Influence of lip support on the soft-tissue profile of complete denture wearers.

Complete dentures change the soft-tissue profile, although the exact relationship remains unclear. This study examined the relationship between the presence and degree of lip support provided by dentures and the lateral views of the facial appearance of edentulous patients. The subjects were five edentulous patients (three men and two women). Their facial appearances with experimental record blocks, with and without their complete dentures, were measured using a three-dimensional laser measuring system. The experimental record block for each subject had different conditions in the anteroposterior direction anteriorly but the same vertical dimensions posteriorly. The lateral digital facial images were displayed on a computer monitor, and the linear and angular measurements were analysed using image analysis software. The nasolabial angle was smaller and the labial points projected more with excessive lip support versus with deficient support. Moreover, the counter of the nose was affected by the labial flange of the record base, particularly in the facial appearance of one subject with highly atrophic residual ridges. The lip support affected the lower facial soft-tissue profile, including the lower part of the nose; the nasolabial angle and positional relationship between the lips and Ricketts's esthetic plane (E plane) are useful indexes for examining lip support.

Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity.

In a curved tube, the amount of airflow appears to be influenced by the amount of curvature. The purpose of this study was to investigate changes in obstructive sleep apnoea (OSA) severity and awake velopharyngeal curvature in response to an anteriorly titrated mandibular position in 20 male OSA patients. Baseline supine cephalometry was obtained before the initial insertion of a titratable oral appliance and follow-up supine cephalometry was undertaken after titration of the mandibular position with the appliance in place. The mean apnoea/hypopnea index (AHI) before treatment (31.6 +/- 13.0 events x h(-1)) was significantly reduced (9.8 +/- 7.4 events x h(-1)) after titration of the mandibular position in all 20 patients. There was a significant increase in the anteroposterior calibre and the radius of the curvature of the anterior wall of the velopharynx in 14 good responders who exhibited an AHI reduction to < or = 15. Similar observations were not found in six poor responders. To conclude, an anteriorly titrated mandibular position reduced obstructive sleep apnoea severity, enlarged the velopharynx and diminished the curvature of the anterior velopharyngeal wall in good responders. It is proposed that this change in the upper airway curvature associated with mandibular advancement may effect obstructive sleep apnoea severity through its effect on airflow dynamics.

A novel phosphotyrosine mimetic 4'-carboxymethyloxy-3'-phosphonophenylalanine (Cpp): exploitation in the design of nonpeptide inhibitors of pp60(Src) SH2 domain.

The novel phosphotyrosine (pTyr) mimetic 4'-carboxymethyloxy-3'-phosphonophenylalanine (Cpp) has been designed and incorporated into a series of nonpeptide inhibitors of the SH2 domain of pp60(c-Src) (Src) tyrosine kinase. A 2.2 A X-ray crystal structure of 1a bound to a mutant form of Lck SH2 domain provides insight regarding the structure-activity relationships and supports the design concept of this new pTyr mimetic.

Impression pressures against teeth in a partially edentulous model with a mobile tooth: influence of impression tray design.

The purpose of the present study was to examine the effect of custom tray designs on local pressures against teeth during the impression procedure. In a previous study, a partially edentulous simulation model with a mobile tooth was used, and the effect of custom tray designs on the displacement of the mobile tooth was examined during the impression procedure. Based on that study's results, we have assumed that the differences in impression pressures between the labial and the lingual sides of a mobile tooth could either cause or affect displacement. The present study was undertaken to determine the local impression pressures against each side of three anterior teeth, including one mobile tooth, using the same simulation model and the same custom trays as in the previous study. It was found that the local pressures exerted against teeth during the impression procedure were affected by the custom tray designs and varied according to the coronal shape, axis inclination and location of the teeth.

Displacement of a mobile tooth during impression procedure: effect of impression tray design.

When fabricating prostheses in a partially edentulous arch with some mobile teeth, it is important to minimize tooth displacement during the impression procedure. The present study examined the effect of custom tray designs on the displacement of a mobile central incisor in a mandibular simulation model with six anterior teeth. Twelve custom trays were designed according to the different spaces and perforated holes in the region of the remaining teeth. As a result, the degree of displacement of the mobile tooth could be reduced according to the size of spaces and the location of perforated holes in the custom tray.

Analysis of residual ridges and ridge relationship by three-dimensional reconstruction method.

The purpose of this study was to develop a diagnostic system with which to determine the adequate area for artificial tooth arrangement on the posterior residual ridge. Edentulous plaster models and occlusion rims were measured by a non-contact type shape measurement system. Three trigonal pyramids and their impressions on the occlusion rims were used as landmarks for the analysis and superimposition of the analysis results for the upper and lower ridges. The data points were obtained at intervals of 0.5 mm in the lateral direction and of 0.25 mm in the anteroposterior direction, and were interpolated by cubic spline curves in the lateral direction. When the ridge contour of the reconstructed image came in contact with the tangent line inclined at 30 degrees to the tentative plane of occlusion at the buccal and lingual sides in the frontal section, the area between their points of contact on both sides was comparatively flat and was regarded as adequate for the artificial posterior tooth arrangement in this study. This diagnostic system seems to be useful in determining the adequate area for the artificial tooth arrangement on the posterior residual ridges of edentulous plaster models and in displaying their horizontal relationship.

A visual method for analysing bucco-lingual position of artificial posterior teeth. Part 1: use of the ridge crest.

We have developed a visual analysis method to examine the spatial relationship between the edentulous ridges and the bucco-lingual position of the artificial posterior teeth in complete denture fabrication. In this system, a non-contact type shape measurement system is used. We applied this system to the plaster models and the wax dentures of an edentulous patient. Using the measurement data on the upper and lower plaster models, we reconstructed their shape three-dimensionally and determined the points regarded as the ridge crests and the inter-alveolar crest lines in the frontal sections. To generate the upper and lower ridge crest lines which consisted of the points of the ridge crests, interpolation by B-spline curves was applied. Furthermore, the loft surfaces that we regarded as the consecutive inter-alveolar crest lines, were generated between the upper and lower ridge crest lines. The surface models of the plaster models and artificial teeth were displayed on the cathode-ray tube display unit, and the ridge crest lines and the consecutive inter-alveolar crest lines were superimposed on the surface models. This method could be utilized to visualize and examine the bucco-lingual position of the artificial posterior teeth in reference to the inter-alveolar crest lines.

[Reduction in mean cerebral blood flow measurements using 99mTc-ECD-SPECT during normal aging].

Mean cerebral blood flow (mCBF) was measured by SPECT using the 99mTc-ECD-Patlak-Plot method in a selected group of 61 normal non-hospitalized subjects aged 51 to 91 years. The mCBF values showed 48.4 +/- 4.7 ml/100 g/min in aged 50-59 years group, 49.9 +/- 5.9 ml/100 g/min in aged 60-69 years group, 46.4 +/- 6.5 ml/100 g/min in aged 70-79 group, 38.0 +/- 3.7 ml/100 g/min in aged 80-89 years group, 38.9 ml/100 g/min in aged 90-99 years group. There was a statistically significant reduction of mCBF with advancing age (R = -0.41; p = 0.001). Women have significantly higher mCBF values than men up to aged 70 years group. In this study, there was no significant laterality in the mCBF between right and left hemispheres in all decade groups. The history of hypertension, alcohol consumption, and cigarette smoking failed to show significant difference in the mCBF values. The present study shows that normal aging is associated with mCBF reduction.

Trial of duplication procedure for complete dentures by CAD/CAM.

The purpose of this study was to duplicate the shapes of complete dentures by using a computer-aided design/manufacturing (CAD/CAM) system. The shapes of the complete dentures of an edentulous patient were measured using a non-contact type shape measurement system and morphological data at the interval of 0.25 mm were obtained in the X-axis and Y-axis directions. Measurement was performed from the occlusal surface and mucosal surface sides. Based on the three-dimensional morphological data, cutter paths for cutting were generated. For cutting, the three-step method consisting of rough cutting, finish cutting, and partial finish cutting was used and for duplicating the dentures the modelling wax was cut using a computerized numerical control (CNC) processor and ball-end mills with diameters of 6 mm and 1 mm. The method for the controlling of three axes (X, Y, and Z) of CNC machine was used, and cutting was performed only from two directions. Although further improvements are needed in the measurement and cutting in acute slope areas, the duplication of complete dentures appears to be possible using the CAD/CAM system.

Application of a three-dimensional reconstruction method to analysis of the residual ridge.

The purpose of this study was to develop a new method of analysing the shape of the residual ridge. The line of the residual ridge crest was regarded as the reference for artificial tooth arrangement and a method of determining it was evaluated. The shape of a plaster model was measured with a contact-type shape measurement system. The measurement data in each frontal section were interpolated by cubic splines. The points corresponding to the residual ridge crest were calculated and superimposed onto the image of the plaster model on a monitor screen of an image processor. Using these points and the image of the plaster model, the line of the residual ridge crest was marked on the plaster model. It was concluded that this method could be used to determine the line of the residual ridge crest on a plaster model.

Diagonistic dyspraxia. Clinical characteristics, responsible lesion and possible underlying mechanism.

We present three patients who showed, in addition to signs of callosal interruption, a variety of abnormal motor behaviour of the left hand dissociated from conscious volition, in the absence of pathological grasping phenomena. The abnormal movements of the left hand consisted of (i) antagonistic movements to the right; (ii) non-antagonistic, irrelevant movements to the right; (iii) symmetric movements to the right in which the left hand sometimes preceded the right, and (iv) occasional inability to move at will during a bimanual task. From these observations and a review of previous publications, we propose that, in most right-handed subjects; diagonistic dyspraxia could be defined as abnormal motor behaviour of the left hand activated by voluntary movements of the right hand. Motor phenomena similar to diagonistic dyspraxia but attributable to impulsive groping movements induced by medial frontal lobe pathology should be excluded from diagonistic dyspraxia. Comparison of MRIs of the three patients with those of five patients who developed no diagonistic dyspraxia following an infarction of the corpus callosum, with or without medial hemispheric involvement, revealed that damage to the ventral part of the posterior end of the body of the corpus callosum was crucial for the development of diagonistic dyspraxia. Since the commissural fibres between the superior parietal lobules pass through the caudal part of the body of the corpus callosum, and also since there is accumulating evidence that the human superior parietal lobule is concerned with selection of movement based on the integration of visual and/or somatosensory information, we infer that diagonistic dyspraxia is produced by a disconnection of the right superior parietal lobule from the left which is dominant for volitional control of movement in most right-handed subjects.

Conformational studies of retro-inverso peptides: the crystal and molecular structure of the hydantoin from H-Ala-g-Ala-mGly-OBzl.

The crystal structure of the hydantoin 1-[(S)-1'-aminoethylmalonyl benzyl ester]-(S)-4-methylimidazolidin-2,5-dione (1) derived from the peptide H-Ala-gAla-mGly-OBzl, having the retro-inverso modification of the Ala-Gly bond, has been determined by x-ray diffraction analysis. The crystals are orthorhombic, space group P2(1)2(1)2(1) with a = 6.539, b = 14.721, c = 17.101 A, z = 4. The structure was solved by direct methods and refined with anisotropic thermal factors to a final R value of 0.067 for the 947 observed reflections. Reversal of the Ala-Gly amide bond perturbs the folding tendency of the backbone shown by the parent peptide t-BuCO-Ala-Gly-NHiPr. The gem-diamino residue, gAla, and the malonyl moieties are found in the helical and the extended conformations, respectively. Intramolecular hydrogen bonding is not observed. The molecules in the crystal are held together by the formation of two intermolecular hydrogen bonds of the N-H ... O=C type with N ... O distances of 2.86 and 3.17 A, respectively.

[A comparison of risk factors between silent brain infarction and symptomatic brain infarction--clinical significance of hypertension and diabetes mellitus].

We studied a clinical significance of hypertension and diabetes mellitus between silent brain infarction and symptomatic brain infarction. History of hypertension was present in 50% of silent infarction and in 53.3% of symptomatic infarction. Untreated hypertension was more frequent in symptomatic infarction than silent infarction (28.3% vs 16.7%) and the control of the blood pressure was very poor even if the patients with symptomatic infarction was treated with antihypertensive drugs. 66.7% of silent infarction with hypertension was treated with antihypertensive therapy and the control of the blood pressure was also relatively good. In the population with silent infarction, good control of the blood pressure was important for the prevention of symptomatic infarction. Diabetes mellitus with long history was strongly related to symptomatic infarction as compared with silent infarction. The prevalence of both hypertension and diabetes mellitus was high in the population with symptomatic infarction as compared with silent infarction and control individual.

[Two cases of cerebral embolism showing global aphasia without hemiparesis].

We report two cases of typical global aphasia without hemiparesis due to cerebral embolism. Case 1 was a 65-year-old right-handed man with a history of old myocardial infarction. No spontaneous speech was noted by his family. Neurological examination upon admission revealed confusional state, global aphasia, conjugate deviation to the left and slight drift of the outstretched right limbs. The right hemiparesis rapidly recovered after admission. CT scan performed on the second hospital day showed discrete low density areas in the left posterior frontal lobe and left temporo-parietal regions. The extent and severity of his global aphasia were unchanged. The second case was an 82-year-old right-handed man with a history of atrial fibrillation. He was admitted to our hospital one hour after he was found unable to speak. Neurological examination upon admission revealed global aphasia, conjugate deviation to the left and suspected right homonymous hemianopia by confrontation. There was no sign of hemiparesis. CT scan showed extensive low density area in the left temporo-parietal regions. In both cases, cerebral angiography failed to demonstrate any occlusion of intra- and extra-cranial blood vessels. IMP-SPECT showed a depression of cerebral blood flow in the left anterior and posterior watershed areas in case 1 and 2. In the literature, there have been 20 cases of global aphasia without hemiparesis including our two cases. In many cases, the initial symptom was inability or difficulty in speaking.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cerebrovascular disease in the elderly--a clinicopathological study of 45 autopsied cases with cortical artery infarction].

The medical records and autopsy data of patients over the age of 70 years at death with a diagnosis of cortical artery infarction (CAI) in the Yokufukai Geriatric Hospital were reviewed. Among 690 autopsied cases from 1981 to 1988, there were 45 cases (21 men and 24 women) with CAI available for this study. Fourteen cases (31.1%) suffered CAI while hospitalized for another disorder. Their ages at death ranged from 70 to 102 years with a mean of 82.4 years. From the results of this neurological and psychological analysis, the residuals of senile stroke were classified into six subtypes: 1) cerebrovascular dementia, 2) cerebrovascular Parkinsonism, 3) pseudobulbar palsy, 4) chronic stage of aphasia, 5) slowly-progressive decreased motivation or spontaneity without dementia, 6) the so-called bedridden state (prolonged vegetative or apallic state). Sixty-nine percent had anamnetic hypertension before the stroke. The ages at which they became bedridden ranged from 69 to 102 years with a mean of 81.8 years. Within one year after becoming bedridden, 83.3% of all patients died. The bedridden state in the elderly with residual CAI indicated a poor prognosis within one year after stroke. Causes of death included brain death in 22.3% of all patients, pneumonia in 20.0%, and digestive bleeding in 8.9%.

[Cerebrovascular disease in the elderly--clinical study of 31 cases with acute intracerebral hemorrhages].

Thirty-one consecutive cases of intracerebral hemorrhage (ICH) in the elderly (over 70 years at the onset) were reported with special reference to neurological evaluations, prognosis and mortality in the acute phase. There were 11 men and 20 women with ICH, who were admitted to the Yokufukai Geriatric Hospital within 24 hours after the onset of ICH. Their ages at the onset ranged from 71 to 93 years with a mean of 81.1 years. The lesion location showed 5 cases with thalamic hemorrhage, 4 cases with putaminal hemorrhage, 6 cases with subcortical hemorrhage, 7 cases with cerebellar hemorrhage, 8 cases with mixed hemorrhage and 1 case with unclassified hemorrhage. 61.3% of all cases showed the onset during daytime but the remaining awoke in the morning with their symptoms or had the onset from the stage of the bedridden state. The classical prodromal symptoms headache and nausea or vomiting were found in 30% and 54.8%, respectively. Two cases with cerebellar hemorrhage were accompanied by vertigo. Twenty-four patients had consciousness disturbance at admission. There were 18 cases with right or left hemiparetic symptoms, 5 cases with tetraparesis, and 5 cases without motor dysfunction. The remaining already had hemiparesis due to old stroke. Patients with mixed hemorrhage usually exhibited conjugate deviation. In 9 of 31 cases there were mental symptoms such as wandering or night delirium. The 30-day mortality rate was 64.5% and sixty-five percent of them died within 6 days after the onset of ICH. Consciousness at admission was the overwhelming predictive factor.(ABSTRACT TRUNCATED AT 250 WORDS)

[A consideration of determining the removal or retention of teeth in the patient with a few remained teeth].

The alveolar bone of edentulous ridge is resorbed after the teeth extraction and the subsequent denture insertion. For the periodontal structure, the stress transmitted along the longitudinal axis is favorable, but the horizontal stress is destructive. Under the overdenture application which the retained teeth have the reduced clinical crown, it is possible to prevent the alveolar bone resorption and to improve the involved teeth. However it is difficult for the inclined teeth to get the successful results. In a case, having a few remained teeth contained the embedded root stump and the overdenture being applicated, we obtained the suggestion as follows. 1. Also the embedded root stump is useful to prevent the alveolar bone resorption. 2. The top and direction of longitudinal axes of the inclined abutment teeth can be determined by means of surveying the least teeth movement when the stress was applied to the teeth by the fingers with dental pincette. 3. Also to the inclined abutment teeth, it is possible to transmit the stress along the longitudinal axes, when the overdenture has the contact with the short dome coping at the top and in the inferior area to the longitudinal axes inclined, and is relieved in the superior area to its axes.

[Cerebrovascular disease in the elderly--a clinicopathological study of 73 autopsied cases with intracerebral hemorrhage].

The medical records and autopsy data of patients over the age of 70 years at death with a diagnosis of intracerebral hemorrhage (ICH) in the Yokufukai Geriatric Hospital were reviewed. All cases with ICH caused by head injury, rupture aneurysms or arteriovenous malformations were excluded from this study. There were 73 autopsied cases with spontaneous ICH from January 1978 to September 1988. There were 33 men and 40 women. Fourteen percent of the patients had a stroke while hospitalized for another disorder. Their ages at death ranged from 70 to 99 years with a mean of 81.8 years. Of these, 48 cases (66%) were 70 years or older at the time of ICH. In the senile ICH (over 70 years), the following characteristics were observed; (1) the most common location was the thalamus, which accounted for 33.3% of the hemorrhage. (2) subcortical and cerebellar hemorrhage accounted for 16.6% and 14.6% of the total, respectively. (3) there was no pontine hemorrhage. Fifty-seven percent had anamnestic hypertension before the stroke. The ages at which they became bedridden state ranged from 62 to 92 years with a mean of 79.5 years. This study revealed that the non-organic factors such as insidious generalized muscular weakness or decreased spontaneity were important as causes of the deterioration of ADL in the chronic stage of the senile ICH. Within one year after becoming bedridden state, 76.1% of all patients died. The bedridden state in the elderly with the residuals of ICH indicated a poor prognosis. As causes of death, pneumonia occurred in 28.8% of all patients, brain death in 19.2%, and sudden death in 12.3%.

[A clinicopathological study of candidemia in the elderly].

Candidemias were reviewed in 22 elderly patients hospitalized in Yokufukai Geriatric Hospital. Their ages ranged from 62 to 101 years, with a mean age of 81 years. Sixteen patients had either old cerebrovascular disease or senile dementia. In seven patients, synchronous or metachronous bacteremia in the blood culture was associated with the candidemia. Eighty-six percent of total candidemias were related to intravenous hyperalimentation (IVH). The mean duration from the start of IVH to candidemia was 46 days. Eleven patients (50%) developed candidemia within one month after the beginning of IVH. Fourteen patients had the IVH catheters changed one or more times before the time of positive candida in the blood culture. The mean duration from the start of IVH to candidemia was 59 days. Eight patients, on the other hand, had the catheters unchanged and the mean duration was 23 days. Ninety-six percent were receiving broad-spectrum antibiotic therapy at the time of the positive candida in blood culture. Eight patients developed DIC. The overall mortality was 91% (twenty patients) and thirteen (65%) of them died within one month after the onset of candidemia. There was no difference in mortality when all candidemic patients received no anti-mycotic therapy were compared with the patients given any amount of miconazole or 5-FC. The causes of death for candidemic patients included fungemic shock (6 patients), hemorrhagic shock (4 patients), and shock associated with DIC (3 patients). From the results of this study, candidemia in the elderly was produced by various underlying diseases such as central nervous system diseases or pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of associative visual agnosia: neuropsychological findings and theoretical considerations.

A 61-year-old right-handed man fell downstairs and was found unconscious. There was no abnormality in the general physical examinations. Neurological examinations revealed a quadrantanopia. Neuropsychological examination revealed an impairment in recent verbal memory, alexia, agraphia, object agnosia, color naming difficulty, prosopagnosia, and visuospatial constructional disability. CT scan demonstrated subcortical hematomas in the temporo-occipital regions of both hemispheres. MRI demonstrated extensive low-intensity lesions in the lingual, fusiform and posterior inferior temporal gyri on both hemispheres. Both inferior longitudinal fasciculi were also affected. His neuropsychological deficits seem best described as a typical form of associative visual agnosia. From the results of neuroradiological findings, the authors emphasize that associative visual agnosia might be produced by an intrahemispheric disconnection between the visual cortices and the temporal lobes which are supposed to be the storage site of the engrams of visual memories. Moreover, the neuropsychological findings suggest that the visuo-constructional ability to convert the two-dimensional input to the three-dimensional construction and the capacity of three-dimensional imagination were severely impaired in our patient. It was considered that these neuropsychological features play an important role in the recognition difficulties of associative visual agnosia.