Surgical and prosthetic reconsiderations in patients with maxillectomy.

The purpose of this study was to establish and evaluate new possibilities for rehabilitation of patients with obturator prosthesis who had undergone partial or total maxillectomy because of tumour ablation surgery. Eleven patients with maxillary defects were reconstructed with a computer-aided design/computer-aided manufacturing designed prosthesis. Missing retention was gained by inserting implants in the remaining bone, so that an expansion of the surgical defect to gain further retention could be avoided. All patients were treated successfully according to the previously described treatment plan. The Obturator Functioning Scale (OFS) of the Memorial Sloan-Kettering Cancer Centre was applied to evaluate the functional quality of the obturator prosthesis and patient's satisfaction. It showed good results in all fields of functional outcome and social acceptance.

Synthesis and aqueous solution properties of sterically stabilized pH-responsive polyampholyte microgels.

Emulsion copolymerization of poly(methacrylic acid) and poly(2-(diethylamino)ethyl methacrylate) (PMAA/PDEA) yielded pH-responsive polyampholyte microgels of 200-300 nm in diameter. These microgels showed enhanced hydrophilic behavior in aqueous medium at low and high pH, but formed large aggregates of approximately 2500 nm at intermediate pH. To achieve colloidal stability at intermediate pH, a second batch of microgels of identical monomer composition were synthesized, where monomethoxy-capped poly(ethylene glycol)methacrylate (PEGMA) was grafted onto the surface of these particles. Dynamic light-scattering measurements showed that the hydrodynamic radius, Rh, of sterically stabilized microgels was approximately 100 nm at intermediate pH and increased to 120 and 200 nm at pH 2 and 10, respectively. Between pH 4 and 6, these microgels possessed mobility close to zero and a negative second virial coefficient, A2, due to overall charge neutralization near the isoelectric pH. From the Rh, mobility, and A2, cross-linked MAA-DEA microgels with and without PEGMA retained their polyampholytic properties in solution. By varying the composition of MAA and DEA in the microgel, it is possible to vary the isoelectric point of the colloidal particles. These new microgels are being explored for use in the delivery of DNA and proteins.

[Central stimulants in adults with AD/HD. Do they help?]. / Sentralstimulerende midler ved AD/HD hos voksne. Kan de hjelpe?

This article is a review of five controlled studies of the efficacy of methylphenidate in adults with attention deficit/hyperactivity disorder (AD/HD). All five had a placebo cross-over design. In one of the studies, patients noted from the side-effects whether they were taking methylphenidate or placebo, and it is, in fact, unlikely that any of the studies were blind. The diagnostic criteria used in two of the studies were not appropriate according to present knowledge, leaving three samples of subjects meeting the present criteria for AD/HD. In one study, the patient material was extremely selective: 74% of subjects belonged to social class 1 and 2, and only 35% of those who came for treatment were eligible. Only one study has an acceptable (though not perfect) design. In this study of patients in a psychiatric clinic, no difference was found between methylphenidate and placebo. In two studies, subjects who improved on methylphenidate were followed up. Of the total of 24 subjects in these two samples, only four continued with methylphenidate after 3-12 months; two of them suffered from narcolepsy and one was a substance abuser. Thus, the efficacy of methylphenidate on AD/HD in adults has not been demonstrated. Present research is more against than in favour of its existence.

[Central stimulants in adults with AD/HD. Can they be abused?]. / Sentralstimulerende midler ved AD/HD hos voksne. Kan de misbrukes?

As early as in 1979, abuse was observed when adults with MBD were treated with psychostimulants. In a study from 1981, five patients (19%) had been stimulated or excited. It was concluded that there was no reason to believe that adults with MBD were immune from stimulant abuse problems. In subsequent studies, it has been the rule to exclude patients who abuse alcohol or drugs. Obviously, there has been agreement that treatment implies a considerable risk of abuse of stimulants. However, nobody has systematically studied the frequency of psychostimulant abuse in subjects with AD/HD with and without abuse of alcohol and drugs, neither during the study nor at follow-up. There has been some attempts at using pemoline, a stimulant which cannot be abused. However, the mental and physical complications have been severe. Some preliminary studies indicate that stimulants can be used to treat alcoholics and substance abusers with concurrent AD/HD. Before such treatment can be recommended, the observations should be confirmed in controlled studies with representative materials, and the patients should be followed over a long period of time. It seems that stimulants are not an appropriate treatment for subjects with psychopathic personality and antisocial behaviour.

[Attention deficit/hyperactivity. Diagnostic criteria and classification]. / Oppmerksomhetsdeficit/hyperaktivitetslidelse. Diagnostiske kriterier og klassifikasjon.

General problems regarding diagnostic criteria and classification of attention deficit/hyperactivity disorder are discussed. A comparison of the most recent versions of the present diagnostic systems shows that they have converged and now overlap each other considerably. ICD-10 (clinical criteria) is still descriptive. DCR-10 (ICD-10's criteria for research) and DSM-IV both have operational criteria. The symptom lists of DCR-10 and DSM-IV are almost identical, and the criteria are very similar. The divisions into types, however, are very different, and none can be recommended. In clinical practice, and particularly in research, it is recommended that cases fulfill the criteria for "disturbance of activity and attention" (F90.0) in DCR-10 or "attention deficit/hyperactivity disorder, combined type" (314.01) in DSM-IV. There are considerable differences between former and present criteria. This must be considered when research results based on former criteria are examined.

[Attention deficit/hyperactivity disorder in adults. Diagnostic problems]. / Oppmerksomhetsdeficit/hyperaktivitetslidelse hos voksne. Diagnostiske problemer.

Following several reports on treatment of adults with attention deficit/hyperactivity disorder, diagnostic problems regarding the diagnosis are discussed. Symptoms and criteria have changed considerably over the years. Many of those who were given this diagnosis earlier would probably be given a different diagnosis today. Patients should be diagnosed according to the latest diagnostic criteria, but these are developed for children, and are not always adequate for adults. Knowledge regarding the manifestation of the disorder in adults is not sufficient. In order to make this diagnosis in an adult, there must be evidence of the symptoms at the time of examination and also in childhood. The latter may be difficult or impossible to demonstrate. Reliable information on the symptomatology of attention deficit/hyperactivity disorder in adulthood will not be available until children who are given the diagnosis today according to DSM-IV or the research criteria of ICD-10 have been followed up in adulthood.

Prediction of criminal behavior in young Swedish women using a group administration of the Hand Test.

2,074 Swedish girls and adolescents were administered a group version of the Hand Test. About ten years later, 80 of these subjects had committed crimes serious enough to be entered on the General Police Register. These young women offenders were then matched by age with nonoffenders and the two groups compared on 17 quantitative Hand Test variables. Significance was found for the Tension and Pathology scores, suggesting that these young female lawbreakers were characterized as youngsters having scores indicating anxiety and other forms of psychopathology rather than innate hostility.

[Traditional and non-traditional curricula. Definitions and terminology]. / Tradisjonelle og utradisjonelle studieplaner. Definisjoner og terminologi.

Differences between traditional (conventional) and innovative curricula are described. Technical terms are defined or explained. In traditional tracks, basic and clinical sciences are studied separately. The students meet the first patient after several years. The education is mainly discipline-, teacher-, lecture- and hospital-based. In innovative programmes, basic sciences are taught throughout the study parallel with clinical subjects (vertical integration), and subjects from related disciplines are often taught concurrently (horizontal integration). The students meet patients from the first day at the university, participate from the first week in courses in clinical skills, and, after some months, attend continuity clinics in the community. Teaching is student-directed, problem-based and/or community-oriented, with several electives. Many of the strategies above are also used in traditional curricula. The main difference between traditional and innovative curricula is whether basic and clinical sciences are vertically integrated or not.

[The psychiatric semester and recruitment of future psychiatrists]. / Psykiatriterminen og rekruttering til psykiatri.

Before and after the psychiatric course, students from three successive year classes received a questionnaire. Of 102 subjects, 75% responded before and 82% after the course to the question: "Would you like to be a psychiatrist? (1 = definitely not--8 = very much). 11% chose one of the alternatives 6-8 before the course, and 24% after. No differences were noted between the three classes prior to the course. After the course, the students were asked to rate the total profit of the course on a 8-point scale from 1 (no gain) to 8 (very much gain). The class with the highest mean for total profit also had the highest mean for motivation for becoming a psychiatrist. The class with the lowest mean for profit had the lowest mean for psychiatry. Among the former, 38% selected one of the alternatives 6-8 regarding preference for psychiatry. Among the latter the corresponding frequency was 16%. Every class consisted of two groups. In the group with most gain from the course (6-8 on the scale), 48% would like to become a psychiatrist (6-8 on the scale). In the group with the lowest profit, the frequency was 6%.

[Evaluation of 2 educational programs by students]. / Studentvurdering av to undervisningsopplegg.

Educational programmes were evaluated by 84 students. The students reported increased gain from the course parallel with more teaching outside the university hospital and teaching in small groups. When the original hospital-based programme was resumed, there was a marked reduction in profit. Of 21 students who followed the modified programme, all except one recommended that it should be continued. Of the 25 students who followed a programme based on lectures and teaching exclusively in hospital, all except one recommended a change of programme.

[Students' evaluation of education in psychiatry]. / Studentevaluering av undervisningen i psykiatri.

Students' written evaluations covering four years of education have been collected. According to the students' judgment, excursions, seminars involving presentation of patients, and teaching and problem solving in small groups were worthwhile. In general, the gain from lectures was regarded as low. The clinical rotation, predominantly based on hospital inpatient services, had been valuable for some, of limited value for about one half, and a waste of time for more than a quarter of the students. Hospital based teaching takes up most of the students' time and most of the institute's financial resources. According to the student's reports, however, it contributes only with 14% of the total gain from the course. Evaluations collected on several years of education provide information which cannot be obtained from a single assessment.

Role of different genes in the virulence and pathogenesis of Aujeszky's disease virus.

In this study the role of different genes located in the unique short region of the genome of Aujeszky's disease virus was examined. Inactivation of the genes encoding the protein kinase (PK), gp63, and gI reduced virulence of the virus for pigs, in contrast to inactivation of the genes encoding the 28 kDa protein, and gX. There was no correlation between virulence and virus multiplication in vitro or in the oropharynx in vivo. The morphogenesis of the PK mutant was altered. The gI mutant replicated to normal titres in the oropharynx and could be recovered from the trigeminal ganglia but not from other parts of the central nervous system, suggesting that gI facilitates the spread of the virus from neuron to neuron. All mutants induced neutralizing antibody and complete or partial protection against a challenge infection. PK and gp63 were required for the induction of complete protection, although these proteins are reportedly not targets for neutralizing antibody or cytotoxic T cells.

Role of memory B-cell responses in serum and mucosal fluids of swine for protective immunity against pseudorabies virus.

We examined primary and memory isotype-specific antibody responses directed against pseudorabies virus in serum and mucosal fluids of pigs with and without passively acquired maternal antibody, and we studied the relationship between these responses and protection against virus challenge. Pigs were inoculated intranasally with the virulent NIA-3 strain or the avirulent Bartha strain, or they were inoculated IM with an inactivated vaccine containing the Phylaxia strain. Ten weeks later, all pigs were challenge-exposed intranasally with strain NIA-3. Only pigs that were without passively acquired antibody at the time they were inoculated with virulent virus appeared to have complete protective immunity against challenge exposure, as evidenced by lack of clinical signs of pseudorabies and lack of virus excretion. In contrast, pigs inoculated with strain Bartha or with the inactivated vaccine developed fever, had a period of growth arrest, and excreted virus after challenge exposure. In pigs without passively acquired antibody, intranasal inoculation with strains NIA-3 or Bartha was followed by primary IgM and IgA responses in serum and in oropharyngeal fluid as well as primary IgG1 and IgG2 responses in serum. Intramuscular inoculation with the inactivated vaccine induced primary serum IgM, IgG1, and IgG2 responses, but no mucosal responses. Challenge exposure of pigs that had been inoculated with the Bartha strain or the inactivated vaccine was followed by clear memory responses in serum and in oropharyngeal fluid. In contrast, challenge exposure of pigs that had been inoculated by the virulent NIA-3 strain was not followed by memory responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Contribution of single genes within the unique short region of Aujeszky's disease virus (suid herpesvirus type 1) to virulence, pathogenesis and immunogenicity.

Pigs (3 and 10 weeks old) were infected intranasally with Aujeszky's disease virus (ADV) mutants that functionally lacked one of the non-essential genes in the unique short region of the genome (except the gene encoding the 11K protein). Virus excretion in oropharyngeal fluid and disease symptoms were monitored. Some pigs were killed to study pathogenesis, whereas others were challenged with virulent ADV 8 weeks after the primary infection. Mutants lacking protein kinase, or glycoproteins gp63 or gI showed reduced virulence, but mutants lacking gX or the 28K protein showed normal virulence. Glycoprotein gI appears to affect the tissue tropism of ADV in pigs, presumably by facilitating the spread of the virus through the central nervous system. In this study, there was no correlation between virulence and virus multiplication in either cultured cells or in the oropharynx in vivo. All mutants induced neutralizing antibody and complete or partial protection against challenge infection. Complete protection was obtained by inoculation with the gI and gX mutants, whereas incomplete protection was obtained using gp63 and protein kinase mutants. Complete clinical and virological protection was associated with the absence of secondary antibody responses in the serum.

Follow-ups of children with attention deficit hyperactivity disorder (ADHD). Review of literature.

The purpose of this review has been to examine the hypothesis that the Attention Deficit Hyperactivity Disorder (ADHD), formerly also referred to as the Hyperactive Syndrome or Minimal Brain Dysfunction (MBD), is a precursor of criminality and abuse of alcohol and illicit drugs. This has been done by reviewing findings from follow-ups. Most reviewed projects suffer from methodological weakness. In most materials, few if any of the cases had ADHD according to present criteria. Some had ADHD and conduct problems. Many probably had exclusively conduct problems, but were too young to fulfill the criteria of Conduct Disorder (CD). Methodological limitations of the examined projects have been pointed out. It has been discussed how weaknesses regarding research design might have influenced the results. As a consequence of methodological shortcomings of most projects, the reviewed studies do not give definite answers. However, they show some rather convincing trends. By early adulthood, ADHD appears to remain present in at least one third of the subjects. Subjects with prior ADHD did not have more mental problems than controls in adolescence and early adulthood, provided they had normal intelligence, and no additional disabilities or mental disorders. Those with mental retardation, cerebral dysfunction or psychosis in addition to ADHD have a poor prognosis. A high percent become psychotic, and some end up in institutions. Although there seems to be an increased rate of delinquency and lawbreaking in prior hyperactives compared to controls, these differences disappear when the results are analyzed. The initially impressive differences between cases and controls are probably consequences of bias. Cases with a childhood history of conduct and educational problems have been compared to controls without a history of such problems. Thus, the reported differences are not related to ADHD. Hyperactives without conduct problems do not have an increased frequency of delinquency. Problems of conduct, CD and Antisocial Personality Disorder, but not psychosis characterize cases with a childhood history of conduct problems (with or without ADHD). In subjects with ADHD as well as conduct problems in childhood, conduct problems and not ADHD predict the prognosis, which is worse than for those with CD without ADHD. ADHD combined with delinquency indicates a high rate of subsequent lawbreaking. Usually, cases have more problems than controls with alcohol and illicit drugs, but this might be the consequence of selection of cases (subjects with school and conduct problems) and controls (subjects without such problems).(ABSTRACT TRUNCATED AT 400 WORDS)

Boys who became offenders. A follow-up study of 2203 boys tested with projective methods.

Future offenders have more ratings than controls on variables indicating psychopathology. The characteristics which most consistently and significantly discriminate between preoffenders and controls, and which also turned out to be the best predictors of future criminality, are those which previously have been observed in subjects with serious mental disorders. The results indicate that the high degree of psychopathology in subsequent offenders is associated with distortion of body image and with poor reality orientation, i.e. that the most prominent characteristics of future offenders are related to a weakness of the ego. Future offenders seem to have a sufficiently developed ego to handle common tasks. However, their ego fails when they are confronted with unfamiliar and frustrating situations. The inability of subsequent offenders to complete a task properly, with failure on difficult and provocative tasks, shows that they have not developed adequate defence mechanisms and that they have a low tolerance for frustration. They are emotionally immature, instable and impulsive. In short, they are dominated by id impulses. There is no indication of gender confusion (homosexuality) in subsequent offenders. However, there are marked differences between the drawings by cases and by controls regarding characteristics related to sexuality. These findings are interpreted as an exaggeration of masculinity and an abnormal preoccupation with sexuality combined with anxiety for the opposite sex. It is possible that severe criminality, contrary to milder forms of lawbreaking, is associated with elevated self-esteem and extroversion. There are indications that ultimate offenders experience human beings (others or themselves) as deviant, monstrous and inhuman, features which indicate that distorted self-concept and distorted self-perception are characteristics of preoffenders. The findings regarding aggression are inconsistent, just as they were in prior projects. The Draw-A-Person Test (DAP) and Colour Slide Test (CST) findings indicate that preoffenders are more aggressive and destructive than controls, whereas the Hand Test (HT) shows neither more aggression nor more acting-out tendencies in future offenders than in controls. The literature offers conflicting findings regarding depression. The CST results indicate that depression is more common in preoffenders than in controls.(ABSTRACT TRUNCATED AT 400 WORDS)