Orthodontists' perceptions of need for jaw surgery

Treatment recommendations in borderline orthognathic surgery cases were examined for influence of orthodontists' traits and orthodontist's perceptions of patients', surgeons', and psychologists' traits. A mail questionnaire consisted of 23 case vignettes describing borderline surgical candidates with certain physical, psychological, attitudinal, and support system traits, as well as demographic and attitudinal items. The response rate from 512 licensed Canadian orthodontists was 65%. Seventy-four percent of orthodontists preferred camouflage for themselves. Recommendation of camouflage predominated in 12 of 23 vignettes and surgery in only four, although the cost of surgery was considered justified. Psychological referral was recommended highly for certain patients: those hoping to improve negative life events through positive facial change, those having low self-esteem, and those wanting to opl out of surgery in the middle of orthodontic treatment. Certain patient traits appeared to influence orthodontists' treatment recommendations. The availability, expertise, and receptiveness to case discussion of oral surgeons and psychologists did not influence orthodontists' treatment recommendations.

Quality of life measures before and one year after admission to an intensive care unit

OBJECTIVE

To assess outcome of patients admitted to an intensive care unit (ICU), using a prospective 1-yr follow-up, with special emphasis on various quality of life measures before and after admission to the ICU.

DESIGN

Prospective comparison of quality of life before and 1 yr after admission to the ICU.

SETTING

Eleven-bed adult medical/surgical ICU.

PATIENTS

All patients admitted to the ICU over a 1-yr period were eligible for inclusion in this study. Repeat admissions were enrolled only on first admission. Patients < 17 yrs of age and those patients who died within 24 hrs of admission were excluded.

INTERVENTIONS

Quality of life measures were collected before and 6 and 12 months after ICU admission.

MEASUREMENTS AND MAIN RESULTS

The following data were collected: duration of ICU and hospital stay; ICU, hospital, 6- and 12-month mortality; quality of life (level of activity, activities of daily living, perceived health, support, and outlook on life) and place of residence at baseline and 12 months after ICU admission. There were 504 patients who met the study criteria; age 55 +/- 20 yrs (median 59), 229 female and 275 male. Mean ICU length of stay was 4.3 +/- 7.4 days. Hospital length of stay was 31 +/- 41 days. Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 14 +/- 7. Cumulative mortality: ICU 5.4%, hospital 13.5%, 6 month 20.6%, and 12 month 25%. One year quality of life questionnaires were completed for 293 patients. Relative to baseline, there was a decrease in the level of activity and activities of daily living at 12 months (p < .01). Perceived health status increased over the year for patients > or = 75 yrs of age (p < .01). There was no difference in the level of support from family or friends, or outlook on life, at 12 months. At 1 yr, 262 (89%) patients were living at home.

CONCLUSION

Patients admitted to intensive care tend to have a decrease in the level of activity and activities of daily living 1 yr after their ICU stay, although in the very elderly, perceived health status increases. As well, the majority (89%) of patients return home.

Pharmacological and morphological effects of in vitro transluminal balloon angioplasty on normal and vasospastic canine basilar arteries

Despite growing clinical use of transluminal balloon angioplasty (TBA) to treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH), the precise mechanism of action of balloon dilation on the cerebral arterial wall is unknown. In this experiment the authors examined the pharmacological and morphological changes in 10 normal and 12 vasospastic canine basilar arteries following in vitro silicone microballoon TBA. For the SAH group in which the double-hemorrhage model was used, vasospasm was confirmed by angiography and the animals were killed on Day 7 after the first SAH. In vitro TBA was performed on basilar arteries from normal and SAH dogs immediately after sacrifice and removal of the brain. The procedure was performed while the arteries were maintained in oxygenated Krebs buffer. In the pharmacological studies, potassium chloride, prostaglandin F2 alpha, serotonin, and noradrenaline were used as vasoconstrictors, and bradykinin and calcium ionophore A23187 were used to produce an endothelium-dependent dilation. In both normal and vasospastic groups, the pharmacological responses of dilated segments of basilar arteries were compared to those of nondilated segments of the same arteries. Vessels from all groups were examined using scanning electron microscopy (EM) and transmission EM. Scanning EM was used to study the intact vessel wall, the smooth-muscle cell layer obtained after digestion with hydrochloric acid, and the extracellular matrix obtained after digestion with bleach. Cross-sections of the vessel wall were examined using transmission EM. The most striking finding was that immediately after in vitro TBA of both normal and vasospastic canine basilar arteries, there was a significant reduction (p < 0.05) of responses to both vasoconstrictors and vasorelaxants. As revealed by scanning EM and transmission EM, both normal and vasospastic vessels dilated with TBA showed flattening and patchy denudation of the endothelium, and straightening and occasional rupturing of the internal elastic lamina. In addition, vasospastic vessels dilated with TBA showed decreased surface rippling and mild stretching and straightening of smooth-muscle cells, and mild thinning of the tunica media. There was no gross vascular disruption or obvious change in the extracellular matrix of the vessel walls of either normal or vasospastic arteries after TBA. These results suggest that functional impairment of vasoreactivity in the vessel wall as a result of mechanical stretching of the smooth-muscle layer plays a more important role than structural alteration, at least in the immediate dilation produced in vasospastic arteries by TBA.

Assessment of the periotest device in baseline mobility measurements of craniofacial implants

The present study aimed to evaluate reliability of the Periotest instrument in baseline mobility measurement of craniofacial implants in a human wet bone specimen. Sixteen 4.0-mm craniofacial Brånemark implants were placed in the most common sites for craniofacial implant placement. A 5.5-mm abutment was attached to each implant except one in the mastoid bone, which was connected with a bone-anchored hearing aid (BAHA) abutment. Baseline Periotest values (PTVs) were recorded on each abutment at different vertical measurement points by three different clinicians using three Periotest devices. Baseline PTVs for each abutment ranged between -1.23 and -5.90. Interoperator and interinstrumental variability did not influence PTVs; however, the vertical measurement point on the abutment proved to have a strong effect on PTV recordings.

Naloxone blocks that portion of feeding driven by sweet taste in food-restricted rats

We evaluated the potency of naloxone on intake of normal and sweet chow in food-deprived and schedule-fed rats. We found that naloxone's anorectic potency was dependent on the type of chow presented to the rats and the deprivation schedule utilized to stimulate food intake. In 24-h and 48-h deprived rats, naloxone decreased intake of normal rat chow at doses ranging from 0.3 to 3 mg/kg. In chronically deprived rats (80% of normal body wt), these doses of naloxone failed to decrease intake of normal chow. Rats eating sweet chow ate more when energy deprived and were more sensitive than rats eating normal chow to naloxone-induced limitations in food intake, both in acute and chronic food-deprived groups. Thus naloxone decreased intake of sweet chow much more effectively than normal chow even when rats were chronically food deprived. We also found that an extremely low dose of naloxone (0.03 mg/kg) decreased intake of sweet chow by almost 50% in satiated rats.

Recovery characteristics following induction of anaesthesia with a combination of thiopentone and propofol

The purpose of this study was to determine the rate and quality of recovery when general anaesthesia was induced with a mixture of thiopentone and propofol, compared with thiopentone or propofol alone. Sixty ASA class I and II women scheduled for out-patient laparoscopic surgery underwent induction of anaesthesia with either (i) thiopentone, (ii) propofol, or (iii) a mixture of the two, in a randomized, double-blind fashion. Anaesthesia was then maintained using nitrous oxide, isoflurane and fentanyl. A psychometric test was administered before and after surgery, and the time taken to reach a series of recovery milestones was noted. Patients were discharged as soon as they were ambulant and had satisfactory control of pain and nausea with oral agents. They were telephoned at 24-48 hr later, and asked to rate their experience of a list of side effects on an ordinal scale. Patient groups were demographically comparable and underwent surgery of the same duration. Those receiving thiopentone were discharged after a mean time of 3 hr 25 +/- 58 min (SD). The corresponding figures for propofol and the thiopentone/propofol mixture were 2 hr 40 min (+/- 49) and 2 hr 48 min (+/- 68) respectively. The recovery time between thiopentone and the other two regimes was different (P < 0.05). All three groups experienced equally frequent and severe nausea, headache, tiredness and other side effects during the next 24 hr. It is concluded that induction with a mixture of thiopentone and propofol leads to a similar rate and quality of recovery to that of propofol above.(ABSTRACT TRUNCATED AT 250 WORDS)