bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic Change of HMG‐CoA Reductase Inhibitors in Patients with Coronary Artery Disease
Authors: Hilleman Daniel E. , Wurdeman Richard L. , Lenz Thomas L. 
Published: June 2004

Study Objective. To evaluate short‐term outcomes when atorvastatin was substituted for pravastatin or simvastatin in patients with coronary artery disease.Design. Open‐label, fixed‐dosage, one‐way crossover from pravastatin and simvastatin to atorvastatin.Setting. University‐affiliated hospital and outpatient clinics.Patients. Eighty patients with coronary artery disease with a minimum baseline low‐density lipoprotein (LDL) above 130 mg/dl: 20 were treated with pravastatin 20 mg/day, 20 with pravastatin 40 mg/day, 20 with simvastatin 20 mg/day, and 20 with simvastatin 40 mg/day for a minimum of 6 months, with a prescription refill rate of 80% or greater.Intervention. Before crossover, patients had a fasting lipid profile determined and were questioned about side effects of pravastatin and simvastatin. All patients were switched to atorvastatin 10 mg/day. After 12 weeks of atorvastatin therapy, a repeat fasting lipid profile was obtained and patients were questioned about side effects with the drug.Measurements and Main Results. Baseline demographic and clinical characteristics of the treatment groups were not significantly different with the exception of a lower baseline LDL in patients receiving pravastatin 20 mg/day. Baseline LDL values were as follows: pravastatin 20 mg/day, 158 ± 26 mg/dl; pravastatin 40 mg/day, 176 ± 22 mg/dl; simvastatin 20 mg/day, 177 ± 27 mg/dl; and simvastatin 40 mg/day, 177 ± 27 mg/dl. Reductions in LDL after treatment with pravastatin or simvastatin were as follows: pravastatin 20 mg/day, 22%; pravastatin 40 mg/day, 32%; simvastatin 20 mg/day, 33%; and simvastatin 40 mg/day, 38%. Patients achieving LDL goal with initial therapy were as follows: pravastatin 20 mg/day, 5%; pravastatin 40 mg/day, 5%; simvastatin 20 mg/day, 20%; and simvastatin 40 mg/day, 30%. After the switch to atorvastatin 10 mg/day, reductions in LDL were as follows: pravastatin 20 mg/day, 39% (p<0.001); pravastatin 40 mg/day, 38% (p<0.01); simvastatin 20 mg/day, 39% (p=0.04); and simvastatin 40 mg/day 38% (p=0.83). Patients achieving LDL goals with atorvastatin 10 mg/day were as follows: pravastatin 20 mg/day, 60%; pravastatin 40 mg/day, 30%; simvastatin 20 mg/day, 25%; and simvastatin 40 mg/day, 30%. The frequency of side effects was similar for all three statins. Based on annual average wholesale price, atorvastatin 10 mg/day was more cost‐effective than all pravastatin and simvastatin regimens.Conclusions. Therapeutic interchange from pravastatin 20 and 40 mg/day and simvastatin 20 mg/day to atorvastatin 10 mg/day was associated with both cost savings and significant reductions in LDL. The change from simvastatin 40 mg/day to atorvastatin 10 mg/day was associated with cost savings and an equivalent reduction in LDL.
Confirming the Reliability of the Sedation‐Agitation Scale Administered by ICU Nurses without Experience in Its Use
Authors: Brandl Katherine M. , Langley Kay A. , Riker Richard. R. , Dork Leslie A. , Qualls Clifford R. , Levy Howard 
Published: June 2004

Study Objectives. To determine the validity and reliability of the Sedation‐Agitation scale (SAS) when administered by intensive care unit (ICU) nurses with no experience in its use.Design. Prospective, psychometric evaluation.Setting. Adult medical‐cardiac ICU.Patients. Sixty patients.Intervention. Sedation and agitation were observed simultaneously but independently by nurses and two investigators, and patients were rated with the SAS. The assessment of an experienced clinical nurse specialist was recorded on visual analog scales (VAS) for sedation (VAS‐S) and agitation (VAS‐A).Measurements and Main Results. The SAS scores of ICU staff nurses were compared with VAS scored by the clinical nurse specialist using Pearson correlation coefficient. The SAS correlated well with VAS‐S (Spearman's ρ = −0.77, p<0.001). Neither SAS nor VAS‐A was correlated (Spearman's ρ = 0.05, p>0.5), but there were few observations of agitated patients. The SAS interrater agreement was excellent between the two trained investigators (weighted κ = 0.93, p<0.001) and between investigators and staff nurses (weighted κ = 0.85 and 0.87, p<0.001 for both).Conclusion. The SAS is reliable when administered by staff nurses with no experience with it. Due to the paucity of observations of agitated patients, we were unable to determine its validity for assessing agitation.
Torsades de Pointes Associated with Chlorpromazine: Case Report and Review of Associated Ventricular Arrhythmias
Authors: Hoehns James D. , Stanford Richard H. , Geraets Douglas R. , Skelly Kelly S. , Lee Hon‐Chi , Gaul Brian L. 
Published: June 2004

Purpose. To present a case of chlorpromazine‐associated torsades de pointes, review established cases of ventricular arrhythmias associated with chlorpromazine, and describe the proarrhythmic characteristics of this drug.Data Sources. Articles identified through a search of MEDLINE and IDIS from January 1966–November 2000 and thorough review of the article bibliographies. Patient cases also were identified from a search of the Food and Drug Administration's Adverse Event Reporting System database (November 1997–March 2001). Cases involving intentional overdoses of chlorpromazine were excluded.Results. In addition to the case reported herein, 12 cases of documented, chlorpromazine‐associated ventricular arrhythmias were identified; five had characteristic features of torsades de pointes. Chlorpromazine delayed repolarization and produced electrocardiographic abnormalities; although, whether chlorpromazine induced torsades de pointes through a mechanism of early afterdepolarizations is unclear. Similar to other instances of drug‐induced torsades de pointes, concurrent factors such as electrolyte deficiencies may place the patient at increased risk for arrhythmia.Conclusions. Chlorpromazine can delay repolarization and produce electrocardiographic abnormalities. These can result infrequently in ventricular arrhythmias and torsades de pointes, particularly in patients with confounding factors.
Surgical Management of Velopharyngeal Incompetence in Velocardiofacial Syndrome
Authors: Mehendale Felicity V. , Birch Malcolm J. , Birkett Louise , Sell Debbie , Sommerlad Brian C. 
Published: June 2004

Objective To analyze the results of surgery for velopharyngeal incompetence (VPI) in velocardiofacial syndrome. Design Prospective data collection, with randomized, blind assessment of speech and velopharyngeal function on lateral videofluoroscopy and nasendoscopy. Setting Two-site, tertiary referral cleft unit. Patients Forty-two consecutive patients with the 22q11 deletion underwent surgery for symptomatic VPI by a single surgeon. Interventions Intraoral examinations, lateral videofluoroscopy (± nasendoscopy) and intraoperative evaluation of the position of the velar muscles through the operating microscope. Based on these findings, either a radical dissection and retropositioning of the velar muscles (submucous cleft palate [SMCP repair]) or a Hynes pharyngoplasty (posterior pharyngeal wall augmentation pharyngoplasty) was performed. As anticipated, a proportion of patients undergoing SMCP repair subsequently required a Hynes. The aim of this staged approach was to maximize velar function, thereby enabling a less obstructive pharyngoplasty to be performed. Thus, there were three surgical groups for analysis: SMCP alone, Hynes alone, and SMCP+Hynes. Main Outcome Measures Blind perceptual rating of resonance and nasal airflow; blind assessment of velopharyngeal function on lateral videofluoroscopy and nasendoscopy; and identification of predictive factors. Results Significant improvement in hypernasality in all three groups. The SMCP+Hynes group also showed significant improvement in nasal emission. There were significant improvements in the extended and resting velar lengths following SMCP repair and a trend toward increased velocity of closure. Conclusions Depending on velopharyngeal anatomy and function, there is a role for SMCP repair, Hynes pharyngoplasty, and a staged combination of SMCP+Hynes, all of which are procedures with a low morbidity.
Veloplasty Using the Wave-Line Technique versus Classic Intravelar Veloplasty
Authors: Henkel Kai-Olaf , Dieckmann Ann , Dieckmann Ortrud , Lenz Jan-Hendrik , Gundlach Karsten Kurt Helmuth 
Published: June 2004

Objective A well-known problem in primary surgery of the soft palate is its shortness and the deficit of local soft tissue. This article introduces a modification of the primary intravelar veloplasty, allowing lengthening of the soft palate, and compares this alternative technique to the classic intravelar veloplasty. Method The soft palate wave-line technique adds a wavy incision at the velar cleft margins to the intravelar veloplasty. In 24 patients with complete clefts of the palate, either the newly developed or classic technique was performed. Four years following primary surgery, speech performance and type of breathing were analyzed. Results Even in wide clefts of the soft palate, repair was easily accomplished using the wave-line technique. Complete closure of the nasal, muscular, and oral layers was achieved, and no postoperative fistula was observed. An average lengthening of the soft palate of 56% (range 24% to 83%) was observed immediately following velar repair with the wave-line technique. Speech was significantly better in the wave-line group (p < .05). Furthermore, physiological breathing was observed more often in these patients. Conclusion Primary repair of clefts of the soft palate using the wave-line technique is straightforward, safe, and easy. On the basis of the present results, this technique seems superior to the classic intravelar veloplasty.
Longitudinal Evaluation of Secondary Bone Grafting into the Alveolar Cleft
Authors: Kawakami Shingo , Hiura Kenji , Yokozeki Masahiko , Takahashi Takumi , Seike Takuya , Nakanishi Hideki , Moriyama Keiji 
Published: June 2004

Objective To longitudinally evaluate the outcome of secondary bone grafting (SBG) using computed tomograms (CTs) and conventional dental radiographs. Subjects Nineteen alveolar clefts from 17 patients were used in this study. Method A two-dimensional evaluation of SBG was performed using dental radiographs at 1 year after SBG by assigning scores of 1 to 4 (from very good to poor) based on postoperative marginal bone level on the alveolar side. On the basis of postoperative marginal bone levels on the nasal side, clefts were also assigned to groups with the bony bridge on or above (group I) or below (group II) a horizontal reference line. Three-dimensional evaluation of the SBG was performed on horizontal CT slices with the residual cortical bone (RCB) ratio before SBG (T0) as well as 1.5 (T1), 3 (T2), 6 (T3), and 12 months (T4) after SBG. Results The RCB ratio at T4 in the group with scores 1 and 2 was significantly smaller than that of score 3. Furthermore, the mean RCB ratio at T4 in group I was significantly smaller than that in group II. Nineteen alveolar clefts were divided into two groups, A and B, based on a cluster analysis of the RCB ratios. Group A showed a continuous decrease in the RCB ratio from T0 to T2, but group B showed a significant decrease only in the period from T0 to T1. Conclusion These results suggested that the RCB ratio might be a useful parameter for evaluation of the bony bridge after SBG.
Differential Diagnosis of the Trapezoid-Shaped Head
Authors: Ehret Frederick W. , Whelan Michael F. , Ellenbogen Richard G. , Cunningham Michael L. , Gruss Joseph S. 
Published: June 2004

Objective To recognize several conditions that result in a trapezoid head shape and review and contrast their various physical findings. Methods A detailed review of all patients seen in the Craniofacial Clinic at the Children's Hospital and Regional Medical Center in Seattle, Washington, over a 10-year period from 1991 to 2001, with the diagnosis of craniosynostosis and plagiocephaly was performed. During this period, 690 patients had a surgical correction of craniosynostosis, and 1537 patients had posterior plagiocephaly. Results and Conclusions The shape of the head when viewed from the vertex position in an axial plane can be a significant diagnostic aid when evaluating a patient with plagiocephaly. Positional molding causes the vast majority of plagiocephaly. This deformational change results in a parallelogram-shaped head. A much more rare cause of plagiocephaly is lambdoid synostosis. With premature fusion of one of the lambdoid sutures, the head takes on a very characteristic trapezoid shape when viewed from the vertex. Unilateral coronal synostosis that occurs on the same side as either posterior positional molding or unilateral lambdoid synostosis will also result in the trapezoid head shape. Furthermore, on the rare occasion when anterior and posterior deformational plagiocephaly occurs on the same side, the trapezoid head shape may be the consequence. The choice of appropriate treatment modality requires systematic evaluation of the patient with a trapezoid-shaped head to determine the etiology of the deformation.
Validation of a Vision-Based, Three-Dimensional Facial Imaging System
Authors: Ayoub A. , Garrahy A. , Hood C. , White J. , Bock M. , Siebert J. P. , Spencer R. , Ray A. 
Published: June 2004

Objective The aim of this study was to assess the accuracy of a newly developed three-dimensional (3D) imaging system in recording facial morphology. Methods Twenty-one infants with cleft lip each had a full-face alginate impression taken at the time of primary lip repair, and a stone cast was constructed from each impression. Five anthropometric points were marked on each cast. Each cast was digitized, and the 3D co-ordinates of the five points were obtained using a co-ordinate measuring machine (CMM, Ferranti) of documented accuracy (9.53 μm). Each cast was scanned in four positions using a computerized stereophotogrammetry (C3D) system. The five points were located on the 3D images, and their 3D co-ordinates were extracted by three operators. The co-ordinate systems produced by C3D were aligned, via translation and rotation, to match the CMM co-ordinate system using partial ordinary procrustes analysis. The displacements of the adjusted C3D co-ordinates from the reference co-ordinates were then measured. Three different types of errors were identified: operator, system, and registration errors. Results Operator error was within 0.2 mm of the true co-ordinates of the landmarks. C3D was accurate within 0.4 mm. The average displacement of points over the 21 casts at four positions for the three operators was 0.79 mm (median 0.68). Conclusions The presented 3D imaging system is reliable in recording facial deformity and could be utilized in recording cleft deformities and measuring the changes following surgery
An Epidemiologic Study of Isolated Cleft Lip, Palate, or Both in Victoria, Australia from 1983 to 2000
Authors: Vallino-Napoli Linda D. , Riley Merilyn M. , Halliday Jane 
Published: June 2004

Objective To report the epidemiological characteristics of isolated cleft lip, cleft palate or both (CL ± P and CP) using population-based data in Victoria, Australia. Design Descriptive study of a cohort of children born between 1983 and 2000 notified to the Victorian Birth Defects Register by multiple ascertainment sources. Participants Data were collected on patients identified with CL ± P and CP without associated defects classified as live births, stillbirths, neonatal deaths, and terminated pregnancies < 20 weeks’ gestation following prenatal identification. Information was collected on sex, plurality, maternal age, and country of birth. Results The overall prevalence (per 10,000 pregnancies) of CL ± P was 7.8 (95% confidence interval [CI] = 7.30, 8.33; cleft lip [CL] 3.3; 95% CI = 2.97, 3.65, CL+P 4.5; 95% CI = 4.13, 4.91) and cleft palate (CP), 4.3 (95% CI = 3.89, 4.66). The prevalence of CL + P was higher among stillbirths, neonatal deaths, and terminated pregnancies than CL (without CP) and CP. Boys were at greater risk than girls for CL ± P and girls at greater risk than boys for CP. Regardless of cleft type, there was a nonsignificant excess of clefts among singleton births than multiple births and no related effects of maternal age or country of birth. Conclusions The prevalence of isolated CL ± P and CP in Victoria parallels other population-based studies of the same conditions. Inclusion of stillbirths, neonatal deaths, and terminations had little impact on rates. The effect of sex and plurality on cleft type is consistent with the literature, but the effects of maternal age and country of birth remain equivocal. Further studies focusing on certain ethnic groups are warranted to explain the higher rates observed.
Maternal Drug Use and Infant Cleft Lip/Palate with Special Reference to Corticoids
Authors: Källén Bengt 
Published: June 2004

Objective To study the association between maternal drug use in early pregnancy and orofacial cleft in the infant. Design Register analysis based on prospectively collected information. Patients All delivered women in Sweden July 1, 1995, through December 31, 2001. Main outcome measure Presence of orofacial cleft in infant. Results Prospective information on maternal drug use during the first trimester, as reported in early pregnancy, was studied in 1142 infants with orofacial clefts, isolated or with other malformations, excluding chromosome anomalies. Any drug use was not associated with clefts (odds ratio [OR] = 0.98, 95% confidence interval [95% CI] = 0.85 to 1.13), with isolated clefts (OR = 0.92) with isolated median cleft palate (OR = 1.03, 95% CI = 0.79 to 1.36) or with isolated cleft lip with or without cleft palate (OR = 0.86, 95% CI = 0.71 to 1.05). Reported use of multivitamins, folic acid, or B12 was not associated with a decrease in orofacial cleft risk (OR = 1.00, 95% CI = 0.63 to 1.52). ORs above 2 were seen for some drugs: sulfasalazine, naproxen, and anticonvulsants, but only a few exposed cases occurred. An association between glucocorticoid use and infant cleft was indicated and seemed to be strongest for median cleft palate. Conclusion Maternal drug use seems to play only a small role for the origin of orofacial clefts, at least in Sweden.
Social Interaction Patterns of Children and Adolescents with and without Oral Clefts during a Videotaped Analogue Social Encounter
Authors: Slifer Keith J. , Amari Adrianna , Diver Tanya , Hilley Lisa , Beck Melissa , Kane Alana , McDonnell Sharon 
Published: June 2004

Objective To examine the social interaction patterns of children with and without oral clefts. Design Participants were videotaped while interacting with a peer confederate. Oral cleft and control groups were compared on social behavior and several self- and parent-report measures. Participants Thirty-four 8- to 15-year-olds with oral clefts, matched for sex, age, and socioeconomic status with 34 noncleft controls. Main Outcome Measures Data were obtained on social behaviors coded from videotapes and on child and parent ratings of social acceptance/competence and facial appearance. Results Statistically significant differences were found between groups: children with clefts made fewer choices and more often failed to respond to peer questions; children with clefts and their parents reported greater dissatisfaction with the child's facial appearance; and parents of children with clefts rated them as less socially competent. Significant within-group associations were also found. Parent perception of child social competence and child self-perception of social acceptance were positively correlated for both groups. Children with clefts who felt more socially accepted more often looked a peer in the face. Controls who felt more socially accepted chose an activity less often during the social encounter. Conclusions Differing patterns of overt social behavior as well as parent and self-perception can be measured between children with and without oral clefts. Such results may be helpful in developing interventions to enhance social skills and parent/child adjustment.
A Case of Cleft Lip and Palate Associated with Seckel Syndrome
Authors: Murthy Jyotsna , Seshadri Krishna G. , Ramanan Padmasani Venkat , Rajamani Arvind , Hussain Altaf 
Published: June 2004

Objective We report an unusual association of complete cleft of the primary and secondary palate with Seckel syndrome. Seckel syndrome is a very rare syndrome, with only 60 reported cases in the medical literature. It is an autosomal recessive disorder characterized by birdlike face, intrauterine growth retardation, dwarfism, and microcephaly. This young child of 5 years had a successful cleft lip repair under general anesthesia. The main features of the syndrome and the technical problems of anesthesia and surgery are discussed.
Three-Dimensional Analysis of Maxillary Dental Casts Using Fourier Transform Profilometry: Precision and Reliability of the Measurement
Authors: Trefný Pavel , Šmahel Zbynek , Formánek Pavel , Peterka Miroslav 
Published: June 2004

Objective Fourier transform profilometry was used for the three-dimensional measurement of maxillary dental casts to analyze the size and shape of the palate. The objective of this study was to test the accuracy of the measuring system and determine the precision and reliability of the measurement Methods Images of dental casts were analyzed using newly developed measuring software. Based on five landmarks located on the alveolar ridge, the measuring software constructed 10 transversal sections of the palate. In each section profile, the width, area, and 23 height variables were assessed. Subjects Maxillary dental stone casts of 25 healthy girls, 14.1 to 15.3 years of age, were studied. Results The technical error of measurement exceeded 5% of the size of the measurement only in variables with means less than approximately 3 mm. In fact, such small absolute dimensions were exhibited only by the palate height in anterior profile 2 and the palate height at the margins of other profiles. Reliability of the measurements was found to be very high for the width and area of the profiles. For height measurements, the coefficient of reliability was slightly lower at the profile margins than near the midline. Nevertheless, only three height variables showed a coefficient of reliability lower than 0.90. The coefficients of reliability of other height measurements of profiles 3 through 10 were only sporadically lower than 0.97. Conclusion With regard to the accuracy of the measuring system as well as the precision and reliability of the measurement, this method proved to be a suitable tool for studying palatal morphology.