Procedural sedation during transradial coronary angiography to prevent spasm.

AIM: Radial artery spasm is common during transradial procedures and is the most common cause of procedural failure. The objectives of this study were to assess whether the routine administration of sedation at the beginning of transradial coronary angiography with the use of hydrophilic-coated and smaller sheaths/catheters would reduce the incidence of radial artery spasm. PATIENTS AND METHODS: Patients undergoing transradial coronary angiography were prospectively randomized to receive midazolam during the procedure or no sedative treatment. The primary endpoint was angiographically confirmed radial artery spasm. Stenosis of the radial artery was measured with a computer-assisted quantification method. RESULTS: In all, 150 patients were randomized into a treatment group and a control group. Spasm occurred in 15 patients of the treatment group (20 %) versus 16 in the control group (21.3 %). There were no differences between the two groups regarding the incidence of spasm and the distribution of spasm severity (p > 0.05). No significant differences were observed between the two groups in terms of 30-day mortality or repeat hospitalization for any cause (p > 0.05). CONCLUSION: Routine use of midazolam could not reduce the occurrence of radial artery spasm during transradial coronary angiography.

Treatment for unstable intertrochanteric fractures in elderly patients: internal fixation versus cone hemiarthroplasty.

PURPOSE: To evaluate the effectiveness of internal fixation versus cone hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients. METHODS: The choice of treatment was based on the year of admission: between 2001 and 2003, 42 patients (mean age, 73 years) underwent cone hemiarthroplasty using a cementless press fit through a posterior approach, whereas between 1999 and 2001, 45 patients (mean age, 75 years) underwent internal fixation using a dynamic hip screw through a lateral approach in a supine position. Patients with stable fractures with intact lesser trochanter, immobility before injury, age younger than 60 years, or with associated injuries (such as another fracture) were excluded. Patients were encouraged active rehabilitation in bed. Bony union was determined by clinical and radiological examinations. Patients were followed up at 6-week intervals in the first sixth months and every 3 months thereafter until bony union was achieved. In the final follow-up, 32 cone hemiarthroplasty patients and 38 internal fixation patients were available for evaluation according to Merle d'Aubigne and Postel criteria. RESULTS: There were no significant differences between the 2 groups in terms of sex, age, fracture type, Singh index, follow-up period, hospital stay, operating time, and receipt of blood transfusions. Clinical results of both groups were similar. Hemiarthroplasty patients were allowed full weight bearing significantly earlier than the internal fixation patients. CONCLUSION: Cone hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilisation.

Environmental sampling for Cryptococcus neoformans var. gattii from the Blue Mountains National Park, Sydney, Australia.

The environmental association of Cryptococcus neoformans var. gattii with decaying wood in tropical and subtropical regions of the world is well documented. In Australia, the yeast appears confined to certain species of Eucalyptus or very closely related tree species. In this study, we attempted to isolate C. n. var. gattii from different gum tree species in the Blue Mountains National Park. Out of 99 samples from 9 different tree species, only 3 yielded viable yeast colonies; 2 were from turpentine gums (Syncarpia glomulifera) and 1 was from a decayed stump of an unknown species. All of the colonized trees occurred in close proximity in urbanized areas of the Park, and all isolates shared identical DNA fingerprinting profiles. We suggest that domestic animal vectors may be responsible for the introduction and transmission of the yeast in this region, but that propagation and dispersal are very limited. This study indicates that C. n. var. gattii may occur on trees and in areas that were not previously expected to host it. However, the low incidence in the Blue Mountains National Park means this yeast is unlikely to pose any hazards to humans and animals living in or visiting this area.

Intraobserver and interobserver reliability of Kalamchi and Macewen's classification system for evaluation of avascular necrosis of the femoral head in developmental hip dysplasia.

This study evaluates the intraobserver and interobserver reliability of the Kalamchi and MacEwen's classification system of avascular necrosis of the femoral head. Radiographs of 48 developmentally dysplastic hips that had an average follow-up of 40.5 months (range: 36 to 52 months) and that had been treated by the same operative technique were interpreted twice by four experienced pediatric orthopaedic surgeons. When the absence or presence of avascular necrosis was taken into consideration the average intraobserver agreement percentage and kappa coefficient were 86% and 0.71, respectively. The average interobserver agreement percentage and kappa coefficient were 83% and 0.66, respectively. When the agreement on the type of avascular necrosis was analyzed, the average intraobserver agreement percentage and kappa coefficient were 85% and 0.74, respectively. The average interobserver agreement percentage and kappa coefficient were 81% and 0.66, respectively. No statistically significant difference was found between the rates of avascular necrosis of four observers. The Kalamchi and MacEwen's classification system was found to be reliable and reproducible.

Interrelations between the fluoride concentrations in dental plaque and enamel, and exposure to fluoride.

The F concentrations in plaque and in underlying enamel were determined in a sample of 99 schoolchildren aged 8.4 years (S.D. = 0.37), comprising four groups, exposed life-long to contrasting concentrations of F in the water (range less than or equal to 0.12 ppm to 2.8 ppm) and to supplements of 350 mg F/kg domestic salt. The mean total F concentrations in plaque (dry wt) increased consistently with increasing exposure to F, but the absolute differences were small and the individual variation was high within each group. Significant inverse associations were demonstrated between individual plaque and surface enamel values within two groups, supported by consistent inverse trends (ns) in the remaining groups. These associations and trends are considered to reflect transfer of F from plaque to underlying surface enamel and concommitant reduction in plaque F concentration.

The fluoride content of human tooth enamel in relation to environmental exposure to fluoride.

Double-layer superimposed biopsies were used for sampling sound labial enamel of upper permanent central incisor teeth of 189 children (mean age 8.4 years, SD = 0.36), comprising five groups, representing life-long exposure to contrasting concentrations of F in the water (range less than or equal to 0.12 ppm to 2.8 ppm) and to supplements of 200 or 350 mg F/kg domestic salt. The mean F concentrations of enamel ranged through the groups from 924 ppm to 2401 ppm in the surface layer (average central depth = 0.49 micron) and from 450 ppm to 1428 ppm in the subsurface layer (average central depth = 2.62 microns). The differences between the mean F concentrations of the groups were significant in each instance and the values consistently reflected the extent of F exposure. It was concluded that the F content of enamel is a reliable indicator of environmental exposure to F for populations, but not for every individual.

Oral health of Australian children using surface and artesian water supplies.

Oral health parameters were compared for 6--8 and 10--11-year-old children living in neighbouring. N. S. W. towns, where the community water supplies consisted of artesian and river were respectively. The demographic characteristics, living pattern and dietary carbohydrate challenge were similar in the two areas and effective oral hygiene practices were uniformly lacking. Children in the artesian water area had 40% lower caries prevalence (DIMFT), 50% less severe carious lesions (SR) and significantly better oral hygiene (OHI) and gingival condition (PI) and correspondingly lesser treatment needs than those supplied by river water. The findings were examined in relation to the concentrations of 10 elements in roof catchment, river and artesian water. Apart from a contribution by fluoride to better oral health, the results implicate lithium as a possible beneficial element.

Oral conditions in Australian children of Aboriginal and Caucasian descent.

Oral health parameters were examined for 211 schoolchildren (128 Aborigines and 83 Caucasians) representative of the 6--8 and 10--11 year age groups in the Brewarrina and Walgett areas of western New South Wales (fluoride in water less than or equal to 0.02-0.26 parts/10(6)). Despite similar dietary carbohydrate challenge and tooth eruption patterns, Aboriginal children, most of whom were members of a transitional community within a low socioeconomic stratum, had higher prevalence of caries (DIMFT) and severity rating of carious lesions (SR), poorer oral hygiene (OHI) and more gingivitis (PI) than Caucasian children, in both age groups. Tooth defects were more frequent (2.5 times) and severe in Aborigines than in Caucasians. Outstanding treatment needs were very high in both ethnic groups, but more so in Aborigines.

Oral health of adolescent and adult Australian aborigines.

A pilot survey of oral health included 83 adolescent and adult Aborigines (41 M, 42 F, range 16--70 years, mean age 37.3 years), resident in fringe settlements around the far western New South Wales towns of Brewarrina and Walgett (fluoride in water less than or equal to 0.02--0.26 parts/10(6)). Dental caries prevalence (mean DIMFT per person) increased from 17.1 at 20 years to 10.7 at 35 years and declined to 14.6 by the age of 50 years and over. Oral hygiene (OHI) was poor overall and deteriorated with age. Periodontal status (PI) was significantly correlated with the presence of debris (DI) and calculus (CI). The mean PI increased from 1.7 at 20 years to 4.8 at 43 years and over. Tooth mortality reached 75% by the age of 43 years. Prosthetic needs were correspondingly high, but 95% of denture requirements were unmet. No evidence of effective or sustained oral health care was seen; 38% of subjects needed emergency treatment.

Plaque minerals and caries experience: associations and interrelationships.

Inverse associations were demonstrated between DMFT and total calcium, phosphorus, magnesium, strontium, potassium, and fluoride concentrations in individual plaques. Lithium, strontium, fluoride, and zinc contents were inversely related to plaque mass. Consistent interdependence patterns between elements indicate the operation of a mineral level regulating mechanism, effective under diverse environmental conditions.

Associations between the total fluoride content of dental plaque and individual caries experience in Australian children.

Individual caries experience (DMFT) and the total fluoride content of dental plaque were determined for 72 schoolchildren, aged 9.7-13.0 years, lifelong residents in one of three New South Wales towns, where the fluoride levels of the reticulated water supplies were: Katoomba, less than 0.1 parts/10(6); Sydney, 1.0 parts/10(6) for 4 years; and Yass, 1.0 parts/10(6) for 16 years, prior to sampling. The mean fluoride content of plaque in Sydney (22.6, s.d. = +/- 16.8 parts/10(6)) and Yass (25.6, s.d. = +/- 16.4 parts/10(6)) differed significantly (t = 2.27, P less than 0.05 and t = 3.30, P less than 0.02, respectively) from that in Katoomba (13.5, s.d. = +/- 8.3 parts/10(6)). Significant inverse associations were demonstrated between total plaque fluoride and individual caries experience (DMFT) in Sydney (r = -0.45, P less than 0.025) and overall (r = -0.28, P less than 0.010). Inverse trends were established between plaque quantity (dry weight of plaque collected) and fluoride levels. No associations could be demonstrated between fluoride treatment (dentifrice, tablets or topical application) and plaque fluoride, DMFT or plaque quantity.