Orthodontic treatment acceleration with corticotomy-assisted exposure of palatally impacted canines.

OBJECTIVE: To evaluate the effectiveness of a new surgical technique in the treatment of palatally impacted canines. MATERIALS AND METHODS: Six consecutive patients presenting with bilaterally impacted canines were compared. One canine was surgically exposed using a conventional surgical technique while the contralateral canine was exposed using a corticotomy-assisted technique. RESULTS: After tooth movement was completed, statistical comparisons of the two methods revealed a reduction of treatment time of 28-33% for the corticotomy-assisted canines. No significant differences were observed in final periodontal condition between the canines exposed by these two methods. CONCLUSION: This preliminary study supports the concept that a corticotomy-assisted surgical technique helps reduce orthodontic treatment time for palatally impacted canines.

Disorders of the forearm axis.

Forearm pronosupination is a complex, integrated activity that demands specialized function of all structures between the elbow and wrist. This article describes the forearm axis as a comprehensive concept to unify these relationships. The anatomy and biomechanics of the forearm axis are reviewed. Pathologies that affect the entire axis are summarized.

Properties of optical data from activated partial thromboplastin time and prothrombin time assays.

Changes in characteristics of optical transmittance data from coagulation assays were examined as a function of concentration of coagulation proteins or anticoagulants. Transmittance data were collected for activated partial thromboplastin time (APTT) and prothrombin time (PT) assays from: 1) plasmas prepared by mixing normal plasmas with deficient plasmas to give varying levels of coagulation proteins; 2) plasmas containing added heparin; and 3) 200 specimen plasmas that were also assayed for fibrinogen, coagulation factors, and other components. Optical profiles were characterized using a set of parameters describing onset and completion of coagulation, magnitude of signal change, rate of coagulation and other properties. Results indicated that parameters other than those typically reported for APTT and PT are associated with individual deficiencies, but that diagnosis of specimen status on the basis of optical data is complex. These results suggest possibilities for expanded interpretation of PT/APTT optical data for clinical or research applications.

Negotiating managed care contracts.

Physicians currently have a major opportunity to help guide the rapid evolution of managed care in the United States. General principles on how physicians can successfully negotiate a managed care contract are discussed.

Predicting the presence of plasma heparin using neural networks to analyze coagulation screening assay optical profiles.

A method for predicting the presence of heparin from coagulation screening assays is described and data are presented. This method incorporates the use of a multilayer perceptron trained through an error back-propagation algorithm in analyzing clotting optical data profiles. This method may lead to the identification of abnormalities from screening assays that might otherwise go undetected, or require additional testing to isolate.

Endoscopic carpal tunnel release. Chow technique.

The first cases using the set of instruments designed by James C. Y. Chow, MD, of Mount Vernon, Illinois, were performed in September of 1987 by the developer. His was the first written introduction of the technique of endoscopically assisted carpal tunnel release published by a US author. This technique has been practiced widely for 5 years. Serious complications can occur but may be avoidable.

A multicenter prospective review of 640 endoscopic carpal tunnel releases using the transbursal and extrabursal chow techniques.

A prospective study involving eight institutions was performed, incorporating 640 cases of carpal tunnel release using a dual portal endoscopic technique. The original transbursal technique described by Chow was used in 110 cases (17%), and the modified extrabursal technique was used in 530 cases (83%). An overall complication rate of 11% was found in the patients in whom the transbursal technique was used, compared with 2.2% in the patients in whom the extrabursal technique was used. The return-to-work status was followed in 291 cases (199 non-worker's compensation cases and 92 worker's compensation cases). The worker's compensation patients returned to work in an average of 57 days, compared with 22 days for non-worker's compensation patients. This study suggests the extrabursal dual portal endoscopic technique is associated with fewer complications than the transbursal approach, and patients covered by worker's compensation return to work later than non-worker's compensation patients.

Improvements in accuracy and reproducibility of quantitative clotting factor assays by use of a novel approach for modeling reference curves.

A method for creating a reference model in the quantitative assay of specific clotting factor activities is described. This method incorporates the use of a piecewise function with two component polynomials. This function allows more accurate representation of the global coagulation reaction, a sequential activation of multiple serine protease enzymes and cofactors, leading to improvements over traditional methods in range, accuracy, precision and robustness in reported activity levels. Clotting factor assay results using this method are compared with traditional and other candidate methods.

Latex allergy in hospital employees.

To investigate the incidence of latex IgE-mediated hypersensitivity, 224 hospital employees were interviewed and prick skin tests were performed to six common aeroallergen extracts, one non-latex "synthetic" glove extract, and four different latex glove extracts. Of the 224 subjects, there were 136 nurses, 41 laboratory technicians, 13 dental staff, 11 physicians, 6 respiratory therapists, and 17 housekeeping and clerical workers. All 224 subjects tested negative for the nonlatex glove (Tactylon) extract but 38 (17%) tested positive for latex extracts. The incidence ranged from 0% in housekeeping staff to 38% in dental staff. Eighty-four percent of the latex skin test-positive employees complained of itching and 68% of rash upon exposure to latex, whereas the latex skin test-negative employees reported these symptoms in 29% and 17%, respectively. Urticaria was a symptom in 55% of the latex skin test-positive and 0.5% of the skin test negative-subjects. Anaphylaxis occurred in 10.5% of the skin test-positive and in none of the skin test-negative employees. Symptoms of sneezing (34% vs 7%), nasal congestion (39% vs 7%), and lacrimation and ocular itching (45% vs 6%) were also significantly different between the latex skin test-positive and latex skin test-negative subjects. We conclude that the incidence of latex IgE-mediated allergy in hospital employees is 17%. The symptoms of anaphylaxis and hives when using latex gloves are sensitive predictors of IgE-mediated latex allergy.

Prevalence of insect allergen-specific IgE in allergic asthmatic children in Cincinnati, Ohio.

Airborne insect antigens can represent significant outdoor aeroallergens. In this pilot study, allergic asthmatic children were screened by RAST for IgE directed against common outdoor insects. Insects studied included ant, cricket, grasshopper, housefly, and moth. Spiders were also tested. Three different extraction procedures were compared to determine which method(s) best preserves the allergenic proteins. RAST discs were made for each insect extract and sera from allergic, asthmatic and nonallergic, nonasthmatic children were tested. The allergic asthmatic sera had a higher percentage of isotope binding than the nonallergic nonasthmatic sera for all insects tested. The number of subjects with a Phadebas RAST score of 2 or greater was significantly higher in the allergic asthmatic group for moth (16 of 37, 43%), housefly (7 of 30, 23%), cricket (8 of 41, 19%), and grasshopper (7 of 36, 19%). Only one of the 25 control sera had a score of 2 to moth; none of the control sera reacted to any of the other insects. Most positive sera tested showed cross-reactivity between insects. A few sera, despite showing positive RAST results to two different extracts, showed no cross-reactivity between the two extracts, suggesting that these sera contained species-specific IgE. These results indicate that a significant proportion of allergic asthmatic children have IgE that binds to extracts of moth, cricket, grasshopper, and housefly. Further studies are needed to determine whether these insect aeroallergens can produce clinically significant symptoms in sensitized atopic individuals.

Preoperative factors and outcome after lunate decompression for Kienböck's disease.

Preoperative factors and outcome were studied after lunate decompression for Kienböck's disease. Twenty-three patients treated with radial shortening or scaphoid-trapezium-trapezoid fusion were evaluated. The mean follow-up was 59 months. Neither good nor excellent outcomes were found with either lunate-preserving procedure when the preoperative radioscaphoid angle was greater than 60 degrees. Outcomes in the radial shortening osteotomy group were superior to those in the group treated with scaphoid-trapezium-trapezoid fusion. Lunate collapse was not prevented by either treatment method. Lunate index, carpal height, and staging did not correlate with outcome. Measurement of radioscaphoid angle provides predictive information regarding the outcome of stage III (Decoulx/Lichtman) Kienböck's disease treated with radial shortening or scaphoid-trapezium-trapezoid fusion.

Evaluation of latex allergy in patients with meningomyelocele.

Seventy-six patients with meningomyelocele were evaluated for latex sensitivity by medical history and epicutaneous skin testing. Four different latex glove extracts, two nonlatex glove extracts, cornstarch, selected inhalant antigens, and negative and positive controls were used for skin testing. Forty-nine patients (64.5%) were skin test positive to latex extracts (latex-positive group). Twenty-four patients (49%) of the latex-positive group and none of the latex-negative group had histories of immediate reactions to latex products (P less than .001). The latex-positive group had a higher mean number of surgical procedures, 12.67 +/- 11.27, compared with 6.89 +/- 6.55 (P less than .001) in the latex-negative group. Twenty-three of the latex-positive patients (47%) used latex products daily compared to seven patients (26%) in the latex-negative group (P = .073). Twenty latex-positive patients (41%) had atopy compared with five patients (19%) of the latex negative group (P = .041). There was no significant difference between the two groups in age, sex, daily catheterization, or positive skin tests to cornstarch. All 76 patients tested negative to the nonlatex glove extracts. Ten control subjects tested negative for all latex and nonlatex glove extracts.

Soft-tissue reconstruction in severe lower extremity trauma. A review.

The reconstruction of soft tissues is a difficult aspect of limb salvage after severe lower extremity injury. Newer techniques such as free-tissue transfer can expedite wound care, decrease morbidity and hospital costs, and spare some limbs from amputation. It is important to know the mechanism of injury and the resultant zone of soft-tissue trauma. This is best defined by serial debridements over several days. The final defect size and composition will determine the type of soft-tissue flap used. Soft-tissue coverage may be accomplished with muscle, with muscle and skin transposition, or with free transfer. Microvascular transfers offer the advantage of one procedure that provides coverage for donor and recipient sites with early patient mobilization.

Systemic vasculitis associated with eosinophilia and marked degranulation of tissue eosinophils.

A 9-year-old girl had fever, life-threatening interstitial pneumonia, a vesicular skin rash, parotid and submandibular swelling, and marked blood eosinophilia (WBC count 47,000/microL, 39% eosinophils). Results of lung and skin biopsies showed vasculitis with intense eosinophil infiltration. Immunofluorescence analyses of these biopsies, as well as analysis of tissue from the parotid, lip, and trachea, showed striking deposition of eosinophil granule major basic protein associated with areas of tissue damage. Treatment with glucocorticoids and hydroxyurea produced clinical improvement. The association between tissue damage and deposition of the cytotoxic major basic protein suggests that the eosinophil contributed to the pathophysiology of this disease. Recognition of the capacity of the eosinophil to produce tissue damage can be helpful in the selection of therapy.

Short-term, high-dose, systemic steroids in children with asthma: the effect on the hypothalamic-pituitary-adrenal axis.

Children with chronic asthma frequently receive "bursts" (less than 7 days) of short-term, high-dose prednisone (1 to 2 mg/kg/day) for acute exacerbations of their disease. Certain of these patients may also require inhaled corticosteroids (IC) for control. The effect of these "bursts" on the hypothalamic-pituitary-adrenal axis (HPAA) is unclear. To test the integrity of the HPAA in such patients, we measured plasma cortisol (F) in response to serial administration of insulin-induced hypoglycemia (nadir = 34 +/- 1.2 mg/dl; mean +/- SE), followed by 250 micrograms/1.73 m2 of synthetic ACTH in the following children with asthma: group I, seven patients who received no more than one "burst" per year (0.71 +/- 0.2); group II, six individuals who received more than one "burst" per year (3.6 +/- 0.2) and no IC; and group III, 10 subjects who received more than one "burst" per year (4.7 +/- 0.3) plus IC. All patients received daily theophylline and beta-agonists; seven patients were taking sodium cromolyn. No patients received troleandomycin. Compared to group I (control subjects), 16% of group II had a subnormal response of F to hypoglycemia. In addition, a subnormal response of F to hypoglycemia or ACTH was documented in 20% and 10% of group III, respectively. All individuals with a subnormal response of F to either hypoglycemia or ACTH received four or more "bursts" per year. We conclude that as a group, children affected by asthma treated with "bursts" alone or "bursts" plus IC appear to have a normal HPAA.(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatric predictive index for hospitalization in acute asthma.

To develop a pediatric predictor index (PPI) for the outcome of emergency management of acute asthma, 156 children were studied prospectively and grouped by outcome. Of 193 episodes, 130 (67.4%) resulted in successful treatment, 39 (20.2%) in relapse, and 24 (12.4%) in admission. Measured and observed variables from before and after initial therapy were analyzed for the three groups. There were no significant differences between the relapse and successful treatment groups, which were combined for analysis and termed the discharge group. Significant differences were noted between the admission and discharge groups only for dyspnea before and after therapy, accessory muscle use, inspiratory breath sounds and wheezing, and post-respiratory rates, but not for pulse or peak expiratory flow rates before or after therapy. The PPI was determined with multivariate logistic regression and is calculated using the following variables: inspiratory breath sounds, wheezing, and respiratory rates. A score of 0 correctly categorized 95% of admissions, but incorrectly categorized 34% of those discharged. Despite low specificity and limited usefulness as early predictors of admission, PPI variables may serve as valuable adjuncts to the physician in determining the outcome of acute asthma in children.