Bone mineral density and lifetime physical activity in South African women.

We investigated the relation between lifetime physical activity and bone mineral density (BMD) in South African women using data collected in a case-control study of breast cancer in relation to BMD. Subjects (n = 144) were of black African or mixed ancestral origin, and <60 years of age (mean age 42.6 +/- 8.9 years). Cases had newly diagnosed breast cancer (n = 62) and controls were referred for conditions unrelated to BMD or breast cancer (n = 82). Physical activity data consisting of household, occupational and leisure-time activity, and activity for transport, were collected via questionnaire at 4 life stages (epochs), viz. 14-21, 22-34, 35-50, and 50+ years of age. Total energy (MET hrs) and peak strain scores were calculated. Lumbar spine and total proximal femur BMD were measured using dual-energy x-ray absorptiometry. BMD measures were similar between groups, therefore data were combined. BMD measures were unrelated to total lifetime physical activity. However, the major determinants of total proximal femur BMD included age, transport activity including walking and bicycling between the ages of 14 and 21 years, and current weight (adjusted r2 = 0.33, P < 0.0001). The major determinants of lumbar spine BMD included age, household energy expenditure between the ages of 14 and 21 years, and current weight (adjusted r2 = 0.23, P < 0.0001). Total peak bone strain score for activities between 14-21 years of age was also significantly correlated with lumbar spine BMD ( r = 0.18, P < 0.05). Intraclass correlation coefficients to assess tracking of activity through epochs 1, 2, and 3 were high for total energy expenditure (0.96; 95%CI: 0.94-0.97), household (0.98; 95%CI: 0.97-0.99) and occupational activity (0.78; 95%CI: 0.71-0.84) and activity for transport (0.92; 95%CI: 0.89-0.94). These data suggest that walking or activities resulting in impact loading at a young age are associated with higher BMD in later years. In addition, our findings suggest tracking of physical activity over time.

Limited Pap screening associated with reduced risk of cervical cancer in South Africa.

BACKGROUND: We investigated the effect of Pap smear screening on the incidence of invasive cancer of the cervix in the Western Cape, South Africa where screening is limited. METHODS: Data were derived from a case-control study of the association of hormonal contraceptives and invasive cervical cancer. Incident cases (n = 524) of invasive cervical cancer who presented at two tertiary hospitals and controls (n = 1540) series matched for age, race, and place of residence were interviewed. Information on a wide range of variables was collected including whether the women had previously had a Pap smear taken and the number and timing of smears. Odds ratios (OR) and 95% CI were calculated using multiple logistic regression. RESULTS: The OR of cervical cancer was reduced among women who had ever had a smear (OR = 0.3, 95% CI: 0.3-0.4). The OR declined with increasing number of smears to 0.2 for >/=>3 smears (trend P = 0.0003). Among women who had a smear <5 years previously the OR was 0.3, but even if the smear was taken >/=15 years previously the women remained at reduced risk (OR = 0.5). CONCLUSION: The data suggest that even limited Pap smear screening reduces the risk of cervical cancer. Should a screening programme be successfully implemented, the incidence of cervical cancer might be reduced by as much as 70%.

Effects of two barrier creams on the diffusion of benzo[a]pyrene across human skin.

Barrier hand creams, often containing antiseptic agents, may provide a form of protection not only for health care professionals, but also for workers in the chemical and pharmaceutical industries. To evaluate the efficacy of two such barrier creams available on the South African market, the in vitro diffusion of a model compound, benzo[a]pyrene, through human skin at 20 degrees and 37 degrees C was studied. Treated (10 min) and untreated human skin disks (4 mm in diameter) were mounted in flow cells of a continuous flow-through diffusion apparatus. Buffer/tritiated benzo[a]pyrene was collected from the acceptor chambers at 2-hour intervals for a total of 24 hours and counted in a liquid scintillation counter. At 20 degrees C no significant differences could be detected between the flux rates of benzo[a]pyrene across barrier cream treated and untreated skin. However, at 37 degrees C Skinguard significantly increased flux rates of this carcinogen. Skin barrier creams therefore need to be carefully scrutinised with respect to their protective effects because the latter may vary for molecules with different chemical properties.

Analysis of the NRAMP1 gene implicated in iron transport: association with multiple sclerosis and age effects.

Multiple sclerosis (MS) is believed to be an autoimmune process occurring in genetically susceptible individuals after an appropriate environmental exposure. We have exploited the homogeneous Afrikaner population of European ancestry to investigate the likelihood that iron dysregulation, in association with infectious and/or autoimmune disease susceptibility, may underlie the MS phenotype in a subgroup of patients. The functional Z-DNA forming repeat polymorphism of the natural resistance-associated macrophage protein-1 (NRAMP1) gene was analyzed in 104 patients diagnosed with MS and 522 Caucasian controls. A family-based control group consisting of 32 parental alleles not transmitted to MS offspring was additionally studied to exclude the likelihood of population substructures. Statistically significant differences in allelic distribution were observed between the patient and control samples drawn from the same population (P < 0.01). Evidence is furthermore provided that alleles considered to be detrimental in relation to autoimmune disease susceptibility may be maintained in the population as a consequence of improved survival to reproductive age following infectious disease challenge. Although it remains to be determined whether the disease phenotype in MS patients with allele 5 of the NRAMP1 promoter polymorphism is directly related to dysregulation of iron or modified susceptibility to viral infection and/or autoimmunity, a combination of these processes most likely underlies the disease phenotype in these patients. In view of the emerging role of polymorphic variants in complex diseases and minimizing of possible confounding factors in this association study, we conclude that allelic variation in the NRAMP1 promoter may contribute significantly to MS susceptibility in the South African Caucasian population.

Diffusion of reduced arecoline and arecaidine through human vaginal and buccal mucosa.

Because alkaloids from areca nut, arecoline and arecaidine, have been implicated in the development of oral submucous fibrosis, we determined their diffusion kinetics through human buccal and vaginal mucosa. Four clinically healthy vaginal mucosa specimens (mean patient age +/- standard deviation: 47 +/- 15 years; age range: 31-60 years) and 4 buccal mucosa specimens from 2 male patients and 2 female patients (mean patient age +/- standard deviation: 31 +/- 9 years; age range: 17-53 years) were obtained during surgery. In vitro flux rates of reduced arecoline and arecaidine (r-arecoline and r-arecaidine) were determined by use of a flow-through diffusion apparatus. Analysis of variance, a Duncan multiple range test, and an unpaired t-test were used to determine steady state kinetics and flux differences over time intervals. Although statistically significant differences were observed between flux values for both alkaloids and tissues at certain time points, these were not considered to be of biological (clinical) significance. However, the flux rates across both mucosa of r-arecoline were significantly higher statistically than those of rarecaidine. The findings demonstrated the differences in the diffusion kinetics between r-arecoline and r-arecaidine across human buccal and vaginal mucosa, an observation that could be explained in terms of their ionisation characteristics. Additionally, the results obtained further support the hypothesis that human vaginal mucosa can be used as a model for buccal mucosa in studies of permeability to various chemical compounds.

The accuracy of self-reported weight by overweight and obese women in an outpatient setting.

OBJECTIVE: To investigate the accuracy of self-reported weight of overweight and obese women and characterisation of under-, correct- and over-reporters based on a number of related variables. DESIGN: Weight was self-reported before entering the study. At baseline, actual weight was recorded, and demographic, health, nutritional, psychological and physical activity questionnaires were completed. SETTING: A hospital outpatient department. SUBJECTS: Participants were 131 women aged 18-64 years with a body mass index attending a Comprehensive Weight Management Programme. OUTCOME MEASURES: The accuracy of self-reported weight was investigated for the total group, and the subjects were then categorised into three groups according to accuracy of self-reported weight (under-, correct- and over-reporters). The relationship between these accuracy groups and demographic, health, nutritional, and psychological variables and physical activity was examined, to characterise the under-, correct- and over-reporters. RESULTS: Although not statistically significantly different, the total group of women tended to underestimate their weight by 0.8 (+/-3.6) kg. Categorisation according to the accuracy groups revealed that 29% underestimated their weight by 2 kg or more, 19% overestimated their weight by 2 kg or more, and only 52% correctly estimated their weight within 2 kg. Some trends and statistically significant differences between the accuracy groups concerning certain variables, e.g. height, age, income, education, contraceptive pill usage, smoking and food choices were evident. CONCLUSIONS: Self-reported weight of a group of overweight/obese individuals may be a valid and reliable indicator of actual weight, but self-reported weight of an overweight/obese individual can not be interpreted similarly. Further research is necessary to ensure reliable characterisation of under-, over- and correct reporters.

Perceptions of fluorosis in northern Cape communities.

The objective of the study was to determine the perception of fluorosis in communities living in the Northern Cape Province of South Africa where there is a considerable range in fluoride levels of drinking water. The fluoride levels of the drinking water were categorised as suboptimal (0.40-0.60 ppmF), optimal (0.99-1.10 ppmF) or supra-optimal (1.70-2.70 ppmF). The teeth of 694 children aged 6, 12 and 15 years were examined. Dental fluorosis occurred among children of all ages in all areas studied. As anticipated there appears to be a direct relationship between fluoride levels in the drinking water and levels of dental fluorosis, and the severity of the condition increased with an increase in levels of fluoride in the water supplies. Children in low fluoride areas showed some form of mild fluorosis (37% very mild and 17% mild). However, 19% of this group experienced moderate or severe forms of fluorosis. In areas with optimal levels of fluoride 30% of children showed a questionable form of fluorosis and 21% mild fluorosis. Moderate or severe forms of fluorosis were recorded in 31% of children in the optimal fluoride area. The Community Fluorosis Index (CFI) scores for the sub-optimal and optimal areas were of medium public health significance and for the supra-optimal area of very high public health significance. Of concern is the high percentage of children (45%) in the supra-optimal area with severe forms of fluorosis. The awareness and concern for stains on teeth were mostly expressed by children with moderate or severe fluorosis. This study suggests that the proposed fluoride concentration (not more than 0.7 ppmF) prescribed in the Regulations on Fluoridating the Water Supplies for South Africa would minimise the risk of dental fluorosis.

The dental health of 12-year-old children whose diets include canned fruit from local factories: an added risk for caries?

OBJECTIVE: To determine the dental health of 12-year-old children from households that are supplied with sweetened canned fruit from local factories. METHODS: The DMFS and DMFT indices were determined for 12-year-old pupils from 6 schools, 3 of which are situated in communities with fruit canning factories. Subjects were questioned about the workplace of household members and supplies of sweetened canned fruit from factories. To compare indices we used a two-way analysis of variance, for multiple comparisons the Bonferroni Test and for proportions the Chi-Squared Test. Fluoride content of the drinking water was measured for each school. RESULTS: The fluoride content for all schools was less than 0.1 ppm. In only 2 schools were the majority of pupils from households that were supplied regularly with canned fruit from factories. An analysis of the DMFT data of the children in all the schools showed that there were significantly fewer children with a DMFT = 0 and significantly more with a DMFT = 4+ in the 2 schools. The mean DMFS and DMFT of children in households supplied with canned fruit were significantly higher than those children without the supply. CONCLUSION: The supply of sweetened canned fruit to households may be an added risk to dental health for the children in that household.

Lipoprotein(a) determination and risk of cardiovascular disease in South African patients with familial hypercholesterolaemia.

OBJECTIVE: A raised plasma level of lipoprotein(a) (Lp(a)) is an established genetic risk factor for coronary heart disease (CHD), particularly in patients with concomitant elevation of low-density lipoprotein (LDL) cholesterol. The current study focused on the comparison of two commercially available Lp(a) assay kits to determine whether differences observed in measured Lp(a) levels could be deemed negligible in CHD risk assessment in familial hypercholesterolaemic (FH) patients. DESIGN: To compare results obtained on duplicate plasma samples using two commercially available Lp(a) measuring kits, the immunoradiometric assay (RIA) and the enzyme-linked immunoabsorbent assay (ELISA). SETTING: Division of Human Genetics, Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg, South Africa and the Institute for Medical Biology and Human Genetics, University of Innsbruck, Austria. SUBJECTS: Plasma samples were obtained from 146 family members of 65 molecularly characterised South African FH families for comparative analysis. RESULTS: Using the RIA method, 34 samples (23%) considered to be in the normal range by the ELISA technique, were placed in the high-risk group (> 30 mg/dl). Only one sample, considered to have a normal Lp(a) level with the RIA method, was categorised by the ELISA technique as high risk. CONCLUSION: Our data demonstrate that measurements of Lp(a) using the RIA method (the only assay available in South Africa at the time of this study) differ significantly from those obtained by the reference ELISA technique, suggesting that misclassification could lead to inaccurate CHD risk assessment. This is an important consideration in Afrikaner FH families, where plasma levels of Lp(a) have been shown to be elevated significantly in FH patients compared with non-FH individuals.

Diffusion of water across human skin in the presence of two barrier creams.

The in vitro permeability of tritiated water through fresh and frozen human skin was evaluated in the presence and absence of two different barrier creams. Treated (10 min) and untreated fresh and frozen human skin disks (4 mm in diameter) were mounted in flow cells of a continuous flow-through diffusion apparatus. Buffer/tritiated water was collected from the acceptor chambers at 2-hour intervals for a total of 20 h and counted in a liquid scintillation counter. The results indicated that both barrier creams lowered the average flux rates of tritiated water through fresh and frozen skin, but no significant differences could be detected between the two preparations. However, different results may be obtained when compounds with molecular weights much higher than water are used.

[What do dental students at the University of Stellenbosch know of the education and functions of oral hygienists?]. / Wat weet tandheelkunde-studente aan die Universiteit van Stellenbosch van die opleiding en funksies van mondhigiëniste?

The purpose of this study was to determine the knowledge of dental students regarding the requirements for the course in oral hygiene at the University of Stellenbosch, the functions of oral hygienists and how they rate the necessity of the profession compared with other health care providers. Students in their second, third, fourth and fifth years of study were asked to complete a questionnaire. Although obvious gaps existed in the knowledge of a notable number of students, the majority of students in all the years showed good insight into the requirements for and contents of the course and functions of an oral hygienist. The number of second- and third-year students who gave the correct answers were consistently fewer than the senior students, indicating that when dental students come into contact with oral hygiene students in their clinical years their knowledge of the course and the profession improves. The void in the knowledge of dental students which most certainly needs correction is the limited concept some of them have about the training oral hygienists receive in periodontics (especially the preclinical students), orthodontics, medicines, legal aspects concerning dentistry, first aid and diagnostic radiology. Regarding the functions of oral hygienists, their importance was regarded by many students as comparable with that of occupational therapists, radiographers, nurses, dieticians and dental therapists, notably higher than that of dental assistants and slightly less important than that of physio-therapists.

Treatment status and experiences of hypertension patients at a large health center in Cape Town.

OBJECTIVE: This study was undertaken at a community health center (CHC) in the Cape Peninsula in order to assess the treatment status, knowledge and experiences of hypertensive patients. In addition, a health indicator sheet for hypertension was evaluated and an attempt was made to identify predictors of blood pressure (BP) control at this clinic. METHODS: Two hundred two hypertensive patients were selected by interviewing the first available hypertensive patients. The patients' BP was measured electronically and by sphygmomanometer, and was compared to that recorded by the clinician on their clinic folders; heights and weights were also determined. RESULTS: Of the hypertensives, 41.6% had a BP above 160/95 mm Hg and only 42.1% had a BP below 140/90 mm Hg. Patients had little knowledge of either the consequences of hypertension or the actions needed to ensure that complications were prevented; 31% suggested home remedies for hypertension. The majority of the patients were satisfied with the service they received, but 47% complained about long waiting times, 37% felt that the doctor did not examine them adequately, and 15.5% reported that insufficient medication was provided when filling prescriptions. Urine and eye tests had been conducted infrequently during the previous two years. Thirty percent of the patients requested the return of the dedicated hypertension clubs. Conditional logistic regression models identified that patients who expressed the need to make proposals to the clinic staff about their care had better BP control than those who did not. CONCLUSIONS: The BP of hypertensive patients is not optimally controlled at this CHC and both non-drug and drug management of hypertension need to be improved. Steps should be taken to help hypertensive patients become more knowledgeable so that they may play more active and compliant roles in their hypertension care. Patients also suggested that dedicated hypertension clubs be reinstituted at the CHCs.

Ambulance visits for severe hypoglycaemia in insulin-treated diabetes.

AIM: To determine, in insulin-treated diabetes the incidence and risk factors for severe hypoglycaemia requiring ambulance visits. METHODS: A cross-sectional, questionnaire survey was made of patients with type 1 diabetes, who received help for severe hypoglycaemia from Ambulance Association personnel, during the period 1/6/95 to 31/5/96. RESULTS: The ambulance service made 386 emergency visits to 247 persons with type 1 diabetes. Of these, 128 respondents (52%) completed a questionnaire detailing personal and diabetes history, usual diabetes care practices and hypoglycaemia management. Two or more visits for severe hypoglycaemia were made to 26.3% of patients, who reported a longer duration of diabetes than those who required only one visit (28 vs 20 years, p<0.03). Self-blood-glucose monitoring was performed by 98.4% of respondents and 66.4% self-adjusted insulin doses. Intensively treated patients (> or = 3 insulin injections daily) reported less awareness of hypoglycaemia than standard therapy patients (< or = 2 insulin injections daily) (p<0.05). Fifty-four per cent of respondents had glucagon available for emergency use, but those who lived alone and in general practitioner care only (27%) were less likely to have glucagon (p<0.05) compared to those with companions and in shared-care arrangements (62%). Hypoglycaemia management was influenced by the availability of glucagon. Oral glucose was used by 82% before injecting glucagon, whereas 40% of patients without glucagon called for the ambulance when severe symptoms were present even before initiating treatment with oral glucose. CONCLUSION: This survey determined the minimum frequency of severe hypoglycaemia requiring the ambulance at 1.6 episodes patient(-1) year(-1). Precipitating factors and a lack of coping skills and behaviours that might prevent severe hypoglycaemia and ambulance calls were identified.

Diffusion rates of vasopressin through human vaginal and buccal mucosa.

The permeability to several chemical compounds and the histology of vaginal and buccal mucosa are very similar. Because vaginal mucosa is more abundant, it may be used as a model for the latter. To further develop the vaginal/buccal mucosa model, the objective of the present study was to evaluate the passage of a small polypeptide, vasopressin, across fresh and frozen specimens of these two mucosae. Specimens of fresh buccal and vaginal mucosa were taken from excised tissue obtained following vaginal hysterectomies and various oral surgical procedures. Pieces of buccal and vaginal tissue specimens obtained were used fresh or were snap-frozen and stored at -85 degrees C for periods of up to 10 months. Biopsies from fresh and thawed specimens were mounted in flow-through diffusion cells and their permeability to tritiated vasopressin was determined using a continuous flow-through perfusion system. Specimens were examined histologically before and after freezing as well as before and after permeability experiments and similarities between vaginal and buccal tissues verified. No statistically significant differences between flux values for fresh and frozen vaginal and buccal mucosa, respectively, were found. These results demonstrate that the permeation of vasopressin across fresh and frozen human vaginal and buccal mucosa is for practical purposes similar. These results further support the human vaginal/buccal mucosa model for in vitro permeability studies on therapeutically active compounds.

South African oral hygienists: their profile and perception of their profession and career.

The aim of the study was to determine a profile of the oral hygienists in South Africa, their views on the profession, work-place, and the practice of their career, which aspects of the work they enjoy and which are not enjoyable, their opinions on expanding duties for hygienists and which duties should be included, and their perceptions about the status and importance of oral hygienists vis-à-vis other health providers. A questionnaire was sent to every third registered oral hygienist and 47 per cent responded. The majority who responded were in the age group 20 to 39 years, had been in practice for less than 15 years, were married, qualified at the Universities of Pretoria and Stellenbosch, and were employed in traditional practice. The larger proportion worked individually and practised from six to eight hours per day. They were happy with the training they received, believed their job was worthwhile, were satisfied with their careers and enjoyed a cordial relationship with dentists. Motivating, educating, assisting patients and communicating with people were the most enjoyable aspects of practice while procedures associated with the treatment of gingivitis and periodontitis and the poor response of patients to treatment were the least enjoyable. The majority preferred expanded duties for hygienists which should include elementary dentistry, local anaesthesia, minor extractions and emergency treatment and they also desired greater independence. Seventy-eight per cent felt that the public does not know what oral hygiene is. The status and importance of the profession were rated comparable to that of physiotherapists, qualified nurses, radiographers and dental therapists but significantly higher than dental assistants.

Smoking in urban pregnant women in South Africa.

AIM: To estimate the exposure to active and passive smoking of pregnant women in South Africa and to determine their knowledge and behaviour with regard to smoking during pregnancy. METHODS: A questionnaire was completed by pregnant women attending antenatal services in four South African cities. Questions were asked about smoking status, beliefs on the health effects of tobacco smoke during pregnancy, exposure to passive smoking and behavioural changes with regard to smoking during pregnancy. Women from different ethnic groups and social classes participated. RESULTS: The study population was 394 pregnant women. Of these 42% were black, 29% coloured and 10% Indian women, who used public antenatal services, and 19% were pregnant women (ethnicity unspecified) who attended private obstetric practices. Of the coloured women, 47% smoked; for the black and Indian women and those who attended a private practice, the smoking rates were 4%, 3% and 28%, respectively. Approximately 90% of the pregnant women knew it was unhealthy to smoke during pregnancy. Most women who smoked stopped or reduced tobacco use during their pregnancy. Of the pregnant women, 70% lived with at least one smoker in the house. CONCLUSIONS: Few black and Indian pregnant women in South Africa smoke, while coloured pregnant women smoke heavily. Quitting programmes should be targeted at them when they attend antenatal services. Pregnant women and their families should be alerted to the impact of environmental tobacco smoke, since so many are passive smokers during pregnancy.

An observer-blind randomised parallel group study comparing the efficacy and tolerability of tenoxicam and piroxicam in the treatment of post-operative pain after oral surgery.

Tenoxicam and piroxicam were compared for analgesic efficacy in 58 patients undergoing removal of bilateral impacted third molar teeth, under general anaesthesia. Pain intensity was assessed over a 7 day period by the patient using verbal and visual analogue scales. The patients received one hour pre-operatively dormicum 7.5 mg orally and either tenoxicam 40 mg or piroxicam 40 mg rectally. This was followed by tenoxicam 20 mg daily in effervescent form, or piroxicam 20 mg daily in despersible tablet form for 7 days. Surgical and anaesthetic techniques were standardized for all patients. Therapeutic gain was assessed by comparing hourly pain levels 4 hours post-operatively and then twice daily for 7 days. Trismus was evaluated pre-operatively, at one hour, 24 hours and 7 days post-operatively. Analysis of the results showed a statistical significant difference between the treatment groups only 4 hours post-operatively, patients in the tenoxicam group experiencing less pain than those in the piroxicam group (p = < 0.05).

Threshold effect of liver iron content on hepatic inflammation and fibrosis in hepatitis B and C.

BACKGROUND/AIMS: In hepatitis C, iron depletion may improve serum aminotransferases and the response to interferon, but it is not known whether inflammation and fibrosis correlate with hepatic iron content. Our aim was to establish whether hepatic iron content correlates with histological and serum indices of hepatic inflammation and fibrosis in hepatitis B and C. METHODS: Total hepatic iron was measured using computerized histomorphometry, and hepatic inflammation and fibrosis using a modified Knodell score, on histological slides from 31 patients with chronic hepatitis B and 38 with hepatitis C. RESULTS: Total hepatic iron was similar in the hepatitis B and C groups (0.82 +/- 1.72% and 0.56 +/- 1.12%; mean +/- SD). No iron was detectable in 11 patients with hepatitis B and 13 with hepatitis C. Alanine aminotransferase (85.96 +/- 67.1 vs 44.2 +/- 39.7 p < 0.05), aspartate aminotransferase (93.8 +/- 75.6 vs 47 +/- 33.5 IU/ml p < 0.05) and histological inflammatory score (9.33 +/- 3.51 vs 7.79 +/- 3.3 p = 0.07) were increased in those with stainable hepatic iron compared to those without. However, where iron was present, no association was found between the amount of hepatic iron and inflammatory or fibrosis scores. In hepatitis C, fibrosis was minimal in 77% of patients if iron was absent vs 24% with iron present, while marked fibrosis was present in 56% with iron vs 15% without iron (p < 0.01, Fisher's exact test). CONCLUSION: Hepatic iron is associated with increased hepatic inflammation in chronic hepatitis B and hepatitis C and with high fibrosis scores in hepatitis C. There is a threshold effect, and once present, increasing iron does not correlate with increasing inflammation or fibrosis.

An evaluation of the effect of oral ketamine and standard oral premedication in the sedation of paediatric dental patients.

We compared the effectiveness of ketamine with standard oral premedication (SOP) in 60 children, 2-7 years of age, sedated orally for dental treatment under local anaesthesia. Children were assigned randomly to receive either 12.5 mg/kg ketamine or 0.5 ml/kg of SOP orally 60 min before the dental procedure. Pulse rate, systolic, diastolic and mean arterial pressures, respiratory rates and blood oxygen saturation were recorded prior to drug administration, 60 min thereafter and immediately before the dental procedure. Anxiety levels were measured at the same time intervals. The level of sedation was measured 60 min after drug administration. No significant differences were found in the anxiety levels between the groups 60 min after oral administration. The level of sedation in both groups before surgery was excellent. Operator evaluation for overall effectiveness of treatment showed that sedation was very good in 60 per cent of children in the ketamine group compared with 20 per cent in the SOP group. More children in the ketamine group were better sedated (p < 0.05). Both premedicants produce good sedation and anxiolysis 60 min after premedication and immediately before the surgical procedure.

Dimensional differences in the craniofacial morphologies of groups with deep and shallow mandibular antegonial notching.

Certain craniofacial characteristics were identified on the lateral cephalograms of 40 untreated subjects with shallow mandibular antegonial notches and 40 subjects with deep notches. Subjects with shallow notches demonstrated more on the morphological characteristics usually associated with horizontal mandibular growth patterns than did subjects with deep notches, and their mandibles were positioned more protrusively. In general, the mandibles of the shallow notch subjects proved to be longer than mandibles of the deep notch subjects. On average, mandibles with deep notches showed greater gonial angles, deeper posterior ramus notch depths, and larger occlusal plane inclinations. The total anterior facial height of shallow notch subjects was much smaller than that of the deep notch subjects. The maxillae in deep notch subjects were more retrusive in relation to the cranial base when compared with the shallow notch subjects. A discriminant analysis was used to determine which combinations of variables were most consistently related to either deep or shallow mandibular antegonial notches. Eighty percent (80%) of the cases were classified correctly as deep or shallow notch cases by means of this discriminant function.