The presenting complaints of low income adults for emergency dental care: an analysis of 35,000 episodes in Victoria, Australia.

OBJECTIVE: This study examined the mix of presenting problems faced by a large diverse dental service treating low-income Australian adults and provides a basis for communities to understand and manage demand for dental services. DESIGN: A retrospective analysis in a state-wide multi-centre dental health service. Data for all patients (in all public adult dental clinics in the state of Victoria during May-Aug 2005) who used the emergency services in a 12 week period were recorded and analysed. A triage question tree was developed and embedded into a neural network based computer triage tool. RESULTS: Approximately 52% of low income adults presenting for emergency treatment required treatment on the day of triage. The main problem was with natural teeth (89.6%). Of those with natural teeth problems, 41.3% had pain disturbing their sleep patterns and 14.7% had experienced a swelling. Metropolitan patients accessed the services 2.3 times more than rural patients. CONCLUSION: These data clearly highlight that there is significant opportunity to reduce nearly 48% of on-day demand for emergency dental care through the application of appropriately clinical based triage.

[Side effects of treatment with the long-acting gonadorelin agonist triptorelin in a case of paraphilia]. / Bijwerkingen van farmacotherapie met de langwerkende gonadorelineagonist triptoreline bij parafilie.

A 35-year-old man with a paraphilia was treated with long-acting gonadorelin. The desired result was reduced preoccupation with sexuality, but there were various side effects including a serious amount of bone loss. We believe that more attention should be given to the adverse effects of long-term treatment with triptorelin. In our view the drug regimen needs to be revised.

[Dutch authors in international medical journals are also authors of publications in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine)]. / Nederlandse auteurs in internationale medische tijdschriften ook auteurs van publicaties in het Nederlands Tijdschrift voor Geneeskunde.

OBJECTIVES: To determine whether Dutch medical scientists who frequently publish in international journals with high impact factors also publish in Dutch in the Nederlands Tijdschrit voor Geneeskunde (NTvG). DESIGN: Bibliometric study. METHODS: By means of a search in Medline, the Dutch authors were selected who had published the largest number of articles in 20 medical journals with high impact factors from 5 different specialties: general medicine, surgery, dermatology, psychiatry and ophthalmology. Subsequently, it was determined how often these authors had published in the NTvG in the same period. Moreover, a countwas made of the number of articles the first authors of original articles in the NTvG in 1991 and 2000 had published in international journals in 1993-1997 and 1998-2002, respectively. RESULTS: A large proportion of the Dutch investigators with many publications in international journals also published in the NTvG: in 1988-1992, 46 authors wrote 219 international publications and 35 of these published 151 articles in the NTvG; in 1998-2002, 55 authors wrote 326 international publications and 41 of these published 145 articles in the NTvG. The proportion of original articles published by these authors in the NTvG was lower than in the international journals: 83% for the international journals in 1998-2002 versus 39% for the NTvG in 2000. In 2001, 93 original articles by 87 different first authors appeared in the NTvG. Of these 87 authors, 67 (77%) published at least one article and 18 (21%) published more than 10 articles in an international journal in the period 1998 to 2002, as either the first author or a co-author. CONCLUSION: Authors that publish many articles in frequently cited international journals also write articles for the NTvG and, vice versa, the authors of articles in the NTvG also publish in international journals.

Effects of hyperthermia on the peripheral nervous system: a review.

The present paper overviews the current knowledge about effects of hyperthermia at temperatures used in clinical oncology on the peripheral nervous system. From the experimental studies it may be concluded that the heat sensitivity of the nerve is determined by the sensitivity of the nerve vasculature. These studies show that in order to avoid induction of severe neuropathy, application of heat to the peripheral nerves should not be in excess of doses of 30 min at 44 degrees C or equivalent. Using modern equipment for application of loco-regional hyperthermia the incidence of even mild neurological complications is very low. In hyperthermic isolated limb perfusion (HILP) neurotoxicity is an often-mentioned side effect, this is in spite of the fact that in all studies a relatively mild hyperthermic temperature is used that, based on the experimental studies, should be well tolerated by the nerves and other normal tissues in the limbs. It seems that the neurotoxicity observed after HILP results from thermal enhancement of drug toxicity, very probably combined with effects of a high tourniquet pressure that is used to isolate the blood flow in the leg. Whole body hyperthermia (WBH), using anesthesia and appropriate monitoring to avoid cardiovascular stress is at present considered a safe procedure. Still in the recent past cases of neuropathy after treatment have been described. When chemotherapy, and notably cisplatin, is administered before or during hyperthermia there are several clinical and experimental observations that indicate a limited tolerance of the peripheral nervous tissue in such case. Also previous radiotherapy may limit the tolerance of nerves to hyperthermia, notably when radiation is applied with a large field size. Experimental studies show that combined treatment with radiation and heat leads to enhancement of effects of radiation (enhancement ratio approximately 1.5 at 60 min at 44 degrees C). A clear contraindication for the application of hyperthermia in patients is the presence of a neurodegenerative disease, such as multiple sclerosis. Vigilance is also required in the treatment of diabetic patients with hyperthermia, this based on experimental animal studies, but so far no clear clinical data are available.

Ultrastructural changes in the rat sciatic nerve after local hyperthermia.

The rat sciatic nerve was heated over a length of 5 mm for 30 min at 43, 44 or 45 degrees C. Morphological changes were not observed after heating at 43 degrees C. Treatment at 44 degrees C resulted in endoneurial oedema and mild vascular changes, such as contraction and vacuolization of endothelial cells and thickening of the media of the larger vessels. Within 1 week several demyelinated axons were observed. The first changes after heating at 45 degrees C included oedema, blood vessel occlusion and severe endothelial cell damage. Axonal changes, e.g. the accumulation of cell organelles, appeared 8 h after treatment; 24 h after treatment most axons and myelin sheaths showed degenerative changes. Absence of blood flow in the heated area of the nerve was shown 2 h after heating at 45 degrees C. We conclude that hyperthermic treatment directly affects endothelial cells and myelin sheaths in the rat sciatic nerve. Axons degenerate most probably as a consequence of ischaemia.

Heat shock proteins (HSP-72 kd) in thermotolerant rat sciatic nerves.

Localized heating of the rat sciatic nerve over a length of 5 mm for 30 min at 43 degrees C resulted in the production of heat shock protein 72 kd in every nucleated cell and in the induction of thermotolerance in the heated area. HSP-72 kd was never detected in axons. Heat treatment (30 min, 45 degrees C) of thermotolerant nerves, 24 h after pretreatment, led to histopathological changes in the nerve, similar to those in non-thermotolerant nerves after a less strong treatment, i.e. heating for 30 min at 44 degrees C. Although axons did not contain HSPs after treatment at 43 degrees C, these structures tolerated treatment at 45 degrees C. Therefore we conclude that axons in the rat sciatic nerve are relatively heat-resistant and therefore we assume that axons do not need protection by HSPs; this is in contrast to endothelial cells and Schwann cells. Axons can be damaged indirectly as a consequence of vascular damage leading to ischaemia. Development of thermotolerance of the vasculature, ensuring a sufficient blood flow in the heated area, prevents this indirect damage.

Influence of cisplatin on the sensitivity of the rat sciatic nerve to local hyperthermia.

The influence of cisplatin on the sensitivity of the rat sciatic nerve to local hyperthermia was investigated. Rats received 1.7 mg/kg cisplatin i.p., twice a week for 6 weeks, up to a cumulative dose of 20.4 mg/kg. After termination of cisplatin treatment, a 5 mm segment of the nerve was locally heated at a temperature of 45 degrees C (5-30 min). Loss of motor function was assessed by means of the toe-spreading test, 24 h post heating. The calculated ED50 for control nerves was significantly (p < 0.01) larger than the ED50 for cisplatin treated rats; 16.3 +/- 1.1 min vs. 10.9 +/- 1.1 min. This indicates that nerves from cisplatin treated rats were more sensitive to heat than nerves from control rats (dose modifying factor = 1.5 +/- 0.2). Histopathological investigation of nerves after heat alone or after heat preceded by cisplatin confirmed these differences and showed that edema, vascular damage and axonal degenerative changes of axons and myelin sheaths occurred at lower heat doses when compared to control nerves. Recovery studies showed that cisplatin treatment before hyperthermia caused a delay in recovery from motor function loss of about 6 days. Cisplatin treatment after hyperthermia had no influence on recovery from motor function loss.

Hyperthermic injury versus crush injury in the rat sciatic nerve: a comparative functional, histopathological and morphometrical study.

Functional and morphological changes of the rat sciatic nerve after local hyperthermia (30 min, 45 degrees C) and crush treatment were compared. After hyperthermic injury nerve function loss developed in a time period of about 7 h. Nerve crush led to an immediate loss of nerve function. Nerve function loss was assessed by a motor and a sensory function test. Recovery from function loss took place in both treatment groups and was complete in 4-5 weeks. Early (within 8 h post-treatment) histopathological changes in the nerve after heating included edema, possible blood stasis and changes in the blood vessel wall, like swelling of the media. During this period some axonal changes were observed. Immediate after crushing axons were severely damaged, while many blood vessels remained normal. Within one week after both treatments, degeneration of axons and myelin was observed at the site and distal from the site of the lesion (Wallerian degeneration). Three weeks after treatment a major part of the axons had regenerated and remyelinated. Vascular changes at the site of lesion could still be observed in the heat-treated nerves. Twelve weeks after both treatments, blood vessels appeared to be normal again. Morphometrical analysis of the treated nerves confirmed the histological observations. Three and 12 weeks after treatment average axon diameters were significant smaller and average myelin sheaths were significant thinner compared to untreated nerves. These parameters did not differ significantly when the two treatment groups were compared.

Angiotensin-converting-enzyme activity in serum from calves infected continuously or with a single dose of Dictyocaulus viviparus infective larvae.

The activity of the angiotensin-converting enzyme (ACE) in calves was monitored during two different regimens of lungworm infection. These different regimens were clearly reflected in the course of the respiratory rate, faecal larval output and liveweight gains, but not in the course of the ACE activity. It is concluded that ACE activity is significantly (P less than 0.05) decreased in calves experimentally infected with lungworms, but that it does not give additional information about the course of the infection, which also could not be obtained from the other parameters.

A pharmacological model of cerebral ischemia. The effects of indomethacin on cerebral blood flow velocity, quantitative EEG and cognitive functions.

Indomethacin decreases cerebral blood flow. Such an effect in humans might offer the possibility to establish a human model of cerebral ischemia. In the present study the effects of a single oral dose of 100 mg indomethacin were studied in male subjects with quantitative electroencephalography, cerebral blood flow velocity and the memory comparison task as parameters. Twelve healthy male students (age 23.2 +/- 2.6 years) were studied. Before the test day the memory comparison task was performed twice (parallel versions). On the test day baseline recordings of quantitative electroencephalography were obtained, together with measurement of blood flow velocity. Ninety minutes after indomethacin ingestion recordings of quantitative electroencephalography and blood flow velocity were repeated and a parallel version of the memory comparison task was performed. The blood flow velocity decreased to 60% of the initial value; quantitative electroencephalography showed a -0.3 Hz slowing of the alpha peak frequency (p less than 0.01) and a decrease in the relative power of the alpha band (p less than 0.10) without any change in the delta or theta band. The memory comparison task showed an increase of the slope index (p less than 0.05), indicating a deterioration of cognitive functioning.

Measurement method for radioactive thyroxine, triiodothyronine, iodide, and iodoprotein in samples with low activity.

A method is described that incorporates resin extraction and thin layer chromatography to isolate and separate radioiodinated thyroxine (T4), triiodothyronine (T3), iodoprotein, and iodide in samples of human plasma up to 3 ml. Tracer studies using this method showed that reverse T3 and 3',5' diiodothyronine (T2), as well as T4, were detected in the "T4 fraction," and that 3-3' T2 and 3' monoiodothyronine, as well as T3, were detected in the "T3 fraction." Monoiodotyrosine and diiodotyrosine (DIT) migrated more slowly than did T4 on the chromatogram, and a large amount of DIT was in the unextracted "iodoprotein fraction." Kinetic studies in 14 normal subjects given intravenous commercial [125I]T3 (T3*) and [131I]T4 (T4*), confirmed the quantitative importance of an iodoprotein in later samples after T3* administration, and its presence after T4*. T4* contamination of commercial T3* also became quantitatively important. On the other hand, despite confirmation of in vivo conversion of T4* to T3*, T3* contributed little quantitatively to the total concentration of radioactivity present even late after T4* injection, due to the more rapid turnover and greater distribution volume of T3*.

Water-soluble proteins of the human red cell membrane.

Procedures were developed for preparation of red cell membranes almost free of hemoglobin but with minimal loss of membrane proteins. Two water-soluble protein fractions are described, each constituting about 25% of the ghost protein. The first is ionically bonded and can be solubilized in water rapidly at pH 7.0 and more slowly at higher ionic strength solutions, with a minimal rate at 20MM. This fraction contains four major components with molecular weights ranging from 30,000 to 48,000. The second fraction can only be solubilized at an appreciable rate if Ca(++) is absent and at higher pH (9.0). It is predominantly a single molecular weight component (150,000). It tends to aggregate at higher ionic strength and in the presence of Ca(++). Evidence is presented suggesting that the water-soluble proteins are present at the inner face of the membrane. The lipids remain in a water-insoluble residue that contains four major protein components ranging in molecular weight from 30,000 to 100,000. The latter is the predominant component. Only the residue contains the Na(+)-K(+)-activated ATPase, the cholinesterase, antigenic activity and most of the sialic acid and carbohydrate. The first water-soluble fraction contains a Mg(++)-activated ATPase. The extraction of the water-soluble proteins is accompanied by anatomical changes resulting finally in the formation of small membranous vesicles.