THE TRAINING AND UTILIZATION OF PARAPROFESSIONAL PERSONNEL IN A PUBLIC HEALTH DENTAL PROGRAM OF PREVENTION

This paper presents the experience of the Public Health Dental Department in Denver with the utilization of Dental Prevention Therapists.     

Mechanism of hemolysis induced by ferriprotoporphyrin IX.

Incubation of a 0.5% suspension of washed, normal mouse erythrocytes with ferriprotoporphyrin IX (FP) at 37 degrees C and pH 7.4 caused potassium loss, swelling, increased susceptibility to hypotonic lysis, and finally hemolysis. Hemolysis was not inhibited by incubation in the dark, malonyldialdehyde was not produced, and various free radical scavengers had no effect on the hemolysis. Only the sulfhydryl compounds, cysteine, dithiothreitol, and mercaptoethanol protected erythrocytes from FP. Potassium loss reached 90% within 30 min of exposure to 5 microM FP. This amount of FP caused greater than 50% hemolysis within 2.5 h. Sucrose (0.1 M) completely prevented hemolysis but had no effect on potassium loss. Likewise, reducing the temperature from 37 to 25 degrees C greatly retarded hemolysis but had no effect on potassium loss. These observations indicate that FP impairs the erythrocyte's ability to maintain cation gradients and induces hemolysis by a colloid-osmotic mechanism.     

The effects of theophylline on the physical performance and work capacity of well-trained athletes

Theophylline, a pharmacologic agent presently permitted during international sporting competition, has come under scrutiny because of the suggestion that it may be ergogenic. This study examined the effects of serum theophylline levels of 10 to 20 mg/L and the administration of a placebo on selected measures of physical performance and work capacity to determine any ergogenic outcomes. Seven male and three female elite athletes from a variety of team sports and aged 18 to 30 years participated in the study. The variables measured were height, mass, maximal oxygen consumption, muscular endurance, muscular power, muscular strength, FVC, FEV1, and reaction time. When the scores obtained after ingestion of theophylline and a placebo with a double-blind, crossover technique were compared, no significant difference was found for any of these variables. A two-way analysis of variance of FEV1 scores obtained before and after maximal exercise revealed no significant "F" ratios. This indicated that none of these trained athletes demonstrated exercise-induced asthma and that there was no difference in airway resistance after maximal exercise while they were under the influence of theophylline or placebo. We conclude that no ergogenic effects were attributable to theophylline therapy which should therefore remain an acceptable means of management of athletes with asthma participating in international sporting events.     

Hepatic oxygen supply during early and late sepsis in the rat

Hepatic oxygen supply and related parameters were evaluated during early (8-10 h) and late (18-26 h) stages of lethal septic peritonitis induced in rats by cecal ligation and puncture. In the early phase, hepatic pO2 was reduced significantly (mean 9.3 versus 22.2 mmHg in sham-operated controls). This was accompanied by elevations of serum glutamic oxaloacetic transaminase and glutamic pyruvic transaminase (p less than 0.02 and p less than 0.10, respectively), and increased hematocrit (p less than 0.001). Total body oxygen consumption was decreased by 19% (p less than 0.001). By the late stage of sepsis, hepatic oxygen supply was depressed profoundly (mean 2.0 versus 24.5 mmHg in controls) concomitant with further elevations of serum transaminases. Lactacidemia, respiratory alkalosis, and tachycardia were also present. Hypoxemia and hypotension were not observed during either early or late stages. Our results may be interpreted as representing early and progressive impairment of hepatic oxygen delivery in rats subjected to cecal ligation and puncture.     

Laboratory protocol for exercise asthma to evaluate salbutamol given by two devices

PURPOSE: As new delivery devices and formulations are being introduced for drugs given by inhalation, there is a need to evaluate their equivalence with old preparations. One way to do this is to investigate their equivalence in protecting from exercise-induced asthma (EIA). METHODS: We used a protocol for EIA to compare the protective effect of salbutamol delivered by the pressurised metered dose inhaler (pMDI) and the new Diskus dry powder device. Twenty-seven asthmatic subjects with moderately severe EIA completed an exercise test on four separate days at two study centers. Exercise was performed by cycling for 8 min while inhaling dry air (0% RH, 20-24 degrees C). The target workload in W was predicted as (53.76 x predicted FEV1) - 11.07 and 95% of this target was achieved at 4 min of exercise. This target was chosen in order to achieve ventilation between 50 and 60% of predicted maximum in the last 4 min. RESULTS: There was no significant difference in the workload, ventilation, or heart rate achieved on the study days. The severity of EIA was measured as the % fall in FEV1. EIA severity was similar on the placebo and control day and the coefficient of variation was 19.4%. The mean +/- SD % fall on the control, placebo, salbutamol by Diskus, and pMDI were 42.0% +/- 15, 39.4% +/-17.6, 13.4% +/- 13.2, and 8.5% +/- 13.8, respectively. Salbutamol significantly inhibited the % fall in FEV1 after exercise, and there was no difference between the preparations. CONCLUSION: The protocol described here is suitable for evaluating equivalence of salbutamol preparations in protecting against EIA and could be used to evaluate the protective effect of other medications.     

Treatment of osteonecrosis in the hip of pediatric patients by free vascularized fibular graft

The purpose of the current study was to review the demographics and etiologies of symptomatic femoral head osteonecrosis in the pediatric and adolescent population and to assess the results of treatment using free vascularized fibular grafting. A group of patients with femoral head osteonecrosis who were treated with free vascularized fibular grafting was reviewed. Patients who were studied were 18 years of age or younger at the time of surgery. Records were examined for demographic data, etiology of osteonecrosis, stage of the disease at time of surgery, and results of treatment including preoperative and postoperative Harris hip scores. Eighty-two pediatric and adolescent patients with osteonecrosis of the femoral head underwent 90 free vascularized fibular grafting procedures. Fifty patients (54 hips) who have been followed up at least 2 or more years (average, 4.3 years) constituted the study group. At the last followup, total hip arthroplasty was performed in seven hips (seven patients) and hip fusion was performed in one hip (one patient). The average Harris hip scores in patients who did not undergo total hip arthroplasty improved from a preoperative average of 55.3 points to 90.2 points at the latest followup. Treatment of patients with osteonecrosis with free vascularized fibular grafting resulted in a lower rate of conversion to total hip arthroplasty or fusion (16%) in pediatric and adolescent patients when compared with conversion to total hip arthroplasty in adults (25%). The quality of life as evidenced by the increased Harris hip scores was improved significantly in this group of pediatric and adolescent patients.