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.     

Retroperitoneal Laparoscopic Nephrectomy in Children

Retroperitoneal pediatric laparoscopic nephrectomy is described in 3 patients requiring 3 to 5 hours with an estimated blood loss of 10 to 60 cc. The children returned to school within 7 days postoperatively. Advantages of this procedure include the avoidance of intraoperative repositioning of the patient and easy conversion to an open lumbodorsal approach, if necessary; early laparoscopic visualization of the renal artery; applicability in cases of previous abdominal surgery, and avoidance of intraperitoneal adhesion.     

Minimally Invasive Coronary Artery Bypass Grafting: A New Method Using an Anterior Mediastinotomy

The benefit of internal mammary artery (IMA) grafting as a long-lasting intervention for coronary artery disease is well recognized. However, largely because they are less invasive, catheter based alternatives are frequently chosen, particularly to treat single or double vessel disease. To retain the advantages of the IMA graft, and to offset the invasiveness of conventional coronary artery bypass grafting, we developed a new minimally invasive method using an anterior mediastinotomy for treating left anterior descending (LAD) or right coronary artery disease, or both. Feasibility studies using 16 pigs and a human cadaver led to approval by the Institutional Review Board for use of this procedure to treat six patients (four men, two women; mean age, 63.8 ± 13.6 [SD] yrs) who granted informed consent. Pedicle dissection of the IMA, using video assisted thoracoscopy if necessary, was made through a 2-to 3-inch horizontal anterior mediastinotomy. The underlying LAD artery was grafted during femoral vessel cardiopulmonary bypass, with cooling to 30°C, induced ventricular fibrillation, and left ventricular venting if required. Transesophageal echocardiography performed after bypass showed that two patients maintained normal wall motion and four had improvement from the original impairment. One patient suffered a recurrence of angina 4 weeks after the procedure; recatheterization showed an acutely angled IMA, subsequently corrected by balloon angioplasty. The results of follow-up dobutamine echocardiographic stress tests were negative in all patients. With this minimally invasive approach, the procedure should provide the benefits of IMA grafting with shorter hospital stay, more rapid recovery, and less overall cost.     

Transplantation of horseshoe kidneyinto single recipient

A case of successful en bloc transplantation of a horseshoe kidney into a single recipient is reported. The literature is briefly reviewed. The use of horseshoe kidneys in transplantation is recommended in selected cases.     

Hypoplasia of the cerebellar vermis in neurogenetic syndromes

There are conflicting reports on the relationship between cerebellar vermal lobule hypoplasia and autism. Using quantitative magnetic resonance image analysis, we measured the cerebellar vermis in 125 normal individuals with a broad age range and 102 patients with a variety of neurogenetic abnormalities. We conclude that hypoplasia of cerebellar vermal lobules VI and VII is a nonspecific finding that even occurs in several conditions without autistic behavior. This suggests that it is not a specific neuroanatomical marker for autism, nor is cerebellar dys- genesis likely to be solely responsible for clinical autistic behaviors.     

Structural Characterization of Variant Forms of Arylsulfatase A that Associate with Alcoholism

Several electrophoretic forms of human platelet arylsulfatase A (ASA), including variant type III_a and normal type IV_a, have been identified by nondenaturing polyacrylamide gel electrophoresis. An alcoholic population that we have analyzed is enriched in variant type III_a compared with nonalcoholic psychiatric and normal controls. Individuals with the III_a enzyme possess greatly reduced levels of ASA activity. To understand further the structural basis for the differences and their potential biological consequences, the nature of the ASA variant expressed by fibroblasts from different individuals was explored. The electrophoretic patterns of fibroblast ASA from the III_a and IV_a individuals differ in degree of phosphorylation. Furthermore, fibroblast ASA from III_a individuals lacks an N -linked glycan found in ASA from IV_a individuals. In addition, differences in peptide and/or posttranslational modification unrelated to the N -linked carbohydrate or phosphorylation exist between the fibroblast ASA from III_a and IV_a individuals. The finding that both fibroblasts and platelets exhibit related electrophoretic isoform patterns characteristic of the donor's ASA type allows for the use of fibroblasts to study the impact of ethanol on the metabolism of cells possessing different ASA types.     

FACTORS AFFECTING THE SELECTION OF PRIMARY MEDICAL CARE AGENCY IN THE WESTERN REGION OF MELBOURNE: AN INTERVIEW STUDY OF ADULT PATIENTS

An interview study investigating attitudinal and other factors influencing the selection of primary medical care (PMC) agency is described. It focuses on adult patients excluding those with trauma of medical/surgical emergencies and was conducted in part of the Western Region of Melbourne in late 1983, the period immediately prior to the introduction of Medicare. It is based on a cross-sectional survey of in-hours attenders of eight general practices (GP), the Western Region (Community) Health Centre (WRCHC) and the general clinic of the casualty department at the Western General Hospital (WGH). Attenders of these different services differed significantly in their socio-demographic characteristics. WGH attenders were significantly younger and had migrated from non-English speaking countries significantly more often. Male attenders at the WGH had significantly lower socioeconomic status. 71 per cent being not in the workforce. The most commonly stated reasons for attendance at particular services generally were “closeness to home, work”, “recommendation” and “good service”. Reasons given by attenders at the different clinics generally were similar. However GP attenders offered “good service” significantly more often as a reason for choice; WGH attenders offered “cheap/economic reasons” significantly more often and “recommendation” significantly less so. WRCHC attenders offered “workers' compensation” significantly more often. Thirty per cent of attenders overall had attended other than their current clinic during their past three to four illness episodes. While a large majority of patients still attend GP for PMC it is concluded that a pluralist model recognising the legitimacy of different PMC arrangements and multiple use of them by individuals best meets community need. This is likely to be even more true under Medicare. It is concluded that instrumental factors and social networks are important in the selection of PMC, particularly given the limited knowledge of respondents about health services. It is also concluded that cost and economic factors have been given undue weight in selection of primary medical care agency. The use of the WGH casualty department by groups not in the work force, given no real financial advantage in doing so, requires further study.