Assessment of respiratory muscle dysfunction in chronic obstructive lung disease.

In COLD, the inspiratory muscles are severely disadvantaged by virtue of the hyperinflation that accompanies this disorder. Such mechanical disadvantage will lead clinically, in the stable patient, to the active recruitment of the accessory muscles of inspiration and to a pattern of rapid, shallow breathing that may be due to either peripheral (muscle) or central (neurogenic) influences thought to be linked to a critical tension-time index of the inspiratory muscles. This pattern appears to be all the more pronounced in the patient with acute respiratory failure and is frequently accompanied by disordered rib cage-abdominal movements. While these movements may reflect the muscles' attempts to stave off fatigue, they may also imply that if the imposed mechanical stress is unrelieved, muscle failure will ensue. In the laboratory, mechanical disadvantage is marked by diminished inspiratory mouth pressures. Because of wide scatter, a low mouth pressure beyond that which can be explained by hyperinflation alone should be confirmed by an assessment of Pesosniff or by the measurement of transdiaphragmatic pressure. Muscle endurance, also compromised in this condition, can be assessed indirectly by the measurement of MVV or MSVC, or more directly by an invasive assessment of the tension-time index and endurance time of the diaphragm or noninvasively by the Endurance Index of McKenzie and Gandevia. And finally, once muscle failure is pending or has been established, a program of muscle rest, either complete or partial, pharmacotherapy, and goal-specific training should be instituted.

A 5-year multicenter study on implant-supported single crown restorations.

In this multicenter prospective study, the results achieved with the use of Brånemark implants for single tooth replacement were evaluated. The overall cumulative success rate was 95.9% for implants and 91.1% for crowns. Two of the 99 implants placed had to be removed before the prosthodontic stage of treatment; thus, 97 were restored with CeraOne crowns. Seventy-seven implants were evaluated radiographically at the 1-year follow-up, 57 at 3 years, and 47 at 5 years. Mean marginal bone resorption was well within the limits set by Albrektsson et al in 1986. The status of the soft tissue around crowns and adjacent teeth remained stable over the evaluation period. The gold abutment screw in the CeraOne system seems to have eliminated the problem of loosening abutment screws in single tooth replacements. The results suggest that the Brånemark system can be safely used for tissue-integrated replacement of single teeth.

Partial recording of gingivitis and dental plaque in children of different ages and in young adults.

In epidemiologic studies, total recordings of the amount of dental plaque and the degree of gingival inflammation tend to be too time-consuming. Various partial recording methods have accordingly been suggested. However, the validity of these methods when applied to different age groups has not been investigated sufficiently. The aim of the present study was to test whether different systems for partial recording of plaque and gingivitis can take the place of a full-mouth recording in children of different ages and in young adults. Ninety children, divided into three age groups (4-6, 7-9, 14-16 yr), and 30 adults (20-22 yr) were examined. The degree of gingival inflammation was recorded using the Gingival Index and the amount of dental plaque using the Plaque Index. Two partial recording methods were tested. One of these covered the teeth suggested by Ramfjord, modified for children with a primary dentition, and the other the front segment of the maxilla. The results were compared with those from an examination of all tooth surfaces. In all age groups excellent agreement was found between the partial recording method suggested by Ramfjord and a full-mouth recording of both the gingival state and the amount of dental plaque. Examination of the maxillary front segment was less accurate and resulted in a systematic underestimate.

The immediate implant: bone preservation and bone regeneration.

This paper demonstrates that an intact extraction socket is not necessary for the successful integration of a titanium implant fixture. Several case reports are used to describe the immediate placement of fixtures into compromised sockets, some in conjunction with bone grafting and/or guided tissue regeneration techniques to enhance the surgical result. Advantages of immediate implant placement are threefold: (1) treatment time is significantly reduced; (2) ridge contour can be preserved; and (3) it is possible to place the fixture in a more ideal axial position, thus enhancing fabrication, esthetics, and biomechanics of the subsequent restoration.

[Evolving in prosthetics with the Brånemark system]. / Evoluer en prothèse avec le système Brånemark.

The incorporation of the Brånemark root-form osseointegrated implant into the practice of Prosthodontics has opened up a new range of treatment options previously unavailable to our patients. No longer limited to their original use in restoring the completely edentulous arch, the role of implants now includes the replacement of one or more missing teeth in partially edentulous situations. Implants may also be incorporated into periodontal prostheses as supplemental support where the number or strength of existing natural abutments is inadequate, and used as a means of salvaging prostheses which have failed as a result of the loss of strategically important abutments. These newer applications, however, combined with patient demands for the optimum in esthetics as well as function, have served to challenge our ingenuity and resourcefulness in this rapidly evolving field. The objective of this paper is to provide an overview of the evolution of our implant experiences in recent years, and to illustrate the ways in which the Brånemark system has been utilized and adapted as the number and complexity of clinical situations have increased. Simply stated, the technical aspects of prosthetic treatment, those involving impression techniques, materials, etc., have remained fairly constant throughout our implant experience. The more dramatic changes have occurred through the utilization of newer components as they have become available, as well as through a growth in our application of the system and in our approach to treatment planning. The Brånemark system has been in use for just over 25 years at this point in time and has proven itself to be reliable, predictable and at the same time versatile enough to admirably meet the challenges placed on us by the new and varied clinical situations we are now undertaking to treat. It is by using our imaginations to stretch the limits of the system without overstepping its boundaries that we have reached the point where osseointegration is truly becoming a part of our basic armamentarium in the practice of Prosthodontics.

Gingival inflammation at deciduous and permanent teeth. An intra-individual comparison.

Previous studies showed that the tendency to develop gingivitis differed between pre-school children with deciduous dentition and adults. A similar difference was noted between juvenile dogs with deciduous teeth and adult dogs with permanent teeth. The juvenile dogs showed morphologic characteristics which might interfere with the permeability of the junctional epithelium, thus protecting the underlying tissues from bacterial irritation. An indirect way to test whether structural differences of clinical importance exist in humans between the gingiva at deciduous and that at permanent teeth is to study the gingival reaction to a controlled amount of plaque in children with mixed dentition. The present paper reports an intra-individual comparison of the gingival reaction at deciduous teeth with that at permanent teeth. 30 children, 7-9 years of age, took part in the study. The amount of plaque was assessed in terms of the plaque index and the degree of gingival inflammation by applying the gingival index. The mean distribution of gingival index scores did not differ significantly between deciduous and permanent teeth, but a higher % of plaque index score 2 + 3 was found in permanent teeth. In the comparison based on areas of similar plaque irritation, a tendency toward a higher degree of gingivitis was found at the deciduous teeth. The results indicate that structural differences, if any, between the gingiva at deciduous teeth and that at permanent teeth have no impact of clinical significance on the gingivitis reaction.

Gingival inflammatory reaction in children at different ages.

Earlier studies have demonstrated that, with similar levels of plaque accumulation, the tendency to develop gingivitis is lower in pre-school children than in young adults. No studies are available in which the gingival reaction in older children and adults to a given amount of plaque has been compared. The aim of the present study was to compare the gingival reaction to dental plaque in children of different ages and in adults. 3 groups of children (4-6, 7-9 and 14-16 years of age) and 1 group of adults (20-22 years of age) were studied. The degree of gingivitis was determined using the gingival index and the amount of dental plaque was assessed in terms of the plaque index. The results showed that with a given plaque score, the % of high gingivitis scores was less in the 4-6-year-old children than in the older children and adults. At all levels of plaque accumulation, the highest degree of gingival inflammation was noted in the 14-16-year-old children and in the adults. The results indicate that the gingival reactivity increases gradually from early childhood to adult age.

[Immediate implantation. Preservation of bone volume and osseous regeneration]. / L'implantation immediate. Preservation du capital osseux et regeneration osseuse.

In recent years, much emphasis has been placed on the refinement and enhancement of prosthetic components and techniques in implant dentistry, while the surgical protocol has remained fairly constant. The evolution of the concept of the immediate placement of fixtures into extraction sites, along with the related concept of guided tissue regeneration, is a major advancement in the surgical field. It provides significant benefit to both patient and clinician in terms of the reduced treatment time and an enhanced prognosis related to biomechanics and aesthetics.

Periodontal considerations in restorative and implant therapy.

The successful integration of periodontal and restorative dentistry for both natural teeth and implants requires knowledge and application of both mechanical and biological principles. In areas of aesthetic concern, an adequate band of attached gingiva can increase patient comfort, reduce the probability of gingival recession following tooth preparation and simplify restorative procedures. While some restorative margins need to be placed at or below the margin of the free gingiva, this should be considered to be a compromise, and margins should not be placed more than 0.5 mm into a healthy gingival sulcus. Approximately 2-3 mm of healthy, natural supra-alveolar tooth surface is needed for attachment of the gingival tissues to the tooth. This dimension is called the biological width. If adequate biological width does not exist, surgical or orthodontic procedures to expose healthy tooth structure are recommended before final restorations are placed. Retraction of soft tissues for impressions is best accomplished with mechanical methods rather than lasers or electrosurgery because of the potentially harmful effects of these devices to the cementum, bone and soft tissues surrounding the teeth. Implants function best and withstand occlusal forces optimally when loaded in a vertical direction. Therefore, planning implant placement is critical for success. Because of increased proprioception, it is suggested that natural teeth be used to guide the occlusion in partially edentulous patients. Cantilevers should be used with caution and with appropriate attention to occlusal forces. While occlusal trauma does not cause periodontal disease, it may contribute to bone loss around teeth and implants. In the opinion of the authors, provisional restorations are an integral part of dental and periodontal therapy. They can be used to establish aesthetic and physiological contours that can be easily cleaned by patients and they can also be used as a guide for any needed surgical tissue modification.

ESR dates for the hominid burial site of Es Skhul in Israel.

The Middle East has been critical to our understanding of recent human evolution ever since the recovery of Neanderthal and early anatomically modern fossils from the caves of Tabun and Skhul (Mount Carmel) over 50 years ago. It was generally believed, on archaeological and morphological grounds, that middle eastern Neanderthals (such as those from Tabun, Amud and Kebara) probably dated from more than 50,000 years ago, whereas the earliest anatomically modern specimens (from Skhul and Qafzeh) probably dated from about 40,000 years. Recent thermoluminescence and electron spin resonance (ESR) determinations, however, have supported biostratigraphy in dating the Qafzeh deposits to an earlier part of the late Pleistocene, probably more than 90,000 years ago. These dates have been questioned on unspecified technical grounds, and it has also been argued that they create explanatory problems by separating the morphologically similar Qafzeh and Skhul samples by some 50,000 years, thus implying a long-term coexistence of early modern humans and Neanderthals in the area. Here we report the first radiometric dating analysis for Skhul, using ESR on bovine teeth from the hominid burial levels. Early uptake and linear uptake ages average 81 +/- 15 and 101 +/- 12 kyr respectively. These analyses suggest that the Skhul and Qafzeh samples are of a similar age and therefore it is possible that the presence of early modern humans in the area was episodic, rather than long-term during the early late Pleistocene.

Effect of partial substitution of invert sugar for sucrose in combination with Duraphat treatment on caries development in preschool children: the Malmö Study.

The aim was to study the effect of substitution of invert sugar for sucrose, in combination with fluoride varnish (Duraphat) treatment twice a year, on caries development in preschool children. One hundred and eighty-seven 4-years-olds were divided randomly into four sugar groups: (1) sucrose (S), (2) sucrose-Duraphat (SD), (3) invert sugar (I), and (4) invert sugar-Duraphat (ID). All families were asked to buy beverages, biscuits, breakfast cereals, marmalade, ice cream, jam, ketchup, sweets and table sugar, totally 32 different food items, sweetened with invert sugar or sucrose. The substitution was, thus, restricted to a number of sugar-rich between-meal products. The study was carried out double-blind for 2 years. The children of those parents who did not want to participate in the sugar groups were divided randomly into one of the following two groups: (5) Duraphat (D), and control (C). Because of lack of cooperation, only 114 of the 187 children (61%) were considered to have completed the study. The mean caries increment, including initial lesions, was 3.86 dmfs in the combined groups S and SD (n = 63) and 3.10 dmfs in the combined groups I and ID (n = 51) during the 2 years (p = 0.34). The corresponding values for the 2nd year only were 1.84 and 0.67 dmfs, respectively (p = 0.09). The mean caries increment was 2.86 dmfs in group D (n = 113) and 4.10 dmfs (p = 0.08) in group C (n = 93). If initial caries lesions were excluded from the index, the difference between groups D and C was significant (p = 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)

A study of a new osmotic purgative for colonoscopy. Is Golytely worth its salt?

An osmotic laxative containing polyethylene glycol and sodium sulfate (Golytely Braintree Laboratories, Inc., Braintree, MA) is widely used to clean the colon for colonoscopy. However, its salty taste makes the mixture unpalatable. We therefore tested the claim that a similar solution but without sodium sulfate (Golytely-RSS Braintree Laboratories, Inc., Braintree, MA) makes preparation of the colon more acceptable to patients in a double-blinded randomized controlled trial. Colonic preparation using polyethylene glycol with or without sodium sulfate was randomized in 100 patients due to undergo colonoscopy. The overall acceptability of the regimen was measured on a linear analogue scale and an estimate of symptoms was obtained. Body weight and serum electrolytes, urea, creatinine, hemoglobin and hematocrit were determined before and after preparation in order to assess fluid absorption. The efficacy of colonic cleansing was graded by the colonoscopist. Four patients did not complete the protocol, 47 received the regimen containing sodium sulfate and 49 received the regimen without it. The two groups did not differ in age or body mass. There was no statistical difference in the overall acceptability of the two regimens to the patients (median acceptability rating 74 for regimen with sodium sulfate, range 4-100 compared with 77 for regimen without, range 3-100, p = 0.32, Mann-Whitney test). Nor was there any difference in taste, nausea, vomiting, cramping or perianal discomfort or in the endoscopists' rating of the cleanliness of the colon. The serum sodium concentration rose slightly (mean 1.6 mmol/L) when the regimen with sodium sulfate was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Circulating somatostatin after food and glucose in man.

Using a recently validated radioimmunoassay, changes in circulating somatostatin have been measured in normal subjects after food (a standard breakfast), and oral and intravenous glucose. After the standard breakfast, a clear and sustained rise in plasma somatostatin was seen in all subjects from a mean value (+/-1 SE) of 28 +/- 7 pg/ml to a mean peak value, at 60 min of 57 +/- 11 pg/ml. When glucose was taken by mouth a significant but smaller rise was seen, but intravenous glucose caused no significant change in plasma somatostatin. A rise in circulating somatostatin after feeding has not previously been demonstrated in normal man and it is suggested that somatostatin may have an important endocrine role in the gut.

Visicorrafia extramucosa con sutura absorbible sintética monofilamento en ratas Wistar / Extramucosal suture of the bladder using absorbable suture material: experimental study

El objetivo del trabajo es comparar los resultados con dos tipos de suturas en vesicorrafias realizadas en un plano.Se efectuó una vesicorrafia extramucosa en 48 ratas Wistar separadas en 2 grupos(n=24):en el primero con catgut 6-0 y en el segundo con polidioxanona(PDS)6-0.Cada grupo fue divido en 3 subgrupos según en momento del sacrificio:7,14 o 28 días luego de la cirugía.Se estudió la presencia de litiasis,alteraciones en los puntos de las suturas y la actividad inflamatoria,aguda y crónica.La litiasis ocurrió en los subgrupos a los 7 días(1),14 días(1),28 días(1)en el grupo catgut a los 14 días(3)y 28 días(1)La granulación,el edema y la presencia de células gigantes fue significativamente mayor en los subgrupos tratados con catgut.El número de macrógrafos y de polimorfonucleares fue mayor en el grupo suturado con catgut a los 7 y 14 días,como también el número de linfocitos a los 28 días.La polidioxanona produjo menor reacción inflamatoria aguda y crónica que el catgut