Gallstone pancreatitis

Gallstone pancreatitis is a disease of high mortality (11%) and significant morbidity (42%). An analysis of 66 patients with this disease revealed the importance of an early aetiological diagnosis; 66% of our patients had evidence of previous biliary disease. Most patients were elderly and the severity of their disease could be predicted using Ranson's predictive indices. Surgery was immediate (within 48 hours) in 11 (17%) patients, early (two-14 days) in 16 (24%) and delayed in 27 (41%) patients. Some patients refused surgery. Our study suggests that very ill patients require immediate surgery--often cholecystostomy alone--and that although in the majority symptoms should settle on conservative treatment, definitive surgery should be carried out at the time of the initial admission. Further delay increases morbidity, mortality and expense.

Ceramometal crowns and bridges. Focus on failures

There are numerous factors that can have an adverse or beneficial effect upon the esthetic appearance of a ceramometal restoration. Some of these factors are beyond the influence of the dentist unless he or she is aware of them. As knowledgable practicing dentists, they have the ability to prescribe for their patients in such a manner as to achieve greater success and, in turn, greater patient acceptance and recognition. These are the rewards of a successful crown and bridge practice, and the ceramometal restoration is the basic state of the art prosthesis in present use. Knowing how to take a shade under the proper lighting conditions is generally well taught as part of the dental school curriculum, but the knowledge that shade guides are manufactured with built in idiosyncrasies of color variations from guide to guide is an enlightening experience. O'Brien of the Department of Dental Materials at the University of Michigan School of Dentistry clearly demonstrated the variabilities of color intensities between porcelain manufacturers. Laboratory technicians have been frustrated by the inconsistency of shades of porcelains from one lot number to another. It is now more fully understood that fluorescence is an important factor in patient satisfaction, as patients observe and have their restorations seen under differing lighting conditions. The type of alloy used in the ceramometal combination can have an effect upon the esthetic result. The wider use of silver-palladium alloys requires that the porcelain employed be of a nongreening nature, or else the final glazed prosthesis will give off a greenish cast. The ability of the opaque to block out the metal substructure while blending with the gingival and incisal shades eliminates the graying out, which can be esthetically objectionable to the patient. However, one of the most important considerations in aesthetic ceramometal restorations is the correct anatomy, placement, and harmonious blending with the oral and facial features and coloring of the patient. It would be comforting if we could all agree on a definition of esthetics. There is perhaps no more important aspect of marketing the ceramometal restoration to the patient than arrive, in advance, on a common ground and understanding of what the esthetic goals of the case are in realistic terms.(ABSTRACT TRUNCATED AT 400 WORDS)

Prostaglandins cause an increase in serum acute-phase proteins in man, which is diminished in systemic sclerosis

The prostaglandin E1 increases the plasma concentration of acute-phase proteins in man and decreases the concentration of certain carrier proteins. This response is greatly diminished in patients with systemic sclerosis, a chronic inflammatory disease leading to fibrosis. These findings pose new questions about the mediation of the acute-phase response and its role in controlling the inflammatory process.

Acute phase serum proteins in syngeneic and allogeneic mouse pregnancy

The levels of two murine acute phase proteins, serum amyloid P component (SAP) and haptoglobin, have been measured in the serum of C57BL/10 female mice during syngeneic and allogeneic pregnancy. Both syngeneic and allogeneic pregnancy resulted in alterations in the levels of these proteins as compared to those observed in virgin females. Syngeneic mating resulted in an increase in concentration of both proteins during the final 3 days of pregnancy. During allogeneic pregnancy, SAP levels, after a transient increase on day 4, rose from days 6-8 and, after remaining relatively stable, increased from day 12 to reach maximum levels on day 18 of pregnancy. Levels fell dramatically during the immediate post-partum period. In contrast, although levels of haptoglobin also increased from days 6-8, for the remainder of pregnancy these increased levels remained stable. The implications of these findings are discussed in relation to the mechanisms of regulation of acute phase reactants and the immunological relationship between the mother and fetus.

[Clinical study on a new acetylsalicylic acid/paracetamol preparation with gastric acid resistant coating (Safapryn), and on two various phenylbutazone dosages in patients with primary chronic polyarthritis as based on a new evaluation method]

The authors describe a simple non-crossover-blind test for the evaluation of subjective indices. A table for recording pains during the 14 days' study is described. The patient's satisfaction with the treatment and the number of days until withdrawal from the trial are recorded. The statistical procedure takes into consideration differences between the treatment groups and makes possible a valuable comparison with drugs tested in other clinical trials. The three dose schedules of antirheumatic treatment were tested on 122 patients and the results compared with those of 342 patients treated with the 6 other antirheumatic drugs (enteric-coated aspirin, paracetamol, indomethacin, flurbiprofen, mefenamic acid, and prednisolone) and those of 41 patients who received placebos. The results show that Safapryn (3,6 g aspirin + 3.0 g paracetamol daily) compared with 3.9 g enteric coated aspirin does not offer any advantage in its analgesic effect, although it gives rise to fewer side effects. Phenylbutazone (3000 mg) was almost as effective as 15 mg prednisolone daily. Between the effects of this dosage of phenylbutazone and other non-steroidal antirheumatic drugs, however, no significant difference could be detected. 50 mg phenylbutazone daily and placebo treatment could not be distinguished. The authors thank the Arthritis and Rheumatism Council for Research in Great Britain for its financial support. One of the authors (PL) was a Merck, Sharp, and Dohme Research Fellow and another one (PMB) received a Robins research scholarship.

The acrylic jacket crown

An attempt has been made to cover briefly the many applications of the acrylic jacket crown. It is readily understandable that this type of restoration has many shortcomings but at the same time it has many useful and important applications in dentistry when properly employed. It is hoped that the specialist and generalist alike will have found some new and useful applications of the acrylic jacket crown.