Occurrence and impact of xerostomia among dentate adult New Zealanders: findings from a national survey.

BACKGROUND: We investigated the prevalence, associations and impact of xerostomia in a nationally representative sample of dentate adult community-dwelling New Zealanders aged 18 years and over. METHODS: The data were collected from a representative sample of 2209 adults, as part of the 2009 New Zealand Oral Health Survey (NZOHS). Data were collected using face-to-face interviews, dental examinations and the short-form Oral Health Impact Profile (OHIP-14). Data analysis used appropriate weighting for all procedures to account for the complex survey design. RESULTS: The overall prevalence estimate for xerostomia was 13.1% (95% CI 11.7, 14.7), and it was more common among females. Those in the 75+  and 25-34 age groups were more likely (odds ratios of 6.5 and 4.0, respectively) to have xerostomia. After controlling for sociodemographic characteristics and clinical oral disease, the mean OHIP-14 score among xerostomics was 50% higher than among those who did not have the condition. CONCLUSIONS: These data indicate that xerostomia is a common condition which can affect quality of life among people of all ages.

Saliva: an overview.

An inherent and yet profound aspect of our well-being is dependent on a humble, unassuming fluid called saliva. This unpretentious secretion is indispensable, contributing to quality of life and the simple joy of living; its absence has been described as an aggravating constant misery. Therefore, understanding how saliva contributes to good oral health and general well-being is essential to assisting oral health professionals in their care for patients. A comprehensive literature search of publications relating to saliva was undertaken in order to assemble an overview of the current knowledge of this multifaceted, multipurpose bodily fluid. This paper revises the anatomical, histological and physiological aspects of saliva production and its functions. Dry mouth and its associated risk factors are described, together with consideration of its clinical significance.

Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes.

BACKGROUND: Cognitive-behavioural therapy (CBT) improves persistent psychotic symptoms. AIMS: To test the effectiveness of added CBT in accelerating remission from acute psychotic symptoms in early schizophrenia. METHOD: A 5-week CBT programme plus routine care was compared with supportive counselling plus routine care and routine care alone in a multi-centre trial randomising 315 people with DSM-IV schizophrenia and related disorders in their first (83%) or second acute admission. Outcome assessments were blinded. RESULTS: Linear regression over 70 days showed predicted trends towards faster improvement in the CBT group. Uncorrected univariate comparisons showed significant benefits at 4 but not 6 weeks for CBT v. routine care alone on Positive and Negative Syndrome Scale total and positive sub-scale scores and delusion score and benefits v. supportive counselling for auditory hallucinations score. CONCLUSIONS: CBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.

Detection of minimization of psychopathology on the Rorschach in cleric and noncleric alleged sex offenders.

The assessment of response-bias is critical in forensic psychological evaluations of alleged sex offenders because sex offenders frequently minimize psychopathology or personal limitations. This study tested predictions based on prior research that minimization on the Rorschach would be reflected by higher P, D, A, Lambda, and PER, and lower R, Blends, and Zf. We divided a sample of cleric and noncleric alleged sex offenders according to (a) whether they showed minimization on the MMPI, and (b) whether they admitted to their charges. We then compared these groups on the purported Rorschach validity indices. Our results do not support the use of any of these Rorschach scores in the assessment of minimization. We recommend that in forensic psychological evaluations, the Rorschach should not be used to assess defensiveness and is best used in combination with other psychometric instruments more sensitive to response-bias.

Dentigerous cysts of inflammatory origin. A clinicopathologic study.

The exact histogenesis of dentigerous cysts remains unknown, but most authors favor a developmental origin from the tooth follicle. The aim of this article is to report a series of 15 dentigerous cysts that we believe to be of inflammatory origin. These inflammatory dentigerous cysts occurred in the first and early part of the second decades of life. Males were affected more frequently, and there did not appear to be any racial predilection. All of the cases involved permanent teeth: premolars in nine cases, canines in four cases, and second molars in two cases. The mandible was affected twice as frequently as the maxilla. In 13 cases, nonvital grossly carious or heavily restored deciduous teeth were associated with the cysts. Some of these teeth had been extracted before the cysts were diagnosed. In the remaining two cases, both of which involved the second permanent molars, there were no nonvital deciduous teeth, however both had concomitant proliferative periostitis. All of the cysts were moderately or intensely inflamed and were lined predominantly or entirely by nonkeratinized stratified squamous epithelium that in some cases was markedly hyperplastic and exhibited anastomosing rete ridges mimicking radicular cysts. In the majority of cases, parts of the cysts were lined with a 2 to 3 cell layer thick cuboidal epithelium that we believe was derived from reduced enamel epithelium. Rests of odontogenic epithelium frequently were evident in the cyst walls. We suggest that these cysts arose as a result of periapical inflammation from any source but usually from a nonvital deciduous tooth and spreading to involve the follicles of the unerupted permanent successors. The inflammatory exudate causes separation of the reduced enamel epithelium from the enamel with resultant cyst formation. This study proposes the existence of two types of dentigerous cysts: one developmental and the other inflammatory in nature.

ST segment alternans during coronary angioplasty.

Four patients with severe proximal or mid-LAD stenosis were noted to have ST alternans during balloon angioplasty. Neither mechanical alternans nor increased ventricular ectopy were noted. In contrast to prior descriptions in animals or patients with variant angina, ST alternans did not occur following a premature ventricular contraction. Frequent use of calcium channel blockers during PTCA may interfere with the mechanism leading to electrical alternans and its consequences as seen in animal studies, accounting for the low frequency with which this phenomenon is noted during PTCA.

The technique of inserting an intra-aortic balloon pump. Indications, contraindications, advice for avoiding complications.

The intra-aortic balloon pump (IABP) uses the timed inflation and deflation of a balloon placed in the descending aorta to augment coronary perfusion and reduce myocardial work. The IABP is useful in a number of settings, including acute myocardial ischemia, cardiogenic shock, and mechanical complications of acute myocardial infarction; it also provides support to perioperative patients. Because the device can be inserted percutaneously, mechanical circulatory support can be instituted rapidly Complications, most of which are reversible, occur in approximately 30% of patients.

Primary structure and expression of a chicken cDNA encoding a protein with zinc-finger motifs.

We report the cloning and sequence analysis of a chicken nearly full-length cDNA clone, cKr1, encoding a protein of 509 amino acids which contains ten 2Cys + 2His-type zinc-finger motifs arranged in two separate sets of five zinc fingers each. The cKr1 transcripts are detected in organs of the adult chicken, predominantly in the brain and lung. At day 4 of embryonic development strong cKr1 hybridization signals are found in the brain and neural tube, in the mesonephros and in the gut, respectively.

Amelogenesis imperfecta: multiple impactions associated with odontogenic fibromas (WHO) type.

Three types of amelogenesis imperfecta (AI) are recognised, namely hypoplastic, hypomature and hypocalcified varieties. We report on two cases of hypoplastic AI, the type which occurs most frequently. Both patients presented with multiple impacted permanent teeth. Odontogenic fibromas of the WHO type were found to be associated with the crowns of all the impacted teeth and are considered to have prevented normal eruption. Dentinal dysplasia found only in the furcation area of the multirooted impacted teeth was evident. The macroscopic, microscopic and radiological appearance of the affected teeth, pericoronal lesions and interradicular dentinal dysplasia are described, and the most likely origins of the odontogenic fibromas and calcifications observed, are discussed.

Clinical correlates do not predict PaO2 response after tolazoline administration in hypoxic newborns.

In an attempt to determine which hypoxic newborns might benefit from administration of tolazoline hydrochloride (Tz), we identified all neonates known to have received Tz at four Chicago area perinatal centers over a 4-yr period. For each of 41 infants, five statistical analyses were used to correlate 31 clinical and ventilatory variables with PaO2 values before and after Tz administration. Fourteen neonates responded to Tz infusion with more than a two-fold increase in PaO2. None of 31 clinical variables successfully predicted a positive Tz response in these infants, and a positive response (increased PaO2) was not associated with increased likelihood of survival. BP fell after Tz in 72% of patients, while heart rate rose after Tz treatment in 66% of cases. These data suggest a need to re-evaluate the administration of Tz to hypoxic newborn infants.

A fetus with a chromosome 13 ring and placenta with chromosome 13 rod/ring mosaicism.

A fetus was identified by prenatal cytogenetic diagnosis as having a karyotype 46,XY,r(13) (p11q13). Termination of the pregnancy yielded a severely malformed fetus. Fetal abnormalities included anencephaly, imperforate anus and urethral meatus, severe talipes, syndactyly, cardiac defects and other anomalies. Confirmatory studies on cultured placental villi cells indicated a second cell line, 46,XY, -13,+13qter leads to cen::13q13 leads to qter. This cell line was not detectable in cells derived from the fetus despite extensive studies. It seems likely that the two cell lines arose simultaneously with selection favouring the 46,XY,r(13) line. How the chromosome rearrangements may have arisen is discussed. We are unaware of other cases where a cell line identifiable by a chromosome abnormality appeared to be confined to placental tissue. However, studies on placental tissue may be helpful in understanding the origin of other unbalanced de novo rearrangements.

Effect of intraluminal pH on the absorption of pteroylmonoglutamic acid.

The administration of pteroylmonoglutamic acid and either sodium bicarbonate or phenytoin sodium in normal subjects and epileptics results in lower serum levels of folic acid than when administered alone. Bicarbonate administration was shown to produce a more alkaline pH in the jejunum, while an alkaline pH was found in some epileptics on phenytoin therapy. The physicochemical mechanisms whereby folic acid absorption is reduced in an alkaline medium are considered, and the implications on folate absorption in other disease states are discussed. The mechanism by which phenytoin sodium alters the intrajejunal milieu is obscure.