Early oral feeding after elective abdominal surgery--what are the issues?

This review analyzes the literature and the historical concerns (restrictions, traditions, nasogastric tube) and pathophysiologic factors (postoperative ileus, risk of anastomotic dehiscence, nausea and vomiting, loss of appetite) invoked for not instituting early oral feeding after major abdominal procedures. It appears that several factors may promote postoperative oral feeding such as thoracic epidural analgesia, multimodal anti-emetic treatment, opioid-sparing analgesia, selective peripheral opioid antagonists, and enforced oral nutrition. Recent data from multimodal fast-track rehabilitation surgical programs in abdominal surgery provide a rational basis for future studies to investigate and facilitate enforced oral feeding after major abdominal procedures.     

Interdental design of porcelain veneers in the presence of composite fillings: finite element analysis of composite shrinkage and thermal stresses

PURPOSE: This study was conducted to optimize the interdental design (wraparound) of porcelain laminates bonded to teeth in the presence of preexisting composite fillings. MATERIALS AND METHODS: A finite element model (2-dimensional mesh generated from a horizontal cross section of a maxillary incisor) was used to evaluate the effects of luting composite shrinkage and thermal changes on the stress distribution within the ceramic. The mesh included 3 restorative designs (3 degrees of interdental wrapping) and a Class III composite filling. Curing contraction of the luting composite was simulated at baseline temperature (37 degrees C). Thermal loads from 37 to 60 degrees C and from 37 to 5 degrees C were assessed with and without preexisting composite shrinkage. Surface tangential stresses were calculated at the ceramic surface and interface. RESULTS: Curing contraction alone generated mostly compressive stresses (peaks at 15 MPa) at both the ceramic surface and interface. Stresses remained compressive (peaks at 20 MPa) when thermal changes were added, except for the conservative veneer with minimum wraparound, the margins of which showed potentially harmful tensile stress peaks (approximately 7 MPa). Deformation of the tooth-restoration complex tended to be more uniform for veneers with maximum wraparound. In the presence of thermal loads alone, opposite effects were observed on the restoration surface and the interface, with compressive stresses on one side (up to 13 MPa) and tensile stresses on the other (up to 9 MPa). This effect of proximal bending (explained by the nearby expansion/contraction of the composite filling) was attenuated by the significant reduction of the bulk of the preexisting interdental composite by the overlapping veneer. CONCLUSION: In the finite element environment, the negative effect of the nearby expanding/contracting composite fillings can be minimized by extending the veneer over the preexisting interdental restoration. Because of the precompressed state resulting from composite shrinkage, ceramics showed lower temperature-induced tensile stresses.     

Sleep and posture

Computer-assisted open catheter studies of 10 healthy, nose-breathing men in dorsal and in lateral recumbent sleep demonstrated stable intrasubject transpharyngeal differential pressures and airflow resistances. They averaged 19.6 Pa (± standard deviation [SD] 11.9) and 0.103 Pa/cm³ per second (± SD 0.065) in the dorsal posture and stage II sleep during quiet breathing and were not significantly different in the lateral posture or in stage I sleep. Five subjects were snorers, and their pharyngeal airflow pressures and resistances increased substantially during quiet breathing on assumption of recumbency and much more in sleep. In the 5 subjects who were nonsnorers, postural changes were not significant and sleep increases were moderate. During snoring, transpharyngeal pressures and resistances increased even further, averaging 188 Pa and 1.02 Pa/cm³ per second for the whole group. Transpharyngeal differential pressures and hypopharyngeal transmural pressures frequently exceeded 300 Pa in inspiration and in expiration during periods of snoring. Yet, transpharyngeal differential pressures and resistances did not reveal appreciable differences between phases that would indicate compliant change of pharyngeal cross section. Breathing frequency was unchanged, but ventilation was significantly diminished at elevated upper airway resistances (P<.01). Transpharyngeal resistances and differential pressures varied independently from widely differing nasal resistances. As with our earlier studies, pressure measurements alone clearly demonstrated breathing patterns and events.     

A computer algorithm for triple radionuclide subtraction studies applied for preoperative localization of enlarged parathyroid glands

This paper presents a computer algorithm for triple radionuclide subtraction studies and its application to preoperative localization of enlarged parathyroid glands. In the clinical examination procedure, ¹³¹I-toluidine blue was used as the principal radionuclide, ^99mTcO₄ and ^113mIn were used to obtain additional images of the thyroid and the blood distribution respectively. A scintillation camera with a pinhole collimator and connected to a digital data aquisition system was used to record the images. Subtraction of uniform background, thyroid and blood contributions to the principal image is done automatically in the computer program. The results from a clinical study is used to illustrate the method.     

Bodily pain and associated mental distress among immigrant adolescents

Abstract Objective The aim of this study was to describe differences among immigrant groups in bodily pain, and analyze its association with mental distress. Method A population-based cross-sectional study was carried out involving tenth grade pupils in Oslo. Of the 7,343 pupils that participated, one-quarter were first- or second-generation immigrants. The Hopkins Symptom Checklist-10 was used to measure mental distress. All information on pain and mental distress was self-reported. Results Girls reported more bodily pain from all types of pain. Headache was the most prevalent pain site across gender and immigrant groups. Strong associations between mental distress and number of pain sites were found for all immigrant groups. Neck and shoulder pain yielded the highest odds ratio (OR) for mental distress among the majority of the immigrant groups. The Sub-Saharan African group had the highest adjusted OR for mental distress [OR=9.8 (1.1–82.7)] when reporting three or more pain sites, and the Indian Subcontinent the lowest [OR=4.0 (1.8–8.8)]. Conclusion The differences in number and types of pain were small, though significant between the different immigrant groups. Adolescents from Sub-Saharan Africa seem to react with more mental distress to bodily pain than adolescents emigrating from the Indian Subcontinent.     

Cold air challenge and specific airway resistance in preschool children

Important asthma outcomes such as lung function and bronchial hyperresponsiveness are probably determined in early childhood. Early and longitudinal objective assessment of lung function and bronchial hyperresponsiveness is necessary to enable early diagnosis, monitor intervention and improve prognosis in preschool children. Cold air challenge and plethysmographic measurement of specific airway resistance (sRaw) are feasible candidate methods for diagnosis, clinical monitoring and research during this critical period of lung growth and development. Methodology and practical aspects of cold air challenge and assessment of sRaw in preschool children are reviewed. Reference values are provided for sRaw and have allowed discrimination between health and respiratory disease, both in cross-sectional and longitudinal studies. Bronchial hyperresponsiveness can be determined with acceptable repeatability and provides good discrimination between asthmatics and healthy. The effects of classic anti-asthmatic therapies have also been documented with these techniques. The need for further standardisation and improvement of these methods and future perspectives are outlined.