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Neurotransmitters and pain control
1024
CURRENT LITERATURE
nous stasis. Heparin sodium (5,000 U) decreases the coagulability of the blood. A previous study showed development of deep vein thrombosis in only 16% of patients treated with dihydroergotamine-heparin combination and 32% of those who were treated with heparin alone, as compared with 69% of untreated patients in the control group. In this randomized, double-blind, placebocontrolled multicenter trail, the efficacy and safety of dihydroergotamine mesylate/heparin sodium as a prophylactic agent for deep venous thrombosis were evaluated in 148 patients who were 40 years old or more and who underwent total hip replacement. The incidence of venographically proved deep vein thrombosis was 52% in the placebo group and 25% in the test group @ = 0.002). The incidence of both proximal thrombi and extensive thrombi were decreased in the test group. Adverse reactions in the two groups did not differ significantly, consisting of hematoma at the site of injection, hematoma at the wound, and excessive postoperative bleeding. It was concluded that the combination agent dihydroergotamine mesylateiheparin sodium was effective and safe for prophylaxis against deep venous thrombosis for patients undergoing total hip replacement.-N. J. BETTS Reprint requests to Dr Biesaw: St. Vincent’s Hospital, University of Massachusetts Medical Center, Worchester, MA 01604
Recommendations for Prevention of Bacterial Endocarditis: Compliance by General Practitioners. Sadowsky D, Kunzel C. Circulation 77: 1316, 1988 This study was directed at determining general practicing (GP) dentists’ knowledge and compliance with antibiotic regimens for patients needing prophylactic coverage against bacterial endocarditis as specified in 1984 by the American Heart Association (AHA). Telephone interviews were conducted using a random sample of 460 GP dentists. Hypothetical clinical situations were presented to test knowledge of, and compliance with the AHA recommendation. Respondents were asked to give the actual regimens they would use to properly cover patients with a history of heart disease presenting for an extraction. For patients who had a history of heart attack or bypass surgery 6 months previously, 20% and 40% of respondents, respectively, said they would provide antibiotic coverage. Approximately one third of the respondents did not recognize that patients with a history of congenital heart disease are at risk. Approximately 90% of the GP dentists surveyed professed to be aware of the AHA recommendations for the prevention of infective endocarditis. Subjects who were more knowledgeable about the pathophysiology of the disease process were more likely to respond correctly and follow the guidelines recommended by the AHA. Furthermore, respondents who kept a copy of the recommendations in the ofice (77%) were more likely to follow them. The findings reflect that the identification of patients at risk remains incompletely understood by GP dentists. The findings are important when considered in light of the serious sequelae that can follow after failed or inappropriate coverage.-A. P. HEISE Reprint requests to Dr Sadowsky: Offtce of Dental Research, Albert Einstein College of Medicine, Van Etten Hospital 5c-15, Bronx, NY 10461.
Non-Union
of Fractures in Children Who Have Osteogen-
esis Imperfecta. Gamble JG, Rinsky Joint Surg [Am] 7OA:439, 1988
LA, et al. J Bone
The various forms of osteogenesis imperfecta, although a heterogenous group of inherited disorders, have in common an abnormality of type-1 collagen. These patients manifest a spectrum of severity of the disease and involvement of tissues; the lesions include retardation of growth, ligament laxity, skeletal dysplasia, and multiple fractures. These patients can also show blue sclera and dentinogenesis imperfecta. The bones of these patients are osteopenic, excessively fragile, and prone to fracture from slight trauma. Although a fracture rarely fails to heal in a healthy child, nonunion is not a rare occurrence in a child who has osteogenesis imperfecta. This article identifies 12 nonunions in ten patients from a population of 52 patients who had osteogenesis imperfecta. The average age at time of diagnosis was 9 years and at time of treatment 12.5 years. Eight of the nine ununited fractures that were operated on healed after the excision of the nonunion, intramedullary nailing, and bone grafting from the local site or iliac crest. Three of the nonunions were not operated on, and one patient in whom surgery failed had an amputation. Nonunion was frequently associated with repeated fractures at a progressively deforming site.N. J. BETTS Reprint requests to Dr Gamble: Children’s Hospital at Stanford, 520 Sand Hill Road, Palo Alto, CA 94304.
New Book Annotations Neurotransmitters and Pain Control. Abil H, Lewis J W (eds). New York, S. Karger 1987, 304 pages, 37 figures, 17 tables, $98.00. This book brings together the knowledge of various experts in the field of neurochemistry of pain and analgesia. Focus is on the three main classes of neurochemical substances: the classic neurotransmitters such as the catecholamines, serotonin, and acetylcholine; the opioid peptides; and the nonopioid peptides. There is also a section dealing with stimulation-produced analgesia, stressinduced analgesia, and acupuncture analgesia. Although many of the contributions deal with very specific aspects of the problem, each section has at least one chapter that provides a more general overview. Cryosurgery of the MaxiIlofacial Region. Volumes 1 and 2, P. F. Bradley (ed), with 11 contributors. Boca Raton, FL, CRC 1986, Vol. 1, 183 pages: Vol. 2, 162 pages, illustrated. Volume 1 of this two-book treatise on cryosurgery deals with the general principles of cryosurgery and its clinical application to the treatment of benign lesions. Volume 2 covers the management of malignant lesions, as well as cryosurgery of bone, nerve, blood vessels, and salivary glands. The final chapter compares cryosurgery and laser surgery. Each subject is covered comprehensively, and the various chapters are well illustrated and contain numerous references. New Trends In Dental Practice Valuation and Associateship Arrangements. Jackson JB, Hill RK. Chicago, Quintessence, 1987, 258 pages, paperback.
CURRENT LITERATURE
nous stasis. Heparin sodium (5,000 U) decreases the coagulability of the blood. A previous study showed development of deep vein thrombosis in only 16% of patients treated with dihydroergotamine-heparin combination and 32% of those who were treated with heparin alone, as compared with 69% of untreated patients in the control group. In this randomized, double-blind, placebocontrolled multicenter trail, the efficacy and safety of dihydroergotamine mesylate/heparin sodium as a prophylactic agent for deep venous thrombosis were evaluated in 148 patients who were 40 years old or more and who underwent total hip replacement. The incidence of venographically proved deep vein thrombosis was 52% in the placebo group and 25% in the test group @ = 0.002). The incidence of both proximal thrombi and extensive thrombi were decreased in the test group. Adverse reactions in the two groups did not differ significantly, consisting of hematoma at the site of injection, hematoma at the wound, and excessive postoperative bleeding. It was concluded that the combination agent dihydroergotamine mesylateiheparin sodium was effective and safe for prophylaxis against deep venous thrombosis for patients undergoing total hip replacement.-N. J. BETTS Reprint requests to Dr Biesaw: St. Vincent’s Hospital, University of Massachusetts Medical Center, Worchester, MA 01604
Recommendations for Prevention of Bacterial Endocarditis: Compliance by General Practitioners. Sadowsky D, Kunzel C. Circulation 77: 1316, 1988 This study was directed at determining general practicing (GP) dentists’ knowledge and compliance with antibiotic regimens for patients needing prophylactic coverage against bacterial endocarditis as specified in 1984 by the American Heart Association (AHA). Telephone interviews were conducted using a random sample of 460 GP dentists. Hypothetical clinical situations were presented to test knowledge of, and compliance with the AHA recommendation. Respondents were asked to give the actual regimens they would use to properly cover patients with a history of heart disease presenting for an extraction. For patients who had a history of heart attack or bypass surgery 6 months previously, 20% and 40% of respondents, respectively, said they would provide antibiotic coverage. Approximately one third of the respondents did not recognize that patients with a history of congenital heart disease are at risk. Approximately 90% of the GP dentists surveyed professed to be aware of the AHA recommendations for the prevention of infective endocarditis. Subjects who were more knowledgeable about the pathophysiology of the disease process were more likely to respond correctly and follow the guidelines recommended by the AHA. Furthermore, respondents who kept a copy of the recommendations in the ofice (77%) were more likely to follow them. The findings reflect that the identification of patients at risk remains incompletely understood by GP dentists. The findings are important when considered in light of the serious sequelae that can follow after failed or inappropriate coverage.-A. P. HEISE Reprint requests to Dr Sadowsky: Offtce of Dental Research, Albert Einstein College of Medicine, Van Etten Hospital 5c-15, Bronx, NY 10461.
Non-Union
of Fractures in Children Who Have Osteogen-
esis Imperfecta. Gamble JG, Rinsky Joint Surg [Am] 7OA:439, 1988
LA, et al. J Bone
The various forms of osteogenesis imperfecta, although a heterogenous group of inherited disorders, have in common an abnormality of type-1 collagen. These patients manifest a spectrum of severity of the disease and involvement of tissues; the lesions include retardation of growth, ligament laxity, skeletal dysplasia, and multiple fractures. These patients can also show blue sclera and dentinogenesis imperfecta. The bones of these patients are osteopenic, excessively fragile, and prone to fracture from slight trauma. Although a fracture rarely fails to heal in a healthy child, nonunion is not a rare occurrence in a child who has osteogenesis imperfecta. This article identifies 12 nonunions in ten patients from a population of 52 patients who had osteogenesis imperfecta. The average age at time of diagnosis was 9 years and at time of treatment 12.5 years. Eight of the nine ununited fractures that were operated on healed after the excision of the nonunion, intramedullary nailing, and bone grafting from the local site or iliac crest. Three of the nonunions were not operated on, and one patient in whom surgery failed had an amputation. Nonunion was frequently associated with repeated fractures at a progressively deforming site.N. J. BETTS Reprint requests to Dr Gamble: Children’s Hospital at Stanford, 520 Sand Hill Road, Palo Alto, CA 94304.
New Book Annotations Neurotransmitters and Pain Control. Abil H, Lewis J W (eds). New York, S. Karger 1987, 304 pages, 37 figures, 17 tables, $98.00. This book brings together the knowledge of various experts in the field of neurochemistry of pain and analgesia. Focus is on the three main classes of neurochemical substances: the classic neurotransmitters such as the catecholamines, serotonin, and acetylcholine; the opioid peptides; and the nonopioid peptides. There is also a section dealing with stimulation-produced analgesia, stressinduced analgesia, and acupuncture analgesia. Although many of the contributions deal with very specific aspects of the problem, each section has at least one chapter that provides a more general overview. Cryosurgery of the MaxiIlofacial Region. Volumes 1 and 2, P. F. Bradley (ed), with 11 contributors. Boca Raton, FL, CRC 1986, Vol. 1, 183 pages: Vol. 2, 162 pages, illustrated. Volume 1 of this two-book treatise on cryosurgery deals with the general principles of cryosurgery and its clinical application to the treatment of benign lesions. Volume 2 covers the management of malignant lesions, as well as cryosurgery of bone, nerve, blood vessels, and salivary glands. The final chapter compares cryosurgery and laser surgery. Each subject is covered comprehensively, and the various chapters are well illustrated and contain numerous references. New Trends In Dental Practice Valuation and Associateship Arrangements. Jackson JB, Hill RK. Chicago, Quintessence, 1987, 258 pages, paperback.