Gender-related differences in the baroreceptor reflex control of heart rate in normotensive humans.

The present study investigates the baroreceptor reflex control of heart rate (HR) of normotensive male and female human volunteers under two conditions: bolus- and infusion-evoked elevations of blood pressure by intravenous administration of phenylephrine. Average age and blood pressure were similar in both sexes, but females had a significantly lower heart period (HP; higher HR). A major difference existed between the two sexes when the blood pressure was elevated by the bolus method.

Cephalometric assessment of sagittal relationship between maxilla and mandible.

This investigation was undertaken to evaluate if palatal plane could be used as a skeletal plane of reference in lateral cephalometric radiographs to evaluate sagittal maxillomandibular relationship. Various cephalometric landmarks in the maxilla and the mandible were projected to the palatal plane, and the linear distances between them were measured. In this three-part study, the first part evaluated changes in the inclination of palatal plane and in the linear distances from the age of 6 to 24 years in longitudinal records of 86 patients (46 male, 40 female).

Regulation of drugs and devices: an evolution.

The U.S. Food and Drug Administration's (FDA's) drug approval process has evolved from a system in which a drug could lawfully be marketed unless the FDA were able to prove that the manufacturer knew that the drug would not work for the conditions for which it was promoted to one in which drug-makers require advance approval from the agency for almost every important step in testing, production, and marketing.

Nursing research in the VA system. A consortium approach.

Five Veterans' Administration Medical Centers formed a consortium to promote nursing research. Consortium arrangements focusing on research are reviewed based on the literature, the consortium's experience, and a survey of 171 VA facilities. Consortiums are suggested for multisite facilities, such as city, state, proprietary, and religious hospital systems, to increase the quality and quantity of nursing research where institutional mechanisms for overcoming the difficulties of meeting and sharing information are already in place.

Histologic study of the fate of autogenous auricular cartilage grafts in the human temporomandibular joint.

Biopsies of 30 autogenous auricular cartilage grafts previously placed in 21 patients with ankylosis and arthropathy of the temporomandibular joint were studied. These joints were reoperated because of persistent pain and limitation of motion. Histologically, all grafts showed viability of the cartilage.

New uses of anticonvulsant drugs in psychosis.

Psychotic patients not adequately relieved by neuroleptic drugs often improve when anticonvulsants are added. In bipolar disorders and organic psychoses, anticonvulsants can sometimes be used to replace neuroleptics. No individual anticonvulsant is clearly, consistently superior.

Detection of human cytomegalovirus in plasma of AIDS patients during acute visceral disease by DNA amplification.

By using the polymerase chain reaction (PCR) amplification procedure, 19 (83%) of 23 plasma specimens obtained from individuals with AIDS and human cytomegalovirus (HCMV) visceral disease were found to be positive for plasma viremia as detected by PCR (PV-PCR), whereas 78% of cultures of peripheral blood leukocytes from the same samples were found to be positive. All 11 specimens prospectively obtained from individuals with acute HCMV disease were positive by PV-PCR. Plasma specimens from patients who received ganciclovir therapy rapidly became both culture and PV-PCR negative, and there was an excellent correlation between the two procedures.

Trigeminal neuralgia: how to rule out the wrong treatment.

Toothache is difficult to diagnose and treat appropriately when traditional dental diagnostic test results are negative. This study looked at 61 patients who were treated for pretrigeminal or trigeminal neuralgia. Of these, 61 percent were incorrectly diagnosed and treated.

Mastitis due to Mycoplasma in the state of New York during the period 1972-1990.

Between January 1972 and December 1990, bulk-tank (n = 721) and cow (n = 9,163) milk samples from dairy herds in New York State were examined by bacteriologic procedures for Mycoplasma. The organism was found in 165 herds in 42 counties, and in 2.3 and 11.

On physicians and litigation.

Because litigation involving physicians has come to influence the practice of medicine in several ways, we describe many of the legal processes involved. We also offer specific advice in regard to steps which can be effectively taken, and those which should be avoided. We close with a plea for active participation by physicians in the judicial process and in the promulgation of appropriate legislation.

Techniques of continuous arteriovenous hemofiltration and hemodialysis. Renal replacement in the ICU for hypervolemic, uremic patients.

Continuous arteriovenous hemofiltration (CAVH) and continuous arteriovenous hemodialysis (CAVHD) are extracorporeal ultrafiltration techniques that permit ongoing removal of plasma water and uremic toxins. Both techniques are performed in the ICU with a minimum amount of equipment and achieve overall fluid balance more readily than intermittent hemodialysis. CAVH is used to manage hypervolemia, electrolyte imbalance, and/or mild uremia.

The technique of slow continuous ultrafiltration. Steps to maintain fluid balance without hemodynamic instability.

Slow continuous ultrafiltration (SCUF) is ideally suited for fluid overloaded patients with renal insufficiency, and for patients who need intravenous fluids in amounts that exceed renal excretory capacity. Like other methods of continuous ultrafiltration, including CAVH and CAVHD, SCUF can be performed in the intensive care unit with a minimum of equipment. During SCUF, arterial blood (usually from the femoral artery) is passed through a hollow-fiber hemofilter; an ultrafiltrate of serum collects at a rate that is determined by the patient's blood pressure.

A histologic evaluation of the accuracy of TMJ diagnostic arthroscopy.

Sixty-seven temporomandibular joints with internal derangement were examined with arthroscopy, and synovial biopsies were taken for histologic evaluation. Histologically, in 10 cases, the synovium appeared to be normal in appearance, 24 cases had moderate to severe synovitis, 11 cases showed hyperplastic synovitis, 13 cases showed synovial fibrosis, and foreign body granuloma was found in 9 cases. Correlation between arthroscopic observation and histologic findings disclosed an 89.

Illness and the workplace: a study of physicians and employers.

Seven million patients with work-related injuries are seen annually in the United States, the majority by primary care physicians. The number of such patients seen in a typical community practice may be significant but has never been studied. Most community-based physicians have little or no formal training in occupational health care.

Paleomagnetism and the nature of the geodynamo.

Records of direct observations of the earth's magnetic field cover less than a ten-millionth ofthe known lifetime of the field. Thus our knowledge of several geomagnetic phenomena, critical to our understanding of the geodynamo, must come firom the paleomagnetic record. A combination of substantial advances during the past decade or so both in dynamo theory (previously the domain of the mathematician) and in paleomagnetism (previously the domain of the geologist) has led to provocative models of the earth's magnetic field and a better understanding of the geodynamo.

Therapeutic levels of valproate for psychosis.

Valproic acid was added to the treatment regimens of 21 psychiatric inpatients whose response to antipsychotic medications had been inadequate, and steady-state serum valproate levels were obtained on 15. The 7 patients who had unequivocal positive therapeutic responses to valproate improved at a mean serum level of 68, with a 95 percent confidence interval of 50 to 86. The 8 nonresponders had a mean serum level of 37.

Central hemangioma of the jaws.

Fifteen cases of central hemangioma of the jaws in 14 patients are reported, and considerations in diagnosis and treatment are discussed. In the management of these tumors, diagnostic considerations are of paramount importance if associated risks are to be minimized while maximizing the chances for a successful outcome. A search of the literature suggests that surgery, either alone or in combination with embolization, remains the treatment of choice for these lesions.

Secondary closure of oroantral and oronasal fistulas: a modification of existing techniques.

Fifty-three patients, 25 with oroantral and 28 with oronasal fistulas, were treated using a modified technique of peripheral de-epithelialization and overlapping flaps. This technique was used with sliding buccal flaps, palatal rotation flaps, palatal island flaps, tongue flaps, and distant tubed pedicle flaps. The advantage of the flap is that it provides more tissue attachment, which promotes healing and resists the tendency of the flap to return to its original position.