The prevalence of clinically significant anaemia and haemoglobinopathy in children requiring dental treatment under general anaesthesia: a retrospective study of 1000 patients

There is little information on the possible value of screening children who are liable to haemoglobinopathies as part of pre-operative assessment for dental treatment under general anaesthesia. The present retrospective investigation examined, first, the number of patients having low haemoglobin levels among 1000 patients who had undergone haematological investigation prior to general anaesthesia in a dental outpatient unit, and, secondly, the subsequent clinical management of these patients. Haemoglobin levels of 10.0 g/dl or less were found in 31 children: 13 Asian, 7 Afro-Caribbean, 5 Mediterranean, 3 Arabic, 1 white Caucasian and 2 Oriental children. In addition, 17 patients had sickle-cell trait and 2 had beta-thalassaemia trait, but there was no relationship between the presence of haemoglobinopathy and low levels of haemoglobin. The planned general anaesthesia was undertaken for 22 of the 31 children who had low levels of haemoglobin and for the 19 children with haemoglobinopathy. Only 6 children ultimately did not undergo general anaesthesia, all failing to return. It is concluded that pre-anaesthetic haematological assessment of children needing minor dental surgery is rarely of any significant clinical value.     

Profile of radical retropubic prostatectomy during a 5-year period

The authors evaluated 165 radical retropubic prostatectomies, which have been performed at the Department of Urology of the 1st School of Medicine, the Charles University and the General Faculty Hospital in Prague, from January 1992 until half of April 1997. After more precise indication criteria have been implemented, even more per cent of patients are operated in clinical T1c stage (only in this year it was up to 45%). Out of all, in 56 patients PSA exceeded 20 ng/ml, in 46 patients, there was proved seminal vesicles invasion and in 29 patients, there have been disclosed regional lymph node involvement. The postoperative decline of PSA below the 4.0 ng/ml within three months was recorded in 80% of patients with seminal vesicles involvement, but only in 69.2% of patients with nodal invasion. It may indicate the worse prognosis of latter patients. Nowadays we perform the routine peroperative staging lymphadenectomy provided PSA exceeds 10 ng/ml preoperatively and in case of presence of cancerous cells in regional lymph nodes, we do not proceed in the operation and the patient is indicated to another therapeutical modality.     

Changes in subjective symptoms of craniomandibular disorders in children and adolescents during a 10-year period

An epidemiologic sample of 293 subjects in three age groups, now 17, 21, and 25 years of age, were followed longitudinally with respect to symptoms of craniomandibular dysfunction during a 10-year period. Reports of one or more such symptoms increased in all three age groups during the 10 years. At the follow-up, 1 in 3 individuals in all three groups had noticed such symptoms occasionally and 10% had them frequently. Reports of oral parafunctions such as bruxing and clenching also increased, while other parafunctions such as nail, lip, cheek, and tongue biting increased from the age of 7 to 11 but then decreased with age. Despite the high incidence of subjective symptoms of craniomandibular disorders, only a few subjects had had any kind of functional treatment performed during the 10-year period, and only 7 had an actual demand for treatment at present.     

Awareness and dreams during general anaesthesia for Caesarian section a study of incidence

One hundred Nigerian patients presenting for emergency caesarian section were interviewed within the first 24 hours post-operatively. The purpose was to determine the incidence of awareness and dreams. The standard anaesthetic technique consisted of atropine 0.6 mg and thiopentone 250 mg given intravenously at the time of induction, suxamethonium bromide 40 mg intravenously to facilitate tracheal intubation and nitrous oxide/oxygen/pancuronium for maintenance. The incidence of awareness was 4% while the incidence of dreaming was 17%. Most (94%) of the patients said they dreamed only occasionally at home and of these, 15% claimed they dreamed more frequently when pregnant than when not pregnant.     

Human growth hormone treatment of short-stature children born small for gestational age: effect on muscle and adipose tissue mass during a 3-year treatment period and after 1 year's withdrawal

In addition to its growth promoting effect, GH has profound metabolic effects that have not always been evaluated in longitudinal studies. We have recently shown that the effect of GH on body composition can be evaluated by magnetic resonance imaging measurement of adipose and muscle tissue cross-sectional (cs) areas in the thigh. The aim of this study was to evaluate the long-term effects of human GH (hGH) (0.2 IU/kg day) on muscle and adipose tissue mass during a 3-yr treatment period and after 1 year's withdrawal in short SGA (small for gestational age) children. Measurement of muscle and fat tissue mass by magnetic resonance imaging of the thighs was used to study the metabolic effect of hGH in 14 prepubertal short children born SGA. Results were compared with those of a control group of 7 normal children followed longitudinally. An increase of muscle tissue cs area was observed during the 3 yr of hGH treatment, an increase which was significantly different during the first 2 yr of treatment from that seen in controls (+31.2+/-2.6% and +18.1+/-1.8% during the 1st and 2nd year, respectively, vs. +9.1+/-2.6% change during 1 yr in controls). After a significant decrease in adipose tissue cs area during the first year of therapy (-16.4+/-3.4% vs. baseline values), an increase in adipose tissue cs area occurred during the second and third years. At the end of the third year, the muscle tissue cs area change was significantly greater in SGA-treated children, as compared with controls (+71.6+/-4.6% vs. 22.1+/-4.6%; P < 0.001), whereas the adipose tissue cs area change was similar in the two groups (+12.6+/-9.5% vs. +19.9+/-4.2%). After hGH withdrawal, the effects were opposite after 3 months, as compared with those observed after the first 3 months of hGH administration, whereas no additional significant change was seen after 1 yr off treatment, indicating the maintenance of muscle and adipose tissue mass. In conclusion, hGH administered to SGA children is effective in improving growth velocity and has long-term effects on muscle and adipose tissue mass. These effects may lead to speculation about the sensitivity of these tissues to GH. The physiological consequences of such effects must be evaluated.     

Vagal paraganglioma: a review of 46 patients treated during a 20-year period

BACKGROUND: Vagal paragangliomas (VPs) arise from paraganglia associated with the vagus nerve. Approximately 200 cases have been reported in the medical literature. Because of their rarity, most information regarding these tumors has arisen from case reports and small clinical series. OBJECTIVE: To detail the clinicopathologic features of 46 patients with VP with an emphasis on the role of a multidisciplinary skull base team in both the successful extirpation and rehabilitation. DESIGN: Retrospective review of 46 patients with VP managed by a single skull base team. SETTING: An academic tertiary medical center. RESULTS: Forty-six patients were treated over a 20-year period (1978-1998). Ten (22%) demonstrated intracranial extension. There was a history of familial paragangliomas in 9 (20%) of the patients. The incidence of multicentric paragangliomas was 78% in patients with familial paragangliomas vs 23% in patients with nonfamilial paragangliomas. Management of this group of 46 patients consisted of surgery (n = 40), radiation therapy (n = 4), and observation (n = 2). The operative approach consisted of a transcervical excision often combined with a transtemporal or lateral skull base approach as dictated by the tumor extent. Postoperative cranial nerve deficits were common, and, as such, aggressive rehabilitation was a vital component in the management of these tumors. CONCLUSIONS: The management of VP and its associated cranial nerve deficits remains a difficult clinical problem. Options for treatment include surgical resection, radiation therapy, and, in selected cases, observation. Surgical extirpation requires a multidisciplinary skull base team to achieve complete tumor resection. Radiation therapy is reserved for elderly patients and patients at risk for bilateral cranial nerve deficits. Rehabilitation of cranial nerve deficits is an integral part of the management of VP.     

Exogenous and endogenous plasma levels of epinephrine during dental treatment under local anesthesia

4-Bromomethyl-6,7-dimethoxy-coumarin labels the (Ca(2+)-Mg(2+)-ATPase of skeletal muscle sarcoplasmic reticulum at Cys-344. Resonance energy transfer has been used to measure the distance between this site and Lys-515 labelled with fluorescein isothiocyanate as about 37 A. The height of Cys-344 above the phospholipid/water interface has been measured by resonance energy transfer for the ATPase reconstituted into bilayers containing fluorescein-labelled phosphatidylethanolamine; the height was found to be about 45 A. None of these distances was found to alter on changing pH, or on addition of Mg2+, Ca2+ or vanadate. Quenching of the fluorescence of the coumarin-labelled ATPase with KI suggested that the fluorophore is not fully exposed on the ATPase.     

Referential communication and reading performance in learning disabled children over a 3-year period.

Examined the ability of 30 learning disabled (LD) and 30 non-LD (NLD) 6- and 7-yr-olds to understand a sequence of instructions, communicate the steps in a sequence to others, and rephrase their verbal messages across a 3-yr period using a referential communication task. In order to perform the puzzle-box task correctly, Ss had to execute 6 steps in an invariant sequence. After Ss demonstrated a perfect nonverbal enactment of the sequence, they were asked to communicate all information about how to open the box to a puppet. Upon completion, the puppet feigned poor memory and asked the Ss to explain the step-by-step process again. Subsequently, the puppet requested that Ss rephrase their explanation of each step by either a verbal or nonverbal rephrase request. Results reveal that LD children differed from NLD peers consistently on referential communication over the 3-yr period in terms of listener competence and speaker competence. For LD Ss, the ability to produce competent verbal messages was highly related to reading comprehension both concurrently and 3 yrs later. By the 3rd yr, NLD Ss were better able to rephrase information, indicating a growing awareness of the speaker's responsibility in communication. Findings suggest that the communication measures studied play very different roles for LD and NLD Ss with regard to reading achievement. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temperament as a predictor of behavior during initial dental examination in children

Temperament refers to children's behavioral style, or the manner in which they interact with their environment. Temperament has been quantified into nine temperament categories and five temperament constellations by Thomas and Chess. Temperament categories and constellations of children can be measured using one of several parental questionnaires, each of which focuses on age-appropriate behavior. For this study the Behavioral Style Questionnaire (BSQ) was administered to the parents of 50 healthy children (mean age 48.8 months) receiving initial dental examinations. The examinations were videotaped and The Ohio State Behavior Rating Scale (OSUBRS) was used to rate each child's behavior into one of four behavioral categories: 1) quiet; 2) crying only; 3) disruptive movement only; and 4) crying and disruptive movement. For data analysis the percentage duration of each behavioral category was calculated. Using one-way ANOVA, significant differences between constellations were found for quiet (P = 0.03) and combination behavior (P = 0.03). Using a stepwise linear regression, the temperament category of approach/withdrawal was found to predict the percentage of quiet (multiple R = 0.42357, R2 = 0.17941, and P = 0.002), crying (multiple R = 0.42124, R2 = 0.17744, and P = 0.002), and combination behaviors (multiple R = 0.30008, R2 = 0.09005, and P = 0.03). Additionally, significant regressions were found with temperament categories predicting behavioral categories depending on the child's age. The results of this pilot study suggest that the BSQ temperament constellations and categories appear to be modest predictors of a child's specific behaviors in the dental environment. Knowledge of a child's temperament may prepare the clinician to predict patient behaviors in the dental environment.     

Was it a phase? Young women's relinquishment of lesbian/bisexual identities over a 5-year period.

There have been many anecdotal accounts of individuals who self-identify as lesbian, gay, or bisexual only to relinquish these identities later. The current study examines this phenomenon among a sample of young nonheterosexual women who underwent 3 interviews over a 5-year period. Over a quarter of the women relinquished their lesbian/bisexual identities during this period: half reclaimed heterosexual identities and half gave up all identity labels. These women did not differ from those who maintained lesbian/bisexual identities regarding the age at which they underwent sexual identity milestones, the factors that precipitated their sexual questioning, or their recollection of childhood "indicators" same-sex sexuality. Women who relinquished their identities for heterosexual identities had small ratios of same-sex to other-sex attractions across the 5-year assessment period, but their attractions did not significantly change. Only 1 woman described her previous same-sex identification as a phase; the rest emphasized changes in how they interpreted or acted on their attractions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in the surgical treatment of gallstones during a 10 year period

OBJECTIVE: To investigate changes in the surgical treatment of gallstones during a 10 year period. DESIGN: A retrospective study of medical records. SETTING: A community hospital serving a population of 108,000 inhabitants. SUBJECTS: All patients having their first operation for gallstones during the periods 1976-1978 and 1986-1988. RESULTS: The annual frequency of operations for gallstones decreased from 2.01 to 1.13/1,000 inhabitants, and the corresponding frequency of operations on the common duct decreased from 0.39 to 0.28. The percentage of urgent operations increased from 19 to 47. CONCLUSION: A decline in the prevalence of cholelithiasis or a more restrictive attitude of elective operations for gallstones, or both, would explain the overall reduction in surgery for gallstones. The introduction of endoscopic sphincterotomy has considerably changed the treatment of cholelithiasis. The increased age of the patients and higher percentage of urgent operations has not resulted in any increase in postoperative morbidity and mortality.     

Changes in plasma lipids and lipoproteins in humans during a 2-year period of dietary restriction in Biosphere 2

BACKGROUND: A cohort study was performed of 8 people sealed inside Biosphere 2 to evaluate the effects of dietary restriction in humans on lipid and lipoprotein levels and the relationship of these levels to energy, fat, and protein content of the diet, and body weight, weight change, and energy expenditure. METHODS: Eight healthy people aged 27 to 67 years, 4 women and 4 men, were sealed inside Biosphere 2 from September 26, 1991, to September 26, 1993, the longest sustained period in an "isolated confined environment" on record. They were studied throughout confinement and for more than 2 years after their exit and return to an ad libitum diet. Food available was severely restricted during most of the 2-year period inside Biosphere 2. High work output was maintained and food quality remained high, resulting in prolonged restriction of energy intake without malnutrition. RESULTS: Fasting plasma cholesterol, triglyceride, and high-density lipoprotein (HDL) cholesterol levels; HDL subfraction distribution; dietary energy, fat, and protein content intake; and height, weight, weight change, and energy expenditure were measured. Total plasma cholesterol and triglyceride levels decreased 30% and 45%, respectively. The HDL and low-density lipoprotein levels also decreased and, in some participants, levels of HDL2 subfractions were increased. Multivariate analysis showed that the major cause of these changes was energy restriction. CONCLUSIONS: Energy restriction was the major factor leading to low lipid and lipoprotein levels. Energy restriction with adequate nutrition of young and middle-aged people may substantially reduce risk for atherosclerosis and consequent coronary artery and cerebrovascular disease.     

Decline and stabilization of managerial motivation over a 20-year period.

Investigated the decline in managerial motivation that began in the early 1960's to determine when and if it stabilized. Data for 1972–1973 (N?=?86) and 1980 (N?=?124) were added to findings for 1960–1961 (N?=?287) and 1967–1968 (N?=?129) showing that managerial motivation as measured by the Miner Sentence Completion Scale (MSCS) continued to decline into the early 1970's and then apparently leveled off. These findings for University of Oregon undergraduate business students were substantiated using similar samples from Georgia State University obtained in 1975 and 1979, as well as comparable groups from other universities. Previously existing differences between male and female business students, which showed that females obtained considerably lower scores on the MSCS, have now disappeared. The overall results continue to indicate major managerial talent shortages for some years to come. Managerial motivation may have experienced a resurgence in the business schools in recent years. The data indicate that decreases have been most conspicuous on attitudes toward authority, competitiveness, assertiveness, and the desire to perform routine communications and decision-making functions. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)