Using the double-cord packing technique of tissue retraction for making crown impressions

The double-cord packing technique is effective and safe for impression taking as long as the following steps are taken: Whenever possible, finish lines should be placed supragingivally. The gingival tissues should always be in good periodontal health. Two knitted cords of different sizes soaked in aluminum chloride solution are used. The first cord should be left in place while making the impression. Retraction cords should never be forced into the sulcus. Always remove both cords before dismissing the patient.

Hemodynamic rounds series II: Coronary hemodynamics for angioplasty and stenting after myocardial infarction: use of absolute, relative coronary velocity and fractional flow reserve

The application of absolute coronary velocity reserve, relative coronary velocity reserve, and pressure-derived fractional flow reserve of the myocardium may have influence on decision making for angioplasty and stenting in patients after myocardial infarction. This case highlights the use and limitations of these techniques in the setting of myocardial infarction where absolute coronary flow reserve may be commonly compromised. The role for absolute, relative coronary, and fractional flow reserve are discussed.

Prognostic significance of late-peaking left ventricular velocity contour in patients with aortic stenosis undergoing valve replacement

BACKGROUND

The presence of an abnormal late-peaking left ventricular velocity contour, detected by Doppler echocardiography, has been reported in patients with hypertrophic cardiomyopathy, left ventricular hypertrophy, and aortic stenosis.

METHODS AND RESULTS

To evaluate the clinical and prognostic significance of this characteristic Doppler finding, we studied a group of patients (n = 57) with isolated AS undergoing aortic valve replacement. Patients were divided into two groups according to the presence (n = 28) or absence (n = 29) of a hypertrophic late-peaking left ventricular velocity pattern. There were no differences between the groups with respect to age, sex, and presence of coronary artery disease. Peak preoperative aortic valve gradients were similar in both groups (70 vs. 67 mm Hg; p = not significant). The postoperative course of patients with abnormal late-peaking ventricular velocity contour was complicated by a higher incidence of arrhythmias (80% vs. 38%; p = 0.0002). Hypotension and the use of inotropic support were significantly more common in the group with abnormal late-peaking ventricular velocity contour (79% vs. 24%; p = 0.0001 and 76% vs. 26%; p = 0.0001, respectively). Hemodynamically, patients with a late-peaking velocity pattern exhibited a higher pulmonary diastolic pressure (16+/-3 vs 12+/-2 mm Hg; p = 0.0003), wedge pressure (12+/-4 vs 10+/-2; p < 0.05), and systemic vascular resistance (2126+/-459 vs 1553+/-199; p = 0.0001) and lower cardiac index (2.4+/-0.3 vs 2.9+/-0.4; p = 0.0001).

CONCLUSIONS

An abnormal late-peaking ventricular velocity contour pattern appears to be a high risk marker for postoperative complications in patients undergoing aortic valve replacement. Routine Doppler evaluation in patients undergoing valve replacement for AS may therefore identify these patients.

Assay of carcinogenicity of tobacco metabolites employing microsomal degranulation technique

Carcinogenicity of salivarty extracts of different types of tobaccos smoked and chewed in India and Pan Parag were tested using microsomal degranulation technique. Results obtained on the basis of RNA/protein ratios (Indices to confirm the detachment of ribosomes from microsomes) showed that tobaccos used for cigarette, bidi, hukah and chewing tobacco with lime as well as Pan Parag were positively carcinogenic. Two fractions out of 7 isolated chromatographically from salivary extract of chewing tobacco plus lime were found to be carcinogenic. Elemental and spectral analyses indicated that the fractions are possibly an aromatic compound with an aliphatic side chain and N-(buty1 nitrosamine)-1-(3-pyridyl)-4-hydroxy-1-butanone.

Studies on the effects of monosodium glutamate on hepatic microsomal lipid peroxidation, calcium, ascorbic acid and glutathione and its dependent enzymes in adult male mice

Daily administration of monosodium glutamate (MSG) to adult male mice subcutaneously, for 6 days, at dose levels of 4 and 8 mg/g body weight, significantly increased lipid peroxidation in the hepatic microsomes, as seen 31 days after the last injection. A highly significant increase was observed in the level of hepatic calcium and ascorbic acid. The glutathione (GSH) content was significantly decreased but the activities of glutathione dependent enzymes like GR, GPX, GSTs were found to be significantly increased. These observations suggested that MSG at dose levels above 4 mg/g body weight induced oxidative stress in hepatic microsomes. Attempts to maintain the redox state of the cell are suggested by increase in the ascorbic acid content and the activities of glutathione dependent enzymes.

In vivo and in vitro studies on the mechanism and clinical significance of spontaneous echocardiographic contrast in patients with atrial dysrhythmias

The pathogenesis of spontaneous echocardiographic contrast (SEC) is complex and multifactorial. Although originally described in low-flow state situations such as in the left atrium of patients with mitral stenosis or in the false lumen of patients with aortic dissection, its detection is highly dependent on technical factors such as the frequency of the transducer used. Multiple blood components have been implicated in SEC formation and erythrocyte aggregation currently appears to be the most likely mechanism. SEC is related to atrial fibrillation and is commonly found in patients with thrombus or prior history of thromboembolism. In addition, it may represent a prognostic marker for patients with atrial fibrillation because patients with SEC have a higher incidence of subsequent thromboembolic events. Therapeutic options include anticoagulation and, perhaps, antiplatelet therapy. Further prospective studies are necessary to better define SEC pathogenesis and treatment.

A novel delivery system for continuous desferrioxamine infusion in transfusional iron overload

Fifteen iron-overloaded thalassaemia major (TM) patients and two homozygous sickle cell patients (SCD) were treated continuously for 7d each week with the novel 48 h continuous subcutaneous (s.c.) desferrioxamine (DFX) delivery device (code C1083, Baxter) and 10 TM patients received the 24 h continuous intravenous (i.v.) DFX delivery device (code C1071). The 27 patients had previously received conventional s.c. DFX for 8-10h on 5 or more days each week. The serum non-transferrin bound iron (NTBI) levels fell significantly in both groups within 12h of commencing the continuous infusion. In the s.c. group the mean level fell from 4.2 to 2.0 mumol/l (P = 0.001), whereas in the i.v. group the mean level fell from 3.6 to 0.1 mumol/l (P = 0.006) the initial levels being measured 12h after stopping conventional s.c. DFX. After 4 weeks there was a significant fall in serum ferritin in both groups (P = 0.009). The new DFX delivery device is effective at removing toxicfree iron from plasma and reducing body iron. Moreover, it is preferred by patients with much improved compliance compared to the conventional s.c. DFX pump.

Antioxidant effects of pyruvate in isolated rat hearts

Sprague-Dawley rat hearts were perfused under constant flow conditions, and a balloon was inserted into the left ventricle to measure heart rate (HR) and left ventricular pressures. Left ventricular generated pressure (LVGP) was calculated as peak systolic minus end diastolic pressure. Three substrate groups, pyruvate (5 mM), glucose (15 mM) and octanoate (0.5 mM), were employed. Oxidative stress was induced by perfusion with tertiary-butyl hydroperoxide (tBHP, 0.35 mM, 12 min) followed by 25 min of perfusion with control buffer. Hearts perfused with pyruvate showed no significant decrease in contractile function following tBHP treatment (HR x LVGP = 17666 +/- 585 mmHg/min, initial: 16414 +/- 2083 post-tBHP treatment). Glucose-perfused hearts had an intermediate decrease in function (19174 +/- 828 mmHg/min, initial; 4379 +/- 2083 post-tBHP), while octanoate-perfused hearts recovered no contractile function. Peak release of LDH was lowest in hearts perfused with pyruvate (115 +/- 17 mU/g wet wt/min), intermediate in glucose-perfused hearts (1575 +/- 380) and highest in octanoate-perfused hearts (3074 +/- 499). Thiobarbituric acid reactive substances (TBARS) were unchanged in hearts perfused with pyruvate (16.2 +/- 5 nmoles/g wet wt), but increased significantly in glucose-perfused hearts (36.1 +/- 1) and in octanoate-perfused hearts (45.5 +/- 9). Total glutathione levels were unchanged in hearts perfused with pyruvate (753 +/- 68 nmoles/g wet wt), but significantly decreased in glucose-perfused hearts (594 +/- 68) and in octanoate-perfused hearts (445 +/- 38) following tBHP-treatment. Pyruvate significantly reduced oxidative injury. In contrast, glucose provided a small reduction in injury while octanoate-perfused hearts had the most severe injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Differences in hepatic drug metabolizing enzymes and their response to lindane in rat, rabbit and monkey

Untreated rabbit liver microsomes demonstrated the highest content of cytochrome P450 and activity of NADPH cytochrome c reductase compared to rat and monkey. The sodium dodecyl sulfate polyacrylamide gel electrophoresis of microsomes from untreated rabbit demonstrated a greater quantity of 50 KDa polypeptide than in rat and monkey. The activity of glutathione-S-transferase towards 1-chloro-2,4-dinitrobenzene and the band intensity of 26 KDa polypeptide was found to be at maximum in untreated rabbits, while rat liver demonstrated the highest activity of glutathione-S-transferase towards ethacrynic acid. The extent of hepatic microsomal lipid peroxidation was at maximum in untreated rats. The activity of catalase was higher in untreated monkeys compared to untreated rats and rabbits. Lindane at a dose of 10 mg kg-1 body weight for a period of six days increased the hepatic content of cytochrome P450 and the activities of NADPH cytochrome c reductase, aminopyrine N-demethylase, glutathione-S-transferases, haem oxygenase and lipid peroxidation, decreased non-protein thiols and concomitantly intensified the 50 and 26 KDa polypeptides in the microsomes and 100,000 x g supernatants respectively, in the rat but not in the rabbit or monkey. The results demonstrate that lindane is a bifunctional inducer in the rat and non-functional in rabbit and monkey. It also increased the activities of hepatic drug metabolizing enzymes with concomitant production of oxidative stress in the rat, whereas in rabbit and monkey it did not alter the drug metabolizing enzymes nor produced any oxidative stress.

Reduced alveolar-capillary membrane diffusing capacity in chronic heart failure. Its pathophysiological relevance and relationship to exercise performance

BACKGROUND

The pulmonary diffusing capacity for carbon monoxide (DLCO) is reduced in chronic heart failure (CHF) and is an independent predictor of peak exercise oxygen uptake. The pathophysiological basis for this remains unknown. The aim of this study was to partition DLCO into its membrane conductance (DM) and capillary blood volume components (Vc) and to assess if alveolar-capillary membrane function correlated with functional status, exercise capacity, and pulmonary vascular resistance.

METHODS AND RESULTS

The classic Roughton and Forster method of measuring single-breath DLCO at varying alveolar oxygen concentrations was used to determine DM and Vc in 15 normal subjects and 50 patients with CHF. All performed symptom-limited maximal bicycle exercise tests with respiratory gas analysis; 15 CHF patients underwent right heart catheterization. DLCO was significantly reduced in CHF patients compared with normal subjects, predominantly because of a reduction in DM (7.0 +/- 2.6 versus 12.9 +/- 3.8 versus 20.0 +/- 6.1 mmol.min-1.kPa-1 in New York Heart Association class III, class II, and normal subjects, respectively, P < .0001), even when the reduction in lung volumes was accounted for by the division of DM by the effective alveolar volume. The Vc component of DLCO was not impaired. DM significantly correlated with maximal exercise oxygen uptake (r = .72, P < .0001) and inversely correlated with pulmonary vascular resistance (r = .65, P < .01) in CHF.

CONCLUSIONS

Reduced alveolar-capillary membrane diffusing capacity is the major component of impaired pulmonary gas transfer in CHF, correlating with maximal exercise capacity and functional status. DM may be a useful marker for the alveolar-capillary barrier damage induced by raised pulmonary capillary pressure.