Nifedipine as a second line antihypertensive drug in pregnancy

Slow-release nifedipine has been used in the treatment of severe hypertension in 23 pregnant women. In 22 this was in combination with other drugs, in 18 including atenolol. Good control of blood pressure was achieved in 20 women. The perinatal mortality of the group was 130/1000, with a high caesarean section rate (71% of live-births), a high rate of abnormal CTGs, a high rate of premature delivery, and a high rate of infants who were small-for-dates. Whether this is due to the disease process or the medication is uncertain. For the present time these combinations should only be used in severe hypertensives or in the context of a controlled trial.     

Comparison of immune electron microscopy and genome electropherotyping techniques for detection of turkey rotaviruses and rotaviruslike viruses in intestinal contents.

Seventy-nine intestinal contents specimens from 65 turkey flocks were examined for rotavirus and rotaviruslike virus (RVLV) by immune electron microscopy (IEM) and genome electropherotyping. The IEM procedure was slightly more sensitive in detecting these viruses; 7 of 48 specimens (14.6%) positive for virus by IEM were negative by the genome electropherotyping technique. The genome electropherotyping technique more readily differentiated the rotaviruses and RVLVs than did the IEM procedure; 15 of 48 specimens (31%) positive for virus by IEM could not be differentiated into rotavirus of RVLV, whereas only 4 of the 41 specimens (9.7%) positive by genome electropherotyping produced incomplete genome electropherotypes and could not be differentiated. Thirty-one specimens negative by IEM were also negative by genome electropherotyping. Specimens determined to contain only rotavirus by IEM produced only rotavirus genome electropherotypes. Likewise, specimens determined to contain RVLV alone by IEM produced only RVLV genome electropherotypes. Three specimens contained viruses morphologically resembling rotaviruses that were not aggregated by either the anti-turkey rotavirus serum or the anti-turkey RVLV serum and possessed genome electropherotypes distinct from those of the turkey rotavirus and RVLV. These rotaviruses may represent a third, previously unrecognized serogroup of turkey rotaviruses.     

Management of adult patients with a left ventricular assist device.

The number of left ventricular assist device (LVAD) implantations is growing as a result of increased waiting periods for cardiac transplantation and the decreased availability of organ donors. Furthermore, the Food and Drug Administration (FDA) has approved permanent LVAD support. After an acute hospitalization, patients with LVADs may need prolonged convalescence in a healthcare facility because they have complex medical needs and are physically disabled. Admission criteria need to be developed as essential patient and nursing competencies need to be defined as a part of a successful LVAD program in an acute rehabilitation center. Acute rehabilitation centers can help patients with LVADs transition to a home setting.     

Botulinum toxin and neuromotor rehabilitation: An integrated approach to idiopathic cervical dystonia.

Currently, the best treatment option for idiopathic cervical dystonia (ICD) is injection of botulinum toxin (BTX) into the affected muscles, whereas rehabilitative approaches have given disappointing results. We evaluated whether the association of an ad hoc rehabilitative program may improve the clinical efficacy of BTX treatment in a single-center, cross-over, controlled study. Forty patients with ICD were randomly assigned to two different treatment groups: (1) BTX type A (BTX-A) plus a specific program of physical therapy (BTX-PT) or (2) BTX-A alone (BTX-0). Patients in the BTX-PT group showed a longer duration of the clinical benefit (118.8 vs. 99.1 days) and needed a lower dose of BTX at reinjection (284.5 vs. 325.5 units). In addition, they showed more marked reductions in their disability in activities of daily living (-9.7 vs. -4.85 points) and subjective pain (-13.35 vs. 6.95 points) scores. Association of BTX-A therapy with a specific program of physical therapy may improve ICD treatment outcome.     

Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects.

This study evaluated the effectiveness of early orthodontic treatment with the Twin-block appliance for the developing Class II Division 1 malocclusion. This multicenter trial was carried out in the United Kingdom. A total of 174 children, aged 8 to 10 years old, with Class II Division 1 malocclusion were randomly allocated to receive treatment with a Twin-block appliance or to an untreated, control group. Data were collected at the start of the study and 15 months later. Results showed that early treatment with Twin-block appliances resulted in reduction of overjet, correction of molar relationships, and reduction in severity of malocclusion. Most of this correction was due to dentoalveolar change, but some was due to favorable skeletal change. Early treatment with the Twin-block appliance is effective in reducing overjet and severity of malocclusion. The small change in the skeletal relationship might not be considered clinically significant.