Effects of artificial sweeteners on body weight, food and drink intake.

Artificial sweeteners are widely used all over the world. They may assist in weight management, prevention of dental caries, control of blood glucose of diabetics, and also can be used to replace sugar in foods. In the animal experimentation mice were given oral doses of water solutions of table top artificial sweeteners (saccharin, cyclamate based, acesulfame-K based, and aspartame) the amount of maximum Acceptable Daily Intake (ADI) ad libitum. The controls received only tap water with the same drinking conditions as the treated groups. The mice were fed chow ad libitum.We measured food intake and body weight once a week, water and solutions of artificial sweeteners intake twice a week. The data were analysed by statistical methods (T-probe, regression analysis).Consumption of sweeteners resulted in significantly increased body weight; however, the food intake did not change.These results question the effect of non-caloric artificial sweeteners on weight-maintenance or body weight decrease.

Unstimulated whole saliva flow rate in relation to sicca symptoms in Hungary.

OBJECTIVE: To assess the prevalence of xerostomia and the related oral and extraoral dryness symptoms in Hungary, to evaluate the association of those symptoms with the unstimulated whole saliva (UWS) flow rate, and to find correlation between the level of UWS flow rate and the oral health status of the questioned patients. SUBJECTS AND METHODS: A total of 600 patients between the age of 18 and 92 years, 265 male, 335 female, were selected in accordance with the current regional age and residence distribution scheme of the Hungarian Statistical Office. A questionnaire was designed to determine the subjective presence or absence of the sicca symptoms. UWS flow rate and the dental and periodontal status were determined. RESULTS: The percentages of subjective symptoms in the questioned subjects were oral dryness, 34%; reduced salivation, 11%; mucous saliva, 15%; dysphagia, 13%; glossopyrosis, 7%; dysphonia, 31%; dysgeusia, 9%; nasal dryness, 32%; ocular dryness, 21%; itching, 40% and xeroderma, 60%. Vaginal dryness was 14%, vaginal itching was 16% in the interviewed women. The grade of xerostomia, dysphagia, tiredness, and additionally the gingival bleeding index showed a negative correlation with the UWS flow rate. After all decayed, missing and filled teeth (DMF-T) mean values, gingival bleeding index and plaque index were significantly higher in hyposalivators, compared with those who had normal flow rates CONCLUSION: This cross sectional study, representative of the Hungarian population, clearly shows that one-third of the adult population suffers from xerostomia. The clinical severity of the xerostomia demonstrated a strong relationship with the lower levels of UWS flow rate. Reduced levels of UWS flow rate in this study were also shown to be associated with dysphagia, fatigue, and increased DMF-T numbers. The data show that oral dryness, its associated desiccation symptoms and its clinical manifestations are significant health problems in Hungary.

Complex care by multiple medical and dental specialists of a patient with aggressive Gorlin-Goltz syndrome.

Gorlin-Goltz syndrome is a genetically predisposed disease characterised by multiple basal cell carcinomas, odontogenic keratocysts and ectopic calcifications. The aim of this study was to show successful treatment of a 37-year-old male patient by cooperation between different dental and medical specialists. Because of the recurrence of a large basal cell carcinoma after multiple operations and a total dose telecobalt irradiation of 66 Gy, the patient's nose was ablated, with resection of the upper lip and part of the maxilla. The intraoral prosthetic treatment helped to restore the subtotal edentulousness. In order to enhance the application of the dental prosthesis, an Abbe plasty was performed at the second stage of surgery. As previous irradiation of the area precluded the use of facial implants immediately after the intraoral treatment, a temporary artificial nose prosthesis was created. The patient tolerated the procedures well and is completely disease-free 12 months after the surgery. Besides presenting a rare and complicated case of Gorlin-Goltz syndrome, the main purpose of this report is to show that, if different specialists in a dental-clinical team (maxillofacial surgeon, oncologist, radiation oncologist, prosthodontist and psychiatrist) combine their skills and expertise, successful management is possible even in a challenging complex case.

Breakdown and partial discharges in magnetic liquids.

The dielectric properties (permittivity, loss factor, dielectric breakdown strength) of magnetic liquids were investigated. The magnetic liquids were composed of magnetite particles coated with oleic acid as surfactant and dispersed in transformer oil. To determine their dielectric properties they were subjected to a uniform magnetic field at high alternating electric fields up to 14 MV m(-1). Nearly constant permittivity of magnetic liquid with particle volume concentration Φ = 0.0019 as a function of electric field was observed. Magnetic liquids with concentrations Φ = 0.019 and 0.032 showed significant changes of permittivity and loss factor dependent on electric and magnetic fields. The best concentration of magnetic fluid was found at which partial current impulse magnitudes were the lowest. The breakdown strength distribution of the magnetic liquid with Φ = 0.0025 was fitted with the Duxbury-Leath, Weibull and Gauss distribution functions.

Evaluation of palatal saliva flow rate and oral manifestations in patients with Sjögren's syndrome.

OBJECTIVE: The purpose of this study was to describe the oral properties of Sjögren's syndrome (SS), including the determination of palatal saliva (PS) flow rate. SUBJECTS AND METHODS: Forty-nine SS patients and 43 healthy controls participated. Subjective symptoms were recorded and clinical assessments of the oral mucosal, dental and periodontal status were made. Unstimulated whole saliva (WS) and PS flow rates, the number of decayed, missing and filled teeth (DMF-T number), the gingival bleeding index (GBI) and the periodontal probing depth (PPD) were determined. RESULTS: Despite the decrease in the flow rate of WS in SS patients, PS was not different from those of the controls (1.57 +/- 1.02 and 1.35 +/- 2.5 microl cm(-2) min(-1), respectively). GBI (20.0% vs. 10.5%, respectively), DMF-T (27.1 +/- 6.12 vs. 23.0 +/- 6.99, respectively) and PPD (2.28 +/- 1.09 mm vs. 1.82 +/- 0.73 mm, respectively) were higher in SS compared with the controls (P < 0.05). DMF-T and PPD showed a positive correlation with anti-SSA and/or anti-SSB antibody positivity in the serum (P < 0.05). CONCLUSIONS: Data of the present study suggest that the subjective feeling of xerostomia in SS patients is the result of a decrease in the volume of the whole saliva, and not of the viscous PS. Correlation of DMF-T and PPD with autoantibody positivity reveals that the oral health status of SS patients may be associated with the general autoimmune process.

[Dental rehabilitation of two epileptic patients suffering from grand mal seizures]. / Az epilepsziás betegségek protetikai elláthatóságának III. Osztályába tartozó (grand mal) rohamban szenvedó páciensek protetikai rehabilitációja.

Inspite of the antiepileptic therapy, both of our patients were suffering from grand mal seizures. They belong to class III according to our previously described clinical guideline from prosthetic treatment at epileptic patients. Since during these seizures, loading is great on the remaining teeth and on the denture, we tried to reduce it with all disposable appliances in prosthetic dentistry. In class III we suggest metal baseplate for the treatment of full edentulousness. In some of the cases of Fábián-Fejérdy class 2B, we approve great allowance in the interest of planning solely fixed denture. Otherwise we suggest combined, fixed and removable part with precisional attachment, rigidly, securely fixed together. In our two cases, we followed the mentioned guiding principles.

[The use of the Dentatus articulator in complete denture prosthetics]. / Teljes kivehetó fogpótlás készítése Dentatus artikulátor segítségével.

The adjustable articulators and the bilaterally balanced occlusal scheme is not commonly used in Hungary, even if it is the mainly used type of occlusion in the world. The authors provide a short historical background about occlusal types then show how to use the Dentatus semi-adjustable articulator in the practice of the complete denture prosthetics: how to use the Dentatus ear-bow, and how to adjust individual values on the articulator. With the help of this procedures a bilaterally balanced occlusal scheme is designed, so the authors show the characteristics of this occlusal type. The aim of the authors is to present a view of "how to organize" occlusion for complete dentures.

Physician, nurse, and social worker collaboration in primary care for chronically ill seniors.

OBJECTIVES: To examine the impact of an interdisciplinary, collaborative practice intervention involving a primary care physician, a nurse, and a social worker for community-dwelling seniors with chronic illnesses. METHODS: A concurrent, controlled cohort study of 543 patients in 18 private office practices of primary care physicians was conducted. The intervention group received care from their primary care physician working with a registered nurse and a social worker, while the control group received care as usual from their primary care physician. The outcome measures included changes in number of hospital admissions, readmissions, office visits, emergency department visits, skilled nursing facility admissions, home care visits, and changes in patient self-rated physical, emotional, and social functioning. RESULTS: From 1992 (baseline year) to 1993, the two groups did not differ in service use or in self-reported health status. From 1993 to 1994, the hospitalization rate of the control group increased from 0.34 to 0.52, while the rate in the intervention group stayed at baseline (P= .03). The proportion of intervention patients with readmissions decreased from 6% to 4%, while the rate in the control group increased from 4% to 9% (P=.03). In the intervention group, mean office visits to all physicians fell by 1.5 visits compared with a 0.5-visit increase for the control group (P=.003). The patients in the intervention group reported an increase in social activities compared with the control group's decrease (P=.04). With fewer hospital admissions, average per-patient savings for 1994 were estimated at $90, inclusive of the intervention's cost but exclusive of savings from fewer office visits. CONCLUSIONS: This model of primary care collaborative practice shows potential for reducing utilization and maintaining health status for seniors with chronic illnesses. Future work should explore the specific benefit accruing from physician involvement in the collaborative practice team.

[Use of an overdenture in the prosthetic correction in a patient with cleft palate]. / Keményszájpad-hasadékos beteg protetikai ellátása "overdenture" típusú fogpótlással.

A fourty-year old male patient with cleft palate had been operated on four times in his childhood in order to close the defect. The shrinked dental arch and the pseudoprogenia, remaining after the operation, caused problems in the mastication and esthetic defects to the patient. With the help of an overdenture a new dental arch was created, in this way the pseudoprogenia could be eliminated, the facial harmony and the mastication could be restored.

History of visible rectal bleeding in a primary care population. Initial assessment and 10-year follow-up.

OBJECTIVE: To determine whether a complaint of visible rectal bleeding that is elicited by a screening review of systems merits investigation and to assess the accuracy of a defined protocol to evaluate bleeding. DESIGN: Prospective cohort study. SETTING: Primary care clinics in a veterans medical center. PATIENTS: We used an 8-item review of systems to identify 297 individuals with visible rectal bleeding; 201 (68%) of these individuals completed a specified protocol consisting of double-contrast barium enema (DCBE) examination, rigid sigmoidoscopy, and follow-up visit after 6 to 12 months. Ten years later we verified the diagnosis in 131 (93%) of 141 patients whose initial evaluation suggested no cause, or a benign anorectal cause, of bleeding. MAIN OUTCOME MEASURES: Final diagnoses after 2 and 10 years; sensitivity and specificity of symptoms, DCBE, and rigid sigmoidoscopy. RESULTS: We diagnosed serious disease in 48 (24%) of the 201 patients; 26 had polyps, 9 had inflammatory bowel disease, and 13 (6.5%) had colon cancer. Symptoms did not predict the diagnosis. Neither DCBE nor rigid sigmoidoscopy alone was sufficiently sensitive to be used alone, but the combination of DCBE and rigid sigmoidoscopy had a sensitivity of 0.96 and a specificity of 0.76 for the diagnosis of polyps, cancer, or inflammatory bowel disease. CONCLUSIONS: Self-reported rectal bleeding detected by means of a review of systems was associated with a high likelihood of important pathology. Physicians should ask all adults about visible rectal bleeding and should visualize the entire colon in those who report bleeding.

Information level and young children's phonological accuracy.

The influence of information level on the production accuracy of 20 children (22 to 28 months) was examined. The data were children's productions of nouns in sets of utterances referring to triplets of pictures representing noun-verb-noun utterances. In each triplet one noun remained the same, thus decreasing in information value from the first to the third picture (new, moderately old, and old information). Words representing new information were produced more accurately than words representing old information. The types of errors did not differ. Further evidence of this effect was provided by an examination of the duration of new versus old word productions by 12 of the children. Productions encoding new information were consistently longer on average than those encoding old information. The result provide experimental evidence of an effect observed in adults that indicates early sensitivity to information level. However, because of the children's young age, the effects are characterized as a speaker-internal process that only serendipitously corresponds to listener needs.

Abnormal corpus callosum: a sensitive and specific indicator of multiple sclerosis.

The authors investigated whether identification of corpus callosal (CC) involvement might increase the specificity of magnetic resonance (MR) imaging in differentiating multiple sclerosis (MS) from other periventricular white matter diseases (PWDs). They prospectively evaluated 42 patients with MS and 127 control patients with other PWDs. Ninety-three percent of the MS patients demonstrated confluent and/or focal lesions involving the callosal-septal interface (CSI). These lesions characteristically involved the inferior aspect of the callosum and radiated from the ventricular surface into the overlying callosum. CSI lesions were optimally demonstrated on sagittal long repetition time (TR)/short echo time (TE) images and frequently (45% of cases) went undetected on axial images. Only 2.4% of the control patients had lesions of the CC. The authors conclude that midsagittal long TR/short TE images are highly sensitive and specific for MS and that callosal involvement in MS is more common than previously reported.

Using the patient's history to estimate the probability of coronary artery disease: a comparison of primary care and referral practices.

PURPOSE: According to probability theory, the interpretation of new information should depend on the prior probability of disease. We asked if this principle applies to interpreting the history in patients with chest pain. We compared the prevalence of coronary artery disease (CAD) in patients who had similar histories but who came from populations with different disease prevalence. PATIENTS AND METHODS: We studied two high-disease-prevalence populations (patients referred for coronary arteriography) and two low-disease-prevalence populations (patients from primary care practices). We used clinical characteristics of one arteriography population to develop a logistic rule for estimating the probability of coronary artery narrowing. The number of clinical findings determined the logistic score, which was proportional to the prevalence of CAD. RESULTS: The prevalence of CAD was much lower in the primary care population than in the arteriography population, even when patients with similar logistic scores, and thus similar clinical histories, were compared. CONCLUSION: A clinician must take account of the overall prevalence of disease in the clinical setting when using the patient's history to estimate the probability of disease. Failure to observe this caution may lead to errors in test selection and interpretation.

Does the mean corpuscular volume help physicians evaluate hospitalized patients with anemia?

The authors analyzed the value of using mean corpuscular volume (MCV) as a guide for selecting tests for further evaluation of anemia in hospitalized patients. Of the 2,082 patients with anemia admitted to the medical service of a teaching hospital over one year, 655 (31%) had further diagnostic tests to evaluate the cause of the anemia. Within this group of 655 patients, 399 (61%) had normal MCVs. Over half the patients with abnormal serum vitamin B12, folate, or ferritin levels, or with low serum iron (Fe) levels with elevated total iron-binding capacity (TIBC), did not have the MCVs expected according to the classification of anemia proposed by Wintrobe. Furthermore, 5% of patients with evidence of iron deficiency had high MCVs, and about 12% of patients with decreased vitamin B12 levels had low MCVs. The MCV was quite specific in identifying patients who had low ferritin levels: specificity was 83%; however, sensitivity was only 48%. The MCV was also specific (88%) for identifying patients who had low Fe with elevated TIBC; however, sensitivity was only 43%. The MCV was poor in identifying patients with abnormalities of serum vitamin B12 and folate levels. In this study the MCV did not provide sufficient diagnostic accuracy to be a useful criterion for the selection of more definitive tests in the evaluation of anemia in hospitalized patients.

Indications for pulmonary function testing.

STUDY OBJECTIVE: To critically assess original studies evaluating the role of preoperative pulmonary function testing in predicting postoperative outcomes. DESIGN: MEDLINE search of English-language articles from 1966 to 1987 using the following medical subjects headings respiratory function tests, lung, lung diseases, and preoperative care. MEASUREMENTS AND MAIN RESULTS: Relevant studies were subdivided by operative site. We included only studies for which we could determine pre- and post-test probabilities of morbidity, mortality, sensitivity, and specificity. Preoperative pulmonary function testing was found to have measureable benefit in predicting outcome in lung resection candidates. In selected patients, split perfusion lung scanning and pulmonary exercise testing appeared to be useful. Confirmation of these reports is necessary before these preoperative tests can be routinely recommended. In studies of upper abdominal surgery, spirometry and arterial blood gas analysis did not consistently have measureable benefit in identifying patients at increased risk for postoperative pneumonia, prolonged hospitalization, and death. Studies of preoperative testing for other patients, including those having coronary artery bypass grafting, lacked adequate data for meaningful analysis. CONCLUSIONS: Preoperative pulmonary function testing helps clinicians to make decisions on management of lung resection candidates. Although many studies of patients before abdominal surgery have focused on the utility of preoperative pulmonary function testing, methodologic difficulties undermine the validity of their conclusions. The impact of testing on care of other preoperative patients is even less clear because of poor study design and insufficient data. Therefore, further investigation is necessary before a consensus can be reached on the role of preoperative pulmonary function testing in evaluating patients before all surgical procedures except lung resection.

A medical algorithm for detecting physical disease in psychiatric patients.

An algorithm for screening psychiatric patients for physical disease was empirically derived from a comprehensive assessment of 509 patients in California's mental health system. The first 343 patients were used to develop the algorithm, and the remaining 166 were used as a test group. Calculations were made for several versions of the algorithm, and the data were compared with the diagnoses listed in the patients' admission mental health record. The algorithmic procedure was more accurate and more cost-effective than the medical evaluation procedures used by the state mental health system. When applied to the test group, the algorithm detected up to 90 percent of patients who had an active, important physical disease at a cost of $156 per patient. The mental health system had detected 58 percent of test-group patients with a disease at a cost of $230 per patient.

The prognostic significance of immunoradiometric CK-MB assay (IRMA) diagnosis of myocardial infarction in patients with low total CK and elevated MB isoenzymes.

Patients with suspected myocardial infarction present a diagnostic problem when they have normal total serum creatine kinase (CK) and an elevated myocardial fraction of this enzyme (CK-MB). We studied 40 patients with normal total serum CK and elevated CK-MB (by standard electrophoretic technique), using an immunoradiometric assay (IRMA) for CK-MB. Diagnosis based on IRMA results of serum samples collected prospectively was compared with diagnosis based on application of strict diagnostic criteria with and clinical diagnosis of the responsible physician(s) by chart review. Diagnostic agreement of all three methods and clinical outcome (mean follow-up 6 months after discharge) were analyzed and compared with two control groups: "rule in" group (17 patients) with elevated total CK, CK-MB, and abnormal electrocardiogram (ECG); and "rule out" group (18 patients) with normal total CK, CK-MB, and ECG. All three diagnostic methods (1) clinical discharge diagnosis, (2) chart review diagnosis by application of strict diagnostic criteria, and (3) IRMA diagnosis, agreed completely for both control groups. Follow-up control group outcomes were in concert with expected outcomes for these groups. Diagnostic differences between methods 1 and 2, and 1 and 3 were statistically significant for the study group. Furthermore, only diagnosis based on the IRMA showed a predictive capability for outcome in this study group when compared with the other methods. Follow-up revealed a similar incidence of cardiac events in the study group (56%) and in the "rule in" control group (60%), but not in the "rule out" group (7%).(ABSTRACT TRUNCATED AT 250 WORDS)