Sequential changes in vital signs and acid-base and blood-gas profiles in Pneumocystis carinii pneumonitis in children with cancer. Basis for a scoring system to identify patients who will require ventilatory support.

Early reliable identification of patients with Pneumocystis carinii pneumonia (PCP) who will require ventilatory support would be desirable. To develop a predictive system to meet this need, we studied, prospectively, the sequential alterations in vital signs and acid-base and blood-gas profiles associated with this disease in 55 children with cancer, 29 of whom did not require ventilatory support (Group I) and 26 who did (Group II). None of the patients had acquired immunodeficiency syndrome (AIDS). On admission to the hospital the only feature that distinguished patients in Group I from those in Group II was the mean (+/- SD) respiratory rate (38.7 +/- 2.1 versus 49.1 +/- 3.5 breaths/min, p < 0.02). By 12 h after admission there was a significant difference in the partial pressure of oxygen (PaO2) between Groups I and II (75.1 +/- 3.2 mg Hg versus 65.4 +/- 3.1 mm Hg, p < 0.05), and also in the two groups' inspired fraction of oxygen (FIO2; 24.9 +/- 0.54% versus 29.6 +/- 1.6%, p < 0.01). Both alterations, as well as tachypnea, persisted for the remainder of the study period. The maximum FIO2 did not exceed 45% in Group I, and by 60 h after admission to the hospital, all patients in this group had persistent increases in PaO2 that exceeded 80 mm Hg, permitting decreases in FIO2 to that of room air. In Group II, hypoxemia was refractory despite an increase in FIO2 to 50%, at which point ventilatory support was begun (at a mean of 81.1 +/- 32.3 h after admission).(ABSTRACT TRUNCATED AT 250 WORDS)

Observations on temperature and temperature patterns of the gingiva. I. The effect of arch, region and health.

The purpose of this investigation was to study the pattern and constancy of temperatures recorded in the gingival crevices and some factors affecting them. The temperatures of the interproximal crevices in the maxillary and mandibular arch of 16 female dental hygiene students were evaluated at the time of examination, immediately afterwards and following a 14-day interval. The temperature difference between each site and the subject's sublingual temperature were calculated. In the analysis, a comparison of sites with a confirmed status of bleeding tendency and pocket depth was carried out. The results show temperature differences between arches (mandible vs maxilla) and regions (posterior vs anterior). The differences are independent of the health status. Inflamed gingiva generally has a higher temperature than clinically healthy gingiva. There is an indication that healthy tissue, more than inflamed tissue, reacts to an outside stimulus with an increase in temperature. It is necessary that environmental and stimulative factors are strictly controlled if temperature gradients are to be applied for diagnostic purposes in periodontics.

Observations on temperature and temperature patterns of the gingiva. II. Estimations of the error in measurement.

The diagnostician may expect an error associated with the measurements of clinical parameters. It is important to know how precise these measurements are. The purpose of this study was to make an estimation of the measurement error by comparing repeated measures of the same site. Six dental hygiene students were examined for gingival and were recorded twice. The maximum error associated with 95% of the temperature data and the average error were calculated as 1.3 degrees C and 0.65 degrees C, respectively. The probabilities of making a correct assessment of pocket depth and of sulcular bleeding were computed to be 0.864 and 0.840, respectively. The need for repeated measures was statistically analyzed. It can be concluded from our data that the thermocouple thermometer used in this study is a suitable instrument for measuring the gingival temperature. However, it is necessary to acquire a higher level of precision for the assessment of pocket depth and sulcular bleeding. This can be accomplished by increasing the number of clinical measures on each point.

Heredity, color vision, and alcoholism.

Ninety-two Cree individuals were tested with the Farnsworth-Munsell 100-Hue Test (FM = 100). Information concerning racial membership, age, sex, and drinking behavior was collected. High error scores (for the FM-100) were found in this Cree population. Alcoholic individuals (both abstinent and nonabstinent) had higher error scores than a comparable population of nonalcoholic Cree individuals from the same population. Implications concerning the etiology of alcoholism are discussed.

The relationship between gingival tissue temperatures and various indicators of gingival inflammation.

IN PERIODONTICS there is a need for objective measurements in monitoring disease processes and in assessing the effectiveness of treatment. The purpose of this study was to compare gingival temperatures with indicators of gingival inflammation in order to examine the application of temperature as a diagnostic aid. In six patients the temperature of interproximal sulcular tissue was measured and compared with bleeding upon probing, crevicular fluid flow, pocket depth, plaque accumulation and calculus formation. The results show significantly higher temperatures with bleeding upon probing and with the presence of dental plaque and calculus. Temperature increase correlated with increase in crevicular fluid flow, but a relationship to pocket depth is not clear. The thermocouple microprobe is a very sensitive instrument. The method used is noninvasive, safe and efficient. It can be concluded from our data that differences in gingival temperature reflect not only a regional tissue variability but also can indicate an inflammatory state.

Cosine analysis of heart beat data of children in a stressful situation.

The EKG of twenty-four children (mean age = = 5.7 years) was individually and continuously recorded in a dental situation. Measures of cardiac activity (heart rate [HR] and heart rate variability [HRV]) were computed by means of a CDC 1,700 and an IBM 360 computer. Histograms of heart rate (HR) and heart rate variability (HRV) measures were generated. -Successive cosine fits were fitted for each 70 beats within an interval for each individual and these cosine fits were also presented in a histogram which represented a frequency analysis of cyclic functions within individuals. Within and between subject correlations were also computed for all measures. Sinus arrhythmia seemed to account for less of the variance than a yet unexplained cosine fit function having a lower limit of 18.6 seconds in this child population. In this population many measures of HRV seem to be negatively correlated with HR.

Craniofacial morphology: a principal component analysis.

A series of 56 measurements was derived from lateral cephalometric radiographs of a large sample of subjects. These measurements were subjected to a principal-component analysis which resulted in a series of six components (factors). These factors, represented in general terms and in rank order of their percentage sample variability were as follows: Factor 1. Vertical facial characteristics Factor 2. Anteroposterior aspects of facial morphology Factor 3. Midfacial and dental protrusion Factor 4. Relationship of the mandible and dentition to the profile Factor 5. Horizontal base-line relationships (internal or deep) Factor 6. Maxillary incisor relationships These principal components and the variables contained within them were shown to have sex and age interactions. A longitudinal study of the principal component changes with age was then undertaken. Demonstrable age changes were verified for Factors 1, 2, and 3, and Factors 1 and 3 were observed to show patterns of change which were statistically different from each other and the remaining principal components. An orthodontically treated sample of patients was also assessed for factor changes. Factors 1 and 2 were found to show statistically reliable changes resulting from treatment and/or growth. The remaining four factors showed no statistically supportable alteration. The data-reduction method involving a principal-component analysis would seem to have potential research and clinical applications.

Species and strain differences in the lethal factor of the mouse submandibular gland.

The differences in susceptibility of animals to the lethal factor extracted from the mouse submandibular gland and magnitude of its lethality were compared among various species, strains, ages, and sex of mice. Comparisons of LD50 values computed by an IBM 360/System computer using a programmed probit analysis yielded the following significant results. The lethal factor of adult male mice was lethal to all species and strains of animals tested. Strain differences were observed in five inbred strains of mice, and varying degrees of resistance against the lethal factor were demonstrated. The lethality was strongest in the submandibular gland of our subline BALB/c mice, and the highest susceptibility to the lethal factor was demonstrated by female C57BL mice. This factor was found to be lethal not only to mice but also to other species of animals, Mongolian gerbils being most susceptible and New Zealand rabbits next.