Management of resistant hypertension: expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology.

To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information based on the strongest scientific rationale and that is easily applicable to daily clinical practice. Resistant hypertension is defined as uncontrolled blood pressure on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least 4 weeks, at optimal doses. Treatment compliance must be closely monitored, as must factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression, drug interactions and vasopressor drugs). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5-25 mg per day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a ß-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.

Morphological parameters as predictors of successful correction of Class III malocclusion.

The aim of the study was to assess pre-treatment cephalometric parameters and measurements of the size of the apical bases as predictors of successful orthodontic correction of Class III malocclusions. Pre- and post-treatment lateral cephalograms and study models of 80 completed Class III subjects were examined to obtain 23 cephalometric parameters taken mainly from the analyses of McNamara and Schwarz, and to measure the size of the apical bases. Success of occlusal correction was evaluated as the percentage change of peer assessment rating score during treatment, which was used as the dependent variable in multivariate statistical analyses testing the predictive value of the parameters assessed. No improvement in the Class III skeletal pattern occurred during treatment and the treatment effects were confined to dentoalveolar changes. With the exception of the percentage midfacial length/mandibular length ratio, the net sum of maxillary and mandibular length differences, the mandibular ramus height/mandibular body length ratio and the gonion angle, most cephalometric parameters of pre-treatment craniofacial morphology assessed were poor predictors of successful correction of Class III malocclusions. Assessment of the size relationship of the maxillary and mandibular apical bases was the strongest predictor of occlusal correction achieved and may serve as a valuable diagnostic addition in the prediction of successful treatment outcome.

Reliability and validity of the Digigraph 100 in orthodontic diagnosis.

Cephalometric analyses of lateral cephalograms allow important statements to be made on diagnosis and treatment planning. Such radiographs should, however, be taken with a considerable reduction in radiation exposure. With the Digigraph 100 (Dolphin Imaging Systems Inc., USA) a cephalometric technique based on distance measurements of emitted sonic signals is now available. This study was aimed at determining the degree to which this procedure can cope with the requirements of reliability and validity in the field of orthodontics. For this purpose 50 volunteers were examined by conventional cephalometry with manual tracing of lateral cephalograms as well as by sonic cephalometry, with Jarabak analysis in both cases. In addition an option was available for reading lateral cephalograms into the Digigraph by means of a radiograph evaluation program. The 31 evaluated parameters were subjected to modified statistical analysis. Good reliability was recorded in the range between 0.96 and 0.99 for eleven sonic cephalometric measurements, whereas 26 values were between 0.69 and 0.95. The validity was significantly lower in comparison to radiocephalometry. In particular, measurements related to landmarks which were difficult to access or could be only indirectly determined, such as the sella point, the articulare point or the apices of the incisors, proved to be weak points of sonic cephalometry. The device is thus indicated rather in the field of communication with the patient or for intermediate examination without radiation exposure. Cephalometry without radiation exposure would represent decisive progress in orthodontic diagnostics. However, some developmental work on the processing software or even the development of a specific sonic cephalometry which deliberately dispenses with parameters that are difficult to record with this procedure is still needed.

Size discrepancy of apical bases and treatment success in angle Class III malocclusion.

The aim of this retrospective clinical study was to measure the apical bases and determine their size relationship in Class III malocclusion cases before and after orthodontic treatment, in order to evaluate their significance for the treatment success. Maxillary and mandibular apical bases were measured on study models of 104 Class III cases treated by conventional orthodontics, using a specifically constructed conveyance apparatus, and related to each other as an index. Treatment success was quantitatively assessed as the percentage change of PAR scores obtained from the pretreatment and posttreatment study models. Statistically significant relationships were disclosed between the measurements of the apical bases and several other evaluated parameters. The results obtained indicate a high prognostic value of the size relationship of the apical bases for the treatment success of Class III malocclusion.

Statistical methods for the comparison of measurements derived from orthodontic imaging.

Biometric comparison procedures for dental imaging methods with continuous outcome were reviewed, mainly concentrating on assessment and comparison of accuracy and precision according to the study design. Univariate graphical and numerical representations of corresponding deviations were summarized to derive a 'check list' of minimum information necessary to compare the measurement methods. The methods reviewed in this investigation are illustrated by the comparison of conventional (radiographic) cephalometry versus assessment using the DigiGraph in 50 female children. A paired t-test and the corresponding confidence interval approach were used to assess deviations in location of two imaging methods; the test procedures of Maloney/Rastogi, Hahn/Nelson, and Grubbs were surveyed as proposals for the comparison of precisions in paired data. The Krippendorff coefficient was used as an aggregate measure for method concordance. Since these methods can be performed by simple modification of standard options available in most statistical software packages, this review intends to enable dental researchers to choose the correct methods, and perform adequate data analysis and representation.

Efficacy of protection by latex gloves during orthodontic therapy.

The wearing of gloves during orthodontic or dental treatment is generally indicated for reasons of hygiene and protection against infection. This study was aimed at determining the extent and localization of perforations caused by the various orthodontic treatment techniques and interrupting the infection barrier. The impermeability was tested by means of a water retention test according to European standard EN 455, Part 1, performed on 1600 Centramed (Centramed, Koblenz), Tekmedic and SafeEx non-sterile disposable latex gloves (both by Safe Med, Switzerland) and Safe Gan latex gloves with an additional acrylate coating (also by Safe Med). The perforation rate in unused gloves was between 0.5% and 7.5%, rising on average to 11% with increasing use. 36% of the total number of lesions resulted from handling removable appliances, and 57% from handling fixed appliances, especially when replacing arch wires and elastics. Most lesions were in the thumb, index finger and palm region. Only 18% of the defects were noticed by the dentists themselves. The gloves worn by beginners in their first year of postgraduate orthodontic training had about twice as many defects as those worn by qualified orthodontists. When patients with an increased risk of infection are to be treated, additional hand disinfection measures should be taken and 2 pairs of gloves worn in view of the relatively unreliable protection offered by commercially available latex gloves.

Relationship between patient discomfort, appliance acceptance and compliance in orthodontic therapy.

Orthodontic treatment is occasionally a discomfort to patients, due to pain or functional restrictions. In this context, several retrospectively planned studies were performed in the 1980s, but correlations between different aspects of patient discomfort were not investigated. The present study aimed at examining and structuring the psychogenic dimensions of patient discomfort. Furthermore, the impact of the patient's attitude on the intensity of discomfort was to be evaluated in addition to the influences of appliance therapy. The study was performed with 67 patients aged from 9 to 32 years. Prior to insertion of a new appliance, psychogenic scales reflecting their attitude towards orthodontic therapy were submitted to them. They were instructed to keep a discomfort log during the first 7 days after insertion. After 6 months they were given lists for retrospective assessment of discomfort and an appliance-acceptance scale to be filled in. At the same time, the respective orthodontist assessed his patient's compliance on a cooperation scale. The factor analysis revealed 3 levels of patient discomfort: feelings of tension, functional restrictions and aversion to wearing an orthodontic appliance in public. Appliance acceptance after 6 months could be predicted from the attitude towards treatment and the experienced discomfort. Patient compliance also correlated with these factors, so that causal flow diagrams of the investigated variables could be produced. Giving detailed information on any discomfort occurring and explaining how to reduce or eliminate it are vital factors in good treatment cooperation.

Spatial reproduction of the root canal system by magnetic resonance microscopy.

This study was intended to achieve an accurate spatial reproduction of the root canal system of extracted teeth by magnetic resonance microscopy (MRM). The measurements were performed in a Bruker spectrometer AMX 300 WB (300 MHz, 7T) with microimaging attachment. The data processing was carried out by a 3D-Fourier analysis and reconstructions were done by the UXNMR (Bruker) software system. The voxel resolution isotropically reached 98 microns, so that insights into the interior of teeth on a microscopic level could be obtained. The spatial configuration of the root canal system could be depicted in all parts from crown pulp to even small lateral canals. Within the pulp, tissue differences in its tissue texture were ascertained. As the necessary strong magnetic fields presently are not allowed to be used in people and as the acquisition of data is costly, the noninvasive MRM technique presently can be applied only in nonclinical situations.

[Reproducibility of the nyctohemeral cycle of blood pressure in patients with severe Parkinson disease]. / Etude de reproductibilité du cycle nycthéméral de la pression artérielle du parkinsonien dans un état grave.

UNLABELLED: Nineteen hospitalised, severe and treated parkinsonians (9 males, 10 females), stage IV and V of Hoehn and Yahr's classification, underwent 2 days running ambulatory blood pressure monitoring (ABPM) by ABPM 630 Nippon-Colin device, during a period of therapeutic stability. Hospitalisation allowed reproducibility of daily activity. Diurnal, nocturnal and 24 hours systolic blood pressure (SBP), as well as nocturnal and 24 hours diastolic blood pressure (DBP) were reproducible with a good correlation for each patient. Diurnal diastolic BP was the lone not reproducible value but had a good day 1-day 2 correlation. [table: see text] CONCLUSION: Parkinsonian ABPM data, except diurnal DBP, are reproducible.

Stray-field imaging (STRAFI) of teeth.

During endodontic treatment radiographs are used to get information about the root configurations of the teeth. Another modern imaging system in medicine, magnetic resonance tomography, provides fine pictures of soft tissues without using ionizing radiation. Currently, imaging of bone and teeth cannot be achieved very well by magnetic resonance tomography, therefore in a research experiment a special variant of magnetic resonance microscopy, stray field imaging, was used, which promises new ways of looking into the structure of solids including teeth. Initial experiences in reproducing the outer and inner contours of teeth with this new technique are presented. Limitations and further applications are discussed.

[The infiltrating angiolipoma--a rare soft tissue tumor with a malignant appearance]. / Das infiltrierende Angiolipom--ein seltener Weichgewebstumor mit malignem Erscheinungsbild.

Angiolipomas are rare benign soft tissue tumours that are mostly encapsulated by fibrous tissue. A case of an infiltrating angiolipoma with mixed vascularisation, not surrounded by a capsule, is described. Differentiation between lipoid degenerated fibromas, lipoid histiocytoses and haemangiomas is radiologically possible with an extensive security and enables an adequate choice of the surgical procedure.

[Combined bilateral idiopathic necrosis of the humerus and femur heads: bone scintigraphy, x-ray, CT and MRT findings]. / Kombinierte beidseitige idiopathische Nekrose der Humerus- und Femurköpfe: Skelettszintigraphie, Röntgen-, CT- und MRT-Befunde.

Aseptic bone necrosis in adults is usually caused by circulation defects or metabolic diseases but may also occur without any obvious reason. In these "idiopathic" cases, alcoholism seems to play a prominent role. In addition to the frequently affected femoral heads other bones may be involved. Here a remarkable pattern of localizations is reported: the bilateral idiopathic necroses of the heads of both humerus and femur. Untreated aseptic bone necroses close to a joint commonly leads to severe secondary arthrosis and destruction of the joint within a short time. Therefore, only a diagnosis in an early stage of the disease offers the chance of a successful joint-preserving therapy. In cases of clinically suspected aseptic bone necrosis but still negative or doubtful X-ray findings, bone scans or MRI are reliable methods of verifying the diagnosis.

[The percutaneous irradiation of osteolytic bone metastases--a course assessment]. / Perkutane Radiatio osteolytischer Knochenmetastasen--eine Verlaufsbeurteilung.

Percutaneous radiotherapy is the most effective modality for treatment of metastatic bone cancer. Local irradiation improves overall quality of life by relieving pain in most patients. It also helps preventing complications as pathological fractures in lytic bone lesions by new bone formation. In a retrospective study on 100 patients, irradiated for lytic bone metastases, the radiotherapeutic effect on alleviation of pain and on recalcification rate was investigated. In our experience in 84% of the cases pain and disability associated with bone metastases could be decreased. 38% of the patients had complete relief of symptoms. A correlation between subjective therapy effect and histology of the primary tumor was not demonstrated. Remineralization was found in 67% of all irradiated skeletal areas (n = 137) (recalcification rate in breast cancer 77%, in bronchial carcinoma 27%, and in renal cell carcinoma 25%). After a total dose of 30 Gy reduction of the metastases-associated pain was achieved in 81% of the cases and remineralization was observed in 70% of the cases.

[A comparative study of the possibility of reducing the dosage in lateral teleradiographs]. / Vergleichende Untersuchung zur Möglichkeit der Dosisreduzierung von Fernröntgenseitenaufnahmen.

Thanks to their capability for post-processing of image data, the digital radiological techniques introduced from 1970 onwards permit dose reduction with no loss of clinical information. The aim of this study was to establish the extent of possible dose reduction in orthodontic lateral cephalography. For this purpose, lateral cephalograms of a head phantom taken with varying radiation doses (5 to 150 mAs, constant 70 kV) were evaluated. The evaluations of ten judges were compared statistically. Conventional lateral cephalograms showed a statistically proven superiority of a number of exposure parameters for the sagittal and vertical localisation of reference points. This correlated with the radiological density of the structures. In contrast to the conventional technique, the reference points in all images obtained by digital luminescence radiography showed no such tendency. Digital luminescence thus meets the clinical need to reduce radiation dose (to about 20% of the usual dose) while providing no less diagnostic information.

[Initial experience with digital luminescence radiography in the radiological diagnosis of the visceral cranium]. / Erste Erfahrungen mit der digitalen Lumineszenzradiographie bei der radiologischen Diagnostik des Gesichtsschädels.

The purpose of this study was the evaluation of digital luminescence radiography (PCR; Philips Computed Radiography) used in routine radiological analysis of the facial skull. Besides the standard radiographs additional PCR shots were taken in 16 cases. The subjective evaluation was carried out by three different people using clinical criteria. PCR films showed a significant advantage compared to standard radiographs for the above mentioned applications.

[Comparative study of the accuracy of localizing cephalometric reference points in using digital and conventional imaging technique]. / Vergleichende Untersuchung zur Genauigkeit der Lokalisierung kephalometrischer Referenzpunkte bei Anwendung digitaler und konventioneller Aufnahmetechnik.

The purpose of this study was to present possible advantages of digital luminescence radiography for cephalometry. Conventional and digitalized lateral headfilms were compared and evaluated. The first impression of an improved simultaneous presentation of bony structures and soft tissue profile in digital x-rays was statistically verified. A significant difference in identification of several reference points was proven by means of the F-test. The superior results of the digital luminescence radiography were evaluated in comparison with xeroradiography and experimental postdigitalization of conventional x-rays.