Repair with a surveyed cast clasp while patient retains the partial denture

A technique is described that allows a removable partial denture with a broken clasp or a removable partial denture in which an abutment has been extracted to be restored by the reattachment of a new cast clasp component or a complete surveyed clasp assembly. The technique is applicable to most clasp designs and can include attachment to the acrylic denture base or the metal major connector. The technique is distinguished from other repair techniques by (1) providing a cast clasp replacement, (2) allowing the patient to retain the prosthesis during the repair, (3) generating a precisely formed surveyed clasp assembly by the laboratory, and (4) including an efficient transfer mechanism for the precision clasp created in the laboratory to be attached to the removable partial denture in the dental office. A two-step impression procedure is used to ensure proper relation of the partial denture to the abutments.     

Haemoglobin O Padova and falsely low haemoglobin A1c in a patient with type I diabetes

Glycated haemoglobin (HbA1c) measured by high performance liquid chromatography (HPLC) in a 20 year old female with insulin dependent diabetes mellitus was consistently within the normal range although her daily blood glucose values were > 11.1 mmol/l. HbA1c measured by immunoagglutination and fructosamine was elevated and correlated with the patient's blood glucose values. The HPLC chromatogram showed an additional peak at HbA0. Electrophoresis of haemoglobin on citrate agar gel revealed an abnormal haemoglobin anodal of HbS. Cellulose acetate electrophoresis and isoelectric focusing demonstrated an additional haemoglobin migrating close to HbA2. Amino acid analysis and DNA sequencing revealed an alpha 30 (B11) Glu-->Lys replacement, that is, haemoglobin O Padova. Investigations of two family members without diabetes revealed the same rare haemoglobin variant. This case showed that this silent haemoglobin mutation caused an additional peak and falsely low HbA1c values when measured by HPLC, the gold standard for this evaluation.     

Long-term outcome evaluation of patients undergoing the meatal advancement and glanuloplasty procedure

A total of 100 consecutive children with distal hypospadias who underwent a variation of the Duckett procedure of meatal advancement and glanuloplasty between 1985 and 1990 was evaluated for outcome in terms of urinary stream, erection, cosmetic appearance and overall parental satisfaction. Minimum interval between procedure and reevaluation for this study was 3 years. Parents of 90 of the 100 children were surveyed by surgeons via telephone and 89 (99%) expressed a high level of satisfaction with the outcome.     

In vivo correlation of Doppler waveform analysis with arterial input impedance parameters

Previous studies have confirmed that Doppler waveform analysis (DWA) offers a valid reflection of changes in peripheral vascular resistance. However, the ability of the pulsatility index (PI), a parameter of DWA, to reflect the dynamic components of the circulation, as assessed by arterial input parameters, remains uncertain. In addition, the state of the central circulation is considered an important factor influencing the accuracy of this technique. This study evaluated the ability of the aortic PI to reflect alterations of input impedance in a chronically instrumented lamb model that was subjected to pharmacologic alteration of the circulation. Pressure, volumetric flow and continuous-wave Doppler frequency shift measurements were recorded from the infrarenal abdominal aorta. The parameters of input impedance, peripheral vascular resistance (Zpr), characteristic impedance (Zo) and reflection coefficient (Rc), were determined and then correlated with changes in the aortic PI. Initially, perturbations of the circulatory state were created with a vasodilator, hydralazine (HY) and a vasoconstrictor, phenylephrine (PE). During a second set of experiments, the effect of the reflex heart rate (HR) responses on the PI was evaluated. This was accomplished by inhibiting reflex HR responses to these vasoactive agents with either trimethophan (TM) or atropine methyl bromide (AMB). In response to HY and HY with TM, significant decreases in the PI and impedance parameters occurred. Administration of PE and PE with AMB resulted in significant increases in PI and each of the impedance parameters. HY and PE induced changes in PI correlated significantly with changes in volumetric flow (r = 0.82, 0.80; p < 0.001), mean arterial blood pressure (r = 0.64, 0.70; p < 0.001) and Zpr (r = 0.77, 0.80; p < 0.001), but not with Zo (r = 0.34, 0.36) and Rc (r = 0.26, 0.31). However, when reflex HR responses were inhibited during the administration of the vasoactive agents, HY with TM and PE with AMB, induced changes in PI correlated significantly with Zo (r = 0.93, 0.89; p < 0.001) and Rc (r = 0.84, 0.83; p < 0.001), and the correlation with mean arterial pressure (r = 0.78, 0.87; p < 0.05) and Zpr (r = 0.92, 0.91; p < 0.05) was significantly greater. These findings indicate that the PI accurately assesses pharmacologically induced changes in the downstream arterial input impedance. The accuracy of this assessment is enhanced further when central circulatory factors such as changes in HR are considered.     

Calbistrins, novel antifungal agents produced by Penicillium restrictum. I. Production, taxonomy of the producing organism and biological activity

Over a 14-year period, from 1971 to 1985, there were 15 patients referred to the Princess Margaret Hospital in Toronto for postoperative radiotherapy to the cervical lymph nodes following radical neck surgery for metastatic cancer. An intensive investigation failed to yield a primary site in any patient. All of the patients had extensive neck disease with significant indications for postoperative radiotherapy (massive neck nodes, invasion of extra nodal structures or fixation to unresectable adjacent structures). Of this highly selected group of patients with advanced neck disease: 4/15 (27%) died within one year of uncontrolled local disease, a further 2/15 (13%) died within four years of metastatic/recurrent disease, 6/15 (33%) died of intercurrent disease and 3/15 (20%) were alive with at least four years follow-up. Although all patients presented with advanced disease, survival and significant palliation was possible in this select group of patients.     

Back pain in patients with ductal pancreatic cancer. Its impact on resectability and prognosis after resection

BACKGROUND: Back pain is a frequent and often ominous clinical sign in patients with ductal pancreatic cancer. METHODS: From 1971 to 1993 a pancreatic carcinoma could be resected in 192 patients, whereas 261 patients underwent either probatory laparotomy alone or palliative bypass procedures. In a retrospective study including uni- and multi-variate survival analysis we have determined the impact of preoperative back pain on both resectability and long-term prognosis after resection. RESULTS: Among the presenting symptoms of patients with ductal pancreatic cancer back pain was a predictive sign of irresectability. In the presence of preoperative back pain the long-term prognosis after resection of the tumour was also significantly impaired. In a multivariate analysis it could be demonstrated that the prognostic impact of back pain was as strong as the influence of residual tumour, tumour grading, and tumour size. CONCLUSIONS: Back pain often indicates irresectability of ductal pancreatic carcinoma and also impairs the long-term prognosis even after curative resection.     

Construction of a mouse blastocyst cDNA library by PCR amplification from total RNA

Prostaglandin E2 (PGE2) and beta-adrenergic agonists can suppress lipopolysaccharide-induced tumor necrosis factor-alpha (TNF) production from elicited macrophages. We assessed the responsiveness of rat peritoneal macrophages to PGE2 and the beta-adrenergic agonist isoproterenol during immunologically-mediated arthritis. We assessed macrophage sensitivity to these mediators from resident macrophages and macrophages elicited with either streptococcal cell wall or complete Freund's adjuvant. Peritoneal macrophages were obtained from female Lewis rats that were (1) injected with complete Freund's adjuvant and non-arthritic (CFA); (2) injected with streptococcal cell wall and arthritic (ART); (3) injected with streptococcal cell wall and non-reactive (NON) and (4) non-elicited resident macrophages (RES). When challenged with graded concentrations of lipopolysaccharide (0.1 to 10,000 ng/ml), macrophages obtained from each group of rats released TNF in a concentration-dependent manner, with macrophages from arthritic rats (ART) producing the greatest amount of TNF (p < 0.001). While PGE2 suppressed lipopolysaccharide (100 ng/ml) stimulated TNF production in a concentration-dependent manner in all groups, the greatest sensitivity to PGE2 was observed with macrophages obtained from rats which received streptococcal cell wall when compared to both complete Freund's adjuvant-elicited and resident macrophages (p < 0.05). The beta-adrenergic agonist isoproterenol also inhibited lipopolysaccharide-stimulated TNF production from macrophages in all groups. In addition, the specific beta 2-adrenergic antagonist, ICI 118.551, shifted isoproterenol concentration-effect curves to the right (p < 0.01). Minimal responsiveness to isoproterenol was observed with resident peritoneal macrophages. Maximum isoproterenol-induced inhibition of TNF production was observed with complete Freund's adjuvant-elicited macrophages, and significantly less in macrophages of streptococcal cell wall-injected rats. Of particular interest, macrophages obtained from streptococcal cell wall-injected rats, which became arthritic, were significantly less sensitive to isoproterenol than those which did not develop arthritis (p < 0.02). In addition, these changes in sensitivity were not reflected by changes in the sensitivity of both CFA and ART groups to dibutyryl cAMP. The present study demonstrates a shift in the balance between inhibitory mediator responses in rats inoculated with one of two different adjuvants. These investigations support the role of PGE2 and a neurotransmitter as immunomodulating compounds which may effectively maintain an inflammatory lesion such as arthritis.