Search

An abbreviated treatment with a chlorhexidine-containing varnish was compared with a similar treatment with a placebo varnish and with a prophylaxis alone for its effects on the numbers of detectable salivary mutants streptococci in 51 adults. The varnishes, applied once weekly for four weeks, were held in place with a covering layer of either of two polyurethane sealants (FluorProtector or Adhesit). On the first appointment, the varnish-sealant combination was applied to all tooth surfaces, but on succeeding appointments only the occlusal and approximal surfaces were covered. The chlorhexidine varnish, covered with either sealant, reduced the salivary mutans streptococci by an average of 3 logs (99.9%) in all of the 20 subjects treated, and below detectable levels for at least four weeks in nine of them. In the groups receiving placebo varnish-sealant combinations, the mean log number of mutans streptococci of the subjects was reduced only by approximately 0.5 log (32%), and none of the subjects experienced loss of their detectable mutans streptococci for four weeks, although one subject did so for three weeks. No significant difference between the effects of the two polyurethane sealants was observed. Treatment with a single prophylaxis had no effect on mutans streptococcus levels. Subjects treated with chlorhexidine varnish also experienced an increase in S. sanguis and a small decrease in yeasts. Loss of detectable mutans streptococci did not cause changes in the numbers of other micro-organisms examined, beyond those observed with chlorhexidine varnish treatment alone.

Trichorhinophalangeal syndrome type 1 is an autosomal dominant variety of peripheral dysostosis. I have reviewed nine cases of this syndrome and have described two of these cases. I have also presented an extensive review of the literature.

This paper reports the authors' experience with latissimus dorsi island pedicle flaps in the acute treatment of massive arm injuries. Seven patients with upper arm injuries and four patients with forearm injuries were treated with latissimus dorsi pedicle flaps. All cases involved massive soft-tissue loss and open fractures. Primary healing of wounds occurred without complications in 10 of 11 patients; the eleventh developed a wound infection. There were no instances of flap loss or vascular complications. This report compares and discusses surgical management options and details the importance of robust, immediate soft-tissue coverage for optimal functional recovery. Contrary to traditional thought, delay in definitive wound closure may be unnecessary when aggressive debridement is followed by acute flap closure.

Metacarpal and phalangeal length were determined in thirty-five patients with constriction band syndrome and acrosyndactyly. Shortening of the remaining phalanges is a consistent component of acrosyndactyly and gives additional functional disability.

Forty-two radiographs and charts of twenty-two patients with a diagnosis of hereditary multiple exostosis and hand involvement were examined to determine the incidence of hand exostoses and association with brachydactyly. An average of 11.6 exostoses were found per hand. The proximal phalanges and metacarpals are affected in the majority of patients and the thumb and distal phalanges are rarely involved. Most exostoses were located in the juxtaepiphyseal region (61.8%) and typically involved less than 50% of the bone diameter. Brachydactyly can be seen in patients with hereditary multiple exostosis when no exostoses is present; however, the presence of an exostosis results in even more shortening. The location and size of the exostosis had no relationship to increased bone shortening. Operative treatment was required in four of twenty-two patients for debulking and impingement.

This report describes the objectives, problems, and current techniques associated with using EEG maps in the management of surgery of epilepsy. The purpose of EEG mapping in epilepsy is to precisely identify and characterize epileptogenic zones of the brain. Such zones may be single or multiple, pointlike or diffuse, and may be near or distant from the recording electrodes. The resulting measured electric fields are used to obtain information which, when analyzed in light of all the complementary clinical information, can frequently help to localize and describe the epileptic foci with more precision.

A new electrode design for the extradural recording of electrical brain activity is described. Epidural peg electrodes are implantable mushroom-shaped composites of Silastic elastomer and a stainless steel or platinum disc. These electrodes are useful for the preoperative mapping of seizure foci in some patients who have cranial defects or severe muscle artifacts on scalp recordings. They are also used for canvassing wide areas of cortex to determine whether a seizure is focal in origin, arises diffusely from a hemisphere, or has a bilateral origin. Advantages of epidural peg electrodes over screw and other types of epidural electrodes include low risk of infection or hemorrhage and improved patient comfort.

The term "tennis elbow" has been used in the medical literature for over 100 years to describe a variety of conditions on the lateral aspect of the elbow. Recent writers seem to agree that the two most common causes for this condition, which may be either distinct or coexisting, are lateral epicondylitis and radial tunnel syndrome. Lateral epicondylitis is not limited to tennis players; 95% of the reported cases occur in non-players. The presenting symptoms are pain over the origin of the extensor carpi radialis brevis and weakness in the wrist and digital extensors. The location of maximal tenderness differentiates lateral epicondylitis from other conditions. A variety of treatments has been suggested, but the most successful is conservative treatment with rest, restriction of lifting with the palms down, anti-inflammatories and local applications of ice. Once the acute inflammatory phase has passed, a flexibility and strengthening program is recommended. Steroid injection may be utilized at this stage if the discomfort has not been reduced. In a small percentage of cases, surgery may be required.

The following Case Report describes the immediate reconstruction of bone and skin defects of the humerus with a free fibular graft and muscle flap. A 33-year-old white female sustained a gunshot wound to the left upper extremity with a 3.08 caliber high-powered rifle. The entry wound was on the lateral aspect of her mid-arm. The exit wound on the anteromedial aspect of the upper extremity measured approximately 10 x 15 cm. A segmental loss of the middle of the humerus and a defect of the radial nerve were noted. Within 48 hours after injury, reconstructive surgery was begun. A free vascularized fibula graft, peroneal artery, and concomitant vein were harvested from the left lower extremity, prepared, and inserted "peg in hole" fashion between the humerus fragments. The proximal segment was inserted between two fracture fragments, and the two fragments, including the proximal fibula, were transfixed with a single screw. The graft was revascularized with end-to-side anastomosis of the peroneal vessels to the brachial artery and its concomitant vein. The entire reconstruction was then covered with rotation of the latissimus dorsi muscle flap and a split-thickness skin graft. All wounds and the donor site healed primarily. Post-operative orthopaedic management consisted of maintenance of the external fixator for three months. Postoperative x-rays at 5 months showed healing at both ends of the fibular graft. A history of free fibula transfers and a discussion of the importance of aggressive, early, bony reconstruction using the free vascularized fibula graft are presented.

Two distinct anatomic variations in the human midcarpal joint have been identified. In type I the triquetrohamate joint is on a smooth oblique plane with the capitolunate joint. In type 2 the triquetrohamate joint is separated from the capitolunate joint by a concave transition facet on the hamate and lunate. Degenerative change occurring at the proximal pole of the hamate and the opposing transition facet on the lunate have been identified as characteristic of both a type 2 joint and lunotriquetral interosseous ligament tears.

This is a retrospective study of 23 infrapatellar tendon ruptures in 22 patients seen at Henry Ford Hospital from 1969 to 1980. Two of the patients had a systemic disease known to predispose to tendon ruptures, while the remainder of the tendon ruptures occurred in otherwise normal individuals as the result of either repetitive or isolated trauma.

A 2-year clinical trial was conducted using an adolescent population from a low-fluoride area to evaluate the anticaries effect of self-applications of zirconium silicate paste containing 9% stannous fluoride. tthree study groups totaling 464 children, with an initial average of 12.8 years, completed the study. The control group brushed with a non-fluoride zirconium silicate paste (tzircate Prophylaxis Paste) once each year: the first experimental group brushed with zirconium silicate paste containing 9% stannous fluoride (Zircate Treatment Paste) once each year; and the second experimental group brushed every 6 months with Zircate Treatment Paste. After 2 year, the DMFT and DMFS increments were virtually identical for the control group and the group that received one application of fluoride paste per year. The group that received two applications of fluoride paste per year had a DMTF increment that was about 24% less than that of the control group; however, the DMFS increment was only 5% less. These differences were not statistically significant at the P=.05 level.

Dental caries is one of the most prevalent diseases afflicting mankind. It reached a peak in the 1950s but has been declining drastically in recent years in children and young adults. This article describes the three contributing factors in dental caries: microbial plaque, tooth susceptibility, and diet, and discusses practical preventive measures which help to reduce caries incidence. Some of these, such as vaccines and antimicrobial varnishes, are still in the research stages, while others, such as sucrose substitutes, low-calorie sweeteners, and limitation of frequency of sugar snacks are well established and can be promoted by family physicians.

Nonunion is an uncommon complication of high tibial osteotomy. Reported techniques of treating such a complication include resection of the pseudarthrosis and cast immobilization with risk of joint stiffness and loss of alignment. The special AO/ASIF threaded external fixator with double clamps was used to treat three patients with nonunions following high tibial osteotomy for medial compartment osteoarthritis. The pseudarthrosis was not resected in any instance. All were allowed full unrestricted joint motion postoperation. Rapid healing of the osteotomy ensued. The external fixator achieved excellent stability and rapid union while maintaining joint motion.

We studied proprioception with the ankle joint and the metacarpophalangeal (MCP) joint of the index finger of humans by use of a method that could distinguish a position sense from a movement sense. The test measured how subjects' ability to detect a fixed displacement of a joint varied with the rate of joint rotation. A position sense should not depend on the speed of joint placement; therefore slow rates of movement should not degrade subjects' ability to sense joint displacements. However, in the absence of a position sense, subjects would presumably rely on movement signals that do depend on the rate of rotation, and their ability to detect displacements should decrease when rate decreases. Subjects could sense small displacements of the ankle (+/- 3.5 degrees) and the MCP joint (+/- 2.5 degrees lateral excursions) with no decrement in performance at speeds as low as 0.25 degrees/min for the ankle and 0.5 degrees/min for the MCP joint (the slowest tested thus far). The findings confirm the existence of a position sense with these joints. Block of the ulnar nerve at the wrist, which paralyzes the interosseous muscles that adduct and abduct the MCP joint but presumably leaves skin and joint mechanisms unaffected, substantially impaired subjects' ability to detect the lateral excursions at slow speeds. Performance fell sharply at speeds less than 128 degrees/min and leveled off at approximately 20% detections at speeds less than 4 degrees/min. Increasing displacement to +/- 7 degrees did not improve performance. Block of the common peroneal nerve at the knee, which paralyzes the ankle dorsiflexor muscles, substantially impaired subjects' ability to detect the +/- 3.5 degrees displacements at slow speeds when the foot was positioned to slacken the plantarflexion muscles (which were not affected by the block). Performance fell sharply at speeds less than 256 degrees/min and approached zero at speeds less than 16 degrees/min. However, positioning the foot to stretch the plantarflexor muscles restored subjects' performance to near normal. Local anesthetic injected into the MCP joint space produced no observable effect on the ability to detect either slow or fast excursions. The joint anesthesia went unnoticed by the subject. We conclude that independent and separable senses exist for limb position and limb movement and that normal position sense requires sensory inputs from the muscles.

Proprioceptive ability with the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the index finger in human subjects was examined using a method that could assess static-position sense independently of movement sense (Clark et al., 1985). The similarity in location and function of these joints would suggest similar proprioceptive mechanisms, but proprioceptive ability was found to be quite different for the two joints. The method of distinguishing a static-position sense from a movement sense was based on whether a subject's ability to detect a small change in joint position was impaired when the rate of rotation was progressively reduced. An awareness of static-position should not depend on the rate at which a joint is placed into position. However, if subjects use movement signals to detect changes in joint position, slowing the rate of displacement should reduce the intensity of these signals and make the displacements more difficult to detect. This method indicated a static-position sense with the MCP joint but only a movement sense with the PIP joint. It was confirmed that sensory input from regions of skin not stretched or deformed by rotation of the joint can influence proprioceptive sensibility with the fingers. Anaesthesia of the tip of the index finger or of the thumb blunted subject's perceptions of movement of the PIP joint of the index finger. However, anaesthesia of the PIP joint itself had no observable effect on the ability to sense movement of the joint.

Rheumatoid arthritic involvement of the wrist severely limits the functional status of the upper extremity. Total wrist arthrodesis, while providing pain relief and reestablishing support, compromises the functional capacity of the hand because of lack of wrist motion. Wrist arthroplasties allow motion, but have not found wide acceptance because of instability and the recurrence of deformity. A technique for establishing an intentional fibrous nonunion between the carpus and the radius was devised 17 years ago. This fibrous hinge gives wrist stability with or without radiocarpal wrist arthrodesis while allowing painless motion at the fibrous radiocarpal hinge and at the less severely involved midcarpal joint. Twenty-three patients have been followed for more than 7 years. All patients whose wrists achieved nonunion had no pain. Twelve of the 19 wrists in which radiocarpal arthrodesis occurred had no pain, and seven had mild pain that did not limit use.

A scaphoid malunion results when a scaphoid fracture heals in a flexed position or when a scaphoid nonunion with carpal collapse is grafted without correction of the angular deformity. The effects of scaphoid malunion on wrist motion were simulated in a cadaveric study. It was found that the loss of wrist extension is proportional to the angular deformity. Loss of radiocarpal extension occurred at 15 degrees of angulation and loss of midcarpal extension occurred at 30 degrees of angulation.

Painful disorders of the distal radioulnar joint severely limit the work capability of the hand. Until recently, the standard treatment for this problem has been transverse resection of the distal ulna, as originally proposed by Darrach. A technique for a "matched" resection arthroplasty of the distal ulna, leaving the ulnar shaft--styloid axis along with the triangular fibrocartilage complex and the distal ulnar ligamentous attachments intact, has been used since 1967. This procedure resects the distal ulna in a long, smooth, convex curve, matching the opposing surface of the concave radial metaphysis in three dimensions. Forty-four wrists were followed for an average of 6.5 years and showed that the procedure is reliable and relieves pain while retaining a more normal ulnocarpal, radioulnar, and radiocarpal alignment, with painless pronation averaging 80.5 degrees and supination of 88.5 degrees.

A new ratio has been devised which allows direct measurement of the position of the patella in relationship to the femur. The range of normal values is from 0.56 to 0.76.

This is the first report of a patient with a history of painless chronic flexor tenosynovitis caused by Actinobacillus actinomycetemcomitans. The slow growth of the organism on culture makes early identification difficult. Flexor tenosynovitis along with proper antibiotic treatment resulted in complete resolution in this patient.

Eleven patients with chronic pain on the ulnar side of the wrist and roentgenographic evidence of a hypertrophic ulnar styloid nonunion were treated with subperiosteal excision of the nonunion fragment. This procedure relieved the localized pain without changing either radiocarpal or distal radioulnar joint stability.

The single and multiple dose pharmacokinetics of oral nifedipine capsules, 10 mg, have been examined in five patients with peripheral vasospasm. After a single dose, nifedipine was rapidly absorbed in three and slowly absorbed in two patients. Mean bioavailability parameters included a tmax of 2.9 h, a Cmax of 33.3 ng ml-1 and a AUC0-8 h of 113.3 ng h ml-1. After multiple dosing with either 10 or 20 mg every 8 h for 10 days the mean tmax at steady state was 2.1 h while the mean dose-corrected (to 10 mg) Cmax and AUC0-8 h were 51.9 ng ml-1 and 146.9 ng h ml-1, respectively. The mean elimination rate constant was 0.173 h-1 after both single and multiple doses. The mean extent of accumulation of nifedipine, defined as the ratio of AUC0-8 h (steady state)/AUC0-8 h (single dose), was 1.3; we concluded that nifedipine accumulates in the body when it is administered every 8 h. This should be taken into account when predicting steady state serum concentrations and haemodynamic effects of nifedipine from single dose kinetic data.

The effect of water-soluble components of extra-old Cheddar cheese on experimental caries was tested by means of the seven-day intraoral cariogenicity test (ICT). Two bovine enamel blocks were placed in each buccal flange of the dental appliances of five volunteers. One side of each appliance (experimental) was dipped in a 25% water extract of the cheese for five min, while the other side (control) was dipped in de-ionized water. Immediately thereafter, the appliance was returned to the subject's mouth, and two 60-second rinses with 10% sucrose were performed. These procedures were repeated six times per day. The cheese-extract dippings reduced the cariogenicity of the sucrose by an average of 55.7% (p less than 0.01), as assessed by enamel microhardness. Neither the mean resting pH nor the mean minimum pH in response to sucrose was significantly different between the experimental and control sides. The concentration of calcium was significantly higher in plaque from the experimental side (32.44 micrograms/mg) as compared with the control side (19.36 micrograms/mg, p less than 0.01). The concentration of plaque phosphorus was higher on the experimental side (12.90 micrograms/mg) than on the control side (9.61 micrograms/mg); however, the difference was not statistically significant. These results show that cheese has one or more water-soluble components which reduce experimental caries in human subjects.

Patients with symptoms of stenosing tenosynovitis and clinical evidence of overlying Dupuytren's contracture were treated with localized total fasciectomy through multiple Y-V plasties and the excision of the A1 pulley of the affected digit. At operation the stenosing tenosynovitis could be separated into two categories--patients with external compression from contracting vertical septa or patients in whom the tendon constriction appeared unrelated to the overlying fascial disease.

The effect of progressive rotatory subluxation of the scaphoid on radio-scaphoid contact area was examined in a cadaveric model. Five degrees of subluxation reduced the contact area of the proximal pole by 44%, with a shift to the dorsal lip of the radius. At 20 degrees of subluxation the contact area was reduced by 77%, with a shift radially to the dorsal lip of the radial styloid. These findings explain the progression of radio-scaphoid arthritis from the radial styloid to the remainder of the fossa and reemphasize the importance of operative reduction of a scapho-lunate disassociation in the prevention of degenerative arthritis.

This report describes 3 types of apparatus that were used to produce precise movements of a joint over a wide range of speeds and angles. The designs feature an ability for ultra slow rotation of the joint (fractions of a degree per min) with a minimum of extraneous cues. Two designs use servo-controlled DC motors configured as velocity servos and a third design uses a galvanometer motor configured as a position servo. Originally designed for use with humans in studies of proprioception with the ankle and two joints of the index finger (the metacarpophalangeal joint and proximal interphalangeal joint), the apparatuses should be useful in a variety of applications where precise control of velocity and position is needed.

In order to isolate and identify the most active anti-cariogenic components(s) of aqueous cheese extract (CE), we separated it into low (LMW) (MW less than 500), medium (MMW) (500 less than MW less than 10,000), and high (HMW) (MW greater than 10,000) molecular weight fractions by means of the Amicon ultrafiltration system. These fractions were then tested in vitro with a bacterial system containing S. mutans, adapted from that of Turtola (1977). The LMW fraction reduced the demineralization caused by the fermentation of sucrose by 96% (p less than 0.001) as compared with the water control; this was not significantly different from a 50% concentration of the CE. The MMW and HMW fractions reduced demineralization by 36 and 42%, respectively. The concentrations of acid-soluble calcium and phosphorus in CE, LMW, MMW, and HMW were 1509 and 462, 991 and 310, 231 and 7, and 162 and 3 micrograms/mL, respectively. A solution containing the same levels of calcium and phosphorus as CE was somewhat more effective in reducing demineralization in vitro than was CE itself (p less than 0.01). In vivo, the addition of these same calcium and phosphorus levels to a 10% sucrose solution reduced its cariogenicity by 67% (p less than 0.001), as judged by the intra-oral cariogenicity test (ICT). Plaque calcium and phosphorus concentrations were significantly higher in the ICT plaque samples subjected to the sucrose-Ca,P solution (p less than 0.01) than in the sucrose control. The resting pH, minimum pH, and shape of the pH curves produced by the sucrose control and sucrose-Ca,P were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Two women, 33 and 55 years of age, with post-traumatic posterior radial head dislocation were treated by open reduction. Normal apposition of the radius to the capitellum was achieved. Although excellent range of motion was restored in both patients, the possibility of post-traumatic arthritis must be determined by long-term follow-up observations.

1. Procedures are described for the purification of amelogenin electrophoretic components and their analysis for homogeneity by polyacrylamide-gel electrophoresis at both acidic and alkaline pH values. 2. Most of these components belonged to two main groups, termed the J group and the C group after their major electrophoretic components. Sodium dodecyl sulphate-polyacrylamide-gel electrophoresis indicated that, within each group, proteins were of similar size, but the C-group proteins were larger than those of the J group. 3. By sedimentation-equilibrium ultracentrifugation and amino acid analysis, the four J-group components were found to be very small proteins (mol. wt. 5500-3000) and, except for one, similar in amino acid composition. The components of the C group were found to be proteins of moderate size (mol. wt. 16800-16100) with very similar amino acid compositions. A third minor amelogenin group of intermediate size was also found, but not further analysed. Details of the results of the ultracentrifuge studies are given in a supplementary paper that has been deposited as Supplementary Publication SUP 50014 at the National Lending Library for Science and Technology, Boston Spa, Yorks. LS23 7BQ, U.K., from whom copies can be obtained on the terms indicated in Biochem. J. (1973) 131, 5. 4. Two of the J-group components were similar to amelogenins isolated by other workers. 5. All amelogenins analysed were rich in proline, glutamic acid, histidine and methionine, and contained no half-cystine. Their amino acid compositions, combined with their molecular weights, serve to distinguish the amelogenins from both collagens and keratins.