End-of-life Models and Emergency Department Care

Many people die in emergency departments (EDs) across the United States from sudden illnesses or injuries, an exacerbation of a chronic disease, or a terminal illness. Frequently, patients and families come to the ED seeking lifesaving or life-prolonging treatment. In addition, the ED is a place of transition-patients usually are transferred to an inpatient unit, transferred to another hospital, or discharged home. Rarely are patients supposed to remain in the ED. Currently, there is an increasing amount of literature related to end-of-life care. However, these end-of-life care models are based on chronic disease trajectories and have difficulty accommodating sudden-death trajectories common in the ED. There is very little information about end-of-life care in the ED. This article explores ED culture and characteristics, and examines the applicability of current end-of-life care models.     

Pituitary abscess in a pregnant woman.

Pituitary abscess is a rare and potentially lethal condition. Pituitary abscess in a pregnant woman has not been previously described. A 38-year-old pregnant woman (34 weeks gestation) with a pituitary mass complained of a progressive headache and sudden visual impairment. She was afebrile and had no inflammatory symptoms on admission. On MRI, the preoperative diagnosis was pituitary adenoma with sphenoid sinusitis. She underwent an uncomplicated transsphenoidal procedure for removal of the pituitary mass. The next day, labor commenced and a healthy preterm baby was delivered. Pathologic examination of the intrasellar mass showed polymorphonuclear cells, debris and no tumor cells. The sellar contents were cultured and Streptococcus viridans was grown. To our knowledge this is the first case of pituitary abscess reported during pregnancy. Although the patient was pregnant, the transsphenoidal approach was safe for the mother and the fetus. Surgical drainage and antibiotic therapy are required for the definitive treatment of this condition.     

Early Designs for the Occlusal Anatomy of Posterior Denture Teeth: Part III

Part III of this series of articles, like Part II, reviews the pioneering efforts in the 19th century to improve the quality of artificial teeth. The focus of this article, unlike that of Part II, is specifically modifications in the design of the occlusal anatomy of the 19th century denture teeth, along with the theories of mandibular movement that inspired those modifications. This article concludes the introductory phase of this project, which seeks to unravel the confusing history of the development of (posterior) denture teeth.     

Palatogram Assessment of Maxillary Complete Dentures

Phonetics, esthetics, function, and comfort form the foundation of a successful dental prosthesis. A review of the mechanics of speech as well as common speech problems encountered with a removable maxillary prosthesis are presented. The use of a palatogram to aid the clinician in the assessment and resolution of speech problems associated with a maxillary denture is demonstrated.