Baclofen for intractable hiccups.
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Biomedical subjects
Publications and source records attributed to N Brill.
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An 11-month-old boy with late infantile metachromatic leucodystrophy was given a bone-marrow transplant (BMT) from an HLA-identical sister; 6 months later his cerebrospinal fluid leucocytes were exclusively of donor origin. Coupled with the patient's continued developmental progress, as assessed 33 months after the procedure, the findings suggest that BMT may be an effective treatment for some congenital metabolic disorders which affect the central nervous system.
In a previous study it was found that the distance between the borders of the comfortable zone was considerably wider when the zone was recorded statically rather than dynamically. However, it was not reported how condylar displacements may be related to the zonal borders. Therefore, an attempt is made in the present study to translate zonal border recordings into the equivalent amount of condylar rotation. Using a dental articulator, it was found that the condyles rotated 4.96 degrees, when the comfortable zone was recorded statically, and 2.50 degrees, when the zone was recorded dynamically. The difference, 2.46 degrees, was statistically significant (P less than 0.001).
Oral temperatures were measured in ten young females and ten young males, and compared to oral temperatures measured in ten elderly females and ten elderly males. Each subject had a complete natural dentition. When analysed by sex, it was found that the temperatures in elderly males were lower than in young males (P less than 0.001), while temperatures in young and elderly females did not differ. Concerning sublingual temperatures, a difference of approximately one-third of a degree centigrade was demonstrated between the two age groups (P less than 0.005).
In nineteen subjects, temperatures were recorded thermo-electrically in the vestibular and proximal crevices of fifty-nine teeth. It was found that the formation of a new plaque was followed by a rise in crevicular temperature. In addition, it was found that the normal as well as the abnormal crevicular temperatures were higher in the mandible than in the maxillae.
Mucosal temperatures were studied in twenty-two subjects, who had worn full upper and lower dentures for at least 5 years. By comparing with a group of twenty-two fully dentate subjects, it was found that in the denture wearers, temperatures were increased significantly in the lower jaw, but not in the upper jaw.
Using a screw jack device the upper and lower borders of the comfortable zone were recorded in a two step procedure designed to counteract bias inherent in previous measurements. In these measurements, successively increasing and decreasing values of zonal borders were recorded corresponding to a fully closed or fully opened starting position of the screw. Both of these positions are outside the comfortable zone. The two step procedure used a starting position which was supposed to lie inside the comfortable zone. However, the procedure did not achieve its aim fully. It succeeded only in stabilizing the lower border values. In the discussion hypothetical considerations are made concerning the neurophysiological mechanism underlying recordings of the borders of the comfortable zone, which might explain the differential behaviour of the zonal borders.
On the assumption that the colour difference between attached gingiva and alveolar mucosa is accompanied by a temperature difference, twenty subjects with a high standard of oral health were studied. Five points on either side of the mucogingival junction were examined by means of a thermocouple probe. A mean difference amounting to about 2/3 degrees C was found between the surface temperatures of the two structures.
A dynamic and a static method of assessing the comfortable zone by means of a screw jack were compared in 12 subjects. Recorded under dynamic conditions the average width of the comfortable zone was approximately 3.0 mm, and under static conditions approximately 5.0 mm (P less than 0.0001). It is suggested that in the dynamic experiments the larger output from receptors in the chewing system was responsible for the narrower zone, i.e. the more precise assessments of the comfortable zone.
It has been shown that a zone of comfort in maxillo-mandibular relationships in edentulous subjects can be identified with some precision. Whilst the neurophysiological mechanism involved has not been explained fully, the phenomenon is influenced by starting position and by fatigue. This experiment was set up to test the hypothesis that age is another significant factor in perception of the comfortable zone. A group of seventeen subjects with a mean age of 62 years and an equivalent younger group, the mean age of which was 28 years, were tested with Timmer screw jacks applied using the central approach to record the upper and lower limits of the zone fifteen times in succession for each subject. A linear statistical model was used to analyse the data from upper and lower borders separately. The results showed that the effect of making successive adjustments, whilst not significant statistically in the young group, was significant in the more elderly. Regression lines from the young group data were horizontal signifying the high degree of accuracy with which their perceptual mechanisms worked: the upwards inclination of those from the more elderly was interpreted as showing that initial appreciations were subjected to constant correction.
1. The introduction of a removable partial denture into the oral cavity adversely affects the prevailing ecologic situation in terms of plaque formation. 2. The rehabilitative effect of a removable partial denture may be safeguarded by controlling plaque formation by strict personal hygienic measures on the part of the patient. In particular, proximal surfaces adjacent to denture bases should be pointed out to patients as surfaces to which they must give special attention. 3. Simplification of the design of removable partial dentures can reduce their damaging potentialities. 4. Further prophylactic measures, such as topical application of fluorides and perhaps other chemicals, should also be taken.
In search of a new clinical method for determining the occlusal height of full dentures, the perception of the comfortable zone was studied in fifteen edentulous patients. In each experimental session perceptual changes were recorded from forty-four consecutive applications of a screw jack per subject. Two stages in perceptual acuity were found. An initial stage, in which only minor variations occurred among the final screw adjustments which the subjects made when they assessed the borders of the comfortable zone. In the ensuing stage greater variations emerged, indicating a deterioration in the ability of the subjects to discriminate.
A new pattern of screwjack for assessing the vertical dimension for occlusion utilizing an edentulous patient's proprioceptive sensation is described. It provides a greater range of movement than other, giving infinitely variable heights between 9 and 21 mm. The elements being captive, it cannot come to pieces in use. Laboratory experiments were contrived to define the magnitude of reading errors and the play in the screw threads. It was found that, only in instances where a graduation related closely to the datum mark, did errors of interpretation arise. These were found to exceed the height set for test purposes by 0-1 mm consistently. An error of this order is of no practical significance clinically and is no impediment to such an application of the device. Mean play in the new pattern jacks was 0-01 mm compared to 0-05 mm in the Timmer versions. In a clinical experiment the performance of the screw was compared to that of Timmer. Statistical evidence was found which suggested a functional difference between the two, the new pattern being significantly more accurate.
By means of a screw jack device, applied to thirteen edentulous subjects, the comfortable zone was approached in three different ways, by the central, the internal and the external approaches. Correspondingly, the zonal borders behaved differently. Applying the central approach it was found that the initial height of the screw jack had a lingering effect upon subsequent adjustments of the screw. Moreover, lower border data collected by the external approach distinguished themselves from other zonal border data by showing a significantly lower susceptibility to successive adjustments. The study suggests that muscle activity is a factor on which the perceptual mechanism relies, when a zonal border is assessed subjectively by a patient.
A controlled trial was made using fifteen subjects and making 120 measurements with a caliper gauge between marks disposed on the upper lip and the point of the chin when maxillo-mandibular relationships were altered vertically by known amounts within a range of 6 mm. It was found that mean facial measurements could account for only half of the skeletal movement involved. The variability of soft tissue translation in relation to skeletal movement led to the conclusion that such facial measurements are inappropriate to clinical practice.
The construction of a linear model is described, and its function in analysing variations in the perception of comfortable mandibular occlusal positions is explained. In principle, the model combines analyses of variance and regression in a number of simple computer operations. Data from a clinical study were used to demonstrate the analytical capacity of a specific model, designed to estimate the effect of factors, which were supposed to influence the perception of comfortable mandibular positions.
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