Mandibular displacement in Angle Class II, Division 2 malocclusion

The effect of the treatment of Angle Class II, Division 2 malocclusion was studied in 22 children by x-ray cephalometry and by recording the relation between the retruded and the intercuspal mandibular positions. The treatment was performed in three phases. In the first phase the upper incisors were proclined, and the deep bite was corrected with an upper removable plate. In the second phase the distal occlusion was corrected with an activator. The result was retained in the third phase with a second activator designed for retention. The relation between the retruded (RCP) and the intercuspal (ICP) mandibular positions was recorded with wax bites and dental casts mounted in a modified gnathothesiometer. The anteroposterior distance between RCP and ICP was large before the start of the treatment. The distance was unchanged after proclination of the upper incisors and correction of the deep bite but decreased after correction of the distal occlusion and increased again somewhat during the retention phase. The proclination of the upper incisors and the correction of the deep bite (phase one of the treatment) did not result in mandibular anterior positioning. This fact and the results of the recordings of the relation between RCP and ICP were interpreted as evidence that the mandible is not posteriorly displaced in Class II, Division 2 malocclusion.     

Serum creatine kinase isoenzymes behavior in hepatic failure with encephalopathy

Serum creatine kinase isoenzymes were determined in 24 patients with hepatic failure. Hepatic failure was due to severe acute and chronic liver disease. The 24 patients presented different degrees of coma. Nineteen cases (seven hepatitis and 12 cirrhosis) in coma grades III and IV showed the presence in serum of BB, brain and MB, myocardial isoenzymes. Follow up in six of these cases demonstrated that worsening or improvement was accompanied by an increase or decrease of this brain isoenzyme concentration. The leakage from their respective tissues of the brain and myocardial creatine kinase isoenzymes is probably due to the toxic and surface activity properties of serum free fatty acids, bile salts, and bilirrubin, which increase, among other factors, in these pathological entities.     

Ethical Theories for Promoting Health Through Behavioral Change

The various philosophical orientations for changing people's unhealthy behaviors are examined. The ethical theories of natural law, utilitarianism, paternalism and distributive justice are reviewed in relation to changing people's behaviors. Finally, the health educators' role in behavior change is examined and it is recommended that health educators may need to limit the conditions in which they intervene into the lives of others.     

Triptorelin in the Treatment of Prostate Cancer

Triptorelin is a synthetic analog of gonadotropin-releasing hormone (GnRH; also known as luteinizing hormone-releasing hormone [LHRH]), which has enhanced receptor affinity, extended half-life and increased bioactivity. Triptorelin initially stimulates the pituitary gland, increasing serum luteinizing hormone and testosterone levels; however, after 3–4 weeks, the pituitary becomes refractory due to receptor desensitization and/or down-regulation, resulting in castration levels of testosterone in men and postmenopausal estradiol levels in women. Pharmacologic equivalence studies have shown that triptorelin, buserelin and goserelin are equally effective in down-regulating the pituitary-gonadal axis, and the new 3- and 1-month depot formulations of triptorelin have equal efficacy. In men with locally advanced or metastatic prostate cancer, administration of triptorelin leads to subjective improvement in lower urinary tract symptoms and pain, as well as objective responses such as decreased serum levels of acid and alkaline phosphatase and prostate-specific antigen, decreased prostate volume, and regression of skeletal metastases. Randomized clinical trials comparing triptorelin with bilateral orchidectomy have shown no significant differences in clinical response, survival or side effects. The time to subjective response was shorter in patients treated with orchidectomy, but there was a trend towards reduced psychologic morbidity in those treated with triptorelin. In randomized clinical trials comparing triptorelin with leuprolide (leuprorelin), two studies concluded that triptorelin induced a more rapid decrease in testosterone levels, although both drugs had similar clinical efficacy, whereas a third study concluded that triptorelin reduced testosterone levels less rapidly than, but maintained castration levels of testosterone as effectively as, leuprolide. The 9-month survival rate was significantly higher for triptorelin (97% vs 90.5% for leuprorelin). Neoadjuvant triptorelin treatment in localized prostate cancer prior to radical prostatectomy may reduce the incidence of positive surgical margins, but no survival advantage has been demonstrated. Neoadjuvant treatment before radiotherapy, by reducing prostatic volume, may decrease radiation-related complications, and may increase survival in a subset of patients with a Gleason score of 2–6. The most common adverse effects of triptorelin and GnRH agonists in general, are hot flushes, loss of libido, and impotence. The initial increase in serum testosterone levels — the ‘flare’ phenomenon — may lead to exacerbation of bone pain, paraplegia and (rarely) death in patients with a large tumor burden. Androgen deprivation leads to a reduction in bone mineral density of 3–5% per year, but it remains to be proven that this significantly increases the clinical fracture risk in patients with prostate cancer. In conclusion, the clinical efficacy and tolerability of triptorelin in the treatment of prostate cancer are similar to that of surgical castration and leuprolide.     

Die Anzeigestellung zur Operation an der Arteria vertebralis

Zusammenfassung Berichtet wird über 53 rekonstruktive Eingriffe an der Arteria vertebralis. Nach unserer Meinung verdienen die operablen Ursachen der vertebrobasilären Insuffizienz am proximalen Abgang der A. vertebralis mehr Beachtung. Die operative Belastung dieser Eingriffe ist gering, sie sind auch Patienten im vorgerückten Lebensalter zuzumuten. Die postoperativen Ergebnisse sprechen für eine aktive Einstellung zur rekonstruktiven Chirurgie der A. vertebralis. Die Doppler—Sonographie kann den Weg zur selektiven Angiographie ebnen. Wird die Vertebralisinsuffizienz zu selten erkannt?

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Indication for operation on the vertebral artery

Summary Fifty-three reconstructive vascular operations on the vertebral artery are reported. In our opinion, the operable causes of the vertebro—basilar insufficiency are worthy of more attention. The operative discomfort of these surgical interventions is of minor importance and may even be expected of patients well advanced in years. The postoperative results decide in favour of a positive attitude towards reconstructive surgery of the vertebral artery. The Doppler ultrasound technique helped to specify more precisely the indication for cerebral angiography. Do we recognize vertebral insufficiency too seldom?

     

Management Strategies for Partially Platinum-Sensitive Ovarian Cancer

The majority of women with advanced ovarian cancer will relapse after first-line chemotherapy. Treatment decisions are based most commonly on the probability of a further response to platinum-based therapy. Many women will respond to second and subsequent lines of therapy with platinum and other drugs such as liposomal doxorubicin, topotecan, paclitaxel, gemcitabine, and etoposide. The decision to include platinum drugs is based mainly on a categorization of patients into those with a partially platinum-sensitive relapse (platinum-free interval of 6–12 months) or a platinum-sensitive relapse (platinum-free interval of >12 months). These categories are based on empirical observations made >15 years ago. Most trials with newer agents have been either non-randomized phase II studies or performed in a heterogeneous population of women, including those with platinum-resistant tumors. Interpretation of the activity of these new drugs is often difficult, and this affects decision-making in clinical practice. Recent randomized trials comparing platinum-based combinations with platinum alone (mainly carboplatin) have shown a benefit in favor of combination therapy. The prolonged chemosensitivity in many cases of ovarian cancer and the use of serum CA125 antigen levels as a surrogate marker of response provide an opportunity to study the activity of new anticancer agents in relapsed disease. However, future studies need to be randomized to reduce selection bias and should stratify for factors known to influence response. Many patients with relapsed ovarian cancer will survive for many years and knowledge of the disease, its response to different treatments, and the appropriate timing of drug delivery and length of treatment requires considerable clinical judgment.