Provision of general dental care for children with cleft lip and palate--parental attitudes and experiences.

OBJECTIVE: To evaluate the attitudes of parents of 4-8 year-old children with cleft lip and palate (CLP) towards the provision of paediatric dental care and to assess their experience of treatment within the General Dental Services. DESIGN: Postal questionnaire distributed to all parents of 4-8 year-old children on the Birmingham CLP database. RESULTS: The response rate was 77%. Ninety-nine (91%) children were registered with a dentist. Seventy-five (69%) had previously received preventive advice and 32 (29%) had experienced restorative intervention. The majority of parents (64%) expressed a wish for a dental check-up to be provided at the designated Cleft Centre, with 42 (39%) requesting preventive advice. Fifty-eight (67%) of the parents who requested a dental check-up were agreeable for treatment to be provided in the primary sector. CONCLUSION: The survey indicates there is parental support for paediatric dental assessment at cleft clinics with subsequent arrangement of treatment in the primary sector. The inclusion of paediatric dental support within the multidisciplinary cleft team should be considered as Regional Cleft Centres are established

West Midlands regional training scheme for orthodontics in dental practice.

The need for continuing education in orthodontics is recognised by many practitioners and the demand for post-graduate courses is high. The limitations of such courses, particularly the short technique type, are recognised and within the West Midlands the value of a longer term clinical attachment has been emphasised. The West Midlands has a well established orthodontic consultant service with fifteen NHS and one honorary consultant; the specialist practitioner service is small by national standards. All of the orthodontic consultants have long supported the clinical assistant post as a valuable vehicle for practitioners' continuing education. Building on the example given by the consultants in the four Thames Regions, a structured, centralised academic programme has been developed to enhance the clinical training given during these two year posts.

Training hygienists for an auxiliary role in orthodontics.

This article describes the procedures that dental hygienists may undertake in the United Kingdom at the present time and compares these with the 'expanded duties' function of auxiliary personnel abroad. An 'expanded duties' training programme in orthodontic procedures taught to Canadian Hygienists at Birmingham Dental Hospital is described in detail.

Envenomation by the puss caterpillar (Megalopyge opercularis).

We discuss the case of a 52-year-old woman who developed urticarial lesions after the acute envenomation of a puss caterpillar (Megalopyge opercularis). The puss caterpillar, one of more than 50 species of caterpillars that can cause envenomation in the United States, is considered to be one of the most serious. Its clinical presentation and current recommended treatments are reviewed.

A comparison of the efficacy and tolerability of enalapril and sustained-release diltiazem in mild to moderate essential hypertension.

The subjects of this multicenter study were 159 patients aged 21 to 76 years with mild to moderate uncomplicated essential hypertension. The patients were randomly assigned to receive up to 40 mg of enalapril daily or 360 mg of sustained-release diltiazem daily for a titration period of eight weeks and then maintenance doses for four weeks. The treatment goal was a supine diastolic blood pressure of less than 90 mmHg or a fall of at least 10 mmHg from baseline. During titration, 62% of the enalapril-treated patients and 51% of the diltiazem-treated patients reached the treatment goal after two weeks, 82% and 74% after four weeks, 87% and 84% after six weeks, and 92% and 87% after eight weeks. During the maintenance period, 85% of the enalapril-treated and 87% of the diltiazem-treated patients maintained the goal blood pressure. Treatment side effects were reported by 21% of the enalapril-treated patients and 29% of the diltiazem-treated patients; treatment was discontinued in two patients from each group because of side effects. It is concluded that both drugs were generally well tolerated and effective in the treatment of adult mild to moderate essential hypertension.

Malignant plasmacytic ascites. A report of two cases and a review of the literature.

Two patients with ascites due to peritoneal involvement by multiple myeloma are reported and seven previously described cases of plasmacytic ascites are reviewed. In all nine cases, ascitic fluid contained large numbers of bizzare, immature plasma cells. Although the cells were often difficult to characterize by light microscopy, they could be rapidly identified as malignant plasma cells by immunofluorescent demonstration of monoclonal, intracellular immunoglobulin as performed in one of the patients. This rare extramedullary complication of plasma cell neoplasia has been unresponsive to therapy and rapidly fatal, with a median survival of 2 months.

An investigation of the effects of a pyridyl and a piperidyl 1, 3-dioxolane derivative on neuromuscular transmission.

2-(4'-pyridyl)-1,3-dioxolane methiodide (KCL-301-14) and 2-(1'-methyl-4' piperidyl)-1,3-dioxolane hydroiodide (KCL-301-39) facilitated the force of contraction in low doses and blocked it in higher doses in the in vivo cat soleus muscle preparation. Both drugs in the cat also reversed d-tubocurarine and succinylcholine blockade, produced post-drug repetitive activity, blocked post-tetanic potentiation (PTP), had no direct muscle affect and reversed the PTP suppression caused by d-tubocurarine and succinylcholine. In the rat phrenic nerve-diaphragm and the chick biventer cervicis preparations in vitro, facilitation, then blockade of the contraction were seen as concentrations increased. However, KCL-301-14 reversed d-tubocurarine and increased succinylcholine blockades in the rat and chick. KCl-301-39 increased both d-tubocurarine and succinylcholine blockades in the rat and chick. The different effects seen in the cat vs. the rat and chick with these drugs are probably due to species variation.