Warfarin use leads to larger intracerebral hematomas.

BACKGROUND: Among patients with intracerebral hemorrhage (ICH), warfarin use before onset leads to greater mortality. In a retrospective study, we sought to determine whether warfarin use is associated with larger initial hematoma volume, one determinant of mortality after ICH. METHODS: We identified all patients hospitalized with ICH in the Greater Cincinnati region from January through December 2005. ICH volumes were measured on the first available brain scan by using the abc/2 method. Univariable analyses and a multivariable generalized linear model were used to determine whether international normalized ratio (INR) influenced initial ICH volume after adjusting for other factors, including age, race, sex, antiplatelet use, hemorrhage location, and time from stroke onset to scan. RESULTS: There were 258 patients with ICH, including 51 patients taking warfarin. In univariable comparison, when INR was stratified, there was a trend toward a difference in hematoma volume by INR category (INR <1.2, 13.4 mL; INR 1.2-2.0, 9.3 mL; INR 2.1-3.0, 14.0 mL; INR >3.0, 33.2 mL; p = 0.10). In the model, compared with patients with INR <1.2, there was no difference in hematoma size for patients with INR 1.2-2.0 (p = 0.25) or INR 2.1-3.0 (p = 0.36), but patients with INR >3.0 had greater hematoma volume (p = 0.02). Other predictors of larger hematoma size were ICH location (lobar compared with deep cerebral, p = 0.02) and shorter time from stroke onset to scan (p < 0.001). CONCLUSION: Warfarin use was associated with larger initial intracerebral hemorrhage (ICH) volume, but this effect was only observed for INR values >3.0. Larger ICH volume among warfarin users likely accounts for part of the excess mortality in this group.

Tooth contacts in eccentric mandibular positions and facial morphology.

Correlations between facial morphology and tooth contacts in excursive mandibular positions were studied in 75 men aged 20 to 33 years. The morphology of the dentition was verified on dental casts and the face was measured by use of roentgen cephalometry. No correlation was observed between facial morphology and the number of tooth contacts in the retruded position; however, wide dental arches and jaws displayed many contacts on protrusion. Numerous contacts on the functional side in group function were noted in individuals with a facial morphology associated with distal occlusion, such as Angle class II, division 1. Wide dental arches were associated with multiple functional-side contacts whereas tooth contacts on the nonfunctional side were related to the inclination of the mandible. A "long-face" morphology was related to contacts on the nonfunctional side. There was a negative correlation between the extent of the overbite (vertical overlap) and the number of tooth contacts on the nonfunctional side.