Position change: effects on electrocardiograms in COPD patients. The effects of the supine and the 45 degrees angle position were tested for the effect of electrocardiograms of 28 COPD patients. No significant differences were found in five EKG parameters: AXIS, PR interval, QRS duration, QT interval, and diagnostic interpretation. A comfort scale was administered to the sample population. Most (89.2%, N = 25) of the patients preferred the 45 degrees angle position; 17.2% (N = 2) felt the supine position to be more comfortable. Implications for research, theory, and practice are discussed.


Important AMSUS anniversaries.

Important AMSUS anniversaries. The article discusses important upcoming anniversaries of the historical development of the modern day Association of Military Surgeons of the United States (AMSUS) and its medical journal Military Medicine. It does this through chronicling the successive, antecedent military medical and dental associations and their journals which amalgamated to form AMSUS. It follows the development of the Association and the journal from the oldest constituent society.


War crimes during the Persian Gulf War.

War crimes during the Persian Gulf War. Evidence of violations of the 1949 Geneva Conventions by Iraq's military personnel during Desert Shield and Desert Storm are described and adverse effects on the Kuwaiti health care delivery system are discussed. New diplomatic and military initiatives that include education and accountability are needed to ensure better compliance with international conventions designed to protect victims of war.


Exuberant local tissue reaction to intramuscular injection of nandrolone decanoate (Deca-Durabolin)--a steroid compound in a sesame seed oil base--mimicking soft tissue malignant tumors: a case report and review of the literature. We present an unusual pseudotumor that formed in reaction to self-administered intramuscular injections of an anabolic steroid, nandrolone decanoate (Deca-Durabolin) in a young soldier. The histopathologic features which closely mimicked several malignant neoplasms could have led to an incorrect diagnosis of malignancy and unnecessary extensive surgery. To our knowledge, this phenomenon has not been previously reported.


Successful treatment of multiple organ system failure in a wartime environment: a case report from Operation Desert Storm. Military weapons produce massive traumatic injuries. Multiple organ system failure can be expected to occur frequently as a result of such injuries. This case report from the recent conflict with Iraq is representative of wartime injuries and complications and the positive impact of modern intensive care capability on such injuries. Availability of critical care in future conflicts is essential.


The traumatic bone cyst: review of literature and report of two cases. The traumatic bone cyst, seen by clinicians both physician and dentist alike, is a well recognized yet poorly understood entity whose pathogenesis remains obscure. Generally asymptomatic, this lesion is most often found as an incidental finding on routine radiographic survey. Its diagnosis, however, is important to rule out more significant pathology. A brief review of pertinent literature and two new cases of traumatic bone cyst have been presented, including an infrequently reported case of traumatic bone cysts occurring bilaterally in the mandible.


Parapneumonic pleural effusions and empyemas: a plea for early drainage. Parapneumonic effusions are relatively common sequelae of pneumonias. Occasionally, parapneumonic effusions will lead to empyemas. If these fluid collections are not aggressively drained in a timely manner, they will become loculated, placing the patient at risk for septic complications. Two cases of parapneumonic empyemas with delayed drainage eventually requiring thoracotomy and decortication are presented. These cases illustrate the need for early, complete drainage of parapneumonic empyemas to avoid septic complications and unnecessary surgery.


Dermatobia hominis infestation: a case report. The hazards presented by the Central American tropical environment are myriad. We report a case of cutaneous myiasis caused by the human botfly, Dermatobia hominis, in a soldier who had participated in military operations in Central America. The clinical presentation, treatment, and unique life cycle of the human botfly is discussed.


[The atheromatous-fibrous plaque studied by cytofluorimetry]. Atherosclerosis is the most frequent disease in the majority of cardiovascular arteries. It is a complex disease with peculiar characteristics, including its principal localisation in the inner stratum of the artery (the intima). The paper examines 36 atherosclerotic lesions in elderly patients in which the presence of stenosing atherosclerotic plaque had been diagnosed. The presence of replicating DNA was demonstrated using flow cytometry together with a proliferative phenomenon within the fibrous-atherosclerotic plaque due to an hypothesised migration of smooth muscle cells inside the intima, leading to the final result, a gradual restriction of the arterial gauge and consequent alteration to blood flow. The plaques examined were localised at the bifurcation of the carotid artery, an area in which it is easier to find the physical and biochemical factors facilitating platelet adhesion, which together with other cells produce mitogenic activity since they release growth factors and create the conditions for the proliferation of fibrous tissue.


[Mitral prolapse and the ergometric findings]. In evaluating the significance of arrhythmias and ECG changes during exercise, 42 consecutive patients (pts) with mitral valve prolapse (MVP) underwent a symptom-limited cycloergometer Exercise Stress Test (EST) with load increase of 25 watts every 3 minutes. Eight patients (19%) were positive for anamnestic cardiopalm. The patients were divided in 2 groups, according to echocardiographic evidence of the MPV: group A (12 patients, mean age 32 +/- 13) with prolapse of one mitral leaflet and group B (30 patients, mean age 30 +/- 13) with prolapse of both mitral leaflets. Exercise duration doesn't differ significantly in the two groups. No arrhythmias during EST were found in group A, while arrhythmias were present in 6 patients (20%) in group B. A strong correlation was found between anamnestic cardiopalm and arrhythmias during EST (6/8 = 75%). Three of four patients (75%) with ST impairment during EST, showed at thallium myocardial scintigraphy a non reversible perfusion defect after exercise. These data showed a higher incidence of arrhythmias during EST in patients with MVP of both leaflets and good relationship with symptomatology of cardiopalm.


[In vitro and in vivo evaluation of the blood-biomaterial interaction]. The Authors, after a short description of the phenomena following the interaction between blood and biomaterials, take into consideration the different methods used in studying the in vitro, in vivo and ex vivo hemocompatibility, as well as the problems involved by each method and its contribution to the knowledge of hemocompatibility. The Authors report their experience on the in vitro study of the effects induced by some biomaterials on platelets and coagulation factors.


[Longevity in tetralogy of Fallot. The natural history of a 63-year-old man living without surgery]. We report the natural history, the clinical, radiological, echocardiographic and hemodynamic pattern of a living sixty-three year old man with tetralogy of Fallot and cyanosis since birth. We discuss the possible circulatory adaptations which allowed exceptional survival up to the seventh decade: it is the sixth case reported in the literature.


[Plasma-erythrocyte viscosity and evaluation of several pro- and anti-aggregating factors in NIDDM patients in metabolic decompensation state]. In NIDDM diabetic subjects, the microcirculatory damage shows a double aspect: an alteration of the vascular wall, particularly of the arteriolar capillary, and a hemorheological alteration at the level of the capillary district. In the microcirculation, because of the low velocity of the flow and the inverse relationship between capillary size and RBC diameter, the viscosity has an important role with its components: RBC viscosity and deformability. Even the erythrocyte aggregation has a key role as resultant of the attracting and repulsing forces, among which the plasma-RBC viscosity and the deformability play opposite role. Our method allows to evaluate the erythrocyte, the whole blood, the plasma and the plasma-RBC viscosity, and the deformability. Studies from this laboratory in NIDDM subjects show an increase in the blood viscosity, a decrease in the erythrocyte deformability and plasma-RBC viscosity. It is suggested that in microcirculatory district the flow reductions are particularly of hemorheological type and that the sludged blood is an "optical" phenomenon with poor meaning. We consider some hematological parameters, namely the Hgb A1c %, Hgb concentration, RBC count, MCV, etcetera.


[Recurrent bacterial endocarditis on mitral and aortic biological prostheses in young drug addicts. The role of transthoracic cardiac echo-Doppler in the diagnosis and assessment of postendocarditis dysfunction]. Bioprosthetic infective endocarditis is a very serious complication since both medical and surgical treatment is associated with a high mortality. We describe a case of a young drug addict who presented 3 recurrent episodes of bacterial endocarditis of mitral and aortic bioprosthetic valves, caused by different virulent germs. All 3 episodes were resolved by medical therapy, but the residual aortic bioprosthetic dysfunction was important and the patient died before surgical replacement. Which was not considered an emergency since the patient was asymptomatic, did not present heart failure and left ventricular function was preserved. Color-Doppler echocardiography permitted us to visualize the vegetations and to establish and follow the evolution of residual bioprosthetic dysfunction.


[Relations between plasma-erythrocyte viscosity factors and ESR]. The ESR is usually put in relationship: to the real density of the RBCs (erythrocytes) (difference between the RBC specific gravity and the plasma one), and to the resistance that the RBCs meet moving in a medium, which is due to the plasma viscosity and to the total external RBC surface. When the RBCs take shape of aggregates, their external surface is decreased and ESR increases. The most important plasma factor causing changes in ESR is the fibrinogen level followed by the plasma globulins and by the products arising from the tissue damage. The resistance that the RBCs meet moving in the plasma is well expressed by the measurement of the plasma-RBC viscosity considering that is inclusive of both factors that are the plasma viscosity and the external RBC surface. The plasma-RBC viscosity is the resultant of several factors: Fa = Fb - Fe - Fs - Fm, were: Fa is the resultant, Fb the attracting forces due to the proteic macromolecules, Fe the repulsing forces due the negative charges. Fs the repulsing forces due to the shear-stress, Fm the force which opposes itself against the surface tension of the aggregation; it depends on the RBC morphology and on the RBC rigidity. The ESR has been recently used like an index of the RBC aggregation. The Authors study the relationship between several hemorheological parameters and the ESR in infective and inflammatory processes.(ABSTRACT TRUNCATED AT 250 WORDS)


[The echocardiographic findings of cardiac rhabdomyomas in a female patient with tuberous sclerosis and Down's syndrome]. This report described the case of a patient with cardiac rhabdomyomas and tuberous sclerosis (TS), associated with Down's syndrome. Diagnosis of TS was made subsequently to sebaceus adenomas, peri-ungual fibromas and ash leaf macules, mental retardation, epilepsy, renal and cerebral calcification findings. Physical examination, ECG and Holter ECG monitoring revealed normal cardiac findings. Two dimensional echocardiography disclosed the presence of two areas of increased acoustic density; one of which was at the level of postero-medial papillar muscle and the second appeared to be adherent to ventricular septum. Left ventricular size, function and intracavitary blood flow were normal.


[High-resolution electrocardiography evaluation of late potentials. A comparison between Frank XYZ orthogonal leads and standard precordial electrocardiographic leads]. High-resolution electrocardiography has been used as a non-invasive method for the study of delayed potentials in order to evaluate the risk of the onset of ventricular arrhythmia first in ischaemic cardiopathy and then in various cardiopathies, generally using XYZ orthogonal derivations. The aim of this study was to compare the results obtained with those using standard precordial leads, in particular V4 and V6 leads. A group of 28 patients, males and females, aged between 15 and 55 years of age, was examined. All patients were suffering from different cardiopathies. Subjects with delayed right and left ventricular activation on the surface ECG tracing were excluded from the study. A 60-200 Hertz bandpass filter and time averaging of 300 consecutive complexes were used to analyse tracings. Dual recordings were performed for each patient. The following parameters were examined: total duration of filtered QRS complex and root-mean-square voltage of potentials in the last 40 msec of filtered QRS (RMS). In particular, the comparison between RMS using Frank's method and those obtained using V4 and V6 precordial leads provided a coefficient of correlation of r = 0.91 with p < 0.001 and r = 0.92 with p < 0.001 respectively, and the comparison between QRS obtained using the same method and that obtained using V4-V6 precordial leads gave a coefficient of correlation of R = 0.80, p < 0.001 and r = 0.77 and p < 0.001 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


[The ultrasonographic assessment of carotid plaques in relation to cerebral events and damage over 3 years]. Three hundred carotid plaques (stenosis 45 to 65%) in 300 asymptomatic patients were included into a follow-up study considering three ultrasound types of plaques: type 1, non echogenic; type 2 intermediate, partially echogenic and type 3 highly echogenic. Types 1 and 2 had regular contour/surface while type 3 was irregular and in some patients associated with ultrasonographic signs of ulceration and intra-plaque haemorrhage. Patients were clinically evaluated for 3 years, randomly selected subgroups were studied with cerebral CT or magnetic resonance (MR) scanning to evaluate brain damage. There were no signs of cerebral damage in type 1 plaque patients. The incidence of signs and symptoms were higher in type 2 and 3 plaque patients. This was associated with an increased incidence of CT lesions and an even higher incidence of MR lesions in plaque type 3. In conclusion type 3 plaques are associated both with more clinical problems and evidence of CT/MR brain damage. Furthermore MR reveals more brain lesions than CT.


[Diabetes and atherosclerosis: a follow-up echographic study of atherosclerotic carotid lesions]. A two years follow up on 105 diabetic patients and 50 normal subjects was carried out by high resolution real time echotomography, aiming to evaluate the prevalence and the evolutionary trends of carotid atherosclerotic plaques. The prevalence of atherosclerotic lesions was higher in diabetic patients than in normal subjects, and the most part of them showed an "intermediate" echographic pattern, minimal stenosis and regular surface. The results of the two years follow up indicate that the "soft" and the "hard" plaque types were those showing a more significant progression toward to the "mixed" type. "Hard" and "mixed" plaques, particularly those showing irregular surface, resulted most associated with higher degree of vessel stenosis. Four diabetic patients experienced three minor and one major ischemic events during the follow up; however all the patients had shown plaques with "intermediate" pattern, regular surface, and no signs of vessel stenosis progression. Further studies, performed for longer period of time with a higher number of patients are needed to evaluate the evolutionary trends of carotid plaques in diabetic patients and their relationship with clinical ischemic events.


[Reciprocating tachycardias in pregnancy. A clinical case report]. The paper describes the case of a patients suffering from a pre-excitation syndrome who underwent numerous episodes of reciprocal tachycardia during pregnancy. The clinical implications and various methods of therapy used are discussed.


Echocardiographic study in acromegalic patients. To assess left ventricular function in acromegaly, M-mode echocardiograms were obtained from 25 patients with acromegaly (A). Echocardiographic tracings of the septum, posterior wall and anterior mitral valve leaflet were analyzed by computer and compared with those of 25 age matched normal subjects (C). Acromegalic patients had a marked increase of the septum, posterior wall thickness and left ventricular muscular mass (p < 0.001). Furthermore, in A an increased change of left ventricular dimension during isovolumic relaxation period (IRP) (p < 0.001), e prolongation of the duration of the IRP (p < 0.001 and a reduction of the percentage dimension change during the rapid filling period (p < 0.01) were shown. We suggest that impairment of some aspects of diastolic function is common and may be the primary abnormality in left ventricular function in acromegaly.


[Ectopic atrial tachycardia persisting from childhood. Its conservative treatment and long-term follow-up]. Chronic ectopic atrial tachycardia in an uncommon form of arrhythmia which is rarely complicated by congestive cardiomyopathy, ictus, sudden death. This possibility has led many authors to ascertain the need of an aggressive diagnostic and therapeutic approach. In need of an aggressive diagnostic and therapeutic approach. In this study the Authors describe the case of one patient who, at the age of 10 years, presented this form of arrhythmia. Due to its benign aspects (relatively low rate, few symptoms, no signs of anatomic-functional heart deterioration), the authors chose a non-aggressive approach. The arrhythmia, which was persistent during the following 3 years, at puberty became intermittent. Now, 4 years later, the subject is asymptomatic and the arrhythmia is beginning to regress spontaneously.


[Electric alternans of QRS: its electrophysiologic significance in narrow QRS supraventricular paroxysmal tachycardia]. The results of 22 patient's transesophageal electrophysiologic studies were analyzed to value the meaning of QRS alternans during narrow QRS tachycardia. Standard ECG showed ventricular pre-excitation in eight patients. QRS alternans were in six of them: heart rate was included between 230 and 374 m/sec (301.8 +/- 42 m/sec); in the remaining 16 patients, heart rate was included between 240 and 450 m/sec (350.0 +/- 42 m/sec). Our findings suggest that QRS alternans is related to the rate of tachycardia rather than to the presence of an accessory pathway.


[An update on surgical laparoscopy].

[An update on surgical laparoscopy]. It is reported a 15-year research experience in the laparoscopic field. General and emergency surgery have been improved by new methods. Further scientific innovations, such as video-laparoscopes, fibrin glues, instruments for the performance of hemostasis, led to carry out real surgical operations, so that laparoscopy may be considered as an alternative method compared with traditional surgery.


[Congenital cysts of the liver. Their instrumental diagnosis and the indications for surgical treatment]. The authors report their experience of 8 cases of congenital cysts of the liver describing instrumental examinations used for diagnosis and different surgical operation performed. The Authors believe that the choice of surgical procedure, performed in symptomatic patients and large cysts, has to be according to different parameters as morphology and localization of the cysts and coexisting pathologies. Being non-malignant pathology, conservative surgery often avoids the complications of liver resection.


[Acute intestinal ischemia. Our experience]. Acute intestinal ischemia is a pathology which is relatively often encountered in elderly patients where the concomitance of other diseases make its prognosis more severe, especially since diagnosis is usually late. Laboratory tests and imaging techniques are not of great value to diagnosis since they do not provide pathognomonic data, but together with a careful anamnesis they contribute a series of findings which, taken as a whole, lead to the diagnosis of intestinal ischemia. The sole therapy is surgery--when still possible and the best results are obtained when surgery is performed at an early stage. The authors report a series of 12 cases of acute intestinal ischemia and underline the difficulty of diagnosing this subtle pathology and the advantages of aggressive surgical techniques.


[Intestinal occlusions in the elderly patient]. After reviewing the literature on this topic, the authors examine all patients admitted to the Institute of Surgical Pathology in Pavia with a diagnosis of intestinal occlusion from 1-1-1974 to 31-12-1990. Of these, only those aged over 65 were included in the study and were in turn subdivided into 3rd and 4th age groups. The etiopathogenesis of this disorder is also discussed, stressing that it may be non-neoplastic (Group I) or neoplastic (Group II). The treatment used is also examined (surgical in the majority of cases) together with postoperative complications occurring in these patients. From the results obtained it is concluded that the method used in the pre-, intra- and postoperative stages provided satisfactory results, also in relation to the postoperative mortality rate which relatively low compared to other published reports.


[Congenital diaphragmatic hernias].

[Congenital diaphragmatic hernias]. Based on their personal experience the authors affirm that if treated early congenital diaphragmatic hernia may be resolved provided no congenital anomalies are present. Pulmonary hypoplasia is secondary to the presence of viscera in the thorax, but excellent results can be obtained if early surgery is performed and provided negative-pressure thoracic drainage and correct anesthesia are ensured. Mortality is due to associated visceral malformations.


[Percutaneous needle aspiration biopsy in intrathoracic lesions]. The authors report their experience of transthoracic needle biopsy of the lung based on 68 consecutive cases from 1984 to 1990. In 55 cases significant data has been found: in 44 cases the diagnosis was exact, instead in other 11 cases it was only indicative. The overall complications were 11.7% and in particular were as follow: pneumothorax in 5 cases, hemoptysis in 2 cases and a temporary Horner syndrome in one case. The authors conclude by confirming the utility of transthoracic needle biopsy of intrathoracic tumors in which there is not other way to obtain a diagnosis. This technique is reliable and its complications can be disregarded.


[Drainage in surgery on the thyroid].

[Drainage in surgery on the thyroid]. The authors report their experience of 534 thyroid operations and underline the importance of neck drainage in this type of surgery. Drainage positioning is very important for the prevention and immediate indication of hemorrhaging complications. Some correct indications, like large goiters, hyperthyroidism, reoperation and the lack of vascular ligature, are considered and discussed.


[The influence of the clinical course and diagnosis on the length of surgical stays]. The length of stay (LOS) is one of the major determinants of rising costs in surgical patient care. We studied the timing of the diagnostic procedures performed in 323 surgical patients admitted to 8 surgical departments of a large hospital. Of these: 50 underwent gastrectomy, 28 colectomy, 90 biliary tract (BT) operation, 94 appendectomy and 61 saphenectomy. The average total and preoperative LOS were respectively 27 and 11 days in the gastrectomy group, 26 and 10 in the colectomy group, 10 and 4 in the appendectomy group, 20 and 11 in the BT group, 12 and 6 in the saphenectomy group. The LOS was not affected by the presence of a benign or malignant lesion in gastrectomy and colectomy. In the appendectomy and BT groups, patients admitted from the emergency room had a significantly lower total LOS when compared to elective admissions (8 vs 12 and 9 vs 21 days respectively, p < 0.01). The multiple regression model showed that global and preoperative LOS were influenced by the number of instrumental exams (contrastographic, endoscopic, echographic).


[The prevention of venous thromboembolism in Italy]. A questionnaire concerning the prophylaxis of venous thromboembolism was filled in by 326 surgical departments in Italy. In 58% the prophylaxis was routinely used and in 29% more than one method was used. The most used method of prevention was subcutaneous heparin followed by elastic compression. In 51% of the centers the prophylaxis was used only in high risk patients and in 22% it was not used at all. The most relevant risk factors in the development of thrombosis were considered age, tumors and obesity. Finally in a questionnaire sent to 350 vascular laboratories it was found that--according to the operators--76% of all documented thromboses were possibly consequent to surgical procedures (in 86% no prophylaxis had been used).


[A case of ureteral stenosis and ureterorectal fistula secondary to sigmoid diverticulitis]. The paper reports a case of ureteral [correction of urethral] stenosis with ureterorectal [correction of urethro-rectal] fistula due to diverticulitis of the sigmoid [correction of sigma] which resolved following reconstruction of the urinary tract by ureterocystostomy [correction of urethrocystotomy] using a modified version of Boari's technique, with satisfactory renal functional recovery. On the basis of an analysis of the literature, the authors comment on ureteral [correction of urethral] stenosis and its etiological diagnosis.


[Adrenal myelolipoma. A case report and review of the literature]. Myelolipoma is a rare benign neoplasm of the adrenal gland, histologically characterized by the presence of mature fat cells and bone marrow elements. In the international literature were reported 126 cases of adrenal myelolipoma surgically treated. The indications to surgical removal of this tumor are the presence of large symptomatic tumours, high risk of spontaneous haemorrhage, and suspicion of malignant neoplasms. The authors present a case of adrenal myelolipoma, preoperatively identified with an abdominal MNR, and surgically removed.


[Cervical thymic cysts. A clinical case report]. The presence of thymic residues in a laterocervical site is very rare, as is cystic degeneration. The paper reports the case of a six-year-old boy who presented a swelling in a left laterocervical site; preoperative tests (especially echography and fine needle aspiration) identified the cystic nature of the swelling which was then confirmed intraoperatively; histological test diagnosed a thymic cyst. The paper analyses the embryological, anatomopathological and clinical aspects of these formations and underlines the difficulty of making a differential diagnosis from other neck pathologies, especially branchial cysts. In conclusion, preoperative tests can only determine the cystic component but not the thymic origin of these formations which can only be confirmed by final histological tests.


Assessment of myocardial viability with 201Tl SPET and reinjection technique: a quantitative approach. The definition of viable myocardium after an acute myocardial infarction (MI) is important as it will determine which therapeutic option will be best for the patient. In 201Tl scintigraphy it has been shown that late redistribution (8-24 h) or reinjection may help to identify viable myocardium which does not appear to reperfuse on the 4 h redistribution image. In a prospective study 20 patients with a persistent defect seen on both stress and redistribution images were imaged after reinjection of 201Tl. On visual analysis a total of 180 segments were studied, 85 were normal, 18 reperfused at redistribution and a further nine (in six patients) after reinjection. Bull's-eye analysis at stress demonstrated a mean defect size of 279 pixels, S.D. +/- 74. After redistribution, there was no significant change in mean defect size (227 +/- 96 pixels). At reinjection, there was a significant reduction in mean defect size (189 +/- 107 pixels) (P < 0.05, paired 't'-test). Quantification shows a significant reduction in defect size between stress and reinjection. The use of the 201Tl reinjection technique in patients with a fixed perfusion deficit on stress and redistribution images improves the detection of viable myocardium and is to be preferred to a method of redistribution analysis alone.


Rapid myocardial perfusion imaging with 99Tcm-teboroxime and a three-headed SPECT system: a comparative study with 201Tl. 99Tcm-teboroxime is a new myocardial perfusion agent with a high first pass extraction and rapid myocardial washout. The usefulness of 99Tcm-teboroxime was evaluated for detection of myocardial ischaemia using a three-headed single photon emission tomography (SPECT) system which allows for rapid data acquisition. The subjects consisted of 14 patients, including seven with ischaemic heart disease, four with cardiomyopathy and three others. After the 99Tcm-teboroxime injection, dynamic data was collected every minute for 15 min with continuous rotation. High-quality SPECT images could be obtained by reconstructing the serial scans from 2 to 8 min. The sensitivity, specificity and accuracy of the 99Tcm-teboroxime study for the detection of the ischaemic region were not significantly different from those of the 201Tl study. Myocardial clearance was slow in the ischaemic lesion and in the myocardium of cardiomyopathy patients, while the coronary angiograms did not show any abnormality. These results therefore indicate that the rapid SPECT imaging and myocardial clearance of 99Tcm-teboroxime obtained with a three-headed SPECT system were useful for the detection of myocardial ischaemia.


Radiation doses from nuclear medicine patients to an imaging technologist: relation to ICRP recommendations for pregnant workers. The ICRP has now recommended that the dose limit to the surface of the mother's abdomen during the declared term of pregnancy is reduced to 2 mSv. Direct measurements of the radiation dose to technologists carrying out a variety of imaging studies were made. The average dose ranged from 0.3 micro Sv for a liver scan to 5.3 micro Sv for a brain scan. Using national data for the frequency of nuclear medicine studies, a weighted average figure of 1.5 micro Sv per study was derived. A technologist could therefore perform approximately eight imaging studies per day during the declared term of her pregnancy and remain within the proposed limit. Generally, there should be no need to alter a technologist's duties during her pregnancy, and these findings should be helpful in allaying any anxiety.


99Tcm-HMPAO-labelled leucocyte scintigraphy in suspected chronic osteomyelitis related to an orthopaedic device: clinical usefulness. Thirty-five patients with suspected chronic osteomyelitis related to an orthopaedic device had 50 99Tcm-HMPAO-labelled leucocyte scans (LS). The scan appearances were compared with the bacteriological or clinical results and gave a sensitivity and specificity of HMPAO-LS of 83 and 100%, respectively. Bacteriological examination is often inaccurate in the diagnosis of osteomyelitis and therefore we assessed the clinical utility of HMPAO-LS. When the clinical, biological and radiological data were clearly suggestive of osteomyelitis (16/50) LS was unhelpful or even misleading when falsely negative (3/16). When the clinical, biological and radiological data were poorly suggestive of osteomyelitis (20/50) or conflicting (14/50) LS was misleading in only one patient (false negative). It is concluded that HMPAO-LS should only be performed to assist in the diagnosis of chronic osteomyelitis when there is no preexisting strong suspicion based on clinical, biological and radiological signs.


Pulmonary granulocyte margination is increased in patients with inflammatory bowel disease. The pulmonary granulocyte content of the lung was quantified in patients with inflammatory bowel disease (IBD) after injection of 111In-labelled granulocytes and compared with patient controls, who, on the basis of their negative white cell scans, were not considered to have active inflammation. The mean ratios of lung:liver count rates per pixel on the posterior gamma camera image in patient controls was 0.34 (S.D. 0.16, n = 8) at 1-1.5 h after injection of the cells, and 0.29 (S.D. 0.14, n = 18) at 2-4 h. This ratio was higher in patients with active IBD at both imaging times: 0.45 (0.13, n = 13, P > 0.05) and 0.44 (0.1, n = 19, P < 0.001). Patients with inactive IBD also had increased ratios at both imaging times: 0.6 (0.14, n = 7, P < 0.01) and 0.54 (0.15, n = 12, P < 0.001), respectively. In a further group of 12 patients with active IBD, there was no correlation between the lung:liver ratio and the severity of the IBD as assessed by whole-body 111In retention at 4-6 days after labelled cell injection. These patients were treated for 3 weeks with an oral, non-absorbable corticosteroid, after which there was a significant decrease in disease activity but no significant change in the lung:liver ratio. Inflammatory bowel disease appears to be associated with abnormal pulmonary granulocyte accumulation. It is not apparently related to disease activity but may be the result of an associated pulmonary abnormality.


Quantification of regional cerebral blood flow (rCBF) using 99Tcm-HMPAO and SPECT: choice of the reference region. The effects of the choice of the reference region in determining the relative regional cerebral blood flow (rCBF) using 99Tcm-hexamethylpropylene amine oxime (HMPAO) single photon emission tomography (SPECT) have been studied in order to establish or exclude it as a cause of inconsistencies in these studies. Relative rCBF was estimated by normalizing the regional count densities to two reference regions, the cerebellum and the whole slice, in 35 patients with Alzheimer's disease (AD), 25 patients with chronic schizophrenia (SCH) and the same number of matched normal volunteers. The statistical significance of the differences in rCBF between patients and their matched normals varied in the two sets of rCBF data. Smaller differences were highly significant while some larger differences were of less significance with whole slice normalization. The results suggest that the choice of reference region is one of the causes resulting in discrepancies in the results from various centres. The need to use a standard reference region is indicated.


Gastro-oesophageal and bile reflux--simultaneous quantitative assessment with gastric and gallbladder emptying evaluation: clinical applicability of a new computerized gammagraphic method. The aim of this study was to develop a new computerized gammagraphic method to evaluate gastrooesophageal (GER), bileo-oesophageal (BER) and bileogastric reflux (BGR) simultaneously with gastric and gallbladder emptying: a long duration (60 min) and a dual energy detection (113Inm-sulphur colloid and 99Tcm-HIDA) test of the different refluxes during slow gastric emptying of an enteric feeding liquid meal. Forty patients with oesophagitis and 18 normal volunteers were evaluated. Good reproducibility of all the quantified parameters was found with r Spearman between 0.75 (P < 0.05) and 1.0 (P < 0.001). Patients with oesophagitis have a tendency for slower gastric emptying patterns (gastric emptying T1/2, GT1/2 P < 0.05). The calculated specificity for gallbladder emptying parameters was 77.8% for the gallbladder T1/2 BT1/2) and 94.4% for gallbladder residue at 60 min (BR60). The calculated accuracy for the GER index was 90%. The predictability for positive values was 95%, owing to a 90% sensitivity and 89% specificity. The predictability for negative values was 80%. The mean GER index in oesophagitis was greater than in controls (P < 0.001). The calculated specificity for BGR was 94.4% and reflux was detected in 12 out of 40 patients. The calculated specificity for BER was 83.3% for a '+' index and 94.4% for a '++' BER index. In 14 patients a positive BER index has been determined ('+' in three and '++' in 11 cases).(ABSTRACT TRUNCATED AT 250 WORDS)


Crossed cerebello-cerebral diaschisis: a SPECT study. A scintigraphic single photon emission computed tomographic (SPECT) evaluation of frontal perfusion alteration was performed in five patients with known cerebellar lesions but with normal supratentorial computed tomographic (CT) or magnetic resonance (MR) scans. A clearly evident asymmetry was found in prefrontal areas in the four subjects with acquired cerebellar damage. The fifth subject, who had congenital left cerebellar hypoplasia, did not show any frontal flow asymmetry. The data support the growing clinical evidence that the cerebellum contributes to the cognitive processes of the frontal lobes and suggest a possible role for SPECT examination in the assessment of functional cognitive impairment in patients with acquired cerebellar lesions.


Feasibility of fractionating MAG3 cold kit for cost reduction. 99Tcm-MAG3 is the first 99Tcm-labelled radiopharmaceutical with a renal clearance similar to that of 131I-OIH. The cost of a unit dose of 99Tcm-MAG3 is comparatively less expensive than the cost of a combined 99Tcm-DTPA and 131I-OIH study dose. However, this cost-saving is dramatically reduced when only a few doses are withdrawn from a 99Tcm-MAG3 kit. Our goal in this study was to subdivide the MAG3 kit into fractions to reduce expense. By dissolving the lyophilized ingredients of MAG3 kits with either 5 or 10 ml N2-purged normal saline, the resultant liquid was divided into 1-ml aliquot vials filled with N2. The MAG3 aliquot vials were then frozen at -70 degrees C for future use. The radiochemical purity (RCP) of each vial was evaluated using the recommended Sep-Pak C18 column chromatography at different time periods. Over the entire 28-day evaluation period, the average RCP of the 5:1 dilution MAG3 vials after reconstitution with 3.7 GBq 99Tcm was maintained at 95.6 +/- 2.7% (n = 100) for 6 h, whereas the 10:1 fractionation MAG3 kits after labelling with 740 MBq 99Tcm showed an average RCP value of 98.4 +/- 2.1% (n = 100) for 6 h. Based upon these results, it is concluded that the fractionation of MAG3 kits and frozen storage in an N2 atmosphere not only maintains the stability of MAG3 but also provides a cost-effective method for using 99Tcm-MAG3.


Dosimetry assessment of 81Krm peripheral venous infusion studies. Calculation of S factors for 81Krm for a full range of target organs from each source organ relevant in 81Krm peripheral venous infusion imaging has been performed. Typical equilibrium activities in the source organs have been measured using quantitative planar gamma camera imaging for a generator with a mean activity at imaging time of 468 MBq eluted at 10 ml min-1. Based on the above measurements and assuming a 10 min infusion period, the mean effective dose equivalent for 81Krm infusion imaging in the assessment of right heart function in adults was found to be 0.365 mSv.


Correlation of splenic function with the splenic uptake rate of Tc-colloids. The splenic uptake rate of Tc-sulphur colloid or Tc-tin colloid was measured and found to correlate well with splenic function. The normal tracer uptake rate was 0.0002/s-0.0006/s (measured uptake rate divided by measured injected activity). Lower values indicated hyposplenism (sensitivity = 0.97, specificity = 0.95), and values over 0.0006/s indicated hypersplenism (sensitivity = 0.96, specificity = 0.97). Higher values of splenic uptake were associated with proportional reductions in the white blood cell and platelet counts, and to a lesser extent the haemoglobin concentration in peripheral blood. Patients with rheumatoid arthritis had increased tracer uptake, but still below the criteria for hypersplenism, whereas patients with Felty's syndrome had tracer uptake rates in the 'hypersplenic' range.


Office management of the draining ear.

Office management of the draining ear. Otorrhea is one of the most common ear complaints and is usually responsive to office treatment. The various causes of this condition are discussed and appropriate treatment options are detailed in this article. Topics include otorrhea from typanostomy tubes, chronic otitis media, external otitis and otorrhea, otorrhea after trauma, congenital anomalies and otorrhea, and neoplastic otorrhea.


Office management of the dizzy patient.

Office management of the dizzy patient. This article has attempted to set out in a logical, step by step fashion the approach to a dizzy or vertiginous patient. All that has been said will not apply to every patient. The investigator must above all be patient and thorough in obtaining the history--this is by far the most important step in the process. The physical examination is tailored to the complaint. Investigations include examinations of hearing, balance, serum chemistry, and radiology. Most otolaryngologists limit themselves to the diagnosis and limited medical management of dizziness and vertigo. It is required, however, that any physician treating dizzy patients have an understanding of the larger medical and surgical picture. A systematic and thorough approach to the dizzy patient will often yield the diagnosis, exclude otologic causes for imbalance, and ultimately set the patient on a proper course of treatment.


Office pediatric otology.

Office pediatric otology. Office pediatric otology requires the management of some of the most common acute and chronic conditions of childhood. Some of these conditions include eustachian tube dysfunction, otorrhea, granulation polyps, extruded tubes, otitis media, trauma, otalgia, and sudden hearing loss. An approach that recognizes the concerns of the child and parent facilitates the examination and treatment with minimal discomfort.


Nasal endoscopy in the outpatient clinic. The introduction of the nasal endoscope has greatly advanced the diagnostic and therapeutic capability of otolaryngologists in the office setting. With continued technologic developments in endoscopic equipment and topical intranasal anesthesia, further advances are expected that undoubtedly will expand endoscopic diagnosis treatment in the office setting. Presently otolaryngologists are beginning to use endoscopes in the evaluation and treatment of nasolacrimal duct obstruction, and we are aware of one case of cerebrospinal fluid leak that has been repaired in the office setting with nasal endoscopic technique. (Lanza D: personal communication, 1991).


Office evaluation of nasal obstruction.

Office evaluation of nasal obstruction. It is evident from the foregoing that the evaluation of such a common complaint as nasal obstruction can be extremely complex. If a thorough history and examination are undertaken, however, only a small number of these investigations (if any) may be required. In each individual, it is always worth considering possible predisposing factors. Good clinical practice dictates that we attempt to quantify problems and measure our success in treating them. Until recently, rhinology has not been overendowed with such investigative tools, so it behooves us to use those now available when unraveling the cause of deceptively simple nasal obstruction.


Office management of taste and smell disorders. Chemosensory disorders have been receiving increasing clinical attention but remain a difficult diagnostic problem. With the development of several well-standardized testing methods, taste or smell loss can now be verified, and this has added to knowledge concerning the common causes of dysfunction. Diagnosis typically rests upon the history and physical examination, but, except in the case of obstructive nasal and sinus pathologic conditions, therapy usually remains elusive.


Office evaluation and management of the sore throat. Most sore throats are caused by viral infections; bacterial infections should be ascertained by laboratory testing and treated aggressively. The wide variety of etiologies demands a thorough history and physical examination to identify unusual causes of sore throat.


Office evaluation of dysphonia.

Office evaluation of dysphonia. The office evaluation of dysphonia is complex. Proper medical care requires an in-depth history and comprehensive physical examination. Diagnosis and treatment are aided by objective assessment and quantification of voice function. Scientific and technologic advances over the last decade have resulted in substantial advances in the medical evaluation of dysphonia.


Office evaluation of pediatric upper airway obstruction. The otolaryngologist who is called on to uncover the cause of a child's airway obstruction is a treasured consultant. Continuing technologic advances in office-based equipment have made it easier to discover pathology with a minimum of complications. However, the physician who does not do a thorough history and physical examination or is unable to develop a bond of trust with the patient and family will be without the essential tools of the profession and will be unable to make an accurate diagnosis and implement a treatment plan.


Recognition of craniomandibular disorders. Craniomandibular disorders often mimic diseases related to the ear, nose, and throat, so patients often seek the care of an otolaryngologist for these problems. After ruling out otolaryngologic disease, craniomandibular disorders should be considered in the differential diagnosis. If a clinical diagnosis is supported by history, symptoms, and clinical evidence, the patient should be referred in a timely manner to a dentist who is competent to manage the patient. In addition to dentists, other health care practitioners may be called on by the primary treating physician to aid in the diagnosis and treatment. These can include a neurologist, radiologist, ophthalmologist, physiatrists, physical therapist, and internist. With recent advances in imaging techniques (computed tomography and magnetic resonance imaging), precise bioelectronic measurement of mandibular movement and electromyography of masticatory function, and conservative orthotic and dental restorative treatments as well as surgical techniques including arthroscopic examination of the TMJ, craniomandibular disorders can be objectively and precisely diagnosed and treated (Figs. 10 through 16).


B-mode ultrasonography of the paranasal sinuses compared with CT findings. Ultrasound as a diagnostic aid in the evaluation of the sinuses has been a controversial issue. Sensitivities have been reported from 29% to 100% and specificities from 55% to 99%. These wide variations in results from previous studies may have resulted from technical differences. However, the "gold standard" most often used for comparison has been a Water's view radiograph, which has been shown to correlate poorly with intraoperative and CT scan findings. To our knowledge, no one in the English language literature has evaluated sonography of the sinuses with computed tomography as the gold standard. In addition, evaluation of the ethmoid sinus has been neglected by previous studies that have primarily assessed the maxillary sinus. We report the results of a blinded, prospective trial comprised of 41 patients examined by B-mode ultrasound with comparison to computed tomography. Frontal and maxillary sinuses were examined with traditional sonographic techniques and the ethmoid sinuses were scanned with a transglobe technique not previously evaluated in the English language literature. Excluding isolated mucous retention cysts and focal minimal mucosal thickening (defined as < 4 mm), sensitivities for ultrasound of the maxillary, frontal, and ethmoid sinuses were 100% each. Specificities were 98% for the maxillary sinus, 100% for the frontal sinus, and 94% for the ethmoid sinus. Technical aspects and implications of this and previous reports will be discussed.


The versatile melolabial flap.

The versatile melolabial flap. The melolabial flap is a versatile technique for reconstruction of defects of the central face. Variations of this flap may be used to reconstruct the lower eyelids, the nose, the upper and lower lip, chin, and malar regions. Regional anatomy, indications, technical considerations, and avoidance of complications are discussed on the basis of 10 bilateral cadaver dissections of the melolabial area, in conjunction with 70 reconstructive cases that used this flap. Statistical analysis of the results reveals that flap viability is compromised by previous radiation and smoking. Consequently, alternate methods of reconstruction of the central face should be used in patients who have a history of these problems.


The role of computed tomography in the management of peritonsillar abscess. Twenty-four patients who fulfilled the clinical criteria for peritonsillar abscess (PTA) were randomized into two groups over a 6-month period. Group A (n = 13) underwent CT with contrast, whereas group B (n = 11) was managed without radiologic investigation. In group A, CT with contrast enabled differentiation of PTA from peritonsillar cellulitis in all 13 cases (100%) and demonstrated abscesses in 11 patients (85%), thereby allowing drainage at first attempt. Two patients with peritonsillar cellulitis were successfully managed with antibiotics only. In group B, all patients underwent needle aspiration. In seven patients (64%), pus was found after needle aspiration at first attempt and in one patient after needle aspirations at two locations. In three patients (27%), no pus was found after needle aspirations at three different locations. We conclude that CT enhances diagnostic accuracy, obviating unnecessary drainage procedures, and reduces patient morbidity.


Use of electrocochleography to monitor antigenic challenge in Menière's disease. Allergy has been reported as a cause of Menière's disease. King et al. have established the validity of the provocative food test (PFT) for the diagnosis of food allergy. When the PFT is used to test patients with Menière's disease, the test is considered positive if the patient develops aural fullness, hearing loss, increased tinnitus, or dizziness during challenge with the offending food and relief of these symptoms during neutralization. Ferraro et al. have shown that electrocochleography (ECoG) provides an objective indication of subjective symptoms in Menière's disease by demonstrating an increased SP/AP amplitude ratio when the symptoms of aural fullness and hearing loss are present. We present several patients with Menière's disease in whom measurement of the SP/AP amplitude ratio was compared with symptom production during antigenic challenge and neutralization.


Selection of surgical approaches for meningiomas affecting the temporal bone. The varied locations of meningiomas within the temporal bone require a wide array of neurotologic approaches to accomplish complete resection with minimal morbidity. We reviewed 56 consecutive patients with temporal bone meningiomas. The six surgical approaches are described with regard to site of lesion, morbidity of procedure, and long-term patient outcome. Recommendations are made for selection of surgical approach. Hearing preservation was attempted in 25%. Middle fossa tumor removal was performed in nine patients (16%), retrosigmoid (suboccipital) in five patients (9%), translabyrinthine in 24 patients (43%), transcochlear in 15 patients (27%), infratemporal fossa in two patients (4%), and retrolabyrinthine in one patient (2%). Overall, meningioma surgery has higher morbidity, poorer facial nerve outcome, and higher recurrence rates than acoustic neuroma surgery. Thirteen percent of patients were unable to resume full preoperative activities after their surgery. Facial nerve transection occurred in 9% of the cases, and 83% of cases with more than 1 year followup had satisfactory or intermediate facial function (grades I to IV). Meningiomas of the temporal bone are insidious and aggressive lesions. Particular care is required to select the surgical approach appropriate for location, level of hearing, and the anatomic structures involved. Patients must be realistically counseled about the surgical morbidity and long-term outcome associated with each approach.


Epidemiology and pathogenesis of paranasal sinus mycoses. In a prospective study, 50 cases of paranasal sinus mycoses were diagnosed in 2 years out of 119 clinically suspected patients from north India. Young men from rural areas were most commonly afflicted. Patients with paranasal sinus mycoses could be grouped in three clinical varieties: noninvasive, 31; invasive, 17; allergic, 2. Maxillary and ethmoid were the common sinuses concurrently involved in these patients, whereas sphenoid and frontal sinuses were also affected in invasive variety. Aspergillus flavus (80%) was the most common isolate, followed by A. fumigatus (6%). Alternaria species was identified in two patients with noninvasive granuloma. In invasive variety, Rhizopus arrhizus and Candida albicans were the causative agents in two patients and one patient, respectively. Regarding pathogenesis besides epidemiologic factors, the immunologic factors were also evaluated. It was found that presence or absence of precipitating antibody against antigens from the etiologic agents correlates well with disease progression. Allergic factor was found in all varieties, though presence of cell-mediated immunity was demonstrated in 29% patients with noninvasive granuloma only. The combination of skin test against aspergillin and precipitin demonstration at the outset will therefore help in preliminary screening.


Palatal extension of middle meatal antrostomy. The palatine bone is an important posterior landmark in the performance of ethmoidectomy. This usually unrecognized structure forms the posterior one third of the lateral nasal wall. Resection of a portion of the palatine bone completes the marsupialization of the sphenoethmoidal recess and medial maxilla. It is a major landmark for localization of the sphenopalatine artery at its entrance into the nose. Middle meatal antrostomy is enhanced by removal of the part of the palatine bone that forms the posterior medial wall of the maxillary sinus. In 1110 consecutive sphenoethmoidectomies, marsupialization of the maxillary sinuses has included partial removal of the perpendicular plate of the palatine bone. Patency has been maintained in all of these antrostomies. Pertinent anatomy and surgical technique are reviewed.


Seropositivity, adenoid hypertrophy, and secretory otitis media in adults--a recognized clinical entity. Otolaryngologic manifestations of AIDS have been described in the past. In this study, I had examined 14 adults with nasal obstruction and mouth breathing. Nine patients also reported deafness--unilateral in three of them and bilateral in six. All of them revealed a mass in the nasopharynx, either on the posterior rhinoscopy or the x-ray neck-lateral view. To exclude nasopharyngeal malignancy, all of the patients underwent examination of the nasopharynx while under general anaesthesia and biopsy. The histopathologic diagnosis in every patient was nonspecific, reactive lymphoid hyperplasia, which has been described in the background of HIV infections. Four were already confirmed HIV-positive and 10 were found positive on the HIV antibody test. A strong association was established between seropositivity, adenoid hypertrophy, and secretory otitis media in adults.


Prevention of early otorrhea in ventilation tubes. The incidence of early postoperative otorrhea after placement of ventilation tubes ranges from 12% to 40%. This prospective randomized study of 430 children, ages 6 months to 15 years, examined the efficacy of sulfacetamide/prednisolone otic drops used for 3 days postoperatively in reducing the incidence of otorrhea at 1 week after the placement of Donaldson tubes. Subjects were randomized into two groups--drops and no drops. Preoperative diagnosis and intraoperative findings were correlated with findings. The incidence of otorrhea among all patients was 11.9%. The use of sulfacetamide/prednisolone drops for 3 days after insertion of ventilation tubes failed to reduce the incidence of otorrhea in the overall study population. The drops did demonstrate a trend toward reducing the incidence of otorrhea in certain subpopulations, including children under 3 years of age, blood at the myringotomy site, and thick middle ear effusions. Subpopulations associated with a higher incidence of otorrhea were also identified.


Effect of irradiation on guinea pig ABR thresholds. A significant number of patients undergo irradiation to the temporal bone for malignancies. Conflicting reports exist regarding the effects of irradiation on hearing thresholds. Although radiation-induced otitis media and osteoradionecrosis of the ossicles with resultant conductive hearing loss are well-documented, there is disagreement regarding the effect of irradiation on sensorineural hearing. Previous animal models, relying only on behavioral tests and reflex thresholds, have failed to reveal consistent threshold shifts after irradiation. However, with the advent of auditory brainstem response (ABR) testing, a reliable objective measurement of hearing in animals is available. Hearing thresholds were determined bilaterally by ABR testing in 21 albino guinea pigs. The left temporal bones of sixteen animals were then irradiated with a total dose ranging from 5750 to 7000 cGy over 7 weeks. The right ears of these animals, plus both ears of five nonirradiated guinea pigs, served as controls. Follow-up threshold ABRs were obtained immediately post-irradiation (RT), and at 6 and 12 months post-RT. Average thresholds in all groups increased over time: 60 dB in the control group; 53 dB in the control ears of the irradiated animals; and 46 dB in the irradiated ears. There were no statistically significant increases in ABR thresholds for irradiated ears vs. control ears. At the 6-month followup, hearing was actually better in the irradiated ears than the control ears and this difference between ears was significantly greater than the difference at baseline (p < 0.026). Overall, there was no evidence that irradiation produces changes in ABR thresholds.


Induction of heat shock protein in interdental cells by hyperthermia. The effect of hyperthermia on induction of the 72 kilodalton (kDa) heat shock protein (HSP72) was examined in interdental cells of the guinea pig cochlea. After being immersed in a water bath of either normal body temperature (37 degrees C, control condition) or 43 degrees C (hyperthermic condition), animals were killed either 0, 1, 2, 6, or 18 hours later. Cochlear sections were incubated with a monoclonal antibody raised against HSP72 and relative staining densities were quantified with a light microscopic image analysis system. Optical densities of the interdental cell region of animals receiving hyperthermia treatment were significantly greater than those of animals in the control group. Further analysis revealed that levels of HSP72 immunoreactivity began increasing by 1 hour after hyperthermia and continued to increase thereafter, to reach maximal levels at 6 hours. The maximal levels were maintained for the rest of the experiment--18 hours. The results indicate that hyperthermia leads to an increase in the synthesis of HSP72 in guinea pig interdental cells.


Arterial chemoreceptor influences on the laryngeal chemoreflex. Prolonged apnea and cardiovascular changes have been elicited in infant animals by the application of water to the laryngeal mucosa. Previous reports have produced conflicting evidence in regard to the possible role of arterial chemoreceptors in modulating this reflex. The present study was designed to determine the effect of carotid body stimulation or suppression on the duration of apnea and severity of cardiovascular changes in response to water in the larynx of piglets. The role of swallowing in terminating the apnea was also investigated. Hypoxia and isoproterenol, both carotid body stimuli, caused decreased apnea duration. Hyperoxia was associated with prolonged apnea duration; however, dopamine, which inhibits carotid body chemoreceptors, produced no significant change. Hypotension and bradycardia were only observed after prolonged apnea or chemoreceptor stimulation, supporting the concept that the cardiovascular component of the laryngeal chemoreflex is a result of changes in blood gas concentration rather than a direct response to laryngeal chemostimulation. The interval between water application and initiation of swallowing was not significantly affected by hypoxia or carotid body stimulation and swallowing did not always occur before resumption of breathing.


Overview: the allergic reaction and site-based therapy. The successful management of upper respiratory tract allergy is based on a triad of interdependent approaches that, with rare exceptions, must all be considered in every allergic patient. They consist of allergen avoidance with environmental control measures, pharmacotherapy with use of a step-care approach, and immunotherapy. Environmental control measures should be used to prevent events that trigger and sustain the condition. Once started, the allergic reaction includes the release of mediators of inflammation that produce well-known symptoms of allergic rhinitis. Treatment should consist of a step-wise, rational approach that includes site-based therapy with one or more drugs acting at different sites. The drugs used are antihistamines, decongestants, cromolyn sodium, and corticosteroids. Immunotherapy should be considered at any step, because it offers the only curative approach.


Environmental control.

Environmental control. Environmental control measures help eliminate triggers that initiate the allergic reaction and reduce the conditions that sustain it. The most frequent offenders are the ubiquitous dust mites, which are ideally suited to living in the home environment. Control measures consist of minimizing their reservoirs in the patient's bedding, carpets, and upholstered furniture; decreasing humidity; and using acaricides. Cats are the source of another important indoor allergen that becomes and stays airborne as small particles. Removal of the animal (or washing it weekly) and the use of high-efficiency particulate air filters for air ducts and vacuum cleaners are useful in reducing dust mite and cat allergens. Dogs and rodents also produce allergens offensive to the sensitized patient and should be removed or relegated outdoors. Cockroaches have become an increasingly prevalent source of allergens responsible for asthma and rhinitis. Their removal is the focus of research, because current control measures are usually inadequate. Molds, which thrive in any moist environment, produce allergens. Closed windows prevent further influx of outdoor molds and pollens, whereas those harbored indoors, including those residing on plants, should be eliminated.


Diagnosis and management of sinusitis in the allergic patient. Allergy is often associated with sinusitis because the inflamed nasal mucosa may block ostial drainage from the sinus and the resulting stasis in the sinuses encourages development of infection. The new tools of nasal evaluation, endoscopy and computed tomographic scanning, are becoming essential in the evaluation of patients who have acute and chronic sinusitis. Nasal endoscopy provides a view of the nose, nasopharynx, sphenoethmoidal recess, and middle meatus to detect areas of inflammation or pathologic drainage. This examination should be followed by computed tomographic scanning, which reveals the fine structures and disease of the area. First-line treatment includes antibiotics and decongestants to control the infection, reduce tissue edema, facilitate drainage, and maintain ostial patency. Topical steroids (or cromolyn sodium) are helpful to reduce the mucosal swelling, particularly in allergic patients. Antihistamines are indicated to reduce the rhinorrhea in allergic patients but not in those with suppurative sinusitis. Functional endoscopic sinus surgery to facilitate drainage and permit appropriate ventilation should be reserved for patients no longer responsive to pharmacotherapy and those with anatomic deformities.


Corticosteroids in the management of upper respiratory allergy: the emerging role of steroid nasal sprays. Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis, not just those of atopic origin. However, this potent class of drugs also has the greatest potential for adverse effects and complications. Proper use requires that they be used only after failure of more conservative measures, at the smallest effective dose, for the shortest possible time, and preferably should be administered by the topical intranasal route. Topical corticosteroids, concentrated at the area involved, offer significant relief to patients with allergic rhinitis, and although only a relatively small amount of drug is taken up systemically, cautions for proper use are important. Topical steroids should be used only after accurate diagnosis. They must adequately contact the nasal mucosa, and patients should be properly instructed in their use and monitored for local and systemic side effects. Currently available topical preparations--dexamethasone, beclomethasone, flunisolide, and triamcinolone--have differing characteristics. The use of a preparation with a high margin of safety reduces the risk of undesirable systemic effects.


Immunotherapy: rationale and mechanisms. Immunotherapy is defined as the controlled exposure to known allergens to reduce the severity of the allergic response. Although available since 1910, its exact mechanisms of action is not known but may involve an increase in allergen-specific IgG antibodies, a decrease in IgE synthesis, and alteration in T-lymphocyte activity. Immunotherapy is indicated in patients with proven allergy who have significant symptoms. It may be used together with pharmacologic measures but is relatively contraindicated in patients receiving beta-blocker therapy. Immunotherapy may be continued during pregnancy and should not be initiated in patients with autoimmune diseases or in human immunodeficiency virus-positive patients. Selection of appropriate diagnostic tests is important. Before immunotherapy is considered, there are two recommended in vivo tests (combined prick and intradermal skin test, and skin end point titration) and two recommended in vitro tests (radioallergosorbent test [RAST] and enzyme-linked immunosorbent assays [ELISA]), all equally safe and sensitive. After appropriate test interpretation, treatment is initiated with slowly escalating doses of allergen. Effects are often apparent in 3 to 6 months and, after continuation for 3 to 5 years, patients usually achieve lasting benefit.


A theoretical framework for the immunoepidemiology of helminth infection. Field studies of parasitic helminths in endemically infected human communities have provided quantitative information on the relationships between parasite burdens, immune responses and age. There are considerable difficulties in the interpretation of these immunoepidemiological data due to the complexities of the biological processes generating the observed patterns. In this paper simple mathematical models are used to explore the expected patterns of variation with host age in parasite burdens, the aggregation of parasites among hosts, levels of immune response, and the correlation between parasite burdens and immune responses. These relationships reflect rates of infection, rates of parasite mortality, the strength of the immune response, and the duration of immunological memory. The models generate some complex and counterintuitive patterns. The analysis suggests that some of these patterns might serve to (i) distinguish effects due to acquired immunity from effects due to age-dependent exposure, (ii) identify potentially protective immune responses, and (iii) identify the parasite stages important in the development of acquired immunity. The results imply that previous analyses of immunoepidemiological data may have been overly simplistic and, especially, that patterns believed to be inconsistent with protective immunity may have been incorrectly interpreted.


The destruction of virulent Entamoeba histolytica by activated human eosinophils. Unlike normal (i.e., non-activated) human eosinophils that are unable to destroy virulent Entamoeba histolytica even in the presence of antibodies and complement, activated eosinophils effectively destroy the parasite in vitro without the help of opsonins, yet increase this capacity with their assistance. Many activated eosinophils succumb in the process as well, probably victims of toxic products released by dying amoebae. Human activated eosinophils thus behave more like activated macrophages than like neutrophil polymorphonuclear leucocytes that are notoriously incompetent in dealing with virulent amoebae. As a regular constituent of early inflammatory reactions, and notwithstanding the absence of blood and tissue eosinophilia in invasive amoebiasis, the activated eosinophil may play a role in the defence against E. histolytica.


Plasma leakage in skin of sheep selected for resistance or susceptibility to fleece rot and fly strike. The leakage of plasma into skin following injection of histamine, bradykinin, activated complement, platelet-activating factor and serotonin was measured in sheep bred for resistance or susceptibility to fleece rot and fly strike. Genetically susceptible sheep had significantly greater plasma leakage to activated complement than genetically resistant sheep, and for all mediators there was a trend for plasma leakage to be greater in susceptible sheep. Within each genotype there was also a tendency for plasma leakage to be positively correlated with fleece rot score. In a flock of sheep of different genetic background not selected for resistance or susceptibility to fleece rot and fly strike, positive phenotypic correlations were also noted between fleece rot and plasma leakage. Plasma leakage provides nutrition for the first instar larvae of Lucilia cuprina, the major cause of primary blowfly strike in Australia. Diminished leakage of plasma following release of endogenous permeability mediators may be one component of the mechanism that confers resistance in animals bred for resistance to fleece rot and fly strike.


Potent immunosuppression by secretory/excretory products of larvae from the sheep blowfly Lucilia cuprina. Secretory/excretory products (sec/ex) of parasitic larvae of the sheep blowfly Lucilia cuprina potently inhibited proliferation of peripheral blood leucocytes stimulated by mitogens in vitro. Suppression of proliferation was not due to irreversible damage because cells cultured for 24 h in high concentrations of sec/ex appeared viable (assessed by Trypan blue exclusion) and did not show impaired proliferation after washing. Furthermore, suppression induced by sec/ex could be overcome by increasing concentrations of mitogen. The inhibitory activity could be demonstrated in cultures where sec/ex was added at different times during the culture period. Inhibitory activities in sec/ex were heat-labile and sensitive to treatment with trypsin. In addition to effects in vitro, sec/ex was strongly immunosuppressive in vivo. Sheep given combined injections of myoglobin and sec/ex had markedly lower anti-myoglobin antibody levels in sera than sheep that received injections of myoglobin alone. There was no significant antibody response to sec/ex itself. Immunosuppressive moieties in sec/ex produced by blowfly larvae may promote parasite survival by inhibiting the immune response of host sheep.


Effects of recombinant tumour necrosis factor on antibody-dependent eosinophil-mediated damage to Schistosoma japonicum larvae. Human recombinant tumour necrosis factor (rTNF) enhanced monoclonal IgE-dependent eosinophil-mediated cytotoxicity to schistosomula of Schistosoma japonicum in a dose-dependent manner. The enhancing effect of rTNF was also observed for the antibody-dependent cytotoxicity of a human eosinophilic leukemia cell line, EoL-3, but not of another cell line, EoL-1. Observation by a slow-motion movie camera demonstrated that activated EoL-3 cells adhered to the surface of schistosomula by 6 h after incubation, which triggered intracellular movement of eosinophil granules. The granules were concentrated toward the surface of the larvae and then degranulation started. The cell membrane was left as a balloon-like remnant. Cell sorting analysis by FACStar indicated that the expression of receptors for C3bi (CR3) and low affinity FcR for IgE (Fc epsilon RII) increased on the surface of EoL-3 cells after stimulation with rTNF, while this was not observed for EoL-1 cells.


Isotypic variation in antibody responses in a community in Papua New Guinea to larval and adult antigens during infection, and following reinfection, with the hookworm Necator americanus. The natural infection of a community with the hookworm Necator americanus induces a vigorous humoral response to both larval and adult parasite antigens. This response occurs in all five human antibody isotypes, and data are presented to show that, at the population level, isotypes respond differently, following chemotherapy and during reinfection, to changes in antigen stimulation. The differential response probably reflects the fact that the parasite, during the course of its life cycle, presents different amounts of antigens at different anatomical locations. It is suggested that IgG and IgM responses against adult excretory-secretory (ES) products most accurately reflect the efficacy of chemotherapy, and the load of resident adult infection, while IgG responses against larval somatic antigens reflect continuous exposure to infection. These hypotheses should now be tested, at the level of the individual, in a longitudinal manner using more closely spaced sampling intervals. This repetitive sampling, and the inclusion of a measure of the exposure of the population to infective stages, will allow more definitive conclusions to be made about the role of the immune response in controlling worm burdens.


Vaccination of young Dorset lambs against haemonchosis. Six Dorset Horn lambs were each vaccinated at age 7 weeks and 9 weeks with 50 micrograms of glycosylated integral membrane proteins, particularly enriched in the protein H11 from the intestinal brush border of adult Haemonchus. At 11 weeks of age the lambs were infected with 10,000 infective third stage Haemonchus larvae. Compared with the average for the control group the vaccinated group of lambs had a 78% reduction in parasite egg output over the patent period, with four of the six better than 93% protected. At autopsy 35 days post-infection the mean total worm burden of the vaccinated lambs was 83% reduced compared with the controls. The serum antibody titres to H11 correlated with the degree of protection.


Fasciola hepatica in the rat: immune responses associated with the development of resistance to infection. F. hepatica infections were established in rats and immune responses were monitored during primary and challenge infections. Antibody levels peaked at 3 weeks post-primary infection and at 6 days post-challenge infection. No significant correlation was found between antibody titre and number of flukes recovered at autopsy. Immunoblotting revealed a limited number of immunogenic polypeptides. When antibodies from these reactive bands were eluted and tested by IFA they all gave identical binding patterns: on juvenile fluke sections tegumental syncytium, tegumental cells and gut cells were labelled, while on adult sections the same antibodies labelled gut cells, reproductive tissue, excretory ducts and flame cells. This suggested that these tissues shared a common epitope or range of epitopes. A pronounced eosinophilia was observed throughout the infection period studied and infected liver sections showed massive cellular infiltration. Histochemical and immunocytochemical investigation of infected liver revealed the presence of large numbers of eosinophils, neutrophils, lymphocytes and phagocytes. The implications of these findings, to an understanding of concomitant immunity in the rat are discussed.


Immune response of Clun Forest sheep to vaccination with membrane glycoproteins from Haemonchus contortus. Clun Forest lambs were injected with a fraction containing integral membrane glycoproteins derived from the intestinal microvilli of Haemonchus contortus in two equal doses of 0.5, 5, 50 or 500 micrograms protein and then challenged with 10,000 infective larvae. The time-course of serum specific antibody responses were determined. Compared to the adjuvant control group, the animals injected with 1000 micrograms protein were better than 84% protected and those injected with 100 micrograms, better than 95% protected by all criteria. For these two groups parasite egg output was reduced 99% on average over the patent period. Two of the animals injected with 10 micrograms protein were partially protected, with 86% reduction in egg output. Two animals in the group injected with 1 microgram protein also showed partial protection. Antibody level correlated with protection.


Understanding the physical and psychosocial stressors of the child who is homeless. Children now constitute the largest segment of the population of persons who are homeless. Their unique needs offer a special challenge to the pediatric nurse. Understanding the physical and psychosocial stressors of homelessness provides the foundation for planning comprehensive nursing care.


Children and poverty: America's future at risk. Growing numbers of America's children are living in poverty, deprived of their most basic needs for security, support, and a healthy future. Nurses can become part of the solution to this urgent problem by identifying poverty as a practice concern.


Childhood lead poisoning: shifting to primary prevention. Childhood lead poisoning remains a serious public health problem for millions of American children. Although adverse health effects related to elevated blood levels have been reported in children from all socioeconomic groups, the prevalence of serious lead poisoning remains highest among poor children in urban areas. The Centers for Disease Control has revised guidelines for intervention with an emphasis on primary prevention.


Play intervention strategies for the Hispanic toddler with separation anxiety. Constructive, therapeutic play is an effective nursing intervention for helping the toddler deal with separation anxiety, but, the play must transcend cultural barriers. Using Bowlby's theoretical framework to understand the response of separation anxiety in the toddler, culturally sensitive interventions of play that allow the Hispanic toddler to work through fears and express issues of separation are examined.


Antecedents to nonorganic failure-to-thrive. Using a retrospective cohort design with a randomly selected control group, this study investigated the relationship between selected maternal, infant, and environmental variables, and the development of nonorganic failure-to-thrive. The groups differed significantly on sex of infant and incidence of breastfeeding.


Understanding hearing loss in children.

Understanding hearing loss in children. At some point in their career, nurses will care for a child with a hearing loss. Understanding how to work best with these children necessitates an in-depth knowledge of how the hearing loss impacts both the child and family. Each component is interrelated. Knowing, for example, that the child has a profound sensorineural hearing loss tells the nurse much about the child's potential prognosis for improvement, use of amplification, communication style, and parental and family stress. While many variables impact on these basic features, they set the foundation for a deeper understanding and the formation of a stronger, trusting bond between the nurse and patient. As in all professional fields, issues related to deafness continue to change. There are new and improved forms of amplification as well as various effective communication methodologies. Most importantly, there is a change in attitude. The deaf do not view themselves as disabled. Instead they have a sense of pride in sharing a culture and a common language. Through this understanding, respect for one another can be achieved.


Intervention studies in pediatric nursing research: a decade of review. This article examines the pediatric nursing research published in seven refereed nursing research journals and pediatric practice journals over the past decade. Of the 319 research articles published, 16.6% were intervention studies that evaluated the outcomes of nursing care. Concerns are raised and suggestions made to strengthen the practice-research-theory link in the nursing care of children and their families.


Parental noncompliance in home care.

Parental noncompliance in home care. Parental noncompliance with the medical regime may lead to serious injury in the pediatric home care patient. Home care providers must understand the liability associated with parental noncompliance and establish policies that will protect them from allegations of negligence.


Family impact of home apnea monitoring: an overview of research and its clinical implications. To determine the clinical applicability of research findings related to home apnea monitoring. A critical review of descriptive and explanatory research on family impact of home apnea monitoring. Strengths and limitations of the research are identified. Clinical practice implications of the research findings are discussed.


Fulminant meningococcemia in pediatric patients: nursing considerations. The mortality rate of children with fulminant meningococcemia is high, and early recognition and intervention by the health care team is crucial for patient survival. Critical care nurses who have knowledge in the cause and treatment of this catastrophic disease and current trends in therapy will be able to provide essential care to these patients.


Prevention of childhood injuries. Part II: Recreational injuries. This is the second of two articles on the prevention of childhood injuries. Here, interventions to reduce death and disability among children from recreational injuries are identified. The major categories of recreational injury are listed, the magnitude of the problem defined, the risk factors described, and selected interventions of the National Committee for Injury Prevention and Control summarized. Recommendations for practice are discussed.


Principles of adhesion.

Principles of adhesion. Understanding interfacial phenomena has been of direct relevance and practical benefit to extending the use of dental adhesives. Both surface physics, which describes properties of the inorganic materials' interfacial zones from their actual phase boundaries toward the bulk phases of the solids, and surface chemistry, which describes phenomena at the solid/biological interface and beyond it into the variable organic environment, have been important. High-energy materials include solids that are very hard, have high melting points, strong intermolecular forces, and basically crystalline structures, such as dental enamel. Low-energy materials, such as dentinal collagen, salivary films, and the organic resins of restorative materials, are softer, lower melting, and have weaker intermolecular forces, poorer crystallinity, and surface energies generally less than 100 ergs/cm. It has been a properly renewed emphasis on wetting of dental surfaces and their modification by primer coats, displacing or mixing with water and adsorbed proteinaceous films, that has promoted the success of many recently developed fourth-generation dentin adhesives. Their improved wettability for biological phases correlates directly with their better infiltration and anchoring of composites.


Allocation of healthcare resources: the case for health promotion. The issue of healthcare resource allocation is examined from the macro perspective with the view to building a case for health promotion and prevention. The author suggests a health promotion framework as an alternative, or at least a complementary approach, to resource allocation, with the potential, over the long term, to slow the growth of healthcare costs. Supportive and opposing arguments are presented for the case of health promotion. The author concludes with a synthesis of a new perspective for nursing in the struggle to allocate healthcare resources in a fair and just manner.


Reevaluation of a nursing diagnosis: spiritual distress. The purpose of this paper is to reevaluate the nursing diagnosis of spiritual distress in relation to Marjory Gordon's criteria of discriminatory power, generality, flexibility, usefulness, and inclusiveness. The author suggests that nursing's perspective of the spiritual dimension and spiritual distress is both narrow and inadequate in today's multicultural, multidimensional healthcare setting. Views of spirituality from multiple disciplines are discussed to illustrate the diversity of the phenomenon and contrast views that primarily emphasize religiosity and psychosocial factors. Reevaluation of spiritual distress and spirituality must come in the form of holistic and humanistic approaches in nursing education and research, integration of the spiritual dimension within nursing curricula, and recognition of multidisciplinary, global perspectives of the spiritual phenomenon. The author stresses the importance of the spiritual dimension and its impact upon a person as a multidimensional being.


Factors affecting adhesion to mineralized tissues. The objective of this paper is to review the literature concerning factors affecting adhesion to mineralized tissues. Factors related to the physicochemical structure of the adherents and to the inherent properties of composite restorative materials, along with the postulated bonding mechanisms of current adhesive systems, are discussed.


Adhesive bonding with 4-META.

Adhesive bonding with 4-META. Research into improved adhesion of resins to tooth substrates has found that methacrylates with both hydrophobic and hydrophilic groups, like 4-methacryloxyethyl trimellitate anhydride (4-META), enhance monomer penetration into dentin pretreated with 10% citric acid and 3% ferric chloride (10-3). Scanning and transmission electron microscope (SEM and TEM) examinations revealed the formation of a transitional zone of resin-reinforced dentin, termed the hybrid layer. The 4-META adhesive resin impregnated the exposed collagen bundles with which it entangled to create the hybrid, essential to attaining high tensile bond strengths.


Stress-coping-adaptation: concepts for nursing. Nursing has arrived at acceptance of several and diverse paradigms in conceptualization of its phenomena, research methodologies, and guidance of the discipline. Scholars and clinicians recognize the interaction of the person with the environment. Some implicitly focus on the experiences of stress, human responses, or efforts to cope with stress and movement toward adaptation or integrity of function. Stress-coping-adaptation is a complex conceptual framework with features powerful enough to explain nursing's phenomena of concern. Discourse dealing with stress-coping-adaptation as integral in nursing theory, research, practice, and education is warranted at this time.


A reexamination of euthanasia: issues raised by Final Exit. The debate over euthanasia continues to be a concern for nurses and consumers of health care. The recent publication of Final Exit, a book addressing euthanasia and how to commit suicide, has stirred much controversy. The authors present an examination of the current legal, religious, and professional issues surrounding euthanasia. Nursing implications are described in relation to caring for terminally ill patients and responding to patients' need for information and possible requests for assisted suicide.


Interactions of conditioners on the dentin surface. The distinction between dentin conditioners and primers has become blurred as agents have been combined to simplify the steps required in dentin bonding. Most bonding systems use acidic conditioners designed to remove the smear layer and demineralize the dentin surface. It would seem desirable to reduce the acid concentration and/or application time to the minimum required to obtain maximum bond strengths and minimum microleakage. The pulpal effects of acidic conditioners seem to be minimal if the subsequently placed bonding agents and resin composites truly seal dentin. Several systems have been designed to be bonded to smear layers, including the new light-cured glass-ionomer cements. More research is needed to develop methods of strengthening smear layers and the bonds between them and adhesive resins.


Dentin extracellular matrix and dentinogenesis. The formation of dentin involves secretion of matrix proteins by odontoblasts, prior to the deposition of apatite crystals. These matrix proteins probably play a role in transformation of predentin to dentin. The physical and chemical properties of dentin collagen, similar to those of bone, are especially adapted for binding matrix proteins and as a grid for mineral deposition. Phosphophoryns, polyanionic, and dentin-specific proteins are secreted at the mineralization front and are involved in some way in the mineralization process of circumpulpal dentin. Dentin sialoprotein is specifically made by odontoblasts and pulp cells and may be in the family of bone proteins known to promote cell attachment. Several proteins originally isolated from bone are also found in dentin and are expressed by odontoblasts. Although the mechanisms of dentinogenesis have not been elucidated, detailed studies of dentin matrix proteins should give valuable insights into this process.


Clinical applications of glass-ionomer cements. The use of glass-ionomer cements in clinical dentistry is now well established. They have a number of unique properties, including adhesion to moist tooth structure, biological compatibility, and anticariogenic properties due to their fluoride release. Their use in treating early carious or erosion lesions has been widely investigated. Established techniques include fissure filling and sealing, restoration of class 5 erosion lesions without cavity preparation, and the internal occlusal fossa or tunnel restoration. The "sandwich" technique using glass-ionomer cements as "dentin substitutes" has enabled composite restorations to be used with greater safety where pulpal damage may occur. The future probably lies in using a laminate technique where materials that attach to dentin and form a biological seal can be covered by tougher and harder enamel veneers, thus mimicking the structure of the tooth. The deficiencies of glass-ionomer cements are well known, including lack of toughness, early water sensitivity, low abrasion resistance, and porosity leading to poor surface polish. Solving these problems is formidable, since inherently the strength of these cements is related to their water content. The clinician should be aware of these deficiencies and stay within the parameters of the techniques outlined in this paper. In particular, clinical success depends upon early protection of the cement from hydration or dehydration, and the current use of light-cured bonding agents has largely solved this problem.


The chemistry of adhesive agents.

The chemistry of adhesive agents. The chemical aspects of dental adhesive systems are reviewed and discussed. Adhesive agents must have the ability to wet and then to adhere to hard dental tissues. Several dental bonding systems are available. They are characterized by containing monomers that have hydrophilic and hydrophobic groups. The polymerized adhesive system should provide a stable link between the tooth structure and the bulk of the restoration. Some adhesive systems provide initial acceptable adhesion, but the long-term bonding to dentin is questionable.


Laboratory evaluation of adhesive systems. Adhesive bonding of resin materials to acid-conditioned enamel is a clinically proven technique in preventative, restorative, and orthodontic procedures. Laboratory evaluations of etched-enamel resin bonding have shown excellent bond strengths and the virtual elimination of marginal microleakage. Adhesion to dentin has been more of a challenge. Earlier-generation dentin bonding systems did not yield high bond strengths in the laboratory or prevent marginal microleakage. Newer-generation adhesive systems generally use a dentin conditioner to modify or remove the smear layer and a subsequent application of an adhesive resin bonding agent. Laboratory evaluations of newer systems have shown bond strengths that approach or actually exceed that of etched enamel resin bonding. Bond strengths have improved with the evolution of dentin bonding systems, and microleakage from the cementum/dentin margin has been significantly reduced or prevented with the newer systems. Although laboratory testing of adhesive systems provides a mechanism to screen and compare newly developed systems, clinical trials are essential to document long-term clinical performance.


Microleakage in various dentin bonding agent/composite resin systems. One important consideration in the selection of a dentin bonding agent/composite resin system is its resistance to marginal leakage. The purpose of this study was to compare both the extent and the pathways of marginal leakage for four currently available dentin bonding agent/composite resin systems. Class 5 restorations were placed in the buccal and lingual surfaces of 20 extracted human teeth. Specimens were subjected to thermal stress before being placed in silver nitrate solution. They were then sectioned longitudinally and observed under a light microscope. Selected samples were further studied using scanning electron microscopy (SEM) and energy-dispersive x-ray analysis (EDX). Different systems exhibited different leakage patterns. Findings suggest that the smear layer should be either conditioned or removed prior to dentin bonding agent application to provide optimal resistance to microleakage.


Development of an adhesive bonding system. Building on findings concerning adhesion to enamel, R L Bowen and his colleagues at the Paffenbarger Research Center, National Institute of Standards and Technology began addressing and solving problems associated with (1) silicate cements and unfilled resins, (2) bonding in an aqueous environment, and (3) the development of an adhesion system for both dentin and enamel that could withstand various stresses. This article reviews the development of an adhesion system for bonding dental composites to dentin and enamel.


Antidepressant effect of carbamazepine--the role of dopaminergic and noradrenergic agents. Fourteen days of treatment with 20 mg/kg/day carbamazepine (CBZ) reduced the immobility time in the behavioral "despair" test in rats. Two blockers of dopaminergic receptors: haloperidol (0.5 mg/kg) and sulpiride (100 mg/kg) antagonized the reduction of immobility caused by CBZ. The anti-immobility effect of CBZ was also counteracted by clonidine (0.1 mg/kg) an agonist of presynaptic alpha 2 adrenoreceptors and propranolol (5 mg/kg) beta-adrenolytic drug.


Basic central pharmacological properties of thiophosphoric acid alkaloid derivatives from Chelidonium majus L. The effects of thiophosphoric acid alkaloid derivatives from Chelidonium majus L. (Ukrain, UKSR-222) on the central nervous system (CNS) of mice and rats was studied. Intraperitoneal (ip) administration of Ukrain in doses of 9.5 and 19 mg/kg for mice depressed spontaneous motor activity, decreased body temperature and potentiated the action of hexobarbital. Only in a dose of 19 mg/kg Ukrain produced analgesic action in the hot plate test. It had no protective effect against electroshock or pentetrazol-induced seizures. In rats, ip administration of Ukrain in dose of 14 and 28 mg/kg potentiated the action of amphetamine and apomorphine but had no effect on catalepsy induced by haloperidol. Ukrain used in dose 9.5, 14, 19 and 28 mg/kg antagonized the head twitches induced by 5-HTP and hyperthermia-induced by m-CPP. Biochemical studies indicated that Ukrain did not affect the NA and DA concentrations in the whole rats' brain and did not affect the 5-HT and 5-HIAA concentrations in the whole brain of rats. These findings demonstrate that the central action of Ukrain involves the stimulation of the dopaminergic system and the inhibition of the serotoninergic system.


Functional interaction between 5-HT1B and 5-HT1A or 5-HT2 receptors in mice. To investigate a possible functional interaction between 5-HT1B and 5-HT1A or 5-HT2 receptors we studied the effects of 5-HT1A selective agonists 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) and gepirone, of a 5-HT1A/5-HT2 agonist 5-methoxy-N,N-dimethyltryptamine (5-MeODMT) and of a putative 5-HT2 agonist (+/-)1-(2,5-dimethoxy-4-iodophenyl)-2-amino-propane (+/- DOI) on the 5-HT1B receptor-mediated hypothermia induced by m-trifluoromethylphenylpiperazine (TFMPP) (25 mg/kg) or m-chlorophenylpiperazine (m-CPP) (20 mg/kg) in mice. 8-OH-DPAT (1.25-5 mg/kg), gepirone (1.25-5 mg/kg), 5-MeODMT (2-8 mg/kg) and (+/-)DOI (0.5-2 mg/kg) reduced dose-dependently the TFMPP- or m-CPP-induced hypothermia. At the same time 8-OH-DPAT (2.5 and 5 mg/kg, but not 1.25 mg/kg) and gepirone (1.25-5 mg/kg) themselves decreased the body temperature in mice, while 5-MeODMT (2-8 mg/kg) and (+/-)DOI (0.5-2 mg/kg) did not affect it. The present results suggest that a functional interaction exists between 5-HT1B and 5-HT1A or 5-HT2 receptors.