The authors report 27 cases of macrocheilia, discussing each cause individually. They classify macrocheilia according to its etiology, emphasizing the importance of an accurate diagnosis in treating the disease. The operative technique indicated for each cause is discussed. The technique basically consists of a fusiform resection, which may include a larger or smaller amount of lip tissue depending on the disease process. The incision may be interrupted at the mid-lip and W-plasty or lateral Z-plasties may be used to avoid the formation of dog ears.

Adolescent↗

PubMedDate not supplied

Connexin 50 mutation in a family with congenital "zonular nuclear" pulverulent cataract of Pakistani origin.

Inherited cataract is a clinically and genetically heterogeneous disease that most often presents as a congenital autosomal dominant trait. Here we report linkage of a three-generation family of Pakistani origin with autosomal dominant cataract "zonular nuclear" pulverulent type (CZNP) on chromosome 1q21.1. Genome wide-linkage analysis excluded all the known cataract loci except on chromosome 1q. Significantly positive 2-point lod score values (Z=3.01 at theta=0) were obtained for markers D1S305 and D1S2721, which are known to flank the gene for connexin 50 (Cx50) or gap junction protein alpha-8 (Gja8). Previously a mutation in this gene has been reported in a British family with zonular pulverulent cataract (CZP). Here we describe a second mutation (E48K) in connexin 50 that confirms the involvement of this gene in cataractogenesis.

Cataract↗

PubMedDate not supplied

Factors affecting access to prenatal care for U.S./Mexico border-dwelling Hispanic women.

A study of attitudes, beliefs, and behaviors about prenatal care was conducted among Hispanic women who resided on the U.S.-Mexico border. As part of a larger study that included chart reviews of 752 mothers and postpartum interviews of 587 of these women, the 118 women who elected to deliver in the university-affiliated teaching hospital, rather than any of four participating private hospitals, were reviewed separately. This study sought to determine whether the prenatal care behaviors and obstetric outcomes experienced by this subset of women would contribute to any particular adverse impact on the teaching hospital, such as the need for additional intervention services. The most common barriers to prenatal care identified among women in the entire study were the same factors identified among women in the university hospital, including lack of financial means to pay for care, lack of information concerning where to obtain care, inadequate infrastructure of clinic services, sadness, and depression. Maternal and infant outcomes were generally favorable, even for women who did not receive any measure of prenatal care.

Adult↗

PubMedDate not supplied

CQI in policy implementation: advance directives.

Recognition of patients' rights is growing in the healthcare field in this country, as is recognition of the need for advance directives. Advance directives are documents that indicate treatment choices and preferences made by an individual while he or she is still competent. Through the use of continuous quality improvement (CQI) tools and the development of a CQI team, the author's facility was able to implement the important process of having patients complete advance directives.

Advance Directives↗

PubMedDate not supplied

Carcinogenicity of chloral hydrate administered in drinking water to the male F344/N rat and male B6C3F1 mouse.

Male B6C3F1 mice and male F344/N rats were exposed to chloral hydrate (chloral) in the drinking water for 2 years. Rats: Measured chloral hydrate drinking water concentrations for the study were 0.12 g/L, 0.58 g/L, and 2.51 g/L chloral hydrate that yielded time-weighted mean daily doses (MDDs) of 7.4, 37.4, and 162.6 mg/kg per day. Water consumptions, survival, body weights, and organ weights were not altered in any of the chloral hydrate treatments. Life-time exposures to chloral hydrate failed to increase the prevalence (percentage of animals with a tumor) or the multiplicity (tumors/animal) of hepatocellular neoplasia. Chloral hydrate did not increase the prevalence of neoplasia at any other organ site. Mice: Measured chloral hydrate drinking water concentrations for the study were 0.12 g/L, 0.58 g/L, and 1.28 g/L that gave MDDs of 13.5, 65.0, and 146.6 mg/kg per day. Water consumptions, survival, body and organ weights, were not altered from the control values by any of the chloral hydrate treatments. Enhanced neoplasia was observed only in the liver. Prevalence and multiplicity of hepatocellular carcinoma (HC) were increased only for the high-dose group (84.4%; 0.72 HC/animal; p < or = 0.05). Values of 54.3%; 0.72 HC/animal and 59%; 1.03 HC/animal were observed for the 13.5- and 65.0-mg/kg per day treatment groups. Prevalence and multiplicity for the control group were 54.8%; 0.74 HC/animal. Hepatoadenoma (HA) prevalence and multiplicity were significantly increased (p < or = 0.05) at all chloral hydrate concentrations: 43.5%; 0.65 HA/animal, 51.3%; 0.95 HA/animal and 50%; 0.72 HA/animal at 13.5, 65.0, and 146.6 mg/kg per day chloral hydrate compared to 21.4%; 0.21 HA/animal in the untreated group. Altered foci of cells were evident in all doses tested in the mouse, but no significant differences were observed over the control values. Hepatocellular necrosis was minimal and did not exceed that seen in untreated rats and mice. Chloral hydrate exposure did not alter serum chemistry and hepatocyte proliferation in rats and mice or increase hepatic palmitoyl CoA oxidase in mice at any of the time periods monitored. It was concluded that chloral hydrate was carcinogenic (hepatocellular neoplasia) in the male mouse, but not in the rat, following a lifetime exposure in the drinking water. Based upon the increased HA and combined tumors at all chloral hydrate doses tested, a no observed adverse effect level was not determined.

Adenoma↗

PubMedDate not supplied

Gamma irradiation: effects on biomechanical properties of human bone-patellar tendon-bone allografts.

Sixty 10-mm bone-patellar tendon-bone allografts from young human donors were placed into four test groups, a control fresh-frozen group and three fresh-frozen irradiated groups. The irradiated groups were exposed to 2.0, 3.0, or 4.0 Mrad of gamma irradiation. The specimens were tested to tensile failure. The initial biomechanical strength of fresh-frozen allografts was reduced up to 15% when compared with fresh-frozen controls after 2.0 Mrad of irradiation. Maximum force, strain energy, modulus, and maximum stress demonstrated a statistically significant reduction after 2.0 Mrad of irradiation (P < 0.01). Stiffness, elongation, and strain were reduced but not with statistical significance. A 10% to 24% and 19% to 46% reduction in all biomechanical properties were found after 3.0 (P < 0.005) and 4.0 (P < 0.0005) Mrad of irradiation, respectively. After irradiation with a 4.0 Mrad dose, the ultimate load was below that of reported values for the human anterior cruciate ligament. It is clinically important to observe and document changes in human ligaments that result from currently used doses of gamma irradiation. The results from this study provide important information regarding the initial biomechanical properties of fresh-frozen human bone-patellar tendon-bone allografts after bacterial sterilization with gamma irradiation. The current accepted dose for sterilization is between 1.5 and 2.5 Mrad. There appeared to be a dose-dependent effect of irradiation on all the biomechanical parameters studied. Four of seven parameters were found to be reduced after 2.0 Mrad of irradiation. Reductions were found in all parameters after 3.0 and 4.0 Mrad of irradiation.

Biomechanical Phenomena↗

PubMedDate not supplied

Surgical correction of spastic equinovarus deformity in the adult head trauma patient.

The results of 59 surgical procedures for correction of spastic equinovarus deformity of the foot using the split anterior tibial tendon (SPLATT) were reviewed in 54 adults with traumatic head injury. The mean time of follow-up was 49.7 months. Thirty-nine individuals had hemiplegic involvement, three had triplegic involvement, and 12 were quadriplegic. Evaluation of the patterns of lower extremity muscle activity preoperatively by dynamic electromyography in 33 patients showed no significant difference from that seen in the hemiplegic stroke population, namely, spastic calf muscles with overactive toe flexors and anterior tibial muscle. At follow-up all feet were in a plantigrade position. The only complication was a superficial skin slough on the dorsum of the foot which healed uneventfully. Postoperatively, 18 extremities (31%) were brace-free. Forty-one extremities required support because of calf weakness, ataxia, or proprioceptive deficits. Of the 15 patients who were nonambulatory prior to surgery, nine (60%) became ambulatory. At follow-up 36 patients (67%) were independent ambulators, four (7%) required supervision assistance, two (4%) required standby assistance, and six (11%) required minimal assistance. The six individuals (11%) who remained maximally assisted or nonambulatory had improved wheelchair positioning and shoe wear. These results show that the split anterior tibial tendon transfer is a safe and effective procedure for the head trauma patient since it corrects the equinovarus deformity, allowing for improved shoe wear and wheelchair positioning in the nonambulatory individual and improved ambulation with decreased brace wear in the more functional patient.

Adolescent↗

PubMedDate not supplied

Joule versus calorie as the fundamental unit in nutrition.

Explore the source record for details and available documents.

Calorimetry↗

PubMedDate not supplied

Non-invasive assessment of digital vascular reactivity in patients with primary Raynaud's phenonenon and systemic sclerosis.

OBJECTIVE: To examine digital microvascular responses in patients with primary Raynaud's phenomenon (PRP) and systemic sclerosis (SSc), and compare these to the responses in healthy control subjects. METHODS: Digital microvascular responses to repeated episodes of iontophoresis of acetylcholine chloride (endothelial-dependent), sodium nitroprusside (endothelial-independant) and adrenaline were measured using dual-channel laser Doppler in 8 healthy control subjects, 8 patients with PRP and 8 patients with SSc. RESULTS: There were no significant differences in responses between groups. For each chemical the greatest response was generally seen in period 7 of the protocol (after the third episode of iontophoresis). For acetylcholine chloride in period 7, the age and baseline adjusted ratio of the maximum response of PRP to control was 0.93, 95% CI (0.26, 3.38) and for SSc to control it was 0.60, 95% CI (0.13, 2.81). For sodium nitroprusside in period 7, this age and baseline adjusted ratio of the maximum response of PRP to control was 1.31, 95% CI (0.74, 2.32) and for SSc to control it was 1.35, 95% CI (0.68, 2.67). For adrenaline in period 7, the age and baseline adjusted ratio of PRP to control was 1.51, 95% CI (0.79, 2.89) and for SSc to control it was 2.18, 95% CI (1.01, 4.69). CONCLUSION: This study demonstrates the usefulness of iontophoresis of vasoactive chemicals, combined with laser Doppler blood flowmetry, in the non-invasive assessment of dermal microvascular responses. One possible explanation for the lack of difference in responses between groups is that vasoactive chemicals other than those discussed are important in the pathophysiology of primary and secondary Raynaud's phenomenon.

Acetylcholine↗

PubMedDate not supplied

How ready are health plans for Medicare?

CONTEXT: The Medicare program is encouraging its beneficiaries to enroll in capitated health plans. OBJECTIVE: To determine how prepared these plans are to handle chronically ill and frail elderly persons. DESIGN: Telephone survey of 28 health plans that together serve about one fourth of all enrollees of the Medicare Risk program. MEASURES: The degree of readiness (high, intermediate, or low) of health plans in seven domains that experts believe are important to the management of an elderly population. RESULTS: None of the 28 health plans had high readiness scores for all seven domains. The two domains for which the plans were most prepared were risk assessment and member self-care. The plans were least prepared for the domains of cooperative team care and geriatric consultations. CONCLUSIONS: Many plans do not offer the programs that experts believe are important for Medicare enrollees. They may hesitate to adopt strategies that lack data on effectiveness.

Aged↗

PubMedDate not supplied

A double-blind placebo-controlled trial of antioxidant therapy in limited cutaneous systemic sclerosis.

OBJECTIVE: To evaluate the effects of a combination of micronutrient antioxidants (selenium, beta-carotene, vitamin C, vitamin E and methionine) with allopurinol in patients with limited cutaneous systemic sclerosis (SSc). METHODS: The study was designed as a placebo-controlled double-blind crossover study. A carryover effect was detected retrospectively for some of the prescribed antioxidants, and so the data were analysed as: (a) a between group comparison of the first 10 week treatment period; and (b) a within group comparison of the first and second 10-week periods in those who received placebo treatment first. Study end-points were plasma von Willebrand factor (vWF), thermographic response to a standard cold challenge, frequency and duration of Raynaud's attacks, patient opinion, and specialised biochemical parameters (fatty acid profiles, antioxidants and markers of free radical injury). RESULTS: Thirty-three patients were recruited. The median duration of Raynaud's phenomenon was 10 years (range 2 to 50 years) in the active-first group and 10 years (range 4 to 53 years) in the placebo-first group. In the 10-week study, there were no differences between the active and placebo groups in the change from baseline for vWF, for the parameters of the rewarming curve, or for patients' symptoms. Despite a rise in circulating antioxidant levels, there was no fall in markers of free radical mediated injury. In the 20-week cross-over study, patients did not experience any clinical benefit from active treatment compared to placebo. CONCLUSION: No clinical benefit could be demonstrated from active treatment. There are several possible explanations for this negative result, including the short duration of therapy. It is possible that antioxidant therapy, to be effective, needs to be given early in the SSc disease process, before the onset of irreversible tissue damage.

Adult↗

PubMedDate not supplied

Relaxation to reduce dyspnea and anxiety in COPD patients.

The purpose of this study was to test the effectiveness of a taped relaxation message in reducing dyspnea and anxiety in chronic obstructive pulmonary disease (COPD) patients. Twenty-six adult COPD patients with dyspnea were randomly assigned to two groups. The treatment group was taught relaxation using a prerecorded tape while the control group was instructed to sit quietly. Skin temperature, heart rate, and respiratory rate were recorded for all subjects during a total of four weekly sessions. Anxiety, dyspnea, and airway obstruction were measured at the beginning and end of the study. The relaxation group achieved the preset relaxation criteria. Dyspnea, anxiety, and airway obstruction were reduced in the relaxation group while the control group remained the same or became worse.

Adult↗