incompetent perforating veins.


Modifications of electrosurgery electrodes. Dermatologists often find that electrosurgical electrodes that are commercially available do not always suit their specific clinical requirements. Some physicians modify electrodes to achieve specific electrosurgical effects. The more popular modifications have given rise to new varieties of commercially available electrodes.


Stents for nasal vestibule.

Stents for nasal vestibule. A method employing vinyl polysiloxane and polyethylene chemical tubing to make nasal stents is described. Vinyl polysiloxane stents, when well molded, are comfortable and easily tolerated. The technique has been useful for maintaining patent nares and enhancing graft viability.


Running vertical mattress suturing technique. The running vertical mattress suturing technique is a quick and simple method of providing skin edge eversion that is equivalent to the simple vertical mattress technique. The running stitch is relatively easy to master and provides excellent apposition of wound edges.


Iontophoretic administration of lidocaine anesthesia in office practice. An appraisal. Obtaining anesthesia for dermatologic, office-based surgeries often involves the pain of needle stick and burning upon injection of local anesthetic agents. No truly effective method for obtaining painless anesthesia is well accepted in the United States. A study was carried out using iontophoresis of lidocaine with epinephrine to determine the practicality of this method of delivering local anesthesia prior to invasive procedures in dermatology offices. A two-center, open-label study was undertaken using iontophoretic administration of 4% lidocaine with epinephrine 1:50,000 before painful procedures occurring in the dermatologists' office. Ninety-four procedures in 64 patients were evaluated. Both patients and physicians recorded 51% of procedures as painless, 36% as minor (partial), and 14% causing moderate to severe pain. Iontophoretic local anesthesia was 80 to 100% effective for pain relief for injections, abrasions, laser surgery, and cautery; it was significantly less effective in effecting pain relief for dermal excisions. Iontophoretic administration of anesthesia is a useful adjunct to the armamentarium of dermatologists performing surgical procedures in their office.


Single hair transplantation using the Choi hair transplanter. A new procedure for single hair transplantation using the Choi hair transplanter is presented. This operation provides obvious cosmetic advantages in hairline refinement and the reconstruction of eyebrows, eyelashes, beards, and pubic escutcheon. The surgical technique is described in detail.


Primary cutaneous B-cell lymphoma. Diagnosis, treatment, and prognosis. An elderly woman with B-cell lymphoma confined to the skin of the lower extremity was treated with combination chemotherapy and radiation therapy. She relapsed with new skin lesions outside the original radiation port that responded to additional radiation therapy and remains in remission 12 months after her last treatment. This article investigates the diagnosis, treatment, and prognosis of primary cutaneous B-cell lymphoma. The relevant literature was researched through computer data bases and bibliographies. Patients who present with localized lesions of primary cutaneous B-cell lymphoma have a favorable prognosis regardless of the type of therapy, although relapses may occur in the absence of systemic disease. We advocate the use of local therapies as initial treatment in patients with localized primary cutaneous B-cell lymphoma.


Deoxyribonucleic acid (DNA) ploidy and proliferative characteristics of metastatic squamous cell carcinoma determined by flow cytometric analysis. The deoxyribonucleic acid (DNA) index and the proliferative index (the fraction of cells in the S phase) can be independent prognostic indicators of the biologic aggressiveness of certain malignant neoplasms. To determine whether the DNA index or proliferative index could predict metastases in cutaneous squamous cell carcinoma. Nineteen different metastases from 15 patients with primary cutaneous squamous cell carcinoma (SCC) were reviewed, graded, and had DNA proliferative indexing performed by fluorescent activated cytometry. A control group of 13 patients with primary cutaneous SCC without metastases were studied in a similar manner. No significant difference between the metastatic and the nonmetastatic SCC groups for either DNA index or proliferative index (non-paired t-test) was observed. No correlative association with histologic grading with DNA index or proliferative index was observed for either group. We conclude that aneuploidy and S-phase fraction by fluorescent activated cytometry are not significant predictors of potential metastases in cutaneous squamous cell carcinoma.


Microlipoinjection for the elevation of depressed full-thickness skin grafts on the nose. Full-thickness skin grafts on the dorsum of the nose may heal depressed and might benefit from elevation. Microlipoinjection has been used to elevate depressed tissue; however, the long-term persistence of the augmentation is questioned. To determine whether microlipoinjection beneath depressed full-thickness grafts on the dorsum of the nose can provide effective and persistent graft elevation. Microlipoinjection was performed at one to three sessions under depressed full-thickness skin grafts on the nose of four patients. Their appearance was assessed clinically and photographically for the amount of correction at their last postmicrolipoinjection visit. All four patients had clinically significant elevation of their full-thickness skin graft. In the two patients followed for over 3 years, significant augmentation persisted. Microlipoinjection can provide cosmetically useful soft tissue augmentation under depressed full-thickness skin grafts; this augmentation can persist.


The importance of bicarbonate in large volume anesthetic preparations. Revisiting the tumescent formula. The tumescent local anesthetic approach is now being used more widely in dermatologic surgery. Although the original formula contains 12.5 mEq sodium bicarbonate per 50 mL of lidocaine, traditionally buffered solutions contain 1 mEq per 10 mL. This study examines the effects of changing the concentrations of sodium bicarbonate in the tumescent formula. Various concentrations of sodium bicarbonate in tumescent anesthetic preparations were measured for pH. Tumescent anesthetic preparations containing 5 mEq/L have a more physiologic pH (7.41) than the classic formula of 12.5 mEq/L (7.73). Clinical use of this reduced sodium bicarbonate solution showed no difference from the original formula. Sodium bicarbonate can be used in a 1 mEq per 10 mL of lidocaine ratio similar to other buffered anesthetic solutions. This solution is physiologic in pH. However, some thought should also be given to the pKa of lidocaine, which is at pH 7.9. To achieve this even higher concentration (20 mEq/L) bicarbonate must be added to the tumescent solution. Thought must be given to these concepts when tumescent solutions are used in large volumes.


Scar wars strategies. Target collagen.

Scar wars strategies. Target collagen. Hypertrophic scarring and keloid formation are clinical problems with effectively limited solutions. Although numerous methods have been devised to combat them, this article focuses on promising pharmacologic strategies that target collagen metabolism. Laboratory investigations of amino-acid analogs, procollagen peptides, D-penicillamine, and pentoxifylline have demonstrated them to be effective inhibitors of collagen synthesis in cultured cells and/or in animal models. Clinical trials of intralesional administration of interferons have shown impressive reductions in the size and collagen production of keloids. Furthermore, interference of extracellular matrix-enhancing cytokines, such as TGF-beta, may be an effective solution to keloids and hypertrophic scars. Additional research of soluble cytokine receptors, autoantibodies to cytokines, cytokine receptor antagonists, and cytokine-binding molecules may lead to the development of better therapeutic agents.


The postoperative use of wound adhesives. Gum mastic versus benzoin, USP. Our results, combined with the work of previous authors, show that gum mastic not only offers superior adhesive qualities compared with benzoin, USP but also has a lower incidence of postoperative contact dermatitis and subsequent skin discoloration. In light of the widespread use of surgical adhesives, this study is important in documenting the low incidence of complications and the advantages of gum mastic compared with benzoin, USP.


Modified electrosurgical adapters.

Modified electrosurgical adapters. Allegedly because of concerns over worker safety in removing spent needles from the Bernsco adapter a new, modified Luer-lok adapter has been introduced by the manufacturer. However, the new adapter frequently holds needles too loosely. To introduce a modification of the original adapter design. The end to be inserted into the needle hub was hollowed and trisected to allow flexibility of the phalanges. A small hole is drilled in the distal shaft to allow the placement of a spiral wire, allowing a snug fit even in older, well used electrosurgical handles. The modified electrosurgical adapter may facilitate needle removal and increase surety of fit with most electrosurgical handles.


Alginates. A "new" dressing alternative. Currently, a wide variety of bio-occlusive dressing materials are available. In general, these dressing materials provide a moist wound healing environment that has been shown to promote healing in both human and animal studies. To effectively use these dressings the clinician must have a full understanding of the properties of the materials as well as the pathophysiology of the particular wound. Most recently, a "new" biosynthetic dressing material, the alginates, has become available. To highlight proper use of alginate dressings for the management of acute and chronic wounds. Case study and literature review. Alginates were shown to be effective in a wide variety of acute and chronic wounds. Alginates possess several unique properties that should prove useful to the dermatologic surgeon as well as the dermatologist. Proper patient selection and use of this "new" dressing material, as well as a review of the literature is presented.


The paramedian scalp reduction with posterior Z-plasty. A technique to minimize the "slot" defect. One consistent and undesired sequela resulting from scalp reductions has been the "slot" or "trough" defect, referring to the scar following the final reduction. Attempts to correct this have not been entirely satisfactory. To present an approach to minimize the "slot" defect that consists of staged modified paramedian scalp reductions combined with a large posterior Z-plasty during the final reduction. A paramedian crescent-shaped ellipse was marked onto the patient's scalp parallel and adjacent to the existing fringe hair. Subsequent reductions were performed in a similar manner approximately 2 months apart. The final reduction consisted of mobilization and transposition of the large flaps used in the posterior Z-plasty. Patients who underwent the staged modified paramedian reductions combined with a posterior Z-plasty had significant minimization and adequate camouflage of the undesirable "slot." Combining a large posterior Z-plasty with a paramedian reduction minimizes the slot defect.


Fixed-tissue micrographic surgery in the treatment of cutaneous melanoma. An overlooked cancer treatment strategy. Many physicians have overlooked the value of adding zinc chloride tissue fixation prior to Mohs micrographic surgery, partly because of the absence of randomized clinical comparison trials. Nevertheless, historic control data indicate a survival benefit in the treatment of cutaneous melanoma. Three possible mechanisms are: 1) prevention of release of viable cells into circulation during surgery, 2) avoidance of disruption of clinically invisible satellite deposits, and 3) stimulation of a local inflammatory reaction and possible immune response.


Eyelid anatomy.

Eyelid anatomy. The following anatomic information concerning the complex structure of the eyelids is distilled from gross and histologic study as well as surgical experience. Our aim is to familiarize the reader with eyelid anatomy. Appropriate shape, contour, height and mobility of the lids are essential to adequate protection and function of the eyes as well as overall appearance. A thorough understanding of eyelid anatomy is therefore necessary to achieve optimal surgical results. For the purpose of this discussion the eyelids can be divided into the following structural planes: 1) skin and subcutaneous tissue; 2) orbicularis muscle and submuscular fibroadipose layer; 3) orbital septum; 4) preaponeurotic fat; 5) eyelid retractors; and 6) the tarsi and conjunctiva.


Oculoplastic surgery. An overview.

Oculoplastic surgery. An overview. BACKGROUND. The interface between the subspecialties of dermatologic surgery and oculoplastic surgery is broad. However, there are many commonly seen oculoplastic conditions that are not foremost in the mind of the dermatologic surgeon. OBJECTIVES. Common oculoplastic problems are detailed in this article and should provide the reader with a basis for understanding the wide spectrum of oculoplastic problems encountered in practice.


Lumps and bumps of the eyelids and their management. Tumors of the eyelids, because of their location and variety, can present management problems. To describe tumors of the eyelid, their identification, and their management. All tumors and inflammations of the lids, except those that are easily diagnosed, should be biopsied and sent for histologic administration.


Benign eyelid lesions.

Benign eyelid lesions. Benign eyelid lesions include a diverse group of tumors, infections, and degenerative lesions that require specialized care for identification and treatment. Diagnosis of benign eyelid lesions based on their clinical characteristics with pathological confirmation by biopsy where indicated. Clinical evaluation, biopsy, and treatment with medication, surgery, and laser surgery are utilized. Improvement or complete resolution of these eyelid lesions is possible. Special care is necessary to avoid ocular complications that could compromise vision, comfort, and cosmesis.


Malignant lesions of the eyelids.

Malignant lesions of the eyelids. The ocular adnexal area contains virtually every tissue type; nearly any type of malignant tumor may develop in this area. However, the vast majority of malignant eyelid tumors are carcinomas. Three types of carcinomas produce most of the malignancies in this group. They are: basal cell carcinomas, squamous cell carcinomas, and sebaceous cell carcinomas. The management of these three tumors is discussed. A review of current treatment options for eyelid malignancies was performed. A summary of the current treatment of the three most common eyelid carcinomas is discussed. With early recognition and appropriate management of eyelid malignancies, an extremely favorable prognosis can be obtained. The management is twofold and consists of curing the patient of the malignancy and then restoring the form and function of the eyelid in order to save the eye if possible.


Closure of eyelid defects.

Closure of eyelid defects. Repair of eyelid defects can be achieved by an array of procedures. To provide a basic approach to repairing eyelid defects. Defects are categorized by size. The method of repair for each defect is described. By selecting the proper method of closure, with due consideration of the size, location, and configuration of the defect, the cutaneous surgeon can repair eyelid defects whilst maintaining the best possible function and cosmetic appearance.


Periocular flaps.

Periocular flaps. Most flaps used in periocular reconstruction are random pattern flaps. To discuss the principles of periocular flaps as they relate to oculoplastic surgery, with an emphasis on reconstruction of the eyelids and ocular adnexa. The advantages, disadvantages, and techniques of reconstruction are reviewed. The ability to conceptualize and utilize flaps in periocular surgery enormously extends the surgeon's capabilities to produce optimal results for the patient.


Lateral canthoplasty.

Lateral canthoplasty. BACKGROUND. Lateral canthoplasty is one of the most valuable procedures in ophthalmic plastic surgery and has a variety of indications. These include the repair of ectropion, paralytic lagophthalmos, and eyelid retraction. The procedure can also be used in the prevention of some of the above entities, in the delivery of orbital tumors, and is a valuable adjunct in lower blepharoplasty. The tarsal strip procedure is probably the most popular technique of horizontal shortening of the eyelid. OBJECTIVE. Indications for this procedure are reviewed. The technique as I perform it is described in detail.


Considerations in aesthetic eyelid surgery. Successful aesthetic eyelid surgery is based upon multiple complex factors that, when put together, yield a pleasing result. Beauty is inherently related to normal eyelid function and symmetry. To review the critical issues facing the aesthetic surgeon, and to propose a systematic method of assessing the patient preoperatively. This article first examines the general considerations for aesthetic eyelid surgery, followed by specific concerns within each anatomic area. The critical task in aesthetic eyelid surgery is to reconstitute or preserve the normal structure and function of the eyelids. This is especially true in the multicontoured areas. It is essential for the surgeon to define the problems in a hierarchal fashion, and plan the surgery accordingly. Thus, not all patients can achieve the desired results in one sitting. The goal of aesthetic surgery is to avoid the telltale signs of surgery and to help the patient attain a youthful and energetic appearance for his or her age bracket.


Upper eyelid blepharoplasty.

Upper eyelid blepharoplasty. The surgical removal of redundant upper eyelid skin along with the excision of prolapsed anterior orbital fat is one of the most popular elective cosmetic surgical procedures performed today. To provide a brief overview of patient selection and upper eyelid blepharoplasty technique. Through careful patient selection and preoperative evaluation in addition to a thorough knowledge of eyelid and orbital anatomy, good outcomes from upper eyelid blepharoplasty can be obtained.


Lower eyelid blepharoplasty.

Lower eyelid blepharoplasty. Lower eyelid blepharoplasty is a frequently performed procedure to reverse partially gravitational aging effects on eyelid tissues. Careful planning, proper execution, and appropriate management of potential postoperative complications will generally result in a happy and satisfied patient. However, in any surgical procedure that is primarily aesthetic in nature, the surgeon needs to be constantly aware of factors that may compromise the functional integrity of the eyelid. A patient with altered visual function or ocular discomfort is no longer primarily concerned about the final aesthetic appearance of even the most perfectly executed, technically correct blepharoplasty procedure. To describe the preoperative evaluation, surgical technique, and postoperative complications of lower eyelid blepharoplasty. Specific attention will be given to lower eyelid retraction and ectropion following blepharoplasty. Successful lower eyelid blepharoplasty surgery can be a source of both patient and physician satisfaction. As long as patient expectations are consistent with realistic surgical goals, lower eyelid blepharoplasty is an important aspect of overall facial aesthetic surgery.


The preseptal and the retroseptal approaches in transconjunctival blepharoplasty. Although transconjunctival blepharoplasty was first described in the beginning of this century, it did not start to become popular until recently. To describe the best approaches to transconjunctival blepharoplasty and their applications. There are two distinct approaches in this technique: the preseptal and the retroseptal. While not easier in execution, and at times it can be more difficult than the transcutaneous approach, the transconjunctival blepharoplasty has definite advantages. It belongs in the armamentarium of surgical procedures of all physicians performing cosmetic surgery.