Anesthesia of the inferior alveolar and lingual nerves as a complication of a fractured condylar process.
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Biomedical subjects
Publications and source records attributed to J Townend.
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The amino-acid homocysteine plays a crucial role in cell metabolism. It participates in the remethylation pathway enabling maintenance of adequate cellular levels of methionine or is catabolized by transsulphuration. A number of hereditary defects in the enzymes involved in homocysteine metabolism and acquired deficiencies in the vitamin cofactors of these enzymes are associated with the development of hyperhomocysteinaemia. The association between high circulating homocysteine levels and premature vascular thrombosis is well established in individuals with hereditary homocystinuria. There is now good epidemiological evidence that mild hyperhomocysteinaemia is an independent risk factor in the development of arterial disease and venous thrombosis although the causes of the elevated plasma homocysteine are unclear. A good candidate is homozygosity for the common thermolabile variant of methylenetetrahydrofolate reductase but the evidence for a causative association is conflicting. A number of in vitro effects of homocysteine on vascular endothelium, platelets and coagulation have been described which may predispose to vascular disease but the exact in vivo mechanisms remain to be elucidated. Dietary folate supplementation may normalize homocysteine in hyperhomocysteinaemic individuals and modify the risk of vascular disease.
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1. We have previously shown that brief voluntary isometric contractions of upper arm flexor muscles performed for one respiratory cycle elicit a significant decrease in the R-R interval. The present study was designed to determine if similar changes are produced by non-voluntary electrically evoked contractions and, if so, to establish the consistency and repeatability of the associated changes in the R-R interval. 2. The heart rate (R-R interval) response to voluntary or non-voluntary brief isometric contraction equivalent to 40% of the maximum voluntary contraction was studied in 10 healthy young male subjects during controlled ventilation at supine rest. 3. The absolute values of R-R intervals occurring in any one of 10 arbitrary phases of a respiratory cycle were measured and plotted by a computer. 4. Both voluntary and non-voluntary contractions elicited similar changes in heart rate and R-R interval, which were greater during expiration than during inspiration. 5. This confirms our previous finding that the magnitude of the R-R interval changes, with brief isometric contraction, is positively related to the degree of cardiac vagal tone. 6. Analysis of the variability between repeated tests initiated in either inspiration or expiration revealed that there was significantly less variability with the electrically induced contraction. 7. It was concluded that electrically induced contractions of 40% maximal voluntary contraction are a viable alternative to voluntary contractions and provide a more controllable means of measuring cardiac vagal withdrawal.
Nitrite-producing bacteria (NPB) were isolated from tongues of laboratory rats. The most commonly found nitrite-producing organism was Staphylococcus sciuri, followed by Staphylococcus intermedius, Pasteurella spp., and finally Streptococcus spp. Both morphometric quantification of bacteria on tongue sections and enumeration of culturable bacteria (CFU) showed an increase in the density of bacteria towards the posterior tongue. Up to 65% of bacteria were located in the deep clefts on the posterior tongue. The proportion of culturable NPB in the total culturable microbial population increased from 6% (10(5) CFU cm-2) on the anterior tongue to 65% (10(7) CFU cm-2) on the posterior tongue. Different species compositions of NPB were found on different tongue sections with S. intermedius populations decreasing and S. sciuri and Pasteurella populations increasing towards the posterior tongue. Nitrite production was sensitive to oxygen, and significant nitrite production was only detected on the posterior tongue where the majority of bacteria are situated in deep clefts in the tongue surface. This study suggests the importance of bacteria in nitrite production, from nitrate, on the tongue. Nitrite produced on the tongue may subsequently form nitric oxide in the acidic environment of the stomach. Because of the antimicrobial properties of nitric oxide, a key role for nitrate-reducing tongue bacteria in host animal defense against food-borne pathogens in proposed.
The long-term conditioning effects of physical training on cardiorespiratory interaction in 11 young healthy males were studied. Significant increases in maximum oxygen uptake (VO2max) (P < 0.05) and decreases in heart rate (P < 0.05) were achieved in all subjects following a 6-week training programme consisting of cycling for 25 min each day at a work level that increased heart rate to 85% of maximum. Heart rate variability, measured as the differences between the maximum and minimum R-R interval in a respiratory cycle, increased in nine of the subjects and decreased in two. The respiratory-cycle-related high-frequency peak in the power spectral plot of R-R variability also showed significant increases in the same nine subjects and decreases in two. The latter result was similar after normalisation of the data for changes in heart rate by calculating the common coefficient of variance [symbol: see text], where HF is the high-frequency component of the power spectral plots, using a further measure of vagal tone it was shown that, for all subjects, the R-R interval change in response to isometric contractions of the arm flexors in one respiratory cycle were significantly greater after training. These data suggest that cardiac vagal tone is increased by aerobic training for all subjects and that this is accompanied by a respiratory sinus arrhythmia (RSA) in most, but may be associated with a decrease in RSA in subjects with a very low (< 50 beats.min-1 heart rate.
1. In order to increase our understanding of the central regulation of human cardiac vagal motoneurones we studied the interaction between two opposing influences on cardiac vagal tone, one related to diving and the other to exercise. 2. The heart rate response to cooling the face (0 degrees C, trigeminal cutaneous receptor stimulation, TGS) and to a brief isometric muscle contraction was studied in fourteen healthy young adults (8 males, 6 females) during controlled ventilation at supine rest. 3. Fluctuations in R-R interval were quantified by spectral analysis. In addition the absolute values of R-R intervals occurring in any one of ten arbitrary phases of a respiratory cycle were measured over thirty to sixty cycles to give a graph of the changes in R-R interval throughout a respiratory cycle. 4. TGS produced a significant decrease in heart rate (-21 +/- 2 beats min-1 in females, -19 +/- 2 beats min-1 in males; means +/- S.E.M.). In addition the autospectral plots of R-R interval variability showed that during TGS there was a significant increase both in the high frequency peak and in the low frequency peak in all subjects. These data suggested that in these experiments the bradycardia of TGS was due to an increase in cardiac vagal tone. 5. Voluntary isometric contractions at 40 and 60% of maximum (40% MVC, 60% MVC) were timed to occur early in expiration or early in inspiration. Analysis of the changes in R-R interval produced by these contractions was confined to the respiratory cycle in which they were initiated. The early onset of these changes was interpreted as showing a decrease in cardiac vagal tone. 6. The 40% MVC and 60% MVC increased heart rate significantly within one respiratory cycle with maximum effects having a mean of 9.5 +/- 3 and 11 +/- 3 beats min-1, respectively. When isometric muscle contraction was initiated during TGS the 60% MVC but not the 40% MVC was able to significantly decrease R-R interval and hence increase heart rate. 7. It is concluded that the TGS excitatory inputs and the muscle inhibitory inputs to cardiac vagal neurones do not interact by one input gating the other early in the pathway but more probably by a process of algebraic summation closer to the cardiac vagal neurone.
The influence of angiotensin converting enzyme inhibitor therapy on elevated plasma endothelin concentrations in chronic heart failure was investigated by measuring plasma endothelin immunoreactivity in 22 patients with severe but stable chronic heart failure before and after 16 weeks of therapy with quinapril (n = 12) or captopril (n = 10). Plasma endothelin immunoreactivity in the patients (10.2 +/- 34 pg/ml) was significantly higher than a control group (5.9 +/- 1.8 pg/ml). Quinapril improved symptoms and haemodynamics but did not affect plasma endothelin immunoreactivity (11.9 +/- 2.9 pg/ml at baseline and 12.3 +/- 3.4 pg/ml after 16 weeks of quinapril). Captopril also had no effect on endothelin levels (8.1 +/- 2.9 at baseline and 8.1 +/- 3.8 pg/ml after 16 weeks of captopril). The vasodilatory effects of angiotensin converting enzyme inhibitors in heart failure are not mediated by, or associated with, changes in plasma endothelin immunoreactivity.
I have devised a template for the Limberg rhombic flap. I originally designed this template as a teaching aid, but I now find it indispensable in deciding the precise orientation of defect and flap without time-wasting and sometimes confusing trial skin marking. It is a simple, autoclavable device that can be added to any soft-tissue surgical set, and in my experience, it has significantly improved the quality of Limberg flap design.
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