ADH ad hoc committee report: the use of restraints in the delivery of dental care for the handicapped—legal, ethical, and medical considerations

Presented is the final report of the Ad Hoc Committee on the Use of Physical Restraints. The report discusses legal, ethical, and medical issues of physical restraint of patients. Conclusions included: there is no consensus among the states on definition of restraint—dental practitioners should check with their own states for currrent rulings; the current national view is that restraint should only be used when absolutely necessary, and the least restrictive form should be used, and it shall not be used as punishment or for the convenience of the staff; use of restraint is acceptable dental practice when appropriately used for behavior control of patients with developmentally disabling conditions; documentation is required; physical restraint should cause no physical injury; and informed consent should be used, after checking with authorities as to proper form.     

Experimental model of cisplatin ototoxicity in chinchillas

Cisplatin is an important antineoplastic agent. Its ototoxicity has been well defined, both in human and animal studies. However, animal models of systemic cisplatin administration have been complicated by multiple toxic effects. We studied cisplatin ototoxicity in an animal model involving topical application of cisplatin to the round-window membrane. Adult chinchillas were anesthetized with ketamine and pentobarbital, and auditory function was tested with the use of auditory brain-stem responses to various stimuli (clicks and 8-and 16-kHz tone bursts). Each animal was used as its own control. The middle-ear cavity was exposed through the bulla. In the experimental ear, a 25-μl solution of 0.25 mg cisplatin/1.0 ml normal saline solution was applied to the round-window membrane. In the control ear, 25 μl normal saline solution was applied to the round-window membrane. Follow-up auditory brain-stem response testing was conducted 7 days after treatment. A significant increase in threshold in the experimental ears was seen on comparison with the control ears. This finding suggests that application of cisplatin to the round-window membrane is a useful animal model in which to study cisplatin ototoxicity. (Otolaryngol Head Neck Surg 1998;119:574-80.)     

Flaccid paralysis due to hyperkalaemia

A 68 year old patient presented to the emergency department with ascending muscular weakness progressing to flaccid quadriplegia and imminent respiratory paralysis. The cause was profound hyperkalemia and the patient responded quickly to emergency management, and went on to make an uncomplicated recovery.     

Concepts of drugs: differences in conceptual structure across groups with different levels of drug experience

Seventy-seven college students varying in degree of drug use experience rated the perceived similarities of all possible combinations of 16 drug classes (cigarettes, other tobacco, alcohol, marijuana, barbiturates, minor and major tranquilizers, amphetamines, amphetamine derivatives, cocaine, heroin, opiates, hallucinogens, inhalants, PCP, anti-depressants). Multi-dimensional scaling (INDSCAL) and network models (PFNET) indicated that abstainers had only one pharmacological category involving sedatives/depressants, and that they attached more importance to whether drugs were licit vs. illicit than to whether they were depressants vs. stimulants. Conceptions became more coherent, differentiated and based on pharmacological properties for more experienced drug users. In line with previous work, groups with greater experience with drugs had more sophisticated conceptions not only about the drugs they had used, but also about drugs they had not used. These findings suggest that early on in drug behavior sophisticated and interrelated concepts are developing that should be taken into account when designing interventions and information campaigns.     

Sixteen Year Follow Up of Workers in an Explosives Factory

Nitroglycerine (NG) has been used in the manufacture of explosivesfor over 100 years and ethylene glycol dinitrate (EGDN), a commonlyused synonym being nitroglycol, for over 50 years. The acuteeffects of exposure to these two substances are well known.The possible long-term effects have been the subject of debatefor many years but only recently has a definitive study indicatedan excess of deaths from cardiovascular disease and cerebrovasculardisease in exposed workers. A cohort of male employees in an explosives factory was defined,some of whom had had exposure to NG and EGDN. Observance ofmortality experience over 16 years revealed an excess of deathsfrom acute myocardial infarction in the younger group of workersexposed to both substances. ⁰Requests for reprints should be addressed to: Dr R. Craig, Senior Medical Officer, Nobel's Explosives Company Limited, Nobel House, Stevenston, Ayrshire KA20 3LN, Scotland.     

Immunotoxicity of Technical Pentachlorophenol (PCP-T): Depressed Humoral Immune Responses to T-dependent and T-independent Antigen Stimulation in PCP-T Exposed Mice

Immunotoxicity of Technical Pentachlorophenol (PCP-T): DepressedHumoral Immune Responses to T-dependent and T-independent AntigenStimulation in PCP-T-Exposed Mice. Kerkvliet, N.I., Baecher-Steppan,L., Claycomb, A.T., Craig, A.M. and Sheggeby, G.G. (1982). Fundam.Appl. Toxicol 2:90–99. The effects of chronic dietaryexposure to technical pentachlorophenol (PCP-T) on humoral immuneresponses in mice were examined. Primary and secondary splenicantibody responses to the T-dependent antigen, sheep red bloodcells (SRBC), were examined in Swiss-Webster mice using ourrecently developed screening technique, the Hemolytic AntibodyIsotope Release (HAIR) assay. To assess direct effects of PCP-Ton B cells, the splenic plaque-forming cell response and serumantibody titers to the T-independent antigen, dinitrophenyl(DNP)-Ficoll, were examined. PCP-T exposure altered both thekinetics and the magnitude of the humoral antibody responsesto SRBC and DNP-Ficoll. Peak splenic antibody production andserum antibody titers were delayed and the magnitude of theantibody responses were dose-dependently suppressed by PCP-Texposure. IgM responses appeared to be more sensitive to PCP-T-inducedsuppression than the IgG response. Significant depression ofthe IgM anti-SRBC splenic HAIR response was apparent as earlyas 2 weeks after initiation of PCP-T exposure and persistedfor at least 8 weeks after termination of PCP-T feeding. Liverweight and serum lactate dehydrogenase (LD-L) and alanine aminotransferase(ALT) levels were significantly elevated during PCP-T exposureand returned to control levels after a 4–6 week recoveryperiod. The immunotoxic effect of PCP on humoral immunity wasobserved only in animals exposed to technical grade PCP knownto be contaminated with significant levels of other chlorinatedphenols as well as non-phenolic impurities including chlorinateddioxins, furans, and diphenyl ethers. Animals exposed to analyticalgrade PCP did not exhibit depressed humoral immunity.     

Hydrolytic stability of silanated zirconia-silica-urethane dimethacrylate composites

Summary The effect of the method of silanation of zirconia-silica by 3-methacryloxypropyltrimethoxy-silane (MAPM) and 3-acryloxypropyltrimethoxysilane (APM) on the diametral tensile and transverse strength of composites made from these silanated fillers and a urethane dimethacrylate was determined after 0– 108 h of boiling in water. The water sorption of these composites was also measured at times up to 108 h. Silanation with either silane significantly increased the tensile and transverse strengths and decreased water sorption relative to comparable unsilanated controls. Silanation with MAPM from ethanol solution at three times the minimum uniform coverage gave the best overall results, and the tensile strength tests appeared to be most predictive of effectiveness of the silane treatments.