Lower Chronic Stimulation Threshold in the Carbon-Tip than in the Platinum-Tip Endocardial Electrode: A Randomized Study

Seventy-nine patients admitted for VVI pacemaker treatment were randomly given a Siemens-Elema 412 S endocardial electrode (tip material vitreous carbon, tip area 12 mm2) (41 patients) or a Siemens-Elema 415 S endocardial electrode (tip material platinum, tip area 12 mm2) (38 patients). The groups did not differ in age, sex, magnitude of intracardiac signal or indication for pacemaker treatment. Pacing threshold was measured by the vario technique at 3 and 15 months after the implantation. In the group of carbon-tip electrodes and in the group of platinum-tip electrodes stimulation thresholds at implantation were 0.49 +/- 0.10 V and 0.54 +/- 0.14 V (ns), at months 31.40 +/- 0.45 V and 1.57 +/- 0.53 V (ns), and at months 15 1.12 +/- 0.33 V and 1.37 +/- 0.38 V (P = 0.003), respectively. After 1 year, 88% of the patients in the carbon-tip group and 66% (P = 0.04) in the platinum-tip group fulfilled our criteria for reducing pacemaker output from 5.0 V to 2.5 V. In comparable platinum-tip and carbon-tip pacing electrodes, the chronic stimulation threshold was lower in the carbon-tip than in the platinum-tip electrode.     

Transsphincteric repair of rectourethral fistulas following laparoscopic radical prostatectomy

Rectourethral fistula is a serious complication following laparoscopic radical prostatectomy. We report our experience with a transsphincteric approach in the repair of this uncommon complication. The rectourethral fistula was repaired in a three-stage procedure comprising fecal diversion, transsphincteric repair of the fistula and, finally, closure of the stoma. Two patients with rectourethral fistulas underwent this procedure and the postoperative course was uneventful. In conclusion, a transsphincteric approach in the repair of rectourethral fistula by a three-stage procedure is safe and may be the treatment of choice.     

Comparison of dental health data obtained from questionnaires, interviews and clinical examination

abstract – Validity of response to a postal questionnaire, answered by 216 persons, was studied by comparing data from the respondents on the occurrence of dentures and on the number of remaining teeth with data recorded by a clinical examination. Information, collected in a personal interview on gingival disease, was compared with clinical records. Reliability was studied by examining the agreement between data from the questionnaires and from the interviews concerning time interval since the last dental visit.
The information on the occurrence of dentures proved to be highly valid, while the reported number of teeth were less likely to conform with the clinical records. A slight tendency towards overreporting of remaining teeth was found. Conceivably, the greatest proportion of overestimates was caused by confusion concerning the counting of fractured teeth and roots. Gingival disease was markedly underreported. At the clinical examination, all subjects with some teeth showed signs of gingival disease, but only every fourth person reported having experienced "gum disease". Information about time interval since the last dental visit was found to be reliable.     

Less dental caries among secretor than among non-secretors of blood group substance

abstract – Salivary mucins can aggregate oral bacteria and are also constituents of pellicle and plaque. A, B, and H blood group antigens are present on the mucins of secretors only. These mucins have also been shown to contain more carbohydrate than non-secretor mucins. The aim of the present study was to relate these genetically determined differences in mucin composition to caries prevalence. Data on blood group, secretor status, and caries prevalence was collected from 69 dental students. In all blood groups, the average caries prevalence was lower for secretors than for non-secretors. The difference was more pronounced for smooth surface than for total surface prevalence. The secretors of blood group mucin A had the lowest caries prevalence. The results would be consistent with an impact of the mucin composition upon the caries prevalence, and possible mechanisms are discussed.     

Outcome of Patients with Diabetic Nephropathy after Kidney Transplantation

ABSTRACT During the period 1973–1983, 1014 patients with end stage renal failure received a kidney graft at the Helsinki University Central Hospital. As a consequence of diabetic nephropathy, 163 of them (16%) developed renal failure. Ten diabetic (6%) and 72 non-diabetic (9%) patients received grafts from a living donor. One-year patient survival did not differ between diabetic and non-diabetic patients (76% and 79%, respectively). From the second post-transplant year onwards patient survival was worse in diabetic than in non-diabetic patients. The two groups did not differ with respect to graft survival. Sixty-two diabetic patients (38%) died during the follow-up period, with myocardial infarction as the most common cause of death (31%), followed by infection (15%) and cerebral stroke (13%). Seven myocardial infarctions out of 19 occurred within three months of transplantation. However, significantly more fatal and non-fatal myocardial infarctions were observed in post-transplant patients who had returned to dialysis therapy than in patients with a functioning kidney graft. Blindness did not influence the outcome of transplantation. Nor did the transplantation significantly affect the course of this diabetic complication. In conclusion, although the early success rate of kidney transplantation in our study population was acceptable, the later outcome was poor, mainly due to advanced disease-related complications.     

Utilization of animal material in the teaching of periodontal surgery

abstract – The problems encountered in teaching periodontal surgery are outlined, and a teaching method using the pig's mandible is proposed. The method whereby the material is used and the effect of the program on students' progress are reported. The results indicate that using the pig mandible as a model system for teaching periodontal surgery improves the theoretical and practical abilities of the students and increases their confidence in performing periodontal surgery.