RESUMEN
Single maxillary denture often represents vigorous challenge to the practicing dentists. The difficulty arises when the maxillary dentures are set to fit the occlusion of natural mandibular teeth. The functionally generated pathway technique registers occlusal pathways of the posterior teeth in functional wax and is described as the "three-dimensional static expression consists of dynamic tooth movement." The current article represents a technique for a patient who was rehabilitated with a maxillary complete denture, and a harmonious occlusion was achieved between the complete denture and the mandibular natural dentition. Functional maxillary denture is therefore in medical dentistry the successful culmination of human's high practice and represents the golden goal sought by every dental practitioner and expected by every denture patient.
Asunto(s)
Diseño de Dentadura , Boca Edéntula , Oclusión Dental , Dentadura Completa , Humanos , MaxilarRESUMEN
The eye is a vital organ and an important component of facial expression. Loss of an eye has a crippling effect on the psychology of the patient. Maxillofacial prostheses restore and replace stomatognathic and associated facial structures with artificial substitutes. The objectives of eye prosthesis is to improve the patient esthetics, restore and maintain the health of the remaining associated structures, consequently provide physical and mental well-being. The primary purpose of an ocular prosthesis is to maintain the volume of eye socket and create the illusion of a healthy eye and surrounding tissue. A custom ocular prosthesis is a good option when reconstruction is done by plastic surgery, and osseointegrated implants are either not possible or not desired. A case of a custom-made ocular acrylic prosthesis is presented with acceptable fit, good retention, and esthetics.
Asunto(s)
Ojo Artificial , Enucleación del Ojo , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis/métodos , Ceras/uso terapéuticoRESUMEN
The objective of this study was to investigate the effects of indoor air pollution on respiratory function of children (aged 7-15 years). The study took place at Ashok Vihar, an urban locality in the northwest part of Delhi during the summer months of June and July 2004. The team did house visits. The questionnaire, administered at the house itself, asked about the history of smoking in the family, type of cooking fuel used, duration of cooking, ventilation and lighting at the cooking place, and other confounders. In total, 441 children (59% male, 41% female) between ages 7 and 15 years were considered for the study, and a detailed profile was collected. Clinical examination with special reference to respiratory system was done. Pulmonary function tests/peak expiratory flow rates of each child were measured. Indoor air pollutant (suspended particulate matter, SO(2), NO(2)) was measured, and the effect of these pollutants on the children's respiratory function was analyzed. The respiratory health profile suggests that children had cough, sputum production, shortness of breath, wheezing, common cold, and throat congestion. Indoor SO(2) , NO(2), and suspended particulate matter levels were high in houses where there was a family history of smoking. SO(2) level was significantly high according to occupancy per room. NO(2) and suspended particulate matter levels were significantly high in houses where children had respiratory problems. It is concluded that indoor air pollution had an association with respiratory function of children.
Asunto(s)
Contaminantes Atmosféricos/toxicidad , Contaminación del Aire Interior/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Mecánica Respiratoria , Enfermedades Respiratorias/epidemiología , Adolescente , Contaminantes Atmosféricos/análisis , Contaminación del Aire Interior/análisis , Distribución de Chi-Cuadrado , Niño , Exposición a Riesgos Ambientales/análisis , Monitoreo del Ambiente , Monitoreo Epidemiológico , Femenino , Humanos , India/epidemiología , Masculino , Óxido Nitroso/análisis , Óxido Nitroso/toxicidad , Material Particulado/análisis , Material Particulado/toxicidad , Pruebas de Función Respiratoria , Mecánica Respiratoria/efectos de los fármacos , Enfermedades Respiratorias/etiología , Factores de Riesgo , Dióxido de Azufre/análisis , Dióxido de Azufre/toxicidad , Encuestas y Cuestionarios , Salud UrbanaRESUMEN
The authors conducted this prospective study at the Shahdara industrial area of Delhi, India. They examined the effects of indoor and outdoor air pollutant levels on respiratory health in 394 children aged 7 to 15 years. The majority of children had a history of respiratory problems, including cough (62.7%), sputum production (24.4%), shortness of breath (32.0%), wheezing (25.6%), common cold (44.4%), and throat congestion (43.1%). The association of indoor and outdoor air pollutant levels showed that outdoor SO2 and NO2 was significantly higher than indoor SO2 and NO2 levels, whereas the mean indoor level of suspended particulate matter (SPM) was significantly higher than outdoor SPM level. Indoor SPM level also was significantly higher in homes of children with a history of respiratory illness than homes of children having no history of respiratory illness. Results suggest that both indoor and outdoor particulate exposure may be important risk factors in the development of respiratory illness in children.
Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire Interior/efectos adversos , Protección a la Infancia , Exposición a Riesgos Ambientales/efectos adversos , Salud Ambiental , Industrias , Material Particulado/efectos adversos , Enfermedades Respiratorias/epidemiología , Adolescente , Niño , Estudios Transversales , Estudios Epidemiológicos , Femenino , Geografía , Encuestas Epidemiológicas , Humanos , India/epidemiología , Masculino , Óxido Nitroso/toxicidad , Pruebas de Función Respiratoria , Factores de Riesgo , Dióxido de Azufre/toxicidad , Encuestas y CuestionariosAsunto(s)
Neovascularización Fisiológica/efectos de los fármacos , Animales , Becaplermina , Factores de Crecimiento Endotelial/farmacología , Factores de Crecimiento de Fibroblastos/farmacología , Humanos , Péptidos y Proteínas de Señalización Intercelular/farmacología , Linfocinas/farmacología , Factor de Crecimiento Derivado de Plaquetas/farmacología , Proteínas Proto-Oncogénicas c-sis , Factor A de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial VascularRESUMEN
OBJECTIVE: We analyzed residual renal function (RRF) in a large number of new peritoneal dialysis (PD) patients to prospectively define the time course of decline of RRF and to evaluate the risk factors assumed to be associated with faster decline. STUDY DESIGN: Single-center, prospective cohort study. SETTING: Home PD unit of a tertiary care University Hospital. PATIENTS: The study included 242 patients starting continuous PD between January 1994 and December 1997, with a minimum follow-up of 6 months and at least three measurements of RRF. MEASUREMENT: All patients had data on demographic and laboratory variables, episodes of peritonitis and the use of aminoglycoside (AG) antibiotics, temporary hemodialysis, and number of radiocontrast studies. Adequacy of PD was measured from 24-hour urine and dialysate collection and peritoneal equilibration test using standard methodology. Further data on RRF was collected every 3 to 4 months until the patient became anuric (urine volume < 100 mL/day or creatinine clearance < 1.0 mL/min) or until the end of study in December 1998. OUTCOME MEASURE: The slope of the decline of residual glomerular filtration rate (GFR) (an average of renal urea and creatinine clearance) was the main outcome measure. Risk factors associated with faster decline were evaluated by a comparative analysis between patients in the highest and the lowest quartiles of the slopes of GFR, and a multivariate analysis using a stepwise option within linear regression and general linear models. RESULTS: There was a gradual deterioration of residual GFR with time on PD, with 40% of patients developing anuria at a mean of 20 months after the initiation of PD. On multivariate analysis, use of a larger volume of dialysate (p = 0.0001), higher rate of peritonitis (p = 0.0005), higher use of AG (p = 0.0006), presence of diabetes mellitus (p = 0.005), larger body mass index (BMI) (p = 0.01), and no use of antihypertensive medications (p = 0.04) independently predicted the steep slope of residual GFR. Male gender, higher grades of left ventricular dysfunction, and higher 24-hour proteinuria were associated with faster decline on univariate analysis only. CONCLUSION: Faster decline of residual GFR corresponds with male gender, large BMI, presence of diabetes mellitus, higher grades of congestive heart failure, and higher 24-hour proteinuria. Higher rate of peritonitis and use of AG for the treatment of peritonitis is also associated independently with faster decline of residual GFR. Whether the type of PD (CAPD vs CCPD/NIPD) is associated with faster decline of residual GFR remains speculative.
Asunto(s)
Riñón/fisiopatología , Diálisis Peritoneal , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: Primarily, to determine whether peritoneal small solute clearance is related to patient and technique survival among anuric peritoneal dialysis [continuous ambulatory (CAPD) and automated peritoneal dialysis (APD)] patients. A secondary goal was to describe the ability to attain Dialysis Outcomes Quality Initiative (DOQI) targets among anuric patients on peritoneal dialysis. DESIGN: Retrospective cohort study via chart reviews. SETTING: Peritoneal Dialysis Unit of Toronto Hospital (Western Division). PATIENTS: The study included 122 CAPD and APD patients between January 1992 and September 1997, with 24-hour urine volume less than 100 mL, or renal creatinine clearance (CCr) less than 1 mL/minute. Adequacy data were available for 115 patients. OUTCOME MEASURES: Mortality and technique failure (TF). Regression analysis was used to estimate the mortality and TF rate ratios (RR) for peritoneal Kt/V urea (pKt/V) and pCCr, adjusting for age, gender, diabetes, months of follow-up prior to anuria, albumin, transport status, coronary artery disease, cardiovascular disease, and peripheral vascular disease. RESULTS: Fifty seven per cent (51/89) of patients on CAPD and 81% (21/26) on APD had a weekly pKt/V > or = 2 and > or = 2.2, respectively (DOQI targets); whereas only 35% on CAPD (31/89) and 35% (9/26) on APD had a weekly pCCr > or = 60 U1.73 m2 and 66 L/1.73 m2, respectively. Median follow-up times among patients were 16.5 and 19.5 months pre- and postanuria, respectively. Patients with pKt/V > or = 1.85 experienced a strong decrease in patient mortality (RR = 0.54, p= 0.10); the effect was less pronounced for pCCr > or = 50 L/1.73 m2 (RR = 0.63, p = 0.25). No relationship was observed between pKt/V or pCCr and TF. CONCLUSION: Mortality was noticeably less frequent among patients with a pKt/V > or = 1.85 compared with those with a Kt/W < 1.85 (p = 0.10). Given the magnitude of the association, the failure to observe statistical significance relates to the size of the patient cohort. Our results imply that it is, in fact, possible to achieve DOQI targets among anuric patients on peritoneal dialysis.
Asunto(s)
Anuria/metabolismo , Anuria/mortalidad , Creatinina/metabolismo , Diálisis Peritoneal , Urea/metabolismo , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de SupervivenciaAsunto(s)
Anticolesterolemiantes/uso terapéutico , Fibrinógeno/análisis , Ácidos Heptanoicos/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hiperlipidemias/tratamiento farmacológico , Diálisis Peritoneal Ambulatoria Continua , Pirroles/uso terapéutico , Simvastatina/uso terapéutico , Adulto , Anciano , Atorvastatina , Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , HDL-Colesterol/sangre , Humanos , Hiperlipidemias/sangre , Persona de Mediana Edad , Factores de Riesgo , Triglicéridos/sangreRESUMEN
We prospectively analyzed 70 consecutive patients who developed acute renal failure (ARF) in the intensive care unit (ICU) during a six year period to define prognostic factors and outcome. Age, sex, preexisting chronic diseases, systemic infections, number of organs failing during the disease course, need and mode of renal replacement therapy (RRT), and length of stay in ICU were recorded. Analysis of factors in survivors (n=7, Gp A) and nonsurvivors (n=63, Gp B) was done by univariate and multivariate analysis. The mean age of patients was 28.6 years. Forty nine (70%) patients developed ARF following surgery, whereas 21 (30%) developed ARF in a medical setting. Cardiovascular surgery (39) and pancreatic surgery (7) were important causes in the surgical group, whereas in the medical group acute pancreatitis (11) was the main causative factor. One patient had ARF only, while in the rest, other organs were also involved. In more than 80% of these patients, organ failure and sepsis were present before the onset of ARF. Fifty two (74.3%) patients required dialytic support. The overall mortality was 90%. Number of organs failing, (1.5 +/-9 in Gp A vs 3.6 +/- 8 in Gp B), presence of systemic infection (1 in Gp A vs 55 in Gp B), prolonged stay in ICU (3.7 +/- 1.1 days in Gp A vs 8.0 +/- 5.4 in Gp B) and need for RRT (2 in Gp A vs 50 in Gp B) correlated with the mortality. Using multiple logistic regression analysis, only multiple organ failure (3 or more) correlated with the mortality. We conclude that multiple organ failure is a poor prognostic factor in patients with ARF in the setting of the ICU.
Asunto(s)
Lesión Renal Aguda/etiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/terapia , Adolescente , Adulto , Femenino , Humanos , India , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
Various factors were analyzed in 80 consecutive children under 16 years who had acute renal failure (ARF), for various prognostic factors. Overall mortality was 42.5%, with significantly higher levels seen in hemolytic uremic syndrome (68%, P < 0.05) and associated with cardiac surgery (90.9%, P < 0.01). Anuria (67.6% vs. 43.5%, P < 0.05), need for dialysis (85.3% vs. 56.5%, P < 0.05), neurological complications (50% vs. 6.3%, P < 0.01), and respiratory complications (35.2% vs. 2.1%, P < 0.01) were significantly higher in nonsurvivors than survivors. Multiple regression analysis showed the presence of neurological and respiratory complications to be poor prognostic factors.
Asunto(s)
Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , India/epidemiología , Lactante , Masculino , Análisis Multivariante , Pronóstico , Sobrevida , Resultado del TratamientoRESUMEN
Nonspecific aortoarteritis is the commonest cause of renovascular hypertension (RVH) accounting for 87% of the patients in the present study. We compared the clinical and radiographic features and outcome in children (n = 16) and adult (n = 24) patients with aortoarteritis. Children have a shorter duration of disease and present more commonly with constitutional symptoms. All the patients were hypertensive; however, malignant hypertension and hypertensive encephalopathy were more common in children. Abdominal bruit and asymmetry of pulses were present only in 75 and 35% of the patients, respectively. Asymmetric kidney size on ultrasound was present in 15 of 24 adults, whereas 9 of 16 children had equal sized kidneys. Captopril renography had a better sensitivity for detection of RVH in children (13 of 16 in children vs. 12 of 24 in adults showing positive results). On intra-arterial digital substraction angiography, abdominal aortic involvement was invariable, whereas the thoracic aorta was involved less frequently in both age groups. Angiographic scores for the severity of vascular involvement was significantly lesser in children (6.87+/-4.8) as compared to adults (11.32+/-4.5). Thirteen of the 15 children were found suitable for revascularization, whereas 12 of 24 adults were not considered for revascularization as their kidneys were small and contributed to less than 10% of total function. Six of the adult patients underwent nephrectomy for the control of blood pressure. Results of angioplasty were also better in children than adults. We conclude that children present earlier with less severe vascular disease and respond better to revascularization, as compared to adults.
Asunto(s)
Obstrucción de la Arteria Renal/complicaciones , Arteritis de Takayasu/complicaciones , Adolescente , Adulto , Encefalopatías/etiología , Niño , Femenino , Humanos , Hipertensión Renovascular/etiología , Hipertensión Renovascular/cirugía , Masculino , Persona de Mediana Edad , Obstrucción de la Arteria Renal/terapia , Arteritis de Takayasu/terapia , Resultado del TratamientoRESUMEN
Eighty-six hypertensive patients with clinical suspicion of renovascular hypertension (RVH) were evaluated by captopril renal scintigraphy (CRS) and intra-arterial digital subtraction angiography (IADSA) to determine the usefulness of CRS in the diagnosis of RVH and to predict the outcome of revascularization procedures. Technetium 99m-diethlenetriaminepentaacetic acid (DTPA) renal scintigraphy was performed on 2 consecutive days before and after captopril administration. Captopril renal scintigraphy was considered positive if there were changes in the time activity curve according to the criteria specified by the American Society of Hypertension working group. Captopril renal scintigraphy data were compared with presence or absence of anatomic renal artery stenosis (RAS). Of 86 hypertensive patients investigated, 45 had RAS. Aortoarteritis was the cause of RAS in 40 (89%) patients. Revascularization was done in 25 patients, and response to revascularization was compared with that of captopril renography. Compared with IADSA, CRS showed a sensitivity of 82.8% and a specificity of 98.2%. Fourteen patients had bilateral RAS on IADSA. In these patients, CRS was suggestive of bilateral disease in seven patients, unilateral in four, and negative in three. Comparison of CRS with the results of revascularization showed a sensitivity and specificity in detecting curable RAS (RVH) of 95% and 100%, respectively (positive predictive value, 100%; negative predictive value, 85%). In conclusion, we found CRS to be useful in the diagnosis of RVH due to aortoarteritis.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina , Antihipertensivos , Captopril , Hipertensión Renovascular/diagnóstico por imagen , Renografía por Radioisótopo/métodos , Adolescente , Adulto , Angiografía de Substracción Digital/métodos , Niño , Femenino , Humanos , Hipertensión Renovascular/etiología , Riñón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/diagnóstico por imagen , Sensibilidad y Especificidad , Pentetato de Tecnecio Tc 99m , Factores de TiempoRESUMEN
The existing liquid low level waste (LLLW) ystem of the Oak Ridge National Laboratory is used to collect, newtralize, concentrate, and store the radiactive and toxic waste from various sources and the Laboratory. The waste solutions are discharged from source facilities to individual collection tanks, transferred by underground piping to an evaporator facility for concentration, and pumped through the underground piping storage in underground tanks. The existing LLLW system was installed in the 1950s with several system additions up to the present. The worst-case accident postulated is an earthquake of sufficient magnitude to rupture tha tanks and/or piping so as to damage the containment integrity to thesurrounding soil and environment, The objective of an analysis of the system to provide a level of confidence in the seismic resistance of the LLWsystem to withstand the postulated earthquake (AU)