Long-term effects of orthognathic surgery on the temporomandibular joint: comparison of rigid and nonrigid fixation methods.

Sixty-six patients were examined between 2 and 9.5 years after bilateral sagittal split mandibular ramus osteotomy. Thirty-two patients had nonrigid fixation consisting of superior border wires and intermaxillary fixation, while 34 patients had rigid plate fixation of the osteotomy sites with immediate function. There were no demonstrable long-term differences between the two groups with respect to mandibular vertical opening, crepitance, and temporomandibular joint pain. Masticatory muscle pain and temporomandibular joint clicking improved with rigid fixation and worsened with nonrigid fixation.

Long-term retrospective analysis of twenty-three Proplast-Teflon temporomandibular joint interpositional implants.

This retrospective analysis reviews 15 patients with a total of 23 Proplast-Teflon interpositional implants. Most of the implants have been removed because of implant fragmentation and giant-cell inflammatory reaction. Recommendations for continued long-term care of patients with such implants are offered.

Calibration of respiratory inductive plethysmograph during natural breathing.

We describe a single-posture method for deriving the proportionality constant (K) between rib cage (RC) and abdominal (AB) amplifiers of the respiratory inductive plethysmograph (RIP). Qualitative diagnostic calibration (QDC) is based on equations of the isovolume maneuver calibration (ISOCAL) and is carried out during a 5-min period of natural breathing without using mouthpiece or mask. In this situation, K approximates the ratio of standard deviations (SD) of the uncalibrated changes of AB-to-RC volume deflections. Validity of calibration was evaluated by 1) analyzing RIP waveforms during an isovolume maneuver and 2) comparing changes of tidal volume (VT) amplitude and functional residual capacity (FRC) level measured by spirometry (SP) with RIP values. Comparisons of VT(RIP) to VT(SP) were also obtained in a variety of postures during natural (uninstructed) preferential RC and AB breathing and with voluntary changes of VT amplitude and FRC level. VT(RIP)-to-VT(SP) comparisons were equal to or closer than published reports for single posture, ISOCAL, multiple- and linear-regression procedures. QDC of RIP in supine posture with comparisons to SP in that posture and others showed better accuracy in horizontal than upright postures.

Variability of the breathing pattern before and after extubation.

A stable breathing pattern during unassisted ventilation through an endotracheal tube (ETT) prior to extubation is an important factor in determining whether a patient can be successfully extubated. Proper interpretation of changes in the breathing pattern requires knowledge of the normal variability of the breathing pattern in critically ill, intubated patients. To establish these guidelines, 50 spontaneously breathing patients who were being weaned from mechanical ventilation were monitored with respiratory inductive plethysmography for one hour immediately prior to and following successful extubation. Immediately after extubation, respiratory rate (f), tidal volume (VT), minute ventilation, and mean inspiratory flow increased slightly. By 30 minutes postextubation, these parameters were similar to preextubation values. There was no significant change in variability of f or VT. Although the breathing pattern of these relatively stable, intensive care patients differed from values of normal ambulatory subjects, values were similar in the preextubation and postextubation periods.

Continuous noninvasive monitoring of respiratory rate in critically ill patients.

Respiratory rate is a sensitive clinical parameter in a multitude of pulmonary diseases, especially in the critical care setting. In order to validate the routine recording of the respiratory rate in the intensive care unit, we compared the values obtained from the nursing records with the breathing frequency continuously recorded by a prototype microprocessor system using respiratory inductive plethysmography. We found a significant (greater than or equal to 20 percent) error in the staff's monitoring of respiratory rate one third of the time. In addition, we demonstrated the ease and reliability of using this prototype system as a continuous, noninvasive, long-term respiratory monitor in the intensive care unit.

[Study of surveillance of women using contraception]. / Enquete de surveillance de femmes sous contraception.

PIP: The results of contraceptive prescription for 1666 French women by 10 physicians are compiled from files covering 1969-1971. 736 women began in 1969-1970; 242 used the same method 1 year or more; 414 discontinued; 80 changed their method in the first 11 months. Comparing those starting in 1971 with the others, there were few significant differences: the 1971 groups more often tended to be married, housewives, recently delivered, and to choose pills. In general the group using pills were young, students or professional women, while those choosing IUDs were multiparas, married and housewives. 1030 chose pills, of whom 201 had side effects or complications such as: bleeding (27), nausea (17), liver disorders (19), weight gain (33), nervousness (27) and decreased libido (16). 442 women received 8 types of IUDs. Th ere were 59 expulsions, 49 with spotting and 25 with pain. Overall there were 359 dropouts, no accidental pregnancies in pill users, 9 pregnancies with IUDs, 6 pregnancies after expulsion of IUDs and 9 pregnancies with diaphrahms.^ieng

[Follow-up survey of women under contraception]. / Enquete de surveillance de femmes sous contraception.

PIP: Records of 908 patients of 10 Parisian gynecologists are included in these preliminary results of an ongoing 3-year survey of patient characteristics and consequences of contraception in France. The population averaged 26.8 years, parity 1.1; 39% were single, 21% not working, 15% students, the rest working. These characteristics, and the methods chosen, differed widely among patients of different physicians. 55.5% first chose pills, 26% IUDs, 18.5% chose diaphragm; of these, 28 pill patients, 11 IUD patients and 13 diaphragm patients then chose another method. The second choices were pills by 17, IUDs by 15, and diaphragms by 20. Those who chose pills tended to be single, working, nulliparas, and without previous contraceptive history. IUD and diaphragm users were similar in these characteristics. 7 types of IUDs (61% Corolle, 25% Saf-T-Coil, 16% Omega, 11% Trefle, 10% Sterilem, 6% Lippes loop, 1% Canel) resulted in 23 (9.7%) patients with bleeding side effects and 17 (7.1%) expulsions. 75% of pill patients took Stediril, 25% took 12 other types. Chief complications were weight gain in 11 (1%), nervousness or depression in 11, bleeding in 7, and nausea in 7. There were 7 accidental pregnancies, 2 with IUDs in place, 1 after expulsion (3.5% Pearl index), 4 pregnancies with diaphragm (11.06% Pearl index), and 2 unplanned pregnancies after the women stopped their pill and diaphragm because of their partner's objections.^ieng