The prosthodontic pathway of the oral cancer patient

Oral cancer patients undergo life-altering curative treatment that consists of surgery or a combination of surgery and radiotherapy. This can severely alter the functional anatomy of the oral cavity and create a challenging environment for successful oral rehabilitation. A multidisciplinary team approach is required to rehabilitate these patients successfully. It is essential to have assessment by an oral rehabilitation specialist before treatment, especially where primary rehabilitation interventions are being considered. Following cancer treatment, patients may suffer from a range of difficulties, from dento-facial appearance, to chewing, speech and swallowing. This dysfunction often leads to psychosocial problems, such as reduced self esteem, social contact and quality of life. Conventional prosthodontics has a role to play in the management of these patients but osseointegrated implants (OII), can be required to overcome the anatomical and physiological barriers. OII can be used in an environment where there is poor soft tissue function or little bone support, and where there is a dry mouth. CLINICAL RELEVANCE: This paper introduces readers to the prosthodontic pathway taken by some oral cancer patients. It provides an overview of current oral rehabilitation techniques that supplement the supportive dental care provided by general dental practitioners and their team after cancer treatment.     

Intermittent brief psychotherapy in an HMO setting

In this exploratory study the authors investigate the practice of intermittent brief psychotherapy in an HMO setting. It was found that returning patients represented 27 percent of the requests for treatment in a four-month period. The majority of these patients found previous treatment helpful, and the authors hypothesize that for many of these individuals the need for further treatment comes about as the result of changes related to problems of normal development or problems in coping with significant life transitions.     

Relationship of testosterone, sex hormone binding globulin, and calculated free testosterone to subsequent clinical progress in patients with carcinoma of the prostate treated with bilateral orchidectomy or estrogens

The concentration in serum of testosterone, sex hormone binding globulin (SHBG), and albumin has been measured, and from these measurements free testosterone has been calculated in 75 patients with carcinoma of the prostate treated with either bilateral orchidectomy, stilbestrol, or estramustine phosphate (Estracyt). After exclusion of 3 noncompliant patients, total testosterone did not differ significantly between treatments, but free testosterone was lower in estrogen-treated patients (5.9 +/- 0.9 (SEM) pmol/l, n = 28) compared with the orchidectomized patients (23 +/- 1.4 pmol/l, n = 44) (P less than 0.001); all of the estrogen-treated patients falling in the lower third of the range of the orchidectomized patients. Free testosterone did not change systematically during several years of treatment and there was no evidence of a rise with clinical deterioration. In the 33 patients with metastatic cancer treated with orchidectomy, the third with the lowest free testosterone or total testosterone showed a better survival over 2 years than the two-thirds with higher free or total testosterone; thereafter, the advantage was lost.     

Near-triploid and near-tetraploid acute lymphoblastic leukemia of childhood

Cytogenetic and DNA flow cytometric analyses of leukemic cells from 1,971 children with newly diagnosed acute lymphoblastic leukemia (ALL) identified stem lines with modal chromosome numbers greater than 65 in 26 patients (1.3%). Near-triploidy (66 to 73 chromosomes) was found in six cases and near-tetraploidy (82 to 94 chromosomes) in 20. A striking morphologic finding was the presence of clumped chromatin with grooved nuclei or Rieder cell formation in 20 cases. Other than a slight excess of the pre-B immunophenotype, the near-triploid cases did not appear to differ substantially from the general ALL population in clinical features. In contrast, near-tetraploid cases were more often associated with a T-cell immunophenotype (47% v 14%, P less than .001) and L2 morphology (30% v 22%, P less than .01), and were older at diagnosis (median age, 8.6 v 4.8 years, P = .01) than cases with other ploidies. Moreover, an unusually high proportion of near-tetraploid cases tested (6 of 15) expressed one or more of the myeloid-associated antigens CD13, CD15, and CD33. Despite the use of contemporary intensive chemotherapy and short follow-up for most patients, 6 of the 20 near- tetraploid cases have relapsed or died. This study suggests that the near-tetraploid subtype differs from other cases of hyperdiploid greater than 50 ALL, which have been associated with a favorable prognosis.     

Bleeding in human volunteers from the bite of the American medicinal leech Macrobdella decora compared with its European counterpart Hirudo medicinalis

In this paper the effectiveness of the so-called American medicinal leech Macrobdella decora in overcoming human haemostasis is compared to that of the European medicinal leach Hirudo medicinalis. Thrombin-clotting times indicated that M. decora prevents coagulation of human blood by means of anti-thrombin activity. Our findings suggest that its role is similar to that of hirudin. In human volunteers, the duration of bleeding from the bite of M. decora (mean = 73 min; n = 18) is significantly shorter than H. medicinalis (mean = 600 min; n = 15). The mean concentration of anti-thrombin units in each specimen of M. decora and H. medicinalis is 100 and 285 AT-U, respectively. These findings support the concept that H. medicinalis is more advanced in terms of haematophagous predation. Despite similar feeding durations by both species of leech (means = 68 min and 70.5 min by M. decora and H. medicinalis, respectively), the mean increase in body weight of M. decora was only 58% compared to 460% in H. medicinalis.     

Development of an Objective Scoring System for Measurement of Resident Performance on the Human Patient Simulator

Background: The decrease in the percentage of patients having cesarean delivery during general anesthesia has led some educators to advocate the increased use of simulation-based training for this anesthetic. The authors developed a scoring system to measure resident performance of this anesthetic on the human patient simulator and subjected the system to tests of validity and reliability.

Methods: A modified Delphi technique was used to achieve a consensus among several experts regarding a standardized scoring system for evaluating resident performance of general anesthesia for emergency cesarean delivery on the human patient simulator. Eight third-year and eight first-year anesthesiology residents performed the scenario and were videotaped and scored by four attending obstetric anesthesiologists.

Results: Third-year residents scored an average of 150.5 points, whereas first-year residents scored an average of 128 points (P = 0.004). The scoring instrument demonstrated high interrater reliability with an intraclass correlation coefficient of 0.97 (95% confidence interval, 0.94-0.99) compared with the average score.