Long-term behavior of double crown retained dentures with metal and metal-free secondary crowns and frameworks made of Vectris(©) on all-ceramic primary crowns: a prospective, randomized clinical trial up to 14 years.

OBJECTIVES: This prospective randomized clinical trial aimed to evaluate the long-term behavior of metal-free double crown retained dentures with secondary crowns and dental frameworks made of the fiber-reinforced composite Vectris(©) on all-ceramic primary crowns (IPS Empress 2(©)) over a period of up to 14 years and to subsequently evaluate patient satisfaction. For the control group, electroplated gold copings and metal frameworks were used. MATERIALS AND METHODS: A total of 29 patients were treated with a total of 37 prostheses on 165 primary crowns. Of these 37 prostheses, 27 were allotted to the control group and 10 to the test group. The mean observation time was 91 ± 57 months; patient satisfaction surveys were conducted over 77 ± 59 months. RESULTS: Success rates in both groups were compared using Kaplan-Meier survival curves and log-rank test. Up to about 3 years, both types of prostheses exhibited similar success rates. Afterwards, a massive decrease in the Vectris(©) curve could be noted, whereas the metal curve dropped only slightly. This difference was also statistically significant (p = 0.032361). There was a comparable susceptibility to damages in both groups: 88.9 % (control) and 90 % (test), respectively, of the prostheses had to be repaired within the period of investigation (p = 0,121). Damages of the Vectris(©) secondary crowns could be detected significantly more often compared to the electroformed gold copings (p < 0.00005). Patient satisfaction with the restorations was comparably high in both groups. CONCLUSION: Metal-free secondary crowns and denture frameworks made with the glass fiber-reinforced composite material Vectris(©) showed a lower survival rate than the electroplated gold copings and metal frameworks. Primary crowns made of IPS Empress 2(©) had insufficient stability. Exclusively high-strength zirconia ceramics should be recommended for this indication. CLINICAL RELEVANCE: Both clinical and statistical data indicated the superiority of the restorations made with electroplated secondary crowns and metal framework. Therefore, the use of Vectris(©) cannot be recommended for the fabrication of double crown retained removable dentures as permanent restorations.

Ibuprofen sodium dihydrate, an ibuprofen formulation with improved absorption characteristics, provides faster and greater pain relief than ibuprofen acid.

OBJECTIVE: The objective of this 6-hour study was to compare rate of pain relief, analgesic efficacy and tolerability of a novel ibuprofen formulation, ibuprofen sodium dihydrate, with that of ibuprofen acid in subjects with postoperative dental pain. MATERIAL AND METHODS: The test formulation of ibuprofen sodium dihydrate (256 mg sodium salt) and the reference product both contain 200 mg ibuprofen. Subjects with moderate-to-severe pain after extraction of third molars were randomized to receive two tablets of either ibuprofen sodium dihydrate (198 subjects) or ibuprofen (198 subjects) in this double-blind, multicenter trial. Pain was measured using traditional descriptor scales and onset of analgesia assessed using the stop-watch method. RESULTS: Median time to substantial pain relief occurred 14 minutes earlier in the ibuprofen sodium dihydrate group (p < 0.001). The first sign of pain relief, an increase in relief and time until the pain was half gone occurred significantly earlier and faster in the ibuprofen sodium dihydrate-treated patients (p < 0.02-0.00003). Corresponding numbers needed to treat were in the range 11. Reduction in pain intensity was evident within 5 minutes (p < 0.01) in the ibuprofen sodium dihydrate group compared to 15 minutes in the ibuprofen group. Pain intensity was reduced to half after 30 and 57 minutes in the ibuprofen sodium dihydrate and ibuprofen groups, respectively (p < 0.025). The overall analgesic efficacy in terms of summed pain intensity differences (SPID), total pain relief (TOTPAR) and remedication times in the two groups were similar. Both treatments were well tolerated and no serious events occurred. CONCLUSION: Ibuprofen sodium dihydrate provides faster and more efficacious pain relief during the first hour after intake when compared to a conventional ibuprofen acid formulation. The tolerability profiles are similar.

Effect of surfactant on pharyngeal mechanics in sleeping humans: implications for sleep apnoea.

Instillation of surfactant into the pharyngeal lumen reduces the pressure required to reopen an occluded airway, and decreases the apnoea/hypopnoea index (AHI). The authors hypothesised that surfactant also reduces the sleep-related increase in pharyngeal resistance. To test this hypothesis two single blind, crossover, placebo-controlled studies were performed. In protocol A seven male, asymptomatic snoring subjects were studied during sleep. Inspiratory pharyngeal resistance was calculated from plots of airflow versus supraglottic pressure (seven breaths) before and after surfactant or saline instillation. In protocol B, in a different group of seven male subjects with sleep apnoea (AHI 15.2 (12) events x h(-1)) the effect of surfactant or saline on sleep disordered breathing was measured, for 1 h immediately before and after surfactant or saline instillation. Surfactant decreased pharyngeal resistance calculated at peak pressure (group mean (SD): pre versus post 83.7 (76.4) versus 49.4 (71.1) cmH2O x L(-1) x s(-1)) and significantly reduced the respiratory disturbance index (RDI pre versus post 79.7 (58.7) versus 59.6 (56.9) events x h(-1)). Saline did not decrease resistance (pre versus post 58.6 (31.1) versus 72.5 (73.4) cmH2O x L(-1) x s(-1)) or RDI (pre versus post 75.3 (42.4) versus 79.9 (46.1) events x h(-1)). Surfactant reduced the collapsibility of the pharynx and led to a modest reduction in respiratory disturbance index. The authors speculate that surfactant may delay occlusion by reducing the liquid "bridging" within the folded pharyngeal lining.

Effect of REM sleep on retroglossal cross-sectional area and compliance in normal subjects.

It has been proposed that the upper airway compliance should be highest during rapid eye movement (REM) sleep. Evidence suggests that the increased compliance is secondary to an increased retroglossal compliance. To test this hypothesis, we examined the effect of sleep stage on the relationship of retroglossal cross-sectional area (CSA; visualized with a fiber-optic scope) to pharyngeal pressure measured at the level of the oropharynx during eupneic breathing in subjects without significant sleep-disordered breathing. Breaths during REM sleep were divided into phasic (associated with eye movement, PREM) and tonic (not associated with eye movements, TREM). Retroglossal CSA decreased with non-REM (NREM) sleep and decreased further in PREM [wake 156.8 +/- 48.6 mm(2), NREM 104.6 +/- 65.0 mm(2) (P < 0.05 wake vs. NREM), TREM 83.1 +/- 46.4 mm(2) (P = not significant NREM vs. TREM), PREM 73.9 + 39.2 mm(2) (P < 0.05 TREM vs. PREM)]. Retroglossal compliance, defined as the slope of the regression CSA vs. pharyngeal pressure, was the same between all four conditions (wake -0.7 + 2.1 mm(2)/cmH(2)O, NREM 0.6 +/- 3.0 mm(2)/cmH(2)O, TREM -0.2 +/- 3.3 mm(2)/cmH(2)O, PREM -0.6 +/- 5.1 mm(2)/cmH(2)O, P = not significant). We conclude that the intrinsic properties of the airway wall determine retroglossal compliance independent of changes in the neuromuscular activity associated with changes in sleep state.

Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep.

We hypothesized that a decreased susceptibility to the development of hypocapnic central apnea during non-rapid eye movement (NREM) sleep in women compared with men could be an explanation for the gender difference in the sleep apnea/hypopnea syndrome. We studied eight men (age 25-35 yr) and eight women in the midluteal phase of the menstrual cycle (age 21-43 yr); we repeated studies in six women during the midfollicular phase. Hypocapnia was induced via nasal mechanical ventilation for 3 min, with respiratory frequency matched to eupneic frequency. Tidal volume (VT) was increased between 110 and 200% of eupneic control. Cessation of mechanical ventilation resulted in hypocapnic central apnea or hypopnea, depending on the magnitude of hypocapnia. Nadir minute ventilation in the recovery period was plotted against the change in end-tidal PCO(2) (PET(CO(2))) per trial; minute ventilation was given a value of 0 during central apnea. The apneic threshold was defined as the x-intercept of the linear regression line. In women, induction of a central apnea required an increase in VT to 155 +/- 29% (mean +/- SD) and a reduction of PET(CO(2)) by -4.72 +/- 0.57 Torr. In men, induction of a central apnea required an increase in VT to 142 +/- 13% and a reduction of PET(CO(2)) by -3.54 +/- 0.31 Torr (P = 0.002). There was no difference in the apneic threshold between the follicular and the luteal phase in women. Premenopausal women are less susceptible to hypocapnic disfacilitation during NREM sleep than men. This effect was not explained by progesterone. Preservation of ventilatory motor output during hypocapnia may explain the gender difference in sleep apnea.

Progressive retropalatal narrowing preceding obstructive apnea.

Pharyngeal occlusion during obstructive apnea is thought to be an inspiratory-related event; however, occlusion also occurs in the absence of negative intrathoracic pressure. We hypothesized that inspiratory-related pharyngeal occlusion would be preceded by significant expiratory narrowing. Eight sleeping patients with obstructive apnea were studied. Pharyngeal caliber, airflow, and esophageal pressure (Pes) were simultaneously monitored during three to four consecutive breaths preceding occlusion (between 3 and 22 events were studied per subject). Relative changes in retropalatal airway cross-sectional area (CSA) were determined from fiberoptic images (five frames per second) normalized to the maximum CSA. During inspiration, CSA was significantly reduced only during the breath immediately preceding the apnea (Group mean CSA +/- SEM: 51 +/- 8% at the start of inspiration compared with 37 +/- 8% at midinspiration). During expiration, for all breaths there was an initial significant increase in CSA compared with the nadir CSA during the preceding inspiration (CSA: breath-3, 57 +/- 10% to 79 +/- 3%; breath-2, 59 +/- 8% to 76 +/- 4%; breath-1, 37 +/- 8% to 64 +/- 8%), followed by a significant narrowing at end-expiration compared with the peak CSA during that expiration (CSA: breath-3, 79 +/- 3% to 62 +/- 6%; breath-2, 76 +/- 4% to 50 +/- 10%; breath-1, 64 +/- 8% to 36 +/- 10%). Occlusion occurred at a pressure significantly less than that generated during the previous unoccluded breath (Pes: breath-1, -10.8 +/- 2.9 cm H2O; occlusion, -8.2 +/- 1.9 cm H2O). These results show that expiratory narrowing produced a significant reduction of CSA at end-expiration prior to obstructive apnea.

The effect of rapid eye movement (REM) sleep on upper airway mechanics in normal human subjects.

1. It has been proposed that the upper airway is more compliant during rapid eye movement (REM) sleep than during non-rapid eye movement (NREM) sleep. The purpose of this study was to test this hypothesis in a group of subjects without sleep-disordered breathing. 2. On the first night, the effect of sleep stage on the relationship of retropalatal cross-sectional area (CSA; visualized with a fibre-optic scope) to pharyngeal pressure (PPH) measured at the soft palate during eupnoeic breathing was studied. Breaths during REM sleep were divided into phasic (associated with eye movements) and tonic (not associated with eye movements). There was a significant decrease in pharyngeal CSA during NREM sleep compared with wakefulness. There was no further decrease observed during either tonic or phasic REM sleep. Pharyngeal compliance, defined as the slope of the regression CSA versus PPH, was significantly increased during NREM sleep compared with wakefulness and REM sleep, with the compliance during both tonic and phasic REM sleep being similar to that observed in wakefulness. 3. On the second night, the effect of sleep stage on pressure-flow relationships of the upper airway was investigated. There was a trend towards the upper airway resistance being highest in NREM sleep compared with wakefulness and REM sleep. 4. We conclude that the upper airway is stiffer and less compliant during REM sleep than during NREM sleep. We postulate that this difference is secondary to differences in upper airway vascular perfusion between REM and NREM sleep.

Effect of induced hypocapnic hypopnea on upper airway patency in humans during NREM sleep.

We wished to determine the effect of reduced ventilatory drive (hypopnea) on upper airway patency in humans during non-rapid-eye-movement (NREM) sleep. We studied nine subjects (58 trials) spanning the spectrum of susceptibility to upper airway collapse including normals, snorers and patients with mild sleep apnea. Hypocapnic hypopnea was induced by abrupt cessation of brief (1 min) nasal mechanical hyperventilation. Surface inspiratory EMG (EMGinsp) was used as an index of drive. Upper airway resistance and supraglottic pressure-flow plots were used as indexes of upper airway patency. Termination of nasal mechanical ventilation resulted in reduced VE to 4904 of pre-mechanical ventilation eupneic control. Upper airway resistance at a fixed flow did not change significantly in inspiration or expiration. Likewise, pressure-flow plots showed no increase in upper airway resistance except in one subject. However, maximum flow (Vmax) decreased during hypopnea in four subjects who demonstrated inspiratory flow-limitation (IFL) during eupneic control. In contrast, no IFL was noted in subjects who showed no evidence of IFL during eupnea. We concluded: (1) Reduced ventilatory drive does not compromise upper airway patency in normal subjects during NREM sleep; (2) the reduction in Vmax during hypopnea in subjects with IFL during eupneic control, suggests that reduced drive is associated with increased upper airway compliance in these subjects; and (3) upper airway susceptibility to narrowing/closure is an important determinant of the response to induced hypopnea during NREM sleep.

Longitudinal IQ changes in fragile X males.

Previous studies have reported a drop of IQ in males with Martin-Bell or fragile X syndrome during childhood and adolescence. It is uncertain when and why this drop occurs and whether it affects all fragile X males. We have analyzed longitudinal IQ data on all 24 fragile X males who have been followed for at least 2 years through the Child Development Unit in Denver and who have been evaluated with a Stanford-Binet Form L-M assessment. A significant drop in IQ occurred for the group as a whole, but an individual z analysis demonstrated that only 7 of 24 had a significant decline in IQ. Visual inspection demonstrates an initial decline in IQ beginning in middle childhood and continuing through adolescence. We postulate that this drop occurs because of relatively greater weaknesses with abstract reasoning and higher symbolic language skills that are stressed in the cognitive testing of later childhood and adolescence.

[Do extended preventive indications for cervix cerclage increase labor complications? A statistical analysis on direct and indirect complications of cerclage using Bavarian perinatal data 1978-1980]. / Bewirkt die erweiterte prophylaktische Indikationsstellung zur Zervixcerclage eine Erhöhung der Geburtskomplikationen?--Eine statistische Analyse über direkte und indirekte Komplikationen der Cerclage mit Hilfe der Bayerischen Perinatalerhebung von 1978-1980.

On the basis of 159.710 single pregnancies with 11.321 cerclages documented in the Bavarian Perinatal Survey of 1978-1980, with 2.676 single-child births, and 514 cerclages performed on the authors' own patients, possible complications of the extended indication for cerclage were determined as follows: The late abortion rate was not increased. Possibly because the group represented a negative selection, rupture of the membranes prior to labour, infant mortality due to infection, and premature labour were significantly more common in gravidae who had undergone cerclage. However, it was not possible to identify a causal connection between these and the cerclage operation. With regard to indirect complications there was an appreciable increase in the number of caesarean deliveries among cerclage patients, a slight increase in the number of cases in which labour lasted over 12 hours, and a significant increase in the number of lacerations of the cervix. There was no increase in the incidence of post-term births, malformations, stillbirths, or infantile acidosis among the children of patients who had undergone cerclage.

[Can premature birth rate be reduced by preventive cerclage? A retrospective statistical analysis on the effect and value of cerclage using the Bavarian Perinatal Survey 1978-1980]. / Kann durch die prophylaktische Cerclage die Frühgeburtenrate gesenkt werden? Eine retrospektive statistische Analyse über Wirkung und Wertigkeit der Cerclage mit Hilfe der Bayerischen Perinatalerhebung (BPE) der Jahre 1978-1980.

There is no simple correlation between cerclage rates and premature birth-rates. This concludes that premature birth-rates cannot be reduced by extending the cerclage. In all comparable categories the premature birth-rate was higher in groups which used the cerclage than those ones which did not use the cerclage even though a) the risk of social economical premature birth-rates was reduced and b) care was intensified for pregnancy cases. Cerclage groups have a higher percentage of case history risks than the non-cerclage groups. There is a direct relationship between the social status and the premature births. The case history of premature birth risks cannot be reduced using the cerclage especially with women who have previously had 2 abortions or premature births. When placenta previa occurs the cerclage does not reduce premature births. In the case of cervix insufficiency and early labor the cerclage reduces the premature birth-rate. Extended prophylactic cerclage cannot be used to diminish premature births.

[Can by preventive cervix cerclage the premature birth rate in multiple pregnancy be reduced? A retrospective statistical analysis on effectiveness of cerclage using the Bavarian Perinatal Survey 1978-1980]. / Kann durch die prophylaktische Zervix-Cerclage die Frühgeburtenrate bei Mehrlingen gesenkt werden? Eine retrospektive statistische Analyse über die Effektivität der Cerclage mit Hilfe der BPE von 1978-1980.

Through a retrospective statistical analyzation of 3081 multiple births with 907 cerclage of BPE from 1978-1980, among which included 77 multiple births and 61 Cerclage cases of the Amberg gynecology clinic, could be proved that the liberal use of prophylactic cerclages could not reduce the premature birth rate of multiple birth pregnancies.

Psychological functioning after severe closed head injury.

The residual effects of severe closed head injury on psychological functioning, as determined by data from the Rorschach test, were examined. Thirty-five young adult patients with severe closed head injury were compared to a nonpatient, non-head injured matched group sample of 36 subjects. The utility of the Rorschach test in distinguishing the characteristic psychological functioning of inpatients who have suffered from severe closed head injury was outlined. The apperceptive disturbance, affective/cognitive problems, and interpersonal difficulties were discussed.