Huntington's disease is a hereditary, progressive, neuro-degenerative disorder characterised by increasingly severe motor impairment, cognitive decline and behavioural manifestations leading to functional disability. Dyskinesia and hyperkinesia of the tongue and the peri-oral musculature make it impossible for the patient to wear a conventional complete denture, despite an adequate alveolar ridge. The present paper reports on a patient with Huntington's disease who was rehabilitated with a mandibular overdenture supported by two endosteal implants. One year follow-up examination showed that the prosthesis was stable and there was considerable improvement in the patient's masticatory function.
We have been using axillary block for upper extremity surgery anesthesia in the Istanbul Hand Surgery Microsurgery Center since 1992. Although articain is fast in effect, acting as a local anesthetic, it seems to be insufficient for controlling tourniquet pain. 1 We decided to combine ketamine and articain, to be able to begin operative procedures immediately and to control tourniquet pain.In search of a new anesthetic agent, a prospective study was designed to compare the effectiveness of the two drugs, articaine and ketamine, used in three different combinations. Three groups of patients, each consisting of 15 patients (25 to 45 years old), were formed randomly. Only ketamine (2 mg/kg + 38 ml 0.9 percent NaCl) was used in one group, with Ultracaine (articaine 2 percent Ϫ 40 ml) in the second group and, with Ultracaine + ketamine (articaine 2 percent Ϫ 40 ml + ketamine 2 mg/kg) in the third group. The time interval between the application of the tourniquet (300 mmHg) and the first sign of pain was recorded in all groups. The operation was started immediately in Groups 1 and 3 that were given ketamine. In Group 2, the operation was delayed for 10 min for the onset of anesthesia.We observed that ketamine alone was not sufficient to achieve adequate anesthesia duration (mean 0.1 hr). Ultracaine only patients had a mean 1.2 hr of anesthesia (onset of tourniquet pain), while patients who had Ultracaine and ketamine together had a mean anesthesia time of 4.2 hr.The sudden onset of anesthesia in Groups 1 and 3 who were given ketamine may be explained as a result of antogonism to NMDA receptors. 2,3 Intrathecal ketamine was shown to block axonal conduction by Gebhardt. 4 We believe that an axonal conduction block may contribute to the analgesic mechanism of regional ketamine. We concluded that articaine and ketamine in combination are more successful than articaine alone. We explain this by the following reasons. Ketamine might increase the binding capacity of local anesthetic to albumin alpha acid glucoprotein and change ionic balance. Another mechanism might be due to two isomers (S) and (R): S isomer blocks the opiate receptors and R isomer has hypnotic effects. 5
The SpO values were low at the onset of POT in infants with CLP before any intervention. Oxygen saturation levels may decrease particularly during extraoral impression taking in infants with CLP despite the supplemental oxygen. SpO measurements were higher during post-POT intraoral and extraoral impression taking when compared with pre-POT measurements.
Regional anesthesia, with its known benefits such as increased blood flow, reduced cost, and security, is a method of choice for hand surgery. Recently, the authors have switched from axillary block to continuous cervical epidural anesthesia, which has several advantages such as low cost, a pain-free postoperative period, better control of tourniquet pain, and the avoidance of a motor block so that early active motion is possible. Continuous cervical epidural anesthesia is a safe and reliable method, providing a sensory block with an infusion rate of 4 ml/hr ultracaine (articaine 2 percent), and a motor block when the dosage is increased to 8 ml/hr ultracaine (articaine 2 percent). Postoperatively, only 4 ml/hr ultracaine (articaine 2 percent) is sufficient to provide a sensory block. The method provides both good perfusion and a lower local anesthetic drug dosage than axillary block.
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