Search

In this study, a technique is described by which large obturators can be retained with an acrylic resin head plate. The technique entails attaching the prosthesis to an acrylic resin plate with a 2-mm-diameter wire and then attaching the plate to the patient's forehead with skin tape.

Polyvinylchloride plumbing parts provide a readily available source of material to use in making facial prostheses. Inexpensive pipe fittings (end cap attachments and closet flanges) can be combined to provide a durable container for stone molds that can be tightened in a strong curing press. The entire unit can be cured in a microwave oven in 30 minutes.

The value and success of a well-fitting and anatomically correct prosthesis are compromised if the color does not match the adjoining tissue. Color and color science are reviewed to help develop a simplified acrylic resin shade guide to aid in fabricating acrylic resin facial prostheses. This guide will help the clinician obtain a good intrinsic shade and minimize extrinsic coloration.

The advantages of multidisciplinary treatment planning of head and neck cancer patients is described. Planning rehabilitation concurrently with curing the malignancy results in the most effective application of treatment modalities coordinated with rehabilitative care. Concentrated multidisciplinary treatment reduces post treatment morbidity by shortening recovery and rehabilitation time.

A technique is presented for making an acrylic resin core for processing silicone facial prostheses. This technique ensures a durable core that can be used to make multiple prostheses. The core resists fungal growth during storage and creates a smooth, easily cleanable internal surface for a facial prosthesis. The core also permits a controllable thickness and therefore a lighter prosthesis.

A simplified technique for preparing, under a vacuum, a polyurethane lining for a facial prosthesis is described. A previously presented technique strengthened the prosthesis and allowed it to be attached with a water-based adhesive. This technique eliminates wrinkling, simplifies bonding, allows multiple linings to be made at the same time, conserves time and cost, and improves predictability of the results.

We performed a prospective randomized trial, comparing the incidence of peritonitis between a flush-disconnect (O-System, Baxter, Deerfield, IL) (OS) and a conventional (System II, Baxter) (CS) continuous ambulatory peritoneal dialysis (CAPD) method. Sixty consenting patients with no significant physical disabilities who commenced CAPD after May 1987 were entered and followed for a minimum of 12 months. Thirty were placed on the OS system and 30 were placed on CS. Age, gender, and time for training did not differ significantly. The period of observation for OS was 375 months; CS was observed for 430 months. OS patients experienced 28 episodes of peritonitis (13.4 months/patient/episode) compared with 88 (4.9 months/patient/episode) in CS (p less than 0.005). By 6 months, 32% of OS patients had had at least one episode of peritonitis, compared with 62% of CS patients; at 12 months, these figures rose to 48% for OS and 91% for CS (p less than 0.01) patients (Life Table Analysis). The median survival time to first peritonitis episode was 5.1 months in CS and 9.7 months in OS (p less than 0.01). Exit-site infections occurred in 14/30 (46%) of patients on OS and in 13/30 (43%) of CS patients. We conclude that the OS was associated with a significant reduction in the incidence of peritonitis.

Rehabilitation of the glossectomy patient is one of the most difficult and challenging problems for the prosthodontist and speech pathologist. The tongue plays an important role in articulation, control of secretions, formation of a bolus, propulsion of the bolus toward the pharynx, clearing the palate, and initiation of the swallow reflex. This paper presents speech and prosthodontic considerations for a patient who underwent a glossectomy and had the additional problem of reduced oral opening.

OKT3, a murine monoclonal anti-T-cell antibody, was used to treat acute renal allograft rejection crises in 140 patients. When used for primary treatment of initial rejections, it was effective in all 20 recipients of related-donor (RD) grafts and in 70 of 74 recipients of cadaver-donor (CD) grafts. OKT3 was also used for resistant rejection unresponsive to conventional antirejection drugs and was effective in 11 of 13 RD and in 26 of 33 CD recipients. Rerejection occurred in 58% of patients in the OKT3 primary treatment group and in 35% of patients in the OKT3 rescue group. Fifty-nine percent of the patients produced anti-OKT3 antibodies. Nearly all recipients experienced a flu-like syndrome following the first and second daily doses of OKT3. Two-year actuarial patient survivals were 100 and 96% for RD and CD recipients, respectively. In the OKT3 primary treatment group, two-year actuarial RD and CD graft survivals were 91 and 76%, respectively. In the OKT3 rescue group, the two-year actuarial RD and CD graft survivals were 85 and 55%, respectively. A proposed immunosuppressive effect of OKT3 is T-cell inactivation by blocking antigen receptors linked to OKT3-reactive molecules. Reuse of OKT3 for recurrent rejection or subsequent organs may be hampered by anti-OKT3 antibody production. OKT3 is an effective steroid-sparing treatment for renal allograft rejection.

A cohort of 22,948 women from a stable homogeneous population who gave birth for the first time between 1964 and 1983 were followed up prospectively. Analysis by mode of delivery showed that of those delivered by caesarean section 23.2% fewer had another pregnancy than those who had a spontaneous vaginal delivery. Women delivered by forceps were in an intermediate group. Miscarriage was more common in women who had been delivered by caesarean section. The relative infertility after caesarean section could not be accounted for by early sterilization, was not associated with maternal height or social status, and was only partly attributable to age.