Dental general anaesthesia--will the service disappear? A pilot study.

OBJECTIVES: To identify likely future trends in recruitment of consultant anaesthetists to the ambulatory dental general anaesthetic (DGA) services. PARTICIPANTS: The sample consisted of all anaesthetic specialist registrars (SpRs) in their final year of training, within Mersey and South-Western Deaneries in the U.K. RESEARCH DESIGN: A questionnaire divided into a quantitative section to establish level of training in ambulatory DGA, and a qualitative section designed to elicit opinions and attitudes towards ambulatory DGA services. RESULTS: The response rate was 75% (27/36). Within both regions 81% (22/27) had received practical training in ambulatory DGA procedures. SpRs in the South-Western Deanery held the greatest misgivings about the ambulatory DGA technique. Once appointed to Consultant position only 11% (3/27) of respondents expressed a definite interest in providing ambulatory DGA services. CONCLUSIONS: Within the Northwest and Southwest of England, most specialist registrars in anaesthetics receive training in ambulatory DGA, although their future commitment to the delivery of these services is questionable.

Monitoring of coastal and transitional waters under the E.U. Water Framework Directive.

A set of guidelines are presented for the definition of monitoring plans in coastal and transitional (estuarine and lagoonal) systems subject to the European Union Water Framework Directive - WFD (2000/60/EC). General principles of best practice in monitoring are outlined, including (a) the definition of three types of broad management objectives: water quality, conservation, and human use, to which the general public may easily relate. These will define the core and research indicators (WFD quality elements) to be used for monitoring; (b) priorities and optimisation in a (financially and logistically) resource-constrained environment; (c) quality assurance; and (d) assessment of monitoring success: this should focus on the outputs, i.e. the internal audit of the monitoring activity, and on the outcomes. The latter component assesses programme effectiveness, i.e. environmental success based on a set of clearly-defined targets, and informs management action. The second part of this work discusses the approach and actions to be carried out for implementing WFD surveillance, operational and investigative monitoring. Appropriate spatial and temporal scales for surveillance monitoring of different indicators are suggested, and operational monitoring is classified into either screening or verification procedures, with an emphasis on the relationship between drivers, pressure, state and response. WFD investigative monitoring is interpreted as applied research, and thus guidelines cannot be prescriptive, except insofar as to provide examples of currently acceptable approaches. Specific case studies are presented for both operational (coastal eutrophication control) and investigative monitoring (harmful algal blooms), in order to illustrate the practical application of these monitoring guidelines. Further information is available at http://www.monae.org/ .

Linkage of the grey coat colour locus to microsatellites on horse chromosome 25.

The progressive loss of colour in the hair of grey horses is controlled by a dominantly inherited allele at the Grey locus (GG). In this study, two paternal Quarter Horse (QH) families segregating for the GG allele were genotyped with a set of 101 microsatellite markers spanning the 31 autosomes and the X chromosome. This genome scan demonstrated linkage of Grey to COR018 (RF=0.02, LOD=12.04) on horse chromosome 25 (ECA25). Further chromosome-specific analysis of seven total QH families confirmed the linkage of Grey to a group of ECA25 markers and the map order of NVHEQ43-(0.24)-UCDEQ405-(0.09)-COR080-(0.05)-GREY-(0.14)-UCDEQ464 was produced. Although G was found to be linked to TXN and COR018 in the chromosome-specific analysis, the data were not sufficiently informative to place either marker on our ECA25 map with significant LODs. Our results excluded the equine tyrosinase related protein 1 (TYRP1) and melanocyte protein 17 (Pmel17) genes as possible candidates for the grey phenotype in horses.

A randomized controlled trial of a community-based consultation service to prevent falls.

BACKGROUND: Multifaceted programs that combine assessment with interventions have been shown to reduce subsequent falls in some clinical trials. We tested this approach to see whether it would be effective if offered as a consultation service using existing health care resources. METHODS: The subjects of this randomized controlled trial had to be aged 65 years or more and had to have fallen within the previous 3 months. They were randomly assigned to receive either usual care or the intervention, which consisted of in-home assessment in conjunction with the development of an individualized treatment plan, including an exercise program for those deemed likely to benefit. The primary outcomes were the proportion of participants who fell and the rate of falling during the following year. Visits to the emergency department and admissions to hospital were secondary outcomes. RESULTS: One hundred and sixty-three subjects were randomly assigned to either the control or the intervention group, and 152 provided data about their falls. There were no significant differences between the control and intervention groups in the cumulative number of falls (311 v. 241, p = 0.34), having one or more falls (79.2% v. 72.0%, p = 0.30) or in the mean number of falls (4.0 v. 3.2, p = 0.43). Analysis of secondary outcomes (health care use) also showed no significant differences between the intervention group and the control group. In the Cox regression analysis, there was no significant difference between the groups in the proportion of subjects having one or more falls (p = 0.55), but there was a significantly (p < 0.001) longer time between falls in the intervention group. In a post hoc subgroup analysis, subjects with more than 2 falls in the 3 months preceding study entry who had been assigned to the intervention group were less likely to fall (p = 0.046) and had a significantly longer time between falls (p < 0.001), when compared with the group who received usual care. INTERPRETATION: The intervention did not decrease significantly the cumulative number of falls, the likelihood of participants having at least one fall over the next year or the mean number of falls. It did increase significantly the time between falls in a survival analysis when age, sex and history of falling were used as covariates.

Oral lichen planus: a review.

Lichen planus is a somewhat frequent oral lesion. The most prevalent type is reticular, which is asymptomatic. The erosive and atropic forms, although not as common, cause discomfort or pain, and the patient usually demands attention. Treatment modalities include the use of topical steroids, although retinoic acid, griseofulvin and cyclosporine have been used. The occurrence of squamous cell carcinoma in areas of lichen planus make it necessary to follow up on patients suffering from chronic lesions.

Effects of filtration, collimation, and target-receptor distance on artificial approximal enamel lesion detection with the use of RadioVisioGraphy.

RadioVisioGraphy is an imaging modality that uses a charge-coupled device electronic sensor. Dental charge-coupled device imaging can be used to detect dental caries; however, it was not known what effect beam collimation, added filtration, or variable target-receptor distance has on this task. The purpose of this investigation was to study these effects were imaged by conventional radiography and RadioVisioGraphy varying exposure time, target-receptor distance, collimation, and filtration. Printed RadioVisioGraphy images without enhancement and E-speed radiographs were evaluated by five viewers. The number of true-positives and false-positives were compared as were sensitivity, specificity, positive and negative predictive values, accuracy, and entrance level radiation exposure. Added filtration reduced the false-positives regardless of collimation or target-receptor distance. True-positives and false-positives were greater at a target-receptor distance of 8 inch at exposures < 0.10 seconds (F < 0.0151). E-speed radiographs had a greater specificity and positive predictive value than RadioVisioGraphy images without image enhancement; however, no significant differences were found between RadioVisioGraphy images and E-speed radiographs in true-positive or false-positive identifications without image enhancement.

Triamcinolone acetonide versus chlorhexidine for treatment of recurrent stomatitis.

This study compared the efficacy of pain control of two medications, used to treat recurrent aphthous stomatitis, placed under a physical barrier of cyanoacrylate. Thirty patients with recurrent aphthous stomatitis were selected from the records of the Diagnostic Referral Clinic at Indiana University School of Dentistry and randomly divided into three groups; one group was a control. Experimental groups received a topical application of either triamcinolone acetonide (0.025%) or chlorhexidine digluconate (0.12%). Medications were covered by isobutyl cyanoacrylate (Iso-Dent). Controls received the Iso-Dent only. Patients kept a diary to record their pain level on a 10 cm visual analog scale until the lesion healed. Ulcer episodes were treated for 12 weeks. Because some patients had multiple episodes, a total of 35 ulcer episodes were available for analysis. The mean number of ulcer days for each group was not significantly different. ANOVA with repeated measures for 10 days on each patient was first performed. A highly significant difference in pain intensity and perception was found at different days (p < 0.0001). No significant difference was found between the triamcinolone acetonide and chlorhexidine gluconate (p < 0.49).

Effects of timolol ophthalmic solution on the intra-ocular pressure rise induced by suxamethonium and tracheal intubation.

Thirty patients received topical application of either timolol ophthalmic solution 0.25%, or normal saline, 2 h before elective ophthalmic surgery in a double-blind study. The responses to suxamethonium and tracheal intubation were compared by measuring intra-ocular pressure before induction of anaesthesia, 1 min after administration of thiopentone 2-4 mg.kg-1, 1 min after administration of suxamethonium 1 mg.kg-1, and 1, 2.5 and 5 min after tracheal intubation. There was no significant difference between the groups.

Presurgical tomographic assessment for dental implants. 1. A modified imaging technique.

A modified technique for presurgical evaluation of intraosseous implant placement using linear tomography has been developed. The simplified technique is applicable to tomographic systems equipped with a cephalometric head positioner (cephalostat) and a fiberoptic positioning light system. It provides precise cross-sectional images for the assessment of bone morphology and associated anatomic structures. This technique is more comfortable for patients who are unable to tolerate the positioning of submentovertex projections used to estimate horizontal angulation of the head position and to determine the depth of radiographic cut. Instead, the positioning light and casts are used to make these two determinations.

Radiographic interpretation of endodontic file length.

The purpose of this study was to evaluate the accuracy of examiners when asked to make file length adjustments with only a radiograph. The examiners viewed several radiographs under proper viewing conditions but without the aid of measuring devices. Two files of varying lengths (sizes 10 and 15) were placed in maxillary and mandibular premolars and molars from cadavers. The nine examiners were 67.91% in agreement of actual file length adjustment needed when adjustments of up to 0.5 mm were needed, 17.76% when adjustments of from 0.5 up to 1.0 mm were needed, and 14.33% when adjustments of greater than 1.0 mm were needed.

Effects of nebulized lignocaine on the intraocular pressure responses to tracheal intubation.

We have examined the effect of preoperative administration of nebulized lignocaine or saline on the intraocular pressure (IOP) response to tracheal intubation in 20 adults. In the saline group, tracheal intubation was associated with a significant increase in IOP above control and preintubation values (P less than 0.01); in the lignocaine group there was no change in IOP following intubation. After intubation, IOP was significantly less in the lignocaine group than in the saline group (P less than 0.05).

The Keeler Pulsair air impulse tonometer. Comparison with the Perkins hand-held applanation tonometer for peri-operative measurement of intra-ocular pressure.

The Keeler Pulsair is a noncontact tonometer which can be used by those without specialist ophthalmic training. The instrument was compared, in a series of 30 patients in whom a total of 150 readings were taken, in respect of accuracy, ease and speed of use, and acceptability to patients, with the Perkins hand-held applanation tonometer. There was good correlation between measurements obtained with the two instruments: r = 0.92, (p less than 0.001); the Pulsair was described as easy to use in 87% of subjects, and no patient found the procedure unpleasant. The median times taken for Pulsair measurements were 7 (range 4-14) seconds for a single reading in conscious patients, and 11 (range 4-29) seconds for four readings in anaesthetised patients. These times were significantly quicker than those recorded with the Perkins tonometer which were 83 (range 66-138) seconds and 20 (range 8-45) seconds respectively (p less than 0.001). We conclude that the Pulsair is suitable for use by those who are not ophthalmologists for the rapid measurement of intra-ocular pressure changes during anaesthesia.

Gastric aspirates after trauma in children.

The volumes and pH of gastric aspirates obtained from 110 children (aged 1-14 years) who underwent surgery for trauma were related to the duration of pre-operative starvation and to the interval between food and injury. Aspirates were larger in children fasted for 4-6 hours than in those fasted for up to 10 hours, and were larger in children injured within 2 hours of eating than in those in whom this interval was longer (p less than 0.05). However, 19 of 39 children (49%) starved for over 8 hours had an aspirate of more than 0.4 ml/kg, as did five of 16 children (31%) injured 3 or more hours after eating. Thus, a 'safe' interval between oral intake and induction cannot be predicted. We conclude that securing the airway by prompt tracheal intubation is the safest way to manage any child who presents for emergency anaesthesia after trauma.

Pharmacokinetics of bupivacaine following intraoperative intercostal nerve block in neonates and in infants aged less than 6 months.

Pharmacokinetics and blood concentrations of bupivacaine were studied after intercostal nerve blocks were performed intraoperatively using 1.5 mg.kg-1 in 11 neonates (age 0-28 days) and 11 infants between age 1 and 6 months. The study aimed to provide pharmacokinetic data that are limited in these age groups, and to identify any adverse effects of intercostal nerve block in infancy. Arterial blood samples were taken at 0, 5, 10, 15, 20, 30, 60, 120, 240, and 360 min. Whole blood bupivacaine was assayed by high-performance liquid chromatography. Peak blood concentrations were attained within 10 min in 18 of 22 subjects, and were 087 micrograms.ml-1 [corrected] +/- 0.56 micrograms.ml-1 (mean and SD) and 0.91 +/- 0.27 micrograms.ml-1 in neonates and infants, respectively. Pharmacokinetic variables in the two groups included elimination half-life (t1/2 beta): 132 +/- 59 min and 102 +/- 39 min; steady-state volume of distribution (Vdss): 2.56 +/- 0.76 l.kg-1 and 2.17 +/- 0.17 l.kg-1; and total body clearance (Clt): 16.93 +/- 9.32 ml.min-1.kg-1 and 15.71 +/- 6.99 ml.min-1.kg-1. There was no statistically significant difference between neonates and infants with regard to any of these parameters. Patients were further divided into those with acyanotic and cyanotic disease. Cyanotic infants were significantly heavier than acyanotic infants (P less than 0.05), but no other differences were demonstrated. No adverse effects resulting from the technique were identified.(ABSTRACT TRUNCATED AT 250 WORDS)