The use of the facial translocation technique in the management of tumors of the paranasal sinuses and skull base.

OBJECTIVE: We sought to assess the efficacy of facial translocation in the management of tumors of the skull base and paranasal sinuses. STUDY DESIGN AND SETTING: From July 1993 to December 1999, 75 patients, aged 3 to 102 years old, underwent facial translocation. Thirty-three (44%) patients also underwent a combined neurosurgical procedure. Nineteen (25%) had previous surgery. These patients were followed up to 6 years. RESULTS: There were 21 benign and 54 malignant tumors. There were no perioperative deaths. The morbidity rate was 31%. Of the 54 patients with malignant tumors, the actuarial 3-year survival rate was 59%, whereas the local control rate was 54%. CONCLUSION: The facial translocation technique offers favorable exposure of the critical zones of the anterior and middle cranial base, thus facilitating extensive resection and reconstruction. SIGNIFICANCE: This study demonstrates that facial translocation is one of the best surgical approaches to the skull base.     

Dietitians' perceptions about and personal nutrition practices for cancer risk reduction

This study was undertaken to examine the beliefs and practices of dietitians in relation to cancer risk reduction through nutrition. Respondents to the national survey (N=384, 70 percent) were similar in demographic, educational, and professional characteristics to the American Dietetic Association census data. They reported a strong preventive health orientation: mean performance on 10 preventive health behaviors was 77.5 on a 100 point scale. Half (53 percent) believed cancer would be serious if they developed it, 47 percent believed it was not likely that they would. About 20 percent of the respondents felt that the role of nutrition in cancer etiology was unclear. Dietitians believed strong research support existed for increasing whole grains, fruits and vegetables, and fiber to reduce cancer risk but that little evidence supported use of dietary supplements. Dietitians regularly practiced 75 percent of nutrition recommendations they believed to be effective in reducing cancer risk. Beliefs about the effectiveness of a recommendation accounted for the largest percentage of variance on nutritional practices. While dietitians reported many preventive health practices, including following nutrition recommendations, they seemed to be doing so for reasons other than preventing cancer.Nancie S. Merlino is Assistant Professor, Nutrition and Food Science, Wayne State University, Detroit, MI 48202 and James H. Price, Professor of Health Promotion, Department of Health Promotion, University of Toledo, Toledo, OH 43606.Acknowledgement goes to Stephen Jurs, PhD; Fredrick Andres, PhD; and John Kish, PhD for assistance in design and analysis.     

Challenges in geriatric oral health research methodology concerning caregivers of cognitively impaired elderly adults

Little is known about oral health care behaviors of community-dwelling, cognitively impaired elderly (CIE) persons. Few studies have been conducted regarding the actual provision of oral care for CIE persons or the attitudes and concerns about oral health among their caregivers. The CIE person's ability to perform self-care decreases over time, and the role of the caregiver in daily oral care becomes increasingly important. The purpose of this pilot study was to explore the attitudes toward oral health and identify related concerns among caregivers who care for community-dwelling CIE persons. Caregivers were surveyed by means of a self-administered, mailed questionnaire. To maintain confidentiality, an intermediary was used for recruitment and data collection. Overall, 148 caregivers were invited by an intermediary to participate in the survey; only 21 (14%) consented to participate and returned the questionnaire. This paper discusses some of the numerous methodological challenges identified when an attempt was made to survey caregivers' attitudes toward and barriers to providing oral care for a dependent CIE.     

Urban/Rural Differences in Prosthetic Dental Service Rates

There have been few reports of relative rates of provision of dental health services in rural and urban settings, a comparative measure of access to care in these populations. One part of a statewide survey of active North Carolina general dentists (n=959, response rate=47%) was designed to quantify provision of prosthetic services. To determine contrasting rural and urban rates, responses were analyzed according to dentists'self-report of practice city size using analysis of covariance with percent of insured patients in the practice as the covariate. Mean per-patient-visit rates for crowns, fixed partial dentures, removable partial dentures, and extractions, as well as the distributions of treatment following tooth extraction, differed by city size, with practitioners in the smallest cities reporting treatment distributions reflecting more frequent loss of teeth and less frequent replacement. These differences in patterns of prosthetic care echo the limited existing information describing oral health status, provider supply, and receipt of care, all of which suggest that differential levels of access to care exist and lead to differences in oral health outcomes.     

Der Risikobegriff in Wissenschaft und Gesellschaft

The formal-normative concept of risk in natural and technical sciences is oriented toward effects and damage. A complete understanding of cause and effect relationships is necessary, however, it is normally not available and uncertainties are inadequately taken into account. Risk is distinguished from safety in the formal-normative context. Safety itself can only be understood, however, in relation to uncertainty and therefore to damage. In the legal context, risk is defined by the triad of danger, risk, and residual risk. Risk in the legal context is limited to the domain between danger and residual risk. However, uncertainty has to be considered as distinct from residual risk. In social sciences risk is distinguished from danger. A difference is made between people who decide, i.e., regulators, and those who are affected by the decision. People who decide attribute consequences of the decision and the involvement of risks to their own decision. Concern, however, is grounded in decisions of others, in non-participation, and possible damage is therefore realized as danger and not as risk.     

Coronary permeability and left ventricular function following thrombolytic therapy

We study 40 patients, 55 +/- 7 years old with acute myocardial infarction treated early by thrombolytic therapy (20 STK and 20 rt-PA). All patients were angiographically studied in the following conditions: 1) baseline, before initiating therapy. 2) Three hours after treatment. 3) Twenty four hours later. 4) Before discharge. The infarct related artery was patent 24 hours after treatment in 31 patients (78%); five of them were patent before treatment, and we observed an early reperfusion in 20 patients (57%) and late reperfusion in 6 patients (17%). The number of patients with angiographic evidence of intraluminal thrombus decreased progressively through conditions while the grade TIMI of coronary perfusion increased in the absence of reocclusion. Final regional wall motion of infarct related myocardial zones and their degree of recovery were significantly higher in recanalized patients, as compared with non-reperfused patients. Similarly, left ventricular functional recovery was higher in patients with antegrade of collateral flow to the infarct area, as compared with totally occluded patients.     

Spectroscopic imaging of the pilocarpine model of human epilepsy suggests that early NAA reduction predicts epilepsy.

Reduced hippocampal N-acetyl aspartate (NAA) is commonly observed in patients with advanced, chronic temporal lobe epilepsy (TLE). It is unclear, however, whether an NAA deficit is also present during the clinically quiescent latent period that characterizes early TLE. This question has important implications for the use of MR spectroscopic imaging (MRSI) in the early identification of patients at risk for TLE. To determine whether NAA is diminished during the latent period, we obtained high-resolution (1)H spectroscopic imaging during the latent period of the rat pilocarpine model of human TLE. We used actively detuneable surface reception and volume transmission coils to enhance sensitivity and a semiautomated voxel shifting method to accurately position voxels within the hippocampi. During the latent period, 2 and 7 d following pilocarpine treatment, hippocampal NAA was significantly reduced by 27.5 +/- 6.9% (P < 0.001) and 17.3 +/- 6.9% (P < 0.001) at 2 and 7 d, respectively. Quantitative estimates of neuronal loss at 7 d (2.3 +/- 7.7% reduction; P = 0.58, not significant) demonstrate that the NAA deficit is not due to neuron loss and therefore likely represents metabolic impairment of hippocampal neurons during the latent phase. Therefore, spectroscopic imaging provides an early marker for metabolic dysfunction in this model of TLE.     

前臂逆行骨间背侧皮瓣的临床应用

目的总结前臂逆行骨间背侧皮瓣的临床疗效。方法回顾性分析42例前臂逆行骨间背侧皮瓣，并结合文献阐明其变异程度及变异的处理。结果骨间背侧血管在前臂中1／3缺如1例．皮瓣边缘坏死；皮瓣向近端延伸超过4cm者4例，远端坏死，延迟愈合；其余均一期愈合：结论虽然前臂骨间背侧血管有变异，但前臂逆行骨间背侧皮瓣仍是修复手背中等大小创面较为理想的方法，以近点皮肤穿支向近端延伸皮瓣不要超过4cm。     

获得性纯红再障患者外周血T细胞亚群分析

目的　本研究通过分析获得性纯红再障患者外周血T细胞亚群 ,进一步探讨该病的细胞免疫发病机制。方法　用抗人CD3、CD4、CD8、IFN γ及IL 4单抗结合人外周血单个核细胞 ,流式细胞术分析单个核细胞中CD3 +、CD4+、CD8+细胞数Th1、Th2、Tc1、Tc2细胞数以及CD4+/CD8+、Th1/Th2、Tc1/Tc2比值。结果　贫血组患者 ,外周血CD3 +细胞和CD8+细胞明显增加 (P <0 .0 1) ,CD4+/CD8+比例倒置 (P <0 .0 5 ) ;Tc2细胞明显增加 (P <0 .0 5 ) ,Tc1/Tc2比值降低(P <0 .0 5 ) ,治疗后血象恢复的患者各增高的亚群细胞均有所恢复 ,接近正常。结论　在获得性纯红再障患者T细胞明显增高 ,其中主要是CD8+细胞 ,而在CD8+细胞中 ,是Tc2细胞发挥了重要作用。经治疗有效的患者 ,其增高的T细胞亚群降低 ,提示以纠正病人细胞免疫异常为主的治疗方案有益于获得性纯红再障的治疗。