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Biomedical subjects

C S Greene

Publications and source records attributed to C S Greene.

At least 19 recordsLinked to original sources
PubMed1994

Temporomandibular disorders in the geriatric population.

Contrary to popular assumptions that temporomandibular disorders may become more prevalent with increasing age, a review of the literature shows that this is clearly not the case. Instead, it seems that most objective "signs" of temporomandibular disorders, namely clicking, tender joints and muscles, crooked opening, limited movement, and so forth, are found either less often in the elderly or at approximately the same rate in all adult age groups. Subjective complaints, however, decrease as populations get older, and the demand for treatment declines accordingly.

Adult↗
PubMed1993

The origins, benefits, harms, and implications of emergency medicine clinical policies.

Emergency physicians desire to provide their patients with care that is of the highest quality and is cost effective. Any tool that promotes these aims is good and should be used. Clinical policies have been proposed as a new method of prompting physicians to provide better care. While there is no direct evidence that emergency medicine clinical policies improve care, there is indirect evidence that they may be useful. ACEP has initiated a process for the development and evaluation of selected clinical policies. We anxiously await information that sheds light on the value of policies in enhancing the clinical practice of emergency medicine.

Emergency Medicine↗
PubMed1993

A quantitative computer-assisted analysis of disc displacement in patients with internal derangement using sagittal view magnetic resonance imaging.

Forty patients diagnosed clinically as having internal derangement of one or both temporomandibular joints underwent magnetic resonance imaging. Seventy-three films were obtained: 26 films from 13 patients with bilateral symptoms; 40 films from 20 patients with unilateral symptomatic joints; and seven films from only the symptomatic joint in the remaining seven patients. Disc positions were evaluated in all of these films, and also in 17 films obtained from 10 asymptomatic volunteers. A system for quantitative measurement of disc position relative to the condyle in the closed-mouth position was used in two ways: manually, with an operator locating reference points and measuring them; and computer-assisted, with a special program developed to locate and measure these points. There was no significant difference in the results produced by these two methods. Important findings of this study were as follows: 1) 35% of the joints in the asymptomatic volunteers were found to have moderately or severely displaced discs; 2) only 75% of the joints diagnosed clinically as having an internal derangement were found to have significant disc displacement, which suggests that the other 25% must have had a different pathologic basis for the symptoms; and 3) the contralateral disc in the unilateral patients was found to be displaced as often as the disc on the symptomatic side (75%).

Adolescent↗
PubMed1992

Managing TMD patients: initial therapy is the key.

It has been the intention of this brief paper to help dentists respond quickly and effectively to patients with TMD. (In lieu of a detailed bibliography, a brief list of articles and books that deal with diagnosis and therapy for TMD follows.) Several present actual guidelines for practice, while others discuss concepts in greater detail. Knowing how to help these troubled patients by using contemporary basic principles of pain management should make every practicing dentist feel a well-deserved sense of fulfillment.

Communication↗
PubMed1992

Quality assurance in the teaching hospital.

The approach emergency medical service (EMS) systems take to quality assurance and quality improvement is evolving rapidly. Methods of quality assurance that have been applied to the prehospital care environment are reviewed. Impediments to effective quality assurance strategies are discussed and an overview of the scope of the activities and resources necessary to perform this task is presented. The potential efficacy and limitations of quality improvement in EMS are also discussed.

Clinical Competence↗
PubMed1991

Treating TM disorders: a survey on diagnosis, etiology and management.

This survey of five dental groups revealed that the dental profession still is far from reaching a consensus about temporomandibular disorders. Despite a great deal of research that has clarified many issues in this field, clinicians often cling to outdated concepts and practices. However, many respondents did give answers that demonstrated their awareness of modern TMD diagnostic and treatment guidelines.

Bruxism↗
PubMed1990

Cerebral blood flow during the acute therapy of severe hypertension with oral clonidine.

A major risk associated with the acute treatment of severe hypertension is a reduction in cerebral blood flow (CBF) with ischemic injury to the central nervous system. The authors studied CBF before and after the acute treatment of severe hypertension (diastolic blood pressure greater than 115 mm Hg) with clonidine in 13 patients. One patient did not reach goal blood pressure (diastolic blood pressure 105 mm Hg or a decrease by 30 mm Hg) after clonidine alone. In the remaining 12 patients, oral clonidine reduced supine blood pressure from 201.7 +/- 5.0/126.3 +/- 2.1 mm Hg to 149.4 +/- 5.3/96.8 +/- 1.7 mm Hg over an average time period of 85 +/- 7 minutes. Although mean CBF for the group did not change (72.6 +/- 4.2 v 73.7 +/- 3.5 mL/100 mg/min), a significant (greater than 10%) change occurred in 9 of the 12 patients (5 increases and 4 reductions). The magnitude and direction of the change were dependent upon initial CBF (r = -0.65, P less than .05); patients with low pretreatment CBF experienced an increase, whereas those with high initial flow exhibited a decrease. No significant adverse effects were observed. These data confirm previous reports that clonidine is effective in the acute treatment of severe hypertension and demonstrate that its effects on CBF are determined by the pretreatment levels of flow.

Administration, Oral↗
PubMed1990

Conservative management of temporomandibular disorders: a posttreatment comparison between patients from a university clinic and from private practice.

Long-term (1 to 7.5 years) follow-up evaluations of 110 adult patients who were seen for diagnosis and treatment of symptoms related to myofascial problems (MP), internal derangement (ID), or both were conducted by means of telephone interview. One half of the patients were seen at the Northwestern University Dental School TMJ Clinic, while the other half were seen in the private office of one author (H. T. P.). The purpose of this study was to evaluate patient response to conservative therapy combined with advice about self-management, as compared with the response to advice only. Further, we desired to compare treatment outcomes among (1) diagnostic categories ID, MP, and ID plus MP, (2) clinic patients and private patients, and (3) patients with acute disease and those with chronic disease. Chronic disease was identified as that in which pretreatment symptoms had persisted for more than 4 months. The ridit analysis was used to assess differences in outcomes for patients in the three diagnostic categories and for clinic patients compared with private patients. The results revealed no significant differences. There was a trend for patients with acute conditions to improve more than those with chronic problems; however, further research is needed to determine whether a correlation exists between symptom duration and treatment outcome. At the time of the follow-up evaluation, 88% of all patients reported substantial or total improvement in their symptoms of pain and dysfunction. Therefore, conservative therapy, including advice about self-management, was found to be both adequate and appropriate for most of these patients.

Acute Disease↗
PubMed1990

Technological methods in the diagnosis and treatment of temporomandibular disorders.

Although there have been numerous technological devices introduced for the diagnosis and treatment of temporomandibular disorders, many are either ineffective or are research tools without direct clinical application. This article reviews the various modalities and makes recommendations regarding their effectiveness based on the available clinical and scientific evidence.

Diagnostic Imaging↗
PubMed1989

The effect of furosemide on intracranial pressure and hemorrhage in preterm rabbits.

The hypothesis that intracranial hypotension due to excessive postnatal fluid loss places the premature infant at risk for germinal matrix and intraventricular hemorrhage (GM-IVH) was tested in preterm rabbits delivered at 28 and 29 days of gestation (term 32 days). Furosemide administered to newborn pups induced a diuresis that resulted in a 11% to 22% loss in body weight and a concomitant decline in muscle water (13% to 16%) and sodium (18% to 21%). Paradoxically, no change occurred in the water or electrolyte content of the brain even though cerebrospinal fluid and brain tissue pressure, but not blood pressure, declined. These changes were absent in littermates treated with saline. Microscopic examination of brain sections revealed a greater incidence of intracranial hemorrhage, particularly in the germinal matrix and choroid plexus, in furosemide-treated than in saline-treated preterm rabbit pups. These results are consistent with the hypothesis that intracranial hypotension promotes the incidence of GH-IVH in preterm animals.

Animals↗
PubMed1989

Effect of arthroscopic temporomandibular joint surgery on articular disk position.

This study used magnetic resonance imaging to assess disk-condyle relationships before and after arthroscopic surgery. Disk positions relative to condyles were found to be generally unchanged, despite the greater range of opening. Clinical findings were positive symptomatic changes with improved interincisal openings in 11 of 12 patients (92%). The results suggest that the clinical success of arthroscopic surgery as a treatment modality does not occur as a result of disk repositioning or recapturing.

Adult↗