Legal wrangles continue after a US judge demanded videos showing forced nasogastric feeding in Guantanamo be made public. Force feeding should play no part in the care of mentally competent patients, ...says W John Kalk, who treated hunger striking prisoners in South Africa during the apartheid era
Background: Salivary gland dysfunction is one of the key manifestations of Sjögren’s syndrome. Objectives: (1) To assess prospectively loss of function of individual salivary glands in patients with ...primary and secondary Sjögren’s syndrome in relation to disease duration and use of immunomodulatory drugs. (2) To study changes in sialochemical and laboratory values and subjective complaints over time. Methods: 60 patients with Sjögren’s syndrome were included in this study. Whole and gland-specific saliva (parotid and submandibular/sublingual (SM/SL)), samples were collected at baseline and after a mean of 3.6 (SD 2.3) years of follow-up. Disease duration was recorded for all patients. Results: Patients with Sjögren’s syndrome with short disease duration had significantly higher stimulated flow rates at baseline than those with longer disease duration (p<0.05). When compared with healthy controls, the decrease in SM/SL flow rates at baseline was more prominent than that in parotid flow rates (p<0.05). Over time, there was a significant further decrease of stimulated flow rates, especially of the parotid gland, accompanied by increasing problems with swallowing dry food (p<0.05). The decrease was independent of the use of corticosteroids or disease-modifying antirheumatic drugs (DMARDs). Sialochemical variables remained stable. Conclusions: Early Sjögren’s syndrome is characterised by a decreased salivary gland function (parotis>SM/SL), which shows a further decrease over time, regardless of the use of DMARDs or steroids. Patients with Sjögren’s syndrome with longer disease duration are characterised by severely reduced secretions of both the parotid and SM/SL glands. These observations are relevant for identifying patients who would most likely benefit from intervention treatment.
Data of a 32-year field experiment (1967–1998), conducted on a fertile sandy loess in the Hercynian dry region of central Germany, were used to (i) demonstrate the methodological basis of energy ...balancing in a long-term trial and (ii) identify time trends of various energetic parameters, as affected by the rate and form of nitrogen (N) application. Of the 16 fertilizer regimes, 5 were selected to represent the broad range of N supply conditions: no N, mineral N only, farmyard manure N only, high input of both mineral and farmyard manure N, and moderate input of the two forms of N. The crop rotation included various cereals, sugar beets, and potatoes. In calculating the energy balances, changes in soil and crop husbandry practices over the past decades were taken into account. The input of energy associated with mineral N fertilization declined markedly with duration of the experiment, whereas the input of energy associated with chemical plant protection increased. The input of energy was highly variable; it ranged from 8.9 to 36.9
GJ
ha
−1 per year in the last crop rotation, depending on the N regime and the crop. Because of the high soil fertility, the average biomass yield of all the crops grown within a rotation was as high as 13.5
t
dry matter (DM)
ha
−1 per year; the output of energy was as high as 215
GJ
ha
−1 per year. On the fertilized plots, net energy output (energy content of the grains minus energy input) and energy utilization improved with time. Winter wheat, fertilized with moderate amounts of mineral and farmyard manure N, showed an increase in net energy output of 86% from 1972 to 1995. During the same period, the energy intensity (input of fossil energy per grain equivalent) declined by 45%, and the output/input ratio increased by 67%. In part, these trends can be attributed to the higher grain yield (+59%). Energy output and net energy output are the crucial parameters when the demand for plant products cannot be met because of the limited area for growing crops. Energy intensity and energy output/input ratio are integrative indicators of the environmental effects of crop production, which can be used to formulate recommendations for fertilization, which are optimum as far as the environment is concerned.
Objective. To assess the value of the parotid biopsy as a diagnostic tool for primary Sjögren's syndrome (pSS), and to compare the parotid biopsy and the labial biopsy with regard to diagnostic value ...and biopsy-related morbidity.
Methods. In 15 consecutive patients with pSS and 20 controls, the parotid biopsy was assessed as a diagnostic tool based on the presence of lymphocytic foci, benign lymphoepithelial lesions and lymphoid follicles. These new histological criteria were compared with established diagnostic criteria for the labial biopsy in 35 consecutive patients suspected for pSS who underwent simultaneous biopsies from both sites. In addition, both biopsies were compared for morbidity.
Results. The first analysis revealed a focus score of ≥1 or lymphocytic infiltrates (not fulfilling the criterion of a focus score of 1) combined with benign lymphoepithelial lesions as diagnostic criteria for pSS. When comparing the parotid biopsy with the labial biopsy sensitivity and specificity were comparable (sensitivity 78%, specificity 86%). Level of pain was comparable and no loss of motor function was observed. No permanent sensory loss was observed after parotid biopsy, while labial biopsy led to permanent sensory loss in 6% of the patients. Malignant lymphoma was detected in one parotid biopsy by chance, without involvement of the labial salivary gland.
Conclusion. A parotid biopsy has a diagnostic potential comparable with that of a labial biopsy in the diagnosis of pSS, and may be associated with less morbidity.
The aim of this review was to identify systematically, criteria for trismus in head and neck cancer, the evidence for risk factors for trismus and the interventions to treat trismus. Three databases ...were searched (time period 1966 to June 2003) for the text “trismus” or “restricted mouth opening”. Included in the review were clinical studies (⩾10 patients). Two observers independently assessed the papers identified. In 12 studies nine different criteria for trismus were found without justifying these criteria. Radiotherapy (follow-up: 6–12 months) involving the structures of the temporomandibular joint and or pterygoid muscles reduces mouth opening with 18% (sd: 17%). Exercises using a therabite device or tongue blades increase mouth opening significantly (no follow-up), effect sizes (ES) 2.6 and 1.5 respectively. Microcurrent electrotherapy (follow-up 3 months) and pentoxifylline (no follow-up) increases mouth opening significantly (ES for both: 0.3).
It has been suggested that the provision of dental implants can improve the oral function of subjects with severely resorbed mandibles, possibly restoring function to the level experienced by ...satisfied wearers of conventional complete dentures. Nevertheless, a quantitative comparison has never been made and can be drawn from the literature only with difficulty, since studies differ greatly in methodology. To make such a comparison, we measured bite force and chewing efficiency by using identical methods in subjects with overdentures, complete full dentures, and natural dentitions. Our results indicated that bite forces achieved with overdentures on dental implants were between those achieved with artificial and natural dentitions. Chewing efficiency was significantly greater than that of subjects with full dentures (low mandible), but was still lower than that of subjects with full dentures (high mandible) and overdentures on bare roots. Differences in the height of the mandible revealed significant differences in chewing efficiency between the two full-denture groups. Furthermore, subjects with a shortened dental arch exerted bite forces similar to those of subjects with a complete-natural dentition, but their chewing efficiency was limited due to the reduced occlusal area. For all groups combined, a significant correlation was found between maximum bite force and chewing efficiency. Nearly half of the variation in chewing efficiency was explained by bite force alone.
BACKGROUND The common occurrence of xerostomia in Sjögren's syndrome (SS) as well as the easy accessibility of saliva supports the use of sialometry and sialochemistry in the diagnosis of SS. ...Collection and analysis of whole saliva (oral fluid) is currently the routine technique for sialometry, despite the fact that it is rather inaccurate and impure. OBJECTIVE To assess the value of glandular sialometry and sialochemistry as diagnostic instruments in SS. METHODS In a group of 100 consecutive patients referred for diagnosis of SS, glandular secretory flow rates and a spectrum of salivary components (sodium, potassium, chloride, calcium, phosphate, urea, amylase, total protein) were assessed. The patients were classified as positive or negative for SS according to the revised European classification criteria. RESULTS Patients with SS differed clearly from those who tested negative for SS, showing lower submandibular/sublingual (SM/SL) flow rates and an appreciably changed salivary composition of parotid and SM/SL saliva. Besides changes in salivary flow rate and composition, distinct sialometric profiles were observed, characteristic of either early or late salivary manifestation of SS, or of the xerogenic side effects of medication. CONCLUSIONS Glandular sialometry and sialochemistry are not only useful tools for differentiating SS from other salivary gland disease in clinical practice, but they also have great potential as diagnostic criteria for SS, showing distinct sialometric and sialochemical changes as well as profiles. Being simple, safe (non-invasive), and sensitive (early disease detection), they have three major advantages over other oral tests for SS.
Background: Analysis of salivary variables has frequently been proposed as a diagnostic tool for Sjögren's syndrome (SS). Because univocal salivary reference values are lacking, it is currently ...rather difficult to use sialometry and sialochemistry for diagnosing SS unless major changes have occurred in salivary secretion and composition. Objective: To define reference values of several salivary variables, which offer a possible new and non-invasive means of diagnosing SS. Methods: Cut off points were selected from receiver operating characteristic curves of gland-specific sialometrical and sialochemical variables, which have proved to be potentially relevant for diagnosing SS in a previous study—that is, sodium, chloride, and phosphate concentration in stimulated parotid and submandibular/sublingual (SM/SL) saliva, unstimulated and stimulated SM/SL flow rates, and lag phase of parotid secretion, respectively. By combining the most discriminating variables, two different diagnostic approaches for SS were applied in a group of 100 patients and subsequently evaluated in a second group of 20 patients. The first approach was to combine variables by applying their cut off points into sets of criteria for a positive diagnosis of SS. The second approach was to construct a logistic regression model that predicts the true state of a patient (SS or non-SS). From both approaches, the tests with highest likelihood ratio combined with the smallest number of rejected cases were selected for clinical use. Results: The most accurate test combined the stimulated SM/SL flow rate and parotid sodium and chloride concentration as salivary variables for diagnosing SS; it had a sensitivity of 0.85 and a specificity of 0.96. The selected tests proved equally accurate in the second group of patients. Conclusions: Because the proposed non-invasive diagnostic tools can be easily applied, do not need a laboratory other than for routine blood testing, and are very accurate, gland-specific sialometry and sialochemistry may eventually replace other, more invasive, diagnostic techniques for diagnosing SS.
Morbidity of chin bone harvesting Raghoebar, Gerry M.; Louwerse, Charlotte; Kalk, Wouter W. I. ...
Clinical oral implants research,
October 2001, Letnik:
12, Številka:
5
Journal Article
Recenzirano
: The chin is a very common donor site for autogenous bone grafts. The aim of this retrospective study was to evaluate long‐term morbidity of the donor site following chin bone graft harvesting. One ...to three years after grafting of local bone defects of the anterior maxilla with chin bone, 21 patients were recalled for objective assessment of any residual morbidity at the harvesting area. Morbidity as well as satisfaction of the patients were evaluated by a survey of the medical record, a mail‐in questionnaire, and a standardized physical examination. The outcome of this study showed that there was good acceptance of the chin bone harvesting procedure. The objective morbidity was low, but subjectively almost half of the patients reported a changed (decreased) sensibility in the harvesting area. This subjective change in sensibility did not result in noteworthy complaints or discomfort by the patients, however. Although bone harvesting from the chin is generally considered as a good option for reconstruction of local bony defects, the patients should be informed about the potential hazard of a changed sensibility in the chin region.
Résumé
Le menton est un site donneur commun pour le prélèvement de greffons osseux autogènes. Le but de cette étude rétrospective a été d’évaluer la morbiditéà long terme du site donneur à la suite du prélèvement au niveau du menton. Une à trois années après leur greffe osseuse à l’aide de greffons osseux prélevés de leur menton, 21 patients ont été rappellés pour une évaluation objective de toute morbidité résiduelle au niveau du site donneur. La morbidité ainsi que la satisfaction des patients ont étéévaluées par une étude attentive de l’examen médical, un questionnaire et par un examen physique standardisé. Ce système chirurgical était en général bien accepté. La morbidité objective était faible mais cependant presque la moitié des patients se plaignaient d’un changement (diminution) de sensibilité dans cette zone. Cette variation subjective de sensibilité n’était suivie ni par d’importantes plaintes ni par un incomfort particulier des patients. Bien que le prélèvement osseux au niveau du menton soit généralement considéré comme une bonne option pour la reconstruction de lésions osseuses locales, les patients devraient être informés des changements possibles de sensibilité dans cette région.
Zusammenfassung
Das Kinn ist eine sehr beliebte Spenderstelle für autologe Knochentransplantate. Das Ziel dieser retrospektiven Studie war es, die Morbidität der Spenderstelle über einen langen Zeitraum nach der Gewinnung von Kinnknochentransplantaten zu untersuchen. Einundzwanzig Patienten wurden 1 bis drei Jahre nach dem Aufbau von lokalen Knochendefekten der anterioren Maxilla mittels Kinnknochen nachuntersucht, um die Spenderregion objektiv auf irgendwelche Residualmorbidität zu überprüfen. Sowohl die Morbidität als auch die Zufriedenheit der Patienten wurden überprüft, indem die Krankengeschichten durchgesehen wurden, ein per Post gesandter Fragebogen ausgewertet wurde und eine standardisierte klinische Untersuchung durchgeführt wurde. Das Ergebnis dieser Studie war, dass die Knochengewinnung im Kinnbereich gut akzeptiert wurde. Die objektive Morbidität war tief, aber subjektiv berichteten fast die Hälfte der Patienten über veränderte (reduzierte) Sensibilität in der Region der Knochenentnahme. Jedoch resultierten die subjektiven Veränderungen in der Sensibilität in kaum nenneswerten Beschwerden und vernachlässigbarem reduziertem Komfort der Patienten. Obwohl die Knochengewinnung in der Kinnregion eine gute Möglichkeit zur Rekonstruktion von lokalen Knochendefekten darstellt, sollten die Patienten über mögliche Nebenwirkungen bezüglich veränderter Sensibilität in der Kinnregion informiert werden.
Resumen
El mentón es un lugar muy común como lugar donante para injertos de hueso autógeno. La intención de este estudio retrospectivo fue evaluar la morbilidad a largo plazo del lugar donante tras la recolección de injertos óseos del mentón. Tras uno a tres años después de injertar defectos óseos locales del maxilar anterior con hueso del mentón se llamó a 21 pacientes para valoración objetiva de alguna morbilidad residual en el área de recolección. Se evaluó la morbilidad al igual que la satisfacción de los pacientes por medio de un peritaje de historia médica, un cuestionario y un examen fisico estándar. Los resultados de este estudio mostraron que existia una buena aceptación del procedimiento de recolección del hueso del mentón. La morbilidad objetiva fue baja pero subjetivamente casi la mitad de los pacientes relataron un cambio (disminución) de la sensibilidad en el área de recolección. De todos modos, este cambio subjetivo de la sensibilidad no resultó en quejas notables ó incomodidad de los pacientes. Aunque la recolección de hueso de la barbilla generalmente se considera una buena opción para la reconstrucción de defectos óseos locales, los pacientes deben ser informados sobre el peligro potencial de un cambio en la sensibilidad de la región mentoniana.
Objective
The aim of this study was to evaluate the objective and subjective morbidity of symphyseal chin bone harvesting used for reconstruction of alveolar defects in young cleft patients.
Design
...All patients who had undergone chin bone harvesting for alveolar cleft reconstruction in the period from 1992 through 2000 at the Department of Oral and Maxillofacial Surgery of the University Hospital Groningen, Groningen, The Netherlands, were invited to participate in this retrospective study.
Patients’ acceptance, perioperative and postoperative morbidity were evaluated. A survey of the medical records was performed. In addition, the patients completed a questionnaire for their appreciation of the procedure. They were also subjected to a clinical and radiographic examination.
Patients
Thirty patients (21 males and 9 females; mean age 11.8 ± 3.6 years) participated in this study.
Results
Neither the medical records nor the experiences of the patients showed significant morbidity. The procedure was appreciated with 6.8 ± 3.5 (scale 0 to 10). Postoperative pain was scored as 1.2 ± 2.5 (scale 0 to 10). Three patients reported transient sensory disturbances at the donor site. Two patients showed a slight sensibility disorder in the symphyseal region. In three patients, an endodontic problem had developed in a lower incisor.
Conclusion
This study showed that chin bone harvesting for reconstructing alveolar cleft in young patients is a well-accepted procedure with low objective and subjective morbidity. Notwithstanding this low morbidity, the patients (and their parents) have to be informed about the risk of objective and subjective disturbances of the sensibility in the donor region and the risk of dental pulp necrosis.
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