Association between self-assessment of complete dentures and oral health-related quality of life.

The purpose of this study was to determine which factors related to patient self-assessment of dentures are associated with changes in oral health-related quality of life (OHRQoL) among edentulous patients after replacement of complete dentures, and to determine whether masticatory performance as determined using an objective method affects the changes in OHRQoL among edentulous patients. As a preliminary study, the existing questionnaire regarding self-assessment of dentures consisting of 39 question items, measured with a 100-mm visual analogue scale, was analysed by factor analysis. Then a questionnaire, composed of 22 question items, was developed containing six subscales of 'function', 'lower denture', 'upper denture', 'expectation', 'aesthetic and speech' and 'importance'. Final participants in the present study comprised 93 edentulous patients requiring new conventional complete dentures (44 men, 49 women; mean age, 75·0 years). These patients were asked to complete the Japanese version of the Oral Health Impact Profile (OHIP)-EDENT, comprising 19 question items for assessment of OHRQoL in edentulous patients, along with the developed questionnaire regarding self-assessment of dentures. Moreover, masticatory performance was measured using a colour-changeable chewing gum. The questionnaire and measurement were completed twice; before and after replacement of complete dentures. Stepwise multiple regression analysis identified 'lower denture' and 'aesthetic and speech' as significant independent variables besides OHIP-EDENT scores before replacement. These results suggest that sufficient retention of lower dentures and appropriate appearance may lead to improved OHRQoL in edentulous patients.

School refusal and depression with school inattendance in children and adolescents: comparative assessment between the Children's Depression Inventory and somatic complaints.

School refusal has become a relatively common problem of increasing magnitude in Japan. Although clarification of the relationship between 'school refusal' and 'depression with school inattendance' is crucial in light of the difference in treatment modalities involved, it is not clear whether the two are to be regarded along the same tangent or as disparate entities. For clarification, a comparison was made between clinical diagnosis, Children's Depression Inventory (CDI) scores, and scores for the three subordinate scales of the CDI in 34 cases of school refusal, 10 cases of depression with school inattendance, and normal students. Significant difference in CDI score was noted between the three groups: highest among depression cases, followed by school refusers, and lowest in normal students. A larger proportion of school refusers expressed somatic complaints together with low CDI scores. The typical case of school refusal appears to exhibit somatic complaints in the foreground rather than depression, both clinical characteristics and CDI scores indicate school refusal and depression to be separate entities. Although many approaches are being taken in the treatment of school refusal, the results appear to justify primacy of the psychotherapeutic approach with the possible adjuvant use of pharmacological agents, for the phenomenon as it presents in Japan.

Human resource assignment and role representation mechanism with the "cascading staff-group authoring" and "relation/situation" model.

We have previously reported the access control mechanism and audit strategy of the "patient-doctor relation and clinical situation at the point-of-care" model with multi-axial access control matrix (ACM). This mechanism overcomes the deficit of ACM in the aspect of data accessibility but does not resolve the representation of the staff's affiliate and/or plural membership in the complex real world. Care groups inside a department or inter-department clinical team plays significant clinical role but also spend great amount of time and money in the hospital. Therefore the impact of human resource assignment and cost of such stakeholders to the hospital management is huge, so that they should be accurately treated in the hospital information system. However multi-axial ACM has problems with the representation of staff groups due to static parameters such as department/license because staffs belong to a group rather temporarily and/or a medical staff may belong to plural groups. As a solution, we have designed and implemented "cascading staff-group authoring" method with "relation and situation" model and multi-axial ACM. In this mechanism, (i) a system administrator certifies "group chief certifying person" according to the request and authorization by the department director, (ii) the "group chief certifying person" certifies "group chief(s)", (iii) the "group chief" recruits its members from the medical staffs, and at the same time the "group chief" decides the profit distribution policy of this group. This will enable medical staff to access EMR according to the role he/she plays whether it is as a department staff or as a group member. This solution has worked successfully over the past few years. It provides end-users with a flexible and time-to-time staff-group authoring environment using a simple human-interfaced tool without security breach and without system administration cost. In addition, profit and cost distribution is clarified among departments and inter-departments groups.

Simultaneous assessment of the hemodynamic, cardiomechanical, and electrophysiological effects of terfenadine on the in vivo canine model.

Prolongation of the QT interval, sometimes leading to torsades de pointes, has been clinically reported during terfenadine treatment. However, information regarding the cardiovascular profile of terfenadine is still limited, particularly in in vivo animal models. In the current study, we examined the cardiovascular effects of terfenadine using halothane-anesthetized, closed-chest in vivo canine models (n = 6) to better simulate the clinical situation. Intravenous infusion of 0.3 mg/kg of terfenadine over 10 min, which would attain the antihistaminic plasma concentration, reduced the heart rate and left ventricular contractility and prolonged the repolarization period as well as the ventricular effective refractory period. An additional infusion of a ten times higher dose of terfenadine over 10 min caused hypotension and increased left ventricular preload and atrioventricular conduction time, in addition to potentiating the changes observed by the lower dose. A reverse use-dependent prolongation of the repolarization period was observed after the higher dose infusion. Moreover, early afterdepolarization-like potential was detected in four out of six experiments. Since each suppressive effect can become deleterious during terfenadine overdose, caution must be taken for those patients with potential cardiac dysfunction and with the risk of elevated plasma drug concentrations.

[The results of questionnaire on quantitative assessment of 123I-metaiodobenzylguanidine myocardial scintigraphy in heart failure].

This study was done by working group under the cooperation between Japanese Society of Nuclear Medicine and Japanese Circulation Society. We evaluated the usefulness of quantitative assessment of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in heart failure by the results of questionnaire. Forty-nine (72.1%) of 68 selected institutions participated in this study. The incidence of MIBG myocardial scintigraphy used in heart failure was 41.1%. The imaging protocol was mostly done by both planar and SPECT at 15 min and 3.6 hr after intravenous injection of 111 MBq of MIBG. The quantitative assessment was mostly done by heart/mediastinum (H/M) ratio and washout rate analysis based on planar imaging. The mean normal value of H/M ratio were 2.34 +/- 0.36, and 2.49 +/- 0.40, at early and delayed images, respectively. The normal value of washout rate was 27.74 +/- 5.34%. On the other hand, those of H/M ratio in heart failure were 1.87 +/- 0.27, and 1.75 +/- 0.24, at early and delayed images, respectively. That of washout rate was 42.30 +/- 6.75%. These parameters were very useful for the evaluation of heart failure. In conclusion, MIBG myocardial scintigraphy was widely used for not only early detection and severity assessment, but also indication for therapy and prognosis evaluation in heart failure patients.

Use of whole-body imaging using Tc-99m RBC in patients with soft-tissue vascular lesions.

We investigated the usefulness of whole-body imaging as an adjunct to spot imaging in soft-tissue vascular lesions, such as hemangiomas and vascular malformations. Spot imaging of the known lesion and whole-body imaging were performed 1-3 hours after the injection of Tc-99m RBC in 42 patients with soft-tissue vascular lesions. Whole-body imaging was considered to be useful in only two patients, who had multiple distant occult lesions in addition to large known lesions. It was suggested that the routine addition of whole-body imaging is not cost effective in patients with soft-tissue vascular lesions, although it may be beneficial for detecting occult lesions in patients with hemangiomas.

Dental health indicator based on a questionnaire.

Dentistry has lacked an effective indicator of the impact of dental problems on a person's daily life. Subjective factors in dental health need to be included in order to improve current indicators. The purpose of this research was to develop a new type of indicator recorded from a questionnaire which takes account of subjective factors in dental health. The indicator we constructed has the following advantages. 1. Calculation process is simple in practice. 2. The indicator values range from 0 to 100, with values closer to 100 indicating a more favorable condition for the individual. 3. The distribution of indicator values is similar to the normal distribution. 4. The score of each item is reflected on the indicator, suggesting the individual's characteristics in terms of dental health. 5. Although it is principally an indicator for individuals, it can also be applied to groups. This study will also provide a model for the preparation of a dental health indicator.

Assessment of the cerebrovascular response to acetazolamide using 99mTc-DTPA-HSA: methodological considerations.

We have reported methods of assessing the cerebrovascular response to acetazolamide using 99mTc-DTPA-HSA and their usefulness in evaluating cerebral hemodynamics. Several problems of this technique were investigated in 10 normal subjects. Following 99mTc-DTPA-HSA injection, dynamic imaging of the anterior head view was performed for 25 to 50 minutes, and 10 minutes after the beginning of imaging, 1,000 mg of acetazolamide was infused intravenously. Venous blood samples were obtained during the imaging period to estimate the blood retention of 99mTc-DTPA-HSA. Radioactivity in the head increased for about 10 minutes following acetazolamide infusion, then decreased slowly. The declining phase almost disappeared after correction for the blood clearance of 99mTc-DTPA-HSA, indicating stability of the vasodilatory effect of acetazolamide. Dilatation index, the percent increase in activity, was a little smaller after correction, but was closely correlated with the index without correction. There was a high correlation between dilatation indices obtained by two analyses, including ROI setting and visual determination of the peak, of the same data. In conclusion, neither blood clearance of 99mTc-DTPA-HSA nor subjective analysis considerably impairs the reliability of the dilatation index, and blood volume in the head from about 15 to 40 minutes after acetazolamide injection is stable and suitable for SPECT.

Postaortic left innominate vein: radiological assessment and pathogenesis.

Postaortic left innominate vein (PALIV) is a rare venous anomaly and the findings on plain chest radiographs have not been well described. Plain chest radiographs, CT and MR of nine adults known to have PALIV were reviewed. They all showed a high aortic arch, including four with a right-sided aortic arch and one with a double aortic arch, in postero-anterior radiographs, and seven showed curved shadows in the left upper mediastinum. On all lateral chest radiographs (n = 5), the superior retrosternal region was opacified by the high aortic arch. CT or MR images confirmed the aortic arch and/or innominate artery to be in that part of the retrosternal space, normally occupied by the left innominate vein, in all cases. Association of a curved shadow in the superior mediastinum with a high aortic arch on plain chest radiographs is therefore suggestive of, though not diagnostic for, PALIV. This entity was well documented by CT or MR and the radiological findings were considered to imply that developmentally PALIV is secondary to a high position of the aortic arch.

[Right ventricular function in patients with dilated cardiomyopathy: assessment using krypton-81 m blood pool scintigraphy].

The characteristics and pathogenesis of right ventricular dysfunction in 14 patients with dilated cardiomyopathy (DCM) were investigated by equilibrium right ventricular blood pool scintigraphy using ultrashort-lifetime 81mKr. Thirteen patients with severe left ventricular dysfunction due to old anterior myocardial infarction (OMI) and nine normal subjects were used as controls. The right ventricular end-diastolic pressure and volume index, mean pulmonary arterial pressure, and total pulmonary vascular resistance index were almost the same in the DCM and OMI patients. The right ventricular ejection fraction was 44.2 +/- 6.0% (mean +/- SD) in DCM patients and 47.1 +/- 7.9% in OMI patients, both significantly lower than those in the normal subjects (54.5 +/- 5.3%), but with no difference between the two case groups. The right ventricular peak filling rate was significantly reduced in both case groups as compared with the normal subjects (2.46 +/- 0.81 EDV/sec). The reduction was significantly greater (p < 0.05) in the DCM group (0.97 +/- 0.47 EDV/sec) than in the OMI group (1.61 +/- 0.46 EDV/sec). Cineangiography showed that the wall motion abnormality of the interventricular septum was remarkable in OMI patients, but was relatively mild in DCM patients. Lesions of the interventricular septum may be of major importance in right ventricular dysfunction in OMI, while extensive severe damage to the right ventricular free wall may be important in DCM. 81mKr blood pool scintigraphy is useful in the study of the right ventricular systolic and diastolic function. The diastolic parameters are more sensitive indicators for evaluation of right ventricular function in DCM than the systolic parameters.

[The assessment of clinical usefulness of 131I-MIBG scintigraphy for localization of tumors of sympathetic and adrenomedullary origin--a report of multicenter phase III clinical trials].

A phase III clinical study of 131I-metaiodobenzylguanidine (131I-MIBG) was performed in 66 patients with tumors of sympathetic and adrenomedullary origin, including 32 patients with suspected pheochromocytoma, 25 with suspected neuroblastoma, 7 pre- or postoperative medullary carcinoma of the thyroid and each with carcinoid and suspected Sipple's syndrome. A total of 150 sites which were confirmed for presence (72 sites) or absence (78 sites) of tumors were examined on 131I-MIBG scintigrams. True positive ratio of the scintigraphy was 84.7% (61/72) and true negative ratio was 94.9% (74/78). Positive scintigraphy was obtained in 86.5% (32/37) of pheochromocytoma, 78.6% (22/28) of neuroblastoma and 100% (6/6) of medullary carcinoma of the thyroid. Accumulation of 131I-MIBG was seen in 16.8% of normal adrenal glands. Neither adverse reactions nor abnormal laboratory findings were noted in relation to 131I-MIBG injections. Our study indicates that 131I-MIBG is a safe and clinically useful radiotracers for the visualization and localization of tumors of sympathetic and adrenomedullary origin.

Radiation therapy of intracranial germ cell tumors with radiosensitivity assessment.

Fifty patients with pineal and/or suprasellar tumors were treated in the Department of Radiology, University of Tokyo, from 1975 to 1988. Histological diagnosis was obtained in 28 cases, whereas 22 patients were irradiated without pathological verification. Of the 28 patients with histological diagnosis, 11 had germinomas, 13 non-germinoma germ cell tumors, including nine teratomas, two choriocarcinomas and two embryonal carcinomas, two pineocytomas and two pineoblastomas. The treatment protocol since 1981 has been that, after 20 Gy is given with a local irradiation field, if tumor regression is marked and germinoma is highly suspected, whole brain or whole CNS irradiation is performed subsequently; otherwise, surgical intervention is performed followed by systemic chemotherapy plus radiation therapy. The five-year survival rates of histologically proven germinomas, histologically proven non-germinoma germ cell tumors, and clinically suspected germinomas by means of the above-mentioned method as well as tumor marker status were 73%, 28%, and 83%, respectively. The overall five-year survival rate was 61.3%. A statistically significant difference was found between the survival rates for the 11 cases with histologically proven germinoma and the 13 cases with non-germinoma germ cell tumors, although there was no significant difference between the survival rates for the histologically proven germinomas and the clinically suspected germinomas. Therefore radiation therapy is an effective treatment method for the management of intracranial germ cell tumors.

[Assessment of factors associated with the outcome in patients with hypertensive putaminal hemorrhage].

A total of 32 patients with hypertensive putaminal hemorrhage, who had been admitted within 24 hours of onset, were reviewed. Patients were divided into three groups on the basis of their outcome at hospital discharge, as follows: Group A, 11 patients who were able to walk independently with good or full recovery from hemiparesis; Group B, 9 patients who were able to walk with a cane and 2 patients in wheel chairs; and Group C, 6 patients who required evacuation of hematoma and 4 who had died. We investigated factors affecting outcome by comparing the clinical features during the acute stage and degrees of hypertensive damage to the retina, heart, and kidney of the above three groups. Furthermore, we examined interrelationships among the volume of the hematoma (as calculated from CT scan), systemic blood pressure, and urinary catecholamine excretion in 10 of these patients. The mean age in groups A, B and C was 61.4 +/- 8.1, 58.0 +/- 11.3, and 52.4 +/- 6.8, respectively. The mean volume of hematoma on admission (Day 1) in Group C (50.2 +/- 28.2 ml) was significantly larger than in the other two groups (p less than 0.01, vs Group A: 19.5 +/- 8.8 ml; p less than 0.05, vs Group B: 25.1 +/- 12.6 ml). In Group C, the mean hematoma volume on Day 2 (98.4 +/- 39.5 ml) was significantly larger than the volume on Day 1 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[The assessment of preoperative transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC)--the comparison between "whole-liver" TAE and "lobar or segmental" TAE].

In 180 patients with hepatocellular carcinoma (HCC) who underwent radical hepatectomy, 52 patients were received preoperative arterial chemoembolization (TAE) for the whole liver (whole-liver TAE group: group A), 39 for the limited area of the liver (lobar or segmental TAE group: group B) and the remaining 89 had no treatments before surgery (control group: group C). In order to evaluate the significance of preoperative TAE, long-term prognoses were compared among the three groups. Although there were no significant differences in survivals between A and C, the 2- and 6-year survivals in group B were significantly better than those in group C (P less than 0.05). With regard to reduction rates of tumors and necrotizing effect for daughter nodules after TAE, the lobar or segmental TAE was significantly superior to the whole-liver TAE. Moreover, the lobar or segmental TAE deteriorated the liver function significantly less than the whole-liver TAE. These findings suggest that the lobar or segmental TAE is more advantageous than the whole-liver TAE as a preoperative adjuvant therapy.

[Assessment of the permeability of the pulmonary microvasculature using radiotracers in a case of adult respiratory distress syndrome].

A 48-year-old man with small cell lung cancer developed ARDS, and massive pulmonary edema fluid was obtained with the fiberoptic bronchoscopy. The pulmonary edema fluid to serum ratios of total protein and albumin were 0.72 and 0.85 respectively. The ratio of LDH was higher (2.71), while that of cholesterol was lower (0.11) than that of total protein. Simultaneously, isopropyl N [I-123] p iodoamphetamine (I-123 IMP) and I-131 human serum albumin (I-131 HSA) were injected into this patient. Samples of blood and pulmonary edema fluid were collected to measure the clearance through the pulmonary microvasculature. The time activity curves of I-123 IMP and I-131 HSA in his blood samples revealed almost constant radioactivity from 5 minutes to 120 minutes after injection, while both radioactivity levels in pulmonary edema fluid samples increased with time. The clearance ratio of I-123 IMP to I-131 HSA was constant at each sampling time (mean +/- SD, 1.51 +/- 0.32). The linear correlation between I-123 IMP clearance and I-131 HSA clearance (r = 0.95, p less than 0.01) suggested that the clearance ratio of exudative plasma components may remain unchanged even if pulmonary microvasculature permeability has changed.

Radiographic assessment of nocturnal gastric juice secretion after administration of roxatidine acetate hydrochloride.

Adult patients with symptoms of gastric disease were randomly assigned to a treatment group (n = 103) or untreated control group (n = 89). The treatment group received 75 mg of roxatidine acetate hydrochloride at 9 PM and 12 to 13 hours later gastric juice secretion was measured with gastric x-ray films in both groups. Mean gastric juice secretion was significantly lower in the treated group (16.1 ml/12 hrs) than in the untreated controls (49.8 ml/12 hrs). Gastric juice suppression by roxatidine was 90% in patients with gastric ulcer, 74% in patients with duodenal ulcer, 63% in patients with gastritis, and 70% in patients with no evidence of disease. It is concluded that 150 mg of roxatidine daily would be adequate to treat patients with gastric diseases.