Diagnosing sleep apnea in dental patients.

Airway dilator or oral appliance therapy has been recommended with behavioral methods as treatment for patients with primary snoring or mild sleep apnea, unless there are patient-specific contraindications. Airway dilator therapy therefore may be a preferred treatment for patients with mild sleepiness and with fewer than 15 episodes of sleep disordered breathing per hour. The dentist's main diagnostic concern is to separate those patients with moderate or severe sleep apnea, who should be referred to a medical specialist for treatment, from those patients with primary snoring or mild sleep apnea, whom the dentist may treat primarily. Diagnostic tests including clinical predictions formulas, polysomnography, cardiorespiratory sleep studies, and oximetry will be discussed in this review.

Oral appliance therapy for obstructive sleep apnea syndrome: progressive mandibular advancement during polysomnography.

Six patients diagnosed with obstructive sleep apnea completed titration of an adjustable oral appliance, called the Silencer, during a single night of polysomnography. This protocol allowed for rapid titration of the oral appliance and effective treatment of sleep apnea. Variables which showed improvement included frequency of obstructive events, oxyhemoglobin saturation and snoring. Dental appliance adjustments with the silencer device can be made within three minutes. We have demonstrated that incremental mandibular advancement and repositioning allow us to determine the most effective jaw position to treat sleep apnea and snoring, which is also most likely to be tolerated by the patient.

Ascending myelopathy after chemotherapy for central nervous system acute lymphoblastic leukemia: correlation with cerebrospinal fluid myelin basic protein.

Ascending myelopathy developed in a previously irradiated 10-year-old boy after intraventricular methotrexate and cytosine arabinoside were given for central nervous system relapse of acute lymphoblastic leukemia. The course was fatal in 10 weeks. Cerebrospinal fluid myelin basic protein levels, indicating a demyelinative process, rose prior to the onset of clinical symptoms and remained at very high levels until death. Myelin basic protein may be useful as a predictor of chemotherapy-associated neurotoxicity.

Familial spastic paraplegia, mental retardation, and precocious puberty.

Two brothers had progressive spastic paraplegia and precocious puberty develop due to Leydig's cell hyperplasia when they were 2 years old. Both later had moderate mental retardation. Family members displayed brisk lower-extremity reflexes and dysarthria in a pedigree that suggested autosomal dominant inheritance with variable expression. Precocious puberty has been associated with other neurologic syndromes. Its occurrence in two brothers with spastic paraplegia has not, to our knowledge, been previously reported.

A unique protein in normal human cerebrospinal fluid.

On analysis of cerebrospinal fluid (CSF) samples from normal volunteer donors by high-resolution zone electrophoresis on agarose gel, an electrophoretically homogeneous protein band consistently appeared in the gamma-globulin region. Application of immunofixation electrophoresis in attempts to identify the band with use of monospecific antibodies against individual human serum proteins and against heavy- and light-chain immunoglobulins as well as polyvalent antisera did not produce a positive immunoprecipitation reaction with the protein band. The serum samples from these subjects did not show similar bands. Therefore, we conclude that this protein band is a normally occurring protein that is unique to CSF.

Comparison of pergolide and bromocriptine therapy in parkinsonism.

Twenty-four parkinsonian patients compared pergolide and bromocriptine therapy in a randomized double-blind, two-period crossover study. Both drugs were adjusted to an optimal balance between benefits and side effects. The mean daily dose and dose range for pergolide and bromocriptine were 3.3 mg (0.7 to 7.2) and 42.7 mg (5.8 to 87.5), respectively. Adjunctive medications, which for most patients included levodopa (plus carbidopa), were not altered during the study. A similar spectrum of clinical effects was found with both drugs and with lisuride, which was used to treat 13 of the patients in a previous study. Despite neurochemical differences in the antiparkinsonian ergots, their clinical utility is quite similar. We draw attention to hepatotoxicity and pleural reactions that may occur rarely with these drugs.