Anticipating failure in extensive restorative treatment of the periodontally compromised patient.

If even one supporting tooth fails, a complex restorative treatment may have to be redone. Improved design of a restoration can anticipate failure and offer alterations to existing appliances.

The social and psychologic factors of bruxism.

Bruxism is a destructive habit that is defined as the nonproductive diurnal or nocturnal clenching or grinding of the teeth. This study investigated whether the combination of physical abnormalities, type A behavior pattern, and the perceived desirability and controllability of life stress are related to bruxism. The subjects for the study were 125 dental patients who were classified as bruxers or nonbruxers by a licensed dentist and who completed two measures, the Jenkins Activity Survey, and a modified version of the Holmes and Rahe Life Events Scale. Regression analyses indicate there is a difference in the separate impact of each variable. Type A behavior and physical abnormalities are significant in a stepwise analysis, while stress is not. Stress appears to be significant only in conjunction with type A behavior, and suggests that the combination of type A behavior, and stress is more predictive of bruxism than either of the individual variables. The linear combination of physical abnormalities, type A behavior, and stress is significant, and suggests that it is the best predictor of bruxism.

Colestipol at varying dosage intervals in the treatment of moderate hypercholesterolaemia.

1. Bile acid sequestrants such as colestipol are effective lipid lowering agents but have a poor reputation for tolerability particularly when administered at the originally recommended doses. We have investigated a low dosage regimen with varying dosage intervals in order to assess efficacy and tolerability. 2. This double-blind, placebo controlled, parallel group study was conducted to investigate the effect of varying administration schedules of colestipol (10 g daily), against placebo in reducing LDL cholesterol levels in patients with moderate hypercholesterolaemia on the American Heart Association step 1 diet. 3. Colestipol or matched placebo, was administered as 5 g twice daily (COL am/pm) or 10 g once daily in the morning (COL am) or evening (COL pm) at fixed times with meals. 4. All 98 patients who entered the initial 16 week dietary phase, subsequently entered the 12 week active treatment phase and were randomised to placebo or active treatment and to one of the three treatment schedules. Fasting lipid profiles were performed every 4 weeks during both phases. 5. All active treatments significantly reduced LDL and total cholesterol compared with placebo (COL am: 17% and 10%, COL pm: 18% and 10%, COL am/pm: 19% and 12% (P = 0.0001)). HDL cholesterol rose significantly with COL am (5% (P = 0.021)) and COL am/pm (7% (P = 0.002)) when compared with placebo while a marginal increase was seen with COL pm (4% (P = 0.063)). Colestipol tended to increase serum triglyceride concentrations but the changes were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Maintenance of silastic-teflon shunts for intermitten haemodialysis.

The occurrence of infection in the tissues surrounding external arteriovenous shunts was studied and die important relationship of pyogenic infection to clotting was confirmed. The local application of fusidic add tulle and lanolin greatly reduced the occurrence of both infection and clotting and the need for cannula replacement.Urokinase used for declotting shunts when standard procedures had failed, restored blood flow whether dotting was related to infection or to local vascular factors. This treatment is not advised when clotting is associated with a local abscess, as it may make cannula replacement necessary. Severe local vascular factors, such as metastatic calcification, Raynaud's phenomenon, and venous stenosis, may lead to poor blood flow, so that despite clot lysis elective cannula replacement or the creation of a subcutaneous arteriovenous fistula is required.

Approach to advanced aortic root infection.

Among our first 11,620 cases of valvular replacement, we observed 285 cases of valvular endocarditis and 59 cases (20.7%) in which the importance of the infectious lesions of the aortic or mitral annulus required complex valvular repair. In 23 patients with aortic valvular endocarditis, the presence of an abcess of the aortic annulus required its closure with a patch resulting in one early and one late death and five reinterventions with one death. Twenty patients are alive and well, 1 to 9 years after operation. In 11 patients, the extent of annular abcesses required the insertion of a subcoronary valved conduit. After a maximum follow-up of 8 years there were two early deaths, two late deaths, one reoperation, and seven good results. Twelve patients had a supracoronary valved conduit resulting in four early deaths, one late death, and two reoperations; seven are alive and well, 2 to 6 years later. Three patients previously operated on had a left ventricular abdominal aorta valved conduit, two of them are alive and well up to 6 years later. Severe infectious lesions of the valvular rings (aortic root) can require complex repairs that can be lifesaving and provide excellent long-term results.