Carboxyhaemoglobin formation and ECG changes during hysteroscopic surgery, transurethral prostatectomy and tonsillectomy using bipolar diathermy.

Diathermy is known to produce a mixture of waste products including carbon monoxide. During transcervical hysteroscopic surgery, carbon monoxide might enter the circulation leading to the formation of carboxyhaemoglobin. In 20 patients scheduled for transcervical hysteroscopic resection of myoma or endometrium, carboxyhaemoglobin was measured before and at the end of the surgical procedure, and compared with levels measured in 20 patients during transurethral prostatectomy, and in 20 patients during tonsillectomy. Haemodynamic data, including ST-segment changes, were recorded. Levels of carboxyhaemoglobin increased significantly during hysteroscopic surgery from median (IQR [range]) 1.0% (0.7-1.4 [0.5-4.9])% to 3.5% (2.0-6.1 [1.3-10.3]%, p < 0.001), compared with levels during prostatectomy or tonsillectomy. Significant ST-segment changes were observed in 50% of the patients during hysteroscopic surgery. Significant correlations were observed between the increase in carboxyhaemoglobin and the maximum ST-segment change (ρ = -0.707, p < 0.01), between the increase in carboxyhaemoglobin and intravasation (ρ = 0.625; p < 0.01), and between intravasation and the maximum ST-segment change (ρ = -0.761; p < 0.01). The increased carboxyhaemoglobin levels during hysteroscopic surgery appear to be related to the amount of intravasation and this could potentially be a contributing factor to the observed ST-segment changes.

Pneumocystis carinii infection of the middle ear and external auditory canal. Report of a case and review of the literature.

We present a 50-year-old male with Pneumocystis carinii infection involving the middle ear and the external auditory canal as the first manifestation of a previously unknown HIV infection. In case of therapy-resistant otitis with a polypoid mass in the external auditory canal histological evaluation should be considered to rule out malignancy or pathogens, like Pneumocystis carinii, that cannot be cultured. Oral or intravenous antiprotozoal agents are the treatment in line with current practice. Exploration of the os petrosum is never required.

Species relationships in Lactuca s.l. (Lactuceae, Asteraceae) inferred from AFLP fingerprints.

An AFLP data set comprising 95 accessions from 20 species of Lactuca s.l. (sensu lato) and related genera was generated using the primer combinations E35/M48 and E35/M49. In phenetic analyses of a data subset, clustering with UPGMA based on Jaccard's similarity coefficient resulted in the highest cophenetic correlation, and the results were comparable to those of a principal coordinates analysis. In analyses of the total data set, phenetic and cladistic analyses showed similar tree topologies for the well-supported parts of the trees. The validity of cladistic analysis of AFLP data is discussed. The results do not support a distinction among the serriola-like species L. sativa, L. serriola, L. dregeana, and L. altaica, which is in line with previous results. Therefore, we postulate that these species are conspecific. The serriola-like species L. aculeata occupies a clearly separate position, making it an ideal outgroup for studies of the closest relatives of L. sativa. The subsect. Lactuca as a group is well supported by our data, but the positions of L. saligna and L. virosa relative to the serriola-like species remain unclear. The close relationship between the sect. Mulgedium species L. tatarica and L. sibirica is corroborated by the present AFLP results and by additional crossability data.

Phylogenetic relationships among Lactuca (Asteraceae) species and related genera based on ITS-1 DNA sequences.

Internal transcribed spacer (ITS-1) sequences from 97 accessions representing 23 species of Lactuca and related genera were determined and used to evaluate species relationships of Lactuca sensu lato (s.l.). The ITS-1 phylogenies, calculated using PAUP and PHYLIP, correspond better to the classification of Feráková than to other classifications evaluated, although the inclusion of sect. Lactuca subsect. Cyanicae is not supported. Therefore, exclusion of subsect. Cyanicae from Lactuca sensu Feráková is proposed. The amended genus contains the entire gene pool (sensu Harlan and De Wet) of cultivated lettuce (Lactuca sativa). The position of the species in the amended classification corresponds to their position in the lettuce gene pool. In the ITS-1 phylogenies, a clade with L. sativa, L. serriola, L. dregeana, L. altaica, and L. aculeata represents the primary gene pool. L. virosa and L. saligna, branching off closest to this clade, encompass the secondary gene pool. L. virosa is possibly of hybrid origin. The primary and secondary gene pool species are classified in sect. Lactuca subsect. Lactuca. The species L. quercina, L. viminea, L. sibirica, and L. tatarica, branching off next, represent the tertiary gene pool. They are classified in Lactuca sect. Lactucopsis, sect. Phaenixopus, and sect. Mulgedium, respectively. L. perennis and L. tenerrima, classified in sect. Lactuca subsect. Cyanicae, form clades with species from related genera and are not part of the lettuce gene pool.

The relationship of age and gender to fear and anxiety in response to dental care.

The apparent association in the published literature of gender and age with dental fear and anxiety is far from consistent or universal. A random, age-stratified telephone survey of 398 adults was performed in a US metropolitan area: Denver, Colorado. Information collected included Kleinknecht's Dental Fear Survey (DFS). In addition to total DFS scores, values were also calculated for the sums of the five DFS physiologic response items (PATRESP) and 12 DFS fear-producing stimulus items (DENTSTIM). Tests for reliability of these three scales were performed (alpha = 0.804 to 0.936). In this sample population, significant age and gender differences were noted. In general, fear and anxiety decreased in importance with increased respondent age, with the largest difference noted between the 40-50 and 60-69 age groups. Increased fear and anxiety were most apparent among younger females (20-30 and 40-50) as compared with older females (60 and older). However, among males, the summary variable for physiologic response to fear and anxiety did not appear to be age-related. Among the oldest respondents (ages 70+), 12.2% did report a "major" response to muscle tension when in the dental chair. Females reported more fear of some stimuli associated with dental care (e.g., "feeling the drill in the mouth") than did males.

The old-old dental patient: the challenge of clinical decision-making.

As the U.S. geriatric population grows older, dentists should recognize the need to carefully consider age-related concerns that influence clinical decision-making. The authors discuss several prevalent problems typically found in "old-old" patients and propose a model for determining the appropriate extent of dental care for them.

Periodontal treatment needs and oral hygiene among Ethiopian immigrants.

Periodontal disease studies in developing countries over the past four decades indicate periodontitis to be a major problem, even in populations with relatively low caries rates. The aim of this study was to document levels of periodontal treatment needs, as well as oral hygiene levels for a large sample covering all ages of an Ethiopian Jewish population recently immigrated into Israel. Over 800 subjects from the total of 15,000 Ethiopians who immigrated were examined utilising the PTNS Index and the OHI-S Index. Results indicate that all the examined population was in need of oral hygiene instruction. Almost 80 per cent are in need of scaling and approximately 20 per cent are in need of more complex treatment such as surgery. Significant differences were found according to age. This could be attributed to the high OHI-S scores, ranging from 2.53 at age 0-12 to 4.82 at the 51+ age group, with a mean Debris Index of 2.12 for the total population. It is suggested that this population should be exposed immediately to preventive and treatment programmes to improve oral hygiene and decrease needs for future, costly periodontal treatment.

Prevalence of dental caries among Ethiopian emmigrants.

Studies have documented the prevalence of caries in developing countries. The current study adds to this body of knowledge. Of the total Ethiopian Jewish population who emmigrated to Israel in 1991, a sample of over 800 individuals was randomly selected representing all age groups. DMF-T and DMF-S scores were recorded, as well as percentages of caries free individuals. Results indicated that almost no fillings or crowns had been provided to the study population. The Missing 'M' component was low as was the Decay 'D' component, although this increased with increasing age, ranging from 0.33 D-T at the 0-12 age group to 2.46 at the 51+ age group. In the permanent dentition 88.4 per cent of those 0-12 years of age were caries free and 74.5 per cent were caries free in both the primary and permanent dentition. Almost 59 per cent of the 13-20 years olds were caries free and 32.8 per cent of those 21-50 years old. Only 16.7 per cent were caries free at age 51+ years old. The data indicate a relatively low prevalence of both coronal and root caries, and an effort has to be made to keep these figures low for years to come mainly by diet and dental health education.

Advances in portable and mobile equipment systems.

Specific efforts need to be directed towards eliminating and/or minimising the significant barriers that threaten the oral health of nursing home and homebound individuals. Exciting new portable dental system options are now available which will help to overcome difficulties associated with meeting the dental needs of this cohort.

Research review of oral health status and service use among institutionalized older adults in the United States and Canada.

United States and Canadian studies have reported that a relatively large proportion of the institutionalized, older adult population is afflicted with a host of dental diseases and rarely seeks dental services. Analysis of existing published information indicates areas of concern including the need for incidence data, consensus on appropriate measures, and samples that will provide representative and comprehensive information about compromised older adults, irrespective of institutional or homebound status. Special emphasis should be placed on determining risk factors for dental disease, through longitudinal study of older adults.

Intraperitoneal toxicity of Hytrast: an experimental study.

The toxic effects of Hytrast were studied on the peritoneum of laboratory rats in order to define the lethal dose and possible causes of toxicity. The results show that Hytrast, due to its toxicity, should not be used in any clinical situation where gastrointestinal tract perforation or leakage is a possibility.

Effect of viable isolated hepatocytes or hepatocyte fractions on survival rate following galactosamine-induced acute liver failure.

Administration of galactosamine to rats results in an acute liver failure. The dose-effect relation appeared to be highly strain-dependent. Intraperitoneal injection of 1,000 mg/kg galactosamine resulted in a 90% lethal acute liver failure in Wag/Rij rats. Transplantation of viable isolated hepatocytes, administration of homogenate or cytosol of normal or regenerating liver tissue, or administration of cell-free liver cell culture supernatant did not improve the survival rate in this model of acute liver failure. These findings, which are in striking contrast with the data reported in the literature, are discussed in relation to the specific properties of this type of experimental model for acute hepatic failure.

Experimental evaluation of various available contrast agents for use in the upper gastrointestinal tract in case of suspected leakage. Effects on lungs.

The reactions of seven contrast agents--pure barium sulphate, Micropaque, Gastrografin, Dionosil, Hytrast, Amipaque and Hexabrix--on the bronchi and lungs of rats were studied. This work was undertaken to find a safe gastrointestinal contrast agent for use in post-operative patients where aspiration may be an accompanying risk. Amipaque and Hexabrix produced no significant histological reaction in the lungs and would, therefore, appear to be suitable for use in such cases.

Effect of propranolol on surgical bleeding and hemostasis: an in vivo study in the rat.

The influence of propranolol on surgical bleeding and hemostasis was studied in two different models in the normotensive rat. Propranolol was administered for 6 days subcutaneously and for 28 days orally. In both the tail and the muscle bleeding test the blood loss after the short-term as well as the long-term administration of propranolol was diminished as compared to control values. Highly significant differences were reached in the tail bleeding test. Previous studies have described the effect of propranolol on several constituents of the highly complex hemostatic process. Some of these effects enhance, others inhibit hemostasis. It is concluded that in the normotensive rat these hemostasis-enhancing effects are of greater importance than the inhibiting ones.

Development of hypertension in spontaneously hypertensive rats after gonadectomy: effects of secobarbital anesthesia on the blood pressure.

Male spontaneously hypertensive rats (SHR) were gonadectomized at an age of 5 weeks. Systolic blood pressure and heart rate were measured up till an age of 12 weeks in trained unanesthetized rats. The development of the hypertension and heart rate were not significantly affected by removal of the testes and epididymis or removal of the testes only. Kidney, adrenal and thymus weight did differ from the values in sham-operated rats. After the administration of secobarbital sodium, however, a significant lower blood pressure had been observed in gonadectomized rats compared with sham-operated rats. Significantly higher levels of secobarbital were detected in plasma and brain of gonadectomized SHR. It is concluded that gonadectomy does not effect blood pressure of SHR and that the previously reported retardation of development of hypertension in gonadectomized SHR is caused by the different effect of anesthesia on blood pressure of gonadectomized and sham-operated rats.

Increase in plasma renin activity, water intake and blood pressure following application and reapplication of a renal artery clip.

Application of a renal artery clip in rats with an undisturbed contralateral kidney caused a sustained increase in blood pressure and a transient rise of plasma renin activity and water intake. The response of blood pressure, plasma renin activity and water intake was augmented after reapplication of the clip to normotensive declipped rats (renal hypertensive rats, from which the clip had been removed 24h before the reapplication). The time-course of the changes of blood pressure, plasma renin activity and water intake were similar after the initial application as after reapplication of the clip. Administration of an inhibitor (SQ 14.225) of the converting enzyme abolished the increase in blood pressure and water intake after reapplication of the clip. These data indicate a critical role of renin in the rise of blood pressure and water intake after initial application of a renal artery clip as well as after reapplication of the clip to declipped rats.

Attenuated depressor response to arachidonic acid and prostaglandins in unclipped renal hypertensive rats.

1 In renal hypertensive rats (one-clip, two-kidney type) blood pressure returned to a normotensive level within 24 h after the removal of the renal artery clip (unclipping). 2 The decrease in blood pressure caused by intravenous administration of arachidonic acid, prostaglandin E2 and prostaglandin I2 was significantly reduced in these unclipped rats. 3 The hypotensive response to bradykinin and acetylcholine was the same in unclipped rats and in control rats. 4 Nephrectomy abolished the difference in blood pressure response to arachidonic acid and the two prostaglandins between unclipped and control rats. 5 An enhanced secretion of renin, as indicated by the absence of an increase in plasma renin activity, did not seem to be involved in the attenuated blood pressure response to arachidonic acid in unclipped rats.