Long-term changes in the perception of comfortable mandibular occlusal positions

The aim of this study was to disclose, whether use of a screw jack device to set the distance between the jaws, would contribute towards a stabilization of the magnitude and position of a comfortable zone of mandibular positions or even eliminate it. Thirteen subjects participated in each of fifteen experimental sessions distributed over a 3-week period. Throughout the investigation the zone prevailed at an average width of 1.3 mm. The gap shrank 0.08 mm on average per experimental session. Although this latter value was found to be significant statistically, it can hardly be of clinical importance, considering the time needed for a total contraction of 0.8 mm to develop.     

Bowenoid lesions, Bowen''s disease and keratoacanthomas in long-term PUVA-treated patients

Four patients are described, two with histologically proven multiple foci of bowenoid lesions, one patient with bowenoid lesions and Bowen's disease, and one patient with two keratoacanthomas, most of the lesions occurring in non sun-exposed but photochemically treated areas of the body. These patients had received long-term PUVA treatment for their psoriasis. Two patients had a history of arsenic intake. The possible relationship of these epidermal lesions to light treatment is discussed.     

Age changes in the two-point discrimination threshold in skin innervated by the trigeminal nerve

Fifty young and fifty elderly subjects were tested by a two-point discrimination method. An aesthesiometer was applied to the facial skin in three different areas innervated exclusively by the ophthalmic, maxillary or mandibular branch of the trigeminal nerve. Two characteristic age differences were disclosed: (1) higher threshold values were found in older subjects, and (2) a greater range of variation in these values was present also among the older subjects. Wales.     

Influence of compensated radioiodine therapy on thyroid volume and incidence of hypothyroidism in Graves' disease

Abstract. Objectives . To investigate the long-term effect of radioactive iodine (¹³¹I) on thyroid function and size in patients with Graves' disease. Setting . Out-patient clinic in Herlev Hospital. Subjects . One hundred and seventeen consecutive patients (104 women) with Graves' disease selected for ¹³¹I treatment and followed for a minimum of 12 months (range 1–10 years, median 5 years). Interventions . ¹³¹I dose was calculated based on thyroid volume and 24-h ¹³¹I uptake. Main outcome measures . Standard thyroid function variables and ultrasonically determined thyroid volume before treatment as well as 0.75, 1.5, 3, 6 and 12 months after treatment, and then once a year were investigated. Results . Seventy-eight patients were cured by one ¹³¹I dose and 30 by two doses, while the remaining nine patients received additional doses (range one to five doses, median one dose). Within one year, 25% developed hypothyroidism, and hereafter, hypothyroidism developed at a constant rate of 3% per year independent of antithyroid pretreatment. The cumulative 10-year risk of hypothyroidism was 60%. Initial median thyroid volume was 33 mL (range 9–106 mL). At 12 months after the last ¹³¹I dose, median thyroid volume was reduced to 14 mL (range 6–36 mL) (P < 0.00001). The median reduction being 58% (range 0–80%,), hereafter no further reduction occurred. A significant reduction in thyroid volume was also noted in patients needing subsequent ¹³¹I doses and in those developing hypothyroidism within the first year. Conclusions . ¹³¹I normalizes thyroid volume in patients with Graves' disease. Hypothyroidism seems an inevitable end result of this treatment. The present study suggests that it will be impossible to modify ¹³¹I therapy in a way to achieve both early control of hyperthyroidism and a low incidence of hypothyroidism.     

Silent pulmonary embolism in patients with deep venous thrombosis. Incidence and fate in a randomized,controlled trial of anticoagulation versus no anticoagulation

Abstract. Objectives . A high frequency of asymptomatic pulmonary embolism (PE) in patients with deep venous thrombosis (DVT) has been reported, but information about the outcome of the patients with PE remains sparse. The aims of the present study were to assess the prevalence of silent PE in patients with symptomatic, venographically proven DVT, and to evaluate the natural history of silent PE. Design . Consecutive patients from one centre of primary care were included in a randomized, open study with blinded control. All patients gave written, informed consent. Subjects . Eighty-seven consecutive patients with venographically proven DVT and with a perfusionventilation lung scintigraphy performed within 48 h of the DVT diagnosis were included. On the 10th and 60th days the lung scintigraphy was repeated in 80 and 60 patients, respectively. All the patients were followed for 3 months in the out-patient clinic. Interventions . All patients were ambulated from the first day and were allocated randomly to no anticoagulant (non-AC) therapy or to AC therapy with intravenous heparin infusion for at least 6 days and oral AC therapy for 3 months. Results . Forty-three of these patients had a high probability lung scintigraphy for PE. Distal vein and femoral vein thrombosis embolized in 33 and 53% of patients, respectively. The progression rate after 60 days was 3% in both the AC and the non-AC group and after 10 days the rates were 13 and 8%, respectively. Conclusions . A high frequency of silent PE in patients with DVT both above and below the knee is demonstrated. AC treatment did not influence the resolution rate of PE or the rate of clinical PE in a 3-month follow-up period.     

Redistribution of granulocytes during adrenaline infusion and following administration of Cortisol in healthy volunteers

Major surgical procedures induce an endocrine metabolic stress response characterized by increased secretion of adrenaline and Cortisol. Furthermore, surgical stress is accompanied by granulocytosis in peripheral blood. The granulocytosis may be due to increased adrenaline and Cortisol secretion. The purpose of this study was to investigate the redistribution of granulocytes during adrenaline infusion and following administration of Cortisol. Granulocytes were isolated from peripheral blood from eight healthy volunteers, labelled with indium–111–tropolene and reinjected. The distribution of granulocytes was imaged by using a gamma camera and calculated with an interfaced computer three times during a control period and three times during a corresponding hour af adrenaline infusion 0.05 μg kg b.w.^-1 min^-1. The distribution was then measured every second h for another 6–h control period and then for 6 h following administration of Cortisol 3.6 mg kg b.w.^-1 Infusion of adrenaline resulted in granulocytosis in peripheral blood and a reduction of radioactivity of the spleen to 83.0% of the initial value. The effect of adrenaline on the bone marrow was negligible. Cortisol administration was followed by granulocytosis and decreased radioactivity of both the spleen (81.5%) and the bone marrow (79.8%). It is concluded that the spleen is an active immunological organ as both adrenaline and Cortisol induces efflux of granulocytes from the spleen. The Cortisol induced efflux of granulocytes from the bone marrow explains that granulocytosis also occurs in splenectomized patients after major surgery.     

Quantitative Tissue Doppler Echocardiography: Physiological Nonuniformity of Left Ventricular Transmural Myocardial Wall-Motion Velocities and Gradients

Tissue Doppler echocardiography (TDE) is a new method by which transmural myocardial function can be studied noninvasively. In order to investigate physiology and reproducibility, 24 young, healthy volunteers were examined by M-mode TDE. Nonuniformity of transmural tissue layer velocities became apparent: Subendocardial and subepicardial velocities of the anteroseptal myocardial wall (AW) were 3.5 ± 0.7 and 1.3 ± 0.5 cm/sec (P < 0.0001 , t- test), whereas in the posterolateral wall (PW) values of 3.6 ± 0.6 and 1.2 ± 0.4 cm/sec (P < 0.0001 , t- test ), respectively, were revealed. The ratios, termed "myocardial velocity gradients" as a new indicator of left ventricular performance, were 3.1 ± 1.0 and 3.4 ± 1.1, respectively. AW and PW did not differ (N.S.). Tolerance borders did not overlap, and intraobserver variability did not reach intersubject variability (P < 0.0001, F-ratio test). TDE provides new and more sophisticated insights into left ventricular performance. It seems to be accurate and reliable and therefore worth introducing into the clinical arena.