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M M Stark

Publications and source records attributed to M M Stark.

At least 19 recordsLinked to original sources

CS spray.

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Emergency Service, Hospital

Linking data from national trauma and rehabilitation registries.

OBJECTIVE: To evaluate te feasibility of retrospectively creating a data base useful in trauma systems evaluations. MATERIALS AND METHODS: Records for 375 patients in both the Major Trauma Outcome Study and the Uniform Data System for Medical Rehabilitation were linked to create an injury-through-rehabilitation data base, including patients from four impairment groups: traumatic brain injury (TBI); spinal cord injury --paraplegic complete (SCI-PARA) and quadriplegic complete (SCI-QUAD); and hip fracture (HIP-FX). MEASUREMENTS AND MAIN RESULTS: The average ages (25.1 years SCI-QUAD, 72.6 years HIP-FX); Injury Severity Score (10.2 HIP-FX, 31.7 SCI-PARA); Revised Trauma Score (5.9 TBI, 7.8 HIP-FX); and acute care lengths of stay (13.3 days HIP-FX, 24.2 days TBI) varied substantially over the four groups. On average, patients spent from approximately 20 days (HIP-FX) to nearly 100 days (SCI-QUAD) in rehabilitation. Functional gains during rehabilitation were primarily in motor skills, but TBI patients also made substantial cognitive gains. Nearly 90% of TBI and SCI patients were discharged to their homes; the percentage of HIP-FX patients discharged to their homes, however, was lower (74%). Across all impairment groups, more patients lived with their relatives after rather than before injury. The correlation between a summary Major Trauma Outcome Study-Functional Independence Measure assessed at acute care discharge and the complete Uniform Data System for Medical Rehabilitation-Functional Independence Measure assessed on admission to rehabilitation was significant for all study patients and for each impairment group except SCI_PARA. CONCLUSIONS: Linking records to create the study data base was arduous and could not be practically accomplished on a large scale or on a continuing basis. Because of the growing emphases on trauma system evaluations and outcomes beyond survival at acute care discharge, we recommend the routine inclusion of rehabilitation data in hospital-based trauma registries.

Activities of Daily Living

An accurate method for open reduction and internal fixation of high and low condylar process fractures.

OBJECTIVE: This study was undertaken to evaluate a protocol for open reduction of both high and low condylar fractures that consistently produces accurate reductions, uses rigid internal fixation, and allows immediate function. MATERIALS AND METHODS: This protocol was retrospectively evaluated in 22 consecutive patients (23 fractures). RESULTS: All patients functioned immediately. There were no inaccurate reductions, malocclusions, wound infections, neurosensory deficits, or reports of chronic pain. No patients required reoperation. CONCLUSION: The results of this study indicate that this protocol consistently produces accurate reduction of condylar process fractures and allows immediate function with a minimum of morbidity.

Adolescent

Management of drug misusers in police custody.

Police surgeons are increasingly being asked by the police to assess whether drug misusers held in police custody are fit to be detained and fit for interview. There has been little published on how they manage these questions, furthermore the management appears to vary in different parts of the country. This study sets out to determine the attitudes and practise of police surgeons to the management of drug misusers in police custody. A questionnaire was sent to the full members of the Association of Police Surgeons of Great Britain (APSGB) in March 1993. It was found that police surgeons are very aware of the increasing drug problem, indeed 76% reported that they were seeing an increasing number of drug misusers. However, they exhibit significantly negative attitudes to drug misusers and there is no common practice for prescribing controlled drugs. Fifty-two per cent said that on average they notified no drug misusers each month. Seventy-six per cent of respondents said they had received a hepatitis B immunization. The majority of respondents called for more training on drug problems. Therefore, there is an urgent need for specific guidelines for police surgeons on the management of drug misusers in police custody to address the arbitrary nature of the current practice.

Adult

Evaluation of the apical sealing ability of apatite root canal sealer.

The apical sealing ability of a tricalcium phosphate sealer was compared with that of three other sealers. Seventy roots of human incisors were cleansed and shaped and randomly assigned to one of seven groups of ten roots each. The root canal systems were obturated with gutta-percha and one sealer using the lateral-vertical condensation technique. The canal was sealed with Roth's sealer, Sealapex, Kerr root canal sealer, or Sankin apatite root sealer (Type I, II, or III). One group was filled with gutta-percha without sealer to serve as a control. After the roots were immersed in silver nitrate, the degree of dye penetration was measured under a dissecting microscope. Results indicated that Sealapex had the best sealing ability, followed by Sankin apatite root sealer, Type II. Roth's cement showed the most dye penetration. Canals that were obturated without sealer showed significantly greater apical leakage.

Apatites

Sealing ability of intermediate restorations and cavity design used in endodontics.

Temporary filling materials are used in endodontics to prevent contamination of the root canal system during intertreatment visits. Recently, a new composition resin (TERM) has been introduced as an interim restoration in endodontics. The purpose of this investigation was to evaluate the efficacy of this resin as an interim restoration and possible effect of access cavity design with respect to its sealing ability compared with other temporary restorative materials. Sixty human teeth were divided into two categories, and two types of access cavities were prepared, namely tapered access with walls divergent toward the occlusal surface and straight access with parallel walls. The prepared teeth from each category were divided into three subgroups of ten each to receive Cavit (group I), IRM (group II), or TERM (group III). After the fillings were placed, the teeth were transferred into a humidor where they stayed for 24 hours. The teeth were then thermocycled. Each group was thermocycled for 2 hours at 1 minute intervals at 60 degrees C and 4 degrees C. Then the teeth were sealed with a compound and coated with two layers of clear varnish, with the exception of cavity margins. Each occlusal surface was immersed in a vial containing silver nitrate. The teeth were sectioned longitudinally, and the degree of dye penetration was evaluated under a dissection microscope according to set criteria. Our findings demonstrated that design of cavity preparation was not a functional parameter in leakage pattern. Results indicated that Cavit had the best sealing ability whereas IRM showed the maximum dye penetration.

Calcium Sulfate

Use of glass ionomers as retrofilling materials.

Many materials have been used as retrofillings. Because of the bonding property of glass ionomer cement, this study was conducted to evaluate its possible use as a retrofilling material. Seventy human maxillary anterior teeth were chosen. The root canal systems were cleansed and shaped, and the teeth were assigned to six groups of 10 each. The root canals were obturated with gutta-percha and Grossman sealer, and the apical 2 mm of each root was resected. In all groups a retrofilling preparation was made to a depth of a number 331 bur. The apical preparations were filled in the following manner: silver amalgam (group I), silver amalgam plus two layers of varnish (group II), Ketac-Silver plus two layers of varnish (group III), Ketac-Silver without varnish (group IV), Ketac-Fil plus two layers of varnish (group V), Ketac-Fil without varnish (group VI), and Ketac-Bond (group VII). All the root surfaces with the exception of 2 mm from the resected line were coated with two layers of clear varnish. All the teeth were immersed in methylene blue for 24 hours. After vertical sectioning, dye penetration was measured under a dissecting microscope. The mean apical leakage (in millimeters) was as follows: I = 0.57, II = 0.39, III = 0.22, IV = 0.54, V = 0.11, VI = 0.46, and VII = 0.17. One-way analysis of variance performed on the group means indicated that Ketac-Fil with varnish (group V) and Ketac-Bond (group VII) had significantly less leakage than other groups (p less than 0.05). This study indicates that Ketac-Fil and Ketac-Bond may have potential as retrofilling materials.

Cermet Cements

Technical note: antimicrobial action of glass-ionomer lining cement on S. sanguis and S. mutans.

There are a number of glass-ionomer lining cements available to the profession. It is generally agreed that the glass-ionomer cements demonstrate reasonably good biocompatibility. The purpose of this study was to evaluate the antimicrobial activity of six glass-ionomer cements on S. sanguis and S. mutans. Forty-eight plates of TSA-SRBC (10%), each with 3.0-mm-diam. wells, were divided into two groups (1 and 2) of 24 each. Group 1 was inoculated with S. sanguis (10558) and Group 2 with S. mutans (6715-13 w.t.). Each well was filled with 4.0 mg of one of the following liners: Glassic (A), Shofu lining cement (B), GC lining cement (C), Ever Bond (D), Gingiva Seal (E), and Ketac Bond (F); the empty wells served as control. Plates were incubated under microaerophilic conditions at 37 degrees C, and checked daily over seven days for inhibition zones. Average inhibition zones (mm) at 7 days were as follows: Group 1-1A = 10.00, 1B = 7.83, 1C = 18.50, 1D = 13.00, 1E = 8.67, and 1F = 9.33; Group 2-2A = 3.08, 2B = 10.25, 2C = 12.75, 2D = 15.58, 2E = 8.83, and 2F = 3.20. All control wells were 0.0 GC liner and Ever Bond showed significantly greater overall inhibition of microbial growth than did other tested liners (p less than 0.5). A one-way ANOVA and SNK test showed that all tested liners were significantly more toxic toward S. sanguis than toward S. mutans (p less than 0.05).

Dental Cavity Lining