Dental treatment of handicapped patients using endotracheal anesthesia

Dental treatment using endotracheal anesthesia is indicated where acute odontogenic infections, accidental injuries, or multiple caries and periodontitis marginalis require surgical and/or restorative treatment. It is also indicated where it is not possible to use psychological support during local anesthesia or during premedication or analgosedation. Dental treatment of handicapped patients using endotracheal anesthesia is described, along with indication and frequency of such treatment. The state of the dentition is illustrated, along with its relationship to the oral hygiene the handicapped patients receive. The main points of the intraoperative dental procedures and the follow-up of patient care are reported. Postoperative dental or general medical complications have not occurred within the patient population under study.

An analysis of the paper-based health record: information content and its implications for electronic patient records

An analysis of paper-based charting was carried out at Sunnybrook Health Sciences Center as a prelude to developing a strategic plan to implement an electronic patient record. A relational model of the Sunnybrook paper chart was developed, describing each of its forms in terms of specific data fields. Three hundred and forty nine different forms are in current use at Sunnybrook, containing 64 types of data fields such as Patient Demographics, Vital Signs, and Doctor's Orders. The extent of data field duplication at the level of hospital forms was significant. A Patient Demographics field was present on all forms and on all pages of a patient's chart, as would be expected. Twenty seven other fields were duplicated on more than ten different forms, including Working Diagnosis which was present on 110 forms, History of Past Illness on 42 forms, and History of Present Illness on 32 forms. Current Medications were recorded on 32 forms and Allergy fields were present on 29 separate forms. Only five data fields of the total 64 were present on only one form. The duplication of data fields within complete patient charts was then examined to confirm that data field duplication was occurring within the actual healthcare delivery process. Using the relational model of the charting system, 143 acute care in-patient encounters were abstracted into the database. The charts were selected randomly from each of the hospital inpatient services. The numbers and types of forms within each chart were recorded, amounting to 18,654 physical pages and using 165 of the different forms. The average in-patient encounter within the model was 130.4 pages long, with a minimum of 27 pages, a maximum of 559 pages, and containing on average 25.8 different forms. The duplication of data fields within actual charts followed a pattern similar to the duplication found on the forms. Initial diagnosis was present on an average of 20.4 pages within the charts, with a minimum of 2 pages and a maximum of 152 pages containing this data field. Other frequently occurring data fields included History of Past Illness present on an average of 12.2 pages per chart, History of present illness on 10.2 pages per chart, and allergies on an average of 9.1 pages per chart. The results obtained through the examination of Sunnybrook charts should be generalizable to most paper-based systems. This study did not measure the workload associated with duplicating chart data. however, the magnitude of the duplication seen in this study leaves little doubt that significant amounts of time could be saved with appropriate modification of health care delivery processes. Multiple copies of the same data field within a database are referred to as aliases of each other. This study demonstrates that hospital charts contain many copies of the same information, such as medication lists, allergies etc. Due to manual replication of data fields, there is no mechanism to ensure that each copy of a data element within a chart actually contains the same information. This aliasing of data through manual duplication compromises the integrity of data within paper-based charts. Decisions and therapy based upon contradictory or inaccurate data are likely to lead to inefficient or erroneous care delivery; this has significant implications for hospital liability and quality of patient care. A growing recognition of the costs and risks of data replication within paper-based charting systems is driving the healthcare industry toward Electronic Patient Record systems. Better quality patient care data, provided by computerized records, is likely to be necessary but not sufficient to improving the efficiency and effectiveness of the healthcare system. Intelligent application of this information will be essential.

[The histology of mastopathy and cumulative ipsilateral breast cancer sequence]

In a retrolective and follow-up study the ipsilateral cumulative risk of breast carcinoma after histological benign diseases in women under 66 years of age (n = 1397) is investigated. The subtypes are mastopathy I (= changes without proliferative lesions), mastopathy II (= proliferative lesions without atypia), and mastopathy III (id sunt atypical ductal and lobular hyperplasias). The cumulative risk with mastopathy I and II over a 15 year time period corresponds with the ordinary age related risk, the cumulative risk with mastopathy III is four times higher (p = 0.001). There is no difference between atypical ductal and lobular hyperplasia (p = 0.7). Women in reproductive age have a higher risk (p = 0.03), which exists even after a carcinoma-free survival of more than 10 years. The mastopathy is more a stigma for a higher breast cancer risk than a direct precancerous lesion.

Dyslexic children learn a new visual strategy for reading: a controlled experiment

Recent studies by Geiger, Lettvin and Zegarra-Moran have proposed a new non-reading test for the diagnosis of dyslexia, and a new method for remediation. The latter involves the learning of a "visual strategy". On adult dyslexics the test was reliable and the remediation apparently effective. The purpose of this study is to confirm the usefulness of the remediation and test with children. Dyslexic children (3rd-6th grade) were divided into two groups. The experimental group (9) was given a new remedial regimen of practise. The control group (6) continued the remedial process given in their school. After 3 months of practising their separate regimens all the dyslexic children who were in the two groups were retested and compared. The "experimental" dyslexics improved in reading by 1.22 grade level on average while the "control" dyslexics improved by 0.17 grade on average. The form-resolving field (FRF) plots narrowed significantly for the experimental dyslexics while they changed little for the control dyslexics. At the end of the second testing the control dyslexics were also given the new regimen of practise. Five months later all the dyslexic children were tested for the third time. The initial control dyslexics who later practised the regimen (2) improved in reading by 2-2.5 grades and their FRF plot narrowed. The experimental dyslexics continued to improve yet further. All the dyslexic who practised the new regimen started at an average of 2.5 grades behind their expected grade/age level and after 8 months were at an average 0.75 grades behind their expected grade/age level. This is on average 1.75 grade level improvement in reading within 8 months, a rate of improvement larger than that of ordinary reading subjects. The dyslexic children were compared with matched grade/age ordinary reading children for reference. The study confirms the usefulness of the test and the applicability of the remediation method for children. It also shows that improvement under that method is quite rapid.

Visual recognition in the peripheral field: letters versus symbols and adults versus children

The plot of the form-resolving field (FRF) was obtained by tachistoscopically presenting two figures in each stimulus, one in the center of gaze and the other in the peripheral field. The figures in the periphery were placed at various eccentricities in different presentations. The ensuing plot of average letter recognition as a function of eccentricity is the FRF. Only the horizontal components of the FRFs were used in the comparisons. Three sets of figures were used as stimuli: regular-size letters, large-size letters, and symbols. Three groups of subjects were compared: adult ordinary readers, reading children, and pre-reading-age children. The last were tested with symbols only. In letter recognition, the FRFs for young and adult ordinary readers are similar and fall off monotonically and symmetrically with eccentricity, hence conforming with the first Aubert-Foerster law (1857). However, the FRFs tested with symbols are narrower than those tested with letters of the same sizes and stroke widths, which is not in accordance with the first Aubert-Foerster law. In addition, the FRFs of symbols are different for each subject group. It is suggested that recognition in the peripheral field is not determined by visual acuity alone; rather, it is further confined or determined by the visual strategy employed to accomplish the task, and its associated distribution of lateral masking.

[Micromorphological studies of the blood vessels of the dental pulp of small ruminants]

The blood vascular supply of the dental pulp of 15 domestic sheep of varying age and sex was investigated using light and electron microscopy. The pulp vascular system is showing arterioles with a media of varying thickness and with endothelial cells of variable structure. In the transitional zone between crown and root pulp, the arterioles are taking a typical S- or U-shaped course. The capillary network of the crown pulp is denser and more regular than that in the root pulp. In addition to the capillaries lined by a continuous endothelial tube, there may be others with a typically fenestrated endothelial lining. Specialised vascular structures of the peripheral blood vessels, especially arterio-venous anastomoses as described in man, have not been observed in the sheep.

Task-determined strategies of visual process

Lateral masking in the peripheral field of vision obscures letter recognition and is not accounted for by diminished acuity. In measuring lateral masking between letters in the peripheral visual field we accidentally discovered that ordinary readers and severe dyslexics differ markedly in tachistoscopic letter recognition tasks. Tests were devised to measure the differences accurately. Ordinary readers recognize letters best in and near the center of gaze. Recognition falls off rapidly with angular distance in the peripheral field. Severe dyslexics recognize letters farther in the periphery in the direction of reading (English-natives to the right, Hebrew-natives to the left). They have marked lateral masking in and near the center of the field when letters are presented in aggregates. With dyslexia as an example, we proposed that the distribution of lateral masking is a task-dependent strategy in visual perception. To test this notion we designed an active practise regimen for 4 severe adult dyslexics, who within a few months improved sharply in reading. At the same time their test results changed to those of ordinary readers. We conclude that there are switchable task-determined pre-cognitive strategies of vision that can be learned and that the distribution of lateral masking may be part of what is learned.

[Scanning electron microscopic studies of the odontoblasts and the pulpodentinal border in domestic sheep (O. ammon aries Linnaeus, 1758)]

In order to investigate odontoblasts and predentin surfaces using SEM techniques, teeth of sheep with one or several roots were subjected to critical point drying. The odontoblasts of the root pulp are distinguished in their shape and arrangement pattern from those in the crown pulp. They regularly are detaching only one process of Tomes, which is extending up to the border between dentin and enamel and which shows a dendritic ramification in the dentin next to the enamel. The distal cell portions of the odontoblasts are joined together by a system of terminal bars. The collagen structures observed between the odontoblasts and predentin are considered to be von Korff's fibres as found in man.

[Micromorphologic studies of the odontoblasts of sheep in different development and maturation stages]

The fine tissue structure of ovine odontoblasts was studied in various developmental and maturational stages. Odontoblasts differentiate from the peripherally-located mesenchymal cells of the dental papilla. On the basis of cytological parameters, it was possible to divide the odontoblasts into the following groups: pre-odontoblasts, juvenile (light) odontoblasts and mature (dark) odontoblasts. The three maturational stages of odontoblasts exhibit substantial differences with respect to their form and to the number and arrangement of their cytoplasmatic organelles. Structural differences in the three cell types appear to be closely correlated to the level of cellular activity.

[Fine tissue studies of the nerve supply to the dental pulp in domestic sheep (O. ammon aries Linné, 1758)]

The nerve supply of the pulp was investigated in 17 sheep of various breeds and age groups belonging to both sexes, using light and electron microscopy. The following results were obtained: The dental pulp of sheep is supplied with myelinated and unmyelinated nerve fibres. The subodontoblastic plexus of Raschkow, as found in man, is absent in sheep. Single axons may be found in the predentine between the odontoblasts and near Tomes' processes. The rare occurrence of both subodontoblastic nerve fibres and cells of the immune system in the ovine pulp is discussed in relation to evolutionary processes, in light of the fact that sheep are relatively resistant to caries.

Deterioration of PTFE-prostheses wall. A SEM study

Specimens of long-term femoro-popliteal ePTFE bypass implants were examined by means of scanning electron microscopy in order to analyze the structure of the prosthetic wall. Twelve months after implantation, the structure of the ePTFE wall was inhomogeneous with a widening of the micropores, and both compressed and ruptured fibrils. The most significant disturbances were observed in the knee joint area. Our results suggest that deterioration of the prosthetic wall is possible and indicate the necessity for a wrap to protect against aneurysm formation, as well as an external supportive device to prevent the graft from bending.

[Ameloblast proliferation within dentigerous cysts of the jaw bone]

The presence of ameloblastic structures in dentigerous cysts in a 26-year-old female patient and a 42-year old male patient is reported. Their non-invasive growth distinguished the present circumscribed ameloblastic tissue structures from classic ameloblastomas. Enucleation of the cysts resulted in undisturbed healing of the surgical area; none of the ameloblastomas recurred. These cases emphasize the importance of careful pathologic-histological examination of all tissues removed.

[Conjunctival oxygen partial pressure, hemorheology and circulatory parameters in acute cerebral infarct before and following infusion of 6 percent low molecular hydroxyethyl starch]

A prospective clinical trial was performed on the effects of a three hour infusion of 500 ml 6% low-molecular-weight hydroxyethyl starch in patients with acute ischemic stroke. Hemorheology and conjunctival oxygen tension were found to be disturbed prior to treatment. After the infusion there was a marked improvement of the pertinent parameters, indicative of an increase in cerebral microcirculation and oxygen supply. Even 3 h later persistent significant effects were observed. The infusion was well tolerated. Blood pressure and cardiac index remained unchanged.

Konjunktivaler Sauerstoffpartialdruck, Hämorheologie und Kreislaufparameter bei akutem zerebralem Insult vor und nach Infusion von 6prozentiger niedermolekularer Hydroxyäthylstärke

In einer prospektiven Studie untersuchten wir bei 12 Patienten mit akutem zerebralem Insult die Wirkung einer dreistündigen Infusion von 500 ml 6%iger niedermolekularer Hydroxyathylstarke. Die an-fangs gestörte Hämorheologie wurde deutlich verbessert, ebenso der anfangs erniedrigte konjunktivale Sauerstoffpartialdruck. Dies kann als Hinweis auf eine Steigerung der zerebralen Mikrozirkulation und Sauerstoffversorgung gewertet werden. Auch 3 h nach Infusionsende waren noch signifikante Veränderungen nachzuweisen. Die Volumen-belastung durch die Infusion wurde gut toleriert. Blutdruck und Herzminutenvolumen blieben stabil.

Sociobiology and the structural stability of behavior patterns

A structural stability approach to population-genetic systems and to dynamic evolutionary games is attempted in order to examine the theoretical significance of sociobiological selection models. A criterion of weak selection is derived that is not restricted to differential reproduction in polymorphic systems but describes possible directions of evolutionary change in time scales governed by genetic mutation rates. The criterion applies to the problems of how the initial mutational basis of an adaptive trait may be established and how this may happen, for analogous traits, independently in different species. Two basic sociobiological concepts are reconsidered with reference to the criterion. It is shown that W. D. Hamilton's condition of increases in inclusive fitness due to altruistic interactions among kin expresses the structural instability of populations against the evolution of altruistic behavior. Using the dynamic approach to evolutionary game theory, it is demonstrated that if a behavioral phenotype is an evolutionarily stable strategy, it is structurally stable against perturbations of the fitness payoffs, provided selection is weak. These results are applied to material problems of the evolution of animal social behavior.

Comparison of the beta-adrenoceptor affinity and selectivity of cetamolol, atenolol, betaxolol, and ICI-118,551

The objective of the present study was to compare the quantitative differences in the beta 1- vs. beta 2-adrenoceptor affinity and selectivity of cetamolol and its enantiomers to the reference compounds atenolol, betaxolol, and ICI-118,551, using isolated tissues obtained from the dog, guinea pig, and rat. Cetamolol antagonized the beta-adrenoceptor-mediated responses induced by isoproterenol, epinephrine, norepinephrine, and salbutamol, in tissues from both the dog and guinea pig, in a concentration-dependent manner. For a given tissue, the beta-adrenoceptor antagonist activity of cetamolol (measured as a pA2 or pKB value) was independent of the agonist used. In the dog tissues, cetamolol was more potent at inhibiting responses in the coronary artery (beta 1-adrenoceptors) than in the saphenous vein (beta 2-adrenoceptors). In the guinea pig tissues, the potency of cetamolol was approximately the same in the trachea (mixed beta 1- and beta 2-adrenoceptors) and atria (predominately beta 1-adrenoceptors), but lower in the soleus muscle (beta 2-adrenoceptors). Studies with the S-(-) and R-(+) enantiomers of cetamolol demonstrated that the S-(-) enantiomer was approximately 100-fold more potent at beta 1-adrenoceptors than the R-(+) enantiomer. In rat brain, cetamolol displaced [3H]-dihydroalprenolol bound to homogenates of cortex (beta 1-adrenoceptor binding sites) and cerebellum (beta 2-adrenoceptor binding sites). The potency of cetamolol at beta 1-adrenoceptors was found to be similar to that of betaxolol but greater than that of atenolol. However, the magnitude of the beta 1-adrenoceptor selectivity displayed by atenolol and betaxolol was greater than that displayed by cetamolol. In contrast, ICI-118,551 was found to possess potent and selective affinity for beta 2-adrenoceptors.

In vitro isolated tissue studies with atiprosin (AY-28,228): a new antihypertensive compound

Using in vitro isolated tissue and binding studies we have defined a receptor activity profile for atiprosin. The most prominent action of the compound was significant alpha-adrenoceptor antagonist activity (pA2 = 8.11) that was less potent than prazosin (pA2 = 8.78) but more potent than either ketanserin (pA2 = 7.34) or indoramin (pA2 = 7.85). In addition, atiprosin was selective for alpha 1-adrenoceptors, since the compound was over 100-fold less potent as an antagonist at alpha 2-adrenoceptors (pA2 = 6.04). Atiprosin also displayed selective serotonin 5-HT2-receptor antagonist activity similar to that seen with ketanserin, but with a lesser potency (pA2 atiprosin, 6.87; ketanserin, 8.61). Although atiprosin also displayed significant histamine H1-antagonist activity (pA2 = 7.32), it was less potent as an H1-antagonist than as an alpha 1-adrenoceptor antagonist. In contrast, both indoramin and ketanserin displayed H1-antagonist activity (pA2 8.77 and 8.83, respectively) greater than their respective alpha 1-adrenoceptor antagonist activities. Atiprosin had little or no activity at either beta 1- or beta 2-adrenoceptors, muscarinic or histamine H2-receptors, nor any marked ability to produce smooth muscle relaxation either by a direct effect or via calcium entry blockade.