Health related quality of life in patients with Parkinson's disease two years following posteroventral pallidotomy.

BACKGROUND: There has been a new emphasis on the use of health related quality of life (HRQOL) measures for translating how a patient's response to treatment is experienced by the patient. The purpose of this study was to describe patient reported HRQOL two years after surgery in subjects who underwent posteroventral pallidotomy (PVP) for the treatment of Parkinson's disease (PD) and a subset of these same subjects four years following PVP. METHOD: A consecutive series of 52 subjects who were evaluated previously, prior to and at 4 months following PVP [3], received long term follow-up using mailed questionnaires. Twenty seven subjects (52% of the original sample) provided 2 year follow-up data and 15 of these subjects (29%) provided 4 year follow-up data. Severity of disease and subject reported HRQOL were evaluated. FINDINGS: Immediately following surgery, there was a sharp decrease in all measures of severity of disease. While there were differing patterns of increasing severity of disease among the measures following the immediate postoperative assessment, all of the measures remained better than the pre-surgery values. The data showed a pattern of marked improvement in HRQOL at 4 months following PVP. Over the 2 years following surgery, there was a gradual deterioration toward preoperative levels that nevertheless remained better than preoperative HRQOL. For the group with data at 4 years following surgery, there was no significant further deterioration in HRQOL between 2 and 4 years, with the 4 year data also remaining better than the preoperative HRQOL reports. CONCLUSIONS: In spite of advanced severe PD and advanced age, subjects in this study reported better HRQOL at 2 years following PVP than they reported at entry into the study prior to surgery. Additionally, the 15 patients who were available for follow-up at 4 years also reported better HRQOL than they experienced prior to the surgery.

Patient participation in physical therapy goal setting.

BACKGROUND AND PURPOSE: An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient's goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if so, what methods they use. Therapists' attitudes toward participation and patient satisfaction with the examination were also examined. SUBJECTS AND METHODS: Twenty-two physical therapists audiotaped the initial examination of 73 elderly patients (mean of 76.4 years of age, SD = 7.1, range = 65-94). The audiotaped examinations were then scored using the Participation Method Assessment Instrument (PMAI) to determine the frequency of attempts made by therapists to involve patients in goal setting. Therapists and patients completed surveys following the examinations. RESULTS: Therapists' use of participation methods during examinations ranged from a minimum of 1 to a maximum of 19 out of 21 possible items on the PMAI. The therapists stated that they believed that it is important to include patients in goal-setting activities and that outcomes will be improved if patients participate. Patients also indicated that participation is important to them. DISCUSSION AND CONCLUSION: In most cases, the therapists did not fully take advantage of the potential for patient participation in goal setting. Patient and therapist education is needed regarding methods for patient participation during initial goal-setting activities.

Radiographic and aerodynamic measures of velopharyngeal anatomy and function following Furlow Z-plasty.

Recent studies have shown that the Furlow double-opposing Z-plasty has several advantages that make it an attractive procedure for cleft palate repair and treatment of velopharyngeal insufficiency in selected cases. The anatomic changes associated with this procedure have never been documented prospectively. The purpose of this study was to describe radiographic dimensions of the velopharynx and aerodynamic measures of velopharyngeal function in a group of patients before and after Furlow Z-plasty for the treatment of velopharyngeal insufficiency. Twelve consecutive patients with cleft palate and velopharyngeal insufficiency, ranging in age from 3 to 19 years, were selected as candidates for Furlow Z-plasty based on perceptual, endoscopic, and radiographic findings. Eight patients had repaired cleft palate with a residual muscle diastasis and four patients had unrepaired submucous cleft palate. Subjects received aerodynamic and cephalometric assessments before and after Z-plasty. Cephalometric x-rays were measured for velar length, thickness, and pharyngeal depth. Mean nasal airflow during pressure consonants (Vn) was calculated from pressure/flow studies, and patients were categorized as having complete closure (<10 cc/sec Vn) or incomplete closure (>10 cc/ sec Vn). After Z-plasty, there was a significant increase in velar length (p = 0.002) and velar thickness (p = 0.001). After surgery, patients with complete velopharyngeal closure had significantly greater velar length than the incomplete closure group (p = 0.05) with nearly twice the increase in length. Similarly, following surgery, the complete closure group had significantly greater thickness than the incomplete closure group (p = 0.01), with a greater postoperative increase in velar thickness (p = 0.005). Finally, there was a significant negative correlation between percent increase in length and percent increase in thickness for patients in the complete closure group (r = -0.91, p = 0.03). Findings demonstrate that following Furlow Z-plasty, patients with cleft palate and velopharyngeal insufficiency obtained significant increases in velar length and thickness. Greater velar length and greater velar thickness both were associated with complete velopharyngeal closure. Patients in the complete closure group tended to demonstrate large percent gains in either length or thickness or moderate gains in both. Patients in the incomplete closure group tended to demonstrate relatively small percent gains in both dimensions. Results suggest there may be important anatomic features (such as pharyngeal depth/velar length ratio) that can be evaluated before surgery to predict which patients may be most likely to benefit from Furlow Z-plasty as a form of treatment for velopharyngeal insufficiency.

Changes in health related quality of life in patients with Parkinson's disease with and without posteroventral pallidotomy.

Traditional clinical outcome measures for the treatment of Parkinson's disease (PD) have focused on motor function and activities of daily living. However, in the past decade there has been a new emphasis on the use of health related quality of life (HRQOL) measures for translating how a patient's response to treatment is experienced by the patient. The purpose of this study was to describe patient reported HRQOL in subjects who underwent Posteroventral pallidotomy (PVP) for the treatment of PD compared with a similar group of subjects who did not undergo surgery (non-PVP). A consecutive series of patients who underwent PVP (n = 52) was compared prospectively with a similar group of patients, who received adjustments to medications without surgery (n = 45). Severity of disease and self reported HRQOL were evaluated at two time periods. Time 1 data were collected within one week prior to surgery for the PVP group or when subjects received medication adjustments for the non-PVP group. Time 2 data were collected 4 months later. Results showed that the severity of disease improved from Time 1 to Time 2 for both groups. HRQOL improved significantly for the PVP group (p = 0.001) but not for the non-PVP group (p > 0.29). Changes in HRQOL were most strongly related to the improvement in severity of disease in the "off" state. The results of this study suggest that PVP is associated with significant improvements in clinical and patient reported outcomes four months following surgery compared with a similar group of patients who did not undergo surgery. Additionally, the results suggest that the difference in perceived outcome between the groups is due in part to the improvement in the levodopa "off" periods which occurred for the PVP group but not for the non-PVP group.

The photic sneeze reflex and ocular anesthesia.

BACKGROUND AND PURPOSE: Intravenous sedation to minimize discomfort from local anesthetic injection has many potential complications including severe involuntary sneezing (i.s.). This prospective study evaluates the occurrence of i.s. and a history of photic sneezing (p.s.). METHODS AND MATERIALS: All patients receiving local anesthesia (retrobulbar or periocular injections) after intravenous thiopentone for eye surgery during eight months were asked about p.s. and observed for i.s. RESULTS: The 557 patients (40% males) had a mean age of 69.9 years and 14% recalled p.s. (29.5% males). I.s. developed in 5.2% of the 557. Only 7.6% of those with p.s. developed i.s. After periocular injections 23.8% developed as compared to 4.5% after retrobulbar injections. (P < 0.001). There was no relationship between p.s. and i.s. (p = 0.43). CONCLUSION: I.s. is not linked to p.s., with males and females at equal risk for either. I.s. is more common after periocular injections.

Open drops in ophthalmology offices: expiration and contamination.

OBJECTIVE: To determine the relationship between eye drop use and contamination rate in ophthalmology offices. DESIGN: Following permission request, open bottles were examined and the nozzle tip and one drop of content was cultured on solid media. OUTCOME MEASURES: Drug category, volume, weight compared to full, clean legible label, expiration date; 2 or more bacterial colonies along the inoculation site. RESULTS: In 18 offices, of 1,485 open bottles (mean 12.2, range 4 to 23 per lane) on average 19.8% (range 0% to 88%) were expired (16.2 of 82.5 bottles per office). The frequency of occurrence (%) and expiration (%E) were 40.3% cycloplegics (19.4%E); 16.4% glaucoma (33.7%E); 10.8% anesthetics (8.8%E); and 4% steroids (8.8%E; or 42.2%E including one outlier). Most likely expired were glaucoma (P < 0.001); small 2-3 ml (P < 0.02), nearly empty (P < 0.05), or dirty (P < 0.001) bottles. Only one (5 ml cyclopentolate, not expired) grew a Micrococcus (0.07%). CONCLUSIONS: Drops in ophthalmology offices may be expired but are not contaminated.

Effect of allogeneic freeze-dried demineralized bone matrix on regeneration of alveolar bone and periodontal attachment in dogs.

This split-mouth study was designed to evaluate regeneration of alveolar bone and periodontal attachment following implantation of allogeneic, freeze-dried, demineralized bone matrix (DBM). Buccal fenestration defects (6x4 mm) were created on the maxillary canine teeth in 6 beagle dogs. DBM was implanted into one randomly selected defect in each animal. The contralateral defect served as surgical control. Tissue blocks were harvested following a 4-week healing interval and prepared for histometric analysis. DBM was discernible in all implanted defects with limited evidence of bone metabolic activity. The DBM particles appeared invested within a dense connective tissue, often in close contact to the instrumented root. Fenestration defect height averaged 3.8+/-0.1 and 3.7+/-0.3 mm, total bone regeneration 0.9+/-0.9 and 0.4+/-1.2 mm, and total cementum regeneration 2.3+/-1.5 and 0.6+/-0.7 mm for DBM and control defects, respectively. Differences with regards to cementum regeneration were statistically significant (p=0.03). In summary, the results of this study suggest that DBM implants may enhance cementum regeneration in this defect model, and that they have no apparent effect on alveolar bone regeneration. Enhanced cementum regeneration may be possibly be explained by provisions for guided tissue regeneration from the implant suppressing a significant influence of the gingival connective tissue on the healing process. Moreover, a 4-week healing interval appears insufficient for turnover of DBM.

Clinical and antimicrobial effects of a single episode of subgingival irrigation with tetracycline HCl or chlorhexidine in deep periodontal pockets.

15 adults, each providing 4 non-adjacent untreated periodontal pockets with a probing depth (PD) exceeding 6 mm, volunteered for a randomized, split-mouth, double-blind, clinical study evaluating subgingival irrigation with chlorhexidine (CHX) or tetracycline HCl (TTC). The study protocol included oral hygiene instructions followed by scaling and root planing. Experimental and immediately adjacent teeth did not receive instrumentation. The 4 deep periodontal pockets in each patient were assigned to be irrigated with 150 ml CHX (0.12%), TTC (10 or 50 mg/ml; TTC10, TTC50), or sterile saline (control) in a single episode. Post-irrigation mechanical plaque control was supported by 2x daily CHX rinses throughout the 12-week observation interval. Recordings of oral hygiene (P1I), gingival health (GI), bleeding on probing (BoP), probing depth (PD), clinical attachment level (CAL), and microbial morphotypes from subgingival paper point samples were performed pre-irrigation, and at 1, 2, 4, 6, 8, 10, and 12 weeks post-irrigation. Mean post-irrigation P1I was low, fluctuating between 0.0 and 0.4, without significant differences between experimental groups. Mean pre-irrigation GI approximated 1.4 and reached 0.8 at the exit of study without significant differences between experimental groups. All experimental sites exhibited BoP pre-irrigation. BoP was significantly reduced in TTC50 compared to TTC10, CHX and control sites from week 8 post-irrigation. PDs were reduced for the experimental groups with TTC50 exhibiting the strongest reduction. CALs remained unaltered from pre-irrigation for TTC10, CHX and control sites over the 12-week observation interval, whereas TTC50 sites consistently improved to significantly differ from all other groups at week 10 and 12 post-irrigation. The distribution of bacterial morphotypes was significantly altered towards one of periodontal health for all experimental groups with a profound effect for TTC50 sites. Our results suggest that subgingival irrigation with TTC solutions at high concentrations may have a role in the management of adult periodontitis.

Effect of allogenic freeze-dried demineralized bone matrix on guided tissue regeneration in dogs.

This randomized, split-mouth study was designed to evaluate the adjunctive effect of allogenic, freeze-dried, demineralized bone matrix (DBM) to guided tissue regeneration (GTR). Contralateral fenestration defects (6 x 4 mm) were created 6 mm apical to the buccal alveolar crest on maxillary canine teeth in 6 beagle dogs. DBM was implanted into one randomly selected fenestration defect. Expanded polytetrafluoroethylene (ePTFE) membranes were used to provide bilateral GTR. Tissue blocks including defects with overlying membranes and soft tissues were harvested following a four-week healing interval and prepared for histometric analysis. Differences between GTR+DBM and GTR defects were evaluated using a paired t-test (N = 6). DBM was discernible in all GTR+DBM defects with limited, if any, evidence of bone metabolic activity. Rather, the DBM particles appeared solidified within a dense connective tissue matrix, often in close contact to the instrumented root. There were no statistically significant differences between the GTR+DBM versus the GTR condition for any histometric parameter examined. Fenestration defect height averaged 3.7+/-0.3 and 3.9+/-0.3 mm, total bone regeneration 0.8+/-0.6 and 1.5+/-0.8 mm, and total cementum regeneration 2.0+/-1.3 and 1.6+/-1.7 mm for GTR+DBM and GTR defects, respectively. The histologic and histometric observations, in concert, suggest that allogenic freeze-dried DBM has no adjunctive effect to GTR in periodontal fenestration defects over a four-week healing interval. The critical findings were 1) the DBM particles remained, embedded in dense connective tissue without evidence of bone metabolic activity; and 2) limited and similar amounts of bone and cementum regeneration were observed for both the GTR+DBM and GTR defects.

Relationship between quality of life and depression in patients with head and neck cancer.

OBJECTIVE: This study describes the relationship between health-related quality of life (HRQOL) and depression in patients following major surgery for head and neck cancer. DESIGN: Cross-sectional study using medical chart review, patient interview, and test administration. METHOD: Fifty patients were evaluated 6 months to 6 years following surgery using one global HRQOL measure (The Functional Assessment of Cancer Therapy-General [FACT-G]); three disease-specific measures of HRQOL (the HN module of the FACT [FACT-HNS], The University of Washington Quality of Life Scale [UWQOL], and The Performance Status Scale for Head and Neck Cancer); and one measure of depression (The Beck Depression Inventory [BDI]). RESULTS: The study population showed a high occurrence of depressive symptoms (22%). A negative correlation existed between the BDI and HRQOL as measured by the FACT-G (r = -0.49, P < .001) and the UWQOL (r = -0.44, P = .003). When somatic symptoms of depression were removed, the BDI remained correlated with HRQOL and was most highly correlated with the Emotional Well-Being (EWB) subscale of the FACT-G (r = -0.42, P = .003). There was no correlation between clinician judgments of EWB and any patient-rated measures of HRQOL or depression. CONCLUSIONS: Results demonstrate an inverse relationship between patient-reported HRQOL and depression. The lack of correlation between physician and patient ratings of HRQOL and EWB stresses the importance of obtaining patient ratings in addition to traditional clinician ratings when assessing outcomes. Finally, the multidimensional construction of the FACT with its specific subscales may make it a useful clinical tool for assessing patient status and augmenting patient interviews.

Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis.

STUDY OBJECTIVE: Although adjunctive intravenous bicarbonate therapy is commonly recommended for children with severe diabetic ketoacidosis (DKA), no studies assessing clinical outcome with this therapy have ever been performed. Our objective was to determine whether bicarbonate therapy influenced outcome for pediatric DKA. METHODS: The study was a retrospective consecutive case series of 147 admissions for severe DKA (initial pH < or = 7.15 and glucose concentration > or = 300 mg/dL [16.7 mmol/L]) in 106 children during a 16-year period at a tertiary university medical center. Descriptive statistics were applied to the 147 admissions. The first patient admitted with DKA was then selected for each of the 106 children, and clinical and laboratory data were compared between subjects who did and did not receive bicarbonate. Multivariate and matched pair analyses were performed to control potentially confounding variables. RESULTS: Fifty-seven of the 147 patients admitted with DKA (39%) were successfully treated without bicarbonate, including 9 with a pH of 7.00 or less and one with a pH of 6.73. The frequency of complications was comparable between bicarbonate and nonbicarbonate groups (4% versus 2%, P = 1.00). The mean duration of hospitalization for children receiving bicarbonate was 23% (16 hours) longer than children who did not receive bicarbonate in the multivariate analysis (P = .07) and 37% (22 hours) longer in the matched pair analysis (P = .01). The mean rate of metabolic recovery by three distinct measures was similar between groups, and the sample had 80% power to detect differences of 14% to 29% in these measures. CONCLUSION: We found no evidence that adjunctive bicarbonate improved clinical outcome in children with severe DKA. The rate of metabolic recovery and complications were similar in patients treated with and without bicarbonate, and prolonged hospitalizations were noted in the bicarbonate group. We conclude that adjunctive bicarbonate is unnecessary and potentially disadvantageous in severe pediatric DKA.

Retrospective analysis of factors related to clinical outcome of guided tissue regeneration procedures in intrabony defects.

The purpose of this retrospective study was to determine factors affecting clinical outcome of guided tissue regeneration (GTR) in the treatment of intrabony periodontal defects. 38 patients each contributing 1 isolated intrabony defect treated with GTR were included in this analysis. Patient and defect characteristics, and defect-specific recordings relative to clinical outcome 6 months postsurgery were assessed. GTR treatment resulted in clinically and statistically significant improved probing depths (PD), clinical attachment levels (CAL), and probing bone levels (PBL). Presurgery PD and PBL were of predictive value for CAL gain and PBL gain, respectively. CAL and PBL gain did not correlate to defect depth or configuration. Cigarette smoking exhibited a highly significant negative correlation to parameters of clinical outcome.

Vaginal pH as a marker for bacterial pathogens and menopausal status.

OBJECTIVE: Our purpose was to confirm the elevation of vaginal pH expected in patients with bacterial pathogens in premenopausal women and to examine the relationship of serum follicle-stimulating hormone and estradiol levels to vaginal pH in menopausal patients without and with hormone replacement therapy. STUDY DESIGN: Vaginal pH was determined by phenaphthazine (Nitrazine) pH paper in 253 patients seen in a solo private practice for routine speculum examination. None of the patients were pregnant. Measurements were made of serum levels of follicle-stimulating hormone and estradiol for 172 patients and vaginal cultures were taken from 82 patients. Vaginal pH was correlated with vaginal cultures and serum follicle-stimulating hormone and estradiol levels by use of statistical analysis. RESULTS: Vaginal pH was elevated in all premenopausal patients with documented bacterial pathogens. Serum estradiol levels showed an inverse and serum follicle-stimulating hormone levels a direct statistical correlation with vaginal pH in menopausal patients. CONCLUSIONS: Measurement of vaginal pH is useful, effective, and inexpensive for screening purposes. A vaginal pH of 4.5 is consistent with a premenopausal serum estradiol level and the absence of bacterial pathogens. An elevated vaginal pH in the 5.0 to 6.5 range suggests a diagnosis of either bacterial pathogens or decreased serum estradiol. In patients with an elevated pH, vaginal culture should establish the diagnosis. In the absence of bacterial pathogens, a vaginal pH of 6.0 to 7.5 is strongly suggestive of menopause. Titration of estradiol level by vaginal pH during estrogen replacement therapy may help menopausal women avoid side effects or cessation of therapy.

Concentrations of indoleamine metabolic intermediates in the ventricular cerebrospinal fluid of advanced Parkinson's patients with severe postural instability and gait disorders.

Postural instability and gait disorders (PIGD) are the primary causes of disability in many but not all advanced Parkinson's disease (PD) patients. We have measured the concentrations of serotonin, 5-hydroxytryptophan (5-HTP), 5-hydroxy-3-indoleacetic acid (5-HIAA), and homovanillic acid (HVA) in samples of ventricular cerebrospinal fluid from ten PD patients with severe disability from PIGD and from ten PD patients with tremor and levodopa induced dyskinesia as their predominant motor dysfunction. The two groups were prospectively matched for duration of disease and age. No significant differences between the two groups were found in the concentration (mean +/- SD in ng/ml, PIGD dominant vs. tremor-dyskinesia dominant) of 5-HIAA (106 +/- 50 vs. 99 +/- 34) or HVA (1,068 +/- 595 vs. 881 +/- 469). Serotonin concentration was significantly lower (0.7 +/- 0.5 vs. 1.5 +/- 0.9) and 5-HTP concentration was substantially higher (684 +/- 1,054 vs. 6 +/- 5) in the patient group with PIGD as their predominant symptoms. Thus, the distinguishing feature of patients with severe PIGD appears to be a derangement in indoleamine metabolism at the reaction step catalyzed by aromatic amino acid decarboxylase (AADC). These findings suggest that aggravation of PIGD in advanced Parkinson's may be related in part to impaired serotonergic transmission secondary to inhibition or down regulation of AADC.

Comparison of mucogingival changes following treatment with coronally positioned flap and guided tissue regeneration procedures.

This study compared the variation in anatomic width of the mucogingival unit following coronally positioned flap or guided tissue regeneration procedures in deep (greater than or equal to 4 mm) buccal maxillary gingival recession defects 12 months postsurgery. Eighteen patients, 10 treated with guided tissue regeneration procedures and eight treated with coronally positioned flap procedures, were retrospectively analyzed. The results demonstrated that both treatments led to consistent recession depth reduction and coronal shift of the mucogingival junction. A significant increase in the amount of keratinized gingiva was observed for the guided tissue regeneration procedure, but a decrease that was not statistically significant was observed for the coronally positioned flap procedure.

Periodontal healing following reconstructive surgery: effect of guided tissue regeneration.

Clinical healing following guided tissue regeneration (GTR) in deep intrabony pockets was compared to healing following gingival flap surgery alone (GFS). 15 patients received the GTR treatment including an expanded polytetrafluoroethylene membrane. 13 other patients received the control treatment GFS. A postsurgery protocol emphasizing wound stability and infection control was used. Treatment effects were evaluated 6 months postsurgery. Mean pre-surgery probing depth for the GTR and control treatments was 7.5 +/- 1.0 and 7.7 +/- 1.5 mm, respectively. Significant probing depth reduction (3.8 +/- 1.2 and 2.9 +/- 1.1 mm), attachment level improvement (2.4 +/- 2.1 and 2.2 +/- 1.2 mm) and bone fill (2.0 +/- 2.0 and 2.4 +/- 0.9 mm) followed the GTR and control protocols, respectively (p < 0.01). Significant differences between GTR and control treatments were observed in probing depth reduction (p < 0.01) and in gingival recession increase (1.7 +/- 1.5 and 0.7 +/- 0.9 mm, respectively; p < 0.05). The results suggest that GTR procedures compared to GFS have similar clinical potential in intrabony pockets, under the present protocol.

Quality of life and functional status measures in patients with head and neck cancer.

OBJECTIVE: To assess the relationship among three validated head and neck-specific measures of functional status and a general measure of quality of life in patients with head and neck cancer. DESIGNS: Cross-sectional study using medical chart review, patient interview, and test administration. SETTING: Academic tertiary referral center. PARTICIPANTS: Fifty adults patients 3 months to 6 years after major surgery for head and neck cancer. MAIN OUTCOME MEASURE: Scores from a general measure of quality of life (the Functional Assessment of Cancer Therapy), a subscale specific to head and neck cancer, the University of Washington Quality of Life Questionnaire, and the Performance Status Scale for Head and Neck Cancer Patients. RESULTS: The disease-specific measures of functional status correlate well with one another. However, there were low correlations between the Functional Assessment of Cancer Therapy and the disease-specific measures, indicating that general and disease-specific instruments contribute unique information about quality of life. CONCLUSION: A general measure of quality of life augments information obtained by disease-specific instruments by interpreting functional status in the broader scope of the patient's life.

Use of chlorhexidine chewing gum significantly reduces dental plaque formation compared to use of similar xylitol and sorbitol products.

A double-blind 3-treatment crossover design employing a 6-day trial period with out mechanical oral hygiene measures was used to compare dental plaque formation following use of chlorhexidine (CHX) acetate-, xylitol-, and sorbitol-containing chewing gum. Fourteen dental students were assigned a random ordering of the chewing gum products and received professional tooth cleaning at the start of trial periods. For each trial period, subjects were instructed to use 5 pieces of the unlabeled chewing gum daily (containing 5.0 mg CHX acetate/piece; 0.8 xylitol/piece; or 1.0 g sorbitol/piece). Two pieces of chewing gum were used following each morning and evening meal and one piece following the noon meal. The subjects were instructed to use the products for 20 minutes at each occasion. A 7-day washout-period between trial periods was used. The Turesky modification of the Quigley and Hein index was used to assess plaque formation. Differences between treatments were evaluated using a repeated measures ANOVA with Newman-Keuls multiple comparisons. The CHX-containing chewing gum showed significantly reduced plaque values (0.7 +/- 0.4) compared to the sorbitol-(2.7 +/- 0.4; P < 0.01) and xylitol-product (1.7 +/- 0.3; P < 0.01). Furthermore, the CHX-product significantly reduced plaque levels compared to the study subjects' regular plaque control routines (1.3 +/- 0.04; P < 0.05). The xylitol-product exhibited significantly lower plaque-values than the sorbitol-product (P < 0.01). Our results suggest that regular use of CHX-containing chewing gum appears useful to control dental plaque formation.

Intra - and inter-examiner reproducibility in constant force probing.

This study evaluated intra- and inter-examiner reproducibility for a conventional manual probe versus a computer-interfaced force-controlled periodontal probe. 2 examiners recorded probing depths (PD) and relative attachment levels (AL) at 1128 sites in 15 periodontal maintenance patients. Each site was evaluated 2x, 7 to 10 days apart by both examiners. Probing force for the electronic probe was 15 g. PD intra-examiner reproducibility (within +/- 1.0 mm) for shallow sites (PD < or = 3 mm) was 98.6% versus 91.5% for the conventional versus the electronic probe for examiner 1 and 98.5% versus 88.7% for examiner 2. Corresponding values for deeper sites (PD > 3 mm) were 96.4% versus 85.9% for examiner 1 and 95.1% versus 77.0% for examiner 2. Generally, AL intra-examiner reproducibility was 1 to 3% lower than for PD. PD inter-examiner reproducibility (within +/- 1.0 mm) was 99.2% versus 90.7% for the conventional versus the electronic probe, respectively, for shallow sites and 95.4% versus 76.9% for deeper sites. AL inter-examiner reproducibility (within +/- 1.0 mm) was 1 to 5% lower than for PD. Both intra- and inter-examiner reproducibility was higher for anterior than for posterior sites. Mean PD and AL were similar for both examiners. However, the electronic probe consistently recorded 0.1 to 0.2 mm higher values than the conventional probe. Standard deviations indicated a greater variability for electronic than for manual probing. The results suggest that intra- and inter-examiner reproducibility may not necessarily be higher with an electronic, force-controlled periodontal probe than with a conventional manual probe.

Quantitative measures of laryngeal function following Teflon injection or thyroplasty type I.

Laryngeal/voice function was evaluated in six patients with unilateral true vocal fold paralysis following treatment with Teflon injection (TEF) compared to six patients treated with thyroplasty type I (THY). Auditory perceptual, aerodynamic, and endoscopic assessments were conducted. Three judges rated nine voice characteristics. Aerodynamic measures included estimated subglottal pressure, airflow, and laryngeal resistance. Two judges rated laryngeal characteristics from flexible fiberoptic assessment. The THY group had significantly better voice quality and better quantitative aerodynamic findings compared to the TEF group. The TEF group also was more likely to have an irregular vocal fold edge, an irregular glottal closure pattern, a higher occurrence of hyperfunction and hypertrophy of the false vocal folds, edema, and erythema of the paralyzed folds. Results suggest that THY was associated with more favorable measures of laryngeal/voice function than TEF. It is likely that the poorer perceptual, aerodynamic, and endoscopic findings associated with TEF injection may be due to violation of the true vocal fold cover, particularly increased true vocal fold mass and stiffness.