Reduction in unstimulated salivary flow rate in burning mouth syndrome.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic condition of burning of the tongue and oral mucosa. It is often accompanied with complaints of xerostomia, although it is unknown whether the dryness is a sensory change similar to the burning sensation or due to hyposalivation. To determine whether there is change in salivary flow rate, whole salivary flows were measured in BMS patients. METHODS: A clinical ambispective study was conducted. Patients' clinical files were reviewed for stimulated and unstimulated whole salivary flow. Patients were divided into four groups based on diagnosis into Sjögren's syndrome (SS), BMS, BMS taking oral drying medications (BMS-med), and control (C). Whole stimulated (SF) and unstimulated flow (USF) measurements were collected and compared among groups. Data were analysed with ANOVA, Levene's test, Tukey's test and Games-Howell test. RESULTS: Twenty SS, 22 BMS, 24 BMS-med and 15 C were included in the study. SF was significantly lower in SS (0.59 ml ± 0.36) compared with BMS (1.56 ml ± 0.65, p <0.001), BMS-med (1.44 ml ± 0.64, p <0.001) and C (2.32 ml ± 1.06, p = 0.001). USF was significantly lower in SS (0.12 ml ± 0.10) compared with BMS (0.30 ml ± 0.18, p = 0.002), BMS-med (0.27 ml ± 0.21, p = 0.022) and C (0.52 ml ± 0.26, p <0.001). SF was not significantly different between BMS and C (p = 0.172) and BMS-med and C (p = 0.096). Both BMS and BMS-med had significantly lower USF compared with C (p = 0.040 and p = 0.018 respectively). SF in BMS was not significantly affected by number of oral drying medications (p = 0.254); however, USF was significantly lower with two or more oral drying medications (0.13 ml ± 0.07) compared with one oral drying medication (0.32 ml ± 0.22) (p = 0.034). CONCLUSION: BMS patients have statistically significant decreased unstimulated salivary flow rate with non-statistically significant decreased stimulated flow rate. Salivary flow rates in BMS patients are decreased further by medication usage whose side effects include dry mouth. This suggests that hyposalivation may play a role in causing dry mouth in BMS, which may respond to treatment with a sialogogue.

The cross-leg soleus muscle flap.

Reconstruction of the lower limb can be a difficult problem, especially when located over the lower third of the leg, or when a large soft-tissue defect exists. When local flap coverage is not possible, a distant flap--free or pedicled--is indicated. There are, however, circumstances that preclude the use of a free flap, and in these situations cross-leg flaps remain a viable alternative. They have been proved to be safe, are usually quick to perform, and do not require specialized facilities for postoperative monitoring. A new variation of the soleus muscle flap--the cross-leg soleus muscle flap--is described. Using this modification, the authors successfully closed large defects of the lower limb in 9 patients. The donor site defect that is left on the contralateral limb is far more acceptable than that left by conventional cross-leg fasciocutaneous or musculocutaneous flaps. The authors prefer the cross-leg soleus flap to conventional cross-leg flaps in these situations.

Rates of, and the factors affecting, cycle helmet use among secondary schoolchildren in East Sussex and Kent.

OBJECTIVES: To assess the level of cycle helmet wearing among young people in two counties in the South East of England in 1994, and to identify the factors associated with helmet wearing. DESIGN: Cross sectional survey in a convenience sample. SETTING: Secondary schools in East Sussex and Kent. SUBJECTS: Students in year 7 (aged 10-12 years) and year 11 (aged 14-16 years). Main outcome measures--Self reported "always wears a helmet". RESULTS: Among those who ride a bicycle, 32% of boys and 29% of girls aged 10-12 years, and 14% of boys and 10% of girls aged 14-16, reported that they always wear helmets. The variables that were most consistently associated with helmet wearing (that is significantly associated with helmet wearing in at least five of the six age, sex, and county subgroups) were: "parental encouragement to wear a helmet" "closest friend wears a helmet", "belief that laws that make children wear helmets are good", and "sometimes rides off-road". CONCLUSIONS: The self reported rates of always wearing a cycle helmet in East Sussex and Kent are consistent with overseas findings for populations who had not been exposed to intensive helmet promotion. The evidence suggests that parental encouragement has a favourable effect on rates of cycle helmet use among secondary schoolchildren, which is separate from and additional to peer influences. When designing a helmet promotion programme, therefore, it will have added impact if both parents and children are addressed.

Human immunodeficiency virus infection in an emergency hand service.

A study prompted by the high number of human immunodeficiency virus (HIV) patients in the South African population was performed to evaluate the incidence of HIV in patients attending our Emergency Hand Service. Over a 6-month period, more than 500 consecutive emergency patients were tested for HIV. In our series, 24 patients tested HIV-positive. Of these, 14 presented with hand sepsis and 10 with hand injuries. Bacteriology was performed on all patients with sepsis to document bacteria type and sensitivity. CD4 counts (T4 lymphocyte counts) were done on 12 patients to assess immunocompetence. Other factors examined included hospital stay, number of operations, postoperative morbidity, and mechanism of injury. Results indicate that septic HIV patients spent more time in the hospital and required more operations than septic non-HIV patients. Furthermore, of all of the population of emergency hand patients, a larger percentage of HIV-positive persons than HIV-negative persons was likely to be seen for infection.

Correlation of transrectal sonographic findings in patients with suspected and unsuspected prostatic disease.

Previous reports describing the diagnostic accuracy of transrectal sonography have not documented the specificity of differentiating abnormal internal echoes of the prostate. To determine the specificity of the examination, a prospective study was designed to correlate sonographic findings with histological diagnoses. Gray scale transrectal sonography was performed on 228 patients and the scans were reviewed without clinical information. The sensitivity (true positive rate) was confirmed by histological evaluation in 121 cases to be 90 per cent. The specificity (true negative rate) was determined by histological evaluation as well as subsequent clinical followup to be 60 per cent. Our experience is similar to that of others showing transrectal sonography as a sensitive diagnostic tool. The relatively low specificity demonstrates the difficulty in differentiating the abnormal internal echoes of the prostate, representing malignant and nonmalignant prostatic disease processes.