Fabrication of a Fixed Retrievable Implant‐supported Prosthesis Based on Electroforming: A Technical Report

This article describes a method of fabricating a fixed retrievable implant‐retained prosthesis based on electroforming. This method combines the advantages of both the cement‐ and screw‐retained prostheses, including passive fit, ease of fabrication, and retrievability. The absence of visible occlusal screw‐canals adds to its increased esthetic appeal.     

Intensive, long-term plasma exchange therapy for severe hypertriglyceridemia in acquired generalized lipoatrophy.

We report dramatic improvement in clinical and laboratory parameters after intensive plasma exchange therapy in a 15-yr-old girl with acquired generalized lipoatrophy and refractory hypertriglyceridemia. One hundred and twenty-five procedures were performed over 720 d. Two or three plasma volumes were exchanged per procedure, using peripheral venous access and albumin as replacement solution. Regression of painful cutaneous xanthomata and reduction in massive hepatomegaly were noted within the first two procedures. Triglyceride levels started at 109 mmol/liter (9670 mg/dl) and decreased acutely by 60-85%/procedure. Lipid removal averaged 83 g/procedure and was highly correlated with preexchange lipid levels. Lipid levels rebounded to baseline values within 7 d after exchange and appeared to rebound more rapidly after larger exchanges. Maximum benefit was achieved with weekly 1.5- to 2.0-volume exchanges. No significant decrease in apolipoprotein CII levels was detected after plasma exchange regardless of the volume of exchange; however, other plasma factors regulating triglyceride synthesis or clearance may have been removed during the procedures. Plasma exchange was well tolerated, without clinical, immunological, or hormonal deterioration. These data indicate that intensive plasma exchange therapy over a protracted time may produce sustained benefit in patients with severe, symptomatic hypertriglyceridemia refractory to standard medical therapy.     

Aortoiliac endarterectomy in young patients

From 1976 to 1981 a total of 304 aortoiliac thromboendarterectomies (TEA) were carried out. Of these, 47 (16%) were performed in young patients: 25 cases were done through a transperitoneal and 22 through a retroperitoneal approach. All retroperitoneal operations were unilateral. All patients were smokers. Twenty-seven patients had incapacitant claudication, 14 had rest pain and 6 had necrotic lesions. Patency rates at four years were 78% for transperitoneal TEA and 79% for retroperitoneal unilateral TEA. These patency rates compared favorably with those obtained using similar techniques in patients over 50 years of age. In this older group, similar 4 year patency rates were 85% and 82%, respectively. The morbidity and mortality of these approaches was analyzed in patients above and below the age of 50. Our results support the use of TEA in young patients with symptomatic advanced atherosclerosis and question the wisdom of limiting the use of TEA to localized segmental lesions of the aortoiliac segment.     

Breastfeeding knowledge and beliefs among adults in eastern Tobago.

Using a cross-sectional survey, the knowledge and beliefs about breastfeeding were evaluated among adults in Eastern Tobago (N = 509). Of the respondents, 95%, 69%, and 48% indicated that a baby should be exclusively breastfed at birth, 3 months, and 6 months, respectively. The baby's mother was thought to have the greatest influence on breastfeeding decisions. Of the respondents, 63% and 80% were unaware of expressed breast milk and cup-feeding a neonate, whereas 82% believed that a solely breastfed baby should receive water. Additionally, 23% and 44% felt that breastfeeding should be terminated before 6 months and between 6 and 12 months, respectively. Inadequate maternal nutrition and employment were reported as the principal factors affecting breastfeeding. There is a lack of knowledge about the anatomy and physiology of lactation and about the benefits of exclusive breastfeeding. These findings are useful for guiding the development and implementation of interventions to promote breast-feeding in Tobago.     

Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up

Forty patients aged 13 to 18 years participated in a placebo-controlled double-blind study of fluoxetine. Fifteen subjects in each group completed the eight week study. Approximately two-thirds of the patients showed marked or moderate clinical global improvement with both fluoxetine and placebo. Fluoxetine was superior to placebo on all clinical measures except for sleep disorder, but the differences were not statistically significant. Thirty-two of the patients and their parents were interviewed after a mean follow-up interval of 24 months (range: 8-46 months). Mean age at follow-up was 18 years (range: 15-22 years). Both groups had shown further improvement at follow-up but there were no significant group differences. Independent of the study, 19 patients (59%) had received intervening treatment following study termination and nine patients (28%) were still in treatment. Adolescent depression appears to respond to treatment but both mood disturbance and psychosocial adaptation problems persist, requiring active follow-through.     

Bupropion effects in attention deficit and conduct disorders

Children with Attention Deficit and/or Conduct Disorders were treated with bupropion, a new antidepressant, to determine its clinical, cognitive, and EEG effects. Seventeen male patients (age range 7 to 13.4 years; mean 10.4) participated in an open clinical trial consisting of a baseline placebo period (4 weeks), bupropion therapy (8 weeks), and post-drug placebo (2 weeks). Evaluations included clinical assessments, parents, teachers, and self-ratings; cognitive tests and blood level measurements of bupropion. Fifteen patients received a daily maximum of 150 mg, one received 100 mg and one 50 mg. Clinical global improvement with bupropion therapy was marked in 5 patients, moderate in 7, mild in 2, and none in 3. The Children's Psychiatric Rating Scale indicated improvements of hyperactivity, withdrawal, anxiety, hostility/uncooperativeness, sleep disorder, antisocial behaviour, neuroticism, depression and eating disturbance. Parents' Questionnaires indicated significant improvements of conduct disorder, anxiety, hyperactivity, muscle tension and psychosomaticism. While no single cognitive test showed significant improvement, all nine tests changed in the positive direction. Adverse effects were infrequent, transient and mild. There were no clinically significant changes of the laboratory values and vital signs. Two weeks following bupropion discontinuation, clinical global improvement was maintained in 8 patients, 7 showed relapses, while 2 remained unimproved. Analyses of computerized EEG revealed that degree of clinical improvement was indexed by baseline EEG parameters and that there were significant bupropion effects on EEG measures. Double-blind trials of bupropion are recommended in child psychiatry disorders.     

The effect of DPT inoculation on the hormonal control of glucose homeostasis in children recovered from malnutrition

The effect of a controlled stress (DPT inoculation) on the hormonal control of glucose homeostasis was investigated in children nutritionally rehabilitated from severe malnutrition. The age range of the 15 children studied was 6-26 months. Plasma insulin (INS), growth hormone (GH) and interleukin-1 (IL-1) were measured by radioimmunoassay; plasma glucose (GLU) by a glucose oxidase method; and red cell insulin binding (%SB) was determined, using A-14 monoiodinated insulin. Measurements were made on two occasions: (T-0) at 10 a.m., 12 hr before DPT inoculation, and (T-36) 36 hr. after inoculation. On both occasions, 4 hr post-prandial blood samples were used, and the mean body temperature (T) on the day of the test was determined. Red cell insulin binding (%SB) was significantly higher at T-36 than at T-0 (16.8 +/- 1.7 vs 12.1 +/- 1.2 (14), p = 0.005). (Results were expressed as mean +/- SEM, numbers of paired observations in parentheses). The higher %SB after DPT was accompanied by an increase in the number of receptor sites (S) (29.05 +/- 6.5 vs 15.6 +/- 2.5 (14), p = 0.025). However, insulin receptor affinity (K x 10(9) M-1) was decreased (0.7 +/- 0.1 vs 1.5 +/- 0.3 (14), p = 0.008). There were no significant differences in the plasma levels of insulin, glucose and interleukin-1, but plasma growth hormone (microU/ml) was increased after DPT, (18.0 +/- 3.0 vs. 11.5 +/- 1.2 (13), p = 0.04). Body temperature (degree C) was also significantly increased after DPT, (99.6 +/- 0.4 vs. 98.3 +/- 0.2 (14), p = 0.006).(ABSTRACT TRUNCATED AT 250 WORDS)