Otodental syndrome: a case presentation in a 6-year old child.

BACKGROUND: Otodental syndrome is a rare condition characterised by globodontia, and sensorineural high frequency hearing loss. To date, only 20 cases of otodental syndrome have been reported. CASE REPORT: A 6 year-old girl presented with a chief complaint of delay in the eruption of primary canines. Following clinical, radiographic and audiologic evaluations, the patient was diagnosed with otodental syndrome. CONCLUSION: Globodontia is a diagnostic feature of the otodental syndrome, which often provides the path to discovery of the associated hearing loss. Missing teeth, arch-size discrepancies, chewing problems and teething disturbances are the other major complications.

Trends in colon cancer surgery in Ontario: 2002-2009.

AIM: The safety and efficacy of laparoscopic surgery for colon cancer is well established but its uptake in the province has not been previously explored. We report an investigation of the trends of open and laparoscopic surgery for colon cancer in Ontario, Canada. METHOD: A retrospective cross-sectional time-series analysis examining population-based rates of elective surgery for colon cancer among 10.5 million adults in Ontario was conducted from 1 April 2002 to 31 March 2009. Databases were linked to assess quarterly elective procedure rates over time. RESULTS: During the study period, 3950 laparoscopic and 13 048 open elective colon cancer operations were performed in Ontario. The overall quarterly rate of colon cancer surgery remained stable at an average of 5.8 per 100000 population (P=0.10). From the first and last quarter, the rate of laparoscopic operations increased nearly threefold from 0.8 to 2.2 per 100000 population with a notable increase after 2005 (P<0.01). In contrast, open surgery decreased by more than 30% from 5.3 to 3.5 per 100 000 population (P<0.01). If current trends continue, the projected proportion of laparoscopic colon operations is estimated to reach 41% by 2015. Patients receiving open surgery had a significantly higher preoperative comorbidity (Charlson comorbidity score≥3) than those having laparoscopy (47.8%vs 39.1%, standardized difference 0.26). CONCLUSION: Trends in Ontario of laparoscopic colon cancer surgery show an increase between 2002 and 2009, but the incidence remains lower than for open surgery.

Changing trends in rectal cancer surgery in Ontario: 2002-2009.

AIM: The safety and efficacy of laparoscopic surgery for colon cancer have been demonstrated in large, multicentre clinical trials. The study aimed to determine the use of laparoscopic surgery for rectal cancer in Ontario over a 7-year period. METHOD: We conducted a retrospective study examining rates of elective rectal cancer surgery among 10.5 million adults in Ontario, Canada, from 1 April 2002 to 31 March 2009. We linked the Canadian Institute for Health Information Discharge Abstract Database, the Registered Persons Database and the database of the Ontario Cancer Registry to assess procedures used over the period. Data on demographics were collected. Trends were assessed using time series analysis. RESULTS: Over the 7-year period, 8189 open and 1079 laparoscopic elective operations for rectal cancer were identified. The annual rate of laparoscopic rectal cancer procedures increased from 0.60 per 100,000 population in 2003 to 2.24 per 100,000 population in 2008 (P < 0.01). Laparoscopic patients were similar to open with respect to age (66.5 ± 11.8 vs 66.2 ± 12.1 years; standardized difference 0.02), gender (63.2%vs 59.4%; standardized difference 0.08), Charlson Comorbidity Index score (standardized difference < 0.1) and socioeconomic status (standardized difference < 0.1). CONCLUSION: Laparoscopic rectal cancer surgery rates are increasing in Ontario. Ongoing research regarding the long-term safety and effectiveness of the laparoscopic approach for rectal cancer surgeries may lead to greater increases in its utilization.

Ready to Go Home? Patients' Experiences of the Discharge Process in an Enhanced Recovery After Surgery (ERAS) Program for Colorectal Surgery.

BACKGROUND: With the adoption of enhanced recovery after surgery (ERAS) programs, patients are being discharged earlier and require more post-discharge teaching, educational materials, and information. OBJECTIVE: The purpose of this study is to assess satisfaction, discharge needs, and follow-up concerns of patients within an ERAS implementation program (iERAS). METHODS: Between 2012 and 2015, the iERAS program was undertaken at an academic hospital where 554 patients having elective colorectal surgery were enrolled. After discharge, patients were sent a survey containing multiple choice questions, preference ranking, and open-ended questions. Free-text responses were analyzed through a thematic approach. RESULTS: Overall, 496 patients were mailed surveys and 219 (44.2%) completed the survey. Ninety-three percent were satisfied with the discharge information, and 90% felt they were ready for discharge. Eighty-six percent of patients saw their surgeon at 6 weeks, and 88% were satisfied with this follow-up plan. Some patients felt they had inadequate post-operative information, including how to resolve complications while at home and lack of reliable information for common post-operative occurrences. Patients with ostomies wanted more information about what to expect post-discharge and what symptoms were normal. Support from the homecare team and having a surgical nurse available were considered to be essential. CONCLUSIONS: Improved post-operative education for surgical patients prior to discharge within iERAS is required to facilitate patient-centered discharge planning. Such interventions may help decrease unplanned hospital visits during the immediate post-discharge period.

Reaction of 5 and 6 year olds to dental injection after viewing the needle: pilot study.

The aim was to evaluate the practice of hiding the needle prior to dental anesthesia administration to children. Fourteen 5 and 6 year olds received dental treatment in two sessions. The needle was shown in one session and hidden in the other. Eleven children were cooperative and 3 uncooperative irrespective of approach. The children's behavior correlated with fears expressed by the mothers. Our initial fndintgs do not support the practice of hiding the needle.

An experimental approach to the evaluation of the biopersistence of respirable synthetic fibers and minerals.

The biopersistence of fibers and minerals in the respiratory tract is an important parameter in the toxicity of those materials. The biopersistence of respirable synthetic fibers and minerals in man can be most closely evaluated in an animal model. While acellular and in vitro systems are important for initial evaluation of solubility and durability, they cannot simulate the dynamics of inhalation deposition and clearance and the subsequent systemic reaction to fibers and minerals that occurs in the animal. To evaluate the biopersistence of synthetic fibers, male rats were exposed to a well defined rat respirable aerosol of man-made vitreous fibers (MMVF), 6 hr/day for 5 days. Following exposure, subgroups were sacrificed at intervals ranging from 1 hr to 52 weeks. Following sacrifice, the lungs were removed, weighed, and immediately frozen at 20 degrees C for subsequent digestion by low temperature plasma ashing. The number, size distribution, and chemical composition of the fibers in the aerosol and lung were determined. With this animal model the role of biopersistence in altering the geometry and clearance of fibers can be systematically evaluated. The model also can be applied for the evaluation of the biopersistence of nonfibrous minerals.

Biopersistences of man-made vitreous fibers and crocidolite fibers in rat lungs following short-term exposures.

Biopersistence of commercial man-made vitreous fibers (MMVF) and crocidolite were studied in Fischer 344 rats. MMVF used were size-selected to be rat-respirable, and rats were exposed nose-only 6 h/day for 5 days to gravimetric concentrations (30 mg/m3) of two fiber glass compositions--a rockwool, and a slagwool--or to 10 mg/m3 of long-fibered crocidolite, or to filtered air. Animals were sacrificed at 1 hr, 1, 5, 31, 90, 180, 270, 365, and 545 days after exposure stopped. Fibers were recovered from digested lung tissue to determine changes in concentrations (fibers/mg dry lung) and fiber retentions (expressed as percent of day 1 retention [PR]) for selected dimension categories. One-day average concentrations of lung-retained MMVF and crocidolite fibers, of diameter > or = 0.5 micron or > 20 microns in length, were nearly equal, permitting direct comparisons between MMVF and crocidolite. At 270 days average PR for MMVF > or = 0.5 micron in diameter were from 3 to 6 +/- 2% and 27 +/- 9% for crocidolite. For fibers > 20 microns, PR were 1 to 4 +/- 4% for MMVF and 37 +/- 20% for crocidolite. At 545 days, MMVF > 20 microns in length were at background level while concentration of crocidolite fibers > 20 microns in length remained at 2000 +/- 400 f/mg DL (dry lung), or 38 +/- 9% of day-1 retention. These results suggest strongly that MMVF dissolved or fractured in vivo whereas crocidolite fibers did not change.

Toward the development of a general chiral auxiliary. 9. Highly diastereoselective alkylations and acylations to form tertiary and quaternary centers.

[reaction--see text] Enolates of a new camphor-derived lactam auxiliary are shown to monoalkylate with very high diastereoselectivity. A second alkylation occurs with reactive alkylating agents to afford quaternary centers also with high diastereoselectivity. In accord with a proposed model for diastereoselection, lithium and sodium enolates provide products with an opposite sense of asymmetric induction.

An epidemiological and toxicological evaluation of the carcinogenicity of man-made vitreous fiber, with a consideration of coexposures.

Exposure to man-made mineral (or vitreous) fiber (MMMF or MMVF) is a potential health concern in both occupational and environmental settings. Previous epidemiologic studies have reported a small increase of lung cancer among workers exposed to MMVF. Most of these studies were cohort studies and lacked information on fiber concentration, occupational coexposures, and cigarette smoking. Some of the coexposures were known human lung carcinogens and could have accounted for the small lung cancer excess. In a recently completed epidemiologic case-control study of lung cancer in MMVF workers exposed to slag wool fibers, we analyzed lung cancer risk in relation to cumulative fiber exposure (concentration and duration) and smoking history and controlled for other coexposures such as asbestos contamination. No increased lung cancer risk with exposure to slag wool fibers was found. As expected, however, we detected a strong confounding effect of smoking. The findings from this epidemiologic study were consistent with the results of recently completed toxicologic studies, which found that slag wool fibers of dimension classically associated with tumor induction ("Stanton" fibers) do not stay in the lung in sufficient quantity or time to induce tumors in animals. In this paper we emphasize the importance of confounding effects due to coexposures and provide guidelines to estimate the magnitude of potential confounding effects of coexposures such as smoking.

Considerations in behavior management of the pediatric dental patient. Helping children cope with dental treatment.

Pediatric dentists use their knowledge of psychologic development and current theories of behavior modification to direct children in coping with the anxieties present at any dental visit. Only if these psychologic techniques are inadequate will conscious sedation, restraints, or general anesthesia be used to control children's behavior during dental treatment. This article emphasizes how dentists help children cope with dental treatment.

Is EPA's radium-226 drinking water standard justified?

The U.S. Environmental Protection Agency's (EPA) proposed drinking water standard for radium-226 (226Ra) of 5 pCi/l is evaluated according to its health basis and carcinogenic implications. Proposed health risks of 226Ra in drinking water by other leading theoreticians (Evans, Gofman-Tamplin and Peterson) are also considered in light of the EPA proposal. It is concluded that the EPA proposal to raise the standard for 226Ra in drinking water is not justified on the basis of present knowledge of 226Ra carcinogenic effects.

Selecting ozone exposure statistics for determining crop yield loss from air pollutants.

Numerous ozone exposure statistics were calculated using hourly ozone data from crop yield loss experiments previously conducted for alfalfa, fresh market and processing tomatoes, cotton, and dry beans in an ambient ozone gradient near Los Angeles, California. Exposure statistics examined included peak (maximum daily hourly) and mean concentrations above specific threshold levels, and concentrations during specific time periods of the day. Peak and mean statistics weighted for ozone concentration and time period statistics weighted for hour of the day were also determined. Polynomial regression analysis was used to relate each of 163 ozone statistics to crop yield. Performance of the various statistics was rated by comparing residual mean square (RMS) values. The analyses demonstrated that no single statistic was best for all crop species. Ozone statistics with a threshold level performed well for most crops, but optimum threshold level was dependent upon crop species and varied with the particular statistics calculated. The data indicated that daily hours of exposure above a critical high-concentration threshold related well to crop yield for alfalfa, market tomatoes, and dry beans. The best statistic for cotton yield was an average of all daily peak ozone concentrations. Several different types of ozone statistics performed similarly for processing tomatoes. These analyses suggest that several ozone summary statistics should be examined in assessing the relationship of ambient ozone exposure to crop yield. Where no clear statistical preference is indicated among several statistics, those most biologically relevant should be selected.

Potential bioindicator plant species for ambient ozone in forested mountain areas of central Europe.

From 1993 to 2000, trees, shrubs, forbs and vines were evaluated for symptoms of probable ozone injury in the vicinity of passive ozone samplers or active ozone monitors in forest condition assessment networks in mostly mountainous regions, principally the Carpathian Mountain Range, in the central European countries Czech Republic, Poland, Romania, Slovakia and Ukraine. Each country was visited at least twice during the time period. Over the course of eight seasons, 29 species of native plants were identified as potential bioindicators of ozone. This is the first report of probable ozone injury on native plants in central Europe. Forbs and shrubs made up the bulk of the species (21 of 29). Potential bioindicators that are widely distributed include the forbs Centaurea nigra. and Impatiens parviflora and the shrubs Alnus incana, Corylus avellana, and Sambucus racemosa. Ozone concentrations in forcsted areas of central Europe appear to be high enough and of sufficient duration to cause foliar injury on a wide variety of native plants.

Growth-stage dependent crop yield response to ozone exposure.

Data from four crop yield-loss field trials were examined to determine if analysis using an imposed phenological weighting function based on seasonal growth stage would provide a more accurate indication of impact of ozone exposure. Alfalfa (Medicago sativa L. cv. Moapa 69), dry bean (Phaseolus vulgaris L. cv. California Dark Red kidney), fresh market and processing tomato (Lycopersicon esculentum Mill. cv. 6718 VF and VF-145-B7879, respectively) were grown at 9-11 ambient field plots within southern California comprising an ambient gradient of ozone. The growing season for each crop was artificially divided into 'quarters' composed of equal numbers of whole days and roughly corresponding to specific growth stages. Ozone exposure was calculated for each of these 'quarters' and regressed against final crop yield using 163 different exposure statistics. Weighting functions were developed using reciprocal residual mean square (1/RMS) or percentage of the best 100 exposure statistics of the 163 tested (TOP100) for each of the quarters. The third quarter of the alfalfa season was clearly most responsive to ozone as measured by both of the weighting functions. Third quarter ozone was also weighted highest by both weighting functions for dry bean. Fresh market and processing tomato were each influenced the greatest by second quartero zone as demonstrated by both weighting functions. The occurrence of ozone during physiologically important events (flowering and initial fruit set in second quarter for tomato; pod development in third quarter for dry bean) appeared to influence the yield of these crops the greatest. Growth-stage-dependent phenological weighting of pollutant exposure may result in more effective predictions of levels of ozone exposure resulting in yield reductions.

Ambient ozone in forests of the Central and Eastern European mountains.

Ambient ozone (O(3)) concentrations in the forested areas of the Central and Eastern European (CEE) mountains measured on passive sampler networks and in several locations equipped with active monitors are reviewed. Some areas of the Carpathian Mountains, especially in Romania and parts of Poland, as well as the Sumava and Brdy Mountains in the Czech Republic are characterized by low European background concentrations of the pollutant (summer season means approximately 30 ppb). Other parts of the Carpathians, especially the western part of the range (Slovakia, the Czech Republic and Poland), some of the Eastern (Ukraine) and Southern (Romania) Carpathians and the Jizerske Mountains have high O(3) levels with peak values >100 ppb and seasonal means approximately 50 ppb. Large portions of the CEE mountain forests experience O(3) exposures that are above levels recommended for protection of forest and natural vegetation. Continuation of monitoring efforts with a combination of active monitors and passive samplers is needed for developing risk assessment scenarios for forests and other natural areas of the CEE Region.

Distribution of ozone and other air pollutants in forests of the Carpathian Mountains in central Europe.

Ozone (O3) concentrations were monitored during the 1997-1999 growing seasons in 32 forest sites of the Carpathian Mountains. At all sites (elevation between 450 and 1320 m) concentrations of O3, nitrogen dioxide (NO2), and sulfur dioxide (SO2) were measured with passive samplers. In addition, in two western Carpathian locations, Vychodna and Gubalówka, ozone was continuously monitored with ultraviolet (UV) absorption monitors. Highest average hourly O3 concentrations in the Vychodna and Gubalówka sites reached 160 and 200 microg/m3 (82 and 102 ppb), respectively (except for the AOT40 values, ozone concentrations are presented as microg/m3; and at 25 degrees C and 760 mm Hg, 1 microg O3/m3 = 0.51 ppb O3). These sites showed drastically different patterns of diurnal 03 distribution, one with clearly defined peaks in the afternoon and lowest values in the morning, the other with flat patterns during the entire 24-h period. On two elevational transects, no effect of elevation on O3 levels was seen on the first one, while on the other a significant increase of O3 levels with elevation occurred. Concentrations of O3 determined with passive samplers were significantly different between individual monitoring years, monitoring periods, and geographic location of the monitoring sites. Results of passive sampler monitoring showed that high O3 concentrations could be expected in many parts of the Carpathian range, especially in its western part, but also in the eastern and southern ranges. More than four-fold denser network of monitoring sites is required for reliable estimates of O3 distribution in forests over the entire Carpathian range (140 points). Potential phytotoxic effects of O3 on forest trees and understory vegetation are expected on almost the entire territory of the Carpathian Mountains. This assumption is based on estimates of the AOT40 indices for forest trees and natural vegetation. Concentrations of NO2 and SO2 in the entire Carpathian range were typical for this part of Europe and below the expected levels of phytotoxicity.

Unsedated animal models of pulmonary mucociliary transport.

Measurements of the rate of mucociliary transport in the airways of the lower respiratory tract have been shown to be influenced by the techniques and protocols used. To avoid the effects associated with invasive techniques and anesthesia in animal models used to study the effect of maturation, drugs, disease, and inhaled pollutants on mucociliary transport we have developed unsedated dog and baboon models of mucociliary transport using radioaerosol techniques. As far as they have been tested these animal models of mucociliary transport react to drugs such as isoproterenol and atropine in the same manner as in man.

In vivo facial tissue depth measurements for children and adults.

This study reports results of a facial tissue depth measurements project conducted over a two-year period on a modern sample of children and adults of both sexes and varying ages and races. The purpose of this research was to increase available tissue depth data for children and update facial tissue depth measurements for American adults. Most volunteers for this project were patients or visitors to the pediatric clinic at the Louisiana State University Medical Center, School of Dentistry, in New Orleans. Using state of-the-art ultrasound technology, we scanned 551 children and 256 adults at 19 points across the face. Thirteen of the scanned points were traditional landmarks while six others were areas not measured by previous researchers or were points for which very little data exist for both children and adults. For this presentation, we analyzed data for 515 children and 197 adults. Results of Pearson's correlations, analysis of variance, and paired t-tests indicate that age, sex, and race are significant factors when considering tissue depth means for different measurement locations across the human face. These new standards are compared to the work of other researchers. Our results provide valuable assistance in both two-dimensional and three-dimensional facial reproductions and superimpositions.

Effect of a clamp on toothbrush bristle deterioration.

The purpose of this study was to evaluate, in vitro, the effectiveness of a device to prevent toothbrush deterioration. Ten toothbrushes from each of four brands, Oral-B 40, Py-co-pay Softex 12.0 row, Butler #330, and Oral-B 20, were divided into control and experimental groups. Toothbrushes were fixed into a machine that simulated toothbrushing by producing a reciprocating motion 41.5 mm in length at a rate of 380 strokes/min. Bristles slid over a ceramic disc that had a hardness similar to dental enamel. Pressure (450 g) was applied at a right angle to the toothbrush while it moved back and forth in a slurry of toothpaste. The pressure was calibrated with load cells. Toothbrushes were run for 15 minutes followed by a drying cycle for a total of four hours, or approximately equivalent to brushing twice daily for six months. During the drying cycle the bristles of the toothbrushes in the experimental group were compressed 3/4 their length from the brush head with a clamp (Gregory Patent #4884311). Bristle deterioration was evaluated based on Wear Index (WI), a quantitative means of ranking brushes in various stages of deterioration. Data on WI and WR showed that toothbrushes in the experimental group had significantly (< or = 0.005) less deterioration. Improvement in wear resistance was dependent on size and configuration of the bristles. Compressing the bristles between brushings retains the non-matted shape of the bristles and reduces their deterioration.

The time used to administer local anesthesia to 5 and 6 year olds.

Pediatric dentistry and local anesthesia textbooks recommend injecting the local anesthetic during dental anesthesia and the rate of 1 ml per min. On the other hand, there are indications that, in practice, most dentists inject the anesthetic considerably faster. There has been no study indicating an ideal rate. Fourteen 5 and 6 year olds received treatment of two operative appointments and the injections were videotaped. All injections were administered by the same dentist, who did not know that the injections would be timed. There was an equal number of maxillary infiltrations and mandibular blocks. Each child received the same type of injection in both appointments. In all cases 1.8 ml of anesthetic were administered and provided anesthetic effect for the operative procedures. Two pediatric dentists rated the behavior of the children during the injection. The injections were timed from tissue piercing until withdrawal of the needle and the times ranged between 36 seconds and 161 seconds (2 minutes 41 seconds) with an average of 80.67 seconds (SD:34.84). This average is about 2/3 the time recommended to administer 1.8 ml. No statistically significant correlation was found between the time it took to administer the local anesthetic and the behavior of the children, or between the time and whether the children saw the needle prior to anesthesia administrator. The data presented no evidence to suggest that varying the time it takes to administer one capsule of anesthetic between 36 and 161 seconds affects the behavior of the children of the success of the anesthesia.