Cross-sectional comparisons of caries time trends in nursery school children in Sendai, Japan

Abstract The aim of this study was to clarify the trends in caries experience in the primary dentition of nursery school children in Sendai, Japan, over a period of 20 yr. An annual clinical dental examination of children aged 2–5 yr at 13 nursery schools in Sendai City was carried out in 1972, 1977, 1982, 1987 and 1992. Data obtained from all five surveys were compared in each age group respectively. The percentages of 2-, 3- and 4-yr-olds free from caries increased remarkably until 1977, while that in 5-yr-olds started increasing several years later. After such increments, percentages in all age groups except 3-yr-olds remained almost at the same level with slight fluctuations. The mean deft and deft values per child in 2-, 3- and 4-yr-olds decreased remarkably until 1977, but then remained almost at the same level thereafter. That in 5-yr-olds continued decreasing slightly during the 20-yr period. The marked reduction of caries experience in nursery school children shown during the 1970's did not continue through the 1980's or the beginning of the 1990's.     

Abdominal incisional hernia occurring after an esophagectomy reconstructed with a gastric tube through an antesternal route: Report of a case

A Japanese man, who had undergone a subtotal esophagectomy reconstructed with a gastric tube through an antesternal route for esophageal carcinoma 16 years previously, was admitted to our hospital because of an abdominal incisional hernia. The abdominal incisional hernia was in his upper abdomen and was difficult to push back into the intraabdominal cavity by hand. The hernia was successfully repaired by operation. We thus conclude that an abdominal incisional hernia is a rare but important late-phase complication occurring after an esophagectomy reconstructed with either an antesternal or retrosternal route, and an operation should be the treatment of choice.     

Periodontal treatment needs assessed by the use of clinical and radiographic criteria

The aim of the present study was to use a decision making model in order to assess the periodontal treatment needs of a random sample of employees in a large Swedish industrial corporation. The model used provided data on critical bone loss limits for different tooth types and ages, beyond which treatment must be initiated, in order to fulfill the goal of maintaining all teeth in a functional state throughout life. A sample comprising 192 subjects belonging to four age strata (31-35 yr, 41-45 yr, 51-55 yr, and 61-65 yr) was involved. From each subject, a full mouth series of intra-oral radiographs were available. The radiographic bone height was assessed at the mesial and distal aspect of all teeth by measuring the distance between the cementoenamel junction and the bone crest. The clinical examination included assessments of plaque, gingivitis, probing pocket depth, and probing attachment level. The results revealed that (i) only 3.1% of all approximal tooth sites exhibited radiographic bone loss exceeding the critical limit, (ii) all individuals and 70% of the approximal tooth sites were in need periodontal treatment when presence of gingival inflammation (bleeding on probing) was employed as the single criterion for therapeutic intervention, (iii) the proportion of individuals and tooth sites requiring treatment amounted to 98% and 27%. respectively, when a probing pocket depth of at least 4 mm was included as an additional criterion, and 54% and 4.1%, respectively, if a probing depth threshold of 6mm was used, while (iv) the use of bleeding on probing in combination with radiographic bone loss beyond the critical limits disclosed a need of treatment in 40% of the subjects and 2.5% of the approximal tooth sites.     

Predictors of good prognosis in total anterior circulation infarction]

We analysed the predictive factors for relatively good prognosis in the patients with total anterior circulation infarction (TACI) defined by the Oxfordshire Community Stroke Project. One hundred patients with first-ever ischemic stroke within 6 hours of onset were enrolled. Outcomes were assessed at 3 months using the modified Rankin Scale (mRS), and rated as good if the mRS was 0 to 3, and as bad if the mRS was 4 or 5, or the patient was dead. These two groups were compared in terms of their clinical background, risk factors, vital signs, laboratory data, and cranial CT at the time of hospitalization and repeated CT at 24 to 48 hours after onset. There were 36 patients with good prognosis and 64 patients with bad prognosis. In univariate analysis, the patients with good prognosis were younger, had lower scores in the National Institutes of Health Stroke Scale (NIHSS, both total score and the score of consciousness sub-item), had fewer rates of deterioration within 7 days than the patients with bad prognosis. In the first cranial CT within 6 hours, the patients with good prognosis had fewer early CT signs including hyperdense middle cerebral artery sign, and brain swelling, as well as infrequent hypodensity more than 33% of total MCA territory, than the patients with bad prognosis. In the second CT during 24 to 48 hours, the patients with good prognosis had smaller lesions than the patients with bad prognosis. In multivariate analysis with logistic regression revealed that age < 70 years, low NIHSS score < or = 15, no deterioration in the acute phase, and small lesion on the second CT were independent predictors of good prognosis.     

Perivascular innervation of the cerebral circulation: Involvement in the pathophysiology of subarachnoid hemorrhage

The authors describe the perivascular innervation of cerebral circulation. The different nerve fiber systems can be classified as follows: 1. Sympathetic (noradrenaline, neuropeptide Y), 2. Parasympathetic (acetylcholine, vasoactive intestinal peptide/peptide histidine isoleucine (methionine), 3. Sensory (tachykinins, calcitonin gene-related peptide). Each of these systems is outlined by their basic anatomical and physiological facts. Then, the etiology of cerebral vasospasm after subarachnoid hemorrhage is discussed in relation to the cerebrovascular innervation.     

Consciousness disturbance caused by iodoform absorption in a patient with decubitus ulcer topically treated with iodoform-gauze]

A 76-year-old man with supranuclear palsy, developed consciousness disturbance followed by the treatment of decubitus ulcer in the sacral region using iodoform-gauze. He was semicoma and tachycardia. His pupils were miotic and light reflexes were absent. EEG demonstrated diffuse and random slow activities. Plasma concentration of free iodine was high (151 micrograms/dl), but the other laboratory findings including thyroid functions were normal. He was diagnosed as suffering from iodoform poisoning. The symptoms and laboratory abnormalities of the patient recovered soon after the removal of iodoform-gauze. Although iodoform has been widely used for the treatment of wounds, there are few case reports of its side effects, such as consciousness disturbance, delirium, headache and tachycardia.     

Ultrasonic plaque density of aortic atheroma and stroke in patients undergoing on-pump coronary bypass surgery.

OBJECTIVE: The purpose of this study was to determine the relationship between the aortic atheromatous plaque echo density and the incidence of postoperative stroke or embolic events in patients undergoing on-pump coronary artery bypass grafting (CABG). PATIENTS AND METHODS: Three hundred and fourteen patients who received on-pump CABG alone were studied. Images of the aortic plaques obtained using transesophageal echocardiography were transferred to a computer. Using an image analysis program, a histogram for plaques more than 3 mm in thickness was obtained through the gray tone frequency distribution of the pixels (0-225). The gray scale median (GSM) was used as a measure of plaque echo density. RESULTS: Fifty-eight plaques in patients not associated with postoperative stroke or embolic events had GSM ranging from 58 to 241 (151.0+/-38.2), while 9 plaques in patients associated with stroke or embolic events had GSM ranging from 67 to 130 (90.6+/-21.3, p<0.001). The incidence of stroke or embolism was 58.3% when GSM of plaque was less than 100, while it was 3.6% when plaque GSM was more than 100 (p<0.001). CONCLUSION: This study indicated that computer analysis of aortic atheromatous plaque was useful for selecting patients who had a high risk of postoperative stroke or embolism when receiving on-pump CABG, and for decreasing the incidence of them.     

Effect of Ventilatory Settings on Accuracy of Cardiac Output Measurement Using Partial CO2 Rebreathing

Background: Recently, a new device has been developed to measure cardiac output noninvasively using partial carbon dioxide (CO2) rebreathing. Because this technique uses CO2 rebreathing, the authors suspected that ventilatory settings, such as tidal volume and ventilatory mode, would affect its accuracy: they conducted this study to investigate which parameters affect the accuracy of the measurement.

Methods: The authors enrolled 25 pharmacologically paralyzed adult post-cardiac surgery patients. They applied six ventilatory settings in random order: (1) volume-controlled ventilation with inspired tidal volume (VT) of 12 ml/kg; (2) volume-controlled ventilation with VT of 6 ml/kg; (3) pressure-controlled ventilation with VT of 12 ml/kg; (4) pressure-controlled ventilation with VT of 6 ml/kg; (5) inspired oxygen fraction of 1.0; and (6) high positive end-expiratory pressure. Then, they changed the maximum or minimum length of rebreathing loop with VT set at 12 ml/kg. After establishing steady-state conditions (15 min), they measured cardiac output using CO2 rebreathing and thermodilution via a pulmonary artery catheter. Finally, they repeated the measurements during pressure support ventilation, when the patients had restored spontaneous breathing. The correlation between two methods was evaluated with linear regression and Bland-Altman analysis.

Results: When VT was set at 12 ml/kg, cardiac output with the CO2 rebreathing technique correlated moderately with that measured by thermodilution (y = 1.02x, R = 0.63; bias, 0.28 l/min; limits of agreement, -1.78 to +2.34 l/min), regardless of ventilatory mode, oxygen concentration, or positive end-expiratory pressure. However, at a lower VT of 6 ml/kg, the CO2 rebreathing technique underestimated cardiac out-put compared with thermodilution (y = 0.70x; R = 0.70; bias, -1.66 l/min; limits of agreement, -3.90 to +0.58 l/min). When the loop was fully retracted, the CO2 rebreathing technique overestimated cardiac output.     

Partial left ventriculectomy for end-stage cardiomyopathy: report of a case.

Cardiac transplantation is an established treatment for end-stage heart failure, but its use is very limited. Partial left ventriculectomy has been reported as an alternative treatment for end-stage dilated cardiomyopathy. However, it has been well recognized that emergency partial left ventriculectomy for intractable decompensation is associated with poor survival. We report a case of a 68-year-old man with a left ventricular end-diastolic diameter of 108 mm, who underwent emergency extended partial left ventriculectomy, without papillary muscle resection, and mitral valve replacement with chordae preservation to deal with ongoing cardiogenic shock caused by end-stage dilated cardiomyopathy. The patient's cardiac status and general condition improved after the operation, and he survived the crisis. This operation should be considered as an alternative strategy for patients with septal motion and very large left ventricle. Thus, we report a successful extended partial left ventriculectomy and mitral valve replacement for end-stage dilated cardiomyopathy with very large left ventricular end-diastolic diameter.