Scanning and transmission electron microscope study of pellicle morphogenesis.

The morphology of pellicle formation was studied using correlated transmission and scanning electron microscopy. Pellicle developed on hydroxyapatite/epoxy resin splints attached to the buccal surfaces of molars and premolars in six young individuals. Splint segments were removed at intervals of 2, 4, 6, 12, 24, and 48 h. Measurements of pellicle thickness revealed that during the first 12 h considerably more material formed on the apatite surfaces than on the epoxy resin areas of the splints. This difference was equalized in 24- and 48-h specimens. Three types of pellicles could be distinguished on the basis of morphologic criteria. A globular pellicle, characterized by a consistent presence of globules of varying size and configuration, seemed to predominate in most subjects. These globules could not be mistaken for bacteria due to their dimensions, contour, and lack of cell walls. A fibrillar pellicle consisted of 3- to 7-nm-wide fibrils and frequently included some finely globular particles. A granular pellicle displayed a relatively even surface contour and did not exhibit globular or fibrillar structures. In contrast to the two other types, the granular pellicle contained distinct laminations. Apparently, the varying morphology of the early pellicle is a reflection of its complex chemical composition.


A longitudinal radiographic study of the mineralization of 2nd premolars.

Odontogenesis of the 2nd premolar begins in the majority of cases at the age of 3-3 1/2 years, although this period can vary more widely than that for other permanent teeth. For this reason, aplasia of this group of teeth cannot be diagnosed as early and with the same degree of certainty. A group of 104 children aged 3-7 years in whom one or more tooth germs mesial to the 1st permanent molar were not visible in the various age groups was reexamined radiographically in the region where they apparently lacked the development of tooth germs. The second examination took place 16-24 months after the first, and a comparison was made of the two examinations. The study confirms that the 2nd premolar can be very late in developing and that the chance of this being so is greater in the maxilla than in the mandible.


Chemistry of the sulfate groups in a sulfated glycoprotein from rabbit submandibular gland.

A 35S-labeled sulfated glycoprotein was isolated from rabbit submandibular glands. Acid stability studies on the 35sulfate groupings present in the intact glycoprotein gave a half-life of 45 min. Partial acid hydrolysis of the 35S-labeled glycoprotein in 0.1 M HC1 for 90 min at 100 degrees C liberated a radioactive fraction which was free from peptide and fractionated in the monosaccharide range of a Sephadex G-15 column. Examination of this fraction by paper chromatography revealed the presence of a major component having the characteristics of N-acetylglucosamine 6-0-sulfate and a minor component having the properties of N-acetylgalactosamine 6-0-sulfate. The presence of ester sulfate groups in the intact glycoprotein was confirmed by infrared spectroscopy.


Susceptibility of various microorganisms to chlorhexidine.

The susceptibility to chlorhexidine of bacteria in aerobic, facultatively anaerobic and anaerobic isolates from clinical specimens of wounds, urine, saliva, and dental plaque was studied. Agar diffusion tests using 50 microng chlorhexidine discs and agar dilution tests were performed and the MIC values correlated with inhibition zone diameters. Anaerobic plaque strains were isolated and tested by the agar dilution method in an anaerobic glove box. Regression lines obtained for five agar media demonstrated a good correlation between zone diameters and MIC values. There was a broad range of susceptibility to chlorhexidine among both Gram-positive and Gram-negative strains. Low MIC values were noted for staphylococci, S. mutans, S. salivarius and E. coli, while strains of Proteus, Pseudomonas and Klebsiella were less susceptible. S. sanguis showed intermediate susceptibility with both low and high MIC values. Among the anaerobic isolates tested, the strains most susceptible to chlorhexidine were Propionibacterium and Selenomonas, While the least susceptible strains were Gram-negative cocci resembling Veillonella.


Effect of some heavy metals on protein and collagen biosynthesis in rabbit dental pulp in vitro.

Cadmium, zinc, copper, and mercury, being components of dental alloys, have been tests at concentrations from 20 to 120 micronM for their effect on the incorporation of 14C-proline into various fractions of rabbit dental pulp incubated in vitro. With cadmium and zinc and increased amount of 14C-activity was recovered from the TCA-soluble pool, whereas the further incorporation into total protein and collagen, i.e. 14C-hydroxyproline, was markedly inhivited. Copper and mercury, however, reduced the amount of label in the TCA-soluble fraction. Both metals exhibited a dose-dependent inhibitory effect on the hydroxylation step in collagen synthesis, whereas for mercury only, an inhibition of the general protein synthesis was indicated. With all four metals the proportion of 14C-labeled protein and hydroxyproline recovered from the medium was reduced, the effect being most prominent with cadmium and zinc.


Lipid pattern and fatty acid composition of human palatal oral epithelium.

The lipid pattern and the fatty acid composition of human oral epithelium were studied qualitatively and quantitatively with the aid of thin-layer chromatography and gas-liquid chromatography. The material studied consisted of scrapings from the mucosa of the hard palate of nine cadavers and of three volunteers. Two methods for collecting the material were used: A) the epithelium was isolated by the removal of subepithelial connective tissue from the connective tissue side and B) the epithelium from the epithelial side was carefully scraped off. The lipid pattern of the epithelium was dominated by cholesterol (25 mol %) and phosphoglycerides (total 45 mol %), while triglycerides and free fatty acids constituted 10-15 mol % each. The fatty acid compostitions of the lipids were remarkably similar to each other, although the specific characteristics of each individual lipid were still noticeable. All lipids showed a large proportion of linoleic acid and a relatively small proportion of other polyunsatured fatty acids. In several respects the lipid pattern and the fatty acid composition of the epithelium were similar to those found in other ectodermal tissues, but they exhibited a number of differences from the corresponding pattern of the mesenchymal connective tissue.


Evaluation of biologic effects of dental materials using four different cell culture techniques.

The cytotoxicity of fresh and 1-day-old silicate cement, composite restorative material and zinc oxide-eugenol cement (ZOE) was tested using human epithelial cells (NCTC 2544) in four different cell culture systems: (1) 51Cr-release from prelabeled cells after incubation for 4 and 24 h in the presence of the materials. (2) Implanting the materials on an agar everlay and visualizing any cytotoxic effects after 24 h by neutral red vital stain. (3) Cell growth during 5 d in the presence of the materials. (4) Colony-forming ability after exposure of the cells for 30 min to medium previously incubated with the materials for 24 h. Freshly prepared and 1-day-old ZOE exhibited a prominent cytotoxic effect in all four systems. A less marked effect was found for the composite material in systems 2, 3, and 4, while silicate cement appeared to be the least toxic material in these three systems. Neither silicate cement nor composite showed any cytotoxic effect in system 1 based on 51Cr-release. It is concluded that the effects obtained by the cell culture techniques did not mimic the reactions obtained when the materials are tested under conditions which reflect their clinical use.


Cuirass respirator treatment of chronic respiratory failure in scoliotic patients.

The results are reported of domiciliary cuirass respirator treatment, using tailor-made shells, in four patients with severe thoracic scoliosis. Three of the patients had suffered from poliomyelitis. All complained of increasing dyspnoea on exertion, ultimately interfering with almost every activity of daily life; three patients had severe acute respiratory failure necessitating urgent admission to the Respiratory Care Unit. Right heart failure was present in two. Two patients required mechanical treatment via an endotracheal tube. All the patients were discharged home with a cuirass respirator. Standard type shells were used initially with low efficiency due to the poor fit of the cuirass shell to the deformed thoracic cage. Tailor-made shells were constructed from polyester reinforced with glass fibre, modelled on plaster casts of the thoracic cage. Subjectively the patients improved greatly and were able to resume and increase many activities. One patient committed suicide for reasons unconnected with treatment but the other three patients have been doing well from the time the cuirass respirator treatment was started, respectively, 3, 6, and 10 years ago. This treatment seems particularly effective in younger patients with severe paralytic scoliosis and cardiorespiratory failure, although the possibility of using it in older patients suffering from scoliosis of other aetiology should certainly be explored.


[The value of local anesthesia in the treatment of difficult children].

The author points out that the elimination of pains in difficult children presents some particularities, referring to certain stages of the psychosomatic development among other things, upon which vegetative reactions may depend. Observations of this kind are mentioned together with their recording, and practice-relevant methods of local anaesthesia are suggested.


[Contribution to the styloid process syndrome].

The report on 4 cases of the styloid process syndrome seems remarkable because of the rarity of this syndrome. In case of complaints of doubtful origin and mainly characterized by pain radiating to the tongue, the styloid process should also be taken into consideration. The diagnosis is confirmed by palpating the styloid process along the mandibular ramus and by radiography. Treatment consists in removing the styloid process by operation.


[Romberg's disease].

Romberg's disease is described in the light of two cases. By way of introduction, a survey of the now extant literature is given and the clinical picture is outlined. After that, the author deals with  the case histories of his own patients.


[Late results of conservative treatment methods in closed sinus injuries].

Posttraumatic inflammations of the maxillary sinus are relatively rare in closed injuries. Clinical and radiographic followup examinations of patients with midfacial fractures showed that a revision of the antrum for the purpose of infection prophylaxis is not necessary and that active intervention should be performed only in case of clinically manifest maxillary sinusitis.


[Maxillofacial fractures in children].

With regard to aetiology, location and therapy, fractures of the facial skeleton in childhood occupy a special position due to the anatomico-morphologic pecularities of the infantile skull. To verify this statement, the author analysed the medical records of 58 patients with fractures of the facial skeleton, having an age range from 1 to 14 years. The fracture incidence was 9.3% as related to the total number of fractures of the facial skeleton. Traffic accidents (41%) were the main cause of these injuries. Clinical and radiographic follow-up examinations of 37 patients (after an average period of 5 years) revealed: jaw or tooth anomalies in 56.7%, anomalous radiographic findings concerning the condyloid process in 14.7%, and anomalous radiographic findings concerning the teeth in the former fracture line in 27%. Conclusions are drawn from these results as to therapeutical management.


[Periodontal care in the GDR].

The extent of the treatment of periodontal diseases in dental practice does not yet correspond to the rate of morbidity. To realize early detection and early treatment, the authors give suggestions for the motivation of the dentists, for a conception of the educational objectives, for the orientation of the qualification of dentists for a specialty and for the organization of health protection.


[Proposal for uniform equipment for dental radiodiagnostic offices].

Corresponding to the different objectives, the Working Group on Radiology of the Stomatological Society has designed 6 standardized work places for routine radiodiagnosis in stomatology. Apart from  the objectives, the problems related to the division of rooms, equipment, radioprotection and film processing are dealt with separately and specifically. The work places for routine stomatological radiodiagnosis are intended for achieving an improvement in a sector of stomatological care.


[Early carcinoma of the stomach from the endoscopic point of view].

3060 gastroscopies were performed during the period from 1971 until April 1976 and the diagnosis of gastric carcinoma, was made in 131 cases. From this series, 25 carcinomas fulfilled the criteria of an "early gastric cancer" after examination of the resection specimen. The percentage of early gastric cancer is 0.82% of all gastroscopies and 19% of all gastric carcinomas detected by endoscopy, in our  patient series. It is confirmed by this data, that the prognostically favorable early gastric cancer does not occur so rarely in our area, when adequate diagnostic possibilities are available. In this context, greatest importance is attributed to gastroscopy, combined with biopsy.


Influence of local insults on sympathetic vasoconstrictor control in feline dental pulp.

The present investigation was undertaken to ascertain whether local insults can affect the sympathetic vasoconstrictor regulation of pulpal blood flow. The rate of disapperance (k-value) of iodide from dentinal cavities was measured in anaesthetized cats. Changes in k-value reflected changes in blood flow. It has previously been shown that stimulation of sympathetic vasoconstrictor nerve fibres generally causes a clearcut decrease in the k-value. Deep cavity preparation was found to inhibit the vasoconstrictor response in a few cases in experiments on mature cats. Heating or cooling the tooth during cavity preparation induced a more frequent inhibition, which proved to be reversible within a few hours. Compound 48/80 applied locally to the cavity was also found to induce inhibition of the vasoconstrictor effect, but in this case no sign of reversibility was observed. Chronic insults were produced by exposing the cavity to oral microorganisms during 1-4 weeks before the experimental procedure. In this case, the sympathetic vasoconstrictor response was not inhibited. A histological study was performed to examine the pulp tissue after cavity preparation and the application of insults. It was found that cavity preparation and acute insults caused little or no disturbance, while chronic insults resulted in severe damage to the pulpal tissue.


Recording of mandibular movements by intraorally placed light emitting diodes.

In order to evaluate an opto-electronic system for recording mandibular movement a simulator and clinical pilot study was performed. The method was based on light emitting diodes (LED) and a photodetector system. One LED was placed intraorally and one on the forehead, the latter acting as reference. When the light spot is focused on the detector surface a photo-current will occur. This current can be used to obtain two signals linearly related to the x and y coordinates of the LED. By using two detectors the three-dimensional coordinates of a movement can be calculated, consequently also the z-coordinate. In the simulator experiment the method was shown to have a satisfactory precision and good reproducibility. The results from the clinical test indicated that it is possible to measure and record mandibular movement with a minimum of external influence to the test person.


Effects of adrenaline and felypressin (octapressin) on blood flow and sensory nerve activity in the tooth.

The present investigations in cats were designed to study the effects of local anaesthetics containing adrenaline and felypressin (octapressin) on dental pulp function. Intradental sensory nerve excitability was measured using electrodes placed in dentinal cavities in canine teeth. Changes in pulp blood flow were measured using the disappearance rate of a radioactive tracer placed in the same cavities. Injections (0.5 ml) of lidocaine (20 mg/ml) - adrenaline (12.5 microng/ml) or prilocaine (30 mg/ml) - octapressin (0.54 microng/ml) were given supraperiosteally in the apical area of the tooth. Adrenaline either alone or with lidocaine caused almost complete inhibition of pulp blood flow within a few minutes. This effect was followed by a total inhibition of the sensory nerve activity. In most cases there was a recovery of both functions after 3 hours. Octapressin, on the other hand, had no inhibitory effects on pulp blood flow or sensory nerve activity. Lidocaine and prilocaine were also without effect. These findings indicate a different mode of action of the two vasoconstrictors and suggest that octapressin may be preferred in infiltration anaesthesia during treatment of the vital tooth.


Thickness of the soft tissue layers and the articular disk in the temporomandibular joint.

Out of 115 right temporomandibular joints from Swedish subjects aged 1 day to 93 years, 48 joints without any gross sign of arthrosis or deviation in form were examined histologically. The joint components were cut sagittaly, each into four parts. Histological sections were made of the condyle, the temporal component and of the articular disk. The total thickness of the soft tissue layers was measured in decalcified sections, cut from the medio-central and lateral parts of the condyle and the temporal component and from the medial, medio-central, latero-central and lateral regions of the disk. In the medio-central sections from the condyle and temporal component the thickness of the fibrous connective tissue layer i.e. the surface layer was also registered. The soft tissue layers were thickest in the condyle superiorly, about 0.4-0.5 mm, in the temporal component on the postero-inferior slope of the articular tubercle, about 0.5 mm, and in the disk posteriorly about 2.9 mm. In the roof of the fossa it was only 0.1 mm. The soft tissue layers on the condyle as well as the disk were thinner laterally while the corresponding tissue in the temporal component was thicker laterally. The thickness of the soft tissue layers seem to reflect the growth and functional load to which the joint is exposed.


Proprotionate linear measurements in radiographic cephalometric assessments. A methodological study.

Craniofacial structures were studied by radiographic cephalometry in 10 boys and 10 girls at 9-14 years and 13 years later. The linear distances were measured in mm as well as with indices with the sella-nasion distance as denominator. The index measurements proved to be dependent on age to a rather limited extent. This held true for index measurements referring to skeletal points as well as soft-tissue points.


The maxillary rotation: Its relation to the cranial base and the mandibular corpus. An implant study.

A material of 22 patients with metallic implants was used in a longitudinal study, based on lateral head-plates, of the relationship between: 1) the maxillary rotation and the cranial base 2) the maxillary rotation and the different mandibular rotations. No connection has been found between the variation of the maxillary rotation and the growth of the cranial base. The correlation between the maxillary and the mandibular rotations is the highest when the rotation of the corpus is considered. A strong correlation is found between the variation of the condylar growth direction and the variation of the maxillary rotation.


The construction and use of diagnostic standards for radiographic caries incidence scores.

The aim was to construct and illustrate the use of diagnostic standards for recording of DFS incidence. Separate standards are presented for ranking of subjects; the mean "intermediate" DFS score per subject, which represented the majority decision of three dentists; and a certainty scale for individual tooth surfaces. The scores recorded for 40 sets of posterior bitewing radiographs of children between 13 and 15 years of age by two fourth year dental students and two dental hygienists were compared with the standards. Spearman's rank correlation coefficient reached the critical level of +0.70 in three of eight instances. Only one mean net DFS increment score differed significantly from the mean standard score (p less than 0.05). The level of agreement with the certainty scale for individual surfaces was low. Focusing attention on recording of DFS incidence gives a more severe test of examiners' diagnostic performance. The construction and use of control charts for monitoring the diagnostic level of examiners is suggested.


The mechanism of lincomycin-induced diarrhoea.

Metabolic studies were performed before and seven days after treating rats orally with lincomycin. Following the treatment the mean faecal weight increased from 302.2 g/72 hr +/- 3.8 (S.D.) to 65.5 +/- 8.2. The faecal fat excretion was unchanged, and the weight increase was mainly due to increased water content. To find whether the watery diarrhoea was due to bile acid malabsorption, the absorption rate of [14C]-taurocholic acid was measured in untreated rats and rats treated with lincomycin using an in vivo perfusion technique. There was no significant difference in bile acid absorption rate measured at three different concentrations of bile acid in the perfusate. Alternative mechanisms of lincomycin-associated diarrhoea are discussed.


Osteomalacia in the stagnant loop syndrome.

Osteomalacia in a 80-year old woman with malabsorption due to the stagnant loop syndrome is reported. The osteomalacia was associated with bacterial overgrowth in the small intestine and increased bile salt deconjugation. Although the mechanism of osteomalacia in the stagnant loop syndrome remains uncertain, it is suggested that abnormal flora reduce the absorption of vitamin D by deconjugation of bile salts in the lumen of the small intestine.


Intensive treatment in severe acute attacks of ulcerative colitis.

The results of intensive treatment including steroids and early surgery in severe colitis in the period 1971-1975 were compared to the results from the period 1966-1970, when systematic intensive therapy was not given. The period of preoperative medical treatment was reduced on average from 31 to 17 days. Approximately half the patients went into remission in each period. In the period 1971-1975 (23 patients) there was no mortality during the acute attacks or in the subsequent follow-up period. In the period 1966-1970, the immediate mortality in 30 patients was 10% (3 patients). One patient died six years later at the age of 81 during a relapse of the colitis, and the overall mortality was 13.3%.


Malignant myelosclerosis. Myeloproliferative disorder or leukemia?

Four patients with the picture of "malignant myelosclerosis" are described and the relationship of this condition to acute granulocytic leukemia is discussed. It is suggested that there is a leukemic process from the beginning, that the fibrosis of the marrow is reactive rather than neoplastic, and that the disease should not be regarded as an accelerated form of chronic (primary) myelosclerosis. The presence of excessive reticulin in the marrow in acute leukemia, especially when the patient is first seen, indicates a bad prognosis and poor response to chemotherapy. A systemic fungal infection in one patient is described.


Busulfan lung.

An uncommon, but lethal, toxic side effect of busulfan (Myleran) therapy for chronic myelogenous leukemia is pulmonary fibrosis. A 16-month-old male infant treated for 11 months with busulfan for chronic myelogenous leukemia is, we believe, the first case of "busulfan lung" in the pediatric age group to be reported. Progressive roentgenographic changes in the lung of a diffuse intra-alveolar and interstitial pattern were noted. The patient died after a four-day episode of cough, fever, and progressive dyspnea. At autopsy, no evidence of infection or leukemic infiltrates were seen in the lungs. Characteristic histologic findings as a result of busulfan therapy were observed in the lung and pancreas.


Sutural development: structure and its response to rapid expansion.

This fine structural study of the suture, its development, structure, and response to rapid expansion has shown that the sutural complex is best described in terms of the functional activity of two cell populations, namely, the osteocytic and fibrocytic series, which have the ability to remodel the tissues which they form. It is suggested that the previous detailed descriptions of differences in fiber orientation and vascular distribution reflect functional activity of a suture at any given time rather than immutable anatomic characteristics. Development of the suture and its rapid expansion showed many similarities in that growth during development and orthopedic expansion both separate the joint. If the initial inflammatory aspect of rapid expansion is ignored, the response of the suture is one of osteogenesis and fibrillogenesis, followed finally by remodeling. It is also suggested that sutural expansion involves injury followed by a proliferative repair phenomenon which, in other tissues, usually leads to the formation of scar tissue. However, the ability of sutural connective tissue fibroblasts to remodel ultimately leads to regeneration of the suture. Finally, programmed cell death has been shown to be an important feature in the development of the suture.


Acute myeloblastic leukemia presenting with diabetes insipidus.

Diabetes insipidus as the presenting manifestation of acute myeloblastic leukemia in a nine-year-old female is reported. In patients with recent onset of diabetes insipidus an underlying leukemic process should be excluded as an etiologic factor.


Acute leukemia after azathioprine treatment of connective tissue disease.

A 23-year-old man is reported who had a connective tissue disorder with features of rheumatoid arthritis and systemic lupus erythematosus. Because of the development of severe myocarditis and acute cerebral dysfunction treatment with azathioprine and prednisone was instituted, with dramatic clinical improvement. Ten months later, when a total of some 52 g of azathioprine had been administered, acute myelomonocytic leukemia developed. Although acute myelogenous leukemia has been noted in several individuals receiving immunosuppressive drugs for treatment of lymphoreticular neoplasms, this complication has heretofore been rare in patients given azathioprine for non-neoplastic disease. The present case is documented because of the increasing use of immunosuppressive drugs in treatment of various rheumatic disorders and the need to establish the relationship, if any, between the use of such agents and malignancy.


Radiation-induced erythroleukemia in the beagle dog. A hematologic summary of five cases.

Eleven cases of myeloproliferative disease occurred in a group of 24 beagle dogs placed in a 60Co gamma-ray field at about 13 months of age and irradiated at an exposure rate of 5 R/22-hour day for duratior of life. Of these 11 dogs, 5 (described in this paper) were diagnosed as having erythroleukemia. The bone marrow showed marked erythroblastic hyperplasia, with maturation arrest of the erythroid elements, and increased numbers of myeloblasts and promyelocytes. The terminal peripheral blood was characterized by marked anemia and thrombocytopenia, with circulating erythrocytic precursors and abnormal erythrocyte morphology. Splenomegaly and hepatomegaly occurred in 4 of the 5 animals. In the spleens and livers of all 5, there was extensive leukemic infiltration and proliferation. The extent of leukemic involvement in other tissues and organs varied in individual dogs.


Injection of steroids in painful breasts.

Fibrositis of the breast results in unilateral localized pain and tenderness in one breast. In most cases it can be specifically and permanently relieved by injection of steroids.


An ameloblastic fibro-odontome.

A case of ameloblastic fibro-odontome is reported. The clinical and histopathological features are discussed in detail and the surgical mangement of such lesions is shown to depend on these features. A plea is made for all lesions of this type to be reported.


Effects of hydrocortisone in the mineralization speed of the dentine.

The effect of hydrocortisone on the rate of mineralization of the dentine of rat incisors has been investigated and a comparative analysis of this effect on the upper and lower incisors as well as the various aspects of these incisors has been made.


The Adelaide undergraduates dental curriculum: an appraisal by recent graduates and final-year students.

Eighty-eight recent graduates and thirty final-year students replied to a questionnaire on the effectiveness of the present Adelaide undergraduate curriculum in relation to general dental practice. A high proportion of the first-year graduates had some difficulties in various aspects of practice management. Some first-year graduates and students lacked confidence in managing interpersonal relationships. Students especially, but also some graduates, were not competent in several clinical skills. A number of graduates and students were unhappy with the present place and purposes of the pre-clinical science subjects.


Clinical pathology. A diagnostic aid to the dental practitioner.

Clinical pathology is concerned with specialized investigations and tests which are used to refine the process of diagnosis. Biopsy, cytology, blood examination, microbiological and biochemical tests are of particular relevance to dental practice and are a valuable aid to the diagnosis of oral disease. The dental clinician should be familiar with the principles of these investigations and fully understand the significance of the data which they yield.


The effect of a pilot dental health education programme on high school students.

A dental health education programme for fourth and fifth year high school students reduced the levels of debris and periodontal disease significantly. Although the use of recommended toothbrushes and fluoride paste was increased the demand for professional care was greater in the control group.


The Nail Patella syndrome--a report of a family.

This report describes two cases of the Nail Patella Syndrome with renal involvement. Pathological studies include immunochemistry, light microscopy, immunofluorescence and electron microscopy. The possibility of secondary immune damage to altered glomerular basement membrane is suggested as a cause of the progressive renal disease which occurs in some of these cases.


Imaging of acute myocardial infarction using technetium 99m labelled phosphate compounds.

Technetium 99m pyrophosphate or polyphosphate administered intravenously soon after acute myocardial infarction produces positive images of the area and extent of myocardial necrosis. Forty-four patients have been studied of whom 39 had myocardial infarction. There was good correlation of the site and extent of infarction as indicated by the scintigram with electrocardiogram and cardiac enzyme criteria.


The complement system in infectious mononucleosis.

The complement system was investigated in 34 patients with infectious mononucleosis. Three had specific complications: one haemolytic anaemia, one severe arthralgia/myalgia and one proliferative glomerulonephritis. Complement changes consistent with classical pathway consumption were seen in ten of the uncomplicated group and the patients with haemolytic anaemia and arthralgia/myalgia. The patient with glomerulonephritis showed evidence of alternative pathway utilisation including C3 splitting activity and the deposition of properdin on renal biopsy. The complement findings suggest that circulating immune complexes are common in such patients and are likely to play a role in the pathogenesis of the complications. It is proposed that both complement pathways may be required for the effective clearance of viral material from the circulation.


Bacteraemia following oesophageal dilatation and oesophago-gastroscopy.

Significant, but asymptomatic, bacteraemia after oesophageal dilatation with Hurst's bougies for oesophageal stricture or spasm was detected in six of 11 patients. No bacteraemia was identified in ten volunteers without oesophageal pathology, who underwent passage of the same dilators. After oesophago-gastroscopy significant bacteraemia was identified in one of ten patients examined. The predominant bacterial isolates were streptococci ("Streptococcus viridans" and non-haemolytic Streptococcus sp.). All the strains were sensitive in vitro to penicillin, amplicillin and cephalosporins. Any of these antibiotics are considered suitable for prophylactic use prior to performing oesophageal dilatation and upper gastrointestinal endoscopy in "at risk" patients. The risk of bacteraemia is much lower after endoscopy than oesophageal dilatation for stricture or oesophageal spasm. Mucosal trauma is concluded as the site of entry of pharyngeal commensals leading to bacteraemia; and the incidence of bacteraemia appears related to the degree of trauma to the oesophagus.


Clinical, biochemical and histological observations on the effect of porcine calcitonin in Paget's disease of bone.

The response to porcine calcitonin has been assessed in 38 patients with Paget's disease, observed during 44 treatment periods of from three to 42 months. In 36 of the treatment courses significant relief of pain was achieved but the contribution of placebo effect could not be determined. Serum alkaline phosphatase and urinary hydroxyproline levels reached normal in a few patients, but the grouped data indicated a plateau effect above the range of normal. The acute hypocalcaemic response to calcitonin was lost only in those patients whose bone turnover was restored to normal. Quantitative histology on iliac crest bone biopsy samples showed no statisically significant lowering of osteoclast counts. No antibody-based clinical resistance occurred and the incidence of side effects was low. The results indicate that porcine calcitonin is a useful treatment of Paget's disease, and the experience of the study helps in arriving at patient selection and treatment schedules. Treatment is recommended for bone pain and for active disease in the relatively young, using intermittent therapy with course of at least six months duration. Resumption of therapy is based on clinical and biochemical indications.


Oxygen therapy for pneumatosis coli: a report of two cases and a review.

Two patients with incapacitating symptoms from pneumatosis coli were successfully treated with high concentration oxygen (55-70%) inhalation via a Hudson face mask for five days. Symptoms improved dramatically starting on the third treatment day. Continuous restriction in an oxygen tent is unnecessary. This is an effective, simple and safe therapy for pneumatosis coli.


Fatal hepatic coma complicating oxymetholone therapy in multiple myeloma.

Two patients with multiple myeloma died in acute liver failure. Both had been treated with the anabolic steroid oxymetholone and both subsequently developed severe cholestatic hepatitis. In one the histological lesion progressed despite cessation of oxymetholone therapy. Myeloma infiltration of the liver and peliosis hepatis were not seen. As a fatal outcome from cholestatic hepatitis due to oxymetholone is rare it is possible that an unknown potentiating factor is present in multiple myeloma that can lead to a fatal outcome. If oxymetholone therapy is to be used in such patients then close clinical and laboratory assessment of liver function should be carried out in an attempt to prevent this unusual and fatal complication.


Endoscopic diagnosis of metastatic disease of the stomach and duodenum.

The commonest tumours which metastasise to the upper gastrointestinal tract are from malignant melanoma, carcinoma of the breast  and lung. Over a period of 12 months, three persons with known malignant disease were submitted to endoscopy by reason of upper gastrointestinal symptoms which could have been due to associated non-malignant disease. Two patients had known malignant melanoma and one a carcinoma of the breast. In each instance, endoscopy and biopsy demonstrated evidence of metastatic disease.


Torulopsis glabrata--urinary tract infections in diabetic patients in Singapore.

Urinary tract infections result mostly from ascending infection by micro-organisms introduced by way of the  urethra. Bacteria are the usual causative agents. Occasionally, yeasts notably Candida albicans, are involved. Females are more prone to acute infections than males because of shorter urethra and the higher risks of contamination in the females.


Multiple myeloma with massive Bence Jones proteinuria and preservation of renal function.

The case history of a patient having multiple myeloma with a remarkably high level of Bence Jones proteinuria (more than 20 g/day) is presented. The patient has responded well to therapy, and at no stage has he shown impairment of renal function as determined by creatinine clearance studies. A review of published reports has shown that such marked Bence Jones proteinuria at presentation is rare and is usually accompanied by renal impairment and a short survival. Additional presentation data from selected patients in the MRC First Myelomatosis Trial is presented. This suggests a higher incidence of marked Bence Jones proteinuria, and underlines the lack of correlation between the quantity excreted and the degree of renal impairment. The mechanisms by which Bence Jones protein may cause renal damage are discussed.


Potassium homeostasis.

Potassium balance is regulated by appropriate changes in potassium excretion in the distal portion  of the nephron. By contrast, potassium intake, absorption and proximal renal reabsorption do not show regulatory variation. Extracellular potassium concentration, which is a critical factor in membrane polarization, may at times vary in a direction opposite to total body content, because of altered distribution across cell membranes. Alterations in acid-base status frequently disturb homeostasis by altering potassium movement into cells, while insulin has an important regulatory effect on distribution. In general, the multiple renal and extra-renal mechanisms which prevent potassium overload are highly developed,  while conservation is relatively ineffective. Consequently, depletion occurs more easily than spontaneous potassium overload. Homeostasis can be disturbed by renal impairment, excessive tissue breakdown, disturbances of acid-base balance, abnormal routes of loss, mineralocorticoid abnormalities and aberrations of sodium balance.


Epidemiological bases for ambient air quality criteria.

Epidemiological information about the health consequences of ambient air pollution is adequate at present to set upper limits so that acute deterioration due to pollution can be prevented in patients with chronic lung disease. However, our knowledge is incomplete with respect to what is a safe chronic background level, particularly with regard to reducing and preventing the amount of chronic respiratory disease presently occurring. This review concentrates exclusively on sulphur dioxide and particulate pollution, although the principles used in setting standards for these two pollutants may be applied to photochemical pollutants such as ozone which may effect the lung. It is only when the dose-effect relationships between pollution and disease are more clearly understood that the benefit of reducing air pollution to improve health can be predicted.


Tuberculosis due to Mycobacterium kansasii.

Eighteen cases of tuberculosis due to Mycobacterium kansasii have been described. Eleven were from Western Australia and seven from Queensland. The symptoms, X-rays and histology of the disease were indistinguishable from those due to Mycobacterium tuberculosis, but the organisms were resistant to streptomycin, para-amino-salicylic (PAS) and isoniazid, but sensitive to ethionamide and cycloserine, and in most cases sensitive to rifampicin and ethambutol. All 18 cases were treated with some form of chemotherapy; three also had surgery.


The role of bradykinin in endotoxic shock of intestinal origin.

A relationship was looked for between blood levels of bradykinin and endotoxaemia produced by superior mesenteric artery occlusion in the rabbit. The levels of bradykinin were unrelated to and unaltered by the degree of endotoxaemia observed in the systemic and portal circulations. These findings suggest that bradykinin is not responsible for the release of endotoxin from the gut, or the circulatory collapse which follows.


The optimum duration of systemic antibiotic administration in the treatment of experimental peritonitis.

The duration of antibiotic therapy for peritonitis is commonly decided on an empirical basis. There is obvious advantage in determining the shortest, yet most effective, period for such drug therapy. This study is a comparison of short-course and long-course antibiotic administration following periotonitis produced by experimental rupture of the rabbit appendix.


Doppler ultrasound in vascular surgery.

Doppler ultrasound was first introduced into the study of arterial and venous disorders in 1966. The devices currently used in clinical practice are continous wave systems which, in their simplest form, are pocket-sized units. Instruments with the capability of distinguishing the direction of flow are also available. The signal may be processed for audio use, or an analogue recording can be made of the Doppler frequency shift. The described clinical information will, in large part, dictate the type of equipment used.


An overview of cardiac surgery.

The scope of cardiac surgery has extended greatly in the last decade, advances being particularly in the areas of perfusion technology, ischaemic heart disease, and congenital defects in the infant. This paper sets out to summarize accepted current practice in the surgery of the heart and great vessels. Principles have been emphasized at the expense of detail, since the aim has been to present information which might be of interest to surgeons in general. Some aspects which have a special reievance to general surgical practice have been grouped separately for the sake of emphasis.


Methods and results of mechanical myocardial support.

In recent years the development of modern direct techniques for revascularization surgery has resulted in a multitude of critically ill patients undergoing open heart surgery. To deal with the increasing numbers of patients who both require urgent open heart surgery and present with many complicated patterns of disease, a spectrum of cardiac assist measures, ranging from simple pharmacological interventions to mechanical cardiac assist techniques, has been developed. Those temporary mechanical cardiac assist devices which employ the principle of couterpulsation and balloon pummping have met with the most consistent clinical success. We now report our experience and progress in this field since early 19729


Arterial counterpulsation in the management of ischaemic heart disease.

Arterial counterpulsation is a major advance in the treatment of myocardial ischaemia in association with myocardial infarction. Counterpulsation is based on sound physiological principles and can be expected to limit ischaemia and necrosis when applied within the first 12 to 24 hours of infarction. It has been used in massive infarction with cardiogenic shock, and in threatening infarction. Good results at both ends of a clinical spectrum suggest an important role throughout the spectrum. Studies in progress are attempting to define this role.


The results of surgical treatment of coarctation of the thoracic aorta.

A retrospective study of the results of surgical treatment in 124 cases of coarctation of the thoracic aorta is presented. The diagnosis was based on clinical findings alone in 90% of cases. Aortography and/or cardiac catheterization were performed if the diagnosis was in doubt or if other cardiac abnormalities were suspected. Surgical treatment involved either resection with end-to-end anastomosis (114) or some form of grafting procedure (10). The results of treatment have been analysed in terms of operative mortality, late mortality, relief of hypertension, and the incidence of re-stenosis.


Reconstruction of vertebral artery stenosis.

Eight patients with transient attacks of cerebrovascular insufficiency were treated by reconstruction of an atheromatious stenosis at the origin of a vertebral artery. The technique was relatively simple and safe, and was effective in relieving symptoms. Previous reviews suggest that the symptoms of vertebrobasilar insufficiency tend to be persistent, frequent and distressing, and that they can be a prelude to brain stem infarction. The collateral circulation to the vertebrobasilar system may be restricted by anatomical variations and by disease, particularly affecting the circle of Willis.  Bilateral vertebral artery disease can cause appreciable ischaemia even without associated carotid artery disease. Carotid endarterectomy is not particularly effective in relieving vertebrobasilar symptoms. Vertebral artery reconstruction appears to be the appropriate treatment for vertebrobasilar insufficiency.


Ruptured abdominal aortic aneurysms: a review of 168 cases.

One hundred and sixty-eight ruptured aortic aneurysms presenting at the Princess Alexandra Hospital in an 11-year period have been reviewed. Surgical treatment still carries a high mortality and a very high postoperative morbidity. The survival rate in the Vascular Unit of this hospital has improved during the period studied and in the last five years has risen to 61%. The operative technique is described in detail, and the operative problems and complications are discussed. It is felt that prompt surgical treatment, and accurate assessment of blood loss with adequate replacement during surgery, combined with attention to early postoperative problems, particularly those of a respiratory nature, are the most important factors in survival.


Acute mesenteric ischaemia.

The experience of acute mesenteric ischaemia at St Vincent's Hospital, Melbourne, has been reviewed over 17 years. The mortality remains appallingly high. This applies particularly to those patients who had thrombosis of the superior mesenteric artery, amongst whom the mortality in this series was 97%. The mortality was slightly less in the group suffering from embolic occlusion of the superior mesenteric artery (66%), and in those suffering from thrombosis of the superior mesenteric vein (60%). A mortality of 66% was also found in patients suffering from non-occlusive gut ischaemia. Delay in diagnosis accounted for this high mortality. Early diagnosis is all-important, and this depends on the performance of mesenteric angiography in any patient suspected of having mesenteric ischaemia. Appropriate surgery may then be carried out in the occlusive group and supportive treatment, including intraarterial papaverine infusion, given to those with non-occlusive ischaemia. There is a pressing need for simple non-invasive tests to segregate those patients suffering from acute mesenteric ischaemia from those whose acute abdomen is due to some other cause.


Claudication of the cauda equina.

The term "claudication of the cauda equina" is examined. It has arisen from semantic errors, and a belief in ischaemia for which there is no scientific evidence. Its use tends to hamper rather than assist the investigation of patients with obscure pain in the lower limb. A preferable alternative term, "atypical sciatica", is suggested.


The incidence of unsuspected peripheral arterial disease amongst surgical patients in Hong Kong.

A survey of surgical in-patients in Hong Kong has shown that subclinical peripheral arterial disease caused by atherosclerosis and detected by palpation is not uncommon and is similar in incidence to that reported in European populations. However, only a small proportion of affected patients had any associated symptoms. Reduced or absent ankle and ulnar pulses occurred with the same frequency in our patients as in those in Europe. Cigarette smoking does not appear to be associated with symptomatic arterial disease in the local population in Hong Kong.


Malignant melanoma: some aspects of pathology and prognosis.

This is a report on the periods of survival, and the factors that influence survival, in a series of 509 patients treated for malignant melanoma in the Peter MacCallum clinic, Melbourne. Not the least of these factors is education of the public and the medical profession in its early recognition, which has greatly improved the prognosis. In this context, it is also firmly believed that whenever possible, one clinician only should be responsible for the total surgical management of any suffering from this disease.


Perforated peptic ulcer: an analysis of 246 cases.

An analysis of 246 cases of perforated peptic ulcer, treated at the Royal Newcastle Hospital from 1964 to 1974, is presented. The incidence has fallen considerably over that period. The rising proportion of women has reached a plateau. A perforated peptic ulcer in an Australian women is still just as likely to be located in the stomach as in the duodenum. In men, however, 84% of perforations are pyloroduodenal. A perforated gastric ulcer is closely associated with the use of salicylate preparations. The mortality rate has remained steady at 15% over the last 30 years. It is significantly higher in women. There is a highly significant relationship between the mortality and (a) the duration of perforation; and (b) the size of the perforation, particularly if it is located in the stomach.


Strangulated para-ileostomy hernia.

Para-ileostomy hernia is an uncommon cause of bowel obstruction following ileostomy. Two cases are reported that demonstrate the difficulty in diagnosis and the high morbidity associated with this condition. Early recognition and repair of the uncomplicated and strangulated hernia are recommended.


Acute pancreatitis associated with gallstones in a twelve-year-old girl.

Pancreatitis is a rare disease under the age of 15 years, and expecially so when associated with gallstones. A case is reported here of a young girl who had acute pancreatitis and was subsequently found to have gallstones. She made an uneventful recovery and remains symptom-free after cholecystectomy.


Mediastinoscopy in the diagnosis of thoracic disease.

One hundred and forty-one patients have undergone mediastinoscopy in the Hong Kong University Surgical Unit since March 1974. Among these there were 109 cases of bronchogenic carcinoma. In approximately 50% of these patients the carcinoma had already spreed to involve the mediastinal lymph nodes at the time of examination. Mediastinoscopy may be the only source of positive histological proof of the diagnosis in bronchogenic carcinoma as well as in other types of intrathoracic disease such as tuberculosis. We believe that mediastinoscopy reduces the number of unnecessary exploratory thoracotomies.


Low thoracic duct ligation for postoperative chylous effusions in infants and children.

Three patients aged from three months to six years underwent thoracic duct ligation at the level of the diaphragm for chylothorax which occurred following cardiac operations. Another three-month-old patient underwent thoracic duct ligation for massive postoperative chylopericardium. Indications for operation were a large recurrent chyle accumulation or prolonged chyle drainage. Operative ductograms to deliniate the cisterna chyli and to exclude the presence of multiple lymph channels were performed in three patients. Excellent postoperative results were obtained in all patients for periods of up to two years. Low thoracic dust ligation is a reliable means of control of postoperative chylothorax and lengthy persistence with conservative treatment is no longer necessary.


Psychosocial factors and myocardial infarction.

Two questionnaires totalling 370 questions were used to compare 61 male patients who had survived a first myocardial infarction with a group controlled for age and social status who had not had an infarction. The questionnaires included the Edwards Personal Preference Schedule, providing a measure of 15 personality variables, the Anxiety and Depression Sub-Scales of the MMPI, and the Cochrane and Robertson Life Events Inventory, as well as originally-designed questions based on known risk factors. Significant differences were found in several dimensions of personality as well as in the family histories of myocardial infarction and in certain life styles. The patient group showed a greater sense of independence, greater difficulty in relaxing, and a sence of personal inferiority. Suggestions are offered for the modification of life styles in susceptible individuals as a possible aid to prevention.


A case of male childhood transsexualism and its management.

The syndrome of male childhood transsexualism is described and the case history of a six year old boy is reported. Treatment strategies are explained in detail and the results of ongoing therapy over an 18 month period are presented.


Changes in granulopoiesis detected by in vitro colony formation in acute lymphatic leukaemia.

Patients with acute lymphatic leukaemia (ALL) could be divided into two groups at diagnosis--those whose peripheral blood and/or bone marrow exhibited in vitro colony formation and those in whom it did not, but this finding did not appear to correlate with any clinical or haematological parameter, or with prognosis. The colonly-forming potential of patients with ALL in their first full remission, early relapse or second remission did not deviate significantly from previously established normal values, but the colony-forming potential of patients in early remission was very significantly reduced. No loss of colony-forming potential of normal marrow cells was noted when they were cultured with cells from patients with ALL.


Analysis of treatment in childhood leukaemia. III. Independence of lymphopenia induced by irradiation and by chemotherapy.

Lymphopenia induced by treatment for acute lymphoblastic leukaemia is analysed and discussed in relation to the type and incidence of infection occurring in those patients during complete remission. Blood lymphocytes can be placed into three largely independent groups: (1) those lymphocytes susceptible to long-term depletion following irradiation; (2) those lost from the blood during and for a short period after maintenance chemotherapy with methotrexate and 6-mercaptopurine; and (3) the remainder which are not depleted by irradiation or maintenance chemotherapy. The number of cells in each compartment varies from child to child and probably with age but on average is about 1.2 x 10(9)/1. for group 1, 0.7 x 10(9)/1. for group 2 and 0.4 x 10(9)/1. for group 3. Conventional lymphocyte typing crosses these barriers in that: Group 1 consists mainly of E-rosetting cells and cells which show a mitotic response to phytohaemagglutinin; Group 2 also contains E-rosetting cells but contains a major proportion of blood lymphocytes with surface immunoglobulin and essentially all antibody dependent cytotoxic lymphocyte (K-cell) activity; Group 3 comprises E-rosetting cells and a few immunoglobulin-staining cells.


Dose response and time course effects of N,N-dimethyltryptamine on disruption of rat shuttlebox avoidance.

N,N-Dimethyltryptamine (DMT) was given (ip) in different doses (0.25, 0.5, 1.0, 2.0, 4.0, 8.0 mg/kg) in a randomized order to a group of ten rats (Fisher 344/Mai) who were trained to a high, stable base line of conditioned avoidance responding in the shuttlebox. DMT produced dose-dependent disruptive effects, as a sigmoid function, with 1.0 mg/kg the minimal dose causing disruption and progressively more disruption with increasing doses, reaching a plateau at the highest dose. The disruptive effects were time-related, with onset and peak 8 min after injection, gradual decline thereafter, and disappearance by about 25-30 min. Both the threshold dose and time course for the disruptive effects correspond closely to what has been previously reported for DMT's psychological effects in humans.


Chronic granulocytic leukemia: cytogenetic conversion of the bone marrow with cycle-specific chemotherapy.

Sixteen patients with Ph1-positive chronic granulocytic leukemic (CGL) were entered on a pulsing chemotherapy program consisting of cytosine arabinoside 100 mg/sq m/day X 5 and thioguanine 100 mq/sq m/day X 5 every 21 days in an attempt to convert the Ph1-positive marrow to a Ph1-negative state and thereby achieve a complete remission. Twelve patients had an adequate trail of drug treatment, and ten of these had adequate chromosome examinations. There were two "conversions," one of which was maintained for 5+ mo, while the other was transient. The program was unacceptable, however, to most patients due to intolerable nausea and vomiting. Thus a prospective chemotherapeutic attempt to convert a Ph1-positive marrow without splenectomy has induced a conversion in two of ten patients. Other regimens which might induce less nausea and vomiting and a higher rate of conversions should be sought in future attempts to alter the invariably fatal outcome of CGL.


A case of acute myeloblastic leukemia with Ph1 chromosome showing translocation 9q+;22q-.

Cytogenetic studies of the bone marrow and peripheral blood with the quinacrine fluorescence banding technique in a patient with the clinical diagnosis of acute myeloblastic leukemia revealed the Philadelphia chromosome due to a translocation between chromosomes 22 and 9. He had been exposed to the atomic bomb in Hiroshima, and some hours after the exposure he wandered into the hypocenter.


Divergent patterns of marrow cell suspension culture growth in the myeloid leukemias: correlation of in vitro findings with clinical features.

Cellular recovery, maturation, and colony-forming cell (CFC) generation patterns of bone marrow cells from 23 patients with acute, subacute, and chronic myeloid leukemia (AML, SML, and CML) were studied using liquid and agar culture techniques. Increased recovery of proliferative myeloid cells from liquid culture was noted in 6 of 8 AML patients at diagnosis or relapse and 5 of 7 untreated SML patients. Patients with either AML or SML with rapid clinical progression exhibited greater recovery of cells in vitro with less maturation than patients with more stable disease. Studies from 3 patients with CML showed normal to increased cellular recovery with normal maturation. Three of 4 studies of AML patients followed sequentially in apparent remission, but with impending relapse, exhibited increased numbers of myeloblasts and promyelocytes, whereas 28 of 32 studies performed during stable remission were normal. The normally observed increase in CFC during liquid culture was absent in most leukemic marrow samples studied (3 of 4 AML, 4 of 6 SML, and 2 of 3 CML). Persistent low recovery of CFC during AML remission was associated in 3 patients with short remission duration. These studies indicated the potential utility of these techniques for the clinical evaluation of patients with myeloid leukemia and for studying factors involved in the progression of these diseases.


HLA linked resistance factors and survival in acute myelogenous leukemia.

The concept that HLA-linked immune response genes may influence survival of patients with malignant disease has been investigated by performing HLA typing on a series of 150 patients with acute myelogenous leukemia. Patients with A1 and B8 and/or A2 and B12 survival longer than patients without either of these pairs of antigens in association. However, after correction of the statistical probability for the number of A and B locus combinations theoretically possible, these differences are not statistically significant. Clarification of this must await independent analysis of other series and more direct approaches to the study of immune response genes in man.


Phytohemagglutinin skin tests in cancer patients.

Phytohemagglutinin (PHA) stimulates blastic transformation of normal lymphocytes in vitro and when injected intradermally produces a skin response histologically similar to a delayed hypersensitivity reaction. We investigated the skin test responses to PHA, mumps, candida, and varidase (SK-SD) and the PHA-induced lymphocyte transformation in patients with malignant neoplasms. Increased incidence of anergy to recall antigens and unresponsiveness to PHA skin testing was observed in patients with lymphoreticular malignancies but not in those with solid tumors. There was a direct correlation between skin test reactivity to at least one recall antigen and/or PHA and survival in lymphoma patients. This was true of both short and long terms survival in Hodgkin's disease and of survival at least through 42 months in non-Hodgkin's lymphomas. In vitro stimulation of lymphocytes with PHA did not correlate with PHA skin test reactivity. We conclude that PHA skin testing is a useful adjunct in the evaluation of patients with lymphoreticular malignancies.


Adult respiratory distress syndrome (ARDS) following aggressive management of extensive acute lymphoblastic leukemia.

The adult respiratory distress syndrome occurred during aggressive therapy of extensive acute leukemia. The pathogenic mechanisms involved includes development of disseminated intravascular coagulation probably initiated by tissue factors from necrotic leukemic cells following chemotherapy. Awareness of the possibility of the complication is stressed.


Phase I study of high-dose cis-dichlorodiammineplatinum(II) with forced diuresis.

Twenty-six patients including 11 with metastatic melanoma received cis-dichlorodiammineplatinum(II) at a dose of either 1 mg/kg or 60 mg/m2 given with intensive diuresis over a 6-hour period. This dose was administered twice weekly for the first three to eight courses and then at q3wk intervals. Eighteen patients received the dose schedule of 1 mg/kg and six patients received 60 mg/m2. A complete response was seen in one of four testicular tumors lasting for 6 months; partial responses were seen in three of 11 metastatic melanomas for 1, 1, and 2 months respectively, one of two osteogenic sarcomas for 4 months, one of one multiple myeloma for 2 months, and one of four testicular tumors for 1 month. A transient drop in creatinine clearance to 50%-75% of the baseline level was observed in 21% of the patients. Cytotoxic effects of cis-dichlorodiammineplatinum(II) are probably enhanced by this dose schedule as indicated by the consistent, moderate hematologic toxicity. Renal toxicity is ameliorated.


[Megakaryocytic myelosis: clinical and morphological features (author's transl)].

In general, megakaryocytic myelosis is nowadays considered to be a separate disease entity, one of the myeloproliferative syndromes. Morphologically there are localised or diffuse proliferations of usually large pleomorphic megakaryocytes and immature atypical megakaryocytes up to megakaryoblasts in the bone marrow, in the sense of a haemoblastosis. In the course of the disease megakaryocytic splenomegaly develops. A sarcomatous form (megakaryoblastoma, megakaryo-sarcoma) is rare. Megakaryocytic myelosis may arise from chronic meyloid leukaemia or polycythaemia vera, rarely as a transitional stage to an acute myeloblastic leukaemia or megakaryoblastic leukemia in the sense of a blast crisis. The mature form of the disease, which has an age peak at 59 years and is not sex-linked, often takes a course over years with increasing splenomegaly, anaemia, moderate leucocytosis and usually marked thrombocytosis (average value of 720 X 10(9)/1). Life threatening complications are haemorrhages, thromboembolism and increased frequency of infections due to antibody deficiency in the advanced stage.


[Splenectomy for chronic myeloid leukaemia in the early and late phases (author's transl)].

Splenectomy was perfomed in three patients with typical chronic myeloid leukaemia after a compensated stage had been reached with busulphan. Marked pancytopenia as a result of hypersplenism occurred in one patient 14 months after the end of the primary induction, and was successfully treated by splenectomy after radiotherapy of the spleen had failed. Splenectomy was performed without complication, and the histological appearance of the spleen showed myeloid infiltrates while there was none in the liver biopsy. After another 18 months the patient remained compensated, without busulphan administration. In the two other patients splenectomy was performed in the recompensated stage, one month and five years, respectively, after the primary induction had been concluded. In these two patients, too, there was myeloid infiltration of the  spleen. In both, mild leucocytosis with shift to the left as far as promyelocytes occurred six and two weeks, respectively, after splenectomy and busulphan was started again. Twelve and ten months, respectively, after splenectomy they are both in the compensated stage. The importance of splenectomy in the early phase lies in the possibility of delaying blast crisis and avoiding myelofibrosis, as well as in the prevention of complications in the later stages.


[The position of the mandibular canal in the edentulous jaw].

The mandibular canal retains its position in the toothless lower jaw, irrespective of the degree of atrophy. The firm point of reference remains the distance from the mandibular border, the lingual and the buccal outer cortex. In the region of the first molar the distance from the mandibular border amounts on the average to 7.3 mm, 2.5 mm from the lingual aspect and 4.9 mm from the buccal. In the region of the lateral teeth the absolute height of the lower jaw is 0-31.6% lower than in the middle of the lower jaw (Average value 13.7%).


[Preparation of bone specimens with implants for histological study].

The exact investigation of the bone-implant border necessitates a combined study of foreign material and host tissue. All the stages of the procedure and their special problems are described and an artificial substance of low viscosity is introduced, which is suitable for implanting larger test probes.


[Comparative animal experimental study on the importance of the surface structure for the stability of extension implantations].

An animal experimental study was undertaken where the embedding of extension implants with a smooth or porous surface was histologically examined. Under extreme functional stress there occurs a mobility of the implants with the formation of a broad connective tissue zone, inflammatory reactions and ingrowth of epithelium, which is independent of the surface structure. Implants under less stress show a narrower connective tissue layer which narrows itself further if the surface is porous. The possible causes of this tissue reaction are discussed.


[Animal experimental studies on the stabilization of enosseous, anchored metal implants by means of electric stimulation].

After removal of all teeth in grown up mini-pigs, extension implants were anchored into the dental area of the lower jaw and connected to a battery unit, one implant always forming the cathode and the other the anode. Clinical, radiological and histological results show completely different reactions of the implant site. In the region of the anode there occurs osteolysis which results in considerable looseness of the implant. The implants used as cathodes are clinically firm and when compared to implants not stimulated show increased bone regeneration.


[Studies on non-metal materials in oral surgery].

Two non-metallic implant materials are introduced and the indications for their use are described. A maxillo-facial indication exists in the reconstruction of the temporo-mandibular joint and the orbital floor. We find dental-surgical indications for the Aluminium-Oxide ceramics as well as for implants in the replacement of single tooth gaps and unilateral as well as bilateral shortened dental rows. The indication in the toothless jaw is the most unfavourable and should be restricted to replacement of both canine teeth.


[Pathological findings in enosseous and subperiosteal implantations].

Several clinical observations in cases where implantations carried out alio loco lead to severe complications, prompted us to report five of these cases and to clarify with reference to the relevant literature the causative factors which have led to the failures. We hope hereby to contribute to the knowledge possibility of error and the limitations of the indications for dental implants.


[Indications and technic of transdental fixation].

Transdental fixation, as closed implant, offers the most favourable preconditions of all dental procedures of implantation. Teeth where the root-crown relation is altered to the detriment of root length, which is held firm in bone, can with its help be made functional. Loosening and premature loss of teeth can be prevented. Further discussed is the indication for this procedure, especially in tooth fractures and luxations as well as the operative steps. Up to now transdental fixation has proved itself although the number of cases and the follow-up time are insufficient to allow final judgment.


[Late reconstruction of the orbital floor and zygomatic prominence with a readily vascularized plastic].

An implant made from a new artificial substance "Proplast" consisting of polytetrafluoroethylene and carbon is suitable for the secondary treatment of fractures of the orbital floor and zygoma. Histomorphological studies in animal experiments show rapid vascularisation and tissue ingrowth, which lead to permanent fixation of the implant. Clinical experiments confirm its suitability for the correction of displacement of the eyeball and enophthalmos as well as in the re-establishment of the zygomatic arch. For cosmetic reasons a new operative approach through a combined cantho-conjunctival incision is recommended.


[Report after 3 years experience with the plastic material "proplast" in the maxillofacial region].

"Proplast" is the propriety name for a recently developed artificial substance developed from Teflon. This porous material is said to be firmly incorporated within 6-8 weeks through tissue ingrowth. It is still under clinical assessment. We report our experiences with 30 Proplast implants in the region of the jaws and face.


[Jaw-enlargement with glass ceramics in the animal experiment].

The use of alloplastic material in the reconstruction of the defective or atrophic mandible appears obvious as the difficulties and risks of bone or cartilage transplants are well known. It appears that all the materials used up to now were demarcated by the bone as foreign bodies so that one could only observe strong union without a connective tissue line of separation with glass ceramics. In experimental operations in the pig, box shaped osteotomies were cut into the lower jaw and glass ceramic bodies were fixed into the  clefts. Clinical and histological examinations proved the bone acceptance. It appears that these bio-active glass ceramics are particularly suited as bone replacement.


[1st results with an alloplastic temporomandibular joint prosthesis including the glenoid cavity].

A newly developed total replacement of the temporomandibular joint by metal is introduced and the advantages and disadvantages of the modelling, the material and the indications are discussed. Up to now our results are satisfactory.


[Bridging of mandibular lesions with metal implants].

The 10-hole third-tube plate ("10-Loch-Drittelrohr-platte") is suitable for replacing central and isolated lateral parts of the mandible up to the six-year molar without exarticulation. It is not suitable for posterior defects, since sufficient fixation at the ascending ramus is not possible. The Tübingen resection plate, however, can be used for central parts and isolated as well as total lateral sections without exarticulation. As the holes in the plate correspond to the spherical sliding principle of the AO system, axial pressure screwing in osteoplastic replacement of the mandible is possible.


[System of alloplastic bridging of mandibular defects].

Primary reconstruction of the mandible after extensive tumor resection is necessary when the median part is lost; in lateral defects of the mandible, however, it is not always indicated. Our own functionally stable plate system with the instruments used for mandibular reconstruction is described. Clinical cases are presented in which this system was applied in combination with silastic interposed as a temporary replacement of the mandible.


[Bone regeneration over plastic implants after mandibular resection breaking the continuity].

In young patients, bone regeneration may start from the region of the temporo-mandibular joint and from the peripheral mandibular stump in cases of continuity defects of the mandible. A resin graft implanted for soft tissue reconstruction is collar-like surrounded by bone which is developing into a functionally and anatomically full regenerate over many years, in correspondence to periosteal and desmal growth stimuli. In adults, regeneration is minimal.


[Apicoectomy in the lateral dental region as an alternative to implantation].

At the Department of Oral and Maxillo-facial Surgery of Heidelberg University, apicectomies in posterior teeth have long been performed in addition to implantation. We always aimed at maintaining a vital periodontium, before alloplastic materials for implantation were considered. In follow-up examinations of 247 resected roots of posterior teeth, we recorded a success rate of 90%.


[The suggestive control of the pain threshold in healthy teeth].

Changes in pain tolerance after administration of differently labelled placebos were studied by measuring the reaction time after a cold stimulus. Significant changes after placebo administration were observed in the morning as well as in the evening. These differed among placebos declared to be analgetics, hyperaesthetics and medications with no effect on pain. The time of day also influenced the results.


[Tooth vitality after interalvolar and perialveolar osteotomies in the maxilla].

Follow-up examinations in 39 patients with osteotomies in the maxillary alveolar ridge for correcting jaw deformities showed that the risk of devitalization of teeth in the mobilized fragments and in the firm residual parts of the jaw is small. In interalveolar osteotomies this risk is slightly greater than in transalveolar osteotomies, because of the restricted space.


[Photoelastic studies for the fixation of osteosynthesis plates].

Because of the biomechanics of the mandible, several viewpoints must be considered in stable metal plate osteosynthesis. A particular AO mandibular dynamic compression (DC) plate with perforations in a 45 degrees arrangement ("Freiburg Zuggurtungsplatte") has been developed to create an interfragmentary pressure zone in the region of the teeth during function. Photoelastic experiments showed that interfragmentary pressure developed due to this arrangement of perforations. To avoid a gap in the lingual region distant from the plate and to enable interfragmentary pressure in this region during function, converging screws are discussed. Photoelastic experiments showed that by slight inclination of the screws in convergent position the interfragmentary pressure is already increased in the lingual fracture gap distant from the plate. For a better guide of the screws in convergent position, an alteration of the spheric DC slide hole should be considered.


[Reconstruction of the bony orbital ring by means of mini-DC-plates after mid-facial fractures].

Surface and structure of austenitic steel wire are changed when processed. Demonstration of unused wire, wire during processing as well as wire used as implant in fracture healing after its removal. Examination of metal ground sections of the used wire did not show any changes of the crystal structure in the sense of corrosion.


Accuracy of blood volume estimations in critically ill children using 125I-labelled albumin and 51Cr-labelled red cells.

Blood volume was estimated using 51chromium labelled red cells and 125iodinated human serum albumin in 5 children with sepsis, in 6 burned children and 7 children with acute lymphoblastic leukaemia. Studies of the equilibration pattern demonstrated that the mixing time of labelled red cells was prolonged to 40 minutes or more in 5 children, indicating the existence of slowly circulating red cells. Mixing of labelled albumin was complete within 10 minutes in 15 patients and within 20 minutes in all the children studied. In a burned patient with severe sepsis, exchange transfusion improved the clinical state and normalized the equilibration pattern of labelled red cells. The mean body/venous haematocrit ratio was 0.893+/-0.018 (SD) in the children with sepsis, 0.859+/-0.052 in the burned patients, and 0.916+/-0.078 in the children with acute lymphoblastic leukaemia, increasing with spleen size in the latter group.


Juxtacortical (parosteal) osteogenic sarcoma: histological grading and prognosis.

In twenty-four cases of juxtacortical osteogenic sarcoma, three histological grades of malignancy were identified and correlated with the prognosis. The eighteen patients with Grade-I or II tumors had a significantly better prognosis than the six with Grade-III lesions. The three grades could not be distinguished roentgenographically. Grade I and II tumors, which showed a high cure rate after amputation, may be amenable to en block resection, provided the entire tumor can be removed with a good margin of uninvolved soft tissue and underlying bone. Grade-III tumors, on the other hand, had a poor prognosis despite early radical surgery.


Gastric pathology and feeding deficits induced by hypothalamic damage in rats: effects of lesion type, size, and placement.

Three doses each of cathodal or anodal direct current were delivered to coagulate lateral hypothalamic tissue bilaterally in rats. Increases in hypothalamic tissue damage were associated with more instances of aphagia, greater amounts of glandular, but not rumenal, gastric pathology, and greater weight loss. Both anodal and cathodal lesions produced aphagia and similar amounts of gastric pathology, but anodal lesions also appeared to facilitate weight loss independently of the tissue damage. Extensive chromatolysis surrounding anodal lesion cavities may be importantly related to the postoperative effects. In additional experiments, anodal electrolytic lesions or cortical suction ablations were used to vary the location of neural damage. Fedding deficits and gastric pathology resulted from the destruction of several brain areas. In particular, eating of dry food in the presence of high gastric pathology was observed in rats with lesions ventral and medial to an area in the dorsolateral hypothalamus that was associated with aphagia. When aphagia was accompained by severe gastric pathology, the brain lesions typically encroached extensively on more ventromedial areas. Moreover, aphagia sometimes was observed with only negligible gastric pathology. It is suggested that gastric pathology is not primary to the expression of the aphagia that follows lateral hypothalamic damage.


Children's response to sequential dental visits.

Behavioral, self-report, and physiological measures were used to study the response of young children to their initial series of dental visits. Their negative response increased from the examination visit through the third treatment visit, then decreased during the fourth treatment visit and the polish visit. Initially, dental experience appeared to sensitize the child to dental procedures. Experience may also allow the child to accurately distinguish bet ween stressful and nonstressful procedures.


Measuring treatment and scale bias effects by linear regression in the analysis of OHI-S scores.

A linear regression model is presented for estimating unbiased treatment effects from OHI-S scores. An example is given to illustrate an analysis and to compare results of an unbiased regression estimator with those based on a biased simple difference estimator.


Enamel surface treated with zinc polyacrylate dental cement.

The surface of tooth enamel that had been left in touch with the liquid or the mix of a zinc polyacrylate dental cement was studied by scanning electron microscopy. Both treatments produced lesions on the enamel and were represented by unevenly distributed microcavities of varying extension. Topically applied SnF2 did not modify the aspect of the treated surface.


Fabrication and characterization of porous-rooted cobalt-chromium-molybdenum (Co-Cr-Mo) alloy dental implants.

A gravity sintering fabrication technique has been developed for producing Co-Cr-Mo alloy dental implants having a porous coating on the root portion. This process allows for control of pore structure enabling ingrowth of either bone or fibrous tissue. The microstructure and mechanical properties of these materials have been determined.


Marginal failure of amalgam class II restoration.

Analysis of stresses in a bicuspid with an amalgam Class II restoration was carried out with the finite element method. When stresses were known, creep in the margin of the restoration was calculated. If the buccal cusp was loaded, the maximum compressive stresses were found in the buccal part of the restoration.


Recrystallization of compacted gold foil specimens.

Gold foil specimens were compacted by a technique commonly used in preparing dental restorations. Their recrystallization behavior for temperatures between 100 and 300 C was followed by the associated decrease in hardness, discontinuous increase in grain size, and disappearance of X-ray line broadening. The empirical dependence of time, t, (in minutes) for 50% recrystallization on annealing temperature (in K), T, is approximately log10 t=-12.3+6.5X1,000/T, indicating a recrystallization time greater than 100 years.


Enamel hypoplasia in relation to caries in Guatemalan children.

Guatemalan children with anterior linear enamel hypoplasia (LEH) had a significantly greater caries experience in posterior dentition than their peers who did not have anterior LEH. The findings suggest that the synergistic mechanism of undernutrition and infection, which may underlie the occurrence of anterior LEH, may also predispose clinically normal appearing deciduous molars to an excessive caries attack equal to that observed in the grossly hypoplastic anterior teeth. The nutritional implications merit further investigation.


Morphology and incidence of torus palantinus and mandibularis in Brazilian indians.

The incidence and morphology of torus platinus and mandibularis was verified in 200 Indians, residents of two Brazilian Indian Reserves in São Paulo State, Brazil. A low incidence of both types of exostoses was observed, with torus palatinus occurring more frequently than mandibularis. These structures did not occur in individuals less than 10 years of age. Flattened torus palatinus predominated in relation to the other forms.


Secretion of drugs by the parotid glands of rats and human beings.

The following drugs have been demonstrated to be secreted by the parotid glands of rats and human beings: amobarbital, chlorpromazine, codeine, glutethimide, meprobamate, pentobarbital, phenobarbital, and secobarbital. Methadone could not be detected in the parotid saliva of either rats or human beings, and morphine has been demonstrated only in parotid saliva of rats.


Influence of growth hormone and thyroxine on endochondral osteogenesis in the mandibular condyle and proximal tibial epiphysis.

Interrelationships of growth hormone and thyroxine effects on endochondral osteogenesis have been investigated. Evidence is offered that thyroxine augments the effect of growth hormone on the mandibular condyle just as at other osteogenetic centers, for example proximal tibial epiphysis in hypophysectomized rats. This contrasts with previous reports of a unique thyroxine antagonism to the effect of growth hormone on condylar development. In a further study on tibial epiphysis, special attention was given to assure absence of the endogenous thyroid hormone by adding thyroidectomy to hypophysectomy and reducing the possibility of thyroteopin residues in growth hormone. By histochemical tests, the responses of both calcified and noncalcified regions of the epiphyseal cartilage plate were measured. Graded growth hormone doses stimulated graded response in a noncalcified region. Thyroxine augmented this response eightfold. The width of the calcified region of the plate did not vary with treatment.


Unusual dissolution behavior of tooth enamel and synthetic HAP crystals under high partial saturation conditions.

The dissolution behavior of enamel and synthetic hydroxyapatite in acidic media possessing a high degree of partial saturation was found to be neither simple surface dissolution nor linear with time. Instead, a repetitive, stepwise dissolution pattern was observed. To explain this phenomenon, a model based upon a hypothesis that the crystals dissolve in a synchronized fashion was proposed.


Quantitative study of enamel dissolution under conditions of controlled hydrodynamics.

A rotating disk method has been used to study the dissolution of bovine enamel. A diffusion model adequately describes the reaction for a wide range of conditions, and the rate is also hydrogen ion dependent. The solubility product of bovine enamel, 5.9 +/- 1.8 X 10(-59) moles9 1(-9) at 25 C is derived by a method that minimizes the possibility of phase changes.


Periodontal sensory innervation of the dentition of the Japanese shrew mole.

The neurohistological investigation of the periodontal sensory innervation in the whole dentition of the Japanese shrew mole showed that the periodontium is much more densely supplied by the free nerve endings at the apical region than at the intermediate one at a ratio of about 8:1 in the upper dentition and 5:1 in the lower dentition. The interdental gingival tissue is innervated by the nerve plexus formed by the nerve fibers deriving mostly from the gingival and a few periodontal nerve fibers. The neurohistology of the tooth is analogous to that of the vibrissa.


Faculty evaluation: review of the literature most pertinent to dental education.

Each dental school will fashion its own faculty evaluation system. The results will be a network of activities related to such questions as these: What are valid sources of information? Which aspects of instructors' responsibilities are most significant? Which questions need answers? How should the system be operated? This review has focused on what is currently being discussed and attempted in each of these critical areas. Faculty evaluation takes place in an essentially political context, and dental educators are now awakening to the political forces at work in the profession. Faculty evaluation is also a scientific process, or at least one capable of being greatly improved by rigorous, empirical study, which has yet to be performed. Finally, the exact form of faculty evaluation developed at each school will likely be unique, since it will depend on the institution's resources, size, funding base, academic affiliation, and the personal preferences of concerned individuals. The degree of success or failure of an evaluation system will depend on how the chosen combination of purposes, sources, objects of evaluation, and implementation strategy serves the needs of the school and its personnel.


Essential features of a faculty evaluation program.

A faculty evaluation system should be developed by cooperation between evaluation specialists and dental faculty. The system should depend on a broad spectrum of data collected from a variety of sources in order to reduce personal bias and subjective judgments concerning the performance of all faculty members. Its primary purpose should be to help faculty improve and to this end should be linked to both a faculty development program and a reward system. The criteria for each faculty member's evaluation should be clearly specified in advance and be directly linked to his duties. Department and college goals must be considered as well as the individual faculty member's own interests. Standards or criteria for both rewards and sanctions should be clearly defined, and guidelines for the operation of the system should be given to each participant. The system itself should not cost more than the benefits derived from it justify, and adequate resources should be allocated to make the system effective.


Faculty behavior: appraisal and rewards.

Faculty A & R systems arrange contingencies of reinforcement (relationships between faculty performance and institutional rewards) which powerfully influence faculty behavior. By and large, the current contingencies influencing teaching performance are defectiive. A frequent result is mediocre instruction and ready diversion of faculty effort to activities controlled by better contingencies. The major obstacles to productive appraisal and reward of teaching are the criterion problem and the inability or reluctance to arrange potent A & R contigencies to influence faculty behavior. Recent developments in behavioral science and instructional technology promise significant help in overcoming both obstacles. An example has been provided. Virtues and difficulties in the proposed procedure have been discussed.


Faculty evaluation at the University of Kentucky.

Faculty at the University of Kentucky College of  Dentistry are now evaluated through the use of a negotiated Distribution of Effort Agreement. This document, negotiated at the beginning of each academic year, must satisfy both department objectives and the professional and personal requirements of the individual faculty member. It may be modified during the year if both the faculty member and his department chairman agree to the change. This document states work objectives for the year similar to learning objectives in a course. At the end of the year, each faculty member is evaluated on how well he has met his individual objectives. Information relevant to teaching, university service, and student service is gathered by college administrators and forwarded to department chairmen. Together with information on research accomplishment, these data are used by the chairman in the evaluation of each faculty member. The college has clearly charged department chairmen with the direct responsibility for faculty evaluation. The Appointments, Promotions, and Tenure Committee also plays a role in faculty development and evaluation by recommending to the dean ways of improving individual faculty performance.


The professional objectives of canadian dental students.

Data from a 1971 national study of Canadian dental education are used as a basis for examining the relative importance which dental students and faculty place on the professional objectives of economic gain and service. Students (N = 1,247) were asked to rank a set of career attributes in terms of their importance both for themselves and for other students. Dental school faculty (N = 510) were asked to assess whether students under emphasized or overemphasized a group of 16 parallel objectives. The results indicate substantial variations between the professional objectives of individual students, those ascribed to others by students, and the faculty's perception of student objectives.


Changes in role perceptions by first-year dental students.

Dental education combines the learning of technical skills with the professional role of health care provider. The investigation compared first-year dental students perception of themselves, dental practitioners, dental school upper-class students, and patients. The study indicated that first-year students are more likely to identify with upper-class students than with dental practitioners. They also tended to see themselves as clearly different from dental patients. It is suggested that dental educators should recognize this fact in order to avoid the depersonalization of dental care delivery.


The association of Ga-67 and lactoferrin.

Activity was seen in the breasts of a patient with galactorrhea 72 h after intravenous injection of Ga-67 citrate. Differential protein separation of breast secretion, extracted from the breast, revealed that the Ga-67 was contained primarily in the lactoferrin-rich protein fraction. Additional studies on partially purified lactoferrin revealed that lactoferrin binds Ga-67 more avidly than does transferrin. Since lactoferrin is present in high concentration non only in human colostrum and milk, but also in neutrophilic leukocytes, bone marrow, spleen, colon, tears, and in genital, salivary, and nasopharyngeal secretions, binding of Ga-67 to lactoferrin may explain the localization of Ga-67 in certain normal tissues and inflammatory lesions.


Study of platelet aggregation in vivo: II. Effect of bencyclan on circulating metastatic tumor cells.

Circulation time of isotope labeled ascites tumor cells was measured after intravenous injection into mice. Circulation time was approximately doubled by pretreatment with the platelet aggregation inhibitor compound bencyclan.


Antipyrine metabolism and bronchogenic carcinoma.

Studies in animals indicate that tumor-bearing is associated with inhibition of hepatic drug metabolism. Our purpose was to determine the influence of a tumor on drug metabolism in man. The plasma clearance of antipyrine reflects the rate of its metabolism by the liver. Antipyrine clearance was measured in 7 patients with bronchogenic carcinoma and in 13 normal subjects and 7 patients with chronic lund disease. Mean (+/- SD) antipyrine clearance rates were 2.98 +/- 0.68 1/hr, 2.14 +/- 0.69 1/hr and 2.02 +/- 0.67 1/hr, respectively; indicating that bronchogenic carcinoma is associated with rapid, rather than slow, antipyrine metabolism. Antipyrine clearance (mean +/- SD) in 8 patients with bronchogenic carcinoma and evidence of liver metastases was 2.17 +/- 0.75 1/hr indicating that liver involvement by tumor decreased antipyrine clearance.


Hemophilic pseudotumors of the mandible.

Three patients with hemophilic pseudotumors of the mandible were described and the treatment of the lesions was discussed. Surgical intervention, accompanied by adequate clotting factor replacement, was used in all three cases with satisfactory results. Pseudotumors of the jaws are a rare but serious complication of hemophilia. The cause of the mandibular lesion can be intraosseous hemorrhage, soft tissue hemorrhage with periosteal stripping and subperiosteal hematoma formation, or a combination of these factors. Surgical management with adequate replacement of clotting factor and the use of EACA is an effective method of treatment.


Maxillary resection for odontogenic myxoma: report of case.

A brief overview of the literature and a report of a resection of an odontogenic myxoma involving the right maxillary sinus are presented. We believe that a lesser surgical procedure might have compromised the patient's health by possible further surgical procedures with a resulting greater facial deformity or morbidity. Through careful evaluation and planning, problems of management were minimized.


Mandibular hypoplasia secondary to perinatal trauma: report of case.

A case of unilateral mandibular hypoplasia is presented. Considerations regarding a differential diagnosis of hemifacial microsomia or traumatically induced ankylosis of the temporomandibular joint are discussed. Although the described malformations might suggest a diagnosis of hemifacial microsomia, the history and clinical findings tend to support the conclusion that the asymmetry was caused by damage to the temporomandibular joint at an early age.


Transantral maxillary neurectomy for intractable neuralgia.

A case of atypical facial pain over the distribution of the maxillary nerve (V2) has been presented as well as its treatment. The maxillary nerve section using the dissecting microscope is a relatively new procedure with potential to become an accepted treatment of intractable V2 neuralgia. A brief review of possible complications of the procedure was presented.


Epidermoid implantation cyst of the lower lip: report of case.

Epidermoid implantation cysts are relatively rare lesions of the oral region. A lesion occurring in the lower lip of a 21-year-old man is reported. In the pathogenesis of these lesions, trauma is usually the precipitating factor. Treatment is surgical and histopathologic examination will give the final diagnosis.


Epidermoid (implantation) cyst after temporomandibular joint surgery.

A case has been reported of an epidermoid inclusion cyst of traumatic origin in the temporomandibular joint region. The cause was attributed to previous surgery.


Bilateral reductions of articular eminence for chronic dislocation: review of eight cases.

Eight cases of chronic dislocation treated by bilateral reductions of the articular eminence have been reviewed. The technique has been found useful when indicated. Good surgical technique with meticulous attention to detail is required. The entire eminence must be removed and the surface left smooth. As with any TMJ disorder or surgery, concomitant local and systemic problems are common and must be considered in preoperative and postoperative evaluations. Patients should be observed for at least two years after surgery for recurrence of any TMJ disorder.


Exposure to anesthetic waste gas in oral surgery.

Exposure to nitrous oxide and halothane during oral surgery was monitored using a Miran infrared analyzer. A "typical" time-weighted analysis exposure was established for the surgeon, assistant, and anesthetist. Values for halothane ranged from 7.5 to 59 ppm, and for nitrous oxide, from 280 to 90,000 ppm.