Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

Older age is not considered a contraindication for liver transplantation, but age-related morbidity may be a cause of mortality. Survival and the incidence of the main post-transplant complications were assessed in 111 adult liver transplant recipients. They were divided in two groups according to their age (patients younger than 60 years, n=54; patients older than 60 years, n=57) and both groups were compared. Older patients were more frequently transplanted for hepatitis C (p= 0.03) and hepatocellular carcinoma (p= 0.05) and their liver disease was less advanced (Child-Pugh and MELD scores were significantly lower; p=0.004 and p=0.05, respectively). After transplantation, older patients had a significantly lower survival (p=0.02). Higher age was independently associated with mortality (hazard ratio for each 10-year increase: 2.1; 95% confidence interval: 1.1- 4.0; p=0.02). The incidence of de novo neoplasia and nonskin neoplasia were higher in older patients (p=0.02 and p =0.007, respectively). Malignancy was the cause of death in one patient younger than 60 years and in 12 patients older than 60 years (p =0.002). In multivariate analysis, a higher age and smoking were independently associated with a higher risk of dying of de novo neoplasia. In conclusion, older liver transplant recipients have a significantly lower survival than younger patients. Malignancy is responsible for this decreased survival.     

Attitudes of College Football Officials Regarding NCAA Mouthguard Regulations and Player Compliance

The National Collegiate Athletic Association (NCAA) mandates the use of brightly colored, intraoral mouth- guards by football players to reduce the frequency and severity of craniofacial and intraoral morbidity and mortality, and to enhance the ability of officials to observe player compliance. The purpose of this 12-question mail survey was to determine the attitudes of on-Held game officials regarding current NCAA mouthguard regulations and patterns of utilization by college football players. The sample consisted of all 50 Big East Football Conference officials; a response rate of 100 percent was achieved. Only 42 percent of the officials reported observing all players in compliance, and quarterbacks were identified by others as the least compliant group (52%). The majority (88%) indicated that the 1990 rule for brightly colored mouthguards had been beneficial to them in determining player compliance, and 52 percent reported that this rule had resulted in more frequent use by these athletes. Nearly all officials (96%) indicated that they would issue a warning for noncompliance to the player or coach, rather than charging a timeout for a violation as prescribed by NCAA regulations. The majority (70%) believe current enforcement is appropriate, but expressed the opinion that coaches should be held more accountable for player compliance.     

In Vitro Wear of Nano-Composite Denture Teeth

PURPOSE: Few laboratory tests have been able to substantiate and quantify the wear resistances of polymeric denture teeth. This study evaluated the relative wear resistance of several types of denture teeth using an in vitro wear testing device. MATERIAL AND METHODS: Four different types of denture teeth [nano-filled (Veracia) and micro-filled composites (SR-Orthosit, Endura, Duradent, Surpass), cross-linked acrylic (SR-Postaris, Genios-P, Creapearl, Vitapan Physiodens, Premium 8, Integral), and a conventional acrylic (Biotone)] were used. The flattened buccal surface of each denture tooth was subjected to the evaluation of Knoop hardness (n=5) and localized wear for 100,000 cycles (n=10). Wear values were determined in micrometers using a profilometer. The data for the hardness, wear depth, and worn surface areas were individually analyzed by one-way ANOVA. RESULTS: Knoop hardness values (KHN) ranged from 28.2 to 29.8 for micro-filled composite, 18.9 to 21.6 for cross-linked acrylic, 22.7 for nano-composite, and 18.6 for conventional acrylic teeth. All micro-filled composite teeth were significantly harder than other teeth (p <0.0001). The wear depth values were 90.5 microm for the nano-composite, 69.8 to 93.0 microm for the micro-filled composite, 80.8 to 104.0 microm for the cross-linked acrylic, and 162.5 microm for conventional acrylic teeth. The worn surface areas were 5.1 mm2 for the nano-composite, 2.6 to 3.6 mm2 for the micro-filled composite, 4.4 to 5.7 mm2 for the cross-linked acrylic, and 10.1 mm2 for conventional acrylic teeth. The wear values of the acrylic control were significantly different from all other denture teeth (p <0.001). CONCLUSION: The nano-composite tooth was harder and more wear resistant than the acrylic teeth but not significantly different from most of the cross-linked and micro-filled composite teeth tested.     

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study

Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.     

Galea and subgalea graft for lip augmentation revision

In this paper we will review the results obtained during the last 2 years with the aponeurotic galea and subgalea for vermillion lip augmentation. The survey was carried out on 42 patients who displayed either an absence of or reduction in the vermillion of one or both lips or a senile lip. In all cases the surgical procedure introduced aponeurotic galea and subgalea in the space found between the orbicular lip muscle and the vestibular mucus, just behind the vermillion. All the operations were performed under local anaesthetic. The size of the aponeurotic galea fragment removed varied in length between 10 and 12 cms. and in width between 1 and 2 cms., using the following parameters for its dimensions: the previous volume of the lips, and the distance between the two buccal commissures when in the “smile position.”