Simple posterior elbow dislocation and brachial artery transection.

We report the uncommon occurrence of a complete brachial artery transection following simple posterior dislocation of the elbow, successfully managed by cephalic vein interposition grafting. This case together with a review of the literature was conducted with the aim of highlighting important issues regarding the diagnosis, management and prognosis of this rare complication.

The readability of printed education materials regarding hormone replacement therapy.

In summary, HRT is a preventative medication that has been shown to decrease the incidence of heart disease and osteoporosis. It also has been shown to reduce symptoms of menopause and to increase the quality of life of users. Choosing to begin and maintain HRT is a personal and complicated decision. In evaluating the risks and benefits of HRT for any one woman, that woman and her primary care provider must individualize her past and current medical history, her family history, and her lifestyle. Together they must come to a decision that best represents the health, social needs, and desires of the patient. Individualizing HRT is difficult for a woman to do on her own, and it is time-consuming for a practitioner. Using PEMs to clarify the benefits and risks of HRT can be very beneficial to a woman considering such therapy. PEMs, however, are not a substitute for one-on-one education, and especially are not appropriate for teaching if their level of technical difficulty is beyond the scope of a patient's comprehension. This study suggests that many of the PEM's provided to women on the subject of HRT are failing to reach their target audiences because of their level of reading difficulty. A stated objective identified in the national initiative Healthy People 2000 (U.S. Department of Health and Human Services, 1997) is to "Increase to at least 90% the proportion of perimenopausal women who have been counseled about the benefits and risks of hormone replacement therapy for the prevention of osteoporosis." PEMs are one way to reach this objective, provided they are understandable to the clientele of focus.

Pricing, regulation, and competitiveness. Lessons for the US from the Japanese pharmaceutical industry.

This paper examines the nature of Japanese government regulation of pharmaceutical prices, and the impact of that regulation on the competitive performance of the Japanese industry. Possible implications for the reintroduction of pharmaceutical price controls in the US are also considered.

Price regulation, industry structure and innovation: an international comparison of pharmaceutical industries.

The home competitive environment has a powerful effect on companies -- shaping skills, strategies, and performance outside the home environment. Government industrial policies, such as pharmaceutical pricing regulations, affect companies primarily through shaping the nature of the home environment. Successful competitive environments (such as the UK) exhibit higher average drug prices and an internal structure of prices that favour significant innovators, discourage minor products, and provide a shield against foreign competitors. Poor competitive environments (such as France) exhibit low average prices and an internal price structure that favours weak local companies producing imitative or minor products.

Effect of sanguinaria extract on development of plaque and gingivitis when supragingivally delivered as a manual rinse or under pressure in an oral irrigator.

The effects on developing plaque and gingivitis following rinsing with a placebo oral rinse or an oral rinse containing 300 micrograms/ml sanguinaria extract (sanguinaria) were compared to effects produced by supragingival irrigation with dilute solutions of the rinse corresponding to 22.5 micrograms/ml sanguinaria and 90 micrograms/ml sanguinaria. The study design was a repeated measures, single-blind crossover with no oral hygiene over 2 weeks duration. After 7 and 14 [corrected] days, significantly lower plaque and gingivitis scores were obtained with use of the sanguinaria-containing rinse and irrigating solutions compared with the placebo rinse. There were no significant differences in plaque and gingivitis scores between the groups using the sanguinaria rinse and the sanguinaria irrigating solutions. A comparison [corrected] of % distribution of 0, 1 and 2+ scores also indicated that rinsing and supragingival irrigation with sanguinaria was more effective in plaque and gingivitis control than rinsing with the placebo. The results suggest that sanguinaria oral rinse may be effective in controlling plaque and gingivitis when delivered by manual rinsing or supragingival irrigation.

Effect of sanguinaria extract on established plaque and gingivitis when supragingivally delivered as a manual rinse or under pressure in an oral irrigator.

Sanguinaria extract (sanguinaria) solutions were evaluated in 44 subjects in a 2-week, no oral hygiene study as a 300 micrograms/ml manual rinse, and the results compared to supragingival irrigation with 22.5 micrograms/ml sanguinaria concentration and supragingival irrigation with water. Both the manual use of sanguinaria and supragingival irrigation of dilute sanguinaria produced significantly less plaque growth than supragingival irrigation with deionized water. In terms of % changes from baseline, manual rinsing and supragingival irrigation with sanguinaria limited plaque growth to 17.7% and 24.2%, respectively, while irrigation with water had a 51.5% growth. For gingivitis, control supragingival irrigation with sanguinarine and with water were statistically different from manual rinsing with sanguinaria. Compared to baseline, the groups irrigating with sanguinaria and with water had gingivitis reductions of 68.7% and 73.3%, respectively, while manual rinsing with sanguinaria had a 29.6% reduction. The results suggest that dilute solutions of sanguinaria delivered via rinsing or supragingival irrigation are effective in controlling plaque as an additional benefit to the use of supragingival irrigation to control gingivitis. Supragingival irrigation with sanguinaria as part of a home care routine for patients with plaque and gingivitis is suggested.

The relationship of sanguinaria extract concentration and zinc ion to plaque and gingivitis.

The effects of sanguinaria extract and zinc chloride on plaque growth and gingivitis inhibition were assessed on subjects with initially plaque-free tooth surfaces using a series of oral rinses in a single-blind, crossover, no-oral-hygiene study lasting 2 weeks. A placebo oral rinse containing no sanguinaria or zinc chloride (A), and test rinses containing 150 micrograms/ml sanguinaria and 0.2% zinc chloride (B), 300 micrograms/ml sanguinaria and no zinc chloride (C), and 300 micrograms/ml sanguinaria and 0.2% zinc chloride (D) were evaluated. Subjects using the higher concentration rinses C and D had significantly lower plaque scores than rinse A at 7 and 14 days (p less than 0.05 for C, p less than 0.01 for D). However, groups C and D were not significantly different from each other. Group D had significantly lower plaque (p less than 0.05) and gingivitis (p less than 0.01) scores than group B. Subjects who used rinse B and placebo rinse A had the highest plaque and gingivitis scores and comparison of these two groups revealed no significant difference. At the end of 14 days, the % distribution of 0 plaque and gingivitis scores was greatest among subjects using rinses C and D. Subjects in these 2 groups also had the lowest incidence of plaque and gingivitis scores of 2+. It is concluded that the effects of sanguinaria rinses on developing plaque and gingivitis are influenced more by sanguinaria concentrations than the presence or absence of zinc ion, but that zinc ion may provide a mild enhancement of sanguinaria effectiveness against gingivitis.